research methods-scholarly articles/ Psychology- Depression in youth and teens

novemBer 2013 The Brown UniversiTy Child & AdolesCenT PsyChoPhArmACology UPdATe 3

The pilot study had “obvious weak- nesses” so it cannot disprove studies that do show the effectiveness of NF, the re- searchers write. Some limitations include: 1) small sample size; 2) 59% of patients had learning disabilities, a higher pro- portion than seen in most studies on NF and ADHD; 3) training sessions weren’t frequent enough; 4) collaborating system- atically with teachers and parents to help patients use new skills may have produced better results.

In conclusion the study supported stimulants, but not NF, for treatment of ADHD. Clinical success was reported 7 to 11 months after onset of treatment with stimulants. The explanation for the success of NF in other studies may be due to “patient selection, frequency of sessions, supplementary training in school or home, and explicit use of new skills,” the researchers wrote. “Choosing the best protocol, standard or QEEG-based, is still a matter of controversy.” ▪

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*The authors declared that they had no compet- ing financial interests for this study, which was supported by Ostfold Hospital Trust, Norway, and connected to The Norwegian University of Science and Technology, Trondheim, Norway, Institute of Psychology.

Ogrim G, Hestad KA. Effects of neurofeedback versus stimulant medication in attention-deficit/ hyperactivity disorder: A randomized pilot study. J Child Adolesc Pyschopharmacol 2013 Sep; 23(7):448–457. Epub 2013 Jun 29. E-mail: geir. [email protected].

WHAt’S neW in reSeArcH

Link found between parental verbal disci- pline, teen depression

précis • Almost half of parents use harsh

verbal discipline, such as swearing and humiliation, with their young adolescents.

• Young adolescents who experience harsh verbal discipline from their parents are more likely to report feeling depressed.

• conduct disorders in the young adolescents also predicted harsh verbal discipline in their parents.

• Interventions should include the parent-child dyad.

C hildren who experience harsh ver-bal discipline are more likely to exhibit symptoms of depression at age 14, according to a new study published online in the journal Child Development. Although some research has linked harsh verbal discipline to behavioral and psy- chological maladjustment in children, studies have failed to identify and isolate harsh verbal discipline as a specific disci- plinary tactic, said the researchers. Their study is the first to examine the impact of parental verbal discipline on teen behavior and depression, they said.

Harsh parental verbal discipline is de- fined by researchers as the use of psycho- logical force with the intention of causing a child to experience emotional pain or discomfort for the purposes of correction or control of misbehavior. Harsh verbal discipline can vary in severity, ranging from yelling and shouting at a child to using words to humiliate him or her.

The study noted that in a nation- ally representative survey, approximately 90% of American parents reported one or more instances of harsh verbal discipline toward children of all ages. Strikingly, the rate of severe verbal discipline (e.g., swearing and cursing, calling a name) di- rected at adolescents was 50%, research- ers stated.

Study methodology Two-parent families with children were

recruited through 10 public middle schools in Pennsylvania. The initial sample of ado- lescents in the first wave of data collection included 976 adolescents from the 985 total consenting seventh-graders. At Wave 2 of collection, the sample comprised 873 adolescents of the 976 total participat- ing seventh-graders (90% retention rate). Adolescents and their parents completed questionnaires at both waves.

Adolescents’ depressive symptoms were assessed at ages 13 and 14 based on the 14 items from the Children’s Depres- sion Inventory. Adolescents were presented with 14 sets of three-response choices (in- creasing in symptom frequency) and asked to select the one that best described their feeling during the previous four weeks. Example items were “I am sad,” “I feel like crying,” “I feel like I hate myself,” and “I am worthless.”

Other measures included adolescents’ conduct problems, harsh verbal discipline, mothers’ and fathers’ warmth, and parental psychological risk factors.

Results At child age 13, 45% of mothers and

42% of fathers reported that they had used harsh verbal discipline toward their child in the past year. At age 14, 46% of mothers continued on next page

and 43% of fathers reported using harsh verbal language to discipline their child.

Researchers found that mothers’ and fathers’ harsh verbal discipline at age 13 predicted an increase in adolescent con- duct problems and depressive symptoms between ages 13 and 14. A child effect was also present, with adolescent conduct problems at age 13 predicting increases in mothers’ and fathers’ harsh verbal disci- pline between ages 13 and 14.

Judging from the sample of 976 Ameri- can families with adolescents, researchers noted that harsh verbal discipline remains a common practice. Nearly half of the mothers and fathers reported that they had directed harsh verbal discipline at their ado- lescent children in the past year.

As hypothesized, researchers said they found that mothers reported greater use of harsh verbal discipline than fathers, but there was moderate concordance between mothers’ and fathers’ harsh verbal disci- pline. This consistency in parenting, they stated, may be explained by the fact that individuals who share similar attitudes and values are likely to self-select into relation- ships with one another, and that once in a relationship, parents are likely to influence each other and adopt each other’s disciplin- ary techniques.

According to the study, given that both mothers’ and fathers’ harsh verbal disci- pline is shown to influence problem be- havior in adolescents, it is important that intervention programs target the parental dyad, ensuring that the role fathers play in disciplining their children is not neglected. Increasing efforts in both academic and practical fields to investigate and raise awareness about the negative outcomes associated with this form of discipline will

4 The Brown UniversiTy Child & AdolesCenT PsyChoPhArmACology UPdATe novemBer 2013

benefit parents and children alike, the re- searchers stated. ▪

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Wang MT, Kenny S. Longitudinal links between fathers’ and mothers’ harsh verbal discipline and adolescents’ conduct problems and depressive symp- toms. Child Dev 2013 Sep 3. Epub ahead of print.

One in three teens with BP develops an SUD within four years of initial use

suicide attempts, legal problems, and aca- demic failure, the authors write.

Family cohesiveness mitigates the risk of SUD among youth with BP, which aligns with previous research finding that family conflict is associated with initiation of substance abuse in adolescents, they note. “Prevention of SUD in this popula- tion is a matter of tremendous clinical and public health importance.” They recom- mend strategies such as “assertive treat- ment of adolescents with BP, early iden- tification of substance use via repeated screening beginning in late childhood, family-focused preventive interventions, and motivation-enhancing interventions targeting subthreshold substance use.”

Variables researchers should take into account when studying first-onset SUD among patients with BP are mood symp- toms, inadequate treatment, recreational alcohol use, and familial factors, the re- searchers conclude. “These findings, albeit tentative, further suggest that treatment of psychiatric comorbidity, both internalizing and externalizing, and incorporating family therapy may confer benefits with regard to SUD,” they write. “Mood exacerbations, particularly those of hypo/manic polarity, may comprise an interval of risk for esca- lating substance use, and in such circum- stances increased vigilance for excessive substance use appears warranted.” While experimenting with substances is often viewed as developmentally appropriate, and parents and clinicians are “reluctant to promote abstinence,” this study “may help to resolve ambivalence among some clini- cians, parents, and perhaps adolescents,” they write. Deferring the first onset of substance use could mitigate the risk of a full-blown SUD in patients with BP, they write. “In addition to yielding a greater un- derstanding of why the prevalence of SUD in BP is so high, advances regarding the neurobiological underpinnings of comorbid SUD in BP may identify novel treatment strategies that may ameliorate the substan- tial psychiatric burden experienced by these doubly affected patients.”

In an accompanying editorial, Robert Milin, M.D., wrote that the findings suggest that treatment of BP could help mediate against the development of substance use disorder (SUD). “From the study findings of Goldstein et al., one can arrive at the clinical importance of assessing and moni- toring for likely high-risk factors, such as

the University of Pittsburgh. COBY is a longitudinal study which will continue to follow these adolescents into adulthood. The participants had no substance use dis- order (SUD) at intake, but some had experi- mented with alcohol or drugs.

The COBY study included 400 children and adolescents aged 7 through 17 years 11 months. For this study, only 167 sub- jects aged 12 through 17 years 11 months at intake, who did not have an SUD, and who had at least one follow-up assessment, were used. The researchers determined first-onset SUD based on the first week in which the subject met threshold criteria in DSM-IV for abuse or dependence of alco- hol or drugs. Nicotine dependence was not included as an SUD.

The participants were interviewed about seven times during the course of the four-year follow-up.

Results Overall, 32.3% of the participants

developed an SUD within four years of intake. On average, abuse or dependence developed 2.7 years from the start of the study, at a mean age of 18 years. The most common SUDs were cannabis (16.8% abuse, 5.4% dependence) fol- lowed by alcohol (15.6% abuse, 4.8% dependence). Other drug abuse and de- pendence did not exceed 1.2%.

The strongest predictor of later sub- stance abuse was repeated early alcohol use, followed by use of marijuana. Other predictors were oppositional defiant dis- order, panic disorder, family history of substance abuse, low family cohesiveness, and absence of antidepressant treatment. More than half (54.7%) of teens with three or more risk factors developed substance abuse, compared to 14.1% of teens with two or fewer risk factors.

Adolescents who were taking antiman- ic or antidepressant medications at intake were less likely to develop SUDs. And the adolescents who did develop SUDs were also significantly more likely to have a family history of mania/hypomania, anxi- ety, and SUDs.

Implications While SUDs are a cause for concern in

all patients, it is particularly important to pay attention to them among adolescents with BP, as the combination is associ- ated with more treatment nonadherence,

continued from previous page

précis • One in three teens with bipolar

disorder develop substance abuse or dependence within four years of first trying a drug or alcohol.

• Marijuana was the most frequently abused substance, followed by alcohol.

• Early alcohol use, oppositional defiant disorder, family history of substance abuse, and family discord predicted an SUD.

• Adolescents who were taking antimanic or antidepressant medication at intake were less likely to develop an SUD.

T eens with bipolar disorder (BP) should be followed for substance abuse, because their first substance abuse makes them likely to develop a diagnosable substance use disorder (SUD) in four years, according to an article in the current issue of the Journal of the American Academy of Child & Adolescent Psychiatry. Based on data from the Course and Outcome of Bi- polar Youth (COBY) study, the researchers, led by Benjamin Goldstein, M.D., of the University of Toronto and the University of Pittsburgh, found that 32% of 167 youth ages 12 to 17 developed abuse or depen- dence of alcohol or drugs — mainly, mari- juana — within four years of follow-up. Any so-called recreational use of alcohol or drugs is like “playing with fire” for teens with BP, says Goldstein.

Study details The COBY study, funded by the Na-

tional Institute of Mental Health, enrolls participants at Brown University, the Uni- versity of California at Los Angeles, and

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