Biomedical subjects

J A Larrieu

Publications and source records attributed to J A Larrieu.

8 recordsLinked to original sources

PubMed2001

Evaluation of a preventive intervention for maltreated infants and toddlers in foster care.

OBJECTIVE: To determine the effectiveness of an intervention designed to improve outcomes for infants and toddlers in foster care. METHOD: Records were reviewed for all children who were adjudicated as in need of care in a specific parish in Louisiana between 1991 and 1998. This period included 4 years before and 4 years after a comprehensive intervention was implemented. Children adjudicated between 1991 and 1994 were the comparison group, and those adjudicated between 1995 and 1998 were the intervention group. RESULTS: After the intervention, more children were freed for adoption and fewer children were returned to their birth families than before the intervention. There was no difference in length of time in care before and after the intervention. With regard to the same child returning in a subsequent incident of maltreatment, relative risk reduction for the intervention group ranged from 53% to 68%. With regard to the same mother maltreating another child subsequently, relative risk reduction for the intervention group ranged from 63% to 75%. CONCLUSIONS: A comprehensive preventive intervention for maltreated infants and toddlers in foster care substantially reduced rates of recidivism but had no effect on length of time in care.

Child Abuse↗

PubMed1999

Research on resilience to child maltreatment: empirical considerations.

OBJECTIVE: To review the current research literature on resilience to maltreatment in childhood and adolescence. METHOD: First, this paper addresses the methodological issues applicable to this area of research. Second, it reviews the empirical literature on the protective factors believed to contribute to resilience to maltreatment and offers commentary on specific issues raised in each study. RESULTS: The current findings are summarized and an integrated descriptive picture, based on the extant literature of the processes and factors contributing to the development of resilience to childhood maltreatment is outlined. CONCLUSION: Based on this extensive review and critique of the current empirical literature on resilience to maltreatment, suggestions for future investigations in this area are recommended.

Adaptation, Psychological↗

PubMed1998

Attachment disorders in infancy and early childhood: a preliminary investigation of diagnostic criteria.

OBJECTIVE: The primary purpose of this study was to compare the reliability of differing sets of criteria for attachment disorders by using a retrospective case review. METHOD: Forty-eight consecutive clinical case summaries from an infant behavior clinic were reviewed by four experienced clinicians. Attachment disorders were coded as present or absent by using competing criteria and were scored by using a continuous scale of relationship functioning. RESULTS: The reliability of alternative criteria was acceptable, but the reliability of DSM-IV criteria in diagnosing attachment disorders was marginal. Preliminary validity for the criteria was demonstrated by the fact that more severe relationship disturbances were seen in infants diagnosed with attachment disorders than in infants diagnosed with other disorders. CONCLUSIONS: Standardized assessments of at-risk populations should be used to replicate these preliminary results; revision of DSM-IV criteria may be necessary to obtain adequate reliability for diagnosing attachment disorders.

Adult↗

PubMed1998

Intensive intervention for maltreated infants and toddlers in foster care.

We have described a program that integrates clinical approaches of infant mental health to infants and toddlers in foster care. The juxtaposition of a mental health program in a forensic setting creates a number of special features that we have highlighted. Unique from the clinical perspective, the team is explicitly relationship-focused, attempting to understand all of the young child's caregiving relationships as they affect development. We strive to enhance the quality of all of relationships in which infants participate, fostering healthy attachments and development. Also unique is the emphasis on system liaison, and making programmatic efforts to affect various systems involved in making custody determinations about infants and toddlers. Unique from the forensic perspective, we offer multidisciplinary expertise about an especially high-risk population, a comprehensive service delivery system in which we provide or coordinate and monitor all intervention efforts for a given family, a prevention orientation, and clinical follow-up with infants for as long as they are in care. The goals of the program include expediting permanency planning decisions, increasing continuity in high-quality foster care placements, increasing court satisfaction with mental health consultation, decreasing the number of court-ordered evaluations for adjudicated families, and increasing CPS satisfaction with available treatment and continuity of care. We believe that this approach integrates delivery of services to the youngest and most vulnerable victims of maltreatment and expedites permanency planning.

Caregivers↗

PubMed1997

Infant development and developmental risk: a review of the past 10 years.

OBJECTIVE: To review critically the research on infant developmental risk published in the past 10 years. METHOD: A brief framework on development in the first 3 years is provided. This is followed by a review of pertinent studies of developmental risk, chosen to illustrate major risk conditions and the protective factors known to affect infant development. Illustrative risk conditions include prematurity and serious medical illness and infant temperament, infant-caregiver attachment, parental psychopathology, marital quality and interactions, poverty and social class, adolescent parenthood, and family violence. RESULTS: Risk and protective factors interact complexly. There are few examples of specific or linear links between risk conditions and outcomes during or beyond the first 3 years of life. Infant development is best appreciated within the context of caregiving relationships, which mediate the effects of both intrinsic and extrinsic risk conditions. CONCLUSIONS: Complex and evolving interrelationships among risk factors are beginning to be elucidated. Linear models of cause and effect are of little use in understanding the development of psychopathology. Refining our markers of risk and demonstrating effective preventive interventions are the next important challenges.

Child Development↗

PubMed1997

Roles of mental health professionals in multidisciplinary medically supervised treatment programs for obesity.

Excess weight is a major medical problem for more than one third of Americans and, after cigarette smoking, is the second largest cause of death. However, obesity treatments remain controversial, and only surgical therapies have patient volume and appropriate follow-up adequate to prove effectiveness. National Institutes of Health conferences on obesity treatments and the Institute of Medicine have suggested that all obesity treatment programs, including those which are medically supervised, should be multidisciplinary, involving professionals from the behavioral, nutritional, and exercise fields to facilitate delivery of a patient-treatment matching strategy. There are no models to suggest how these recommendations should be accomplished or whether they are financially feasible. We present a case management model that includes psychotherapists in a multidisciplinary obesity treatment program. More data are needed to show whether these suggestions improve cost-effectiveness of obesity treatments.

Behavior Therapy↗

PubMed1997

Differential diagnosis between attention-deficit/hyperactivity disorder and pervasive developmental disorder--not otherwise specified.

The lack of clarity in diagnostic classification and the lack of specificity of assessment devices deter accurate identification of children with Pervasive Developmental Disorder-Not Otherwise Specified (PDD--NOS). The current study was designed to assess the utility of the Personality Inventory for Children (PIC) and the Conners Parent Rating Scale (CPRS-48) in differentiating PDD--NOS from Attention Deficit Hyperactivity Disorder (ADHD), disorders with overlapping symptom constellations. Subjects were 44 children recruited from a tertiary-care center with the diagnosis of ADHD or PDD--NOS. Results showed significant differences between groups on PIC scales assessing internalizing behaviors, social skills, and unusual affect and behavior. There were no group differences on the externalizing or learning scales of the CPRS-48. Discriminant function analysis using preselected PIC variables yielded a correct group classification of 92.7%. The PIC appears to be a useful tool in the differential diagnosis between PDD--NOS and ADD, while the CPRS-48, a commonly used screening measure for attentional and behavioral disorders, does not.

Attention Deficit Disorder with Hyperactivity↗

PubMed1995

Two approaches to the diagnosis of posttraumatic stress disorder in infancy and early childhood.

OBJECTIVE: The reliability and validity of DSM-IV criteria and an alternative set of criteria for posttraumatic stress disorder (PTSD) are assessed in infants and young children (younger than 4 years of age). METHOD: This study was conducted in three phases. Phase 1 applied DSM-IV criteria for PTSD to 20 case reports of severely traumatized infants from the literature. Phase 2 used an expanded checklist of symptoms that were developmentally sensitive and behaviorally anchored to create an alternative set of criteria for PTSD in infants. Phase 3 compared the DSM-IV criteria to the alternative criteria on 12 new cases of traumatized infants. RESULTS: Infants and young children who have experienced severe traumas show many symptoms of impairment, similar to posttraumatic symptoms in older children and adults. The alternative criteria were more reliable and more valid for diagnosing PTSD in infancy than DSM-IV criteria. CONCLUSIONS: Clinicians ought to be aware that infants and young children can develop posttraumatic disorders after traumatic events. Criteria for diagnosing these disorders in standard nosologies may need revision for use with children younger than 48 months of age.

Child Behavior Disorders↗