Psychodynamic counselling with parents of children with developmental disabilities

A joint treatment of parents and child can be the treatment of choice when dealing with developmental disabilities. In our clinical experience, we have observed that psychoanalytically oriented support (developmental guidance), which involves the child and the parents together, answers the needs and addresses the difficult dynamics that are characteristic of developmental disabilities.     

Recognizing emotion in faces: developmental effects of child abuse and neglect

The contributions to the recognition of emotional signals of (a) experience and learning versus (b) internal predispositions are difficult to investigate because children are virtually always exposed to complex emotional experiences from birth. The recognition of emotion among physically abused and physically neglected preschoolers was assessed in order to examine the effects of atypical experience on emotional development. In Experiment 1, children matched a facial expression to an emotional situation. Neglected children had more difficulty discriminating emotional expressions than did control or physically abused children. Physically abused children displayed a response bias for angry facial expressions. In Experiment 2, children rated the similarity of facial expressions. Control children viewed discrete emotions as dissimilar, neglected children saw fewer distinctions between emotions, and physically abused children showed the most variance across emotions. These results suggest that to the extent that children's experience with the world varies, so too will their interpretation and understanding of emotional signals.     

Being with a psychotic child a psycho-analytical approach to the problems of parents of psychotic children.

The reactive and adaptive responses of parents to their overtly psychotic children are described and an attempt is made to reconstruct the specific mother/infant interactions contributing to the development of different types of childhood psychosis. The concepts of 'maternal structure' and of 'delusional primary maternal preoccupation' are found to be relevant in this context. These considerations throw light on some aspects of countertransference encountered by workers in this field and of creative search in general. Whilst exploring parental psychology and psychopathology this paper attempts to outline the psychodynamic environment of the psychotic child at the various stages of his life and dis-ease. It emphasizes the value of the psychoanalytical approach as a guide in such an exploration and as a source of hope for better understanding and more effective interventions, both therapeutic and prophylactic.     

Occupational therapy using a sensory integrative approach for children with developmental disabilities

This article provides an introduction and overview of sensory integration theory as it is used in occupational therapy practice for children with developmental disabilities. This review of the theoretical tenets of the theory, its historical foundations, and early research provides the reader with a basis for exploring current uses and applications. The key principles of the sensory integrative approach, including concepts such as "the just right challenge" and "the adaptive response" as conceptualized by A. Jean Ayres, the theory's founder, are presented to familiarize the reader with the approach. The state of research in this area is presented, including studies underway to further delineate the subtypes of sensory integrative dysfunction, the neurobiological mechanisms of poor sensory processing, advances in theory development, and the development of a fidelity measure for use in intervention studies. Finally, this article reviews the current state of the evidence to support this approach and suggests that consensual knowledge and empirical research are needed to further elucidate the theory and its utility for a variety of children with developmental disabilities. This is especially critical given the public pressure by parents of children with autism and other developmental disabilities to obtain services and who have anecdotally noted the utility of sensory integration therapy for helping their children function more independently. Key limiting factors to research include lack of funding, paucity of doctorate trained clinicians and researchers in occupational therapy, and the inherent heterogeneity of the population of children affected by sensory integrative dysfunction. A call to action for occupational therapy researchers, funding agencies, and other professions is made to support ongoing efforts and to develop initiatives that will lead to better diagnoses and effective intervention for sensory integrative dysfunction, which will improve the lives of children and their families.     

A descriptive analysis of client outcomes associated with staff interventions in developmental disabilities

Although a large body of research supports the use of behavioral staff management interventions in developmental disabilities, the nature of client outcomes associated with such interventions has not been systematically assessed. We reviewed 59 staff management studies published over 20 years (1971–1990) in order to determine the generality or scope of the research (i. e., range of settings, types and levels of clients' disabilities, clients' ages), the frequency of inclusion of client outcome measures, the types of measures and levels of analysis selected (i. e., individual groups, combination), and the effects of the interventions on client behavior. Results indicated that: (a) over two-third of the studies were conducted in institutional settings; (b) more than one-half involved clients with profound to severe mental retardation; (c) clients of various ages were served; (d) assessment of client outcomes increased progressively over the period; (e) engagement and skill acquisition were the most frequently used measures; (f) group data were presented twice as frequently as either individual or a combination of group and individual data; and (g) staff interventions were associated with either positive or mixed client outcomes in 80% or more of the cases, although maladaptive behavior went unchanged in one-fifth of the studies in which they were reported. Based on these findings, suggestions are made for how researchers might extend the generality of staff management research, improve client outcome assessment practices, and produce even more consistently positive results.     

Primary and secondary effects of parenting and stress management interventions for parents of children with developmental disabilities: a meta-analysis

A meta-analysis of the group intervention research for parents of children with developmental disabilities was conducted in order to characterize the efficacy of treatments in reducing depressive symptoms and other forms of psychological distress associated with stress in parents of children with developmental disabilities. An extensive search led to the identification of 17 studies which were divided into three categories for comparative purposes: parenting education studies usually based on behavioral parent training, coping skills education studies based primarily on cognitive behavioral training, and studies that combined these methods along with other support services. Studies were rated for the quality of the research designs and of the reports. Consistent positive benefits were found in the form of reductions in parents' distress, and these effects were comparable to those reported in other syntheses of parenting interventions for parents of children without disabilities. The studies were evaluated in order to assess whether or not they met standards for established evidence-based practices. On the basis of the quality and number of the randomized trials, we present evidence to support the claim that there are established evidence-based interventions for reducing psychological distress at least in middle-class mothers in the short term. The interventions for fathers are promising as are the data on somewhat longer-term effects. The need for replications with a more diverse group of parents and longer-term follow-up were discussed. Multiple component interventions addressing both parent well-being and behavioral parent training were significantly more effective than either behavioral parent training or cognitive behavioral training along.     

Judgements of Solomon: the relevance of a systems approach to psychiatric court reports in child care cases

This study examines the way in which systems approaches have been used in court reports by a group of child psychiatrists experienced in medico-legal work, and explores some ways in which these reports differ from those derived from a more individually based 'psychiatric' approach. The appropriateness of applying a systems approach to court work is also discussed.     

Maternal employment and child cognitive outcomes: the importance of analytic approach

J. Brooks-Gunn, W. J. Han, and J. Waldfogel (2002) and the National Institute of Child Health and Human Development Early Child Care Research Network (ECCRN; 2000b) came to different conclusions about the effects of maternal employment--although they were addressing similar questions using the same data set. Brooks-Gunn et al. concluded that maternal employment in infancy has a negative effect on children's cognitive abilities at age 3, whereas the ECCRN found that early nonmaternal care is not related to children's cognitive abilities in their first 3 years. The authors account for this difference by comparing 2 approaches to data analysis: a top-down testing of continuous variables (the approach used by the ECCRN, 2000b) and an a priori comparison approach that involves pairwise testing of specific dichotomous contrasts (the approach used by Brooks-Gunn et al., 2002). This comparison illustrates the critical importance of analytic approach. It also suggests that Brooks-Gunn et al.'s conclusion from this data set is overstated and should not be used on its own as the basis for practical or policy decisions.     

A multimodal behavior analytic model for evaluating the effects of medical problems on nonspecific behavioral symptoms in persons with developmental disabilities

A relationship between various medical illnesses and the frequency and severity of nonspecific behavioral symptoms such as aggression and self-injury has been described by a number of writers. None, however, provides a clinical case formulation model that articulates the specific nature of this relationship or the manner in which potential biomedical influences interact with psychological and socioenvironmental ones to determine the occurrence and strength of behavioral symptoms. A model is described in this paper that suggests possible contributions of medical illnesses or conditions to occurrence of nonspecific behavioral symptoms and provides a diagnostic basis for selecting and evaluation related interventions. © 1997 John Wiley & Sons, Ltd.     

Behavioral intervention to reduce physical restraint of adolescents with developmental disabilities

Physical restraint procedures sometimes are approved for implementation in human service settings for children and adults who have developmental disabilities and seriously challenging behaviors. Although use of restraint may be clinically justified to manage behavior disorders and prevent injury to self and others, procedures should be evaluated to decrease, and possibly eliminate, such methods. This study addressed the effects of restraint‐reduction procedures with two adolescents who had developmental disabilities and displayed severe aggression. Clinically significant reductions in the frequency of physical restraint were achieved through a treatment package that included the behavior‐specific criterion for the application of restraint and antecedent control approaches. The implementation of strategic interventions to decrease physical restraint utilization is discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

Developmental transition of EEG spectra to alpha band in a sample of children with developmental disabilities

Developmental transition of EEG spectra to alpha band of 14 children with developmental disabilities (from 7 yr. and 3 mo. to 16 yr. and 1 mo. of age at the first EEG recording: M= 13.2, SD=2.6; 6 girls and 8 boys) was studied by auto-power spectrum analysis longitudinally. The results showed the mean age (14.1 yr. to 14.8 yr. in the four regions of the frontal, central, parietal, and occipital regions) for subjects and their mean frequency (4.2 Hz to 4.7 Hz in the 4 regions) at which EEG shift started from theta band, and those means (15.1 yr. to 15.7 yr. and 9.5 Hz to 9.6 Hz in the 4 regions) at which EEG shift reached the alpha band. Prior EEG research on healthy children has shown that approximately 10 years of age is critical for developmental transition of EEG spectra to alpha frequencies. It is suggested that the present data showed a delay of this critical age for this sample of children with developmental disabilities relative to 10 years for healthy children reported by Katada, et al. and Benninger, et al.     

Parenting stress in parents of children with attention-deficit hyperactivity disorder and parents of children with learning disabilities

Parenting a child with ADHD can challenge parenting resources and coping. Increasingly, researchers are examining the relationship between the behavior of the child with ADHD and family functioning. While studies have shown inceased parenting stress in parents of children with ADHD, these studies have compared children with ADHD to non-disabled children. This study compares reports of parenting stress among mothers of children with ADHD, mothers of children with learning disabilities and mothers of non-referred children. Results showed that parenting stress was highest for mothers of children with ADHD. Increased parenting stress was associated with child characteristics and, in particular, with externalizing behavior problems.     

Improving instruction for adults with developmental disabilities: Evaluation of a staff training package

Improvements in adaptive behavior among adults with developmental disabilities often depends on the quality of instruction delivered by direct-care staff. The present study evaluated the effectiveness of a multifaceted package for improving the quality of instructional interactions among three staff/adult dyads. Instructional interactions were first analyzed to identify areas for improvement. A multifaceted intervention package consisting of inservice training, participative management, and on-going feedback was then implemented in a multiple-baseline design across dyads. The package trained staff to increase their use of time delay and reinforcement strategies and these changes were associated with greater independence in a sandwich making task among two of the three participating adults. The results suggest direct observation of existing instructional interactions may provide valuable information when training staff to implement effective habilitative programs for adults with developmental disabilities.     

Visuomotor organization in the child: a neuropsychological approach

The ability of children to copy a complex figure was investigated by means of the Rey-Osterrieth complex figure and the corresponding methodology. The sample consisted of 420 children (boys and girls) aged 5 1/2 to 12 1/2 years. Responses indicate that the visuomotor ability involved in copying a complex figure increases with increasing age and that girls show significantly better performance than boys during the ages 8 1/2 to 12 1/2 years. The differences in performance can be attributed to differential neuropsychological strategies or functional differences that require further investigation.     

Participation in school environment of children and youth with disabilities: a person-oriented approach

This study investigated patterns of interrelated positive subject and environmental factors related to participation in school activities of pupils with different kinds of disabilities. Questionnaires concerning participation were collected from 472 pupils with disabilities and their teachers, parents and special education consultants. A person-oriented approach with the aim to identify patterns of variables related to a high degree of participation of pupils with disabilities was used. Cluster-groups were formed based on scores for individual subjects on factors identified as important for participation. Groups with a high degree of participation were characterized by high scores in autonomy and perceived interaction with peers and teachers and an internal locus of control. Type and degree of disability did not predict cluster group membership. A conclusion is that the outcome participation is better predicted by patterns of interrelated positive subject and environmental factors than by type of disability or any other single factor.     

Expanding the utility of behavioral momentum for youth with developmental disabilities

Non‐compliance with requests in educational or therapeutic settings interferes with teaching and learning. Recent studies indicate that the probability of compliance can be increased when short sequences of requests with a high probability of compliance are followed by a request less likely to be followed by compliance. The high probability command sequence (HPCS) consists of requests that produce compliance rates of 80% or more. For some individuals with severe disabilities it is difficult to find sufficient number of requests that result in 80% compliance. This study assessed the effects of two levels of high probability request sequences on compliance with subsequent low probability requests. The three participants (ages 7, 11, and 20) met the diagnostic criteria for autism and/or severe to profound mental retardation. Results showed that both high (>80% compliance) and medium (50–70% compliance) request sequences produced increases in compliance to subsequent requests that had produced low compliance rates (<40%) during baseline. No systematic differences were observed between high and medium probability sequences. Copyright © 2000 John Wiley & Sons, Ltd.