Caregivers as gatekeepers: Professional mental health service use among urban minority adolescents.

Mental illness among adolescents frequently goes untreated, especially among low income and ethnic minority families. We sought to examine parent and adolescent psychological factors influencing mental health service use among 120 urban adolescents (82% African American, Age 13-18 years, M = 14.29, SD = 1.52) who had access to mental health treatment through their community primary care setting. We utilized structural equation modeling (SEM) to explore the independent and combined associations among parent and adolescent variables hypothesized to be associated with the youth's engagement in mental health treatment. Results showed that more than half (63.6%) of youth with clinically significant levels of symptoms were not currently engaged in treatment or seeking mental health services. One latent variable emerged: caregivers' perceptions of adolescent mental health problems (consisted of youth psychological symptoms, youth functional impairment, and strain on caregiver). Together with caregivers' attitude toward professional help, these two caregiver-reported variables, but not adolescents' attitude, were associated with higher likelihood of service utilization among adolescents. Findings suggest caregivers functioned as the "gatekeepers" to mental health services. We discuss findings' implications for engaging youth in mental health services as well as study limitations and future directions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Caregivers' abuse stigmatization and their views of mental health treatment following child sexual abuse.

Many families do not utilize mental health services after the discovery of child sexual abuse (CSA), even when trauma-focused treatments are offered at low or no cost. Non-offending caregivers frequently serve as gatekeepers to youths' treatment, and their reactions to CSA may figure into decisions about treatment engagement. The current study examined caregivers' abuse stigmatization (i.e., self-blame and shame about their children's CSA) and associations with two factors predictive of treatment engagement (motivation, obstacles). Participants were recruited from a Child Advocacy Center where they received forensic interviews and were offered services following CSA discovery. Participating caregiver-child dyads included 52 non-offending caregivers (83% biological parents) and their children (69% girls; Mage=10.94, SDage=2.62). Caregiver abuse stigmatization was associated with higher motivation for treatment but also more obstacles to treatment. Further, abuse stigmatization moderated associations between children's PTSD symptoms and perceived obstacles to treatment with medium effect sizes (M f2=0.287). Among caregivers experiencing high abuse stigmatization, greater child PTSD symptoms were associated with more obstacles to treatment. Among caregivers experiencing low stigmatization, child PTSD was either associated with fewer treatment obstacles or was unrelated to treatment obstacles. Results highlight the potential significance of reducing parents' abuse stigmatization for increasing mental health service utilization following CSA discovery, especially for more symptomatic youth.

An Analysis of Self: The Development and Assessment of a Measure of Selfobject Needs.

Based on the psychoanalysis of adults with borderline and narcissistic personality disorder symptoms, Kohut ( 1971 , 1977, 1980, 1984) formulated a theory of self psychology that emphasized the importance of early developmental experiences; most centrally, the empathic attunement of caregivers as key ingredients for fostering the capacity for healthy self-regulation and interpersonal relations. Kohut elaborated 3 critical selfobject needs (i.e., idealizing, mirroring, and twinship) that were ideally satiated by these early experiences, deeming the fulfillment of these needs as essential for developing a healthy sense of self. The research presented here sought to develop a self-report measure, titled the Arble Estimate of Selfobject Pursuits (AESOP), capable of assessing the selfobject needs identified by Kohut. Across 2 studies involving 686 and 672 respondents, participants completed the AESOP. In the first study, an exploratory factor analysis supported the theorized 3-factor structure. In the second study, a confirmatory factor analysis indicated adequate-to-strong model fit and cluster analysis with theoretically related measures supported the AESOP's discriminant and convergent validity. Further research is encouraged to elaborate the implications of these preliminary findings.

Attention Problems and Stability of WISC-IV Scores Among Clinically Referred Children.

We examined the stability of Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) scores among 51 diverse, clinically referred 8- to 16-year-olds (M(age) = 11.24 years, SD = 2.36). Children were referred to and tested at an urban, university-based training clinic; 70% of eligible children completed follow-up testing 12 months to 40 months later (M = 22.05, SD = 5.94). Stability for index scores ranged from .58 (Processing Speed) to .81 (Verbal Comprehension), with a stability of .86 for Full-Scale IQ. Subtest score stability ranged from .35 (Letter-Number Sequencing) to .81 (Vocabulary). Indexes believed to be more susceptible to concentration (Processing Speed and Working Memory) had lower stability. We also examined attention problems as a potential moderating factor of WISC-IV index and subtest score stability. Children with attention problems had significantly lower stability for Digit Span and Matrix Reasoning subtests compared with children without attention problems. These results provide support for the temporal stability of the WISC-IV and also provide some support for the idea that attention problems contribute to children producing less stable IQ estimates when completing the WISC-IV. We hope our report encourages further examination of this hypothesis and its implications.

Convergent validity of the Integrated Visual and Auditory Continuous Performance Test (IVA+Plus): associations with working memory, processing speed, and behavioral ratings.

Though the Integrated Visual and Auditory Continuous Performance Test (IVA + Plus) is commonly used by researchers and clinicians, few investigations have assessed its convergent and discriminant validity, especially with regard to its use with children. The present study details correlates of the IVA + Plus using measures of cognitive ability and ratings of child behavior (parent and teacher), drawing upon a sample of 90 psychoeducational evaluations. Scores from the IVA + Plus correlated significantly with the Working Memory and Processing Speed Indexes from the Fourth Edition of the Wechsler Intelligence Scales for Children (WISC-IV), though fewer and weaker significant correlations were seen with behavior ratings scales, and significant associations also occurred with WISC-IV Verbal Comprehension and Perceptual Reasoning. The overall pattern of relations is supportive of the validity of the IVA + Plus; however, general cognitive ability was associated with better performance on most of the primary scores of the IVA + Plus, suggesting that interpretation should take intelligence into account.

Do children orphaned by AIDS experience distress over time? A latent growth curve analysis of depressive symptoms.

This longitudinal study aimed to examine the enduring effects of parental HIV/AIDS on children's psychological well-being in Asia. A sample of 1625 children aged from 6 to 18 years old were assessed annually for their depressive symptoms over three years. Latent growth curve modeling (LGCM) was used to examine the trajectories of depressive symptoms among AIDS orphans and vulnerable children in comparison with children from HIV-free families. AIDS orphans demonstrated the highest initial level of depressive symptoms among the three groups. On average, children's depressive symptoms' scores can be expected to realize an approximate 25% decrease for AIDS orphans, 19% decrease for vulnerable children, and 15% decrease for comparison children over a three-year period. Individual differences within the groups showed that children with higher initial level of depressive symptoms can be expected to decrease slower over time. Multiple group LGCM showed that the three groups of children demonstrated significantly different trajectories of depressive symptoms. Among the key demographic factors, only age exerted an effect on the trajectory of depressive symptoms of vulnerable children, indicating that the younger children showed higher level of initial depressive symptoms and lower rate of decrease than the older children. The current study enriched our knowledge on the longitudinal effect of parental HIV/AIDS on children's emotional distress. Future psychological support might take the children's developmental stages and cultural appropriateness into consideration and deliver service for the most vulnerable group of children affected by HIV/AIDS.

Risk, resilience, and the rorschach: a longitudinal study of children who experienced sexual abuse.

Experiencing sexual abuse increases the risk that children will report or otherwise demonstrate problems with emotion, behavior, and health. This longitudinal study of 44 children who experienced sexual abuse examined whether information processing as assessed via the Rorschach Inkblot Test was associated with child-reported depression symptoms assessed via the Children's Depression Inventory (Kovacs, 1992) concurrently and an average of 15 months later. Children whose Rorschach protocols were relatively free of scores suggesting intense distress, complex processing, and sexual content were more likely to experience remission of depression symptoms at follow-up. Findings provide incremental validity for certain Rorschach indexes to inform prognosis regarding depression symptoms and perhaps their treatment.

Parenting and attachment among low-income African American and Caucasian preschoolers.

Despite a plethora of research on parenting and infant attachment, much less is known about the contributions of parenting to preschool attachment, particularly within different racial groups. This study seeks to build on the extant literature by evaluating whether similar associations between parenting and attachment can be observed in African American and Caucasian families, and whether race moderates them. Seventy-four primary caregivers and their preschool children (51% African American, 49% Caucasian, 46% male) from similar urban, low-income backgrounds participated in two visits 4 weeks apart when children were between 4 and 5 years of age. Attachment was scored from videotapes of the Strange Situation paradigm using the preschool classification system developed by Cassidy, Marvin, and the MacArthur Working Group. Parenting was assessed using a multimethod, multicontext approach: in the child's home, in the laboratory, and via parent-report. Seventy-three percent of the children were classified as securely attached. Warm, responsive parenting behavior (but not race) predicted attachment. Although parents of African American and Caucasian children demonstrated some significant differences in parenting behaviors, race did not moderate the relationship between parenting and child attachment. These findings highlight the direct role that parenting plays over and above race in determining attachment security during the preschool period.

Nonsuicidal self-injury in an ethnically diverse college sample.

Self-report data pertaining to Nonsuicidal Self-Injury (NSSI; e.g., cutting) were collected from 5,691 undergraduates at a Midwestern urban university. Consistent with the small literature on NSSI among college students, 12.8% of the sample indicated having engaged in NSSI at least once (3.4% in the past year). Women and younger students were at slightly higher risk. Important ethnic differences were found, as Caucasians and individuals self-identifying as Multiracial were at especially high risk for a history of NSSI, whereas Arab Americans and African Americans had particularly low rates. Further, links between NSSI and religion were found, such that participants with stronger self-reported religious convictions had the lowest rates of NSSI. Those who self-described as Atheist, Agnostic, or Nonbeliever were several times more likely to have engaged in NSSI (31.3%), while Muslims (7.4%) and Baptists (6.3%) had relatively low rates. Multivariate analyses revealed that ethnic differences in NSSI could not be accounted for by religious differences. Processes that may explain the associations between NSSI and ethnic affiliation and religion are discussed.

Risk and protective factors for depression symptoms among children affected by HIV/AIDS in rural China: a structural equation modeling analysis.

Previous research has revealed a negative impact of orphanhood and HIV-related stigma on the psychological well-being of children affected by HIV/AIDS. Little is known about psychological protective factors that can mitigate the effect of orphanhood and HIV-related stigma on psychological well-being. This research examines the relationships among several risk and protective factors for depression symptoms using structural equation modeling. Cross-sectional data were collected from 755 AIDS orphans and 466 children of HIV-positive parents aged 6-18 years in 2006-2007 in rural central China. Participants reported their experiences of traumatic events, perceived HIV-related stigma, perceived social support, future orientation, trusting relationships with current caregivers, and depression symptoms. We found that the experience of traumatic events and HIV-related stigma had a direct contributory effect on depression among children affected by HIV/AIDS. Trusting relationships together with future orientation and perceived social support mediated the effects of traumatic events and HIV-related stigma on depression. The final model demonstrated a dynamic interplay among future orientation, perceived social support and trusting relationships. Trusting relationships was the most proximate protective factor for depression. Perceived social support and future orientation were positively related to trusting relationships. We conclude that perceived social support, trusting relationships, and future orientation offer multiple levels of protection that can mitigate the effect of traumatic events and HIV-related stigma on depression. Trusting relationships with caregivers provides the most immediate source of psychological support. Future prevention interventions seeking to improve psychological well-being among children affected by HIV/AIDS should attend to these factors.

Parental loss, trusting relationship with current caregivers, and psychosocial adjustment among children affected by AIDS in China.

The objective of this study was to examine the relationship between parental loss, trusting relationship with current caregivers, and psychosocial adjustment among children affected by AIDS in China. In this study, cross-sectional data were collected from 755 AIDS orphans (296 double orphans and 459 single orphans), 466 vulnerable children living with HIV-infected parents, and 404 comparison children in China. The trusting relationship with current caregivers was measured with a 15-item scale (Cronbach's α = 0.84) modified from the Trusting Relationship Questionnaire developed by Mustillo et al. in 2005 (Quality of relationships between youth and community service providers: Reliability and validity of the trusting relationship questionnaire. Journal of Child and Family Studies, 14, 577-590). The psychosocial measures include rule compliance/acting out, anxiety/withdrawal, peer social skills, school interest, depressive symptoms, loneliness, self-esteem, future expectation, hopefulness about future, and perceived control over the future. Group mean comparisons using analysis of variance suggested a significant association (p < 0.0001) between the trusting relationship with current caregivers and all the psychosocial measures, except anxiety and depression. These associations remained significant in General Linear Model analysis, controlling for children's gender, age, family socioeconomic status, orphan status (orphans, vulnerable children, and comparison children), and appropriate interaction terms among factor variables. The findings in the current study support the global literature on the importance of attachment relationship with caregivers in promoting children's psychosocial development. Future prevention intervention efforts to improve AIDS orphans' psychosocial well-being will need to take into consideration the quality of the child's attachment relationships with current caregivers and help their current caregivers to improve the quality of care for these children. Future study is needed to explore the possible reasons for the lack of association between a trusting relationship and some internalizing symptoms such as anxiety and depression among children affected by HIV/AIDS.

Positive future orientation as a mediator between traumatic events and mental health among children affected by HIV/AIDS in rural China.

OBJECTIVE: The current study was designed to explore the effect of future orientation in mediating the relationship between traumatic events and mental health in children affected by HIV/AIDS in rural China. METHODS: Cross-sectional data were collected from 1221 children affected by HIV/AIDS (755 AIDS orphans and 466 vulnerable children). Future orientation among children was measured using three indicators (future expectation, hopefulness toward the future, and perceived control over the future). Measures of mental health consisted of depression, loneliness, and self-esteem. Children's experience of any traumatic events was measured using a modified version of the Life Incidence of Traumatic Events-Student Form. Mediation analysis was conducted using structural equation modeling (SEM) methods. RESULTS: Among the children surveyed, most of the traumatic indicators were negatively associated with future expectation, hopefulness, perceived control, and self-esteem, and positively associated with depression and loneliness. The SEM of mediation analysis demonstrated an adequate fit. Future orientation fully mediated the relationship between traumatic events and mental health and accounted for 67.9% of the total effect of traumatic events on mental health. CONCLUSIONS: Results of this study support the positive effect of future expectation in mediating the relationship between traumatic events and mental health among children affected by HIV/AIDS in China. Future mental health promotion and intervention efforts targeting children affected by HIV/AIDS should include components that can mitigate the negative impact of traumatic events on their lives. These components may aim to develop children's positive future expectations, increase their hopefulness toward the future, and improve their perceived control over the future.

Lifetime incidences of traumatic events and mental health among children affected by HIV/AIDS in rural China.

Cross-sectional data were gathered from 1,625 children (M age = 12.85, SD = 2.21) which included 755 AIDS orphans, 466 vulnerable children, and 404 comparison children. Participants completed self-report measures of exposure to traumatic events, and psychosocial adjustment including behavior problems, depression, self-esteem, and future orientation. AIDS orphans and vulnerable children reported experiencing a higher total occurrence, density, duration, initial impact and lasting impact of traumatic events compared to comparison children. Scores reflecting adjustment were lower among orphans and vulnerable children than among comparison children. Both orphan status and traumatic events contributed unique variance in the expected direction to the prediction of psychosocial adjustment. The data in the current study suggested that children affected by HIV/AIDS in China are exposed to more trauma and suffer more adjustment problems than children who do not experience HIV/AIDS in their families.

Feasibility of a multigroup deterministic solution method for three-dimensional radiotherapy dose calculations.

PURPOSE: To investigate the potential of a novel deterministic solver, Attila, for external photon beam radiotherapy dose calculations. METHODS AND MATERIALS: Two hypothetical cases for prostate and head-and-neck cancer photon beam treatment plans were calculated using Attila and EGSnrc Monte Carlo simulations. Open beams were modeled as isotropic photon point sources collimated to specified field sizes. The sources had a realistic energy spectrum calculated by Monte Carlo for a Varian Clinac 2100 operated in a 6-MV photon mode. The Attila computational grids consisted of 106,000 elements, or 424,000 spatial degrees of freedom, for the prostate case, and 123,000 tetrahedral elements, or 492,000 spatial degrees of freedom, for the head-and-neck cases. RESULTS: For both cases, results demonstrate excellent agreement between Attila and EGSnrc in all areas, including the build-up regions, near heterogeneities, and at the beam penumbra. Dose agreement for 99% of the voxels was within the 3% (relative point-wise difference) or 3-mm distance-to-agreement criterion. Localized differences between the Attila and EGSnrc results were observed at bone and soft-tissue interfaces and are attributable to the effect of voxel material homogenization in calculating dose-to-medium in EGSnrc. For both cases, Attila calculation times were <20 central processing unit minutes on a single 2.2-GHz AMD Opteron processor. CONCLUSIONS: The methods in Attila have the potential to be the basis for an efficient dose engine for patient-specific treatment planning, providing accuracy similar to that obtained by Monte Carlo.

A developmental psychopathology framework of the psychosocial needs of children orphaned by HIV.

In addition to the obstacles to a successful resolution of grief normally faced by children whose parents have died, children orphaned by AIDS may face additional psychological and social challenges. However, limited attention has been paid to psychosocial and developmental needs of children orphaned by HIV/AIDS, particularly in resource-poor countries or regions. In this article the authors review the global literature on child bereavement and AIDS orphan care experiences in developing countries and present a developmental psychopathology model of the psychosocial issues facing AIDS orphans. The authors identify gaps in the literature and provide suggestions for future research on AIDS orphans in resource-poor countries and regions. They emphasize that future studies need to assess the status of behaviors and mental health of children orphaned by AIDS within a developmental framework, identify those individual and social factors associated with grief, and examine the long-term impact of quality of care, developmental maturation, and attachment with caregivers on the psychosocial well-being of AIDS orphans.

Maternal resolution of child diagnosis: stability and relations with child attachment across the toddler to preschooler transition.

In this longitudinal study, the authors investigated individual differences in how families adapt to a child's congenital disorder. Family impact, maternal grief resolution, and child attachment were assessed among 74 mothers and their toddlers with a neurological disorder or disfigurement. Fifty dyads were reevaluated 16 months later. For children with neurological compared with disfigurement diagnoses, there was a greater likelihood of negative impact on family, unresolved maternal grief, and insecure attachment at Time 1. Children classified as secure were significantly more likely to have mothers classified as resolved regarding their reactions to their children's diagnosis. Maternal grief resolution was significantly stable (77%) over time and mediated the relation between type of diagnosis and child security. With time, negative impact of child condition on the family decreased and percentage of children classified as secure increased, suggesting that on average families improved. Results suggest that helping parents come to terms emotionally and cognitively with their child's condition may be a useful focus for intervention.

Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems.

Although the term attachment disorder is ambiguous, attachment therapies are increasingly used with children who are maltreated, particularly those in foster care or adoptive homes. Some children described as having attachment disorders show extreme disturbances. The needs of these children and their caretakers are real. How to meet their needs is less clear. A number of attachment-based treatment and parenting approaches purport to help children described as attachment disordered. Attachment therapy is a young and diverse field, and the benefits and risks of many treatments remain scientifically undetermined. Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists. In this report, the Task Force reviews the controversy and makes recommendations for assessment, treatment, and practices. The report reflects American Professional Society on the Abuse of Children's (APSAC) position and also was endorsed by the American Psychological Association's Division 37 and the Division 37 Section on Child Maltreatment.