In-home treatment of abusive families: Cost and placement at one year.

Evaluated a child-abuse prevention project designed to keep abused children safely at home. In-home prevention services were provided to 59 children in 26 families referred by county child protective services as an alternative to out-of-home placement. Therapists, carrying a caseload of 2 families each, provided intensive treatment in the families' homes for 4–6 wks. A comparison group of 24 child protective service referred families, with 49 children, received usual county services. A 1-yr follow-up evaluated the 2 groups on cost, on whether or not the children stayed at home, and on psychological measures of family functioning. Results indicate that the goals of reducing out-of-home placement and lowering placement costs were being met. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of maltreatment on young children's socioemotional development: An attachment theory perspective.

The effects of maltreatment on early childhood development were examined in three domains suggested by attachment theory: relationships with novel adults, effectance motivation, and cognitive maturity. Three samples of children between 4 and 8 years of age were studied: 93 maltreated children, 67 demographically matched nonmaltreated children from families receiving welfare, and 30 nonmaltreated children from middle-class families. Children's scores on 10 dependent variables across the three domains of interest were factor analyzed, and two theoretically meaningful factors emerged. Maltreated children scored lower than welfare children, who in turn scored lower than middle-class children, on a factor measuring secure readiness to learn in the company of novel adults. Maltreated children and welfare children also scored higher than middle-class children, but did not significantly differ from each other, on a factor measuring outer-directedness. Results indicate that, during early childhood, maltreatment disrupts a dynamic balance between the motivation to establish safe, secure relationships with adults and the motivation to venture out to explore the world in a competency-promoting fashion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genomic characterization of members of the Bet v 1 family: genes coding for allergens and pathogenesis-related proteins share intron positions

Births while on public assistance has been one of the central topics in the welfare debate in Maryland because the welfare grant increases with the number of children, and there is debate about whether or not to continue the increased income provision. Based on the Quality Control (QC) data for the period from July 1991 to June 1992, this study examined differentials in the incidence of births conceived and borne while the mothers were on welfare. The results indicate that about one-quarter of recipient children were born on welfare and that higher incidences of these births occur among mothers with less than high-school education, never-married, young, Baltimore residents, and with fewer children at entry on welfare. The presence of parents of welfare mothers or of any adults in the household is found to reduce the incidence of births. Disallowance of the increased welfare grant for additional children may increase the number of families in poverty and the number of children in foster care unless efforts are made to reduce unintentional births and school drop-outs and to fill the gap between mothers' schooling and the needs of the job market.     

The dyadic parent–child interaction coding system: Standardization and validation.

The Dyadic Parent–Child Interaction Coding System (DPICS) is a comprehensive observational system for conduct problem families. Ss were 22 families referred for treatment of a conduct problem child (2–7 yrs of age) and 22 normal families observed in the laboratory in child-directed and parent-directed interactions. The conduct problem children displayed higher rates of noncompliance than normal children, and their parents were more critical and directive than normal parents. Both the referred child and its sibling exhibited behavior problems in conduct problem families, but the referred child was deviant in a greater variety of situations than the sibling. The DPICS was a reliable, clinically practical, research instrument that correctly classified 94% of families and predicted 61% of the variance in parent report of home behavior problems. The effectiveness of this brief procedure may be attributable to the structure of the clinic observation situations, which varied in degree of parental control. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with child mental health service use in the community

OBJECTIVE: To determine the association of parent, family, and child factors with mental health services need and utilization. METHOD: Possible determinants of services need and utilization were assessed in a general population sample of 2,227 children aged 4 to 18 years. RESULTS: 3.5% of the total sample had been referred for mental health services within the past year. The most potent factors associated with service need and utilization were the child's problem behaviors (both internalizing and externalizing) and academic problems and family stress. Socioeconomic factors and the child's sex were not in itself associated with help-seeking factors. Parental psychopathology, life events, and family psychopathology lowered the parents' threshold for evaluating the child's behavior as problematic but did not increase the likelihood of referral. CONCLUSION: Referred children are more likely to live in families under stress than are children with the same level of problems who live in well-functioning families. Clinicians and researchers who make inferences from findings in clinical samples should realize, therefore, that children from problem families are overrepresented in their samples.     

Problem solving in the treatment of childhood obesity.

This study randomized obese children from 67 families to groups that received a 6-month family-based behavioral weight-control program plus parent and child problem solving, child problem solving, or standard treatment with no additional problem solving. The standard group showed larger body mass index (BMI) decreases than the parent?+?child group through 2 years, with significant differences in the percentage of children who showed large BMI changes. Significant statistical and clinical improvements were observed over time in child behavior problems and parental distress. Parent problem solving increased in the parent?+?child condition relative to the other conditions, whereas child problem solving increased equally in all conditions. The bulk of evidence suggests that problem solving did not add to treatment effectiveness beyond the standard family-based treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of parental stress to enhance therapeutic change among children referred for aggressive and antisocial behavior.

This study evaluated a parent problem-solving (PPS) intervention designed to augment the effects of evidence-based therapy for children referred to treatment for aggressive and antisocial behavior. All children (N=127, ages 6-14 years) and their families received problem-solving skills training (PSST), and parents received parent management training (PMT). Families were randomly assigned to receive or not to receive an additional component (PPS) that addressed parental stress over the course of treatment. Children improved with treatment; the PPS intervention enhanced therapeutic change for children and parents and reduced the barriers that parents experienced during treatment. The implications of the findings for improving evidence-based treatment as well as the limitations of adding components to treatment are detailed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Birth order and personality.

Investigated 6 personality variables for birth order differences in 339 male and 447 female and 210 male and 266 female undergraduates. Ss in the former were studied for dogmatism, ambiguity tolerance, and rigidity. Measures of (a) internal-external locus of control, and (b) social responsibility were administered to the latter. Both samples were given the Marlowe-Crowne Social Desirability Scale. Data were analyzed in 2 * 3 factorial analysis of variance design: 2 levels of sex and 3 levels of birth order (only child, 1st born, and later born). It was found that (a) later borns from 2-child families were more external than those from larger families; (b) later borns from 2-child families were more external than only children or 1st borns from 2-child families; (c) only children and 1st borns were more socially responsible than later borns; (d) 1st borns were more rigid than only-child and later-born Ss; and (e) only-female Ss manifested higher need for approval than only males. (26 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health outcomes of children receiving EPSDT checkups: a pilot study

This pilot study used medical records to examine the health outcomes of children receiving care in Medicaid's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. Medical records from 76 children seen for EPSDT visits during a 6-month period were reviewed to assess whether health problems were identified and whether treatment, follow-up, or referral care was provided. Health problems were identified for 43% of the children; 22% received treatment, and 18% were referred for specialty care. Checkups uncovered fewer problems than would be expected in a poor, largely minority population. Almost one third of the children referred for specialty care apparently did not receive such care. The study verified the need for further research and provides direction for future study.     

Treatment-related changes in objectively measured parenting behaviors in the multimodal treatment study of children with attention-deficit/hyperactivity disorder.

The present study examined treatment outcomes for objectively measured parenting behavior in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ADHD). Five hundred seventy-nine ethnically and socioeconomically diverse children with ADHD-combined type (ages 7.0-9.9 years) and their parent(s) were recruited at 6 sites in the United States and Canada and randomly assigned to 1 of 4 treatment groups for 14 months of active intervention: medication management (MedMgt), intensive behavior therapy, combination of the 2 (Comb), or a community-treated comparison (CC). Baseline and posttreatment laboratory observations of parent-child interactions were coded by observers blind to treatment condition. Comb produced significantly greater improvements in constructive parenting than did MedMgt or CC, with effect sizes approaching medium for these contrasts. Treatment effects on child behaviors were not significant. The authors discuss the importance of changes in parenting behavior for families of children with ADHD and the need for reliable and objective measures in evaluating treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of decreasing sedentary behavior and increasing activity on weight change in obese children.

Obese children 8–12 years old from 61 families were randomized to treatment groups that targeted increased exercise, decreased sedentary behaviors, or both (combined group) to test the influence of reinforcing children to be more active or less sedentary on child weight change. Significant decreases in percentage overweight were observed after 4 months between the sedentary and the exercise groups (–29.9 vs. –23.2). At 1 year, the sedentary group had a greater decrease in percentage overweight than did the combined and the exercise groups (–28.7 vs. –20.3 and –8.7) and greater decrease in percentage of body fat (–4.7 vs. –2.3). All groups improved fitness during treatment and follow-up. Children in the sedentary group increased their liking for high-intensity activity and reported lower caloric intake than did children in the exercise group. These results support the goal of reducing time spent in sedentary activities to improve weight loss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of family systems intervention on recidivism and sibling delinquency: A model of primary prevention and program evaluation.

86 families of 38 male and 48 female 13–16 yr old delinquents were randomly assigned to 1 of 4 treatment conditions: no treatment controls, a client-centered family approach, an eclectic-dynamic approach, and a behaviorally oriented short-term family systems approach. Three levels of evaluation were performed: process changes in family interaction at the termination of treatment (tertiary prevention); recidivism rates of identified delinquents 6–28 mo following treatment (secondary prevention); and rate of sibling contact with the court 2?–3? yrs following intervention (primary prevention). The family systems approach, when compared to the other conditions, produced significant improvements in process measures and a significant reduction in recidivism. To evaluate the primary prevention impact, juvenile court records were examined to obtain rates of court referrals for siblings of initially referred delinquents. Results indicate that only 20% of families in the treatment condition had subsequent court contacts for siblings, compared to a 40% rate for no-treatment controls and 59% and 63% rates for the alternative treatment conditions. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Somatic mosaicism: a common cause of classic disease in tumor-prone syndromes? Lessons from type 2 neurofibromatosis

Blood samples from 125 families with classic type 2 neurofibromatosis with bilateral vestibular schwannomas were analyzed for mutations in the NF2 gene. Causative mutations were identified in 52 families. In five families, the first affected individual in the family (the index case) was a mosaic for a disease-causing mutation. Only one of nine children from the three mosaic cases with children are affected. Four of these nine children inherited the allele associated with the disease-causing mutation yet did not inherit the mutation. NF2 mutations were identified in only 27/79 (34%) of sporadic cases, compared with 25/46 (54%) of familial cases (P<.05). In 48 families in which a mutation has not been identified, the index cases have had 125 children, of whom only 29 are affected with NF2 and of whom only a further 21 cases would be predicted to be affected by use of life curves. The 50/125 (40%) of cases is significantly less than the 50% expected eventually to develop NF2 (P<.05). Somatic mosaicism is likely to be a common cause of classic NF2 and may well account for a low detection rate for mutations in sporadic cases. Degrees of gonosomal mosaicism mean that recurrence risks may well be <50% in the index case when a mutation is not identified in lymphocyte DNA.     

A retrospective study of risk to siblings in abusing families.

Relatively little research has considered the risk to siblings within maltreating families. The sample in the present study consisted of the 795 siblings from a cohort of 400 "index" children who had been referred to police child protection units in England for abuse and/or neglect. In 44% of families (valid cases), the index child was scapegoated, in 37% maltreatment was nonspecific to all siblings, and in 20% maltreatment was specifically directed at some but not all siblings. Scapegoated children were more likely to be older and to experience physical or sexual abuse, whereas younger children and index child referrals for neglect, emotional abuse, or mixed abuse were associated with risk to some or all siblings. Parental difficulties and family stressors increased the risk of maltreatment to all siblings. There was no evidence of increased risk to stepsiblings or children with difficulties, suggesting that the special victim model has limited application. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Welfare policies and very young children: Experimental data on stage-environment fit.

The authors examined the effects of welfare programs that increased maternal employment and family income on the development of very young children using data from 5 random-assignment experiments. The children were 6 months to 3 years old when their mothers entered the programs; cognitive and behavioral outcomes were measured 2?5 years later. While there were no overall program impacts, positive or negative, on the development of children in this age group, there was a pair of domain- and age-specific effects: The programs decreased positive social behavior among 1-year-olds and increased school achievement among 2-year-olds. After exploring several explanations for these results, the authors suggest that the contextual changes engendered by the programs, including children's exposure to center-based child care, interacted differentially with specific developmental transitions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating a brief prevention program for improving marital conflict in community families.

Marital conflict is related to well-being in children and adults (E. M. Cummings & P. T. Davies, 2002). Marital conflict is likely most effectively ameliorated before it becomes clinically significant. However, families without significant problems may be unwilling to participate in couples therapies or other lengthy or intensive interventions. Responding to this gap, the authors developed a 4-session psychoeducational program about marital conflict for community families. Couples with children 4-8 years of age were randomly blocked into 1 of 3 groups: (1) a parent-only group (n = 24), (2) a parent-child group (n = 33), or (3) a self-study group (n = 33). Pre- and posttest and 6-month and 1-year assessments were conducted. This report evaluates (a) whether participation in a psychoeducational program for parents improved marital conflict, especially concerning ways of expressing disagreements, and (b) whether changes in marital conflict subsequently improved marital satisfaction, parenting, and child adjustment. Greater constructive and less destructive marital conflict was observed at all assessments for treatment groups, and these changes were linked with improvements in other family processes. The findings support the promise of brief, psychoeducational programs for improving marital conflict for community samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood depression and conduct disorder: II. An analysis of family interaction patterns in the home.

Directly sampled the interaction patterns of families with depressed (DEP), conduct-disordered (CD), mixed DEP-CD, and comparison children (aged 7–14 yrs) in the homes during the evening meal. Observational measures were taken of positive and aversive behaviors and affect expression for both parents, the referred children, and their siblings. Results replicated previous research showing that CD children express high levels of aversive behavior and anger and are part of a family system marked by conflict and aggression. The DEP children were exposed to maternal aversiveness but did not show any evidence of elevated levels of anger or aversiveness. Surprisingly, this was also true for the mixed-disorder children. High levels of depression in both groups of DEP children were associated with low levels of conflict and anger in family members. Overall, siblings showed very similar patterns of behavior and were exposed to similar patterns of parental behavior as the referred children. Results are discussed in terms of family models that emphasize the function of aggression and depression in the maintenance of child psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biological monitoring of organophosphorus pesticide exposure among children of agricultural workers in central Washington State

Children up to 6 years of age who lived with pesticide applicators were monitored for increased risk of pesticide exposure: 48 pesticide applicator and 14 reference families were recruited from an agricultural region of Washington State in June 1995. A total of 160 spot urine samples were collected from 88 children, including repeated measures 3-7 days apart. Samples were assayed by gas chromatography flame photometric detector for dimethylphosphate metabolites. Dimethylthiophosphate (DMTP) was the dominant metabolite. DMTP levels were significantly higher in applicator children than in reference children (p = 0.015), with median concentrations of 0.021 and 0.005 microg/ml, respectively; maximum concentrations were 0.44 and 0.10 microg/ml, respectively. Percentages of detectable samples were 47% for applicator children and 27% for reference children. A marginally significant trend of increasing concentration was observed with decreasing age among applicator children (p = 0.060), and younger children within these families had significantly higher concentrations when compared to their older siblings (p = 0.040). Applicator children living less than 200 feet from an orchard were associated with higher frequency of detectable DMTP levels than nonproximal applicator children (p =0.036). These results indicate that applicator children experienced higher organophosphorus pesticide exposures than did reference children in the same community and that proximity to spraying is an important contributor to such exposures. Trends related to age suggest that child activity is an important variable for exposure. It is unlikely that any of the observed exposures posed a hazard of acute intoxication. This study points to the need for a more detailed understanding of pesticide exposure pathways for children of agricultural workers.     

A practical clinical trial of coordinated care management to treat substance use disorders among public assistance beneficiaries.

This study tested whether coordinated care management (CCM), a continuity of care intervention for substance use disorders (SUD), improved rates of abstinence when compared with usual welfare management for substance-using single adults and adults with dependent children applying for public assistance. The study was designed as a practical clinical trial and was implemented in partnership with a large city welfare agency. Participants were 421 welfare applicants identified via SUD screening and assigned via an unbiased computerized allocation program to a site that provided either CCM (n = 232) or usual care (UC; n = 189). Outcomes were assessed for 1 year postbaseline with self-reports and biological measures of substance use. As hypothesized, for participants not enrolled in methadone maintenance programs (n = 313), CCM clients received significantly more services than did UC clients. Nonmethadone CCM also showed significantly higher abstinence rates (odds ratio = 1.75; 95% confidence interval = 1.12, 2.76; d = 0.31) that emerged early in treatment and were sustained throughout follow-up. In contrast, no treatment services or outcome effects were found for methadone maintenance clients (n = 108). Findings suggest that CCM is promising as a wraparound to SUD treatment for welfare recipients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior.

Comorbidity and complexity of cases seen in clinical work form a basis for discounting the applicability and generality of evidence-based treatments (EBTs). The authors evaluated treatment outcomes in 2 samples of clinically referred children who met criteria for oppositional defiant disorder (n = 183; 42 girls, 141 boys; ages 3-14) or conduct disorder (n = 132; 35 girls, 97 boys; ages 7-14) but varied in comorbidity (up to 5 additional disorders). In addition to comorbidity, 4 domains of case complexity were evaluated: scope and severity of child dysfunction, socioeconomic disadvantage, parent and family functioning, and barriers that emerged during treatment. Comorbidity was associated with greater therapeutic change. Children who varied in comorbidity did not differ on outcome measures at the end of treatment. Complexity was either unrelated or positively related to therapeutic change. As an exception, perceived barriers were associated with less child improvement, but, even with high barriers, effect sizes for these children were large. The findings suggest that comorbidity or complexity of cases does not necessarily influence outcome or limit the applicability of EBTs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)