Youths are vulnerable to appreciable PTS after disaster, with pre-existing child characteristics, aspects of the disaster experience, and study methodology each associated with variations in the effect magnitude. Findings underscore the importance of measurement considerations in post-disaster research. Areas in need of research include the long-term impact of disasters, disaster-related media exposure, prior trauma and psychopathology, social support, ethnicity/race, prejudice, parental psychopathology, and the effects of disasters in developing regions of the world. Policy and clinical implications are discussed.

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Objective To examine patterns and recent trends in multi-class psychotropic treatment among youth visits to office-based physicians in the United States. Method Annual data from the 1996–2007 National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in multi-class psychotropic treatment within a nationally representative sample of 3466 child and adolescent visits to office-based physicians in which a psychotropic medication was prescribed. Results There was an increase in the percentage of child visits in which psychotropic medications were prescribed that included at least two psychotropic classes. Across the twelve year period, multi-class psychotropic treatment rose from 14.3% of child psychotropic visits (1996–1999) to 20.2% (2004–2007) (AOR: 1.89; 95% CI: 1.22–2.94, p<.01). Among medical visits in which a current mental disorder was diagnosed, the percentage with multi-class psychotropic treatment increased from 22.2% (1996–1999) to 32.2% (2004–2007) (AOR: 2.23, 95% CI: 1.42–3.52, p<.001). Over time, there were significant increases in multi-class psychotropic visits in which ADHD medications, antidepressants, or antipsychotics were prescribed, and a decrease in those visits in which mood stabilizers were prescribed. There were also specific increases in co-prescription of ADHD medications and antipsychotic medications (AOR: 6.22, 95% CI: 2.82–13.70, p<.001) and co-prescription of antidepressant and antipsychotic medications (AOR: 5.77, 95% CI: 2.88–11.60, p<.001). Conclusions Although little is known about the safety and efficacy of regimens that involve concomitant use of two or more psychotropic agents for children and adolescents, multi-class psychotropic pharmacy is becoming increasingly common in outpatient practice.

Research on the psychological impact of terrorism on youth is reviewed and evaluated. Children having proximal contact with terrorism show elevated posttraumatic stress, separation anxiety, and/or other symptoms. Following a terrorist attack, youth proximal and distal to the attack are exposed to a vast amount of attackrelated media coverage and exposure to such media coverage is associated with postattack posttraumatic stress disorder (PTSD) symptomatology. However, the research is inchoate, including an insufficient scope and methodological limitations. Research has yet to examine the impact that exposure to an extended context of threat, expectation, and alert has on child development. Importantly, how are children influenced by secondhand terrorism -the context in which cultural influences disproportionately attend to the possibilities , rather than probabilities , of future terrorism? Research is needed to evaluate the impact of terrorism on psychopathology (beyond PTSD), functional impairment, and ethnic stereotyping in youth, and to examine the efficacy of psychological programs that strive to redress the problems of youth affected by terrorism.

Findings build on the small but growing literature supporting the promising role of new technologies for expanding the delivery of behavioral parent training. (PsycINFO Database Record

Mental illness imposes a staggering public health burden in the United States. Although the past 40 years have witnessed tremendous advances in the identification of evidence-based practices (EBPs) in psychological treatments, gaps persist between treatment in experimental settings and services available in the community. In response, considerable attention and large financial commitments have focused in recent years on broad dissemination and implementation efforts designed to improve the quality of psychological services delivered by a variety of generalist practitioners across practice settings. Increasingly, under the influence of the Patient Protection and Affordable Care Act, it is envisioned that these generalists will practice in integrated primary care settings. These advances hold enormous potential, and yet, given the tremendous diversity of mental health problems and human suffering, broad dissemination and implementation efforts to generalists alone may not be sufficient to adequately address the burden of mental illness. Some EBPs may prove too complex for universal dissemination, and the time and expense required for quality dissemination and implementation preclude large-scale training in the treatment of low base rate disorders. As dissemination and implementation efforts work to ensure a quality generalist mental health care workforce, herein we highlight the vital need for available specialty care in the delivery of psychological treatments. Given traditional barriers that interfere with the accessibility of specialty care, we propose the transformative potential of a specialty behavioral telehealth care workforce, transacting with the generalist practitioner workforce to collectively ensure the highest quality and timely delivery of needed treatments to affected individuals.

Parental accommodation—i.e., changes in parents’ behavior in attempts to prevent or reduce child distress—has been most studied in relation to OCD. Although recent work suggests parents of children with non-OCD anxiety diagnoses also engage in accommodation, little is known about the specific forms, correlates, and associated interference of such accommodation. The present study examined the range and associated interference of parental accommodation behaviors using the newly developed Family Accommodation Checklist and Interference Scale (FACLIS) in a sample of the parents of 71 clinic-referred children with anxiety disorders (NMothers = 68; NFathers= 51). The FACLIS demonstrated good reliability and validity. Ninety-seven percent of mothers and 88% of fathers reported engaging in at least one type of accommodation in the previous two weeks, with parents reporting an average of roughly 4 interfering parental accommodation behaviors. Greater parental accommodation and associated interference were associated with higher maternal distress. Among the anxiety disorders, accommodation was most strongly associated with generalized and separation anxiety disorder, as well as specific phobias. Findings (a) offer psychometric support for the FACLIS as a reliable and valid tool for the assessment of accommodation range and impact, and (b) help clarify the considerable scope and interference associated with parental accommodation of childhood anxiety.

Objective Service use trends showing increased off-label prescribing in very young children and reduced psychotherapy use raise concerns about quality of care for early disruptive behavior problems. Meta-analysis can empirically clarify best practices and guide clinical decision making by providing a quantitative synthesis of a body of literature, identifying the magnitude of overall effects across studies, and determining systematic factors associated with effect variations. Method We used random-effects meta-analytic procedures to empirically evaluate the overall effect of psychosocial treatments on early disruptive behavior problems, as well as potential moderators of treatment response. Thirty-six controlled trials, evaluating 3,042 children, met selection criteria (mean sample age, 4.7 years; 72.0% male; 33.1% minority youth). Results Psychosocial treatments collectively demonstrated a large and sustained effect on early disruptive behavior problems (Hedges’ g = 0.82), with the largest effects associated with behavioral treatments (Hedges’ g = 0.88), samples with higher proportions of older and male youth, and comparisons against treatment as usual (Hedges’ g = 1.17). Across trials, effects were largest for general externalizing problems (Hedges’ g =0.90) and problems of oppositionality and noncompliance (Hedges’ g = 0.76), and were weakest, relatively speaking, for problems of impulsivity and hyperactivity (Hedges’ g = 0.61). Conclusions In the absence of controlled trials evaluating psychotropic interventions, findings provide robust quantitative support that psychosocial treatments should constitute first-line treatment for early disruptive behavior problems. Against a backdrop of concerning trends in the availability and use of supported interventions, findings underscore the urgency of improving dissemination efforts for supported psychosocial treatment options, and removing systematic barriers to psychosocial care for affected youth.