The relevance of current clinical practice in child psychotherapy to child psychiatry

SUMMARY

The role of child psychiatrists is evolving. Economic and psychosocial factors such as marital breakdown, inner city decline, unemployment, plus increased awareness of conditions such as Substance Abuse and all forms of Child Abuse have led to stress for children and their caretakers. There is also increasing recognition that with help many troubled children and their families can emerge better able to function. Child psychiatrists occupy a pivotal position in the child mental health team and need to be familiar with all the treatment options available to ensure their effective use. This paper presents examples of current work being undertaken by child psychotherapists and discusses the implications of this for the training of child psychiatrists as well as for clinical work.     

The establishment of the department of psychiatry in the Mount Sinai Hospital: a conflict between neurology and psychiatry

A conflict between neurology and psychiatry and controversies about psychoanalysis played an important role in the establishment of psychiatry in the general hospital. This article reviews the impact of this conflict on the establishment of an independent Department of Psychiatry in the Mount Sinai Hospital in New York during the first half of the twentieth century. A unique opportunity is provided to consider the relationships and personalities of the individuals involved, as well as economic, social, and scientific factors, including the introduction of psychoanalysis as a major psychiatric treatment.     

The basic importance of applied behavior analysis

We argue that applied behavior analysis is relevant to basic research. Modification studies, and a broad range of investigations that focus on the precipitating and maintaining conditions of socially significant human behavior, have basic importance. Applied behavior analysis may aid basic researchers in the design of externally valid experiments and thereby enhance the theoretical significance of basic research for understanding human behavior. Applied research with humans, directed at culturally-important problems, will help to propagate the science of human behavior. Such a science will also be furthered by analogue experiments that model socially important behavior. Analytical-applied studies and analogue experiments are forms of applied behavior analysis that could suggest new environment-behavior relationships. These relationships could lead to basic research and principles that further the prediction, control, and understanding of behavior.     

The role of child adrenocortical functioning in pathways between interparental conflict and child maladjustment

This study examined the interplay between interparental conflict and child cortisol reactivity to interparental conflict in predicting child maladjustment in a sample of 178 families and their kindergarten children. Consistent with the allostatic load hypothesis (McEwen & Stellar, 1993), results indicated that interparental conflict was indirectly related to child maladjustment through its association with individual differences in child cortisol reactivity. Analyses indicated that the multimethod assessment of interparental conflict was associated with lower levels of child cortisol reactivity to a simulated phone conflict between parents. Diminished cortisol reactivity, in turn, predicted increases in parental reports of child externalizing symptoms over a 2-year period. Associations between interparental conflict, child cortisol reactivity, and child externalizing symptoms remained robust even after demographic factors and other family processes were taken into account.     

Patterns of interprofessional conflict resolution on school child study teams

This study proposes to investigate perceived and desired methods of conflict resolution by school psychologists, social workers, and learning disability specialists. Data were based on responses to a questionnaire which requested information on how decisions were reached or should have been reached when their child study teams were required to classify a child and there were conflicting opinions between professional groups. While majority vote and resolution by the psychologist accounted for the methods most often used in actual resolutions, there were great disagreements between professions as to how resolutions should have been made. Analysis indicates that the school psychologists are generally satisfied because they are the single group most often making final decisions, but they are generating feelings of discontent among other the other groups which suggst that team functioning and decision making, especially during voting, may be overly affected by interprofessional rivalry rather than objective data.     

Assessment of the use of timeout in an inpatient child psychiatry treatment unit

This article describes the use of response contingent brief social isolation (i.e., timeout) with 770 children admitted to an inpatient child psychiatry treatment unit during a 2-year study period. A total of 2,256 timeouts were recorded during the study period. Preliminary normative frequency, duration, and reason for timeout information are reported for age and sex groups and for common diagnostic categories. Only a third (255) of the inpatients earned one or more timeouts during their hospitalization. The results suggest 2 trends for timeout in this inpatient setting. First, there was an inverse relationship between timeout frequency and subjects' age; i.e., frequency of timeouts tended to decrease as subjects' age increased. Second, there was a positive relationship between timeout duration and subjects' age; i.e., older subjects required longer timeouts. A third and tentative finding suggested that the frequency of timeout was differentially associated with primary diagnosis for some groups. Alternative treatment procedures are discussed.