A recent U.S.-based survey (Boyle et al,. 2011) estimated stuttering prevalence in American children ages 3-17 years at 1.6% or 1 in 63 children. In comparison to the reported 1 in 68 school age children living with Autism Spectrum Disorder (Centers for Disease Control and Prevention, 2010), stuttering affects nearly as many. These estimates suggest that Speech-Language Pathologist (SLPs) should increasingly develop their skill sets for identifying and providing interventions for children who stutter. The evidence base for school-age fluency intervention, while promising, leaves much room for further development (Nippold, 2011). The majority of current interventions revolve around the traditional methods of fluency shaping and stuttering management. While these approaches are widely used, there is limited evidence to support their efficacy with the school-aged population (Bothe, et al., 2006). In addition, there is disagreement about whether treatment of stuttering in children should focus exclusively on "building fluent speech" or, whether interventions should also include cognitive/emotional components (Yaruss, Coleman, & Quesal, 2012) as are often associated with interventions for stuttering in adults. As a solution to the need for a cognitive/emotional component, Michael Boyle (2011) suggested including mindfulness in school-aged stuttering intervention by pointing out the similarities between the advantages of mindfulness treatment and personality traits necessary for long-term fluency maintenance. Although there has not yet been any published research in direct support of this idea, the notion that these three elements influence the effects of fluency intervention provides a foundation for the proposed research questions.

This study had three main purposes. First, the relationship between Processing Speed (Gs) and poor word recognition skills was examined. Second, various formats of processing speed tests that measure different types of processing speed (i.e. naming facility, perceptual speed, semantic speed, attention and concentration) were administered to determine what aspects of Gs were more strongly correlated with word reading performance. Pearson correlations and coefficients of determination were used to evaluate the strength of the relationships and the shared variance. Third, the study sample was evaluated to determine what percentage of the poor readers participating in the study had slow processing speed.Forty-four students in grades 1-3, ages six- to ten-years old were administered the Woodcock-Johnson III Achievement reading tests of Letter-Word Identification, Reading Fluency, and Word Attack. The subjects were additionally administered the Woodcock-Johnson III Cognitive Abilities tests of Verbal Comprehension, Visual-Auditory Learning, Sound Blending, Visual Matching, Numbers Reversed, Decision Speed, Rapid Picture Naming, Pair Cancellation, and Cross Out.The results of the study indicated processing speed, as measured by the Gs Cluster score, was strongly correlated with word reading, r = .749, r2=.56. The Gs tests of Visual Matching, (r = .663, r2 = .44) and Decision Speed (r = .811, r2 = .66) were most strongly correlated with poor word reading skill. The Basic Reading Skills Cluster and the Test of Letter-Word Identification were both moderately correlated at various strengths with different formats of Gs tests. Tests of Visual Matching, Rapid Picture Naming, Pair Cancellation and Cross Out all had a moderate, significant correlation.Lastly, 47% of the poor readers (SS<85 on any of the measures of>reading) also had low Gs scores (SS<85).The results from the study demonstrate the need for further exploration of the impact of poor Gs on the development of reading skills, as well as determination of the most effective interventions for poor readers with slow processing speed.

No description available.

<p>Background: Bariatric surgery produces marked weight loss and improvement in comorbid health conditions among individuals with Class II or Class III obesity (Class I = 30.0 &le; BMI &le; 34.9kg/m2; Class II = 35.0 &le; BMI &ge; 39.9kg/m2; Class III = BMI &ge; 40 kg/m2). However, suboptimal weight outcomes occur in a significant minority of patients. Evidence suggests that psychological and behavioral factors might affect weight loss, but most of the literature has focused on preoperative factors, with mixed results. The current study tested the hypothesis that postoperative depressive symptoms, eating behaviors, and lower levels of physical activity would be associated with poorer weight loss outcomes. Method: Preoperative data were obtained from an extant clinical database, and postoperative data were collected via a mail or online questionnaire in a sample of 141 female Roux-en-y gastric bypass (RYGB) patients at an average of 16.80 (SD=2.20) months post-surgery. Self-report measures assessed cognitive-affective and somatic symptoms of depression; binge eating, grazing, night eating, distress about overeating or loss of control over eating; and physical activity. Results: Weight outcome measures were defined as percentage of excess BMI loss (%EBMIL) and successful weight loss (&ge; 50% EBMIL). Higher distress was associated with poorer %EBMIL, and higher level of physical activity was associated with greater %EBMIL. Decreased cognitive-affective symptoms and increased somatic symptoms of depression were associated with a higher probability of successful weight loss. Increased somatic complaints predicted greater %EBMIL unless those symptoms were associated with higher sedentary behavior. Conclusions: Consistent with hypotheses, preoperative depressive symptoms and binge eating disorder did not predict weight loss. Aspects of all three postoperative domains were associated with weight outcomes. Future research should explore the relations among these psychological and behavioral factors and weight loss over a longer follow-up period.</p> / Dissertation

Emotionally Focused Couple Therapy (EFT; Johnson, 2004) is an empirically validated approach to couple therapy that uses attachment theory to understand the needs and emotions of romantic partners. In EFT, relationship distress is conceptualized as resulting from negative affect, emotional disconnection, and unmet attachment needs. Although EFT is recognized as one of the most researched and effective approaches to couple therapy, little research has examined theoretically related characteristics of couples to changes in marital satisfaction throughout EFT. The present doctoral thesis examined this area of literature. Thirty-two couples were provided approximately 21 sessions of EFT. The goal of the first study was to identify intake characteristics related to change in marital satisfaction over the course of EFT. Couples completed self-report measures of marital satisfaction, attachment security, relationship trust, and emotional control at pre- and post-therapy and after each therapy session. Individuals higher on self-report attachment anxiety and higher levels of emotional control had greater change in marital satisfaction over the course of EFT. The goal of the second study was to examine intake levels of attachment security and its relationship to the occurrence of the blamer-softening event, a key change event in EFT, and changes in marital satisfaction. Results indicated that the occurrence of a blamer-softening event significantly predicted positive changes in marital satisfaction. Results also suggested that the occurrence of a softening event significantly moderated the relationship between attachment avoidance at intake and change in marital satisfaction from pre- to post-therapy. For couples who completed a blamer-softening event, partners with lower levels of attachment avoidance were more likely to have positive changes in marital satisfaction. However, this relationship was not evident for attachment anxiety. Overall, results from this thesis suggest that attachment security is a key characteristic of couple partners for therapists to consider when implementing EFT. Therapists may benefit from assessing attachment security at the start of therapy to help inform them of the emotion regulating strategies used by couple partners. This information may help therapists to tailor specific interventions such that couples may begin to develop more secure attachment bonds.

This study examined interpersonal predictors of early therapeutic alliance in a cognitive-behavioral treatment study for adolescents with anxiety and/or depressive disorders. Client, therapist, and observer rated measures of alliance were obtained from the third session of treatment in a sample of twenty-seven adolescents. Results indicate that alliance ratings across the three perspectives are significantly associated with one another, but that pretreatment interpersonal variables were differentially associated with varying informant perspectives. Adolescents’ perceptions of their relationships to their caregivers positively related to their perceptions of the therapeutic alliance, such that adolescents with more positive representations of relationships with their attachment figures were more likely to endorse stronger working alliances early in treatment. Adolescent-reported symptom severity at pretreatment predicted observer ratings of alliance, such that adolescents who indicated greater symptoms at pretreatment were rated as having stronger early alliances with their therapists by independent observers. Adolescent perceptions of social support also predicted observer ratings of alliance. Therapists perceived having weaker alliances with adolescents showing clinically significant depression, as compared to adolescents diagnosed with anxiety disorders alone. Future research is needed to examine whether identification of relevant interpersonal factors can help improve therapeutic engagement and outcomes for the psychosocial treatment of adolescents with anxiety and depressive disorders.

The efficacy of cognitive-behavioural therapy (CBT) in the treatment of child anxiety disorders has been well established in the literature, with on average, just over 50% of children becoming free of their primary anxiety diagnosis immediately following treatment (James et al., 2008). Despite the existence of these efficacious treatments, up to two thirds of children with anxiety do not receive assistance for their difficulties (Essau et al., 2002). The reasons for this are varied, and include lack of available therapists or services, long waiting lists, high therapy costs and stigma associated with therapy. Computer- and internet-based interventions represent a modern alternative for delivering CBT interventions that may be more appealing and accessible to a greater proportion of children with anxiety. Various forms of computer-assisted therapies have been investigated, including palmtop computers, desktop computers, virtual reality and online programs. Although computerised interventions have demonstrated promise in the treatment of adult anxiety, they have only recently received interest in the child literature. Specifically, there are very few controlled trials evaluating the efficacy of computer- and internet-based interventions for childhood psychological disorders, including anxiety disorders. The present research involved the initial development and subsequent testing of an entirely internet-based, CBT intervention for child anxiety disorders. BRAVE-ONLINE was developed as an internet adaptation of The BRAVE Program, a clinic-based program which has demonstrated efficacy in the treatment of childhood anxiety. The online intervention is a therapist-mediated program, in which children and parents receive email and telephone assistance from a therapist throughout treatment. BRAVE-ONLINE is an interactive program consisting of 10 child and 6 parent sessions to be completed by families in their own home. Following the development of BRAVE–ONLINE, the first study of this thesis included a randomised control trial to investigate the efficacy of the internet-based intervention (NET) compared to a waitlist control (WL). Seventy-three children aged between 7 and 12 years, diagnosed with separation anxiety disorder, social phobia, generalised anxiety disorder or specific phobia were randomly allocated to NET and WL conditions. Treatment effects were evaluated at 10-14 weeks post-assessment and 6-month follow-up, using multiple outcome measures including a diagnostic interview, clinician ratings of severity, parent and child questionnaires. Results indicated that at post-assessment, 30% of NET participants in the completer sample (22.5% in the Intent-to-Treat (ITT) sample) no longer met criteria for their primary anxiety diagnosis, compared to 10% of WL participants. Significant gains were also evident for clinician severity ratings, global assessments of functioning, and several questionnaire measures. However, results also indicated that children and parents were slow to progress through therapy, such that a large proportion of families had not completed all treatment sessions at the post-assessment point. For this reason, 6-month follow-up may present a better indication of treatment efficacy. Indeed, at 6-month follow-up, treatment gains were improved upon such that 75% of children in the completer sample (52.5% in the ITT sample) no longer met criteria for their primary anxiety disorder. Reductions in severity ratings, global assessments of functioning and child and parent self-report measures were also improved upon at 6-month follow-up. Further, the online intervention was found to be highly acceptable to families and was associated with only minimal rates of attrition. The second study of this thesis aimed to explore factors associated with treatment outcome for the online intervention. Factors of interest included demographic factors (age, gender, income and educational background), treatment expectancy, initial symptom severity, program compliance and pre-treatment diagnostic comorbidity. Specifically, this study investigated the extent to which each of these factors predicted the improvement made by children on global assessments of functioning (CGAS) at 6-month follow-up. Results indicated that only some of these factors were directly associated with treatment outcome. Although treatment expectancy predicted compliance with the program, it was not associated with treatment outcome. Baseline severity also did not predict treatment outcome. Contrary to expectation, levels of program compliance by children negatively predicted outcome, such that children who were more compliant with the program showed fewer improvements in overall functioning. Parent compliance did not predict treatment outcome. A significant relationship was evident between diagnostic comorbidity (number of pre-treatment anxiety diagnoses) and treatment outcome, such that higher baseline comorbidity predicted poorer functioning on the CGAS at 6-month follow-up. None of the demographic factors were associated with treatment outcome. Overall, the findings of this research suggest that a CBT intervention delivered entirely over the internet was associated with reductions in indicators of anxiety at post-assessment, compared to a WL control, particularly for the completer sample. Further, these reductions were improved upon at 6-month follow-up, with a substantial proportion of children becoming free of their primary anxiety diagnosis. The results also indicated that the online intervention might not be as effective for children suffering from multiple anxiety disorders. The effects of program compliance were somewhat surprising and possible explanations are offered. Although these results are promising, conclusions should be regarded as tentative until further trials are conducted and the online intervention is compared with clinic-based treatments. Limitations of this research and areas for future research are discussed.

The efficacy of cognitive-behavioural therapy (CBT) in the treatment of child anxiety disorders has been well established in the literature, with on average, just over 50% of children becoming free of their primary anxiety diagnosis immediately following treatment (James et al., 2008). Despite the existence of these efficacious treatments, up to two thirds of children with anxiety do not receive assistance for their difficulties (Essau et al., 2002). The reasons for this are varied, and include lack of available therapists or services, long waiting lists, high therapy costs and stigma associated with therapy. Computer- and internet-based interventions represent a modern alternative for delivering CBT interventions that may be more appealing and accessible to a greater proportion of children with anxiety. Various forms of computer-assisted therapies have been investigated, including palmtop computers, desktop computers, virtual reality and online programs. Although computerised interventions have demonstrated promise in the treatment of adult anxiety, they have only recently received interest in the child literature. Specifically, there are very few controlled trials evaluating the efficacy of computer- and internet-based interventions for childhood psychological disorders, including anxiety disorders. The present research involved the initial development and subsequent testing of an entirely internet-based, CBT intervention for child anxiety disorders. BRAVE-ONLINE was developed as an internet adaptation of The BRAVE Program, a clinic-based program which has demonstrated efficacy in the treatment of childhood anxiety. The online intervention is a therapist-mediated program, in which children and parents receive email and telephone assistance from a therapist throughout treatment. BRAVE-ONLINE is an interactive program consisting of 10 child and 6 parent sessions to be completed by families in their own home. Following the development of BRAVE–ONLINE, the first study of this thesis included a randomised control trial to investigate the efficacy of the internet-based intervention (NET) compared to a waitlist control (WL). Seventy-three children aged between 7 and 12 years, diagnosed with separation anxiety disorder, social phobia, generalised anxiety disorder or specific phobia were randomly allocated to NET and WL conditions. Treatment effects were evaluated at 10-14 weeks post-assessment and 6-month follow-up, using multiple outcome measures including a diagnostic interview, clinician ratings of severity, parent and child questionnaires. Results indicated that at post-assessment, 30% of NET participants in the completer sample (22.5% in the Intent-to-Treat (ITT) sample) no longer met criteria for their primary anxiety diagnosis, compared to 10% of WL participants. Significant gains were also evident for clinician severity ratings, global assessments of functioning, and several questionnaire measures. However, results also indicated that children and parents were slow to progress through therapy, such that a large proportion of families had not completed all treatment sessions at the post-assessment point. For this reason, 6-month follow-up may present a better indication of treatment efficacy. Indeed, at 6-month follow-up, treatment gains were improved upon such that 75% of children in the completer sample (52.5% in the ITT sample) no longer met criteria for their primary anxiety disorder. Reductions in severity ratings, global assessments of functioning and child and parent self-report measures were also improved upon at 6-month follow-up. Further, the online intervention was found to be highly acceptable to families and was associated with only minimal rates of attrition. The second study of this thesis aimed to explore factors associated with treatment outcome for the online intervention. Factors of interest included demographic factors (age, gender, income and educational background), treatment expectancy, initial symptom severity, program compliance and pre-treatment diagnostic comorbidity. Specifically, this study investigated the extent to which each of these factors predicted the improvement made by children on global assessments of functioning (CGAS) at 6-month follow-up. Results indicated that only some of these factors were directly associated with treatment outcome. Although treatment expectancy predicted compliance with the program, it was not associated with treatment outcome. Baseline severity also did not predict treatment outcome. Contrary to expectation, levels of program compliance by children negatively predicted outcome, such that children who were more compliant with the program showed fewer improvements in overall functioning. Parent compliance did not predict treatment outcome. A significant relationship was evident between diagnostic comorbidity (number of pre-treatment anxiety diagnoses) and treatment outcome, such that higher baseline comorbidity predicted poorer functioning on the CGAS at 6-month follow-up. None of the demographic factors were associated with treatment outcome. Overall, the findings of this research suggest that a CBT intervention delivered entirely over the internet was associated with reductions in indicators of anxiety at post-assessment, compared to a WL control, particularly for the completer sample. Further, these reductions were improved upon at 6-month follow-up, with a substantial proportion of children becoming free of their primary anxiety diagnosis. The results also indicated that the online intervention might not be as effective for children suffering from multiple anxiety disorders. The effects of program compliance were somewhat surprising and possible explanations are offered. Although these results are promising, conclusions should be regarded as tentative until further trials are conducted and the online intervention is compared with clinic-based treatments. Limitations of this research and areas for future research are discussed.

The present research sought to understand patient experiences during Hyperbaric Oxygen Therapy (HBOT) by using 24 HBOT patients (17 men, 7 women) to examine the relationship between individual variables and anxiety, and providing One Session Exposure Therapy (OSET; Öst, 1989) if necessary. Pre-HBOT participants completed the following measures: State-Trait Anxiety Inventory (STAI; Spielberger, 1983), Claustrophobia Questionnaire (CLQ; Radomsky, Rachman, Thordarson, McIsaac, & Teachman, 2001), Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), and Treatment Credibility/Expectancy Questionnaire (CEQ; Devilly & Borkovec, 2000). State Anxiety was assessed pre-HBOT and at the tenth and last sessions. Findings suggest Dispositional Anxiety (STAI-Trait + ASI), Expectancy of symptom improvement (CEQ), and gender were significantly predictive of State Anxiety before and during HBOT. Limitations and directions for future research are discussed.

Eating behaviors, notably eating behaviors conceptualized as appetitive traits, have been suggested as important determinants of individual differences in body weight and thus overweight and obesity. Such appetitive traits include emotional overeating, food responsiveness, enjoyment of food, satiety responsiveness and slowness in eating. Yet little is known about the factors that influence the development of these appetitive traits. Therefore, the current study prospectively investigated a range of predictors of appetitive traits related to both individual child characteristics and parent factors in a large population-based sample of children followed from age 6 to 8 years (N = 689). When adjusting for the initial levels of the specific appetitive trait in question at age 6 and the other predictors, the results showed that instrumental feeding and low levels of effortful control predicted emotional overeating at age 8, whereas instrumental feeding and parental restrained eating predicted food responsiveness at age 8. Enjoyment of food, satiety responsiveness and slowness in eating were not affected by any of the predictors investigated in this study. In conclusion, these findings support low effortful control and instrumental feeding as predictors of emotional overeating, and instrumental feeding and parental restrained eating as predictors of food responsiveness. These findings are relevant in providing a better understanding of the development of children’s eating behaviors, in addition to informing prevention and treatment strategies for childhood obesity.