Parent Perceptions of Pediatric Primary Care Providers' Mental Health-Related Communication and Practices.

INTRODUCTION: The pediatric primary care office is an ideal setting to address children's socioemotional-behavioral health. However, research is limited regarding parents' experiences and satisfaction in sharing mental-health concerns about their children during well-child visits. METHOD: One thousand seven hundred sixty-three parents and caregivers with children aged 3-17 years completed an online survey that addressed mental-health-related communication. RESULTS: Findings supported the key role that primary care providers play in communicating about mental-health issues; 75% of parents who had such a concern about their child raised it during the visit, although the majority desired more time devoted to discussing mental health. Parents' comfort discussing mental-health concerns was inversely related to providers' dismissing those concerns. DISCUSSION: Despite satisfaction with how providers addressed mental-health issues, results suggested that nonjudgmental, knowledgeable staff and discussion of child and parent strengths could facilitate both parental comfort and communication between parents and pediatricians.

The effect of location on psychotropic treatment practices among pediatricians.

OBJECTIVE: The purpose of the study was to examine how access factors affect prescribing practices of psychotropic medications among pediatricians. More specifically, the aim of the current study was to examine differences in the treatment of mental and behavioral health problems among children and adolescents across small nonmetropolitan, regional, metropolitan, and urban settings across the United States. METHOD: A total of 516 pediatricians working in outpatient clinics located in 12 US states, 3 in each of the following regions: New England, the Plains, the Pacific Northwest, and the South completed surveys on their prescription practices for children and adolescents with mental and behavioral health needs. RESULTS: Findings indicate that pediatricians in small nonmetropolitan settings with populations of fewer than 20,000 prescribe antidepressants; antianxiety, antipanic, and antiobsessive medication; antipsychotics; and mood stabilizers significantly more frequently than their counterparts in urban, metropolitan, and regional settings. CONCLUSION: Implications of these findings for clinical practice and training are discussed.

Efficacy of cognitive-behavioral and pharmacological treatments for children with social anxiety.

Childhood social anxiety is associated with significant social and academic impairment. The purpose of this study was to compare and contrast the efficacy of two major treatments for social anxiety disorders in children: cognitive-behavioral therapy and selective serotonin reuptake inhibitor (SSRI) drug treatment. Treatment studies in the literature were evaluated using meta-analytic techniques to compare pre- and post-treatment measures of social anxiety symptoms, general anxiousness, social competency, and impairment. Results indicate that the core symptoms of social anxiety and impairment were reduced by both cognitive-behavioral treatment (ES=0.86 and 1.56) and SSRI treatment (ES=1.30 and 2.29), respectively. Similarly, peripheral symptoms of general anxiousness were reduced by both cognitive-behavioral treatment (ES=0.75) and SSRI treatment (ES=1.29). Finally, both cognitive-behavioral (ES=0.68) and SSRI treatment (ES=0.68) resulted in moderate improvements in social competence. Implications and the limitations of these meta-analytic findings are discussed with respect to the evidence-based intervention movement.