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This study examined the tripartite model of depression and anxiety in 131 psychiatric outpatients, ages 55-87. Confirmatory factor analyses revealed that a 3-factor model provided an adequate fit to the observed data, that the 3-factor model was empirically superior to 1- or 2-factor models, and that the 3-factor structure obtained in the current sample of older adult outpatients converged with that obtained on a separate, younger 'sample. Negative affect was significantly related to depression and anxiety symptoms and syndromes, and positive affect was more highly related to depression than anxiety symptoms and syndromes. Ways for taking into account possible age-associated differences in emotion in older adults and thus improving the conceptual model of anxiety and depression are briefly noted.

Nine incidents of multiple-victim homicide in American secondary schools are examined and common risk factors are identified. The literature dealing with individual, family, social, societal, and situational risk factors for youth violence and aggression is reviewed along with existing risk assessment methods. Checklists of risk factors for serious youth violence and school violence are used in reviewing each school shooting case. Commonalties among the cases and implications for psychologists practicing in clinical and school settings are discussed.

Developmental studies suggest that marital quality improves in old age (e.g., Guilford & Bengtson, 1979). However, many of the studies are replete with sampling biases that probably led to an overinflated positive report of marital satisfaction in older adults. Our review evaluated contemporary studies that have investigated interpersonal and psychological factors associated with dissatisfaction in long-term marriages. Recent investigations indicate that older marriages benefit from lower levels of conflict and greater sources of mutual pleasure following child-rearing cessation. Studies of social support in long-term marriages suggest that perceptions of spousal support are more strongly related to marital satisfaction and general well-being for older women than for men. A few investigations have found a significant relationship between depression and marital discord in older adult samples, and the causal flow between these two variables appears to be unidirectional in that depression has a detrimental impact on late-life marital quality. Indeed, depression has been found to mediate the link between many age-related stressors (e.g., ill health, retirement) and declines in marital adjustment. However, our preliminary analysis of marital adjustment within a depressed, older adult, outpatient sample of married individuals did not confirm statistically that marital discord is associated with depressive symptomatology. This, in part, was attributed to the very narrow range of older adults sampled (i.e., clinic patients suffering from depression). However, the majority of depressives characterized their marriages as discordant. The implications for these findings are discussed and future directions are offered.

The present study examined substance refusal skills of 44 conduct-disordered male adolescents. Fifty percent of these adolescents were dually diagnosed with substance abuse/dependence. Substance refusal skills were assessed utilizing a role-play test that con- sisted of four interpersonal scenarios in which a confederate prompted youths to engage in il- licit drug and alcohol activity. The test demonstrated adequate interrater agreement and va- lidity. Overall skill in refusing alcohol was positively related to adolescents' perceptions of belonging and attention, and overall skill in refusing illicit drugs was positively related to school performance and social competence. Contrary to expectations, substance refusal skills of dually diagnosed adolescents were comparable to their non-substance-abusing counter- parts. Clinical implications of this study are discussed. © 1998 Elsevier Science Ltd

In order to assess the psychometric properties and diagnostic utility of the Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI) with older adults, these measures were administered to 217 older adult outpatients with mixed psychiatric disorders. Both the BAI and STAI scales demonstrated high internal reliabilities. The BAI demonstrated good factorial validity, with a somatic anxiety and a subjective anxiety factor emerging. In contrast, the STAI did not evidence factorial validity, with analyses failing to support presence of state and trait anxiety factors. Both the BAI and Trait Anxiety scale of the STAI demonstrated discriminant validity in separating patients with a current anxiety disorder from patients without such a disorder. However, the State Anxiety scale of the STAI did not discriminate between these groups. When used to predict presence of an anxiety disorder, no single cutting score for either the BAI or STAI proved optimal, due to tradeoffs between sensitivity and specificity. Results suggest that both the subjective subscale and total score on the BAI can be somewhat useful as a quick screening instrument in detecting presence of a current anxiety disorder for older adult psychiatric outpatients, although results were not as strong as previous findings regarding screening tests for depression in the elderly.

The 4 years that Michel Hersen spent at the University of Mississippi Medical Center (1970-1974) are described in this article from the viewpoint of his place in the history of the development of behavior analysis and therapy. The Department of Psychiatry at the University of Mississippi Medical Center became a leader in enhancing the role of psychologists as clinician researchers within psychiatry and applying basic findings from psychology to the bedside. A vigorous research program involving psychology residents and postdoctoral students, and psychology and psychiatry faculty emerged from this integration of science and practice. Many of the faculty members, including Michel Hersen, became leaders in the field of behavior therapy. Much of what was groundbreaking at the time is now commonplace within many medical schools.

Recent calls for eclecticism in clinical practice have been fueled by the putative limitations of behavioral techniques in treating a variety of psychological problems. However, calls for such integration do not appear to be justified for two related reasons. First, the precise conditions under which behavioral interventions are and are not effective have not yet been adequately delineated. consequently, rejection of behavioral interventions in favor of relatively indiscriminate application of cognitive strategies is premature. Second, behavior therapy has as its hallmark a thorough grounding in inductive empiricism, while cognitive/dynamic theories are wholly based in deductive rationalism. As a result, wholesale acceptance of alternative theories and techniques by behaviorists is both inconsistent and retrogressive. Cognitive interventions have their place, but only when cognitive distortions have been specifically identified. Therefore, refinement of behavioral treatments into prescriptive interventions is warranted. The parameters of prescriptive behavior therapy are described in this paper.

This article provides an empirically derived description of social phobia, including onset, prevalence, comorbidity, and issues of differential diagnosis. Assessment and behavioral treatment strategies for social phobia are reviewed. It was not until the past few years that structured clinical interviews and self-report inventories have been developed with adequate reliability and validity to specifically assess social phobia. Thus much of the treatment outcome research is confounded with heterogeneous samples that make generalization of results difficult to interpret. Heterogeneity of samples, lack of controlled comparisons with adequate statistical power to detect treatment differences, and inconsistent findings do not permit the drawing of any definitive conclusions concerning the efficacy of behavioral treatment procedures at this time. More treatment comparison studies for social phobia need to be perfonmed using structured clinical interviews and standardized assessment devices specific for use with social phobia. Pre hoc power analyses should be performed to determine the number of subjects deemed adequate to detect differences when performing comparison studies. Assessment and treatment of social phobia with children is conspicuously nonexistent. Assessment and treatment procedures for social phobia need to be developed and standardized with children.

Research evaluating the reliability of the Structured Clinical Interview for DSM-III-R (SCID) is reviewed. Reliability procedures and studies are examined. Several versions of the SCID are covered, including the SCID-I (axis I disorders), SCID-II (axis II disorders), SCID-Positive and Negative Syndrome Scale (SCID-PANSS; functional-dimensional assessment for psychotic disorders), and SCID-Upjohn Version (panic disorder). The SCID has been found to yield highly reliable diagnoses for most axis I and axis II disorders. Suggestions for future research on the SCID are offered, particularly with respect to (1) the lack of studies in which SCID diagnoses are compared with diagnoses from unstructured interviews or other structured-interview formats, and (2) the need for a more natural evaluation of this instrument. Also, the importance of establishing norms and obtaining reliability data for underserved clinical populations is discussed.

Many persons who have multiple sensory, physical, and developmental disabilities display behaviors that interfere significantly with adaptive functioning and social acceptance. In this investigation, the efficacy of multiple component behavioral interventions for reducing maladaptive responding exhibited by two individuals with dual sensory impairment and profound mental retardation was evaluated. Results indicated that differential reinforcement of other behavior (DRO) approaches were not effective in either case. However, when deceleration procedures (overcorrection or brief physical restraint) werc added, target behaviors decreased quickly. Also, interventions were faded in such a way that gains were maintained for 6 months with only minimal effort by staff. Ongoing assessment of concurrent effects of behavior reduction strategies revealed increases in time on task or amount of work completed, even though these responses were not targeted specifically. Yet negative side effects (e.g., increases in self-stimulation) also were documented, highlighting the importance of evaluating multiple behaviors during intervention. Finally, despite the fact that objective assessments led to positive conclusions regarding treatment efficacy, ratings of baseline and treatment behavior samples by independent judges showed overall improvement in only one case. These findings suggest the need for multifaceted evaluation to determine the utility of interventions in applied settings.

The behavioral assessment of anxiety in older adults is reviewed in this article. Despite the high rate of anxiety symptoms uncovered during the course of large-scale epidemiological studies, the comprehensive evaluation of anxiety in this age group (55 and over) is not highly sophisticated at this juncture. In this review, diagnostic issues, psychometric evaluation, motoric assessment, and psychophysiological assessment are considered. Throughout the articles, gaps in the extant research are identified, and a research agenda for the future is developed.

Background There is a paucity of research on the distinguishing features of double depression, particularly in older adults. Preliminary studies have revealed that individuals with double depression diagnoses tend to have more severe depression than individuals with major depression or dysthymia alone, but few other distinctions between the diagnostic categories have been found. Method We examined the possibility that hopelessness particularly characterizes double depression, by comparing older adults with double depression, dysthymia alone, or major depression alone, on hopelessness, as well as on internal and external locus of control. The sample included 54 older psychiatric outpatients who completed a battery of cognitive and symptom measures, and underwent structured clinical interviews. Results Double depressed patients showed high levels of hopelessness, whereas patients with either major depression or dysthymia alone showed more moderate levels of hopelessness. Low internal locus of control characterized both groups with a dysthymia diagnosis (dysthymia alone and double depression), and differentiated them from the group with major depression alone. Limitations The sample size was modest, and the results may not generalize to older adults with different demographic characteristics. Conclusions Hopelessness may be important in understanding the phenomenology of double depression in older adults, and may inform diagnostics and psychotherapeutics as well.

A single-case analysis was used to assess the effects of imaginal exposure in a 57-year-old woman suffering from current and reactivated post-traumatic stress disorder (PTSD) following a transient ischemic attack. The client’s responses to self-reported depression, anxiety, and PTSD symptoms were repeatedly recorded during four phases: (a) initial psychotherapy, (b) imaginal exposure, (c) skill generalization, and (d) fading of treatment. In addition to dramatic reduction in levels of depression and anxiety, results showed a significant improvement in PTSD symptoms relating to recent and remote traumatic experiences. Improvements were maintained approximately 16 months after imaginal exposure ended, despite ongoing external stressors.

The Keane, Malloy, & Fairbank (1984) MMPI-PTSD Scale has proven to be a reliable and valid measure of posttraumatic stress disorder (PTSD) in combat veterans. However, few studies have examined the MMPI-PTSD Scale’s validity in civilian trauma victims, including battered women. In the present study, 46 battered women who completed the MMPI-PTSD Scale were assigned to PTSD-Positive and PTSD-Negative groups based on a structured diagnostic interview and then contrasted on the MMPI-PTSD Scale. Significantly higher scores on the scale were found in the PTSD-Positive group. Also, a cutoff score of 22 on the MMPI-PTSD Scale correctly classified 80.4% of the sample. Correlations between the MMPI-PTSD and DSM-III-R criteria suggest that the scale is moderately sensitive to many of the symptoms particularly those involving intrusion and psychological arousal, comprising the diagnosis of PTSD. This investigation provides further support for the validity of the MMPI-PTSD Scale and its utility in screening battered women for PTSD.

Objective: To evaluate course and outcome of DSM-Ill-R anxiety disorders prospectively in clinically referred children. Method: Children were blindly and repeatedly assessed with a structured diagnostic interview over a 3- to 4-year period to determine recovery from anxiety disorder and development of new psychiatric disorders. Both psychopathological (attention-deficit hyperactivity disorder, n = 50) and never psychiatrically ill (NPI, n = 83) controls served as comparison groups for children with anxiety disorders (n = 84). Results: The majority of children (82%) were free from their intake anxiety disorders by the end of the follow-up. Relapse of these anxiety disorders after remission was rare (8%). During follow-up, anxious children were more likely to develop new psychiatric disorders (30%), primarily new anxiety disorders (l6%), than were NPI children (1 1% and 2%, respectively), but not psychopathological controls (42% and lo%, respectively). Conclusions: Overall, results suggest a favorable outcome with respect to diagnostic status for clinically referred children with anxiety disorders. However, these children may be at risk for new psychiatric disorders over time. J. Am. Prior to 1980, anxiety disorders in children and adolescents had been relatively ignored in terms of scientific inquiry. One reason for this was the widely held notion that fears and worries during childhood were transitory in nature and thus did not constitute an important or compelling area for investigation. With the arrival of DSM-III (American Psychiatric Association, 1980), childhood anxiety disorders gained a prominent position in our diagnostic nomenclature. The improvements in the diagnostic criteria that accompanied this revision led to increased attention to childhood anxiety disorders from the research community. Anxiety disorders now are recognized to be among the most prevalent of childhood disorders (Bernstein and Borchardt, 199 l), with anxious children manifesting levels of symptom severity and impairment akin to adult anxiety disorders (Last, 1993). Moreover, retrospective studies of children and adults suggest that childhood anxiety

The Minnesota Multiphasic Personality Inventory (MMPI)-Keane Posttraumatic Stress Disorder (PTSD) Scale (PK) has proven to be a reliable and valid measure of PTSD in combat veterans. However, few studies have examined the scale's validity in battered women, who often present with PTSD. Using empirically derived cutoff scores for the PK Scale, 69 battered women were assigned to PTSD-Positive and PTSD-Negative groups and then compared on measures of PTSD, distress, social support, and history of abuse in and out of the battering relationship. The PTSD-Positive group scored significantly higher across all measures of PTSD and distress, supporting the concurrent validity of the PK Scale in this population. However, the two groups differed only for the frequency of death threats, suggesting that the PK Scale is only mildly sensitive to the level of trauma exposure. Finally, lower levels of perceived social support were found in the PTSD-Positive than the PTSD-Negative group. Implications of these findings for the assessment of PTSD in battered women are discussed.

Late-onset visual impairment due to cataracts, glaucoma, macular degeneration, or diabetic retinopathy afflicts approximately 10% of people older than 65, and often results in depression and social dysfunction. Whereas the majority of sighted older adults are active participants in their community, individuals suffering from progressively worsening vision experience heightened levels of isolation and reduced social support, and participate in fewer reinforcing recreational activities. This article describes our social skills training package for the treatment of depressed, visually impaired, older adults. Our treatment focuses on increasing the frequency and level of assertiveness with which visually impaired older adults interact with each other. In addition to specified treatment methods, our empirically derived program employs standardized assessment measures to evaluate therapeutic progress. Sessions are implemented to reinforce efforts to apply social skills in the environment and reestablish skills that have begun to fade.

A multiple baseline design was used to assess the effects of social skills training (SST) in a 65-year-old woman suffering from major depression and severe macular degeneration. Responses to role-played scenarios requiring assertiveness, in vivo request for assistance and social involvement, self-reported assertiveness, depression, and happiness were repeatedly recorded during baseline, treatment, and follow-up phases. Results showed progressive improvement in targeted social skills with SST in both clinic and home settings. Concurrent with enhanced levels of social skill were dramatic decreases of depression to a nonclinical level. Improved skill levels and diminished Geriatric Depression Scale scores were maintained during the 7-month follow-up period, except at the 6 month assessment after which booster treatment was applied to reinstate maximum improvement.

Objective The goals of this study were (1) to determine the prevalence of child maltreatment in hospitalized children and adolescents with developmental disabilities and concomitant psychiatric disorders, and (2) to identify the contribution of specific mother and child characteristics to the use of more severe disciplinary practices by mothers. Method One hundred thirty-eight psychiatrically hospitalized children and adolescents with developmental disabilities and mothers were assessed using a semistructured interview (Child Abuse and Neglect Interview Schedule) examining factors associated with risk of child maltreatment, and questionnaires measuring maternal and child functioning. The Child Abuse and Neglect Interview Schedule and hospital charts were then used to derive ratings on the prevalence and severity of child maltreatment. Results Findings revealed that 61% of children had experienced some form of severe maltreatment by a care provider in their lifetime. Regression analysis indicated that interactions between high levels of social functioning and disruptive/oppositional behaviors and younger age in children, and low levels of social support and increased anger reactivity in mothers, were most predictive of mothers' use of severe disciplinary practices. Conclusions Maltreatment in psychiatrically hospitalized children and adolescents with disabilities is very prevalent, and it warrants careful clinical assessment. In the psychiatric setting, families in which the child is younger, higher functioning, and behaviorally disruptive, and where mothers have little social support and exhibit increased anger reactivity, are at especially elevated risk.

Alcohol and substance abuse in older adults until recently has received little empirical attention in the literature. However, in light of the increasing number of older adults in the population, clinicians and researchers alike are recognizing the importance of evaluating specific assessment and treatment strategies for such older substance abusers. Because distinctive biological, cognitive, and psychosocial variables appear to be correlated with substance abuse in older adults, evaluation and intervention methods employed with younger cohorts may be inappropriate or ineffective with individuals 55 and over. Our article, therefore, examines these characteristics as they pertain to the unique problems and service needs of the elderly. Relevant diagnostic and assessment strategies are reviewed. Finally, suggestions for future work in this area are outlined.

This study investigated the characteristics of each of the specific DSM-III-R (American Psychiatric Association, 1987) anxiety disorders in a clinic sample of 188 anxiety disordered children. Characteristics examined included sociodemographic variables (age-at-intake, gender, and race of the child, and family marital and socioeconomic status) and clinical variables (disorder age-at-onset and severity, and history of additional disorders). Findings are discussed in light of the contemporary literature on childhood anxiety disorders.

Three chronic and severe obsessive-compulsive neurotics were treated with behavioral intervention strategies and psychotropic medication. The effects of treatment were evaluated in three separate experiments with single case experimental designs. The results suggest that response prevention was effective in reducing ritualistic behavior while the effects of flooding and antidepressant medication added little to outcome. The results also suggest that strategies aimed only at reducing compulsive behavior per se are insufficient in eliminating other associated difficulties (e.g., depressive symptoms, interpersonal problems) and that a comprehensive approach to treatment is needed.

The clinical response to social skills training was studied in four women with definite endogenous depression (melancholia) to ascertain if a behavioral intervention could be effective with more severe and pervasive affective syndromes. Three of four patients responded to social skills training, although both patients available for longitudinal follow-up relapsed within 24 months post-treatment. Implications for research and practice are discussed.

A behavioral-analytic assessment approach was conducted to identify social skill deficits in visually-handicapped adolescents. The investigation was conducted in two phases. In the first phase, a role-play test of social skill relevant to visually-handicapped persons was derived empirically using separate samples of professional and paraprofessional staff. Also, situation-specific criteria for evaluating levels of social skill were established. The second phase involved validation of the role-play test by determining the extent to which it discriminated visually-handicapped from nonhandicapped participants. Further, the first empirical data concerning the specific nature of interpersonal skill deficits in the blind were obtained in this part of the study. Results indicated that blind S s showed deficiencies in selected verbal and nonverbal social skill components. However, their performance was not uniformly deficient. Indeed, visually-handicapped clients received higher ratings on a global skill measure. Overall, these findings support the notion that many blind individuals experience problems in social adaptation and underscore the need for further research in this area.

The current study examined the validity of a subscale for endogenomorphic depression derived from the Hamilton Rating Scale for Depression. In a sample of 147 women outpatients with primary depression, subscale (HES) scores were bimodally distributed around the mean score of 7.38. High-HES patients had significantly elevated scores on measures of depressive symptomatology, generalized symptomatic distress, and social impairment relative to low-HES patients. Classifications based on HES scores significantly predicted RDC and DSM-III subtype diagnoses of endogenous and nonendogenous depression. Diagnostic predictions based on the subscale's items were superior to predictions made using the ‘non-endogenomorphic’ Hamilton items. Potential applications for research are discussed.

Medical charts of 150 consecutive admissions of multihandicapped children to a psychiatric hospital were examined to determine the extent and characteristics of abuse and neglect. Results indicated that 39% of the sample experienced or had a history that warranted suspicion of past and/or current maltreatment. Physical abuse was the most frequent type of maltreatment, followed by neglect and sexual abuse. Maltreated multihandicapped patients admitted to the psychiatric unit were less likely to receive diagnoses of organic brain syndrome or profound mental retardation than nonmaltreated multihandicapped counterparts on the same unit. Moreover, data indicated that less severely impaired patients were more likely to be maltreated than were the more severely impaired. Particularly striking was the severity of maltreatment in this multihandicapped sample and the relatively high percentage (40%) of sexually abused patients who were assaulted by multiple perpetrators.

The present study evaluated the effects of live modeling, covert modeling, and rehearsal in unassertive psychiatric patients. Psychiatric patients scoring 19 or below on the Wolpe-Lazarus Assertiveness Scale were assigned to one of five conditions, with 10 subjects in each group: (1) Test-retest (no treatment). (2) Live modeling plus rehearsal. (3) Live modeling without rehearsal. (4) Covert modeling plus rehearsal, and (5) Covert modeling without rehearsal. All subjects were videotaped (pre- and post-test) while responding to eight interpersonal situations (four training scenes; four generalization scenes) requiring assertive responses. Pre- and post-test responses for all subjects were rated independently by judges on several verbal and non-verbal components of assertiveness. The results indicated that live modeling and covert modeling effected improvements in the assertive behavior of the patients, but that the two treatments were not differentially effective. Generally, the addition of rehearsal to live or covert modeling failed to enhance treatment. But on two measures, the covert modeling plus rehearsal condition was superior to the other treatments. There was evidence for transfer of treatment effects from training to generalization scenes. No differences were found among the groups on the Wolpe-Lazarus Assertiveness Scale and the Eysenck Personality Questionnaire. The results were discussed in light of prior findings with live and covert modeling procedures.

This study compared four treatments for unipolar (non-psychotic) depression: Amitriptyline, Social-Skills Training (SST) + Amitriptyline, SST + Placebo and Psychotherapy + Placebo. In addition, 25 normal women were assessed on the behavioral measures in order to evaluate the ecological validity of the dependent measures and the changes produced by treatment. The four treatments, conducted by experienced clinicians, all produced statistically-significant and clinically-meaningful changes in symptomatology. However, there were several notable differences. The SST groups had greater improvement on measures of social skill, and were more similar to the normal women after treatment. In addition the SST + Placebo group had the lowest level of attrition and had the highest proportion of patients who were significantly improved. Significance of the results for future research on SST and role-play measures of social skill was discussed.

The relationship between anxiety and depression was examined in a sample of 106 children and adolescents referred to an outpatient anxiety disorder clinic for children. Twenty-eight percent of patients with DSM-III diagnoses of anxiety disorders displayed a concurrent major depression. Children with anxiety disorders plus major depression were found (1) to be older, (2) to demonstrate more severe anxiety symptomatology, and (3) to be diagnosed with different rates of certain anxiety-disorder subtypes, when compared to anxious patients without major depression. Nondepressed anxious children and adolescents did not differ from a psychopathological control group in severity of either anxiety or depression symptoms.

Techniques employed in the behavioral assessment and treatment of socially deficient children are reviewed. General definitions and components of assertion and social skill in children are presented. While considerable data attest to the potential efficiency of behavioral approaches with this population, several methodological problems prevent any definitive conclusions from being drawn at this time. Some of these include: (1) lack of an accurate classification system of socially isolated children, (2) need for an empirical determination of skill components, and (3) the paucity of data concerning generalization and maintenance of treatment effects. The utility of incorporating developmental and social psychological methods into behavioral programs also is discussed. Suggestions for future directions of research are offered.

The authors contrasted four treatments for unipolar (nonpsychotic) depression: 1) amitriptyline, 2) social skills training plus amitriptyline, 3) social skills training plus placebo, and 4) psychotherapy plus placebo. They studied 72 female outpatients, 52 of whom completed the 12 weeks of treatment. The four treatments, conducted by experienced clinicians, were not substantially different from one another. Each treatment produced significant and clinically meaningful changes in symptomatology and social functioning. However, the authors identified several notable differences across groups: a significant difference in dropout rates (from a high of 55.6% for the amitriptyline group to a low of 15% for the social skills plus placebo group) and a significant difference in the proportion of patients who were substantially improved. The social skills plus placebo treatment was the most effective treatment on this dimension.

Assertion is a major focus of many social skills interventions for alcoholics. The assessment of assertion often relies on self-report measures. However, few psychometric data are available on the most frequently used instruments. This study determined the internal characteristics and structure of two commonly employed measures of assertion: the Wolpe-Lazarus Assertion Inventory and the Callner-Ross Assertion Inventory. In addition, the relationship between responses on these devices and demographic variables, extent of substance abuse, and level of social functioning were examined. Results indicated that both inventories exhibit adequate internal consistency and test-retest reliability. Factor structures were relatively simple and represented general assertion situations. Results are discussed in terms of the need for further refinement of these instruments.

Treatment of a 52-yr.-old male complaining of repeated incestuous behavior with his daughter is described. Objective and subjective measures of incestuous interest were devised along with ratings of normal father-daughter interaction. Covert sensitization, employing noxious scenes based on subjectively reported aversive aspects of the incestuous behavior, eliminated incestuous interest but did not de-value appropriate interaction.

The effects of social-skills training consisting of instructions, feedback, behavior rehearsal, and modelling were examined in a multiple-baseline analysis in four unassertive children. The treatment was effective in that the behaviors selected for modification changed markedly. The effects of treatment generalized from trained to untrained items (interpersonal situations requiring assertive responding) and gains were maintained at the two-and four-week followup probe sessions. In addition, overall assertiveness in all subjects increased from baseline assessment to the conclusion of treatment and into followup.

The present study provided a comprehensive behavioral assessment of social skill in visually-handicapped adolescents. Role-play tests, standardized interviews, parent ratings and judgements of physical attractiveness were employed to evaluate level of social functioning among: (1) 18 visually-handicapped adolescents in a residential school; (2) 17 visually-handicapped adolescents in public schools; and (3) 17 sighted adolescents in public schools. Results indicated that visually-handicapped adolescents exhibited deficits on selected verbal components of social skill. Moreover, these deficiencies were most apparent in visually-handicaped Ss from a residential setting. Findings are discussed in terms of the utility of social skills training for a subset of visually-handicapped adolescents and the importance of additional controlled research with visually-handicapped persons.

In an initial empirical evaluation of the DSM-III diagnostic categories of separation anxiety disorder (SAD) and overanxious disorder (OAD), the demographic characteristics and patterns of comorbidity associated with the two anxiety diagnoses were examined and compared in a clinical sample of 69 children and adolescents. The two anxiety disorders differed on several dimensions: age, social class, and presence of a coexisting anxiety disorder. Children with SAD were younger and from families of lower socioeconomic status than children with OAD. Children with OAD were much more likely than children with SAD to present with an additional concurrent anxiety disorder, usually simple phobia or panic disorder. Results from this study support the DSM-III distinction between SAD and OAD.

Investigations that have employed social skills training with skill impaired alcoholics and drug addicts are reviewed. General definitions of assertion and social skill and research related to social skills acquisition are presented. While use of skills training with these populations is at an exploratory stage, preliminary findings suggest the utility of this approach for enhancing interpersonal performance. However, these results should be interpreted with caution due to various methodological problems. Generalization and maintenance of training, transfer measures, interaction between treatment components and subject characteristics, and validity of role played assessment procedures are all areas that warrant further attention. Usefulness of a more global social skills concept and approach also is discussed; suggestions for future directions of research are offered.

In 1969 Gordon Paul stated that “the ‘hard core’ refractory group of chronic mental patients is clearly one of the most difficult problems facing the mental health field today.” 1 Although some progress has been achieved in this area since then, 2–7 this same hard-core group of patients (most of whom bear schizophrenic diagnoses) remains a persistent challenge to mental health practitioners. A variety of pharmacologic, socioenvironmental, and behavioral approaches (primarily the token economy) have been applied to this group of chronic psychiatric patients. We will very briefly examine the major contributions and limitations of each approach.

The efficacy of peer-mediated intervention for increasing social behaviors in blind, multihandicapped children was examined in a multiple-baseline analysis. Two nonhandicapped peers were trained to direct social initiations to four multihandicapped subjects during free play. An increase in play initiations by peers served to increase social behaviors in multihandicapped subjects. Moderate generalization of treatment effects was obtained under circumstances that differed from the intervention condition in that peers were present but not administering treatment. Maintenance of treatment gains was evidenced at a four-month follow-up. This study expands the literature on social skills training of the blind by targeting young, multihandicapped children with age-relevant skills, and on peer-mediated intervention by focusing on socially withdrawn children whose condition is complicated by severe physical disabilities.

The development of assertive responses in unassertive individuals is surveyed in terms of clinical application, measurement techniques and experimental study. Case reports indicate that assertive training is an effective technique for a large variety of disorders as it enables patients to overcome deficits in inter-personal functioning. Some of the effective elements in assertive training have been identified by using analogue research designs. In most of these investigations the major focus has been on expressing hostile feelings and thoughts. However, more efforts at instigating positive responses (clinically and experimentally) are warranted. In addition, there is a need to assess the effects on ‘clinically’ unassertive subjects of techniques in which the transfer of training is programmed rather than expected.

A recent study by Heap, Boblitt, Moore, and Hord (1970), comparing the combined effects of token economy, milieu, and attitude therapies with a no-treatment chronic ward control group, is criticized because of several methodological deficiencies: confounding of several treatment modalities, incomparable living arrangements for experimentals and controls, and the absence of an “attention-placebo” control group. An alternative experimental design is offered and suggestions for further research employing token economic methods are outlined.