Although some treatments for depression in children and adolescents have been found to be efficacious, the effects sizes have tended to be modest. Thus, there is considerable room to improve upon existing depression treatments. Some children may respond poorly because they do not yet have the cognitive, social, or emotional maturity needed to understand and apply the skills being taught in therapy. Therefore, treatments for depression may need to be tailored to match children’s ability to both comprehend and implement the therapeutic techniques. This paper outlines the steps needed for such developmental tailoring: (1) specify the skills being taught in depression treatments; (2) identify what cognitive, social, and emotional developmental abilities are needed to attain these skills; (3) describe the normative developmental course of these skills, and how to determine a child’s developmental level; and (4) use this information to design an individualized treatment plan. Possible approaches to intervening include: alter the therapy to meet the child’s level of development, train the child on the skills needed to engage in the therapy, or apply a dynamic assessment approach that integrates evaluation into treatment and measures children’s potential as well as their current abilities.
BACKGROUND AND OBJECTIVES: Systems of care emphasize parent-delivered intervention for children with autism spectrum disorder (ASD). Meanwhile, multiple studies document psychological distress within these parents. This pilot longitudinal randomized controlled trial compared the parent-implemented Early Start Denver Model (P-ESDM) to P-ESDM plus mindfulnessbased stress reduction (MBSR) for parents. We evaluated changes in parent functioning during active treatment and at follow-up.METHODS: Participants included children (,36 months old) with autism spectrum disorder and caregivers. Participants were randomly assigned to P-ESDM only (n = 31) or P-ESDM plus MBSR (n = 30). Data were collected at baseline, midtreatment, the end of treatment, and 1, 3, and 6 months posttreatment. Multilevel models with discontinuous slopes were used to test for group differences in outcome changes over time. RESULTS: Both groups improved during active treatment in all subdomains of parent stress (b = 21.42, 21.25, 20.92; P , 0.001), depressive symptoms, and anxiety symptoms (b = 20.62 and 20.78, respectively; P , 0.05). Parents who received MBSR had greater improvements than those receiving P-ESDM only in parental distress and parent-child dysfunctional interactions (b = 21.91 and 21.38, respectively; P , 0.01). Groups differed in change in mindfulness during treatment (b = 3.15; P , .05), with P-ESDM plus MBSR increasing and P-ESDM declining. Treatment group did not significantly predict change in depressive symptoms, anxiety symptoms, or life satisfaction. Differences emerged on the basis of parent sex, child age, and child behavior problems.CONCLUSIONS: Results suggest that manualized, low-intensity stress-reduction strategies may have long-term impacts on parent stress. Limitations and future directions are described.WHAT'S KNOWN ON THIS SUBJECT: Parents play an integral role in early intervention for young children with autism spectrum disorder. They also report high levels of stress and psychopathology. Training in mindfulness practice may help parents of older children with autism spectrum disorder.WHAT THIS STUDY ADDS: This pilot randomized controlled trial compares the functioning of parents who participated in child-focused, parent-mediated behavioral intervention alone to that of parents who also received stress-reduction training.
Long waits for diagnostic assessment prevent early identification of children suspected of having autism spectrum disorder. We evaluated the benefit of embedded diagnostic consultation within primary care clinics. Using a streamlined diagnostic model, 119 children with concerns for autism spectrum disorder were seen over 14 months. Diagnostic clarity was determined through streamlined assessment for 59% of the children, while others required follow-up. Latency from first concern to diagnosis was 55 days and median age at diagnosis was 32 months: considerably lower than national averages or comparable tertiary clinics. Findings support that embedded processes for effective triage and diagnosis within the medical home is a viable mechanism for efficient access to diagnostic services and assists in bypassing a common barrier to specialized services.
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