A multivariate, criterion-referenced approach was used to assess prevalence of serious emotional disturbance among children on protective service case loads. Of 140 recipients of protective services. 72% were statistically indistinguishable from children in Washington State's most intensive mental health treatment programs. School problems, substance abuse, and antisocial behaviors were common in the sample, as were family histories of mental illness or substance abuse. Greatest service needs included family support groups, outpatient treatment, school-based treatment, and diagnostic services. These results underline the importance of structural changes to facilitate cross-system collaboration between mental health and protective services.

Suicide is a major public health problem among adolescents. Although the event is rare, and rates have stabilized and even shown slight reduction in recent years, suicide has nevertheless become the second leading cause of morbidity among youths aged 15 to 24, which is otherwise a robust and relatively disease-free population. Although research on predictive factors has yielded increasingly sensitive indices of who the high-risk adolescent might be, the inherent difficulty of predicting rare events from common ones has made sensitive and specific prediction most elusive. Current neurobiologic research holds promise for the use of biologic markers in the identification of high-risk adolescents, and pharmacologic research may yield further advances in the treatment of affectively disordered youths. At this point, the most promising approaches to treating adolescent suicide appear to be (1) treatment of disorders antecedent to suicide crises, such as depression, substance abuse, family conflict, and conduct disturbance, and (2) prevention efforts targeting known high-risk groups, such as affectively disordered young men with accompanying alcohol and drug involvement and other antisocial behavior.

Parents of severely emotionally and behaviorally disturbed children rarely have the opportunity to participate in the policy-making processes that affect their children's welfare. In the present study, a structured parent interview was developed as part of Washington State's Child and Adolescent Services System Program (CASSP). Thirty-five parents of disturbed children provided information about their children's problems and services histories. Respondents identified unnet needs and barriers to timely, effective intervention. The nature and quality of services received were examined in the context of CASSP service standards. The study confirmed that parents of disturbed children can provide information rich in implications for system change.

REKERs, GEORGE A.; AMARO-PLOTKIN, HORTENSIA D.; and Low, BENSON P. Sex-typed Mannerisms in Normal Boys and Girls as a Function of Sex and Age. CHILD DEVELOPMENT, 1977, 48, 275-278. Base rates were obtained in normal children on the occurrence of 8 expressive gestures previously observed in gender-disturbed boys. Although certain mannerisms of these boys had been labeled feminine by clinicians, no data existed on the occurrence of such gestures in the normal population. 8 operationally defined feminine gestures were recorded while 48 boys and girls of 2 age groups (4-5 years and 11-12 years) individually performed a standardized play task. Analysis of variance showed a significant overall difference between the sexes, and 3 of the gestures (limp wrist, arm flutters, and flexed elbow) were found to discriminate significantly between the sexes. No age differences were found.

SUMMARYBehavioral assessment and diagnostic testing procedures were developed to evaluate the treatment of an 8‐yr‐old boy with a pronounced gender disturbance. When a combined response‐cost and verbal prompt contingency was applied, the single target mannerism of limping‐the‐wrist markedly decreased and response generalization of the treatment effect occurred to other mannerisms. Behavior therapy procedures successfully suppressed feminine voice inflections, doll‐play, and predominant play with girls, and increased masculine play. The treatment effects were replicated in a multiple‐baseline intrasubject design. The 2‐yr independent follow‐up found a marked shift to normal gender‐role adjustment.

Behavioral treatment procedures were developed to suppress feminine sex-typed behaviors and to increase masculine sex-typed behaviors in an 8-year-old boy with “childhood cross-gender identity.” The boy's clinical history paralleled the retrospective reports of adult transsexuals, including (1) feminine voice inflection and predominantly feminine content in speech, (2) verbal self-reference as “sissy” and “fag” and statements about his preference to be a girl, (3) feminine hand and arm gestures and “swishy” gait, (4) an aversion to masculine play activities, (5) a strong preference for girl playmates and taking a feminine role in play and role-playing, and (6) improvised cross-dressing. With a multiple-baseline intrasubject design across stimulus environments and across behaviors, the subject was treated sequentially in the clinic, at home, and in the school. The boy's mother was trained to administer a token economy program in the home, and the school teacher was taught to apply a response-cost procedure in the classroom. The initial treatment effects were found to be largely response specific and stimulus specific, necessitating treatment for a number of behaviors in the three major environments. Followup data 12 months after treatment termination suggest that the boy's sex-typed behaviors have become essentially normalized. This treatment holds promise for correcting pathological gender identity development in boys and for relieving the associated emotional adjustment problems.