52 terms

Child Intervention Final

STUDY
PLAY
Risk factor
believed to predispose children and adults to mental disorder; to qualify as a risk factor, a variable must pre-date the disorder and increase the chances that a person will develop the disorder (biological, psychosocial, individual, family, community, institution level).
Protective factor
believed to "protect" individuals against the association between a risk factor and a negative mental health outcome. In other words, protective factors modify, ameliorate, or otherwise change a person's response to a known risk factor(biological, psychosocial, individual, family, community, institution level).
efficacy
refers to evidence that a treatment works under tightly controlled, experimental conditions (maximizes internal validity).
effectiveness
refers to evidence that a treatment works in a real-world setting under real-world conditions, such as in clinics or schools (maximizes external validity).
treatment mediator
a factor that explains the relationship between the treatment and an outcome of interest, and therefore can be said to be a mechanism of change in the treatment.
treatment moderator
a factor that changes the nature of the relationship between the treatment and the outcome of interest, thereby demonstrating that the treatment is more effective or less effective for specific groups of participants.
3 types of measurements
Broad-Band Mental Health Measure,
Measure specific to Disorder(s)
Weekly/Bi-weekly monitoring
FEAR Cycle
anticipation of negative consequences, increased physiological arousal, avoidance of feared situation, reduce physiological arousal, reinforcement from reduced arousal and avoidance
2 ways avoidance is reinforced in the FEAR cycle
1. avoidance of event 2. reduced physiological arousal
Types of modeling
Live modeling involves in-person observation of the models' non-fearful behavior.
Symbolic modeling employs video or other representations of models showing non-fearful behavior.
Participant modeling pairs the fearful youngster with a model who encourages shared involvement in the feared activity.
Treatment steps in Modeling Treatment
1. Assess fear levels 2. arrange for child to watch someone engage with fear. 3. have child engage in fear 4. give positive rewards for engaging in fear (optional)
Pitfalls of Modeling treatment
Low credibility of the model
Failure to repeat the model's behavior
Excessive dependence on the model
Treatment Steps for Systematic Desensitization
1. assess level of fear 2. establish fear hierarchy from least to greatest 3. train child to relax 4. expose child to fear from least to greatest 5. if child shows too much anxiety, revert back to previous level 6. when child remains relaxed through fear hierarchy, repeat
Pitfalls of systematic desensitization
Therapist difficulty in conveying a vivid image for imaginal exposure
Youth difficulty in imagining and in mental elaboration
Treatment Steps for Reinforced Exposure
1. identify feared situation and figure out a way for gradual exposure to occur 2. present child with situation and response items, rewarding after increased exposure 3. upon exposure give feedback 4. continue until child reaches success
Pitfalls of Reinforced Exposure
Exposure task too easy or too hard
Rewards not rewarding enough
Treatment Steps for Self-Talk
1. Identify feared situation and assess baseline fear levels 2. identify thoughts child is having 3. teach child alternative thoughts 4. observed and document child's degree of tolerance of feared situation using self-talk 5. give child feedback on progress and reward success 6. continue until child reaches goal
Pitfalls of Self-talk
The "I don't know problem"
Confusing thoughts w. Feelings
Failure of self-talk to generalize
FEAR steps
F "Feeling Frightened?"
E "Expecting bad things to happen?"
A "Attitudes and Actions that will help"
R "Results and Rewards"
Pitfalls of coping cat
In vivos and STIC tasks that are too easy
Children who resist exposures
Anxious cognitions are the only ones the child can think of, or are more believable than the non-anxious ones
Rigid manual adherence that fails to adapt to child characteristics and contexts
Family Anxiety Management program steps
1. remain calm and speak in a calm voice 2. try not to interfere or come to rescue when partner is dealing with child, parent who gives instructions should follow through 3. help partner if needed 4. back each other up 5. do not comment on each others behavior until calm and relaxed, do not criticize each other 6. after problem is over, discuss it together and problem solve
Family Anxiety Management Problem Solving
AGREE on a mutual time and place to talk
IDENTIFY the problem behavior
BRAINSTORM solutions together
DISCUSS solutions and pro and con them
PLAN a strategy for solution
REVIEW how solution is working
Pitfalls of FAM
Parents' wariness about being targeted in treatment
Parental reluctance to grant independence to the child
Interparental conflict that undermines child progress
Parents can't/won't model exposure for the child
Problem-Solving for Depression
1. Define the problem
2. Brainstorm possible solutions
3. focus energy and attention at task
4. imagine outcome of each solution
5. weigh consequences of each
6. evaluate outcome after trying it
7. reward for success or repeat steps 1-6
Sleuthing for Truth
The child identifies a negative thought, then makes a list of supporting and refuting evidence bearing on that thought, and finally make a verdict.
Pitfalls for interventions for depression
Homework not done
Cognitive focus seen as criticism of the child
Mismatch between coping skills and child's developmental level
Child's pessimism and hopelessness may undermine efforts to cope
Treatment Steps for the Quick Benson
1. Check the tension level in the area you are tense
2. Take a deep breath and let it out slowly
3. picture yourself relaxing in your favorite place
two-process model of control and success of understanding it
Primary control involves enhancing reward or reducing punishment by making objective conditions conform to one's wishes
Secondary control involves enhancing reward or reducing punishment by adjusting oneself to objective conditions that are hard to change, so as to control their subjective, personal impact
Successful coping with depression may require: 1) learning to apply primary control to distressing conditions that are modifiable, 2) learning to apply secondary control to distressing conditions that are not modifiable
ACT and THINK
ACT = change the situation (when situations are modifiable = primary control)
THINK = change your response to the situation (situations are distressing but not modifiable = secondary control)
IPT-A
Affect identification is used to assist the teen in linking interpersonal experiences to changes in their mood. By understanding their communication style, the therapist is also able to help them experience more interpersonal interactions that will improve their mood.
Communication analysis is used to assist the teen in understanding: 1) the impact of their words on others, 2) the feelings they convey with verbal and nonverbal communications, 3) the feelings that generated the exchange, 4) their ability to modify such exchanges, and, therefore, the affect associated with the relationship, and consequently, their general mood.
Decision analysis is used when teens are experiencing conflict. They are taught basic problem-solving skills, such as negotiation and compromise.
Role-playing is used to: 1) give adolescents a safe place to practice newly acquired interpersonal skills, 2) to provide an opportunity to receive feedback before testing out a new skill in real life, and 3) to increase the teen's social confidence.
SAFETY program
1. Settings 2. People 3. Activities and Actions 4. Thoughts 5. Stress reactions
What are the average effect sizes for the effects of youth psychotherapy at post-treatment and at follow-up? What does this suggest about the effects of youth psychotherapy?
The average effect size is .46. The probability that youth would fare better than the control group was 63%.
Does therapy impact vary by target problem? Please describe. What implications does this have for intervention development within clinical child psychology?
Yes, psychotherapy was strongest when used for anxiety and weakest when used for depression. The implications are that certain therapies show better outcomes and based on research, a certain treatment should be applied. In some cases with depression, treatment fared worse than the control.
Does therapy impact differ according to the therapy used? Please describe.
There is mixed evidence regarding this. Studies show that treatment may differ in their effects in highly specific ways. Youth focused behavioral therapies have shown robust outcomes while other therapies had differences in significance depending on the informant.
Concerns about cultural adaptations to EBT
Evidence that EBTs are less effective with minorities is limited
May prompt haphazard or inappropriate adaptations that actually compromise the fidelity of the intervention and their effectiveness.
Concerns regarding generalization of EBT
If the clinician is unable to give the appropriate dosage of treatment due to cultural differences
May not take into account the language, values, customs, child-rearing traditions, expectancies for child and parent behavior and distinctive stressors and resources associated with different cultural groups
cultural adaptations are warranted when....
Translational research suggests that a particular problem may emerge within a distinct set of risk and resilience factors in a given community.
*According to the Weisz (2004) text, what type of modeling has been shown to be the most potent?
participant modeling
What are some important moderators of the effectiveness of the Coping Cat program? For whom is Coping Cat most effective?
The two potentially most important moderators are race and ethnicity.
When given the choice, would you choose to administer Coping Cat in an individual or a group format? What research influenced your choice?
Individual format, seeing as research by Flannery et. al that compared Coping Cat showed better outcomes in , individual (73%), than in group (50%) and wait-list outcome (8%).
What are some important moderators of the effectiveness of the family component of Coping Cat/Koala? Who is most likely to benefit from an added family component? For whom does it not make a difference?
Treatment moderators: age, gender.
Family Component seems to fare better for younger children, girls, children whose parents had anxiety.
Kendall (1994) randomly assigned children with anxiety to a Coping Cat group or a wait list control group. This study found that children in the Coping Cat group exhibited improvements in what measure(s) of child anxiety? In what risk and protective factors?
The children exhibited improvements on their RCMAS scores, the child's interview data, parent structured interview data, CDI scores, and TRF internalizing t scores.
Protective factors: parental involvement
Hancock and colleagues (2018) randomly assigned children with anxiety to (a) Acceptance and Commitment Therapy, (b) Cognitive-Behavioral Therapy, or (c) a wait list control group. What did the authors find regarding the efficacy of ACT in reduction of anxiety symptoms and/or anxiety diagnoses? What did the authors find regarding the efficacy of CBT in reduction of anxiety symptoms and/or anxiety diagnoses? Was there evidence to suggest that ACT or CBT was superior to the other in the reduction of anxiety symptoms? Please discuss.
Analyses revealed that both ACT and CBT were efficacious superior to wait list in treating anxiety symptoms and/or anxiety diagnoses, with ACT having greater effect sizes on QoL outcomes but not on avoidance/fusion outcomes. completer analyses showed that both ACT and CBT produced highly significant reductions in CSR in contrast to the WLC group, maintained at 3MFU. Furthermore, approximately one third of participants in both treatment groups no longer met criteria for an anxiety disorder, with further improvement evident at 3MFU. The WLC did not evidence improvement over time. Means were neither statistically or clinically different over time overall when comparing ACT and CBT, with small effect sizes. The average number of anxiety diagnoses was reduced from three to one, a difference of large effect size for ACT and CBT. Recovery rates also indicated superior outcomes for the treatment groups relative to WLC.
Was ACT, CBT (or both) effective at improving psychological quality of life? Physical quality of life?
In terms of QoL outcomes, both treatments, but not the WLC, produced significant improvements in psychosocial measures of QoL, with gains maintained at follow-up, in line with predictions. Effect sizes were similar for all QoL measures, except the CALIS, with larger effect sizes for ACT compared with CBT, providing some support for outcomes reflecting the emphasis of ACT on QoL
Stark and colleagues' second test of an expanded CBT program (Stark, 1990; Stark et al., 1991) compared a CBT intervention that combined elements of self-control and behavioral problem-solving with a traditional counseling condition. What did these studies find?
First test:
Results indicated that this intervention was more effective than the supportive counseling program for the treatment of moderately depressed (based on a semistructured diagnostic interview) boys and girls.
Second test (ACTION program):
Results indicated that the ACTION treatment with and without parent training was more effective than the minimal contact control condition, because girls in both treatment conditions reported significantly lower mean levels of depressive symptoms at posttreatment relative to girls in the minimal contact control condition. The two active treatments were not significantly different from one another. On a clinical level, more than 80% of the girls no longer met criteria for a diagnosis of a depressive disorder (based on child and parent K-SADS-P ratings) after completion of the treatment. In contrast, 47% of the girls in the minimal contact control condition were no longer depressed after treatment. Results of the measure of the cognitive triad indicated that the girls who completed both treatments experienced significantly greater improvement in their sense of self and future on the CTI-C, and that the girls in the CBT-only condition reported significantly more positive sense of self and future relative to girls whose parents also participated in parent training. 84% of the girls in the CBT + PT condition reported maintaining their improvements and 73% of the girls in the CBT-only condition reported maintaining their improvements.
Weisz et al. (1997) examined the effectiveness of PASCET. What did this study find?
Results showed significantly greater reductions in depressive symptoms for the PASCET group than the control group. In addition, relative to the control group, children in the PASCET condition were more likely to transition from above the normal range for depressive symptoms to within the normal range on both measures at post- treatment (50% vs. 16%) and 9-month follow-up (62% vs. 31%). The findings suggested that PASCET had the potential to produce beneficial effects.
Mufson et al. (2004) found that IPT-A was superior to clinical monitoring for clinic-referred adolescents with Major Depressive Disorder. Which outcomes were impacted by treatment with IPT-A?
Depression assessment scores were significantly lower for participants (Hamilton Scale, BDI) than those in control group. Participants also improved on social functioning and positive problem-solving and rational problem-solving.
Reyes-Portillo and colleagues (2017) examined (a) the effectiveness of IPT-A compared to a treatment-as-usual (TAU) condition, and (b) possible mediators of IPT-A on depression and suicidal ideation among Latina/os with depression diagnoses. What did the authors find regarding the effectiveness of IPT-A vs. TAU? What factor(s) mediated treatment-outcome effects and for what outcomes?
IPT-A led to greater improvement in interpersonal functioning with family and peers. Improved family and peer interpersonal functioning emerged as significant partial mediators of the relationship between IPT-A and depression. Only improved family interpersonal functioning emerged as a significant partial mediator of the relationship between IPT-A and suicidal ideation. However, this indirect effect was small, suggesting that most of the benefit of IPT-A for suicidal ideation appears to proceed through a pathway other than family interpersonal functioning.
The impact of IPT-A on depressive symptoms is partially mediated by family and peer interpersonal functioning.
Rosenbaum Asarnow and colleagues (2015) conducted a pilot test of the SAFETY intervention, a brief, pilot suicide prevention intervention for youth who had at least one prior suicide attempt. [Note that this is a pre- to post-intervention study design (only one group of youth, who were all exposed to the intervention) rather than an RCT where there is a control or comparison condition.] Results suggest early support for the efficacy of the SAFETY program on what outcomes?
Reductions in suicidal behavior, youth and parent depression, hopelessness and social adjustment
BLUE thoughts
B- blaming myself L- looking for bad news U- unhappy guessing (fortune telling and mind reading) E- exaggerating
Broadband Measures
Child Behavior Checklist, Youth Self-Report, and Teacher Report Form
Measure Specific
Depression: BDI Youth
Anxiety: BAI youth
Substance: Personal Experience Screening Questionnaire (PES=Q)
ADHD, CD, ODD: Conners 3
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