This review examines theoretical and empirical literature on children's reactions to three types of violence--child maltreatment, community violence, and interparental violence. In addition to describing internalizing and externalizing problems associated with exposure to violence, this review identifies ways that violence can disrupt typical developmental trajectories through psychobiological effects, post-traumatic stress disorder (PTSD), cognitive consequences, and peer problems. Methodological challenges in this literature include high rates of co-occurrence among types of violence exposure, co-occurrence of violence with other serious life adversities, heterogeneity in the frequency, severity, age of onset, and chronicity of exposure, and difficulties in making causal inferences. A developmental psychopathology perspective focuses attention on how violence may have different effects at different ages and may compromise children's abilities to face normal developmental challenges. Emphasis is placed on the variability of children's reactions to violence, on outcomes that go beyond diagnosable disorders, and on variables that mediate and moderate children's reactions to violence.

Coparenting is examined as an explanatory link between marital conflict and parent-child relations in 2-parent families. Data were collected from 3 samples (pilot sample, n = 220 mothers; preadolescent sample, n = 75 couples; preschool sample, n = 172 couples) by using the Coparenting Questionnaire (G. Margolin, 1992b) to assess parents' perceptions of one another on 3 dimensions--cooperation, triangulation, and conflict. Main effects for child's age and for parents' gender were found for cooperation, and an interaction between parent and child gender was found for triangulation. Regression analyses were consistent with a model of coparenting mediating the relationship between marital conflict and parenting. Discussion addresses the theoretical and clinical importance of viewing coparenting as conceptually separate from other family processes.

In the history of science, technical advances often precede periods of rapid accumulation of knowledge. Within the past three decades, discoveries that enabled the noninvasive measurement of the psychobiology of stress (in saliva) have added new dimensions to the study of health and human development. This widespread enthusiasm has led to somewhat of a renaissance in behavioral science. At the cutting edge, the focus is on testing innovative theoretical models of individual differences in behavior as a function of multilevel biosocial processes in the context of everyday life. Several new studies have generated renewed interest in salivary alpha-amylase (sAA) as a surrogate marker of the autonomic/sympathetic nervous system component of the psychobiology of stress. This article reviews sAA's properties and functions; presents illustrative findings relating sAA to stress and the physiology of stress, behavior, cognitive function, and health; and provides practical information regarding specimen collection and assay. The overarching intent is to accelerate the learning curve such that investigators avoid potential pitfalls associated with integrating this unique salivary analyte into the next generation of biobehavioral research.

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Exposure of youth to violence in their families and communities is a serious societal problem because of the number of youth who experience violence and the documented toll of violence on youth's physical, emotional, and academic adjustment [1]. Approximately 5-16% of youth are recipients of parent's severe aggression or abuse, and over 50% experience minor parental aggression including corporal punishment [2]. Interparental aggression is experienced by 29% of youth in two-parent households [3], whereas community violence is directly experienced by 30-50% and witnessed by over 90% of youth [4].The need for integrated approaches to examining violence exposure arises from mounting evidence that children who experience violence in one domain have an increased likelihood of violence in other domains [5,6,7]. Hundreds of studies examining separate types of violence exposure show wide ranging negative outcomes including aggression and delinquency, emotional and mood disorders, post-traumatic stress symptoms, risk-taking behaviors, and compromised cognitive performance [8]. However, the compartmentalization of literatures on exposure to marital aggression, parent-to-child aggression, and community violence has limited our overall understanding of the impact of violence. The present study integrates these three interpersonal domains of violence exposure in two ways. First, using frequency counts, we examine whether different interpersonal domains of violence exposure are uniquely associated with specific symptoms. Second, we assess the impact of cumulative violence exposure that sums presence vs. absence of violence across domains and years.Direct comparisons linking specific violence exposure types with specific outcomes are relatively rare. In a study of youth receiving mental health services, community violence and maltreatment contributed uniquely to conduct disorders, whereas domestic violence did not, and community violence, but not maltreatment and domestic violence, predicted externalizing behavior [9]. In a sample of youth identified by child protective services, harsh physical discipline was associated with externalizing, whereas witnessing home violence was associated with internalizing behaviors [10]. A school-based study [11] examining school, home and neighborhood violence reported that school and home exposure predicted internalizing symptoms whereas only home exposure predicted delinquency and overt Corresponding Author: Gayla Margolin, Ph.D., University of Southern California, Psychology Department-SGM 930, 3620 McClintock, Los Angeles, CA 90089-1061, Telephone: 213-740-2308.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the con...

Objective Most tests of cognitive behavioral therapy (CBT) for youth anxiety disorders have shown beneficial effects, but these have been efficacy trials with recruited youths treated by researcher-employed therapists. One previous (non-randomized) trial in community clinics found that CBT did not outperform usual care (UC). We used a more stringent effectiveness design to test CBT vs. UC among youths referred to community clinics, with all treatment provided by therapists employed in the clinics. Method RCT methodology was used. Therapists were randomized to (a) training and supervision in the Coping Cat CBT program or (b) UC. Forty-eight (48) youths (56% girls; aged 8–15; 38% Caucasian, 33% Latino, 15% African-American) diagnosed with DSM-IV anxiety disorders were randomized to CBT or UC. Results At the end of treatment more than half the youths no longer met criteria for their primary anxiety disorder, but the groups did not differ significantly on symptom (e.g., parent report η2=.0001; child report η2=.09, both differences favoring UC) or diagnostic outcomes (CBT: 66.7% without primary diagnosis; UC: 73.7%; OR=.71). No differences were found with regard to outcomes of comorbid conditions, treatment duration, or costs. However, youths receiving CBT used fewer additional services than UC youths (χ2(1) = 8.82, p = .006). Conclusions CBT did not produce better clinical outcomes than usual community clinic care. This initial test involved a relatively modest sample size; more research is needed to clarify whether there are conditions under which CBT can produce better clinical outcomes than usual clinical care.

Community clinic therapists were randomized to (a) brief training and supervision in CBT for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), aged 8-15, 33% Caucasian, 26% African-American, and 26% Latino; most youths were from low-income families; all had DSM-IV depressive disorders (plus multiple comorbiditities). All youths were randomized to CBT or UC and treated until normal termination. Session coding showed more use of CBT by CBT therapists, more psychodynamic and family approaches by UC therapists. At Address inquiries to John Weisz, Department of Psychology, Harvard University, William James Hall, 33 Kirkland Street, Cambridge, MA 02138, or via to jweisz@jbcc.harvard.edu. 5 When group variances differed significantly (p < .05) and violated the equal variance assumption of the standard t-test, we used the relatively robust Welch statistic and its associated degrees of freedom (Welch, 1951;Blalock, 1972). Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at http://www.apa.org/journals/ccp/ NIH Public Access Author Manuscript J Consult Clin Psychol. Author manuscript; available in PMC 2010 December 24. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript post-treatment, depression symptom measures were at sub-clinical levels, and 75% of youths had no remaining depressive disorder, but CBT and UC groups did not differ on these outcomes. However, compared to UC, CBT was (a) briefer (24 vs. 39 weeks), (b) superior in parent-rated therapeutic alliance, (c) less likely to require additional services [including all psychotropics combined and depression medication in particular], and (d) less costly. The findings showed advantages for CBT in parent engagement, reduced use of medication and other services, overall cost, and possibly speed of improvement-an hypothesis that warrants testing in future research. Keywordsdepression; children; adolescents; youth; cognitive-behavioral therapy; community clinicAdvocates for evidence-based treatments (EBTs; e.g., National Advisory Mental Health Council Workgroup, 2001; Office of the Surgeon General, 1999General, , 2004 President's New Freedom Commission, 2003) have made a case for transporting these treatments to a broad array of everyday practice contexts. This perspective may make sense, in principle. However, before major resources are devoted to large-scale dissemination, it may be wise to study the implementation process, to learn what steps are needed to transport these treatments effectively.As several researchers have suggested...

The data were consistent with sAA-cortisol asymmetry among maltreated youth. Further research should seek to replicate this finding and investigate its implication for developmental trajectories.