Treatment practices for childhood posttraumatic stress disorder

OBJECTIVE: This study surveyed practices in treating childhood PTSD among child psychiatrists and non-M.D. therapists with self-identified interest in treating traumatized children. METHOD: An anonymous survey was mailed to 207 child psychiatrists ("medical") and 460 nonphysician ("non-medical") therapists inquiring about current interventions used to treat children with PTSD. RESULTS: Two hundred and forty-seven responses were received: of 77 medical and 82 nonmedical respondents who currently treat children with PTSD, a wide variety of modalities are used. Most preferred modalities among medical responders were pharmacotherapy, psychodynamic, and cognitive-behavioral therapy. Most preferred modalities among nonmedical respondents were cognitive-behavioral, family, and nondirective play therapy. Ninety-five percent of medical respondents used pharmacotherapy for this disorder; most preferred medications to treat childhood PTSD were selective serotonin reuptake inhibitors and alpha-adrenergic agonists. Several significant differences between medical and nonmedical practices were identified. CONCLUSIONS: There is little clinical consensus regarding the effectiveness of the many modalities used to treat traumatized children who have PTSD symptoms; empirical research is particularly needed to evaluate the efficacy of pharmacotherapy and EMDR.     

The peer group as a context for the development of young adolescent motivation and achievement

This study investigated the peer group as a context for the socialization of young adolescents' motivation and achievement in school. Social network analysis was used to identify peer groups of adolescents in middle school whose members regularly interacted with each other (N = 331). Actual reports from these peer group members were used to assess peer group characteristics. Multilevel analyses indicated that peer groups did socialize some academic characteristics, controlling for selection factors. Students' peer group context in the fall predicted changes in their liking and enjoyment of school (intrinsic value) and their achievement over the school year. Students' peer group context was unrelated to changes in their beliefs about the importance of school (utility value) or expectancies for success over the school year.     

Reaction to videocolposcopy in the assessment of child sexual abuse.

OBJECTIVE: The purpose of this study was to clinically assess children's reactions to videocolposcopy with real-time observation of magnified anogenital images (VCO), and to evaluate whether these reactions are affected by patient or other characteristics such as response to preparation, disclosure of child sexual abuse (CSA), or examination findings. METHOD: Consecutive cases of children ages less than 18 years referred to a children's hospital clinic for nonemergent evaluation of suspected CSA during 1997 through 1999 were studied. We noted the child's response with clinical observation before and after videocolposcopy, and used the Genital Examination Distress Scale (GEDS) after evaluation. We compared these responses to patient gender, age, ethnicity, pubertal status, disclosure of child sexual abuse (CSA), and physical examination findings using univariate and regression analyses. RESULTS: Two hundred twenty-seven children (mean age 7.2 years, range 0-17) underwent videocolposcopy, of whom 55.1% disclosed sexual abuse and 17.2% had a positive examination. More than 80% were female, prepubertal, and non-Hispanic White. Most (85%) watched their examination on the monitor and were either cooperative or enthusiastic before and after videocolposcopy. Fewer very young children (ages 0-3 years) or female adolescents (13-17 years) watched the monitor. Summed GEDS scores were strongly correlated with observed responses after the procedure (p = .01), and children with CSA disclosure were three times more likely to watch the monitor and five times more likely than those without disclosure to have improved comfort. Other patient characteristics were not significantly associated with patient reaction to VCO. CONCLUSIONS: Most children are interested in watching their anogenital examination using magnified real-time images obtained during videocolposcopy and tolerate the procedure well. The GEDS is highly correlated with subjective clinical observation. While some children may particularly benefit from participating in their examination by using VCO, long-term effects of the evaluation and any relationship of a child's reaction to videocolposcopy with their history of sexual victimization remain to be established.     

Early Cerebral Constraints on Reading Skills in School‐Age Children: An MRI Study

Reading relies on a left‐lateralized network of brain areas that include the pre‐lexical processing regions of the ventral stream. Specifically, a region in the left lateral occipitotemporal sulcus (OTS) is consistently more activated for visual presentations of words than for other categories of stimuli. This region undergoes dramatic changes at the functional and structural levels when children learn to read, but little is known about the effects of early cerebral constraints on reading skills. Using anatomical magnetic resonance imaging, we investigated whether the sulcal pattern of the lateral OTS—a stable brain feature—was associated with oral reading skills. The sulcal pattern of the left but not the right lateral OTS was associated with the number of words correctly read in 3 min. This study is the first to evidence that reading is affected by early cerebral constraints, such as the sulcal morphology of the left lateral OTS.     

Young children's understanding of perception, desire, and emotion

Very young children seem to know that people experience several mental states: desires, perceptions, emotions. In three studies, we investigated 2- and young 3-year-olds' judgments and communications about how these states connect together in people's lives and minds. Two experimental studies with 56 participants demonstrated young children's understanding of at least one set of connections: In appropriate circumstances, a person's perception of desirable or undesirable objects leads to related emotional experiences. A complementary investigation of four young children's everyday conversations demonstrated their awareness of and expression of several additional connections between people's desires, perceptions, and emotions.     

Do infants see emotional expressions in static faces?

To determine whether young infants discriminate photographs of different emotions on an affect-relevant basis or on the basis of isolated features unrelated to emotion, groups of 17-, 23-, and 29-week-olds were habituated to slides of 8 women posing either Toothy Angry, Nontoothy Angry, or Nontoothy Smiling facial expressions and were then shown 2 new women in the familiarized expression and in a novel Toothy Smiling expression. At all 3 ages, recovery to the novel Toothy Smiling faces occurred only after habituation to Nontoothy faces (whether smiling or angry), not after habituation to Toothy Angry faces, indicating that infants had been responsive to nonspecific features of the photographs (presence or absence of bared teeth) rather than to affectively relevant configurations of features. In a second experiment, 2 older age groups (35 and 41 weeks) also proved to be insensitive to affect-related aspects of still faces, though more so for angry than for happy expressions. It is suggested that the young infant's difficulty in extracting emotional information from static stimuli may be attributable to the absence of the critical invariants (dynamic, multimodally specified) that characterize naturalistic expressions of emotion.     

AN EXAMINATION OF THE CONTEXT EFFECT IN ITEM SAMPLING

Item sampling and/or multiple matrix sampling techniques have been recommended for a variety of purposes. For some of these purposes, it must be assumed that examinee performance on a set of items is unaffected by the conditions under which the items are taken (i.e., no context effect exists). In this paper factors that may lead to a context effect among high school students are discussed. The net effect of such factors on examinee scores for an English test and a mathematics test is investigated empirically. For the English test there was little support for the existence of a context effect, However, a definite context effect was found for the mathematics test.