A haven of green space: learning from a pilot pre-post evaluation of a school-based social and therapeutic horticulture intervention with children.

BACKGROUND: Research suggests outdoor activity in green spaces is important for children's mental, emotional and social wellbeing. A recognised green space intervention is "Social and Therapeutic Horticulture" (STH). We discuss findings from a pilot STH intervention, "A Haven of Green Space" conducted in North West England. The target group were school children aged 9-15 years experiencing behavioural, emotional and social difficulties. This exploratory study aims to assess the mental wellbeing of the children pre- and post-intervention, and assess the value of the evaluation methods and "Five Ways to Wellbeing" evaluation framework. METHODS: The intervention involved 6 monthly sessions with two horticulturists and a psychotherapist. Sessions were participatory with the development of selected greenspaces at each school directed by the children. Evaluation was situated in the "Five Ways to Wellbeing" framework, using a mixed-methods pre- post-evaluation design. Existing public mental health evaluation methodologies were adapted for use with school children: Mental Well Being Impact Assessment (MWIA) and Wellbeing Check Cards. The MWIA was analysed qualitatively identifying over-arching themes. The quantitative wellbeing check cards were analysed by mean score comparison. RESULTS: Results were collected from 36 children across the three participating schools, and suggest that the Haven Green Space intervention was associated with improved mental wellbeing. MWIA factors relating to mental wellbeing ("emotional wellbeing" and "self-help") were positively impacted in all three schools. However, findings from the wellbeing check cards challenge this, with worsening scores across many domains. CONCLUSIONS: A key study limitation is the pilot nature of the intervention and challenges in adapting evaluation methods to context and age-range. However, results indicate that group based socially interactive horticulture activities facilitated by trained therapists are associated with positive impacts upon the mental and emotional wellbeing of children experiencing behavioural, emotional and social difficulties. Further research is needed to verify this, and to support using the "Five Ways" in intervention development and evaluation. Finally, we recommend continued efforts to develop age-appropriate evaluation methods.

Evaluation of a Music Therapy Social Skills Development Program for Youth with Limited Resources.

BACKGROUND: Children living in low-resource communities are at risk for poorer socio-emotional development and academic performance. Emerging evidence supports use of group music therapy experiences to support social development through community afterschool programming. OBJECTIVE: To examine the potential benefit of a music therapy social skills development program to improve social skills and academic performance of school-aged children with limited resources in an afterschool program. METHOD: We used a single-group pre/post-test design, and recruited 20 students (11 females, 9 males), ages 5 to 11 years, from an afterschool program. The music therapy social skills program consisted of eight 50-minute sessions, and we measured social competence and antisocial behavior using the Home & Community Social Behavioral Scale (HCSBS; Merrell & Caldarella, 2008), and social skills, problem behaviors, and academic competence using the Social Skills Improvement System (SSIS; Gresham & Elliot, 2008a, 2008b). RESULTS: Only students who attended a minimum of six sessions (N = 14) were included in data analysis. Results showed no significant change in individual HBSC subscale scores; however, the total number of low-performance/high-risk skills significantly decreased. SSIS teacher results indicated significant improvement in communication, significant decrease of hyperactivity, autistic behavioral tendencies and overall problem behaviors, and marginal decreases in internalization. Parent ratings mirrored, in part, those of the teacher. CONCLUSIONS: Results indicated that music therapy has the potential of being an effective intervention for promoting social competence of school-aged children with limited resources, particularly in the areas of communication and low-performance/high-risk behaviors. Teaching skills through song lyrics and improvisation emerged as salient interventions.

Mindfulness, posttraumatic stress symptoms, depression, and social functioning impairment in Chinese adolescents following a tornado: Mediation of posttraumatic cognitive change.

Previous studies have shown that mindfulness is associated with less negative traumatic outcomes in people who experienced traumatic events. The present study investigated how mindfulness is related to posttraumatic stress disorders (PTSD) symptoms, depression and social functioning impairment in Chinese traumatized adolescents by considering the role of posttraumatic cognitive change (PCC). A total of 247 Chinese adolescents, who had experienced a severe tornado six months prior to this study, were recruited to complete a series of questionnaires. Results showed that the proposed model fitted the data very well (χ2 = 16.200, df = 8, χ2/df = 2.025, GFI = 0.983, CFI = 0.991, TLI = 0.976, RMSEA = 0.063). Further analyses revealed that PCC mediated the relation between dispositional mindfulness and all negative posttraumatic outcomes (including PTSD symptoms, depression and social functioning impairment). Limitations, clinical implications, and directions for future research were discussed.

Autism: Pathophysiology and Promising Herbal Remedies.

Autism is a comprehensive growth abnormality in which social skills, language, communication, and behavioral skills are developed with delay and as diversionary. The reasons for autism are unclear, but various theories of genetics, immunity, biological, and psychosocial factors have been proffered. In fact, autism is a complex disorder with distinct causes that usually co-occur. Although no medicine has been recognized to treat this disorder, pharmacological treatments can be effective in reducing its signs, such as self-mutilation, aggression, repetitive and stereotyped behaviors, inattention, hyperactivity, and sleeping disorders. Recently, complementary and alternative approaches have been considered to treat autism. Ginkgo biloba is one of the most effective plants with an old history of applications in neuropsychological disorders which recently is used for autism. The present review discusses the recent findings, pathophysiology, and etiology of autism and thereafter addresses the promising results of herbal remedies.

The Yin and Yang of support from significant others: Influence of general social support and partner support of avoidance in the context of treatment for social anxiety disorder.

Support from social networks is generally considered to protect against mental disorder but in some circumstances support for negative behaviours (such as avoidance) may be counterproductive. Given the critical interplay between social anxiety disorder and social interactions, it is surprising that the relationship of support from significant others to this disorder has received so little attention. The current study evaluated the reciprocal relationships between perceived social support and perceived partner support for avoidance behaviours (avoidance support) among a sample of 131 participants with social anxiety disorder who were assessed three times within the context of a treatment outcome study. A new measure of partner support for avoidance behaviours was developed, called the Avoidance Support Measure, and showed adequate internal consistency and construct validity. Correlations at baseline showed significant negative relationships between perceived social support and social anxiety and significant positive relationships between avoidance support and social anxiety. Path analysis showed that perceived social support at Times 1 and 2 negatively predicted future social anxiety at Times 2 and 3. On the other hand, only a single predictive relationship involving avoidance support was significant and showed that social anxiety at Time 1 positively predicted avoidance support at Time 2. These early results point to the different ways that support from significant others might relate to social anxiety and suggest that further work in this area may be fruitful.

Improvement in social deficits in autism spectrum disorders using a theatre-based, peer-mediated intervention.

Social Emotional NeuroScience Endocrinology Theatre is a novel intervention program aimed at improving reciprocal social interaction in youth with autism spectrum disorder (ASD) using behavioral strategies and theatrical techniques in a peer-mediated model. Previous research using a 3-month model showed improvement in face perception, social interaction, and reductions in stress. The current study assessed a 2-week summer camp model. Typically developing peers were trained and paired with ASD youth (8-17 years). Social perception and interaction skills were measured before and after treatment using neuropsychological and parental measures. Behavioral coding by reliable, independent raters was conducted within the treatment context (theatre) and outside the setting (playground). Salivary cortisol levels to assess physiological arousal were measured across contexts (home, theatre, and playground). A pretest-posttest design for within-group comparisons was used, and prespecified pairwise comparisons were achieved using a nonparametric Wilcoxon signed-rank test. Significant differences were observed in face processing, social awareness, and social cognition (P < 0.05). Duration of interaction with familiar peers increased significantly over the course of treatment (P < 0.05), while engagement with novel peers outside the treatment setting remained stable. Cortisol levels rose on the first day of camp compared with home values yet declined by the end of treatment and further reduced during posttreatment play with peers. Results corroborate previous findings that the peer-mediated theatre program contributes to improvement in core social deficits in ASD using a short-term, summer camp treatment model. Future studies will explore treatment length and peer familiarity to optimize and generalize gains.

[Social skills training in severe mental illness--is it effective?]. / Das Training sozialer Fertigkeiten bei schweren psychischen Erkrankungen--ist es wirksam?

OBJECTIVE: To report about existing evidence of effectiveness of social skills training for severely mentally ill adults. METHODS: Systematic electronic and manual literature search for systematic reviews and randomized clinical trials (RCTs). RESULTS: Social skills training is a widely used intervention for people with severe mental illness. We identified four reviews and seven RCTs demonstrating the efficacy and effectiveness of social skills training. Results suggest that patients would benefit from trainings by improving social skills and social functioning. There are ambiguous results regarding other outcomes. CONCLUSIONS: People with severe mental illness should be provided with social skills training, if necessary, combined with cognitive remediation. Those techniques are required which actively support the generalization of positive achievements into patients' natural environments.

Modulating behavioral inhibition by tDCS combined with cognitive training.

Cognitive training is an effective tool to improve a variety of cognitive functions, and a small number of studies have now shown that brain stimulation accompanying these training protocols can enhance their effects. In the domain of behavioral inhibition, little is known about how training can affect this skill. As for transcranial direct current stimulation (tDCS), it was previously found that stimulation over the right inferior frontal gyrus (rIFG) facilitates behavioral inhibition performance and modulates its electrophysiological correlates. This study aimed to investigate this behavioral facilitation in the context of a learning paradigm by giving tDCS over rIFG repetitively over four consecutive days of training on a behavioral inhibition task (stop signal task (SST)). Twenty-two participants took part; ten participants were assigned to receive anodal tDCS (1.5 mA, 15 min), 12 were assigned to receive training but not active stimulation. There was a significant effect of training on learning and performance in the SST, and the integration of the training and rIFG-tDCS produced a more linear learning slope. Better performance was also found in the active stimulation group. Our findings show that tDCS-combined cognitive training is an effective tool for improving the ability to inhibit responses. The current study could constitute a step toward the use of tDCS and cognitive training as a therapeutic tool for cognitive control impairments in conditions such as attention-deficit hyperactivity disorder (ADHD) or schizophrenia.

A systematic review of the use of aromatherapy in treatment of behavioral problems in dementia.

We aimed to fill the literature gap by identifying the clinical benefits of aromatherapy in older adults with dementia, and its efficacy in reducing behavioral and psychological symptoms of dementia (BPSD) based on available randomized controlled trials (RCT). A systematic review of 11 clinical trials shortlisted from electronic databases from 1995 to 2011 was carried out. The RCT showed that aromatherapy had positive effects on reduction of BPSD, improvement in cognitive functions, increasing quality of life, enhancing independence of activities of daily living and so on. However, adverse effects were noted in some studies. Limitations on methodology are discussed and suggestions on directions of further studies are made. It is recommended that aromatherapy shows the potential to be applied as a therapeutic and safe complementary and alternative therapy for the management of BPSD on more evidence collected from better designed RCT.

Comprehensive care of children with Dravet syndrome.

The comprehensive care of a patient with Dravet syndrome encompasses both the "care" and the "cure" of the patient, and requires cooperation among family, doctors, and several other specialized caregivers to search for the attainment of the best quality of life for the patients and their families. Several issues peculiar to the disease to be faced while dealing with the patient are: (1) SMEI is an "evolving" disease that appears in an otherwise healthy child with symptoms that appear and mutate throughout the course of the disease; (2) the severity of the disease is not fully predictable at onset and appears to be individual-specific; (3) the seizures are invariably drug resistant and seizure freedom is not a realistic goal; and (4) in addition to seizures many other invalidating clinical problems, including cognitive impairment, behavior disorders, and a number of comorbidities characterize the disease course. The comprehensive caring must be physician-guided and patient-centered and implies a multidisciplinary approach to be built around the children and caregivers, who need to be guided through the steps of the diagnosis, treatments, and managements of the various comorbidities.

Religion, spirituality, positive youth development, and thriving.

Issues of spirituality and thriving are pertinent to the period of adolescence given the marked changes in body, mind, and relationships. In order to provide an overview of the relationship between religion, spirituality, and positive youth development, this chapter offers a developmental systems perspective and proposes a relational spirituality as a framework for understanding adolescent religious and spiritual development. In addition, the chapter examines various psychological mechanisms through which religion and spirituality may promote positive youth development. Existing empirical research on the relationships between adolescent religion, spirituality, thriving, and specific indicators of positive youth development is reviewed. Finally, future directions for continuing to build the field of study are discussed.

The effect of a music therapy social skills training program on improving social competence in children and adolescents with social skills deficits.

Three separate studies were conducted in school, residential and after-school care settings to test the effectiveness of a music therapy-based social skills intervention program on improving social competence in children and adolescents. A total of 45 children (n = 12; n = 13; n = 20) aged 6-17 years with social skills deficits participated in a group-based five session intervention program. The same curriculum, adapted to be age appropriate, was used at all 3 sites. Specific deficits within the social skills areas of peer relations and self-management skills were targeted. Active interventions like music performance, movement to music and improvisation were used. Cognitive-behavioral techniques like modeling, feedback, transfer training and problem solving were also incorporated. Data on social functioning were collected before, during, and after the music therapy intervention from participants, appropriate adult personnel and via behavioral observations. Results indicated that significant improvements in social functioning were found in (a) school participant pre and post self-ratings, (b) researcher pre and post ratings of school participants, (c) case manager's pre and post treatment ratings for the residential participants, (d) after-school care participants' pre and post self-ratings, and (e) behavioral observations at all three settings. Additional changes, although not significant, were noted in teacher ratings, residential participant self- and peer ratings, and after-school case manager ratings. Results from these studies suggest that the music therapy intervention was effective in improving social competence in children and adolescents with social deficits. More research is warranted to provide additional guidance about the use of music therapy interventions to improve social functioning.

War's long shadow: masculinity, medicine, and the gendered politics of trauma, 1914-1939.

War is an inherently traumatizing experience, and during the First World War more than 15,000 Canadian soldiers were diagnosed with some form of war-related psychological wounds. Many more went unrecognized. Yet the very act of seeking an escape from the battlefield or applying for a postwar pension for psychological traumas transgressed masculine norms that required men to be aggressive, self-reliant, and un-emotional. Using newly available archival records, contemporary medical periodicals, doctors' notes, and patient interview transcripts, this paper examines two crises that arose from this conflict between idealized masculinity and the emotional reality of war trauma. The first came on the battlefield in 1916 when, in some cases, almost half the soldiers evacuated from the front were said to be suffering from emotional breakdowns. The second came later, during the Great Depression, when a significant number of veterans began to seek compensation for their psychological injuries. In both crises, doctors working in the service of the state constructed trauma as evidence of deviance, in order to parry a larger challenge to masculine ideals. In creating this link between war trauma and deviance, they reinforced a residual conception of welfare that used tests of morals and means to determine who was deserving or undeserving of state assistance. At a time when the Canadian welfare state was being transformed in response to the needs of veterans and their families, doctors' denial that "real men" could legitimately exhibit psychosomatic symptoms in combat meant that thousands of legitimately traumatized veterans were left uncompensated by the state and were constructed as inferior, feminized men.

Effects of nutritional supplements on aggression, rule-breaking, and psychopathology among young adult prisoners.

In an earlier study, improvement of dietary status with food supplements led to a reduction in antisocial behavior among prisoners. Based on these earlier findings, a study of the effects of food supplements on aggression, rule-breaking, and psychopathology was conducted among young Dutch prisoners. Two hundred and twenty-one young adult prisoners (mean age=21.0, range 18-25 years) received nutritional supplements containing vitamins, minerals, and essential fatty acids or placebos, over a period of 1-3 months. As in the earlier (British) study, reported incidents were significantly reduced (P=.017, one-tailed) in the active condition (n=115), as compared with placebo (n=106). Other assessments, however, revealed no significant reductions in aggressiveness or psychiatric symptoms. As the incidents reported concerned aggressive and rule-breaking behavior as observed by the prison staff, the results are considered to be promising. However, as no significant improvements were found in a number of other (self-reported) outcome measures, the results should be interpreted with caution.

Outcomes of anti-bullying intervention for adults with intellectual disabilities.

Although existing research is scarce, evidence suggests that children and adults with intellectual disabilities may be at increased risk of being bullied (as they are for maltreatment generally) and possibly more likely than those without disabilities to also engage in bullying behavior. Despite significant clinical interest in bullying, we could find no published research on the outcomes of bullying intervention for individuals with intellectual disabilities. Adults with intellectual disabilities in three work center settings participated in one of two interventions for perpetrators and/or victims of bullying: (a) psychoeducational intervention with a cognitive behavioral orientation (n=20), or (b) the same intervention but with additional involvement of community stakeholders such as parents, the police, and local schools (n=22). A third work center (n=18) acted as a waiting list control comparison. Pre-intervention, 43% of participants reported that they had been bullied within the preceding three months and 28% identified themselves as having bullied others. Reports of being bullied decreased significantly within the two intervention groups over time but not in the control group. There were no differences between the two intervention groups, and no statistically significant reduction in self-reported bullying behavior. Initial data on this intervention suggest that its effects might be clinically meaningful with an associated Numbers Needed to Treat for reduction in exposure to bullying of 5.55.

Survivors of childhood cancer and comparison peers: the influence of peer factors on later externalizing behavior in emerging adulthood.

OBJECTIVE: To examine group differences and predictors of externalizing behavior and substance use during the transition to emerging adulthood (i.e., ages 18-25) among survivors of childhood cancer and comparison peers. METHODS: Peer acceptance and social behavior were assessed in classrooms of 55 children (ages 8-15) during cancer treatment. Children with cancer, comparison peers (n = 60), and parents completed measures of externalizing behavior and/or substance use during an initial home visit and soon after participants turned 18. RESULTS: At follow-up, survivors and peers exhibited similar externalizing behaviors and substance use, except peers were more likely to use marijuana. Substance use was associated with earlier peer acceptance and social behavior. Survivors who were older at diagnosis were at greater risk for later externalizing behavior and substance use. CONCLUSIONS: Mean externalizing behaviors and substance use generally fell within normative ranges for both survivors and peers. Some survivors may benefit from interventions to reduce risk behavior.

[Asperger syndrome - a too late diagnosed disorder?]. / Asperger-Syndrom - eine zu spät diagnostizierte Störung?

Asperger syndrome is a disorder within the autistic spectrum, which was first described by Hans Asperger in 1944. It belongs to the group of pervasive developmental disorders and is particularly characterized by qualitative impairments of social interaction and communication as well as distinct special interests and stereotyped patterns of behaviour. We present a patient, showing the typical behavioural symptoms of the Asperger syndrome, which were first diagnosed at the age of sixteen.

[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.

Keep music live: music and the alleviation of apathy in dementia subjects.

BACKGROUND: A recent Cochrane report concluded that more and better quality research is required to investigate the effectiveness of music therapy in reducing problems in behavioral, social, emotional and cognitive domains in patients with dementia. This randomized placebo-controlled trial with blinded observer rater aimed to explore whether music, live or pre-recorded, is effective in the treatment of apathy in subjects with moderate to severe dementia. METHODS: Thirty-two subjects meeting ICD-10 diagnostic criteria for moderate to severe dementia and fulfilling diagnostic criteria for apathy were exposed to live interactive music, passive pre-recorded music or silence for 30 minutes. Each subject was randomized to 30-minute music or silent periods and was video recorded and the muted recording analyzed every 3 minutes using dementia care mapping to assess the quality of engagement to the blinded music intervention. RESULTS: Compared to low baseline levels of positive engagement (12.5%) in the silent placebo period, the majority of subjects (69%), regardless of dementia severity, showed a significant and positive engagement to live music. Engagement to pre-recorded music was non-significant, with just 25% of all subjects showing positive engagement. No subjects showed any evidence of experiencing a state of ill-being during either the live or pre-recorded music sessions. CONCLUSIONS: During the intervention, live interactive music has immediate and positive engagement effects in dementia subjects with apathy, regardless of the severity of their dementia. Pre-recorded music is non-harmful but less clearly beneficial.

Music therapy in moderate and severe dementia of Alzheimer's type: a case-control study.

BACKGROUND: Music therapy is a potential non-pharmacological treatment for the behavioral and psychological symptoms of dementia, but although some studies have found it to be helpful, most are small and uncontrolled. METHODS: This case-control study was carried out by qualified music therapists in two nursing homes and two psychogeriatric wards. The participants were 38 patients with moderate or severe Alzheimer's disease (AD) assigned randomly to a music therapy group and a control group. RESULTS: The study showed a significant reduction in activity disturbances in the music therapy group during a 6-week period measured with the Behavior Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). There was also a significant reduction in the sum of scores of activity disturbances, aggressiveness and anxiety. Other symptoms rated by subscales of the BEHAVE-AD did not decrease significantly. Four weeks later the effects had mostly disappeared. CONCLUSIONS: Music therapy is a safe and effective method for treating agitation and anxiety in moderately severe and severe AD. This is in line with the results of some non-controlled studies on music therapy in dementia.