RESUMEN

OBJECTIVE: To review family-based treatment research. A growing body of research and several meta-analytic reviews demonstrate that family-based treatments are effective for a variety of child and adolescent disorders. In addition, an emerging tradition of family-based process research has begun to identify important ingredients of effective family psychotherapy. This article reviews these advances and their implications for future research. METHOD: Selected studies on the treatment of schizophrenia, depression, anxiety, eating disorders, attention deficit, conduct disorder, and substance abuse are reviewed, as well as several process research and meta-analytic studies. RESULTS: Family-based therapies have been shown to be effective for treating schizophrenia, conduct disorder, and substance abuse. Some data support their effectiveness in the treatment of eating disorders. Few studies have targeted internalizing disorders. A process research tradition is emerging, but it is in need of methodological advances. Meta-analytic studies suggest that family-based therapies are as effective as other models. CONCLUSIONS: More well-designed studies with diverse populations are needed to assess accurately the effectiveness of this increasingly popular treatment approach.

Asunto(s)

Asunto(s)

RESUMEN

Intake data for 61 children in three types of mental health programs in Philadelphia--partial hospitalization, home-based services, and outpatient treatment--were compared to examine an assumption of the continuum-of-care concept: the level of a program's intrusiveness is positively related to a child's severity of dysfunction. Results supported the relationship between intrusiveness and dysfunction only when children in outpatient treatment were compared with those in the other two programs. Children treated in the less intrusive home-based program were more dysfunctional than those treated in the more intrusive partial hospitalization program. Factors other than degree of dysfunction, such as a history of outpatient treatment, were more predictive of treatment type. Results suggest that it may be more accurate to speak of an array of services rather than a continuum.

Asunto(s)

RESUMEN

To summarize, six issues have been identified in this article that need to be considered before adequate assessment of relative efficacy of treatment programs can be attempted, starting at the front door of treatment. First, the differential referral sources that bring these youngsters to treatment must be considered, with their differential perspectives and definitions of problem behavior. Second, the differential characteristics of the patient population must be assessed. This involves, primarily, systematic and thorough medical and psychiatric diagnosis, but it also includes careful assessment of genetic, familial, social, legal, and developmental characteristics that subcategorize these youngsters. As indicated, when this is done the typical adolescent referred for treatment is likely to have a lifetime diagnosis of attention deficit disorder, conduct disorder, some drug use diagnosis (most likely alcohol and marijuana), past legal problems, a family in turmoil (which has included personal, physical, and possibly sexual abuse to the youngster and also genetic loading for alcoholism), or some learning disability. Third, the differential characteristics of treatment programs must be adequately described and catalogued. No such assessment instruments currently exists. The differential characteristics based on philosophy, treatment strategies, personnel selection, patient admission criteria, treatment techniques employed, length and type of treatment, and length and type of aftercare, all must be assessed. Fourth, the presence or absence of differential treatment strategies responsive to the particular needs of individual adolescents must be categorized. In addition to the overall philosophic flexibility of the program, the capability of responding to particular issues such as the presence of major depressive disorder, learning disability, sexual abuse, or the need for a careful neurologic assessment for subtle temporal lobe issues, must be identified in the program. Fifth, the differential response of the youngster to the treatment process as it is progressing must be able to be assessed and considered as a variable. For example, the ability of the youngster to participate in group confrontational sessions and honestly review his or her past behavior is a measurable variable that to date is ignored in program evaluation. Essentially the only variable currently assessed is treatment completion or failure to complete treatment. Sixth, appropriate outcome variables need to be identified and used. While abstinence is a laudable theoretic goal of treatment, the reality falls somewhat short of that goal.(ABSTRACT TRUNCATED AT 400 WORDS)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

We report a controlled standardized behavioral assessment of 33 girls with true precocious puberty using the Child Behavior Checklist. Although a majority of the girls were reported not to have behavior problems, many were reported to have a dysphoric adjustment to their condition. Twenty-seven percent of the girls with true precocious puberty scored greater than 2 SD above the mean on the Total Behavior Problem scale 10 times the expected prevalence rate. They also scored significantly higher (P less than 0.01) than matched controls on both the internalizing or "overcontrolled symptom" and externalizing or "undercontrolled symptom" scales. Forty-eight percent scored greater than 2 SD above the mean on the Social Withdrawal scale. The high prevalence of reported problem behaviors in this sample may be related directly or indirectly to the precocious maturation mediated by biologic, psychologic, social, and environmental variables. Although elevated levels of sex steroids may directly contribute to increased aggressive and hyperactive behaviors, they may also be modified by social and environmental factors.

Asunto(s)

Asunto(s)

RESUMEN

Postencephalitic behavioral syndrome secondary to measles is an almost extinct condition in Western culture. The present paper describes the clinical state of a 13-year-old pubertal female who presented nine years after the original acute febrile illness. In addition, an innovative behavioral approach to treatment of intractable seizures and aggressive behavior is described.

Asunto(s)

RESUMEN

The present study evaluated behavioral treatment of symptoms of depression in a 10 yr-old boy. Diagnosis of the child's depression was made on the basis of DSM-III criteria. Information was obtained from separate interviews with the child and mother and from multiple assessment instruments. Ratings from several sources (mother, psychiatrist, psychologist and staff) confirmed the diagnosis. Four behaviors that characterized the child's depression were selected for intervention and included inappropriate body position, lact of eye contact, poor speech and bland affect. Treatment, evaluated in a multiple-baseline design across symptoms, consisted of the combination of instructions, modeling, role-playing and feedback. Results indicated that behaviors characteristic of childhood depression could be reliably identified and effectively treated by behavioral techniques. Treatment effects were maintained at 12-week follow-up assessment.

Asunto(s)

Asunto(s)

Asunto(s)