Changing patterns of inpatient care for children and adolescents at the Menninger Clinic, 1988–1994.

The authors describe trends in inpatient psychiatric length of stay (LOS) and admissions for the population of children and adolescents (N?=?784) at the Menninger Clinic from 1988 to 1994. During this period, median LOS declined dramatically from 7 months to 3 weeks, whereas admissions increased 4-fold. The diagnostic case mix changed substantially, with a crossover in modal principal diagnosis from personality disorder to affective disorder. Use of medications became almost universal. Diagnosis and medication use became less important determinants of LOS over time. The practical implications of these patterns include higher patient turnover, fewer inpatient clinical contact hours, and heightened importance of continuity with outpatient care. Research should center on the impact of declining LOS on clinical and functional outcomes for children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analytic review of depression prevention programs for children and adolescents: Factors that predict magnitude of intervention effects.

In this meta-analytic review, the authors summarized the effects of depression prevention programs for youth as well as investigated participant, intervention, provider, and research design features associated with larger effects. They identified 47 trials that evaluated 32 prevention programs, producing 60 intervention effect sizes. The average effect for depressive symptoms from pre-to-posttreatment (r = .15) and pretreatment to-follow-up (r = .11) were small, but 13 (41%) prevention programs produced significant reductions in depressive symptoms and 4 (13%) produced significant reductions in risk for future depressive disorder onset relative to control groups. Larger effects emerged for programs targeting high-risk individuals, samples with more females, samples with older adolescents, programs with a shorter duration and with homework assignments, and programs delivered by professional interventionists. Intervention content (e.g., a focus on problem-solving training or reducing negative cognitions) and design features (e.g., use of random assignment and structured interviews) were unrelated to effect sizes. Results suggest that depression prevention efforts produce a higher yield if they incorporate factors associated with larger intervention effects (e.g., selective programs with a shorter duration that include homework). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How much do I tell thee? Strategies for managing information to parents among American adolescents from Chinese, Mexican, and European backgrounds.

Strategies for managing information about activities to parents, including partial disclosure, avoidance, lying, and full disclosure, were examined in 479 American adolescents (M = 16.38 years, SD = 0.77) varying in generational status and from Mexican, Chinese, and European backgrounds. Information management strategies for personal, prudential, and overlapping (multifaceted) activities as defined within social domain theory were examined. With age, parental education, and generational status controlled, Chinese American adolescents partially disclosed more to mothers about personal and multifaceted activities than did Mexican American adolescents and more to fathers about personal activities than did European American teens. In contrast, European and Mexican American adolescents fully disclosed more to mothers about personal activities than did Chinese-origin adolescents. Strategies varied by generation among Chinese American youth; second-generation adolescents avoided discussing activities with parents more than did immigrants. Adolescents who fully disclosed about all activities and lied less about multifaceted and personal activities reported stronger endorsement of obligations to assist their families, more trust in parents, and less problem behavior. More depressed mood was associated with more lying about personal activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Should a psychotherapist be compelled to release an adolescent’s treatment records to a parent in a contested custody case?

The issue of whether to release a minor’s treatment records to a parent presents a complex ethical dilemma for clinicians. This is made more complex when the child is an adolescent and when the parents are involved in a custody dispute. The author presents a case summary followed by a review of the literature. A section on court rulings in similar cases is included. In general, courts have ruled in favor of maintaining the privilege for mature minors involved in custody proceedings. Health Insurance Portability and Accountability Act regulations pertaining to minors whose parents may not be acting in their best interests are also reviewed. Procedural recommendations by several experts in the field are offered that may serve to establish the child’s rights to privacy at the outset of treatment and thus avert ethical conflicts. The author concludes with the case outcome and an advisory for the clinician. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric properties of the Affect Intensity and Reactivity Measure adapted for Youth (AIR–Y).

A valid and reliable instrument for measuring affect intensity does not exist for adolescents; such a measure may help to refine understanding of emotion among youths. The purpose of the current study was to evaluate the psychometric properties and clinical relevance of a measure of affect intensity adapted for youths. Two hundred five community adolescents and 179 adolescents from a residential treatment program were recruited; both samples completed self-report questionnaires, and the community-based sample participated in positive and negative mood-eliciting laboratory tasks. Confirmatory factor analyses comparing multiple models indicated a 3-factor structure was the best fit. This Affect Intensity and Reactivity Scale for Youth (AIR–Y) evidenced good internal consistency and test–retest reliability, and the 3 factors showed incremental predictive validity for mood ratings following emotion-elicitation procedures, even after accounting for the relevant scale on the Positive and Negative Affect Scale for Children. Evidence for the clinical relevance of the AIR–Y, particularly the Negative Intensity factor, was found. Overall, the AIR–Y appears to be a psychometrically sound measure for the assessment of affect intensity among youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Daily family conflict and emotional distress among adolescents from Latin American, Asian, and European backgrounds.

The authors employed a daily diary method to assess daily frequencies of interparental and parent–adolescent conflict over a 2-week period and their implications for emotional distress across the high school years in a longitudinal sample of 415 adolescents from Latin American, Asian, and European backgrounds. Although family conflict remained fairly infrequent among all ethnic backgrounds across the high school years, its impact on emotional distress was significant across ethnicity and gender. In addition, parent–adolescent conflict significantly mediated the association between interparental conflict and emotional distress. These associations were observed at both the individual and the daily levels, providing evidence for both the chronic and episodic implications of family conflict for adolescents’ emotional adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analytic review of the Penn Resiliency Program’s effect on depressive symptoms.

The purpose of this review was to evaluate whether the Penn Resiliency Program (PRP), a group cognitive–behavioral intervention, is effective in targeting depressive symptoms in youths. We identified 17 controlled evaluations of PRP (N = 2,498) in which depressive symptoms had been measured via an online search of PsycINFO, Medline, ERIC, and ProQuest Dissertations and Theses and by requesting data from PRP researchers. We combined effect sizes (ESs; Glass’s d), using random effects models at postintervention and two follow-up assessments (6–8 and 12 months postintervention). PRP participants reported fewer depressive symptoms at postintervention and both follow-up assessments compared with youths receiving no intervention, with ESs ranging from 0.11 to 0.21. Subgroup analyses showed that PRP’s effects were significant at 1 or more follow-up assessments among studies with both targeted and universal approaches, when group leaders were research team members and community providers, among participants with both low and elevated baseline symptoms, and among boys and girls. Limited data showed no evidence that PRP is superior to active control conditions. Preliminary analyses suggested that PRP’s effects on depressive disorders may be smaller than those reported in a larger meta-analysis of depression prevention programs for older adolescents and adults. We found evidence that PRP significantly reduces depressive symptoms through at least 1-year postintervention. Future PRP research should examine whether PRP’s effects on depressive symptoms lead to clinically meaningful benefits for its participants, whether the program is cost-effective, whether CB skills mediate program effects, and whether PRP is effective when delivered under real-world conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond neighborhood poverty: Family management, neighborhood disorder, and adolescents’ early sexual onset.

The authors examined how neighborhood disorder modifies associations between family management practices and youth transitions to sex among low-income African American and Latino urban families. The sample included 846 young adolescents and their mothers who participated in Welfare, Children and Families: A Three-City Study. Results from multilevel logistic regression models indicated no main effects of family management practices or neighborhood-level conditions on transitions to sex once accounting for demographics. However, higher levels of family routines and parental knowledge (i.e., awareness of youths’ friends, whereabouts, and activities) were more strongly associated with a lower probability of youth sexual onset as neighborhood disorder increased. Results provide further evidence for the contextually specific nature of parenting impacts on adolescent adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Pediatric and adolescent behavioral medicine: Issues in treatment.

Reviews the book, Pediatric and Adolescent Behavioral Medicine: Issues in Treatment edited by Patrick J. McGrath and Philip Firestone (1983). With recent advances in behavioural medicine more generally, paediatric behavioural medicine has been expanding rapidly during the last decade. At this time, it seems most opportune to integrate notions from psychological and developmental models of treatment with medical treatment models, practice, and services. This book covers a number of childhood and adolescent disorders, including abdominal pain syndrome, asthma, elevated blood pressure, cigarette smoking, and obesity. The issues raised in this edited volume cover a number of important difficulties in the behavioural paediatrics area. Psychologists and other professionals working with difficulties associated with treating paediatric problems in well-child health care facilities will find it very useful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unfair Treatment, Discrimination, and Ambulatory Blood Pressure in Black and White Adolescents.

The authors tested the hypotheses that unfair treatment and its attribution to race, physical appearance, and peer group were related to elevated ambulatory blood pressure (ABP). During 2 school days, 207 Black and White adolescents wore an ABP monitor and answered questions about mood, posture, location, and activity level at the time of the ABP assessment. At a separate session, in-clinic resting blood pressure and perceptions of unfair treatment were measured. Multilevel mixed models showed that unfair treatment and its attribution to race were not associated with ABP. However, adolescents who indicated that the primary reason for unfair treatment was their physical appearance had elevated ABP. Feeling unfairly treated because of physical appearance may impact blood pressure uniquely during the adolescent transition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)