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Troxel M, Kraper C, Verbalis A, Safer-Lichtenstein J, Seese S, Ratto A, Myrick Y, Armour AC, Pugliese CE, Strang JF, Ba C, Martucci J, Biel MG, Jackson V, Hardy KK, Mandell D, Goode TD, Anthony BJ, Kenworthy L, Anthony LG. Reaching "The Other Half": Teacher Referral Increases Inclusivity in Intervention Research for Neurodivergent School-Age Children. J Clin Child Adolesc Psychol 2024:1-14. [PMID: 38270579 DOI: 10.1080/15374416.2024.2303723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Researchers employed two recruitment strategies in a school-based comparative effectiveness trial for students with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) or autism. This study assessed the: 1) effectiveness of school-based referrals for identifying students meeting diagnostic criteria and 2) impact of eliminating requirements for existing diagnoses on recruitment, sample characteristics, and intervention response. METHOD Autistic students and students with ADHD in schools serving underresourced communities were recruited for an executive functioning (EF) intervention trial over 2 years. In Year 1, school staff nominated students with previous diagnoses. In Year 2, school staff nominated students demonstrating EF challenges associated with ADHD or autism; previous diagnosis was not required. Study staff then confirmed diagnoses. RESULTS More students were included in Year 2 (N = 106) than Year 1 (N = 37). In Year 2, 96% of students referred by school staff met diagnostic criteria for ADHD or autism, 53% of whom were not previously diagnosed. Newly identified students were less likely than previously diagnosed students to be receiving services and, for those with ADHD, were more likely to speak primarily Spanish at home. Previously diagnosed and newly identified students did not differ on other demographic variables or intervention response. Caregivers of previously diagnosed students reported more symptoms than caregivers of newly identified students for both diagnostic groups. Previously diagnosed students with ADHD had more researcher-rated symptoms than newly identified students. CONCLUSIONS Recruitment for an intervention study using behavior-based referrals from school staff enhanced enrollment without compromising the sample's diagnostic integrity and engaged children who otherwise would have been excluded.
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Affiliation(s)
- Mary Troxel
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
| | - Catherine Kraper
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Alyssa Verbalis
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Jonathan Safer-Lichtenstein
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
| | - Sydney Seese
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Allison Ratto
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Yetta Myrick
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - A Chelsea Armour
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Cara E Pugliese
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - John F Strang
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Caroline Ba
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Jillian Martucci
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Matthew G Biel
- Department of Psychiatry, Georgetown University Medical Center
| | - Vivian Jackson
- Center for Child and Human Development, Georgetown University
| | - Kristina K Hardy
- Center for Autism Spectrum Disorders, Children's National Hospital
- Center for Child and Human Development, Georgetown University
| | - David Mandell
- Center for Mental Health, Department of Psychiatry, University of Pennsylvania, School of Medicine
| | - Tawara D Goode
- Center for Child and Human Development, Georgetown University
- National Center for Cultural Competence, Department of Pediatrics, Georgetown University Medical Center
| | - Bruno J Anthony
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
- Department of Psychiatry, Georgetown University Medical Center
- Center for Child and Human Development, Georgetown University
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Laura Gutermuth Anthony
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
- Center for Autism Spectrum Disorders, Children's National Hospital
- National Center for Cultural Competence, Department of Pediatrics, Georgetown University Medical Center
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2
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Holzman JBW, Hawks JL, Kennedy SM, Anthony BJ, Anthony LG. Parenting in a Pandemic: Preliminary Support for Delivering Brief Behavioral Parent Training Through Telehealth. Behav Modif 2022; 47:128-153. [PMID: 35707864 PMCID: PMC10076234 DOI: 10.1177/01454455221103226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Behavioral problems, such as noncompliance and aggression, are a common referral reason to mental health services for young children. Behavioral parent training (BPT) is the leading intervention for addressing behavioral problems and leads to benefits in a variety of parental factors (e.g., parenting efficacy and parenting stress). While the COVID-19 pandemic dramatically shifted service delivery toward telehealth services, limited work has evaluated the effectiveness of BPT when delivered in a brief, group format through telehealth. The current retrospective chart review study evaluated the engagement to and preliminary effectiveness of a brief version of BPT delivered through telehealth to 64 families of 3- to 7-year-olds referred for behavioral problems. Families attended an average of 4.55 of 6 sessions and most families had two caregivers who engaged in the intervention. Significant reductions in caregivers' report of children's behavioral problems and improvements in parenting self-efficacy resulted. Future research and clinical implications are discussed.
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Affiliation(s)
- Jacob B W Holzman
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, USA.,Pediatric Mental Health Institute at Children's Hospital of Colorado, Aurora, USA
| | - Jessica L Hawks
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, USA.,Pediatric Mental Health Institute at Children's Hospital of Colorado, Aurora, USA
| | - Sarah M Kennedy
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, USA.,Pediatric Mental Health Institute at Children's Hospital of Colorado, Aurora, USA
| | - Bruno J Anthony
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, USA.,Pediatric Mental Health Institute at Children's Hospital of Colorado, Aurora, USA
| | - Laura G Anthony
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, USA.,Pediatric Mental Health Institute at Children's Hospital of Colorado, Aurora, USA
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3
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Troxel M, Anthony LG, Robertson HA, Anthony BJ. Mental health first aid USA implementation: Trainee reported quality and impact of training. J Community Psychol 2022; 50:1717-1735. [PMID: 34825375 DOI: 10.1002/jcop.22750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
This study investigated the association of training implementation factors (Quality, Impact, Usefulness) with Mental Health First Aid (MHFA)-targeted outcomes (e.g., increased knowledge, confidence helping someone). Trainees who completed MHFA USA training in 2016 (N = 1003) were surveyed post training about its influence on their thoughts and behaviors, and about implementation factors. Some trainees completed 3- and 6-month follow-ups (N = 430, N = 276, respectively). Training Quality, Impact and Usefulness were rated highly. Differences in Quality and Impact across demographic groups were found; trainees from racially and ethnically marginalized backgrounds, and trainees with lower education levels, reported greater effect. Quality and Impact predicted positive changes in MHFA-targeted constructs such as self-efficacy, stigma and trainee perceived positive effect of MHFA strategies for those in crisis. Impact predicted positive change in mental health knowledge; this association strengthened over time. Results provide information about acceptability and perceived Impact of MHFA USA training and lead to recommendations for future evaluation and implementation.
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Affiliation(s)
- Mary Troxel
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
- Pediatric Mental Health Institute, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Laura G Anthony
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
- Pediatric Mental Health Institute, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Hillary A Robertson
- Georgetown Center for Child and Human Development, Georgetown University, Washington, District of Columbia, USA
| | - Bruno J Anthony
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
- Pediatric Mental Health Institute, Children's Hospital of Colorado, Aurora, Colorado, USA
- Georgetown Center for Child and Human Development, Georgetown University, Washington, District of Columbia, USA
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4
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Rothschild LB, Ratto AB, Kenworthy L, Hardy KK, Verbalis A, Pugliese C, Strang JF, Safer-Lichtenstein J, Anthony BJ, Anthony LG, Guter MM, Haaga DAF. Parents matter: Parent acceptance of school-based executive functions interventions relates to improved child outcomes. J Clin Psychol 2022; 78:1388-1406. [PMID: 34997971 DOI: 10.1002/jclp.23309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES School-based interventions with parent-training components might improve access among lower-income families to effective help for children with neurodevelopmental disorders. This potential might be realized, however, only if parents perceive the interventions as acceptable and therefore engage with treatment. METHODS Parents (N = 124) of 3rd-5th grade students diagnosed with Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder rated the acceptability of their child's treatment (one of two culturally responsive behavioral interventions). Parent engagement was measured through attendance at parent training sessions and the extent to which they read a corresponding workbook. RESULTS Education and income correlated inversely with parent perceptions of treatment acceptability. Acceptability correlated positively with engagement, more strongly among lower-income families. Acceptability had an indirect effect on treatment outcome, mediated by parent engagement. CONCLUSIONS Treatment providers should focus on strategies to increase parent acceptability, with particular attention to improving access for lower-income families.
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Affiliation(s)
- Leah B Rothschild
- Department of Psychology, Asbury Building, American University, Washington, District of Columbia, USA
| | - Allison B Ratto
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Kristina K Hardy
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Alyssa Verbalis
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Cara Pugliese
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - John F Strang
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | | | - Bruno J Anthony
- Department of Psychiatry, CU Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado, USA.,University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Laura G Anthony
- Department of Psychiatry, CU Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado, USA.,University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Madison M Guter
- Department of Psychology, Asbury Building, American University, Washington, District of Columbia, USA
| | - David A F Haaga
- Department of Psychology, Asbury Building, American University, Washington, District of Columbia, USA
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Hill TL, White TC, Anthony BJ, Reaven J, Harris B, Reyes N, Anthony LG. Disparities in autism spectrum disorder diagnoses among 8-year-old children in Colorado: Who are we missing? Autism 2020; 25:102-113. [PMID: 32859134 DOI: 10.1177/1362361320950058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Although autism can be reliably diagnosed as early as 2 years of age, many children are not diagnosed with autism until much later. We analyzed data to determine why many of the 8-year-old children who resided in Colorado and were identified as having autism through a review of their health and/or educational records did not have a documented clinical diagnosis of autism and were not eligible for special education services under an autism eligibility. We found that children who did not have a documented clinical diagnosis of autism and were not eligible for special education services under an autism eligibility were more likely to be female, aggressive, and argumentative. They had a poorer quality of information in their records and were less likely to have had a developmental regression, sleep problems, or an autism screener or diagnostic measure in their records. These results suggest that the symptoms characteristic of autism among this group of children may have been attributed to another disorder and that clinicians may be able to recognize autism more readily in children with more functional impairment and those who experience a developmental regression. We also discovered that differences in symptom presentations among children who had a documented clinical diagnosis of autism and/or were eligible for special education services under an autism eligibility were associated with different ages at autism diagnosis.
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6
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Dickter CL, Burk JA, Anthony LG, Robertson HA, Verbalis A, Seese S, Myrick Y, Anthony BJ. Assessment of Sesame Street online autism resources: Impacts on parental implicit and explicit attitudes toward children with autism. Autism 2020; 25:114-124. [PMID: 32842768 DOI: 10.1177/1362361320949346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The current study sought to characterize implicit bias toward children with autism and examine whether viewing educational materials about autism would change attitudes toward children with autism. A website developed by Sesame Street containing information about autism and resources for families was distributed to parents of children with autism (n = 473) and parents of children without autism (n = 707). Pre- and post-test measures of implicit bias toward children with autism; explicit attitudes and knowledge about autism; and parenting confidence, strain, and stigma were completed before and after the website was presented. Results indicated that parents of children with autism showed less implicit bias compared with those of non-autistic children during the pre-test, but the groups did not differ at the post-test. Parents without autistic children and those with more negative explicit attitudes showed a greater reduction in implicit bias from the pre- to the post-test. In addition, for parents of children with autism, a more positive change in explicit attitudes and increased knowledge from the pre- to the post-test was associated with more empowerment at the post-test. Together, our findings suggest that the online educational resources can reduce implicit bias against children with autism and help mitigate some of the psychological issues associated with parenting children with autism.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruno J Anthony
- University of Colorado School of Medicine, USA.,Georgetown University Medical Center, USA
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7
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Barnes AJ, Anthony BJ, Karatekin C, Lingras KA, Mercado R, Thompson LA. Identifying adverse childhood experiences in pediatrics to prevent chronic health conditions. Pediatr Res 2020; 87:362-370. [PMID: 31622974 PMCID: PMC6962546 DOI: 10.1038/s41390-019-0613-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/16/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023]
Abstract
Despite evidence that over 40% of youth in the United States have one or more adverse childhood experiences (ACEs), and that ACEs have cumulative, pernicious effects on lifelong health, few primary care clinicians routinely ask about ACEs. Lack of standardized and accurate clinical assessments for ACEs, combined with no point-of-care biomarkers of the "toxic stress" caused by ACEs, hampers prevention of the health consequences of ACEs. Thus, there is no consensus regarding how to identify, screen, and track ACEs, and whether early identification of toxic stress can prevent disease. In this review, we aim to clarify why, for whom, when, and how to identify ACEs in pediatric clinical care. To do so, we examine the evidence for such identification; describe the efficacy and accuracy of potential screening instruments; discuss current trends in, and potential barriers to, the identification of ACEs and the prevention of downstream effects; and recommend next steps for research, practice, and policy.
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Affiliation(s)
- Andrew J Barnes
- Department of Pediatrics, University of Minnesota, St Paul, MN, USA.
| | - Bruno J Anthony
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Canan Karatekin
- Institute of Child Development, University of Minnesota, St Paul, MN, USA
| | - Katherine A Lingras
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, St Paul, MN, USA
| | - Rebeccah Mercado
- Departments of Pediatrics, Health Outcomes and Policy, University of Florida, Gainesville, FL, USA
| | - Lindsay Acheson Thompson
- Departments of Pediatrics, Health Outcomes and Policy, University of Florida, Gainesville, FL, USA
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8
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Anthony BJ, Robertson HA, Verbalis A, Myrick Y, Troxel M, Seese S, Anthony LG. Increasing autism acceptance: The impact of the Sesame Street "See Amazing in All Children" initiative. Autism 2019; 24:95-108. [PMID: 31113212 DOI: 10.1177/1362361319847927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To promote knowledge and acceptance of autism, Sesame Workshop created an online initiative: See Amazing in All Children. This nationwide evaluation of See Amazing assessed whether it increased knowledge and acceptance, promoted community inclusion, reduced parenting strain, and enhanced parenting competence. Survey responses were collected online from parents of children (age ⩽ 6) with and without autism before (N = 1010), 1 week after (N = 510), and, for parents of autistic children, 1 month after (N = 182) they viewed the See Amazing materials. Following exposure, parents of non-autistic children showed small but significant increases in knowledge of autism and, like parents of autistic children, greater acceptance of autistic children. Parents of autistic children reported less strain, increased parenting competence, and more hope about involving their child in their community. That the See Amazing materials invoked positive changes in the general parent community and in parents of autistic children suggests that See Amazing materials have the potential to be an effective resource to increase acceptance and community inclusion, although limitations of self-selection, dropout rate, and lack of control group constrain interpretation. Implications include support for targeting acceptance as a step beyond awareness campaigns, though actual behavior change is a subject for future research.
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Affiliation(s)
- Bruno J Anthony
- University of Colorado School of Medicine, USA.,Georgetown University, USA
| | | | | | | | - Mary Troxel
- University of Colorado School of Medicine, USA
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9
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Tercyak KP, Bronheim SM, Kahn N, Robertson HA, Anthony BJ, Mays D, O’Neill SC, Peterson SK, Miesfeldt S, Peshkin BN, DeMarco TA. Cancer genetic health communication in families tested for hereditary breast/ovarian cancer risk: a qualitative investigation of impact on children's genetic health literacy and psychosocial adjustment. Transl Behav Med 2019; 9:493-503. [PMID: 31094441 PMCID: PMC6520800 DOI: 10.1093/tbm/ibz012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Children's literacy about the genetics of late-onset hereditary breast/ovarian cancer (HBOC) often develops through conversations with parents about BRCA gene testing and adults' cancer diagnoses. These conversations may promote early understanding of HBOC, but the long-term impact on children's psychosocial adjustment remains unclear. We investigated cancer genetic health communication in BRCA-tested families to consider benefits, risks, and moderating influences on children's understanding and well-being. Adolescent and young adult children (ages 12-24) of mothers who underwent BRCA testing 1+ years previously completed qualitative interviews that were transcribed, coded (intercoder K ≥ .70), and content-analyzed (N = 34). Children readily recalled conversations about BRCA testing and HBOC (100%) that they considered important (94%), but implications for children were ambiguous and obfuscated their concerns. Psychosocial impacts were muted, multifaceted, and displayed a range of favorable (82%), neutral (71%), and unfavorable (59%) response-frequently co-occurring within the same child over different aspects (e.g., medical, concern for self and others). Children verbalized active (50%) and avoidant (38%) coping strategies: about 1:5 endorsed transient thoughts about vulnerability to HBOC, 1:3 had not further considered it, and all reported specific actions they had or would undertake to remain healthy (e.g., diet/exercise). A majority (94%) of children had or would consider genetic testing for themselves, usually later in life (59%). Long-term outcomes highlighted benefits (awareness of HBOC, psychological hardiness, healthier lifestyle behaviors), as well as some psychosocial concerns that could be managed through interventions promoting genetic health literacy.
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Affiliation(s)
- Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Suzanne M Bronheim
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Nicole Kahn
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Hillary A Robertson
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
| | - Bruno J Anthony
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Suzanne C O’Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Susan K Peterson
- Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, USA
| | - Susan Miesfeldt
- Scarborough Campus, Maine Medical Center Cancer Institute, Scarborough, ME, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Abstract
Peer delivered, family-to-family (F2F) support-defined as the provision of outreach, engagement, knowledge, care coordination, and support to family members of children and youth with mental health challenges-is a rapidly growing and needed component of the service array. Progress is occurring toward greater specification of program models and core competencies for the parent support providers (PSPs) with lived experience providing these services; however, strategies to inform quality improvement and ensure accountability are lacking. The Family Journey Assessment (FJA), completed by PSPs and family members, fills this gap by tracking caregiver progress toward self-advocacy and self-efficacy. Analyses of 436 FJAs showed a reliable 3-component structure, reflecting progress in the recognition of needs, collaboration to access help from formal and natural supports, and activation of skills to cope with stress, enhance resilience, and develop and carry out plans of care. PSP feedback provided strong evidence for relevance and usability. Examination of FJAs at baseline and follow-up provides one of the first reports showing significant improvement in key indicators of benefit of F2F for participating families. The FJA holds promise as a measure of the impact of F2F services on key goals and as a way to identify benchmarks for focused and individualized peer-to-peer support depending on the family's level of need. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Celia Serkin
- Montgomery County Federation of Families for Children's Mental Health
| | - Nicole Kahn
- Center for Child and Human Development, Georgetown University
| | - Mary Troxel
- Department of Psychiatry, University of Colorado School of Medicine
| | - Jane Shank
- Michigan Association for Children's Mental Health
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11
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Banh MK, Chaikind J, Robertson HA, Troxel M, Achille J, Egan C, Anthony BJ. Evaluation of Mental Health First Aid USA Using the Mental Health Beliefs and Literacy Scale. Am J Health Promot 2018; 33:237-247. [DOI: 10.1177/0890117118784234] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This study assessed the impact of Mental Health First Aid (MHFA) in the United States with a theoretically based and psychometrically sound measure, the Mental Health Beliefs and Literacy Scale (MBLS). Design: Online MBLS surveys were administered pre-MHFA training, 3-weeks post-training, and 6-months posttraining. Setting: Mental Health First Aid trainings carried out across the United States. Participants: Six hundred sixty-two trainees were contacted, and 273 (41%) completed the presurvey. Of those, 63% filled out the postsurvey and 35% completed the 6-month survey. Seventy-six individuals completed all 3 surveys. Intervention: Mental Health First Aid is an 8-hour education program to help the general public identify, understand, and respond to signs of mental illness and substance abuse; to date, almost 1 million people have been trained. Measure: The MLBS, based on the Unified Theory of Behavior Change framework, consists of attitudinal, social-, and skill-based constructs affecting the intention to perform and achievement of MHFA actions and reports of their actual completion. Analysis: Change across time points was assessed using multivariate repeated measures analysis of variance. Results: Significant short- and longer term changes were found in internally consistent constructs tapping positive beliefs about MHFA actions, the confidence and intention to perform them as well as mental health literacy. Conclusion: The MBLS documented strong positive effects of MHFA training that were greater in individuals without prior mental health training, the intended targets of MHFA efforts.
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Affiliation(s)
- My K. Banh
- Department of Psychiatry, Georgetown University, Washington, DC, USA
| | - Jeremy Chaikind
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Mary Troxel
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Justine Achille
- Georgetown University School of Medicine, Washington, DC, USA
| | - Caroline Egan
- Georgetown Center for Child and Human Development, Washington, DC, USA
| | - Bruno J. Anthony
- Department of Psychiatry, Georgetown University, Washington, DC, USA
- Georgetown Center for Child and Human Development, Washington, DC, USA
- Department of Pediatrics, Georgetown University, Washington, DC, USA
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12
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Biel MG, Beers LS, Godoy L, Mlynarski L, Anthony BJ. Authors' Response to Comment on "Collaborative Training Efforts with Pediatric Providers in Addressing Mental Health Problems in Primary Care". Acad Psychiatry 2017; 41:855-856. [PMID: 29039123 DOI: 10.1007/s40596-017-0839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Matthew G Biel
- Georgetown University School of Medicine, Washington DC, USA.
| | - Lee S Beers
- Children's National Health System, Washington DC, USA
| | - Leandra Godoy
- Children's National Health System, Washington DC, USA
| | - Laura Mlynarski
- Georgetown University School of Medicine, Washington DC, USA
| | - Bruno J Anthony
- Georgetown University School of Medicine, Washington DC, USA
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13
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Biel MG, Anthony BJ, Mlynarski L, Godoy L, Beers LS. Collaborative Training Efforts with Pediatric Providers in Addressing Mental Health Problems in Primary Care. Acad Psychiatry 2017; 41:610-616. [PMID: 28421477 DOI: 10.1007/s40596-017-0709-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/20/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Matthew G Biel
- Georgetown University School of Medicine, Washington, DC, USA.
| | - Bruno J Anthony
- Georgetown University School of Medicine, Washington, DC, USA
| | - Laura Mlynarski
- Georgetown University School of Medicine, Washington, DC, USA
| | - Leandra Godoy
- Children's National Health System, Washington, DC, USA
| | - Lee S Beers
- Children's National Health System, Washington, DC, USA
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Ratto AB, Anthony BJ, Pugliese C, Mendez R, Safer-Lichtenstein J, Dudley KM, Kahn NF, Kenworthy L, Biel M, Martucci JL, Anthony LG. Lessons learned: Engaging culturally diverse families in neurodevelopmental disorders intervention research. Autism 2016; 21:622-634. [PMID: 27313190 DOI: 10.1177/1362361316650394] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Low-income and ethnic minority families continue to face critical disparities in access to diagnostic and treatment services for neurodevelopmental conditions, such as autism spectrum disorder and attention deficit hyperactivity disorder. Despite the growing cultural diversity of the United States, ethnic minority children and families continue to be substantially underrepresented across research on neurodevelopmental disorders, and there is a particularly concerning lack of research on the treatment of these conditions in low-income and ethnic minority communities. Of note, there are currently no published studies on adapting autism spectrum disorder treatment for low-income Latino communities and relatively few studies documenting adapted treatments for children with attention deficit hyperactivity disorder in these communities. This article describes methodological considerations and adaptations made to research procedures using a Diffusion of Innovation framework in order to effectively recruit and engage low-income, ethnic minority, particularly Latino, families of children with neurodevelopmental disorders, in a comparative effectiveness trial of two school-based interventions for executive dysfunction.
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Affiliation(s)
- Allison B Ratto
- 1 Children's National Health System, USA.,2 The George Washington University School of Medicine, USA.,3 Children's Research Institute, Washington DC, USA
| | - Bruno J Anthony
- 4 Georgetown University Center for Child and Human Development, USA.,5 Georgetown University Medical Center, USA.,6 MedStar Health Research Institute, USA
| | - Cara Pugliese
- 1 Children's National Health System, USA.,3 Children's Research Institute, Washington DC, USA
| | - Rocio Mendez
- 4 Georgetown University Center for Child and Human Development, USA
| | | | - Katerina M Dudley
- 1 Children's National Health System, USA.,3 Children's Research Institute, Washington DC, USA
| | - Nicole F Kahn
- 4 Georgetown University Center for Child and Human Development, USA
| | - Lauren Kenworthy
- 1 Children's National Health System, USA.,2 The George Washington University School of Medicine, USA.,3 Children's Research Institute, Washington DC, USA
| | - Matthew Biel
- 4 Georgetown University Center for Child and Human Development, USA.,7 MedStar Georgetown University Hospital, USA
| | - Jillian L Martucci
- 1 Children's National Health System, USA.,3 Children's Research Institute, Washington DC, USA
| | - Laura G Anthony
- 1 Children's National Health System, USA.,2 The George Washington University School of Medicine, USA.,3 Children's Research Institute, Washington DC, USA
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Biel MG, Kahn NF, Srivastava A, Mete M, Banh MK, Wissow LS, Anthony BJ. Parent Reports of Mental Health Concerns and Functional Impairment on Routine Screening With the Strengths and Difficulties Questionnaire. Acad Pediatr 2015; 15:412-20. [PMID: 25922333 PMCID: PMC4492834 DOI: 10.1016/j.acap.2015.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 01/15/2015] [Accepted: 01/17/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study used the Strengths and Difficulties Questionnaire (SDQ) to describe the prevalence of parent-reported mental health (MH) concerns in youth presenting for primary care appointments and to examine relationships between children's MH issues and functional impairment. We hypothesized that increased MH symptomology would be associated with increased impairment and family burden. METHODS Parents of 4- to 17-year-old children were approached at routine visits in 13 primary care sites. Chi-square tests, independent sample t tests, and a 1-way analysis of variance (ANOVA) were used to make comparisons between demographic groups. Age-, sex-, and race-adjusted ordered logistic regression models and ANOVAs examined relationships between impact and SDQ scales. RESULTS Boys had higher total Hyperactivity and Peer Problems. Adolescents showed higher Emotional Symptoms, while younger children showed more Hyperactivity. Latinos reported more Conduct Problems, Hyperactivity, and Peer Problems. Latinos also indicated less distress on the child, impairment at home and school, and family burden. Regression analyses indicated increased odds of impairment with higher scale scores. MH symptoms identified with the SDQ in pediatric primary care settings were associated with parent-reported impairment affecting youth and their families. CONCLUSIONS The presence of significant impairment suggests that parents' concerns identified by screening are likely to be clinically important and worthy of practice strategies designed to promote assessment, treatment, and referral for these common problems. Identifying and exploring parents' concerns with strategic use of screening tools may allow primary care providers to directly engage families around the MH issues that affect them most.
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Affiliation(s)
- Matthew G. Biel
- Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC
| | - Nicole F. Kahn
- Georgetown University Center for Child and Human Development, Washington, DC
| | - Anjuli Srivastava
- Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC
| | - Mihriye Mete
- MedStar Health Research Institute, Hyattsville, MD
| | - My K. Banh
- Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC,Georgetown University Center for Child and Human Development, Washington, DC
| | | | - Bruno J. Anthony
- Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC,Georgetown University Center for Child and Human Development, Washington, DC
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Le LT, Anthony BJ, Bronheim SM, Holland CM, Perry DF. A Technical Assistance Model for Guiding Service and Systems Change. J Behav Health Serv Res 2014; 43:380-95. [DOI: 10.1007/s11414-014-9439-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Screening children to determine risk for Autism Spectrum Disorders has become more common, although some question the advisability of such a strategy. The purpose of this systematic review is to identify autism screening tools that have been adapted for use in cultures different from that in which they were developed, evaluate the cultural adaptation process, report on the psychometric properties of the adapted instruments, and describe the implications for further research and clinical practice. A total of 21 articles met criteria for inclusion, reporting on the cultural adaptation of autism screening in 19 countries and in 10 languages. The cultural adaptation process was not always clearly outlined and often did not include the recommended guidelines. Cultural/linguistic modifications to the translated tools tended to increase with the rigor of the adaptation process. Differences between the psychometric properties of the original and adapted versions were common, indicating the need to obtain normative data on populations to increase the utility of the translated tool.
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Affiliation(s)
- Sandra Soto
- San Diego State University/University of California, USA
| | - Keri Linas
- Georgetown Center for Child and Human Development, USA
| | | | | | - Talia Migdal
- Georgetown Center for Child and Human Development, USA
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Affiliation(s)
- Bruno J Anthony
- Center for Child and Human Development, Department of Pediatrics, Georgetown University, Washington, DC 20057-1485, USA.
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Ghuman JK, Arnold LE, Anthony BJ. Psychopharmacological and other treatments in preschool children with attention-deficit/hyperactivity disorder: current evidence and practice. J Child Adolesc Psychopharmacol 2008; 18:413-47. [PMID: 18844482 PMCID: PMC2935821 DOI: 10.1089/cap.2008.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This article reviews rational approaches to treating attention-deficit/hyperactivity disorder (ADHD) in preschool children, including pharmacological and nonpharmacological treatments. Implications for clinical practice are discussed. DATA SOURCES We searched MEDLINE, PsychINFO, Cumulative Index to Nursing & Allied Health, Educational Resources Information Center, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects for relevant literature published in English from 1967 to 2007 on preschool ADHD. We also reviewed the references cited in identified reports. STUDY SELECTION Studies were reviewed if the sample included at least some children younger than 6 years of age or attending kindergarten, the study participants had a diagnosis of ADHD or equivalent symptoms, received intervention aimed at ADHD symptoms, and included a relevant outcome measure. DATA EXTRACTION Studies were reviewed for type of intervention and outcome relevant to ADHD and were rated for the level of evidence for adequacy of the data to inform clinical practice. CONCLUSIONS The current level of evidence for adequacy of empirical data to inform clinical practice for short-term treatment of ADHD in preschool children is Level A for methylphenidate and Level B for parent behavior training, child training, and additive-free elimination diet.
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Affiliation(s)
- Jaswinder K Ghuman
- Department of Psychiatry, University of Arizona, Tucson, Arizona 85724-5002, USA.
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Reeves GM, Tonelli LH, Anthony BJ, Postolache TT. Precipitants of adolescent suicide: possible interaction between allergic inflammation and alcohol intake. Int J Adolesc Med Health 2007; 19:37-43. [PMID: 17458322 DOI: 10.1515/ijamh.2007.19.1.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suicide is a leading cause of mortality among adolescents. There is a pressing public health need to investigate triggers and novel vulnerabilities for suicide in order to improve risk assessment and develop innovative prevention strategies. Alcohol is a well established risk factor for adolescent suicide. In this paper, we outline a novel mechanism linking allergy, alcohol, and suicide, reviewing (a) the association between allergic inflammation, depression, and suicide; and (b) the role of alcohol in inducing phosphorylation and rearrangement of tight junction proteins of the blood-brain barrier (BBB) resulting in increased "leakiness", i.e. passage of cells and molecules. Seasonal peaks of suicide in spring have been consistently reported, but their causality is poorly understood. A preliminary epidemiologic study found increased nonviolent suicide rates in females in spring during intervals of high tree pollen, in comparison to similar intervals of low tree pollen. This initial report added to the emerging literature proposing a relationship between allergy and depression, and is being further pursued at clinical, epidemiological, animal and postmortem tissue levels. We propose that allergic inflammation influences depression-related brain function via molecular and cellular mediators, but those mediators have a very limited access to the brain when the BBB is intact. Alcohol intake disrupts BBB, allowing increased brain exposure to cellular mediators of allergy. Considering the greater prevalence of allergy in adolescence when alcohol use starts, studies investigating the connection between allergy, alcohol, and suicide should be expanded to also include a focus on youth.
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Affiliation(s)
- Gloria M Reeves
- Child and Adolescent Psychiatry Division and Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Anthony LG, Anthony BJ, Glanville DN, Naiman DQ, Waanders C, Shaffer S. The relationships between parenting stress, parenting behaviour and preschoolers' social competence and behaviour problems in the classroom. Inf Child Develop 2005. [DOI: 10.1002/icd.385] [Citation(s) in RCA: 362] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Foster LG, Hunter SJ, Bilgrave D, Anthony BJ. ADHD and the Nature of Self-Control. Clin Psychol Rev 2000. [DOI: 10.1016/s0272-7358(98)00067-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Schmidt KL, Stark KD, Carlson CL, Anthony BJ. Cognitive factors differentiating attention deficit-hyperactivity disorder with and without a comorbid mood disorder. J Consult Clin Psychol 1998; 66:673-679. [PMID: 9735585 DOI: 10.1037/0022-006x.66.4.673] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mood disorders and attention deficit-hyperactivity disorder (ADHD) co-occur in 20-30% of children and adolescents diagnosed in both epidemiological and clinical studies, but little information is available regarding cognitive factors that may be relevant to the expression of co-occurring mood disorders and ADHD. This study examined whether ADHD with and without a comorbid mood disorder could be differentiated on the basis of cognitive factors associated with prominent theories of depression. Children meeting diagnostic criteria for ADHD (n = 14) or ADHD and a comorbid mood disorder (n = 27) were assessed on a variety of cognitive indices. Children in the comorbid group reported more negative views of themselves and a more depressogenic attributional style. Cognitive disturbances associated with A. T. Beck's (1967) cognitive model and attributional style theories of depression differentiate ADHD children with significant mood pathology.
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Rebok GW, Smith CB, Pascualvaca DM, Mirsky AF, Anthony BJ, Kellam SG. Developmental changes in attentional performance in urban children from eight to thirteen years. Child Neuropsychol 1997. [DOI: 10.1080/09297049708401366] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pascualvaca DM, Anthony BJ, Arnold LE, Rebok GW, Ahearn MB, Kellam SG, Mirsky AF. Attention performance in an epidemiological sample of urban children: The role of gender and verbal intelligence. Child Neuropsychol 1997. [DOI: 10.1080/09297049708401365] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
A model for conceptualizing the components or elements of attention is presented. The model substitutes for the diffuse and global concept of "attention" a group of four processes and links them to a putative system of cerebral structures. Data in support of the model are presented; they are derived from neuropsychological test scores obtained from two samples, the first consisting of 203 adult neuropsychiatric patients and normal control subjects, and the second, an epidemiologically-based sample of 435 elementary school children. Principal components analyses of test scores from these two populations yielded similar results: a set of independent elements of attention that are assayed by different tests. This work presents a heuristic for clinical research in which the measurement of attention is essential.
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Affiliation(s)
- A F Mirsky
- Laboratory of Psychology and Psychopathology, National Institute of Mental Health, Bethesda, Maryland 20892
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Abstract
Reduction of reflex startle by brief changes in prestimulation is a robust phenomenon in adults of several species. Although the phenomenon does not require structures above midbrain, it has a long and uneven developmental course. This study of human infants assessed prestimulus effects at 15 months, within a period which has failed, in past work, to show the usual inhibitory modulation. Magnitude and onset latency of the startle blink and concurrent changes in heart rate were measured under four conditions: 2 single-stimulus conditions, 25-msec, 84-dB, 1000-Hz tone or 50-msec, 109-dB white noise; 2 paired-stimulus conditions, noise bursts preceded by tone at lead times of 125 msec or 225 msec. Compared to noise-alone, paired conditions elicited insignificant increases in blink size, significant shortening of blink onset latency, and significant attenuation of heart rate responses. The findings add to growing evidence of a dissociation between modulating effects on blink magnitude and latency and of a dissociation between modulating effects on somatic and autonomic reflexes.
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Abstract
Alternative hypotheses of differential development of auditory and visual systems versus temporal-processing systems were tested to explain prior adult-infant differences in reflex blink latency. The present study removed a confound between stimulus modality and duration, present in prior work, and determined whether age interacted with modality or with duration when they were varied orthogonally. Reflexes were elicited from human adults and infants under 4 stimulus conditions: flash and click, delivered singly and in trains. Age interacted only with duration to affect latency and elicitation probability, reflex characteristics which depend on adequate triggering by a transient change at onset. In contrast, age did not interact with duration to affect peak amplitude which presumably depends on temporal integration. Findings are compatible with the hypothesis that processes or structures, specialized for differentiation of transient stimulus change, mature at a different rate than those specialized for integration of stimulus energy over time.
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Abstract
Probe stimuli which elicit activity reflexly provide a means of assessing 'top-down' effects of attentional manipulations while minimizing the perhaps insolvable problem of determining whether effects are due to post-perceptual selection or to changes in the input pathway. Parallel experiments on adults and infants presented acoustic and visual probes unpredictably while subjects attended to acoustic and visual foregrounds: Attention was indexed by heart rate deceleration. When probe and foreground modality matched, probe-elicited reflex blinks were significantly facilitated in magnitude (infants) or latency (adults) relative to reflexes elicited when probe and foreground modality mismatched. Further, facilitation was greater when modality-matching probes were presented over foregrounds judged a priori to be more 'interesting' than 'dull' foregrounds. Because acoustic and visual blink reflexes have a common efferent path, modulating effects must have occurred earlier, in modality-specific paths. As such, the results suggest that attention can influence 'automatic' sensory-perceptual analysis.
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Abstract
The existence of low-level filtering of sensory input is a point of debate among cognitive theorists. This present study suggests that filtering by modality exists at levels low enough to modulate the brainstem blink reflex and that it is evident as early as the 16th week of life. During foreground listening or looking conditions, blinks elicited by acoustic or visual probes were larger when probe and foreground modality matched than when they mismatched. "Interesting" foregrounds, by comparison with "dull" ones, intensified the modality-selective effect.
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