Search

Using both group (nomothetic) and individual (idiographic) approaches to measuring clinical change may provide more information about the effectiveness of an intervention than either approach alone. The current study re-examined previously published data from two randomized clinical trials of omega-3 fatty acids and Individual-Family Psychoeducational Psychotherapy as treatment for mood disorders in youth, using modified Brinley plots, a method of illustrating individuals’ treatment response in the context of group information. Although the original nomothetic approach provided information about the average effect of treatment, modified Brinley plots gave more information about individual children’s outcomes. Practicing clinicians in particular could use modified Brinley plots to track treatment trajectories and outcomes for specific clients and subsequently use these data to inform treatment planning.

Several psychosocial, family-focused Evidence-Based Treatments (EBTs) for youth with disruptive behavior have proven effective in practice settings. However, limited research has examined community implementation of EBTs for pediatric depression and bipolar disorder. This pilot open trial evaluated Multi-Family Psychoeducational Psychotherapy (MF-PEP) with 41 children ages 7 to 12 (54% male, 92% Caucasian) with mood disorders and their parents in an outpatient setting. MF-PEP is an 8-session, adjunctive EBT with parallel child and parent groups. Fourteen community therapists facilitated six MF-PEP groups at three agencies over two years. Developed checklists were used to evaluate adherence. Clinical outcomes were measured via clinician assessment and self-report questionnaires at pre-treatment, post-treatment, 6-month follow-up, and 12-month follow-up, and analyzed via hierarchical linear modeling. Therapist group adherence ranged from 66.71% to 78.68% (M = 72.14%, SD = 4.85). Children experienced significant improvement in depressive and manic symptoms, and parents reported a significant increase in knowledge of mood disorders. Children with bipolar disorder and families with limited treatment history benefitted most from MF-PEP. Effect sizes (Cohen’s d) ranged from small to large for mood outcomes (d = 0.34 to 1.18), knowledge (d = 1.02), and treatment beliefs (d = 0.04 to 0.41). Limitations included small sample, missing data, and open design. Results suggest that MF-PEP may be impactful for families affected by pediatric mood disorders in the community, especially among youth with bipolar disorder and families novice to treatment. Randomized controlled trials are needed to provide more definitive evidence for the effectiveness of MF-PEP in practice settings.

Expressed Emotion (EE; criticism/hostility and emotional overinvolvement) displayed in family interactions has been associated with the presence and poorer course of multiple disorders in adults and children. As such, validating appropriate tools for measuring EE could have important implications for research and clinical practice. Child EE measures are limited though there are some established methods of assessing EE in adults. The Expressed Emotion Adjective Checklist (EEAC), a self-report measure of EE, has demonstrated validity with adults but has not been evaluated in child samples. The present study examined reliability, stability, and validity of the EEAC in measuring EE in caregivers of children with mood disorders. EEAC scores were associated with the criticism component of the Five Minute Speech Sample (FMSS), a commonly used EE measure in children. EEAC scores were also stable and predicted manic symptom severity and global impairment one year later. These data suggest the EEAC may be a useful self-report measure of EE in children.

[Clin Psychol Sci Prac 17: 187–190, 2010] Muralidharan, Yoo, Ritschel, Simeonova, and Craighead (2010) propose that iatrogenic family environment and socioemotional cue processing deficits may interact to confer risk in offspring of adults with bipolar disorder (BD), the group at highest risk for developing early-onset BD. In this commentary, I review the relevant family environment and neurocognitive literature, then link the vulnerability areas noted in these bodies of literature to evidence-based interventions for youth with or at risk for BD.

Barriers to the comprehensive clinical assessment of child-onset bipolar disorder (BPD) are numerous and include factors common to many pediatric diagnoses (e.g., disentangling comorbid conditions and overlapping symptoms; cross-situational variability in behavior; limited reliability of child report), as well as issues more specific to child-onset BPD (e.g., lack of empirically validated screening instruments; disagreement over age-specific symptom presentation and temporal discontinuity of symptoms). Thorough assessment includes careful consideration of differential diagnosis, investigation of familial history of affective illness, a focus on longitudinal data collection, and the use of multiple informants. Though a number of standardized measures may assist clinicians in gathering diagnostic information, clinical judgment based on familiarity with the unique presentation of child-onset BPD remains essential.

Despite sleep problems being part of the diagnostic criteria for mood disorders, research on sleep difficulties related to early-onset bipolar spectrum disorders (EBSDs) is sparse. The authors examined the parent and child agreement, frequency, and severity of EBSD-related manic, depressive, and comorbid sleep problems. A sample of one hundred thirty-three 8- to 11-year-olds with EBSDs was assessed with parental and self-report measures of EBSD-related sleep problems. Dimensional and categorical measures indicated low agreement and high discrepancy between parent and child reports of EBSD sleep problems. Subsequent combination of parent-child data revealed the majority (96.2%) of children had moderate-to-severe sleep problems related to manic, depressive, or comorbid symptoms, either currently or during their worst mood period. More depression-related sleep problems than mania-related sleep problems were reported, especially initial insomnia. Over half the sample had sleep problems associated with current comorbidity, particularly separation anxiety disorder. These findings, their implications, and study limitations are discussed.

Last summer I read The Bipolar Child [D. F. Papolos & J. Papolos, 2002] and said, you know, this really fits him. And we took it to our psychiatrist at the time, who pooh-poohed the idea: "You know, those people don't know what they are talking about. And they're not scientists."... He put him on Depakote; when I told him it worked, he was surprised. He kept saying... [my son] was... attention deficit disorder.... We ended up calling the police one night because he tried to put his foot through the window; he wanted to jump through the window.... We decided we had enough... of broken walls and of the kids getting hurt. And we took him to [the local crisis center]... and they found him a bed at... [the local inpatient treatment facility]. And then... we fought with the insurance company for two days before we could get him in for a medication review. We went through twelve days with him at... [the inpatient treatment facility] and us at home.... The medication was real scary. They took him off some, added some; we'd see him, he'd be totally out of it... then we would come back the next day and he would be shaking.

There are considerable advantages for professional psychologists who form partnerships with mental health consumer groups. This collaboration can utilize the strengths of both partners and result in benefits to the psychologist, the consumer group, the research field, and the community as a whole. By identifying mutual needs and forming alliances, professional psychologists and consumer groups can gain a great deal from each other's unique perspectives. This article outlines the importance of consumer-professional partnerships, focusing on the authors' experiences with children and their families.

We review the methods in the ranking of clinical psychology doctoral programs provided by Stewart, Roberts, and Roy (2007). Using our own program as an example, we identify several areas of concern (e.g., authorship credits, criteria applied, faculty attrition). The inaccuracies identified for our program ranking, in combination with methodological concerns highlighted by previous commentaries, suggest that the validity of the rankings can be called into question.