Adolescent Treatment Program Research Articles

Neuroplasticity and Cocaine Exposure During Adolescence

The adolescent brain is particularly vulnerable to the effects of cocaine exposure due to ongoing neurodevelopment especially in areas that are crucial for cognitive and emotional regulation. This review explores the multifaceted impact of cocaine on neuroplasticity during adolescence, thereby highlighting both the immediate and long-term consequences of drug exposure. Key findings from recent studies indicate that cocaine use during adolescence leads to significant alterations in synaptic plasticity, dendritic spine morphology, and neurotransmitter systems, which may persist into adulthood and contribute to addictive behaviors. Additionally, the interaction between genetic predispositions, environmental stressors, and drug exposure is emphasized. The review also analyzed the risks of early-life stress and social isolation on cocaine-induced neuroplasticity, which can render anxiety-related behaviors and lead to neurological changes. Future studies should incorporate longitudinal design to understand the long-term trajectory of neuroplasticity induced by cocaine. This paper can provide some suggestions to the development of prevention and intervention programs for adolescents at risk.

Development and Acceptability of Provider Training to Increase Treatment Engagement of Parents in Their Children's Behavioral Health Care Need.

BACKGROUND: Disruptive, Impulse-Control, and Conduct disorders (DIC) affect 5 million children in the United States and often require comprehensive and long-term behavioral health care for which sustained parental involvement is essential. Our research team is developing an intervention to improve parental engagement in the behavioral health care of their children with DIC. The intervention, which will be a modification of an evidence-based shared decision-making intervention called DECIDE, will include a parent component and a provider component. AIM: To determine the acceptability of the provider component of the modified DECIDE intervention. METHODS: The provider intervention is an asynchronous self-paced online training program made up of five modules: introduction, shared decision-making, perspective-taking, attributional errors, and being a responsive provider. The training was piloted with 41 providers in two public child and adolescent treatment programs. Following completion of the training, semi-structured interviews were conducted with the providers to assess the acceptability of the training. The interviews were analyzed with conventional content analysis. RESULTS: The provider training was well received by providers, and many had made practice changes based on what they had learned. Several offered recommendations for improvement, most notably the need to tailor the training based on provider role, discipline, and level of expertise. CONCLUSIONS: The feedback given by providers will be used to refine future iterations of the provider training component of the modified DECIDE intervention. Psychiatric nurses and other clinicians may draw from strategies incorporated in the training program to improve parent engagement in the treatment of children with DIC.

Parental Knowledge and Attitudes Towards Helicobacter Pylori Screening in Adolescents: A School-Based Questionnaire Study Among Guardians of Junior High School Students in Yokosuka City, Japan

PurposeHelicobacter pylori (HP) infection, a risk factor for gastric cancer, is prevalent in Japan. Consequently, some municipalities across Japan are implementing HP screening and treatment programs for adolescents. However, little is known about parents’ attitudes and awareness regarding HP screening for their children. This study aimed to elucidate parental perspectives on HP screening for their children and identify the factors influencing these attitudes.MethodsThis study focused on the parents of first-year junior high school students in Yokosuka City, Kanagawa Prefecture, where an HP screening and treatment program had been implemented for adolescents. The survey questionnaire was distributed among parents in all 23 public junior high schools in Yokosuka City.ResultsAmong the 618 respondents, 86.4% supported HP screening for their children. Regression analysis identified sufficient knowledge about HP (adjusted odds ratio (aOR) = 5.80; 95% confidence interval (CI), 2.10–16.03) and being in their 40s (aOR = 2.25; 95% CI, 1.35–3.77) as significant factors influencing supportive attitudes. For parents favoring the screening, common reasons included perceiving it as a promising opportunity (53.2%) and considering the test necessary (44.0%). In contrast, those who opposed screening frequently cited it as unnecessary (66.7%) or believed that their children did not have HP.ConclusionsA significant proportion of parents in Yokosuka City, Japan, demonstrated a good understanding of HP and expressed a high level of interest in HP screening for their children. Further investigation of parents’ attitudes is essential for the effective implementation of adolescent HP screening programs.

Suicide progression and influencing factors in Chinese adolescents: A latent transition analysis

The developmental progression before suicide death is multi-directional and reversible, with differing influencing factors at each stage. However, previous research on this topic is very limited. This study aims to delve into the transitional features of adolescent suicide progression and associated factors. A longitudinal survey of 1,407 adolescents (Mage = 14.64, SD = 0.73) was conducted over six months. Latent transition analysis and logistic regression were employed to explore the transitions in the suicide process and examine the effects of psychache, childhood maltreatment, regulatory emotional self-efficacy, and demographic factors on the transition patterns. Adolescents could be categorized into three subgroups at two time points: Non-Ideators (T1: 83.7 %, T2: 86.7 %), Ideators (T1: 12.0 %, T2: 9.1 %), and Attempters (T1: 4.3 %, T2: 4.2 %). Non-Ideators demonstrated the highest stability, while Ideators and Attempters were more likely to transition to other groups. Psychache positively predicted the emergence of suicide ideation and its transition to suicide attempt, and negatively predicted the diminishment of suicide ideation. Childhood maltreatment positively predicted the transition from suicide ideation to attempt. Regulatory emotional self-efficacy negatively predicted the emergence of suicide ideation. Findings enhance the understanding of the transitional patterns of adolescent suicidality and influencing factors at different stages. More targeted prevention and intervention programs for adolescents’ suicidal thoughts and behaviors can be developed accordingly.

Reduction of craving in an adolescent in residential treatment for addictions through a brief intervention: A case study

Introduction: Craving refers to a subjective desire to consume substances. It has been found that craving is one of the best predictors of relapse, so it is important to address it during addiction treatment. The Brief Intervention Program for Adolescents (PIBA) has been shown to be effective in reducing drug consumption patterns, increasing self-efficacy to deal with consumption situations, and reducing problems associated with consumption in adolescents who are in middle or high school schools, as well as in outpatient addiction care institutions. However, the effectiveness of this program has not been tested with adolescents in residential treatment or in reducing craving. Objective: To evaluate the effectiveness of PIBA in reducing craving and increasing self-efficacy in a female adolescent who was in a residential center. Method: A single-case design was applied, consisting of the treatment and a follow-up at four months, intentional and non-probabilistic, with a 16-year-old female adolescent. Result: A reduction in craving was found throughout the treatment and maintained during the follow-up, as well as an increase in self-efficacy. Conclusion: These findings extend the effectiveness of PIBA to addiction components and populations not previously explored, suggesting that PIBA may be an alternative to work with these components and populations.

The Effectiveness and Tolerability of an Intensive Outpatient Trauma Treatment Program for Adolescents With PTSD

Following the promising effects of an intensive trauma treatment for adults, the question arises whether adolescents suffering from posttraumatic stress disorder (PTSD) can also benefit from a similar treatment program. The objective of this study was to assess the effectiveness and tolerability of an intensive trauma treatment program combining two evidence-based, trauma-focused therapies—prolonged exposure (PE) and eye movement desensitization and reprocessing (EMDR)—with psychoeducation and physical activity for adolescents suffering from PTSD in an outpatient clinic. We used a multiple-baseline study design. Fifteen adolescents aged 12–18 years old with aDiagnostic and Statistical Manual of Mental Disorders(5th ed.) diagnosis of PTSD were included. Participants were randomized to wait 2, 3, or 4 weeks between the start of baseline and the start of the intervention. In the 2-week intervention period, participants received daily PE, EMDR, and physical activity. The social network of adolescents was involved for support. PTSD symptoms and treatment tolerability were assessed daily. PTSD diagnosis was assessed at baseline and at 1 month and 3 months after completion of treatment. In addition, semistructured interviews were conducted after treatment to determine the tolerability. After treatment, we found a diagnostic PTSD remission of 58%–62% and a decrease in PTSD severity compared with baseline. The effects were maintained at 1-month and 3-month follow-ups. The dropout rate was 13%. Participants reported good treatment tolerability. This study provides initial evidence that an intensive outpatient trauma treatment including PE, EMDR therapy, psychoeducation, and physical activity is effective and tolerable for adolescents with PTSD and is associated with low dropout rates.

Factors associated with informal and formal help-seeking among Asian adolescents with nonsuicidal self-injury.

Although nonsuicidal self-injury (NSSI) is prevalent among adolescents and is associated with an increased risk of adverse outcomes, many adolescents with NSSI do not seek help. However, there is a lack of research on the factors that may increase the likelihood of help-seeking, especially within Asia. To address this gap, the present study examined whether certain factors were associated with informal and formal help-seeking - specifically gender, severity of NSSI, functions of NSSI and authoritative parenting. 121 adolescents (Mage = 16.2years, 71.1% female) were recruited from specialist outpatient clinics and inpatient psychiatric wards from a public hospital in Singapore. One caregiver per adolescent was also recruited. Data from self-report questionnaires were analysed using logistics regression analyses. The results suggest that the severity of NSSI increases the likelihood of informal help-seeking, while adolescents who have parents with more authoritative parenting style are less likely to seek informal help. Gender and functions of NSSI were not found to be associated with help-seeking. The findings from this study can guide professionals in their efforts to encourage help-seeking within Asian populations, as well as inform prevention and treatment programs for Asian adolescents with NSSI.

5. “Safe,” “Individualized,” and “Supportive,” With a Touch of “Fun Things”: The Ideal Treatment Program for Adolescents and Young Adults Who Use Opioids

5. “Safe,” “Individualized,” and “Supportive,” With a Touch of “Fun Things”: The Ideal Treatment Program for Adolescents and Young Adults Who Use Opioids

Evaluation of the multimodal DELTA therapy for adolescents with substance use disorders: an exploratory pilot trial.

In order to address the lack of manualized treatment programs for adolescents with substance use disorders (SUDs), we developed a manualized group intervention (DELTA). DELTA focusses on substance use reduction and abstinence as well as alleviation of SUD symptoms via additional modules for co-occurring disorders. The goal of this exploratory trial was to assess if DELTA can be conducted in adolescent SUD patients and if participation is related to reductions in substance use, SUD-related problems, and further psychopathologies. We recruited adolescents at a psychiatric outpatient unit, which were then allocated to either DELTA intervention group (N = 85) or to a waiting-list control group (WL, N = 61) based on parental decision to start a therapy or not. Self-report measures were used as primary outcomes (substance use via interview, use-related problems via DUDIT-Drug Use Disorder Identification Test) and secondary outcomes (psychopathologies via YSR-Youth Self Report). T-tests and Pearson correlations were used to analyze between-group differences across time. On average, participants attended M = 7.7 (SD = 5.1) of the 16 sessions. Substance use and use-related problems regarding all substances but nicotine was decreased after the intervention, with small to medium not significant effects in favor of DELTA. Self-reported psychopathologies were also reduced at follow-up, with non-significant advantages for DELTA. DELTA showed small effects on SUD-related and depression-related variables. However, the interpretation is limited by the small sample size. Nonetheless, the DELTA intervention is viable in SUD outpatient treatment and will be further evaluated.Clinical trial registration: The study was registered at clinicaltrials.gov under NCT03444974. Registered February, 26th 2018 (https://clinicaltrials.gov/ct2/show/NCT03444974).

Individual and social predictors of Greek early adolescents’ self-determination: A longitudinal structural equation analysis

Given that early adolescence is a dynamic and vulnerable developmental period, it is important to examine factors that promote adolescents’ individual development and, more specifically, the satisfaction of psychological needs within the framework of self-determination theory. In a two-wave longitudinal sample (N = 218) of Greek adolescents (eighth grade in autumn 2020 and ninth grade in autumn 2021), we used structural equation modeling to determine which individual and social factors longitudinally predict autonomy, competence, and relatedness. The examination of these psychological needs is regarded as a necessary step in designing school-based prevention and intervention programs for adolescents. Individual factors, such as self-esteem, self-efficacy, and depression or anxiety, foster self-determination through social factors, such as recognition and support from teacher and parents, and social resources. Adolescents with a migration background showed lower levels of social factors. The model was gender invariant and indicated that social agents (teachers and parents) and social resources predict a very large proportion of variance in early adolescents’ individual development. These findings support the view that early adolescents’ development depends on social factors through the satisfaction of psychological needs.

Behavioural Issues in Horses Working in Human Mental Healthcare Services

Abstract Horses commonly engage in physical contact with their conspecifics through mutual grooming, which serves several important functions for social communication and comfort. However, horses may react differently to social contact with humans. When such contact is unwanted, horses may display calming, displacement, or more significant stress-related behaviours. This can impact their welfare while simultaneously posing safety risks for the humans involved. Understanding and addressing horse behaviour during interactions with humans is critical across the equestrian industry, and particularly when horse-human interactions are incorporated into human healthcare and educational services. This hypothetical case study explores a horse’s negative behavioural changes in response to grooming activities used in a substance use treatment programme for adolescents. The case concludes with a description of strategies for pinpointing the underlying reasons for the horse’s behaviours and proposed courses of action to enhance the horse’s overall experience of human contact. This case underscores the complexity of horse-human interactions, emphasizing the need for behavioural assessment as an essential tool for improving horse welfare within the realm of animal-assisted interventions. Information © The Author 2023

Gratitude, parental support, professional help-seeking attitudes for mental health problems among adolescents

ABSTRACT The current study aims to examine the relationship between gratitude and parental support through the mediation of perceived stress and the influence of parental support on adolescent professional help-seeking for mental health problems. 1987 participants completed the survey, including 41.4% boys and 58.6% girls aged 11–15 years. The findings indicated that (i) parental support mediated the relationship between perceived stress and professional psychological help-seeking attitudes; (ii) perceived stress mediated the effect of gratitude on parental support; (iii) gratitude predicted professional psychological help-seeking attitudes through perceived stress and parental support; and (iv) gratitude predicted positively adolescents’ academic achievement. The study highlights the potential influence of parental support on adolescents’ professional help-seeking attitudes. Mental health services should be developed to be more accessible to adolescents to facilitate more independent help-seeking. Prevention and intervention programmes for adolescents may be more effective at decreasing stress symptoms by combining gratitude interventions.

A hop, skip and a jump towards evaluating social interaction and learning through play at a child and adolescent inpatient treatment program.

The number of inpatient mental health facilities for children and adolescents in the United States is growing rapidly. While undergoing inpatient treatment, children and adolescents can benefit from innovative play opportunities designed to foster social interaction and learning. The Playful Learning Landscapes (PLL) initiative is a group of projects designed to transform everyday spaces into opportunities for playful learning. As a part of this initiative, two designs-Lifesize Ruler and Jumping Feet-were installed in an inpatient mental health facility for children and adolescents in the Mid-Atlantic region of the United States. Results of pre-installation and post-installation naturalistic observations suggested that social interactions, the use of STEM-related language and 21st century skills, including confidence, increased after interacting with the installations. While previous research on PLL projects has demonstrated the efficacy of transforming public spaces into places for playful learning, this research provides support that, even in private, targeted settings, using a trauma-informed approach, children and adolescents, can reap the benefits of playful learning.

Examining the Use of Career Development Curricula in Adolescent Residential Treatment Programs

Research suggests adolescents leaving residential treatment programs have higher levels of unemployment and homelessness than average. This exploratory study examined what types of career development curricula are being used in residential treatment programs. The findings suggest that most residential treatment programs use little to no career development curriculum. The long-term goal is to support the critical need and development of a specialized career development curriculum for adolescents residing in residential group home programs.

Effects of a Standardized DBT-A Program on Identity Development in Adolescents.

Identity diffusion plays a central role in the onset of borderline personality disorders. Dialectical Behavioral Therapy for Adolescents (DBT-A) is a treatment program for adolescents with emotional instability and dysregulation. The interest of this study is to examine the potential effects of a standardized and certified DBT-A therapy program on the identity development of adolescents in an inpatient setting. A total of 138 adolescents aged 13 to 18 years with symptoms of severe emotional instability were assessed before and after a certified and standardized 12-week in-patient DBT-A program targeting emotional regulation with the following standardized instruments: the Assessment of Identity Development in Adolescence (AIDA), Scale of the Experience of Emotions (SEE), and Symptom Checklist (SCL-90-R). The results indicate a significant change in identity development, emotion regulation, and general symptoms of psychopathology after treatment with DBT-A. In this large sample of adolescents, DBT-A significantly improved identity development and reduced identity diffusion, however, without a treatment-as-usual control group as a limitation. Nevertheless, our results may become clinically relevant for the prevention of chronic impairment in emotionally unstable adolescents.

Social Functioning Outcomes of a High School-Based Treatment Program for Adolescents with ADHD

ABSTRACT Objective We evaluated the extent to which receiving the multi-component treatment of the Challenging Horizons Program (CHP) would lead to significant improvements in social functioning, as well as in inattention, internalizing symptoms, parent stress, and emotion dysregulation for high-school-aged adolescents with attention-deficit hyperactivity disorder (ADHD). Method Participants were 186 high-school-aged adolescents (74% White) with a diagnosis of ADHD who were randomly assigned to either CHP (n = 92; 80% boys; M age = 15.0; SD = 0.8) or Community Care (CC; n = 94; 78% boys; M age = 15.1; SD = 0.9) within each of 12 participating schools. Parent and adolescent reports of social functioning were the primary outcome measures. Secondary outcomes included ratings of symptoms of ADHD and related disorders, parent stress, and emotion regulation. Results Intent-to-treat analyses using hierarchical linear modeling revealed significant group-by-time interactions of medium magnitude (d range = .40 to .52) on parent-rated social skills. Significant group-by-time benefits were also identified for adolescent self-rated social skills as well as the secondary outcomes of parent-rated inattention symptoms, emotion regulation, and parenting stress. Discussion CHP appears to benefit social skills along with related characteristics for adolescents with ADHD. Understanding these unique findings for this population informs additional research related to treatment mechanisms and effectiveness trials.

The Maudsley model of anorexia nervosa treatment for adolescents and emerging adults: A multi-centre cohort study.

The aim of this study was examining the efficacy of the Maudsley Model of Anorexia Nervosa Treatment for Adolescents and Young Adults (MANTRa) compared to individual psychotherapy that can be considered as standard in Austria (TAU-O). In this cohort study, 92 patients between 13 and 21years suffering from full-syndrome, atypical or weight-restored anorexia nervosa (AN) received either 24-34 individual MANTRa sessions (n=45) or TAU-O (n=47). Outcome variables were age- and sex-related BMI, eating disorder and comorbid psychopathology at 6-, 12- and 18-month post baseline as well as acceptability of treatment and therapeutic alliance. Both treatments resulted in significant improvements in age- and sex related BMI and reductions in eating disorder and comorbid psychopathology over time with significant differences between groups in favour of MANTRa. The percentage of participants with fully remitted AN was significantly higher in the MANTRa group compared to TAU-O at 18-month follow-up (MANTRa: 46% vs. TAU-O: 16%, p=0.006). Satisfaction with both treatments was high. MANTRa is an effective treatment programme for adolescents and young adults with AN. Randomised controlled trials comparing MANTRa with existing treatments are necessary. The trial was registered at clinicaltrials.gov (Identifier: NCT03535714).

A novel treatment program for adolescents with post traumatic stress disorder with virtual reality technology

Recent advancements in the study of posttraumatic stress disorder (PTSD) have led to the discovery of innovative improvements to therapies that have already received empirical validation. The purpose of this paper is to investigate the theoretical feasibility and expected effects of a new treatment approach for the adolescent PTSD patient population that combines VR virtual reality technology with traditional treatment modalities by referring to relevant studies, literature, and survey feedback from the relevant groups. The main focus is on the use of virtual reality technology to address the reluctance of the adolescent patient population to accept treatment and to explore other possibilities for the development of a relevant target population. The limitations and drawbacks of current VR systems in the treatment of psychological disorders are also discussed, but theoretical solutions are also given. The specific role of the senses in the theoretical model and the role and usefulness for patients, physicians, and others, respectively, are also given.

Assessment of Screening Tools to Identify Substance Use Disorders Among Adolescents

Efficient screening tools that effectively identify substance use disorders (SUDs) among youths are needed. To evaluate the psychometric properties of 3 brief substance use screening tools (Screening to Brief Intervention [S2BI]; Brief Screener for Tobacco, Alcohol, and Drugs [BSTAD]; and Tobacco, Alcohol, Prescription Medication, and Other Substances [TAPS]) with adolescents aged 12 to 17 years. This cross-sectional validation study was conducted from July 1, 2020, to February 28, 2022. Participants aged 12 to 17 years were recruited virtually and in person from 3 health care settings in Massachusetts: (1) an outpatient adolescent SUD treatment program at a pediatric hospital, (2) an adolescent medicine program at a community pediatric practice affiliated with an academic institution, and (3) 1 of 28 participating pediatric primary care practices. Participants were randomly assigned to complete 1 of the 3 electronic screening tools via self-administration, followed by a brief electronic assessment battery and a research assistant-administered diagnostic interview as the criterion standard measure for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnoses of SUDs. Data were analyzed from May 31 to September 13, 2022. The main outcome was a DSM-5 diagnosis of tobacco/nicotine, alcohol, or cannabis use disorder as determined by the criterion standard World Mental Health Composite International Diagnostic Interview Substance Abuse Module. Classification accuracy of the 3 substance use screening tools was assessed by examining the agreement between the criterion, using sensitivity and specificity, based on cut points for each tool for use disorder, chosen a priori from previous studies. This study included 798 adolescents, with a mean (SD) age of 14.6 (1.6) years. The majority of participants identified as female (415 [52.0%]) and were White (524 [65.7%]). High agreement between screening results and the criterion standard measure was observed, with area under the curve values ranging from 0.89 to 1 for nicotine, alcohol, and cannabis use disorders for each of the 3 screening tools. These findings suggest that screening tools that use questions on past-year frequency of use are effective for identifying adolescents with SUDs. Future work could examine whether these tools have differing properties when used with different groups of adolescents in different settings.

Adolescent, Parent, and Provider Perspectives of a Social-Media-Based Support Tool for Parents of Teens in Treatment for Substance Use.

Adolescent substance use disorder contributes to negative psychosocial and physical health outcomes. Parents best support their child's treatment and recovery when they are equipped with knowledge and skills; however, barriers hinder parental engagement. Social-media-based groups present an opportunity for parents who may not otherwise seek support. Qualitative data were collected via focus groups to examine the opinions of adolescents, parents, and treatment providers on the potential utility and possible concerns of a Facebook-based parent support group; input constituted the development phase for an online group (PURPOSE). Fifty-eight participants, recruited through adolescent treatment programs, took part in six focus groups: two parent ( n = 18), two adolescent ( n = 21), and two provider ( n = 19) groups. Groups were audio recorded and transcribed, and themes were extracted. Three main themes emerged: (a) traditional support groups and treatment services, (b) PURPOSE intervention content and delivery, and (c) issues related to PURPOSE implementation. Traditional treatment/support groups can be helpful, but participation in them is limited. Emotional support offered by peers is valuable, but parents also need and seek out psychoeducation, parenting skills, and self-care support. PURPOSE could offer easy access to skills and real-time peer support.