Gender and infant psychiatry

The practice of infant psychiatry raises theoretical and clinical issues for the feminist psychotherapist. The psychological and social development of infants, the mother-child relationship, and the role of fathers are all areas of shared concern for infant psychiatry and a feminist project. This paper argues that attention to gender as a fundamental category of analysis is crucial in order to understand the context of infant development, to develop a realistic theory of mothering that avoids both mother blaming and the idealization of mothers, and to illuminate the political content of our approaches to therapeutic intervention and research.     

Reflective family play: A model for whole family intervention in the infant and preschool clinical population

This article proposes a new treatment model, Reflective Family Play, for clinical intervention in two‐parent families of children aged 0 to 5 years. It is play‐based and grounded in the evidence‐based treatment approach of Watch Wait and Wonder (WWW) as well as the assessment tool known as the Lausanne Family Play paradigm (LFP). WWW is a dyadic treatment for caregivers and their infants or preschoolers that has been shown to shift attachment in the very young (N.J. Cohen, E. Muir, & M. Lojkasek, 1999; N.J. Cohen, M. Lojkasek, E. Muir, R. Muir & C.J. Parker, 2002). The LFP is a more recent adaptation of the Lausanne Trilogue Play paradigm (LTP; E. Fivaz‐Depeursinge & A. Corboz‐Warnery, 1999). Together, the LTP/LFP have now been used for over 2 decades as reliable measures of the family alliance and interactions in two‐parent households. By combining concepts from WWW and the LTP/LFP, a novel approach is presented for treatment in two‐caregiver households. Clinical excerpts are used to illustrate.     

Infant psychiatry clinic grand rounds. Unresolved grief: A two-year-old brings her mother for treatment

Rebecca was a 2 ¹/₂ -year-old Caucasian female who was brought to the Infant Psychiatry Clinic by her 28-year-old widowed mother. Her mother's chief concern was around parenting issues as well as how to explain to Rebecca the death of her father. This loss occurred when Rebecca was 6 months old and was a source of great pain and unresolved grief to her mother. Central to this case was the chaotic history of Rebecca's mother, who was a victim of incest from the time she was 13 until she was 23 years old. Both of her parents struggled with chronic alcoholism during much of her childhood. It appeared that a factor precipitating the mother's request for help was her struggle to move out of her own mother's home. This outpatient Infant Clinic case involved two primary goals: (1) the assessment of the parent-child relationship and (2) the development of confidence in this “good enough” mother. Vitally important to the process of treatment was the mother's modulation of timing and frequency of sessions. The issue of pacing was carefully monitored as this mother could have been overwhelmed by delving precipitously into her incestuous history. The use of a structured videotape interview to address mother-child interaction and parenting issues was particularly helpful. Referral to an AlAnon group provided the mother with social support as she separated herself from her alcoholic mother and moved toward autonomy in her own parenting role.     

The changing practices of an infant psychiatry program: The McGill experience

The present paper describes the development of a university-based infant psychiatry program. The paper initially highlights the organizational structure of the program that involves some 20 professionals, then reports on 57 infants who presented with disruptive behavior disorders and ends by describing an innovative treatment program for fathers and an attempt to help teenage mothers in caring for their infants. © 1997 Michigan Association for Infant Mental Health     

The role of a language scale for infant and preschool assessment

The PLS-4 (Preschool Language Scale, 4th edition) is a psychometrically sound instrument constructed to assess language skills in children from birth to 6 years 11 months. It is a useful diagnostic and research tool that can be used to identify current comprehension and expressive language skills and can measure changes in language skills over time. The test is individually administered and includes tasks that assess skills in the areas of preverbal behaviors, as well as linguistic skills in the areas of semantics, morphology, syntax, integrative language skills, and preliteracy skills. Extensive reliability and validity evidence are presented. The test has been used extensively in research examining language development of young children from different home environments, children with identified medical conditions, and children participating in a variety of habilitation and intervention programs. Both the previous edition (PLS-3) and the new PLS-4 English and Spanish editions are used extensively in clinical, medical, and research settings to examine developmental language patterns of infants, toddlers, and preschoolers.     

A two year audit of a family therapy clinic in adult psychiatry

This paper reports a 2 year audit of a family therapy clinic in a psychiatric department, focusing especially on the relationship between diagnosis and outcome. Patients with affective disorders–especially where anxiety predominated–and eating disorders had good outcome. Structural change occurred in families with psychotic members, even though psychotic symptoms were often unchanged. Difficulties with an acute onset were more responsive than long-term problems, but a substantial number of the latter did improve. Families receiving between four and 10 sessions had the best outcome, and improvement was generally maintained at 2 year follow-up.     

The problem behavior model: the development of a stalkers clinic and a threateners clinic

Traditionally, forensic mental health services have focused on the assessment and treatment of offenders with serious mental disorders. In recent years, there has been growing recognition that forensic clinicians have an important role to play for those offenders who engage in criminal acts driven by psychological or/and social problems, which may, or may not, occur in conjunction with a major mental disorder. This is especially true for specific offenses such as stalking and threatening. This article describes the innovation of the problem behavior model. This model uses a reductionist approach and the nexus between psychiatry and psychology to address the complex phenomena associated with specific problem behaviors that often culminate in offenses. The model is illustrated by describing the development of specialist clinics for the problem behaviors of stalking and threatening.     

Emergency psychiatry and crisis intervention in a primary clinic

The terms Notfall and Krise, and the semantic problems arising, are elucidated; and an analysis of one years work in provision for emergency psychiatry and stress intervention is presented. Psychoreactive syndromes were found to be most common, followed in second place by psychotic conditions. In third place come disorders in connection with alcohol, which display a rising tendency. 40% of the clinic's beds are occupied by acute emergency cases, chiefly of short duration. Emergency provision is thus shown to be a major feature in the work of psychiatric clinics.     

The application and utility of a family assessment procedure in a child psychiatry clinic

The application of a method of assessing families from a total family systems viewpoint is explored. It was found that the method (the McMaster Model) was well-suited to routine practice in a British child psychiatry setting with routine clinic referrals. It constituted a good procedure both for assessing and for preparing families for family therapy. In this paper the practical procedure is described. Some of the issues arising from the approach and from the assessment of thirty-four clinic families are discussed. It was also found that the method provided a very good framework for teaching.     

The Good Behavior Game in preschool classrooms: An evaluation of feedback

The Good Behavior Game (GBG) is a popular group contingency implemented to decrease disruptive behavior in classrooms. However, despite numerous replications of the GBG, there are few direct comparisons evaluating the effectiveness of specific components of the GBG. In the present study, we directly compared the type of feedback delivered during the GBG on the effectiveness of the GBG to reduce disruptive behavior in two preschool classrooms. Results showed that delivering vocal feedback (e.g., “raise your hand”) alone or in combination with visual feedback (i.e., hatch marks) was superior to no feedback or visual feedback alone during the GBG. These results suggest that different variations of the GBG are not equally effective and that a collection of effective procedural variations from which teachers can choose would be beneficial.     

A constructivist model of infant cognition

We propose six Information-Processing Principles (IPPs) that together describe a constructive, hierarchical system by which infants come to understand objects and events in the world around them. We then demonstrate the applicability of these principles to four specific domains of infant perception and/or cognition, (i.e., form perception, object unity, complex pattern perception, and understanding of causal events). In each case empirical developmental changes appear to be consistent with the IPPs. We then present the Constructivist Learning Architecture, a computational model of infant cognitive development. This model is based on the IPPs, and uses self-organizing, neurally based techniques from Kohonen (1997) and Hebb (1949). We then apply the model to the complex domain of infant understanding of causal events, and replicate many of the developmental changes found empirically. Finally, we discuss the applicability of this constructivist approach to infant cognitive development in general.     

The variability of client,therapist and clinic in psychotherapy outcomes: A three-level hierarchical model

This article investigates the percentage of variance in psychotherapy outcomes explained by the case-mix variables for individual cases, by the therapist (therapist effects), and what additional variance is explained by the clinic with which the therapist is affiliated. While there has been substantial recent research regarding therapist effects, very little has been published regarding clinic-level effects after controlling for therapist effects. The study utilised the largest sample reported to date, using data from 28 clinics with a minimum of 2,000 cases in a clinical range of severity of symptoms with pre-post change scores on an outcome questionnaire. Only cases treated by a therapist with at least 30 cases were included. These selection criteria resulted in a case count of 156,258 clients treated by 874 therapists located at 28 clinics. After controlling for differences in case mix using diagnosis and intake score (severity of symptoms), the resulting analyses indicated that 5.21% of the variance in treatment outcome was explained by the therapist, while another 1.13% of the variance was associated with the clinic. Findings are discussed with implications for practice and policy.     

A cross-cultural study of infant temperament: Predicting preschool effortful control in the United States of America and Russia

Effortful control (EC) has been conceptualized as a dimension of temperament related to self-regulation and associated with the development of executive attention skills. Research has focused on documenting the development of EC, but there has been little systematic study of its precursors. The present study was designed to examine infant temperament characteristics as potential predictors of EC in the toddler/preschool period across two countries: Russia and the USA. Specifically, contributions of negative emotionality (NE), positive affectivity/surgency (PAS), and regulatory capacity/orienting (RCO) measured in the first year of life were expected to explain EC in the preschool period. For the US sample, toddler NE, infant PAS and RCO explained significant amounts of EC variance, whereas infant RCO was the single significant predictor of later EC in the Russian sample. Analyses with the combined sample provided an opportunity to evaluate temperament-by-culture interactions, one of which (PAS×Culture) reached statistical significance. Follow-up analyses indicated that higher levels of infant PAS were related to higher EC scores for US children only, whereas for the Russian youth preschool EC did not vary as a function of infant PAS. Results of this study support the importance of early appearing regulation in contributing to the development of EC and illustrate the value of cross-cultural longitudinal research.     

Stuttering: A multidimensional treatment and evaluation package

A regulated breathing method associated with systematic desensitization and cognitive restructuring was applied to eight adult stutters. Behavioral measures (percentage of stuttered syllable [%SS] and rate of speech) were taken during telephone, interview, and public speaking situations using both obtrusive and unobtrusive conditions. Cognitive and subjective assessment included the Erickson Scale of Communication Attitudes, an irrational beliefs scale, self-efficacy perception, and the percentage of improvement reported by the stutterers. Eight adult nonstutterers were also assessed in identical conditions and compared with the treated subjects in the purpose of a social validation perspective. Results showed that the treatment package significantly reduced stuttering at post-test, and therapeutic gains were maintained at 6 month follow-up study. On the %SS, no significant difference emerged at follow-up between treated stutterers and normals. The multicomponent treatment appears to be a successful treatment for stuttering.     

A model for clinical-quantitative classification. Generation I: Application to language-disordered preschool children

A model is presented for the integration of clinical-inferential and quantitative approaches to classification. In this, the first application of the proposed model, preschool children with developmental language disorders were classified on the basis of clinical interpretations of performance on psychometric subtests. Five hypothesized subgroups were validated on the basis of (a) consensus among five clinical neuropsychologists, (b) language pathologists' reports, (c) comparisons with subgroups defined by a cluster analytic approach, and (d) comparisons among subgroups on variables not used for classification. Results are discussed in terms of the feasibility of the integrated approach, commonalities with other typologies, and the implications of this work to issues of subtype stability, remediation, predictions of later reading achievement, brain-behavior relationships, and generalizability to other clinical groups.