ABSTRACT
BACKGROUND: Many untreated psychiatric problems occur in families where there is child abuse. It is very important to find ways of ensuring that the hard-to-reach families receive adequate psychiatric assessment and appropriate treatment. AIM: To describe the treatment method and first results of multisystemic therapy for child abuse and neglect (mst-can). METHOD: We report the psychiatric problems of the first 18 families that were treated and we report the follow-up during the first 18 months. In addition, the mst-can treatment and the psychiatrist's role are illustrated by taking two cases as an example. RESULTS: Most of the families agreed to a psychiatric assessment and subsequent treatment. In most families safety improved considerably and out-of-house placements were avoided. CONCLUSION: The first results suggest that mst-can is a promising treatment for families where there is child abuse. Essential elements of mst-can are targeted psychiatric diagnostic assessment and subsequent treatment.
Subject(s)
Child Abuse , Cognitive Behavioral Therapy/methods , Family Therapy/methods , Mental Disorders/therapy , Adolescent , Adult , Child , Child Abuse/diagnosis , Child Abuse/psychology , Child Abuse/therapy , Combined Modality Therapy , Female , Humans , Internal-External Control , Male , Netherlands , Outcome Assessment, Health Care , Parents/psychology , Treatment OutcomeABSTRACT
INTRODUCTION: Cystinosis is an autosomal recessive disorder leading to intralysosomal cystine accumulation in various tissues. It causes renal Fanconi syndrome and end stage renal failure around the age of 10 years if not treated with cysteamine. Children with cystinosis seem to have a normal intelligence but frequently show learning difficulties. These problems may be due to specific neurocognitive deficits rather than impaired renal function. Whether cysteamine treatment can improve cognitive functioning of cystinosis patients is thus far unknown. We aim to analyze neurocognitive functioning of school-aged cystinosis patients treated with cysteamine in order to identify specific deficits that can lead to learning difficulties. PATIENTS AND METHODS: Fourteen Dutch and Belgian school-aged cystinosis patients were included. Glomerular filtration rate was estimated using the Schwartz formula. Children were tested for general intelligence, visual-motor integration, inhibition, interference, sustained attention, accuracy, planning, visual memory, processing speed, motor planning, fluency and speed, and behavioural and emotional functioning using standardized methods. RESULTS: Glomerular filtration rate ranged from 22 to 120 ml min(-1) 1.73 m(-2). Median full-scale intelligence was below the average of a normal population (87, range 60-132), with a discrepancy between verbal (median 95, range 60-125) and performance (median 87, range 65-130) intelligence. Over 50% of the patients scored poorly on visual-motor integration, sustained attention, visual memory, planning, or motor speed. The other tested areas showed no differences between patients' and normal values. CONCLUSION: Neurocognitive diagnostics are indicated in cystinosis patients. Early recognition of specific deficits and supervision from special education services might reduce learning difficulties and improve school careers.
