Monitoring phenylalanine concentrations in the follow-up of phenylketonuria patients:An inventory of pre-analytical and analytical variation

Background: Reliable measurement of phenylalanine (Phe) is a prerequisite for adequate follow-up of phenylketonuria (PKU) patients. However, previous studies have raised concerns on the intercomparability of plasma and dried blood spot (DBS) Phe results. In this study, we made an inventory of differences in (pre-)analytical methodology used for Phe determination across Dutch laboratories, and compared DBS and plasma results. Methods: Through an online questionnaire, we assessed (pre-)analytical Phe measurement procedures of seven Dutch metabolic laboratories. To investigate the difference between plasma and DBS Phe, participating laboratories received simultaneously collected plasma-DBS sets from 23 PKU patients. In parallel, 40 sample sets of DBS spotted from either venous blood or capillary fingerprick were analyzed. Results: Our data show that there is no consistency on standard operating procedures for Phe measurement. The association of DBS to plasma Phe concentration exhibits substantial inter-laboratory variation, ranging from a mean difference of −15.5% to +30.6% between plasma and DBS Phe concentrations. In addition, we found a mean difference of +5.8% in Phe concentration between capillary DBS and DBS prepared from venous blood. Conclusions: The results of our study point to substantial (pre-)analytical variation in Phe measurements, implicating that bloodspot Phe results should be interpreted with caution, especially when no correction factor is applied. To minimize variation, we advocate pre-analytical standardization and analytical harmonization of Phe measurements, including consensus on application of a correction factor to adjust DBS Phe to plasma concentrations

False Memory for Trauma-Related DRM Lists in Adolescents and Adults with Histories of Child Sexual Abuse

The purpose of the present research was to examine Deese-Roediger-McDermott (DRM) false memory for trauma-related and nontrauma-related lists in adolescents and adults with and without documented histories of child sexual abuse (CSA). Individual differences in psychopathology and adult attachment were also explored. Participants were administered free recall and recognition tests after hearing CSA, negative, neutral, and positive DRM lists. In free recall, CSA and negative lists produced the most false memory. In sharp contrast, for recognition, CSA lists enjoyed the highest d’ scores. CSA-group adolescents who evinced greater PTSD symptoms had higher rates of false memory compared to: 1) nonCSA-group adolescents with higher PTSD symptom scores (free recall), and 2) CSA-group adolescents with lower PTSD symptom scores (recognition). Regression analyses revealed that individuals with higher PTSD scores and greater fearful-avoidant attachment tendencies showed less proficient memory monitoring for CSA lists. Implications for trauma and memory development and for translational research are discussed

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis.

BACKGROUND: Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES: To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN: For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS: Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS: Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES: Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS: Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS: We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS: It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS: Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK: Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003889. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Coping with Conflict Between Work and Family Roles.

Data from the 1976 Survey of Modern Living were used to investigate the impact of work-family conflict on psychological well-being. The sample was 755 currently married, working parents. Effects were hypothesized as varying by family employment status, family life stage, and by the sex of the respondent. Hence six groups were compared: dual-earner mothers and fathers, and traditional earner fathers of children grade school-aged and younger, and dual-earner mothers and fathers and traditional-earner fathers with at least one high-school aged child. Exploratory and confirmatory factor analyses were used to construct measures for indicating the centrality of roles, and for indicating psychological well-being. Multivariate analyses of variance were used to determine the degree to which respondents involved themselves in a role and considered it salient. A linear modelling technique (LISREL) was used to evaluate the relationships between salience of and involvement in roles, and also between salience of and involvement in roles and psychological well-being. Men were found to work significantly more hours than women; and women were significantly more involved in housework and child care than men. Dual-earner men did more housework and child care than traditional-earner men. When work was most salient for younger women, involvement in child care was low, and perceptions of the parent role were negative. These data indicated the perceived incompatibility of the nature of work and parenthood to some younger women. High salience and involvement in both work and family roles related to a belief was not further related to psychological distress. When salience of a role was high, yet involvement in the role was low, distress most often resulted. Future research is directed toward investigating the relationships among values, self-identity, behavior, and well-being. Better information about conflict between work and family roles could be gained by investigating work-family conflict in people who lack congruity between their values and behavior, rather than in dual-career couples.Ph.D.Developmental psychologyUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/158753/1/8204778.pd

Parent-Child Interaction Therapy: Enhancing Parent-Child Relationships

Disruptive child behavior problems are common problems for parents and can be associated with serious delinquent behaviors and aggressive/violent behaviors in adolescence and adulthood. Parenting interventions to address disruptive child behavior problems has gained widespread acceptance. One of these parenting interventions is Parent-Child Interaction Therapy (PCIT). PCIT is a 14- to 20-week, founded on social learning and attachment theories, designed for children between 2 and 7 years of age with disruptive, or externalizing, behavior problems. This article will provide a brief review of the history of PCIT, a description of the basic components of PCIT, and an overview of recent developments that highlight the promise of PCIT with maltreating parent-child relationships, traumatized children, and in developing resilience in young children. In addressing the three basic treatment objectives for PCIT (i.e., reduction in child behavior problems, improving parenting skills, enhancing the quality of parent-child relationships), there is an abundance of research demonstrating very strong treatment effects and therefore, its value to the field. Recent research has also demonstrated the value of PCIT in reducing trauma symptoms in young children

Parent-Child Interaction Therapy: Enhancing Parent-Child Relationships * Un Programa para la Mejora de las Relaciones Padres-Hijos. La Terapia de Interacción Padres-Hijos

Abstract. Disruptive child behavior problems are common problems for parents and can be associated with serious delinquent behaviors and aggressive/violent behaviors in adolescence and adulthood. Parenting interventions to address disruptive child behavior problems has gained widespread acceptance. One of these parenting interventions is Parent-Child Interaction Therapy (PCIT). PCIT is a 14-to 20-week, founded on social learning and attachment theories, designed for children between 2 and 7 years of age with disruptive, or externalizing, behavior problems. This article will provide a brief review of the history of PCIT, a description of the basic components of PCIT, and an overview of recent developments that highlight the promise of PCIT with maltreating parent-child relationships, traumatized children, and in developing resilience in young children. In addressing the three basic treatment objectives for PCIT (i.e., reduction in child behavior problems, improving parenting skills, enhancing the quality of parent-child relationships), there is an abundance of research demonstrating very strong treatment effects and therefore, its value to the field. Recent research has also demonstrated the value of PCIT in reducing trauma symptoms in young children. Keywords: behavior problems, Parent-Child Interaction Therapy, parenting skills, treatment. Resumen. Los problemas de comportamiento infantil disruptivo son frecuentes para muchos padres y pueden estar asociados con graves conductas delictivas o agresivas/violentas en la adolescencia o en la edad adulta. Las intervenciones con los padres que tratan este tipo de problemas de comportamiento disruptivo han ganado aceptación. Unos de estos programas de intervención con los padres es la Terapia de Interacción Padres-Hijos (PCIT). El PCIT es un programa, basado en las teorías del apego y del aprendizaje social, diseñado para niños y niñas de entre 2 y 7 años de edad que presenten problemas de conducta disruptiva o externalizados, y que tiene una duración de entre 14 y 20 semanas. En este artículo se presentará una breve revisión de la historia del PCIT, una descripción de sus componentes básicos, y una visión general de los avances recientes que subrayan las posibilidades del PCIT para mejorar las relaciones padres-hijos en familias maltratantes, para tratar a niños y niñas víctimas de situaciones traumáticas y para mejorar la resiliencia en niños y niñas de corta edad. En relación con los tres objetivos básicos del PCIT (es decir, reducción de los problemas de conducta, mejora de las habilidades parentales y mejora de la calidad de las relaciones entre padres e hijos), hay una abundancia de investigaciones que demuestran robustos efectos del tratamiento y, por tanto, su validez para ser aplicado de manera generalizada. La investigación más reciente ha demostrado también el valor de PCIT en la reducción de síntomas traumáticos en niños y niñas de corta edad

Parent–Child Care as a Brief Dyadic Intervention for Children With Mild to Moderate Externalizing Problems: A Case Study

Although many parenting interventions have been shown efficacious in reducing externalizing behavior problems in young children, they often take months to implement and tend to target children with moderate to severe behavior problems. Parent–Child Care (PC-CARE) was designed to be an engaging, brief (six-session) dyadic intervention to reduce mental health symptoms even for children with few behavior problems and/or parents who are unable to commit to lengthy treatments. We present an evidence-based case study of a 5-year-old child with mild externalizing problems and his biological parents, who participated in PC-CARE. Standardized measures were collected, and the child’s and parents’ emotional availability were assessed at pre- and posttreatment. Weekly codings of parent–child interactions and parent-reported measures of child behaviors were also collected. This child’s behavioral symptoms improved from pre- to posttreatment (per parents’ reports and observation), and he maintained this improved behavior 1 month after treatment. The parents similarly demonstrated improvement in their use of parenting skills and emotional availability. Aspects of treatment that may affect effectiveness are discussed

Testing the empirical integration of threat-deprivation and harshness-unpredictability dimensional models of adversity.

Recent dimensional models of adversity informed by a neurobiological deficit framework highlights threat and deprivation as core dimensions, whereas models informed by an evolutionary, adaptational and functional framework calls attention to harshness and unpredictability. This report seeks to evaluate an integrative model of threat, deprivation, and unpredictability, drawing on the Fragile Families Study. Confirmatory factor analysis of presumed multiple indicators of each construct reveals an adequate three-factor structure of adversity. Theory-based targeted predictions of the developmental sequelae of each dimension also received empirical support, with deprivation linked to health problems and cognitive ability; threat linked to aggression; and unpredictability to substance use and sexual risk-taking. These findings lend credibility to utility of the three-dimensional integrative framework of adversity. It could thus inform development of dimensional measures of risk assessment and exploration of multidimensional adversity profiles, sensitive to individual differences in lived experiences, supporting patient-centered, strength-based approaches to services