Therapeutic Assessment With Child Inpatients

Growing evidence supports Therapeutic Assessment (TA), a collaborative and therapeutic approach to psychological assessment, as an effective method for enhancing motivation for and engagement with psychotherapy across a variety of clinical populations and treatment settings. However, to date there are no known studies assessing the use of TA in child psychiatric inpatient settings. This article briefly reviews the structure of child and family TA, enumerates the challenges and risks associated with short-term inpatient stays, and proposes a path for integrating TA into these units as a way to enhance the quality of care and reduce the risk of rapid rehospitalization. The authors provide three case examples from a child psychiatric inpatient unit, each using a modified version of TA and each integrating assessments into brief family interventions. The authors conclude with suggestions for best practice for child psychiatric inpatient TAs.     

The Role of BIS Sensitivity in the Relationship Between Family Enmeshment and Child Anxiety

Previous work has demonstrated that three overarching vulnerabilities–genetic, environmental, and temperamental–contribute to the development of child anxiety. The purpose of our study was to assess: (a) the relationship between an environmental vulnerability, family enmeshment, and child anxiety; (b) whether parental anxiety accounts for this relationship; and (c) whether this relationship is mediated by levels of child Behavioral Inhibition System sensitivity, a highly persistent temperamental variable demonstrating positive associations with child anxiety. Our study included 38 Canadian parent–child dyads from an urban area, of which 33 children were Caucasian and 18 were girls. Children were aged 9 or 11 years (M = 10.21, SD = 1.07). Children completed measures of anxiety and sensitivity towards threat and parents completed measures of family enmeshment. The results supported a significant positive relationship between family enmeshment and child anxiety; parental anxiety did not account for this relationship; and the relationship was partially mediated by Behavioral Inhibition System sensitivity. Specifically, when the effect of Behavioral Inhibition System sensitivity was controlled for, the association between family enmeshment and child anxiety became non-significant. The results suggest that family enmeshment is associated with levels of child anxiety largely through the function of children’s sensitivity to threat. Enmeshed families may increase children’s susceptibility to anxiety through their effect on child temperament, specifically sensitivity to threat.     

Bereavement and triangular relationships in a case of a child suffering from anorexia

This paper describes the mother–child assessment of a five-year-old girl suffering from anorexia since weaning, which was carried out in an Italian NHS neuropsychiatric child and adolescent unit. The author aims to show how she was able to link the little girl’s refusal of food to a death in the maternal family, which occurred soon after her birth. As well as this post-traumatic formulation, the author links the child’s anorexia to two related aspects of the family dynamics: avoidance of the awareness of death and the inability to manage triangular relationships, due to important intrusion and exclusion anxieties. Using extracts from the sessions, the author shows how the little girl was able to begin to work through the death phantasy which was previously inaccessible to her and her family. The concept of the death phantasy is defined and explored and possible analogies between this case and what is observed in some anorexic adolescent girls and their families are described.     

Felt obligation and the family life cycle: A study on intergenerational relationships

Since the 1990s researchers have considered as the dominant view on family obligation a set of responsibilities, duties, and obligation of care and assistance, that adult children should assume when parents are old or infirm. This concept is limited, because it assumes that family obligation is salient only in one period of life: when parents reach old age and are infirm. In contrast, a relational approach to family obligation considers family relationships as central to understanding children's duties and responsibilities. Following Stein, family obligation can be defined as felt obligation: expectations for appropriate and negotiated behaviour, perceived within the context of specific personal relationships with kin across life course. Felt obligation is conceptualized in five dimensions: a duty to maintain contact, assistance, avoidance of conflict, personal sharing, and self‐sufficiency. The purpose of the present study was to analyze perceptions of felt obligation in intergenerational relationships (parent–child and family of origin) in different phases of the family life cycle in a specific cultural context (Italy). The sample was composed of 92 parents with children of different ages (infants, school‐aged children, and young adults). The measure addressed the five dimensions of felt obligation, all assessed in various phases of family life. Results indicated differences in dimensions of felt obligation between intergenerational relationships (both parent–child and with family of origin). Some of these differences, such as self‐sufficiency and personal sharing, assumed more importance and salience in some periods of the life cycle than in others.     

Image du corps chez l’enfant sourd. Perception et vécu à travers le dessin et le TSEA

The body is as a living entity with three interrelated aspects: the physical motor skills, development processes, social and emotional interaction. The young child, regardless of his mental or physical condition, appropriates this entity when he is in contact with the surrounding world. Thus, the self-image will depend, in large part, on the person he is, the situation in which he lives (society, family), the nature and frequency of surrounding stimuli. A child carrying a handicap is likely to have a poor representation of his own self-image (disproportionate or deformed body) and an altered self-image, as far as he lives in a rejecting environment. In this paper, we have focused our research on how deaf children sees their self-image, based on our nineteen years of experience as a psychologist with hearing impaired children, in special schools. The various observations and assessments in this research, in addition to groups support offered to parents during all these years, give us today enough elements to show what kind of self-image the deaf child has of himself. Our assessment material was essentially thematic projective test of socialization –TSEA– and the drawing of the person.     

Understanding suicidal behaviour in young people referred to specialist CAMHS: a qualitative psychoanalytic clinical research project

A qualitative psychoanalytic clinical research project using a post-Kleinian contemporary approach was undertaken by a team of seven qualified and experienced child psychotherapists working in community Tier 3 Child and Adolescent Mental Health Services (CAMHS). A number of referred young people who deliberately harmed themselves or attempted suicide, who fulfilled the inclusion criteria and consented to participate, were offered an extended individual and family assessment. Grounded Theory analysis of the qualitative data led to the formulation of the Truth Danger Theory. Typical situations in which suicidal behaviour occurred were identified, including intergenerational confusion, neglect, physical and/or sexual abuse within the family, Oedipal conflict, maternal depression and families in which there was a chronically ill sibling. We found that there was a marked disparity between the young person's experience of relationships in the family and the family's own account of their situation, a fractured reality. This can be reflected in an incongruence in the young person's presentation, which may be misleading when assessing risk. The young person feels him/herself to be in a dead end from which there seems to be no escape. Self-harm, for some, contains this impossible dilemma (albeit pathologically) but when it does not, suicide may seem the only option. The Truth Danger Theory provides explanations and predictions for suicidal behaviour and has implications for clinical practice.     

Kinderpornografie

The quantity and distribution of child abuse material (“child pornography”) has substantially risen since the advent of the internet facilitated access. Due to the international character of the associated delinquency prosecution is confronted with several difficulties. In 2003 the European Union established a framework agreement to legally combat child pornography. The market for child abuse material is profitable, as production is comparably cheap. The number of convictions for relevant crimes varies but is generally still on a high level, even though reporting of relevant contents is decreasing. Providers and users might have switched to less controllable internet platforms. The physical and/or psychological sequelae for victims of child pornography are serious and ongoing. Studies show that compared to hands-on-offenders users of child exploitation material are generally younger, better educated and less often have a criminal record. Some of them (10–25?%) fulfill the diagnostic criteria of pedophilia. A child pornography offender’s risk of committing a hands-on-offence seems to be increasing with the diagnosis of pedophilia and antisocial personality traits. According to existing data, individuals whose only criminal record refers to illegal pornography seem to be at low risk for future offending with child abuse (0.2–6.6?%). Offenders who were already convicted for child abuse have a higher risk for re-offending when consuming (deviant) pornography. Several cognitive behavioral treatment manuals exist, however accurate diagnostic assessment and indication are required.     

Decision-Making by Children and Young People in the Home: The Nurture of Trust,Participation and Independence

This article presents the findings of a qualitative research study of children and young people (aged 7–17 years) in Ireland. It seeks to investigate whether, for the children and young people involved, the home is a space where supportive, trusting family relationships can be nurtured; where independence grows with age; and where parents listen, discuss and explain decisions made. It furthermore outlines the views and experiences of parents with regard to children and young people’s participation in the home and will focus on relational and spatial aspects of child participation within the home. The study recognizes children and young people as social actors and is also informed by a relational and spatial approach to children’s participation which recognizes the respective roles and positions of children in facilitating child participation. The results indicate that age and issues of trust and tokenism were significant barriers in young people’s participation and decision making at home. Key enablers of children and young people’s participation included spaces where discussion can happen at home, good family relationships, being listened to by parents, trust and growing levels of independence with age, seeing decisions as fair and having the rationale for decisions explained to them by parents. Among suggestions for improvements the most important were designated family spaces for discussion, encouragement of active listening by parents, and promotion of explanation by adults of their decisions.     

Impact of Family Efficacy Beliefs on Quality of Family Functioning and Satisfaction with Family Life

The present study tested with 142 families a structural model of the interplay of perceived dyadic and collective forms of efficacy within the interdependent family system, and how these different forms of efficacy are structurally related to quality of family functioning and satisfaction with family life. Dyadic parent–child efficacy, dyadic spousal efficacy, and filial efficacy were linked to family satisfaction through the mediating impact of collective family efficacy. A high sense of collective family efficacy was accompanied by open family communication and candid disclosure by adolescents of their activities outside the home. Collective family efficacy contributed to parents' and adolescents' satisfaction with their family life both directly and through its impact on quality of family functioning. An alternative structural model in which quality of family functioning affects the different forms of perceived family efficacy and family satisfaction provided a poorer fit to the data.     

Stress for families today

Rapid changes in family life have created enormous challenges and pressures on developing families - divorce, two working parents, disappearance of the extended family, unclear cultural values for our children's future, poorly defined support systems for stressed families, inadequate substitute care when both parents work-all contribute to an anxious atmosphere for young families. Parents who must return to work „too early”︁ (and we have no established standards yet for what this means to either child or adult development) seem to grieve about the loss of the relationship with the developing child. They may even set up defenses against making a strong and painful attachment. They may not become involved in the child's development in a way that will foster their own development as nurturing adults. The grieving and the necessary defenses against it are predictable and must be mitigated in order to foster nurturing adults within the family. Children must be provided with caring, intensely involved adults in order to assure their optimal future development. We must provide them and their parents with adequate substitute care. This paper suggests adjustments at the industrial level that must be made to foster parental involvement and to assure positive outcomes for future generations.     

Parent–child relationships and offspring’s positive mental wellbeing from adolescence to early older age

We examined parent-child relationship quality and positive mental well-being using Medical Research Council National Survey of Health and Development data. Well-being was measured at ages 13–15 (teacher-rated happiness), 36 (life satisfaction), 43 (satisfaction with home and family life) and 60–64 years (Diener Satisfaction With Life scale and Warwick Edinburgh Mental Well-being scale). The Parental Bonding Instrument captured perceived care and control from the father and mother to age 16, recalled by study members at age 43. Greater well-being was seen for offspring with higher combined parental care and lower combined parental psychological control (p < 0.05 at all ages). Controlling for maternal care and paternal and maternal behavioural and psychological control, childhood social class, parental separation, mother’s neuroticism and study member’s personality, higher well-being was consistently related to paternal care. This suggests that both mother–child and father–child relationships may have short and long-term consequences for positive mental well-being.     

Parents,Siblings, or Friends? Exploring Life Satisfaction among Early Adolescents

This study analyzes 2,617 10–15 year olds surveyed in wave 1 of the United Kingdom Household Longitudinal Study (UKHLS). Specifically, it tests the associations of three variables with life satisfaction among early adolescents: parent–child relationship quality, being a perpetrator or victim of sibling bullying, and being a perpetrator or victim of friend bullying. The results suggest that all of these social relationships have significant associations with life satisfaction, both individually and in combination. Of the three, parent–child relationship quality explained the most variance in predicting life satisfaction. This is followed by friend victimization (i.e., being bullied by friends), whereas the influence of sibling victimization is significant but not as strong. This study also tests the interaction effects between parent–child relationship quality, sibling bullying, and friend bullying. The association of parent–child relationship quality with life satisfaction is found to be stronger among adolescents who were either victims of sibling bullying or of friend bullying, highlighting the protective importance of parent–child relationship quality. Lastly, when testing whether the influences of sibling bullying, friend bullying, and parent–child relationship quality vary between male and female adolescents, this study finds some significant gender differences. Specifically, the positive associations of lower friend victimization and better parent–child relationship quality with life satisfaction are found to be stronger among female adolescents.     

Life Transitions and Life Satisfaction During Young Adulthood

In Sweden the overall life satisfaction trajectory between ages 22 and 40 is slightly hill-shaped and dominated by life transitions, especially those relating to one’s family situation. Among persons in their twenties, partnership formation and birth of a child typically lead to a slight increase in overall satisfaction with life. Between ages 30 and 40 average life satisfaction declines, chiefly due to the increasing strains of family life and the breakup of couples. These strains are evident in data relating to specific aspects of family life. After age 30 satisfaction with one’s partner declines, and so does satisfaction with both one’s mother and father. Also, despite rising income, satisfaction with one’s economic situation lessens. Considered as a whole, the evidence suggests that even in a welfare state the strains on young adults of balancing work and family life are substantial. The analysis is based on panel data, 1999–2009, that focus especially on family life.     

Psychoanalytic aspects of inpatient treatment

This paper looks at the experience of inpatient hospital treatment at the Cassel Hospital and how formal psychoanalytic psychotherapy, with its emphasis on the transference and the inner world, fits into that context and orientates itself to some of the realities of the setting. It outlines how psychotherapy and nursing can work to inform and enrich each other, and what is psychoanalytic about the overall work. A bridge of understanding is built using the patients' perceptions of, adjustment to and conflict about the inpatient setting, and the affective impact of the processes on patients and staff alike. Two clinical examples of severe child abuse family cases are given, the first of Munchhausen syndrome by proxy, the second in which a baby sibling had been killed. They show how in-depth psychoanalytic work with mother and child and individual psychotherapy of the child can be combined with psychotherapy of the parents and intensive work in the therapeutic community. Such a combination can contribute, even in cases of severe pathology, to the development of the relationship between mother and child and promote successful rehabilitation in the outside community.     

Parental Locus of Control and Family Functioning in the Quality of Life of Children with Sickle Cell Disease

The objective was to examine the association of parental locus of control (PLOC) with pediatric quality of life (QOL) for children with sickle cell disease (SCD), specifically addressing the potential mediating role of family functioning. Associations with disease severity were also investigated. Thirty-one primary caregivers completed standard measures of parental locus of control, family functioning, and quality of life during their child's inpatient admission for pain or fever. Results indicated that the PLOC total score was significantly associated with QOL in terms of self-competence and showed marginal significance with QOL social competence; it was significantly negatively correlated with family functioning. The association of the PLOC with QOL subscales was maintained when controlling for family functioning. Disease severity was not associated with PLOC scores. Primary caregivers endorsed more external parental locus of control beliefs. Further investigation of the association of caregiver appraisals and family functioning is warranted with the goal of addressing the stress that disease management with sickle cell may add to parent–child relationships.     

What happened in kindergarten? Mother-child conversations about life story chapters

ABSTRACT

Research indicates that adults form life story chapters, representations of extended time periods that include people, places and activities. Life chapter memories are distinct from episodic memories and have implications for behaviour, self and mental health, yet little is known about their development during childhood. Two exploratory studies examined parent–child conversations about life chapters. In Study 1, mothers recorded naturalistic conversations with their 5–6 year old children about two chapters in the child’s life. In Study 2, mothers recorded conversations with their 6–7 year old children about a particular life chapter—the child’s kindergarten year—and also about a specific episode of their choice. The results indicated that young children are able to recall and discuss information about life chapters and that parents actively scaffold children’s discussion of general information in chapters as well as specific events. Mothers’ conversational style when discussing chapters (e.g., elaborativeness) predicted children’s memory contributions, and was also positively correlated with their style when discussing specific events. The results suggest new avenues for research on the ontogeny of life chapters, the factors that shape them, and their role in development.     

Delay of Gratification in Two- and Three-Year-Olds: Associations with Attachment, Personality, and Temperament

Delay of gratification in young children has been linked to long-term behavioral and academic outcomes. This study explored temperament, personality, and child–parent attachment as possible associates of delay ability. The sample consisted of 50 2- and 3-year-old children and their primary caregivers. Two laboratory tasks, the Preschool Strange Situation and the newly created Gift Delay Task, were conducted on separate occasions to assess child–parent attachment and delay of gratification, respectively. Parents and preschool teachers completed child temperament (EASI-III) and personality (California Child Q-Set) questionnaires. Based on the award-oriented behavior in the Gift Delay Task, children were classified into three groups: Delay (20 %), Touch and Go (i.e., approached the gift, but demonstrated some delay ability; 46 %), and Non Delay (34 %). Reports on activity, impulsivity, decision time, negative emotionality, over-control, and affect were found to be associated with delay ability. The association between child–parent attachment and delay was not statistically significant, but an interesting trend emerged. A larger percentage of Non Delayers were rated as Insecure-Ambivalent (“C”), and more Delayers were rated as Securely attached (“B”). Implications for behavioral interventions focused on parental support and scaffolding are discussed.     

The impact of temperament factors and family functioning on resilience processes from infancy to school age

A Norwegian sample of 401 mothers was used to investigate the effects of child factors and family risk and supportive factors on both child competencies and behaviour problems at 8 years. The contribution of the various predictors on the differentiation of children into groups of resilient vs. vulnerable across four different time periods was also examined within a prospective longitudinal study design. The study showed that a substantial proportion of the variance in both behaviour problems and social competence at 8 years could be explained by risk and supportive factors in child and family already present at 18 months. Within-child and within environment predictors had selective impact on each outcome domain in addition to common effects. Depending on time of assessment, 73 – 89% of the children from stressed families could be correctly classified as resilient. Pathways to “resilience” and “positive adjustment” are apparent from early in life, with social support factors and temperament characteristics being of continuing importance. The study confirms the importance of attending to early emerging child functioning and corresponding family conditions, and hence the need for prevention and early intervention efforts.     

Discrepancies Between Parent and Adolescent Beliefs About Daily Life Topics and Performance on an Emotion Recognition Task

Parents and children and adolescents commonly disagree in their perceptions of a variety of behaviors, including the family relationship and environment, and child and adolescent psychopathology. To this end, numerous studies have examined to what extent increased discrepant perceptions—particularly with regard to perceptions of the family relationship and environment—predict increased child and adolescent psychopathology. Parents’ and children and adolescents’ abilities to decode and identify others’ emotions (i.e., emotion recognition) may play a role in the link between discrepant perceptions and child and adolescent psychopathology. We examined parents’ and adolescents’ emotion recognition abilities in relation to discrepancies between parent and adolescent perceptions of daily life topics. In a sample of 50 parents and adolescents ages 14-to-17 years (M?=?15.4 years, 20 males, 54 % African-American), parents and adolescents were each administered a widely used performance-based measure of emotion recognition. Parents and adolescents were also administered a structured interview designed to directly assess each of their perceptions of the extent to which discrepancies existed in their beliefs about daily life topics (e.g., whether adolescents should complete their homework and carry out household chores). Interestingly, lower parent and adolescent emotion recognition performance significantly related to greater parent and adolescent perceived discrepant beliefs about daily life topics. We observed this relation whilst accounting for adolescent age and gender and levels of parent-adolescent conflict. These findings have important implications for understanding and using informant discrepancies in both basic developmental psychopathology research and applied research in clinic settings (e.g., discrepant views on therapeutic goals).     

FAMILY CONFLICT MODERATES EARLY PARENT–CHILD BEHAVIORAL TRANSACTIONS

The reciprocal transactions that shape early parent–child relationships are influenced by contextual stress, such as family conflict. Although family conflict is a salient stressor to the family system, few studies have considered how parent–child transactions vary according to exposure to family conflict. The present study examined how family conflict alters early parent–child behavioral transactions. We utilized three waves of data from a multisite longitudinal study of low‐income families (N = 2, 876), child age 14 months, 24 months, and 36 months, to identify behavioral transactions of positive and negative maternal (supportiveness, negative regard) and child (engagement, negativity) behaviors. Results indicated that family conflict at 14 months diminished the positive association between maternal supportiveness and child engagement, and amplified the inverse association between maternal negativity and child engagement. Family conflict at 14 months also was associated with increased stability of child negativity and subsequent increased maternal negative regard at 36 months, in part via increases in 24‐month child negativity. In sum, family conflict occurring early in childhood predicted and moderated behavioral transactions between young children and their mothers.