„Rocken statt Ritzen“

Background

Non-suicidal self-injury (NSSI) starts in adolescence and decreases during young adulthood. Despite a high prevalence among adolescents only a few therapeutic interventions directly addressing adolescents exist.

Aim

By connecting music therapy with elements from behavioral therapy an attempt was made to create a therapeutic program which is attractive to adolescents.

Material and methods

A pilot trial of the program “Stop cutting - rock!” was conducted with 12 adolescent females with a mean age of 15.15 years (standard deviation SD ±1.34). The study aimed to compare the frequency of NSSI throughout the treatment phase as well as a pre-post comparison of depression scores.

Results

The results showed a trend towards a decreasing frequency of NSSI. Depression scores decreased significantly between the assessment before therapy and at a 3-month follow-up after the end of the therapy.

Conclusion

The positive feedback concerning music therapeutic elements points to the attractiveness of the approach. By integrating multimodal therapeutic strategies it seems possible to create an individually tailored intervention for adolescents with NSSI.     

Intervallbehandlung statt disziplinarischer Entlassung

Background

Conduct disorder is a frequent mental health problem in children and adolescents characterized by high functional impairment and a poor prognosis. Different types of interventions have been established but only few have proven effective. Relevant effect sizes could only be shown for family centred interventions. Inpatient treatment is not the first line treatment even though children, adolescents and their families often present with a query for inpatient admission when outpatient resources are at their limits.

Aim

The effectiveness of a newly developed interval treatment for adolescents with conduct disorder, which focuses on motivation of the adolescent, involvement of the family in the therapy and the avoidance of disciplinary discharge, was evaluated.

Material and methods

A total of 19 adolescents aged between 16 and 18 years with conduct disorder was treated and assessed within the new interval treatment. The key symptoms of conduct disorder, sociodemographic data, psychosocial functioning (children global assessment of functioning scale, CGAS) as well as the severity of impairment of behavior (health of the nation outcome scales for children and adolescents, HoNOSCA) were recorded before treatment (T1). After completion of treatment (T2) the frequency of participation in the three possible treatment intervals, as well as psychosocial functioning and severity of impairment of behavior were documented.

Results

Interval treatment leads to a reduction of disciplinary discharges. Engagement in and motivation for treatment was enhanced. At the end of treatment a significant effect on psychosocial functioning, behavior and severity of symptoms could be shown for interval treatment.

Conclusion

Inpatient interval treatment for adolescents with conduct disorder is an innovative and effective concept, when outpatient treatment has reached its limits.     

Psychotherapeutenausbildung aus Sicht der Absolventen

Background

A survey was performed to assess the current situation in education and to identify critical issues 10 years after the inception of the psychotherapy act in Germany.

Methods

In August 2008 all non-medical psychotherapists who had graduated since 2002 according the psychotherapy act were invited to take part in the survey and a total of 863 persons participated. The answers from 666 could be evaluated corresponding to a participation rate of 20%.

Results

A total of 57.6% of the graduates had completed a full-time training and approximately 50% of the graduates had completed the training within the allotted time. In the majority of cases evaluation occurred only for the theoretical courses. During the practical work (PT I) 36.8% of the graduates did not receive any salary or remuneration, 82% had their own field of activity and of these 38% treated patients without the presence of qualified tutor.

Conclusions

The training often lasts longer than intended, the financial situation in the PT I is exceptionally critical and in clear contrast to the field of activity in this section of training. Further detailed results will be presented and discussed.     

„Pervasive refusal syndrome“

Pervasive refusal syndrome (PRS), as a new psychiatric disorder among children and adolescents, was first described 1991 by Lask et al. It is characterized by a determined refusal of the child to eat, talk, walk, care for themselves or participate in daily activities. An organic explanation for the symptoms is absent. The observed refusal of functions can be either active or passive. Children also demonstrate a clear resistance to help or treatment. This paper presents a case study that depicts PRS from the therapists’ and the patients’ viewpoint and helpful elements in therapy are evinced from both points of view.     

Eltern und Patienten als Subjekt der Behandlung

Background

There are hardly any alternatives to inpatient treatment for children and adolescents in need of intensive psychiatric treatment. In the randomized study BeZuHG (“behandelt zu Hause gesund werden”, treated at home become healthy), equality of treatments could be shown in the outcome parameters when comparing TAU (inpatient treatment) and the new treatment module BeZuHG (early discharge followed by intensive home treatment enhanced by clinical elements). Patient satisfaction with each treatment module was evaluated at follow-up.

Material and methods

In this study 144 parents and patients of the intervention group (n?=?79) and the control-group (n?=?65) were interviewed after an average of 8 months. Information on expectations, experience with BeZuHG, changes in communication and interaction within the family as well as problem solving strategies (and sustainability of the changes), overall satisfaction and treatment suggestions for modification of the BeZuHG treatment were collected in semistructured telephone interviews.

Results

The following aspects in the BeZuHG treatment were rated as important by parents and patients: support and help with transfer problems, single sessions, a trusting therapeutic relationship as well as treatment setting at home. Enhanced problem solving skills as well as improved family communication were noticed. In the intervention group 70?% would prefer the BeZuHG setting to inpatient care and 46?% in the control group.

Conclusion

The BeZuHG concept is a good and functional alternative to inpatient treatment. Continuity in treatment and therapeutic relationships are essential for successful treatment at home. Positive treatment results within the family as well as the patient remain stable at follow-up after 8 months.     

Irritability and Emotional Impulsivity as Core Feature of ADHD and ODD in Children

The categorical approach of diagnosing mental disorders entails the problem of frequently occurring comorbidities, suggesting a more parsimonious structure of psychopathology. In this study, we therefore aim to assess how affective dysregulation (AD) is associated with attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in children. To assess AD in children aged 8–12 years (n?=?391), we employed the parent version of a newly constructed parent rating scale. Following item reduction, we conducted exploratory and confirmatory factor analyses to establish a factorial structure of AD. One core dimension was identified, comprising irritability and emotional impulsivity, and two smaller dimensions, comprising positive emotionality and exuberance. Subsequently, we examined five different latent factor models – a unidimensional model, a first-order correlated factor model, a second-order correlated factor model, a traditional bifactor model, and a bifactor S-1 model, in which the first-order factor AD-Irritability/Emotional Impulsivity (II) was modeled as the general reference factor. A bifactor S-1 model with the a priori defined general reference domain AD-II provided the best fit to our data and was straightforward to interpret. This model showed excellent model fit and no anomalous factor loadings. This still held true, when comparing it to bifactor S-1 models with ADHD/ODD-related reference factors. Differential correlations with emotion regulation skills and the established Parent Proxy Anger Scale validate the interpretation of the different dimensions. Our results suggest that irritability/emotional impulsivity might be a common core feature of ADHD and ODD.

     

Correction to: Irritability and Emotional Impulsivity as Core Feature of ADHD and ODD in Children

Journal of Psychopathology and Behavioral Assessment -     

Die Psychotherapeutenausbildung aus Sicht der Teilnehmer

Background

A survey was performed to assess the current situation in education and to identify critical issues 10 years after the inception of the German law regulating the education of psychological psychotherapists and child and adolescent psychotherapists. The study reports the results of a nationwide survey of German psychological psychotherapists and child and adolescent psychotherapists currently in training. The aim of the survey was to evaluate the individual sections of training, desired alterations and structural and financial conditions.

Methods

All trainees were contacted via the training institutes and the umbrella organizations. A total of 3,223 trainees participated and answered questions mainly using an online questionnaire.

Results

Most respondents practiced their training part-time and in most cases the trainees thought that the training would last longer than initially expected. The practical training was rated most poorly, whereas practical education and individual supervision were rated as most useful. The survey revealed deficits concerning the evaluation of the quality of several components of the training.

Conclusions

From the perspective of the trainees there is a necessity to modify the financial conditions of the training. This result has been considered in the recommendations of a research expertise on psychotherapy training and should stimulate further research.