Child parent dyadic treatment for anxiety disorders in youths

There is evidence for the efficacy of treatments for childhood anxiety disorders; however, less is known about whether including parents in the child's treatment enhances child treatment response. There also are few studies that have examined predictors of treatment completion/non-completion and success/failure. In this dissertation, a child focused individual treatment was compared to a dyadic child-parent treatment. In dyadic, parent anxiety symptoms and child-parent relationships were targeted. Based on the Transfer of Control Model proposed by Silverman and Kurtines (1996a, b, 2005), it was hypothesized that treatment changes in parent anxiety symptoms and child-parent relationships would be related to positive child treatment response. ^ Participants were 119 youths (ages 6 to 16 years, M = 9.93 SD = 2.75; 68 girls) and their parents. All youth were born in the U.S. but had various backgrounds; 40 were European American, 73 were Latinos/as, 6 were of other ethnic backgrounds or did not report their ethnicity. Participants signed informed consent (assent for youths) and completed a pretreatment assessment. Participants were randomized to a child individual treatment or dyadic treatment, were assessed immediately after treatment and one year post treatment. Findings showed that treated youths improved across all measures over time. Comparison of treatment conditions across all measures showed no statistically significant differences between the child individual and dyadic treatment. Reductions in parent anxiety symptoms and improvements in child-parent relationships were significantly related to child treatment change at posttreatment and at one year follow-up across treatments. No factors differentiated completers from non-completers and only parent reported child internalizing behavior problems were significantly negatively related to child treatment response. ^ The study findings support a premise of the Transfer of Control Model that changes in parent anxiety symptoms and child-parent relationships are related to child treatment response. The study findings show that children can be successfully treated when parents are included as co-clients in dyadic treatment, thereby supporting the utility of this approach in practice. ^

Evaluating the external validity of comorbid disorders in youth using rating scales and behavior observations

To evaluate the theoretical underpinnings of current categorical approaches to classify childhood psychopathological conditions, this dissertation examined whether children with a single diagnosis of an anxiety disorder (ANX only) and children with an anxiety diagnosis comorbid with other diagnoses (i.e., anxiety + anxiety disorder [ANX + ANX], anxiety + depressive disorder [ANX + DEP], and anxiety + disruptive disorder [ANX + EXT]) could be differentiated using external validation criteria of clinical phenomenology (i.e., levels of anxiety, depression, and internalizing, externalizing and total behavior problems). This study further examined whether the four groups could be differentiated in terms of their interaction patterns with their parents and peers, respectively. The sample consisted of 129 youth and their parents who presented to the Child Anxiety and Phobia Program (CAPP) housed within the Child and Family Psychosocial Research Center at Florida International University, Miami. Youth were between the ages of 8 and 14 years old. A battery of questionnaires was used to assess participants' clinical presentation in terms of levels of anxiety, depression, and internalizing and externalizing symptoms. Family and peer interaction were evaluated through rating scales and through behavior observation tasks. Statistics based on the parameter estimates of the structured equation models indicated that all the comorbid groups were significantly different from the pure anxiety disorder group when it came to depression indices of clinical phenomenology. Further, significant differences appeared mainly in terms of the ANX + DEP comorbid group relative to the other comorbid groups. In terms of Parent-child interaction the ANX + EXT and the ANX + DEP comorbid groups were differentiated from the pure anxiety disorder and ANX + ANX comorbid group when it came to the appraisal of the parent/child relationship by the parent, and the acceptance subscale according to the mother report. In terms of peer-child interaction the ANX + EXT and the ANX + DEP comorbid groups were statistically significantly different from the pure anxiety disorder only when it came to the positive interactions and the social skills as rated by mother. Limitations and future research recommendations are discussed.

Marxists into Muslims: The Iranian irony

This dissertation examines the influence of Islamic ideology on Iranian Marxists during the 1979 revolution. The purpose of this study is to extricate the influence of Islamic culture, ideology, and terminology on Marxist organizations and on individuals who identified themselves as Marxists in Iran. This is especially of interest since in many ways Marxism and Islam are ideologically in conflict. Were Marxists aware of the influences of Islam in their behavior and ideology? To investigate the irony publications put forth by several Marxist organizations before and after the 1979 revolution were examined. A history of such influence both ideologically and contextually is depicted to demonstrate their political and cultural significance. Through the study of Marxist political organs, theoretical publication and political flyers distributed during and after the revolution, the phenomenon of Marxists converting to an Islamic ideology became clearer. Many Marxist organizations were demonstrably utilizing Islamic political ideology to organize and mobilize masses of Iranians. This study shows a historical precedence of Marxists’ usage of Islam in the political history of Iran dating back to early twentieth-century. Primary and secondary Marxist literature showed that Islam was an inescapable social and political reality for Iranian Marxists. Not only was there a common upbringing but a common enemy fostered provisional collusion between the two. The internalizing the idea of martyrdom—of Shi’a Islam—was a shared belied that united Marxists with Muslins in their attempt to effect sociopolitical change in Iran. Studying Marxist publications shows evidence that many Iranian Marxists were not conscious of using Islamic ethics and terminology since Islamic beliefs are part of the taken-for-granted world of Iranian culture. This contextual belief system, pervasive within the culture and a change of political ideology is what created the conditions for the possibility of Marxists becoming Muslims.

Maltreatment, psychiatric symptoms and human immunodeficiency virus/sexual transmitted infection risk behavior among youth with alcohol and other drug use problems: A person-centered analysis

Multi-problem youth undergoing treatment for substance use problems are at high behavioral risk for exposure to sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Specific risk factors include childhood adversities such as maltreatment experiences and subsequent forms of psychopathology. The current study used a person-centered analytical approach to examine how childhood maltreatment experiences were related to patterns of psychiatric symptoms and HIV/STI risk behaviors in a sample of adolescents (N = 408) receiving treatment services. Data were collected in face-to-face interviews at two community-based facilities. Descriptive statistics and Latent Profile Analysis (LPA) were used to (a) classify adolescents into groups based on past year psychiatric symptoms, and (b) examine relations between class membership and forms of childhood maltreatment experiences, as well as past year sexual risk behavior (SRB). ^ LPA results indicated significant heterogeneity in psychiatric symptoms among the participants. The three classes generated via the optimal LPA solution included: (a) a low psychiatric symptoms class, (b) a high alcohol symptoms class and (c) a high internalizing symptoms class. Class membership was associated significantly with adolescents’ self-reported scores for childhood sexual abuse and emotional neglect. ANOVAs documented significant differences in mean scores for multiple indices of SRB indices by class membership, demonstrating differential risk for HIV/STI exposure across classes. The two classes characterized by elevated psychiatric symptom profiles and more severe maltreatment histories were at increased behavioral risk for HIV/STI exposure, compared to the low psychiatric symptoms class. The high internalizing symptoms class reported the highest scores for most of the indices of SRB assessed. The heterogeneity of psychiatric symptom patterns documented in the current study has important implications for HIV/STI prevention programs implemented with multi-problem youth. The results highlight complex relations between childhood maltreatment experiences, psychopathology and multiple forms of health risk behavior among adolescents. The results underscore the importance of further integration between substance abuse treatment and HIV/STI risk reduction efforts to improve morbidity and mortality among vulnerable youth. ^

Evaluating the effects of initial participation in the group therapy process

Although the effectiveness of group therapy has been highlighted, the underlying mechanisms involved in the group process have been under studied. The purpose of this study is twofold. First, the current study utilized an outcome mediation model to examine whether initial level of participation in the intervention (Control/No intervention, non-participatory, participatory) predicted change in Identity Conflict Resolution (IDCR), Personal Expressiveness (PE) and Informational Identity Style (INFO) at posttest, and Internalizing (INT) and Externalizing (EXT) behaviors at post and follow-up assessment. Secondly, the current study examined whether relationships between variables varied as a result of group differences in initial participation. The study utilized an archival sample of 234 high school students, ages 14 to 18, who participated in the Changing Lives Program of the Youth Development Project (YDP) since 2003. Structural equation modeling (SEM) was used to examine differences in direct effects as a result of initial participation on an outcome meditational model. To further analyze this model, SEM was utilized to conduct a multi-group solution to examine whether group differences based on level of initial participation in the variables^

Children's perceptions of marital conflict, parent -child relations and anxiety in children: A proposed systemic model

This study tested a systemic model in which internalizing behaviors in a clinically-referred sample of children are predicted by children's perceptions of marital conflict in the context of three additional, well-researched, familial variables: parent-child relations, mother's emotional functioning, and children's perception of social support. After finding preliminary support for the model, its generalizability was tested in a combined sample of the clinically-referred group and a community-based group of elementary school children. ^ The clinical group consisted of 31 participants from a specialty clinic for children's anxiety disorders: 15 boys and 16 girls, aged 6 to 16, from both intact and divorced homes. Children's reports and mothers' reports of children's internalizing behaviors were submitted to separate analyses. Mothers' reports of children's internalizing behaviors were predicted only by mothers' emotional functioning. As hypothesized by the model, children's own reports of their internalizing behaviors were predicted significantly by children's perceptions of marital conflict. Parent-child relations, children's perception of social support, and one interaction term, children's perception of marital conflict x children's perception of parental rejection, contributed to the regression solution, while mother's emotional functioning failed to meet entry criterion. ^ The combined sample added 37 community-based children, 18 boys and 19 girls, aged 6 to 11, creating a total of 68 subjects. The model was replicated on the combined sample. ^ Findings of the study suggest child perceptions of marital conflict have a strong direct effect on child internalizing behaviors, accounting for 28% of the variance between marital conflict and child outcome in the clinical sample and 42% in the combined sample. In the past only about 10% of the variance in children's internalizing behaviors was explained by marital conflict. Importance implications are made for optimal assessment and specific treatment strategies for children and families experiencing marital conflict, especially for those at risk for anxiety disorders. ^

Compensatory effects of parent and peer support on well -being and achievement during pre- and early adolescence

The current study was designed to explore the salience of parent and peer support in middle childhood and early adolescence across two time periods as indicated by measures of achievement (grade point average (GPA), Stanford Achievement Test (SAT) scores and teacher rated school adaptation) and well-being (loneliness, depression, self-concept and teacher-rated internalizing behaviors). ^ Participants were part of an initial study on social network relations and school adaptation in middle childhood and early adolescence. Participants at Time 1 (in the spring of 1997) included 782 children in grades 4 and 6 of eight lower and middle income public elementary schools. Participants (N = 694) were reinterviewed two years later in the spring of 1999 (Time 2). ^ Multivariate analyses of variance (MANOVA) were used to investigate the change in salience of parent and peer support from Time 1 to Time 2. In addition, Tukey-HSD (Honestly Significant Difference) post hoc tests were used to test the significance of the differences among the means of four support categories: (1) low parent-low friend, (2) low parent-high friend, (3) high parent-low friend, and (4) high parent-high friend. ^ Compensatory effects were observed for loneliness and self-concept at Time 1, as well as for SAT scores, self-concept and overall achievement at Time 2. Results were consistent with existing findings that suggest a competitive model of parent/peer influence on achievement during adolescence. This study affirms the need for a more contextual approach to research examining competing and compensatory effects on adolescent development. ^

An investigation into the lived experiences of racism among African -American nurses

The purpose of this study was to investigate the lived experience of racism among African-American nurses. Utilizing a qualitative phenomenological approach, data were collected by interviewing 10 African-American nurses currently practicing in Dade county. The interviews were tape recorded and transcribed verbatim. Data were analyzed using the seven step method of Colaizzi (1978). The findings of this study indicate that racism encompasses attitudes and beliefs which generate behaviors reflecting ethnocentric ideations. The process of racism creates glass ceilings that hinder the career advancement of African-American nurses. Internalizing these experiences of racism engenders feelings of betrayal and erodes unity and cohesion within the group. This study points out the need to openly confront racism in the nursing profession, from the classroom to the workplace.

Marxists into Muslims: An Iranian Irony

This dissertation examines the influence of Islamic ideology on Iranian Marxists during the 1979 revolution. The purpose of this study is to extricate the influence of Islamic culture, ideology, and terminology on Marxist organizations and on individuals who identified themselves as Marxists in Iran. This is especially of interest since in many ways Marxism and Islam are ideologically in conflict. Were Marxists aware of the influences of Islam in their behavior and ideology? To investigate the irony publications put forth by several Marxist organizations before and after the 1979 revolution were examined. A history of such influence both ideologically and contextually is depicted to demonstrate their political and cultural significance. Through the study of Marxist political organs, theoretical publication and political flyers distributed during and after the revolution, the phenomenon of Marxists converting to an Islamic ideology became clearer. Many Marxist organizations were demonstrably utilizing Islamic political ideology to organize and mobilize masses of Iranians. This study shows a historical precedence of Marxists’ usage of Islam in the political history of Iran dating back to early twentieth-century. Primary and secondary Marxist literature showed that Islam was an inescapable social and political reality for Iranian Marxists. Not only was there a common upbringing but a common enemy fostered provisional collusion between the two. The internalizing the idea of martyrdom—of Shi’a Islam—was a shared belied that united Marxists with Muslins in their attempt to effect sociopolitical change in Iran. Studying Marxist publications shows evidence that many Iranian Marxists were not conscious of using Islamic ethics and terminology since Islamic beliefs are part of the taken-for-granted world of Iranian culture. This contextual belief system, pervasive within the culture and a change of political ideology is what created the conditions for the possibility of Marxists becoming Muslims.

Maltreatment, Psychiatric Symptoms and Human Immunodeficiency Virus/Sexual Transmitted Infection Risk Behavior Among Youth with Alcohol and Other Drug Use Problems: A Person-Centered Analysis

Multi-problem youth undergoing treatment for substance use problems are at high behavioral risk for exposure to sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Specific risk factors include childhood adversities such as maltreatment experiences and subsequent forms of psychopathology. The current study used a person-centered analytical approach to examine how childhood maltreatment experiences were related to patterns of psychiatric symptoms and HIV/STI risk behaviors in a sample of adolescents (N = 408) receiving treatment services. Data were collected in face-to-face interviews at two community-based facilities. Descriptive statistics and Latent Profile Analysis (LPA) were used to (a) classify adolescents into groups based on past year psychiatric symptoms, and (b) examine relations between class membership and forms of childhood maltreatment experiences, as well as past year sexual risk behavior (SRB). LPA results indicated significant heterogeneity in psychiatric symptoms among the participants. The three classes generated via the optimal LPA solution included: (a) a low psychiatric symptoms class, (b) a high alcohol symptoms class and (c) a high internalizing symptoms class. Class membership was associated significantly with adolescents’ self-reported scores for childhood sexual abuse and emotional neglect. ANOVAs documented significant differences in mean scores for multiple indices of SRB indices by class membership, demonstrating differential risk for HIV/STI exposure across classes. The two classes characterized by elevated psychiatric symptom profiles and more severe maltreatment histories were at increased behavioral risk for HIV/STI exposure, compared to the low psychiatric symptoms class. The high internalizing symptoms class reported the highest scores for most of the indices of SRB assessed. The heterogeneity of psychiatric symptom patterns documented in the current study has important implications for HIV/STI prevention programs implemented with multi-problem youth. The results highlight complex relations between childhood maltreatment experiences, psychopathology and multiple forms of health risk behavior among adolescents. The results underscore the importance of further integration between substance abuse treatment and HIV/STI risk reduction efforts to improve morbidity and mortality among vulnerable youth.

Identity and intimacy as predictors of adolescent adjustment

Stressful developmental transitions related to identity and intimacy may have significant implications for adjustment in adolescence that last into young adulthood. Social and economic barriers experienced by minority adolescents have attracted attention as significant influences on normative developmental processes and psychosocial adjustment. The primary aim of this study was to describe significant relations among identity, intimacy, and adjustment in a sample of adolescents in an alternative school who were at elevated risk for problem behaviors. A sample of 120 multi-ethnic high school students responded to five self-administered questionnaires. In addition to describing significant gender differences in identity, and internalizing problems, this study documented that measures of identity accounted for significant variance in standard measures of internalizing problems using hierarchical multiple regression. The implications of these results for future research and practice are discussed.

The genetic and environmental effects of parental age on the expression of psychopathology in adoptees

Secondary analysis of 581 adoptees was utilized to determine if parental age is related, either genetically or environmentally, to the development of psychopathology. The significant results showed that proband adoptees (with psychopathology in biologic relatives) with younger birthparents had increased alcohol abuse and those with younger birthfathers had increased antisocial personality while adoptees with older birthparents had increased depression. Analyses on control adoptees (with background free of known genetic disturbances) showed that those with younger adoptive mothers had increased antisocial personality and drug abuse and those with younger adoptive fathers had increased antisocial personality while adoptees with older adoptive fathers had increased depression. Implications of these findings are that adoptees with both younger birth and adoptive parents are more likely to have externalizing symptoms, while adoptees with both older birth and adoptive parents are more like to have internalizing symptoms. This information is beneficial to those involved in adoption placement.

Effects of pubertal status and timing on externalizing behavior problems and anxious/depressed symptoms in a sample of adolescent girls of color

Empirical research has shown that pubertal development is closely linked with adolescent externalizing (e.g., aggressive) and internalizing (e.g., anxiety) problems. In most studies, pubertal timing, pubertal status, or both, are used to examine this link. The present study adds to the existing literature by examining the link between puberty and adolescent behavior problems in a sample of predominantly urban African American adolescent girls. One hundred and seventeen adolescent girls of color, aged 11-18 (M = 14.72 SD = 1.44), and their primary caregiver participated in this study. Sixty-eight percent were African American, 22.2 % were Hispanic/Latina, and 9.4% were Haitian. Among the Hispanic/Latina girls, 9.4% were Black Hispanic/Latina. Results showed that pubertal status and perceived pubertal timing (breasts) are better predictors of externalizing behavior problems than chronological age and quality of relationship with peers. No significant findings were found with anxious/depressed symptoms.