David Leach

The aim of this study was to examine parent–youth concordance in reporting of eating disorder pathology, as assessed by the Eating Disorder Examination (EDE) in a clinical pediatric sample.

The sample comprised 619 parent-youth dyads of youth (8–18 years) presenting for treatment at a specialist eating disorder clinic. A cross-sectional correlational design was used to examine the association between parent and youth symptom reports.
On the whole, parent–youth inter-rater agreement was poor to moderate. Agreement was acceptable for the presence of behavioral symptoms, with the exception of excessive exercise (PAK = 0.48–0.98). There was poor inter-rater agreement on frequency of behavioral symptoms, with parents providing lower estimates than youth (ICC = 0.07–0.52). Although we predicted that inter-rater agreement on cognitive symptoms would by higher with adolescents than children, both groups were discordant with parent reports. Younger children identified less severe eating disorder cognitions than parents and the opposite occurred for adolescents. An anorexia nervosa presentation and lower malnutrition were not associated with lower inter-rater agreement, as might have been expected through ego syntonicity. Youth with bulimia nervosa presentations reported significantly higher severity of cognitive symptoms and more frequent disordered eating behaviors compared with their parents.

Results support the utility of parent–youth assessment via the EDE to obtain a wider clinical picture of eating disorder psychopathology in children and adolescents, particularly for younger children. Clinical implications pertinent to administration of the EDE and parent literacy regarding eating disorder symptoms are discussed.

To examine child and adolescent differences in the clinical presentation of eating disorders (EDs) at referral to a specialist pediatric program. This study compared cognitive, behavioral, and physical and medical features of children (≤12 years) and adolescents (13–18 years) with EDs presenting to a state-wide specialist pediatric ED service over two decades (N = 656; 8–18 years; 94% female). Significant differences were found between the groups. Children were more commonly male (p < .001), had lower eating pathology scores (p < .001), were less likely to binge eat (p = .02), purge (p < .001) or exercise for shape and weight control (p < .001), and lost weight at a faster rate than adolescents (p = .009), whereas adolescents were more likely to present with bulimia nervosa spectrum disorders (p = .004). Children and adolescents did not differ significantly on mean body mass index z-score, percentage of body weight lost, or indicators of medical compromise (p > .05). The clinical presentation of EDs differs among children and adolescents, with eating pathology and behavioral symptoms less prominent among children. Frontline health professionals require knowledge of these differences to assist with early detection, diagnosis, and prognosis.

Behavioural Activation (BA) therapy is a stand-alone evidence-based treatment for depression and also is being applied to anxiety with promising outcomes. Essentially, BA involves structured therapy aimed at increasing the amount of activity in a person's daily life, so that he or she comes into contact with sources of positive reinforcement for clinically healthy behaviours. Originally, contemporary BA was developed as a behaviour therapy treatment condition in a study that compared BA to Cognitive Behavioural Therapy (CBT). Over time, many variants of BA have appeared in the published literature, which included techniques that might be viewed as being incompatible with the original intended treatment model and more similar to generic forms of CBT. The purpose of this article is to provide researchers and practitioners with a description of what we consider to be the distinctive and essential elements of BA therapy.

This paper describes three single-case experimental evaluations of behavioral activation treatment of anxiety (BATA) applied with a 51-year-old male, a 62-year-old female, and a 53-year-old female, each of whom met DSM-IV criteria for generalised anxiety disorder (GAD). Each case was a clinical replication of an initial trial of BATA reported in Turner and Leach (2009). Treatment was delivered in twelve weekly 60-minute individual sessions and evaluated using an A-B-C phase change with repeated measurement design. Decreased scores in self-reported anxiety were obtained in each case and the improvements were maintained during a 3-month no treatment maintenance phase. Compared to baseline, each participant also recorded increases in activity levels in some key life areas during the treatment phase. These preliminary findings suggest that increased activation in functionally positive areas is associated with reported decreases in anxiety and that BATA could be an effective stand-alone treatment for GAD in adults.

This report describes three single-case experimental evaluations of Behavioral Activation Treatment of Anxiety (BATA) applied with a 51-year-old male, a 62-year-old female, and a 53-year-old female, each of whom met DSM-IV criteria for anxiety. Each case was a clinical replication of an initial trial of BATA reported in Turner and Leach (2009). Treatment was delivered in twelve weekly 60-minute individual sessions and evaluated using an A-B-C phase change with repeated measurement design. Decreased scores in self-reported anxiety were obtained in each case and the improvements were maintained during a 3-month no treatment maintenance phase. Compared to baseline, each participant also recorded increases in activity levels in some key life areas during the treatment phase. These preliminary findings suggest that increased activation in functionally positive areas is associated with reported decreases in anxiety and that BATA could be an effective stand-alone treatment for anxiety in adults.

A 64-year-old male who met criteria for social and generalised anxiety was treated using a brief behavioural activation (BA) approach. The intervention was delivered in twelve weekly 60-minute individual sessions. The effects of the intervention were assessed using a simple A-B-C phase change with repeated measurement design. Change in reported anxiety was recorded across phases. Decreased scores in self-reported anxiety measures were obtained and significant clinical improvement was maintained during a 4-month no treatment maintenance phase. This preliminary investigation suggests BA could be an efficient and effective treatment for anxiety and that replications are warranted.

The changing age structure of the population and its potential impact on government provisions for healthcare has focused attention on the development of appropriate policies and services. In particular, there has been an emphasis on preventative measures. Hence significant resources are being directed towards research and other initiatives, such as media campaigns, that aim to encourage older people to adopt healthier and more active lifestyles. However, improving the wellbeing of older people involves arranging supportive contexts for behaviour change, including their self-management of more active behaviours. This symposium outlines the development and evaluation of a comprehensive, home-based intervention founded on behaviour change principles that targeted increasing healthy activities in older people. Papers will describe components of our Back for Action Program (BAP) specifically, selecting and measuring the type and frequency of daily activities, evaluating generalized benefits to health and wellbeing, and assessing the utility of feedback, behaviour activation and self-management as behaviour change strategies. Single-case studies will be presented to illustrate the implementation of the bap in a West-Australian community. These four papers provide a novel perspective on ways of increasing the ‘healthy aging’ activities of people over 70 years.

Despite considerable resources being directed towards healthy living initiatives and mass media campaigns urging older people to adopt more physically active lifestyles, 75.2% of Australians over the age of 65 were considered “sedentary” in a recent National Heath Survey (Australian Bureau of Statistics, 2006). Improving the health and wellbeing of older people involves arranging supportive contexts and self-management of more physically active behaviours – an area that has received surprisingly little attention by behaviour analysts.This paper explores mainstream, approaches to increasing the healthy activities of older people, gives the rationale for a comprehensive, home-based behavioural program, and presents a behaviour analytic perspective as it pertains to the future of health promotion and healthy living initiatives for older people.

We examine the current definition of ADHD and its subtypes and the diagnostic procedure described in the DSM-IV. The use of parent and teacher reports and behaviour rating scales in the diagnostic process is also evaluated. The value of more objective data sources, such as direct observations, simulated environments, and continuous performance tests is highlighted. We also describe the measurement of the three behavioural domains of ADHD – Inattention, Hyperactivity and Impulsivity – according to current theory and research. We suggest that greater attention to this literature will help the development of comprehensive, standardised performance tests that add precision to the assessment and diagnosis of ADHD and the ADHD construct itself.

ADHD remains controversial in both its diagnosis and its treatment. Currently, diagnosis and assessment of ADHD rely on the use of questionnaires, rating scales, evaluation based on DSM-IV criteria, and continuous performance tests, all of which have their own weaknesses. This paper reports on the development of the Test of Attention Impulsivity and Hyperactivity in Children (TAIH-C), a standardised, behaviour based assessment of attention impulsivity and hyperactivity in children with ADHD. We present individual and group data on children independently diagnosed with ADHD and nonADHD classroom peers, to validate the implementation of the TAIH-C as a valuable tool in both diagnosing ADHD and designing precise.