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OFSN RESEARCH CORNER 
Brain scan images, originally from:  http://brighamrad.harvard.edu/education/online/BrainSPECT/Background/Background_Multi.gif
 
This is the Age of the Brain.  Literally, hundreds of research studies are underway worldwide on the causes and treatment of disabling mental health conditions in children. 
 
Listed here are summaries of research findings that might give families hope for their child(ren) and adolescents.  Nothing presented here is in any way intended to substitute for professional, medical, or legal advice of any kind (see Disclaimer below).  Results can vary in their relevance and weight.  Consider factors such as the study(s)' sampling technique, sample size, construct validity, research methodology, presence of a control group, data quality, interrater reliability, consistency of results across repeat studies, generalizability, time span, external influences, analytic tools, and more.  In some cases, the information presented may consist of proven, evidence-based practices, promising practices or even preliminary research (awaiting further studies to confirm valid, consistent results).  Research articles include but are not limited to those that may focus on prevention and intervention strategies, proposed causal relationships (e.g. diet and behavior), and activities, experiences, or environmental factors which could potentially aggravate or trigger a child's behavior or condition. 

 

 News and Research in Children's Mental Health Minimize 

OFSN will regularly update this section with new information, and keep archives of previously displayed studies so visitors can search on the subject they want.

Information on this page has been drawn from peer-reviewed journals and press releases from psychiatric news sources.  Included with each article is information or a link.  Readers are encouraged to contact the researcher or news source directly for complete and accurate information on a study and its implications.

If you have come across research appropriate for this web page, please feel free to contact us and/or email the article to: research-articles@ofsn.orgThank you.


ARTICLES


More news from the world of mental health:
 
Secondhand Smoke May Double Likelihood of Depression:
 
Non-smokers exposed to cigarette smoke at home or work are more than twice as likely as those not exposed to have major depression, according to a new report. The study confirmed exposure to smoke by measuring cotinine—a chemical that occurs in blood after breathing in smoke. Those exposed to smoke were far more likely to have symptoms of serious depression, says study leader Frank Bandiera, a public health researcher at the University of Miami School of Medicine. Even working where smoking was allowed in public places more than doubled the risk of depression, he says. (USA Today, 3/4/09)
 
Mental disorders and suicide risk:
 
Mental Health America reports that 90 percent of all suicides are related to an untreated or under-treated mental or substance abuse disorder, particularly depression. Fortunately, depression is highly treatable with therapy, medication, or the combination of the two. The organization has prepared tips to help people who take or may need antidepressant drugs. Jackson County Banner, “Tips on Taking Antidepressant Medication,” March 5, 2009
 
Sleep Problems Common in Children with ADHD:
 
Children with attention deficit/hyperactivity disorder (ADHD) who are not receiving medication often have sleep disturbances characterized by difficulty falling asleep and short duration of sleep and of REM sleep, Canadian investigators have found. "Clinicians have reported sleep problems in an estimated 25 to 50 percent of children with ADHD, and treatment of sleep problems has been shown to improve behavior and decrease the need for stimulant medication in children with ADHD," said lead author Dr. Reut Gruber at McGill University. (Reuters, 3/26/09)

 
Anger management techniques for teens
Teen anger. We all have seen it. Is anger just a normal part of growing up and learning to manage angry feelings? How can a parent help? Teens can be as confused about their angry outbursts as you are.
 
Anger and tears when you try to talk to them may indicate that they could feel embarrassed and helpless to change. We will look at a variety of possible causes of teen anger and some strategies for helping both you and your teen to express feelings in safe, appropriate ways.

Anger can be triggered by many factors. Some people are temperamentally more volatile, more sensitive and more easily angered.

Developmentally, there are periods of life where growth struggles bring about increased frustration (like when you're a toddler or a teenager), because kids are trying to understand what they get to control and what they don't get to control. Finally, there are stressful circumstances with friends, sports, school, or home which can cause increased feelings of anger.

In thinking about anger, it is important to remember that it is usually a secondary emotion. The underlying emotion is more likely to be rejection, fear, failure, frustration or sadness. For boys, society is often more accepting of anger than it is of these other underlying emotions and so anger may be what your son shows most readily.

However, it's important to bear in mind that there are other feelings underneath that need to be expressed and resolved. Here are some suggestions for working with your teenager:

Approach discussions from a supportive place. While it is natural to be disappointed and frustrated with your adolescent for losing control one more time, he/she needs your support and understanding. They need to know that you have confidence in them. It is from this base of support that they will be able to pay attention to their feelings, think clearly and figure out what is happening inside of them. Try saying something like, "I know we both get frustrated when you lose your temper, but let's see if we can understand what happens when you start getting mad and come up with some solutions."

Understand that feelings are not wrong. In our society, certain feelings are viewed as "negative" and others as "positive." In fact, every feeling is a normal part of being human. When adolescents get the message that there is something wrong with some of their feelings, they come to believe that something must be wrong with them.

Understanding that feelings are normal can turn our energies to learning to express them appropriately rather than repressing them.

Help your adolescent explore acceptable ways to express anger and other feelings.
An important distinction to make is that we want our kids to learn to control the expression of their feelings, not the feeling itself. So rather than asking your adolescent to suppress or ignore their anger, tell them you would like them to learn alternative, safe and appropriate ways to express that anger. Each family needs to decide what ways are acceptable and which aren't: "In our family, we yell a lot. We don't call names or say hurtful things, but people get loud when they are angry." "Dad prefers to have time alone when he is feeling mad. It helps me to punch the punching bag or take a run around the block."

It can sometimes be tricky when people in one family have different ways of expressing anger. It is important that you and your adolescent think about ways they could show their anger that are both satisfying to them and acceptable in your family.

Think about the models your adolescent sees.

Even more important than what we tell our kids is appropriate, is what they see. They are watching the people in their family, people on TV, friends. Work on modeling the ways you would like to see your adolescent express their anger and discuss with them the other models they are seeing.

Explore your own feelings. When our children are struggling with big feelings, especially anger, very often our own feelings get stirred up. Take some time to think about what you learned about anger as a child and what healthy messages you would like to pass on to your adolescent.

Help your teen discover the sources and triggers of their anger. By age fourteen, most people haven't yet learned what events and circumstances are likely to trigger their anger. Many of us, as adults, have still not learned this!)

Helping your adolescent figure out the things that are likely to get them mad will give them some power. ("I've noticed that every time you call Susan after school and she can't get together, you blow up.")

As your adolescent learns the things that are likely to trigger their anger (not eating enough, not getting enough sleep, having a disappointment in school, experiencing a setback in sports), they will feel less blindsided by their feelings.

Eventually, understanding their triggers will give them the ability to choose alternative routes so they don't end up so angry.
Help your teen learn to recognize their feelings before they get out of control.
Once your adolescent has identified some of the things that they have been mad about, they may be able to think about how they felt just before they "lost their temper."

Often this is the moment when they experienced the underlying feelings of hurt, fear or sadness. When your adolescent can learn to recognize that they are "on the way" towards being mad, they can make some decisions about what they want to do with the feeling, rather than letting the feeling overtake them.

Sometimes it can be helpful to share your own stories: "I remember when I was in a big track meet and I could tell I was going to come in second in a race I really wanted to win. As I started thinking about who I wanted to punch, I realized I was really sad about not winning and I decided to go off and be by myself for a while."
Get help when you need it. When your adolescent's angry outbursts continue or feel out of control, or when they are being violent toward pets or people, seek out the support of a counselor or other professional who works with angry adolescents.

This story appears courtesy of UT Southwestern Medical Center, www.utsouthwestern.edu/


 
A mother’s love helps autistic teens and adults
 
An unusual research study set out to test whether a mother’s personal warmth and praise would reduce negative behavioral symptoms in their autistic teen or adult child.  This is something mothers everywhere have already observed—that loving attention and a quality relationship can help their child.  The study shows that a mother’s love reduces the repetitive behaviors and acting out associated with autism, and improves the social interactions and responses that are so challenging for them as well.  The research abstract is below, and the entire article can be found in the online American Journal on Mental Retardation.
  
Symptoms and behavior problems of adolescents and adults with autism: effects of mother-child relationship quality, warmth, and praise.
Authors: Smith LE, Greenberg JS, Seltzer MM, Hong
American Journal on Mental Retardation; Pp: 387-402; Volume: 113(5), Sep 2008

EXCERPT: Using a cross-lagged panel design, we investigated the impact of positive familiy processes on change in autism symptoms and behaviors.  A sample of 149 co-residing mothers and their adolescent or adult child with autism was drawn from a large, longitudinal study.  Maternal warmth and praise were measured using coded speech samples in which mothers talked about their son or daughter.  A high level of relationship quality was associated with subsequent reductions in internalizing and externalizing problems as well as reductions in impairments in social reciprocity and repetitive behaviors.  Maternal warmth and praise were also related to symptom abatement in the repetitive behaviors domain.

   
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 HOW TO SUBMIT AN ARTICLE Minimize 

If you have come across research appropriate for this web page, please feel free to contact us and/or email the article to: research-articles@ofsn.org.  Thank you.

   
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 MARGARET PUCKETTE Minimize 

This information was submitted by Margaret Puckette, mpuckette@comcast.net .  Margaret facilitates a support group for parents with children with mental and emotional disorders in the Portland Metro Area.  Email her for more information about this group.

   
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 RESEARCH OPPORTUNITIES Minimize 

From time to time OFSN may post announcements of opportunities to participate in research projects, surveys, focus groups and more.  Often, these are opportunities to inform policymakers, politicians, decision-makers, clinicians, providers, citizens and the general public about real-life challenges and successes, diagnostic and treatment strategies, community resources and program effectiveness, and more.  In some but not all cases, researchers may offer stipends for participation. 

OFSN does not make any guarantees or accept any liability whatsoever in any relation to any of these opportunities.  Participation is strictly voluntary, at the sole discretion of the individual.  Participate at your own risk and expense.  An individual has the right to discontinue participation at any time.  There are rules governing research involving human subjects (participants) and generally, there is a human subjects review board to whom the researcher must be accountable.  Nothing on this web page or beyond shall substitute for legal, medical or other professional counsel and you are hereby notified and advised to seek legal, medical, and other professional counsel at your own risk and expense. 

It is the policy of OFSN to NOT release any names or personally-identifiable information to third parties for research or marketing purposes.  OFSN reviews any requests to communicate with OFSN families and the public through email, web, and other communication channels. 

OFSN staff and volunteers will not post any opportunities that do not appear to be legitimate and beneficial to families and may remove such announcements at any time without notification. 

Please forward any concerns or complaints immediately to OFSN should any arise. 

Thank you.

   
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 EBP Guidelines Minimize 
EVIDENCE BASED PRACTICE GUIDELINES
Sources of evidence must have the following characteristics:
• The research must be current (either completed in, or updated within, the last three years)
• The investigator cannot have a vested interest in the outcome of the research
• The investigator must use accepted methods of research based on the outcomes of multiple studies
• The research must be peer-reviewed and published in the scientific literature
 
NOTE:
Clinical judgment still must be exercised to determine the strength of evidence appearing on any sites.
Features an excellent diagram and list of relevant resources for evaluating the credibility of practices, with the best at the top of the list:
  • COCHRANE SYSTEMIC REVIEWS
  • OTHER SRs & META ANALYSES
  • EVIDENCE GUIDELINES
  • EVIDENCE SUMMARIES
  • RCTs CASE COHORTS, CONTROL STUDIES
  • CLINICAL RESEARCH TECHNIQUES
  • OTHER REVIEWS OF LITERATURE
  • CASE REPORTS, CASE SERIES, PRAcTICE GUIDELINES
  • CLINICAL REFERENCE TEXTS

EVIDENCE BASED PRACTICE CRITERIA
Last viewed on 2010 Jan 14

There are four generally accepted evidence levels along the continuum of research support on which experts attempt to categorize practices, based on the body of evidence and outcomes indicated supporting each treatment method. Briefly, they are:

Level 1: “Best Support”
Level 2: “Good Support or Moderate Support”
Level 3: “Promising Practice”
Level 4: “Practices with Known Risks”

Specifically, evidence determinations are based on the following criteria:

Level 1: “Best Support” - Interventions receiving “best” support must have supporting research evidence obtained in one of the following ways:
  • Two or more between-group design experiments demonstrating that treatment is superior to placebo or already established treatment
  • Two or more between-group design experiments demonstrating that treatment is equivalent to an already established treatment
  • Ten or more rigorous single case design experiments which demonstrate treatment efficacy
  • In addition, all experiments must:
    Be conducted with treatment manuals
    Specify characteristics of client samples
    Have treatment effects demonstrated by at least two different investigators

Level 2: “Good Support or Moderate Support” - Interventions receiving “good or moderate” support must have supporting research evidence obtained in one of the following ways:

  • Two or more experiments showing treatment is superior to a wait-list control group
    Treatment manuals, specification of the sample, and independent investigators is not required
  • One between-group design experiment utilizing manuals and a specified sample which demonstrates treatment is superior to placebo or previously established treatment
  • One between-group design experiment utilizing manuals and a specified sample which demonstrates treatment is equivalent to previously established treatment
  • Four or more rigorous single case design experiments utilizing manuals and specifying sample clients which demonstrate treatment efficacy

Level 3: “Promising Practice” - “Promising practices” meet the following criteria:

  • Sound theoretical basis in generally accepted psychological principles or has been demonstrated to be effective with another target behavior.
  • Substantial clinical-anecdotal literature indicating treatment value with the target behavior
  • Generally accepted in clinical practice as appropriate for use with the target behavior
  • No clinical evidence indicating that the treatment constitutes a substantial risk of harm to those receiving it, compared to likely benefits
  • Book, manual, or other available writings which specify components and describe administration of treatment

Level 4: “Practices with Known Risks” - “Practices with known risks” meet the following criteria:

  • Interventions which have evidence demonstrating harmful effects of a treatment.
  • This evidence need only be based on one study or review of the intervention.


CRITICISMS OF EVIDENCE BASED PRACTICES
Excerpted from:
Last viewed on 2010 Jan 14

Criticisms of evidence-based practice (EBP) have focused on four major issues:

  1. The belief that EBP focuses exclusively on the use of medical literature in making diagnostic and therapeutic decisions, to the exclusion of the clinical knowledge and skill of the health care practitioner (although this is not implicit in the definition of the term).
  2. A concern that if EBP relies too heavily on quantitative criteria, qualitative factors and specific patient information will be ignored.
  3. That EBP is, or will be, controlled by HMOs and used as a form of economic control rather than as a method of providing best patient care.
  4. That EBP is not new. Good practitioners have always looked at the literature.

A sampling of critical, peer-reviewed articles on the topic of evidence-based practice appearing in MEDLINE during the past year include:


Theory of Change

Hernandez, Mario and Hodges, Sharon.  (2000).  Turning Ideas into Action: Using Theory Based Frameworks.  Last viewed online on 2010 Oct 14 at: http://www.dcf.state.fl.us/programs/cbc/docs/attach2b.doc

Excerpt(s):
 
[the outcome measures selected] should reflect
[the] issues and strengths of [the] population of focus,
tied to strategies...
 
Criteria for Selecting Outcomes:
  • Is the outcome information useful to managers and administrators?
  • Is the outcome information useful to front-line workers?
  • Is the outcome information relevant to children and families?
  • Is the outcome information relevant to other significant stakeholders?
  • Does the process provide the opportunity for corrective action?
  • Does the information support the achievement of cultural competence?”

...and identify external factors of influence to determine weight etc. 

USF LOGIC MODEL TEAM
 
  Features exemplary annotated, narrated logic models at:
 
   Recommended Reading

 

   
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 Research Corner Disclaimer Minimize 

DISCLAIMER:  OFSN does not warrant the accuracy or fitness of any information on this web site or beyond, and makes no guarantees and accepts no liability regarding content on this web site.  Nothing on this web site or connected to this web site shall substitute for legal, medical or other professional advice from qualified persons.  You are advised to seek professional counsel at your own risk and expense.  Please contact OFSN immediately with any concerns or complaints that arise.  Thank you.

   
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