Enrichment and Stress in Families Caring for a Child with a Serious Emotional Disorder

We examined enrichment and stress in 214 families who had children with severe emotional disorders. Caregivers' ratings of enrichment and stress were obtained through a newly developed instrument, the Effects of the Situation Questionnaire, which used parallel items covering 17 life areas. While ratings of stress were generally higher than enrichment, caregivers reported some enrichment in areas encompassing self concept and family relationships, Bivariate and multivariate analyses using various child, family, and service-system variables revealed that stress was notably associated with severity of the child's disorder, low empowerment, and a lack of coordination among service providers. Enrichment was unrelated to severity but associated with high empowerment and spiritual support. Our findings suggest that families' experiences of caregiving can have both positive and negative aspects and that a comprehensive approach to serving and studying families should take both into account.     

Psychosocial Impact of Predictive Testing for Illness on Children and Families: Challenges for a New Millennium

Predictive testing for adult- and child-onset diseases is becoming widely available. The identification of individuals prone to develop certain illnesses is often medically advantageous in that it may afford opportunities to engage in risk reduction behaviors to detect or delay disease onset. However, sometimes the knowledge gained from these tests can be ambiguous, generate distress, and potentially affect several generations of family members. Overall, these factors create a challenging set of circumstances for persons considering genetic and other forms of predictive testing, particularly parents and children. In this article, we (1) address conceptual issues involved in determining the impact of predictive testing on child and family well-being, (2) review empirical data on this topic, and (3) provide a case example to illustrate these findings. Recommendations are made for additional psychological research on child- and family-focused outcomes associated with participation in testing, highlighting their clinical implications.     

流动儿童家庭环境的特点及其对生活满意度的影响

以北京市1018名流动儿童和447名城市儿童为调查对象,采用家庭生活环境调查问卷、家庭功能问卷、学生多维生活领域满意度量表和学生总体生活满意度量表,考察流动儿童家庭环境的特点及其对生活满意度的影响。结果表明:(1)流动儿童的家庭经济状况和家庭功能均显著差于城市儿童。(2)父亲从事体力类工作显著负向预测流动儿童的环境满意度;家庭生活指数显著正向预测流动儿童的家庭、环境满意度及总体生活满意度;家庭居住的社区环境显著正向预测流动儿童的家庭和环境满意度。(3)家庭亲密度显著正向预测流动儿童的家庭、环境满意度和总体生活满意度,家庭的适应性显著正向预测其家庭满意度。     

Grandparents Dealing with the Divorce of Their Child: Tips for Grandparents and Therapists

Some grandparents are still in their forties. When these young people are faced with the divorce of one of their children they have two dilemmas: 1) How to be supportive of their child and 2) How to avoid losing contact with their grandchildren. This article gives tips to grandparents and therapists faced with this common problem.     

瑞典的双生子与子代研究： 通过双生子及其家庭来增加对遗传与环境互动的了解

双生子及子代研究（TOSS）收集了909对双生子及他（她）们的配偶和他（她）们的青少年子女的数据。设计该项目是为研究以下三个问题：1）遗传与环境是如何影响双生子父母的养育方式的？2）遗传与环境是如何影响成年人的家庭关系的？3）家庭关系是如何影响成年人的心理调适的？由于此研究包括了双生子及其子女,该设计可以与其他研究相比较来具体地分析遗传与环境的关联。此研究的结果有助于厘清遗传与环境在养育方式和家庭关系中的型态,同时也澄清了父母亲个人特征是如何影响他（她）们的养育方式,以及父母的个体特征是如何帮助解释了遗传对家庭关系的影响。此研究今后将进一步分析遗传与环境的关联与互动,以及候选基因与环境的关联与互动     

Children of Probationers in the Child Welfare System and Their Families

This study describes changes over a 36-month period in the lives of children of probationers who were subjects of reports of maltreatment. Data on a nationally representative sample of reported victims of maltreatment were used to examine probationer-parents’ contact with the criminal justice system, and concurrent changes in their children’s households, risk exposure, and emotional and behavioral problems. Results show that 36 months after coming in contact with the child welfare system, about 40% of probationer’s children no longer lived with their probationer-parents. During the same period, children’s exposure to risk (i.e., parental substance abuse, mental illness, and domestic violence) dropped markedly; however, there was an upward trend in the prevalence of child emotional and behavioral problems. These problems ultimately declined among very young children, but persisted among elementary school age children. Further prospective studies are needed to better understand the confluence of factors affecting the outcomes of probationers’ children.     

The Voices of Therapists and Children Regarding the Inclusion of Children in Family Therapy: A Systematic Research Synthesis

In 1970, Nathan Ackerman challenged the field of marriage and family therapy to actively involve young children in the family therapy process. How has the field of marriage and family therapy responded to his challenge? Using a systematic research synthesis to review and critique the non-empirical and empirical literature in the area of children in family therapy, the author discovered that the field of marriage and family therapy has not responded to Ackerman's challenge in the way he may have hoped for nearly three decades ago. A summary of the literature's findings is provided and recommendations for future research, as well as implications, for the field of marriage and family therapy are discussed.     

Families of Children With Attention-Deficit/Hyperactivity Disorder: Review and Recommendations for Future Research

This review integrates and critically evaluates what is known about family characteristics associated with childhood Attention-Deficit/Hyperactivity Disorder (ADHD). Evidence suggests that the presence of ADHD in children is associated to varying degrees with disturbances in family and marital functioning, disrupted parent–child relationships, specific patterns of parental cognitions about child behavior and reduced parenting self-efficacy, and increased levels of parenting stress and parental psychopathology, particularly when ADHD is comorbid with conduct problems. However, the review reveals that little is known about the developmental mechanisms that underlie these associations, or the pathways through which child and family characteristics transact to exert their influences over time. In addition, the influence of factors such as gender, culture, and ADHD subtype on the association between ADHD and family factors remains largely unknown. We conclude with recommendations regarding the necessity for research that will inform a developmental psychopathology perspective of ADHD.     

家庭社会经济地位与父母教养方式对儿童青少年公正世界信念的影响

以全国24013名10~15岁儿童青少年为对象,探讨家庭社会经济地位与父母教养方式对公正世界信念的影响。结果发现：（1）家庭社会经济地位能够正向预测一般公正世界信念与个人公正世界信念;（2）权威型教养方式能够正向预测一般公正世界信念与个人公正世界信念,独裁型与纵容型教养方式能够负向预测一般公正世界信念与个人公正世界信念;（3）家庭社会经济地位与父母教养方式的交互作用对公正世界信念的影响显著,其中,权威型教养方式对高家庭社会经济地位比对低家庭社会经济地位儿童青少年公正世界信念的促进作用更大,独裁型与纵容型教养方式对低家庭社会经济地位比对高家庭社会经济地位儿童青少年公正世界信念的削弱作用更大。     

残疾儿童家长亲职压力的特点及其与生活质量的关系:社会支持的中介作用

本研究旨在考查残疾儿童家长亲职压力的特点, 并探讨亲职压力、社会支持对生活质量的影响。使用《亲职压力指标简表》、《社会支持评定量表》和《世界卫生组织生活质量测定简表》(中文版)对孤独症、智力残疾、听力残疾、视力残疾以及脑瘫5种残疾类型儿童的369名家长进行问卷调查。结果发现:(1)残疾儿童家长亲职压力及其各维度在不同残疾儿童类型中差异显著, 孤独症儿童家长在总分及各维度中均最高, 听力残疾儿童家长均最低;(2)亲职压力各维度与社会支持各维度以及生活质量各维度均呈显著负相关, 社会支持各维度与生活质量各维度之间均呈显著正相关;(3)亲职压力与生活质量的典型相关分析表明两者的整体相关显著;(4)社会支持在亲职压力和生活质量间起部分中介作用。     

The Cultural Adaptation of the Youth Quality of Life Instrument-Research Version for Latino Children and Adolescents

We reviewed the Spanish translation of the Youth Quality of Life Instrument-Research Version (YQOL-R) and culturally adapted the measure with Puerto Rican and Mexican American children and adolescents. The YQOL-R is a self-reported measure that includes four domains: Sense of Self, Social Relationships, Environment, and General Quality of Life. A total of 10 focus groups were conducted with children aged 9 to 11, adolescents aged 12 to 17, their parents, and mental health providers. Five focus groups were conducted in San Diego, California and five in San Juan, Puerto Rico. Eligible participants were recruited from children’s outpatient psychiatry clinics. We followed an iterative and recursive process in reviewing changes and modifications to the instrument using a bilingual committee and a Multi National Bilingual Committee. Greater semantic, content, and technical equivalence of the Spanish and English versions for the YQOL-R was achieved for the two largest U.S. Latino subgroups: Mexican Americans and Puerto Ricans. The cultural adaptation process revealed several important issues regarding the measurement of quality of life in different age groups. Additional items for school, relationships (both family and friends) and spare time suggested the need for a future children’s version of the instrument. For the adolescents, additional items were suggested in the areas of sexuality, intergenerational conflict and acculturative stress.     

Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

The concordance between parent reports of children's mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their child's emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global any use service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.     

Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.     

Stigma and Ostracism Associated with HIV/AIDS: Children Carrying the Secret of Their Mothers' HIV+ Serostatus

Qualitative interviews were conducted with mothers (N = 47) who had disclosed their HIV status to their children. The majority of mothers explicitly told their child not to disclose to other people that she was HIV-positive because they feared repercussions in the way of stigma and ostracism for both themselves and their child. Approximately one-fourth of the mothers identified safe people, to whom their child could discuss her serostatus, such as family members, health care providers, or therapists. The majority of the children respected their mothers' wishes; only four children disclosed to someone after being explicitly told not to do so. A significant number of children expressed concerns about their friends finding out, fearing that they would be ostracized or that it would be assumed they were also infected. In addition, the children did not want others to find out because they wanted to protect their mothers. The burden of keeping the secret of their mothers' serostatus does seem to be a stressor for some of the children.     

Ferenczi and Freud – From psychoanalysis as a “professional and personal home” to the creation of a “psychoanalytic home” for the patient1

Abstract

The author explores the relationship between Sándor Ferenczi and Sigmund Freud in the light of their correspondence. This allows us to see how Freud was able to offer and create for Ferenczi a “professional and personal home” that enabled the latter to find a much more meaningful and creative contact with himself. According to the author, this experience played an important role in Ferenczi’s later readiness to offer to and create with his patients a similar “psychoanalytic home.” As Freud was not able to share such clinical research work with Ferenczi, a conflict developed between them whose nature has occupied psychoanalysts ever since, and whose seeds can be found in the 1246 letters that they exchanged between January 1908 and May 1933. From this point of view, Ferenczi’s Clinical diary (written in 1932 and published only in 1985) can be seen as the continuation of the dialogue they had entertained for so many years, as well as Ferenczi’s attempt not to give up the “professional and personal home” that they had created together.     

Assessment of Tripartite Factors of Emotion in Children and Adolescents II: Concurrent Validity of the Affect and Arousal Scales for Children

The authors assessed the reliability and validity of the Affect and Arousal Scale for Children (AFARS; Chorpita, Daleiden, Moffitt, Yim, & Umemoto, 2000). The AFARS is a new measure of children's positive affect (PA), negative affect (NA), and physiological hyperarousal (PH). In the first study, 176 school children, 7 to 17 years of age, were administered measures of childhood worry, anxiety sensitivity, and autonomic arousal and their parents completed a child behavior problem checklist. In a second study, two groups of 100 and 114 school children, 8 to 18 years of age, were administered measures of childhood depression and anxiety, respectively, Also, 120 of these children took part in a 1-week retest administration of the AFARS. These studies provided preliminary evidence of acceptable 1-week test–retest reliability, convergent validity, and discriminant validity for the AFARS PA, NA, and PH scales. However, the predicted pattern of convergent and discriminant relations with parent-reported criterion only emerged for children over 11 years of age. Further, a consistent positive relation emerged between NA and PH, yet each of these scales accounted for unique variance in the prediction of criterion measures.     

The Importance of Religious Orientation and Purpose in Life for Dying Well: Evidence from Three Case Studies

ABSTRACT

As older adults approach the end of their lives, it is not uncommon to find a decrease in subjective well-being. However, a number of studies have indicated that elders with an intrinsic rather than extrinsic religious orientation often are able to keep a high level of subjective well-being even if they are close to death. In a previous quantitative study, only intrinsic religiosity was indirectly and positively related to subjective well-being in a sample of 103 relatively healthy older adults and 19 hospice patients (aged 61 +), mediated by shared spiritual activities and purpose in life. Extrinsic religiosity, by contrast, was indirectly and negatively related to subjective well-being. To explore in greater depth how religious orientation might influence subjective well-being at the end of life, we used the method of objective hermeneutics to examine semi-structured qualitative interviews with three older male hospice patients (aged 79, 80, and 98) on religion/spirituality and attitudes about death and dying. Results of the analyses revealed that the intrinsically religious respondent maintained his sense of cosmic purpose in life, which continued to be a source of satisfaction for him, unaffected by his terminal illness. The two extrinsically religious respondents, however, did not find solace in their religion and, hence, were unable to cope with their physical and emotional dependence and vulnerability. The findings suggest that an intrinsic religious orientation is most likely to be related to a cosmic sense of purpose in life, which facilitates subjective well-being even in the face of death.