The Efficacy of Parent-Child Interaction Therapy (PCIT) for Youth with Attention-Deficit/Hyperactivity Disorder (ADHD): A Meta-Analysis.

Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent in early childhood and has long-term negative effects when left untreated. Parent-Child Interaction Therapy (PCIT) is an early intervention for children aged 2- to-7-years that has extensive evidence for treating child externalizing problems by teaching parents effective strategies to manage child behavior. However, the effect of PCIT for families with children diagnosed with ADHD is not completely understood. This meta-analysis aims to synthesize research on the use of PCIT for children with ADHD. Nine out of 711 identified studies were analyzed. Summary effect sizes were calculated using the standardized mean gain for child ADHD symptoms, child behaviors, parent stress, and parenting behaviors, and the Fail-Safe N was calculated to determine the robustness of the results. Overall, PCIT had a significant beneficial effect on child ADHD symptoms (g = 0.90), child behavior (g = 0.44), parent stress (g = 0.82), and parenting behaviors (g = 2.15). Results of this meta-analysis suggest that PCIT is an effective treatment for reducing core symptoms of ADHD.

Animal Interaction Affecting Core Deficit Domains Among Children with Autism: A Meta-Analysis.

Animal-assisted intervention (AAI) has garnered public interest and has been implemented for youth with autism spectrum disorders-a practice supported by anecdotal evidence. While investigations of AAI for children with autism have been conducted, the extant literature is characterized by significant variability in methodology and practice. The present meta-analysis examines the aggregated effects of equine AAI on adaptive functioning among children with autism. Results indicated that interacting with an equine specifically during AAI produced small-to-medium effects (g = 0.40) on the adaptive functioning of children with autism. Recommendations are made for future research on this topic.

Differentiating Dissociative from Non-Dissociative Disorders: A Meta-Analysis of the Structured Clinical Interview for DSM Dissociative Disorders (SCID-D).

Inaccurate diagnosis of dissociative disorders (DDs) remains a frequent problem. Misdiagnoses may lead to delayed or ineffective treatment, and subsequently poorer quality of life for those struggling with DDs, who frequently utilize mental health treatment and evidence high rates of self-harm and suicidality. This study's objective was to examine the magnitude of the effects with which the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) and revised version (SCID-D-R) - henceforth referred to as the "SCID-D interviews" - provide diagnoses of DDs and differentiate them from nondissociative disorders as well as factitious and simulated dissociative presentations. For inclusion, studies had to be empirical investigations comparing SCID-D data of DD populations with other populations. Using combined methods of searching for "SCID-D" in electronic indexing databases, seeking recommendations from experts, and reviewing reference sections of identified studies, 15 studies were identified and subjected to meta-analytic review. Analyses showed that the overall SCID-D interview score (effect size 3.12) as well as each of the five subscales - particularly amnesia and identity alteration (effect sizes 2.16 and 2.87, respectively) - significantly differentiated DD from non-DD. Findings suggest that the SCID-D interviews show good validity identifying and differentiating those with DDs as compared to those without DDs. The SCID-D interviews are valid instruments for diagnosing and differentiating DD from other psychiatric disorders and feigned presentations of DD. Clinicians, researchers, and forensic experts can use the SCID-D interviews with confidence to make differential diagnoses of DDs. Future research using the SCID-D interviews is discussed.

Exploring the occurrence of sudden gains among anxious youth receiving evidence-based cognitive-behavioral therapy.

BACKGROUND: There is limited information on the occurrence of 'sudden gains' - recognized improvements of substantial magnitude occurring between individual sessions of treatment. This study explores changes in anxiety across sessions of CBT for youth anxiety disorders to determine whether evidence exists for sudden gains in this population. METHOD: A total of 133 anxious youth (Mage  = 10.16 years; 55.6% male) were randomly assigned to receive 16 sessions of individual cognitive-behavioral therapy (ICBT), family-based CBT (FCBT), or a family-based educational support and attention control (FESA). At each treatment session, youth completed a measure of anxiety. Sudden gains were calculated from weekly state anxiety scores using methods consistent with previous research (i.e., Tang & DeRubeis, 1999). RESULTS: Three participants experienced a sudden gain at any point during treatment; all experienced a reversal of the sudden gain, although one experienced a regain of the improvement that occurred during the sudden gain. CONCLUSIONS: While sudden gains have been demonstrated in some studies, in a relatively new topic to the literature such as this, it should also be considered that many evidence-based treatments are actually intended to produce more steady/gradual gains - which may be particularly true for youth who are not as cognitively advanced as adults and who have much to learn about how psychopathology - and for this analysis, anxiety - operates.

Atomoxetine treatment for children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): a comprehensive meta-analysis of outcomes on parent-rated core symptomatology.

Attention-Deficit/Hyperactivity Disorder (ADHD) impacts a significant number of children and adolescents and often leads to deleterious functional impairment. Psychostimulant medication has historically been the first line of pharmacological intervention, though recent years have seen greater attention paid to non-stimulant alternatives. The objective of the present study was to conduct the most comprehensive meta-analysis to date evaluating the efficacy of atomoxetine in reducing core symptomatology of ADHD according to parent report. Selection criteria were applied, and studies were located by searching electronic databases, review of reference sections, and contact with expert researchers; article searching began on 10/01/2013, and the final search was conducted on 09/01/2014. A total of 42 studies met inclusion criteria-33 with control groups and 9 without-for a total sample of 8398 individuals. For those receiving atomoxetine, the summary pre-post (e.g., standardized mean gain) effect size estimate was 1.37 (95% CI [1.24, 1.51], p < .001); atomoxetine was found to statistically significantly outperform control conditions overall (Z = 4.07, p < .001), though results differed by the type of control group; for instance, when comparing atomoxetine to alternative medications as controls, significant differences were no longer present. The non-stimulant atomoxetine led to significant improvement in core ADHD symptomatology and should be considered as a viable pharmacological treatment option for ADHD.

Brief Cognitive-Behavioral Therapy for Anxious Youth: The Inner Workings.

We provide a detailed description of the clinical application of brief cognitive-behavioral therapy (BCBT) for anxious youth. A rationale for the development of BCBT is presented, followed by a description and discussion of the 8 sessions of the treatment. Mike, a 7-year-old youth with anxiety disorders, is used to illustrate the inner workings of implementing BCBT. Case conceptualization, session details, and pre-, post- and follow-up-treatment information are provided. Conclusions regarding clinical advantages and future directions are made.

Evaluation of trauma characteristics as predictors of attrition from cognitive-behavioral therapy for child victims of violence.

Little research has investigated psychotherapy attrition among child victims of violence, and no studies have evaluated the role of trauma characteristics (e.g., level of threat or injury, trauma frequency, perpetrator relationship, victim type, and trauma type). The current study evaluated premature psychotherapy termination with 134 child victims (ages 5-19 years) who were referred for exposure-based cognitive-behavioral therapy. Results indicated that premature treatment termination was associated with children who experienced (a) a single incident of trauma (compared to multiple), (b) neither life threat nor physical injury during the victimization, (c) and an incident that was perpetrated by an older child compared to a parental figure. Certain trauma characteristics may be important factors for identifying children at risk for terminating treatment prematurely.

Training School Mental Health Providers to Deliver Cognitive-Behavioral Therapy.

Anxiety disorders are among the most prevalent mental health difficulties experienced by youth. A well-established literature has identified cognitive-behavior therapy (CBT) as the gold-standard psychosocial treatment for youth anxiety disorders. Access to CBT in community clinics is limited, but a potential venue for the provision of CBT for child anxiety disorders is the school setting. The present study examined a subset of data from a larger study in which therapists from a variety of settings, including schools, were trained in CBT for child anxiety (N = 17). The study investigated the relationship between provider- and organizational-level variables associated with training and implementation among school mental health providers. The present findings indicate a positive relationship between provider attitudes and adherence to CBT. Self-reported barriers to implementation were also identified. Integrating CBT into school mental health providers' repertoires through training and consultation is a critical step for dissemination and implementation of empirically supported psychosocial treatments.

Assessing and Treating Child Anxiety in Schools.

Anxiety disorders in youth are common and, if left untreated, can lead to a variety of negative sequelae. Randomized clinical trials have demonstrated that cognitive-behavioral therapy (CBT) is an efficacious treatment for anxiety disorders in youth with preliminary evidence showing that CBT can be successfully transported into schools. The present article provides (a) a discussion of the inherent challenges and advantages of implementing CBT in the school setting, (b) methods used to identify anxious youth, and (c) key components of CBT for anxious youth with an emphasis on adaptation and application in the school environment. Future research directions are discussed. The successful integration of a flexible CBT approach into the domain of school mental health would be a favorable step toward effective dissemination and would ensure the enduring provision of evidence-based practice to children and adolescents struggling with anxiety.

The meaning of attention-deficit/hyperactivity disorder medication and parents' initiation and continuity of treatment for their child.

OBJECTIVE: The aim of this study was to examine parents' early understanding of medication for attention-deficit/hyperactivity disorder (ADHD) in relation to decisions to initiate and continue treatment for their child. METHODS: Qualitative, semistructured telephone interviews were conducted with 48 parents of children newly diagnosed with ADHD. Parents were recruited from inner city, outpatient primary care, and mental health clinics affiliated with a large university hospital. Data were analyzed using grounded theory. RESULTS: Parents' initial perspectives of the appropriateness, anticipated effects, and symbolic meaning of medication were classified by four typologies (illness oriented, problem oriented, generally acceptable, unacceptable). In this sample, 29% of parents believed medication was required to treat the illness and 20% believed medication was unacceptable. Except for the unacceptable group, nearly all of the parents in the other groups initiated medication shortly after diagnosis. More than 80% of the illness- and problem-oriented groups used medication at 6 months; this fell to 64% and 78%, respectively, at 12 months. Only half of the unacceptable group ever used medication for their child. CONCLUSIONS: Parents' views of ADHD medication may be predictive of continuity of treatment. Increasing physician awareness of parent preferences for managing their child's ADHD problems may lead to care management plans that maximize continuity.

Community perspectives of childhood behavioral problems and ADHD among African American parents.

OBJECTIVE: To explore parents' perceptions of childhood behavior problems and attention-deficit/hyperactivity disorder (ADHD) among a sample of African American (AA) parents. METHODS: Five focus groups were conducted in inner-city Baltimore and the Washington, DC, metropolitan region with 5 to 7 AA parents per group. Adults with children under the age of 17 years were recruited from pediatric practices. One investigator moderated each focus group, and a second took notes. Sessions averaged 1.5 hours long, were recorded on audiotape, and were transcribed verbatim. The narrative data were coded for recurring themes. RESULTS: Five major themes emerged from the analysis: causes of behavioral problems in children, the legitimacy of ADHD as a diagnosis, attitudes about doctors, opinions of medication, and perceptions of the school environment. Many participants felt that behavior issues, including those accompanying ADHD, were caused by inappropriate parenting and disciplinary practices. Some viewed the diagnosis as a label applied with racial inequality to exert social control over AAs. Several expressed distrust in physicians who were quick to make a diagnosis of ADHD and recommend medications. Others worried that medication would lead to drug addiction in adulthood. Some perceived that children were labeled with ADHD because of poor educational environments that were unresponsive to the needs of AA children. CONCLUSIONS: These focus groups identified important community perceptions about ADHD and its medical treatment. Understanding how these perceptions contribute to racial disparities in ADHD diagnosis and treatment can help inform culturally sensitive interventions to improve the management of ADHD among AA children.

Coming to terms with ADHD: how urban African-American families come to seek care for their children.

OBJECTIVE: This study investigated how parents' interpretations of their child's disruptive or inattentive behaviors led them to seek medical care that resulted in a diagnosis of attention-deficit hyperactivity disorder (ADHD). METHODS: Qualitative, semistructured telephone interviews were conducted with parents of children who had been newly diagnosed as having ADHD (96% of the children were African American). The 26 participants were recruited from primary care, developmental and behavioral, and specialty mental health pediatric clinics affiliated with a large, urban teaching hospital. The analysis followed a grounded theory approach. RESULTS: By the time that parents sought treatment for their child's ADHD, they had been through an extensive process to pinpoint their child's problems. Parents' conceptualizations emerged as they described their child's behavior, explained the situation, described how ADHD affected their children, and explained how they sought answers. Their reactions to the behavior and visions they had for their child's future reflected their motivation to manage the situation. Parents' conceptualization and management of the behaviors described the process of coming to terms with their child's ADHD and the need for care. Four distinct patterns describing this process emerged from the analysis: immediate resolution, pragmatic management, attributional ambivalence, and coerced conformance. CONCLUSIONS: It is likely that clinicians' awareness of the different approaches by which families come to the decision to seek care for their child's ADHD will allow clinicians to provide more responsive care and better tailor interventions to improve therapeutic outcomes for children receiving mental health treatments.