Weight outcomes for adolescents with atypical anorexia nervosa in family-based treatment.

Background: Although over one-third of adolescents presenting with restrictive eating disorders have a history of being overweight, there is no evidence-based treatment for atypical anorexia nervosa (AAN). Family-Based Treatment (FBT) is a feasible treatment and is routinely applied to treat atypical anorexia nervosa in adolescents; however, identifying a treatment target weight within FBT for these patients is a challenge. Objective: This study aimed to 1) increase understanding regarding recommendations for weight gain versus weight stabilization in FBT for adolescents with AAN and 2) examine treatment outcomes in FBT for adolescents with AAN. Method: Using a retrospective design, we reviewed the files of 41 patients with AAN who were referred for FBT at a pediatric eating disorder program located within a tertiary care health centre. Results: We found variability in recommendations for weight gain, with 56% of the sample recommended to gain weight and 44% recommended to stabilize weight. Baseline BMI for age appeared to be a key factor in establishing recommendations for weight gain. AAN patients in our sample gained a significant amount of weight across treatment, with those recommended to gain weight showing more weight gain during treatment. Forty-nine percent of the sample completed FBT; those patients displayed a mean of 10kg of weight gain during treatment. Conclusions: Findings suggest that many patients gained weight during the course of FBT for AAN. Further study on weight changes during FBT for adolescents with AAN and increased diagnostic consistency for AAN will be important for this field.

Contexte: Bien qu'un tiers des adolescents présentant des troubles alimentaires restrictifs aient des antécédents d'être en surpoids, il n'y a pas de traitement fondé sur des données probantes pour l'anorexie mentale atypique (AMA). Le traitement basé sur la famille (TBF) est un traitement faisable et est régulièrement appliqué pour traiter l'AMA chez les adolescents; toutefois, identifier un poids cible de traitement dans un TBF pour ces patients est un problème. Objectif: La présente étude visait à 1) accroître la compréhension des recommandations pour le gain de poids contre la stabilisation du poids dans un TBF pour adolescents souffrant d'AMA et 2) examiner les résultats du traitement dans un TBF pour des adolescents souffrant d'AMA. Méthode: À l'aide d'une méthode rétrospective, nous avons révisé les dossiers de 41 patients souffrant d'AMA qui ont été renvoyés pour un TBF à un programme de troubles alimentaires pédiatrique situé près d'un centre de soins tertiaires. Résultats: Nous avons constaté une variabilité dans les recommandations de gain de poids, on a recommandé à 56 % de l'échantillon de gagner du poids et à 44 % de stabiliser leur poids. L'IMC à la base pour l'âge semblait être un facteur clé pour établir les recommandations de la prise de poids. Les patients d'AMA de notre échantillon prenaient une quantité significative de poids durant le traitement, et ceux à qui il était recommandé de prendre du poids montraient une plus grande prise de poids durant le traitement. Quarante-neuf pour cent de l'échantillon a terminé le TBF; ces patients ont affiché une moyenne de 10 kg de gain de poids durant le traitement. Conclusions: Les résultats suggèrent que de nombreux patients ont pris du poids au cours du TBF pour l'AMA. D'autres études sur les changements de poids durant le TBF pour adolescents souffrant d'AMA et une cohérence diagnostique accrue pour l'AMA seront importants dans ce domaine.

Middle and High School Student Perspectives on Digitally-Delivered Mental Health Assessments and Measurement Feedback Systems.

Implementation of measurement-based care (MBC) by child-serving community mental health providers, particularly school-based providers, is low. To inform user-centered design of measurement feedback systems (MFSs) and MBC implementation more broadly, semi-structured interviews were conducted with 61 middle and high school students. Interviews explored student preferences for and perceived helpfulness of different assessment methods and use of MFS in counseling. Results indicate that student preference for digitally-administered assessment is equivocal, with preferences being influenced by student perceptions of the ease of use, impersonalization, and confidentiality. Students with exposure to the MFS found it helpful when used by their provider to share assessment feedback.

Mediators and Moderators of a School-Based Cognitive-Behavioral Depression Prevention Program.

This study tested potential moderators and mediators of an indicated depression prevention program for middle school students, Positive Thoughts and Actions (PTA). Participants were 120 students randomly assigned to PTA, or a brief, individually administered supportive intervention (Individual Support Program, or ISP). Youths completed measures of depressive symptoms at baseline, post-intervention, and 12-month follow-up. Hierarchical regression was used to test three moderators-ethnic minority status, gender, and baseline depressive symptoms-and three mediators representing functional outcomes targeted by PTA-parent-child communication, attitude towards school, and health behavior. Ethnic minority status did not moderate PTA effects at post-intervention but did moderate PTA effects at 12-month follow-up. At 12 months, PTA appeared to be more effective for White participants than ethnic minority youth. Follow-up analyses suggested this moderation effect was due to the tendency of ethnic minority youth, especially those with fewer symptoms at baseline, to drop out by 12 months. Neither gender nor baseline depressive symptoms moderated the effects of PTA. Although PTA improved health behavior and attitudes toward school, there was no evidence that any of these functional outcomes measured mediated the impact of PTA on depressive symptoms. Future directions are discussed.

Exposure to Violence in the Community Predicts Friendships with Academically Disengaged Peers During Middle Adolescence.

Adolescents who have been exposed to violence in the community often experience subsequent difficulties with academic achievement. Because competence in the classroom is a salient developmental task during the adolescent years, outcomes in this critical context can then have broader implications for social and psychological functioning. In the current study, we tested a hypothesized progression in which the association between violence exposure and deficient achievement is presumed to potentiate friendships with academically disengaged peers. We followed 415 urban adolescents (53 % girls; average age of 14.6 years) for a one-year period, with two annual assessment of psychosocial functioning. Exposure to violence in the community and academic engagement were assessed with a self-report inventory; reciprocated friendships were assessed with a peer interview; and achievement was indexed based on a review of school records. Consistent with our hypotheses, neighborhood violence was associated with deficient classroom achievement. Poor achievement, in turn, mediated associations between community violence exposure and low academic engagement among friends. Our findings highlight pathways though which exposure to community violence potentially predicts later dysfunction.

Do academically-engaged adolescents experience social sanctions from the peer group?

Existing theoretical perspectives suggest that adolescents who are characterized by high achievement may experience social sanctions from peers. The central premise is that, in many North American settings, adolescent peer groups are characterized by negative attitudes toward the school environment. To test these hypotheses, we examined associations between indicators of low social power (unpopularity and victimization by peers) and academic competence for 415 adolescents (193 boys; 222 girls) attending an urban high school. This school served neighborhoods that were characterized by a moderate degree of economic distress and the students were predominately of Hispanic American descent. A short-term longitudinal design was used, with two waves of data collected over consecutive school years. The adolescents completed a peer nomination inventory assessing relational and overt victimization by peers, unpopularity, and social rejection. In addition, we obtained math and language arts grades from school records, and we assessed behavioral engagement in school with a self-report inventory. Structural equation models did not reveal a strong pattern of longitudinal change in social standing with peers or academic functioning. However, we found positive correlations between academic achievement and problematic peer relationships in both years of the project. We also found evidence that gender moderates these associations, with the effects reaching significance only for boys. Our results provide evidence that, in some settings, high achieving adolescents can be prone to negative treatment or marginalization by peers.

Longitudinal associations of electronic aggression and victimization with social standing during adolescence.

Prior empirical work has documented that the dynamics of social standing can play a critical role in the perpetration and receipt of aggression during adolescence. Recently, investigators have emphasized the emergence of new, electronic modalities for aggressive acts. Our longitudinal project therefore considered electronic forms of aggression and victimization as correlates of social standing. We recruited 415 ninth grade students (53% female) from a high school in Southern California. In the spring of two consecutive school years, participants completed peer nominations assessing their social standing, aggression, and victimization. More popular youths were concurrently more electronically aggressive and victimized than their peers. Popularity also was associated with increases in electronic aggression over time. In turn, electronic aggression was related to increases in popularity for girls and decreases for boys. We additionally found concurrent, positive associations between social acceptance and electronic forms of aggression and victimization, although these effects held only at the first time point. Among adolescent males, social acceptance also was related to increases in electronic victimization over time. Overall, our results suggest that adolescents may rely on electronic aggression to establish and maintain a privileged position in their peer hierarchy. Our results additionally highlight that popular and accepted youths, who likely possess a large, digitally-connected social network, may be at increased risk for electronic victimization.

Associations between maternal physical discipline and peer victimization among Hong Kong Chinese children: the moderating role of child aggression.

This study examines the relation between maternal physical discipline and victimization by peers, as moderated by child aggression. The sample consisted of 211 Hong Kong Chinese children (98 boys, 113 girls; average age of 11.9). Physical discipline was assessed with a questionnaire completed by mothers, and victimization by peers and aggression were measured using a peer nomination inventory. Latent variable models revealed a moderately strong link between children's experiences with maternal physical discipline and peer victimization, but this effect held only for children who were also high on aggression. These results highlight the interplay between harsh home environments and child aggression and their contributions to the child's adjustment in the peer group.

Violent victimization in the community and children's subsequent peer rejection: the mediating role of emotion dysregulation.

This paper describes a short-term longitudinal study of the relation between violent victimization in the community and peer rejection among 199 children (mean age = 9.02 years) attending two urban Los Angeles area elementary schools. We used a multi-informant approach to assess victimization by community violence, peer group victimization, peer rejection, and impairments in emotion regulation. These data were collected annually for two consecutive school years. Violent victimization in the community predicted later peer rejection after accounting for the effects of initial levels of peer rejection. Analyses indicated that this relation was mediated by deficient emotion regulation skills. In addition, we found evidence that victimization by community violence and peer rejection are reciprocally related over time. The developmental implications of these findings are discussed.