Leonard Doerfler - Academia.edu (original) (raw)
Papers by Leonard Doerfler
Psychological Services, 2010
This study examined whether stressful events occurred during the week preceding admission to an i... more This study examined whether stressful events occurred during the week preceding admission to an inpatient psychiatric unit in a sample of 97 adults with serious mental illness. The study also examined whether patients who had been readmitted within 30 days reported different stressful events than patients who had lived in the community for at least 6 months prior to admission.
Mental Health Services Research, 2000
This study examined predictors of readmission to a general hospital psychiatric unit that provide... more This study examined predictors of readmission to a general hospital psychiatric unit that provided acute inpatient care. Participants were 370 patients admitted to the inpatient unit over a 15-month period. During this period, 105 (28%) patients were readmitted to the unit. Readmitted patients were compared to patients who were not readmitted on (a) symptom improvement during hospitalization, (b) psychosocial and clinical variables, and (c) length of hospitalization. The readmitted patients presented with levels of psychological symptoms similar to those of patients who were not readmitted. Moreover, readmitted patients and patients who were not readmitted reported comparable relief in symptom severity during hospitalization. Readmitted patients were more likely to have at least one previous psychiatric hospitalization, be unemployed, be participating in day treatment, and receiving medicare and social security disability insurance. Rehospitalization is a significant problem and the patients' self-reported symptomatology is not a major determinant of readmission for inpatient treatment.
Journal of Behavioral Health Services & Research, 2002
Journal of Behavioral Health Services & Research, 2002
The evolution of managed behavioral health care has led to an increased emphasis on reliable and ... more The evolution of managed behavioral health care has led to an increased emphasis on reliable and valid assessment of outcomes in clinical practice. The present study evaluated the convergent, divergent, and concurrent validity and sensitivity to change of two widely used measures: Behavior and Symptom Identification Scale (BASIS-32) and Outcome Questionnaire (OQ-45). Comparisons of the two measures revealed that both were sensitive to change over a relatively short inpatient stay. Both measures also showed evidence of convergent and divergent validity of specific subscales, although the total scores of each measure also were highly correlated. Evidence of concurrent validity was suggested by differences between diagnostic groups on specific subscale scores. Together with previous research, these results suggest that the BASIS-32 and OQ-45 can be useful measures for tracking patient functioning over a range of treatment contexts.
Cognitive Therapy and Research, 1981
Cognitive Therapy and Research, 1984
Recent research has emphasized the importance of interpersonal problems with depression. It has b... more Recent research has emphasized the importance of interpersonal problems with depression. It has been hypothesized that deficits in interpersonal problem-solving skills may account for many of these problems. Three studies that examined the relationship between problem-solving skills and depression are reported. Problem-solving skills among children, adolescents, and adults were assessed by the Means-Ends Problem Solving Test. Contrary to prediction, there were no differences in problem-solving skills between depressed and nondepressed groups; these findings were consistent across each age group. The external validity of such paper-and-pencil measures of problem solving is questioned; it is suggested that future research focus on how depressed individuals solve real-life problems.
Annals of The New York Academy of Sciences, 2003
Abstract: Our objective was to investigate the relationship between a lifetime history of traumat... more Abstract: Our objective was to investigate the relationship between a lifetime history of traumatic stress, defined as physical and/or sexual abuse and aggression and psychosocial functioning in a sample of clinically referred and nonclinically referred children and adolescents. This is a retrospective case comparison study. Three groups of children were identified, assessed, matched for age, and partially matched for gender. Children clinically referred to residential treatment with a history of abuse (N= 29) were compared with children clinically referred to residential treatment without a history of abuse (N= 29), and a nonclinical group of children residing in the community (N= 29). Variables investigating specific types of aggression, IQ, and psychopathology were assessed across the three groups. Clinically referred children scored worse on all measures compared with nonclinical community children. Clinically referred abused children scored higher on measures of aggression and significantly higher on measures of reactive aggression and verbal aggression than clinically referred nonabused children. Clinically referred abused children had significantly lower verbal IQ scores than clinically referred nonabused children, but no difference in psychopathology. Results support the importance of assessing specific types of aggression in samples of traumatized youths. Verbal information processing may be especially vulnerable in abused children and adolescents and enhance vulnerability to aggressive responding.
Child Psychiatry & Human Development, 2007
The present study examined the frequency and characteristics of panic disorder in children and ad... more The present study examined the frequency and characteristics of panic disorder in children and adolescents who had been referred to a pediatric psychopharmacology clinic. Of the 280 children and adolescents evaluated in this clinic, 35 were diagnosed with panic disorder using a semi-structured clinical interview (K-SADS) and other objective measures. Approximately half of the youngsters with panic disorder also met criteria for the diagnosis of agoraphobia. There was extensive comorbidity between panic disorder and other internalizing and externalizing disorders. Parents reported clinically significant levels of child symptomatology on the CBCL. Teacher-and child-reported symptomatology on the CBCL was within the normal range. At the same time, it was notable that no child had been referred specifically for evaluation or treatment of panic disorder or agoraphobia. Implications for clinical assessment/identification and treatment are discussed.
Annals of Clinical Psychiatry, 2007
Conduct disorder is considered difficult to treat, but comorbid psychiatric disorders may be a ba... more Conduct disorder is considered difficult to treat, but comorbid psychiatric disorders may be a basis for treating some youths with conduct disorder. We sought to identify patterns of comorbid psychiatric diagnoses and psychopathology associated with conduct disorder by reported age-of-onset. Referred children and adolescents, aged 4-17 years old, were clinically evaluated. Ages of onset of CD symptoms (N=53) were ascertained and divided according to DSM-IV criteria as childhood onset (<10 years old) or adolescent onset (>or=10 years old). Childhood-onset conduct disorder was associated with higher rates of ADHD and anxiety disorders, male gender, and perceived and total hostility scores than adolescent-onset conduct disorder. Adolescent-onset was associated with higher rates of PTSD, alcohol and substance use disorders, complex comorbidity (i.e., 6+ diagnoses lifetime), and female gender. Understanding age-of-onset-related patterns of comorbidity may facilitate psychiatric treatment planning in children and adolescents with conduct disorder.
Journal of Child and Family Studies, 2009
We examined the relationship of gender and different forms of abuse experience on internalizing s... more We examined the relationship of gender and different forms of abuse experience on internalizing symptoms, externalizing symptoms, and IQ in a sample of 397 youngsters who were admitted to a residential treatment program. Three types of abuse experience were examined in this study: sexual abuse only, physical abuse only, and both sexual and physical abuse. Results indicate that girls exhibited higher levels of internalizing and externalizing symptoms even though abuse experience was accounted for in the analyses. Moreover, youngsters who had experienced sexual abuse (but not physical abuse) exhibited higher levels of internalizing and externalizing symptoms than youngsters who had not been abused. Implications for developing individualized interventions based on gender and abuse experience in residential treatment programs is discussed.
Journal of Affective Disorders, 2011
Background: This study had two objectives: (1) examine characteristics of aggression in children ... more Background: This study had two objectives: (1) examine characteristics of aggression in children and adolescents diagnosed with bipolar disorder and (2) determine whether the CBCL pediatric bipolar disorder profile differentiated youngsters with bipolar disorder from youngsters with ADHD. Method: Children and adolescents referred to a pediatric psychopharmacology clinic were systematically evaluated for psychopathology using a psychiatrist-administered diagnostic interview, parent-and teacher-report rating scales assessing the child's behavior, and childcompleted self-report scales. In this sample, 27 children and adolescents were diagnosed with bipolar disorder and 249 youngsters were diagnosed with ADHD without co-occurring bipolar disorder. These two groups were compared to determine whether there were significant differences on various measures of psychopathology. Results: Youngsters diagnosed with bipolar disorder were more verbally aggressive and exhibited higher levels of reactive aggression than youngsters with ADHD without co-occurring bipolar disorder. Youngsters with bipolar disorder also reported higher levels of depressive symptoms than youngsters with ADHD without bipolar disorder. The CBCL pediatric bipolar disorder profile did not accurately identify youngsters diagnosed with bipolar disorder. Conclusions: The present findings present a picture of manic youngsters as verbally aggressive and argumentative, who respond with anger when frustrated. Youngsters diagnosed with bipolar disorder and ADHD exhibited significant levels of impulsive behavior and attention problems, but youngsters with bipolar disorder also exhibited significant levels of aggressive behavior and dysphoric mood. Finally, the CBCL pediatric bipolar disorder profile did not accurately identify youngsters who were diagnosed with bipolar disorder.
Journal of Anxiety Disorders, 2008
This study examined whether youngsters with separation anxiety disorder (SAD) and panic disorder ... more This study examined whether youngsters with separation anxiety disorder (SAD) and panic disorder (PD) had experienced more separation-related events than youngsters with SAD (without comorbid PD). We also examined whether age of onset of SAD and comorbidity with other psychological disorders was related to the occurrence of PD. We compared youngsters who were diagnosed with SAD and PD (N = 31) with youngsters who were diagnosed with SAD without comorbid PD (N = 63) for the number of separation-related events, severity of psychopathology, and parent and child CBCL ratings, age of onset of SAD, and the number of comorbid diagnoses. The findings indicate that youngsters with SAD and PD had a later age of onset of SAD and more extensive psychopathology and functional impairment than youngsters with SAD (without comorbid PD). Contrary to hypothesis, there were no differences between the groups in the occurrence or number of separation-related events. #
Journal of Child and Family Studies, 2004
Studies of youths in residential treatment that utilize systematic assessments and validated meas... more Studies of youths in residential treatment that utilize systematic assessments and validated measures are rare. We examined psychopathology, family characteristics, occurrence of physical or sexual abuse, types of aggressive behavior, hyperactive/impulsive behavior, medical and neurological problems, and self-reported drug and alcohol use in 397 youth who were assessed using reliable measures and consecutively treated in a residential treatment center. Results indicate high rates of internalizing and externalizing psychopathology, aggressive behavior, and consistent gender differences, with girls having higher levels of internalizing and externalizing psychopathology and aggressive behavior. The sample was characterized by high rates of medical problems including asthma, seizures, and obesity, as well as evidence of extensive family dysfunction, including high rates of parental alcohol use, violence, and physical or sexual abuse. Residential treatment needs to progress beyond the one size fits all approach and develop more specific and empirically proven treatments for the specific needs of this population.
Current Attention Disorders Reports, 2009
Comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) are common in clinically r... more Comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) are common in clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Early recognition and treatment of co-occurring ADHD and ODD and/or CD is important because comorbidity influences symptom severity, prognosis, and treatment. Research on treatment supports the importance of behavior therapies for ODD and multimodal psychosocial interventions delivered simultaneously and intensively for CD with adjunctive medication for ADHD symptoms. Clinical trials are beginning to show that stimulants and atomoxetine are effective for ADHD and ODD symptoms when the disorders occur together. It is presently unclear if ODD in the absence of ADHD responds to pharmacotherapy. More research is needed examining the effects of commonly prescribed ADHD medications on CD symptoms. Research suggests a high prevalence of lifetime comorbidity with ODD in clinically referred patients with ADHD.
Journal of Abnormal Psychology, 1985
ABSTRACT Several theories propose that depression is best conceived as an interactional process i... more ABSTRACT Several theories propose that depression is best conceived as an interactional process involving the depressed person and that person's family and friends. In contrast, laboratory studies designed to test these models have examined strangers' reactions to depressives and therefore have little relevance to the models. We argue that relevant empirical research is necessary before theoretical conjectures and treatment strategies based on an interactional model are accepted.
Journal of Abnormal Psychology, 1985
ABSTRACT Several theories propose that depression is best conceived as an interactional process i... more ABSTRACT Several theories propose that depression is best conceived as an interactional process involving the depressed person and that person's family and friends. In contrast, laboratory studies designed to test these models have examined strangers' reactions to depressives and therefore have little relevance to the models. We argue that relevant empirical research is necessary before theoretical conjectures and treatment strategies based on an interactional model are accepted.
Psychological Services, 2010
This study examined whether stressful events occurred during the week preceding admission to an i... more This study examined whether stressful events occurred during the week preceding admission to an inpatient psychiatric unit in a sample of 97 adults with serious mental illness. The study also examined whether patients who had been readmitted within 30 days reported different stressful events than patients who had lived in the community for at least 6 months prior to admission.
Mental Health Services Research, 2000
This study examined predictors of readmission to a general hospital psychiatric unit that provide... more This study examined predictors of readmission to a general hospital psychiatric unit that provided acute inpatient care. Participants were 370 patients admitted to the inpatient unit over a 15-month period. During this period, 105 (28%) patients were readmitted to the unit. Readmitted patients were compared to patients who were not readmitted on (a) symptom improvement during hospitalization, (b) psychosocial and clinical variables, and (c) length of hospitalization. The readmitted patients presented with levels of psychological symptoms similar to those of patients who were not readmitted. Moreover, readmitted patients and patients who were not readmitted reported comparable relief in symptom severity during hospitalization. Readmitted patients were more likely to have at least one previous psychiatric hospitalization, be unemployed, be participating in day treatment, and receiving medicare and social security disability insurance. Rehospitalization is a significant problem and the patients' self-reported symptomatology is not a major determinant of readmission for inpatient treatment.
Journal of Behavioral Health Services & Research, 2002
Journal of Behavioral Health Services & Research, 2002
The evolution of managed behavioral health care has led to an increased emphasis on reliable and ... more The evolution of managed behavioral health care has led to an increased emphasis on reliable and valid assessment of outcomes in clinical practice. The present study evaluated the convergent, divergent, and concurrent validity and sensitivity to change of two widely used measures: Behavior and Symptom Identification Scale (BASIS-32) and Outcome Questionnaire (OQ-45). Comparisons of the two measures revealed that both were sensitive to change over a relatively short inpatient stay. Both measures also showed evidence of convergent and divergent validity of specific subscales, although the total scores of each measure also were highly correlated. Evidence of concurrent validity was suggested by differences between diagnostic groups on specific subscale scores. Together with previous research, these results suggest that the BASIS-32 and OQ-45 can be useful measures for tracking patient functioning over a range of treatment contexts.
Cognitive Therapy and Research, 1981
Cognitive Therapy and Research, 1984
Recent research has emphasized the importance of interpersonal problems with depression. It has b... more Recent research has emphasized the importance of interpersonal problems with depression. It has been hypothesized that deficits in interpersonal problem-solving skills may account for many of these problems. Three studies that examined the relationship between problem-solving skills and depression are reported. Problem-solving skills among children, adolescents, and adults were assessed by the Means-Ends Problem Solving Test. Contrary to prediction, there were no differences in problem-solving skills between depressed and nondepressed groups; these findings were consistent across each age group. The external validity of such paper-and-pencil measures of problem solving is questioned; it is suggested that future research focus on how depressed individuals solve real-life problems.
Annals of The New York Academy of Sciences, 2003
Abstract: Our objective was to investigate the relationship between a lifetime history of traumat... more Abstract: Our objective was to investigate the relationship between a lifetime history of traumatic stress, defined as physical and/or sexual abuse and aggression and psychosocial functioning in a sample of clinically referred and nonclinically referred children and adolescents. This is a retrospective case comparison study. Three groups of children were identified, assessed, matched for age, and partially matched for gender. Children clinically referred to residential treatment with a history of abuse (N= 29) were compared with children clinically referred to residential treatment without a history of abuse (N= 29), and a nonclinical group of children residing in the community (N= 29). Variables investigating specific types of aggression, IQ, and psychopathology were assessed across the three groups. Clinically referred children scored worse on all measures compared with nonclinical community children. Clinically referred abused children scored higher on measures of aggression and significantly higher on measures of reactive aggression and verbal aggression than clinically referred nonabused children. Clinically referred abused children had significantly lower verbal IQ scores than clinically referred nonabused children, but no difference in psychopathology. Results support the importance of assessing specific types of aggression in samples of traumatized youths. Verbal information processing may be especially vulnerable in abused children and adolescents and enhance vulnerability to aggressive responding.
Child Psychiatry & Human Development, 2007
The present study examined the frequency and characteristics of panic disorder in children and ad... more The present study examined the frequency and characteristics of panic disorder in children and adolescents who had been referred to a pediatric psychopharmacology clinic. Of the 280 children and adolescents evaluated in this clinic, 35 were diagnosed with panic disorder using a semi-structured clinical interview (K-SADS) and other objective measures. Approximately half of the youngsters with panic disorder also met criteria for the diagnosis of agoraphobia. There was extensive comorbidity between panic disorder and other internalizing and externalizing disorders. Parents reported clinically significant levels of child symptomatology on the CBCL. Teacher-and child-reported symptomatology on the CBCL was within the normal range. At the same time, it was notable that no child had been referred specifically for evaluation or treatment of panic disorder or agoraphobia. Implications for clinical assessment/identification and treatment are discussed.
Annals of Clinical Psychiatry, 2007
Conduct disorder is considered difficult to treat, but comorbid psychiatric disorders may be a ba... more Conduct disorder is considered difficult to treat, but comorbid psychiatric disorders may be a basis for treating some youths with conduct disorder. We sought to identify patterns of comorbid psychiatric diagnoses and psychopathology associated with conduct disorder by reported age-of-onset. Referred children and adolescents, aged 4-17 years old, were clinically evaluated. Ages of onset of CD symptoms (N=53) were ascertained and divided according to DSM-IV criteria as childhood onset (<10 years old) or adolescent onset (>or=10 years old). Childhood-onset conduct disorder was associated with higher rates of ADHD and anxiety disorders, male gender, and perceived and total hostility scores than adolescent-onset conduct disorder. Adolescent-onset was associated with higher rates of PTSD, alcohol and substance use disorders, complex comorbidity (i.e., 6+ diagnoses lifetime), and female gender. Understanding age-of-onset-related patterns of comorbidity may facilitate psychiatric treatment planning in children and adolescents with conduct disorder.
Journal of Child and Family Studies, 2009
We examined the relationship of gender and different forms of abuse experience on internalizing s... more We examined the relationship of gender and different forms of abuse experience on internalizing symptoms, externalizing symptoms, and IQ in a sample of 397 youngsters who were admitted to a residential treatment program. Three types of abuse experience were examined in this study: sexual abuse only, physical abuse only, and both sexual and physical abuse. Results indicate that girls exhibited higher levels of internalizing and externalizing symptoms even though abuse experience was accounted for in the analyses. Moreover, youngsters who had experienced sexual abuse (but not physical abuse) exhibited higher levels of internalizing and externalizing symptoms than youngsters who had not been abused. Implications for developing individualized interventions based on gender and abuse experience in residential treatment programs is discussed.
Journal of Affective Disorders, 2011
Background: This study had two objectives: (1) examine characteristics of aggression in children ... more Background: This study had two objectives: (1) examine characteristics of aggression in children and adolescents diagnosed with bipolar disorder and (2) determine whether the CBCL pediatric bipolar disorder profile differentiated youngsters with bipolar disorder from youngsters with ADHD. Method: Children and adolescents referred to a pediatric psychopharmacology clinic were systematically evaluated for psychopathology using a psychiatrist-administered diagnostic interview, parent-and teacher-report rating scales assessing the child's behavior, and childcompleted self-report scales. In this sample, 27 children and adolescents were diagnosed with bipolar disorder and 249 youngsters were diagnosed with ADHD without co-occurring bipolar disorder. These two groups were compared to determine whether there were significant differences on various measures of psychopathology. Results: Youngsters diagnosed with bipolar disorder were more verbally aggressive and exhibited higher levels of reactive aggression than youngsters with ADHD without co-occurring bipolar disorder. Youngsters with bipolar disorder also reported higher levels of depressive symptoms than youngsters with ADHD without bipolar disorder. The CBCL pediatric bipolar disorder profile did not accurately identify youngsters diagnosed with bipolar disorder. Conclusions: The present findings present a picture of manic youngsters as verbally aggressive and argumentative, who respond with anger when frustrated. Youngsters diagnosed with bipolar disorder and ADHD exhibited significant levels of impulsive behavior and attention problems, but youngsters with bipolar disorder also exhibited significant levels of aggressive behavior and dysphoric mood. Finally, the CBCL pediatric bipolar disorder profile did not accurately identify youngsters who were diagnosed with bipolar disorder.
Journal of Anxiety Disorders, 2008
This study examined whether youngsters with separation anxiety disorder (SAD) and panic disorder ... more This study examined whether youngsters with separation anxiety disorder (SAD) and panic disorder (PD) had experienced more separation-related events than youngsters with SAD (without comorbid PD). We also examined whether age of onset of SAD and comorbidity with other psychological disorders was related to the occurrence of PD. We compared youngsters who were diagnosed with SAD and PD (N = 31) with youngsters who were diagnosed with SAD without comorbid PD (N = 63) for the number of separation-related events, severity of psychopathology, and parent and child CBCL ratings, age of onset of SAD, and the number of comorbid diagnoses. The findings indicate that youngsters with SAD and PD had a later age of onset of SAD and more extensive psychopathology and functional impairment than youngsters with SAD (without comorbid PD). Contrary to hypothesis, there were no differences between the groups in the occurrence or number of separation-related events. #
Journal of Child and Family Studies, 2004
Studies of youths in residential treatment that utilize systematic assessments and validated meas... more Studies of youths in residential treatment that utilize systematic assessments and validated measures are rare. We examined psychopathology, family characteristics, occurrence of physical or sexual abuse, types of aggressive behavior, hyperactive/impulsive behavior, medical and neurological problems, and self-reported drug and alcohol use in 397 youth who were assessed using reliable measures and consecutively treated in a residential treatment center. Results indicate high rates of internalizing and externalizing psychopathology, aggressive behavior, and consistent gender differences, with girls having higher levels of internalizing and externalizing psychopathology and aggressive behavior. The sample was characterized by high rates of medical problems including asthma, seizures, and obesity, as well as evidence of extensive family dysfunction, including high rates of parental alcohol use, violence, and physical or sexual abuse. Residential treatment needs to progress beyond the one size fits all approach and develop more specific and empirically proven treatments for the specific needs of this population.
Current Attention Disorders Reports, 2009
Comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) are common in clinically r... more Comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) are common in clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Early recognition and treatment of co-occurring ADHD and ODD and/or CD is important because comorbidity influences symptom severity, prognosis, and treatment. Research on treatment supports the importance of behavior therapies for ODD and multimodal psychosocial interventions delivered simultaneously and intensively for CD with adjunctive medication for ADHD symptoms. Clinical trials are beginning to show that stimulants and atomoxetine are effective for ADHD and ODD symptoms when the disorders occur together. It is presently unclear if ODD in the absence of ADHD responds to pharmacotherapy. More research is needed examining the effects of commonly prescribed ADHD medications on CD symptoms. Research suggests a high prevalence of lifetime comorbidity with ODD in clinically referred patients with ADHD.
Journal of Abnormal Psychology, 1985
ABSTRACT Several theories propose that depression is best conceived as an interactional process i... more ABSTRACT Several theories propose that depression is best conceived as an interactional process involving the depressed person and that person's family and friends. In contrast, laboratory studies designed to test these models have examined strangers' reactions to depressives and therefore have little relevance to the models. We argue that relevant empirical research is necessary before theoretical conjectures and treatment strategies based on an interactional model are accepted.
Journal of Abnormal Psychology, 1985
ABSTRACT Several theories propose that depression is best conceived as an interactional process i... more ABSTRACT Several theories propose that depression is best conceived as an interactional process involving the depressed person and that person's family and friends. In contrast, laboratory studies designed to test these models have examined strangers' reactions to depressives and therefore have little relevance to the models. We argue that relevant empirical research is necessary before theoretical conjectures and treatment strategies based on an interactional model are accepted.