Faculty Bibliography

Anxiety disorders are common among children but can be difficult to diagnose. An actuarial approach to the diagnosis of anxiety may improve the efficiency and accuracy of the process. The objectives of this study were to determine the clinical utility of the Achenbach Child Behavior Checklist (CBCL) and Youth Self Report (YSR), two widely used assessment tools, for diagnosing anxiety disorders in youth and to aid clinicians in incorporating scale scores into an actuarial approach to diagnosis through a clinical vignette. Demographically diverse youth, 5 to 18 years of age, were drawn from two samples; one (N = 1,084) was recruited from a research center, and the second (N = 651) was recruited from an urban community mental health center. Consensus diagnoses integrated information from semistructured interview, family history, treatment history, and clinical judgment. The CBCL and YSR internalizing problems T scores discriminated cases with any anxiety disorder or with generalized anxiety disorder from all other diagnoses in both samples (ps < .0005); the two scales had equivalent discriminative validity (ps > .05 for tests of difference). No other scales, nor any combination of scales, significantly improved on the performance of the Internalizing scale. In the highest risk group, Internalizing scores greater than 69 (CBCL) or greater than 63 (YSR) resulted in a Diagnostic Likelihood Ratio of 1.5; low scores reduced the likelihood of anxiety disorders by a factor of 4. Combined with other risk factor information in an actuarial approach to assessment and diagnosis, the CBCL and YSR Internalizing scales provide valuable information about whether a youth is likely suffering from an anxiety disorder.

This editorial presents an overview of the two books discussed in the issue Journal of the American Academy of Child & Adolescent Psychiatry. The first book is about fighting stigma that argues against several myths. It is important to keep debates around stigma alive and to investigate the myths and realities of stigma, rather than just assuming that stigma is an all-powerful force, that we are necessarily bound to our patients with a shared stigma, or that it explains more than it really does. The second book examines treatment for a behavior that has been imbued with all the hallmarks of stigma, including shame and secrecy.

This article provides an overview of the books featured in the present issue of Journal of the American Academy of Child & Adolescent Psychiatry book forum section. The books encounter some of the challenges that come with moving a unique identity into a diagnostic construct. Feng Liu reviews a book about evaluating and assessing autism spectrum disorders (ASD), which is how we as professional caregivers move individuals into a group. Janella Hong takes us in a different direction, looking at a book that explores identity from within a group whose members often found meaning by being part of that group; this particular book quickly became significantly dated, not because the experiences it describes belong to a different era, but because formally, in certain circles, that group vanished and became part of another group. Finally, Aaron Roberto reviews a novel about an adolescent with ASD who works "in the real world, " imaginative literature with a poignant message about how a child with an ASD might find it difficult to become the next Tommy Hilfiger. Three books, 3 genres, all of which explore the relationship of the individual to the group.

This editorial briefs the articles featured in section "Book Forum" of this issue of Journal of the American Academy of Child & Adolescent Psychiatry. One of the books is about trichotillomania, skin picking, and other body focused repetitive disorders with a wonderfully vivid image of professional life as a type of constant repetitious act, always in (comic) motion. The other one is about medications: specifically, a book about adverse effects. The list of potential adverse effects grows with every new case report, letter to the editor, or revelation that a drug that was not supposed to cause a particular side effect actually does.

Reviews the book, Reading Anna Freud by Nick Midgley (see record 2012-32286-000). Reading Anna Freud is less a work of criticism than a work of orientation, and doubly valuable as such. First, because of the Freud family fame, one sometimes presumes one knows more about them than one really does (indeed, a misplaced presumption of familiarity is at the core of so much of the popular contempt hurled Sigmund's way). Second, orienting yourself to Anna Freud is a way of orienting yourself to child mental health: from how we speak to children and the role of schools in a child's psychological health to developmental psychopathology and the consultation-liaison service. What comes through in Reading Anna Freud is that the core of Freud's success was not just patient, compassionate intellectualism, genes, or an ability to get published, but advocacy. Moreover, you do not need a degree or an internal review board to be an advocate. In fact, it is in this regard that she is most inspiring. Although the book provides a historical and personal orientation, it is intended as an orientation to Freud's intellectual contributions, and Midgely does an excellent job translating her work, some of it nearly a century old, into a language that is still alive, relevant, and enriching.

In this qualitative study the authors examine factors associated with the successful implementation and plans for continued use of an evidence-informed intervention, the 4Rs and 2Ss Program for Strengthening Families, in a sample of 29 New York State, Office of Mental Health licensed child mental health clinics. A learning collaborative (LC) approach was used as a vehicle for supporting training and implementation of the program. The PRISM theoretical framework ( Feldstein & Glasgow, 2008 ) was used to guide the data analysis. Data were analyzed using a multi-phase iterative process, identifying influences on implementation at multiple levels: the program (intervention), the external environment, implementation and sustainability infrastructure, and recipient characteristics. Clinics that were more proactive evidenced staff with advanced organizational skills were able to take advantage of the trainings and supports offered by the LC and fared better in their ability to adopt the intervention. The ability to adapt the intervention to the specific constraints of the clinics was a strong influence on continued use following the end of the LC. These preliminary results suggest that the supports provided by the LC are useful in consolidating information about the process of implementing evidence-informed interventions in community mental health settings. The impact of these supports is also based on their interactions with specific clinic contextual factors.

The aim of this study was to examine the information acquisition strategies of expert and competent non-expert intensive care physicians during two simulated diagnostic scenarios involving respiratory distress in an infant. Specifically, the information acquisition performance of six experts and 12 competent non-experts was examined using an eye-tracker during the initial 90 s of the assessment of the patient. The results indicated that, in comparison to competent non-experts, experts recorded longer mean fixations, irrespective of the scenario. When the dwell times were examined against specific areas of interest, the results revealed that competent non-experts recorded greater overall dwell times on the nurse, where experts recorded relatively greater dwell times on the head and face of the manikin. In the context of the scenarios, experts recorded differential dwell times, spending relatively more time on the head and face during the seizure scenario than during the coughing scenario. The differences evident between experts and competent non-experts were interpreted as evidence of the relative availability of task-specific cues or heuristics in memory that might direct the process of information acquisition amongst expert physicians. The implications are discussed for the training and assessment of diagnostic skills.

We propose a new way to describe affordances for action. Previous characterizations of affordances treat action possibilities as binary categories-either possible or impossible-separated by a critical point. Here, we show that affordances are probabilistic functions, thus accounting for variability in motor performance. By measuring an affordance function, researchers can describe the likelihood of success for every unit of the environment. We demonstrate how to fit an affordance function to performance data using established psychophysical procedures and illustrate how the threshold and variability parameters describe different possibilities for action. Finally, we discuss the implications of probabilistic affordances for development, perception, and decision-making.

This article reviews the progression of a research program designed to develop, implement, and study the implementation of "achievable" evidence-based practices (EBPs) in schools. We review challenges encountered and ideas to overcome them to enhance this avenue of research. The article presents two federally funded randomized controlled trials involving comparison of a four-component targeted intervention (Quality Assessment and Improvement, Family Engagement and Empowerment, Modular Evidence-Based Practice, Implementation Support) versus a comparison intervention focused on personal wellness. In both studies, primary aims focused on changes in clinician attitudes and behavior, including the delivery of high-quality EBPs and secondary aims focused on student-level impacts. A number of challenges, many not reported in the literature, are reviewed, and ideas for overcoming them are presented. Given the reality that the majority of youth mental health services are delivered in schools and the potential of school mental health services to provide a continuum of mental health care from promotion to intervention, it is critical that the field consider and address the logistical and methodological challenges associated with implementing and studying EBP implementation by clinicians.

The Patient Protection and Affordable Care Act of 2010 (ACA) is revamping the access, quality, and financing of the health and mental health systems. However, its impact on training and education in clinical psychology is unclear. This article aims to identify specific components of the ACA, in particular the Mental and Behavioral Health Education and Training Grants, that are expected to affect training and education in the field. The article further connects the ACA with four paradigm shifts in clinical psychology that have broad implications for training and educationevidence-based practices, research methodology, interprofessionalism, and the quality indicator movement. The overarching goal of this article is to begin timely discussions on the future directions of the field under the current healthcare reform.