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The increasing number of children diagnosed with psychosocial disorders reflects a trend toward pathologizing behavior that is unusual, challenging or extreme. Although these behaviors may match items on the symptom lists for various disorders, a therapist must first consider the origin and context of those behaviors for an individual child through a non-pathological lens. This paper proposes a framework for understanding the behavior of difficult children based on core issues rather than diagnostic symptoms: arousal/excitability, range of focus, perfectionism, intensity, interpersonal sensitivity, sensory sensitivity, cognitive/perceptual style, perception of time, reaction style, and affiliation/integrity. Each trait is examined from two perspectives: how it can lead to or be interpreted as a problem, and how a therapist can re-frame the trait and build on it to identify effective interventions. This approach affirms children's strengths and upholds social work values. KEY WORDS: Childhood Disorders; Difficult Behavior; Therapy; Strengths.

The trend toward adopting a strengths approach to mental health practice with children and adolescents amounts to a paradigm shift from an emphasis on diagnosing disorders to tapping child capacities and assets toward the achievement of treatment goals. While the potential value and challenges associated with this shift has received ample attention in the literature, minimal research has been conducted to assess the benefits and barriers related to the use of strength-based strategies with youth. Utilizing an experimental design, this author examined the impact of strength-based assessment using the Behavioral and Emotional Rating Scale (BERS) with seriously emotionally or behaviorally disturbed children and adolescents. Results revealed that child functioning outcomes were significantly better for youth who received BERS-guided assessment versus the usual deficit-based assessment protocol only when the treating therapist reported an orientation toward service that reflects highly strength-based attitudes and practices. Furthermore, high adherence to the strength-based assessment protocol was associated with significantly higher parent satisfaction with services and lower rates of missed appointments. These findings highlight the importance of accounting for practitioner effects and treatment fidelity in future studies of strength-based practice effectiveness. KEY WORDS: strength-based assessment; children's mental health; practitioner orientation.

For children and adolescents with behavioral and emotional disorders and their families, education about their disorders and the treatments is an essential component of a comprehensive approach to their care. Education can encourage active participation in treatment, enhance adherence to treatment regimens, and provide patients and families with important coping skills. Thus, the Children's Medication Algorithm Project (CMAP) incorporated a psychoeducational program into the medication algorithm created to improve treatment of children with ADHD and/or depression in the Texas public mental health sector. This article describes the process by which a comprehensive educational program was developed in partnership with parents and advocates. The final program is described, as well as a pilot study to examine the feasibility of implementation in four community clinics. KEY WORDS: pshycoeducation; education; major depressive disorder; attention deficit hyperactivity disorder; Children's Medication Algorithm Project; treatment algorithm.

Byline: David Wacker (1), Wendy Berg (1), Jay Harding (1), Linda Cooper-Brown (1) Keywords: brief experimental analysis; multielement design; functional analysis Abstract: We describe the historic and current use of brief experimental analysis procedures in outpatient clinic and home settings. We discuss some applications of the designs and suggest design modifications for improving internal validity. We describe our application of the designs to longitudinal, in-home programs for children with severe behavior disorders and demonstrate how related versions of brief experimental analysis procedures can be linked to form a more comprehensive evaluation. Author Affiliation: (1) The University of Iowa, Iowa City, Iowa Article History: Registration Date: 27/10/2004

The Simplifying Mental Illness + Life Enhancement Skills program, for children with a mentally ill parent or sibling, is a 3-day program that aims to increase children's knowledge of mental illness and to better equip them with life skills considered beneficial for coping in their family. Self-report data from 25 children who attended 3 of these programs, in Canada and Australia, indicate that these aims were achieved. Their parents also report benefits for their children.

A study of the role played by societal factors on the behavioral and emotional problems of clinic-referred African-American and Jamaican children is described. ANCOVAs revealed significantly more problems for African American than Jamaican youth but the converse was true for severe problems. Further studies needed are described.

A critique of the implementation of supplemental security income for disabled children reveals that this supplementary income is not being used correctly as mandated by the law. Data show that a disparity exists between the rate of participation of children due to mental illness and retardation and the prevalence of mental illness within a given state.

A longitudinal study of a representative sample of 328 children with hemiplegia was conducted to examine the likelihood that these children will develop or outgrow psychiatric problems. The study also investigated the early symptoms that can best predict later symptoms, the non-psychiatric factors that may determine the persistence of the psychiatric problems, and the possibility of accurately predicting future psychiatric problems to identify at-risk patients who might benefit from early intervention. The results are discussed.

The ability of children and adolescents with emotional and behavioral disorders to recognize facial expressions was investigated in a sample of patients receiving in-patient psychiatric services. Results revealed that accuracy in identifying expressions increased with age. Patients diagnosed with mood disorders, adjustment disorders or disruptive behavior disorders were more accurate than those without diagnoses. Likewise, subjects with mood disorders were more accurate in identifying sadness than patients without this diagnosis.

Of 100 consecutive admissions to an acute child psychiatric facility in South Africa 43 had at least one substance-abusing parent, while 10 children were from families in which both parents abused substances. 23 children received a diagnosis of depression, but no significant association was found between their diagnoses and parental substance-abuse status.

Objective: Identify associations among early maltreatment, sufficiencies. and psychopathological interferences in the domains of conscience functioning and low serum dopamine beta hydroxylase activity. Method: Nineteen emotionally disturbed boys screened for maltreatment experiences were compared according to age at onset of maltreatment, enzyme activity, and their conscience functioning in the domain of moral valuation. They were also compared in conscience functions to 19 age and sex matched normal counterparts. Results: Subjects who endured maltreatment prior to 36 months had developmental delays and interferences with functioning in more conscience domains than those who were either spared such experiences or who endured maltreatment later in life. Subjects with low enzyme activity had significantly more interference with authority and peer valuation than subjects with high enzyme activity. Greater interference with valuation was associated with lower enzyme activity and more frequent abuse prior to 36 months. Conclusions: Psychosocial sequelae of early maltreatment have been identified in the domains of conscience. An association has been established between pathological interference in the domain of moral valuation and a putative neurobiologic sequelae of early maltreatment. Implications for future research in the psychobiology of maltreatment are discussed. Key Words - Maltreatment, Conscience, Dopamine Beta Hydroxylase.

This study sought to identify which syndromes of initial problems predicted later syndromes among children and youths referred for mental health services. Standardized parent reports on the Child Behavior Checklist obtained at intake were compared to standardized parent, teacher, and self-reports obtained at follow-up. There were 1,103 subjects (774 males and 329 females) 4 to 18 years old, followed up an average of 6 years after referral. High quantitative and categorical stability was found for cross-informant syndromes within samples of younger and older subjects. Throughout childhood and into young adulthood, parent ratings of most syndromes at the time of referral predicted the counterpart cross-informant syndrome construct at follow-up, controlling for other types of problems at referral. There were multiple additional independent predictors of many syndromes, including Delinquent Behavior, Aggressive Behavior, and Shows Off for young adult males. Time I Social Problems and Attention Problems independently predicted diverse problems at Time 2 for younger males. A wide variety of problems also predicted younger males' self-ratings of withdrawal, anxiety, and depression. The stability of problems for the referred sample was similar to that found for demographically matched nonreferred subjects drawn from a national sample.

Remarkably less criticism and higher maternal warmth after 9 months is noticed in mothers of children with conduct disorders(CD). Symptomatic change in variance to expressed emotion scale is revealed by initial externalizing scores in the CD group and initial internalizing scores in the emotional disorder group at the first assessment. Presence of CD at the last contact with the clinician is expected due to initial externalizing scores and low levels of maternal warmth. The lack of measurement of the impact of particular types of treatment is a limitation.

Study of 90 children and adolescents admitted in two-state-operated psychiatric hospitals in Virginia during hospitalization, three months after discharge and one year after discharge revealed that patients were emotionally and behaviorally disturbed and they were from poor families many of which were not intact. One-third of the children had placement difficulties during the three-month period after discharge though many of them received quality after care treatment. Placement instability increased at the one-year post-discharge follow-up. Family members' presence during the time of hospitalization and their involvement in treatment planning had positive effects on the treatment outcome.

Use of a multitrait-matrix method, of a study of 489 emotionally disturbed subjects aged between eight and 18; and child, parent and teacher ratings help assess problem behaviors of emotionally disturbed children. This matrix produces large method effects for each of the rating types for the four emotional and behavioral difficulty factors: internalizing, thought, attention and externalizing. Modeling of these method effects indicates good convergent validity of the three ratings and discriminant validity of the four problematic areas.

Peer interactions are among the greatest challenges experienced by children who have severe emotional and behavioral problems. This study evaluated an intervention package designed to increase the ratio of these children's desirable to undesirable interactions. The package included three principal components: (a) observation of videotapes following regularly scheduled peer activity sessions; (b) self-evaluation of the children's peer interactions observed on the videotapes; and (c) delayed feedback and reinforcement for desirable peer interactions. Five students from two elementaty schools participated. Multiple baseline designs and one reversal were used to evaluate the effects of the intervention package. The results showed that the intervention produced lower levels of undesirable peer interactions and higher ratios of desirable to undesirable interactions for all participants. The results are discussed in regard to their conceptual and applied implications and in terms of specific directions for future research. DESCRIPTORS: social behavior, peer interaction, self-evaluation, videotape feedback, severe emotional disturbance. DESCRIPTORS: social behavior, peer interaction, self-evaluation, videotape feedback, severe emotional disturbance

Differential emotions theory (Izard, 1972) provides a conceptual framework for the role of emotions in affective disorders. The present study investigated the relation of emotions to depression in a sample of child and adolescent psychiatric inpatients (N = 145). Findings indicate that shyness, anger, enjoyment, and shame explained 51.4% of the variance in depression scores. Furthermore, profiles of emotions experienced by youths with a depressive disorder differed significantly from emotion profiles of nondepressed youths on the following emotions: enjoyment, surprise, sadness, anger, shame, shyness, guilt, and self-directed hostility. Differential emotions also correctly classified 80.0% of depressed and nondepressed subjects into their respective groups.