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A model curriculum for mental disorders and behavioral problems in primary care.

Changes in the health care delivery system will increasingly emphasize the role of the primary care physician in diagnosing and treating mental disorders and behavioral problems. This increasing emphasis points to the need for more systematic definition of the knowledge and skills that future primary care physicians will need for effective delivery of mental health services. The model curriculum described in this paper represents the efforts of a multidisciplinary Task Force to describe basic training objectives for the psychiatric education of future primary care physicians.

Clinical Competence↗

[Effect of psychotherapy on problem behavior of children and adolescents in stomatological office].

The group of 269 "untreatable patients" aged 3-18 years was followed up for the effectiveness of psychotherapeutical management of problem behavior (in %). The used psychotherapeutical methods appeared to be most effective in individuals attending primary school (81.5%), satisfactory were in patients attending the school with special education (44.8%). No effects of psychotherapy were observed in oligophrenic patients who refused cooperation during the first stomatological treatment.

Adolescent↗

Coping strategies, drinking motives, and stressful life events among middle adolescents: associations with emotional and behavioral problems and with academic functioning.

A sample of 733 middle adolescents was used to study interrelations among coping strategies, drinking motives, stressful life events (major, daily positive, and daily negative), emotional and behavioral problems, and academic functioning. A main-effects (vs. stress-buffering) model was supported. Some predictors (e.g., task-oriented coping, major stressful events) were general in their predictive relations to the outcome variables, whereas others were highly specific (e.g., emotion-focused coping predicting depressed affect). Overall, the predictors accounted for 22-53% of the variance in regression equations. Positive daily events predicted higher levels of alcohol use, alcohol problems, and delinquent activity; as well as higher academic performance and lower levels of depressed affect.

Achievement↗

Behavioral approach-inhibition in toddlers: prediction from infancy, positive and negative affective components, and relations with behavior problems.

In this study, 126 children were observed at 6 months, 12 months, and 2 years. During infancy, latencies to reach for novel objects were measured. At 2 years, positive and negative affect, and behavioral approach-inhibition to low- and high-intensity situations were coded, and mothers assessed behavior problems. Confirmatory factor analysis indicated a 3-dimension model of positivity, negativity, and behavioral approach-inhibition. Positivity was related to low- and high-intensity behavioral approach-inhibition, whereas negativity was linked only to low-intensity behavioral approach-inhibition. Shorter 12-month latencies to reach were predictive of low negativity, high positivity, and behavioral approach at 2 years. Positivity and negativity were correlated with externalizing and internalizing behaviors, respectively. Finally, cluster analysis identified an exuberant group high in externalizing and an inhibited group high in internalizing.

Adult↗

[Statistical genetic analysis of some problem behaviors during sleep in childhood--estimation of genetic and environmental factors influencing multiple health phenomena simultaneously].

This study was conducted to clarify the genetic and environmental factors for some problem behaviors during sleep in childhood, namely sleep talking, half-sleeping, night terrors and nocturnal enuresis. The subjects were 881 pairs of twins, consisting of 609 monozygotic (279 male-male, 330 female-female) and 272 dizygotic (86 male-male, 84 female-female, 102 opposite-sexed). They were all applicants to the junior high school affiliated with Tokyo University from 1981 to 1998. The twins' mothers had previously completed a medical questionnaire and had been interviewed by three to five interviewers. With regard to the above mentioned four traits, they selected one answer from the choices 'often', 'sometimes' 'never' and 'unknown' for each twin. The interviewer checked the answers and, where necessary, explained the meaning of any terms such as "night terrors". Genetic analysis was performed as follows. First the answers were summarized in the form of a 2 x 2 contingency table; 'often' and 'sometimes' were included in one category. Then, tetrachoric correlations of the contingency table were calculated according to zygosity using the program package PRELIS2. Furthermore, covariance structure analysis was performed for several genetic models using the program package LISREL8. The results were as follows. Univariate genetic analysis showed that all four traits were under genetic control. Sleep talking, half-sleeping and night terrors were under strong or moderate genetic control. As to nocturnal enuresis, the genetic effect was moderate and shared environmental factors played an important role. Sex difference was observed in the case of half-sleeping and enuresis. Moreover these traits tended to occur together, and sleep talking, half-sleeping and night terrors shared common genetic and environmental factors in addition to specific genetic and environmental factors.

Child↗

Psychopathology and behavioral problems in mental retardation.

1. The lack of psychiatric services for the mentally retarded is of particular concern for advanced practice nurses in psychiatry. 2. Prevalence of psychopathology and behavioral problems in the mentally retarded appears to be significant. 3. For purposes of diagnostic clarity, a thorough mental status and neurological examination specifically devised for the mentally retarded population must be utilized.

Humans↗

The mass media and the prevention of child behavior problems: the evaluation of a television series to promote positive outcomes for parents and their children.

This paper examines the impact of a 12-episode television series, "Families", on disruptive child behavior and family adjustment. This media intervention comprises the first of a five-level early intervention parenting and family support strategy, known as Triple P (Positive Parenting Program). Fifty-six parents of children aged between 2 and 8 years were randomly assigned to either watching the television series or to a waitlist control group. Compared to the control group, parents in the television viewing (TV) condition reported significantly lower levels of disruptive child behavior and higher levels of perceived parenting competence, immediately following intervention. Prior to intervention approximately 42.9% of the children in the TV condition were in the clinically elevated range for disruptive child behavioral problems. This had reduced to 14.3 % following intervention. In addition, a high level of consumer acceptability was reported by parents in the TV condition. All post-intervention effects were maintained at 6-month follow-up. Implications for public health approaches to family mental health are discussed.

Adult↗

The effect of fathers or father figures on child behavioral problems in families referred to child protective services.

This study examines some possible effects of the presence and quality of parent-child interaction of fathers and father figures on the behavior of young children in a sample of families reported to child protective services. Whereas the presence or absence of a father or father figure seemed to make little difference in child behavioral problems at age 4, lower levels of aggression and depression were observed for children by age 6 if an adult male in some form of father-like relationship was present in the child's life. When controlling for mother's ethnicity, child's gender, the number of referrals to child protective services, and the presence of domestic violence, the direct effect of a father/father figure was no longer significant but remained in the multivariate models as a significant interaction term.

Adult↗

A multidimensional assessment of parent-identified behavior problem toddlers.

Sixty-eight 2- and 3-year-olds (46 parent-referred, 22 controls) participating in an identification, assessment, and follow-up study of hyperactivity and related behavior problems were evaluated on parent-report, observational, and cognitive measures. Referred youngsters were described by both parents as more active, inattentive, difficult to discipline, and aggressive with peers than were controls. Mothers of referred children also reported a more difficult infancy period. Laboratory assessments confirmed parental reports of current problems. Referred children shifted activities more during free play, were more active and inattentive during structured tasks, and made more impulsive responses on a delay task than did controls. Discriminant function analysis indicated that parental ratings of activity paired with laboratory measures of sustained attention and impulsivity correctly classified 88% of the sample. These data suggest that the core symptoms of hyperactivity can be identified in very young children, although their prognostic significance remains to be determined.

Attention↗

Pathways of self-reported problem behaviors from adolescence into adulthood.

OBJECTIVE: The authors determined the impact of different pathways of psychopathological development on adult outcome in subjects followed from ages 11-18 to ages 21-28. METHOD: Problem behaviors of subjects from a general population sample were assessed through the Youth Self-Report and the Young Adult Self-Report given at four time points (1987, 1989, 1991, and 1997). In addition, DSM-IV diagnoses, information pertaining to signs of maladjustment, and measures of social functioning were obtained at the last assessment. On the basis of the self-report ratings, four contrasting developmental pathways of psychopathology were determined: persistent, decreasing, increasing, and consistently normal. RESULTS: Subjects whose overall level of psychopathology was persistent over time had a higher lifetime prevalence of DSM-IV diagnoses and a poorer general outcome in adulthood than did subjects whose level of psychopathology increased. Subjects whose level of psychopathology returned to normal after high levels of problems in adolescence were only slightly different in terms of outcome from subjects with consistently normal ratings. CONCLUSIONS: 1) People who showed high levels of problems in early adolescence but whose level of psychopathology diminished by adulthood seemed to be as healthy as people who never attained a serious level of psychopathology. 2) An ongoing devious pathway into adulthood had negative effects on many domains of functioning. These two findings are both powerful arguments for early intervention in adolescence.

Adolescent↗

Early drinking onset and its association with alcohol use and problem behavior in late adolescence.

OBJECTIVE: To examine the relationship between age of drinking onset and patterns of use, abuse of other substances, and the prevalence of other alcohol-related problems in a population of midwestern high school seniors. DESIGN: We analyzed self-report survey data on public school students' history of alcohol and other drug use and related problems from the Minnesota Student Survey conducted in 1989. The sample consisted of 2,650 male and female seniors, representing a 10% random sample of all white seniors in the study. RESULTS: The findings suggest that early onset of alcohol use (by age 12) is associated with subsequent abuse of alcohol and related problem behaviors in later adolescence, including alcohol-related violence, injuries, drinking and driving, and absenteeism from school or work, as well as increased risks for using other drugs. CONCLUSION: This paper identifies the preadolescent years from age 10 to 12 as a particularly vulnerable period for the development of early alcohol dependence and abuse. Delaying alcohol use onset to age 13 may significantly reduce the risk of severe alcohol abuse in later adolescence.

Adolescent↗

Deviant peer affiliation and problem behavior: a test of genetic and environmental influences.

This study uses a multitrait, multimethod (MTMM) approach to investigate the genetic and environmental etiologies of childhood deviant peer affiliation (DPA) and problem behavior (PROB). The variability of genetic and environmental estimates by agent and method is also examined. A total of 77 monozygotic and 72 dizygotic twin pairs and each twin's close friend were assessed. The informants included parents, teachers, and twins, and the methods involved questionnaire reports and coder ratings of videotaped dyadic interactions between each twin and their close friend. Twin intraclass correlations and univariate models attributed DPA and PROB to genetic, and shared and nonshared environmental effects. Parameter estimates differed by rater and method, however. Results accentuate the imperative to attend to method effects inherent in MTMM behavioral geneticresearch.

Adolescent↗

How universal are social influences to drink and problem behaviors for alcohol use? A test comparing urban African-American and Caribbean-American adolescents.

The purpose of this study is to test specifically which social influences and which problem behaviors predict drinking among a sample of African-American and Caribbean-American black adolescents residing in New York City. A total of 3212 African-American or Caribbean-American seventh graders completed questionnaires assessing their alcohol use, demographic characteristics, social influences to drink, and other behavioral measures. Logistic regression analyses examined predictors for the overall black sample and separately for each of the two black groups. The predictors of alcohol initiation were virtually identical for both groups (father's drinking, siblings' drinking, friends' drinking, peer drinking, and smoking) with the exception of marijuana use. Although there were some common predictors of alcohol consumption for the two groups (siblings' drinking, friends' drinking, and smoking), some factors only influenced alcohol consumption for African-Americans (father's drinking and marijuana use) and others only did so for Caribbean-Americans (deviance and absenteeism). These findings highlight the importance of examining the etiology of alcohol use for different black groups.

Adolescent↗

Behavioral problems and medication utilization.

Although psychotropic medications are commonly used with older adults who have mental retardation, patterns of medication use for this group are not easily determined. Our objective was to explore relations between prescribed psychoactive treatments and rated behavioral difficulties. Adults with moderate mental retardation living in congregate and group care settings were rated by care providers using a standard behavior rating instrument. Older adults demonstrated a tendency toward higher medication utilization. Results indicated higher drug utilization in the larger setting despite the fact that behavior problems and cognitive level was matched across all settings. Medication utilization appears to be related to multiple factors, not only the behavioral or cognitive characteristics of adults with mental retardation.

Activities of Daily Living↗

Multiple risk factors in the development of externalizing behavior problems: group and individual differences.

The aim of this study was to test whether individual risk factors as well as the number of risk factors (cumulative risk) predicted children's externalizing behaviors over middle childhood. A sample of 466 European American and 100 African American boys and girls from a broad range of socioeconomic levels was followed from age 5 to 10 years. Twenty risk variables from four domains (child, sociocultural, parenting, and peer-related) were measured using in-home interviews at the beginning of the study, and annual assessments of externalizing behaviors were conducted. Consistent with past research, individual differences in externalizing behavior problems were stable over time and were related to individual risk factors as well as the number of risk factors present. Particular risks accounted for 36% to 45% of the variance, and the number of risks present (cumulative risk status) accounted for 19% to 32% of the variance, in externalizing outcomes. Cumulative risk was related to subsequent externalizing even after initial levels of externalizing had been statistically controlled. All four domains of risk variables made significant unique contributions to this statistical prediction, and there were multiple clusters of risks that led to similar outcomes. There was also evidence that this prediction was moderated by ethnic group status, most of the prediction of externalizing being found for European American children. However, this moderation effect varied depending on the predictor and outcome variables included in the model.

Black or African American↗

Epidemiological personology: the unifying role of personality in population-based research on problem behaviors.

Epidemiological personology refers to a paradigm in which a developmental perspective on individual differences is paired with a population-based sampling frame to yield insights about the role of personality in consequential social outcomes. We review our work in epidemiological personology, linking personality to diverse, problematic social outcomes: Mental disorders, health-risk behaviors, and violence. We conclude that broad-band personality measurement is both feasible and fruitful in large-scale research on problem behaviors, and we call for increased collaboration between personality psychologists and researchers in fields such as public health, epidemiology, and sociology.

Health Behavior↗

Cigarette smoking, life stress, and behavioral problems in Chinese adolescents.

This study investigated a sample of 1360 Chinese adolescents. About 31% of boys and 3.7% of girls reported ever smoking. Smokers experienced more life stress than nonsmokers. Smoking was associated with increased risk for internalizing and externalizing behavioral problems, but the association was markedly reduced after controlling for life stress

Adolescent↗

The relations between cluster indexes of risk and promotion and the problem behaviors of 6- and 7-year-old children from economically disadvantaged families.

This study examined the relations between alternative representations of poverty cofactors and promotion processes and teacher reports of the problem behaviors of 6- and 7-year-old children from economically disadvantaged families (N = 159). The results showed that single-index representations of risk and promotion variables predicted child aggressive behaviors but not child anxious/depressed behaviors. An additive model of individual risk indicators performed similarly. Smaller indexes representing clusters of parent adjustment variables and family instability variables, however, differentially predicted aggressive and anxious/depressed behaviors, respectively. The results suggest the importance of promotion processes and of representing environmental adversity at varying levels of specificity for children from economically disadvantaged families.

Caregivers↗