During this investigation, Dr. Zeanah was supported in part by NIMH Grant No. MH 16744. Dr. Ander... more During this investigation, Dr. Zeanah was supported in part by NIMH Grant No. MH 16744. Dr. Anders was a Fellow at the Center for Advanced Studies in the Behavioral Sciences in Palo Alto, California, supported in part by the John D. and Catherine T. MacArthur Foundation. The investigation was supported by the David und Lucille Puckurd FuunduLiuu uml by Llw Hum)' J. Kaisor Family Foundation. The authors appreciate the assistance of Marilyn Hansen with data collection, of William T. Hole and J. R. Semple with data analysis, and the helpful suggestions of Marianne Barton, Julie Hofheimer, and Morton Silverman about an earlier version of the manuscript.
Journal of the American Academy of Child and Adolescent Psychiatry, Nov 1, 2005
This parameter reviews the current status of reactive attachment disorder with regard to assessme... more This parameter reviews the current status of reactive attachment disorder with regard to assessment and treatment. Attachment is a central component of social and emotional development in early childhood, and disordered attachment is defined by specific patterns of abnormal social behavior in the context of ''pathogenic care.'' Clinically relevant subtypes include an emotionally withdrawn/inhibited pattern and a socially indiscriminate/disinhibited pattern. Assessment requires direct observation of the child in the context of his/her relationships with primary caregivers. Treatment requires establishing an attachment relationship for the child when none exists and ameliorating disturbed attachment relationships with caregivers when they are evident. Coercive treatments with children with attachment disorders are potentially dangerous and not recommended.
F1000 - Post-publication peer review of the biomedical literature, 2009
Objective-Less than half of youths achieve remission (minimal to no symptoms) after acute antidep... more Objective-Less than half of youths achieve remission (minimal to no symptoms) after acute antidepressant treatment. Early identification of who will or will not respond to treatment and achieve remission may help clinicians formulate treatment decisions and shorten the time spent on ineffective treatments. In a prospective open-label fluoxetine study, we investigate indicators of acute treatment response and remission. Method-One hundred sixty-eight children and adolescents, ages 7 to 18 years, with primary diagnoses of major depressive disorder received 12 weeks of fluoxetine treatment. The youths were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia. The outcome measure included the Children's Depression Rating Scale-Revised. Results-Positive first-degree family history of depression was the only baseline demographic and clinical characteristic that predicted a favorable treatment response (p = .01). The rate of symptom improvement, however, is a good indicator of acute treatment response. A significant symptom reduction (approximately 50%) by week 4 is needed to achieve remission at the end of acute treatment. Conclusions-This study demonstrated that the rate of symptom improvement during early weeks of acute fluoxetine treatment is a good indicator of remission. Treatment approach may be reevaluated and modified as early as week 4 during acute treatment. Keywords acute treatment; pediatric depression; fluoxetine For the past 10 years, research for the treatment of pediatric major depressive disorder (MDD), particularly the acute phase of treatment, has increased remarkably. Although most clinical trials use treatment response as the primary outcome, remission (i.e., minimal or no depressive symptoms) is the goal of acute treatment. 1 Previous double-blind placebo-controlled acute
Institutional rearing negatively impacts the development of children's social skills and exec... more Institutional rearing negatively impacts the development of children's social skills and executive functions (EF). However, little is known about whether childhood social skills mediate the effects of the foster care intervention (FCG) and foster caregiving quality following early institutional rearing on EF and social skills in adolescence. We examined (a) whether children's social skills at 8 years mediate the impact of the FCG on the development of EF at ages 12 and 16 years, and (b) whether social skills and EF at ages 8 and 12 mediate the relation between caregiving quality in foster care at 42 months and subsequent social skills and EF at age 16. Participants included abandoned children from Romanian institutions, who were randomly assigned to a FCG (n = 68) or care as usual (n = 68), and a never‐institutionalized group (n = 135). At ages 8, 12, and 16, social skills were assessed via caregiver and teacher reports and EF were assessed via the Cambridge Neuropsychological Test Automated Battery. Caregiving quality of foster caregivers was observed at 42 months. FCG predicted better social skills at 8 years, which in turn predicted better EF in adolescence. Higher caregiver quality in foster care at 42 months predicted better social skills at 8 and 12 years, and better EF at 12 years, which in turn predicted 16‐year EF and social skills. These findings suggest that interventions targeting caregiving quality within foster care home environments may have long‐lasting positive effects on children's social skills and EF.
During this investigation, Dr. Zeanah was supported in part by NIMH Grant No. MH 16744. Dr. Ander... more During this investigation, Dr. Zeanah was supported in part by NIMH Grant No. MH 16744. Dr. Anders was a Fellow at the Center for Advanced Studies in the Behavioral Sciences in Palo Alto, California, supported in part by the John D. and Catherine T. MacArthur Foundation. The investigation was supported by the David und Lucille Puckurd FuunduLiuu uml by Llw Hum)' J. Kaisor Family Foundation. The authors appreciate the assistance of Marilyn Hansen with data collection, of William T. Hole and J. R. Semple with data analysis, and the helpful suggestions of Marianne Barton, Julie Hofheimer, and Morton Silverman about an earlier version of the manuscript.
Journal of the American Academy of Child and Adolescent Psychiatry, Nov 1, 2005
This parameter reviews the current status of reactive attachment disorder with regard to assessme... more This parameter reviews the current status of reactive attachment disorder with regard to assessment and treatment. Attachment is a central component of social and emotional development in early childhood, and disordered attachment is defined by specific patterns of abnormal social behavior in the context of ''pathogenic care.'' Clinically relevant subtypes include an emotionally withdrawn/inhibited pattern and a socially indiscriminate/disinhibited pattern. Assessment requires direct observation of the child in the context of his/her relationships with primary caregivers. Treatment requires establishing an attachment relationship for the child when none exists and ameliorating disturbed attachment relationships with caregivers when they are evident. Coercive treatments with children with attachment disorders are potentially dangerous and not recommended.
F1000 - Post-publication peer review of the biomedical literature, 2009
Objective-Less than half of youths achieve remission (minimal to no symptoms) after acute antidep... more Objective-Less than half of youths achieve remission (minimal to no symptoms) after acute antidepressant treatment. Early identification of who will or will not respond to treatment and achieve remission may help clinicians formulate treatment decisions and shorten the time spent on ineffective treatments. In a prospective open-label fluoxetine study, we investigate indicators of acute treatment response and remission. Method-One hundred sixty-eight children and adolescents, ages 7 to 18 years, with primary diagnoses of major depressive disorder received 12 weeks of fluoxetine treatment. The youths were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia. The outcome measure included the Children's Depression Rating Scale-Revised. Results-Positive first-degree family history of depression was the only baseline demographic and clinical characteristic that predicted a favorable treatment response (p = .01). The rate of symptom improvement, however, is a good indicator of acute treatment response. A significant symptom reduction (approximately 50%) by week 4 is needed to achieve remission at the end of acute treatment. Conclusions-This study demonstrated that the rate of symptom improvement during early weeks of acute fluoxetine treatment is a good indicator of remission. Treatment approach may be reevaluated and modified as early as week 4 during acute treatment. Keywords acute treatment; pediatric depression; fluoxetine For the past 10 years, research for the treatment of pediatric major depressive disorder (MDD), particularly the acute phase of treatment, has increased remarkably. Although most clinical trials use treatment response as the primary outcome, remission (i.e., minimal or no depressive symptoms) is the goal of acute treatment. 1 Previous double-blind placebo-controlled acute
Institutional rearing negatively impacts the development of children's social skills and exec... more Institutional rearing negatively impacts the development of children's social skills and executive functions (EF). However, little is known about whether childhood social skills mediate the effects of the foster care intervention (FCG) and foster caregiving quality following early institutional rearing on EF and social skills in adolescence. We examined (a) whether children's social skills at 8 years mediate the impact of the FCG on the development of EF at ages 12 and 16 years, and (b) whether social skills and EF at ages 8 and 12 mediate the relation between caregiving quality in foster care at 42 months and subsequent social skills and EF at age 16. Participants included abandoned children from Romanian institutions, who were randomly assigned to a FCG (n = 68) or care as usual (n = 68), and a never‐institutionalized group (n = 135). At ages 8, 12, and 16, social skills were assessed via caregiver and teacher reports and EF were assessed via the Cambridge Neuropsychological Test Automated Battery. Caregiving quality of foster caregivers was observed at 42 months. FCG predicted better social skills at 8 years, which in turn predicted better EF in adolescence. Higher caregiver quality in foster care at 42 months predicted better social skills at 8 and 12 years, and better EF at 12 years, which in turn predicted 16‐year EF and social skills. These findings suggest that interventions targeting caregiving quality within foster care home environments may have long‐lasting positive effects on children's social skills and EF.
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Papers by Charles Zeanah