Relational attitudes in adolescent girls with and without a diagnosis of anorexia nervosa or atypical anorexia nervosa.

BACKGROUND: People with eating disorders experience interpersonal difficulties, but little research explores relational attitudes in this population. We examined sense of relational entitlement towards parents, pathological concern, and psychological distress in adolescent girls with and without anorexia nervosa (AN) or atypical anorexia nervosa (AAN). METHODS: Questionnaires assessing sense of entitlement towards parents, pathological concern, and symptoms of depression and anxiety were completed by 85 girls with and 100 girls without AN/AAN (mean age 15.06 ± 1.41). The AN/AAN group also completed a measure of ED pathology. RESULTS: Eating pathology, pathological concern and symptoms of depression and anxiety were positively associated with both restricted and inflated sense of entitlement towards parents. AN/AAN participants scored significantly higher than controls on restricted and inflated sense of entitlement, pathological concern and symptoms of depression and anxiety. Restricted sense of entitlement and pathological concern partially mediation the association between AN/AAN and symptoms of depression and fully mediated the association between AN/AAN and anxiety. Within the AN/AAN group, pathological concern and symptoms of depression explained a large proportion of the variance in ED pathology. CONCLUSIONS: Adolescent AN/AAN takes a heavy toll on emotional and social health, perhaps in part because crucial aspects of relational mutuality fail to develop. Teens with AN/AAN tend to over-focus on their parents' needs at the expense of their own needs. They also have impaired capacity to realistically appraise expectations from their parents, tending to feel over- and/or under-entitled to need fulfillment. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.

In healthy relationships people trust another person to fulfill some but not all their needs. It is maladaptive to expect the fulfillment of all needs (inflated entitlement) or of no needs (restricted entitlement). Restricted entitlement generally masks frustration and an unconscious wish for need fulfillment, so that restricted and inflated entitlement can co-occur. We examined to what degree 85 adolescent girls with a restricting ED and 100 without an ED felt entitled to need fulfillment by their parents, and to what extent they sacrificed their own needs for their parents'. Girls with an ED reported higher levels of both restricted and inflated entitlement from their parents than the other girls, and reported placing their parents' needs before their own more often. The more restricted and/or inflated their entitlement was, the more they tended to place their parents' needs before their own, to have severe ED symptoms and to feel depressed and anxious. Teens with EDs may over-focus on their parents' needs at the expense of their own and feel they deserve to have all or none of their needs fulfilled by their parents. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.

The impact of coping patterns and chronic health conditions on health-related quality of life among children and adolescents.

This study examined the relationship among chronic disease, coping strategy patterns, and health-related quality of life (HRQOL) among children and adolescents. The cohort included 273 Israeli children and adolescents aged 8-18 years diagnosed with asthma, diabetes mellitus, or celiac disease. All completed the Coping with a Disease Questionnaire (CODI) and the DISABKIDS Chronic Generic Measure (DCGM-37). The outcome measures were as follows: association of the use of effective and non-effective coping strategies with type of disease; predictive value of coping patterns for health-related quality of life; a European sample was used for comparison. On k means cluster analysis, three strategy patterns (two "effective" and one "non-effective") were associated with health-related quality of life and disease specifics. Disease predicted coping patterns, but it had a weak direct relationship to health-related quality of life. Coping patterns were the strongest predictor of health-related quality of life. These results are similar to the European DISABKIDS study, indicating cross-cultural parallels. CONCLUSIONS: The findings highlight the power of the concept of coping patterns as opposed to coping strategies to explain HRQOL of children and adolescents with chronic disease. Both types of disease (categorical approach) and coping patterns (non-categorical approach) are relevant to predicting HRQOL. What is Known: • The literature on coping has widely documented the existence of individual (unique) coping strategies. • Coping strategies are considered "useful" or "non-useful," based on whether they increase or decrease negative outcomes caused by certain stressors, such as chronic illness. What is New: • Our findings suggest that youngsters can use "non-useful" strategies to reduce stress caused by chronic illness, while still maintaining higher quality of life, as long as they also apply certain "useful" strategies. • The use of certain combinations of coping strategies, rather than single strategies, is more important to our understanding of how coping affects HRQOL of children with chronic disease.

Where Are They Now?

BACKGROUND: While a history of suicide attempts has been identified as the most powerful risk factor among adults, it is not clear if this is also true for the adolescent population. Our aim was to examine the differences between attempters and nonattempters in the years following a documented suicide attempt and to investigate the adolescents' prognosis in terms of suicidal behavior and adjustment. METHOD: Military records at induction and during active military service were used to compare 105 adolescent suicide attempters with 105 matched controls. All were rated on cognitive/educational performance and psychosocial adaptation, psychological health diagnoses, and performance during their military service. RESULTS: Suicide attempters had higher school dropout rates and lower scores on educational indicators. They registered more incidents of disciplinary and adjustment problems in the military. However, the overall prognosis of the suicide attempters appeared surprisingly good. No significant differences were found between the groups in suicide risk or in behavior in their military service. LIMITATIONS: Data were derived from the computerized records and no direct interviews were conducted with the participants. CONCLUSION: Attempted suicide in adolescence appears to be different in nature from attempted suicide in adulthood, and can be viewed as an indicator of social distress rather than as major risk factor of completed suicide. Implications in terms of intervention and prevention are discussed.

Non-Motor Aspects of Tic Disorders-New Developments.

The cardinal characteristics of tic-related disorders are stereotyped motor movements and vocalizations. However, they may be accompanied by non-motor features that appear sequentially during the course of the disorder and can sometimes be more disabling than the tics themselves. This review presents our perspectives on several non-motor aspects of Tourette syndrome based on the long experience of the Neuropsychiatric Tourette Clinic of a tertiary pediatric medical center. The effect of premonitory urges, sensory modulation disorder, tic-related cognitions, and environmental conditions on the expression and intensity of tics is elaborated, with suggestions for treatment approaches to each. We also describe the mediatory effect of parental attachment style on the link between maternal stress and ticcing intensity and the need to adjust psychotherapy interventions to account for the importance of this factor in emotion regulation. This review is intended to direct attention to the non-motor aspects of Tourette syndrome. An in-depth understanding of this complex and debilitating disorder will facilitate the formulation of innovative therapeutic protocols.

Screening for psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain.

BACKGROUND: Recurrent pain symptoms in children are associated with psychiatric comorbidities that could complicate treatment. We investigated the prevalence of psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain and evaluated the screening potential of the Strength and Difficulties Questionnaire compared with the Development and Well-Being Assessment (DAWBA). METHODS: Eighty-three outpatients aged 5-17 years attending a tertiary medical center for a primary diagnosis of migraine (n = 32), tension-type headache (n = 32), or recurrent abdominal pain (n = 19), and 33 healthy matched controls completed the brief self-reporting Strength and Difficulties Questionnaire followed by the Development and Well-Being Assessment. Findings were compared among groups and between instruments. RESULTS: The pain groups were characterized by a significantly higher number of Development and Well-Being Assessment diagnoses (range 0-11) than controls and a significantly greater prevalence (by category) of Development and Well-Being Assessment diagnoses (P < 0.001 for both). Anxiety and depression were the most prevalent Development and Well-Being Assessment diagnoses. Comorbidities were more severe in the headache groups than the controls (P < 0.001). In general, any diagnosis by the Development and Well-Being Assessment was associated with a significantly higher Strength and Difficulties Questionnaire score (P < 0.001). Abnormal scores on the emotional, conduct, and hyperactivity Strength and Difficulties Questionnaire scales were significantly predictive of a Development and Well-Being Assessment diagnosis (P < 0.003). CONCLUSION: Children referred to specialized outpatient pediatric units for evaluation of recurrent pain are at high risk of psychopathology. The Strength and Difficulties Questionnaire may serve as a rapid cost-effective tool for initial screening of these patients.

Development of adaptable and flexible treatment manuals for externalizing and internalizing disorders in children and adolescents.

In this paper we describe the process used to develop treatment manuals for internalizing and externalizing disorders in children and adolescents. These manuals were developed to offer health care providers and others working in child mental health a flexible intervention that could be adapted to different countries and localities based on: 1) the amount of health care and school resources that are available; 2) the nature and severity of the types of problems children have; and 3) the preferences and cultural factors that are important within these communities. We also discuss the experiences and cultural issues faced by sites in Egypt, Lebanon, Israel, and Brazil who volunteered to implement the manualized treatment programs. The feedback received from these sites indicates that the manuals can be implemented to help children with internalizing and externalizing problems.

Training of evidence-based assessment and intervention approaches in cross-cultural contexts: challenges and solutions.

Dissemination of evidence-based assessment and intervention approaches for child and adolescent with behavioral and/or emotional problems is now a priority in the field worldwide. However, developing staff competence in evidence-based assessment and intervention approaches in different countries is complicated by some environmental and economic constraints. In this paper a distance training/supervision model is discussed. We describe seven specific challenges encountered and solutions used for overcoming the obstacles in order to implement evidence-based assessment and intervention approaches in different sites in Brazil, Egypt, Israel, and Lebanon.

Development of adaptable and flexible treatment manuals for externalizing and internalizing disorders in children and adolescents / Desenvolvimento de manuais adaptáveis e flexíveis para transtornos de externalização e internalização em crianças e adolescentes

In this paper we describe the process used to develop treatment manuals for internalizing and externalizing disorders in children and adolescents. These manuals were developed to offer health care providers and others working in child mental health a flexible intervention that could be adapted to different countries and localities based on: 1) the amount of health care and school resources that are available; 2) the nature and severity of the types of problems children have; and 3) the preferences and cultural factors that are important within these communities. We also discuss the experiences and cultural issues faced by sites in Egypt, Lebanon, Israel, and Brazil who volunteered to implement the manualized treatment programs. The feedback received from these sites indicates that the manuals can be implemented to help children with internalizing and externalizing problems.

Neste artigo, descrevemos o processo utilizado para elaborar manuais de tratamento para transtornos de externalização e intrnalização em crianças e adolescentes. Esses manuais foram elaborados para oferecer uma intervenção flexível para provedores de atenção à saúde e demais profissionais que trabalham com a saúde mental da criança, podendo ser adaptados a diferentes países e localidades, com base: 1) no nível de atenção médica e de recursos educacionais disponíveis; 2) na natureza e na gravidade dos tipos de problemas que as crianças apresentam; e 3) nas preferências e fatores culturais que são importantes nessas comunidades. Discutimos, também, as experiências e os problemas culturais enfrentados pelas localidades no Egito, Líbano, Israel e Brasil que foram voluntárias em implementar os programas de tratamento especificados nos manuais. O retorno recebido dessas localidades indica que os manuais podem ser implementados para auxiliar as crianças com problemas de externalização e internalização.

Training of evidence-based assessment and intervention approaches in cross-cultural contexts: challenges and solutions / Treinamento de estratégias de intervenção e avaliação baseadas em evidências em contextos transculturais: desafios e soluções

Dissemination of evidence-based assessment and intervention approaches for child and adolescent with behavioral and/or emotional problems is now a priority in the field worldwide. However, developing staff competence in evidence-based assessment and intervention approaches in different countries is complicated by some environmental and economic constraints. In this paper a distance training/supervision model is discussed. We describe seven specific challenges encountered and solutions used for overcoming the obstacles in order to implement evidence-based assessment and intervention approaches in different sites in Brazil, Egypt, Israel, and Lebanon.

A disseminação de estratégias de intervenção e avaliação baseadas em evidências para crianças e adolescentes com problemas comportamentais e/ou emocionais é hoje uma prioridade mundial. No entanto, o desenvolvimento de equipes capacitadas para implementação de estratégias de intervenção e avaliação baseadas em evidências nos diferentes países é limitado por restrições ambientais e econômicas. Neste artigo, discute-se um modelo de treinamento/supervisão à distância. Em seguida, são descritos sete desafios específicos encontrados e as soluções utilizadas para superar os obstáculos para implementação de estratégias de intervenção e avaliação baseadas em evidências em diferentes localidades no Brasil, Egito, Israel e Líbano.