Adolescent Psychiatry - Volume 7, Issue 3, 2017

Objective: The Maryland Assessment of Recovery in Serious Mental Illness (MARS) is a 25-item, 5-point Likert recovery scale that has been validated for use with adult clients. The present study examined the psychometrics of the MARS in an adolescent residential sample. Methods: Adolescents (n = 121, 60% male, 52% Caucasian, 42% African American) were assessed periodically during residential treatment using MARS, K-SADS-PL diagnostic interviews, Youth Self Report (YSR), and Personal Well-Being Index (PWI-SC). Results: T tests (MARS x gender) and one-way ANOVA (MARS x age, race, primary diagnosis) showed no differences in MARS scores for normative data. Reliability was strong using test retest (r = .914) and internal consistency (Chronbach's a = .952). Repeated measures ANOVAs found significant main effects and interactions; as number of diagnoses declined from admission (M = 3.13) to discharge (M = 1.70), MARS scores significantly increased from admission (M = 93.97) to discharge (M = 105.90); as symptom severity (YSR total Problems) decreased from admission (M = 66.55) to discharge (M = 60.55), MARS scores increased showing sensitivity to change validity. Construct validity revealed a moderate correlation with PWI-SC (r =.42). Conclusion: The present study provides preliminary evidence that the MARS is a psychometrically sound instrument for use in assessing recovery in adolescents. Several limitations of the study are discussed in the interest of further research on use of the MARS with adolescent clients.

Background: A considerable proportion of children and adolescents attending mental health services suffer from severe affective and behavioral dysregulation. The Dysregulation Profile, which was identified based on certain subscales of the Child Behavior Checklist and later, also in certain subscales of the Strengths and Difficulties Questionnaire, has been defined as a marker of a broader form of severe psychopathology. DP has been described as a theoretical construct and research data have been provided to consolidate its operational description. However, its stability, which is one of the fundamental aspects for operational definition of a construct, remains unexplored. Methods: A retrospective six-month follow-up study was conducted in order to clarify stability and persistence of the Dysregulation Profile, assessed with the Strengths and Difficulties Questionnaire, in a clinical sample of 299 children and adolescents. Results: The temporal consistency of the Dysregulation Profile, assessed with the Strengths and Difficulties Questionnaire, found in this sample was fair. Test-retest reliability of Dysregulation Profile, assessed with Strengths and Difficulties Questionnaire, over six months was moderate. There were no differences between groups by sex or age. Conclusion: Results support the Strengths and Difficulties Questionnaire-Dysregulation Profile as a useful tool to assess Dysregulation Profile, with a moderate stability and fair persistence, in line with previous literature. Further investigation is needed in order to clarify risk and maintenance factors.

Objective: Increased concern exists regarding non-prescription use of stimulants in college populations such as for perceived enhancement of cognition and subsequent improved academic performance or for recreational purposes. Psychiatrists face serious clinical challenges in making a new diagnosis of adult ADHD in college-age patients and distinguishing between students who have legitimate ADHD symptoms versus students seeking secondary gain. Methods: A hypothetical case will illustrate those challenges and an ethics-based framework named dialectical principlism will be applied to the case to demonstrate how the competing considerations can be balanced to inform a resolution for this clinical dilemma. Results: The weighted considerations related to principles of autonomy, beneficence, nonmaleficence, and distributive justice were balanced to favor not prescribing stimulant medication in this hypothetical situation. Others might come to the opposite conclusion using the same dialectical principlism model because their unique narrative and set of values may lead to weighing the importance of these principles differently and thus altering the balance in the other direction. Conclusion: The method of dialectical principlism was applied to this hypothetical to illustrate how practitioners can make clinical decisions guided by what is most ethical after identifying, prioritizing, and balancing the competing considerations. Dialectical principlism is primarily an aspirational model for practitioners, with the goal of empowering them with a systematic approach to determine the best way to resolve complex challenges via an ethics analysis.

Background and Goals: Social anxiety disorder is a common and disabling disorder in adolescents. It is generally assumed that cognitive processes play a central role in the maintenance of SAD and this is the basis for cognitive-behavioral therapy. Interpretation bias, a form of cognitive bias, namely the tendency to systematically assign a negative meaning to ambiguous social situations, is an important theoretical construct that has empirical support, and is considered to play a role in SAD. Interpretation bias has been extensively studied in adult populations, but has received little attention in adolescents. This paper aims to highlight what is known about interpretation bias in adolescents with social anxiety and discuss directions for future research in this area. Methods: First, we present the main features of Social Anxiety Disorder (SAD) in adolescence, the developmental issues associated with this age, and the two major cognitivebehavioral models related to SAD development and maintenance. Next, we review the literature about the interpretation bias in adolescents with social anxiety, with reference to the component of the bias related to the interpretation of ambiguous social situations. Conclusion: The literature regarding interpretation bias in adolescents is meager. Future studies should be conducted using both on-line (i.e., reaction time) and off-line (i.e. selfreport questionnaire) instruments, with the last being administered both immediately and after about two days, aiming to evaluate the relation between positive and negative interpretations at different stages of information processing. Moreover, the role of belief in negative interpretations should be analyzed further, in order to understand its role in the development and maintenance of SAD. Finally, adolescents' studies should differentiate between pre-adolescents, adolescents, and older adolescents, since there could be age-related differences.

Background: Forgiveness therapy has been used in many settings and with various populations. Existing theoretical and empirical perspectives on forgiveness point to the potential utility of this innovative theoretical model. However, its use with those who have experienced child abuse and neglect is undocumented. Method: This paper represents an initial exploration of the contribution of forgiveness therapy (FT) to heal the wounds of child maltreatment. A case study is presented that demonstrates the utilization of DiBlasio's family based conjoint approach to assist an adolescent victim of severe paternal maltreatment within the context of the Bedouin-Arab family. Structured assessment instruments were used to measure change over time in a father and son. Results: Positive child outcomes related to self-esteem, life satisfaction, and school attendance are reported. At the same time, decreased valuation of parenting skills and family functioning was also found, which may be related to the sober confrontation of interpersonal difficulties integral to FT. Conclusions: The therapeutic process described points to the importance of engaging the maltreating father as additional victim. This necessitates a modification of existing forgiveness therapy models that focus exclusively on the pain and suffering of the primary and obvious victim. Therapist readiness to compromise on traditional considerations related to therapeutic setting may also be needed in order for forgiveness therapy to succeed within this understudied cultural context.