Evaluation of a brief child-focused group-based intervention for anxiety-disordered children

This paper presents a pilot study of a brief, group-based, cognitive-behavioural intervention for anxiety-disordered children. Five children (aged 7 to 13 years) diagnosed with a clinically significant anxiety disorder were treated with a recently developed 6-session, child-focused, cognitive-behavioural intervention that was evaluated using multiple measures (including structured diagnostic interview, self-report questionnaires and behaviour rating scales completed by parents) over four follow-up occasions (posttreatment, 3-month follow-up, 6-month follow-up and 12-month follow-up). This trial aimed to (a) evaluate the conclusion suggested by the research of Cobham, Dadds, and Spence (1998) that anxious children with non-anxious parents require a child-focused intervention only in order to demonstrate sustained clinical gains; and (b) to evaluate a new and more cost-effective child-focused cognitive-behavioural intervention. Unfortunately, the return rate of the questionnaires was poor, rendering this data source of questionable value. However, diagnostic interviews (traditionally the gold standard in terms of outcome in this research area) were completed for all children at all follow-up points. Changes in diagnostic status indicated that meaningful treatment-related gains had been achieved and were maintained over the full follow-up period. The results would thus seem to support the principle of participant-intervention matching proposed by Cobham et al. (1998), as well as the utility of the more brief intervention evaluated.

Sleepiness, sleep-disordered breathing, and accident risk factors in commercial vehicle drivers

Sleep-disordered breathing and excessive sleepiness may be more common in commercial vehicle drivers than in the general population. The relative importance of factors causing excessive sleepiness and accidents in this population remains unclear. We measured the prevalence of excessive sleepiness and sleep-disordered breathing and assessed accident risk factors in 2,342 respondents to a questionnaire distributed to a random sample of 3,268 Australian commercial vehicle drivers and another 161 drivers among 244 invited to undergo polysomnography. More than half (59.6%) of drivers had sleep-disordered breathing and 15.8% had obstructive sleep apnea syndrome. Twenty-four percent of drivers had excessive sleepiness. Increasing sleepiness was related to an increased accident risk. The sleepiest 5% of drivers on the Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire had an in-creased risk of an accident (odds ratio [OR] 1.91, p = 0.02 and OR 2.23, p < 0.01, respectively) and multiple accidents (OR 2.67, p < 0.01 and OR 2.39, p = 0.01), adjusted for established risk factors. There was an increased accident risk with narcotic analgesic use (OR 2.40, p < 0.01) and antihistamine use (OR 3.44, p = 0.04). Chronic excessive sleepiness and sleep-disordered breathing are common in Australian commercial vehicle drivers. Accident risk was related to increasing chronic sleepiness and antihistamine and narcotic analgesic use.

Use of electropalatography in the treatment of disordered articulation following traumatic brain injury: A case study

Electropalatography (EPG) was used as a biofeedback tool in a case study of a 30-year-old male with disordered articulation following traumatic brain injury (TBI). Based on qualitative measures of the participant's intelligibility, improved articulation of the fricatives /s/ and /integral/ were selected as treatment targets. Therapy was administered three times a week for 5 weeks. Results showed that word and sentence intelligibility increased approximately 10%, and error patterns for lingual articulation indicated that fricative -> stop and other fricative errors decreased considerably. EPG measures for /s/ exhibited a significantly more anterior main focus of articulatory contact post therapy. Consonant durations were significantly longer during weeks 3 and 4, and this finding was associated with the emergence of an articulatory contact pattern with a groove rather than complete closure. This articulatory pattern appeared inconsistently and was found to vary across articulations of /s/ but also within a single consonant production. For /integral/, the amount of contact was significantly reduced post therapy and an increase in duration was noted during week 4, similar to that occurring in the production of /s/. Spatial and timing measures were more variable than in normal speakers of English and indicated a general increase in variability across weeks for both /s/ and /integral/. It was concluded that, although the correct fricative patterns appeared only intermittently during production of the consonants, there seemed to be sufficient information for the listener to be able to classify the sound as a fricative. As a part of an intervention program, visual EPG biofeedback therapy would appear to have a definite role in assisting dysarthric speakers exhibiting difficulties with lingual articulation in understanding their errors, learning how to exploit kinesthetic, and acoustic sources of feedback, and how to make appropriate adjustments in tongue articulation to increase the level of speech intelligibility.