CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care

There is growing concern that although the more severe forms of HIV-associated neurologic deficits are reduced following highly active anti-retroviral therapy (HAART), mild to moderate cognitive disorders may persist for years after HAART initiation and this may occur despite complete plasma viral suppression. According to the UNAIDS 2014 report, there were 3.2 million children living with HIV around the world at the end of 2013 and 91 % of these resided in sub-Saharan Africa. In the same year, only 24 % of children who needed antiretroviral treatment (ART) received it and 190,000 children died of AIDS-related illnesses. We propose that behavioral interventions are needed in combination with medical treatment and care in order to fully address the needs of children and adolescents in Africa living with HIV. In early childhood, caregiver training programs to enhance the developmental milieu of the child with HIV can enhance their cognitive and social development and that such interventions are both feasible and well-accepted by the local population. For school-age children, computerized cognitive rehabilitation training can be an entertaining and engaging way to improve attention, working memory, and problem solving skills for children with HIV. Further dissemination and implementation science work is needed for arriving at cost-effective strategies for scaling up such behavioral interventions in African resource-constrained settings, given that the vast majority of HIV-affected children and youth worldwide presently live in sub-Saharan Africa.     

Establishing evidence-based training in cognitive behavioral therapy: A review of current empirical findings and theoretical guidance

Cognitive behavior therapy's (CBT) demonstrated efficacy has prompted calls for its increased dissemination to routine clinical practice settings. For the widespread dissemination of CBT to be successful in achieving effects similar to the original efficacy trials, there must also be effective dissemination of CBT training practices. However, as yet, CBT training is not evidence-based. This review examines what can be learned from existing research into the efficacy and effectiveness of CBT training. Due to the paucity of research specifically investigating CBT training, CBT effectiveness and dissemination studies are also examined to glean information about potentially effective training practices. In order to draw conclusions about effective training practices, comparisons are drawn between studies according to the clinical outcomes that they achieved. Training approaches are compared according to dose and active training elements, and theoretical models of learning are applied to interpret the findings. The limitations of the existing literature are discussed, as well as recommendations for improving training research to meet the standards evident in treatment trials (e.g., random allocation, control conditions, self-report and blind assessment, and adherence monitoring). Finally, the process of developing efficacious CBT treatment protocols is offered as a template for developing evidence-based CBT training protocols.     

“What do you say to them?” investigating and supporting the needs of lesbian,gay, bisexual,trans, and questioning (LGBTQ) young people

This study explores the experiences and support needs of lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people living in Sussex (UK), and the training needs of practitioners working with LGBTQ young people. The aims were to explore the experiences of young people including bullying, “coming out,” social service and educational needs, and to investigate how practitioners view the needs of LGBTQ young people. Twenty‐nine interviews were conducted and analyzed thematically. Participants stressed the social and health impact of discrimination and bullying on young people as well as barriers faced in accessing services. Young people require support, yet practitioners lack the training to provide that support. Practitioners are open to this training and both groups of participants believe effective training should include youth in the development and delivery. There is an urgent need for the development of appropriate and dedicated LGBTQ youth training for all practitioners working with young people. © 2011 Wiley Periodicals, Inc.     

Training in Empirically Supported Treatments Using Alternative Learning Modalities

[Clin Psychol Sci Prac 18: 84–88, 2011] Godley, Garner, Smith, Meyers, and Godley (2011) describe an intensive dissemination and implementation program for empirically supported substance use treatment in a community setting. Among the many procedures employed by this dissemination program is the integration of in‐person and alternate learning modalities (web‐based training.) The use of alternate learning modalities to aid treatment dissemination is relatively new, and much needs to be learned about how to best use these methodologies. Early research suggests that, at a minimum, these training aids may be an effective adjunct to more traditional approaches and potentially may become an invaluable tool for large‐scale treatment dissemination.     

A Multisite,Multidisciplinary Delphi Consensus Study Describing “Usual Care” Intervention Strategies for School-Age to Transition-Age Youth With Autism

Understanding usual care is important to reduce health disparities and improve the dissemination of evidence-based practices for youth (ages 7–22 years) with autism spectrum disorder (ASD). A barrier to describing “usual ASD care” is the lack of a common vocabulary and inventory of the practices used by a diverse provider field. To address this barrier, we gathered input from expert providers to develop an inventory of usual care practices and assess expert familiarity and perceptions of these practices as interventions for anxiety, externalizing, and social difficulties in ASD. Purposeful sampling recruited 66 expert ASD providers representing multiple disciplines from 5 sites. Via a 2-round Delphi poll, experts reviewed, suggested revisions to and rated 49 literature-derived practices on several dimensions (familiarity, usefulness, common use, research support). A revised list of 55 practices and anonymous summary of group characteristics and ratings was then returned for further review. Results yielded 55 intervention practices, 48 of which were identified as “familiar” approaches by consensus (≥ 75% endorsement). Greater variation was observed in practices identified by consensus as most often used, useful, and research supported, depending upon the target problem. Findings provide an inventory of practices, reflective of the multidisciplinary language and approaches of expert ASD providers. This inventory may be used to better assess what constitutes usual care for youth with ASD in the United States. Moreover, findings offer insights from clinical experts regarding the range and acceptability of practices that may inform and ground treatment research, dissemination, and implementation efforts.     

昆明市一所大学预防药物滥用及HIV／AIDS研究

在云南省财贸学院开展为期半年的预防药物滥用及感染性免疫缺陷病毒／艾滋病（ＨＩＶ／ＡＩＤＳ）活动。５３名自愿参加预防活动的大学生作为预防对象。预防方法以个人和社会技能训练为主，辅予信息传播方法和拒绝技能训练。训练课程分为８次，每次９０分钟。活动前后进行自身对照比较。结果显示，预防活动能提高预防对象相关知识的水平。预防对象的个人和社会技能比参加活动前有显著的提高。不足的是这种预防活动没有能改变预防对象对药物滥用及ＨＩＶ／ＡＩＤＳ的负性态度。研究对今后以学校为基础的预防方法提出了建议。     

Anxiety Treatment and Targeted Sleep Enhancement to Address Sleep Disturbance in Pre/Early Adolescents with Anxiety

Sleep disturbance is prevalent in anxious youth and prospectively predicts poor emotional adjustment in adolescence. Study 1 examined whether anxiety treatment improves subjective and objective sleep disturbance in anxious youth. Study 2 examined whether a sleep intervention called Sleeping TIGERS can further improve sleep following anxiety treatment. Study 1 examined 133 youth (ages 9–14; 56% female; 11% ethnic/racial minority) with generalized, social, or separation anxiety over the course of anxiety treatment (cognitive behavioral treatment or client-centered treatment). Sleep-related problems (parent-, child-report) and subjective (diary) and objective (actigraphy) sleep patterns were assessed across treatment in an open trial design. Study 2 included 50 youth (ages 9–14; 68% female; 10% ethnic/racial minority) who continued to report sleep-related problems after anxiety treatment and enrolled in an open trial of Sleeping TIGERS. Pre- and postassessments duplicated Study 1 and included the Focal Interview of Sleep to assess sleep disturbance. Study 1 demonstrated small reductions in sleep problems and improvements in subjective sleep patterns (diary) across anxiety treatment, but outcomes were not deemed clinically significant, and 75% of youth stayed above clinical cutoff. Study 2 showed clinically significant, large reductions in sleep problems and small changes in some subjective sleep patterns (diary). Anxiety treatment improves, but does not resolve, sleep disturbance in peri-pubertal youth, which may portend risk for poor emotional adjustment and mental health. The open trial provides preliminary support that Sleeping TIGERS can improve sleep in anxious youth to a clinically significant degree.     

红细胞剪切弹性模量与表面粘度的改变对红细胞变形与取向的影响

神经氨酸酶 (唾液酸酶 )与红细胞发生生物化学作用能部分地去掉其表面电荷 ,从而引起红细胞膜微观结构发生改变 ,导致其膜剪切弹性模量和表面粘度的变化 ,分别改变其作用时间和二者的相对作用剂量 ,然后用一种在低粘切变流场中能将红细胞变形指数 DI分解为取向指数 (DI) or和小变形指数 (DI) d 的新型激光衍射法 ,分别测量经过各种处理的红细胞的小变形指数 (DI) d 和变形恢复过程即松弛过程中变形恢复到最大值 (DI) max一半的时间 t0 .5 ,并将其结果分别代入由文宗曜、严宗毅等 [1 ]提出的一种测量红细胞膜的剪切弹性模量 (E)公式和表面粘度(μm)公式。得出各种处理后的红细胞膜剪切弹性模量和表面粘度的变化规律。同时测量经过各种处理的红细胞的变形指数 DI和取向指数 (DI) or,也得到二者的变化规律。发现随着神经氨酸酶处理剂量的增加和处理时间的延长红细胞膜剪切弹性模量和表面粘度明显增大 ,而红细胞的变形指数 DI和取向指数 (DI) or却减小 ,呈现明显的反相关关系。说明红细胞膜剪切弹性模量的增大使其变形性变差 ,表面粘度的增大导致其取向能力变差     

Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety: Predictors and Associations With Outcomes

Cognitive behavioral therapy (CBT) for anxiety disorders is effective, but nonadherence with treatment may reduce the benefits of CBT. This study examined (a) four baseline domains (i.e., demographic, youth clinical characteristics, therapy related, family/parent factors) as predictors of youth adherence with treatment and (b) the associations between youth adherence and treatment outcomes. Data were from 279 youth (7–17 years of age, 51.6% female; 79.6% White, 9% African American), with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, who participated in CBT in the Child/Adolescent Anxiety Multimodal Study. Adherence was defined in three ways (session attendance, therapist-rated compliance, and homework completion). Multiple regressions revealed several significant predictors of youth adherence with CBT, but predictors varied according to the definition of adherence. The most robust predictors of greater adherence were living with both parents and fewer youth comorbid externalizing disorders. With respect to outcomes, therapist ratings of higher youth compliance with CBT predicted several indices of favorable outcome: lower anxiety severity, higher global functioning, and treatment responder status after 12 weeks of CBT. Number of sessions attended and homework completion did not predict treatment outcomes. Findings provide information about risks for youth nonadherence, which can inform treatment and highlight the importance of youth compliance with participating in therapy activities, rather than just attending sessions or completing homework assignments.     

An evaluation of peer coping-skills training for childhood aggression

Peer coping-skills (PCS) training is a new school-based intervention designed to promote prosocial coping among school-age children. The intervention is based on a coping-competence model that addresses the development of antisocial and asocial coping among youth at elevated risk for conduct disorder. PCS training was tested in a controlled evaluation with children in Grades 1 to 3 who exhibit high rates of aggressive behavior, and it was found to increase prosocial coping via information exchange, improve social skills, and reduce aggression. These improvements were maintained into the next school year, as reflected in a 6-month follow-up assessment by teachers. Competent-nonaggressive children who also participated not only showed no adverse effects by demonstrated skill enhancement. Children, parents, and teachers in the ethnically diverse sample rated PCS training as highly acceptable. It is recommended that PCS training be combined with family and classroom intervention strategies over multiple years to promote the development of competence and to increase the likelihood of preventing conduct disorders in high-risk youth.     

Getting to Dissemination

The combination of a stage model of psychotherapy and treatment manualization has been a major step forward in treatment development and efficacy testing, but not in dissemination. I argue that the technological model of treatment development makes research on the practical application of these technologies difficult. If we continue on our present course, research on dissemination will be uncommon, expensive, and largely irrelevant to the practical issues that need to be faced. It makes more sense to proceed directly to dissemination research. Alternative methods, including manipulated training designs, will permit this, but these fundamentally challenge the implicit assumptions of the stage model.     

Fear and Missing Out: Youth Anxiety and Functional Outcomes

Anxiety disorders are prevalent and associated with functional impairments. Outcome research has focused on symptom reduction, rather than positive factors such as life satisfaction and improved functioning. We review the impact of youth anxiety disorders and elevated anxiety symptoms on academic, occupational, family, social, and legal functioning. Emphasis is placed on the degree to which developmental trajectories differ for youth with and without anxiety disorders. In some areas, psychopathology generally, rather than anxiety specifically, is associated with functional impairment. Other studies support youth anxiety as a unique predictor of functional impairment. In particular, social anxiety is associated with impairments in social functioning throughout development. The short‐ and long‐term impacts of anxiety treatment in youth are discussed. Last, research directions are suggested.     

Using Treatment Integrity Methods to Study the Implementation Process

[Clin Psychol Sci Prac 18: 36–40, 2011] The last decade has witnessed increased interest in the implementation and dissemination of evidence‐based treatments (EBTs) for youth. Nakamura et al. (2011) detail lessons learned over the past decade from the large‐scale implementation of EBTs for children in Hawaii. This commentary discusses how lessons from Hawaii’s initiative can help inform the next generation of implementation research. Specifically, we focus on how treatment integrity models and methods designed to characterize core aspects of treatment delivery can be used to study the implementation process. Using the new interactive online reporting systems developed by Nakamura et al. to collect treatment integrity data offers researchers a way to determine how best to implement EBTs in community‐based service settings with integrity and skill.     

Commentary on Berger,Hohl, and Caspar's (2009) Internet‐based treatment for social phobia: a randomized controlled trial

In this commentary, we discuss the implications of the findings by Berger, Hohl, and Casper (this issue) together with the emerging database on the effects of Internet treatment for social anxiety disorder (social phobia). Their article is the third independent replication of guided Internet treatment of social anxiety disorder, and in this article, we comment on future research challenges and if Internet treatment now can be regarded as ready for dissemination into regular clinical settings. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1–3, 2009.     

Political violence,social integration,and youth functioning: Palestinian youth from the Intifada

Informed by social ecological, social capital, and social disorganization theories, this study tested an ecological model of youth experience in the Palestinian Intifada. The sample included 6,000 Palestinian 14 year olds, assessed in 1994 and 1995 after the end of the conflict. Data from retrospective self‐reports of youth exposure to and involvement in political violence, and self‐reports of current individual functioning (depression and antisocial behavior) and integration in several social contexts (family, peer relations, religion, education, and community), revealed: direct associations between Intifada experience and antisocial behavior and depression (females only); Intifada experience was positively associated with religiosity and unrelated to social integration in family, school, and peer relations; in some cases, social integration in family, education, religion, and peer relations significantly moderated the associations between Intifada experience and youth problems; integration in the several social contexts was directly related in predictable ways to youth problem behaviors, with neighborhood disorganization the most consistent and powerful predictor. The discussion centers around youth resilience to the effects of political violence, the role of psychological meaning children and adolescents can attach to political violence, and the overall salience of social integration in youth development. © 2001 John Wiley & Sons, Inc.     

Behavior Therapy for Youth With Tourette Disorder

Persistent tic disorders and Tourette disorder (TD) are neuropsychiatric conditions that commonly co‐occur among youth with obsessive‐compulsive disorder. Although historically managed with pharmacological agents such as antipsychotics and alpha‐2 agonists, behavioral interventions like habit reversal training (HRT) and the comprehensive behavioral intervention for tics have demonstrated considerable efficacy in reducing tic symptom severity. This case study illustrates the implementation of behavior therapy in reducing tic symptom severity of an adolescent with TD. Arlene was a 14‐year‐old girl with TD who presented with moderate tic symptom severity that caused her physical, academic, and social impairment. In addition to concurrent pharmacotherapy, Arlene completed a 20‐session weekly course of HRT, and experienced a clinically meaningful reduction in tic symptom severity and tic‐related impairment. This example provides further evidence of the benefit of behavior therapy in reducing tic symptom severity and highlights key considerations for treatment of youth with TD.     

Unimpaired maintenance of a conditioned avoidance response in the rat with diabetes insipidus.

The ability to maintain a conditioned avoidance response (CAR) was studied in normal Long-Evans rats and rats of the Brattleboro strain which were either homozygous or heterozygous for hereditary hypothalamic diabetes insipidus (DI). Homozygous DI rats had a lower CAR acquisition rate than did normal or heterozygous DI rats. However, the homozygous DI rats exhibited significantly greater CAR retention than did the other animals over the total period of extinction testing. The greater CAR retention could not be accounted for by either increased sensitivity to the electric foot shock used as the unconditioned stimulus or by perching on the metal center barrier of the training shuttle box, a form of behavior unique to the homozygous DI rats. Since the homozygous DI rat is totally lacking in hypothalamic antidiuretic hormone (ADH), the greater CAR retention of these animals indicates that ADH is not a requirement for CAR retention.     

Concerns and coping of African-American mothers after youth assault requiring emergency medical treatment

OBJECTIVE: To explore maternal experience following youth assault occurring in the community. METHODS: A semistructured interview was used to elicit concerns and coping strategies among 35 African-American mothers whose children received emergency department (ED) treatment for assault-related injuries. Mothers also completed measures of violence exposure, trauma symptoms, social support, and youth functioning. RESULTS: The most common concerns involved family safety, maternal mental health, and youth externalizing behavior. Faith and social support were the most common coping strategies. High levels of distress were found, which were directly related to maternal violence exposure, relationships that required mothers to nurture others, and youth functioning. Distress was inversely related to relationships that provided guidance from others. CONCLUSION: Distress is common among low-income African-American mothers of youth assault victims. To bolster youth recovery and to reduce the risk of future injury, ED staff should be knowledgeable regarding culturally sensitive resources to address maternal distress.     

Clinical Child Psychology's Progress in Disseminating Empirically Supported Treatments

Advances have been made over the past decade in identifying, evaluating, and disseminating empirically supported treatments (ESTs). Progress with adult ESTs, compared to child treatments, however, has differed. This article highlights areas of advancements, reviews literature related to specific training methods (i.e., treatment manuals, graduate education, continuing education, and EST protocols), discusses issues relevant to adult versus child treatment dissemination, and provides recommendations for enhancing the dissemination of ESTs.