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.     

THE WORLDWIDE BURDEN OF INFANT MENTAL AND EMOTIONAL DISORDER: REPORT OF THE TASK FORCE OF THE WORLD ASSOCIATION FOR INFANT MENTAL HEALTH

Children worldwide experience mental and emotional disorders. Mental disorders occurring among young children, especially infants (birth –3 years), often go unrecognized. Prevalence rates are difficult to determine because of lack of awareness and difficulty assessing and diagnosing young children. Existing data, however, suggest that rates of disorders in young children are comparable to those of older children and adolescents (von Klitzing, Dohnert, Kroll, & Grube, 2015 ). The lack of widespread recognition of disorders of infancy is particularly concerning due to the unique positioning of infancy as foundational in the developmental process. Both the brain and behavior are in vulnerable states of development across the first 3 years of life, with potential for enduring deviations to occur in response to early trauma and deprivation. Intervention approaches for young children require sensitivity to their developmental needs within their families. The primacy of infancy as a time of unique foundational risks for disorder, the impact of trauma and violence on young children's development, the impact of family disruption on children's attachment, and existing literature on prevalence rates of early disorders are discussed. Finally, global priorities for addressing these disorders of infancy are highlighted to support prevention and intervention actions that may alleviate suffering among our youngest world citizens.     

Maternal insightfulness and preschoolers' emotion and behavior problems: Reciprocal influences in a therapeutic preschool program

Mothers' insightfulness, which involves understanding the motives underlying the child's behavior in a complete, open, and accepting way, was examined both at the beginning and at the end of a therapeutic preschool program for preschoolers using the Insightfulness Assessment (Oppenheim & Koren‐Karie, 2002). The goal of the study was to examine the links between improvement in mothers' insightfulness and reduction in children's behavior problems. Thirty‐two children referred to a therapeutic preschool program for a range of behavioral and emotional problems and their mothers participated in the study. Results showed that mothers who shifted from noninsightfulness before treatment to insightfulness after treatment had children whose behavior problems decreased whereas mothers who did not make such gains had children whose behavior problems increased. The social skills of all children improved during treatment. The possible mechanisms linking the gains of mothers and children are discussed within the framework of attachment theory.     

Parenting of 7‐month‐old infants at familial risk for attention deficit/hyperactivity disorder

Patterns of interaction between parents and 7‐month‐old boys at familial risk for attention deficit/hyperactivity disorder (ADHD) and a comparison group were studied during a warm‐up and two play episodes. The sample included 78 (47 at‐risk, 31 comparison) mother–child and 45 (27 at‐risk, 18 comparison) father–child dyads. A coding system developed by G. Kochanska (1997, 1998) was used. Infants in the risk group did not differ from the comparison group in the rate of emission of infant‐related events. However, they received less adequate responsivity from both their fathers and their mothers to these events, and specifically to negative emotions or distress, than did the comparison group. Maternal psychopathology did not account for these findings. Mothers were more adequately responsive than were fathers, especially for physiological needs. The association between nonoptimal interaction in infancy and the development of ADHD is discussed.     

Elevated content of cortisol in hair of patients with severe chronic pain: a novel biomarker for stress

Hair analysis has been used to reflect long-term systemic exposure to exogenous drugs and toxins. Several studies have demonstrated the feasibility of measuring endogenous steroid hormones, e.g. cortisol, in hair. Recently, a study in macaques showed a significant increase in hair cortisol levels induced by stress. We explored whether hair cortisol levels may be used as a biomarker for long-term stress in humans. Patients with severe chronic pain, aged 18 years or older, receiving opioid treatment for at least one year were recruited. Controls were non-obese (body mass index, BMI < 30 mg/kg(2)) adults. The Perceived Stress Scale (PSS) questionnaire was used to assess perceived stress over the last 4 weeks. A hair sample was obtained from the vertex posterior. Cortisol was measured using an enzyme-linked immunosorbent assay. We included fifteen patients (nine females and six males) and 39 non-obese control subjects (20 females, 19 males). PSS scores (median and range) were significantly higher in chronic pain patients (24: 12-28) than in controls (12: 3-31)(P < 0.001). Hair cortisol contents (median and range) were significantly greater in chronic pain patients (83.1: 33.0-205 g/mg) than in controls (46.1: 27.2-200 pg/mg) (P < 0.01). We conclude that hair cortisol contents are increased in patients with major chronic stress. Measurement of cortisol levels in hair constitutes a novel biomarker of prolonged stress.     

Visual orientation estimation

A systematic error is reported in orientation estimation, in that on average, estimates are closer to the vertical axis than are the stimuli by up to 6°. This systematic error results from a specific mechanism that may be related to depth perception, and that is avoided in certain circumstances or when other mechanisms take over. For example, the estimates of one observer who was a welltrained professional draughtsman did not show this systematic error. Furthermore, for all observers tested, estimation of clock time is not subject to the regular orientation estimation error. Rather, observers tend to estimate timesas slightly further from the quarter hour than they really are. Orientation judgment channel capacity was also studied under various conditions. The number of discriminable orientations is far above the magic number “7“ limit, reaching over 20 in optimal circumstances. The distribution of discriminable orientations is nonlinear, in that these are more closely packed about the horizontal and vertical axis than at the oblique.     

How parents view professional behaviors: A cross-professional analysis

This study examined the responses of more than 900 parents of children with serious emotional disorders to survey questions about the importance and frequency of professional behaviors and compared these responses across professions. The findings indicated that parents with lower income and less education tended to work more with social workers, counselors, and teachers, less with psychologists and psychiatrists. Professional behaviors concerned with the parent-professional relationship, honesty, non-blaming attitude, supportiveness, and inclusion in decision-making were considered important by most parents regardless of the professional with whom they worked. Parents rated professions differently on the importance of evaluation, home visits, and providing child-raising information, probably reflecting expectations that parents have about the roles and training of professionals. The behaviors that parents considered important also tended to occur frequently. Significant differences across professions were found with respect to the frequency of providing information on child rearing, advocacy, home visits, providing information on resources, and help with coping, although these behaviors were considered relatively less important by parents. An examination of discrepancies between what parents considered important and what they experienced suggested that parents' expectations were only partially met. Implications for practice, professional education, and research are discussed.Editor's Note: We acknowledge the sampling issue raised by the low survey return rate in this study and the resulting threat to generalizability of findings. Nevertheless, the study is judged to merit publication as one of the first efforts to examine empirically parents' views of their relationships with mental health professionals. Our hope is that this report will serve to stimulate further scientific investigation on the topic—Donald Oswald (AE).     

Achievement-oriented and dependency-oriented parental psychological control: An examination of specificity to middle childhood achievement and dependency-related problems

Middle childhood is considered a sensitive phase for the development of both dependency and achievement-related problems. In order to target efficient prevention and treatment, it is necessary to identify unique associations with possible precursors. This study hypothesized that children’s dependency-related problems (i.e., separation anxiety and generalized anxiety) would uniquely relate to parental dependency-oriented psychological control and that children’s achievement-related problems (i.e., extrinsic motivation and maladaptive perfectionism) would uniquely relate to parental achievement-oriented psychological control. The study included 180 elementary school children. Results showed that higher levels of children’s separation anxiety uniquely related to more parental dependency-oriented psychological control, while higher levels of children’s extrinsic motivation uniquely related to more parental achievement-oriented psychological control. Contrary to the expectations, higher levels of children’s maladaptive perfectionism were associated with both dimensions of parental psychological control, and children’s generalized anxiety was not associated with any dimension. Study implications are discussed.