Developmentally and culturally appropriate screening in primary care: development of the behavioral health checklist.

OBJECTIVE: To evaluate the construct validity of the Behavioral Health Checklist (BHCL) for children aged from 4 to 12 years from diverse backgrounds. METHOD: The parents of 4-12-year-old children completed the BHCL in urban and suburban primary care practices affiliated with a tertiary-care children's hospital. Across practices, 1,702 were eligible and 1,406 (82.6%) provided consent. Children of participating parents were primarily non-Hispanic black/African American and white/Caucasian from low- to middle-income groups. Confirmatory factor analyses examined model fit for the total sample and subsamples defined by demographic characteristics. RESULTS: The findings supported the hypothesized 3-factor structure: Internalizing Problems, Externalizing Problems, and Inattention/Hyperactivity. The model demonstrated adequate to good fit across age-groups, gender, races, income groups, and suburban versus urban practices. CONCLUSION: The findings provide strong evidence of the construct validity, developmental appropriateness, and cultural sensitivity of the BHCL when used for screening in primary care.

Parent-child discussions of anger and sadness: the importance of parent and child gender during middle childhood.

This chapter provides conceptual background and empirical evidence that parental emotion socialization continues well into middle childhood and is influenced by the social context. Data are presented to illustrate the influence of parent and child gender on parental socialization of emotion in 113 Caucasian, middle-class children. Mothers and fathers discussed historical sadness- and anger-eliciting events with their sons and daughters. Fathers appear to play a unique role in sadness socialization whereas mothers' influence seems distinctive for the socialization of anger. Socialization of emotion is a transactional process in which parents and children are both socializing agents and emotion regulators.

Behavioral Health Screening: Validation of a Strength-Based Approach.

OBJECTIVE: To evaluate the validity of the Behavioral Health Checklist (BHCL) strength-based factor scores and the extent to which this factor has a buffering effect on the relationship between behavioral health symptom severity and children's social problems. METHOD: The parents of 1,392 children aged 4 to 12 completed the BHCL and Child Behavior Checklist (CBCL) during sick and well-child visits to urban and suburban primary care practices affiliated with a large children's hospital. RESULTS: Findings support a single, strength-based factor on the BHCL, and the structure was largely invariant across race, sex, and socioeconomic status. Increased psychopathology symptoms (internalizing, externalizing, and attention-deficit hyperactivity disorder) and lower levels of strengths predicted increased social problems (p < 0.001). Moreover, the interaction terms were statistically significant in all analyses, suggesting that higher levels of strengths may buffer the deleterious impact of psychopathology symptoms on social problems. Post hoc analyses indicated that the buffering influence of strengths on the relationship between psychopathology symptoms and social problems was clinically meaningful except in the older sample for the relationship between externalizing and social problems. CONCLUSION: The findings support the validity of a strength-based factor of the BHCL and indicate that this factor has a buffering effect on the association between the degree of child mental health symptoms and level of social impairment. This factor, in combination with the problem-focused factors of the BHCL, provides a balanced approach to screening children's mental health functioning.

School-based interventions for students with attention-deficit/hyperactivity disorder.

Children with attention-deficit/hyperactivity disorder typically manifest impairments in multiple settings. Perhaps the most common reason for referral relates to the school impairments experienced by these children. A wide range of intervention strategies have been developed for these children to improve attention and behavior, enhance academic competence, and promote social competence. A strong majority of the research on nonpharmacologic interventions has focused on strategies to improve attention and behavior. More recently, strategies specifically designed to promote the academic and social competence of these children are being developed. Also, most of the research has focused on elementary school-age children, but evidence-based strategies for intervening with preschoolers and adolescents are beginning to emerge.

Comparing active pediatric obesity treatments using meta-analysis.

The current meta-analysis reviews research on the treatment of pediatric obesity focusing on studies that have been published since 1994. Eleven studies (22 comparisons, 115 effect sizes, N = 447) were included in the present meta-analysis. Results indicated that comprehensive behavioral interventions may be improved in at least two ways: increasing the "dose" of behavioral components and increasing parental involvement. Although limited to just one investigation, support for the use of medication was also found. The addition of cognitive therapy techniques did not appear to increase, and possibly detracted from, the efficacy of established treatments.

Emotion regulation in children and adolescents.

Within the past two decades, an "affect revolution" [Fischer and Tangney, Self-conscious Emotions: The Psychology of Shame, Guilt, Embarrassment, and Pride 1995:3-22] in research has revolutionized the ways in which emotion processes have been conceptualized and subsequently studied. This review discusses the literature on emotion regulation (ER) in childhood and adolescence by first summarizing the trajectory of emotional development from infancy through adolescence, followed by a discussion of the biological and environmental influences on ER, and then a review of the literature linking ER to psychosocial functioning. The penultimate section offers practical suggestions for identifying ER difficulties in children and strategies for intervention efforts. Potential areas for future research conclude the review.

Emotion socialization in families of children with an anxiety disorder.

Compared emotion socialization in 26 children with anxiety disorders ages 8-12 years and their mothers to 26 nonclinical counterparts without psychopathology. Children and their mothers participated in an emotion interaction task in which they discussed occasions when the child felt worry, sadness, and anger. Responses were coded for length of discussion, proportion of words spoken by child vs. mother, frequency of positive and negative emotion words, explanatory discussion of emotion, and maternal facilitation of emotion discussion. Children and their mothers also completed the Expressiveness and Control scales of the Family Environment Scale. Results indicated that mothers of children with an anxiety disorder spoke less frequently than their child, used significantly fewer positive emotion words, and discouraged their children's emotion discussions more than did mothers of nonclinical children. Nonclinical children and their mothers indicated significantly more emotional expressiveness in their families than did children with an anxiety disorder and their mothers. These results highlight the potential role of truncated family emotional expressivity in the emotional development and functioning of children with an anxiety disorder.

Evaluation and tracking of Alzheimer's disease severity using resting-state magnetoencephalography.

We have conducted multicenter clinical studies in which brain function was evaluated with brief, resting-state magnetoencephalography (MEG) scans. A study cohort of 117 AD patients and 123 elderly cognitively normal volunteers was recruited from community neurology clinics in Denver, Colorado and Minneapolis, Minnesota. Each subject was evaluated through neurological examination, medical history, and a modest battery of standard neuropsychological tests. Brain function was measured by a one-minute, resting-state, eyes-open MEG scan. Cross-sectional analysis of MEG scans revealed global changes in the distribution of relative spectral power (centroid frequency of healthy subjects = 8.24 ± 0.2 Hz and AD patients = 6.78 ± 0.25 Hz) indicative of generalized slowing of brain signaling. Functional connectivity patterns were measured using the synchronous neural interactions (SNI) test, which showed a global increase in the strength of functional connectivity (cO2 value of healthy subjects = 0.059 ± 0.0007 versus AD patients = 0.066 ± 0.001) associated with AD. The largest magnitude disease-associated changes were localized to sensors near posterior and lateral cortical regions. Part of the cohort (31 AD and 46 cognitively normal) was evaluated in an identical fashion approximately 10 months after the first assessments. Follow-up scans revealed multiple MEG scan features that correlated significantly with changes in neuropsychological test scores. Linear combinations of these MEG scan features generated an accurate multivariate model of disease progression over 10 months. Our results demonstrate the utility of brief resting-state tests based on MEG. The non-invasive, rapid and convenient nature of these scans offers a new tool for translational AD research and early phase development of novel treatments for AD.

Parental socialization of sadness regulation in middle childhood: the role of expectations and gender.

The authors of this study investigated mothers' and fathers' socialization of their children's sadness. The particular focus was an examination of how socialization practices changed when parents' expectancies concerning their child's sadness management abilities were violated. Methods included an experimental manipulation and direct observation of parent-child interactions in 62 families of White, middle-class children in 3rd and 4th grades. Families were randomly assigned to 1 of 2 conditions. After parents were provided with a description of normative child behavior on a sadness-induction task, feedback was manipulated such that parents in the control condition were told their child had demonstrated typical regulation while parents in the violated-expectancy condition were informed their child did not manage sadness as well as peers. The hypothesis that violated expectancies influence socialization processes was supported, with greater evidence emerging for fathers than mothers. In certain circumstances within the violated-expectancy condition, there was more parental similarity in socialization practices than in the control condition. Further, mother-father comparisons indicated differences in socialization as a function of parent and child gender that were generally consistent with gender stereotypes.

Initial validation of a knowledge-based measure of social information processing and anger management.

Over the past fifteen years many schools have utilized aggression prevention programs. Despite these apparent advances, many programs are not examined systematically to determine the areas in which they are most effective. One reason for this is that many programs, especially those in urban under-resourced areas, do not utilize outcome measures that are sensitive to the needs of ethnic minority students. The current study illustrates how a new knowledge-based measure of social information processing and anger management techniques was designed through a partnership-based process to ensure that it would be sensitive to the needs of urban, predominately African American youngsters, while also having broad potential applicability for use as an outcome assessment tool for aggression prevention programs focusing upon social information processing. The new measure was found to have strong psychometric properties within a sample of urban predominately African American youth, as item analyses suggested that almost all items discriminate well between more and less knowledgeable individuals, that the test-retest reliability of the measure is strong, and that the measure appears to be sensitive to treatment changes over time. In addition, the overall score of this new measure is moderately associated with attributions of hostility on two measures (negative correlations) and demonstrates a low to moderate negative association with peer and teacher report measures of overt and relational aggression. More research is needed to determine the measure's utility outside of the urban school context.

The inclusion of fathers in the empirical investigation of child psychopathology: an update.

This investigation provides an update on the inclusion of fathers in child psychopathology research. Articles published from January 1992 to January 2005 that examined parental contributions to child psychological maladjustment were identified. Each article was coded for child age, parental race, how parent gender was analyzed, type of journal, and year of publication. Overall, results replicated previous reviews (Phares & Compas, 1992), suggesting that fathers continue to be neglected in child psychopathology research. Further analyses revealed (a) higher rates of paternal research involvement as child age increased, (b) studies with a predominantly Caucasian sample included separate analyses for mothers and fathers more frequently than those with predominantly African American samples, (c) paternal research inclusion was higher in clinical compared to developmental psychology journals, and (d) over the past 6 years, more research has included fathers as participants than from the previous 7-year period (1992-1998).