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Objective. There is confusion regarding the presentation and correct classification of anxiety symptoms in autism spectrum disorders (ASD) as comorbid anxiety disorders, core ASD symptoms or a separate syndrome. The present study examined the degree to which Diagnostic Statistical Manual-Fourth Edition (DSM-IV) anxiety disorders ("typical anxiety") can be reliably distinguished from atypical presentations in ASD ("atypical anxiety"). To inform their classification, the study also assessed how these typical and atypical presentations were differentially related to child characteristics (i.e. IQ, language ability) and features of anxiety disorders (i.e., anxious self-talk) and ASDs (i.e., ASD symptomology, sensory abnormalities). Method. Youth (N = 59; 7 - 17 years; IQ > 60) diagnosed with ASD and their parents completed a semi-structured diagnostic interview (ADIS-C/P) adapted to measure both typical and atypical presentations of anxiety as well as self- and parent-report measures. Results. Seventeen percent of the sample met criteria for a typical anxiety disorder, 15% for an atypical anxiety disorder and 31% for both typical and atypical disorder variants. Whereas IQ, language ability, anxious self-talk and sensory sensitivity significantly predicted typical anxiety, atypical anxiety was significantly associated with anxious self-talk and ASD symptomology. Conclusions. Results suggest that ASD youth display two, phenomenological distinct classes of anxiety. These typical and atypical presentations likely reflect comorbid anxiety and a novel variant of anxiety, which may be missed by current, unmodified anxiety measures. How these presentations differentially respond to interventions and contribute to the range of results regarding the prevalence and presentation of anxiety in ASD warrants investigation. / Psychology

Previous research indicates an increase in the prevalence of depression around adolescence, especially for females. Research suggests depressogenic cognitions play an essential role in the development of depression and may mediate the relation between risk factors and depression. Research has also shown the family environment, negative life events, and maternal depression are all related to the development of depressogenic cognitions. Additionally, few studies have tested models of depression while measuring both anxiety and depressive symptoms despite the high rates of comorbidity between the two disorders. The current study used path analytic techniques to integrate correlates of depression while accounting for comorbid anxiety symptoms in comprehensive model of depression for early adolescent girls. Participants included 203 girls, aged 9-14, along with their mothers. Participants completed self-report measures of the family environment, cognitive triad, and negative life events. Mothers of participants completed a self-report measure of psychopathology. Participants also completed a semi-structured diagnostic interview, which served as the measure for symptoms of depression and anxiety. Results supported previous literature finding a more depressogenic cognitive triad was significantly associated with higher depressive severity. Family environments, characterized by more cohesive and less conflictual family relationships, more communication, and higher engagement in social/recreational activities, were significantly associated with a more positive cognitive triad. Additionally, more negative life events were significantly associated with a more depressogenic cognitive triad. Both family social/recreational activities and negative life events had significant indirect effects on depression. Results indicated a strong relation between anxiety and depression, with anxiety having a significant positive direct effect on depression. The pathways from maternal depression and anxiety to the cognitive triad, anxiety symptoms to the cognitive triad, as well as family environment variables, maternal depression and anxiety and negative life events to anxiety symptoms were not found to be significant. Results from an exploratory analysis suggest anxiety may moderate the relation between the cognitive triad and depression. Implications of these results, limitations, and recommendations for future research are provided. / text

Previous research supports the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) in patients with comorbid psychiatric diagnoses; however, questions remain about the effectiveness of CBT-I due to the fact that previous studies excluded patients with significant psychiatric symptoms and comorbid diagnoses. This study begins to address this gap in the insomnia literature by testing a five-session CBT-I intervention in a diverse sample of patients receiving mental health treatment in an outpatient psychiatry clinic (N=23) who continue to experience chronic insomnia despite receiving pharmacological treatment for sleep. Participants were randomized to CBT-I (n=13) or a treatment as usual control group (n=10). Following one week of baseline sleep diary assessment, those in the CBT-I group completed five sessions of individual treatment; three in-person and two by phone. Those in the treatment as usual group continued with medication treatment as prescribed by their psychiatrist for a five-week period and were then given the opportunity to cross over to receive CBT-I. Study results show that adding a brief CBT-I intervention to usual care led to significant improvements in sleep compared to treatment as usual. Effect sizes were generally large, illustrating the potency of CBT-I in a psychiatric sample. Sleep gains were largely maintained at two-month follow-up. No significant changes in depression or anxiety severity were seen in the CBT-I group, suggesting that sleep interventions alone may not have the same impact in a psychiatric population with more severe and chronic mental health symptoms. Quality of life in the area of social functioning was improved following CBT-I compared to treatment as usual; however, this gain was not maintained at two-month follow-up. Finally, CBT-I was not associated with a reduction in use of sleep medication. This may reflect this sample's high level of chronicity of insomnia or a propensity towards medication dependency. In sum, the findings of this study suggest that selected patients with complex and chronic psychiatric conditions can obtain sleep improvements with CBT-I beyond those obtained with pharmacotherapy alone. Future research should focus on identifying factors that predict which “real-world” psychiatric patients are most likely to undergo and benefit from CBT-I.

This research study examined the effects of high levels of sugar intake on mental health in marijuana smokers. Because the literature demonstrates a similarity between refined sugar and other commonly addictive drugs, those who ingest a higher percentage of dietary sugar will score more poorly on the DASS21, meaning that with higher levels of sugar ingestion, a greater deficit in mental health functioning will be measurable. Of 16 participants, nine were female and seven were male, and the participants ranged from a normal weight to obese. The results did support the hypothesis of sugar dependence. This has implications for future studies on the impact of sugar on mental health. The results to this study may provide insight into potential for greater understanding of eating disorders associated with sugar dependence, thereby potentially leading to the development of more effective treatment options.

Depression is a pervasive mental health disorder worldwide. Although being diagnosed with chronic illness exacerbates susceptibility to depression, detection and subsequent treatment of comorbid depression in primary care settings remain suboptimal because patients with chronic medical disorders are not commonly screened for depression. There is a need to initiate proactive measures by implementing routine screening in primary care settings. The plan-do-study-act (PDSA) model guided an intervention to establish a depression screening practice. This study aimed to determine if the implementation of evidence-based screening for depression using the Patient Health Questionnaire-9 (PHQ-9) tool could increase diagnosis of comorbid depression among patients suffering from chronic diseases. Convenience sampling served as the method for selecting healthcare records that met the predetermined criteria. Two hundred established patients over 18 years of age were screened for depression at a primary care clinic in Maryland within a 10-week period following Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Study participants included 84 (42%) males and 116 (58%) females. Of these, 84 (42%) had minimal depression, 57 (29%) had mild depression, 23 (12%) had moderate depression, 24 (12%) had moderate-severe depression, and 12 (6%) had severe depression. The baseline report from the clinic revealed 0% depression screening practices yet the post-project chart review revealed a surprisingly high rate of depression diagnosis in 34 (17%) of 200 patients suffering from chronic illnesses. Identification of a reliable tool that would be used to screen depression among patients with chronic diseases at primary care clinics to mitigate the deleterious effects of depression and promote the well-being and health of patients and their families is important.

Many children and their families who seek assistance for childhood behaviour disorders experience comorbid disorders, namely the presence of two or more disorders. Although comorbid disorders are recognized as a frequent clinical complication, minimal direction exists within the literature about the risk factors for comorbid conditions and how best to provide intervention services. In this study an ecological framework was used to compare the individual, family, and community environmental contexts of young girls who presented at intake at a children’s mental health centre with comorbid externalizing and internalizing disorders, and girls who presented at intake with externalizing disorders only. The treatment response to a cognitive-behavioural intervention for externalizing behaviour disorders was examined, by comparing externalizing scores over time between girls with comorbid externalizing and internalizing disorders and girls with externalizing disorders only. Additionally, internalizing scores over time for girls with comorbid disorders were examined. Results indicated that a history of abuse and a cluster of individual characteristics placed girls at higher risk to present with comorbid conditions. The results also indicated that girls with comorbid disorders experienced a reduction of both externalizing and internalizing symptoms. Only 1 in 7.4 girls, however, scored below the clinical range for both externalizing and internalizing disorders at the end of the treatment phase, in comparison to 1 in 5 girls scoring below the clinical range for externalizing disorders in the noncomorbid group.

Children with co-occurring internalizing and externalizing problems (MIXED children) represent a distinct aggressive subtype with negative outcomes; understanding what works for them in treatment is imperative. The success of MIXED children in some family-based programs for aggression may be attributable to collateral reductions in internalizing symptoms. The current study examined whether reductions in internalizing behaviour in MIXED children were due to reductions in maternal depression and parent-child co-rumination. Co-rumination, a dyadic interaction related to internalizing symptoms, is defined as excessively discussing problems and dwelling on negative feelings. We investigated 154 MIXED children and 49 pure externalizers who underwent Parent Management Training/Cognitive Behavioural Therapy. Mother-child co-rumination was assessed using videotaped observations of problem discussions gathered at pre-treatment, post-treatment and follow-up. We hypothesized that, at pre-treatment, mother-child co-rumination would mediate the relation between maternal depression and child internalizing problems. During treatment, we expected that co-rumination and maternal depression would predict reductions in child symptoms. Finally, we hypothesized that reductions in co-rumination would mediate the association between improvements in maternal depression and improvements in child internalizing which would, in turn, impact externalizing outcomes. Results did not support our pre-treatment and during treatment hypotheses about the role of co-rumination as a mediator. At pre-treatment, maternal depression was associated with child internalizing problems and co-rumination; co-rumination was not associated with internalizing when controlling for maternal depression. Reductions in maternal depression were associated with improvements in child internalizing and, marginally, with child externalizing, thus partially supporting our hypotheses. We also found that reductions in co-rumination impacted child externalizing, but not internalizing behaviour, again partially supporting our hypotheses regarding co-rumination changes and child symptom changes. Finally, results demonstrated that internalizing improvements affected externalizing outcomes, partially supporting our treatment-related hypothesis. Findings have implications for understanding the development and treatment of problems in MIXED children.

Many children and their families who seek assistance for childhood behaviour disorders experience comorbid disorders, namely the presence of two or more disorders. Although comorbid disorders are recognized as a frequent clinical complication, minimal direction exists within the literature about the risk factors for comorbid conditions and how best to provide intervention services. In this study an ecological framework was used to compare the individual, family, and community environmental contexts of young girls who presented at intake at a children’s mental health centre with comorbid externalizing and internalizing disorders, and girls who presented at intake with externalizing disorders only. The treatment response to a cognitive-behavioural intervention for externalizing behaviour disorders was examined, by comparing externalizing scores over time between girls with comorbid externalizing and internalizing disorders and girls with externalizing disorders only. Additionally, internalizing scores over time for girls with comorbid disorders were examined. Results indicated that a history of abuse and a cluster of individual characteristics placed girls at higher risk to present with comorbid conditions. The results also indicated that girls with comorbid disorders experienced a reduction of both externalizing and internalizing symptoms. Only 1 in 7.4 girls, however, scored below the clinical range for both externalizing and internalizing disorders at the end of the treatment phase, in comparison to 1 in 5 girls scoring below the clinical range for externalizing disorders in the noncomorbid group.

Children with co-occurring internalizing and externalizing problems (MIXED children) represent a distinct aggressive subtype with negative outcomes; understanding what works for them in treatment is imperative. The success of MIXED children in some family-based programs for aggression may be attributable to collateral reductions in internalizing symptoms. The current study examined whether reductions in internalizing behaviour in MIXED children were due to reductions in maternal depression and parent-child co-rumination. Co-rumination, a dyadic interaction related to internalizing symptoms, is defined as excessively discussing problems and dwelling on negative feelings. We investigated 154 MIXED children and 49 pure externalizers who underwent Parent Management Training/Cognitive Behavioural Therapy. Mother-child co-rumination was assessed using videotaped observations of problem discussions gathered at pre-treatment, post-treatment and follow-up. We hypothesized that, at pre-treatment, mother-child co-rumination would mediate the relation between maternal depression and child internalizing problems. During treatment, we expected that co-rumination and maternal depression would predict reductions in child symptoms. Finally, we hypothesized that reductions in co-rumination would mediate the association between improvements in maternal depression and improvements in child internalizing which would, in turn, impact externalizing outcomes. Results did not support our pre-treatment and during treatment hypotheses about the role of co-rumination as a mediator. At pre-treatment, maternal depression was associated with child internalizing problems and co-rumination; co-rumination was not associated with internalizing when controlling for maternal depression. Reductions in maternal depression were associated with improvements in child internalizing and, marginally, with child externalizing, thus partially supporting our hypotheses. We also found that reductions in co-rumination impacted child externalizing, but not internalizing behaviour, again partially supporting our hypotheses regarding co-rumination changes and child symptom changes. Finally, results demonstrated that internalizing improvements affected externalizing outcomes, partially supporting our treatment-related hypothesis. Findings have implications for understanding the development and treatment of problems in MIXED children.