A school-based mental health program for traumatized Latino immigrant children

OBJECTIVE: To pilot-test a school mental health program for Latino immigrant students who have been exposed to community violence. METHOD: In this quasi-experimental study conducted from January through June 2000, 198 students in third through eighth grade with trauma-related depression and/or posttraumatic stress disorder symptoms were compared after receiving an intervention or being on a waitlist. The intervention consisted of a manual-based, eight-session, group cognitive-behavioral therapy (CBT) delivered in Spanish by bilingual, bicultural school social workers. Parents and teachers were eligible to receive psychoeducation and support services. RESULTS: Students in the intervention group ( = 152) had significantly greater improvement in posttraumatic stress disorder and depressive symptoms compared with those on the waitlist ( = 47) at 3-month follow-up, adjusting for relevant covariates. CONCLUSIONS: A collaborative research team of school clinicians, educators, and researchers developed this trauma-focused CBT program for Latino immigrant students and their families. This pilot test demonstrated that this program for traumatized youths, designed for delivery on school campuses by school clinicians, can be implemented and evaluated in the school setting and is associated with a modest decline in trauma-related mental health problems.     

Brief Report: Effects of Cognitive Behavioral Therapy on Parent-Reported Autism Symptoms in School-Age Children with High-Functioning Autism

This pilot study tested the effect of cognitive behavioral therapy (CBT) on parent-reported autism symptoms. Nineteen children with autism spectrum disorders and an anxiety disorder (7–11 years old) were randomly assigned to 16 sessions of CBT or a waitlist condition. The CBT program emphasized in vivo exposure supported by parent training and school consultation to promote social communication and emotion regulation skills. Parents completed a standardized autism symptom checklist at baseline and posttreatment/postwaitlist and 3-month follow-up assessments. CBT outperformed the waitlist condition at posttreatment/postwaitlist on total parent-reported autism symptoms (Cohen’s d effect size = .77). Treatment gains were maintained at 3-month follow-up. Further investigation of this intervention modality with larger samples and broader outcome measures appears to be indicated.     

Comorbidity in childhood anxiety disorders and treatment outcome.

OBJECTIVE: Psychiatric comorbidity is common in anxious children. The purpose of this study was to investigate the impact of comorbidity on treatment outcome in anxious children. METHOD: Participants were 173 children between the ages of 8 and 13 years who met primary DSM-III-R/DSM-IV diagnoses of separation anxiety disorder, overanxious disorder/generalized anxiety disorder, or avoidant disorder/social phobia assessed by the Anxiety Disorders Interview Schedule for Children (ADIS-C). The majority (79%) had at least one comorbid diagnosis. Participants were randomly assigned to cognitive-behavioral therapy or waitlist. Group differences in ADIS-C diagnoses were compared after treatment. Multiple parent and child self-report measures were used to measure symptoms as well. RESULTS: Pretreatment comorbidity was not associated with differences in treatment outcome: 68.4% of noncomorbid participants and 70.6% of comorbid participants were free of their primary diagnosis after treatment. Regarding parent and child self-report symptoms, multivariate analyses of variance revealed significant time (treatment) main effects, but no significant main effect for group (comorbid status) or time/group interaction. CONCLUSIONS: The cognitive-behavioral treatment program was similarly effective in anxious children with and without comorbid disorders; both groups showed clinically significant reductions in pretreatment diagnoses and symptoms.     

Cognitive-behavioral group treatments in childhood anxiety disorders: the role of parental involvement.

OBJECTIVES: This study examined (1) the effect of a cognitive-behavioral group intervention on anxiety, depression, and coping strategies in school-age children (aged 7-12 years) with Axis I anxiety disorders; and (2) the effect of parental involvement on treatment outcomes. METHOD: Parents and children (N = 62) were randomly assigned to one of three 12-week treatment conditions: parent and child intervention, child-only intervention, and parent-only intervention. Child anxiety, depression, and coping strategies were assessed before and after treatment. RESULTS: All treatment groups reported fewer symptoms of anxiety and depression posttreatment and changes in their use of coping strategies. Children in the parent and child intervention used more active coping strategies posttreatment compared with children in the other 2 treatment conditions. Parents in this treatment condition reported a significantly greater improvement in their children's emotional well-being than parents in the other treatment conditions. CONCLUSIONS: Cognitive-behavioral group interventions reduced symptoms of anxiety and depression in school-age children with anxiety disorders. Concurrent parental involvement enhanced the effect on coping strategies. Further investigation is needed to corroborate the effectiveness of such short-term interventions and the maintenance of treatment effects.     

Family adversity in DSM-IV ADHD combined and inattentive subtypes and associated disruptive behavior problems

OBJECTIVE: This study evaluated the relationship between a family adversity index and DSM-IV attention-deficit/hyperactivity disorder (ADHD) subtypes and associated behavior problems. The relationship of family adversity to symptoms and subtypes of ADHD was examined. METHOD: Parents and 206 children aged 7-13 completed diagnostic interviews and rating scales about socioeconomic status, parental lifetime psychiatric disorders, marital conflict, and stressful life events. RESULTS: Children with ADHD combined type experienced more risk factors than community controls (p = .002) or children with ADHD predominantly inattentive type (p = .02). The families of children with ADHD combined type described more risk factors associated with family adversity than the families of children with ADHD inattentive type and the control group. Parent-rated symptoms of child inattention/disorganization were related uniquely to the adversity index score independently of conduct disorder symptoms. Children's perceptions of marital conflict were independently related to inattention and hyperactivity behaviors as rated by parents and teachers after control of all other risk factors. Oppositional defiant symptoms were independently related to marital conflict and maternal psychopathology, whereas conduct disorder symptoms were uniquely related to low socioeconomic status and maternal psychopathology. CONCLUSIONS: Family adversity is related to ADHD combined type in children and may be related specifically to ADHD symptoms in addition to conduct disorder symptoms.     

Reducing the Prevalence of Anxiety in Children and Adolescents: An Evaluation of the Evidence Base for the FRIENDS for Life Program

Current estimates suggest that between 8 and 22% of children and adolescents may suffer from an anxiety disorder. Effective intervention efforts are therefore clearly needed to reduce the likelihood of anxious symptoms and promote healthy functioning. One intervention that appears feasible for use in schools and was designed to target anxiety symptoms is the FRIENDS for Life program. Evaluation of FRIENDS has been limited in the United States; however, criteria for evaluation of such programs are available. Thus, the purpose of this paper is to review the research base regarding the FRIENDS for Life program and apply coding procedures to examine program effectiveness. Overall, results suggested promise for use in school-based settings, given demonstrated effectiveness in reducing anxiety symptoms in both universal and targeted populations when implemented within the school ecology. Limitations of the existing evidence base, however, are discussed, thus providing direction for future research.     

The feelings club: randomized controlled evaluation of school‐based CBT for anxious or depressive symptoms

Background: Children with anxious or depressive symptoms are at risk of developing internalizing disorders and their attendant morbidity. To prevent these outcomes, school‐based cognitive‐behavioral therapy (CBT) has been developed, but few studies include active control conditions. We evaluated a preventive CBT program targeting internalizing symptoms relative to an activity contrast condition post‐intervention and at 1‐year follow‐up. Methods: One thousand one hundred and thirty‐nine children from Grades 3–6 from a diverse sample of schools, were screened with the Multidimensional Anxiety Scale for Children and Children's Depression Inventory. Those with t>60 on either measure were offered participation in a randomized 12‐week trial, school‐based group CBT versus a structured after‐school activity group of equal duration. We explored several therapeutic elements as potential predictors of change. Results: One hundred and forty‐eight children participated (84 boys, 64 girls; 78 CBT, 70 contrast; 57% Caucasian) and 145 completed the program. Self‐reported anxious and depressive symptoms decreased significantly over time (η²=.15 and .133, respectively), with no group by time interaction. There was a trend toward fewer children meeting diagnostic criteria for an anxiety disorder on the Anxiety Disorders Interview Schedule at 1‐year post‐CBT than post‐contrast (6/76 versus 12/69). Positive reinforcement of child behavior was associated with change in anxiety symptoms; checking homework was understood with change in depressive symptoms. Conclusions: Findings suggest that children with internalizing symptoms may benefit from both school‐based CBT and structured activity programs. Replication, longer follow‐up, and further studies of therapeutic elements in child CBT are indicated. ISRCTN Registry identifier: ISRCTN88858028, url: http://www.controlled‐trials.com/ Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

School-based social skills training for young people with autism spectrum disorders

ABSTRACT

Background: The Secret Agent Society (SAS) Program, an intervention to enhance social–emotional skills, was provided by schools for children with autism spectrum disorder (ASD). The program was assessed to determine if it improved social skills at school and home, and whether improvements were maintained.

Methods: Eighty-four students participated. Key outcomes were parent and teacher ratings of emotion regulation, social skills, and direct child social problem-solving measures. The standard school curriculum served as the control condition. Phase 1 was a two-group waitlist-control comparison of SAS versus the standard curriculum. Phase 2 was a follow up of all participants before and after the intervention and at 12-months post-intervention.

Results: Parent and child measures improved after the intervention but not in the waitlist condition. Improvements in parent, child, and teacher measures were apparent at 12 months.

Conclusions: The SAS Program warrants further research as a potential program for schools that serve children with ASD.     

Adversity and psychosocial competence of South African children.

Black children in South Africa commonly experience low socioeconomic status and community violence. Parents (N = 625) in a longitudinal study of urbanization responded to structured questionnaires related to resilience, affability, maturity, and school readiness of their six-year olds. SES was found to have an inverse and linear relation to competence at age six; the relationship to violence was curvilinear, with children from moderately safe communities achieving better outcomes than those from very safe or very unsafe ones.     

A School Nurse-Delivered Intervention for Anxious Children: An Open Trial

Anxiety disorders are common in children and severely impair their functioning. Because a hallmark symptom of anxiety is somatic complaints, anxious youth often seek help from their school nurse. Thus, school nurses are in an ideal position to identify anxious children and intervene early. This study assessed the feasibility of a brief nurse-administered intervention (CALM—Child Anxiety Learning Modules) based on cognitive behavioral strategies to reduce anxiety symptoms and improve academic functioning. Nine elementary school nurses completed a one-day training and administered the CALM intervention to 11 children with elevated symptoms of anxiety (M age: 8.09; range 5–11; 54% male; 91% White). Feasibility of the intervention was assessed using several indicators (e.g., training satisfaction, intervention satisfaction/helpfulness). Pre-post intervention child outcomes were collected from evaluators, parents, children, and teachers. Results indicated that the majority of nurses were highly satisfied with the training and reported the intervention was feasible. Paired t tests on pre-post outcome measures revealed significant reductions in anxiety, somatic symptoms, and concentration problems. Nurses (70%), parents (81%), and children (50%) reported that the intervention was either somewhat or very helpful. Preliminary results identified barriers to implementation but also suggest that the intervention is feasible and helpful. A sufficiently powered randomized controlled trial is needed to assess the intervention’s efficacy.     

Psychosomatic symptoms among 14–16 year old Finnish adolescents

Summary The occurrence of psychosomatic symptoms and their associations with school performance and some sociodemographic characteristics (family structure, number of siblings, birth order, the parents' socioeconomic status) was studied among all eighth-grade pupils (n=2246) in secondary schools in a Finnish town. The same pupils were re-examined twice: after 5 months and after 17 months. The mean age of the pupils at the beginning of the study was 14.5 years. Girls experienced more psychosomatic symptoms than boys throughout the study, but there was an increase in symptoms among both sexes during the follow-up. Transient symptoms were common, but about one tenth of adolescents reported frequent symptoms throughout the follow-up. Higher levels of psychosomatic symptoms were observed in pupils with non-intact family structure and in those with poor school performance. There was a systematic though small increase in symptoms as the number of siblings increased. Children from working class families reported slightly greater scores than children from higher social classes.     

School-based interventions for anxious children

OBJECTIVE: To compare the effectiveness of three school-based interventions for anxious children: group cognitive-behavioral therapy (CBT) for children, group CBT for children plus parent training group, and no-treatment control. METHOD: Students (7-11 years old) in three elementary schools (N = 453) were screened using the Multidimensional Anxiety Scale for Children and teacher nomination. Subsequently, 101 identified children and their parents completed the Anxiety Disorders Interview Schedule for DSM-IV, Child Version. Children with features or DSM-IV diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia (n = 61) were randomized by school to one of three conditions. Active treatments were nine weekly sessions of either group CBT or group CBT plus concurrent parent training. RESULTS: Clinician-report, child-report, and parent-report measures of child anxiety demonstrated significant benefits of CBT treatments over the no-treatment control group. Effect size was 0.58 for change in composite clinician severity rating, the primary outcome measure, favoring collapsed CBT conditions compared with control. In addition, several instruments showed significantly greater improvement in child anxiety for group CBT plus parent training over group CBT alone. CONCLUSIONS: Both active CBT treatments were more effective than the no-treatment control condition in decreasing child anxiety symptoms and associated impairment. When parent training was combined with child group CBT, there were some additional benefits for the children.     

Working memory and sleep in 6- to 13-year-old schoolchildren

OBJECTIVE: To study the associations between sleep quality/quantity and performance in auditory/visual working memory tasks of different load levels. METHOD: Sixty schoolchildren aged 6 to 13 years from normal school classes voluntarily participated. Actigraphy measurement was done during a typical school week for 72 consecutive hours. It was timed together with the working memory experiments to obtain information on children's sleep during that period. The n-back task paradigm was used to examine auditory and visual working memory functions. RESULTS: Lower sleep efficiency and longer sleep latency were associated with a higher percentage of incorrect responses in working memory tasks at all memory load levels (partial correlations, controlling for age, all p values < .05, except in visual 0-back and auditive 2-back tasks); shorter sleep duration was associated with performing tasks at the highest load level only (partial correlations, controlling for age,p < .05). Also in general linear models (controlling for age, gender, and socioeconomic status), sleep efficiency (F = 11.706, p = .050) and latency (F = 3.588, p = .034) were significantly associated with the mean incorrect response rate in auditory working memory tasks. CONCLUSIONS: Sleep quality and quantity affect performance of working memory tasks in school-age children. In children with learning difficulties the possibility of underlying sleep problems should be excluded.     

School performance, race, and other correlates of sleep-disordered breathing in children

OBJECTIVES: Childhood sleep-disordered breathing (SDB) has been associated with poor school performance. Both problems are common among African-American (AA) children, but potential confounders such as low socioeconomic status (SES) and obesity have not been well studied. METHODS: Children in second and fifth grades at six urban elementary schools were evaluated by teachers' ratings and year-end reading and math assessments. Risk for SDB was assessed with the validated parental Pediatric Sleep Questionnaire, and SES by qualification for school lunch assistance. RESULTS: Among 146 children whose parents completed surveys, risk for SDB was associated with AA race, low SES, and poor teacher ratings (P<0.01), but not assessment scores (P>0.1). In multiple regression models, poor school performance was consistently and independently predicted by low SES (P<0.01) but not by AA race or SDB risk. Risk for SDB was associated with low SES before, but not after body mass index (BMI) was taken into account. CONCLUSIONS: The SDB symptoms, AA race, and low SES all vary to some extent with poor school performance, but the only consistent and independent covariate of performance is SES. Risk for SDB is associated with low SES, perhaps because of a third variable, namely high BMI.     

Individualism and socioeconomic diversity at school as related to perceptions of the frequency of peer aggression in fifteen countries

The purpose of this study was to examine two aspects of context for peer aggression: national individualism and distributions of socioeconomic status in the school. School administrators for each school reported on their perceptions of the frequency of bullying and violence in their school. The sample comprised 990 school principals/headmasters from nationally representative samples of schools in 15 countries surveyed as part of the larger IEA Civic Education Study (Torney-Purta, Lehmann, Oswald, & Schulz, 2001). A national context of individualism was associated with violence but not bullying. Schools with high socioeconomic diversity had more bullying than homogeneously low or high socioeconomic status schools. In addition, diverse schools had more violence than affluent schools. Results suggest that bullying and violence should be investigated as separate constructs. Furthermore, contexts, such as national culture and school socioeconomic diversity, are important in understanding the prevalence of bullying and violence in schools internationally.     

Reducing anxiety in Alzheimer's disease family caregivers: the effectiveness of a nine-week cognitive-behavioral intervention

Although the literature is replete with studies examining the psychological concomitants and interventions for Alzheimer's disease (AD) family caregivers, a surprisingly small amount of research exists on anxiety. Given prevalence rates suggesting that anxiety significantly impacts one in three family caregivers, brief group cognitive-behavioral therapy (CBT) interventions may offer assistance. To assess CBT's effectiveness, 38 anxious AD family caregivers were recruited and randomly assigned to a nine-week group CBT intervention or to a waitlist control. Caregivers randomized to CBT demonstrated less anxiety on self-report and clinician-administered questionnaires than waitlist group participants at posttreatment and six-week follow-up assessments. A subsample of caregivers also demonstrated improved sleep, as assessed through actigraph measurements. Additional study is recommended with diverse anxious family caregiving groups to further investigate the effectiveness of brief CBT group interventions.     

A comparison of the social competence of children with moderate intellectual disability in inclusive versus segregated school settings

This is the first study to compare the social competence of children with moderate intellectual disability in inclusive versus segregated school settings in the Republic of Ireland. A convenience sample was recruited through two large ID services. The sample comprised 45 children across two groups: Group 1 (n=20; inclusive school) and Group 2 (n=25; segregated school). Parents and teachers completed the Strengths and Difficulties Questionnaire and the Adaptive Behaviour Scale-School: 2nd edition. A series of 2 x 2 ANOVAs were carried out on social competence scores using educational placement type (inclusive vs segregated school) and proxy rater (parent vs teacher) as the independent variables. Key findings indicated that children in inclusive schools did not differ significantly from children in segregated schools on the majority of proxy ratings of social competence. This supports the belief that children with intellectual disabilities can function well in different educational settings. Present findings highlight the importance of utilising the functional model of ID when selecting and designing school placements for children with moderate ID.     

Sleep disordered breathing in children: which symptoms do parents consider a problem?

Study objectiveParents tend to under-report symptoms suggestive of sleep disordered breathing (SDB) at medical consultation. It is thought that a contributing factor may be whether parents view SDB symptoms as a problem. The aim of the study was to examine to what extent parents view SDB symptoms as a problem in children recruited from the general community and especially in children who currently have symptoms suggestive of SDB.MethodsParents of 1639 children aged 5–10 y attending middle school in South Australia completed a questionnaire which included demographics and assessed the frequency over the previous school week of 32 sleep habits including six SDB sleep habit items. The sample was restricted to typically developing children and excluded children with medical problems likely to impact SDB. The final sample included 1610 children without a prior diagnosis of SDB and 29 with a prior diagnosis and/or treatment of SDB. Parents were asked to rate children's sleep habits using a 4-pt scale (never, rarely, sometimes and usually) and if the sleep habit was perceived to be a problem (yes/no). Children who sometimes or usually reported a sleep habit item were labelled as symptomatic.ResultsParents of children with, compared to those without, a prior diagnosis of SDB, were more likely to report the presence of SDB symptoms which were more frequently viewed as a problem. In children without a prior diagnosis of SDB, parents of symptomatic children viewed most SDB symptoms as a problem ranging from 91% for apnoea, 63% snorted/gasped, 63% watched child breathing at night, 58% snored loudly, 49% snored to 32% breathing heavily at night. Additional analyses in the combined sample revealed that a prior diagnosis of SDB, gender, socioeconomic status and ethnicity were weak predictors of whether parents viewed SDB sleep symptoms as a problem.ConclusionIn children with symptoms suggestive of SDB, most parents viewed most SDB symptoms as a problem especially apnoea. The high frequency is contrary to that expected given the under-reporting of SDB symptoms at medical consultation. This suggests that additional factors other than whether parents consider SDB symptoms as a problem might better explain the under-reporting of SDB symptoms at medical consultation. Given the important impact on child health and medical service provision, future studies examining the factors that prompt parents to discuss SDB symptoms at medical consultation are warranted.     

An evaluation of school involvement and satisfaction of parents of children with autism spectrum disorders

Parental school involvement and satisfaction are unstudied in families raising a child with an autism spectrum disorder (ASD). To fill this gap, the current study utilized a national sample of families (N = 8,978) from the 2007 Parent and Family Involvement in Education survey ( U.S. Department of Education, National Center for Education Statistics, 2006-2007 ). Parents of children with ASDs were found to be more likely than parents of children without the disorder to attend parent-teacher conferences, meet with school guidance counselors, and help with homework. Parents of children with ASD were also more dissatisfied with the level of communication provided by the school. There was a significant positive correlation between parental school involvement and parental school satisfaction. These findings have important implications for how schools interact with families with children with ASD.