Neurodevelopmental correlates of behavioural and emotional problems in a neuropaediatric sample.

Most research does not address the overlap between neurodevelopmental disorders when investigating concomitant mental health problems. The purpose of the present study was to examine the association of intellectual disability (ID), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) with the presence of behavioural and emotional problems after controlling for other well-known correlates and risk factors. The sample included 4- to 18-year-old children who attended neuropaediatric clinics (N = 331). After controlling for adversity, age, gender, other developmental/neurological disorders, parental emotional problems, and parenting strategies, the presence of ADHD but not ASD or ID was uniquely associated with behaviour problems. Neither ADHD nor ASD nor ID was significantly associated with emotional problems after controlling for other risk factors. However, ADHD, ASD and behavioural/emotional disorders but not ID were significantly associated with functional impairment in everyday activities after controlling for other risk factors. Because children with neurodevelopmental disorders have complex needs, a holistic approach to diagnosis and interventions is highly warranted, including the assessment and treatment of behavioural and emotional disorders.

Therapeutic body wraps (TBW) for treatment of severe injurious behaviour in children with autism spectrum disorder (ASD): A 3-month randomized controlled feasibility study.

INTRODUCTION: The use of therapeutic body wraps (TBW) has been reported in small series or case reports, but has become controversial. OBJECTIVES: This is a feasibility, multicentre, randomized, controlled, open-label trial with blinded outcome assessment (PROBE design). SETTING: Children with autism and severe-injurious behaviours (SIB) were enrolled from 13 specialized clinics. INTERVENTIONS: Dry-sheet TBW (DRY group) vs. wet-sheet TBW (WET group). PRIMARY OUTCOME MEASURES: 3-month change in the Aberrant Behaviour Checklist irritability score (ABC-irritability) within per-protocol (PP) sample. RESULTS: From January 2008 to January 2015, we recruited 48 children (age range: 5.9 to 9.9 years, 78.1% male). Seven patients (4 in the DRY group, 3 in the WET group) were dropped from the study early and were excluded from PP analysis. At endpoint, ABC-irritability significantly improved in both groups (means (standard deviation) = -11.15 (8.05) in the DRY group and -10.57 (9.29) in the WET group), as did the other ABC scores and the Children Autism Rating scale score. However, there was no significant difference between groups. All but 5 patients were rated as much or very much improved. A repeated-measures analysis confirmed the significant improvement in ABC-irritability scores according to time (p < .0001), with no significant difference between the two groups (group effect: p = .55; interaction time x group: p = .27). Pooling both groups together, the mean 3-month change from baseline in ABC-irritability score was -10.90 (effect size = 1.59, p < .0001). CONCLUSIONS: We found that feasibility was overall satisfactory with a slow recruitment rate and a rather good attrition rate. TBW was a safe complementary therapy in this population. There was no difference between wet and dry TBW at 3 months, and ABC-irritability significantly decreased with both wet and dry sheet TBW. To assess whether TBW may constitute an alternative to medication or behavioural intervention for treating SIB in ASD patients, a larger randomized comparative trial (e.g. TBW vs. antipsychotics) is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT03164746.

The Mechanism of Cortico-Striato-Thalamo-Cortical Neurocircuitry in Response Inhibition and Emotional Responding in Attention Deficit Hyperactivity Disorder with Comorbid Disruptive Behavior Disorder.

The neurocircuitries that constitute the cortico-striato-thalamo-cortical (CSTC) circuit provide a framework for bridging gaps between neuroscience and executive function in attention deficit hyperactivity disorder (ADHD), but it has been difficult to identify the mechanisms for regulating emotional problems from the understanding of ADHD comorbidity with disruptive behavior disorders (DBD). Research based on "cool" and "hot" executive functional theory and the dual pathway models, which are thought of as applied response inhibition and delay aversion, respectively, within the neuropsychological view of ADHD, has shed light on emotional responding before and after decontextualized stimuli, while CSTC circuit-related domains have been suggested to explain the different emotional symptoms of ADHD with or without comorbid DBD. This review discusses the role of abnormal connections in each CSTC circuit, especially in the emotion circuit, which may be responsible for targeted executive dysfunction at the neuroscience level. Thus, the two major domains - abstract thinking (cool) and emotional trait (hot) - trigger the mechanism of onset of ADHD.

Tailoring Parent-Child Interaction Therapy (PCIT) for Older Children: A Case Study.

Parent-Child Interaction Therapy (PCIT) is an evidence-based intervention designed for families of 2- to 6-year-old children with disruptive behavior disorders. This article illustrates the application of PCIT in a 10-year-old boy with attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). Both parents and the patient attended PCIT sessions. The course of therapy included minor changes to the PCIT protocol. After 13 PCIT sessions, the patient displayed disruptive behaviors within normal limits, and 12 months later he no longer met diagnostic criteria for ODD. Results remained stable at a 17-month follow-up assessment. This case study suggests that the use of PCIT in families of children with ODD markedly older than the recommended age range might be a promising approach for improving family functioning and reducing behavior problems. Further research with larger samples of older children with ODD is needed to replicate and elaborate the findings of this case study.

Propiedades psicométricas del "Cuestionario de Agresividad" en adolescentes chilenos: comparación de diferentes versiones / Psychometric properties of the Five Facets Mindfulness Questionnaire (FFMQ-M) in Mexico

El objetivo de esta investigacion fue analizar las propiedades psicométricas del "Cuestionario de agresividad" (Aggression Questionnaire, AQ), en las versiones de 29, 20 y 12 items, en una muestra de 898 estudiantes chilenos de 14 a 17 anos. El analisis factorial confirmatorio identifico que la version de 12 items fue la que mostro un ajuste mas adecuado al modelo de cuatro factores propuesto por los autores de la escala. Los indices de consistencia interna de los cuatro factores fueron aceptables, oscilando entre 0,67-0,78. La validez de la escala fue analizada mediante correlaciones con el "Inventario de expresion de ira estado-rasgo en ninos y adolescentes" (State-Trait Anger Expression Inventory for Children and Adolescents, STAXI-NA). Los resultados revelaron correlaciones positivas y estadisticamente significativas entre las puntuaciones del AQ de 12 items y las dimensiones de rasgo y estado del STAXI-NA, oscilando entre 0,20 (Hostilidad-Ira/estado) y 0,57 (Puntuacion total AQ-Ira/rasgo). Los resultados obtenidos en este trabajo ponen de manifiesto que la version abreviada del AQ presenta adecuadas pruebas de fiabilidad y validez para evaluar conductas agresivas en adolescentes chilenos

The objective of this research was to analyze the psychometric properties of the Aggression Questionnaire (AQ), in its 29, 20 and 12-item versions, in a sample of 898 Chilean students from 14 to 17 years of age. The confirmatory factor analysis identified that the 12-item version was the one showing a more suitable fit to the four-factor model proposed by the authors of the scale. The internal consistency of the four dimensions was acceptable, ranging between .67 and .78. The results also revealed positive and statistically significant correlations between scores of AQ-12-item version and trait and state dimensions of the State-Trait Anger Expression Inventory for Children and Adolescents (STAXI-NA), ranging from .20 (Hostility-State anger) to .57 (AQ total score-Trait anger). These results indicate that the AQ-12-item version is an instrument that shows reliability and convergent validity for evaluating aggressive behaviors in Chilean adolescents

Pediatric emotional dysregulation and behavioral disruptiveness treated with hypnosis: a time-series design.

A case of pediatric oppositional defiant disorder (ODD) with concomitant emotional dysregulation and secondary behavioral disruptiveness was treated with hypnosis by means of the hypnotic hold, a method adapted by the authors. An A-B-A-B time-series design with multiple replications was employed to measure the relationship of the hypnotic treatment to the dependent measure: episodes of emotional dysregulation with accompanying behavioral disruptiveness. The findings indicated a statistically significant relationship between the degree of change from phase to phase and the treatment. Follow-up at 6 months indicated a significant reduction of the frequency of targeted episodes of emotional dysregulation and behavioral disruptiveness at home.

The impact of disruptive behavior disorder on substance use treatment outcome in adolescents.

The current study examined the impact of disruptive behavior disorder (DBD) on substance use outcomes in an adolescent sample. Sixty-eight adolescents and their caregivers were randomized to one of two fourteen-week, outpatient treatments: Motivational Enhancement Therapy/Cognitive Behavior Therapy (MET/CBT)+Parent Management Training+Contingency Management (CM; experimental) and MET/CBT+Parent Drug Education (attention control). This study assessed abstinence, substance use, externalizing behavior, and parenting outcomes over five assessment periods for youth with DBD (DBD(+)) and without DBD (DBD(-)). Results showed DBD(+)/experimental adolescents reported fewer days of marijuana use than DBD(+)/control adolescents. Results also showed that parents of DBD(-) adolescents in the experimental condition reported significantly better parenting outcomes compared to DBD(-)/control. Substance abuse treatment for adolescents with DBD which includes a component such as contingency management and parent training has the potential to contribute to substance use outcomes. Such treatment strategies, however, should include additional support for parents.

Matching adolescents with a cannabis use disorder to multidimensional family therapy or cognitive behavioral therapy: treatment effect moderators in a randomized controlled trial.

BACKGROUND: In a recent randomized controlled trial (Hendriks et al., 2011), multidimensional family therapy (MDFT) and cognitive behavioral therapy (CBT) were equally effective in reducing cannabis use in adolescents (13-18 years old) with a cannabis use disorder (n=109). In a secondary analysis of the trial data, we investigated which pretreatment patient characteristics differentially predicted treatment effect in MDFT and CBT, in order to generate hypotheses for future patient-treatment matching. METHODS: The predictive value of twenty patient characteristics, in the area of demographic background, substance use, substance-related problems, delinquency, treatment history, psychopathology, family functioning and school or work related problems, was investigated in bivariate and subsequent multivariate linear regression analyses, with baseline to month 12 reductions in cannabis use days and smoked joints as dependent variables. RESULTS: Older adolescents (17-18 years old) benefited considerably more from CBT, and younger adolescents considerably more from MDFT (p<0.01). Similarly, adolescents with a past year conduct or oppositional defiant disorder, and those with internalizing problems achieved considerably better results in MDFT, while those without these coexisting psychiatric problems benefited much more from CBT (p<0.01, and p=0.02, respectively). CONCLUSIONS: The current study strongly suggests that age, disruptive behavior disorders and internalizing problems are important treatment effect moderators of MDFT and CBT in adolescents with a cannabis use disorder. If replicated, this finding suggests directions for future patient-treatment matching in adolescent substance abuse treatment.

Effect of music on mealtime disruptions.

BACKGROUND: People with learning disabilities can disrupt mealtimes with non-cooperative, aggressive and self-injurious behaviours that challenge other people to tolerate and manage them. These behaviours appear to arise because the proximity of other people, and the heightened activity and noise of a dining room, causes anxiety and agitation. AIM: To examine how delivering calming background music via headphones affected anxiety-driven behaviours that disrupted mealtimes. METHOD: A sample of 30 adults with mild, moderate or severe learning disabilities were videotaped during mealtimes on two consecutive days. On the first day, half the group ate without any calming music while the other half sat opposite them wearing earphones and listening to calming music. On the second day, the non-music and music groups swapped around. RESULTS: Of the participants who tolerated the earphones, only three showed disruptive behaviour; all three had been sitting at the table waiting for their food. With so few examples, meaningful inferential analysis was not possible. However, there were signs that calming music had a positive effect on disruptive mealtime behaviours. It eliminated physical harm, complaining and verbal repetition in one person, and stopped another from shouting/swearing. It also reduced the incidence of shouting/swearing, restlessness and vocalising. CONCLUSION: Calming music and reduced waiting at tables for food may reduce disruptive behaviours.

The influence of animals on the development of children.

There is a widespread belief that interaction with an animal is beneficial for the development of children, and several studies (most with methodological shortcomings) have investigated the influence of (companion) animals on the social-emotional and cognitive development of children. In this article, the 1984 model of Professor Jay Belsky has been used to describe which variables influence the development of children and how the companion animal-child interaction influences these variables. The value of the AAA/AAT (Animal Assisted Activities/Animal Assisted Therapy) programmes in children with a wide variety of clinical and social problems, such as behaviour problems and autistic spectrum symptoms, is discussed. The findings suggest that (companion) animals positively influence children's development and have a valuable role in therapy.

Multi-sensory rooms: comparing effects of the Snoezelen and the Stimulus Preference environment on the behavior of adults with profound mental retardation.

The present study examined whether Snoezelen and Stimulus Preference environments have differential effects on disruptive and pro-social behaviors in adults with profound mental retardation and autism. In N=27 adults these target behaviors were recorded for a total of 20 sessions using both multi-sensory rooms. Three comparison groups were created by diagnosis and motor respective linguistic abilities. Each client was exposed to only one multi-sensory room. Results showed that Snoezelen intervention decreased disruptive behaviors only in individuals with autism, while Stimulus Preference increased pro-social behaviors only in participants with profound mental retardation with co-occurring poor motor and linguistic abilities. Furthermore, several trend analyses of the improved behaviors were conducted throughout all sessions toward short and mid term effects of the multi-sensory room applications. These findings support both the prudence of using the Snoezelen room in individuals with developmental disabilities and the importance of using a Stimulus Preference assessment in multi-sensory environments in clients with profound mental retardation.

A controlled naturalistic study on a weekly music therapy and activity program on disruptive and depressive behaviors in dementia.

AIM: This study explores the effects of a weekly structured music therapy and activity program (MAP) on behavioral and depressive symptoms in persons with dementia (PWD) in a naturalistic setting. METHODS: PWD attended a weekly group MAP conducted by a qualified music therapist and occupational therapist for 8 weeks. Two validated scales, the Apparent Emotion Scale (AES) and the Revised Memory and Behavioral Problems Checklist (RMBPC), were used to measure change in outcomes of mood and behavior. RESULTS: Twenty-eight subjects completed the intervention, while 15 wait-list subjects served as controls. Baseline AES and RMBPC scores were not significantly different between the intervention and control groups. After intervention, RMBPC scores improved significantly (p = 0.006) with 95% CI of the difference between the mean intervention and control group scores compared to baseline at -62.1 to -11.20. Total RMBPC scores in the intervention group improved from 75.3 to 54.5, but worsened in the control group, increasing from 62.3 to 78.6. AES scores showed a nonsignificant trend towards improvement in the intervention group. CONCLUSION: The results suggest that a weekly MAP can ameliorate behavioral and depressive symptoms in PWD.

The effect of multisensory stimulation on persons residing in an extended care facility.

BACKGROUND: Non-pharmacological interventions, such as multisensory stimulation environments (MSSE), have demonstrated the ability to reduce inappropriate behavior among individuals with Alzheimer's disease. METHODS: In this study, we compared the incidences of problematic behavior among individuals with Alzheimer's disease residing in a long-term care facility who were and were not exposed to an MSSE. Retrospective data were obtained using the Psychotic Behavior Assessment Record (PBAR), mandated by Medicare to be used when antipsychotic medications are administered. Psychotic Behavior Assessment Record data were collected using the first and sixth month of admission for residents after appropriate consent was secured. RESULTS: Documented disruptive behavior included pacing, exit-seeking activities, hitting, yelling, and aggressive talking. The use of the MSSE resulted in a decrease in the number of incidences of disruptive behavior, but not the behaviors present. CONCLUSION: The use of MSSE, as a non-pharmacological intervention, demonstrates the ability to decrease the number of incidences of disruptive or problematic behavior. The use of these interventions, where feasible, should be considered prior to the use of pharmacological methods.

Comorbidity as a predictor and moderator of treatment outcome in youth with anxiety, affective, attention deficit/hyperactivity disorder, and oppositional/conduct disorders.

In the present review, we examine one of the critical issues that have been raised about evidence-based treatments and their portability to real-world clinical settings: namely, the presence of comorbidity in the participants who have been treated in these studies and whether the presence of comorbidity predicts or moderates treatment outcomes. In doing so, we examine treatment outcomes for the four most commonly occurring childhood psychiatric disorders: Anxiety disorders, affective disorders, attention deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD)/conduct disorder (CD). For each of these disorders, we first review briefly the prevalence of comorbidity in epidemiological and clinical samples and then highlight the evidence-based treatments for these disorders. We next determine the effects of comorbidity on treatment outcomes for these disorders. For the most part, comorbidity in the treated samples is the rule, not the exception. However, the majority of studies have not explored whether comorbidity predicts or moderates treatment outcomes. For the not insignificant number of studies that have examined this issue, comorbidity has not been found to affect treatment outcomes. Notable exceptions are highlighted and recommendations for future research are presented.

Therapeutic work with a physically abused preschooler.

This paper explores the impact of early abuse by a parental figure (foster mother) on a child's subsequent development. The child's adoption into a nurturing home at age 3-1/2 allowed for early intervention, and a brief follow-up period of treatment at age ten provides further insight into the impact of early trauma across developmental periods. The paper highlights unique challenges that may arise in treatment with child victims of interpersonal violence. During treatment, the child struggled with profound difficulty tolerating his natural aggressive impulses and distinguishing inner fantasies from external stressors. Significant modifications in treatment format, including encouraging the adoptive mother to be an active participant and using settings outside the consultation room when the child could not tolerate affects associated with the familiar playroom, were helpful in moderating the child's anxiety.

[Between empathy and setting limits--reflections on psychodynamics and treatment techniques in psychoanalytic therapies for hyperkinetic disorders]. / Zwischen Empathie und Grenzsetzungen--Uberlegungen zur Psychodynamik und Behandlungstechnik bei psychoanalytischen Therapien von hyperkinetischen Störungen.

The rise in "hyperkinetic disorder" diagnoses is not based on better but rather on less precise diagnoses. As a rule the co-morbidities as mentioned in ICD-10 like emotional disorders, commitment disorders and social behaviour disorders, are the real clinical pictures accompanied by such symptoms as inattentiveness, hyperactivity and impulsiveness. These are disorder pictures based possibly on unconscious areas of conflict which can be managed by psychoanalytic treatment. However, this involves considerable treatment challenges taking into account that there are some major difficulties: Children showing said disorder pictures have not only symbolizing disorders but mostly also playing disorders. They experience playing not symbolically, no longer mainly "as if" and taking place in a space between imagination and reality. Their play may easily turn into concreteness or reality and get out of control all of a sudden. In addition, children and young people with externalizing disorders constantly attack basic conditions and seek to destroy them. Verbal intervention frequently does not reach the patients. Counter transferences are very difficult to bear and to control, and the tendency of psychotherapists to join in is strong. It is therefore of great importance to work on the ability of symbolization and mentalization, on relationship and transference, simultaneously however on frame and structure, with reliability and regularity of the settings. Analytic therapies as well as therapies founded on depth psychology may be indicated, possibly supplemented by parallel medication; at the beginning a particularly careful diagnosis should be made.

[KES--training for parents of children with conduct behaviour problems]. / Kompetenztraining für Eltern sozial auffälliger und aufmerksamkeitsgestörter Kinder (KES).

Conduct behaviour problems are the most frequent problems in childhood and adolescence. They make special demands on parenting. Possible causes for the emergence and maintenance of this distinctive features can be summarized in a bio-psychosocial disturbance model. The parental educating behaviour is thereby usually not the cause of the childlike behaviour problems, but can stabilize initial behaviour problems. Parenting trainings are therefore considered as an effective possibility of intervention and prevention of childlike behaviour disturbances. In this article contents and effectiveness of the "Kompetenztraining für Eltern sozial auffälliger und aufmerksamkeitsgestörter Kinder (KES)" (Lauth a. Heubeck 2005) are to be represented. The KES is a secondary preventive parenting training, which is offered as an intensive short time intervention and accomplished in groups. The contents of the training fit with the individual problems of parents' everyday educating situations. In the available study this training is operate in three variants in order to examine differential training effects apart from the general effectiveness. The results show a general effectiveness of the KES. Burdens in family educating situations can be reduced likewise the experienced stress in the family. The results also indicate, that the parents of the group with behaviour exercises seems to benefit most from the training. They do not only speak about their problems (alternative treatment) or get suggestions for changes in the educating behaviour (group without behaviour exercises). They are also requested to practice the connected skills in the form of role plays and homework to be able to transfer into everyday life.