Psychoeducational multi-family group treatment with adolescents at high risk for developing psychosis

Aim: In this study, we investigate the feasibility and acceptability of a 9‐month psychoeducational multi‐family group (PMFG) intervention for adolescents who are at ultra‐high–risk (UHR) for developing psychosis. Methods: The treatment programme was adapted from those previously shown to be effective in patients with established psychotic illness, but emphasizes content relevant to adolescence and to a pre‐onset phase of illness. Results: Participants report that psychoeducational presentations are highly useful, they attend the PMFG group sessions regularly and report feeling comfortable in meetings and benefiting from them, and adolescents demonstrate improvement in symptoms and functional outcome. Conclusions: This study was not a randomized controlled trial and multiple interventions were introduced simultaneously; thus, changes in outcome cannot be attributed to the PMFG intervention per se. Nonetheless, these results establish the acceptability of PMFG to adolescents and families, and encourage further research into the potential positive impact of PMFG with this at‐risk population.     

Parent-teen connection: Towards a family systems approach to group therapy with young “At-risk” adolescents and their parents

The theoretical principles underlying a family systems approach to group therapy are discussed. Bowen's concepts ofemotional system anddifferentiation of self, together with principles and practices from the Satir model of family therapy are incorporated into a program of group therapy with “at risk” adolescents and their parents. Components of the program are described together with examples.     

Taking charge of epilepsy: the development of a structured psychoeducational group intervention for adolescents with epilepsy and their parents

Children and adolescents with epilepsy frequently experience poor psychosocial outcomes due to numerous factors such as perceived stigma, behavior problems, academic difficulties, and depression. Health psychology research has documented the effectiveness of psychoeducational interventions aimed at improving psychosocial outcomes for individuals with a variety of health conditions. With increasing numbers of adolescents living with epilepsy, interest in improving the quality of life for this particular population has grown. There remains, however, a paucity of research concerning psychosocial interventions for adolescents with epilepsy. The present study outlines the development and initial implementation of a 6-week structured psychoeducational group intervention for adolescents with epilepsy and their parents. Preintervention, the QOLIE-AD-48, Childhood Depression Inventory, and Revised Children's Manifest Anxiety Scale were administered. Educational topics included medical aspects of epilepsy, healthy lifestyle behaviors, family and peer relationships, understanding self-image and self-esteem, and stress management techniques. Participants were introduced to a variety of cognitive-behavioral strategies, and were encouraged to share their own experiences with epilepsy. Feedback from adolescent and parent participants indicated that the intervention was relevant to their needs, helped them better understand their epilepsy, and allowed an opportunity for positive peer support. Also, postintervention outcome measurement indicated an overall positive trend for quality of life improvement in the adolescents.     

Cross-informant agreement between adolescents with myelomeningocele and their parents

The development of self-management skills by adolescents with myelomeningocele is an ongoing process. Previous studies lack consensus about what data can be accurately obtained from adolescents. This cross-sectional study using a convenience sample of 66 adolescent-parent dyads evaluated whether adolescents with myelomeningocele and their parents are interchangeable reporters of data. Adolescents' ages ranged from 12 to 21 years with a mean of 16 years 2 months (SD 2y 8mo); 38 were female, 28 were male; 30% had thoracic lesions, 32% had lumbar lesions, 15% had lumbosacral lesions, 23% had sacral lesions, and 85% had ventriculoperitoneal shunts. In this analysis, participants reported activities (decision-making, household responsibility, and friendship activities) and select outcomes (functional status, self-management, and social competence) similarly. However, differences emerged in reports of beliefs (adolescent future expectations, family variables) and select developmental competencies (school, job, athletic, behavioral, attractiveness, and romantic appeal). Analysis using t-test and interclass correlations supported a pattern of adolescent-parent agreement in areas of observable behavior and differences in more subjective domains such as perception of developmental competencies.     

Posttraumatic stress in adolescents with asthma and their parents

OBJECTIVE: To assess posttraumatic stress (PTS) symptoms in adolescents with and without asthma and their parents and the relationship between PTS symptoms and asthma morbidity. METHOD: Three groups of adolescents (12-18 years) participated: adolescents who had experienced a life-threatening asthma episode (n=49), asthma controls (n=71), and healthy controls (n=80). Adolescents completed the UCLA PTSD Reaction Index, Multidimensional Anxiety Scale for Children, and Reynolds Depression Inventory. Parents completed the Impact of Events Scale-Revised, Brief Symptom Inventory, and Asthma Functional Morbidity Scale. RESULTS: Twenty percent of adolescents with life-threatening asthma met criteria for PTSD compared with 11% of the asthma controls and 8% of the normal controls. Twenty-nine percent of parents of adolescents with life-threatening asthma met criteria for PTSD compared with 14% of parents of asthma controls and 2% of normal controls. Adolescent PTS symptoms accounted for 5% of the variance in functional asthma morbidity even after controlling for disease severity and other anxiety and depressive symptoms (beta=.26). CONCLUSIONS: Adolescents with asthma and their parents, particularly those who have experienced a life-threatening event, have high levels of PTS symptoms that are linked to asthma morbidity. Interventions to improve asthma outcomes should include assessment and treatment of trauma and PTS symptoms.     

Consulting for substance abuse: mental disorders among adolescents and their parents

Studies conducted outside of Scandinavia indicate that most adolescents with substance misuse problems suffer from co-morbid mental disorders. The present study assessed the mental health of adolescents seeking help for substance misuse problems in a large Swedish city. Parents' mental health was also examined. The sample included 97 girls with their 90 mothers and 52 fathers, and 81 boys with their 72 mothers and 37 fathers. The adolescents completed a diagnostic interview, either the Kiddie-SADs or the Structured Clinical Interview for DSM-IV (SCID) depending on their age. Their parents underwent diagnostic interviews with the SCID. Ninety per cent of the girls and 81% of the boys met criteria for at least one disorder other than substance misuse, and on average, they suffered from three other disorders, most of which had onset before substance misuse began. Almost 80% of the mothers and 67% of the fathers met criteria for at least one mental disorder other than alcohol and drug-related disorders. The findings concur with those reported from studies conducted in North America. The results suggest that in Sweden mental disorders are not being identified and effectively treated among some children and young adolescents who subsequently abuse alcohol and/or illicit drugs. Adolescents who consult for substance abuse problems require assessments and treatment by mental health professionals.     

Dreamwork with children and adolescents in group therapy

Clinical literature stresses the intimate connection between social support and mental health. This paper pilots an experimental model of group treatment for children and adolescents using dreams to develop courage and an internal sense of social support. Using methods adapted from Senoi dreamwork, Gardiner, Ullman and Mills, most of the experimental subjects showed enhancement of their social support networks and improvement in psychosocial functioning over the groups' six month time frame.     

Psychological education as a group process for parents of adolescents with eating disorders

Psychoeducation is a well-established component of cognitive-behavioral therapy in adult patients with eating disorders. This paper describes a group model of psychoeducation that has been offered by our department for the past two years to parents of adolescent patients with anorexia and bulimia nervosa. According to their own reports, parents appreciate this means of support to help them cope with their child's illness.     

Transition from East to West: Vietnamese adolescents and their parents

A 28-item questionnaire assessing family values was completed by 191 Vietnamese and 639 Caucasian adolescents in Oklahoma City Public Schools and by about half their parents. Vietnamese refugee parents, regardless of time in the United States, strongly endorsed traditional family values. Vietnamese adolescents tended to reject traditional values. This generation gap increased with time in the United States and was greater for girls than for boys. Despite wholehearted endorsement of traditional family values, Vietnamese parents tended to approve certain adolescent privileges. The results suggest that Vietnamese adolescents may receive conflicting messages from their parents. On the one hand, parents endorsed such traditional values as absolute obedience to parental authority but on the other, they registered relative approval of adolescent freedom of choice regarding dating, marriage, and career. Such ambivalence suggests that Vietnamese refugee families may experience considerable strain while adjusting to American values.     

Anger management for adolescents: efficacy of brief group therapy

OBJECTIVES: To investigate the efficacy of a brief, manual-based group therapy for adolescents with poor anger control. A previously developed anger management treatment package of 10 to 12 sessions was condensed to a 4-session package to be given within 2 weeks. Immediate effectiveness and the transfer of skills were investigated; anger management skills not only had to be acquired, they also had to be used in the adolescents' natural social interactions. METHOD: Fifty adolescent psychiatric inpatients were selected for high levels of anger and randomly assigned to treatment or control conditions. Pre- and posttreatment measures were administered to subjects and adults who rated the subjects' behaviors. RESULTS: Pre/post self-report measures, as well as behavior ratings by adults, indicated that the patients who went through the anger management series exhibited significantly improved skills. CONCLUSIONS: These results suggested that the intervention for adolescents was effective even though it was condensed, but it should not be further abbreviated.     

An experience of group work with parents of children and adolescents with gender identity disorder

This article gives an account of an experience of group work with parents and carers who had children or adolescents with gender identity disorder (GID). The history of this intervention within the context of a service for children with gender identity problems is outlined. The limited literature on the subject is reviewed. Group meetings were held monthly for 6 months, facilitated by two therapists (the authors). Selection criteria for group participants, the aims of the group and the methodology for achieving those aims are described. Some information about the group's composition is provided. The structure and content of the group sessions are outlined together with details of some group interactions. Finally, we present the results of an evaluation of the intervention through feedback questionnaires and discuss the value for the children and young people of running such groups.     

Manual-Driven group cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: a pilot study.

OBJECTIVE: Concerns about isolation, compromised development, partial pharmacotherapy response, therapist scarcity, and inadequate cognitive-behavioral therapy (CBT) adherence led the authors to adapt a CBT protocol to a group format for adolescents with obsessive-compulsive disorder (OCD). A naturalistic, open trial of group CBT for adolescent OCD is described. The authors predicted symptom improvement and format acceptability. METHOD: Over a 1 -year period, 18 adolescents aged 13 to 17 years with OCD received 14-week group CBT based on March and Mulle's OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual in four consecutive sessions of five to nine patients. Eighty-three percent had undergone at least one medication trial, and 78% had previous CBT experience. RESULTS: OCD symptoms measured by the Children's Yale-Brown Obsessive Compulsive Scale improved significantly, both statistically and clinically. Adolescents consistently shared information and designed exposure interventions for themselves and others during sessions. Repeated self-report measures confirmed adolescents' satisfaction with therapy. CONCLUSIONS: This pilot study demonstrates that a manual-based treatment protocol may be exported for clinical use, adaptable for the end-user's needs, and palatable to adolescent patients. Clinical improvement and patient satisfaction justify further investigation in a controlled study.     

Structured group therapy for learning and behaviorally disabled children and adolescents

This paper will describe verbal group psychotherapy with children diagnosed as ADD, ADHD, LD and behaviorally disturbed. Such verbally oriented group psychotherapy is a powerful tool when the language needs of the children are addressed and when there is adequate external structure to allow for real therapy. Structure insures safety and reduces the experience of emotional threat. Focusing on the language processing allows children whose language problems may have precluded them from a talking group to be included and helped. This allows them to progress through the stages of group development. Without structure and attention to their language needs, these children will become stuck in the initial regression because they do not have the tools to progress. The authors have developed two models that incorporate these principles. These models have shown success and are of practical use with a learning and behaviorally disabled population.