'Adventure therapy' combined with cognitive-behavioral treatment for overweight adolescents.

OBJECTIVE: Since peers have such an important influence on adolescents, we evaluated the efficacy of adding peer-based 'adventure therapy' to a standard cognitive-behavioral weight control program for overweight adolescents. METHODS: Adolescents (N = 76) aged 13-16 years and 20 to 80% overweight (M = 60.56%, s.d.=15.17%), were randomly assigned to one of two treatment conditions: cognitive-behavioral group treatment with 'adventure therapy' similar to Outward Bound (cognitive-behavioral treatment with peer-enhanced adventure therapy (CBT + PEAT)) or cognitive-behavioral group treatment with aerobic exercise (CBT+EXER). Anthropometric and psychosocial measures were obtained at baseline, at the end of the 16-week intervention, and at 10 months following randomization. RESULTS: Adolescents assigned to both treatment conditions demonstrated significant weight loss over time, F = 29.06, df = 2, 53, P < 0.01. Average weight loss did not differ significantly between groups (-5.31 kg for CBT + PEAT and -3.20 kg for CBT + EXER) at the end of treatment. There was a significant difference in the percentage of participants maintaining a minimum 4.5 kg (10 pounds) weight loss (35% in the CBT + PEAT condition vs 12% in the CBT+EXER condition, P = 0.042) 10 months from randomization. We also observed a significant age by treatment group interaction, such that older adolescents randomized to CBT + PEAT demonstrated more than four times the weight loss of older adolescents assigned to CBT + EXER (M = -7.86 kg vs M = -1.72 kg) at the end of treatment. CONCLUSIONS: Peer-based 'adventure therapy' is a promising adjunct to standard cognitive-behavioral weight control intervention for adolescents, and may be most effective for older adolescents.

The clinical presentation of childhood partial arousal parasomnias.

Objectives: The goal of the current study was to compare the sleep characteristics of children diagnosed with a partial arousal parasomnia to a community sample and further, to compare children diagnosed with sleep terrors to those diagnosed with sleepwalking.Background: Many children experience frightened awakenings, with up to 15% meeting criteria for a parasomnia. Despite this, very little empirical data exists examining parasomnias in childhood.Method: The parents of children (between 2 and 12 years of age) referred to a pediatric sleep disorders clinic completed the Children's Sleep Habits Questionnaire (CSH) on their child. The group meeting criteria for partial parasomnia was then matched with a community sample to identify differences in sleep characteristics between children with parasomnias and a normative sample.Results: Children with parasomnias had higher rates of bedtime resistance, sleep onset delay, night waking, and reduced sleep duration than a matched community sample. Sleepwalkers had more sleep onset problems than children with sleep terrors. Almost one quarter of sleepwalkers between 3 and 12 years of age reported nocturnal enuresis.Conclusions: Children with partial arousal parasomnias do have slightly more disturbed sleep than community controls.