Psychosocial interventions used to treat children with ADHD: safety and efficacy

Although stimulant therapy is the most common treatment for attention-deficit/hyperactivity disorder (ADHD) in children, it is not always effective in reducing behavioral symptoms. As a result, research on psychosocial interventions has progressed in recent years. This article provides a synopsis of psychosocial interventions for childhood ADHD, with an emphasis on basic behavior management principles, evidence-based interventions, and safety issues. Developmental issues that distinguish psychosocial interventions for children and adolescents are highlighted, and practical recommendations for collaborating with mental health professionals are provided.     

Substance abuse

Liddle and Dakof's (1995) comprehensive review of the status of family-based treatment for drug abuse concluded that this modality offered a "promising, but not definitive" approach to treating drug abuse among adolescents and adults. Less than a decade later, significant progress can be seen in the treatment of drug abuse problems using family-based approaches, particularly with adolescents. Family-based treatments are currently recognized as among the most effective approaches for adolescent drug abuse. Family-based treatment of adult drug abuse problems has also advanced in important ways with the recent systematic application and testing of engagement techniques and behavioral couples therapy approaches. The current review characterizes and discusses the developmental status of this subspecialty and outlines areas in which continued research attention is needed.     

Long-term safety of stimulant medications used to treat children with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a common mental health condition that affects children, adolescents, and adults. Because it is a chronic condition and typically requires effective treatment for several years or more, information on the benefits and risks of long-term pharmacotherapy for ADHD is vital to clinicians. This article reviews the emerging literature on the safety of long-term stimulant medications in ADHD-the most commonly prescribed medications for this condition. Common side effects, including cardiovascular effects, growth effects, and tics, are discussed, as well as treatment of children younger than age 6 and evidence of carcinogenic and reproductive effects.     

Which Adolescents Need to Talk About Safety and Violence?

Summary

Exposure to violence has harmful psychological effects on adolescents, and when asked, inner-city adolescents will talk openly about violence in their lives. In response to a clinical self-assessment questionnaire, prospective adolescent mental health clients revealed high rates of exposure to physical, sexual, and community violence: 73.5% had witnessed violence, 43.6% had been a victim of violence, 26.4% had had their bodies touched in a way that made them feel uncomfortable, 24.4% had been threatened with a weapon, and 11.1% had experienced forced sex. Clients also expressed substantial worry about their own and their friends' dangerous behaviors. Desire to talk to a counselor about safety was significantly related to overall safety risk (p < .001), and over three-quarters of adolescents either wanted or needed to talk with a counselor. Age and gender differences in patterns of vulnerability and type of counseling need were explored.     

Examining Outpatient Treatment Dropout in Adolescents: A Literature Review

This literature review explores the research to date on adolescent mental health treatment drop out. As many as one in five adolescents in the United States has been diagnosed with an Axis-I psychiatric disorder. Adolescents with Axis-I psychiatric disorders face significant short- and long-term consequences if they do not obtain mental health treatment. However, treatment dropout research has focused on child and adult populations with little focus on the unique issues that are likely to impact adolescents. The theoretical underpinnings for understanding adolescent mental health treatment are explored in relation to adolescent psychological development and the therapeutic alliance. The review concludes with suggestions for future research to extend our understanding of adolescent treatment drop out.     

Selfobject functions of the family: Implications for family therapy

The application of Self-Psychology theory to family functioning adds to our models of understanding and intervention in family therapy. This article develops a theory of the family as a supraordinate selfobject and explores diverse clinical applications of the theory. The family as a selfobject matrix enhances the self development of the child by the provision of continuity through the maintenance of proximity over time, and by an enhanced quality and quantity of selfobject responsiveness for the individual. This application of Self Psychology theory has wide implications for family therapy with children in foster care, family therapy with elderly couples coping with dementia in one spouse, and family therapy as a component of treatment with suicidal adolescents.     

Social support in aftercare services for troubled youth

Aftercare interventions that utilize social support strategies hold promise for increasing the posttreatment success of youths placed in residential or institutional treatment facilities. This review evaluates programs in which social support strategies are used to facilitate the community adaptation of troubled adolescents. The evidence shows that the development of supportive relationships and prosocial networks in a youth's community, school, and workplace and among parents and family members is important to success in community reentry. The final section outlines research necessary to advance the development and application of aftercare interventions for institutionalized adolescents returning to the community.     

Confidentiality of child and adolescent treatment records

The confidentiality of records of a child or an adolescents who is receiving therapeutic intervention is not an absolute right. There are certain conditions under which the records of a minor who is undergoing treatment can be reviewed by others without prior written consent. This issue will be explored using the application of case laws to various conditions under which other professionals who are not directly involved in the minor's treatment may become privy to the individual's records.She has several years of experience in medical social work and as a chemical dependency counselor.     

Perceived Stigma and Depression among Black Adolescents in Outpatient Treatment

Despite the high prevalence of depression among children and adolescents, most that need mental health treatment do not seek care. This is especially true for ethnic minority adolescents. Prior research has shown that perceived stigma may act as a barrier to the initiation of and adherence to depression treatment, yet few studies have examined the relationship between stigma and depression among Black adolescents. This exploratory study examined the relationship between Black adolescents' depression severity and their current level of perceived stigma in an outpatient sample. Face-to-face interviews were conducted with a clinical sample of adolescents referred for mental health services at a community-based outpatient clinic (n =108), participating in a prospective pilot study on adolescents' patterns of mental health service use. The analyses revealed that greater depression severity was significantly associated with higher perceived stigma (p < .05), particularly among females. The results also suggest that Black adolescents appear to exhibit an appropriate level of self-assessment regarding their need for mental health services. These results are interpreted in relation to previous literature, and limitations and directions for future research are discussed.     

"The young ones are the condom generation": condom use amongst out-of-school adolescents in rural southwest Uganda

This article reports on factors influencing condom use among out-of-school adolescents in rural southwest Uganda. Despite an abundance of negative discourses and myths about condoms in the community, these adolescents believe condoms protect them from sexually transmitted infections, HIV, and premarital pregnancies. Girls want partners to use condoms, but most lack the confidence to insist. Girls aged 13 to 14 reported the least difficulty asking for condoms; older girls attributed this to coming-of-age in the era of AIDS when condom use is the norm. Boys under 16 years want to use condoms, but lack confidence in application skills. Boys over 17 years always use condoms with casual partners, but only occasionally for pregnancy prevention with steady partners. Girls need skills training to improve confidence in negotiating condom use. Younger boys require training to improve confidence in skills with condom application. These findings are compared with studies conducted with in-school adolescents in the same study area. Health promotions that provide this skills training and focus on the need to think of the health of future family would be most effective for out-of-school adolescents. This study shows that it is self-confidence, rather than years of schooling, that has the greatest impact on condom use in this cohort.     

Adolescents in Treatment: Effects of Parental Substance Abuse on Treatment Entry Characteristics and Outcomes

SUMMARY

Research strongly supports an increased risk of substance use disorders among the adolescent children of addicted parents. However, little documentation exists of how these adolescents fare when they present for treatment. This article uses data taken from a two-state study on the effects of adolescent substance abuse treatment to examine the characteristics of adolescents with substance-abusing parents and their outcomes following an episode of outpatient treatment. Although such adolescents enter treatment with greater problem severity in a range of areas, outcomes appear similar to adolescents with no substance-abusing parents. The impact of family and individual counseling on outcomes was also examined, demonstrating mixed results for adolescents with substance-abusing parents.     

“The Young Ones are the Condom Generation”: Condom Use amongst Out-of-School Adolescents in Rural Southwest Uganda

This article reports on factors influencing condom use among out-of-school adolescents in rural southwest Uganda. Despite an abundance of negative discourses and myths about condoms in the community, these adolescents believe condoms protect them from sexually transmitted infections, HIV, and premarital pregnancies. Girls want partners to use condoms, but most lack the confidence to insist. Girls aged 13 to 14 reported the least difficulty asking for condoms; older girls attributed this to coming-of-age in the era of AIDS when condom use is the norm. Boys under 16 years want to use condoms, but lack confidence in application skills. Boys over 17 years always use condoms with casual partners, but only occasionally for pregnancy prevention with steady partners. Girls need skills training to improve confidence in negotiating condom use. Younger boys require training to improve confidence in skills with condom application. These findings are compared with studies conducted with in-school adolescents in the same study area. Health promotions that provide this skills training and focus on the need to think of the health of future family would be most effective for out-of-school adolescents. This study shows that it is self-confidence, rather than years of schooling, that has the greatest impact on condom use in this cohort.     

A Piagetian approach to social work practice with children and adolescents

While the field of social work is heavily committed to the treatment of children and adolescents with behavior problems, it has given little attention to the application of Piaget's egocentrism theory to these problems. This paper outlines the theory proposed by Piaget and reviews subsequent empirical validation and clinical applications of his theory. The role of social work in developing more sophisticated applications of Piaget's theory is discussed.     

Anxiety in Adolescence: The Integration of Attachment and Neurobiological Research into Clinical Practice

Attachment theory illuminates aspects of adolescent development and points to critical treatment directions for adolescents. Recent neurobiological research illustrates the importance of integrating physiological understanding into clinical work. The application of attachment theory and neurobiology to treatment is illustrated best through the case example of one adolescent with panic disorder treated in an outpatient setting.     

Antidepressants & suicide: putting the risk in perspective

Suicidal thoughts are a symptom of depression, and completed suicide is a tragic complication of depressive illness. Although pharmacotherapy is effective for the treatment of depression, the U.S. Food and Drug Administration has ordered that all antidepressant medications carry a warning indicating that they are associated with an increased risk of suicidal thinking, feeling, and behavior in children, adolescents, and young adults. These warnings have received much attention in the general media and have caused much controversy and debate about the relative safety of these commonly used drugs and the appropriateness of their use, especially in younger patients. In this article, I will discuss this issue with the goal of putting the risk in perspective.     

Advances in Sex Offender Treatment and Challenges for the Future

Abstract

This paper describes what the authors believe to be the major advances, the areas of debate, and the future direction of sexual offender treatment as we leave the 20th century and enter the new millennium. In the area of sex offender treatment, the modification of relapse prevention for use with sex offenders has had a profound effect on the way that therapy is done. Additionally, the development of the selective serotonin reuptake inhibitors and other pharmacotherapies has moved the field more toward a bio-psychosocial model of etiology and treatment, and focused more attention on comorbid psychiatric disorders in the treatment of sexual offenders. The late 1990s saw major advances in the development of actuarial prediction tools for recidivism, and a concerning move toward phallometric stimuli with unclear reliability and validity. Additionally, the development of the Abel Screen for Sexual Interest has provided a promising, but as yet unvalidated, alternative to phallometry. The 1990s were also a period of considerable growth in the application of sexual offender treatment to special populations, such as adolescents, the developmentally disabled, women and children. The major challenge for the future is to develop methodologically sound research on which to base our decisions about the treatments to apply, the unique needs of special populations, and the assessment of dangerousness.     

The Inside Out? Views of Young People,Parents, and Professionals Regarding Successful Secure Residential Care

Although adolescents often seem to improve in their functioning during residential care, there still is little knowledge on what factors are important in achieving these changes. The present study aims to identify the care factors that are important for adolescents’ behavior change during secure residential care. We conducted in-depth interviews with eight adolescents, their parents, eight group care workers and seven teachers concerning their in-care experiences. Both adolescents and parents commonly attributed changes during secure residential care to the treatment environment. Group care workers and teachers did not have a clear, consistent view on the treatment aspects causing positive change with the adolescents. According to the adolescents, good professionals apply a fine balance between rules and freedom, show empathy and are available for support. The view of parents corresponds to this image. Although group care workers are perceived as available for support, adolescents tend to make little use of this help if they experience personal problems during care. The results highlight the importance of responsiveness of secure residential care professionals to the needs and perspectives of adolescents and parents.     

Trauma Focused Cognitive Behavioral Therapy with Children of Incarcerated Parents

This paper explores children’s trauma symptoms related to parental incarceration and lays the groundwork for the implementation of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) within a clinical community-based setting treating children and adolescents affected by parental incarceration. Children and adolescents who experience parental incarceration are more likely to develop symptoms of post-traumatic stress disorder (PTSD): depression, anger, aggression, and isolating and self-harming behaviors. Although parental incarceration is a known source of trauma, there are no documented studies examining effective clinical treatments to reduce the effects of the trauma experienced by these children and adolescents. Except for children and adolescents affected by parental incarceration, TF-CBT, a promising model for treating and reducing the symptoms of PTSD, has been successfully applied to various populations affected by trauma. Children of incarcerated parents resemble populations treated with TF-CBT in earlier applications. In this paper, we present a case illustration that examines the application of TF-CBT with one child who experienced trauma symptoms related to parental incarceration, while discussing the results of that application and the potential for broader applicability of TF-CBT within community-based organizations that treat the population of children and families affected by parental incarceration.