[On the problem of an epoch-making change in the symptomatology of child behavior disorders].
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Standardized teacher observations of 2,527 schoolchildren, selected at random for the revised Bristol Social Adjustment Guides were partitioned into four subsamples consisting of 797 5- to 10-year-old boys, 758 5- to 10-year-old-girls; 508 11- to 15-year-old boys, and 464 11- to 15-year-old girls, respectively. The children were observed by over 900 teachers and rated on 104 indicators of maladaptive behavior. Item scores for each age/sex sample were subjected to first- and second-order factor analysis, with varimax rotation yielding identical second-order models of behavior disorder across age and sex samples and somewhat different first-order models for each sample. Comparison of derived dimensions with dimensions emergent in other behavior problem research indicated considerable consistency. Moreover, the similarity of the factorially derived dimensions confirmed the cross-age and -sex generality of the syndromes known as unforthcomingness, hostility, and depression, and provided reasonable support for the utility of the syndrome of inconsequence, although it was apparent that inconsequence stands as more a composite of underlying factor dimensions reflecting hyperactive and attention-seeking behaviors. While the withdrawal syndrome found factorial support, its integrity was clearly specific to child age and sex.
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The stability of children's disorders was studied, using Adelaide versions of the Conners teachers and parent rating scales, with 5- to 12-year-olds. Of the 20 scales, 14 had high or moderate test-retest stability over the 1-year interval. Most scales also showed discriminant validity over this time. All but 2 of the 14 stable scales gave moderate stability coefficients at each of three age levels. Three teacher scales (Conduct Problem, Socially Rejected, and Antisocial) gave very low stability for the youngest group. Stability was not generally affected by teacher "practice." Little effect of subject selection or repeated-rating bias on scale means was evident. There was a general reduction of some scale means on the second assessment, and the contributions of practice, age, and study-entry effects were examined.
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Reviews 48 outcome studies that applied self-statement modification (SSM) to childhood behavior disorders. Selection criteria restricted the review to controlled experimental studies and to children with disorders of clinically relevant severity. Meta-analysis was used to provide summary information about the observed effects of SSM. Collectively, SSM outcomes surpassed no treatment and placebo treatment by roughly a half of a standard deviation, on the average. Efficacy varied considerably with length of follow-up, experience level of therapists, age of children, outcome content area, and a number of other clinical and methodological differences among the studies. These qualifiers of observed efficacy are summarized and discussed in terms of implications for further research and application of SSM in child psychotherapy.
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Adherence with inhaled beta-agonists and corticosteroids in 24 asthmatic children was tracked over 3 months utilizing the metered-dose inhaler chronolog (MDIC). Patients seldom took all of their medications as prescribed, and failed to take any inhaled corticosteroid doses on a median of 41.8% of days or inhaled beta-agonists on 28.1% of days despite prescribed daily use. Medication nonadherence was correlated with lower levels of asthma knowledge (Asthma Knowledge Questionnaire) and family dysfunction (Family Assessment Device), but not child behavior disorder (Child Behavior Checklist). Patients tended to dramatically over-report medication use. Improved identification of the markers of nonadherence can directly facilitate more efficient targeting of behavioral interventions, resulting in improved adherence, better illness control, and less requirement of urgent medication intervention.
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