Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders

Habits, such as hair pulling and thumb sucking, have recently been grouped into a category of clinical conditions called body-focused repetitive behavior disorders (BFRBDs). These behaviors are common in children and, at extreme levels, can cause physical and psychological damage. This article reviews the evidence base for psychosocial treatment of pediatric BFRBDs. A review of academic databases and published reviews revealed 60 studies on psychosocial treatments for pediatric BFRBDs, 23 of which were deemed suitable for review. Based on stringent methodological and evidence base criteria, we provided recommendations for each specific BFRBD. Individual behavior therapy proved probably efficacious for thumb sucking, possibly efficacious for several conditions, and experimental for nail biting. Individual and multicomponent cognitive-behavioral therapy was named experimental for trichotillomania and nail biting, respectively. No treatment met criteria for well-established status in the treatment of any BFRBD. Recommendations for clinicians are discussed. Reasons for the limitations of existing research in children and adolescents are explored. Several recommendations are presented for future pediatric treatment research on BFRBDs

Abnormal Perceptual Sensitivity in Body-Focused Repetitive Behaviors

Objective Several compulsive grooming habits such as hair pulling, skin picking, and nail biting are collectively known as body-focused repetitive behaviors (BFRBs). Although subclinical BFRBs are common and benign, more severe and damaging manifestations exist that are difficult to manage. Researchers have suggested that BFRBs are maintained by various cognitive, affective, and sensory contingencies. Although the involvement of cognitive and affective processes in BFRBs has been studied, there is a paucity of research on sensory processes. Methods The current study tested whether adults with subclinical or clinical BFRBs would report abnormal patterns of sensory processing as compared to a healthy control sample. Results Adults with clinical BFRBs (n = 26) reported increased sensory sensitivity as compared to persons with subclinical BFRBs (n = 48) and healthy individuals (n = 33). Elevations in sensation avoidance differentiated persons with clinical versus subclinical BFRBs. Sensation seeking patterns were not different between groups. Unexpectedly, BFRB severity was associated with lower registration of sensory stimuli, but this finding may be due to high psychiatric comorbidity rates in the BFRB groups. Conclusions These findings suggest that several sensory abnormalities may underlie BFRBs. Implications for the etiology and treatment of BFRBs are discussed

Investigation of real-gas and viscous effects on the aerodynamic characteristics of a 40 deg half-cone with suggested correlations for the shuttle orbiter

Parameters were evaluated that might be used to correlate shuttle orbiter aerodynamic data to be used in extrapolating from wind-tunnel to flight conditions. Preliminary calculations indicate that the lee-side forces will have an insignificant influence on the aerodynamic characteristics of the orbiter for moderate angle-of-attack entries; therefore, this work is focused on phenomena which have an overriding influence on windward forces, namely, real-gas (equilibrium and nonequilibrium) and viscous-interaction effects. Analytically determined flow fields previously obtained on 40 deg blunted cones were used as a data source to evaluate various correlation parameters. Inviscid effects were found to be the dominant contributor to the aerodynamic coefficients in the altitude range of 64 to 76.2 km. The most suitable correlation of the aerodynamic forces on these cones is based on local dynamic pressure and local Mach number

Emotion Regulation Deficits in Persons with Body-Focused Repetitive Behavior Disorders

Background Conceptualizations of emotion dysregulation (ED) and body-focused repetitive behavior disorders (BFRBDs) imply that ED may be a central component of BFRBDs as well as a factor that distinguishes BFRBDs from non-impairing, subclinical body-focused repetitive behaviors (BFRBs). The current study empirically tested these observations. Methods One hundred thirty-eight undergraduates (of 1900 who completed a screening survey) completed self-report measures assessing four emotion regulation (ER) deficits hypothesized to underlie ED (alexithymia, maladaptive emotional reactivity, experiential avoidance, and response inhibition when distressed); 34 of these participants had BFRBDs, 64 had subclinical BFRBs, and 42 were unaffected by BFRBs. Results Results indicated that participants with BFRBDs reported higher levels of maladaptive emotional reactivity, experiential avoidance, and response inhibition when distressed than participants with subclinical BFRBs and participants unaffected by BFRBs. These results held even when controlling for comorbidity and total number of reported BFRBs. Participants did not differ on alexithymia. Limitations Limitations of the current study include the BFRB groups’ different distributions of BFRB types (e.g., hair pulling versus skin picking), the sample\u27s demographic uniformity, and the fact that negative affectivity was not controlled when exploring BFRB group differences on ER deficits. Future research should improve on these limitations. Conclusions The current results suggest that ED is a factor that differentiates BFRBDs from subclinical BFRBs. Such results may be useful for generating hypotheses regarding mechanisms responsible for BFRBs’ development into BFRBDs. Furthermore, these results may provide insight into factors that explain the efficacy of more contemporary behavioral treatments for BFRBDs

Effluent sampling of Scout D and Delta launch vehicle exhausts

Characterization of engine-exhaust effluents (hydrogen chloride, aluminum oxide, carbon dioxide, and carbon monoxide) has been attempted by conducting field experiments monitoring the exhaust cloud from a Scout-Algol III vehicle launch and a Delta-Thor vehicle launch. The exhaust cloud particulate size number distribution (total number of particles as a function of particle diameter), mass loading, morphology, and elemental composition have been determined within limitations. The gaseous species in the exhaust cloud have been identified. In addition to the ground-based measurements, instrumented aircraft flights through the low-altitude, stabilized-exhaust cloud provided measurements which identified CO and HCI gases and Al2O3 particles. Measurements of the initial exhaust cloud during formation and downwind at several distances have established sampling techniques which will be used for experimental verification of model predictions of effluent dispersion and fallout from exhaust clouds

Pilot Open Case Series of Voice over Internet Protocol-Delivered Assessment and Behavior Therapy for Chronic Tic Disorders

Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious treatment for children with chronic tic disorders (CTDs). Nevertheless, many families of children with CTDs are unable to access CBIT due to a lack of adequately trained treatment providers, time commitment, and travel distance. This study established the interrater reliability between in-person and Voice over Internet Protocol (VoIP) administrations of the Yale Global Tic Severity Scale (YGTSS), and examined the preliminary efficacy, feasibility, and acceptability of VoIP-delivered CBIT for reducing tics in children with CTDs in an open case series. Across in-person and VoIP administrations of the YGTSS, results showed mean agreement of 91%, 96%, and 95% for motor, phonic, and total tic severity subscales. In the pilot feasibility study, 4 children received 8 weekly sessions of CBIT via VoIP and were assessed at pre- and posttreatment by an independent evaluator. Results showed a 29.44% decrease in clinician-rated tic severity from pre- to posttreatment on the YGTSS. Two of the 4 patients were considered treatment responders at posttreatment, using Clinical Global Impressions–Improvement ratings. Therapeutic alliance, parent and child treatment satisfaction, and videoconferencing satisfaction ratings were high. CBIT was considered feasible to implement via VoIP, although further testing is recommended

Instrumentation of sampling aircraft for measurement of launch vehicle effluents

An aircraft was selected and instrumented to measure effluents emitted from large solid propellant rockets during launch activities. The considerations involved in aircraft selection, sampling probes, and instrumentation are discussed with respect to obtaining valid airborne measurements. Discussions of the data acquisition system used, the instrument power system, and operational sampling procedures are included. Representative measurements obtained from an actual rocket launch monitoring activity are also presented

Metabolic Effects of Bariatric Surgery in Mouse Models of Circadian Disruption

Background/Objectives: Mounting evidence supports a link between circadian disruption and metabolic disease. Humans with circadian disruption (for example, night-shift workers) have an increased risk of obesity and cardiometabolic diseases compared with the non-disrupted population. However, it is unclear whether the obesity and obesity-related disorders associated with circadian disruption respond to therapeutic treatments as well as individuals with other types of obesity. Subjects/Methods: Here, we test the effectiveness of the commonly used bariatric surgical procedure, Vertical Sleeve Gastrectomy (VSG), in mouse models of genetic and environmental circadian disruption. Results: VSG led to a reduction in body weight and fat mass in both ClockΔ19 mutant and constant-light mouse models (PP\u3e0.05). Within circadian-disrupted models, VSG also led to improved glucose tolerance and lipid handling (P\u3c0.05). Conclusions: Together these data demonstrate that VSG is an effective treatment for the obesity associated with circadian disruption, and that the potent effects of bariatric surgery are orthogonal to circadian biology. However, as the effects of bariatric surgery are independent of circadian disruption, VSG cannot be considered a cure for circadian disruption. These data have important implications for circadian-disrupted obese patients. Moreover, these results reveal new information about the metabolic pathways governing the effects of bariatric surgery as well as of circadian disruption

Computerized Response Inhibition Training For Children With Trichotillomania

Evidence suggests that trichotillomania is characterized by impairment in response inhibition, which is the ability to suppress pre-potent/dominant but inappropriate responses. This study sought to test the feasibility of computerized response inhibition training for children with trichotillomania. Twenty-two children were randomized to the 8-session response inhibition training (RIT; n = 12) or a waitlisted control (WLT; n = 10). Primary outcomes were assessed by an independent evaluator, using the Clinical Global Impression-Improvement (CGI-I), and the NIMH Trichotillomania Severity (NIMH-TSS) and Impairment scales (NIMH-TIS) at pre, post-training/waiting, and 1-month follow-up. Relative to the WLT group, the RIT group showed a higher response rate (55% vs. 11%) on the CGI-I and a lower level of impairment on the NIMH-TIS, at post-training. Overall symptom reductions rates on the NIMH-TSS were 34% (RIT) vs. 21% (WLT) at post-training. The RIT\u27s therapeutic gains were maintained at 1-month follow-up, as indicated by the CGI-I responder status (= 66%), and a continuing reduction in symptom on the NIMH-TSS. This pattern of findings was also replicated by the 6 waitlisted children who received the same RIT intervention after post-waiting assessment. Results suggest that computerized RIT may be a potentially useful intervention for trichotillomania