Dysfunctional attitudes and the cognitive therapy for depression

Nineteen depressed community volunteers received a replication of the cognitive therapy group treatment used by Shaw (1977). Two groups were created based upon a median split of pretreatment scores on the Dysfunctional Attitude Scale (Weissman & Beck, Note 1). The Beck Depression Inventory, Hamilton Rating Scale for Depression, Hopelessness Scale, and Social Adjustment Scale were administered prior to and following a 4-week treatment and following a 4-week follow-up. Subjects with higher initial levels of dysfunctional attitudes evidenced a poorer response to the treatment than their attitudinally more functional counterparts. This result was robust and held over a residual gain scoring procedure. Results lend support to the hypothesis that dysfunctional attitude level acts as a general psychopathological indicator.     

The role of parent depression in interactions between mothers and their clinic-referred children

The purpose of this study was to examine the relationship between parent depression and each of three dimensions of interaction between parents and their clinic-referred children: child behavior, parent behavior, and parent perceptions of their children. Thirty-one parent-child pairs served as subjects. All children had been referred to a clinic for treatment of noncompliant behavior problems. The parents were classified into one of three depression levels according to their scores on the Beck Depression Inventory. Parents completed questionnaires concerning their child's adjustment and collected data on the daily occurrence of selected child behavior problems. Independent observers coded parent-child interactions during four home observations. The results indicated that maternal scores on the Beck Depression Inventory were related to parent perceptions of child adjustment but not to parent or child behavior as collected by independent observers or child behaviors collected by the parents.     

Stimulant drug treatment of four multihandicapped children using a randomized single-case design

Single case methodology was employed to assess effects of methylphenidate on the Attention Deficit Disorder with Hyperactivity (ADDH) symptoms of four multihandicapped children. Several doses, ranging from 0.3 mg/kg to 0.9 mg/kg, were randomly administered to each child in a double-blind place bo study. All children demonstrated increased percentage of time on-task in a school setting on methylphenidate as contrasted to placebo, although optimal drug doses varied. Positive changes were also noted on the Abbreviated Conners Teacher Rating Scale (ACTRS), percentage of accurate response to task, and duration of task completion for some children. Negative change in social behavior (i.e., interactive to isolative) with increasing dosages of stimulants was also noted. Implications of these findings were discussed with respect to idiosyncratic dose response, changes in affect, and the utility of single case methodology.     

The Parental Cancer Questionnaire: scale structure, reliability, and validity

Purpose

This study aims to determine the principal component structure of the Parental Cancer Questionnaire (PCQ) in a sample of adult children whose parents had cancer and to illustrate the validity and reliability of subscales.

Method

The PCQ was administered to 311 adult children of parents with cancer along with the Posttraumatic Growth Inventory, Carer's Assessment of Difficulties Scale, Carer's Assessment of Satisfactions Scale, Reaction to Diagnosis of Cancer Questionnaire, and the Grief Diagnostic Instrument.

Results

Exploratory Principal Components Analysis identified three dimensions of the parental cancer experience (explaining 51 % of the variance amongst scale items). The components were parental cancer benefits (e.g. ‘I became closer to my sick parent during his/her cancer.’), emotional experiences (e.g. ‘I was devastated by my parent's cancer.’), and caregiver strain (e.g. ‘I feel/felt there was nobody to assist or support me in caring for my parent.’). Convergent and discriminant validity were demonstrated by meaningful correlations with other related measures (ranging from 0.14 to 0.68), and strong internal reliability was shown with Cronbach α between 0.87 and 0.91.

Conclusions

The PCQ has a clear three-component structure and demonstrates good reliability. The measure has excellent face, content, convergent, and discriminant validity, indicating a structure suitable for use in future research. The measure appears to be a useful measure of the experience of parental cancer for adult children.     

Perceptions of mental handicap: a comparison of Australian and Irish school children

Australian secondary school children (N = 955) were surveyed concerning their perceptions of persons with mental handicap. Data collected related to reactions to meeting a person with disability, helping the handicapped person, responses to specific statements about handicapping conditions, causes of disability and the need for further information about handicaps. Results showed some parallels between Australian and Irish school children with both groups reflecting the positive impact.     

Social competence in children and young people treated for a brain tumour

Purpose

The purposes of this study were to provide a multi-informant assessment of social competence in 8–16-year olds treated for a brain tumour (BT) and then to compare these assessment outcomes to peers.

Method

A cross-sectional, mixed (within and between group) design was used to compare a paediatric BT survivor group (n?=?33) with an age-matched control group (n?=?34) on two multi-informant (self-report, parent, teacher) social competence questionnaires: Social Skills Improvement System (SSIS) and Social Responsiveness Scale (SRS). Demographic factors (age, gender, social economic status (SES), intellectual ability and emotional/behavioural difficulties were investigated as potential non-insult-related risk factors.

Results

Compared to controls, the BT group was reported to have difficulties in social adjustment, interactions and information processing, on both social competence questionnaire measures by parents and teachers, but not self-report. Social competence scores for the BT group were broadly distributed within the normal-severe clinical range, with 40 % of BT survivors scoring in the clinical range for social competence difficulties on the SRS. Lower intellectual ability and emotional/behavioural difficulties accounted for some of the group differences in social competence, but group effects remained once estimated IQ and emotional/behavioural difficulties were controlled for.

Conclusions

Paediatric BT survivors were reported by parents and teachers to have significant difficulties at all three levels of social competence: adjustment, interaction and information processing. The results highlight the importance of routine assessment in clinic settings for social competence and emotional/behavioural difficulties in BT survivors, to promote early identification and to ensure that survivors are referred for appropriate services and intervention as part of their multi-disciplinary care package.

     

Oral Health-Related Quality of Life among Parents and Teachers of Disabled Schoolchildren in Kuwait

Objective

The objective of this study was to assess the oral health-related quality of life between the parents and the teachers of disabled schoolchildren in Kuwait.

Subjects and Methods

The three category response version of the General Oral Health Assessment Index (GOHAI) (12 questions, always, sometimes, never) was used in the questionnaires in Kuwait. Three hundred and eight (308) parents and 112 teachers were enrolled in this study.

Results

The mean age of the parents was 45 ± 9.9 years and of the teachers 38 ± 8.4 years. The mean GOHAI was 27.2 ± 3.5 among the parents and 27.8 ± 3.3 among the teachers (p = 0.091). GOHAI was higher in the older age groups (p = 0.002) and among the parents with a university education (p < 0.001). GOHAI was also higher with increasing toothbrushing frequency among the parents (p = 0.047) and the teachers (p = 0.003). Altogether, 203 (66%) of the parents and 85 (76%) of the teachers were always able to swallow comfortably; 123 (40%) of the parents and 41 (37%) of the teachers were able to eat without discomfort. Overall, 132 (43%) of the parents and 41 (37%) of the teachers were always pleased and happy with the looks of their teeth and gums, or dentures. The Cronbach''s alpha (0.83) indicated a high degree of internal consistency between different GOHAI items.

Conclusion

There seemed to be no difference in the impact of oral health on the quality of life between the parents and the teachers of disabled schoolchildren. Oral health had a relatively weak impact on the quality of life of these adults.Key Words: Quality of life, GOHAI, Parents, Teachers, Disabled children     

Comparing Social Skills in Children Diagnosed with Autism Spectrum Disorder According to the DSM-IV-TR and the DSM-5

Criteria for Autism Spectrum Disorder (ASD) changed significantly with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) with more symptoms needed to meet criteria for ASD. Several researchers have suggested that this will lead to a significant decrease in prevalence for the disorder. Because social skills have been established as a core symptom since autism was first described, the present study examines differences in social functioning using the Matson Evaluation of Social Skills in Youngsters-II (MESSY-II) among children diagnosed with ASD (ages 3–16 years) using DSM-IV-TR criteria, children diagnosed using the DSM-5, and a control group of typically developing children. In the present study of 205 children and adolescents, significant differences were found between the control group and the ASD groups combined. Differences between the DSM-5 group and the DSM-IV group were not found related to inappropriate social skills, suggesting that those who no longer meet diagnostic criteria for ASD exhibit similar social deficits as those who continue to meet criteria for ASD. Concerning socially appropriate behavior, significantly more impairment was found in the DSM-5 group compared with the DSM-IV group, though both groups evinced severe impairments. The implications of these findings are important. Individuals who no longer meet criteria for ASD have clinically significant social deficits and do not differ significantly from those who continue to meet criteria for ASD. Thus, children no longer meeting ASD criteria continue to need interventions that are effective for treating social deficits in autism.     

Assessing the determinants of children's academic self-efficacy beliefs: A replication

Since previous research suggested that modeling is a more important predictor of children's academic/scholastic self-efficacy (comprising efficacy and response-outcome expectations) than performance accomplishments, the present study reexamines this issue. Subjects, 358 schoolchildren (Mage = 10.58 years), completed the children's scholastic self-efficacy and Intelligence Achievement Responsibility Scales, while their mean grade score was obtained. Their teachers completed the Teacher Self-Efficacy Scale. Multiple regression showed that performance accomplishments with feedback was a more effective determinant of efficacy and responseoutcome expectations than modeling. Also, age and attributional style mediated the influence of performance accomplishments on efficacy and outcome expectations, attributional style interacted with modeling in predicting efficacy expectations, while age interacted with performance accomplishments and modeling in explaining outcome expectations. These results support self-efficacy predictions.     

Perceived Control and Vulnerability to Anxiety Disorders: A Meta-analytic Review

Contemporary theories of psychopathology suggest a lack of perceived control as central to the experience of negative emotion and to be particularly relevant to the development of anxiety disorders. The present study meta-analytically reviewed the relationship between perceived control and both trait and disorder-specific measures of anxiety in order to determine whether current evidence is consistent with perceived control functioning as a transdiagnostic vulnerability factor. A comprehensive literature review identified 51 studies with a total of 11,218 participants that were determined to meet eligibility criteria. The mean effect sizes between perceived control and trait measures of anxiety (k = 29) and disorder specific measures of anxiety (k = 37) were calculated using random-effects methods. Results indicated a large, negative association between perceived control and both trait measures of anxiety and disorder-specific measures of anxiety, with the largest associations being between perceived control and generalized anxiety disorder. Moderator analyses indicated that the associations between perceived control and trait anxiety were greater in adults than children, and varied across different measures of perceived control. These results underscore the importance of perceived control as a transdiagnostic vulnerability factor across the anxiety disorders.     

Psychiatric outcome following paediatric intensive care unit (PICU) admission: a cohort study

Objective To determine whether paediatric intensive care unit (PICU) admission is associated with greater psychiatric morbidity in children and parents as compared with general paediatric ward admissions.Design Retrospective cohort study.Setting Paediatric intensive care unit and two general paediatric wards of a London teaching hospital.Participants Children aged 5–18 years discharged from PICU (exposed cohort) and general paediatric wards (unexposed cohort) 6–12 months previously, together with their parents.Measurements and results Children: the Clinician Administered Post Traumatic Stress Disorder (PTSD) Scale for Children (CAPS-C), the Impact of Event Scale (IES), Strengths and Difficulties Questionnaire, Birleson Depression Scale, Revised Childrens Manifest Anxiety Scale, Child Somatization Inventory. Parents: IES, General Health Questionnaire, Beck Depression Inventory, Hospital Anxiety and Depression Scale. Thirty-five of 46 (76%) PICU-discharged families and 33 of 41 (80%) from general paediatric wards participated. Valid CAPS-C data were obtained for 19 PICU-admitted children and 27 children admitted only to the general paediatric ward; 4/19 (21%) of PICU-discharged children developed PTSD (compared with none of 27 ward admissions), p=0.02. PICU children had significantly more PTSD features of irritability and persistent avoidance of reminders of the admission. Parents of PICU children were more likely to screen positive for PTSD (9/33 (27%) compared with 2/29 (7%) parents of ward-admitted children), p=0.04. There were no significant differences between the groups for other measures of psychopathology.Conclusion Post traumatic stress disorder diagnosis and symptomatology is significantly more common in families where a child has been admitted to the PICU. Consideration should be given to providing psychological support for children and parents after PICU admission.     

Parental satisfaction,involvement, and presence after pediatric intensive care unit admission

Purpose

To describe satisfaction, involvement, presence, and preferences of parents following their child's admission to an intensive care unit (ICU).

Methods

A survey, administered 1 month after their child's ICU admission, described perceptions of parental satisfaction with their interaction with healthcare providers, their presence during resuscitation, involvement in treatment decision-making, and preferences if events were to be re-enacted.

Results

One hundred three parents of 91 patients were enrolled; 64 primary parents (70%) completed the survey at 1 month. The mean (SD) satisfaction rating was 87.6 (± 14.8) and involvement rating was 70.2 (± 34.4) on a scale from 0 (not satisfied/involved) to 100 (completely satisfied/involved). There were no differences in satisfaction (P = .46), involvement (P = .69) and change in preferences (P = .97) between parents who were present and not present. After adjusting for child's baseline illness, receipt of more ICU therapies was associated with worse parental satisfaction (P = .03). Twenty-four (38%) parents reported that if events were repeated, they would have changed their preferences.

Conclusions

Overall, parental satisfaction ratings were high, lower in parents of children receiving more ICU therapies, and not associated with presence during resuscitation. These data contrast the American Heart Association's recommendation and suggestion of benefit from parental presence during periods of intensive therapies.     

The utility of secretin-enhanced MRCP in diagnosing congenital anomalies

Purpose

To assess the additional value of secretin-enhanced MRCP (SMRCP) over conventional MRCP in diagnosing divisum.

Methods

Retrospective HIPAA-compliant and IRB-approved review found 140 patients with SMRCP and ERCP correlation within 6 months of each other. All studies were anonymized and the SMRCP images (SMRCP image set) were separated from 2D and 3D MRCP and axial and coronal T2-weighted images (conventional MRI image set). Each image set on each patient was assigned different and randomized case numbers. Two reviewers (R1 and R2) independently reviewed the image sets for divisum vs. no divisum, complete divisum vs. incomplete divisum, and the certainty of diagnosis (1 = definitely certain, 2 = moderately certain, and 3 = unsure). ERCP findings were taken as gold standard.

Results

There was no difference in age and gender between the divisum (n = 97, with 13 incomplete divisum) and no divisum (n = 43) groups. In diagnosing divisum anatomy, the sensitivity was higher for SMRCP compared to conventional MRI for R1 (84.5 vs. 72.2, p = 0.02) but not R2 (89.7 vs. 84.4, p = 0.25). The specificity was higher in SMRCP image set compared to conventional MRI (R1: 88.1 vs. 76.2, p = 0.01; R2: 81.4 vs. 65.1, p < 0.001). The mean area under ROC curve was higher for SMRCP image set (R1: 0.86 vs. 0.74, p = 0.01; R2: 0.87 vs. 0.74, p = 0.01). The certainty of diagnosis was higher in SMRCP image set compared to conventional MRI (p = 0.02 for both reviewers). SMRCP was not found to be superior in distinguishing incomplete from complete divisum. The main reasons for erroneous SMRCP diagnosis were the presence of an ansa loop in the main duct and ductal strictures due to chronic pancreatitis.

Conclusion

Even though the reviewers had more sequences (axial and coronal) to evaluate in the non-secretin image set, there was some improvement in diagnosing divisum with SMRCP.     

Anxiety,Attributional Style,and perceived coping ability

Subjects (N =134) completed an instrument package consisting of the Spielberger State-Trait Anxiety Inventory, the Attributional Styles Questionnaire, the Beck Depression Inventory, and scales designed to assess efficacy expectation, outcome expectation, situational perception of danger, and situational importance. The study was designed to assess attributional styles and cognitive measures associated with anxiety as distinct from depression. Multiple regression was used to determine which predictor variables significantly accounted for explained variance on the three criterion variables of state anxiety, trait anxiety, and depression, respectively. Results showed that bad outcomes-global contributed significantly to explained variance on trait anxiety and that efficacy expectation, importance, and bad outcomes-stable contributed significantly to explained variance on depression. When BDI scores were entered first, no other predictor variables contributed significantly to explained variance on either state or trait anxiety. Significant correlations among the BDI and efficacy expectation, bad outcomes-stable, and trait anxiety were found.     

Parental sleep experiences on the pediatric oncology ward

Purpose

Parents of pediatric oncology patients are encouraged to sleep on the ward with their child to provide additional care throughout the night. The purpose of this study was to provide the first prevalence estimates of self-reported sleep quantity and quality among parents accommodated on the pediatric oncology ward, compared to parents of age-matched controls.

Methods

Parents of children receiving in-patient cancer treatment and parents of healthy, age-matched children completed a self-report questionnaire, including validated measures of parental sleep and psychological distress, demographic, and clinical characteristics.

Results

In total, 114 parents participated (52 parents of children with cancer; 62 control parents; over all response rate 70 %). Parents on the pediatric oncology ward reported sleeping 5.7 h (SD?=?1.8) on average, in comparison to control parents who reported sleeping 7.0 h at home (SD?=?1.4; t?=?4.3, p?<?0.001). Parents reported waking an average of 4.6 times (SD?=?0.3) per night on the ward, compared to control parents who reported 2.0 (SD?=?0.2) nighttime awakenings (t?=?7.69, p?<?0.001). Parents of children with cancer were significantly more likely to report that they had slept “badly” (67.3 versus 21.0 %; χ²?=?21.9, p?<?0.001). Significant predictors of sleep duration included anxiety (p?=?0.013) and caffeine consumption (p?=?0.017). Parents who slept on the ward attributed poor sleep to feelings of anxiety, environmental noise, and child-related factors.

Conclusions

Parents who sleep on the pediatric oncology ward experience poor sleep outcomes, including inadequate duration and frequent interruptions. The detrimental effects of sleep deprivation on parents' ability to cope during this challenging time require further investigation and intervention.     

The efficacy of group and individual cognitive therapy for mild depression

Eighteen mildly depressed subjects were randomly assigned to group or individual cognitive therapy. Twenty mildly depressed subjects were later recruited to serve as delayed treatment controls. Beck's cognitive therapy of depression was provided in a 6-week format by five graduate student therapists. Subjects were assessed before and after the 6-week treatment or waiting period using the Beck Depression Inventory, the D30 Depression Scale, the Brief Symptom Inventory, the State-Trait Anxiety Inventory, and the Tennessee Self Concept Scale. A repeated-measures multivariate analysis of variance determined that there was a significant treatment by time interaction. Subjects who received individual therapy improved more than subjects in the group and delayed treatment conditions. There were no statistically significant differences between subjects in the group and delayed treatment conditions, though subjects who received group therapy tended to show greater improvement than the controls..     

The contribution of self-reinforcement training and behavioral assignments to the efficacy of self-control therapy for depression

Four conditions were compared in a study attempting to assess the contribution of self-reinforcement training and behavioral assignments to the efficacy of a behavioral self-control program previously shown to be effective in alleviating moderate depression. Conditions were (1) self-monitoring, self-evaluation, and self reinforcement training (principles and assignments); (2) self-monitoring and self-evaluation training (principles and assignments); (3) didactic training of principles as in condition 1 without behavioral assignments; and (4) a control treatment—problemoriented, psychodynamic group psychotherapy. Forty-nine volunteer female subjects from the community were screened on Beck Depression Inventory and Research Diagnostic Criteria for unipolar, nonpsychotic depression. Two groups were conducted for each of the three structured self-control treatment conditions. One psychotherapy group was conducted. All groups met weekly for 12 weeks. Results based on the 39 participants who completed treatment indicated that all four conditions were equally effective in producing improvements on self-report and clinician measures of symptoms and severity of depression. All four treatments were equally effective in maintaining improvement at 3-month follow-up. Results are discussed in terms of the problem of identifying core components of effective therapy programs and of assessing them in future outcome studies.     

Dexamethasone pretreatment for 24 h versus 6 h for prevention of postextubation airway obstruction in children: a randomized double-blind trial

Purpose

Multidose steroid pretreatment is effective in preventing postextubation airway obstruction (PEAO) in adults, however controversy continues for children. This study was designed as a randomized, placebo-controlled, double-blind trial to compare the effect of 24-h pretreatment with dexamethasone (24hPD) versus 6-h pretreatment (6hPD) on PEAO and reintubation in children at a tertiary care hospital in a developing economy.

Methods

Hundred twenty-four children (3 months to 12 years) intubated for ≥48 h and planned to have extubation during next 24 h were randomized to receive 24hPD (0.5 mg/kg/dose, q6h, total of six doses; n = 66) or 6hPD (total of three doses; n = 58). Patients with preexistent upper airway conditions, chronic respiratory diseases, steroid therapy in last 7 days, gastrointestinal bleeding, hypertension, and hyperglycemia and those likely to have poor airway reflexes were excluded.

Results

The two groups were similar at baseline. 24hPD reduced the incidence of PEAO (43/66 versus 48/58; p = 0.027) with absolute risk reduction of 17 %. It also reduced the incidence of reintubation, though nonsignificantly, by half [5/61 versus 9/58; relative risk (RR), 1.09; 95 % confidence interval (CI), 0.96–1.25]. Time to recovery from PEAO among non-reintubated patients was shorter among 24hPD patients (p = 0.016). No adverse event was noted with dexamethasone use. Intubation duration >7 days and cuffed tracheal tubes were found to be independent risk factors for PEAO (odds ratio 6 and 3.12, respectively).

Conclusions

24-h pretreatment with multidose dexamethasone reduced the incidence of PEAO and the time to recover from it. 24hPD should be considered for high-risk children intubated for >48 h in the study setting. Further studies with larger sample size from different socioeconomic background are desirable to validate these findings.