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Recent research: six papers on helping children & adolescents

Here are half a dozen papers on helping kids and adolescents.  The Fuligni et al paper found that adolescents experiencing frequent interpersonal stresses tended to have increased levels of C-reactive protein, " ... an inflammatory marker that is a key indicator of cardiovascular risk ... ".  Jackson et al showed that in preschool kids each extra hour of regular TV viewing is associated with an extra 1 kg of body fat.  This appeared to be due to increases in calorie intake rather than reduction in physical activity.  Decreased family accommodation is associated with improved outcome in paediatric OCD, Merlo et al found.  Naylor et al found that a six lesson teaching block on mental health benefitted young teenagers.  Proctor et al provide a free full text overview of teenage life satisfaction assessment measures, while Wilkinson and colleagues report on 28 week follow-up in a treatment trial for depressed adolescents.  The authors found "Depression at 28 weeks was predicted by the additive effects of severity, obsessive-compulsive disorder and suicidal ideation at entry together with presence of at least one disappointing life event over the follow-up period. Conclusions Clinicians should assess for severity, suicidality and comorbid obsessive-compulsive disorder at presentation and should monitor closely for subsequent life events during treatment."

Fuligni, A. J., E. H. Telzer, et al. (2009). "A Preliminary Study of Daily Interpersonal Stress and C-Reactive Protein Levels Among Adolescents From Latin American and European Backgrounds." Psychosom Med 71(3): 329-333.  [Abstract/Full Text]
Objective: To examine the association between the experience of daily interpersonal stress and levels of C-reactive protein (CRP), an inflammatory marker that is a key indicator of cardiovascular risk, during the teenage years. Methods: A total of 69 adolescents (Mage= 17.78 years) completed daily diary checklists each night for 14 days in which they reported their experience of negative interpersonal interactions in the domains of family, peers, and school (e.g., conflict with family and friends, peer harassment, punishment by parents and teachers). Blood samples were obtained an average of 8.63 months later and assayed for circulating levels of CRP, using enzyme-linked immunosorbent assay. Measures of body mass index (BMI), socioeconomic status (SES), substance use, stressful life events, rejection sensitivity, and psychological distress were obtained. Results: A greater frequency of daily interpersonal stress was associated with higher levels of CRP, even after controlling for BMI, SES, substance use, life events, rejection sensitivity, psychological distress, and frequency of daily interpersonal stress 2 years earlier. Conclusions: Experiencing a high frequency of interpersonal stressors that are typical of adolescent life is associated with higher levels of inflammation even among a normative, healthy sample of adolescents. Additional work should focus on other daily experiences during the adolescent period and their implications for elevated risk for later cardiovascular disease.

Jackson, D. M., K. Djafarian, et al. (2009). "Increased television viewing is associated with elevated body fatness but not with lower total energy expenditure in children." Am J Clin Nutr 89(4): 1031-1036.  [Abstract/Full Text]  
Background: Television (TV) viewing in children is associated with a higher body mass index, but it is unknown whether this reflects body fatness, and, if it does, why. Objective: The objective was to investigate whether TV viewing is associated with body fatness, physical activity, and total energy expenditure in preschool children. Design: Eighty-nine children were recruited into a cross-sectional study. Total daily energy expenditure (TEE) was measured by doubly labeled water, body composition by dual-energy X-ray absorptiometry, and physical activity by accelerometry. Results: There was a significant positive association between fat mass (corrected for fat-free body mass) and TV viewing (F = 9.05, P = 0.004). Each extra hour of watching TV was associated with an extra 1 kg of body fat. Children who watched more TV were also significantly less physically active (F = 5.16, P = 0.026). Independent of body composition and sex, children with greater physical activity levels had higher TEE (F = 5.15, P = 0.029); however, physical activity did not mediate the relation between TV viewing and adiposity (P > 0.05). Conclusions: Preschool children who watch more TV are fatter and are less active, and activity influences TEE. However, despite TV viewing being linked to lower physical activity, the relation between TV viewing and fatness is not mediated by physical activity. The results suggest that a relation between TV viewing and fatness is more likely to be due to an effect on food intake.

Merlo, L. J., H. D. Lehmkuhl, et al. (2009). "Decreased family accommodation associated with improved therapy outcome in pediatric obsessive-compulsive disorder." J Consult Clin Psychol 77(2): 355-60.  [PubMed
          Pediatric obsessive-compulsive disorder (OCD) is a chronic, disabling condition that affects both patients and their families. Despite the identification of efficacious treatments (e.g., cognitive-behavioral therapy and selective serotonin reuptake inhibitor medications), not all patients respond fully. The purpose of the present study was to examine whether the amount of family accommodation provided to pediatric patients with OCD is associated with treatment outcome, and whether decreases in accommodation are associated with improved outcome. The sample consisted of 49 youths (6-18 years of age), who participated in 14 sessions of family-based cognitive-behavioral therapy for OCD, and their parents. Participants completed measures at pretreatment and posttreatment. Results indicate that family accommodation was prevalent among families of pediatric patients with OCD and that such accommodation was associated with symptom severity at pretreatment. In addition, decreases in family accommodation during treatment predicted treatment outcome, even when controlling for pretreatment OCD severity-impairment. Results suggest that the level of accommodation provided by the family may indicate an important obstacle to, or predictor of, treatment outcome in pediatric OCD. Directions for future research are discussed.

Naylor, P. B., H. A. Cowie, et al. (2009). "Impact of a mental health teaching programme on adolescents." The British Journal of Psychiatry 194(4): 365-370.  [Abstract/Full Text
Background Child and adolescent mental health disorders are present in around 10% of the population. Research indicates that many young people possess negative attitudes towards mental health difficulties among peers. Aims To assess the impact of a mental health teaching programme on adolescent pupils' understanding. Method Two-group pre-test-post-test control group study in two English secondary schools. Experimental classes (School E) received a six-lesson teaching intervention on mental health; control classes (School C) did not. Participants were 14- and 15-year-old pupils. The intervention consisted of six lessons on mental health issues common to young people: stress; depression; suicide/self-harm; eating disorders; being bullied; and intellectual disability. School C was given access to these lesson plans and materials on completion of the study. Understanding was measured at two time points, Time 1 (T1) and Time 2 (T2), 8 months apart, by a Mental Health Questionnaire. Behavioural, emotional and relationship strengths and difficulties were measured by the self-rated Strengths and Difficulties Questionnaire (SDQ) with five subscales: hyperactivity, emotional symptoms, conduct problems, peer problems and prosocial behaviour. Results At T2, pupils in School E compared with those in School C showed significantly more sensitivity and empathy towards people with mental health difficulties. They also used significantly fewer pejorative expressions to describe mental health difficulties. There was a significant reduction in SDQ scores on conduct problems and a significant increase on prosocial behaviour among School E pupils compared with controls. Pupils valued the intervention highly, in particular the lessons on suicide/self-harm. Conclusions Teaching 14- and 15-year-olds about mental health difficulties helps to reduce stigma by increasing knowledge and promoting positive attitudes. The intervention also reduced self-reported conduct problems and increased prosocial behaviour. Generally, participating pupils were positive about the importance of lessons on mental health, and said that they had learnt much about the lesson topics.

Proctor, C., P. Alex Linley, et al. (2009). "Youth life satisfaction measures: a review." The Journal of Positive Psychology 4(2): 128 - 144.  [Abstract/Free Full Text
The burgeoning field of positive psychology has highlighted the need to discover what makes life worth living. Within this framework is the exploration of how youths perceive their lives and achieve happiness. Recent research demonstrates that perception of life satisfaction (LS) among youths has important implications for their psychological, social, and educational functioning. An important part of understanding how youths perceive their lives is the incorporation of measurement of life satisfaction, and this article provides a review of the extant measures of youth life satisfaction. Following systematic literature searches, empirical studies (n = 47) of youth LS measures are reviewed. The review provides an overview of each instrument outlining its normative samples, reliability, and validity. Recommended future research directions are briefly discussed.  (Free full text article).

Wilkinson, P., B. Dubicka, et al. (2009). "Treated depression in adolescents: predictors of outcome at 28 weeks." The British Journal of Psychiatry 194(4): 334-341. [Abstract/Full Text
Background There is great heterogeneity of clinical presentation and outcome in paediatric depression. Aims To identify which clinical and environmental risk factors at baseline and during treatment predicted major depression at 28-week follow-up in a sample of adolescents with depression. Method One hundred and ninety-two British adolescents with unipolar major depression were enrolled in a randomised controlled trial (the Adolescent Depression Antidepressants and Psychotherapy Trial, ADAPT). Participants were treated for 28 weeks with routine psychosocial care and selective serotonin reuptake inhibitors (SSRIs), with half also receiving cognitive-behavioural therapy (CBT). Full clinical and demographic assessment was carried out at baseline and 28 weeks. Results Depression at 28 weeks was predicted by the additive effects of severity, obsessive-compulsive disorder and suicidal ideation at entry together with presence of at least one disappointing life event over the follow-up period. Conclusions Clinicians should assess for severity, suicidality and comorbid obsessive-compulsive disorder at presentation and should monitor closely for subsequent life events during treatment.



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