Cognitive behavioral treatments for children and adolescents exposed to traumatic events: A meta-analysis examining variables moderating treatment outcomes.

Due to the negative impact of trauma exposure, effective treatments are necessary to prevent and improve negative trauma-related outcomes. Cognitive behavioral therapy (CBT) is considered an efficacious treatment for children and adolescents exposed to traumatic events. Despite the various meta-analyses that have examined trauma treatments, there is a paucity of research on the moderating variables that may impact treatment outcomes. This meta-analytic CBT study addressed those limitations by examining the moderating effects of treatment components on outcomes. A search identified 94 CBT studies with 97 relevant effect sizes for children and adolescents exposed to traumatic events. Consistent with prior meta-analytic studies, CBT was shown to be effective for trauma-exposed youth. CBT subtreatments did not produce significantly different results from one another. Moderators shown to significantly impact CBT treatment outcomes for posttraumatic stress symptom were trauma type, Q = 24.09, p = .004, ds = -0.22 to -1.42, and gender, Q = 10.68, p = .005, ds = -0.53 to -1.36, whereas moderators shown to impact treatment outcomes for depression were study design, Q = 10.95, p = .004, ds = -0.26 to -0.50, and treatment setting, Q = 10.98, p = .004, ds = -0.31 to -0.56. The implications of these findings for research and practice are discussed.

Current state of evidence for medication treatment of preschool internalizing disorders.

Psychotropic medications are being prescribed off-label by psychiatrists to treat preschool children diagnosed with internalizing disorders. In this review, the current state of evidence is presented for medications used to treat preschool children (ages 2-5 year olds) diagnosed with anxiety and/or depressive disorders. Eleven studies were systematically identified for this review based on a priori criteria. Overall, the available literature revealed that studies addressing the medication treatment of internalizing disorders in preschoolers are extremely limited and represent relatively weak research methodologies. Given the increasing prevalence of the use of psychotropic medications to treat preschool children and the unique challenges associated with working with this population, it is imperative that mental health practitioners are aware of the current, albeit limited, research on this practice to help make informed treatment decisions. Suggestions about how to monitor potential costs and benefits in those unique cases in which psychopharmacological treatments might be considered for young children are given. Moreover, areas of additional research for this population are discussed.

"Our Generation Is Trying to Break Some of That Resistance to Emotions"-A Mixed-Methods Pilot Examination of Tuning in to Kids for Black Parents of Preschoolers in the United States.

BACKGROUND: A growing body of literature examines the utility of emotion-focused parenting programs, as behaviorally based programs currently dominate the parenting literature. Few of those studies examine differences in how Black parents may benefit. This mixed-methods pilot study examined preliminary fidelity, efficacy, and acceptability of Tuning in to Kids (TIK), an emotion-focused parenting program targeting parenting practices and children's emotion regulation through a strengths-based approach. METHODS: Pre, post, and one-month follow-up measurements were collected from 21 parents in the United States who were randomly assigned to a treatment (i.e., TIK) or waitlist control group. They were assessed across several self-report parent measures (parental emotion regulation, emotion socialization parenting practices and beliefs) and parent-report of children's social-emotional competence. Parents in the TIK group completed interviews to further understand their experience participating in the intervention. RESULTS: Descriptive analyses showed general improvements and positive change in parenting practices, beliefs, parental emotion regulation, and children's self-regulation. Large effect sizes indicate reductions of parents emotion dismissing and distressed reactions to children's negative emotions. TIK was overall rated as a highly acceptable intervention. Parent interviews offer essential information to provide context to Black parents' experiences utilizing TIK as well as themes related to challenges in raising Black children with self-regulation difficulties. CONCLUSIONS: Overall, these preliminary mixed-methods outcomes suggest that TIK is a promising parenting program to improve Black parents' emotion regulation, emotion coaching beliefs and positive parenting practices. Further research is needed to investigate the effectiveness of TIK and other emotion-focused parenting programs with Black parents and assess the necessity of future cultural adaptations.

Integrated Behavior Therapy for Exclusively Anxious Selective Mutism: A Nonconcurrent Multiple-Baseline Design across Five Participants.

Selective mutism (SM) is a rare childhood anxiety disorder which may be markedly detrimental to a child's academic and social functioning if left untreated. Cognitive-behavioral treatments for social anxiety disorders have been found to be effective for SM, yet a paucity of published studies have explored manualized treatment approaches carried out by novice clinicians. The purpose of the present study was to examine the adherence, effectiveness, and acceptability of a condensed, 16-session version of Integrated Behavior Therapy for Selective Mutism (IBTSM; Bergman, 2013), the first manualized treatment for SM. A nonconcurrent multiple-baseline single-case design was used across five children diagnosed with SM, exclusively anxious subtype. IBTSM was implemented with excellent adherence (M = 98%) over an average of 19 weeks (range = 16-22 weeks). Visual analyses of weekly caregiver ratings of social anxiety and speaking behaviors did not demonstrate a replicated intervention effect; however, Tau-U effect sizes and Reliable Change Index (RCI) calculations demonstrated significant individual improvements in social anxiety and speaking behaviors over time on several measures. Three children (60%) no longer met diagnostic criteria for SM following treatment. All caregivers rated IBTSM as acceptable, with specific endorsements of acceptability in the areas of time required and treatment quality.

State of the Evidence for Use of Psychotropic Medications in School-Age Youth.

Psychotropic medications are commonly prescribed to school-aged youth for the management of mental health concerns. This paper describes the current state of evidence for psychotropic medications in school-aged youth. More specifically, the following sections summarize relevant medication research trials and practice parameters pertaining to psychotropic medication prescribing as well as the specific medications indicated for a range of commonly presenting disorders and symptom clusters in school-aged youth. For each of these disorders and symptom clusters, key findings pertaining to the current state of science and practice are highlighted for the purpose of offering patients, clinicians, researchers, and policymakers with nuanced considerations for the role of psychopharmacology within the context of a larger "whole-child" approach to care that relies on the collaboration of providers and services across systems of care to promote optimal child and family health and wellness. The paper concludes with a discussion about supporting the use of medication treatments in schools, including considerations for ensuring effective family-school-health system collaboration to best meet youth mental health needs.

Examining the Effect of a Parent-to-Parent Intervention for Low-Income Youth with Serious Emotional and Behavioral Challenges.

BACKGROUND: Numerous barriers to mental health utilization exist for families of children who present with serious emotional and behavioral challenges. Evidence-based practices that facilitate equitable outcomes across diverse populations are essential to identify. This study examined possible differential service outcomes in a Medicaid-funded, parent-to-parent intervention called Parent Support Partner (PSP). METHOD: Data from four hundred and sixty-four parents who received PSP services were evaluated for possible demographic differences in service completion. Within-group analyses were utilized for an analysis of outcomes (parent change, child functioning; treatment acceptability) within a subset (N = 153) of those who completed services. RESULTS: No racial disparities were found in those who completed PSP (43%) when compared to those who did not (57%). Regression analyses uncovered significant improvements in parent competence and confidence, as well as overall child functioning (global functioning across domains such as school, home, behaviors). Consistent with identifying evidence-based practices, findings were seen consistently across the diverse sample of those who completed PSP services. Improvements in parents' sense of competence and confidence were correlated with perceptions of treatment acceptability. DISCUSSION: PSP is an innovative and promising intervention with demonstrated high levels of acceptability found to increase parent confidence and self-competence to advocate for treatments that can improve the mental health functioning of their child. Future investigations of factors associated with increasing PSP service completion and outcomes in larger and more diverse populations are necessary. Implications for considering and possibly adopting this evidence-informed practice within the nursing profession are provided.

Implementing a statewide early childhood mental health consultation approach to preventing childcare expulsion.

State- and local-level mental health administrators and practitioners can work collaboratively to provide effective early childhood mental health consultation (ECMHC) services that address the growing need in communities to promote healthy socioemotional functioning in infants and young children and prevent longer term mental health challenges. This article describes one state's model of ECMHC, the Child Care Expulsion Prevention Program (CCEP), as well as preliminary evaluation findings on consultants' fidelity to the developed approach to service within 31 counties in Michigan. The CCEP approach is flexible, yet adheres to six cornerstones which are essential to effectively and consistently carrying out services across local projects, including the provision of relationship-based programmatic and child/family-centered consultation, hiring and supporting high-quality consultants through professional development and reflective supervision, ongoing provision of state-level technical assistance, use of evidence-based practices, and collaboration with other early childhood service providers. In addition to the overview of CCEP's approach and effectiveness, lessons learned are provided to guide those engaged in policy development, practice, and applied research pertaining to ECMHC. Abstracts translated in Spanish, French, German, and Japanese can be found on the abstract page of each article on Wiley Online Library at http://wileyonlinelibrary.com/journal/imhj.

A Pilot Feasibility Study of an Intensive Summer Day Camp Intervention for Children with Selective Mutism.

Cost, scheduling, and implementation competency are barriers to accessing traditional evidence-based behavioral interventions for childhood selective mutism (SM). Brief, or intensive, interventions are a disruptive innovation to traditional therapy given the use of fewer sessions during a short-term time period. This study explored the acceptability, integrity, and effectiveness (i.e., single-case replicated AB design) of an intensive summer camp consisting of a 5-day behavioral therapy for 25 children with SM. Caregiver-rated treatment acceptability ratings and family interviews support intensive summer day camp as an acceptable intervention approach for SM. Additionally, results revealed that counselors and parents implemented SM behavioral therapy during camp with impressive integrity (>90%) after receiving training about SM behavioral therapy from an SM expert clinician. Effect size calculations of counselor-rated daily behavior ratings revealed reductions in anxiety during camp for 18 of the 25 campers. Significant caregiver-rated improvements in speaking behaviors were reported for 9 out of 14 campers with data available for analysis at the 3-month follow-up. This pilot feasibility study is the first to investigate intensive summer day camp as a treatment approach for SM and implications for future research are discussed.

A Meta-Analysis of the Current State of Evidence of the Incredible Years Teacher-Classroom Management Program.

This meta-analysis evaluated the current state of evidence and identified potential treatment moderators of the Incredible Years Teacher Classroom Management (IYTCM) program used to reduce externalizing and internalizing behaviors in school-aged children. Inclusion criteria involved published studies between 1984-2018 and examining the effects of IYTCM as a standalone program on teacher and/or child behavioral outcomes. We identified and narratively summarized potential moderators, which included the severity of child behavior, dosage, study design, and reporting methods. Overall, effect sizes revealed IYTCM had moderate positive effects on teachers and small positive effects on children. Narrative summaries indicated larger effect sizes in higher dosage studies and higher risk children. The results align with previous systematic reviews on the Incredible Years Parent Training (IYPT) program but this is the first study to look at the teacher training program. Overall, IYTCM seems to be an effective intervention; however, what components of this program work best, for whom, and under what conditions require further empirical investigation.

Effects of secondary warm up following stretching.

Evidence suggests that static stretching inhibits muscular power. However, research does not reflect practice whereby individuals follow up stretching with secondary activity. This study investigated muscular power following stretching, and after a second bout of activity. Participants (n = 13) completed 3 randomized testing sessions which included a 5 min warm-up, followed by a vertical jump (VJ) on a force platform; an intervention (static stretching, dynamic, or control), followed by a second VJ. Participants then completed a series of movements, followed by a VJ, up to 60 min post activity. Immediately following the intervention, there was a 10.7% difference in VJ between static and dynamic stretching. The second warm up bout increased VJ height following the dynamic intervention, whereas the static stretching condition did not show any differences. The novel finding from this study demonstrates a second exercise bout does not reverse the effects of static stretching and is still detrimental to VJ.

The lifestyle of our kids (LOOK) project: outline of methods.

This methods paper outlines the overall design of a community-based multidisciplinary longitudinal study with the intent to stimulate interest and communication from scientists and practitioners studying the role of physical activity in preventive medicine. In adults, lack of regular exercise is a major risk factor in the development of chronic degenerative diseases and is a major contributor to obesity, and now we have evidence that many of our children are not sufficiently active to prevent early symptoms of chronic disease. The lifestyle of our kids (LOOK) study investigates how early physical activity contributes to health and development, utilizing a longitudinal design and a cohort of eight hundred and thirty 7-8-year-old (grade 2) school children followed to age 11-12 years (grade 6), their average family income being very close to that of Australia. We will test two hypotheses, that (a) the quantity and quality of physical activity undertaken by primary school children will influence their psychological and physical health and development; (b) compared with existing practices in primary schools, a physical education program administered by visiting specialists will enhance health and development, and lead to a more positive perception of physical activity. To test the first hypothesis we will monitor all children longitudinally over the 4 years. To test the second we will involve an intervention group of 430 children who receive two 50min physical education classes every week from visiting specialists and a control group of 400 who continue with their usual primary school physical education with their class-room teachers. At the end of grades 2, 4, and 6 we will measure several areas of health and development including blood risk factors for chronic disease, cardiovascular structure and function, physical fitness, psychological characteristics and perceptions of physical activity, bone structure and strength, motor control, body composition, nutritional intake, influence of teachers and family, and academic performance.

Efficacy of cognitive-behavioral and pharmacological treatments for children with social anxiety.

Childhood social anxiety is associated with significant social and academic impairment. The purpose of this study was to compare and contrast the efficacy of two major treatments for social anxiety disorders in children: cognitive-behavioral therapy and selective serotonin reuptake inhibitor (SSRI) drug treatment. Treatment studies in the literature were evaluated using meta-analytic techniques to compare pre- and post-treatment measures of social anxiety symptoms, general anxiousness, social competency, and impairment. Results indicate that the core symptoms of social anxiety and impairment were reduced by both cognitive-behavioral treatment (ES=0.86 and 1.56) and SSRI treatment (ES=1.30 and 2.29), respectively. Similarly, peripheral symptoms of general anxiousness were reduced by both cognitive-behavioral treatment (ES=0.75) and SSRI treatment (ES=1.29). Finally, both cognitive-behavioral (ES=0.68) and SSRI treatment (ES=0.68) resulted in moderate improvements in social competence. Implications and the limitations of these meta-analytic findings are discussed with respect to the evidence-based intervention movement.

Performance and anthropometric characteristics of prospective elite junior Australian footballers: a case study in one junior team.

The aim of the study was to compare anthropometric and physical performance data of players who were selected for a Victorian elite junior U18 Australian rules football squad. Prior to the selection of the final training squad, 54 players were assessed using a battery of standard anthropometric and physical performance tests. Multivariate analysis (MANOVA) showed significant (p<0.05) differences between selected and non-selected players when height, mass, 20-m sprint, agility and vertical jump height were considered collectively. Univariate analysis revealed that the vertical jump was the only significant (p<0.05) individual test and a near significant trend (p=0.07) for height differentiating between selected and non-selected players with medium effect sizes for all other tests except endurance. In this elite junior football squad, physical characteristics can be observed that discriminate between players selected and non-selected, and demonstrates the value of physical fitness testing within the talent identification process of junior (16-18 years) players for squad and/or team selection. Based on MANOVA results, the findings from this study suggest team selection appeared to be related to a generally higher performance across the range of tests. Further, age was not a confounding variable as players selected tended to be younger than those non-selected. These findings reflect the general consensus that, in state-based junior competition, there is evidence of promoting overall player development, selecting those who are generally able to fulfil a range of positions and selecting players on their potential.

Examining predictors of initial outpatient psychiatric treatment for conduct problems in youth: A records review.

PURPOSE: To investigate predictors of conduct problem (CP) treatment in an outpatient child psychiatry clinic. DESIGN AND METHODS: Medical records (N = 78) of youth with CPs (71% male; mean age = 9.9 years) were analyzed to determine how treatment history, race, gender, travel distance, aggression symptoms, internalizing disorder symptoms, and age of diagnosis influenced initial treatment decisions. FINDINGS: Severity of aggression symptoms and travel distance significantly increased the likelihood that initial treatments included psychotropic medication. Travel distance also moderated the relationship between history of psychosocial intervention for CPs and treatment recommendations. PRACTICE IMPLICATIONS: Adhering to treatment guidelines for youth with CPs is essential for furthering evidence-based psychiatric nursing care.

Integrated care models for ADHD in children and adolescents: A systematic review.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) in children and adolescents is commonly managed in primary care. Changes in United States health care have led to the integration of behavioral health services within a patient's "medical home" to improve access to, engagement in, and continuity of quality health care. Despite proliferation of these integrated care models, no studies have specifically examined models for managing ADHD in children and adolescents within primary care. METHOD: We searched PsycINFO, MEDLINE, and Google Scholar databases, and found 8 studies describing 6 integrated care models (i.e., combined psychosocial and medication treatments with coordination of care between primary care clinicians and behavioral health clinicians). We reviewed characteristics (i.e., settings, target populations, providers, levels of integration, evaluation and treatment approaches, and methods of interprofessional collaboration) and outcomes (i.e., access, outcomes, and acceptability) of these models. RESULTS: The 6 integrated care models demonstrate the potential to improve access to and acceptability of ADHD care for children and adolescents. The models also demonstrate that behavioral health clinicians can integrate at various levels within primary care to achieve superior clinical outcomes compared with nonintegrated models. DISCUSSION: We identified 6 effective integrated care models for addressing ADHD in children and adolescents that may be adaptable to local needs and internal capacities. We discuss results of these models with regard to their implications for clinical practice and research. (PsycINFO Database Record

An Examination of Fluoxetine for the Treatment of Selective Mutism Using a Nonconcurrent Multiple-Baseline Single-Case Design Across 5 Cases.

This study examined the utility of fluoxetine in the treatment of 5 children, aged 5 to 14 years, diagnosed with selective mutism who also demonstrated symptoms of social anxiety. A nonconcurrent, randomized, multiple-baseline, single-case design with a single-blind placebo-controlled procedure was used. Parents and the study psychiatrist completed multiple methods of assessment including Direct Behavior Ratings and questionnaires. Treatment outcomes were evaluated by calculating effect sizes for each participant as an individual and for the participants as a group. Information regarding adverse effects with an emphasis on behavioral disinhibition and ratings of parental acceptance of the intervention was gathered. All 5 children experienced improvement in social anxiety, responsive speech, and spontaneous speech with medium to large effect sizes; however, children still met criteria for selective mutism at the end of the study. Adverse events were minimal, with only 2 children experiencing brief occurrences of minor behavioral disinhibition. Parents found the treatment highly acceptable.

A meta-analysis of combined treatments for children diagnosed with ADHD.

OBJECTIVE: Meta-analytic procedures are used to review the literature of combined treatments of psychosocial and pharmacological treatments for children diagnosed with ADHD. METHOD: Eight combined treatment studies meet specific inclusion and exclusion criteria regarding the core and peripheral features of the disorder. RESULTS: The results of this study highlight the individual and average effect sizes within the categories of inattention, hyperactivity, impulsivity, social skills, and academics. These findings are compared with the effect sizes of meta-analytic findings previously reported in the pharmacological literature. CONCLUSION: The results reveal large effect sizes for the core features of the disorder and the peripheral feature of social skills. A small effect size is found for the peripheral feature of academics. Findings are discussed in light of the paucity of included studies focused on combined treatments for ADHD.

A pilot investigation of teachers' perceptions of psychotropic drug use in schools.

OBJECTIVE: Children's behavior at school often leads to parental interest in seeking physician treatment. This study examines teachers' knowledge and perceptions of psychotropic drug use in schools. METHOD: Structured interviews were conducted with 27 general education teachers from a diverse representation of elementary schools within central Michigan. Information on (a) current use of psychotropic medications by their students, (b) consultation and collaboration with parents and mental health professionals, and (c) knowledge of the properties and side effects of Ritalin was gathered. RESULTS: Teachers report limited knowledge of how and why medication treatment works despite reporting that 11.5% of their students were currently being prescribed a psychotropic medication. Teachers indicate little communication with parents or professionals regarding medication use or the side effects associated with their use. CONCLUSION: Issues related to the amount of knowledge that school professionals should have about this increasingly used treatment remain unresolved and warrant further research.

Prescription practices and empirical efficacy of psychopharmacologic treatments for pediatric major depressive disorder.

PROBLEM: Limited research on pharmacologic treatments for pediatric major depressive disorder (MDD) exists. METHODS: Prescription practices data for MDD from 1,209 American Academy of Child and Adolescent Psychiatry members collected in 1998 are compared to the current empirical support for this treatment approach. FINDINGS: Results indicated that psychiatrists have willingly used medication as a first-line treatment for MDD in children under age 7, despite a paucity of research support for this practice. CONCLUSIONS: Recent warnings regarding the use of selective serotonin reuptake inhibitors warrant the need to reexamine current prescription practices of psychiatric care providers for children diagnosed with MDD.

Player movement patterns in an elite junior Australian rules football team: an exploratory study.

This study explored the physical movement patterns associated with an elite Under 18 Australian Football (AF) team. Five field positions were selected with observations recording the number and relative per cent of "working "efforts (jogging, running, and sprinting), "resting "efforts (walking) and the total distances associated with "working "or "resting "efforts. Intra-observer reliability, using test- retest method, showed correlations were r = 0.98 or greater. The Wing position covered 11,877 m, the greatest total distance during an entire game, whilst the HBF and Centre positions both recorded 11,545 m and 11,537 m respectively and the Ruck position covered 9,203 m. The HBF recorded the greatest frequency of 'working' and 'resting' efforts (180 and 182 respectively), whilst the Wing (166 and 158), Centre (162 and 149) and Ruck (161 and 166) showed similarities in their results. The Wing position recorded the longest average distance per 'working' effort (58 m) whilst the Centre position recorded the longest average distance per 'resting' effort (17 m). Results also show the completion of less total efforts and smaller total distances, in Under 18 players, recorded compared to professional senior AF data. The results from this study suggest that further in-depth research is required into movement patterns and game activity demands in this AF playing group. Key pointsLittle information currently exists in the movement patterns and physical activity levels in Australian football at both senior and junior levels.The results from this preliminary study found differences in the number of physical efforts and the total volume of work completed in junior Australian football players when compared to previous research in senior players.Further in-depth research is required in movement analysis, particularly at the junior level, in order to assist junior coaching staff in developing specific programs for this population group.