Analytic approaches for assessing long-term treatment effects. Examples of empirical applications and findings.

Analytic approaches, including the structural equation model (autoregressive panel model), hierarchical linear model, latent growth curve model, survival/event history analysis, latent transition model, and time-series analysis (interrupted time series, multivariate time-series analysis) are discussed for their applicability to data of different structures and their utility in evaluating temporal effects of treatment. Methods are illustrated by presenting applications of the various approaches in previous studies examining temporal patterns of treatment effects. Recent advancements in these longitudinal modeling approaches and the accompanying computer software development offer tremendous flexibility in examining long-term treatment effects through longitudinal data with varying numbers and intervals of assessment and types of measures. A multimethod assessment will contribute to a more complete understanding of the complex phenomena of the long-term courses of substance use and its treatment.

Perceived parental burden and service use for child and adolescent psychiatric disorders.

OBJECTIVES: Pediatric chronic physical illness and adult psychiatric disorders are substantial sources of burden for family care-takers, but little attention has been paid to parental burden resulting from children's or adolescents' psychiatric disorders. This paper describes the predictors of perceived parental burden and its impact on the use of specialty mental health and school services. METHODS: A representative general population sample of 1015 9-, 11-, and 13-year-olds and their parents completed structured psychiatric diagnostic interviews and the Child and Adolescent Burden Assessment. RESULTS: Weighted estimates indicated that 10.7% of parents in the general population perceived burden resulting from their children's symptomatology. Significant predictors of perceived burden were levels of child symptomatology and impairment and parental mental health problems. Children's depressive and anxiety disorders were associated with less burden than other diagnoses. The effects of child disorder severity on specialty mental health service use appeared to be mediated by the level of burden induced. CONCLUSIONS: Substantial levels of parental burden resulted from child psychiatric disorders and were a major reason for specialist mental health service use.

Psychosocial correlates of childhood anxiety disorders.

OBJECTIVE: This study explored psychosocial and "environmental" correlates of childhood anxiety disorders. The study examined relationships among parental psychiatric symptomatology, perceived family environment, temperament, and self-competence in children with a DSM-III-R anxiety disorder. METHOD: A community sample of third through sixth graders was screened initially for symptoms of test anxiety. Those with high and low scores were administered the Anxiety Disorders Interview Schedule for Children. Three groups (childhood anxiety disorder, test-anxious only, and normal controls) were identified and compared on the psychosocial variables. RESULTS: Children with an anxiety disorder had greater impairment on the indices of perceived self-competence and temperamental flexibility than controls, with the test-anxious children showing intermediate, yet significant, levels of disturbance. There was a trend for children with an anxiety disorder to describe their families as less promoting of independence than the other groups. Finally, measures of parental psychiatric symptomatology revealed more obsessive-compulsive symptoms for the fathers of both the anxiety disorder and test-anxious children compared with controls. CONCLUSIONS: Results are consistent with previous findings suggesting the familial transmission of anxiety disorders and recent speculations regarding a relationship between behavioral inhibition, environmental control, and anxiety. Further research may isolate psychosocial and family environmental factors as instrumental treatment targets in the management of childhood anxiety disorders.

Caregivers of Alzheimer's disease and stroke patients: immunological and psychological considerations.

Demands of caregiving for Alzheimer's Disease (AD) patients have been reported to affect the psychological and immunological health of the caregivers. The question of whether the observed psychological and immunological changes were unique to AD caregivers was addressed in this study. The subjects were 25 caregivers of AD patients, 25 caregivers of stroke patients, and 25 noncaregiving individuals. Comparisons of all subjects made on several psychologic and immunologic indices indicated that the AD caregiving group was more psychologically distressed than the stroke group, and both of these groups were more psychologically distressed than a control group. With respect to immunologic function, there were no differences among the three groups. Implications of the findings are discussed.

Cognitive distortions and adolescent affective disorder. Validity of the CNCEQ in an inpatient sample. Children's Negative Cognitive Error Questionnaire.

Despite a proliferation of recent research examining childhood and adolescent depression, the area still lags behind the adult depression field, particularly in the investigation of cognitive correlates of affective psychopathology. To advance cognitive research with youth, the Children's Negative Cognitive Error Questionnaire (CNCEQ) was developed to provide a measure of cognitive distortions or errors in children and adolescents. Yet, few studies have employed the CNCEQ and no evidence exists supporting the validity of its four component cognitive error scales. The purpose of the present study was to examine the construct validity of the CNCEQ and its constituent scales through the use of factor analysis and criterion-group comparisons. Groups of adolescent psychiatric inpatients, diagnosed as affective or disruptive disordered, completed the CNCEQ following admission. Results failed to support the implicit four-factor structure of the CNCEQ, instead suggesting the appropriateness of a single-factor solution labeled "negative thinking." Despite no diagnostic group differences on the CNCEQ total or other scale scores, affective disordered patients evinced more cognitive errors on the Overgeneralizing scale. Findings suggest that the CNCEQ in its current stage of development holds promise, yet requires refinement to produce a valid measure of cognitive functioning in youth.

Childhood depression and aggression: a covariance structure analysis.

The purpose of the present study was to: (a) evaluate the comorbidity of depression and aggression in a community sample of school-age children; (b) demonstrate the use of confirmatory factor analysis as a statistical tool in the assessment of the construct validity of childhood depression and aggression measures; and (c) using multisample analysis and structural equation modeling, examine the generalizability of comorbidity across two potential moderating or mediating variables (i.e. gender and peer unpopularity). A series of hypothetical models was tested to identify the number of factors represented by the data, the convergent and discriminant validity of the measures, the relationship between the latent variables of childhood depression and aggression, the influence of method-specific variation, and structural relationships among the latent constructs. Results supported a two-factor comorbidity model (childhood depression and aggression) and the presence of method effects (i.e. rater bias). Though the basic measurement model identified substantial comorbid symptoms and was generally invariant across gender, boys' self-reports of symptomatology evidenced poor validity. The structural equation models supported the independent effects of peer aggression and unpopularity on depression for both boys and girls, though aggression may be somewhat more strongly related to unpopularity among girls. Results were consistent with psychiatric investigations of comorbid depressive and aggressive disorders and emerging developmental psychopathology research on the socioemotional development of aggression and depression in youth.

A multicomponent behavioral treatment for social phobia: social effectiveness therapy.

The development of a new, comprehensive and multicomponent treatment for social phobia is described. Initial results of a pilot study with the new treatment also are reported. The treatment was found to be effective with severe (generalized) social phobics, most of whom had co-occurring Axis I and/or II conditions. In addition to significant change on a host of outcome variables, a normative-based endstate functioning index was used to determine treatment efficacy. The results are discussed with respect to the implementation of the treatment and in terms of the need for a comprehensive approach to treating social phobia.

Oral motor control, posturing, and myofunctional variables in 8-year-olds.

One hundred thirty-three rural second graders were evaluated for diadochokinetic abilities and myofunctional variables. Single-syllable diadochokinetic rates were significantly correlated with open-mouth resting postures. Slow trisyllable diadochokinetic rates were significantly correlated with a dentalized resting tongue posture and dentalized swallow patterns. The implications of these relationships are discussed.

Social support networks among families of children with craniofacial anomalies.

Investigated the social support available to families of children born with craniofacial anomalies and the perceived degree of satisfaction derived from these relationships. Thirty-six children (1 month to 5 years old) born with craniofacial deformities (FD) were matched by age and sex to 36 children with no significant physical or behavioral problems. The Social Support Questionnaire-Revised, the Revised Denver Developmental Screening Test, and a semistructured interview were administered. Results indicated that parents of FD children reported less available social support and were significantly less satisfied with their support. Parents of children who had more severe physical impairments and were rated as less attractive reported having less available and less satisfying social support. In particular, the social competence of the child was the most important predictor of parental social support. This result is interesting as the parents of FD children appeared to underreport the presence of behavioral-psychological problems in their children.

Myofunctional and dentofacial relationships in second grade children.

One hundred and thirty-three second graders in rural public school were assessed on a number of dental, skeletal, and oral muscle function measures. Correlational analyses were conducted in order to determine whether specific myofunctional variables were associated with dentofacial development. Significant relationships were observed between open mouth posture and a narrow maxillary arch and long facial height. Labial and lingual rest and swallow patterns were also related to poor coordination of lip and tongue movements.