Common Behavioral Problems Research Articles

Sleep Habits and Behavioral Problems in Preschool-aged Children with ADHD

Objective: This study aimed to investigate the relationship between sleep habits and behavioral problems in preschool-aged children with ADHD. Materials and Methods: A cross-sectional study was conducted in a child developmental clinic at Siriraj Hospital between October and December 2023. Parents of children aged 4-6 years with ADHD completed the Children’s Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ). Descriptive analysis, Pearson correlation, and multivariate linear regression analysis were used to examine the association between sleep habits and behavioral problems. Results: This study recruited 80 preschoolers with ADHD and 75% were boys. The mean total CSHQ score was 43.76 ± 7.38 and 40% of the participants had sleep problems. 31.3 % had clinically significant behavioral problems. The most common behavioral problems were hyperactivity (33.8%), emotional problems (16.3%), and conduct behavior (10%). More sleep disturbances were highly correlated with all behavioral problems in SDQ, with a Pearson correlation between 0.78 and 0.90. After multivariate regression analysis, the total CSHQ score remained the strongest predictor of all domains of behavioral problems in preschool-aged children with ADHD (p < 0.05). Conclusion: More than 1/3 of preschool children with ADHD were affected by sleep disturbances. Furthermore, sleep problems in these children can contribute to significant behavioral problems. Therefore, the treatment of ADHD in preschoolers should always include the management of sleep disturbances.

Reciprocal effect between non-suicidal self-injury and depressive symptoms in adolescence.

Non-suicidal self-injury (NSSI) is a common psychological and behavioral problem among adolescents. The COVID-19 pandemic has had a significant impact on people's mental health. To date, few studies have documented the temporal changes in adolescents' psychological status during the pandemic, as well as the impact of large-scale public health intervention strategies. This study contributes to the existing evidence on the subject. Participants were 6,023 adolescents aged 10 years and older, with data from two waves of longitudinal surveys, including data for a 7-month interval before and during the pandemic. A cross-lagged model was used to test the bidirectional relationship between NSSI and depressive symptoms in adolescents; logistic regression analysis was used to explore the predictors of NSSI implementation in adolescents with depressive symptoms. In this study, 32.69% participants reported depressive symptoms at baseline and 34.27% at follow-up; 44.34% participants with depressive symptoms reported NSSI at baseline and 53.44% at follow-up. The duration of the online class, depressed affect, and somatic and related activity were the risk factors for NSSI; sleep duration and positive mood were the protective factors. The lag effect of depression symptoms on NSSI is significant, and so is NSSI on depressive symptoms. During the COVID-19 pandemic, adolescents' mental health has worsened, resulting in an increase in the prevalence of NSSI among those with depressive symptoms compared to pre-pandemic levels. Early screening for depression is crucial in preventing or decreasing NSSI in adolescents.

THE NEEDS OF FAMILY CAREGIVERS OF PERSONS LIVING WITH DEMENTIA CARED FOR IN PRIMARY CARE PRACTICES

Abstract Background The proportion of persons living with dementia (PLWD) in the US is projected to increase; the majority will be cared for by family caregivers and primary care providers. Purpose: At baseline for intervention studies to support primary care practices caring for persons with dementia, we assessed caregiver self-efficacy to inform our interventions. Methods We conducted a survey of 143 caregivers of persons living with dementia receiving care from 34 primary care practices in a Medicare ACO. The survey was conducted by postal mail and telephone in English and Spanish and used 9-item caregiver self-efficacy scale.4 , analyzing variation by caregiver relationship and location. Results A majority of 143 respondents were female (70%), White Non-Hispanic (80.4%) and lived with person with dementia (65.7%). Caregivers agreed that their doctors understand how memory or behavioral problems complicate health (85.3%) and least likely to agree that they had a health professional who helped them work through dementia care problems (39.2%). Only 45% agreed that they received advice on what problems to expect in the future related to Alzheimer’s or dementia. Caregivers who lived with the care recipient were significantly less likely than those who did not to report getting advice about common behavioral problems (43.6% vs. 68.6%, P = .005) and how to access community services (63.8% vs. 81.3%, P = .03). Discussion System innovations to support caregivers should tailor information to help caregivers of and PLWD to prepare for course of illness including treatment and management of behavioral symptoms of dementia.

Physicians' beliefs and perceived importance of traumatic brain injury-associated agitation in critically ill patients: a survey of Canadian intensivists.

Agitation is a common behavioural problem following traumatic brain injury (TBI). Intensive care unit (ICU) physicians' perspectives regarding TBI-associated agitation are unknown. Our objective was to describe physicians' beliefs and perceived importance of TBI-associated agitation in critically ill patients. Following current standard guidance, we built an electronic, self-administrated, 42-item survey, pretested it for reliability and validity, and distributed it to 219 physicians working in 18 ICU level-1 trauma centres in Canada. We report the results using descriptive statistics. The overall response rate was 93/219 (42%), and 76/93 (82%) respondents completed the full survey. Most respondents were men with ten or more years of experience. Respondents believed that pre-existing dementia (90%) and regular recreational drug use (86%) are risk factors for agitation. Concerning management, 91% believed that the use of physical restraints could worsen agitation, 90% believed that having family at the bedside reduces agitation, and 72% believed that alpha-2 adrenergic agonists are efficacious for managing TBI agitation. Variability was observed in beliefs on epidemiology, sex, gender, age, socioeconomic status, and other pharmacologic options. Respondents considered TBI agitation frequent enough to justify the implementation of management protocols (87%), perceived the current level of clinical evidence on TBI agitation management to be insufficient (84%), and expressed concerns about acute and long-term detrimental outcomes and burden to patients, health care professionals, and relatives (85%). Traumatic brain injury-associated agitation in critically ill patients was perceived as an important issue for most ICU physicians. Physicians agreed on multiple approaches to manage TBI-associated agitation although agreement on epidemiology and risk factors was variable.

Challenges with phenotyping dementia in a low resource setting; Frontotemporal dementias (FTDs) as a case study in Nigeria

AbstractBackgroundPhenotyping dementia is a major problem in low resource settings like Nigeria and it has implication for research and management of people with dementia. Challenges associated with phenotyping dementia are embedded in poor health financing and lack of health personnel. This study aimed at scoping studies on dementia in Nigeria to identify those related to frontotemporal dementia (FTD) and describe the pattern of its presentation in a memory clinic as a means of highlighting challenges of phenotyping.MethodA literature search of studies on dementia that reported FTDs as a phenotype and or described profile or pattern of FTDs in Nigeria was conducted. In addition, a review of hospital records of all persons clinically diagnosed with dementia (PWD) using the ICD 10 criteria was conducted. Those with FTD phenotypes were identified. The cohort comes from a memory clinic in University College Hospital, Ibadan, Nigeria. Records of these individuals with FTDs were reviewed and data (including sociodemographic details, clinical profile and pattern of presentation) extracted for case series report.ResultsLiterature search yielded 2 studies; a retrospective study that reported dementia phenotypes including FTD and a case report. From a total of 216 PWD, we identified and included 14 persons with FTDs (6.5%) in this case series. Initially, 32 records of tentative diagnosis of FTD were identified, however, 18 persons with incomplete evaluation after the initial assessment were excluded. The mean age (±S.D) of those included (n = 14) is 67.7(±8.4). The main presenting complaints were behavioral with 57.1% presenting to the hospital at least a year after onset of symptoms. The most common behavioral problem identified was personality change accompanied with disinhibition in 9 persons (64.3%). Symptoms started before age 60 years in only one person. Two of the 14 persons had an initial diagnosis of schizophrenia until subsequent review with neuroimaging. Delay in carrying out neuroimaging due to financial constraint was a major challenge in making a diagnosis.ConclusionThere is paucity of data on FTDs in Nigeria. Out‐of‐pocket payment for assessment is a major setback in phenotyping dementia and it has implication on both clinical practice and research.

Therapy and Prevention of Noise Fears in Dogs—A Review of the Current Evidence for Practitioners

Noise fears represent the most common behavioural problem in dogs. This manuscript provides an overview of diverse approaches for alleviating fear of noises in dogs and the supporting evidence. In the treatment of noise fears, both short-term solutions to prevent trauma or the deterioration of fear during unavoidable noise events and longer-term training need to be considered. Environmental management, the provision of incentives (food/play) during noise exposure, and, when indicated, anxiolytic medication, can safeguard dogs’ welfare during noise events. Most “alternative” products (such as nutraceuticals, herbal remedies, pheromones, homeopathy, Bach flowers, and essential oils) are unlikely to be sufficient as monotherapy for noise fears, whereas there is good evidence for the efficacy of several anxiolytic medications. In the longer term, counterconditioning to real-life noises, relaxation training, and desensitisation/counterconditioning using noise recordings have been shown to improve fear of noises in dogs. Preventative training appears to be highly effective in preventing the development of noise fears in puppies and adult dogs.

Management of Gadget Addiction Through Ayurveda in Pediatric Patient: A Single Case Study

11-year-old male patient brought by relatives in Kaumarbhritya OPD with complaints of spending excessive time on smartphones andcomputers with changes in the patient's behavior since 1 year. Relatives counseled the patient, but he didn't change his behavior. Previous Doctorsadvised Cognitive behavioral therapy, but that facility was not available at their place, and the parents could not afford it. Hence they came toAyurveda Hospital. The patient is assessed using the Internet addiction test scale and DSM-V scale for social behavior. The patient is diagnosed as acase of Gadget addiction (internet addiction) with abnormal social behavior. After proper physical examinations, the patient is counseled inexplaining the hazardous effects of excessive use of gadgets; along with this, he is advised daily Suryanamskara, &Dhyana(meditation) as a Yogaintervention. The patient was advised to play outdoor games daily, and his gadgets using time were reduced by systematic order. Parents wereadvised to be patient in family functions and social meetings & to spend time with children. All the training regarding intervention is given in PPTformat to the patient. The patient was asked to perform Suryanamaskara on follow-up days. On the 91st day, the patient was reassessed using theInternet addiction test scale and DSM-V scale for social behavior, which were normal. Gadget addiction is a common behavioral problem inchildren. Online gaming, gambling, excessive web browsing, and social media use are all included under the umbrella term "gadget addiction.". Evenif there is treatment for gadget addiction, people in remote areas may find it inconvenient due to a lack of infrastructure and specialized pediatricpsychologists. Hence, finding an effective and convenient treatment for Gadget addiction is necessary. This study aims to assess the efficacy ofAyurvedic management in Gadget addiction based on Ayurveda Non-pharmacological intervention. Any addiction results from bad decision-makingcapacity and less control over the mind. The intervention in this study, like Yoga, satvavajaya, proves beneficial to the patient.

A Literature Review of Digital Behavioral Parent Training Programs for Parents of Adolescents.

Parents of adolescents are faced with a variety of challenges related to their children's behavior and development. Behavioral parent training (BPT) programs may be effective strategies to mitigate adverse childhood experiences (ACEs) and other common behavioral problems in the adolescent period. Adolescence is the period following the onset of puberty and describes the transition from childhood to adulthood. Digital BPTs, including those delivered via the internet, downloaded digital content, text message, tablet, and video call, may present a unique opportunity to reach a broad audience of parents of adolescents by removing barriers to program accessibility (e.g., cost and transportation). We conducted a literature review to synthesize the existing evidence on digital BPTs for parents of adolescents. We described the digital BPTs, study designs, and evaluation and feasibility outcomes. A structured literature search identified studies meeting the following criteria for inclusion: (a) published between January 2000 and October 2022, (b) peer-reviewed, (c) available in English language, (d) study included a description of a digital BPT methodological approach, (e) study had to identify at least one parent or child behavioral outcome (e.g., parent-reported communication with their child) or feasibility outcome associated with the digital BPT, and (f) study included parents of adolescents aged 10-18years. We extracted data on the characteristics of the study and demographic characteristics of participants, digital BPT, and evaluation and feasibility outcomes. Twenty-eight studies met inclusion criteria. Twenty-two unique digital BPTs were evaluated across the published studies. Thirteen digital BPTs (59.1%) were developed from or grounded by an identified theory. Six digital BPTs were freely accessible by the public, while the remaining 16 were available through study participation or purchase. One digital BPT was specifically tailored to parents of adolescents of a racial/ethnic minority group. Of the 16 studies that reported either parent or adolescent race/ethnicity, 10 consisted of more than 50% White parent or adolescent participants. Twenty-four (88.9%) studies provided evaluation data for the digital BPT. Fourteen studies (63.6%) employed a randomized control trial study design, and the remaining study designs included quasi-experimental (n = 2), mixed methods (n = 1), open trial (n = 3), case study (n = 1), pretest-posttest design (n = 1), and feasibility and acceptability trial (n = 2). All studies reported improvements in at least one parent-reported or adolescent-reported behavioral outcome or feasibility outcomes, with effect sizes (Cohen's d) ranging from small (e.g., 0.20-0.49) to very large (e.g., > 1.20). The findings of this review illustrate that technology may be a valuable way to deliver BPTs to parents of adolescents. However, few digital BPTs were developed for parents of adolescents from racial/ethnic minority groups, and many digital BPTs were not available without cost or participation in a research study. Considerations for future research are discussed.

Creating a reference range of common problem behaviors and replacement behaviors in neurotypical children

AbstractThere are limited resources outlining age‐referenced rates of problem behavior displayed by neurotypical children. Such information is important for practitioners as a basis for social comparison when they are targeting behavior reduction goals for neurodivergent clients. We distributed a survey to parents of children aged 1–10 years without a developmental diagnosis in which parents reported frequency of five problem behaviors across a 24‐h period, as well as commonly targeted replacement behaviors. Problem behavior was reported across all age groups to varying degrees based on topography and age. Replacement behaviors, such as waiting and tolerating denials generally improved as children increased in age but still largely remained below 80% of opportunities. The present study may serve as a reference for researchers and clinicians to set goals that are developmentally appropriate.

Tantrums in Early Childhood Due to Permissive Parenting

Tantrums are a common behavioural problem experienced by young children, which can result from various factors, including permissive parenting practices. This qualitative case study aims to explore the forms of tantrums displayed by 6-year-old children, identify the factors contributing to these tantrums, and examine the efforts made by parents with permissive parenting styles to manage their children's tantrums. The research design involves descriptive qualitative methods, utilizing observation, interviews, and documentation techniques for data collection. Data triangulation is applied to ensure the reliability and validity of the findings. The study reveals that tantrums exhibited by the children in the study include crying, hitting, kicking, screaming, and more. The factors leading to tantrums encompass unfulfilled desires, reprimands, neglect, and teasing. The parents' response to these tantrums involves always fulfilling the child's wishes, even when aggressive behaviour is displayed. Furthermore, parents refrain from providing clear explanations to correct negative behaviour. Sometimes, parents let the child continue their tantrum until it subsides without intervening. These findings highlight the presence and consequences of permissive parenting practices on children's emotional development and behavioural patterns.

The use of a picture activity schedule for vocal stereotypy reduction in a child with autism

Children with ASD exhibit auto-stimulatory behaviour of different types, with the most common behavioural problem being auto-stimulatory stereotyped behaviour. It is believed that vocal auto-stimulatory behaviour occurs because the individuals with ASD do not receive sufficient stimulation from their environment and therefore have the need to stimulate themselves by emitting vocal stereotypy of different form and magnitude. The participant is a 10-year-old boy diagnosed with ASD. The intervention used was a picture activity schedule. Results showed an immediate decrease in self-stimulatory behaviour upon implementation of the intervention, with a 100% success rate. There is insufficient research on the implementation of picture activity schedules in order to reduce self-stimulatory behaviour in children with ASD. The present study shows that picture activity schedules can be used in certain situations where it is inappropriate to exhibit self-stimulating behaviour. It is not certain if the picture activity schedule functioned as a prompt for the participant to actively engage in his spare time, or if it functioned as a discriminative stimulus for situations when the problem behaviour is inappropriate. The social validity of the intervention was discussed, as well as suggestions for future research implementation.

Homoeopathy for Reducing Disruptive Behavioural Symptoms in Children with Conduct Disorder-

Background: Conduct disorder (CD) and associated antisocial behaviour is one of the most common behavioural problems in children and young people that lead to considerable burden for the patients themselves, their family and society. There is scarcity of literature for effectiveness of homoeopathic medicines in childhood psychiatric disorders such as CD.
 Summary of cases: 10 children diagnosed as CD, five each from Child psychiatry OPD and Peripheral camp at a Children’s home were treated with individualized homoeopathic medicines. All the cases were assessed at baseline and successive visits with Conduct Disorder Rating Scale (CDRS)- Parent version and the results are summarized. There was a marked reduction of disruptive behaviour and improvement in the general condition of the children.
 Conclusion: The analysis of 10 cases generates a preliminary evidence for usefulness of individualized homoeopathic medicines in the management of CDs. Studies with appropriate designs are indispensable to corroborate the evidence.

Childhood trauma, peer victimization, and non-suicidal self-injury among Chinese adolescents: a latent variable mediation analysis

BackgroundChildhood and peer experiences can influence adolescents’ perceptions of interpersonal relationships, which can, in turn, influence their emotional states and behavior patterns. Non-suicidal self-injury (NSSI) is now a common problem behavior among adolescents. The present study examined the role of childhood trauma and peer victimization in adolescents’ NSSI.MethodsA cross-sectional survey was conducted among 1783 adolescents (1464 girls and 318 boys) in the psychiatric outpatient clinics or wards of 14 psychiatric hospitals or general hospitals in nine provinces in China. Data were collected using the Multidimensional Peer Victimization Scale (MPVS), Short-form Childhood Trauma Questionnaire(CTQ-SF), and Functional Assessment of Self-Mutilation (FASM). Structural equation modeling (SEM) with latent variables was used to demonstrate the mediating role of peer victimization in the association between childhoodtrauma and NSSI.ResultsThe SEM analysis demonstrated that peer victimization plays a partial mediating role in the relationship between childhood trauma and NSSI. In addition, several covariates (such as age, gender, education level, and place of residence) effectively regulated the relationship between peer victimization and NSSI.ConclusionIn future studies of NSSI among Chinese adolescents, attention should be paid to the roles of childhood trauma and peer bullying; there is a temporal sequence between these two variables and, to some extent, childhood trauma can have an impact on bullying during adolescence which, in turn, influences NSSI behavior.

Effect modification of an effective transdiagnostic cognitive behavioral psychotherapy in youths with common mental health problems: Secondary analyses of the randomized mind-my-mind trial

Mind My Mind (MMM) cognitive behavioral therapy (CBT) manualized treatment is effective in the management of common emotional and behavioral mental health problems in youth, yet not all individuals respond satisfactorily to treatment. This study explored potential effect modifiers, i.e., baseline factors associated with a differential treatment effect. We conducted secondary effect modifier analyses with MMM trial data, which involved randomization of 396 youths aged 6–16 years to either MMM CBT treatment (9–13 sessions) or management as usual in local community settings. We examined sociodemographic- (sex, age, family composition, ethnicity, parental education, and income) and clinical variables (mental disorders and duration of mental health problems) as potential effect modifiers of the a) change in parent-rated impact of mental health problems measured by the Strengths and Difficulties Questionnaire (SDQ) or b) response (reduction of ≥1 on SDQ-impact). In intention-to-treat analyses, superior treatment (net) benefits from the MMM intervention were found among youths who met criteria for any mental disorder at baseline (-1.25 [95%CI: -1.67;-0.82]) compared to youths that did not meet diagnostic criteria (-0.22 [95%CI:-1.09;0.65]). Comorbidity vs no comorbidity (-1.84 [95%CI:-2.58;-1.10] vs -0.72 [95%CI:-1.15;-0.29]) and longer duration of untreated mental health problems, i.e., more vs less than 6 months (-1.16 [95%CI:-1.55;-0.78] vs 0.43 [95%CI:-1.01;1.86]) were also associated with superior treatment benefits. The sociodemographic factors were not associated with differential treatment effects in the intention-to-treat analyses. These findings suggest that community-based programs like the MMM are well-suited for youths with substantial mental health problems. Clinical Trials Identifier: NCT03535805

Do psychotic experiences act as effect modifiers in youths with common mental health problems allocated to transdiagnostic cognitive behavioural therapy versus management as usual? Secondary analyses of the Mind-My-Mind randomized trial.

Psychotic experiences (PEs) are common in help-seeking youths with non-psychotic mental health problems, yet the clinical importance of PEs as potential effect modifiers of psychotherapy interventions has been scarcely examined. We examined if PEs were associated with a differential response to transdiagnostic cognitive behavioural therapy (CBT) aimed at common emotional and behavioural problems. We present secondary analyses from the Mind My Mind (MMM) trial that randomized 396, 6-16-year-old youths to either 9-13 sessions of transdiagnostic modular community-based CBT (MMM) or community-based management as usual (MAU). MMM was superior to MAU in reducing parent-reported impact of mental health problems according to the Strengths and Difficulties Questionnaire (SDQ). PEs were assessed by semi-structured screening interviews at baseline. The contrast between subgroups (presence/absence of PEs) was calculated to test if PEs are potential effect modifiers regarding the change in parent-reported SDQ-impact (primary outcome, rated 0[low]-10[high]) and other SDQ-related outcomes. Baseline PEs were present in 74 (19%) of youths. The superior effect of MMM on changes in SDQ-impact from baseline to week 18 was not effect modified by the presence of PEs (PEs[yes] -0.89 [95%CI -1.77;-0.01] vs. PEs[no] -1.10 [95%CI -1.52;-0.68], p-value for interaction .68). For secondary outcomes similar patterns were observed. Limitations Statistical power was limited to show if PEs modified treatment response. Replication and meta-analytic evidence are needed. The beneficial effects of MMM transdiagnostic CBT did not differ by PE-status, indicating that youths with emotional and behavioural problems could be offered such psychotherapy irrespective of co-occurring PEs.

Integration of Common Elements Treatment Approach (CETA) into public sector HIV clinics for unhealthy alcohol use in urban Zambia: Qualitative evaluation on acceptability and feasibility

BackgroundIn Sub-Saharan Africa, unhealthy alcohol use (UAU) is a growing threat to achieving ‘the last mile’ towards ending AIDS by 2030. Common Elements Treatment Approach (CETA) is a multisession transdiagnostic cognitive behavioral therapy protocol that can treat a range of common co-morbid mental and behavioral mental health problems, including UAU. In a randomized controlled trial (RCT), we previously reported that CETA was clinically effective in reducing UAU and mental health comorbidities among PWH in Zambia. In this qualitative evaluation we sought to explore health worker, key policymaker and patient perspectives on the acceptability and feasibility of integrating CETA within existing HIV services. MethodologyWe conducted focus group discussions (FGDs) with PWH who reported alcohol use, lay and profession HIV clinic staff, and key informant interviews with policy-makers. Following trial completion, we conducted in-depth interviews (IDIs) among people with HIV and UAU who received CETA, and HIV peer counsellors that provided CETA. Data were transcribed verbatim and analyzed in NVivo 12 using thematic analysis. Emerging themes were organized according to acceptability and feasibility. ResultsAll participant types reported CETA to be acceptable due to the perceived need and relevance to HIV-related behavioral health issues. HIV peer counselors, successfully provided CETA with a rigorous supervision structure using an apprenticeship model. Participants receiving CETA also remained motivated throughout the sessions as they learned new problem-solving skills, which they continued to use following the close of the study. Implementation factors related to limited behavioral health infrastructure, workloads, and human resources were seen as challenges to the scale-up and sustainability of CETA within HIV care. ConclusionCETA was feasible and acceptable at 2 urban sites in Zambia. Future studies integrating of CETA into HIV care should consider implementation factors such as infrastructure, workloads, and human resources to support integration into HIV care.

Evaluation of Teachers Awareness Regarding Common Behavioral Problems among School Age Children in Shendi Town (Ashagalwa Village)

Background: One of the most challenging aspects of teaching is dealing with students' behavioral issues because they interfere with lessons and produce an unsuitable learning environment. All students have a variety of emotional and personal struggles when they first enter school, which can make their behavior undesirable and challenging to change. Objectives: The main goal of this study to evaluate teachers awareness regarding common behavioral problems among school age children. Methods: Descriptive cross sectional community based study done to assess teachers awareness regarding Common behavioral Problems among school age Children in Al shaqalwa village during period extended from November to June 2022 , the enrolled (52) teachers through multi stage simple random sampling ,questionnaire use for data collection composed of (23) questions finally the data was analyzed by statistical package for social science (SPSS) version (21) then the data was represented in form tables and figures. Results: The result of the present study showed that more than half (55.8%) of study group had poor knowledge about behavioral Problems only (11.5%) of study group had good knowledge about the causes of behavioral Problems and (28.8%) of them had fair knowledge about the causes of behavioral Problems inside the School. Conclusion: The study concluded that studied teachers awareness regarding common behavior problems in (55.8%) was poor also (17%) fair about causes of behavioral problem and only (7.7%) had was good awareness regarding dealing with difficult behavior.

Psychological mechanism of acceptance and commitment therapy and rational emotive behavior therapy for treating hoarding: Evidence from randomized controlled trials.

Hoarding is a common problem behavior worldwide and is detrimental to the physical and mental health of individuals and groups. Currently, effective interventions for hoarding are cognitive-behavioral therapies, but their post-intervention efficacy is questionable, and the available research does not examine the mediating variables of the effects of interventions on clinical outcomes. Moreover, current research on hoarding has focused on Western countries. Therefore, there is a need to investigate the efficacy of other forms of cognitive behavioral therapy on hoarding as well as other psychological outcomes related to hoarding and mediating variables that contribute to its effectiveness in different cultural contexts. One hundred thirty-nine college students with higher hoarding behaviors were randomly divided into three groups: 45 in the Acceptance and Commitment Therapy (ACT) group, 47 in the Rational Emotive Behavior Therapy (REBT) group, and 47 in the control group. They completed the Saving Inventory-Revised (SI-R), Obsessive-Compulsive Symptom Scale (OCSS), Difficulties in Emotion Regulation Scale (DERS), Experiences in Close Relationships Inventory-Attachment Anxiety Subscale (ECR), Depression Anxiety Stress Scales (DASS-21), Acceptance and Action Questionnaire II (AAQ-II), and Cognitive Fusion Questionnaire (CFQ) before and immediately after the intervention. The results showed that ACT and REBT improved individuals' psychological flexibility, cognitive fusion, acquisition-difficulty discarding, clutter, negative affect (anxiety, depression, stress), attachment anxiety, obsessive-compulsive disorder, and difficulty in emotion regulation compared to the control group. In addition, ACT was more effective than REBT in improving psychological flexibility and reducing hoarding, cognitive fusion, depression, stress, and obsessive-compulsive disorder; there were no significant differences between the two in anxiety and emotion regulation difficulties. Furthermore, psychological flexibility is a mediator of the effect of ACT and REBT on some behavioral and psychological outcomes (hoarding, negative affect, attachment anxiety). Limitations were discussed.

Eating Difficulties and Relationship With Nutritional Status Among Patients With Dementia

One of the most common behavioral problems in patients with dementia is eating problems, which are known to increase the risk of malnutrition. However, few studies have been conducted in this patient group regarding the relationship between eating difficulties and nutritional status. This study was designed to determine the eating difficulties faced by patients with dementia and to evaluate the relationship in this population between eating difficulties and malnutrition. This study was carried out in a dementia outpatient clinic of a university hospital in Istanbul, Turkey. This cross-sectional, case-control study included 50 patients and 50 healthy controls as participants. Participants were assessed for eating difficulties and for nutritional, cognitive, and functional statuses. The patients with dementia had more difficulties in terms of self-feeding skills. Although problems related to manipulating food on the plate and the use of utensils were not seen in the control group, these problems were found in 30% of the participants in the dementia group ( p < .001). Moreover, 30% of the patients in the dementia group were unable to eat without assistance ( p < .001). Associations were found between eating difficulties and age, duration of illness, and cognitive and functional (basic and instrumental activities of daily living) statuses. In addition, self-feeding skills were found to be associated with nutritional status. Rate of malnutrition or risk of malnutrition was higher in patients with dementia than in those in the control group. In this study, compared with the control group, patients with dementia had more problems in self-feeding skills such as manipulation of food on a plate, use of utensils, need for assistive tools, ability to eat without assistance, and negative eating behaviors (refusal to eat). An association was found between eating difficulties and nutritional status. Evaluating eating difficulties is recommended in patients with dementia to prevent nutritional deterioration.

The Differential Preliminary Belief in Prevention: The Case of Adolescents’ Problem Behaviors

Current literature on the barriers to the implementation of prevention efforts highlights circumstantial organizational and personal factors. However, the possibility that there is a more profound individual difference in people’s preliminary Belief in the Ability to Prevent (BIP; Israelashvili, 2018 ) has not yet been investigated. To explore this possibility, two sequential studies were performed on the case of adolescents’ problem behaviors. Study 1 ( N = 200) examined the utility of a new measurement of BIP. Respondents were adolescents and adults (parents and teachers), living in northern Israel, who evaluated each of the vignettes in terms of the possibility of preventing the emerging adolescent’s problem behavior. Results from Study 1 supplied preliminary support for this research tool’s structure and validity, and demonstrated that there is variance in BIP scores and that past exposure to problem behaviors, especially suicidal behavior, is associated with lower BIP scores. Assuming that BIP emerges on the basis of cultural background and life experiences, Study 2 ( N = 995) explored possible sex, age, and cultural differences and their accumulating contribution to explaining the variance in BIP. Based on MANCOVA analyses, the results from Study 2 support the hypothesized background differences and show that at-risk adolescents have lower levels of BIP. An additional tree analysis suggests that a person’s perception regarding the possibility of preventing more common problem behaviors, rather than extreme behaviors, serves as the basis upon which BIP is established. It is suggested that BIP is an additional possible variable that is related to people’s reluctance to collaborate with, and respond to, prevention efforts. Implications for implementation science are suggested.