Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): a feasibility study.

Conduct disorder (CD) is a common psychiatric disorder in youth characterized by persisting norm-violating or aggressive behavior. Considering high individual and societal burden, feasible and effective psychotherapeutic treatment is desirable. Yet, treatments and research in this patient group are scarce. This study investigates the feasibility of mentalization-based treatment for adolescents with CD (MBT-CD) in terms of acceptability of MBT-CD and scientific assessments by participants as well as necessary organizational resources to conduct a consecutive randomized controlled trial (RCT). Recruitment, adherence and treatment session numbers were descriptively analyzed. Treatment evaluation interviews were qualitatively analyzed. A subset of sessions of therapists without prior MBT experience was rated for MBT adherence. Quantitative data were used to plan a consecutive RCT. Pre to post treatment changes in diagnosis and self-reported aggression, mentalizing and personality functioning were preliminarily analyzed. N = 45 adolescents with CD were recruited. 43% dropped out. Acceptance of scientific assessments was somewhat lower than therapy adherence (questionnaires filled out by ~ 80% of adolescents in treatment), and low at follow-up (25% of treatment completers). Mean session number was 30.3. Most treatment completers were satisfied with MBT-CD. Referrals mainly came from child and youth services and psychiatry. Nine of 16 sessions rated for MBT adherence were adherent. A priori sample size estimation for a prospective RCT with a drop-out rate of 43% yielded a sample of N = 158 to detect an effect f = .15 with 80% power in a repeated measures ANOVA. Pre-post analyses revealed diagnostic improvement in 68%. Of self-reported data, empathy pathology improved. Findings provide a sound basis for a consecutive feasibility and pilot RCT. TRIAL REGISTRATION: Clinicaltrials.gov, registration number NCT02988453, November 30, 2016, https://clinicaltrials.gov/ct2/show/NCT02988453.

[What Did You Like About the Therapy? - A Qualitative Study on the Evaluation of Mentalization-Based Treatment for Adolescents with Conduct Disorder]. / Was hat dir an der Therapie gefallen? ­ Eine qualitative Studie zur Evaluation der Mentalisierungsbasierten Therapie für Jugendliche mit Störungen des Sozialverhaltens.

Psychotherapeutic treatment for adolescents with conduct disorder (CD) is considered difficult for various reasons. On the one hand, patients frequently lack psychological strain, and striving for autonomy is part of typical adolescent development. On the other hand, therapists can react aversively to delinquent and violent behavior, and insufficient psychological models explaining aetiology and maintenance of symptoms can impede treatment of adolescents with CD. Mentalization-Based Therapy for adolescents with CD (MBT-CD) was developed with the aim of addressing these difficulties and improving psychotherapeutic treatment for this patient group. MBT-CD focuses on the promotion of the adolescents' autonomy by increasing their scope of action via an improvement of mentalizing ability. The aim of this qualitative study is to investigate the acceptance of MBT-CD by the adolescents in terms of their experience with MBT-CD and thus obtain information about aspects which enhance therapy motivation for this group of patients. For this purpose, we conducted semi-structured interviews with twelve adolescents after completion of therapy assessing their subjective therapy evaluation. Qualitative content analysis was used to analyze the data. The results show both helpful and hindering aspects of the mentalization-based interventions. In addition, the monthly family sessions included in the therapy were regarded as important. Adolescents also regarded emotion regulation strategies as helpful. Implications for the treatment of adolescents with CD are discussed.

Review of Neuropsychological and Electrophysiological Correlates of Callous-unemotional Traits in Children: Implications for EEG Neurofeedback Intervention.

Conduct disorder is a significant psychiatric disorder of childhood and adolescence. The Diagnostic and Statistical Manual of Mental Disorders, fifth version (DSM-5), added the limited prosocial specifier to identify those individuals who exhibit a more severe pattern of behavior characterized by a callous and unemotional (CU) interpersonal style across multiple settings and relationships. This review has attempted to summarize the relevant research focusing on the significance of CU interpersonal style in the development of psychopathy. The primary focus was on the electrophysiological and neuropsychological correlates of CU traits and their implication on the treatment protocol using neurofeedback training for children with such traits. The source of the literature search was PubMed, which majorly uses the MEDLINE database. The keywords used included CU traits, conduct disorder, child psychopathy, empathy, electrophysiology, criminal behavior, neuropsychology, neurofeedback training, and so on. Studies from the last 15 years were considered for the review. This review revealed that children with conduct disorder and high-CU traits with a combination of reactive and proactive aggression are more likely to develop psychopathy. Evidence suggests that these children have distinct forms of electrophysiological and neuropsychological correlates. However, research in this area is still not conclusive as they yield variation in findings. Studies on the efficacy of neurofeedback training on reducing symptoms such as impulsivity, hostility, and psychopathy indicate that neurofeedback training can be a promising treatment alternative for children with severe conduct disorder.

Social skills training and play group intervention for children with oppositional-defiant disorders/conduct disorder: Mediating mechanisms in a head-to-head comparison.

Objective: Social-cognitive information processing, social skills, and social interactions are problem-maintaining variables for aggressive behavior in children. We hypothesized that these factors may be possible mediators of the mechanism of change in the child-centered treatment of conduct disorders (CDs). The aim of the present study (Clinical trials.gov Identifier: NCT01406067) was to examine putative mechanisms of change for the decrease in oppositional-defiant behavior resulting from child-centered treatment of patients with oppositional-defiant disorder (ODD) or CD. Method: 91 children (age 6-12 years) with ODD/CD were randomized to receive either social skills training or to a resource activating play group. Mediator analyses were conducted using path analyses. Results: The assumed mediating effects were not significant. However, alternative models with the putative mediators and outcome in reversed positions showed significant indirect effects of the oppositional-defiant symptoms as mediator for the decrease of disturbance of social-information processing, social skills, and social interactions. Conclusions: The proposed model for mechanisms of change could not be confirmed, with the results pointing to a reversed causality. Variables other than those hypothesized must be responsible for mediating the effects of the intervention on child oppositional-defiant behavior. Possible mechanisms of change were discussed.

[Mentalizing as a Mechanism of Change in the Therapy of Conduct Disorder. A Controlled Case Study]. / Mentalisieren als Veränderungsmechanismus in der Behandlung von Störungen des Sozialverhaltens. Eine kontrollierte Fallstudie.

Mentalizing as a Mechanism of Change in the Therapy of Conduct Disorder. A Controlled Case Study This controlled case study is dedicated to mentalizing as a mechanism of change in the course of a mentalization-based therapy for the treatment of conduct disorder. Following an introduction to conduct, oppositional defiant disorder and the concept of mentalizing, the case study of a 17-year-old male patient is presented. The patient's mentalizing is measured with the Reflective Functioning Scale and assessed prior to and after treatment as well as in therapy sessions at three time points through the course of therapy. Analyses show that the capacity for mentalizing fluctuates noticeably within but also between the coded therapy sessions. During the course of therapy first an increase and then a slight decrease in mentalizing qualities become apparent. The comparison of the pre- and post-measurement shows a slight increase in the patient's mentalizing abilities. Additionally the patient no longer fulfilled the criteria of a conduct disorder. The results are discussed and implications for clinical practice are formulated.

Musicoterapia en la enfermedad de Alzheimer: efectos cognitivos, psicológicos y conductuales / Music therapy and Alzheimer's disease: Cognitive, psychological, and behavioural effects

Introducción: La musicoterapia forma parte de los programas de envejecimiento activo que se ofrecen a las personas mayores. Su utilidad en el campo de las demencias empieza a ser valorada por la comunidad científica, ya que se han reportado efectos positivos a nivel físico, cognitivo y psicológico. Son necesarios más estudios que perfilen el alcance de tales cambios en la enfermedad de Alzheimer. Objetivos: Conocer el perfil de mejoría clínica que experimentan los pacientes con enfermedad de Alzheimer con la aplicación de una intervención de musicoterapia. Pacientes y métodos: Se aplicó un tratamiento con musicoterapia durante 6 semanas a 42 pacientes con enfermedad de Alzheimer en estadio leve-moderado. Se estudiaron los cambios en las puntuaciones de Mini-examen del estado mental, Inventario de síntomas neuropsiquiátricos, Escala hospitalaria de ansiedad y depresión, e índice de Barthel. Se estudió si estos cambios se influían por el grado de severidad de la demencia. Resultados: Se observó una mejoría significativa de memoria, orientación, depresión y ansiedad (escala HAD) en pacientes leves y moderados; de ansiedad (escala NPI) en pacientes leves; de los delirios, alucinaciones, agitación, irritabilidad y trastornos del lenguaje en el grupo con demencia moderada. El efecto sobre las medidas cognitivas es ya apreciable a las 4 sesiones de musicoterapia. Conclusiones: En la muestra estudiada, la musicoterapia mejoró algunas alteraciones cognitivas, psicológicas y conductuales de los pacientes con enfermedad de Alzheimer. Sería interesante complementar la musicoterapia con intervenciones de danzaterapia a fin de mejorar los aspectos motores y funcionales (AU)

Introduction: Music therapy is one of the types of active ageing programmes which are offered to elderly people. The usefulness of this programme in the field of dementia is beginning to be recognised by the scientific community, since studies have reported physical, cognitive, and psychological benefits. Further studies detailing the changes resulting from the use of music therapy with Alzheimer patients are needed. Objectives: Determine the clinical improvement profile of Alzheimer patients who have undergone music therapy. Patients and methods: Forty-two patients with mild to moderate Alzheimer disease underwent music therapy for 6 weeks. The changes in results on the Mini-mental State Examination, Neuropsychiatric Inventory, Hospital Anxiety and Depression Scale and Barthel Index scores were studied. We also analysed whether or not these changes were influenced by the degree of dementia severity. Results: Significant improvement was observed in memory, orientation, depression and anxiety (HAD scale) in both mild and moderate cases; in anxiety (NPI scale) in mild cases; and in delirium, hallucinations, agitation, irritability, and language disorders in the group with moderate Alzheimer disease. The effect on cognitive measures was appreciable after only 4 music therapy sessions. Conclusions: In the sample studied, music therapy improved some cognitive, psychological, and behavioural alterations in patients with Alzheimer disease. Combining music therapy with dance therapy to improve motor and functional impairment would be an interesting line of research (AU)

[Mentalization Based Treatment of an Adolescent Girl with Conduct Disorder]. / Mentalisierungsbasierte Therapie einer Jugendlichen mit Störung des Sozialverhaltens.

Mentalization Based Treatment of an Adolescent Girl with Conduct Disorder This paper will give a short overview on the theoretical concept of mentalization and its specific characteristics in adolescence. A previous study on Mentalization based treatment for adolescents (MBT-A) demonstrated the effectiveness of MBT-A for the treatment of adolescents with symptoms of deliberate self-harm (Rossouw u. Fonagy, 2012). Based on the results of this study Taubner, Gablonski, Sevecke, and Volkert (in preparation) developed a manual for mentalization based treatment for adolescents with conduct disorders (MBT-CD). This manual represents the foundation for a future study on the efficacy of the MBT-A for this specific disorder in young people. The present case report demonstrates the application of specific MBT interventions, as well as the therapeutic course over one year in a 16-year old girl who fulfilled all criteria of a conduct disorder. During the course of treatment, the de-escalating relationship-oriented therapeutic approach can be considered as a great strength of MBT-A, especially for patients with conduct disorders. The clinical picture, as well as the psychological assessment, showed a positive progress over the course of treatment. Despite frequent escalations, forced placements due to acute endangerment of self and others, and a precarious situation with the patient's place of residence towards the end of therapy, MBT-A treatment enabled the patient to continually use the evolved mentalizing capabilities as a resource.

Beneficios de la musicoterapia en las alteraciones conductuales de la demencia. Revisión sistemática / Benefits of music therapy on behaviour disorders in subjects diagnosed with dementia: a systematic review

Introducción. La demencia se caracteriza por un deterioro cognitivo y por la aparición de síntomas psicológicos y conductuales, entre los que destacan las alteraciones de percepción, del contenido del pensamiento, estado de ánimo y de conducta. Para tratar estos síntomas, además del tratamiento farmacológico, se utilizan intervenciones no farmacológicas, entre ellas la musicoterapia. Esta técnica novedosa, por sus características no verbales, puede ser usada en todas las fases del tratamiento de las personas con demencia ya que, aunque haya un gran deterioro cognitivo, las respuestas ante la música se mantienen hasta los estadios más avanzados de la enfermedad. Desarrollo. Se realizó una búsqueda bibliográfica con un intervalo temporal entre 2003 y 2013 en las bases de datos Academic Search Complete, PubMed, Science Direct y Dialnet. Los términos de búsqueda incluyeron la combinación de las palabras claves «music therapy, dementia, behaviour, behavioural disorders y behavioural disturbances». Se seleccionaron 11 registros de los 2188 localizados tras aplicar los criterios de inclusión. Conclusiones. El tratamiento con musicoterapia es beneficioso para mejorar las alteraciones conductuales, la ansiedad y la agitación en pacientes con demencia (AU)

Introduction. Dementia is characterised by cognitive deterioration and the manifestation of psychological and behavioural symptoms, especially changes in perception, thought content, mood, and conduct. In addition to drug therapy, non-pharmacological treatments are used to manage these symptoms, and one of these latter treatments is music therapy. Since this novel technique in non-verbal, it can be used to treat patients with dementia at any stage, even when cognitive deterioration is very severe. Patients’ responses to music are conserved even in the most advanced stages of the disease Development. A literature research was carried out using the following databases: Academic Search Complete, PubMed, Science Direct y Dialnet. The period of publication was 2003 to 2013 and the search keywords were «Music Therapy, Dementia, Behaviour, Behaviour Disorders y Behavioural Disturbances». Out of the 2188 studies that were identified, 11 studies met inclusion criteria for the systematic review. Conclusions. Music therapy is beneficial and improves behavior disorders, anxiety and agitation in subjects diagnosed with dementia (AU)

Masoterapia en las alteraciones conductuales de ancianos con demencia / Therapeutic massage on behavioral disturbances of elderly patients with dementia

OBJETIVO: Conocer la eficacia del masaje terapéutico sobre las alteraciones conductuales de ancianos con demencia. DISEÑO: Revisión de la literatura científica. Fuente de datos: La búsqueda de las publicaciones se llevó a cabo en 6 bases de datos científicas: PubMed, Cochrane Library Plus, PEDro, Dialnet, Scopus y CSIC, entre 1983 y 2013. Los términos de búsqueda incluyeron la combinación de las palabras clave (R)massage», (R)dementia», (R)therapy», (R)behavior disorders» y (R)Alzheimer». Selección de los estudios: Se seleccionaron 11 registros de los 496 localizados tras aplicar los CRITERIOS DE INCLUSIÓN: Los criterios de inclusión han sido ensayos clínicos, publicados en inglés o en español, en los que se ha analizado los efectos de la terapia del masaje sobre los comportamientos alterados en personas con demencia. Extracción de datos: Las principales variables recogidas son los beneficios del masaje, el tipo de masaje y el lubricante utilizado. RESULTADOS: Los estudios que han analizado las alteraciones conductuales de los pacientes con demencia han sido escasos. Sus autores utilizan diferentes técnicas de masaje (effleurage, pétrissage, presiones, fricciones y amasamientos), obteniendo beneficios en la mejora de los trastornos de conducta (agresividad, ansiedad, agitación y resistencia a los cuidados) de estos ancianos. CONCLUSIONES: El masaje terapéutico puede ser un tratamiento complementario en el programa de rehabilitación tradicional para mejorar las alteraciones conductuales de la demencia

OBJECTIVE: To know the efficacy of therapeutic massage on behavioral disturbances of elderly patients with dementia. Design: Literature review. Data source: The literature search was done in six scientific databases: PubMed, Cochrane Library Plus, PEDro, Dialnet, Scopus and CSIC, between 1983 and 2013. The search terms were 'massage', 'dementia', 'therapy', 'behavior disorders' and 'Alzheimer'. Selecion of studies: Of the 496 articles analyzed, 11 scientific articles have met the selection criteria. Inclusion criteria were: clinical trials, published in English or Spanish, which had analyzed the effects of massage therapy on altered behaviors in people with dementia. Data extraction: The variables were massage benefits, type of massage and massage lubricant. Results: Their authors use different massage techniques (effleurage, pétrissage, pressures, frictions and kneading), obtain better conduct disorders (aggression, anxiety, agitation, and resistance to care) of elderly. Conclusions: The therapeutic massage can be a complementary treatment in the rehabilitation program for better behavior disorders

[Multidimensional family therapy: which influences, which specificities?]. / La thérapie familiale multidimensionnelle (MDFT) : quelles influences, quelles spécificités ?

BACKGROUND: Among illegal psycho-active drugs, cannabis is the most consumed by French adolescents. Multidimensional family therapy (MDFT) is a family-based outpatient therapy which has been developed for adolescents with drug and behavioral problems. MDFT has shown its effectiveness in adolescents with substance abuse disorders (notably cannabis abuse) not only in the United States but also in Europe (International Cannabis Need of Treatment project). MDFT is a multidisciplinary approach and an evidence-based treatment, at the crossroads of developmental psychology, ecological theories and family therapy. Its psychotherapeutic techniques find its roots in a variety of approaches which include systemic family therapy and cognitive therapy. OBJECTIVE: The aims of this paper are: to describe all the backgrounds of MDFT by highlighting its characteristics; to explain how structural and strategy therapies have influenced this approach; to explore the links between MDFT, brief strategic family therapy and multi systemic family therapy; and to underline the specificities of this family therapy method. DISCUSSION: The multidimensional family therapy was created on the bases of 1) the integration of multiple therapeutic techniques stemming from various family therapy theories; and 2) studies which have shown family therapy efficiency. Several trials have shown a better efficiency of MDFT compared to group treatment, cognitive-behavioral therapy and home-based treatment. Studies have also highlighted that MDFT led to superior treatment outcomes, especially among young people with severe drug use and psychiatric co-morbidities. In the field of systemic family therapies, MDFT was influenced by: 1) the structural family therapy (S. Minuchin), 2) the strategic family theory (J. Haley), and 3) the intergenerational family therapy (Bowen and Boszormenyi-Nagy). MDFT has specific aspects: MDFT therapists think in a multidimensional perspective (because an adolescent's drug abuse is a multidimensional disorder), they work with the system and the subsystem, focusing on the emotional expression and the parental and adolescent enactment (a principle of change and intervention). MDFT includes four modules (adolescent, parent, family interaction, and extra-familial systems) in three steps (1) build the foundation, (2) prompt action and change by working the themes, and (3) seal the changes and exit). The supervision philosophy and methodology is also based on the principle of multidimensionality. Indeed, many different supervision methods are used in a coordinated way to produce the required adherence and clinical skill (written case conceptualizations, videotape presentation and live supervision). CONCLUSION: Family vulnerability and chronicity factors are a major challenge of modern research. MDFT questions the reciprocal adjustments that have to be made by the subject and his/her familial environment. It also helps to clarify the therapeutic interventions in order to enhance better adolescent development. For this purpose, MDFT offers a specific therapeutic frame, for it is a family therapy focused on adolescents with cannabis abuse problems. Its action and questioning on parental practices and adolescents lead to better psycho-educational support. It focuses the therapeutic process on emotions and family capacity for change.

The efficacy of systemic therapy for childhood and adolescent externalizing disorders: a systematic review of 47 RCT.

Systemic (family) therapy is a widely used psychotherapy approach. However, most systematic efficacy reviews have focused solely on "family-based treatment" rather than on the theoretic orientation "systemic therapy." We systematically review trials on the efficacy of systemic therapy for the treatment of childhood and adolescent externalizing disorders. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems-oriented therapy in various forms (family, individual, group, multi-family group therapy) with child or adolescent index patients (0-17 years) suffering from mental disorders were identified by data base searches and cross-references. Inclusion criteria were as follows: index patient diagnosed with a DSM- or ICD-listed mental disorder, and trial published in any language up to the end of 2011. The RCTs were analyzed for their research methodology, interventions applied, and results (postintervention; follow-up). A total of 47 trials from the United States, Europe, and China, published in English, German, and Mandarin, were identified. A total of 42 of them showed systemic therapy to be efficacious for the treatment of attention deficit hyperactivity disorders, conduct disorders, and substance use disorders. Results were stable across follow-up periods of up to 14 years. There is a sound evidence base for the efficacy of systemic therapy for children and adolescents (and their families) diagnosed with externalizing disorders.

Sudden gains as a long-term predictor of treatment improvement among children in community mental health organizations.

OBJECTIVE: Sudden gains have been described as rapid, sizeable changes observed between treatment sessions and have been associated with improved treatment outcome in adults. The current study examined weekly sudden gains among children seeking treatment in the community mental health setting. METHOD: Participants were 161 children (age M = 10.58, SD = 1.73; 69.6% male; 47.8% Caucasian) and their parents who were randomized to one of three treatment modalities and were administered weekly and quarterly assessments throughout treatment. RESULTS: When idiographic (youth- and parent-identified "top problems") and nomothetic measures (standardized checklists) were used to calculate sudden gains (i.e., gain must be large: in absolute terms, relative to prior session, and relative to changes in prior and subsequent sessions), 20-42% of participants experienced at least one sudden gain during treatment. Most sudden gains occurred early in treatment, and session content of relaxation was associated with sudden gain presence. Using a modified Bonferonni correction, sudden gains predicted overall symptom levels at final assessment (i.e., last assessment obtained following post-treatment) even after controlling for pre-treatment symptom levels and magnitude of the overall gain from pre- to post-treatment. CONCLUSIONS: Suddenness of gains may have a direct effect on long-term treatment outcome among children in the community.

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.

Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial.

CONTEXT: Prior qualitative work with internally displaced persons in war-affected northern Uganda showed significant mental health and psychosocial problems. OBJECTIVE: To assess effect of locally feasible interventions on depression, anxiety, and conduct problem symptoms among adolescent survivors of war and displacement in northern Uganda. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled trial from May 2005 through December 2005 of 314 adolescents (aged 14-17 years) in 2 camps for internally displaced persons in northern Uganda. INTERVENTIONS: Locally developed screening tools assessed the effectiveness of interventions in reducing symptoms of depression and anxiety, ameliorating conduct problems, and improving function among those who met study criteria and were randomly allocated (105, psychotherapy-based intervention [group interpersonal psychotherapy]; 105, activity-based intervention [creative play]; 104, wait-control group [individuals wait listed to receive treatment at study end]). Intervention groups met weekly for 16 weeks. Participants and controls were reassessed at end of study. MAIN OUTCOME MEASURES: Primary measure was a decrease in score (denoting improvement) on a depression symptom scale. Secondary measures were improvements in scores on anxiety, conduct problem symptoms, and function scales. Depression, anxiety, and conduct problems were assessed using the Acholi Psychosocial Assessment Instrument with a minimum score of 32 as the lower limit for clinically significant symptoms (maximum scale score, 105). RESULTS: Difference in change in adjusted mean score for depression symptoms between group interpersonal psychotherapy and control groups was 9.79 points (95% confidence interval [CI], 1.66-17.93). Girls receiving group interpersonal psychotherapy showed substantial and significant improvement in depression symptoms compared with controls (12.61 points; 95% CI, 2.09-23.14). Improvement among boys was not statistically significant (5.72 points; 95% CI, -1.86 to 13.30). Creative play showed no effect on depression severity (-2.51 points; 95% CI, -11.42 to 6.39). There were no statistically different improvements in anxiety in either intervention group. Neither intervention improved conduct problem or function scores. CONCLUSIONS: Both interventions were locally feasible. Group interpersonal psychotherapy was effective for depression symptoms among adolescent girls affected by war and displacement. Other interventions should be investigated to assist adolescent boys in this population who have symptoms of depression. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00280319.

Who cares for patients with attention-deficit/hyperactivity disorder (ADHD)? Insights from Nordbaden (Germany) on administrative prevalence and physician involvement in health care provision.

OBJECTIVE: To determine age and gender specific administrative prevalence of ADHD (hyperkinetic disorder, HKD, and hyperkinetic conduct disorder, HKCD, according to ICD-10-based coding) in Germany in 2003, and to assess physician involvement in medical care. METHOD: Retrospective claims database analysis covering the insured population of Nordbaden, Germany (n = 2.238 million). RESULTS: A total of 11,875 subjects with a diagnosis of HKD/HKCD were identified (overall 12-month prevalence rate 0.53%). Prevalence was highest among children age 7-12 years (5.0%; boys, 7.2%; girls, 2.7%). Among adults age 20 years and higher, prevalence was 0.04% (males, 0.04%; females, 0.03%). 36.0% (13.0%) of children and adolescents and 33.5% (12.5%) of adults with a diagnosis of ADHD were seen by a specialized physician at least once (four times) during the year. Physician involvement by discipline was highly skewed. CONCLUSION: Diagnosis rates in children and adolescents exceeded those expected according to ICD-10 criteria, but matched DSM-IV-based estimates. In the adult population, ADHD was rarely detected. Most patients were not seen by a mental health specialist, and physician involvement was highly concentrated. Potential policy implications include a high need for expertise among pediatricians and general practitioners. The data indicate an urgent need for further research into health care utilization and quality.

Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder of infancy and early childhood.

This parameter reviews the current status of reactive attachment disorder with regard to assessment and treatment. Attachment is a central component of social and emotional development in early childhood, and disordered attachment is defined by specific patterns of abnormal social behavior in the context of "pathogenic care." Clinically relevant subtypes include an emotionally withdrawn/inhibited pattern and a socially indiscriminate/disinhibited pattern. Assessment requires direct observation of the child in the context of his/her relationships with primary caregivers. Treatment requires establishing an attachment relationship for the child when none exists and ameliorating disturbed attachment relationships with caregivers when they are evident. Coercive treatments with children with attachment disorders are potentially dangerous and not recommended.

Contribution de l'homeopathie au depassement du dualisme corps-esprit ou l'unite psychophysique de l'etre humain / Contribution of homeopathy to the surpass of the dualism body-spirit or the unity psychophysical os the human being

Je me propose de montrer dans cet article comment la comprehension de l'originalite homeopathique concernant l'unite psychophysique de l'etre humain peut contribuer a depasser le dualism... (AU)

Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids.

Reviews psychosocial interventions for child and adolescent conduct problems, including oppositional defiant disorder and conduct disorder, to identify empirically supported treatments. Eighty-two controlled research studies were evaluated using the criteria developed by the Division 12 (Clinical Psychology) Task Force on Promotion and Dissemination of Psychological Procedures. The 82 studies were also examined for specific participant, treatment, and methodological characteristics to describe the treatment literature for child and adolescent conduct problems. Two interventions were identified that met the stringent criteria for well-established treatments: videotape modeling parent training program (Spaccarelli, Cotler, & Penman, 1992; Webster-Stratton, 1984, 1994) and parent-training programs based on Patterson and Gullion's (1968) manual Living With Children (Alexander & Parsons, 1973; Bernal, Klinnert, & Schultz, 1980; Wiltz & Patterson, 1974). Twenty of the 82 studies were identified as supporting the efficacy of probably efficacious treatments.