Clinical Child Psychology and Psychiatry

Published by SAGE Publications
Online ISSN: 1461-7021
Publications
Article
This article reviews the paper by Liebman, Minuchin, and Baker (1974) describing the use of a family meal as part of an integrated treatment approach for anorexia nervosa. The ideas laid out in the paper are described and discussed in terms of the understanding of anorexia nervosa at the time as well as placed in a current clinical and theoretical context. A comment is made on whether or not, in this author's opinion, the paper stands 'the test of time'.
 
Article
The objective of this study was to explore young children's views on the impact of chronic illness on their life in order to inform future development of a patient-based self-report health outcome measure. We describe an approach to facilitating self-report views from young children with chronic illness. A board game was designed in order to obtain qualitative data from 39 children with a range of chronic illness conditions and 38 healthy controls ranging in age from 3 to 11 years. The format was effective in engaging young children in a self-report process of determining satisfaction with life and identified nine domains. The board game enabled children aged 5-11 years with chronic illness to describe the effects of living with illness on home, family, friends, school and life in general. It generated direct, non-interpreted material from children who, because of their age, may have been considered unable or limited their ability to discuss and describe how they feel. Obtaining this information for children aged 4 and under continues to be a challenge.
 
Article
This article describes the development and the clinic-based evaluation of the Parents Plus Children's Programme (PPCP), a group-based video-modelling-assisted programme for parents of children aged 6 to 11 referred to a Child Mental Health Service with significant behavioural problems both with and without associated developmental difficulties. In evaluating the programme, a sequential block design was used to assign 74 parents of children referred to the service to the PPCP group (n = 42) or the Treatment as Usual (TAU) Comparison Group (n = 32). Assessment took place before and immediately following the 8-week intervention for both groups and at 5-month follow-up for the PPCP Group. Compared to the TAU Group postprogramme, the PPCP Group displayed significant reductions in total difficulties and conduct problems as measured by the Strengths and Difficulties Questionnaire, decreased parental stress, increased parental confidence and significant improvements in parent-defined problems and goals. These positive changes were maintained at 5-month follow-up for the PPCP group, in addition to further significant improvements in peer problems and prosocial behaviour. The analysis also suggests that the programme is more effective for parents of children with behavioural problems only, than for those with associated developmental difficulties. The strengths and limitations of the study are discussed, as well as the difficulties of conducting practice-based research.
 
Article
Narcolepsy is a common disorder with a prevalence of 0.56/1000. Patients present with a classic tetrad of excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations, which is seen only rarely in children. The term ;narcolepsy' is taken from Greek and means ;seized by somnolence'; it was first described in 1880 by Gelineau. This article is a case study of an 11-year-old male with pseudonarcolepsy. He presented to accident and emergency with episodes of falling asleep at inappropriate and unexpected times, often falling to the floor. Pseudonarcolepsy is a term coined to describe the phenomenon in which a patient presents with the symptoms and signs of narcolepsy, but the origin is psychogenic. Differential diagnosis, investigation and possible aetiology are discussed, along with treatment and outcome.
 
Article
The main aim of this article is to describe the development of a new day treatment program for older children (8-11 years) with behavioural problems. The article outlines the content of the program and it also sets out the rationale behind the development of the new day service. The day program involves therapeutic and educational input and children attend the program two days a week for one academic term (10-13 weeks). Therapeutic input focuses on improving functioning in relation to a number of developmental processes that are known to be linked to the development of problem behaviour. These include improving emotional competence, dealing with peer relationship problems and interpersonal difficulties, and changing negative patterns of thinking about the self and others. The GoZone team also attempt to work collaboratively with the children's families and schools. A preliminary investigation of the effectiveness of the program is also reported. Parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ) pre- and posttreatment. Findings showed that over the course of treatment parents reported a significant decrease in overall levels of emotional and behavioural problems and also reported a significant decrease in levels of emotional symptoms and peer problems. However, no significant changes in emotional and behavioural functioning were reported by teachers at school over the course of treatment. Potential ways of boosting the magnitude of positive change achieved by the new day treatment program are discussed.
 
Search and selection flow sheet 2001-2011. 
Article
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.
 
Article
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.
 
Number of occasions in which the reliability and/or validity of a mental health instrument was evaluated in Indigenous child health research from 1998-2008. Mental health instruments used Previously found to be 'appropriate' n=11 'Appropriateness' not yet tested n= 68 
Instrument and sample characteristics. 
Summary of instrument properties. 
Article
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.
 
Article
This study examined the effects of a short-term group cognitive-behavioural intervention in children who were experiencing PTSD symptoms following the Athens 1999 earthquake. Twenty children, aged 8-12 years, referred for treatment to a local child mental health team were assigned, depending on timing of referral to two groups-- Group 1 (N = 10), which started treatment 2 months after the earthquake and Group 2 (N = 10), which started treatment at 4 months postearthquake. A statistically significant reduction in overall PTSD (Posttraumatic Stress Disorder) symptoms across the three PTSD symptom clusters - intrusion, avoidance, and arousal--as well as in depressive symptoms was reported immediately after the intervention. The treatment also produced a statistically significant improvement in children's psychosocial functioning. Further significant improvement was reported in children at an 18-month follow-up. Treatment gains were maintained at a 4-year follow-up. Despite several limitations to this study, short-term group CBT (cognitive-behavioural therapy) was found to be a useful treatment approach, which can be offered in clinical settings, particularly if resources are limited.
 
The figure displays the moderator effects of parental PTSD (IES-R) on the relationship between children's level of tsunami exposure and children's level of PTSD. 
Article
This study examined the association between parents' and children's posttraumatic stress reactions after the tsunami disaster in Southeast Asia in 2004. Parents of 319 Norwegian children and adolescents aged 6-18 years reported on children's exposure to the tsunami and children's immediate subjective responses. The Child Stress Disorder Checklist was used to measure children's posttraumatic stress reactions 6-8 months after the tsunami, and the Impact of Event Scale Revised measured parental PTSD. Results indicated that parents' posttraumatic stress reactions significantly predicted PTSD reactions in their children. The strongest association was found for parental intrusive reactions and hyperarousal. Highly exposed children seemed to be more vulnerable to parental distress compared to children with lower levels of exposure. The study demonstrates that parental distress can endure and worsen the impact of a disaster in children. In assessments of trauma-related consequences and in therapeutic work with children clinicians need to expand the focus to include their parents and family.
 
Confirmatory factor analyses of the Yoruba PedsQL TM (N = 527). 
Distribution of the Yoruba PedsQL TM scores according to the SDQ scores (N = 527). 
Yoruba PedsQL TM scores among healthy adolescents with chronic conditions (N = 527). 
Correlations between the Yoruba PedsQL TM and the SDQ scale scores (N = 527). 
Article
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.
 
Article
Clinicians understand the importance of their clients' past relationships on current functioning. The notion of attachment disorganization is especially salient to many clinicians because based on the traditional model of attachment it is the category in which clients with a history of relational trauma are most likely to fall. Unfortunately, lumping together what so many clinicians feel is clinically important may not inform clinical practice and the process by which attachment is assessed is beyond the reach of many clinicians. A different model of attachment, the Dynamic Maturational Model of Attachment and Adaptation offers a new lens through which to view relational trauma and to understand the ways in which danger is processed. This article describes the similarities and differences in the two models of attachment.
 
Article
The present article describes a pattern of abnormal responses to pain (APR) among children in care, suggestive of pain insensitivity or failure to communicate felt pain. Exploratory analyses of caregiver-reported APR were conducted within a larger epidemiological study of 347 preadolescent children in foster and kinship care. APR items were generated from clinical assessment reports and a clinician survey, during development of a psychiatric rating scale for children in care. An APR construct was identified in factor analysis. Nine per cent of the sample had scores suggesting clinically meaningful APR, with a high level of corresponding psychological disturbance. Various analyses suggest the phenomenon may be a discrete, but integral component of complex, multifaceted psychopathology. Concurrent and retrospective measures of a large number of potential risk variables did not discriminate between APR scores and other estimates of psychopathology. However, moderate correlations between APR and ad hoc measures of impulsivity, dissociative behaviours, and inhibited-avoidant attachment difficulties suggest a number of hypothesized developmental mechanisms that might be explored in further studies.
 
Symptom frequency at 3 time points, N = 28 
Article
This is a follow-up study of 28 young people aged between 7 and 17 meeting the Oxford criteria for the diagnosis of chronic fatigue syndrome treated in a specialist paediatric/psychiatric service. Retrospective case note analysis revealed a wide range and duration of symptoms together with high levels of school absenteeism prior to the diagnosis. The mean follow-up interval after discharge from the specialist service was 3 years and although most of the young people regarded themselves as fully recovered by this time, improvement was variable and about one third were still experiencing disabling symptoms. The illness had impacted on the education or career plans of all the young people to some extent with 15 experiencing difficulty returning to school. This article highlights the need for early recognition and diagnosis of chronic fatigue syndrome in young people and the importance of continuing paediatric support to reduce symptom persistence in the sensitive recovery period. Maintaining school attendance by close liaison between health and education services both before and after diagnosis and treatment is also vital if long-term morbidity is to be reduced.
 
Article
Childhood sexual abuse (CSA) is a recognized risk factor for various negative outcomes in adult survivors and their offspring. We used the Dynamic-Maturational Model of attachment theory as a framework for exploring the impact of maternal CSA on children's attachment relationships in the context of a longitudinal sample of adult survivors of CSA and non-abused comparison mothers and their children. Results indicated that children of CSA survivors were more likely to have extreme strategies of attachment than the children of non-abused mothers. However, because both groups were at socioeconomic risk, both were typified by anxious attachment. Explanations for findings and implications for children's development are explored.
 
Article
Music is part of everyday life, and is generally regarded as therapeutic. There is increasing interdisciplinary interest in innate human musicality and the link between music and the emotions. Innate musicality is evident in the dynamic forms of emotional expression that both regulate and cultivate the foundations of meaning in human communication (intersubjectivity). This article discusses music therapy, drawing from interdisciplinary perspectives, and illustrated by case material of individual music therapy with a sexually abused child. Where the growth of mind and meaning is devastated at its core by early relational trauma, music, when used with clinical perception, may reach and work constructively with damaged children in an evolving, musically mediated therapeutic relationship.
 
Means, Standard Deviations and t-values (t-test) comparing the groups' narrative categories 
Drawing showing instruments connected to drug use. 
Article
The study aimed to examine the extent to which the use of drawing prior to narrative description increases the richness of the narrative given by children who are exposed to a succession of negative life events. The sample consisted of study and comparison groups (60 children: 27 boys, 33 girls), ranging in age from 9 to 14, whose fathers were addicted to drugs. The study group was asked to first 'draw your life in the shadow of your father's addiction to drugs', then verbally describes 'your life under the shadow of an addicted father'; the comparison group was asked only the latter. Following evaluation of drawings and narratives by two judges, analysis of variance between the groups' narratives revealed that when children were first asked to draw, their narratives were more detailed and more revealing of emotions compared to children who were asked only to verbally describe their lives, whereas expressions of resistance and splitting were more apparent in the comparison group.
 
Article
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.
 
Article
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.
 
Article
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.
 
Pre-to post-treatment comparisons for non-trauma measures 
Comparison of all measures from pre-treatment to 12-month follow-up 
Article
The present study investigated the efficacy of four EMDR sessions in comparison to a six-week wait-list control condition in the treatment of 27 children (aged 6 to 12 years) suffering from persistent PTSD symptoms after a motor vehicle accident. An effect for EMDR was identified on primary outcome and process measures including the Child Post-Traumatic Stress-Reaction Index, clinician rated diagnostic criteria for PTSD, Subjective Units of Disturbance and Validity of Cognition scales. All participants initially met two or more PTSD criteria. After EMDR treatment, this decreased to 25% in the EMDR group but remained at 100% in the wait-list group. Parent ratings of their child's PTSD symptoms showed no improvement, nor did a range of non-trauma child self-report and parent-reported symptoms. Treatment gains were maintained at three and 12 month follow-up. These findings support the use of EMDR for treating symptoms of PTSD in children, although further replication and comparison studies are required.
 
Participant demographics. 
Article
This research examines the experiential impact of hospitalisation on the parents of young people with early psychosis. In-depth interviews were conducted with a small sample of parents, and the resulting transcripts were analysed using Interpretative Phenomenological Analysis. Five themes emerged from the data: Accepting and blaming, Feeling out of control, Hospitalisation as temporary containment, Feeling let down by services and Stigma. Aspects of the hospitalisation process were characterised by parents as generally negative, but a number of positive affirmations were also offered regarding the containing, supportive and crucial role of services. Parents' perceptions of hospitalisation as a difficult, and sometimes distressing, experience are exacerbated by the complexity of being the carer of a young person. Negotiating services and boundaries within the context of this relationship contributes to feelings of exclusion and disregard by professionals and services. The implications of this study resonate with the current government mental health strategy with regard to how services can engage and include carers in the mental health system, and equip and enable them to support their relatives with early psychosis. © The Author(s) 2015.
 
Sample characteristics. 
Flow diagram showing the number of children satisfying criteria for inclusion who completed the index test and the reference standard.  
Sensitivity and specificity of statutory health assessments in detecting mental health and developmental disorders: comparison with reference standard. 
Analysis of evidence for selective under-reporting of symptoms by foster carers: Ages and Stages Questionnaire: Socio-Emotional (ASQ: SE) domain scores contrasted between children who did and did not have disorders according to reference standard. 
Article
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.
 
Participant information 
Table of Themes 
Article
Many young people growing up with HIV are choosing not to disclose their status to others, yet are likely to face difficult decisions and conversations such as explaining school absence, taking medication, coping with physical changes and for many, parental bereavement. This study aims to describe and explore the attitudes and opinions of adolescents with perinatally acquired HIV towards disclosure. Semi-structured interviews were conducted with nine young people aged 13-19 and analysed using Interpretative Phenomenological Analysis. Four themes emerged to illuminate the young people's attitudes towards disclosure. These were 1) myths and assumptions, 2) the disclosure dilemma, 3) fear and 4) keeping HIV in its place. This study confirms that many young people with HIV are choosing not to disclose. However, it appears that it is a complex decision-making process that changes over time and is influenced by developmental factors and societal attitudes towards HIV. Recommendations are suggested for services to better support adolescents growing up with HIV.
 
Article
This paper aims to build on the existing literature, by presenting some thoughts based on clinical experience with nine families of children referred for intractable contact refusal with one parent following marital separation. This particular group of high-conflict divorce cases engenders an inordinate amount of frustration both within the courts and therapeutic agencies. We outline here our assessment process and therapeutic strategies, as well as consideration of the role of the wider professional system and the courts. We conclude that whether or not direct contact with the rejected parent is achieved, useful therapeutic work can be carried out to assist children in moving on with their lives.
 
Children's 3-category attachment classifications using the PAA at 3 years: actual rates, base rates, and ratio of actual/base rates (N = 32) 
Cross-tabulation of the attachment classifications of grandmothers and grandchildren using EXACON (N = 32) 
Article
We followed a normative Finnish sample of primiparous mothers, fathers, and maternal grandmothers from pregnancy until the child was 3 years old (N = 32 families). The Adult Attachment Interview (AAI) was used to assess attachment in mothers, fathers and grandmothers during the last trimester of the mother's pregnancy. The Preschool Assessment of Attachment (PAA) was used to assess attachment in children at 3 years. Forty-seven percent of the 32 grandmother-mother-infant triads had the corresponding attachment classifications. Using EXACON for the analysis of single cells of 3 x 3 contingency tables with type-antitype classifications, and frequency tabulation of the major three-generation combinations, both triads indicating continuity across three generations (B/B/B 22% and A/A/A 19%) and reversal reactions (A/C/A and C/A/C 22%) were found. The results indicated continuity across three generations for Type B and for Type A and alternations from A to C and vice versa for insecure attachment. We discuss the implications of these findings for theory development and clinical work.
 
Article
This study examined attachment in association with preschoolers' emotional functioning among 54 predominantly low-income families living in Appalachia. Attachment was assessed at age 4 years using the Strange Situation (Ainsworth, Blehar, Waters, & Wall, 1978) and classified with the PAA (Crittenden, 2004). Emotional competence was measured via an interview about children's memories for six emotions, rated in terms of both emotion understanding and regulation. Parent-, teacher-, and self-reports of children's internalizing and externalizing symptoms were also completed. Questionnaires and interviews assessed socioeconomic risk and parental symptoms and negative childhood experiences. Children's PAA strategies were significantly associated with risks, emotion regulation and understanding, and symptoms. Children using highly coercive strategies showed the greatest difficulties. Emotion regulation and understanding also were associated with parent- and teacher-report of symptoms. These findings suggest that intervention efforts with at-risk youngsters should target not only attachment security, but also emotional competence skills.
 
Article
Studies have demonstrated a strong relation between adult attachment security, using the Adult Attachment Interview (AAI), and infant security, using the Strange Situation Procedure (SSP). This suggests that a mother's representations of attachment may influence the development of her infant's attachment to her. This study both confirms and modifies that finding in a cohort of 47 first-time mothers and their infants. The AAIs were administered during the third trimester of pregnancy and the SSPs were performed when the infant was 14 months of age. The AAIs were classified using Crittenden's Dynamic-Maturational Model (DMM) and the SSPs using both the DMM and also Main and Solomon's ABC+D methods. There was a significant match of patterns for secure mothers and babies, but a tendency for inversion of insecure patterns of attachment, that is Type A mothers often had infants with a Type C pattern and vice versa. No significant relation was seen between the DMM adult and ABC+D infant patterns of attachment. A significant, but modest, association was found between the DMM and ABC+D infant SSP classifications. These findings may help guide treatment of insecure mother-infant dyads by individualizing interventions to include a focus on maternal representations of the infant and maternal responses to infant behavior.
 
Article
Schulman and colleagues demonstrated that classroom activity level can be reduced in hyperactive boys using activity-level feedback and positive reinforcement. This article reports preliminary results using a device that combines modern beeper and actigraphy technology for the purpose of measuring, monitoring, and modifying motor excess in children with confirmed diagnoses of Attention Deficit Hyperactivity Disorder (ADHD). Nine boys ranging in age from 8 to 9 years with the ADHD Combined Type wore prototype BuzzBee feedback actigraphs during school periods and were reinforced for activity-level reductions in the context of a simple pre/post research design. The findings indicated that 7 of the 9 boys reduced their activity level from 20 to 47% of baseline levels while the activity levels of the two remaining boys increased from 2 to 7% of baseline levels. These changes were statistically significant and constitute a large effect.
 
Inquiry and experimentation.  
Jill and Karen's recovery programs.  
Article
This article describes a model for change that draws upon motivational and cognitive-behavioural theories. It is suggested that maladaptive beliefs hold individuals captive in destructive self-perpetuating cycles dominated by the illness. In the context of a trusting therapeutic relationship, inquiry and experimentation can lead to the reformulation of maladaptive beliefs, and to the development, reprioritization and/or strengthening of higher values. A clear cohesive system of higher values allows individuals to make autonomous life decisions, which reduces the need for maladaptive coping strategies.
 
Article
Practitioners extending their repertoire to include supervising the practice of others may see it as an additional professional activity which may be accommodated within their current identities. For some, it may also become a turning point that requires/promotes a second order development across personal and professional identities. Positioning theory (Harre and Langhove 1999) offers a framework which practitioners can use in making the intellectual and linguistic distinctions between different activities/identities, including the supervisory relationship. This paper further explores how a reflexive awareness of physical position, and an ability/willingness to move and re-position can facilitate the elaboration of both the activity of supervision and the identity of supervisor at the levels of approach, method and technique (Burnham 1992, 1993).
 
Article
Although a substantial number of adolescents suffer from emotional or behavioural problems, only a minority receive mental health care. In order to understand this discrepancy, this article aims to increase insight into the help-seeking process. First, a model of the help-seeking process for adolescent psychopathology was formulated. This model takes into account the sequential nature of help seeking and the involvement of multiple actors (adolescents, parents and teachers) and service providers (general practitioners, mental health care professionals, teachers, and friends/relatives). Using structural equation modelling, the model was empirically tested on 114 Dutch adolescents (aged 12-17 years), who were selected for having emotional or behavioural problems from a representative general practice sample. Of these 16.5% had used mental health services. The sequence of stages and the actors involved in the process leading to mental health care use was similar across gender. Parents and adolescents had a comparable impact on this process. The general practitioner functioned as gatekeeper to mental health care, whereas the teacher's role in the process was limited. Interventions aimed at increasing adolescent mental health service use should be directed at parents and adolescents, and at the roles of school personnel and general practitioners in the detection of problems and referral.
 
Article
The predictive validity of the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) were examined in relation to 'intention to attend' and 'actual attendance' at a universal parent-training intervention for parents of children with behavioural difficulties. A validation and reliability study was conducted to develop two questionnaires (N = 108 parents of children aged 4-7).These questionnaires were then used to investigate the predictive validity of the two models in relation to 'intention to attend' and 'actual attendance' at a parent-training intervention ( N = 53 parents of children aged 4-7). Both models significantly predicted 'intention to attend a parent-training group'; however, the TPB accounted for more variance in the outcome variable compared to the HBM. Preliminary investigations highlighted that attendees were more likely to intend to attend the groups, have positive attitudes towards the groups, perceive important others as having positive attitudes towards the groups, and report elevated child problem behaviour scores. These findings provide useful information regarding the belief-based factors that affect attendance at universal parent-training groups. Possible interventions aimed at increasing 'intention to attend' and 'actual attendance' at parent-training groups are discussed.
 
Article
Survival rates for children with cancer have improved significantly, but lengthy and painful treatments compromise the quality of life of children and their families. The aim of this article is to describe children's behaviour and coping over the 2- or 3-year-course of treatment. We interviewed 32 mothers of children newly diagnosed with Acute Lymphoblastic Leukaemia (ALL) shortly following diagnosis, 1 and 2 years later. Thematic analysis was used to extract themes related to adjustment and behaviour. The results were organized separately for children in three age groups: 0-4 years, 5-9 years and 10-14 years. Mothers described children in the 0-4-year age group as adjusting well, and attributed this to their limited understanding and ability to integrate treatments into normal life. Children in the 5-9-year group were adjusting less well, experiencing social problems and worries about appearance. Older children (10-14 years) adjusted least well. Many withdrew socially and were concerned about the need to look and feel normal. These findings will be useful for parents and clinicians in identifying typical behaviours of children coping with ALL. They also have implications for the development of child-centred age-specific measures of quality of life in children treated for ALL.
 
Article
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.
 
Article
This qualitative study aimed to gain an in-depth understanding of the adaptation of children and families to childhood chronic illness. Considering ecological theories and child empowerment, we departed from the usual practice of relying solely on parental report by also soliciting children's views. Eighteen children aged 7-14 with cancer, chronic renal failure or type 1 diabetes, and 21 of their parents, participated. The inclusion of several conditions enabled the examination of data from a categorical versus non-categorical perspective. Focus groups supplemented by individual interviews explored participants' views about challenges and the processes they considered important in enhancing adaptation to a chronic illness. Children, as well as parents, provided rich material. Thematic analysis revealed 11 main themes. Six concerned the impact of the illness on various aspects of life. The other main themes were the meaning of disease, stress-processing, social support, future concerns and psychosocial interventions. There were many similarities and some differences between parent and child reports. Many issues were common across illness groups, consistent with a non-categorical approach, though there were some illness-specific issues, especially for those with cancer. Positive as well as negative material emerged. Implications for clinical services are discussed.
 
Article
The major challenge for a clinician is integration of the wisdom available in the wide range of therapeutic paradigms available. I have found the principles guiding dialectic behaviour therapy (DBT; see Miller, Rathus, & Linehan, 2007, for applying DBT to adolescents) extremely useful in my practice running a general adolescent unit; similarly, the understanding of the different information processing and learning principles associated with each of the Type A and C attachment strategies, as understood in dynamic maturational model (DMM), has guided me through the dark corners of treatment. Specifically, how does DMM inform practice of DBT? As a 'DBTer' might say, 'Where is the wisdom in both points of view?' Nevertheless, DMM is not primarily about treatment. It concerns how different ways of adapting to developmental contingencies bias perceptual propensities, and hence the information available for reflective brain function. Recognition of these twists to knowing what is going on can then be used to inform a variety of therapeutic approaches. The purpose of this article is to look for the signposts in DBT and DMM which together help navigate the comprehensive approach necessary in complicated therapy. In the process, hopefully some more general principles for addressing discomfited adolescents arise for informing future practice. Although many steer shy of using personality disorder diagnoses for adolescents, clinicians are nevertheless addressing, directly or indirectly, the personality development of all adolescents in treatment, regardless of their classical axis I diagnoses, including both those with developing emotional instability and a group of avoidant over-controlled adolescents, which in Norway is growing in prominence. © The Author(s) 2014.
 
Article
We present here a qualitative study of nine time-limited therapies with children. Time-limited psychotherapy with children is a structured therapeutic method, where the objectives and contents are individual for each child. The number of hours for the therapy is contracted together with the child and the parents. The goal of the therapy is formulated as a shared focus based on the needs of the individual child. The focus is expressed metaphorically and is decided upon together with the child and parents before the therapy is commenced. The therapist's task is to connect the material that the child brings in to the sessions to the agreed focus. The study showed that a clear framework gave the children and the families the necessary security during the therapy process. Attunement to the children's experiences within this framework invited the children to communicate their experiences. Parents, teachers and therapists reported in all cases a positive change after the therapies had been concluded.
 
Eight memory systems organized conceptually and developmentally. 
Dynamic-Maturational Model of self-protective strategies in adulthood. 
Article
This article gives a brief over view of the Dynamic-Maturational Model of attachment and adaptation (DMM; Crittenden, 2008) together with the various DMM assessments of attachment that have been developed for specific stages of development. Each assessment is discussed in terms of procedure, outcomes, validity, advantages and limitations, comparable procedures and areas for further research and validation. The aims are twofold: to provide an introduction to DMM theory and its application that underlie the articles in this issue of CCPP; and to provide researchers and clinicians with a guide to DMM assessments.
 
Article
Primary care institutions, including clinics, schools and community organizations, because of their closeness to the family living environment, are often in a privileged position to detect problems in traumatized refugee children and to provide help. In a collaborative care model, the child psychiatrist consultant can assist the primary care consultee and family in holding the trauma narrative and organizing a safe network around the child and family. The consultant can support the establishment of a therapeutic alliance, provide a cultural understanding of presenting problems and negotiate with the consultee and the family a treatment plan. In many settings, trauma focused psychotherapy may not be widely available, but committed community workers and primary care professionals may provide excellent psychosocial support and a forum for empathic listening that may provide relief to the family and the child.
 
Article
This article reports the preliminary findings of a study of attachment patterns and relationship themes using the TAAI (Transition to Adulthood Attachment Interview), AAI (Adult Attachment Interview) and family interviews (based on the first of 15 families). Research data is presented on a young man aged 16 with a diagnosis of ADHD and his family. Individual interviews, attachment interviews, and family interviews were conducted in order to explore the link between family dynamics, ADHD and attachment strategies. In contrast to findings from existing research indicating pre-occupied patterns for young people diagnosed with ADHD, the young man displayed a complex 'disoriented' attachment pattern which primarily featured a dismissive strategy. However, this was combined with pre-occupied patterns triggered by intrusions from unresolved traumas and memories of his parents' continuing unresolved conflicts. His sense of confusion and lack of a coherent strategy appeared to be closely related to his position of being triangulated into his parents' conflicts. Trans-generational processes were also influential, in that the parents' corrective intentions at more positive parenting were impeded by their own lack of experience of positive attachments in their own childhoods. The study emphasizes the need to consider the relationship between attachment patterns and problems within wider systemic process in the family, in particular triangulation and corrective scripts.
 
Top-cited authors
Peggy T Cohen-Kettenis
  • Amsterdam University Medical Center
Thomas D Steensma
  • Amsterdam University Medical Center
Alan Rushton
  • King's College London
Fijgje de Boer
  • Amsterdam University Medical Center
Rudi Dallos
  • University of Plymouth