The Latent Structure of Youth Responses to Peer Provocation

This study examined whether the three categories often applied to children’s behavior—aggressive, avoidant, and assertive—actually capture the structure of a naturalistic sample of youth behavior coded at a more micro level. A sample of lower-income youth (N = 392; M age = 12.69, SD = 0.95) completed a new multiple-choice measure asking them to select responses to scenarios depicting physical, verbal, and relational provocation by a peer. Youth responses to the vignettes showed the expected associations with self-reported aggression and regulation of anger, providing preliminary evidence for the convergent validity of the measure. Factor analysis confirmed that responses loaded on three factors: aggression, avoidance, and assertion. Model fit was adequate (RMSEA = .028) and cross-validated in a second sample (RMSEA = .039). Several types of responses loaded on two factors suggesting that some strategies that youth use to manage provocation are not “pure” examples of these broadband categories. Implications for conceptualization and measurement of youth social behavior are discussed

Examining outcome variability: Correlates of treatment response in a child and adolescent anxiety clinic

Examined correlates of treatment response in a clinic providing cognitive-behavioral therapy for children with anxiety disorders. Youth (ages 7 to 15) with a primary Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev., or 4th ed.; American Psychiatric Association, 198

What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice

Across 5 decades, hundreds of randomized trials have tested psychological therapies for youth internalizing (anxiety, depression) and externalizing (misconduct, attention deficit and hyperactivity disorder) disorders and problems. Since the last broad-based youth metaanalysis in 1995, the number of trials has almost tripled and data-analytic methods have been refined. We applied these methods to the expanded study pool (447 studies; 30,431 youths), synthesizing 50 years of findings and identifying implications for research and practice. We assessed overall effect size (ES) and moderator effects using multilevel modeling to address ES dependency that is common, but typically not modeled, in meta-analyses. Mean posttreatment ES was 0.46; the probability that a youth in the treatment condition would fare better than a youth in the control condition was 63%. Effects varied according to multiple moderators, including the problem targeted in treatment: Mean ES at posttreatment was strongest for anxiety (0.61), weakest for depression (0.29), and nonsignificant for multiprob lem treatment (0.15). ESs differed across control conditions, with "usual care" emerging as a potent comparison condition, and across informants, highlighting the need to obtain and integrate multiple perspectives on outcome. Effects of therapy type varied by informant; only youth-focused behavioral therapies (including cognitive-behavioral therapy) showed similar and robust effects across youth, parent, and teacher reports. Effects did not differ for Caucasian versus minority samples, but more diverse samples are needed. The findings underscore the benefits of psychological treatments as well as the need for improved therapies and more representative, informative, and rigorous intervention science

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

Health Care Service Utilization Among Anxious and Nonanxious Youth

Background: Anxiety disorders are the most common mental health problem, impacting 15% to 20% of youth at any given time. Despite high prevalence, little is known about the type of health care services utilized by anxious youth, impeding public health efforts to improve access to and quality of care. To address this need, the current study will directly compare service utilization in a large sample of anxious and nonanxious youth patients enrolled within Mental Health Research Network (MHRN). Methods: Preliminary analyses were conducted using a sample of 17,929 youths (ages 4 to 17 years) from Kaiser Permanente Northwest (KPNW). Anxiety diagnoses were derived from ICD-9 codes and service use from procedure codes during 2013–2014. Analyses were completed using a match-control design, in which anxious youth were matched with their nonanxious peers using sociodemographic indices. Results: Results from the KPNW site showed that anxious youth were significantly more likely to receive care than nonanxious matched controls in pediatrics (odds ratio [OR]: 2.28; P \u3c 0.001), family medicine (OR: 1.36; P \u3c 0.001), emergency departments (OR: 2.23; P \u3c 0.001), and urgent care (OR: 1.66; P \u3c 0.001). Anxious youth also were more likely to receive services in specialty care settings such as outpatient mental health (OR: 17.34; P \u3c 0.001), inpatient mental health (OR: 16.56; P \u3c 0.001), neurology (OR: 3.71; P \u3c 0.001) and cardiology (OR: 2.85; P \u3c 0.001). Overall, anxious youths in this insured sample were high utilizers of services, including increased use of high-cost services. Conclusion: Final analyses will integrate data from an additional three MHRN sites using innovative statistical methods designed to pool and analyze de-identified services data across multiple sites. The present study will be one of the first to examine health services use for a large and diverse sample of anxious youth across several different health care settings and systems. Findings from this study will provide unique and critical information about the availability and type of care currently utilized by anxious youth. Results may be useful in guiding efforts to most efficiently intervene with this widely prevalent and highly impairing condition