A retrospective study of children's perceptions of participation as clinical research subjects in a minimal risk study.

The purpose of the study was to evaluate children's perceptions of their participation as research subjects in a minimal risk research study (a methylphenidate population pharmacokinetic study conducted 8 months earlier). We identified 115 children of an original 189, aged 6 to 19 years, who were responding well to regular methylphenidate for attention-deficit hyperactivity disorder. By using a structured format, telephone interviewers unconnected to the original study questioned the children about what it had been like to be a subject in terms of voluntariness, accuracy of informed consent, reasons for participating, and satisfaction with their experience. Children overwhelmingly perceived their involvement as voluntary (89%) and the information about the study as accurately presented (80%), and they reported a high level of satisfaction with their participation (97%). Self-interest was the most frequently reported reason for participation (47%). In a subsample of 25 children, the percentage of agreement of a 1-week test-retest equaled or exceeded 72% for all answers.

Trazodone is only slightly faster than fluoxetine in relieving insomnia in adolescents with depressive disorders.

This retrospective chart review examined the relative effectiveness of fluoxetine and trazodone in relieving insomnia associated with depressive disorders in adolescents (aged 13-17 years). We reviewed the hospital charts of consecutively admitted adolescents with a depressive disorder and insomnia, who received one of three treatments: fluoxetine (20 +/- 2.2 mg), trazodone (71 +/- 32 mg), or a fluoxetine-trazodone combination (fluoxetine 29 +/- 2.2 mg, trazodone 68 +/- 29 mg). Each treatment was examined in 20 patients. Insomnia was defined as a change in sleep patterns characterized by decreased total sleep time that was sufficient to cause clinical concern, and insomnia resolution was defined as sleep starting by midnight and lasting 6 hours. Mean time to resolution of insomnia was significantly faster in adolescents treated with trazodone rather than fluoxetine (2.5 vs. 5.1 days, p < 0.05). Trazodone seemed to save only about 3 days and insomnia resolved in all subjects by the 11th day of antidepressant treatment. Median time to insomnia resolution was 2 days (range 1-5 days) in the trazodone group and 4 days (range 1-11 days) in the fluoxetine group. This difference between trazodone and fluoxetine, although statistically significant, was generally not clinically significant in the management of insomnia associated with depressive disorders in adolescents. The resolution of insomnia was not faster for treatment with a combination of fluoxetine and trazodone in comparison to fluoxetine monotherapy. Insomnia resolution was slightly later in older children. These clinical findings await confirmation by a controlled study. Both drugs seemed effective in ameliorating sleep symptoms in this sample, although it is likely that they produced these changes by different mechanisms.

Childhood sexual abuse and parental alcoholism: interactive effects in adult women.

Symptoms associated with histories of childhood sexual abuse and parental alcoholism were investigated in a sample of 364 university women. A significant association was found in occurrence between the two stressors, and a substantially higher level of symptoms was revealed in women who had experienced both during childhood.

Childhood family environment and sexual abuse as predictors of anxiety and depression in adult women.

A study of 46 women with histories of childhood sexual abuse and a control group of 93 women without such histories showed an association between childhood sexual abuse and the women's symptoms of anxiety and depression, as well as their perceptions of their families of origin. Results also suggested that family conflict, control, and cohesiveness moderated the relationship between the childhood abuse and current symptoms of depression.

Locus of control as a mediator of negative divorce-related events and adjustment problems in children.

Beliefs about whether locus of control mediates the relationship between negative divorce-related events and children's adjustment were explored in a group of 78 children and their primary residential parents. In the children's self-reports of adjustment, locus of control was found to be a partial mediator in the relationship. Analyses of the parents' reports of the children's adjustment did not support a mediational model.

Joint consequences of parental alcoholism and childhood sexual abuse, and their partial mediation by family environment.

This study investigated the effects of childhood sexual abuse and parental alcoholism in a sample of university women. Current symptoms of anxiety and depression were measured together with retrospective reports of subjects' families of origin. Using a 2 x 2 factorial design, main effects on symptoms were obtained for sexual abuse and parental alcoholism, but their interaction was not significant. With respect to family environment, a history of sexual abuse was associated with perceptions that families of origin had less cohesion, more conflict, less emphasis on moral-religious matters, less emphasis on achievement, and less of an orientation towards intellectual, cultural, and recreational pursuits. Similarly, subjects who had alcoholic parents reported less family cohesion, more conflict, and less emphasis on moral-religious matters. Results of analyses of covariance suggested that family environment was a mediator of current symptoms of anxiety, but not symptoms of depression.

Frequency of visitation by divorced fathers: differences in reports by fathers and mothers.

Most previous research documenting the frequent abandonment by fathers of contact with their children has been based on survey responses of custodial mothers. The present survey of 220 divorcing couples revealed that the noncustodial parents reported significantly more visits with their children, as well as significantly more denial of visitation by their ex-spouses, than did the custodial parents.

Events of parental divorce: stressfulness ratings by children, parents, and clinicians.

The stressfulness, for the "typical" child, of 62 events that occur to children of divorce was rated by children of divorce (n = 58), their custodial parents (n = 58), and clinicians (n = 50). In addition, a larger group of children (n = 123) rated the goodness or badness of the events that had happened to them. The rank orderings of the mean stress ratings for the typical child made by children, parents, and clinicians were highly correlated. However, when the absolute stress value of the events was compared across raters, children rated 10 events as significantly less stressful than did parents (p less than .05); parents' and clinicians' ratings differed for 9 events, parents rating 7 as less stressful (p less than .05). Children rated 19 events as less stressful than did clinicians (p less than .05). The rank ordering of the children's mean ratings of events actually experienced correlated highly with the rank orderings of the children's mean ratings of the negative events for the typical child.