This study tests the hypothesis that therapist responsiveness in the first two sessions of therapy relates to three measures of early patient engagement in treatment. Using videotapes and data from the NIMH Treatment of Depression Collaborative Research Program (TDCRP), an instrument was developed to measure therapist responsiveness in the first two sessions of Cognitive Behavior Therapy and Interpersonal Psychotherapy. A factor measuring positive therapeutic atmosphere, as well as a global item of therapist responsiveness, predicted both the patient's positive perception of the therapeutic relationship after the second session and the patient's remaining in therapy for more than four sessions. A negative therapist behavior factor also predicted early termination. Factors measuring therapist attentiveness and early empathic responding did not predict the engagement variables.

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We assessed the academic performance and behavior of 121 nondisabled elementary boys and 107 boys with attention-deficit hyperactivity disorder (ADHD), ages 7.4 through 14.5 years. Students completed computer-generated tasks of reading, computation, and math problem solving, and we recorded two performance measures (accuracy and speed) and three behavioral measures (vocalizations, head movements, and bottom movements). Our purpose was to determine the effects of ADHD on conceptual and computational math. For greater precision than has been available in past math research, we held reading and problem structure constant, while recording speed of processing, number recognition, and motor response. Our analysis yielded significantly lower problem-solving scores in specific math concepts and slower computational performance for the boys with ADHD. These findings demonstrated the educational implications of attention deficit disorders for mathematical skill and the need for interventions that are geared more specifically to these deficits, and that also provide accommodations for reading complexity and length, visual-motor skill, feedback, and self-pacing.

Residential treatment centers (RTCs) for youth are plagued by high turnover of youth care workers who provide round-the-clock treatment and supervision to youth with severe affective and behavioral problems. This article presents findings from a 15-month ethnographic study of workforce issues in one RTC related to youth care workers' exposure to client violence (CV). Findings are based on 65 semistructured interviews and 490 hours of participant observation with consenting employees. Participants reported CV incidents, including punching, kicking, biting, hair pulling, choking, threats or assaults with a weapon, and other physical and sexualized violence. Workers viewed CV as an inevitable aspect of youth care work that could be reduced-though not eliminated-through proper use of de-escalation and behavior management techniques. Participants reported that exposure to CV sometimes resulted in serious physical injury and/or missed work, as well as substance abuse, anxiety, sleep disturbance, and memory loss. Participants reported that CV was the most difficult part of their jobs and cited it as a reason for leaving or wishing to leave youth care work. We conceptualize youth care workers in RTCs as a vulnerable class whose biopsychosocial well-being must be protected to better serve the vulnerable youth in their care. To that end, we suggest directions for future research on CV in residential treatment and propose measures RTCs can take immediately to better understand and prevent CV in their organizations.