Biomedical subjects

M R Dadds

Publications and source records attributed to M R Dadds.

At least 19 recordsLinked to original sources

PubMed2002

The efficacy of a psychosocial intervention for HIV/AIDS caregiving dyads and individual caregivers: a controlled treatment outcome study.

The present study examined the comparative efficacy of intervening at the caregiver/care-recipient dyadic level, versus the individual caregiver level, for caregivers and their care-recipients with HIV/AIDS. Participants were randomly assigned to a Dyad Intervention (DI), a Caregiver Intervention (CI) or Wait List Control group (WLC), and assessed by interview and self-administered scales immediately before treatment and eight weeks later. Participants in the intervention groups also completed a four-month follow-up assessment. Dependent variables included global distress, social adjustment, dyadic adjustment, subjective health status, HIV/AIDS knowledge and target problem ratings. Results showed that caregivers in the DI group showed greater improvement from pre- to post-treatment on global distress, dyadic adjustment and target problems than the CI and WLC caregivers. The CI and DI caregivers showed greater improvement than the WLC group on all dependent variables except social adjustment. Care-recipients in the DI group improved significantly from pre- to post-treatment on dyadic adjustment, social adjustment, knowledge, subjective health status and Target Problem 1, whereas the CI and WLC care-recipients failed to improve on any of these measures. The treatment gains made by the DI caregivers and care-recipients on most dependent variables were maintained at a four-month follow-up. Findings support a reciprocal determinism approach to the process of dyadic adjustment and suggest that intervening at the caregiver/care-recipient level may produce better outcomes for both the caregiver and care-recipient than intervening at the individual caregiver level.

Acquired Immunodeficiency Syndrome↗

PubMed2001

The influence of family and experimental context on cognition in anxious children.

Examined the influence of family on anxious children's cognition. Research by Barrett, Rapee, Dadds, and Ryan (1996) found anxious children reported increased avoidance after interacting with their parents. They labelled this finding the FEAR effect-Family Enhancement of Avoidant Responses. Whilst some subsequent studies have found similar results, others have not. These contradictory findings question whether the direction of parental influence on anxious children is determined by the perceived demands of the experimental context. Anxious children (N = 101) and their parents were asked to interpret seven ambiguous situations and to discuss what their child would do if the scenario actually occurred. Study 1 found that children in the anxious group and an externalizing control group were more likely to interpret ambiguous situations as threatening than nonclinic children were. Study 2 sought to examine changes in the children's responses from pre- to postfamily discussion, and to identify variables associated with the FEAR effect in anxious families. Interestingly, anxious children whose families completed the discussion task after they (children) had been offered treatment were more likely to show a FEAR effect than anxious families who completed the task as part of assessment. Study 3 examined predictors of enhanced avoidance in anxious families. Treatment context and maternal distress were correlated with the child's increased avoidance following family discussion. Limitations of these studies and directions for future research are discussed.

Anxiety↗

PubMed2001

Practitioner review: psychological management of anxiety disorders in childhood.

Many anxiety problems begin in childhood and are a common form of psychological problem that can be highly distressing and associated with a range of social impairments. Thus, skills for conceptualising, assessing, and treating childhood anxiety problems should be in the repertoire of all child mental health specialists. This paper reviews psychosocial treatments for the most common anxiety disorders in children and adolescents. Developmental models of anxiety disorders emphasise maximum risk in children with shy or inhibited temperaments who are exposed to high family anxiety and avoidance, and/or acutely distressing experiences. As children mature these temperamental and environmental experiences are internalised to low self-competence and high threat expectancy. Both individual or group-based interventions utilising cognitive-behavioural strategies to address multiple risk factors are highly efficacious and family involvement can contribute to positive outcomes. Guidelines for assessment and treatment are presented, and suggestions are made for effectively managing clinical process.

Adolescent↗

PubMed2001

The efficacy of a universal school-based program to prevent adolescent depression.

Evaluated whether a universal school-based program, designed to prevent depression in adolescents, could be effectively implemented within the constraints of the school environment. Participants were 260 Year 9 secondary school students. Students completed measures of depressive symptoms and hopelessness and were then assigned to 1 of 3 groups: (a) Resourceful Adolescent Program-Adolescents (RAP-A), an 11-session school-based resilience building program, as part of the school curriculum; (b) Resourceful Adolescent Program-Family (RAP-F), the same program as in RAP-A, but in which each student's parents were also invited to participate in a 3-session parent program; and (c) Adolescent Watch, a comparison group in which adolescents simply completed the measures. The program was implemented with a high recruitment (88%), low attrition rate (5.8%), and satisfactory adherence to program protocol. Adolescents in either of the RAP programs reported significantly lower levels of depressive symptomatology and hopelessness at post-intervention and 10-month follow-up, compared with those in the comparison group. Adolescents also reported high satisfaction with the program. The study provides evidence for the efficacy of a school-based universal program designed to prevent depression in adolescence.

Adolescent↗

PubMed2001

Cognitive-behavioral treatment of anxiety disorders in children: long-term (6-year) follow-up.

Authors evaluated the long-term effectiveness of cognitive-behavioral therapy (CBT) for childhood anxiety disorders. Fifty-two clients (aged 14 to 21 years) who had completed treatment an average of 6.17 years earlier were reassessed using diagnostic interviews, clinician ratings, and self- and parent-report measures. Results indicated that 85.7% no longer fulfilled the diagnostic criteria for any anxiety disorder. On a majority of other measures, gains made at 12-month follow-up were maintained. Furthermore, CBT and CBT plus family management were equally effective at long-term follow-up. These findings support the long-term clinical utility of CBT in treating children and adolescents suffering from anxiety disorders.

Adolescent↗

PubMed2000

Parent training skills and methadone maintenance: clinical opportunities and challenges.

Children raised in substance abusing families show high rates of behavioural and emotional problems, in particular oppositional, defiant and non-compliant behaviours. While a range of social and individual factors correlate with poor parenting, it is often the quality of the parent-child relationship that mediates the effects of most other risk factors on child development. By addressing this relationship using behavioural family interventions, child behaviour problems have been reduced in multiple problem families. However, there has been little attempt to systematically evaluate such programs in substance abusing families. It is argued that methadone replacement programs provide a window of opportunity to deliver well-validated parent training programs that enhance the quality of parent-child relations. However, it is likely that such programs would need to be medium to long term and address issues beyond parent child relationships. How such interventions may be delivered and evaluated is discussed.

Child↗

PubMed2000

Home visiting intervention for vulnerable families with newborns: follow-up results of a randomized controlled trial.

OBJECTIVE: This study aimed to: (1) Assess the community utility of a screening tool to identify families with child abuse or neglect risk factors in the immediate postnatal period (2) Determine the social validity and effectiveness of a home visiting program using community child health nurses and offering social work services for identified families, and (3) Identify factors in the immediate postnatal period associated with the child's environment that predict poor adjustment to the parenting role. METHOD: A randomized controlled trial using a cohort of 181 families was undertaken to evaluate the impact of a home visiting program. Mothers were recruited in the immediate postnatal period and allocated either into the home visiting program or into a comparison group. The research design required self-identification into the study by providing positive responses to a range of risk factors. A repeated measures design was used to test parenting stress and maternal depression from the immediate postnatal period to 12-month follow-up and physical child abuse potential to 18-month follow-up. To test whether measures taken in the immediate postnatal period were predictive for poor adjustment to the parenting role, a linear regression model was used. RESULTS: The screening procedure was shown to have utility in the context of recruitment to a research trial and mothers were willing to accept the home visiting program examined by this study from the immediate postnatal period. From as early as 6 weeks the program demonstrated ability to impact positively on maternal, infant, family, and home environment variables (testing 90 randomly allocated intervention vs. 91 comparison families). At follow-up, parental adjustment variables were not significantly different between groups (testing the remaining 68 (75.5%) intervention vs. 70 (76.9%) comparison families) and home environment assessment scores had converged. Predictive analysis of factors measured in the immediate postnatal period revealed an absence of any predictive value to demographic characteristics, which secondary prevention efforts typically target. CONCLUSIONS: Follow-up evaluation did not demonstrate a positive impact on parenting stress, parenting competence, or quality of the home environment confirming the need to test early program success on longer term outcomes. Further, thestudy not only demonstrated that there was a relationship between maternal, family and environmental factors identified in the immediate postnatal period. and adjustment to the parenting role, but also challenged demographic targeting for child abuse and neglect risk. At the same time, the immediate postnatal period presented an exciting window of opportunity to access high-risk families who may otherwise have become marginalized from traditional services.

Adaptation, Psychological↗

PubMed2000

Promoting secure attachment, maternal mood and child health in a vulnerable population: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of an early home-based intervention on the quality of maternal-infant attachment, maternal mood and child health parameters in a cohort of vulnerable families. METHODOLOGY: A total of 181 families were recruited to the study in the immediate postnatal period on the basis of a self report questionnaire relating to known family vulnerability factors. Families were assigned randomly to intervention (90), or control (91) groups. The intervention group received a series of home visits from a child health nurse (weekly to 6 weeks, fortnightly to 3 months), with a subgroup receiving home based short-term dynamic therapy from a social worker. Parent/family function was assessed at inception and at 4 months by the Parenting Stress Index and the Edinburgh Post Natal Depression Scale. At 4 months the quality of the home environment was assessed, utilizing the Home Observation for Measurement of the Environment Inventory, as were child and family health parameters and satisfaction with the community child health service. RESULTS: At 4 month follow-up, 160 families (80 intervention, 80 control) were available for assessment. The intervention improved family functioning at 4 months. All aspects of the home environment, including the quality of maternal-infant attachment and mothers' relationship with their child, were significantly enhanced. In particular, significant and positive differences were found in parenting with the intervention group feeling less restrictions imposed by the parenting role, greater sense of competence in parenting, greater acceptability of the child, and the child being more likely to provide positive reinforcement to the parent. Early differences in maternal mood were not maintained at 4 months. Various child health parameters were enhanced including immunization status, fewer parent-reported injuries and bruising, and researcher confirmed lack of smoking in the house or around the infant. The families were consistently more satisfied with their community health service. CONCLUSIONS: This form of early home based intervention targeted to vulnerable families promotes an environment conducive for infant mental and general health and hence long-term psychological and physical well-being, and is highly valued by the families who receive it.

Adult↗

PubMed2000

Attachment and coercive sexual behavior.

This study examined the relationships between childhood attachment and coercive sexual behavior. One hundred sixty-two male undergraduate students completed self-report measures of childhood maternal attachment, childhood paternal attachment, adult attachment, antisociality, aggression, and coercive sexual behavior. As predicted, insecure childhood attachment, especially insecure paternal attachment, was associated with antisociality, aggression, and coercive sexual behavior. Moreover, childhood attachment independently predicted coercive sexual behavior after antisociality and aggression were statistically controlled. The hypothesis that paternal avoidant attachment would predict coercive sexual behavior independently of its relationship with aggression and antisociality was also supported. Posthoc analysis indicated that maternal anxious attachment was associated with antisociality and that paternal avoidant attachment was associated with both antisociality and coercive sexual behavior. These results are consistent with criminological and psychological research linking adverse early family experiences with offending and lend support to an attachment-theoretical framework for understanding offending behavior in general and sexual offending behavior in particular.

Adolescent↗

PubMed1999

Early intervention and prevention of anxiety disorders in children: results at 2-year follow-up.

The Queensland Early Intervention and Prevention of Anxiety Project evaluated a child- and family-focused group intervention for preventing anxiety problems in children. This article reports on 12- and 24-month follow-up data to previously reported outcomes at posttreatment and at 6-month follow-up. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After diagnostic interviews, 128 children were selected and assigned to either a 10-week school-based child- and parent-focused psychosocial intervention or a monitoring group. Both groups showed improvements immediately at postintervention and at 6-month follow-up; the improvement was maintained in the intervention group only reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. At 12 months, the groups converged, but the superiority of the intervention group was evident again at 2-year follow-up. Severity of pretreatment diagnoses, gender, and parental anxiety predicted poor initial response to intervention, whereas pretreatment severity was the only predictor of chronicity at 24 months. Overall, follow-up results show that a brief school-based intervention for children can produce durable reductions in anxiety problems.

Adolescent↗

PubMed1999

A randomized, controlled trial of nurse home visiting to vulnerable families with newborns.

OBJECTIVE: This project aimed to evaluate the impact of a home visiting programme that targeted families where the child, for environmental reasons, was at great risk of poor health and developmental outcomes. METHODOLOGY: Women in the immediate postpartum period were recruited to a randomized double-blind controlled trial on the basis of self-reported vulnerability factors and were randomly assigned to receive either a structured programme of nurse home visiting, supported by a social worker and paediatrician (n = 90), or assigned to a comparison group receiving standard community child health services (n = 91). Parenting stress and maternal depression were measured at enrollment and at 6 weeks. Preventive health behaviour, service satisfaction and home environment outcomes were tested at 6 weeks, as were child health outcomes. RESULTS: At six weeks, women receiving the home-based programme had significant reductions in postnatal depression screening scores as well as improvements in their experience of the parental role and improvement in the ability to maintain their own identity. Maternal-infant interactions were more likely to be positive, with significantly higher (better) scores in aspects of the home environment related to optimal development in children, particularly maternal-infant secure attachment. Intervention group mothers were significantly more satisfied with the community child health service. CONCLUSIONS: This form of intervention for families is effective in promoting secure maternal-infant attachment, preventing maternal mood disorder and is welcomed by the families receiving it. These findings may predict long-term benefits for the healthy development of children otherwise at risk of a range of poor health and development outcomes.

Analysis of Variance↗

PubMed1999

Anxious children and their parents: what do they expect?

Assigned 73 children, ages 7 to 14, to 1 of 3 groups (anxious, clinical control, and nonclinical control) according to their diagnostic status. Within the anxious group, children were assigned to 1 of 2 further groups on the basis of self-reported parental anxiety--either the child anxiety only group or the child + parent anxiety group. All children completed an experimental task (giving a brief talk in front of a video camera), which was the focus for a series of structured family discussions between the child and his or her parents. The aims of the study were to measure and compare across groups (a) the evaluations of children and their parents regarding the child's predicted anxiety and skill level and (b) the effect of the family discussion on children's expectations. Results indicated that, prior to the family discussion, anxious children's expectations of their future performance did not differ from those of control children. Similarly, there were no differences in children's expectations between the child anxiety group and the child + parent anxiety group. Second, compared to mothers in the child anxiety group, mothers in the child + parent anxiety group expected that their children would be more anxious and more likely to choose an avoidant problem solution (but not less skilled). Finally, the family discussion was found to produce no changes in anxious children's expectations of their future performance. The implications of these findings are discussed.

Adaptation, Psychological↗

PubMed1998

Social desirability and self-reported anxiety in children: an analysis of the RCMAS Lie scale.

There are important applied and theoretical reasons for research into the association between social desirability and self-reported anxiety in young people. The aim of this study was to examine the relationship between anxiety and social desirability in a large normative sample of 7- to 14-year-olds (N = 1,786). Participants completed the Revised Children's Manifest Anxiety Scale and their teachers rated children as anxious-not anxious according to specified descriptions. Results indicated that anxiety and lie scores do not correlate for either gender or age grouping. However, anxiety scores interacted with lie scores differently for males and females in terms of the agreement between children's and teacher's ratings of anxiety. Indications are that social desirability levels may in part explain the consistent discrepancies found between child and adult reports of anxiety in young people.

Adolescent↗

PubMed1998

The role of parental anxiety in the treatment of childhood anxiety.

Sixty-seven children aged 7 to 14 who met diagnostic criteria for an anxiety disorder were assigned to conditions according to parental anxiety level. Within these conditions, children were randomly assigned to 1 of 2 treatments: child-focused cognitive-behavioral therapy (CBT) or child-focused CBT plus parental anxiety management (CBT + PAM). At posttreatment, results indicated that within the child-anxiety-only condition, 82% of the children in the CBT condition no longer met criteria for an anxiety disorder compared with 80% in the CBT + PAM condition. Within the child + parental anxiety condition, 39% in the CBT condition no longer met criteria compared with 77% in the CBT + PAM condition. At follow-up, these differences were maintained, with some weakening over time. Results were not consistent across outcome measures. The interpretation and potential clinical implications of these findings are discussed.

Adolescent↗

PubMed1998

Sleep deprivation or postnatal depression in later infancy: separating the chicken from the egg.

OBJECTIVES: To explore the association between maternal distress and depression in the first years of a newborn's life and the child's sleeping behaviour and problems associated with this behaviour. To asses the effectiveness of an outpatient-based individualised behaviour modification programme to modify children's sleep behaviour and to decrease levels of maternal distress and depression. METHOD: Families were referred to an outpatient childhood sleep problems clinic. Intervention consisted of an individualised management programme including recognised modes of child sleep behaviour management ('controlled crying', 'cold turkey,' rewards) together with occasional use of short-term (less than 2 weeks) tapering dose sedating medication for the child. Two months after the initial contact with the clinic, families completed a second questionnaire collating similar data to that collected at time of enrolment. RESULTS: A total of 114 consecutive families referred to the clinic provided initial data. Follow-up questionnaires were returned by 70 (61%). Significant change was recorded in children's sleep parameters including reduction in mean number of night time awakenings (4.1-1.3, P < 0.001), proportion of children requiring longer than 30 min to settle at night (49% to 21%, P < 0.01) and in the proportion of children settling after 8 pm (51% to 33%, P < 0.01). Sleep problem rating on a 0-10 scale decreased from a mean of 8.1-3.1 (P < 0.001). On initial assessment, 40% of mothers had Edinburgh Postnatal Depression Scale (EPNDS) scores greater than 12 (screening cut-off point). At repeat assessment, 4.3% had scores greater than 12. The mean score on the EPNDS fell from 11.2 to 5.8 (P < 0.001). CONCLUSIONS: An outpatient-based individualised approach to modifying children's problematic sleep behaviour using recognised behaviour management techniques is effective. Modification of problematic childhood sleep behaviour is associated with significant improvement in maternal mood. Given the high incidence of childhood sleep problem and diagnosed postnatal depression, it is likely significant numbers of mothers being diagnosed as having postnatal depression are suffering the effects of chronic sleep deprivation. Management of postnatal mood disorder and childhood sleep behaviour must occur with due recognition to their close association.

Adult↗

PubMed1998

Family caregivers' criticism of patients with schizophrenia.

OBJECTIVE: Relationships were examined between patients' negative symptoms, family caregivers' knowledge of schizophrenia, caregivers' attributions about the cause of patients' symptoms, and caregivers' response to the symptoms. METHODS: A sample of 84 caregivers of patients with schizophrenia in Brisbane, Australia, were interviewed using a structured format and measures designed for the study. RESULTS: Results of regression analyses indicated that three variables significantly predicted caregivers' criticism of patients--a smaller proportion of negative symptoms in the patient's overall symptom pattern, the caregiver's low level of knowledge about the illness, and the caregiver's attributing the cause of negative symptoms to the patient's personality rather than to the illness. CONCLUSIONS: Overall, findings supported the utility of an attributional framework in enhancing conceptions about and research on schizophrenia and family caregiving.

Adolescent↗

PubMed1997

Prevention and early intervention for anxiety disorders: a controlled trial.

The Queensland Early Intervention and Prevention of Anxiety Project evaluated the effectiveness of a cognitive-behavioral and family-based group intervention for preventing the onset and development of anxiety problems in children. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After recruitment and diagnostic interviews, 128 children were selected and assigned to a 10-week school-based child- and parent-focused psychosocial intervention or to a monitoring group. Both groups showed improvements immediately postintervention. At 6 months follow-up, the improvement maintained in the intervention group only, reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. Overall, the results showed that anxiety problems and disorders identified using child and teacher reports can be successfully targeted through an early intervention school-based program.

Adolescent↗

PubMed1997

Imagery in human classical conditioning.

Many clinical strategies use patients' imagery to explore and treat phobic and posttrauma reactions, however little attention has been paid to the underlying assumption that imagery of relevant stimuli may help maintain conditioned behavior. In this article, the authors examine the premise that mental images can potentiate and substitute for physical stimuli in human classical conditioning. The authors review empirical evidence to detail the role of images of conditioned stimuli (CS) and unconditioned stimuli (US) during pre-exposure to stimuli, the actual pairing of the CS and US, and extinction when the CS is presented alone. The evidence suggests that mental imagery can facilitate or diminish the outcome of classical conditioning in humans and, more tentatively, that mental images can substitute for actual US and CS in autonomic conditioning. They argue that researchers should explore the role of mental imagery in conditioning through the use of advances in the measurement of imagery. Finally, they analyze anxiety and trauma reactions as examples of how applied areas can be used to explore and benefit from developments in this area.

Animals↗