Rethinking risk in pediatric research

This article reviews four areas of pediatric research in which we have identified questionable levels of allowable risk, exceeding those foreseen by the Commission. They are the following: (1) the categorization of increasingly risky interventions as minimal risk in a variety of protocols; (2) the increasing number of applications for federal panel review of research not otherwise approvable because of higher projected risk levels; (3) research on asymptomatic at risk children; and (4) the inclusion of children and adolescents in placebo-controlled trials for participants of all ages without performing subgroup analysis. While embracing the imperative to include children in research is an encouraging step towards providing the pediatric population with effective medical care and finally eradicating the therapeutic orphan, we must ensure that this research does not become overly permissive.     

Matching Judicial Supervision to Clients' Risk Status in Drug Court

This article reports outcomes from a program of experimental research evaluating the risk principle in drug courts. Prior studies revealed that participants who were high risk and had (a) antisocial personality disorder or (b) a prior history of drug abuse treatment performed better in drug court when scheduled to attend biweekly judicial status hearings in court. In contrast, participants who were low risk performed equivalently regardless of the court hearings schedule. This study prospectively matches drug court clients to the optimal schedule of court hearings based on an assessment of their risk status and compares outcomes to clients randomly assigned to the standard hearings schedule. Results confirmed that participants who were high risk and matched to biweekly hearings had better during-treatment outcomes than participants assigned to status hearings as usual. These findings provide confirmation of the risk principle in drug courts and yield practical information for enhancing the efficacy and cost-efficiency of drug courts.     

Dangerously antisocial youths who kill their parents

Adolescent parricide offenders are typically presented in the popular and professional literature as prosocial youths in fear of their lives, often killing to protect themselves or others from death or serious physical injury or to end the chronic abuse they and other family members suffer. There are, however, dangerously antisocial youths who kill their parents for selfish, instrumental reasons. The trial of Lyle and Eric Menendez, two affluent youths accused of the first degree murder of their parents, captured worldwide attention. The question “Were they abused kids or did they kill for the money” is addressed in terms of the author’s typology of parricide offenders. Pertinent case facts are examined in relation to her synthesis of the literature on adolescent parricide offenders. Close study of this case indicates that the brothers did not fit the profile of “the severely abused child”. An alternative explanation that more closely fits the established facts is presented. Pertinent questions that need to be addressed by mental health professionals examining adolescent parricide offenders are addressed.     

A planning-centred approach to project evaluation: Women in mainstream development projects

This article describes the process and outcomes of a “planning-centred” approach to three development projects in the Caribbean. A planning-centred approach to research involves the collaboration of planners and researchers in evaluation research, special attention to the dissemination and use of information and the promotion of contact between planners, sector specialists and recipients of development plans. The planning-centred approach to research is also conducive to understanding the role of gender in distributive processes. The paper describes the methodology of this form of project evaluation, alternative evaluation procedures and selected evaluation guidelines used by the agencies involved in the three Caribbean projects. The outcomes of a planning-centred approach are assessed. In the Caribbean projects the approach resulted in the better use of research information, better communication among planners, officials and project participants, greater sensitivity to women's participation in development and improved consciousness of the significance of gender for redistribute development programmes.     

Managing children's and adolescents' medical complaints amid parent conflict: Strategies and tools for professionals

Children and adolescents who are having difficulty coping with stress often present with complaints of physical discomfort. Effective treatment approaches exist for many of these issues. Among high-conflict parents, however, children's medical issues can become another canvas for conflict, with parents focused more on blaming one another for the child's distress than on options for assisting the child. Professionals can be drawn into the conflict to such a degree that they overlook essential steps for addressing and managing these issues. The authors present a research-informed model for managing medical and psychophysiological issues amid parental conflict.