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Type 1 diabetes is a chronic illness with a high burden of care. While effective interventions and recommendations for diabetes care exist, the intensive nature of diabetes management makes compliance difficult. This is especially true in children and adolescents as they have unique psychosocial and diabetes needs. Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions, namely time, cost, and access. Telehealth interventions allow for the dissemination of these interventions to a broader audience. Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use. While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over in-person interventions, many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered. These and other challenges are discussed with recommendations for researchers and telehealth providers provided.

Obsessive-compulsive disorder (OCD) affects approximately 2-3% of the adult population and is considered a debilitating and costly disorder, with associated impairments spanning the social, occupational, and familial domains. Although effective treatments of OCD exist, many individuals who suffer from OCD go undiagnosed or misdiagnosed, preventing them from obtaining appropriate treatment. As a result, making improvements to the assessment and diagnosis of OCD remains an important area of focus for research and clinical practice. This paper provides a critical review of instruments used in the assessment and diagnosis of OCD as well as a review of adjunctive measures used to assess associated symptoms. Types of instruments reviewed include diagnostic interviews, self-report questionnaires, family-report questionnaires, and clinician-administered inventories. Discussion of each instrument includes information regarding the pragmatics of administration and the psychometric properties of each instrument, as well as an evaluation of each instrument's strengths and weaknesses. We conclude by providing a synthesis of the literature and highlighting directions for future research.

Objective To provide preliminary estimates of the effectiveness of cognitive-behavioral therapy (CBT) in treating pediatric obsessive-compulsive disorder (OCD) of the pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) subtype. Method Seven children with OCD of the PANDAS subtype (range 9-13 years) were treated in a 3-week intensive CBT program conducted at a university clinic. Six of seven children were taking selective serotonin reuptake inhibitor medication(s) upon presentation. Assessments were conducted at four time points: baseline, pretreatment approximately 4 weeks later, posttreatment, and 3-month follow-up. Raters were blind to the nature of the study treatment. Results Six of seven participants were classified as treatment responders (much or very much improved) at posttreatment, and three of six remained responders at follow-up. Clinician severity ratings, as measured by the Children's Yale-Brown Obsessive-Compulsive Scale and Anxiety Disorder Interview Schedule for DSM-IV Child Interview Schedule-Parent version, decreased significantly following intervention, with effect sizes of 3.38 and 2.29, respectively. Self-reported general anxiety and depression symptoms were not significantly reduced. Conclusions This study provides preliminary support for CBT in treating the PANDAS subtype of pediatric OCD. This approach is also considered a safe and minimally invasive treatment approach.

Several lines of evidence suggest a meaningful association between obsessive-compulsive disorder and Tourette syndrome, including comorbidity, phenomenologic overlap, evidence from family and genetic studies, and the possible role of basal ganglia circuitry in both conditions. Obsessive-compulsive behaviors occur frequently in patients who have Tourette syndrome and tend to have a later onset than tics. Despite commonalities, the approaches to treating tics and obsessive-compulsive symptoms are actually quite distinct. A specialized form of cognitive behavior therapy and pharmacotherapy with a potent serotonin reuptake inhibitor are the two established first-line therapies for obsessive-compulsive disorder. An adequate trial of a serotonin reuptake inhibitor is 10 to 12 weeks in duration at doses near the upper end of the recommended range for age and weight. Cases of obsessive-compulsive disorder that do not sufficiently improve with serotonin reuptake inhibitors might benefit from adjunctive low-dose antipsychotic (eg, risperidone) medication whether or not tics are present. Warnings about an increased risk of suicidality among children and adolescents taking antidepressants for pediatric depression extend to those taking the medications for obsessive-compulsive disorder, but the risk-to-benefit ratio is more favorable in this latter population because several serotonin reuptake inhibitors have been shown to be efficacious in obsessive-compulsive disorder. (J Child Neurol 2006;21:704— 714; DOI 10.2310/7010.2006.00169).

To investigate the reliability and validity of the Yale Global Tic Severity Scale (YGTSS), 28 youth aged 6 to 17 years with Tourette's syndrome (TS) participated in the study. Data included clinician reports of tics and obsessive-compulsive disorder (OCD) severity, parent reports of tics, internalizing and externalizing problems, and child reports of depression and anxiety. All children participated in a 2nd YGTSS administration by the same rater 48 days later. Good internal consistency and stability were found for the YGTSS scores. YGTSS scores demonstrated strong correlations with parent-rated tic severity (r = .58-.68). YGTSS scores were not significantly related to measures of clinician ratings of OCD severity (r = .01-.15), parent ratings of externalizing and internalizing behavior (r = -.07-.20), and child ratings of depression (r = .02-.26) and anxiety (r = -.06 -.28). Findings suggest that the YGTSS is a reliable and valid instrument for the assessment of pediatric TS.

We report on the factor structure of the Yale Global Tic Severity Scale. Participants were 76 children and adolescents diagnosed with tic disorders. Overall, the model proposed by Leckman et al. [Leckman, J.F., Riddle, M.A., Hardin, M.T., Ort, S.I., Swartz, K.L., Stevenson, J., Cohen, D.J., 1989. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child and Adolescent Psychiatry 28, 566–573.] represented an adequate fit. The internal consistency of the factors was acceptable and the convergent and divergent validity was supported vis-a-vis correlations with parent ratings of Tourette's Disorder symptoms. These findings support the use of the original scoring structure in assessing pediatric tic severity.

This study examined the relations between overt and relational aggression, social anxiety, loneliness, depressive symptoms, and alcohol and drug use in a sample of 287 undergraduate college students. Consistent with prior work, men reported engaging in more overt aggression than women. Contrary to our predictions, men also reported engaging in more relational aggression than women. Results also indicated that overt and relational aggression were positively associated with social anxiety, loneliness, depressive symptoms, alcohol use, and drug use for the overall sample. Hierarchical regression analyses showed positive relations between overt aggression and alcohol use for men and no relations between relational aggression and any psychosocial adjustment index. For women, overt aggression uniquely predicted social anxiety, loneliness, and depressive symptoms, whereas relational aggression uniquely predicted social anxiety, loneliness, depression, and alcohol and drug problems. Implications of these findings are discussed in terms of the role of peer aggression in students’ psychosocial adjustment.

Objective To determine the association among diabetes-related bullying, diabetes self-management, metabolic control, and depression in children and adolescents with type I diabetes (TID). Study design Measures of diabetes-related bullying and depression were administered to 167 youth with TID at their regularly scheduled diabetes care visits. Parents were administered a clinician-rated index of their child's diabetes self-management. HbA1c levels were assessed. Results Diabetes-related bullying was positively related to HbA1c concentration and negatively related to overall self-management and specifically to adherence to glucose testing and dietary tasks. Depressive symptoms partially mediated the relation between diabetes-related bullying and overall self-management. Conclusion Given the associations between diabetes-related bullying and regimen self-management, the issue of illness-related bullying merits serious attention for pediatricians and school personnel.

An educational Website was designed by the Florida Initiative in Telehealth and Education group, and an online diabetes education test was developed using a sample of 60 children and young adults aged 8–22 years, all of whom had diabetes. The 31 items were analysed for item difficulty. Eight test items were eliminated as being unsuitable. The test was then used in 67 prospective diabetes counsellors (23 men, 44 women) who volunteered for a summer camp. Camp counsellors ranged in age from 17 to 33 years (mean 22 years, SD 3). The counsellors' mean pre-test scores were 80% and their mean post-test scores were 92%. There was a significant improvement ( P < 0.001) of approximately 1.25 questions from pre- to post-test. This supports the use of the online educational Website for training individuals working with children with diabetes. The Website may prove to be useful for online education in other areas of diabetes management.

Pediatric OCD, a chronic and impairing condition, is not uncommon. Diagnosis is often difficult given the secrecy of many patients and co-occurring psychopathology. CBT alone or CBT with concurrent SSRI therapy are considered the first-line treatment. Nevertheless, relatively few mental health professionals are adequately trained in CBT for OCD. For example, in a national survey of 79 clinicians treating pediatric OCD in Norway, less than 33% of clinicians reported using exposure/response prevention (or similar techniques) despite rating CBT as a favorable approach to treatment. Limited access to professionals proficient in CBT may result in the prescription of pharmacotherapy alone or pharmacotherapy with other concurrent psychotherapies (that are not demonstrated as efficacious). Clearly, improving the referral network to experts trained in CBT for OCD is necessary to provide efficacious treatment, associated with reduced rates of relapse. Intensive CBT may extend resources to families without access to trained professionals in their area, given the potential for effective therapy in a succinct time period. Accordingly, in addition to the controlled trial evaluating CBT, pharmacotherapy, and combined treatment, initial investigations of intensive CBT for pediatric patients appear necessary. Additionally, intervention studies for children with significant comorbid psychopathology should be pursued.

We describe an adolescent boy's experience of peer victimization and its relation with his development of obsessive-compulsive disorder (OCD). Subsequent to being peer victimized, this boy was seen for 20 sessions of cognitive-behavioral therapy over the course of 4 weeks that followed the protocol outlined by March and Mulle in 1998. Standardized post-treatment assessment indicated significant reductions in OCD, depressive, and anxious symptomatology as compared to baseline. This case illustrates how negative peer experiences may be related to the development and maintenance of OCD.

This study compared the psychological adjustment between children with short stature and youth with type 1 diabetes mellitus (DM1). The Child Behavior Checklist, Children's Depression Inventory, Social Anxiety Scale for Children--Revised, and Asher Loneliness Scale were administered to 58 children (26 with short stature and 32 with DM1) and a parent during a regularly scheduled clinical appointment for endocrinology care. Results show that the parents of children with short stature rated their children as having more social, thought, and attention problems, and exhibiting greater delinquent behavior, as compared to parental ratings of children with DM1. No diagnostic group differences in child or parent-rated internalizing symptoms were found. Implications of these findings for personnel working with children with short stature are discussed.

This study evaluated the psychometric properties of the Tourette's Disorder Scale-Parent Rated (TODS-PR), a 15-item parent-rated instrument that assesses a range of common symptoms seen in childhood Tourette's Disorder (TD) patients including tics, obsessions, compulsions, inattention, hyperactivity, aggression, and emotional disturbances. Participants were 67 children and adolescents ages 6-17 years who were diagnosed with TD and/or OCD and seen as a part of a larger study. Confirmatory factor analyses supported the original 4-factor structure of the TODS-PR with some slight re-specification of factor content. Internal consistencies were acceptable for the TODS-PR Total Score and factors. The TODS-PR Total Score and factors showed good convergent validity with other measures of symptomatology and impairment. These findings suggest that the TODS-PR is a reliable and valid parent-rating scale for assessing TD symptoms.

Five adolescents with diabetes participated in an intensive outpatient treatment programme designed to improve adherence to their regimen and improve metabolic control. Families reported blood sugar levels, injections and food intake daily by telephone. After four weeks they were offered a video-phone. Nine subjects were recruited but four of them dropped out. Of the remaining five, one subject used a video-phone and one subject reported blood sugar results by email. Most of the children improved their metabolic control and all five subjects showed reduced HbA1c levels during the three months of the study. The use of telehealth facilitated the treatment of adolescents with poor glycaemic control.

The authors describe the successful treatment of a 17-year-old female with comorbid type 1 diabetes mellitus and anorexia nervosa within the context of a residential program in a tertiary care facility. Assessment and treatment of the complex combinations of the psychological and medical symptoms involved in this patient required the interaction of medical, psychological, and nutritional services. Diagnostic and treatment challenges are discussed.

A descriptive outcome study of 52 children with insulin-dependent diabetes mellitus (IDDM) admitted to a residential treatment program over 6 years. Criteria for admission included repeated hospitalizations for diabetes-related problems, excessive school absences, and/or familial disruption. Residential treatment included individual, group, and family psychotherapy, diabetes education, and close medical supervision. The design included collection of data before, during and after treatment. Children admitted to the residential unit were compared to a population of pediatric IDDM outpatients from the same geographical area. Treatment was associated with a reduction in diabetes-related hospitalizations, improved school attendance, decreased glycosylated hemoglobin levels, weight gain, individualized insulin changes, improved knowledge about diabetes, and a normalization of attitudes towards this disease.

Children with insulin-dependent diabetes mellitus (IDDM) typically self-inject insulin twice daily. Injection sites must be rotated with each insulin administration to avoid lipohypertrophy. Lipohypertrophy results in erratic insulin release and threatens metabolic stability. To aid rotation, children are usually provided with a picture of a human figure with injection sites identified within a grid. Children often have difficulty using the charts or lack the skills necessary to identify injection sites. An alternative three-dimensional visual aid, a pair of "injection bears," simplifies injection site identification. Fifty-eight 6- to 11-year-old children with IDDM identified 10 injection sites using both the injection chart and the injection bears. Accuracy of injection site identification was compared on five subcomponents. Forty-four percent of informants recalled that their doctors recommended using injection charts. Of those recalling the recommendation, 81 % never or rarely used charts at home. Thirty-nine percent of the informants reported a history of lipohypertrophy. Matched sample t-tests demonstrated that children committed significantly fewer identification errors on all subcomponents (P ≤.05) when using the injection bears. Chi square analyses indicated a significant preference (P ≤.05) for the injection bears, which may be a useful tool for insulin injection rotation with younger children.

Compared 19 siblings of severely autistic children with 20 siblings of children with Down syndrome and 20 siblings of developmentally normal children. Results reveal that siblings of autistic children have more internalizing and externalizing behavior problems than siblings of developmentally normal children; however, the three groups did not differ significantly on measures of perceived self-competence or parents' report of social competence. Examination of demographic variables indicate that age of sibling and parents' marital satisfaction were associated with siblings' psychological functioning. Implications for future research are discussed.

ObjectivesThe purpose of the current study was to investigate the influence of therapeutic alliance (TA) as a treatment process variable on outcome in cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD). Although CBT for pediatric OCD disorder is considered a first-line treatment, not all youth have positive treatment responses, suggesting the need for investigating factors that enhance or reduce treatment effects.MethodsTwenty-five youth aged 7-17 years (M = 13.16, SD = 2.69) with a principal diagnosis of OCD and parents participated in the study. Using a multiple-informant, multiple-time point design, the current study examined the role of TA in family-based CBT for pediatric OCD.ResultsFindings indicated(1)stronger child-rated, parent-rated, and therapist-rated TAs were predictive of better treatment outcome,(2)larger, more positive early alliance shifts (rated by changes in child-rated TA between sessions 1 and 5) were predictive of better treatment outcome.ConclusionsTA was a predictor of subsequent change in OCD symptoms in youth treated with CBT. These findings correspond with alliance-outcome research among youth treated with evidence based therapies for behavior disorders.

This case report of a child with insulin-dependent diabetes mellitus (IDDM) describes a naturally occurring ABABCA design. The A condition represents poor diabetes management provided in the home setting, and the B and C conditions represent improved diabetes management in residential treatment (condition B) or foster care (condition C). The A condition was consistently associated with episodes of diabetic ketoacidosis, high glycosylated hemoglobin percentage, and school failure. In contrast, the B/C conditions were consistently associated with improved health status and school performance. On two occasions, the child was returned to condition A by the state's protective service agency (HRS) in direct conflict with the recommendations of the child's psychological and medical treatment staff. During her last condition A placement, the youngster died. Chronically ill children who are neglected may not receive the protection they need because of lack of awareness about the psychosomatic aspects of their problem.

Fathers have been largely neglected in previous research of families of autistic children. We compared fathers of 20 autistic, 20 Down syndrome, and 20 developmentally normal children on several measures of psychosocial adaptation. Groups were matched on child's adaptive behavior age equivalent, gender, birth order, family size, and SES. The three groups differed significantly on measures of intrapersonal and family functioning but not on social-ecological variables. Fathers of children with autism or Down syndrome reported more frequent use of wish-fulfilling fantasy and information seeking as coping strategies as well as more financial impact and disruption of family activities than did fathers of developmentally normal children. There were few significant differences between fathers of children with autism and those of children with Down syndrome. These results suggest that fathers adapt relatively well to the demands associated with raising a child with a developmental disability.

The adaptive behaviors of 20 autistic, 20 Down syndrome, and 20 developmentally normal children were compared using the Vineland Adaptive Behavior Scale. Unlike previous studies, we included a comparison group of very young normally developing children and matched subjects on overall adaptive behavior as well as several pertinent demographic characteristics. Findings revealed that, relative to children with Down syndrome or normal development, autistic children displayed significant and pervasive deficits in the acquisition of adaptive social skills, and greater variability in adaptive skills. These findings underscore the need to longitudinally assess the development of socialization in autistic children and further highlight the utility of the Vineland in operationally defining the nature of social dysfunction in autistic children.