Les représentations mentales de l’enfant chez les parents : situation,illustrations et réflexions sur les catalyseurs de changements en évaluation thérapeutique de l’enfant

Therapeutic assessment of the child (TA-C) is a model of psychological assessment that allows for collaborative work with parents and child on their reasons for consultation, a collaboration that breaks away from a traditional double separation (parent/assessor, and assessor/therapist) in child assessment. This paper, grounded in a contemporary psychodynamic viewpoint, presents clinical illustrations to support a conceptualization of change processes in TA-C. It is argued that, in order to revitalize empathy in parents, work focusing on the parents’ mental representation of their child is central. We propose a hierarchy of assessment/therapeutic goals that allows for a better distinction between TA-C and standard assessment in work with children.     

Long-term effects of the death of a child on parents' adjustment in midlife.

The death of a child is a traumatic event that can have long-term effects on the lives of parents. This study examined bereaved parents of deceased children (infancy to age 34) and comparison parents with similar backgrounds (n = 428 per group) identified in the Wisconsin Longitudinal Study. An average of 18.05 years following the death, when parents were age 53, bereaved parents reported more depressive symptoms, poorer well-being, and more health problems and were more likely to have experienced a depressive episode and marital disruption than were comparison parents. Recovery from grief was associated with having a sense of life purpose and having additional children but was unrelated to the cause of death or the amount of time since the death. The results point to the need for detection and intervention to help those parents who are experiencing lasting grief.     

Father–child and mother–child interaction in families with a child feeding disorder: The role of paternal involvement

To date, research about feeding disorder (FD) has focused almost exclusively on the mother–child dyad, ignoring fathers' roles. The current study investigated father–child interactions with children having FD. The sample consisted of 67 children (1–3 years old) and their mothers and fathers. Thirty‐four children, diagnosed with a nonorganic‐based FD (FD group) and 33 children without an FD (control group) were matched for age, gender, birth order, and maternal education. Data were collected during home visits. Mothers were interviewed about their and the father's involvement in childcare. In addition, mother–child and father–child interactions were videotaped during play and feeding. Both mothers and fathers from the FD group experienced less positive parent–child interactions than did parents in the control group. Furthermore, mothers in the FD group reported greater maternal versus paternal childcare involvement than did control group mothers. Finally, FD group mothers exhibited more parental sensitivity than did fathers during feeing interactions; however, this difference was observed only when coupled with low paternal involvement. In families where fathers were highly involved, no difference was evident in paternal and maternal sensitivity. These findings highlight the importance of fathers' involvement, especially in families with children exhibiting an FD.     

Parental manipulation of child behavior in home observations

The object of this study was to investigate the extent to which parents can manipulate their children's behavior in home observations. Twelve families with four- to six-year old children were recruited for the research. The parents were instructed to make their child look "bad" or "deviant" on three days of a six-day observation and to look "good" or "nondeviant" on alternate days. Results indicated that, as predicted, the rate of child deviant behavior, parental negative responding, and parental commands were all significantly higher on bad than good days. Parental responses to questionnaires provided more detailed information on how parents felt that they influenced their children in the desired directions. These results were discussed in terms of their implications for child psychopathology and the methodology of data collection in the natural environment.     

Joint custody and the preschool child

A longitudinal study of 25 families, with children aged 14 months-5 years, in joint custody, is reported. Varying motivations that lead divorcing parents to undertake and sustain joint custody are discussed, together with the stresses and gratifications of these arrangements for the parents and children. Findings are that where both parents are motivated primarily by interest in the child, where the parenting is sensitive and where the child is shielded from interparental conflict, young children do well. Such families were not the majority in this study. Significant differences emerged in the adjustment of the 1–3 age group as compared with the 3–5 age group which point to greater difficulties for the 3–5-year-olds.     

Age, Gender, and Ethnicity Effects on Parent–Child Discrepancy Using Identical Item Measures

Objective assessment of child and adolescent behavioral and emotional symptoms is traditionally obtained from multiple sources. However, a substantial body of research indicates that parental and child reports provide significant amounts of contradicting diagnostic information. Although a large and growing body of research attempts to identify potential influences of discrepant reports, the current research improves upon previous research in three primary ways: using identical item measures, using expanded statistical analyses, and evaluating cultural influences on observed discrepancies. A total of 2,153 parent–child dyads completed ratings of child behavior and emotional functioning. Specifically, parents and children completed the Ohio Scales, an empirically supported, identical item measure. Generally, reporter agreement was greater than typically reported. Similar to previous research with clinical populations, parents reported greater levels of child problems than their children. While age was not associated with observed discrepancies, parents and daughters demonstrated greater discrepancies on fewer specific items while parents and sons demonstrated more pervasive yet less severe discrepancies. Additionally, Hispanic dyads demonstrated less discrepancy than did African American and Caucasian dyads independent of discrepancy analysis. Discrepancies must be measured using multiple statistical methods in order to understand patterns. Furthermore, discrepancy research must address key demographic factors (e.g., ethnicity, gender).     

Parent and child causal attributions during clinical interviews

Attributions made by children and their parents for the cause of the child's clinical problem were monitored during assessment interviews. Results support previously observed differences obtained through questionnaires, with parents making more attributions than their children to characteristics of the child. This pattern was affected by variations in interview format. Parents and children differed in the locus of their attributions when interviewed individually, but these differences were not present when families were interviewed with both parents and children present. Implications for the methodology of attribution research with child-clinical populations are highlighted.     

Therapeutic Assessment With Children: Intervening With Parents “Behind the Mirror”

All the steps in the model of therapeutic assessment used with children (TA–C) are designed to involve and impact the child's parents. However, a distinctive process that parallels and accompanies the testing sessions with the child might be the most significant in helping parents shift their story of their child and family. In this process, parents are invited to observe their child's testing sessions (in an adjacent room through a live video feed, through a 1-way mirror, or in the corner of the testing room) and process the experience with the assessor (either simultaneously in the case of the 2-assessor model or after the fact in the 1-assessor model). We discuss the development and evolution of what we have come to call the “behind the mirror” method. We describe the therapeutic intent of the method and delineate 13 techniques utilized to enlist parents as active collaborators. We illustrate each technique using the case study of a 10-year-old boy where the 2-assessor model and live video feed method were used. We also provide research findings from the case study that address the parents’ experience of the assessment and their changed view of their child.     

Therapeutic assessment with children: intervening with parents "behind the mirror"

All the steps in the model of therapeutic assessment used with children (TA-C) are designed to involve and impact the child's parents. However, a distinctive process that parallels and accompanies the testing sessions with the child might be the most significant in helping parents shift their story of their child and family. In this process, parents are invited to observe their child's testing sessions (in an adjacent room through a live video feed, through a 1-way mirror, or in the corner of the testing room) and process the experience with the assessor (either simultaneously in the case of the 2-assessor model or after the fact in the 1-assessor model). We discuss the development and evolution of what we have come to call the "behind the mirror" method. We describe the therapeutic intent of the method and delineate 13 techniques utilized to enlist parents as active collaborators. We illustrate each technique using the case study of a 10-year-old boy where the 2-assessor model and live video feed method were used. We also provide research findings from the case study that address the parents' experience of the assessment and their changed view of their child.     

Family sessions as part of child psychological assessment: goals, techniques, clinical utility, and therapeutic value

Including a family session in a child assessment can significantly advance the assessor's and parents' understanding of the child's problems and enhance the likelihood that parents will follow through on recommendations after the assessment. A family session allows the assessor to observe the child in the family context, test systemic hypotheses, better understand the meaning of individual test results, and try out possible interventions. A family session may also help parents see systemic aspects of their child's problems, help the child feel less blamed, foster positive experiences among family members, and offer the family a glimpse of family therapy. We describe methods and techniques for structuring family sessions and offer guidance on preparing for and conducting such sessions depending on one's case conceptualization. Detailed case examples illustrate each technique and demonstrate the immediate and subsequent impact of family sessions as well as their therapeutic value. We also address common clinical and pragmatic issues.     

An outcome evaluation of the implementation of the Triple P-Positive Parenting Program in Hong Kong

The present study evaluated the effectiveness of the Positive Parenting Program (Triple P) with a sample of Chinese parents of children with early onset conduct-related problems in Hong Kong. The participants consisted of 91 parents whose children attended maternal and child health centers and child assessment centers for service, and were between three to seven years old. Participants were randomly assigned to the intervention (TP) and a waitlist control group (WL). There was no significant difference in pre-intervention measures between the two groups. However, at post intervention, participants in the TP group reported significantly lower levels of child behavior problems, lower dysfunctional parenting styles, and higher parent sense of competence, compared to the WL group. Implications of these findings for the use of Triple P with families of Chinese descent are discussed.     

Parent-directed cognitive behavioral therapy for young anxious children: a pilot study

Anxiety in children age 8 years and above has been successfully treated with cognitive behavioral therapy (CBT). However, the efficacy of CBT for anxious children ages 4-7 years has not, to date, been fully investigated. This paper piloted a CBT intervention targeting child anxiety that was delivered exclusively to parents of 26 children with anxiety symptoms ages 4-7 years. The intervention consisted of four 2-hour group sessions of four to six parents (couples). These group sessions were followed by four individual telephone sessions, once per week across a 4-week period. The pre- and postintervention assessment involved measures of multiple constructs of child anxiety (anxiety symptoms, children's fears, behavioral inhibition, and internalizing symptoms) from multiple informants (parents, children, and teachers). Parents also reported parenting strategies they were likely to use to manage their children's anxiety pre- and postintervention. Results indicated a significant decrease in child anxiety and behavioral inhibition as reported by parents and teachers. Furthermore, mothers reported significant increases in their use of positive reinforcement, and modeling and reassurance, and a significant decrease in their use of reinforcement of dependency directly after treatment. Taken together, parent-directed CBT appears to be an effective approach for treating children ages 4-7 years with anxiety symptoms. Limitations of the current research are discussed.     

The prospective relationship between child personality and perceived parenting: Mediation by parental sense of competence

This study examined the prospective relationship between childhood Big Five personality characteristics and perceived parenting in adolescence. In addition, we investigated whether this relationship was mediated by parental sense of competence, and whether associations were different for mothers and fathers. For 274 children, teachers reported on children’s Big Five personality characteristics at Time 1, mothers and fathers reported on their sense of competence at Time 2, and the children (who had now become adolescents) rated their parents’ warmth, overreactivity and psychological control at Time 3. Mediation analysis revealed both direct and indirect effects. No differences in associations were found for perceived parenting of mothers and fathers. This study demonstrates that child personality in late childhood is significantly related to perceived parental warmth, overreactivity and psychological control in adolescence. In addition, parental sense of competence mediates the relationship between child conscientiousness and perceived parental warmth, overreactivity and psychological control.     

Ethical Considerations for Assessing Parent Mental Health during Child Assessment Services

Parents play an integral role in the mental health service provision of children and adolescents, and they can have significant effects on the outcomes of youth. A growing body of research has linked parents’ own mental health status to numerous outcomes for their children, and recent guidelines have emerged recommending the assessment of parent psychopathology when treating child patients. However, these recommendations present a range of ethical considerations. Mental health professionals must determine if the assessment of a parent is empirically supported and that an assessment procedure appropriate for parents can be feasibly implemented. They must also respect the autonomy and confidentiality of parents while ensuring that assessment findings can be translated to meaningful benefits for child patients. This article details and discusses each of these concerns within the context of the relevant principles and standards of the 2016 American Psychological Association’s Code of Ethics. Further, it provides guidelines, relevant clinical examples, and an applied model for mental health professionals to consider the ethical implications of assessing parent mental health when serving child patients.     

Characteristics and Effects of the Co-parenting Alliance between Incarcerated Parents and Child Caregivers

We examined co-parenting alliance based on information provided by 57 incarcerated parents and their corresponding child caregivers who took part in the Messages Project, in which incarcerated parents video recorded greetings to children that were then mailed home. We assessed perceptions of co-parenting alliance, measured by the Parenting Alliance Measure, and levels of child contact from both parents and caregivers. We also observed expressions of positive and negative attitudes that prisoners expressed regarding the home caregiver during the video recording. Incarcerated parents reported more frequent phone contact with children and more frequent letter-writing to children than did home caregivers. Incarcerated parents likewise reported higher levels of co-parenting alliance with the home caregiver in comparison to the assessment of co-parenting alliance reported by the home caregiver. Among children observing the video recorded message, a more positive co-parenting alliance between their parent and home caregiver was associated with increased positive mood. More frequent displays of negative attitudes toward caregivers during the recordings were associated with more negative mood indicators among children. Results suggest the importance of a strong co-parenting alliance between incarcerated parents and home caregivers, but imply that incarcerated parents may have a more optimistic view of their connection home than is the case for collaborating caregivers.     

Investigating the neurodevelopmental mediators of aggression in children with a history of child maltreatment:An exploratory field study

Maltreatment of children is a chronic community problem that increases the risk of future aggression. Despite several decades of research highlighting this relationship, few studies have explored the potential neuropsychological deficits that are likely to mediate it. This exploratory study aimed to examine how child maltreatment may be associated with aggression via impairment in the developing prefrontal-limbic-autonomic pathways that are implicated in neuropsychological models of aggression. Furthermore, it aimed to investigate the relationship between child maltreatment and both reactive and proactive aggression subtypes. To investigate this non-invasively in an at-risk population, children with a documented protective care history (n = 20) and a community control group (n = 30), aged between 6 and 12 years, were compared on measures of cardiovascular functioning, affect regulation and cognitive functioning aligned with this neuropsychological model. Whilst no group differences were found on cardiovascular functioning (i.e., resting heart rate, heart rate reactivity, heart rate variability), the protective care group performed significantly worse on measures of affect regulation and cognitive functioning (i.e., global intelligence, executive functioning, smell identification and social cognition). The relationship between child maltreatment and aggression was mediated by executive dysfunction and affect dysregulation but not global IQ, social cognition or olfactory identification. The results suggest that interventions targeting aggression in maltreated children will benefit from clinical assessment and psychological strategies that address the executive dysfunction and affect dysregulation that has been associated with this clinical outcome.     

The effects of the child with Down syndrome on maternal stress

This article examines the nature and correlates of stress in mothers of children with Down syndrome. In the first part of our study, we compared 27 mothers of children with Down syndrome with 15 mothers of children with heterogeneous causes of learning difficulty. Using Abidin's (1995) Parenting Stress Index (PSI), mothers in the Down syndrome group reported lower total child‐related stress levels, particularly concerning the degree to which the mother considers the child acceptable and reinforcing. In the second part, we identified predictors of stress in mothers of children and adolescents with Down syndrome (N = 37). Children's behaviour problems related to higher levels of overall and specific domains of child‐related stress, and children who were reported as being more cheerful and outgoing had parents who judged their offspring as more acceptable and reinforcing. Mothers also rated their children as less reinforcing when offspring were older.     

The use of child drawings to explore the dual↔group analytic field in child analysis

Awareness that the child is part of a complex relational system has ensured that all child analysts agree on the necessity of establishing a therapeutic alliance with the parents. Unconscious conflictual dynamics involve the child analyst and include him, from the time of the initial consultation, in an analytic field that is closer to that of a group than to the bi‐personal set‐up of therapy with adults. Through a clinical example, the author hypothesizes that the child’s drawings and play can be viewed as tools capable of mapping the unconscious emotions present in an analytic field that extends beyond the analyst–child couple. Play and drawings can be used in the relationship with the parents not in an explanatory sense, but as a probe with which to explore the universe of unconscious emotions present in the group field. The images or the story of the play used with this particular modality prove to be an attractive pathway that is effective in facilitating the alpha function of each of the members of the group. Furthermore, in this sense, they create the conditions for an occasion through which the parents can become more aware of their own unconscious emotions that have been entrusted to the child and expressed through his symptomatology. The possibility for the little group of subjects involved in a child analysis for oscillation in a dual–group field permits not only a shared experience of knowledge, but also a shared creativity aimed at knowledge of emotional truth (O).     

When a child dies: the sociobiology of bereavement

According to modern evolutionary theory, the fitness of individuals consists of both their personal reproductive success and the reproductive success of those with whom they share genes in common. It follows that one of the most biologically costly events possible is the death of a child. This study investigated the grief intensity of bereaved parents and their immediate families using ratings made by 263 bereaved parents. Predictions were derived from sociobiological tenets relating to parental investment, paternal uncertainty, and the propagation potential of both parents and children. Consequently, it was found that mothers grieved more than fathers, healthy children were grieved for more than unhealthy children; male children were grieved for more than female children; health of child and sex of child interacted such that the pattern of grief intensity obtained was healthy male greater than healthy female = unhealthy female = unhealthy male; similar children were grieved for more than dissimilar children; maternal grandmothers grieved more than either maternal grandfathers or paternal grandmothers, who in turn grieved more than paternal grandfathers; and mothers' siblings grieved more than fathers' siblings.     

Help when it's needed first: a controlled evaluation of brief, preventive behavioral family intervention in a primary care setting

This study evaluated the effects of a brief 3- to 4-session behavioral family intervention program for parents of preschool-aged children in a primary care setting, compared to parents in a wait-list control condition. Parents receiving the Primary Care Triple P-Positive Parenting Program intervention reported significantly lower levels of targeted child behavior problems, dysfunctional parenting, and reduced parental anxiety and stress in comparison to wait-listed parents at postassessment. These short-term effects were largely maintained at 6-month follow-up assessment of the intervention group. Implications of these findings for the prevention of behavioral and emotional problems in children are discussed.