DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) are rare disorders sharing social difficulties with autism. The DSM-5 and ICD-10 (International Classification of Diseases, 10th revsion) state that RAD/DSED should not be diagnosed in children with autism. The purpose of our study is to determine whether children can meet criteria for both autism and RAD/DSED and to identify specific symptoms discriminating the disorders. Subjects were 486 children with autism and no RAD/DSED and 20 with RAD/DSED, 4–17 years of age. In total, 13 children with RAD/DSED met criteria for autism. Using the Checklist for Autism Spectrum Disorder (CASD), there was no overlap in total scores between the RAD/DSED with autism group (score range = 15–27) versus the RAD/DSED without autism group (range = 7–10 ). The autism with and without RAD/DSED groups did not differ in CASD scores. Nine of the CASD autism symptoms were found only in the autism with and without RAD/DSED groups. Our study demonstrates that children can meet criteria for both autism and RAD/DSED and that the disorders are easily differentiated by the presence of specific autism symptoms. Autism is a neurogenetic disorder, and RAD/DSED results from severe social–emotional maltreatment. Given the different etiologies, there is no reason why a child cannot have both disorders.
Having the opportunity to re-read Pet-Oriented Child Psychotherapy was like visiting an old friend and reminiscing about times gone by all too fast. The re-read allowed me an opportunity to conceptualize how many of Levinson’s early tenets continue to be relevant today. As a trailblazer, Levinson made a discovery that drastically changed the way we view and understand the power of the human animal bond.
Many therapists regard alliance ruptures as one of the greatest challenges therapists face in the therapy room. Alliance ruptures has been previously defined as breakdowns in the process of negotiation of treatment tasks and goals and a deterioration in the affective bond between patient and therapist. Alliance ruptures have been found to predict premature termination of treatment and poor treatment outcomes. But ruptures can also present important opportunities for gaining insight and awareness and for facilitating therapeutic change. A process of rupture resolution may lead to beneficial outcomes and serve as a corrective emotional experience. The article describes unique processes of alliance rupture resolution inherent in animal-assisted psychotherapy (AAP). Building on Safran and Muran’s model and on clinical examples, the article describes strategies for identifying ruptures in AAP and techniques for repairing them to facilitate a corrective experience in treatment. Implications for clinical practice and future research are discussed.
Animal-assisted psychotherapy (AAP) inherently incorporates standpoints, interventions, and ways of action promoting the development of the reflective function and mentalization, and thus has special value for parent–child psychotherapy. Two central tools in AAP contribute to this process. The first is the ethical stance of the therapist, who sees the animals as full partners in the therapy situation, respecting them as subjects with needs, desires, and thoughts of their own. The second tool combines nonverbal communication with animals together with the relating, in the here and now, to the understanding and decoding of body language of everyone in the setting. Nonverbal communication in AAP enables access to implicit communication patterns occurring between parent and child. This article provides a survey of theoretical development and research constituting a basis for the development of therapeutic approaches for the improvement of parent–children dynamics, followed by a description of a dyadic therapy model of a mentalization-based treatment originating from a psychoanalytic-relational orientation. Clinical examples are provided to illustrate AAP processes in parent–child psychotherapy (consent was received for examples that were not aggregated).
Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has a prevalence of 0.4–2.4% and is defined as ‘generalised disabling fatigue persisting after routine tests and investigations have failed to identify an obvious underlying cause’. One-third of young people with CFS/ME have probable depression. Little is known about why depression develops, the relationship between depression and CFS/ME, or what treatment might be helpful.
We conducted nine semi-structured interviews with young people with CFS/ME (aged 13–17 years, 8/9 female) and probable depression, covering perceived causes of depression, the relationship between CFS/ME and depression, and treatment strategies.
Most thought CFS/ME caused depression. Many discussed a cyclical relationship: low mood made CFS/ME worse. A sense of loss was common. CFS/ME restricted activities participants valued and changed systemic structures, causing depression. There was no single helpful treatment approach. Individualised approaches using combinations of cognitive behavioural therapy (CBT), medication, activity management and other strategies were described.
This study suggests that depression may be secondary to CFS/ME in young people because of the impact of CFS/ME on quality of life. Clinicians treating young people with CFS/ME need to consider strategies to prevent development of depression, and research is needed into approaches that are effective in treating CFS/ME with co-morbid depression.
Individuals with sensory regulation disorders present with many difficulties in terms of managing emotions, behavior, and motor control. Children with such difficulties are often referred to psychiatric clinics for assessment of their behavioral and emotional problems. Few studies have investigated the role of environmental factors on sensory dysfunctions, and none have specifically studied its association with child attachment in a clinical sample.
In this cross-sectional study, we examined the association between sensory regulation and child attachment among preschoolers referred to a psychiatric clinic.
A sample of 60 preschoolers and their mothers were recruited through a child psychiatric clinic. Child attachment was assessed with the gold standard separation–reunion procedure for preschoolers. Parents completed the sensory profile, which assesses the presence of child hypersensitivity (sensitivity and avoidant scale) and hyposensitivity (sensory seeking and registration scale).
Data showed that 57% of the children were presented with clinical symptoms of sensory regulation. In addition, 53% of the children were classified insecure behaviorally disorganized or insecure disorganized controlling. In particular, results revealed that children classified as insecure disorganized controlling were significantly more likely to show hypersensitivity avoidance and sensory-seeking behaviors.
This study underscores the importance of the parent–child relationship for children with sensory regulation difficulties.
The newest iteration of the Diagnostic and Statistical Manual–fifth edition (DSM-5), is the first to include the diagnosis of disruptive mood dysregulation disorder (DMDD). The assessment and diagnosis of psychopathology in children are complicated, particularly for mood disorders. Practice can be guided by the use of well-validated instruments. However, as this is a new diagnosis existing instruments have not yet been evaluated for the diagnosis of DMDD. This study seeks to provide a method for using existing structured interview instruments to assess for this contemporary diagnosis. The Children’s Interview for Psychiatric Syndromes (ChIPS) and the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) are reviewed and existing items consistent with a diagnosis of DMDD are identified. Finally, a case is presented using both measures and applying the theoretical items identified to illustrate how one might use these measures to assess DMDD. Limitations and future directions are discussed.
Punch injuries are a form of self-harm characterised by the intentional act of striking an object with a closed fist. We aimed to describe the characteristics and trends in young people presenting with injuries sustained via the punch mechanism. A comprehensive retrospective review of medical records was completed of all young people aged 10–18 years presenting to our Central London Emergency Department over a 12-month period. A subset of the total group was identified as the punch injury subgroup. A total of 78 punch injury presentations were identified. In this subgroup, the male:female ratio is 4.57:1; 37.18% of presentations were associated with a fracture (n = 29) and 35.90% (n = 28) of patients re-presented following another punch injury, as a victim of violence, or by other psychiatric presentation. In conclusion, a male preponderance was observed, with frequent re-presentations, often in high-risk circumstances. An opportunity for screening, including mental health, social and substance misuse, was identified. Further research is needed to enable targeted effective interventions in this group.
As survival rates continue to improve for children diagnosed with cancer, strides in achieving better psychosocial outcomes for both children with cancer and their families have been accentuated. The current study aimed to explore the experiences of siblings of children diagnosed with cancer and attempted to overcome some of the limitations described in previous research. Primarily, the study considered the theoretical framework of posttraumatic growth (PTG) in the project design and analysis. Semi-structured interviews were completed with six siblings. Thematic analysis was employed to identify themes within the data set as a whole. The data revealed that siblings experienced a range of difficult emotions throughout the cancer trajectory as well as experiencing remarkable changes in their lives. This included both positive and negative changes. These changes included increased empathy and resilience, improved family relationships, disrupted routine, increased responsibility and perceived changes in the ill child. Siblings described factors which they found helpful and unhelpful in adjusting to these changes. The report ends with a discussion of the themes and their clinical and theoretical implications. The report also highlights the research limitations and areas for future investigation.
Cognitive remediation therapy (CRT) is an intervention for anorexia nervosa (AN) that focuses on ameliorating the neuropsychological inefficiencies that underlie the illness. The current literature has reported promising results regarding its efficacy as an intervention for AN. However, there is a scarcity of studies considering the implementation of CRT in a child and adolescent population. This article describes an individual CRT therapy programme for children and adolescents with AN delivered on an inpatient unit for eating disorders. It considers the therapeutic process including the differing viewpoints of the patients and the therapists. The article concludes that CRT can be viewed as an engaging therapeutic intervention that could be useful as an additional treatment for AN.
The development of ‘youth-friendly’ services has become a priority across a wide range of health-care contexts. However, relatively few studies have specifically examined users’ experiences of, and preferences for, child and adolescent mental health care. The current study investigated young service users’ views of outpatient and community mental health clinics in Sweden, based on two data sources. First, focus group interviews were conducted with seven children and adolescents (aged 10–18 years) to explore both positive and negative experiences of mental health care. Second, written suggestions about specific service improvements were obtained from 106 children and adolescents. Qualitative content analysis revealed three overarching themes: ‘Accessibility’, ‘Being heard and seen’ and ‘Usefulness of sessions’. Young people’s recommendations for improving practice included more convenient appointment times, offered in welcoming settings; opportunities to communicate more openly with clinical staff, enabling sensitive discussion of mental health and wider personal issues; and more structured treatments that offer greater credibility and relevance to young people’s mental health and developmental needs. Young people also discussed being compelled by parents and school professionals to engage in treatment. Attending to young people’s preferences must be a priority in order to overcome ambivalence about session attendance, and enhance treatment participation and outcomes.
The complexity of children’s entrance into mental health treatment has been the growing focus of much recent research. However, little attention has been given to the exploration of this phenomenon from the clients’ point of view. This study aimed to gain understanding of the experience of entering therapy as a child through examination of the recollections of adult former clients who had participated as children in expressive arts group therapy (EAGT). Semi-structured open-ended interviews were conducted with 20 adult former child therapy clients who had participated in EAGT for at least 1year. Two major themes were revealed: one concerning participants’ perceptions of the reasons for being in therapy as children and the other concerning their recollections and perception of their attitudes toward the idea of being in therapy. These two themes point to the central role of social, emotional, and cognitive developmental factors in the establishment of attitudes toward enrollment in psychotherapy, highlighting the difference between adults and children. These findings correspond with other studies in this area, adding a presentation of the experience from the client’s perspective.
To obtain a child’s perspective during a mental health assessment, he or she is usually interviewed. Although researchers and clinicians generally agree that it is beneficial to hear a child’s account of his or her presenting issues, there is debate about whether children provide reliable or valid clinical information during these interviews. Here, we examined whether children provide clinically and diagnostically relevant information in a clinical setting. In all, 31 children aged 5–12-years undergoing mental health assessments were asked open-ended questions about their presenting problems during a semi-structured interview. We coded the information that children reported to determine whether it was clinically relevant and could be used to diagnose their problems and to formulate and plan treatment. We also coded children’s information to determine whether it was congruent with the children’s presenting problems and their eventual clinical diagnoses. Most of the information that children reported was clinically relevant and included information about behaviour, affect, temporal details, thoughts, people, the environment, and the child’s physical experiences. The information that children reported was also clinically valid; it was congruent with the problems that were discussed (84%) and also with the eventual diagnosis that the child received after a complete assessment (74%). We conclude that children can contribute relevant, clinically useful, valid information during clinical psychological assessments.
The aim of the present research was to explore clinician attitudes to outcome measures and, in particular, the facilitators and barriers to implementing outcome measures. An up-to-date exploration of clinician attitudes is especially needed in the context of recent policies on the implementation of outcome measures in child and adolescent mental health services (CAMHS), and because evidence suggests that there is a disparity between policy recommendations and the use of outcome measures in clinical practice. Semi-structured interviews were conducted with nine CAMHS clinicians from a Mental Health Trust in South London. Two levels of implementation emerged from the analysis: (1) the service level, regarding the implementation of outcome measures across a service to inform service improvement and (2) the session level, regarding the implementation of outcome measures within individual clinical sessions. The present research described training and ongoing support as a crucial facilitator of use at both service and session levels. This included help overcoming local contextual barriers, such as resources, information systems and administrative processes. The research showed that a balance is needed between a mandatory and uniform approach across a service and providing clinicians with support to use outcome measures with all service users for whom they are appropriate.
Family therapists understand that children presenting for treatment are often bearers of symptoms signalling relational problems within the family system. Rather than addressing the children’s symptoms in isolation, family therapists typically take those relational problems as their starting point in therapy. This study used the School-aged Assessment of Attachment (SAA) to assess the self-protective (attachment) strategies of the siblings of children presenting for psychiatric evaluation and also of the siblings of control children drawn from the normative population. Siblings of children in the clinical group were much more likely than siblings of control children to use at-risk self-protective strategies and to have markers suggestive of unresolved loss or trauma. School-aged siblings were found to use a broad range of strategies, and the pattern of change from first born to later born involved either a reversal of strategy or a shift to a more complex strategy. The study highlights that siblings of children presenting to mental health services are significantly affected by family relational stress. A family systems approach to assessment, one that enquires about the wellbeing of all family members, will ensure that the emotional needs of siblings are also addressed during the therapy process.
Who I am as a working-class black African woman cannot be disconnected from how I work. It shapes my lens with regard to power, difference and liberation. It is not surprising that I have been drawn to social justice approaches to psychological intervention, such as Narrative Therapy, Coordinated Management of Meaning (CMM), social constructionist systemic therapy and liberation psychology. These practices involve taking up the cause of the oppressed in ways that respect them as agents of their own liberation. In this article, I describe what I term ‘solidarity practice’ with young people and their families as a counter force resisting the increasingly blaming and individualising discourse of mainstream psychology, psychiatry and social policy.
Policy on Child and Adolescent Mental Health Services (CAMHS) in England has undergone radical changes in the last 15 years, with far reaching implications for funding models, access to services and service delivery. Using corpus analysis and critical discourse analysis, we explore how childhood, mental health and CAMHS are constituted in 15 policy documents, 9 pre-2010 and 6 post-2010. We trace how these constructions have changed over time and consider the practice implications of these changes. We identify how children’s distress is individualised, through medicalising discourses and shifting understandings of the relationship between socio-economic context and mental health. This is evidenced in a shift from seeing children’s mental health challenges as produced by social and economic inequities to a view that children’s mental health must be addressed early to prevent future socio-economic burden. We consider the implications of CAMHS policies for the relationship between children, families, mental health services and the state. The article concludes by exploring how concepts of ‘parity of esteem’ and ‘stigma reduction’ may inadvertently exacerbate the individualisation of children’s mental health.
Research into the effectiveness of therapeutic interventions for older children who have experienced multiple forms of trauma within the context of their early development is scant. This article explores the effectiveness of Neuro-Physiological Psychotherapy (NPP): a wrap-around multi-disciplinary, neuro-sequential, attachment-focussed intervention for children and families who present with multiple, clinically significant, emotional and behavioural difficulties. In total, 31 young people and their adoptive parents took part in the study. Baseline measures were repeated and parents and children interviewed. An assessment of the parent/child relationship and child attachment was undertaken but not analysed for this article. Analysis of the repeated measures received statistically significant changes in behavioural regulation, metacognitive executive functioning and externalising and internalising difficulties, alongside an improvement in thought and social problems. An analysis of the parent interviews provided positive results in terms of the children’s engagement in education, an absence of further mental health diagnosis or involvement in the criminal justice system. Further hypotheses are posited regarding the impact of the treatment and further research into the effectiveness of the model outlined.
Our prospective study investigated couples’ expectations of adoptive parenthood and explored how these changed with their actual experience of parenthood. Six heterosexual couples were interviewed just before placement began and 6 months after the children had arrived. Interpretative Phenomenological Analysis (IPA) was used to analyse both sets of interview data. Expectations of adoptive parenthood mostly transformed smoothly into adoption experience for couples, but challenges were experienced when family scripts collided and a continued feeling of unsafe uncertainty then prevailed within these newly formed family systems. Family script collision seemed a particular problem for couples adopting sibling pairs. To further professional practice in working with families over the transition to adoptive parenting, we suggest that professionals keep in mind a framework that includes the following: Internal and external world influences on family members, Intergenerational issues, Family scripts and the Structural challenges of adoption (IIFS).
Research on early intervention for young children (infants and toddlers) with fetal alcohol spectrum disorders (FASD), particularly children with comorbid maltreatment experiences, is limited. Existing research has primarily focused on structuring environments to be responsive to the needs experienced by children with FASD rather than improving their functioning. The purpose of this study is to present outcomes from an early psychosocial intervention with 10 adopted, maltreated young children diagnosed with FASD, aged 10–53 months (M = 35 months), and their adoptive parents. The potential for early, targeted interventions to improve developmental outcomes for children with prenatal alcohol exposure was examined, as well as improving the skills of and reducing stress experienced by their adoptive parents. Based on the outcomes of a neurodevelopmentally informed assessment protocol, the 10 children whose data are presented were recommended to receive a range of regulatory, somatosensory, relational, and cognitive enrichments. As part of their treatment, children and caregivers received Child–Parent Psychotherapy (CPP), and caregivers (here, adoptive parents) also received Mindful Parenting Education (MPE). Related-samples Wilcoxon signed-rank tests indicated that scores of several measures of child developmental functioning improved from pre- to post-intervention and that parents’ caregiving skills improved while their caregiving stress decreased. Reliable change analyses indicated that change observed from pre- to post-intervention was reliable. The promise of using neurodevelopmentally informed assessment strategies to sequence interventions for young children with diverse neurodevelopmental insults is discussed.
This article describes the development and application of a wrap-around, multidisciplinary, brain-based, developmental and attachment-focussed intervention for children who have experienced significant trauma in the context of their early life. It outlines the presentation of the children and families who are referred to the service and the model of treatment that they receive. In doing so, it identifies the core components underpinning Neuro-Physiological Psychotherapy (NPP) and links the application of the integrative model to research and practice in the field of neuroscience and attachment and to the use of therapeutic approaches that are beneficial to maltreated children and their adoptive parents. It highlights the need for a neuro-sequential approach that impacts all aspects of the child’s life in the effort to redress the impact of developmental trauma with the aim of improving their overall functioning and their ability to develop healthy relationships into the future.
This research assessed the feasibility of Social Communication Anxiety Treatment (S-CAT) developed by Elisa Shipon-Blum, a brief multimodal approach, to increase social communication in 40 children aged 5–12 years with selective mutism (SM). SM is a disorder in which children consistently fail to speak in specific situations although they have the ability to do so. Key features of this approach are the SM-Social Communication Comfort Scale (SCCS), transfer of control (ToC), a nonchalant therapeutic style, and cognitive-behavioral strategies over a brief time frame. Following 9 weeks of treatment, children showed significant gains in speaking frequency on all 17 items from the Selective Mutism Questionnaire (SMQ), a standardized measure of SM severity. Children also showed decreased levels of anxiety and withdrawal as reported by parents on the Child Behavior Checklist (CBCL). SM initial symptom severity and family therapy compliance, but not duration of SM, contributed to treatment outcomes.
Reder and Duncan’s well-known studies of the 1990s on fatal child abuse drew attention to how parental scripts regarding their children could dangerously distort relationships in ways that were sometimes fatal to children. This article reports on a new system for assessing the ‘meaning of the child to the parent’, called the Meaning of the Child Interview (MotC). Parents are interviewed using the established Parent Development Interview, or equivalent, and the transcript of the interview is then analysed according to parental sensitivity and likely risk to the child. The MotC constructs were developed from those used in observed parent–child interaction (specifically, the CARE-Index) and the form of discourse analysis used in the Dynamic Maturational Model – Adult Attachment Interview, allowing a more systemic and inter-subjective understanding of parenting representations than often put forward. This article discusses the theoretical background to the MotC, gives a brief review of similar measures and then introduces the coding system and patterns of caregiving. The validity of the MotC is addressed elsewhere.
The assessment of children and young people with history of complex developmental trauma presents a significant challenge to services. Traditional diagnostic categories such as post-traumatic stress disorder (PTSD) are argued to be of limited value, and while the proposed ‘Developmental Trauma Disorder’ definition attempts to address this debate, associated assessment tools have yet to be developed. This review builds on a previous review of assessment measures, undertaken in 2005.
To identify trauma assessment tools developed or evaluated since 2004 and determine which are developmentally appropriate for children or adolescents with histories of complex trauma.
A systematic search of electronic databases was conducted with explicit inclusion and exclusion criteria.
A total of 35 papers were identified evaluating 29 measures assessing general functioning and mental health (N = 10), PTSD (N = 7) and trauma symptomatology outside, or in addition to, PTSD (N = 11). Studies were evaluated on sample quality, trauma/adversity type, as well as demographic and psychometric data. Distinction was made between measures validated for children (0–12 years) and adolescents (12–18 years).
Few instruments could be recommended for immediate use as many required further validation. The Assessment Checklist questionnaires, designed with a developmental and attachment focus, were the most promising tools.
Foster care remains a valuable and safe intervention for many children unable to live with their birth family. When birth family reunification is not considered possible, a small proportion of children in foster care will go on to achieve permanency by way of adoption. This article reports on some unexpected findings to emerge from two national adoption studies of previously looked after children in England and Wales. Focussing on a subset of families who had experienced or were at risk of an adoption disruption, the findings revealed that not only did children carry elevated risks for disruption due to their older age at entry to care, multiple foster care placements and traumatic early histories, but once in care, many of the children whose placements had disrupted were considered by their adoptive parents to have had very poor, even harmful fostering experiences before being placed for adoption. Possible explanations for these findings are discussed, together with the implications for social work practice.
Access to needed mental health services can be particularly difficult for newly arrived refugee and asylum-seeking adolescents, although many attend school. This study examined young refugees’ impressions and experience of mental health services integrated within the school system. Semi-structured interviews were conducted with 40 adolescent refugees discharged by three school-based mental health services across the United Kingdom. Two-thirds preferred to be seen at school. Rumination and worry about insecurity in the asylum process had a negative impact particularly on the adolescents’ social functioning and ability to focus at school. The important role played by teachers in supporting and mediating contact with mental health services was valued by those interviewed. The study confirms that schools offer an important location for mental health services for adolescent refugees and provide an important portal for integration of services.
Class and income level influence parenting styles and values, yet are rarely discussed in treatment approaches and parenting interventions with families. In this soapbox article, I argue that discrepancies in outcome, retention, and participation could be fruitfully addressed through a fuller understanding of the needs, realities, and parenting goals of families struggling with financial disadvantage. I compare and contrast ethnographic studies of parenting in low socioeconomic environments with the types of strategies and interventions commonly advanced in parent training programs and suggest that clinicians must become more aware of the cultural and socioeconomic overtones of those interventions in determining whether, how, and when to use them with families.
A narrative analysis explored the accounts of eight mothers, each of whom had left an abusive relationship at least 12 months previously. Existing research investigating the strategies used by women to cope with domestic violence rarely considers women in their capacity as mothers. Furthermore, women’s lives after leaving an abusive relationship have received limited research attention. Thus, this study aimed to understand how women described coping with domestic violence and mothering their children, both during an abusive relationship and after leaving. The analysis focused on how the eight participants described their experiences (narrative form) as well as what they talked about (narrative content). Three types of narrative form were identified: (1) ‘The story told to help others’, (2) ‘The story too difficult to tell’ and (3) ‘Where’s my story going?’ Each woman spoke about the contextual factors that influenced whether she coped with domestic violence by seeking support from others, changing her thinking or changing her behaviour. Caring for their children was a major source of support for all the women both during their relationship and after leaving. The findings indicate that mothers who have been abused by their intimate partner may come into contact with a wide range of social and emergency support services. Implications for clinical practice, service delivery and service development relate to the different ways of supporting women in talking about abuse and also the need to recognise trauma in parents.
The goal of this study was to examine how observed Callous–Unemotional (CU) behavior influenced change in externalized and internalized problems, hyperactivity, social competence, and treatment satisfaction following parent management training.
Three hundred twenty-three children and their families received Parent Management Training—the Oregon model (PMTO). They were compared at intake and after treatment in order to examine differences in 14 treatment outcomes using hierarchical regression analyses.
Children with low levels of observed CU showed the greatest gains after PMTO treatment. This was evident in parent, therapist, self, and teacher reports.
The results indicate that it is possible to observe CU behavior among children with conduct problems, and that children with elevated levels of observed CU behavior may be in need of additional treatment or components of treatment or more intense versions of parent management treatment.
This article explores how children see their relationships, particularly their sibling relationships, in families affected by domestic violence (DV) and how relationality emerges in their accounts as a resource to build an agentic sense of self. The ‘voice’ of children is largely absent from the DV literature, which typically portrays them as passive, damaged and relationally incompetent. Children’s own understandings of their relational worlds are often overlooked, and consequently, existing models of children’s social interactions give inadequate accounts of their meaning-making-in-context. Drawn from a larger study of children’s experiences of DV and abuse, this article uses two case studies of sibling relationships to explore young people’s use of relational resources, for coping with violence in the home. The article explores how relationality and coping intertwine in young people’s accounts and disrupts the taken-for-granted assumption that children’s ‘premature caring’ or ‘parentification’ is (only) pathological in children’s responses to DV. This has implications for understanding young people’s experiences in the present and supporting their capacity for relationship building in the future.
We present the case of a 10-year-old boy, Evan, where a knock to the head activated memories of past bullying, causing intense distress, activation of the body’s stress-regulation systems and recurrent hospital presentations with hyperventilation-induced non-epileptic seizures. We describe the initial assessment session that enabled Evan and his family to understand the context for Evan’s non-epileptic seizures, to engage with the therapeutic team and to collaborate in the implementation of a mind–body multimodal family-based intervention. Once the physical symptoms had been addressed therapeutically, we explored possible dangers within the family and school systems and we worked with Evan and his family to increase his ability to access comfort and protection from his parents. Our short hospital intervention highlighted the importance of ongoing therapeutic work with Evan and the family and laid the foundation stones for the next part of the family’s therapeutic journey.
Personalised care requires personalised outcomes and ways of feeding back clinically useful information to clinicians and practitioners, but it is not clear how to best personalise outcome measurement and feedback using existing standardised outcome measures.
The constant comparison method of grounded theory was used to compare goal themes derived from goals set at the outset of therapy for 180 children aged between 4 and 17 years, visiting eight child and adolescent mental health services, to existing standardised outcome measures used as part of common national datasets.
In all, 20 out of 27 goal themes corresponded to items on at least one commonly used outcome measure.
Consideration of goal themes helped to identify potential relevant outcome measures. However, there were several goal themes that were not captured by items on standardised outcome measures. These seemed to be related to existential factors such as understanding, thinking about oneself and future planning.
This presents a powerful framework for how clinicians can use goals to help select a standardised outcome measure (where this is helpful) in addition to the use of a goal-based outcome measure and personalise choices. There may be areas not captured by standardised outcome measures that may be important for children and young people and which may only be currently captured in goal measurement. There is an indication that we may not be measuring what is important to children and young people. We may need to develop or look for new measures that capture these areas.
The study explored children’s experience of triangulation in their families. In all, 15 children aged 11–16 years, who were attending an early intervention family therapy service, participated in the study. The children’s understandings and emotional experience of triangulation were explored by comparing their responses to pictures from the Separation Anxiety Test (SAT) and a set of pictures designed for the study depicting a variety of triangulation conflicts in families. An interview regarding the children’s personal family experiences of triangulation was also undertaken and clinical information about the children’s family contexts was also utilised. Statistical analysis was conducted based on eight of children for whom a full data set was available. This indicated that children showed greater levels of anxiety in response to the triangulation as opposed to the separation scenarios. Qualitative analysis supported this finding and revealed that many of the children felt ‘invisible’ due to parents’ pre-occupation with marital conflict, felt caught in the middle of conflicts and coerced to take sides. Although able to describe their reactions and showing greater negative emotional responses to the triadic pictures, they were not consciously aware of the negative impacts of triangulation on their sense of well-being. Clinical implications are discussed with a focus on encouraging child-centred approaches to family therapy.
Children adopted from care are known to be at increased risk for mental health difficulties although relatively little research has been carried out to explore this question. This study assessed the mental health and psychological development of children placed for adoption by one UK Local Authority. We compared the pattern and prevalence of difficulties to existing data including that on Looked-After Children (LAC) children. Totally, 106 families were initially approached and parent interviews and at least partial questionnaire data were gathered on 47 children, 72.3% of whom were known to have been maltreated prior to adoption. Of the 34 children with a complete data set including Development and Well-Being Assessment (DAWBA), 76.4% met full criteria for at least one neurodevelopmental or mental health diagnosis, a markedly higher rate than comparison data on LAC or community samples. Less than half of those identified with a mental health diagnosis had received any prior diagnosis, and only a minority had received appropriate services. Despite the children’s difficulties, the great majority of parents reported high enjoyment of bringing up their child.
Animal-Assisted Interventions (AAIs) are thought to overcome some of the limitations of traditional therapies as they do not rely exclusively on language as a medium for change. One such Animal-Assisted Therapy (AAT) approach involves horses as a therapeutic medium. Equine-Assisted Psychotherapy (EAP) comprises a collaborative effort between a licensed therapist and a horse professional working with clients to address treatment goals. The purpose of the present Australian-based qualitative study was to examine EAP facilitators’ perspectives on the biospychosocial benefits and therapeutic outcomes of EAP for adolescents experiencing depression and/or anxiety. The findings suggest a range of improvements within adolescent clients, including increases in confidence, self-esteem and assertiveness, as well as a decrease in undesirable behaviours. The effectiveness of the therapy was thought to be due to the experiential nature of involving horses in therapy. The lack of understanding in the wider community about EAP was seen as a barrier to recognition and acceptance of EAP as a valid therapeutic intervention.
There are significant controversies regarding rising antipsychotic prescription trends in children and adolescents. Many pharmacoepidemiology trend studies have been published, and interpretations of these data are helpful in explaining what is happening in prescribing practices, but not why these patterns exist. There is a lack of qualitative data in this area, and the experience of prescribing antipsychotics to children and adolescents has not been adequately researched. We conducted a qualitative study using an interpretive phenomenological analysis of physicians’ experiences of antipsychotic prescribing to children and adolescents. Prescribers participated in individual interviews and a focus group. We used a staged approach for data analysis of transcriptions. In all, 11 physicians including psychiatrists and general practitioners participated in our study. We identified themes related to context, role and identity, and decision-making and filtering. Struggles with health system gaps were significant leading to the use of antipsychotics as substitutes for other treatments. Physicians prescribed antipsychotics to youth for a range of indications and had significant concerns regarding adverse effects. Our results provide knowledge regarding the prescribers’ experience of antipsychotics for children and adolescents. Important gaps exist within the health system that are creating opportunities for the initiation and continued use of these agents.
No increased effect has been associated with parent involvement in cognitive behavioral therapy (CBT) for youths with anxiety disorders. The purpose of this study was to explore parent and therapist experiences of CBT among non-responding youths with anxiety disorders, with a primary focus on parent involvement in therapy. Interpretative phenomenological analysis was applied to 24 sets of semi-structured interviews with families and therapists of anxiety-disordered youths who had not profited from CBT with parental inclusion. From the superordinate theme parents’ difficulties acting as co-therapists, which emerged from the analyses, two master themes represented the perspectives of parents (difficulty working together with the youth and feeling unqualified, with limited resources), and two represented the perspectives of therapists (family dynamics stood in the way of progress and difficulty transferring control to parents). Parent and therapist experiences complemented each other, offering two different perspectives on parent difficulties as co-therapists. However, the two groups’ views on their respective roles in therapy were in conflict. Parents wished to remain being "just the parents" and for the experts to take over, while therapists wished to act as facilitators transferring the control to parents. Clinical implications are drawn for parental involvement and enhancement of treatment outcomes for likely non-responders.
Parents are perhaps the best placed individuals to comment upon their child’s life story, including early life experiences, transitions and their child’s needs. However, research has rarely focussed on the views of parents of young people who have committed serious offences. This research aimed to explore parents’ opinions of which factors may have led to their child becoming involved with the criminal justice system. Interviews were undertaken with six parents who were asked to narrate their child’s life journey into offending behaviours. The data were then analysed using narrative analysis techniques, and a shared story was created which incorporated the main transitional stages in the children’s journeys, as seen by the parents. The findings suggest that it is not just the child but the whole family who have been in a state of distress throughout the child’s life. Systemic and environmental factors are argued to contribute to this distress, and the use of diagnosis for this population is critically evaluated. The research highlights a life story in which the child’s and family’s distress remains unheard and therefore unresolved. Clinical implications for working with this population are discussed.
The scientific knowledge about adverse effects of psychological therapies and how such effects should be detected is limited. It is possible that children and adolescents are particularly vulnerable and need specific support in order to express adverse effects. In this exploratory study, we used a qualitative approach to explore practitioners’ experiences of this phenomenon. Fourteen practitioners providing psychological therapy within the Child and Adolescent Psychiatric Service were interviewed. Qualitative content analysis was applied to the data. Four overarching categories brought up by the practitioners were identified: vagueness of the concept (reflecting that the concept was novel and hard to define), psychotherapist–client interaction (encompassing aspects of the interaction possibly related to adverse effects), consequences for the young person (including a range of emotional, behavioural and social consequences) and family effects (e.g. professional complications and decreased autonomy for the parent). Professional discussions on these issues could improve psychological therapy for children and adolescents. Based on our findings and previous research, we propose three basic aspects to consider when adverse effects are detected and managed in this context: typology (form, severity and duration), aetiology (hypothesis about the causes) and perspective (adverse effects seen from the points of view of different interested parties).
When a child has a disability, parents’ adaptation has traditionally been viewed in negative terms (e.g. grief and stress). However, recent research suggests that parents’ adaptation is determined by their appraisals of their situation, both positive and negative. It would be valuable for clinicians to have a conceptual framework for exploring such cognitions.
This study aimed, first, to devise an attribution theory–based framework for understanding parental cognitions and, second, to examine its usefulness for analysing the appraisals of parents through a qualitative study.
A wide-ranging review of literature on cognitions, particularly attribution theory, was used to devise the ‘Four Ws’ framework: What is the problem? Who is to blame? Why did it happen? When? This was used as a scaffold to organise the data from semi-structured interviews with 36 parents of young children with physical disabilities.
The framework proved robust, with a range of subthemes emerging through thematic analysis. Additional themes also emerged, for example, about emotions.
The Four Ws framework provides a potential tool for clinicians working with parents of children with disabilities, both to guide general conversations when the child’s needs are the main focus and for more in-depth clinical work with struggling parents.
Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a disabling condition known to have a negative impact on all aspects of a child’s life. However, little is understood about the impact of CFS/ME on siblings. A total of 34 siblings completed questionnaires measuring depression (Hospital Anxiety and Depression Scale (HADS)), anxiety (HADS and Spence Children’s Anxiety Scale (SCAS)) and European Quality-of-life-Youth (EQ-5D-Y). These scores were compared with scores from normative samples. Siblings had higher levels of anxiety on the SCAS than adolescents of the same age recruited from a normative sample; however, depression and quality-of-life were similar. Interviews were undertaken with nine siblings of children with CFS/ME who returned questionnaires. Interview data were analysed using a framework approach to thematic analysis. Siblings identified restrictions on family life, ‘not knowing’ and lack of communication as negative impacts on their family, and change of role/focus, emotional reactions and social stigma as negative impacts on themselves. They also described positive communication, social support and extra activities as protective factors. Paediatric services should be aware of the impact of CFS/ME on the siblings of children with CFS/ME, understand the importance of assessing paediatric CFS/ME patients within the context of their family and consider providing information for siblings about CFS/ME.
This study is a first-level evaluation of an intervention targeted at adolescents with social, emotional and behavioural difficulties in Irish post-primary schools. It is a combined implementation of the Working Things Out adolescent programme and the Parents Plus Adolescent Programme (WTOPPAP). Overall, 47 parents and their children (mean age: 13.81 years) took part in the study. The study used a repeated measures design to assess change at pre- and post-intervention and 5-month follow-up using the Strengths and Difficulties Questionnaire, McMaster General Functioning Scale, Goal Attainment (parent- and adolescent-rated), Parent Stress Scale and Kansas Parenting Satisfaction Scale (parent-rated) as assessment measures. This study found that parent-rated child total difficulties and adolescent-rated emotional difficulties significantly improved from pre-test to 5-month follow-up. Parent- and adolescent-rated goals, and parent-rated child conduct difficulties, parental stress and satisfaction with parenting also significantly improved from pre- to post-test. These gains were largely maintained at 5-month follow-up. These findings indicate that the WTOPPAP may be an effective intervention for adolescents with emotional and behavioural difficulties and their parents. It was demonstrated that a manualised family intervention could be effectively rolled out at a number of school locations, with delivery and evaluation being conducted by school staff. Further implications are also discussed.
Despite the evidence linking chronic early trauma with psychological distress, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) has excluded developmental trauma disorder from its taxonomy. This article considers developmental trauma from an attachment-based perspective and raises some of the difficulties professionals may experience conceptualising the trauma–attachment relationship. It explores the impact of the decision to exclude the diagnosis from DSM-5 on professionals, those who have had traumatic early experiences and their carers. Finally, it presents formulation as an alternative proposition which may better suit those who present to mental health services with attachment- and trauma-linked difficulties.
The goals of this study were to evaluate the quality of information concerning anxiety disorders in children that is available on the Internet and to evaluate changes in the quality of website information over time. The authors identified websites addressing child anxiety disorders (N = 26) using a Google search and recommendations from an expert in child anxiety. Each website was evaluated on the extent to which it addressed questions that parents consider important, the quality of information, and the reading level. All websites provided adequate information describing treatment options; however, fewer websites had information addressing many questions that are important to parents, including the duration of treatment, what happens when treatment stops, and the benefits and risks of various treatments. Many websites provided inadequate information on pharmacological treatment. Most websites were of moderate quality and had more difficult reading levels than is recommended. Five years after the initial assessment, authors re-analyzed the websites in order to investigate changes in content over time. The content of only six websites had been updated since the original analysis, the majority of which improved on the three aforementioned areas of evaluation. Websites could be strengthened by providing important information that would support parent decision-making.
Few interventions for Postnatal Depression (PND) have focused on parenting difficulties; the aim of this research was to investigate the feasibility and evaluate a parenting intervention (Baby Triple P) in women with PND. This was a pilot randomised controlled trial (RCT) to evaluate and determine the feasibility of the newly developed Baby Triple P compared with treatment as usual (TAU) in women with PND. In all, 27 female participants aged from 18 to 45 years (mean age = 28.4 years, standard deviation (SD) = 6.1), with a primary diagnosis of major depression and an infant under 12 months (mean age = 6.2 months, SD = 3.2 months), were recruited from primary care trusts in Greater Manchester, United Kingdom. Participants were randomly allocated to receive either eight Baby Triple P sessions in addition to TAU or TAU only. Outcomes were assessed at post-treatment (Time 2) and 3 months post-treatment (Time 3). Self-report outcomes were as follows: Beck Depression Inventory, Oxford Happiness Inventory, What Being the Parent of a New Baby is Like, Postpartum Bonding Questionnaire and the Brief Parenting Beliefs Scale–baby version. An assessor-rated observational measure of mother–infant interaction, the CARE Index and measure of intervention acceptability were also completed. Significant improvements from Time 1 to Time 2 and Time 1 to Time 3 were observed across both groups. Although women allocated to Baby Triple P showed more favourable improvements, the between-group differences were not significant. However, the intervention was highly acceptable to women with PND. A large-scale RCT is indicated.
We examined discrepant parent–child reports of subjective distress and psychosocial impairment.
Parent–child pairs (N = 112 pairs) completed the Health Dynamics Inventory at intake for outpatient therapy.
Average parent scores were significantly higher than average child scores on distress, impairment, and externalizing symptoms, but not internalizing symptoms. There were significant associations between parent–child discrepancy (i.e. children who reported greater distress or impairment than parents or vice versa) and child endorsement of several notable symptoms (rapid mood swings, panic, nightmares, and suicidal ideation).
Parents tended to report more externalizing symptoms, distress, and impairment than children reported; however, when children report more distress and impairment than parents, this may indicate serious psychological problems.
Parental meaning systems (ethnotheories) constitute a very important part of the context in which children live and develop. Parental ethnotheories are in turn shaped by implicit cultural ideals that organize parental beliefs and actions and frame child-rearing practices. The article presents a qualitative research into Bangladeshi parental ethnotheories in the United Kingdom, which illustrates both the rich cultural meanings that orientate parental action and also demonstrates how parents generate new meanings following migration and culture change. Professional understandings about children’s developmental needs, of child rearing and parenting, are not culture free and an examination of the cultural frames of professional theories is important as parenting is often taught as a universal technique that takes little account of the cultural context and of what parents think. An engagement with other cultural theories about child development can enhance critical reflexivity in clinical practice by provoking reflection on the cultural constructions of professional theories. Creating a context for the expression of parental ethnotheories is necessary for developing cross-cultural collaborations in clinical practice as it empowers families and redresses the power relationship between the therapist and the parent.
Autistic spectrum disorder (ASD) is a life-long condition. In recent years, there has been a rise in the number of children diagnosed with ASD and a greater recognition that parents need clear, accessible information communicated through different modalities. The objective of this research was to explore the views of stakeholders regarding their information needs, current information modalities and the perceived barriers and complexities of information. Three focus groups with the same stakeholders were conducted with a range of individuals from a variety of backgrounds, all of whom had a personal and/or professional interest in ASD. The same stakeholders were included in all three groups to promote depth of analysis and to facilitate rapport. All focus groups were audio-recorded, transcribed and analysed using thematic analysis. Three main issues were identified, including (1) the value of particular information sources; (2) the vulnerability of families and (3) the need for validated evidence. It was concluded, therefore, that information should be available through a multitude of modalities, accounting for the educational ability and economic status of families. The information should also be communicated in an accessible style, should be presented as trustworthy and clinical professionals may play a key role in translating information. Such information also needs to account for practical problems inherent to having a child with ASD, including time constraints and fatigue.
Pre-school children placed in local authority care show elevated rates of mental health disorders when compared to the general population. This study investigated risk factors for mental health disorders relating to the period prior to entering care and while in care. A representative sample of 43 children in care aged 0–72 months in an inner London borough underwent comprehensive multidimensional assessments. Presence of emotional, behavioural, attachment and adaptive disorders was ascertained. Exposure to two pre-placement risk factors and six placement risk factors was compared between children with and without a disorder. A total of 26 children (60.5%) had at least one mental health disorder. The two pre-placement risk factors, multiple types of maltreatment and entry into care after the age of 6 months, were both significantly associated with mental health disorders. The three placement risk factors of sudden placement moves, multiple placement moves and child–carer alienation showed a significant association with mental health disorders. There was a strong correlation between the number of risk factors and the number of co-morbid mental health disorders per child (r = .67, p < .001). In conclusion, this study identified five modifiable risk factors related to the quality of safeguarding and fostering services which showed a significant association with pre-school mental health.
The use of psychosocial forums in paediatric settings has been recommended as a means of providing psychological consultancy. However, no research has explored staff perceptions of these meetings or whether they have a positive impact on patient care. In this study, six members of a paediatric gastroenterology multidisciplinary team were interviewed about their experience of a weekly psychosocial forum using a qualitative approach. The data revealed that staff regarded the forum as an essential and useful part of the service. Staff reported a number of benefits to their clinical work as a result of attending the forum, in addition to the general benefits of having a clinical psychologist available to see patients. However, staff also made recommendations for improving the forum. The results suggest that psychosocial forums may provide an efficient means of delivering specialist psychological consultation for patients with psychological difficulties, in line with Department of Health recommendations for paediatric services. Future research should aim to investigate the effectiveness of psychosocial forums in different settings and to establish the cost-effectiveness of these meetings.
Young people’s transition from child and adolescent (CAMHS) to adult mental health services (AMHS).
To systematically review evidence on the effectiveness of different models of CAMHS–AMHS transitional care, service user and staff perspectives, and facilitators of/barriers to effective CAMHS–AMHS transition.
A systematic search in May 2012 of Medline, PsycINFO, CINAHL, EMBASE, AMED, Health Business Elite, HMIC, Cochrane Database, Web of Science and ASSIA; ancestral searches; and consultation with experts in the field.
Qualitative, quantitative and mixed-methods primary research on the CAMHS–AMHS health-care transition of young people (aged 16–21 years) with mental health problems.
Two reviewers independently completed a standardised data extraction form and critically evaluated identified documents using a validated appraisal tool for empirical studies with varied methodologies.
A total of 19 studies of variable quality were identified. None were randomised or case-controlled trials. Studies incorporating service user/carer perspectives highlighted the need to tackle stigma and provide accessible, age-appropriate services. Parents/carers wanted more involvement with AMHS. Transitional care provision was considered patchy and often not prioritised within mental health services. There was no clear evidence of superior effectiveness of any particular model.
High-quality evidence of transitional care models is lacking. Data broadly support the development of programmes that address the broader transitional care needs of ‘emerging adults’ and their mental health needs but further evaluation is necessary. Developing robust transitional mental health care will require the policy–practice gap to be addressed and development of accessible, acceptable, responsive, age-appropriate provision.
We report on clinical outcomes from the first 10 years of operation of an Adolescent Assertive Outreach Team (AAOT) which forms part of an integrated Tier 4 service offering inpatient, day-patient and intensive community treatment.
Prospective data were recorded at pre- and post-treatment for patients accepted for treatment by the AAOT over a 10-year period.
A total of 393 adolescents were treated by the AAOT, and 135 received some hospital care as part of their treatment. Contact periods with the team were significantly shorter for those treated wholly in the community. Outcome measures indicated severe pathology at onset with substantial improvement in function regardless of whether treatment involved hospital care or community support only.
Adolescent Outreach is a viable and sustainable alternative to inpatient care for some young people referred for admission, reducing but not eliminating the need for acute beds.
The behaviour of children in foster care is influenced by a variety of factors including previous experiences of maltreatment and adverse parenting, as well as the impact of separation from birth parents and placement in care. These factors make it difficult for foster parents to accurately interpret the child’s behavioural cues, a necessary precursor to sensitive parenting. The relational learning framework introduced in this article, drawing on attachment theory, facilitates the foster parents’ access to some features of the child’s mental representations, or internal working model, which may be pivotal in understanding the child’s behaviour and therefore successfully managing it. Recent studies suggest that parents’ ability to understand the child’s psychological perspective, or mental state, is related to the child’s cognitive and social development. This article presents a method to enhance the foster parents’ understanding of the child’s psychological perspective. The model is currently being evaluated for use with foster parents, mental health and social work practitioners.
AMBIT (Adolescent Mentalization-Based Integrative Treatment) is a developing team approach to working with hard-to-reach adolescents. The approach applies the principle of mentalization to relationships with clients, team relationships and working across agencies. It places a high priority on the need for locally developed evidence-based practice, and proposes that outcome evaluation needs to be explicitly linked with processes of team learning using a learning organization framework. A number of innovative methods of team learning are incorporated into the AMBIT approach, particularly a system of web-based wiki-formatted AMBIT manuals individualized for each participating team. The paper describes early development work of the model and illustrates ways of establishing explicit links between outcome evaluation, team learning and manualization by describing these methods as applied to two AMBIT-trained teams; one team working with young people on the edge of care (AMASS — the Adolescent Multi-Agency Support Service) and another working with substance use (CASUS – Child and Adolescent Substance Use Service in Cambridgeshire). Measurement of the primary outcomes for each team (which were generally very positive) facilitated team learning and adaptations of methods of practice that were consolidated through manualization.
This article reports on the analysis of a Child Attachment Interview using the Dynamic Maturational Model (DMM) of attachment coding system developed by Crittenden for use with the Adult Attachment Interview (AAI). The aim of the study was to see if the two coders could classify the child interviews using the DMM-AAI approach and produce the range of DMM attachment strategies to be expected from previous research and the literature.
Two coders independently classified interviews with 41 children aged between 6 and 13 years with an average age of 9.8 years. In total, 24 of the children were from a local authority middle school (the community children) and 17 were in foster care (looked-after children).
The full array of DMM strategies was identified, with significant differences between the community and looked-after children in terms of attachment security and lack of resolution of loss and trauma. There was 100% agreement between coders on secure versus insecure attachment patterns, a Kappa of .910 for the full range of DMM attachment strategies and Kappas of between .655 and .773 for unresolved loss, trauma and depression. Discussion focuses on the strengths and deficits of the use of the DMM compared with other published work on child attachment interviews, the use of interviews to assess post-traumatic stress disorder in children and the implications of defensive attachment strategies for services offered to looked-after children.
A growing body of evidence suggests that the prevalence of male body dissatisfaction and muscle dysmorphia is rising. To date, however, there is no published evidence on the efficacy of treatments for muscle dysmorphia. We present the case of a 15-year-old boy who met full diagnostic criteria for muscle dysmorphia, whose symptoms were treated into remission with eating disorder-focused, family-based treatment. The age of this patient fell within the time period in which symptoms of muscle dysmorphia are most likely to develop and this case represents the first published case report of family-based treatment for muscle dysmorphia in this age group. Thus, this case report has important implications for clinicians considering treatment options for presentations of muscle dysmorphia when first presenting in adolescence. Implications for the development of treatment guidelines for muscle dysmorphia and for the diagnostic debate surrounding muscle dysmorphia are also discussed.
The Kidstime programme is an innovative attempt to address the particular needs of children and young people who have parents with mental illnesses. It comprises a monthly psycho-educational workshop involving discussions about the meaning of mental health, dramatizations of stories constructed by the children (often filmed), and concurrent parents’ groups, as well as joint seminars and review sessions. This paper presents a qualitative analysis of interviews with young people (n=6) and parents (n=5) attending the groups and interviews with former service users (n=9). Five themes emerged from the thematic analysis: initial engagement, sharing with others, learning about mental health, opportunity for fun and impact on family relationships. Areas for further development were identified including the formation of a distinct adolescent Kidstime workshop to better meet their age-specific needs, and adjustments to the system for introducing new families to established workshop groups. Given the positive experience of the groups by those attending, a rigorous evaluation of the approach is suggested.
Typically the social-emotional development or mental health of under 5-year-old Children in Care (CiC) is not routinely assessed and there are few published data in the UK on the prevalence of difficulties for these children.
Our hypothesis was that there could be a significant level of unidentified and unmet need within this group. A screening procedure was developed and piloted in a 12-month study assessing both child factors and the developing relationships between children and their caregivers.
Previous screening studies have shown that recommendations for interventions are not reliably expedited. An intervention component was incorporated to address this and minimise delay in the children and their carers receiving support.
Close inter-agency collaboration was integral to the establishment, implementation and high level of participation in the study.
The screening proved acceptable to the majority of birth parents and caregivers, with 94% uptake of participants. In the year prior to screening only 10% of under-fives coming into care were identified as having difficulties in contrast to 67% of children in the screening cohort. The brief interventions offered were taken up in three-quarters of cases, leading to increased referrals on and access to mental health services for these children.
People who work with children who have neurological and learning disabilities frequently need to manage the health and emotional risks associated with eating, drinking and swallowing (dysphagia). Some approaches can support children to develop oral feeding competence or to maximise their ability to maintain some oral intake supplemented with tube feeding. However, some clinicians feel that oral-motor exercises can support eating and drinking skills as well as speech and language development, whereas there is little evidence to support this.
The implied "beneficial" association between oral-motor exercises, speech and swallowing skills gives a false impression in terms of future outcomes for parents and carers of children with learning disabilities. This paper considers oral-motor approaches in the remediation of dysphagia and the need for a cultural shift away from this view. Realistic and useful outcomes for people with learning disabilities need to be an essential part of therapeutic intervention.
The aim of this project was to replicate and extend findings from two recent studies on parent-child relatedness in autism (Beurkens, Hobson, & Hobson, 2013; Hobson, Tarver, Beurkens, & Hobson, 2013, under review) by adapting an observational assessment and coding schemes of parent-child relatedness for the clinical context and examining their validity and reliability. The coding schemes focussed on three aspects of relatedness: joint attentional focus (Adamson, Bakeman, & Deckner, 2004), the capacity to co-regulate an interaction and the capacity to share emotional experiences. The participants were 40 children (20 with autism, 20 without autism) aged 6–14, and their parents. Parent-child dyads took part in the observational assessment and were coded on these schemes. Comparisons were made with standardised measures of autism severity (Autism Diagnostic Observation Schedule, ADOS: Lord, Rutter, DiLavore, & Risi, 2001; Social Responsiveness Scale, SRS: Constantino & Gruber, 2005), relationship quality (Parent Child Relationship Inventory, PCRI: Gerard, 1994) and quality of parent-child interaction (Dyadic Coding Scales, DCS: Humber & Moss, 2005). Inter-rater reliability was very good and, as predicted, codes both diverged from the measure of parent-child relationship and converged with a separate measure of parent-child interaction quality. A detailed profile review revealed nuanced areas of group and individual differences which may be specific to verbally-able school-age children. The results support the utility of the Relationship Development Assessment – Research Version for clinical practice.
Self-harm in young people is a common presentation to mental health services. There is little literature, however, on how professionals view their role and the role of others within the assessment of these young people, and the relative accountability. This study explored Child and Adolescent Mental Health Services (CAMHS) professionals’ views of these roles utilising a qualitative framework. The interviews of 18 CAMHS professionals from different disciplines were analysed using a thematic approach. Findings showed participants to be clear regarding the remit of their own role and the purpose of the assessment process, but were less confident in the abilities of those outside their service. They commented on the ongoing problems of stigma in this area and the difficulties with multi-agency working. Findings suggested possible ways to ameliorate these problems; however, the current economic climate may not be conducive to this.
The increased prevalence of anorexia nervosa reported in non-Western societies inevitably raises the issue of the influence of cultural factors in the genesis and the patterns of this disorder. Anorexia nervosa is not a straightforward Western culture-bound syndrome, although an influence of Western ideals of thinness does exist. The illness seems more related to rapid cultural shifts, either societal or individual, such as those occurring in the migratory process. Migrants and their children have to face the acculturation process and may experience a culture-clash. The pathology can also fulfil a positive acculturative function. This is a case study concerning a second-generation Chinese girl born in France presenting with anorexia nervosa. This case leads us to raise the issue of the choice of diagnostic criteria in relation to cultural background. We will also discuss the impact of the family’s migratory history on the construction of identity in adolescence. Finally we will explore the specific features of care provision for anorexia nervosa in a transcultural setting.
It is well recognised that Looked After Children (LAC) and Young People Leaving Care (YPLC) have complex mental health needs and often engage in self-destructive behaviours such as self-harm, drug and alcohol use and suicide attempts. They can experience a high level of instability in relationships and frequently live transient lifestyles. Traditional mental health services for children, young people and adults have been unable to meet the attachment needs of this particular group such that they rarely benefit from therapeutic interventions and remain in a constant state of emotional dysregulation. This article describes the way in which two distinct therapeutic models – Dyadic Developmental Psychotherapy and Dialectical Behaviour Therapy – have been interwoven in order to engage and captivate young people leaving care in a therapeutic relationship. This relationship can then be used to help build skills to increase their resilience as they enter adulthood.
Moving suddenly into temporary accommodation with their mothers is a reality for many children who live with domestic violence. The experience of this transition is under-researched despite being considered a unique event for children alongside that of being exposed to domestic violence involving their mothers. This piece of qualitative research aimed to address the following question: ‘How do girls aged 10–16 years old experience the transition into temporary accommodation following exposure to domestic violence’? Five girls aged 10–16 years who had moved into either refuge or ‘bed and breakfast’ accommodation with their mothers were interviewed. Interviews were analysed using interpretative phenomenological analysis. Three master themes emerged: (1) ‘Out of their hands: The transition into a whole new world with loss and change’, (2) ‘The relentlessness of feeling unsafe and uncertain’, (3) ‘Coping with the transition: At the mercy of their environment and the actions of others’. All themes show how a lack of agency was experienced by the girls throughout the transition. Findings suggest that the environment of temporary accommodation may inhibit the child’s capacity to emotionally process the transition. The role of others was central to either facilitating or constraining coping for the girls throughout this transition.
Eight pregnant women, considered to be ‘vulnerable’ due to exposure to a number of underlying risk factors, participated in semi-structured interviews regarding their experiences of pregnancy and of Mellow Bumps, a 6-week targeted antenatal intervention. Interview transcripts were explored using interpretative phenomenological analysis. The analysis revealed five superordinate themes: pregnancy as a time of reflection; the body being taken over; pregnancy as an emotional rollercoaster; relationships as important; separating identities. Pre- and post-natal attachment theories were found to be useful in interpreting the data. Findings suggest that pregnancy may be ‘normalising’ and provide an important opportunity for building more positive representations of the self. Findings also provide clinical support for the assertion that the attachment relationship begins before birth. The Mellow Bumps intervention was uniformly seen as helpful. It appeared to nurture prenatal attachment relationships, playing a potentially protective role, by helping to establish the foundations for secure mother–infant relationships in the future. Meeting similar women and engaging in ordinary, supportive conversation during Mellow Bumps seemed to reduce feelings of isolation and stigma. Implications for clinical practice are considered.
This paper offers research case studies of four severely maltreated children who had received a diagnosis of autistic spectrum disorder. A range of measures were employed to explore the children’s psychological and emotional functioning, including Theory of Mind assessment (Sally–Anne Test), attachment measures (Story Stems Assessment Profile and Relationship Problems Questionnaire), along with measures to assess general psychological and emotional well-being. Contrary to the diagnosis, the children did not reveal a theory of mind deficit. However, they did indicate a profile of difficulties in mentalisation on the Story Stems. The findings are discussed in terms of the extent to which mentalisation and theory of mind are influenced by situational factors, especially the anxiety evoked by the Story Stem attachment scenarios. Clinical implications regarding mentalisation as a state vs. trait phenomenon are discussed.
Objective: By analysing the suicide notes from suicide victims 15 years and younger, we attempt to gain insight into the process leading to youth suicide and explore the characteristics of the note writers.
Method: During a psychological autopsy on 42 youths, we were entrusted with 23 suicide notes in which we explored the themes and compared the note writers to the non-note writers.
Results: The key messages were as follows: explain the reason for suicide, declare love and give instructions. The note writers had showed suicidal behaviour more frequently than non-note writers.
Conclusion: In the notes from youth suicide victims they present themselves as fully responsible and without confusion or overwhelming despair. The notes are likely equally informative as the notes of older victims.
Anorexia nervosa (AN) in childhood and adolescence has a poor prognosis. It is possible that this may in part be due to the fact that cognitive weaknesses that appear to be risk factors for its development and maintenance are not being targeted in treatment. Through its focus on these deficits, cognitive remediation therapy (CRT) has been shown to be a promising intervention for AN. Furthermore, family interventions are widely recommended for this patient population, but to date no studies have reported the use of CRT in a family setting. This paper presents a case series in which family-based CRT was a significant component of the management. It was well received by patients and their families and previously treatment resistant patients became more engaged with the entire treatment process. In addition, all patients receiving family-based CRT went on to make progress towards recovery. These initial clinical observations suggest family-based CRT is likely to be a useful addition to treatment for child and adolescent AN and justifies formal evaluation.
The aim of this study was to describe how, in the aftermath of intimate partner violence against the mother, children understand and relate to their father. Face-to-face interviews with four girls and four boys, aged between eight and twelve, were analysed using an interpretative phenomenological approach. All of the children had been exposed to the father’s violence towards the mother. Two super ordinate themes were identified in the analysis: the disjunctive image of the father and being entangled in a conflict. The children’s understanding of the father and their relationship with him was built on different versions of the father and his actions; those experienced by the child and those recounted to them. The situational context surrounding the described experience pervaded the image of the father. An ambiguity appeared to exist in the sense of different versions of the father and children described different emotions that could both hinder and elicit other feelings connected to the father. Children also conveyed the sense of being trapped or entangled in a conflict where their own needs and desires could be deemed as unsafe to express, and that they felt responsibility for dealing with the father’s influence.
This mixed method systematic review appraises the individual, familial and systemic effect of 9/11 and the war on terror for majority and minority children and youth in North America. The results highlight the broad social consequences of the socio-political transformations associated with the terror context, which cannot be understood only through a trauma focus analysis. The social stereotypes transformed youth experiences of belonging and exclusion. The difference between the consequences for majority and minority youth suggests the need for a broader appraisal of this societal context to support the development of prevention and intervention intersectorial programs.
Ethnocultural variables in cognitive behavioral therapy (CBT) are gaining an increasing amount of attention. This is a welcome development since cultural responsiveness is a core element in ethical and effective CBT practice. However, the literature is sparse and generally silent regarding CBT with children of Pakistani descent. Accordingly, this case based article attempts to close the knowledge gap by reviewing the extant literature pertaining to the role of religion, help seeking behavior, and emotional expression in Pakistani families. The literature review is followed by a case discussion of an 11 year old second generation Pakistani male living in the United Kingdom who is struggling with posttraumatic stress disorder (PTSD). The case presentation highlights the importance of culturally informed case conceptualization and individually tailored interventions. The case illustrates the way cognitive behavioral psychotherapy balanced empirically based procedures with a sensitive appreciation of cultural context.
Unaccompanied asylum-seeking children aged 10–16 years (N = 93, M = 13.8, SD = 1.4, 81% boys) were assessed 6 months after arrival in Norway (SD = 5 months). Participants originated from 14 countries (63% Asia; 36% Africa). Severe life events (SLE) and psychological symptoms were measured by self-report. Participants reported a mean of 5.5 SLE (SD = 2.4), the most prevalent being death of a close person (68%), witnessing violence (63%), and war (62%). Some 54% scored above clinical cutoff on posttraumatic stress symptoms, 30% on anxiety symptoms, 20% on depressive symptoms, and 7% on externalizing symptoms. Number of SLE was associated with posttraumatic stress disorder symptoms (r =.50, p < .001), depression (r =.27, p = .020), and anxiety symptoms(r =.34, p = .003), but not externalizing symptoms (r =.02, p = .874). None of the symptom variables were associated with age or gender. Results indicate that many unaccompanied asylum-seeking children have experienced not only war-related traumas but several other severe life adversities as well. It may thus be helpful to conduct early assessments on this group of children to assess their need for treatment or other psychosocial interventions.
Antenatal substance use and related psychosocial risk factors are known to increase the likelihood of child protection involvement; less is known about the predictive nature of maternal reflective functioning (RF) in this population. This preliminary study assessed psychosocial and psychological risk factors for a group of substance dependent women exposed to high risks in pregnancy, and their impact on child protection involvement. Pregnant women on opiate substitution treatment (n = 11) and a comparison group (n = 15) were recruited during their third trimester to complete measures of RF (Pregnancy Interview), childhood trauma, mental health and psychosocial assessments. At postnatal follow-up, RF was reassessed (Parent Development Interview – Revised Short Version) and mother–infant dyads were videotaped to assess emotional availability (EA). Child protection services were contacted to determine if any concerns had been raised for infant safety. Significant between-group differences were observed for demographics, psychosocial factors, trauma and mental health symptoms. Unexpectedly, no significant differences were found for RF or EA between groups. Eight women in the ‘exposed to high risks’ group became involved with child protection services. Reflective functioning was not significantly associated with psychosocial risk factors, and therefore did not mediate the outcome of child protection involvement. Women ‘exposed to high risks’ were equally able to generate a model of their own and their infants’ mental states and should not be seen within a deficit perspective. Further research is required to better understand the range of risk factors that predict child protection involvement in high risk groups.
Past research has shown that young children affected by maternal HIV present with elevated stress/anxiety and negative well-being. This pilot intervention for children aged 7–14 affected by maternal HIV targeted improving positive child–mother communication, improving HIV/AIDS knowledge and reducing anxiety (especially related to transmission), and lessening feelings of stigma. Each of the three child intervention sessions included behavioral skills training and a themed craft exercise; mothers attended an open discussion group while the children attended their sessions. Study participants were 37 child–mother pairs. The study design was a randomized two-group pretest-posttest experimental design. The intervention sessions were audiotaped for transcription. Results showed significant decreases in anxiety and worry for children in the intervention group, and increases in happiness and knowledge regarding HIV/AIDS transmission. Intervention group mothers reported greater social support. Qualitative findings for the intervention group children and mothers also support these findings. Early intervention reduces child stress, and may affect longer-term outcomes.
From epidemiologic research, we know that children of parents with a mental illness (COPMI) have an elevated risk of developing a serious mental disorder. Aside from studies based on risk and resilience, there has been little research on the children’s own perceptions. The aim of this study was to expand our understanding of key variables influencing COPMI’s seeking support and to explore whether a website targeted at COPMI could help them improve their ability to cope with their circumstances and to find professional help. This case study illustrates one visitor’s use of a website that was specifically designed to help COPMI. The visitor was a young adult female whose two parents both suffered from mental illness. She participated for 3 years in an intervention delivered through the website. Several things helped to inform us about her perspective on living with parents suffering from mental illness, her use of the website and the benefits she derived from using the website. These included (a) her story as she told it in the exit interview, (b) her messages to her peers and counsellors, (c) her user data and (d) the content of her chat conversations with her peers.
When children require mental health services, clinicians need to conduct assessments that are developmentally sensitive and that include the child’s point of view. Drawing is a popular tool that is commonly used in clinical settings. Research on drawing in experimental settings has confirmed that the opportunity to draw while talking increases the amount of verbal information that children report during an interview. The present research examined whether drawing also facilitates children’s self reports during a mental health assessment. A total of 33 5–12-year-old children were asked either to draw and tell about their presenting problem or to tell only. Children who drew and told provided twice as much verbal information as children who told only. Further, interviewers in the draw and tell condition used a greater number of minimal responses than did interviewers in the tell only condition. These data have important implications for clinical practice.
Video feedforward is a solution-focused intervention used to improve desired behaviour. We present two case studies of using video feedforward in reactive attachment disorder. Children with reactive attachment disorder, their caregivers and their clinician completed storyboards of behaviours desired during a ‘miracle day’ and filmed the individual scenes. These scenes were edited to a prolonged sequence of successful behaviour which was fed back to the child and their caregiver using principles of video interaction guidance. Families reported major improvements in the targeted behaviours, usually within a week of filming the ‘miracle day’.
Objective: This article outlines an approach to assessing the quality of relationships between young foster children and their carers. These children are at high risk of disorganised attachment relationships and of developmental psychopathology given their relational experiences prior to and in care. During a semi-structured play interaction the emphasis is on identifying behaviours of clinical interest. This can be complex given the likelihood of atypical or unexpected behaviours expressed within relationships.
Method: The paper draws on literature on the clinical application of attachment theory to the assessment of relationships and on the authors’ experience of developing and delivering an assessment and intervention service for children aged 0 to 5-years-old within a mental health service for children in foster care. Clinical material is used to illustrate and develop the issues.
Conclusion: The case for including a semi-structured observational procedure as part of a comprehensive assessment of foster children and their carers is outlined. This is argued to have more clinical utility than formal approaches to attachment classification. The benefits of including a semi-structured and relational approach to clinical assessment of foster children are outlined along with the need to be cautious in the use of attachment related terminology when formal assessments have not been undertaken.
Management of childhood epilepsy places significant demands and increased stress on the family unit. How parents adjust to this illness-related stress is believed to be shaped by their cognitive appraisals of the situation and the coping behaviours that are employed (Wallander & Varni, 1992). We investigated the cognitive and behavioural strategies that regulated psychological symptomatology in mothers following an epilepsy diagnosis of their child. Twenty-one mothers participated in this qualitative study. Interview data was analyzed using theory-driven thematic analysis. The analysis revealed common effective cognitive appraisals that include maintaining a positive outlook, re-structuring expectations and finding meaning from their experiences. Problem-solving, emotional venting, time to self and speaking with parents in similar situations were behaviours that buffered against carer strain. The coping strategies identified in this study can be seen as sources of resilience and therefore provide a guide for improving parent outcomes in the context of pediatric illness. Implications for clinical services are discussed in this paper.
Over the past 30 years, there has been much research into the health benefits of humour and laughter. Although often viewed very positively, rigorous evaluation of the therapeutic effect of clowning is complex. Clowning is a multi-modal intervention, which may have an impact on medical conditions, procedures, family functioning and health care teams. Clowns help children to adapt to their hospital surroundings and can distract from, and demystify, painful or frightening procedures through ‘doses of fun’ to complement traditional clinical interventions. This paper provides a review of the paediatric literature and reveals studies looking at the effect of clown interventions on various practical procedures and individual medical conditions, and the effects of clowning within clinical teams.
Given the increasing interest in demonstrating effectiveness in psychiatric treatment, the current paper seeks to advance outcome measurement in child psychiatry by demonstrating how more informative analytic strategies can be used to evaluate treatment in a real world setting using a brief, standardized parent-report measure. Questionnaires were obtained at intake for 1294 patients. Of these, 695 patients entered treatment and 531 (74%) had complete forms at intake and follow-up. Using this sample, we analyzed the data to determine effect sizes, rates of reliable improvement and deterioration, and rates of clinically significant improvement. Findings highlighted the utility of these approaches for evaluating treatment outcomes. Further suggestions for improving outcome measurement and evaluation are provided.
The Marlborough Family Education Centre (MFEC) uses a specific multi-family group approach with families where children exhibit (primarily) conduct problems and function poorly in school. Research indicates that failure to intervene with these children carries great potential cost to both the family and society. Outcomes for 50 families receiving intervention from the MFEC were compared with a control group of 28 who had access to a range of interventions, but not the multi-family group approach pioneered by the MFEC. Data on child and family social, emotional and behavioural functioning were collected at the point of referral, and at 6 and 12 months. Parents of children receiving support from the MFEC reported statistically and clinically significant improvements in their children that were maintained at 12 months whereas there was no change in the control group. In addition, measures of family functioning were fairly stable for the MFEC group, while the control group showed significant deterioration over the same time period. Other results were not significant. These findings are interpreted within the context of early intervention. The methodological limitations of the study are considered and suggestions for future research are outlined.
Objective: Emergency mental health admissions (EA) for children under 13 years are not routinely offered in the UK, which may be related to preconceptions about their safety, appropriateness and acceptability. Our aim was to evaluate routinely offered EA of children in a national unit over a three-year period.
Method: A retrospective, naturalistic study was conducted, comparing EA with planned admissions (PA) in terms of children’s functioning on admission and discharge, clinical characteristics, significant risk-related incidents and parental and children satisfaction.
Results: EA children (N=47) did not differ from PA children (N=35) in age, length of admission, medication treatment, significant risk-related incidents, functioning at discharge, access to education at discharge and satisfaction. EA children had lower functioning and were less likely to have been out of education on admission. Parental satisfaction in EA was higher compared to PA.
Conclusions: EA for children are an appropriate, clinically indicated and safe alternative to PA, associated with higher parental satisfaction.
The current study investigated relationships among self-reported peer victimization, suicidality, and depression in adolescent psychiatric inpatients. Sixty-seven adolescent psychiatric inpatients at a Midwestern children’s hospital completed measures of bullying and peer victimization, suicidal ideation, and depression during their inpatient stay. Analyses indicated significant moderate correlations among victimization, suicidal ideation, and depression in adolescents. Results from mediational analyses found that negative self-esteem mediated the relationship between peer victimization and suicidal ideation. To date, this study is the first to directly examine the mechanisms underlying the relationship between peer victimization and suicidal ideation in adolescent psychiatric inpatients.
Objectives: Parental behaviour appears to influence the adjustment of children with chronic pain. However, research in this area has failed to produce consistent evidence. Studies have tended to rely on self-report measures derived from adult pain populations. This qualitative, observational research provides descriptive data of parental behaviour in a clinical environment.
Design: A qualitative observational study was made of parents and adolescents in a physically stressful setting. Modified grounded theory was used to analyse verbal and non-verbal behaviours.
Methods: Eight parent–adolescent dyads seeking treatment for chronic pain were videoed during physical exercise sessions. Verbal and non-verbal behaviours were recorded and transcribed.
Results: Four overarching categories emerged: ‘monitoring’, ‘protecting’, ‘encouraging’ and ‘instructing’. These often had both verbal and non-verbal aspects. Within these categories, more precise behavioural groups were also identified.
Conclusions: This research identifies categories of parental behaviour that were derived directly from observation, rather than imposed on the basis of results from different populations. Four categories of behaviour were derived, which clarify and extend dimensions used in existing self-report instruments. Careful description of parental behaviours showed features that past research has neglected, and highlighted potential drawbacks of apparently positive parental actions.
Routine Outcome Monitoring (ROM) is held as a greatly important part of practice across many Health Care Services, both in the NHS and in private practice. Yet despite this, there has been little research into the attitudes of practitioners towards ROM. This paper looks at the attitudes of 50 clinicians from two Child and Adolescent Mental Health Services in greater London. The findings showed that although the practitioners were not overwhelming positive in their attitudes to ROM, neither were they overwhelming negative, and many of their concerns involved practical issues surrounding ROM that are potentially soluble. Practitioner engagement in ROM is key if ROM is to be used constructively to reflect on practice.
In this study we discuss implications of the dimensional versus categorical approach in the diagnosis of attention-deficit hyperactivity disorder (ADHD) and focus on the educational relevance of an early assessment. In a longitudinal study in a German community sample we investigated the development of ADHD symptoms from kindergarten until the end of Grade 1 as well as the association to pre-academic skills and later academic performance. At three time points in kindergarten, children (original sample N = 793; Mn age 4 years 10 months) were assessed in regard to school-relevant precursors of reading, spelling and mathematical abilities; ADHD symptoms were rated by parents and preschool teachers. In elementary school academic performance in reading, spelling, and mathematics was measured with standardized tests. Results show that stability of ADHD symptoms during preschool was high considering the dimensional approach, whereas in regard to the categorical classification many children crossing the cut-off point at one measurement point did not do so at the next assessment. Furthermore, preschool ADHD symptoms were negatively correlated with all school-relevant precursors. This was more pronounced for symptoms of inattention than for hyperactivity/impulsivity. Observing later development, preschool ADHD symptoms predicted academic achievement in mathematics and reading at the end of Grade 1 even after individual differences in nonverbal intelligence and specific precursors had been statistically controlled for.
Children who spend their early life in social-emotionally depriving institutions have limited opportunities to engage in relationships. This early experience has been associated with many problematic behavioral outcomes; however, researchers have not frequently examined relationship quality of post-institutional adoptees, nor have they examined aspects of the adoptive family that might moderate institutionalization effects. The purpose of this study was to examine the self-reported relationship quality of 10–17-year-old children adopted into the USA from Russian institutions and to determine whether sibling characteristics (relative age, gender composition, sibling adoption status) moderate institutionalization effects. Older age at adoption was related to poorer friendship and sibling, but not mother, relationship quality. Older siblings and same-sex siblings buffered children from this negative age-at-adoption association.
Background: Cognitive Remediation Therapy (CRT) aims at improving neuropsychological weaknesses and associated thinking styles in patients with anorexia nervosa (AN). It has only recently been developed for adolescents with AN, and evidence of its applicability for this particular patient group is limited. This study aimed to test the feasibility of individually tailored and delivered CRT for young females with AN.
Methods: A sample of 20 in- and outpatients (13–18 years) with AN participated in once- or twice weekly individual CRT sessions. The CRT materials used were available in a "CRT Resource Pack." Feasibility was assessed with regards to the recruitment process, the delivery of the intervention, the materials used and clinical experiences.
Results: Overall results indicate that the intervention was feasible with regards to (a) the recruitment of both in- and outpatients, (b) individual tailoring and delivery, (c) the CRT materials adapted to suit young females with AN, and (d) the acceptability for clinicians involved in the study. There were no voluntary dropouts, with 19 of 20 patients completing the entire course of treatment.
Conclusions: The findings have implications for the refinement of CRT for the youngest AN population, and strengthens our understanding of the core components in the development and evaluation of novel interventions targeting AN. This study will help inform the design of a subsequent randomized controlled trial.
Purpose: This study explored binge eating among an adolescent obese population to ascertain the prevalence of bingeing, the relationship between binge eating and body mass index (BMI), and to evaluate significant relationships between binge eating, emotional/behavioral functioning, and health-related quality of life.
Methods: Participants included 102 overweight adolescents aged 12–17 years presenting to a multidisciplinary outpatient obesity clinic. Data obtained included height, weight, and self-report questionnaire data on emotional and behavioral functioning.
Results: Binge eating prevalence included 33% moderate to severe binge eating. Binge eating was significantly positively related to BMI and depression, negative mood, feelings of ineffectiveness, negative self-esteem and significantly negatively related to somatic complaints and all aspects of health-related quality of life. Important demographic differences emerged with regard to the impact of binge eating on health-related quality of life with Caucasians, females, and older groups experiencing more pervasive impact.
Conclusions: This research suggests that bingeing behaviors have pervasive and important implications for health-related quality of life for obese adolescents.
The school environment offers significant opportunities to deliver psychological interventions to groups of young people in the UK. However, the nature and effectiveness of programmes are not consistently documented. This systematic review aimed to identify and examine group-based interventions delivered in UK schools. Sixteen papers describing eight interventions were included. It was found that nurture groups have an immediate positive impact on the social and emotional well-being of young people. Results from follow-up studies are less clear, and limited by a high level of sample attrition. The findings reported in relation to social and emotional aspects of learning, cognitive, behavioural and social skills based interventions were limited as each intervention is only evaluated by one paper. The review highlighted a need to implement well-designed, longitudinal studies with larger samples in order to evaluate which interventions are effective in UK schools.
The aim of this study was to determine the diagnostic accuracy of statutory health assessments in identifying existing mental health disorders in pre-school foster children. It was examined whether a foster carer completed screening instrument could enhance accuracy. A representative sample of 43 pre-schoolers under the care of one inner-city local authority underwent comprehensive multidimensional mental health assessments as the reference standard. Statutory health assessments gave false negative results for 65% (95% confidence interval (CI) 44–82%) of children diagnosed with at least one mental health disorder according to the reference standard and 18% (95% CI 3–52%) of children with developmental delay. The Ages & Stages Questionnaire completed by the foster carers failed to identify 65% (95% CI 44–82%) of the children with diagnosed mental health disorders. There was no evidence of selective underreporting by foster carers in relation to specific diagnostic categories. In conclusion, statutory health assessments in their current form may fail to identify the majority of pre-school foster children with mental health disorders. Adding a screening instrument to the assessment process may not be adequate to improve diagnostic accuracy.
Background: Indigenous young people are disproportionately exposed to risk factors for poor mental health. Methodologically rigorous research will be critical in the development and evaluation of prevention and treatment programs. Research examining the mental health of Indigenous young people may have been undermined by poor measurement. The extent to which research has used measures with adequate psychometrics is unknown.
Methods: MEDLINE, PsychINFO and PUBMED databases, were systematically searched to identify papers published between 1998–2008 measuring the mental health of Indigenous young people from Australia, Canada, New Zealand or the US. Data extracted included type of mental health instrument, psychometric analyses reported and results.
Results: Fifty-four relevant studies were identified. Seventy-nine mental health instruments were used, and 18% were bespoke. Only 14% of instruments had been validated for the relevant Indigenous population. Few studies reported assessment of the reliability or validity of instruments. Data about both the reliability and validity of 10 measures were reported. None of the measures met the standards set by the review. Evidence of at least one type of reliability and validity was demonstrated for six measures.
Conclusions: From 1998–2008 few studies of mental health in Indigenous young people used measurement instruments with previously determined reliability and validity.
Background: Quality of life (QOL) is a universally accepted concept for measuring the impact of different aspects of life on general well-being. Adaptation of existing QOL instruments to local cultures has been identified as a better strategy than development of new ones.
Aims: To translate and adapt the Paediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL™) to the Yoruba language and culture and to test the psychometric properties of the adapted instrument among adolescents.
Methods: Psychometric properties including internal consistency reliability, construct and factorial validity of the Yoruba version of PedsQL™ were evaluated using standard procedures.
Results: The self report and proxy scales of the Yoruba PedsQL™ were developed with good cultural relevance and semantic/conceptual equivalence. Results from 527 adolescents revealed a Cronbach’s coefficient which exceeded 0.7 for internal consistency reliability for all scores. The healthy subjects reported higher PedsQL™ scores than those with mental health and physical problems, which confirmed construct validity. Confirmatory factor analysis revealed a good model fit for the Psychosocial Health score, but not for the other measures.
Conclusions: The Yoruba PedsQL™ is culturally appropriate and with good internal consistency, reliability and construct validity. More work is needed regarding its factorial validity.
This paper presents an integrative model for supervising counselors of parents who face eating-related problems in their families. The model is grounded in the theory of parallel processes which occur during the supervision of health-care professionals as well as the counseling of parents and patients. The aim of this model is to conceptualize components and processes in the supervision space, in order to: (a) create a nurturing environment for health-care facilitators, parents and children, (b) better understand the complex and difficult nature of parenting, the challenge counselors face, and the skills and practices used in parenting and in counseling, and (c) better own practices and oppose the judgment that often dominates in counseling and supervision. This paper reflects upon the tradition of supervision and offers a comprehensive view of this process, including its challenges, skills and practices.
A large proportion of child psychiatry patients have undiagnosed language disorders. Adequately developed language is critical for psychotherapy and cognitive-behavioral therapies. This study investigated (1) whether assessment of oral narratives would identify language impairments in this population undetected by assessment of only core language abilities, and (2) the extent to which measures of cognition, working memory, emotional distress, and social function differentially predict core language and narrative development. Results showed that (1) more than twice as many children were identified with language impairment when both narrative and core language assessment were used, and (2) core language comprehension and complex verbal working memory were the strongest predictors of narrative production, while core language comprehension, a less complex working-memory task, and social skills best predicted narrative comprehension. Emotional distress did not predict either. The results emphasize the importance of evaluating child psychiatry patients’ language, using both core language and narrative measures.
Millions of children incur potentially traumatic physical injuries every year. Most children recover well from their injury but many go on to develop persistent traumatic stress reactions. This study aimed to describe children’s coping and coping assistance (i.e., the ways in which parents and peers help children cope) strategies and to explore the association between coping and acute stress reactions following an injury. Children (N = 243) rated their acute traumatic stress reactions within one month of injury and reported on coping and coping assistance six months later. Parents completed a measure of coping assistance at the six-month assessment. Children used an average of five to six coping strategies (out of 10), with wishful thinking, social support, and distraction endorsed most frequently. Child coping was associated with parent and peer coping assistance strategies. Significant acute stress reactions were related to subsequent child use of coping strategies (distraction, social withdrawal, problem-solving, blaming others) and to child report of parent use of distraction (as a coping assistance strategy). Findings suggest that children’s acute stress reactions may influence their selection of coping and coping assistance strategies. To best inform interventions, research is needed to examine change in coping behaviors and coping assistance over time, including potential bidirectional relationships between trauma reactions and coping.
This study examined children of substance-abusing mothers approximately 10 years after mothers’ admission to drug abuse treatment, and identified maternal characteristics that may be risk factors for child behavior problems on the Child Behavior Checklist. Data were obtained from 396 mothers who were included in a sample consecutively admitted to 44 treatment programs in 13 California counties during 2000–2002. The Addiction Severity Index was administered at both intake and follow-up. Each mother reported on one child 6–17 years of age. All of the children had been exposed to drugs, either in utero or postnatally. At follow-up about 22% of the children demonstrated borderline or clinical range problem behaviors. Child behavior problems were related significantly to the mothers’ ethnicity (lower among Hispanics relative to white), and problem severity in family/social relationship and mental health, marginally related to her prior medical/health problem, and not related to severity of alcohol, drug, legal and employment problems. Assisting mothers to address their family/social relationship and psychological problems may have an added value to prevent or reduce behavioral problems of their children.
Accumulating evidence suggests that children suffering deprivation and maltreatment at critical times in their development often pay a cognitive toll. While children vary to the extent that neurocognitive domains are affected, those factors influence how children process, manage and understand traumatic and attachment experiences as well as how they respond to treatment. Current research on trauma and attachment favor some aspects of cognition over others. The literature discusses attention, memory, cognitive biases, internal working models, beliefs and attributions as ways that impact an individual’s understanding of experience. Other categories such as working memory, processing speed, verbal, auditory or perceptual processing, metacognitive skills, and cognitive rigidity or flexibility rarely surface. This paper examines what is and is not known about the interface of cognition with attachment and complex trauma and how that knowledge can inform treatment. It explores existing research and offers a case vignette as an example of how that knowledge can be integrated into treatment strategies.
In this paper, we describe the use of an aim-based outcome measure used in routine outcome monitoring of child and adolescent psychotherapy within a child and adolescent mental health service. We aim to explore the clinical feasibility and implications of the routine use of this measure. We argue that use of the measure provides a simple and useful way of clarifying the focus of the clinical work and reflecting its progress, while also having the potential to illuminate the clinical picture by contributing an additional source of clinical information from a collaborative process with the patient, parents or both. We argue that while there are some cases where use of the measure may be impossible, or even perverse, in general it enhances rather than detracts from clinical work.
Background: Clinical experience and research suggest that teachers’ attitudes about attention deficit/hyperactivity disorder (ADHD) are an important factor influencing access to specialist assessment and treatment, including medication.
Methods: We performed a thematic analysis of comments written by primary school teachers who participated in a case-vignette study investigating the ability of teachers to recognise ADHD. Teachers read one of four types of vignette describing the behaviour of a nine-year-old child who met diagnostic criteria for ADHD (either a boy or a girl with inattentive or combined subtype of ADHD). They answered questions (identical for all types of vignette) about their views regarding the problems and their management. Teachers were invited to add their own comments.
Results: Altogether 496 teachers from 110 schools completed the questionnaire: 250 (50%) teachers from 94 schools wrote at least one comment, adding up to 341 comments. Regarding their views on the need to refer the child to specialist services, 32 teachers made comments that reflected caution. The most frequent comments were that it was too early to say whether a referral was necessary, the problems were not severe enough or the main support would come from school. Teachers also reported a lack of knowledge about specialist services or criticised them. When asked whether medication might be beneficial for the child, 125 teachers expressed hesitant or negative views: that it was premature to express an opinion about medication or too soon to give medication to the child; that medication was not necessary or should not be used at all; or that the problems were not severe enough or were emotional in nature. Only five teachers reported having a positive experience of the effect of medication.
Conclusion: Teachers’ comments suggested a strong preference in using within-school strategies for the management of children with ADHD. Teachers were reluctant to endorse medication for DHD and expressed negative views about its use. Health services should support teachers’ management of ADHD-related behaviours in school and provide information to increase teachers’ ability to identify the need for a referral to specialist health services.
Millions of children are exposed to domestic violence. How children negotiate and make sense of living with domestic violence is still under-researched. This study sought to capture the dual-perspectives of school-aged children and their mothers, to develop a richer understanding of children’s experiences of domestic violence, using a community-based sample. A qualitative research design was employed, with interpretative phenomenological analysis used to interpret the data. Five school-aged children and three of their mothers participated in the study. Two master themes are discussed from the analysis of the children’s perspective: domestic violence through the eyes of children; and learning from children’s experiences. Two master themes are discussed from the analysis of the mothers’ perspective: reflecting on the child in the context of domestic violence; and learning from mothers: insights, support and services. The crucial importance of the mother-child relationship in shaping children’s experience of domestic violence was illustrated in both the perspectives; a finding which may have important implications for the development of interventions. It was also evident that children as young as eight were able to powerfully articulate their experiences of domestic violence.
In many child services across health, education and social care, ‘attachment disorder’ is a popular description and explanation for complex presentations of children who have been neglected or maltreated and is frequently used to describe fostered and adopted children. Very often the use of this term bears little resemblance to the established diagnostic systems, nor indeed to attachment theory as conceptualised by Bowlby. Its misuse can lead professionals to overlook commoner and more treatable conditions, to the detriment of the children. In fact both reactive and disinhibited attachment disorders are rare, but are becoming better characterised by high quality research. Poor understanding about the attachment disorder construct can pose particular problems for clinicians working with adopted children. The current paper briefly reviews the practical difficulties with the attachment disorder diagnosis as applied to adopted children and uses four case studies taken from a specialist Adoption and Fostering Service to highlight some of the problems for services working with adopted children. Finally, we propose some provisional recommendations for the assessment and treatment of adopted children and their families, which aim to be consistent with attachment theory as well as with the existing evidence base on wider child mental health problems.
The Child and Family Refugee Service at the Tavistock Centre in London has run a series of ‘Tree of Life’ groups for both parents and children in schools. The groups were developed in response to a concern about the majority of psychological treatments, which focus predominantly on vulnerability factors in refugee populations, and the effect that this can have on those they are attempting to help. In addition, these are modelled on western assumptions, which do not adequately take account of culture. The Tree of Life groups have provided an alternative to traditional mental health services, which many refugee families find hard to access because of perceived stigma and lack of knowledge about what is on offer. The groups employed a strength-based narrative methodology, using the tree as a creative metaphor, which enabled parents and children to develop empowering stories about their lives, which were rooted in their cultural and social histories. From this secure base, participants were able to develop shared, culturally congruent solutions to their problems. The groups have been found to benefit parents and children alike, as well as the school communities in which they have taken place.
In Japan, the practice of disclosing the diagnosis of cancer to young people varies between hospitals. Some hospitals respect parent’s wishes and do not to tell young people about their diagnoses whereas others encourage parents to adopt their policy of informing patients. Unfortunately, there is no research about parents’ adjustment to either course of action. This study examines parents’ perspectives regarding this decision. Parents (55) and grand-parents (3) were interviewed about their experience of sharing or not sharing the diagnosis with their children. Analysis of the interviews reveals a complex picture in which parents struggle to balance their emotions, their representation of ‘cancer as death’, their views of their children’s level of understanding as well as the positive and negative effects of disclosure on their children. We suggest that knowledge of parents’ perspectives can be useful to health professionals who support parents living with this dilemma.
Recent research has examined the contribution of parental anxiety sensitivity to child anxiety, suggesting only a modest relationship between these two variables. No study to date, however, has examined the role of parental anxiety sensitivity in parent reports of the child’s anxiety. It was hypothesized that anxiety sensitivity, a cognitive risk factor for the development of anxiety, would be significantly correlated with parents’ reports of their child’s anxiety, specifically with respect to panic and separation anxiety. The present study employed a sample of 56 treatment-seeking children and their parents. Parent and child reports of the child’s anxiety were obtained, and self-reports of anxiety sensitivity were obtained from parent and child. Parent reports of their child’s panic and separation anxiety symptoms were significantly related to not only parental anxiety sensitivity (r = .39 and r = .29, respectively) but also the child’s self-reported level of anxiety sensitivity (r = .35 and r = .37, respectively). These findings suggest that anxiety sensitivity, a significant predictor of panic symptomatology amongst both adults and children, might be related to parents’ perceptions of their child’s symptoms of panic and separation anxiety. These findings further suggest taking into consideration parental levels of anxiety sensitivity when interpreting parent reports of child anxiety in clinical settings.
Therapeutic computer games might enhance children’s motivation for psychotherapy, facilitate their understanding of important therapeutic concepts, structure therapy sessions, enhance treatment of migrant children and disseminate evidence-based treatment approaches. The game Treasure Hunt was developed to support cognitive behaviour therapy with children who come into treatment for various mental health problems. To evaluate the applicability and appropriateness of the game, 124 therapists answered a questionnaire on their impression of Treasure Hunt three months after download. Of these, 42 consented to participate in the further evaluation and sent questionnaires of 218 children in whose therapy Treasure Hunt had been used. A limitation of these data is an eventual positive bias, as therapists with a positive attitude towards therapeutic computer games may have been more likely to participate. Data show that the vast majority of children were satisfied their therapist had used the game during treatment. Therapists used Treasure Hunt for a broad range of diagnoses. They judged the game as helpful in the explanation of cognitive-behavioural concepts, used it as reinforcement and reported it enhanced child motivation for psychotherapy and strengthened the therapeutic relationship with the child.
This paper provides an overview of basic Marte Meo video interaction guidance concepts and describes the therapeutic performance of the method applied in the context of early mother–infant interaction and postnatal depression. Weight is put upon the importance of the therapeutic relationship. Further Marte Meo therapy is understood in the light of Daniel Stern’s theory of ‘schemas of being with’ and accompanied by clinical vignettes from therapy sessions. The empirical basis for the paper is a study of postnatal depression, mother–infant interaction and video guidance, carried out in Southern Norway. The study examined Marte Meo from a phenomenological perspective. Marte Meo was offered to mothers with either postnatal depression or depressive symptoms. In in-depth interviews the participants reported that the Marte Meo method, ‘from the outside looking in’, increased their reflections about their infants and their own mental states as well as their sensitive interaction with their newborn. Their mothering was improved and they reported feeling less depressed. We argue that Marte Meo methodology can guide new mothers with depressive symptoms, and contribute to the creation of new schemas of being together.
In 2005, the Scottish Executive recommended that young people with severe mental health difficulties should be managed in the community wherever possible. This study reports on the clinical outcomes associated with the development of a Child and Adolescent Mental Health (CAMH) Intensive Treatment Service (ITS) embedded within a Tier Four CAMHS structure. Following intervention, mean CGAS ratings significantly improved by 16 points (p<0.001) and HoNOSCA Clinical Scores significantly decreased by a mean of 6.94 points (p<0.001). This trend was replicated in self-report measures, where service users reported significant clinical improvements in mental health symptoms and indicators of quality of life. A CAMHS ITS, with close links to an adolescent inpatient unit, can provide a balanced care approach where young people with severe mental health difficulties can be treated in the community, where possible, without compromising on patient safety and quality of care.
Background: Adolescents with anorexia nervosa rarely present themselves as having a problem and are usually reliant on parents to recognise the problem and facilitate help-seeking. This study aimed to investigate parents’ experiences of recognising that their child had an eating problem and deciding to seek help.
Methods: A qualitative study with interpretative phenomenological analysis applied to semi-structured interviews with eight parents of adolescents with a diagnosis of anorexia nervosa.
Results: Parents commonly attributed early signs of anorexia nervosa to normal adolescent development and they expected weight loss to be short-lived. As parents’ suspicions grew, close monitoring exposing their child’s secretive attempts to lose weight and the use of internet searches aided parental recognition of the problem. They avoided using the term anorexia as it made the problem seem ‘real’. Following serial unsuccessful attempts to effect change, parental fear for their child’s life triggered a desire for professional help.
Conclusions: Parents require early advice and support to confirm their suspicions that their child might have anorexia nervosa. Since parents commonly approach the internet for guidance, improving awareness of useful and accurate websites could reduce delays in help-seeking.
This mixed methods study examined the phenomenon of nonsuicidal self-injury (NSSI) of adolescents in Singapore. The researchers analyzed quantitative data to understand the functions of NSSI, the relationship of parental invalidation to NSSI, and the association between academic stress and parental invalidation. In addition, the researchers employed semi-structured qualitative interviews to provide supportive qualitative data. The participants were outpatients at the Child Guidance Clinic, Singapore, between the ages of 13 to 19 years old. Researchers compared 30 participants who engage in NSSI with 30 participants who do not engage in NSSI. The emotional regulation function was the most commonly endorsed function for NSSI. Adolescents who engage in NSSI have statistically significant (p < .01) higher mean parental invalidation scores than those who do not engage in NSSI. There is also a moderate, positive correlation between the level of parental invalidation and the level of academic stress for Singaporean adolescents. The researchers discuss the implications of this study for mental health professionals.
High levels of mental health problems have been identified in young people who have offended (committed/been convicted of a criminal offence). However, as with many young people, they tend not to seek support for their difficulties. This research aimed to explore support-seeking in this population by asking ‘What are the perceptions of support-seeking in young people attending a Youth Offending Team?’ Semi-structured interviews were carried out with six males (aged 13–18) and the transcripts were analysed using interpretative phenomenological analysis. Four master themes were revealed: Youth Offending Team attendance prompting reflection, Damaged self, Complexity of relationships and Internal conflicts. Generally participants perceived support-seeking as beneficial, but various barriers meant that they did not tend to view it as a viable coping strategy for themselves. Interventions aimed at addressing these barriers may help young people who have offended to seek support.
Storytelling is perennial, and central to the human condition. Although illness may shatter identity and one’s role and place in the broader social world, narrative may aid in the process of self-reparation. Despite the merits of the narrative approach, it has been underutilized with children who are living with cystic fibrosis (CF). The role that illness narratives may play in influencing CF youths’ physical activity also remains poorly investigated. This article drew on the qualitative case study methodological tradition to narrate the stories of two children living with CF at a children’s hospital in Canada. The findings beg researchers to consider (a) how children with life-limiting diseases borrow multiple illness narrative types, (b) the role of development in influencing the kinds of stories that children can tell, and (c) the impact of illness narratives on physical activity. By rendering the tales of two CF youth in this study, we respond to Aurthur Frank’s call; taking a multiple narrative turn, we listen to stories of a different kind of suffering.
The role of psychosocial factors in perpetuating and predisposing towards the development of attention deficit hyperactivity disorder (ADHD) symptoms has been neglected within the field of child mental health. Clinicians, when told that a child had a diagnosis of ADHD, have been found to underestimate the presence of psychosocial factors, and are less likely to ask about the possibility of neglect or abuse. This article details the considerable research showing links between ADHD symptoms and parental mental illness, child maltreatment, post-traumatic stress disorder (PTSD), attachment disorders and other environmental factors. Recent neuro-biological findings showing the impact on brain development of early abuse and attachment concerns are cited. The implications of these findings both for clinicians, and at policy level, are discussed, and the reasons underlying the need for a more integrated Bio-Psycho-Social approach to ADHD are outlined.
Numerous studies have been conducted internationally on the subject of multigenerational trauma; however, little is currently known about its existence in the context of the Northern Ireland conflict. The present study explored the outcomes of and mechanisms through which the trauma of one generation impacts on subsequent generations in this context. Using an Interpretative Phenomenological Approach (IPA), this study examined the subjective experiences, beliefs and perceptions of four mothers from Northern Ireland, all of whom had endured trauma during their childhoods. Three main master themes emerged: 1. "Attempting to cope" addressed how the trauma was dealt with, and how these efforts can be the very mechanisms through which multigenerational trauma occurs. Examples include hiding the truth, seeing the truth as dangerous, and knowing and not knowing about the trauma; 2. "The trauma still goes on" highlighted the negative outcomes and consequences of the traumatic experiences within the family such as delayed impact, symptoms and anger; and 3. "Strength through adversity" included the more positive outcomes of their experiences, such as finding meaning through suffering and making efforts to stop the cycle. The results are discussed in terms of the existing theories on multigenerational trauma, and implications for practice are explored.
Little is known about the characteristics of young psychologically-distressed refugees in mental health services, and how they vary according to the duration of settlement. This study of 102 young refugees referred to a community-based mental health service describes past adversities and current circumstances, referral problems, service utilization and treatment outcomes using the Strengths and Difficulties Questionnaire (SDQ). The more recently-arrived refugees had significantly higher levels of close exposure to war and violence, were more likely to have suffered separation from immediate family and to have insecure legal status. Those refugees settled longer were significantly more likely to be referred because of conduct problems while there was a trend in recent arrivals to present with internalizing pathology. A comparison of the teachers’ and parents’ mean SDQ scores of the study’s young refugees sample and a national study representative of Great Britain as a whole showed that young refugees have higher scores in total problem and all subscales scores than the British scores. Community-based mental health services for young refugees appeared effective – significant improvement was found in SDQ scores for the sub-group (n = 24) who took up the treatments offered. The implications are discussed for service development and practitioners.
The aim of this study was to evaluate the effectiveness of the parent training, Parents Plus Children’s Programme (PPCP) as an intervention for parents of children with mild intellectual disabilities. Participants were parents of children, aged six to 12, attending a special school for children with mild general learning disability (n = 29). Minor programme adaptations were made. Pre and post-assessment included the Strengths and Difficulties Questionnaire, the Parenting Stress Index, the Kansas Parent Satisfaction Scale and parent identified personal and child-related goals. A significant reduction in clinical range scores for treatment group participants (n = 16) was observed. Conversely, clinical range scores for control group participants (n = 13) increased, or remained elevated. These preliminary results suggest that PPCP may be successfully delivered as a routine community-based intervention and aid to prevent and reduce behavioural problems, reduce parent stress and increase parent confidence and satisfaction. Further investigation of programme effectiveness for parents of children with developmental disability is warranted.
Young people with chronic fatigue syndrome or myalagic encephalopathy (CFS/ME) (CFS/ME) experience higher levels of psychological distress than healthy controls and young people with other chronic illnesses, and it was recently demonstrated that 38% of this population scored above the clinical cut-off on the Spence Child Anxiety Scale. Subscales of social and separation anxiety were consistently high across gender and age groups. In this study, we used qualitative methods to help us understand more about these two types of anxiety in young people with CFS/ME. Eleven young people (age 12–18) were interviewed. Interviews were self-directed by the participants and were wide ranging. The transcripts were analysed using interpretative phenomenological analysis. Five superordinate themes were identified: social loss and adjustment; introduction of uncertainty and unpredictability; the vulnerable self; individual differences; and contributions towards recovery. Many themes were identical to those described in young people coping with other chronic illnesses in adolescence. In addition, young people with CFS/ME describe experiences associated with the perceived illegitimacy of this condition, namely: feeling unable to explain their illness; bullying from peers; disbelief; and distrust from adults around them. This becomes an additional challenge for these young people. Clinicians need to be aware of these problems, and offer appropriate support.
Referrals of ‘people you know’ to Child and Adolescent Mental Health Services (CAMHS) raise issues around anxiety, equity and confidentiality. Research in this area is limited. The framework approach was used to analyse interviews with CAMHS teams across Yorkshire. Issues identified included choice (and whose choice this is), power and perceived imbalances of power and relative lack of ‘professional distance’. The notion that health staff should receive preferential treatment by right was not widespread, but nevertheless existed. Standard procedure has to be flexibly applied to offer the best quality care. Families should not be inappropriately advantaged by ‘knowing us’, but disadvantage should be recognised and kept to a minimum.
Background: Outcome measurement in child and adolescent mental health services in New Zealand became mandatory in 2005 and little is known about how this is perceived by service users.
Aims: This study aimed to ascertain what service users think about routine outcome measurement in child and adolescent mental health services.
Method: Nine semi-structured focus groups of child and adolescent service users (n=34) and family members (n=21) were held in different sites in New Zealand to determine their views on outcome measures.
Results: Consumers supported outcome assessment with some provisos that have important implications for clinical services: the method of collecting information is critical to acceptance; assessment should be done in the context of an established relationship with the clinician; care is needed over the timing and context of assessment, access to information and feedback of results; and measures should be brief and holistic and their limitations recognised.
Conclusion: Service users support outcome measures but their implementation requires care and consultation.
The aim of this article is to discuss how parallel therapy work with parents can be structured to achieve the goals of therapy with their children. Time-limited psychotherapy with children is a structured therapeutic method, where the goal and the number of sessions are contracted together with the child and parents. In this study, we focus on parallel parental therapy for three separate families whose children are experiencing difficult family situations. Six main themes emerge from our interviews with the parents and an analysis of session notes: The parents expressed positive experiences with the therapy; their perspectives about the family situation changed; they reported positive changes on behalf of the children, and they reported an increasing number of factors to explain these changes. In addition, a number of positive changes in the family situation itself were reported, and the parents were increasingly concerned with understanding their children’s expressions. Our findings indicate that this therapy method gives parents an opportunity for reflection and mentalization, which is found to be crucial to the child’s mental health. Based on these findings, we suggest some guidelines for effectively engaging in therapy work with parents.