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Biomedical subjects

John R Weisz

Publications and source records attributed to John R Weisz.

At least 19 recordsLinked to original sources
PubMed2006

Examining the association between parenting and childhood anxiety: a meta-analysis.

Theoretical models emphasize the role of parenting in the development and maintenance of child anxiety, but reviews of the empirical literature have provided mixed support for existing theories. To help clarify the role parenting plays in childhood anxiety, we conducted a meta-analysis of 47 studies testing the association between parenting and child anxiety. Across these studies, parenting accounted for only 4% of the variance in child anxiety. Moderator tests indicated that methodological factors (i.e., how child anxiety and parenting were conceptualized and assessed) may be a source of inconsistent findings within the literature. In addition, our analyses revealed that parental control was more strongly associated with child anxiety than was parental rejection. Specific subdimensions within parental rejection and control differed in their association with child anxiety (e.g., autonomy-granting accounted for 18% of the variance, but warmth <1%), indicating that efforts to disaggregate parenting dimensions may inform theory development and future research. Overall, however, the modest association between parenting and child anxiety suggests that understanding the origins of children's anxiety will require identifying factors other than parenting that account for the bulk of the variance.

Adolescent↗
PubMed2006

Perceived control mediates the relation between parental rejection and youth depression.

Previous research suggests that both perceived parental control and rejection may be linked to youth depression. However, research has not definitively determined which dimension matters more, nor examined mediation within a clinical sample. We used a sample of clinically referred youth (aged 7-17) to determine (a) which parenting dimension is more closely associated with youth depression, and (b) whether youngsters' perceptions of control mediated the association. Perceived parental rejection was strongly linked to depressive symptoms (perceived parental control was not); youth perceived control did in fact mediate the association, and robustly so across gender and age groups. The findings suggest a developmental process in depression, plus potential foci for prevention and treatment programs.

Adolescent↗
PubMed2006

Abusive parents' reports of child behavior problems: relationship to observed parent-child interactions.

PURPOSE: We evaluated the hypothesis that abusive parents' reports may exaggerate rates of child behavior problems in a clinical sample. METHOD: The association between parental ratings of behavior problems and independent observations of child behaviors was examined in a sample of 205 clinic-referred families, 58 of which had a reported history of physical abuse. RESULTS: Relative to the comparison group, parents in the abuse group reported more externalizing problems in their children after controlling for parental psychopathology, and displayed more emotionally controlling and less supportive behavior during parent-child interactions. However, there was no association between abuse history and observed child behaviors during the interaction tasks. Abuse status significantly moderated the association between parent-reported externalizing behaviors and observed demanding behavior by the child; the association was significant among comparison families, but not in the abuse group families. CONCLUSIONS: Results indicate that abusive parents may over-report externalizing behavior problems in their children.

Adolescent↗
PubMed2006

Evidence-based youth psychotherapies versus usual clinical care: a meta-analysis of direct comparisons.

In the debate over evidence-based treatments (EBTs) for youth, one question is central: Do EBTs produce better outcomes than the usual interventions employed in clinical care? The authors addressed this question through a meta-analysis of 32 randomized trials that directly compared EBTs with usual care. EBTs outperformed usual care. Effects fell within the small to medium range at posttreatment, increasing somewhat at follow-up. EBT superiority was not reduced by high levels of youth severity or by inclusion of minority youths. The findings underscore a need for improved study designs and detailed treatment descriptions. In the future, the EBT versus usual care genre can inform the search for the most effective interventions and guide treatment selection in clinical care.

Adolescent↗
PubMed2006

Syndrome co-occurrence and treatment outcomes in youth mental health clinics.

Despite widespread speculation that syndrome co-occurrence undermines treatment outcomes, this hypothesis has not been fully examined within clinical care settings. To address this gap, the authors investigated the relation between syndrome co-occurrence and outcome among 325 clinically referred youths. For every syndrome, higher initial severity was predictive of greater treatment gains and higher posttreatment symptom levels; contrary to speculation in the literature, co-occurrence effects were rare and modest in size, accounting for 0.6% of outcome variance on average. The results suggest that co-occurrence, though common in youth clinical care, is not an obstacle to treatment success in most cases. In addition to its substantive findings, the study illustrates how a dimensional approach can be used to shed new light on co-occurrence in clinical care.

Adolescent↗
PubMed2006

Culture and youth psychopathology: testing the syndromal sensitivity model in Thai and American adolescents.

Current widespread use of the same youth assessment measures and scales across different nations assumes that youth psychopathology syndromes do not differ meaningfully across nations. By contrast, the authors' syndromal sensitivity model posits 3 processes through which cultural differences can lead to cross-national differences in psychopathology syndromes. The authors tested this model in a comparison of Child Behavior Checklist syndromes for adolescents in Thailand and the United States. In support of the model, about half of the Thai-U.S. syndrome comparisons showed poor agreement (kappa = .40), and distinctive Thai syndromes emerged reflecting 3 prominent themes in Thai research literature: delayed maturation, indirect aggression and/or delinquency, and sex problems in boys. Such syndromal dissimilarity carries significant implications for assessment, diagnosis, epidemiology, and intervention across national boundaries.

Adolescent↗
PubMed2006

Effects of psychotherapy for depression in children and adolescents: a meta-analysis.

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability.

Adolescent↗
PubMed2005

Identifying and selecting the common elements of evidence based interventions: a distillation and matching model.

A model is proposed whereby the intervention literature can be empirically factored or distilled to derive profiles from evidence-based approaches. The profiles can then be matched to individual clients based on consideration of their target problems, as well as demographic and contextual factors. Application of the model is illustrated by an analysis of the youth treatment literature. Benefits of the model include its potential to facilitate improved understanding of similarities and differences among treatments, to guide treatment selection and matching to clients, to address gaps in the literature, and to point to possibilities for new interventions based on the current research base.

Evidence-Based Medicine↗
PubMed2005

Promoting and protecting youth mental health through evidence-based prevention and treatment.

For decades, empirically tested youth interventions have prevented dysfunction by addressing risk and ameliorated dysfunction through treatment. The authors propose linking prevention and treatment within an integrated model. The model suggests a research agenda: Identify effective programs for a broadened array of problems and disorders, examine ethnicity and culture in relation to intervention adoption and impact, clarify conditions under which programs do and do not work, identify change mechanisms that account for effects, test interventions in real-world contexts, and make tested interventions accessible and effective in community and practice settings. Connecting the science and practice of prevention and treatment will be good for science, for practice, and for children, adolescents, and their families.

Adolescent↗
PubMed2005

The therapy process observational coding system-alliance scale: measure characteristics and prediction of outcome in usual clinical practice.

The authors describe psychometric characteristics of the new Therapy Process Observational Coding System-Alliance scale (TPOCS-A; B. D. McLeod, 2001) and illustrate its use in the study of treatment as usual. The TPOCS-A uses session observation to assess child-therapist and parent-therapist alliance. Both child and parent forms showed acceptable interrater reliability and internal consistency; when applied to cases treated for internalizing disorders, both forms were associated with youth outcomes. Child-therapist alliance during treatment predicted reduced anxiety symptoms at the end of treatment. Parent-therapist alliance during treatment predicted reduced internalizing, anxiety, and depression symptoms at the end of treatment. The findings held up well after confounding variables were controlled, which suggests that both child-therapist and parent-therapist alliance play key (and potentially different) roles in the outcome of treatment as usual.

Adolescent↗
PubMed2005

Iatrogenic effects of group treatment for antisocial youths.

It has been argued that group treatment of antisocial adolescents may increase rather than decrease conduct problems. One mechanism that has been suggested to underlie this effect is "deviancy training," wherein during group sessions deviant peers reinforce each other's antisocial actions and words. These 2 hypotheses have important implications and warrant close review at conceptual and empirical levels. In this article, the authors present such a review. Conceptually, deviancy training potential of treatment sessions appears less significant than the more extensive peer influences outside treatment. Empirical findings previously cited in support of iatrogenic effects appear on close examination to provide little support. Finally, 17 of 18 new meta-analytic tests produced results not supportive of iatrogenic or deviancy training effects.

Adolescent↗
PubMed2005

Jousting with straw men: comment on Westen, Novotny, and Thompson-Brenner (2004).

Empirically supported treatments (ESTs) do not cure every patient, and the randomized trial is not a flawless methodology. Upon these often-noted and widely accepted points, D. Westen, C. M. Novotny, and H. Thompson-Brenner (2004a; see record 2004-15935-005) built a critique of ESTs and EST research. However, important work developing effective, clinically relevant treatments for serious problems was omitted from the Westen et al. (2004a) review. Little documentation was offered for the purported "assumptions" of EST methodology that Westen et al. (2004a) criticized; and different review standards were applied to studies supporting versus those disagreeing with Westen et al.'s (2004a) views. Finally, the correlational research designs proposed as a remedy by Westen et al. (2004a) have far more serious weaknesses than randomized trials, thoughtfully applied to real-world clinical care.

Empirical Research↗
PubMed2005

Youth psychotherapy outcome research: a review and critique of the evidence base.

Over the past four decades, researchers have produced extensive evidence on psychotherapy for youth mental health problems and disorders. The evidence often has been evaluated through narrative reviews and through meta-analyses assessing the magnitude of treatment effects, but methodological analysis addressing the character and quality of the evidence base itself is an important complement, needed to place treatment effects in perspective and to suggest directions for future research. We carried out such an analysis, focusing on all the methodologically acceptable published randomized trials our search identified involving treatment of anxiety, depression, ADHD and related conditions, and conduct-related problems and disorders. The 236 studies tested 383 treatments and included 427 treatment-control comparisons, spanning the years 1962 through 2002. The analysis revealed considerable breadth, diversity, and rigor in the measurement approaches used to assess participant characteristics and treatment outcomes. However, reporting on important sample characteristics (e.g., ethnicity) showed major gaps, and more than half the studies failed to use well-standardized procedures to ensure appropriate sample selection. Because sample sizes left most studies underpowered, and procedures to enhance treatment fidelity were generally weak, many of the treatments investigated may not have received fair tests. Studies were particularly weak in clinical representativeness of their samples, therapists, and settings, suggesting a need for increased emphasis on external validity in youth treatment research.

Adolescent↗
PubMed2005

Youth versus parent working alliance in usual clinical care: distinctive associations with retention, satisfaction, and treatment outcome.

We investigated associations between both youth-therapist and parent-therapist alliances and retention, satisfaction, and symptom improvement among 65 youth and their parents receiving usual community-based outpatient mental health services. Parent (but not youth) alliance was significantly related to more frequent family participation, less frequent cancellations and no-shows, and greater therapist concurrence with termination decision. In contrast, youth (but not parent) alliance was significantly related to both youth and parent reports of symptom improvement. Youth and parent alliance were each significantly related to their satisfaction with services. Findings suggest that youth and parent alliance may play important but distinctive roles in the processes and outcomes of usual clinical care.

Adolescent↗
PubMed2004

Empirically tested psychotherapies for youth internalizing and externalizing problems and disorders.

This article is a review of specific psychotherapies that have been supported in clinical trials. Treatments that showed significant effects in studies published over a period of 4 decades were identified, with the goal of complementing the overall picture of treatment benefit provided in narrative reviews and meta-analyses with a detailing of the specific interventions that have shown significant effects. The article focuses on treatments for four broad clusters of problems and disorders that account for a very large proportion of youth mental health referrals: anxiety, depression, attention-deficit/hyperactivity, and conduct.

Adolescent↗
PubMed2004

Parent-child interactions in relation to critical and emotionally overinvolved expressed emotion (EE): is EE a proxy for behavior?

Expressed emotion measures, encompassing dimensions of criticism (CRIT), and emotional overinvolvement (EOI) are increasingly being used to assess the parent-child relationship in child clinical populations, despite the lack of studies assessing their validity. We examined the correspondence between CRIT, EOI, and parent-child interactions as observed by neutral coders in a sample of 252 clinic-referred children and adolescents, ages 7-17 years. We found support for the validity of the CRIT code, with high critical parents showing more antagonism, negativity, disgust, harshness, and less responsiveness, compared to parents who scored in the low or borderline ranges. In contrast, none of the observed behaviors were found to correspond with parental EOI, suggesting either that this construct lacks validity with juvenile samples or that behaviors that correspond to EOI are difficult to observe. We conclude that high parental CRIT can be used as an index of problematic parent-child interactions.

Adolescent↗
PubMed2004

Using dissertations to examine potential bias in child and adolescent clinical trials.

The major youth psychotherapy meta-analyses have relied on published studies, which may have led to biased effect size estimates. To examine this possibility, the authors compared 121 dissertations with 134 published studies and found the following: (a) few differences on individual methodological variables, but, overall, stronger methodology in dissertations; (b) no differences in the steps taken to ensure treatment integrity; and (c) a mean dissertation effect size less than half that of published studies. The effect size difference remained robust across tests controlling for all reliable method differences. The findings suggest that dissertations are so strong, both methodologically and clinically, that they warrant inclusion in child psychotherapy meta-analyses and that previous meta-analyses, by excluding them, may have overestimated treatment effects.

Academic Dissertations as Topic↗