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Play therapy with African American children exposed to adverse childhood experiences
Abstract
African American children living in poverty often experience adverse childhood conditions such as overexposure to violence, either witnessing domestic violence or community violence, or direct victimization. These conditions can cause an increase in future mental health problems. In this pilot study, 12 African American children ages 5–9 participated in six weeks of child-centered individual play therapy followed by six weeks of group play therapy. Individual and group play therapy addressed the participants’ problematic behaviors as reported by teachers at an afterschool program for disadvantaged youth. Findings indicated that a combination of individual and group child-centered play therapy significantly decreased problematic behaviors affecting academic performance and the classroom overall. The combination of individual and group interventions also demonstrated a significant decrease in general worry and negative intrusive thought patterns. The results support therapists utilizing individual and group child-centered play therapy when working with children who experience adverse childhood experiences. Further research is needed to understand the impact of child-centered play therapy as a preventative intervention for children at-risk for developing mental health problems.
... Patterson, Stutey, and Dorsey (2018) examined the efficacy of child-centred play therapy in reducing problematic behaviours exhibited by children exposed to adverse childhood experiences, specifically domestic violence, community violence, or direct victimisation . Participants underwent 6 weeks of individual therapy followed by 6 weeks of group therapy, and the study found that a combination of individual therapy and group therapy significantly decreased problematic academic behaviours, general worry, and intrusive thought patterns (Patterson et al ., 2018) . ...
... This has also been identified by respondents of the survey administered to domestic violence services in Ireland . Both individual and groupbased interventions have been effectively used to enable children and young people to develop positive social skills and understanding of healthy relationships (Patterson et al ., 2018) . ...
... The establishment of play therapy services is also recommended, the literature supports the utilisation of both individual and group-based child centred play therapy to enable children and young people to explore their experiences of domestic violence and to build healthy relationships, coping strategies, and develop emotion regulation (Hall, 2019;Kot et al ., 1998;Patterson et al ., 2018) . ...
This report was commissioned to explore existing,
evidence-based, interventions for children and
young people who have experienced, or are
experiencing, domestic violence. Additionally, the
report explores the current national landscape of
domestic violence services for children and young
people.
... Patterson et al., [18] is a study that aimed at evaluating the effectiveness of applying both play and individual therapy to a child population that is currently living in poverty. The objective of the intervention was to reduce the effects of Adverse Childhood Experiences as identified as problematic behaviors, classroom performance, and reductions in anxiety [18]. ...
... Patterson et al., [18] is a study that aimed at evaluating the effectiveness of applying both play and individual therapy to a child population that is currently living in poverty. The objective of the intervention was to reduce the effects of Adverse Childhood Experiences as identified as problematic behaviors, classroom performance, and reductions in anxiety [18]. All the participants identified as Black/African American and were between ages five and nine. ...
... On the other hand, there was a lack of data in four of the studies that would have provided stronger conclusions and validity. Harden et al., [16] and Patterson et al., [18] both lacked sufficient data to calculate the studies effect sizes. Harden et al., [16] and Allen et al., [14] lacked the experiment's attrition data. ...
Purpose: Research demonstrates tremendous harmful effects for children and adolescents that have experienced trauma of various forms before the age of eighteen. These effects are profound as not only are they linked to current detrimental effects such as increased rates of substance abuse, early sexual activity, higher rates of depression, and suicidal ideation, but they also have shown to be damaging in adulthood. This systematic review provides an examination of interventions that reduce the effects of Adverse Childhood Experiences (ACEs) for Black/African American children and adolescents. Methods: This study used an intervention assessment tool to determine the methodological rigor derived from the American Psychological Association on assessing interventions as the risk of bias tool. The methodological rigor was used to assess the interventions that reduce the effects of ACEs. Effect sizes for controlled trials, pre-post effect sizes, and pilot studies were calculated. Results: This search identified a total of 1,594 studies in which 617 were screened and five were selected. The five utilized harm reduction interventions to address the effects of ACEs. All of the study participants were Black/African American children and adolescents. The effect sizes that were available ranged from medium to large. The Strong African American Families Program (SAAF) intervention had the strongest methodological rigor with a medium effect size. Conclusion: The review suggests that the combination of individual therapy, group therapy, and psychoeducational training techniques provided positive effects on the reduction of ACE related symptoms for Black/African American children and adolescents. The randomized control trials yielded the greatest improvements from the interventions. However, the findings were few and the need for interventions for this population continue to grow.
... These studies, often conducted in realworld settings, such as schools or counseling clinics, provided varied, though statistically significant, positive results; the authors called for more rigorous studies that measure ACEs based on Felitti et al.'s (1998) ACEs Questionnaire (Parker et al., 2021). Since that time, researchers have found that child-centered play therapy significantly improved children's difficulties and prosocial behaviors for children reporting four or more ACES (e.g., Haas & Ray, 2020) and for African American children living in poverty and having other ACEs (e.g., Patterson et al., 2018). Axline (1969) demonstrated that play is the child's natural medium for self-expression, both within and beyond the therapeutic endeavor. ...
... Therapeutic powers of play are the heart and soul of play therapy treatment . Children who have access to play therapy will be better positioned later in life physically, mentally, and socially, for play therapy is well designed to be effective for children who have experienced ACEs (Haas & Ray, 2020;Parker et al., 2021;Patterson et al., 2018). ...
Objective: This dissertation offers a contemporary understanding of childhood trauma, neurobiological principles of prolonged effects of adverse childhood experiences, and the importance of play, in context with nurturing relationships. In this qualitative study, the researcher explored the narratives of adults who had experienced complex and prolonged childhood adversity, which are potentially traumatic events that later contribute to poor health and psychological outcomes, yet who did not experience these negative outcomes to wellbeing. Specifically, the researcher examined the importance of interpersonal relationships in the context of expressive arts (drama, music, dance/movement, art) as protective through childhood and into adulthood. Method: The researcher used grounded theory methodology and recruited 10 adult participants 25 years and older who reported having four or more adverse childhood experiences (ACE), who did not report significant negative behavioral, physical or chronic health conditions. Participants completed two qualitative retrospective interviews including a structured family history and a semi-structured interview regarding important relationships and the arts. Data analysis used the constant comparative method to complete both iterative and theoretical coding. Findings: Interview data supported the importance of nurturing relationships combined with expressive arts, which served as protective factors for adults against long-term health implications of ACEs. Relationships provided a context for identity formation and integration of emotional and cognitive processing in relation to early trauma. Expressive arts enacted in the context of supportive relationships demonstrated how activating therapeutic powers of play, in the forms of self-expression, emotional catharsis, stress management, indirect teaching (learning through metaphor), improved self-esteem, and creative problem solving, diminished the effects of ACEs exposure. Findings conclude that self-care was achieved across the lifespan through continued play and art expression. Participants reported that these two facets, relationships and the arts, together in early life attenuated the impact of their negative childhood experiences later in life. Conclusion: The findings reveal how relationships in combination with the therapeutic powers of play, provide a context for self-expression, self-care, and healing. This potent combination promotes the development of posttraumatic growth following childhood trauma. The systemic health consequences of childhood trauma merit building protective factors into societal frameworks to enhance child health and development. Thus, the implications of this work extend to public health policy and education as institutions evaluate the necessity of public funding for arts programs in schools. Schools utilizing approaches to learning that incorporate the arts in addition to science, technology, engineering, and mathematics (STEAM), may contribute to lessening the impact of trauma.
... More specifically related to the current study, CCPT outcome research has resulted in positive findings for children who have experienced events that are considered ACEs such as refugee trauma (Schottelkorb et al., 2012), domestic violence (Kot et al., 1998), and natural disaster (Shen, 2002). Two quasi-experimental studies have offered promising findings for children who were identified with ACEs Patterson et al., 2018), yet no studies to date have employed a randomized controlled design to determine the effectiveness of CCPT with children who have experienced multiple ACEs. ...
There is a preponderance of evidence that adverse childhood experiences (ACEs) result in harmful physical, learning, social, emotional, and behavioral health outcomes during childhood, with far reaching effects lasting across the lifespan. The cumulative effect of childhood adversity and its relationship to childhood trauma represent an urgent call to action among stakeholders, yet treatment studies are rare. The purpose of this randomized controlled trial was to explore the impact of child-centered play therapy (CCPT) among children with two or more ACEs on improvement of social and emotional assets and behavioral problems. Results of a repeated measures linear mixed model demonstrated statistically significant increases in social-emotional competencies including empathy, social competence, and self-regulation/responsibility and decreases in total behavior problems among children who participated in CCPT. Results of this study support the effectiveness of CCPT among children who have experienced ACEs and at risk for complex trauma.
... This makes spontaneous discussion with the play therapist challenging but consistent with cultural norms (O'Connor, 2005). African-American children experience levels of poverty (Patterson, Stutey, & Dorsey, 2018). Odom, Pungello, and Gardner (2012) reported that African American infants and toddler levels of poverty measured by the national poverty levels was 42% where White infants and toddler poverty rates were 15%. ...
When setting up a play therapy training clinic, there are many considerations to explore regarding designing a therapeutic space, selecting toys and other materials, exploring the rationale for the toy selection and examining the cultural considerations in play therapy settings. This chapter will review the different types of play therapy clinics and the specific toys recommended based on the fourteen primary play therapy theoretical orientations. General considerations will be reviewed when utilizing art media and other materials, books and bibliotherapy, puppets and puppet theaters, sandtrays and miniatures, and psychotherapeutic games. Recommendations will be made for establishing community and university-based play therapy training sites offering clinical and mock play therapy services. Suggestions will be made regarding the importance of establishing play therapy laboratories in the classroom setting when providing graduate play therapy instruction. Additional recommendations will be made for the 2019 Play Therapy Best Practices published by the Association for Play Therapy.
... In a study of children and their incarcerated fathers, FRE showed greater levels of empathy and acceptance in fathers and improved self-concept children had toward their fathers, when compared with the control group (Landreth & Lobaugh, 1998). Similarly, Patterson, Stutey, and Dorsey, (2018) found that a combination of individual and group play therapy demonstrated significant decreases in anxiety and negative intrusions in children exposed to ELA, providing support for variations of child-centered play as a possible intervention to mitigate the impact of ELA. ...
Exposure to early life adversity (ELA) is a major public health crisis posing as a significant risk of immediate and sustained mental and physical health consequences. While a remarkable body of knowledge has been amassed showing psychological, cognitive, social, developmental, and neurobiological consequences of ELA exposure, little has been done to improve the long-term mental and physical health outcomes for youth exposed to ELA. Furthermore, neurobiological processes underlying poor outcomes in this population have been largely left out of prevention and intervention target efforts. In this review, we first describe ELA-related alterations across psychological and neurobiological systems in children and adolescents. Next, we describe existing evidence-based interventions targeting ELA-related outcomes. We then turn to experimental studies examining individual differences in mechanistic functioning consequent to ELA exposure, and strategies that target these mechanisms and modulate disrupted functioning. Finally, we highlight areas of future research that may be promising in engaging behavioral and neurobiological targets through novel preventive interventions or augmentation of existing interventions, thereby reducing negative mental and physical health outcomes later in life.
... As an intervention, CCPT has been used for more than 60 years in the successful treatment of a variety of present-Child-Centered Play Therapy for Children on the Autism Spectrum ing problems and diagnoses (Bratton, Ray, Rhine, & Jones, 2005;Jensen, Biesen, & Graham, 2017;Leblanc & Ritchie, 2001;Lin & Bratton, 2015;Pester, Lenz, & Dell'Aquila, 2019). Studies suggest that CCPT reduces attention problems (Ray, Schottelkorb, & Tsai, 2007;Robinson, Simpson, & Hott, 2017;Schottelkorb & Ray, 2009;Swank & Smith-Adcock, 2018); decreases internalizing problems as well as symptoms of anxiety (Gholamalizadeh, Asghari, & Farhangi, 2018;Mosavi & Koolaee, 2016;Stulmaker & Ray, 2015); improves externalizing problems, including aggression and conduct problems (Garza & Bratton, 2005;Ray, Blanco, Sullivan, & Holliman, 2009;Swan & Ray, 2014;Wilson & Ray, 2018); and decreases symptoms relating to trauma and adverse childhood experiences (Patterson, Stutey, & Dorsey, 2018;Schottelkorb, Doumas, & Garcia, 2012). Despite these promising results, limited research exists on the effectiveness of CCPT for children with ASD. ...
To investigate the effectiveness of intensive child‐centered play therapy (CCPT) for children diagnosed with autism spectrum disorder (ASD), the authors randomly assigned 23 children with diagnosed ASD and symptoms of ASD on the Social Responsiveness Scale–2nd Edition (Constantino, 2012), to an intensive CCPT condition (n = 12) or a no‐intervention control group (n = 11). Children who participated in 24 sessions of CCPT showed a statistically significant decrease in ASD core symptoms and behavioral symptoms, such as externalizing problems, attention problems, and aggression, compared with children in the control group. Implications are discussed.
... This makes spontaneous discussion with the play therapist challenging but consistent with cultural norms (O'Connor, 2005). African-American children experience levels of poverty (Patterson, Stutey, & Dorsey, 2018). Odom, Pungello, and Gardner (2012) reported that African American infants and toddler levels of poverty measured by the national poverty levels was 42% where White infants and toddler poverty rates were 15%. ...
When setting up a play therapy training clinic, there are many considerations to explore regarding designing a therapeutic space, selecting toys and other materials, exploring the rationale for the toy selection and examining the cultural considerations in play therapy settings. This chapter will review the different types of play therapy clinics and the specific toys recommended based on the fourteen primary play therapy theoretical orientations. General considerations will be reviewed when utilizing art media and other materials, books and bibliotherapy, puppets and puppet theaters, sandtrays and miniatures, and psychotherapeutic games. Recommendations will be made for establishing community and university-based play therapy training sites offering clinical and mock play therapy services. Suggestions will be made regarding the importance of establishing play therapy laboratories in the classroom setting when providing graduate play therapy instruction. Additional recommendations will be made for the 2019 Play Therapy Best Practices published by the Association for Play Therapy.
Humans are the only species that engages in sustained, complex pretend play. As pretend play is practically ubiquitous across cultures, it might support or afford a context for developmental advances during the juvenile period that have implications for functioning in adulthood. Early in development, learning to separate our thoughts from reality is practiced in pretend play and is associated with changes not just in cognition, but in emotional and social domains as well. Specifically, pretend play affords opportunities to engage in abstractions that could support abilities such as perspective-taking, emotion recognition and regulation, and cooperation and negotiation in childhood. In turn, the abstraction skills promoted by early pretend play might underlie creativity, innovation, and our capacity to feel empathy and moral obligation to others in later childhood and adulthood. In fact, because pretend play affords sharing our abstractions with others, it might be an early context for behaviors that ultimately promote the shared abstractions of human culture itself.
Adverse childhood experiences (ACEs) have been shown to have long-term negative health impacts for adults and an increase in maladaptive behaviors in children exposed to ACEs. There are limited studies that explore effective interventions to support children exposed to ACEs. Child-centered play therapy (CCPT) could be an appropriate intervention to assist children exposed to ACEs but needs more research. This study utilized an A-B-A single case research design with five participants. Participants completed 16 30-min CCPT sessions through the course of the study. Participants showed a decrease in externalized behaviors throughout the study that carried over after the intervention stopped. This study provides evidence that CCPT could be an effective intervention for counselors to utilize with children exposed to ACEs.
The U.S. health service psychology workforce is 88% White and 12% racial and ethnic minorities (American Psychological Association, which is inconsistent with the rapid-changing demographics of children in the U.S. Play therapy, a specialized field within the mental health realm, has been found to lack publications addressing issues of multiculturalism and social justice. In this paper, we aim to address potential racist practices in the playroom and offer anti-racist suggestions for play therapists to consider and reflect on.
The purpose of this article is to propose child‐centered interventions that may support disrupting systemic oppression within the education system for Black children. The author shares Black children's experiences in the U.S. education system and how child‐centered interventions may be helpful for both school and school based clinical counselors.
Despite the Brown v. Board of Education Supreme Court decision ending school segregation in 1954, African American children and other children of color still experience severe and adverse challenges while receiving an education. Specifically, Black and Latino male students are at higher risk of being placed in special education classes, receiving lower grades, and being suspended or expelled from school. Although adverse childhood experiences (ACEs), and the negative outcomes associated with experiencing them, are not specific to one racial or ethnic group, the impact of childhood adversity exacerbates the challenges experienced by male students of color at a biological, psychological, and sociological level. This article reviews the literature on how ACEs impact the biopsychosocial development and educational outcomes of young males of color (YMOC). A strengths-based perspective, underscoring resilience among YMOC, will be highlighted in presenting strategies to promote culturally responsive intervention with YMOC, focused professional development, and advocacy in the school counseling profession.
The Adverse Childhood Experience (ACE) Questionnaire is one of the most widely used assessments for trauma exposure and adversity experienced during the first 18 years of life (Felitti et al., 1998 Felitti, V. J, Anda, R. F, Nordenberg, D., Williamson, D. F, Spitz, A. M, Edwards, V., Koss, M. P, & Marks, J. S, (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 4, 14, 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8 http://doi.org/10.1016/j.amepre.2019.04.001[Crossref], [Web of Science ®] , [Google Scholar]; Kia-Keating et al., 2019). While the ACE Questionnaire has shown to have good reliability and validity, inconsistencies have been demonstrated for the test-retest form of reliability (MacKenzie et al., 2005 MacKenzie, S., Podsakoff, P., & Jarvis, C. (2005). The problem of measurement model misspecification in behavioral and organizational research and some recommended solutions. Journal of Applied Psychology, 4, 90, 710–730. https://doi.org/10.1037/0021-9010.90.4.710[Crossref], [Web of Science ®] , [Google Scholar]; Pinto et al., 2014 Pinto, R., Correia, L., & Maia, A. (2014). Assessing the reliability of retrospective reports of adverse childhood experiences among adolescents with documented childhood maltreatment. Journal of Family Violence, 4, 29, 431–438. https://doi.org/10.1007/s10896-014-9602-9[Crossref], [Web of Science ®] , [Google Scholar]; Zanotti et al., 2018 Zanotti, D. C., Kaier, E., Vanasse, R., Davis, J. L., Strunk, K. C., & DeMarni Cromer, L. (2018). Examination of the test-retest reliability of the ACE-SQ in a sample of college athletes. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 10, 559–562. https://doi.org/10.1037/tra0000299[Crossref], [Web of Science ®] , [Google Scholar]). To address the lack of consensus on the test-retest reliability of the ACE Questionnaire and the appropriateness for use with adolescents, the current study examined test-retest reliability of the ACE measure for a small group of adolescents in residential treatment. Participants (n = 20) completed the ACE during week 1 and were later assessed at week 9. The test-retest reliability of the ACE was very high (r = 0.913), thereby supporting the overall reliability of the ACE questionnaire and its effectiveness in identifying baseline trauma. However, the results indicate that adolescents might not fully understand their past trauma experiences prior to receiving trauma-focused treatment. Potential explanations of unreliable reporting of ACEs, counseling implications and recommendations for multiple administrations are discussed.
Nonpharmacological treatment of children with mental and behavioral health concerns includes the treatment modalities of play and group therapies. This chapter addresses the importance and evidence‐based benefits of play and group therapies and highlights research on neurobiological impact from use of these modalities. It describes the significance of these interventions in promoting healthy child and adolescent growth and development. The chapter provides an introductory overview and encourages the advanced practice registered nurse (APRN) in primary care to seek further education and skills in basic play and group therapy techniques for use with common behavioral presentations. It also encourages the APRN in primary care to refer children and adolescents to child and adolescent psychiatric‐mental health (PMH) APRNs trained and certified in these treatment modalities, and to work collaboratively with PMH APRNs to meet both the medical and behavioral/mental health needs of the pediatric population.
Background
Little is known about which therapeutic treatment models are being used most commonly at community-based mental health settings to treat young children exposed to violence.
Objective
We aimed to (1) explore the use of commonly applied treatment models for young children exposed to violence across community-based clinical sites and (2) examine the associations of the use of these models with child demographics and type(s) of violence to which the child was exposed. The models examined included Cognitive Behavioral Therapy (CBT), Attention, Regulation, and Competency (ARC), Child-Parent Psychotherapy (CPP), and Child-Centered Play Therapy (CCPT).
Participants and Setting:
Participants were 500 children aged 0-6 years, who were exposed to violence and received treatment at 1 of the 12 community-based sites. The mean age was 48.1 months (SD = 13.9 months).
Methods
Descriptive analyses were conducted on child demographics, type of violence, and treatment model(s) employed. Binary logistic regressions were conducted to examine the associations of treatment model(s) used with child demographics and type of violence.
Results
76.2% of the sample received CCPT or an integrative approach, rather than evidence-based treatments (e.g., CBT, CPP). Black children were more likely to receive CCPT (OR = 6.490; 95% CI = 1.262, 33.375). Hispanic children were less likely to receive ARC (OR = 0.234; 95% CI = 0.074, 0.738). Associations between type of violence exposure and treatment model utilization were also found. Conclusions: Our results underscore a need to disseminate EBTs, as well as to assure that treatment needs of individual children are met.
This qualitative study explored communicative processes of resilience in Equine Assisted Psychotherapy (EAP) among young women with adverse childhood experiences (ACEs). Utilizing communicative resilience (Buzzanell, 2010), findings suggest that adults, peers, and equines assist adolescents in (a) crafting normalcy, (b) building new communication networks, (c) legitimizing negative feelings while foregrounding positive action, (d) putting alternative logics to work through goal-oriented talk, and (e) cultivating identities of empowerment. Communication messages and processes in equine assisted therapy are considered, specifically, how relationship building with humans and equines fosters resilience among adolescents with ACEs.
Background
Mental health problems (MHPs) in preschoolers are precursors of mental disorders which have shown to be associated with suffering, functional impairment, exposure to stigma and discrimination, as well as enhanced risk of premature death. A better understanding of factors associated with MHPs in preschoolers can facilitate early identification of children at risk and inform prevention programs. This cross-sectional study investigated the association of risk and protective factors with MHPs within a German representative community sample. MethodsMHPs were assessed in a sample of 391 preschoolers aged 3–6 years using the Strength and Difficulties Questionnaire (SDQ). The effects of parental MHPs, children’s temperament, parental socioeconomic status (SES), social support and perceived self-competence on MHPs were assessed using bivariate and multivariate logistic regression analyses that controlled for sociodemographic characteristics. ResultsOverall, 18.2% of preschoolers were classified as ‘borderline or abnormal’ on the total difficulties score of the SDQ. Bivariate analyses showed that parental MHPs, children’s difficult temperament, and parental low SES increased the likelihood, whereas high perceived parental competence decreased the likelihood of preschool MHPs. In the multivariate analyses, only difficult child temperament remained significantly associated with preschool MHPs when other variables were controlled. Conclusions
The results underline the importance of children’s difficult temperamental characteristics as a risk factor for mental health in preschoolers and suggest that these may also be an appropriate target for prevention of preschool MHPs. More research on specific aspects of preschool children’s temperament, the socioeconomic environment and longitudinal studies on the effects of these in the development of preschool MHPs is needed.
It is well documented that children living in poverty experience disadvantages in virtually every area of health and mental health, development, academic achievement, and other areas, compared to their more well-off peers. Mechanisms behind these disadvantages certainly include the lack of resources of all kinds inherent in poverty, including access to health care, high-quality education, safe housing, nutritious food, and many other resources. Less well recognized is the contribution of prenatal stress to these gaps, as poor children’s disadvantages often start early in fetal life due to high stress experienced by their mothers. Animal research and emerging human research demonstrate that stress during pregnancy affects fetal brain development through the mother’s hypothalamic–pituitary–adrenocortical axis, influencing the developing stress system and other parts of the brain of the fetus. Understanding these relationships among poverty, prenatal stress, and child outcomes is important for social workers, whose policy and service provider roles provide opportunities for amelioration at both micro- and macro-levels. This paper elucidates the consequences of prenatal stress, demonstrating that the physiological stress response operates prior to birth and directly influences infant and child biological, psychological, and social well-being. First, we briefly review the well-documented disadvantages experienced by poor children. Then, we describe the physiology of stress, clarifying the often-confusing definitions and elaborating to explain unique physiological aspects of stress during pregnancy. Finally, we discuss the important role social work may play in addressing this important problem.
This study examined the relationship among child abuse (physical, emotional, and sexual), social support from friends and family, and social functioning in a sample of low income African American children (N=152).With the exception of the association between sexual abuse and peer support, all of the correlations among study variables were significant. The relationship between child physical and emotional abuse and social functioning were mediated by both family and peer support; however, only family (not peer) support was a significant mediator in the sexual abuse-social functioning link. Additionally, there was no difference found in the strength of mediation via family support versus peer support. Results suggest that mental health professionals should inquire about and attempt to increase children’s levels of social support from family and peers when working with abused youth in order to promote healthy psychological and psychosocial outcomes.
Mental disorders among children are described as "serious deviations from expected cognitive, social, and emotional development" (US Department of Health and Human Services Health Resources and Services Administration, Maternal and Child Health Bureau. Mental health: A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and National Institutes of Health, National Institute of Mental Health; 1999). These disorders are an important public health issue in the United States because of their prevalence, early onset, and impact on the child, family, and community, with an estimated total annual cost of $247 billion. A total of 13%-20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994-2011 has shown the prevalence of these conditions to be increasing. Suicide, which can result from the interaction of mental disorders and other factors, was the second leading cause of death among children aged 12-17 years in 2010. Surveillance efforts are critical for documenting the impact of mental disorders and for informing policy, prevention, and resource allocation. This report summarizes information about ongoing federal surveillance systems that can provide estimates of the prevalence of mental disorders and indicators of mental health among children living in the United States, presents estimates of childhood mental disorders and indicators from these systems during 2005-2011, explains limitations, and identifies gaps in information while presenting strategies to bridge those gaps.
The aim of this article is to report on a qualitative study of a school-based ecological treatment intervention for maltreated children and to articulate best practice guidelines. Sixty-three interviews were conducted at 6, 12, and 18 months with parents, teachers, and therapists of 11 maltreated children, exploring the child's development, the influence of therapy on the family, and the therapist's relationship with teachers and parents. Findings indicated that the treatment was effective in improving the children's emotional, social, and academic functioning. An ecological treatment approach requires team building which in turn requires flexibility, consultation, and two-way communication between therapists and others. Implications for practice are presented.
Child welfare and criminology research have increasingly sought to better understand factors that increase the likelihood that abused and neglected children will become involved in the juvenile justice system. However, few studies have addressed this relationship among African American male adolescents. The current study examines the relationship between child maltreatment (i.e., neglect, physical abuse, sexual abuse, and other/mixed abuse) and the likelihood of a delinquency petition using a sample of African American males (N = 2,335) born before 1990. Multivariable logistic regression models compared those with a delinquency-based juvenile justice petition to those without. Results indicate that African American males with a history of neglect, physical abuse, or other/mixed abuse were more likely to be involved in the juvenile justice system than those without any child maltreatment. Additionally, multiple maltreatment reports, a prior history of mental health treatment, victimization, and having a parent who did not complete high school also increased the likelihood of a delinquency petition. Implications for intervention and prevention are discussed.
This cross-sectional study examined the relations among children’s ethnic pride, perceived parenting behavior (i.e., parental
control, parental acceptance), anxiety sensitivity, and child anxiety symptoms (i.e., physical symptoms, social anxiety symptoms,
separation anxiety symptoms, and harm avoidance symptoms) in 266 African American school children (M = 9.98 years old; 55% girls). Structural equation modeling results indicated that high ethnic pride was associated with high
parental acceptance. High perceived parental acceptance, in turn, was related to children reporting low levels of social anxiety
symptoms and high levels of harm avoidance. In addition, high parental control was related to high anxiety sensitivity. Anxiety
sensitivity partially mediated the relation between parental control and separation anxiety symptoms, such that parental control
was both directly and indirectly related to separation anxiety symptoms. Parental control was indirectly related to physical
symptoms, social anxiety symptoms, and harm avoidance symptoms through its direct link to anxiety sensitivity. The study’s
results increment knowledge about factors influencing specific dimensions of anxiety in African American children.
Domestic violence is a relatively common problem that has serious, negative consequences for preschoolers'' emotional, behavioral, and interpersonal functioning. Many children who witness domestic violence also experience the loss of a caregiver, which can exacerbate difficulties. Unfortunately, only a small number of preschoolers receive treatment for these problems, possibly because there are few well-developed programs for this age group. This paper describes a group play therapy for preschoolers exposed to domestic violence and other traumas. The group is designed for 14 sessions, each lasting 60 minutes, and takes place in a Head Start preschool. Individual sessions follow a consistent format; the group begins with a warm-up exercise about feelings, followed by structured activities, and ends with unstructured free play and clean-up. General techniques used in the group and their therapeutic uses are described. Recommendations for future groups and future research on the efficacy of groups are also discussed.
This article examines evidence-based assessment practices for attention deficit hyperactivity disorder (ADHD). The nature, symptoms, associated features, and comorbidity of ADHD are briefly described, followed by a selective review of the literature on the reliability and validity of ADHD assessment methods. It is concluded that symptom rating scales based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), empirically and rationally derived ADHD rating scales, structured interviews, global impairment measures, and behavioral observations are evidence-based ADHD assessment methods. The most efficient assessment method is obtaining information through parent and teacher rating scales; both parent and teacher ratings are needed for clinical purposes. Brief, non-DSM based rating scales are highly correlated with DSM scales but are much more efficient and just as effective at diagnosing ADHD. No incremental validity or utility is conferred by structured interviews when parent and teacher ratings are utilized. Observational procedures are empirically valid but not practical for clinical use. However, individualized assessments of specific target behaviors approximate observations and have both validity and treatment utility. Measures of impairment that report functioning in key domains (peer, family, school) as well as globally have more treatment utility than nonspecific global measures of impairment. DSM diagnosis per se has not been demonstrated to have treatment utility, so the diagnostic phase of assessment should be completed with minimal time and expense so that resources can be focused on other aspects of assessment, particularly treatment planning. We argue that the main focus of assessment should be on target behavior selection, contextual factors, functional analyses, treatment planning, and outcome monitoring.
Assessing impairment is an explicit component of current psychiatric diagnostic systems. A brief parent and teacher rating scale for assessing impairment was developed and studied using attention deficit hyperactivity disorder (ADHD) as an exemplar disorder. The psychometric properties of the Impairment Rating Scale (IRS) were measured in 4 samples. Two included ADHD and matched comparison children and the other 2 a school sample. Overall, IRS ratings exhibited very good temporal stability. They correlated with other impairment ratings and behavioral measures and displayed evidence of convergent and discriminant validity. The IRS was highly effective in discriminating between children with and without ADHD. Evidence that the parent and teacher IRS accounted for unique variance beyond ratings of ADHD symptoms is also presented. The scale is brief, practical, and in the public domain. The results of the studies and implications for the assessment of impairment are discussed.
African American children experience higher rates of poverty than other children. According to the National Center for Children in Poverty (National Center for Children in Poverty, 2014), not only does poverty contribute to children’s poor physical and mental health, it can also impede their learning abilities and contribute to problems socially, emotionally, and behaviorally. In this single-case design study, 4 at-risk African American preschool children ages 3–5 participated in 7 weeks of Adlerian individual play therapy followed by 7 weeks of Adlerian group play therapy. This intervention was chosen to address the participants’ problematic classroom behaviors, i.e., “calling out” and maintaining boundaries. Findings showed that upon completion of 7 weeks of individual Adlerian play therapy, children demonstrated questionable to moderate effect-size (ES) gains in reducing disruptive classroom behaviors. After receiving an additional 7 weeks of the Adlerian group play therapy, children demonstrated moderate to high ES improvements. Implications for play therapists working with African American preschool children living in poverty, interventions for addressing externalizing behaviors, and recommendations for future research are discussed.
Purpose of the study:
The goal of the study was to examine barriers and facilitators to clinical research participation among African Americans, as well as recommendations for overcoming these.
Design and methods:
Eight focus groups were conducted consisting of 64 individuals. These focus groups targeted 2 groups of individuals: (a) community members, including both individuals involved in research and individuals not involved in research, and (b) community leaders, including clergy, community health care providers and service providers who may influence decisions to participate in research.
Results:
Among participants in both groups, the most common barriers to participation included fear and mistrust of research due to multiple factors, such as a lack of information about research and prevailing knowledge of historical occurrences. Facilitators to research participation included intrinsic factors, such as a desire to help others, and extrinsic factors, such as familiarity with the research recruiter. The focus groups also directly engaged participants in discussions of strategies that might improve recruitment, such as the importance of providing personal stories that enable community members to understand the potential benefits of research.
Implications:
Findings from these focus groups address the mandate from funding agencies that emphasize the importance of including racially diverse populations in clinical research studies, and offer potential solutions for increasing the recruitment and retention of minority participants.
Children who are off-task in schools struggle with completing their work and engage in disruptive behaviors. Without intervention, these behaviors tend to worsen, putting them at risk for more serious, ongoing problems throughout life. Group counseling provides opportunities for people to practice socially useful behaviors. Using a single case design, we investigated the effectiveness of Adlerian group play therapy with children identified by teachers as having problematic classroom behaviors. Results suggest that students’ on-task behaviors improve during the Adlerian group play therapy intervention. The results revealed mixed findings for the follow-up period.
Child-centered play therapy (CCPT) can be a valuable creative method to gain understanding of children's life, culture, and needs. This approach allows children to play out life problems in an accepting environment through the experiential and cultural components inherent in creative interventions such as CCPT. This manuscript will share insights and examples in the use of CCPT to provide culturally competent services to a diverse population of child clients.
ABSTRACT Few studies have examined the incidence of behavior problems in toddlers and preschool children from families living in poverty. The available research suggests behavior problems occur at higher rates in children living in poverty and may have long-term negative outcomes if not identified and properly treated. This study included an ethnically representative sample of 357 children, five years of age and younger, from a diverse, low-income, urban area. All families' incomes met the federal threshold for living in poverty. Behavior problems were assessed by parent report through a questionnaire specifically designed for low-income families. Boys and younger children were reported as demonstrating a higher rate of externalizing behaviors than girls and older children. The overall rate of children scoring at least one standard deviation above the sample's mean for challenging behaviors was 17.4% and was not related to the child's gender, age or ethnicity. This study also sampled children's positive behaviors, which is unique in studies of behavior problems. Gender and age were not related to the frequency of reported positive behaviors. Ethnicity did influence scores on the positive scale. African American children appeared to present their parents more difficulty on items reflecting cooperative behaviors than Caucasian or Latino children. The implications of the study are discussed based on the recognized need for universal screening of behavior problems in young children and the small number professional training programs targeting the identification and treatment of early childhood behavior problems, despite the availability of evidence-based treatment programs tailored to young children in low-income families.
African Americans' poverty and deep-poverty rates are higher than those of Whites, and African Americans' poverty spells last longer. Furthermore, nonpoor African Americans are especially likely to slip into poverty, and over the course of a lifetime, very many African Americans will experience poverty. Accordingly, African Americans are disproportionately likely to be assisted by safety net programs providing income support and health and social assistance. When mental health-related outcomes are assessed, U.S.-focused and international studies of safety net programs sometimes find that adults and children show a decline in symptoms of mental illness after participating. All things being equal, these improvements can disproportionately benefit African Americans' mental health. Safety net programs' mental health-related impact should be routinely assessed when evaluating the programs' economic and social outcomes and the impact they have on African Americans' mental health. Policy research of this kind can help us to understand whether these very large interventions show society-wide mental health-related improvement in the disproportionately large number of African Americans who participate in them. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Mental health problems in children and adolescents are frequent, with a high risk of persistence into adulthood. Therefore, the investigation of determinants of onset and course of mental health problems is of high importance.
The present paper investigates the impact of protective and risk factors on the development of depressive symptoms in children and adolescents. The BELLA study is the mental health module of the German National Health Interview and Examination Survey for children and adolescents (KIGGS). Based on the first three measurement points of the BELLA study (covering a period of 2 years), the present analysis focused on children and adolescents aged 11–17 years at baseline (n = 1,643; 50.6 % female). A longitudinal growth modelling approach was used. Mental health problems in parents (parent-reports) predicted depressive symptoms in children and adolescents (self-reports) as well as the development of these symptoms over time. Further, child-reported protective factors of self-efficacy, positive family climate and social support were associated with less depressive symptoms at baseline. Additionally, positive changes in protective factors were associated with the development of less depressive symptoms over time. Finally, family climate and social support moderated the detrimental influence of parental psychopathology on child’s depressive symptoms. The addressed determinants for the development of depressive symptoms in children and adolescents are highly relevant for prevention and intervention strategies. Future research should investigate specific risk and protective factors focusing in detail on further mental health disorders and their development in children and adolescents.
Previous research suggests a relationship between poverty, caregiver depression, caregiver stress and children's externalizing behaviour. However, little research exists to suggest the manner in which these concepts are interrelated. Latent growth curve analyses were conducted on caregiver–child dyads data from the Early Head Start Research and Evaluation Project to identify the path through which poverty, caregiver depression, caregiver stress and child externalizing behaviours were related. Analyses identified a path through which caregiver stress and depression mediated the effect of poverty on child externalizing behaviours. In addition, the influence of caregiver depression on child externalizing behaviours was mediated by caregiver stress. Implications and limitations of these findings are discussed.
Culturally sensitive counseling interventions are needed for African American boys in elementary school. Two important components of counseling African American boys are honoring the African worldview and building self‐confidence. Child‐centered group play therapy is a common intervention for elementary school children. In this article, the authors describe how child‐centered group play therapy with African American boys at the elementary school level honors the African worldview and facilitates their self‐confidence. Counseling implications and recommendations for research are discussed.
Children exposed to the trauma of domestic violence tend to experience difficulties with internalized and externalized behavior problems, social skills deficits, and academic functioning. Mental health practitioners in the school setting, including school counselors, school psychologists, and school social workers, can address developmental concerns that impede development through group counseling interventions that include both structured activities and play therapy. The school environment offers an ideal setting in which to work with child survivors of trauma, as all students have accessibility to school mental health resources. This article outlines the primary objectives and corresponding procedures for a developmentally- appropriate group interventions for elementary-aged children who have been exposed to the trauma of domestic violence.
African American youth residing in low income urban neighborhoods are at increased risk of experiencing negative life events in multiple domains, increasing their risk for internalizing and externalizing behaviors. However, little is known about youth’s differential responses to life event stress, or protective processes and coping strategies for urban African American youth exposed to adverse life events. Thus, the present study examined whether variability in predominantly low income, urban African American youth’s responses to life event stress are accounted for by the type of life event experienced or the type of coping strategies used. Participants were a community sample of 353 urban African American youth (52.8 % girls; age range 8–12 years) who participated in the Multiple Opportunities to Reach Excellence (MORE) Project. Youth reported about their experiences with adverse life events, coping strategies, and internalizing and externalizing symptoms. Results indicated that violent life events were uniquely associated with externalizing behavior, while discrimination and economic stress were uniquely associated with internalizing behavior. The utility of coping strategies varied by gender, such that avoiding problems was protective for girls who experienced violent life events, but not for boys. For boys, exposure to violence was significantly positively associated with externalizing symptoms regardless of the amount of avoiding problems coping used. Findings suggest that interventions to develop coping strategies may need to be gender-specific as well as tailored for the types of stressors common for low income urban youth.
Adopting an ecological framework, this study examines the role of community violence exposure, interpartner conflict, positive parenting, and informal social support in predicting the social skills and behavior problems of low-income African American preschoolers. Participants were 184 African American mothers and female caregivers of Head Start children who completed study measures in a structured interview. Regression analyses revealed that greater community violence exposure predicted more internalizing and externalizing child behavior problems and lower levels of self-control and cooperation. Greater interpartner conflict predicted more internalizing problems. Positive parenting was predictive of fewer internalizing and externalizing problems and higher levels of child self-control and cooperation. Greater informal social support predicted higher levels of all four child social skills, including self-control, cooperation, assertion, and responsibility. Positive parenting and informal social support failed to moderate the relationships between community violence exposure and interpartner conflict and child outcomes. Implications of the findings for intervention and future research are discussed.
The author defines and presents a rationale for service learning, provides procedures for implementing service learning with children affected by poverty, and describes methods of facilitating multicultural counseling competence. Examples are provided from a graduate counseling class that conducted group play therapy with 11 African American children at a community center.
Previous research has suggested that the factor structure of anxiety measures is different in African American samples compared to majority population samples. However, these findings may be due to misuse of analytic methods rather than meaningful differences in the underlying presentation of anxiety. To address this, we examined the factor structure of two measures of child anxiety: the Revised Children's Anxiety and Depression Scale and the Multidimensional Anxiety Scale for Children in a sample of 229 African American youth. Contrary to previous research, confirmatory factor analyses yielded good fit for the original factor structures of both measures. These results suggest that the underlying factor structure of these measures may not be significantly different for African American and majority population youth as previously thought. The effect of data analytic procedures on subsequent conclusions and theory is discussed and recommendations are made.
Like its predecessor—which awakened the therapeutic community to the varying assumptions, needs, and biases of culturally different clients—this updated and revised "Second Edition" opens new doors and lays the groundwork for exciting new directions.
While the overall approach has remained the same, there is heightened emphasis on the damaging effects of political and racial biases inherent in the mental health field and on the need for developing culture-specific communication/helping styles for culturally different clients. Also highlighted are the key issues of ethnic and racial identity formation and culturally specific concepts of the family and their relationship to counseling.
"Counseling the Culturally Different" moves from the theoretical to the practical in three sections covering: Issues and Concepts—provides a conceptual framework with which to view the complex interplay of values, expectations, and social and political forces in the counselor-client relationship and the practice of cross-cultural counseling in public schools, mental health agencies, industries, and correctional institutions. Counseling Specific Populations—guidelines and detailed methods for counseling specific minority groups (including African Americans, Hispanics, American Indians and Asian Americans). Critical Incidents—a series of case vignettes portraying typical issues and dilemmas.
Combining a sound conceptual framework for multicultural counseling with proven therapeutic methods for specific groups, "Counseling the Culturally Different, Second Edition" prepares students, like no other text in the field, for the rigors of counseling in the "real world." At the same time, as a source of enlightenment and guidance for professionals, it has been proven to make a difference in clients' lives. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Despite the strong correlation between caregiver substance abuse and child maltreatment, little information exists to understand the typology of African American caregivers with substance abuse problems in the child welfare system. Research shows African American caregivers contend with multiple problems stemming from substance abuse. Unfortunately, we do not yet know how to best tailor resources to be responsive to varying groups of African American caregivers. Using data from the National Survey of Child and Adolescent Well-being (NSCAW), this investigation tested for distinct multivariate profiles among a subset of African American caregivers with substance abuse problems (n=258). Latent Class Analysis (LCA) was used to classify caregivers, and five classes were identified among this high risk sample - each with distinct risk profiles. Based on these findings, we discuss implications for tailored practices to enhance the safety and stability of children involved with child welfare.
We examined the association between neighborhood violence and three domains of psychosocial adjustment in low-income, urban African American children: internalizing, externalizing, and physical symptoms. Based on anecdotal and empirical evidence, it was hypothesized that, relative to internalizing and externalizing problems, a stronger association would emerge between physical symptoms and neighborhood violence. Mother-reported neighborhood violence was associated with child-reported physical symptoms, but not internalizing or externalizing symptoms. Child-reported neighborhood violence was associated with child-reported internalizing, externalizing, and physical symptoms; however, neighborhood violence accounted for a greater percentage of variance in physical symptoms than the other two symptom domains. Our findings were not moderated by the age or gender of the child. We discuss the importance of physical symptoms as a marker of child adjustment in low-income, urban, African American children, as well directions for future research.
This paper is a case study of an eight month long preschool therapy group for developmentally delayed and emotionally traumatized,
inner-city, prelatency-age children. The purpose of this paper is to examine the usefulness of group work with this age group
and includes illustrations of the progression from play group to therapy group as well as discussions of the importance of
peer relationships and play for this age group. Following descriptions of the setting, children, therapists, and treatment
structure of the group, clinical vignettes from sessions are presented illustrating group processes over a period of time
as well as developments in individual children and the group. Also included are discussions of relevant literature and challenges
faced by therapists.
Considerable research has documented associations between adverse life events and internalizing symptoms in adolescents, but much of this research has focused on the number of events experienced, with less attention to the ecological context or timing of events. This study examined life events in three ecological domains relevant to adolescents (i.e., family, peers, themselves) as predictors of the course of depressive symptoms among a community epidemiologically defined sample of 419 (47.2% females) urban African American adolescents. Given that youth depressive symptoms change over time, grade level was examined as a moderator. For males, the strength of associations between life events happening to participants, family life events, and peer life events and depressive symptoms did not change from grades 6-9. For females, the strength of the association between peer life events and depressive symptoms did not change over time, but the strength of associations between life events happening to participants and family life events and females' depressive symptoms decreased over time. Implications of the findings and directions for future research are discussed.
Demographics, parental risk factors, and experiencing interpersonal trauma (domestic violence, community violence, and physical and sexual abuse) are related to childhood posttraumatic stress disorder (PTSD). Little is known about these factors and the risk of PTSD in African American children. This study examined associations between PTSD symptoms and gender, age, parent mental illness, parent substance abuse, and interpersonal trauma in African American children. Participants were 257 children and adolescents, ages 8-17 years (M = 11.7, SD = 2.5), who received outpatient mental health treatment. Being female and witnessing domestic violence was associated with more PTSD symptoms. Exposure to community violence and physical abuse increased the odds of clinically significant PTSD symptomatology by more than 2 times. The rate of PTSD (16%) was lower in the current study than in other same-age study populations (25%-40%). Risk factors and identification strategies for PTSD are discussed.
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