Feasibility and potential effectiveness of an intensive trauma-focused treatment programme for families with PTSD and mild intellectual disability

Background: Persons with mild intellectual disabilities or borderline intellectual functioning (MID-BIF; IQ 50–85) have a higher risk of being exposed to traumatic events and developing posttraumatic stress disorder (PTSD). EMDR therapy has shown to be applicable, safe and potentially effective for the treatment of PTSD in individuals with MID-BIF. However, in traumatized multi-problem families with MID-BIF and (impending) out of home placement of children, standard PTSD treatment in an outpatient setting may not be appropriate. Objective: To evaluate the feasibility and potential effectiveness of KINGS-ID, a six-week clinical trauma-focused treatment programme consisting of intensive EMDR therapy with parents and children, and parental skills training followed by two weeks of parent support at home. Method: Six families (nine parents of whom six had MID-BIF) and 10 children (all having MID-BIF) participated in the KINGS-ID programme. Seven parents and seven children had PTSD. Data were collected within a single case study design. For each family member data were collected during baseline (three measurements), treatment (seven weekly measurements), posttreatment (three measurements) and at follow-up (three measurements). Results: None of the family members dropped out. Within the first two treatment weeks all but one child and one parent no longer met PTSD symptom criteria. In both children and parents, trauma-related symptoms and daily life impairment significantly decreased following treatment and in parents a significant decrease in symptoms of general psychopathology and parental stress was found. Results were maintained at six-month follow-up. Conclusions: The findings of the current study are promising given that the treatment programme seems to offer new perspectives for traumatized multi-problem families with MID-BIF

Differential negative reinforcement of other behavior to increase compliance with wearing an anti-strip suit

Using a changing-criterion design, we replicated and extended a study (Cook, Rapp, & Schulze, 2015) on differential negative reinforcement of other behavior (DNRO). More specifically, educational assistants implemented DNRO to teach a 12-year-old boy with autism spectrum disorder to comply with wearing an anti-strip suit to prevent inappropriate fecal behavior in a school setting. The duration for which the participant wore the suit systematically increased from 2 s at the start of treatment to the entire duration of the school day at the termination of the study. Moreover, these effects were generalized to a new school with novel staff and persisted for more than a year. These findings replicate prior research on DNRO and further support the use of the intervention to increase compliance with wearing protective items, or medical devices, in practical settings

The Demand Side: Uses of Research in Child and Adolescent Mental Health Services

This special issue on child and adolescent mental health contains a thoughtful set of papers that address many of the challenges in bridging research and practice. These articles, however, focus predominantly on the supply side of producing research for use by a range of audiences, including practitioners, administrators and policy makers. This commentary emphasizes the importance of attending to, and better understanding, the demand side with regard to how research evidence is evaluated, understood, and utilized. Drawing from work underway at the William T. Grant Foundation, the authors argue for the need to understand three broad topics: user settings and perspectives, political, economic and social contexts, and the various uses of research. Furthermore, understanding the use of research evidence, or the demand side, is itself a topic for empirical investigation. The authors conclude that, when it comes to supplying evidence, don’t forget the demand side

Early risk factors for adolescent antisocial behaviour: an Australian longitudinal study

Objective: This investigation utilizes data from an Australian longitudinal study to identify early risk factors for adolescent antisocial behaviour. Method: Analyses are based on data from the Mater University Study of Pregnancy, an on-going longitudinal investigation of women’s and children’s health and development involving over 8000 participants. Five types of risk factors (child characteristics, perinatal factors, maternal/familial characteristics, maternal pre- and post-natal substance use and parenting practices) were included in analyses and were based on maternal reports, child assessments and medical records. Adolescent antisocial behaviour was measured when children were 14 years old, using the delinquency subscale of the Child Behaviour Checklist. Results: Based on a series of logistic regression models, significant risk factors for adolescent antisocial behaviour included children’s prior problem behaviour (i.e. aggression and attention/restlessness problems at age 5 years) and marital instability, which doubled or tripled the odds of antisocial behaviour. Perinatal factors, maternal substance use, and parenting practices were relatively poor predictors of antisocial behaviour. Conclusions: Few studies have assessed early predictors of antisocial behaviour in Australia and the current results can be used to inform prevention programs that target risk factors likely to lead to problem outcomes for Australian youth

Study protocol: evaluation of a parenting and stress management programme: a randomised controlled trial of Triple P discussion groups and stress control

<br>Background: Children displaying psychosocial problems are at an increased risk of negative developmental outcomes. Parenting practices are closely linked with child development and behaviour, and parenting programmes have been recommended in the treatment of child psychosocial problems. However, parental mental health also needs to be addressed when delivering parenting programmes as it is linked with parenting practices, child outcomes, and treatment outcomes of parenting programmes. This paper describes the protocol of a study examining the effects of a combined intervention of a parenting programme and a cognitive behavioural intervention for mental health problems.</br> <br>Methods: The effects of a combined intervention of Triple P Discussion Groups and Stress Control will be examined using a randomised controlled trial design. Parents with a child aged 3?8?years will be recruited to take part in the study. After obtaining informed consent and pre-intervention measures, participants will be randomly assigned to either an intervention or a waitlist condition. The two primary outcomes for this study are change in dysfunctional/ineffective parenting practices and change in symptoms of depression, anxiety, and stress. Secondary outcomes are child behaviour problems, parenting experiences, parental self-efficacy, family relationships, and positive parental mental health. Demographic information, participant satisfaction with the intervention, and treatment fidelity data will also be collected. Data will be collected at pre-intervention, mid-intervention, post-intervention, and 3-month follow-up.</br> <br>Discussion: The aim of this paper is to describe the study protocol of a randomised controlled trial evaluating the effects of a combined intervention of Triple P Discussion Groups and Stress Control in comparison to a waitlist condition. This study is important because it will provide evidence about the effects of this combined intervention for parents with 3?8?year old children. The results of the study could be used to inform policy about parenting support and support for parents with mental health problems. Trial registration ClinicalTrial.gov: NCT01777724, UTN: U1111-1137-1053.</br&gt

Case Management as a Significant Component of Usual Care Psychotherapy for Youth with Disruptive Behavior Problems

Youth with disruptive behavior problems (DBPs) represent the majority of youth served in usual care (UC) psychotherapy, and are at high risk for maladaptive outcomes. Little is known about UC psychotherapeutic strategies utilized with this population. Researchers and clinicians suggest that case management (CM) is a major activity occurring in usual care. CM includes coordinating care with service providers and individuals, including schools, psychiatrists, and community-based services. This study assesses the prevalence and predictors of clinician use of CM in usual care. Results from this study suggest that CM is frequently used in UC psychotherapy with youth with DBPs. The extent of use of CM in UC may have implications for implementation of evidence-based practices in usual care psychotherapy

Predictors of Treatment Attrition Among an Outpatient Clinic Sample of Youths With Clinically Significant Anxiety

Predictors of treatment attrition were examined in a sample of 197 youths (ages 5–18) with clinically-significant symptoms of anxiety seeking psychotherapy services at a community-based outpatient mental health clinic (OMHC). Two related definitions of attrition were considered: (a) clinician-rated dropout (CR), and (b) CR dropout qualified by phase of treatment (pre, early, or late phases) (PT). Across both definitions, rates of attrition in the OMHC sample were higher than those for anxious youths treated in randomized controlled trials, and comorbid depression symptoms predicted dropout, with a higher rate of depressed youths dropping out later in treatment (after 6 sessions). Using the PT definition, minority status also predicted attrition, with more African-American youths lost pre-treatment. Other demographic (age, gender, single parent status) and clinical (externalizing symptoms, anxiety severity) characteristics were not significantly associated with attrition using either definition. Implications for services for anxious youths in public service settings are discussed. Results highlight the important role of comorbid depression in the treatment of anxious youth and the potential value of targeted retention efforts for ethnic minority families early in the treatment process

Don't Make Me Angry! A Psychophysiological Examination of the Anger–Performance Relationship in Intermediate and Elite Fencers

We aimed to identify the effect of state-anger on precision, speed, and power components of performance during fencing attacks. We conducted a laboratory-based, single-case research experiment to test the fine motor task performance of two experienced and two elite-level fencers under two emotional states: anger and emotion-neutral. We assessed anger via psychophysiological and self-report measures, and we induced anger via a brief imagery intervention. Through the use of an innovative design, which included multiple measures of change, we showed that anger had a consistent negative effect on precision but an inconsistent relationship with response time and muscle activity. The current research design and protocol offer a novel and in-depth method for examining the specific relationships between affective states, emotions, and the complexities that underpin performance. The specific effects of anger on performance were multifarious, complex, and inconsistent. Nonetheless, the results tend to indicate that anger facilitates reaction time and debilitates performance, and these effects were clearer for the most elite performers. The effects of anger on performance are clearly complex, so it would be rather premature to make any suggestions for future practice at this point. Nonetheless, the clearer findings with the elite fencers indicate that researchers will likely yield the most fruitful insights by examining the effects of emotion of performance in elite performers

The impact of behavioural skills training on the knowledge, skills and well-being of front line staff in the intellectual disability sector: a clustered randomised control trial

© 2019 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd Background: Staff with varying backgrounds and educational qualifications can be effectively trained to implement procedures in line with evidence-based practice. Behavioural skills training (BST) is a competency-based training model used to effectively educate a broad selection of professionals, including front line staff, in a range of work-related skills. However, BST has yet to be evaluated in a large group-based experiment. Methods: This study involved a parallel cluster randomised control trial. Six service sites, with a total of 54 participants, were randomised to the intervention condition using the ‘coin toss’ method. The intervention condition used BST to coach intellectual disability staff in reinforcement, systematic prompting, functional communication training and task analysis. Six service sites, with a total of 50 participants, were also randomised to a control condition in which generalised training in behavioural interventions was restricted. Recruited service sites were randomly assigned to the intervention condition (N = 6, n = 54) or the control condition (N = 6, n = 50) at one point in time, immediately after recruitment and before baseline testing took place. Allocations were stratified by service type (residential or day) and geographical region. One member of the research team allocated service sites using the ‘coin toss’ method, and another member, blind to the allocations, decided which experimental arm would receive the intervention and which would be designated as control. It was not possible to mask the intervention from participants, but they were recruited prior to randomisation. Results: Participants in the intervention condition demonstrated statistically significant improvements in their knowledge scores over the study period. Participants in the control condition showed no change or a statistically significant decrease in their knowledge scores. No statistically significant changes to well-being were observed for either group. There was clear evidence of knowledge maintenance, as well as skill acquisition and subsequent generalisation to the workplace environment, among participants in the intervention condition. Participants also evaluated the BST intervention positively. Conclusions: Results support BST as a method for disseminating evidence-based practice to front line staff working with adults with intellectual and developmental disabilities