ABSTRACT
CASE: Marcus is a 10-year-old boy who was followed by his pediatrician for several years. She knows him as a socially engaged, active athlete, playing soccer and baseball, out-going, and a good student. He has been in good health without a significant medical history.At the beginning of this academic year, a new student was placed in Marcus's fourth grade class. This student is disruptive, impulsive, and abusive. He has frequent violent outbursts, yelling, kicking, and throwing objects, including recently throwing a desk across the room. The school has made efforts to manage this student. The teacher sets up behavior contracts, and the school has temporarily suspended the child; however, the school is unable to remove the child from the classroom. Many students, including Marcus, have been significantly affected by this disruption.Marcus describes the classroom environment as "tense." He reports he is never sure what is going to make the student "so mad." Over the last 3-4 months, Marcus developed nightmares, enuresis, and trichotillomania. The hair pulling is the most distressing feature for both Marcus and his parents. Marcus acknowledges that he is usually unaware of the behavior at first but then finds the sensation is relaxing. Afterward, he is typically embarrassed by the behavior. There is a family history of anxiety in both parents.He has been seeing a psychologist with some mild improvement in his enuresis. However, the hair pulling has not improved and has worsened. They were seeking additional advice regarding the next steps.
Subject(s)
Attention Deficit and Disruptive Behavior Disorders/psychology , Child Reactive Disorders/psychology , Peer Group , Schools , Social Behavior , Students/psychology , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Child , Child Reactive Disorders/diagnosis , Child Reactive Disorders/therapy , Cognitive Behavioral Therapy , Cooperative Behavior , Dreams/psychology , Enuresis/psychology , Enuresis/therapy , Humans , Interdisciplinary Communication , Male , Pediatrics , Social Environment , Stereotyped Behavior , Trichotillomania/psychology , Trichotillomania/therapyABSTRACT
The aim of the work is to present the influence of unreconciled grief in a family for functioning and growth of a child. The paper is based on some examples of clinical work from the field of family therapy, where developmental problems of children followed their carer's inability to cope with death and bereavement. Presented cases from family therapy serve as examples of possible therapeutic interventions in such situations. They show examples of developmental disturbances and psychopathology of the child who stays in relationship with deeply bereaved intimates.
Subject(s)
Bereavement , Child Behavior/psychology , Child Development , Child Reactive Disorders/therapy , Parent-Child Relations , Adaptation, Psychological , Attitude to Death , Child , Child Reactive Disorders/psychology , Female , Humans , Male , Professional-Family RelationsABSTRACT
PURPOSE OF REVIEW: Over a million children and their families have now experienced the stress of the deployment of a family member during the recent wars in Iraq and Afghanistan. Whereas there is an extensive clinical literature about the developmental challenges facing children and issues of family adjustment, there is a lack of systematic research. This review summarizes the findings of recent publications. RECENT FINDINGS: Some veterans develop posttraumatic stress disorder as a consequence of their experiences. This condition drives many of the adverse changes in the families of returning veterans through the effects on intimacy and nurturance in their families of withdrawal, numbing and irritability that are components of posttraumatic stress disorder. There is the more general challenge that all families and children face when a partner/parent deploys of role ambiguity consequent on anxiety that is provoked by the threat that deployed family members experience. A study of Kuwaiti military showed that mothers' anxiety had the greatest impact on the children of deployed fathers, although absence of posttraumatic stress disorder in mothers could mitigate the effects of their fathers' posttraumatic stress disorder. Intervention programs are described, but there is a poverty of their evaluation. SUMMARY: A substantial advantage of focusing on family adjustment is that it can facilitate access to mental healthcare for veterans while assisting families' positive adaptation.
Subject(s)
Adaptation, Psychological , Afghan Campaign 2001- , Child Reactive Disorders/psychology , Combat Disorders/psychology , Family Conflict/psychology , Iraq War, 2003-2011 , Military Personnel/psychology , Stress Disorders, Post-Traumatic/psychology , Veterans/psychology , Adolescent , Age Factors , Child , Child Abuse/psychology , Child Abuse/statistics & numerical data , Child Abuse/therapy , Child Reactive Disorders/diagnosis , Child Reactive Disorders/therapy , Child, Preschool , Combat Disorders/diagnosis , Combat Disorders/therapy , Cross-Sectional Studies , Family Therapy , Humans , Population Dynamics , Spouse Abuse/psychology , Spouse Abuse/statistics & numerical data , Spouse Abuse/therapy , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/therapy , United StatesABSTRACT
OBJECTIVE: The purpose of the present study was to evaluate the effectiveness of a group psychosocial intervention for children (aged 12-18) of a parent with mental illness (copmi). METHOD: A treatment and waitlist-control design study with pre- and post-treatment, and 8 week follow up, was carried out. The treatment (n=27) and control (n=17) groups were compared on three groups of dependent variables: intervention targets (mental health literacy, connectedness, coping strategies), adjustment (depression, life satisfaction, prosocial behaviour, emotional/behavioural difficulties), and caregiving experiences. RESULTS: Group comparisons failed to show statistically significant intervention effects, but reliable clinical change analyses suggested that compared to the control group, more intervention participants had clinically significant improvements in mental health literacy, depression, and life satisfaction. These treatment gains were maintained 8 weeks after treatment. Participant satisfaction data supported these treatment gains. CONCLUSIONS: Given study limitations and the modest support for intervention effectiveness it is important that this and other similar interventions should continue to be revised and undergo rigorous evaluation.
Subject(s)
Child of Impaired Parents/psychology , Mental Disorders/psychology , Resilience, Psychological , Adaptation, Psychological , Adolescent , Bipolar Disorder/psychology , Caregivers/psychology , Child , Child Reactive Disorders/psychology , Child Reactive Disorders/therapy , Child of Impaired Parents/education , Comorbidity , Depressive Disorder, Major/psychology , Female , Health Education , Humans , Male , Peer Group , Psychotherapy, Group , Psychotic Disorders/psychology , Schizophrenic Psychology , Social Adjustment , Social IsolationABSTRACT
OBJECTIVES: A severely ill 11-year-old boy came to the child psychiatric outpatient department of the Fachkrankenhaus Neckargemünd with the diagnosis of a somatoform disorder. Main symptoms included nausea, vomiting, abdominal pain and diarrhoea. He wished to be examined in order to enter the Stephen-Hawking-School for physically handicapped children in the town of Neckargemünd. RESULTS: Manual examination revealed a palpable mass in the right upper quadrant of the abdomen, which was imaged as a tumour of the liver. During the subsequent operation, a 500 ml hepatocellular carcinoma was found. CONCLUSIONS: The symptoms of the hepatocellular carcinoma, which rarely occurs in childhood, can perfectly mimic those of a somatoform disorder of the gastro-intestinal tract.
Subject(s)
Carcinoma, Hepatocellular/diagnosis , Gastrointestinal Diseases/diagnosis , Liver Neoplasms/diagnosis , Somatoform Disorders/diagnosis , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/psychology , Carcinoma, Hepatocellular/surgery , Child , Child Reactive Disorders/diagnosis , Child Reactive Disorders/psychology , Child Reactive Disorders/therapy , Combined Modality Therapy , Diagnosis, Differential , Family Therapy , Follow-Up Studies , Gastrointestinal Diseases/psychology , Hepatectomy/psychology , Humans , Liver Neoplasms/pathology , Liver Neoplasms/psychology , Liver Neoplasms/surgery , Male , Neuropsychological Tests , Psychotherapy , Referral and Consultation , Sick Role , Somatoform Disorders/psychologyABSTRACT
OBJECTIVE: Relying on indicators coded from information collected routinely during intake assessments at a secure inpatient psychiatric facility, this study examined the extent to which different forms of maltreatment accounted for variations in youths' emotional and behavioral problems. METHODS: Clinical information was reviewed for a large (N=401) and diverse sample (mean age=13.9 years; 53% male; 54.6% racial/ethnic minority) of youth admitted to a publicly funded psychiatric hospital. Data were drawn from intake narratives, standardized psychopathology rating scales, and psychiatric diagnostic ratings. RESULTS: Findings provide some support for a hierarchical classification of multiple maltreatment experiences with sexual abuse identified as the specific form of maltreatment most reliably associated with poor adjustment. Support also was obtained for a cumulative classification approach, as the number of different types of maltreatment experiences was linked positively to elevated psychopathology ratings. CONCLUSIONS: Even in this high-risk, atypical sample, maltreatment experiences account for variation in levels of psychopathology. These results have implications for classifying multiple maltreatment and enhancing clinical care for atypical youth who have been maltreated. PRACTICE IMPLICATIONS: Clinicians working in youth psychiatric populations should implement maltreatment-specific psychotherapy approaches for maltreated youth, even as adjunctive treatments in a therapeutic milieu.
Subject(s)
Adjustment Disorders/psychology , Child Abuse, Sexual/psychology , Child Abuse/psychology , Child Reactive Disorders/psychology , Hospitalization , Stress Disorders, Post-Traumatic/psychology , Adjustment Disorders/diagnosis , Adjustment Disorders/therapy , Adolescent , Child , Child Abuse/diagnosis , Child Abuse/therapy , Child Abuse, Sexual/diagnosis , Child Abuse, Sexual/therapy , Child Reactive Disorders/diagnosis , Child Reactive Disorders/therapy , Combined Modality Therapy , Female , Hospitals, Psychiatric , Humans , Male , Milieu Therapy , Psychopathology , Psychotherapy , Risk Factors , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/therapyABSTRACT
The article reviews the current status (1993-2007) of psychosocial treatments for children and adolescents who have been exposed to traumatic events. Twenty-one treatment studies are evaluated using criteria from Nathan and Gorman (2002) along a continuum of methodological rigor ranging from Type 1 to Type 6. All studies were, at a minimum, robust or fairly rigorous. The treatments in each of these 21 studies also are classified using criteria from Chambless et al. (1996), and Chambless and Hollon (1998). Trauma-Focused Cognitive-Behavioral Therapy met the well-established criteria; School-Based Group Cognitive-Behavioral Treatment met the criteria for probably efficacious. All the other treatments were classified as either possibly efficacious or experimental. Meta-analytic results for four outcomes (i.e., posttraumatic stress, depressive symptoms, anxiety symptoms, and externalizing behavior problems) across all treatments compared to waitlist control and active control conditions combined reveal that, on average, treatments had positive, though modest, effects for all four outcomes. We also cover investigative work on predictors, moderators, and mediators of treatment outcome, as well as the clinical representativeness and generalizability of the studies. The article concludes with a discussion of practice guidelines and future research directions.
Subject(s)
Child Reactive Disorders/therapy , Evidence-Based Medicine , Psychotherapy/methods , Stress Disorders, Post-Traumatic/therapy , Adolescent , Child , Child Abuse/psychology , Child Reactive Disorders/diagnosis , Child, Preschool , Cognitive Behavioral Therapy/methods , Early Intervention, Educational , Female , Humans , Male , Peer Group , Personality Assessment , Prognosis , Stress Disorders, Post-Traumatic/diagnosis , Violence/psychologySubject(s)
Aggression , Anxiety/etiology , Attention Deficit Disorder with Hyperactivity/psychology , Attention Deficit Disorder with Hyperactivity/therapy , Child Reactive Disorders/psychology , Child Reactive Disorders/therapy , Communication Disorders/psychology , Communication Disorders/therapy , Aggression/psychology , Anti-Bacterial Agents/therapeutic use , Antidepressive Agents/therapeutic use , Anxiety/psychology , Attention Deficit Disorder with Hyperactivity/diagnosis , Child , Child Reactive Disorders/diagnosis , Child Reactive Disorders/drug therapy , Comprehension , Faculty , Humans , Learning Disabilities/psychology , Learning Disabilities/therapy , Male , Parents , Selective Serotonin Reuptake Inhibitors/therapeutic use , Sertraline/therapeutic use , Speech Disorders/psychology , Speech Disorders/therapy , Streptococcal Infections/drug therapy , Streptococcal Infections/psychology , Stress, Psychological/complicationsSubject(s)
Child Behavior Disorders/psychology , Child of Impaired Parents/psychology , HIV Seropositivity/psychology , Mother-Child Relations , Mothers/psychology , Truth Disclosure , Anger , Art Therapy , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/psychology , Attention Deficit Disorder with Hyperactivity/therapy , Child , Child Behavior Disorders/diagnosis , Child Behavior Disorders/therapy , Child Reactive Disorders/diagnosis , Child Reactive Disorders/psychology , Child Reactive Disorders/therapy , Combined Modality Therapy , Diagnosis, Differential , HIV Seropositivity/diagnosis , Humans , Male , Psychotherapy , Referral and Consultation , UnderachievementABSTRACT
OBJECTIVE: Treatment outcome for preschool-age children exposed to marital violence was assessed, comparing the efficacy of Child-Parent Psychotherapy (CPP) with case management plus treatment as usual in the community. METHOD: Seventy-five multiethnic preschool mother dyads from diverse socioeconomic backgrounds were randomly assigned to (1) CPP or (2) case management plus community referral for individual treatment. CPP consisted of weekly parent-child sessions for 1 year monitored for integrity with the use of a treatment manual and intensive training and supervision. Parents completed the Child Behavior Checklist and participated in the Structured Clinical Interview for DC:0-3 to assess children's emotional and behavioral problems and posttraumatic stress disorder (PTSD) symptoms. Mothers completed the Symptom Checklist-90 and the Clinician Administered PTSD Scale interview to assess their general psychiatric and PTSD symptoms. RESULTS: Repeated-measures analysis of variance demonstrated the efficacy of CPP with significant group x time interactions on children's total behavior problems, traumatic stress symptoms, and diagnostic status, and mothers' avoidance symptoms and trends toward significant group x time interactions on mothers' PTSD symptoms and general distress. CONCLUSIONS: The findings provide evidence of the efficacy of CPP with this population and highlight the importance of a relationship focus in the treatment of traumatized preschoolers.
Subject(s)
Child Reactive Disorders/therapy , Domestic Violence/psychology , Evidence-Based Medicine , Family Therapy/methods , Mother-Child Relations , Spouse Abuse/psychology , Stress Disorders, Post-Traumatic/therapy , Case Management , Child Reactive Disorders/diagnosis , Child Reactive Disorders/psychology , Child, Preschool , Combined Modality Therapy , Community Mental Health Services , Female , Humans , Life Change Events , Male , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychology , Treatment OutcomeSubject(s)
Food Preferences , Hyperphagia/psychology , Weight Gain , Candy , Child , Child Reactive Disorders/diagnosis , Child Reactive Disorders/psychology , Child Reactive Disorders/therapy , Combined Modality Therapy , Diet, Vegetarian , Divorce/psychology , Family Therapy , Female , Humans , Hyperphagia/therapy , Mother-Child Relations , Play Therapy , Referral and ConsultationABSTRACT
A substantial number of children in foster care exhibit psychiatric difficulties. Recent epidemiological and historical trends in foster care, clinical findings about the adjustment of children in foster care and adult outcomes are reviewed, followed by a description of current approaches to treatment and extant empirical support. Available interventions for these children can be categorized as either symptom-focused or systemic, with empirical support for specific methods ranging from scant to substantial. Even with treatment, behavioral and emotional problems often persist into adulthood resulting in poor functional outcomes. We suggest that self-regulation may be an important mediating factor in the appearance of emotional and behavioral disturbance in these children.
Subject(s)
Affective Symptoms/diagnosis , Child Behavior Disorders/diagnosis , Child Reactive Disorders/therapy , Foster Home Care/psychology , Adolescent , Adult , Affective Symptoms/epidemiology , Affective Symptoms/therapy , Child , Child Behavior Disorders/epidemiology , Child Behavior Disorders/therapy , Child Reactive Disorders/diagnosis , Child Reactive Disorders/epidemiology , Cross-Sectional Studies , Female , Follow-Up Studies , Foster Home Care/statistics & numerical data , Humans , Male , Outcome and Process Assessment, Health Care , Personality Development , Psychotherapy/methodsABSTRACT
The term childhood traumatic grief (CTG) is being increasingly used to refer to the particular reaction in children that may follow the death of a loved one during a traumatic event. The goal of this case study is to describe the theoretical argument and framework for, as well as a clinical example of, cognitive-behavioral therapy (CBT) for CTG. We present a case of a five-year-old boy whose father, a firefighter, died in the line of duty at the World Trade Center on September 11, 2001. This specific case will highlight the steps of CBT for CTG, the value of assessment during the therapeutic process, and the need to consider developmental and family factors in treatment.
Subject(s)
Bereavement , Cognitive Behavioral Therapy/methods , Stress Disorders, Post-Traumatic/therapy , Terrorism/psychology , Adaptation, Psychological , Age Factors , Attitude to Death , Child , Child Reactive Disorders/psychology , Child Reactive Disorders/therapy , Child, Preschool , Counseling , Depression/psychology , Family Therapy/methods , Fear/psychology , Fires/prevention & control , Grief , Homicide/psychology , Humans , Life Change Events , Male , New York City , Occupations , Psychiatric Status Rating Scales , Psychotherapeutic Processes , Stress Disorders, Post-Traumatic/psychologySubject(s)
Bereavement , Cognitive Behavioral Therapy , Person-Centered Psychotherapy , Stress Disorders, Post-Traumatic/therapy , Benchmarking , Boston , Child , Child Health Services , Child Reactive Disorders/psychology , Child Reactive Disorders/therapy , Community Health Planning , Community Mental Health Services/organization & administration , Crisis Intervention , Grief , Health Services Needs and Demand , Humans , Life Change Events , Organizational Case Studies , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/psychology , Stress, Psychological/therapy , Trauma Centers/organization & administration , Trauma Centers/standards , Treatment OutcomeABSTRACT
There has been increasing interest in the newly identified condition of childhood traumatic grief (CTG) since the 2001 attack on the World Trade Center. The case presented here is one of an adolescent girl who was diagnosed with CTG following the death of her father, a firefighter killed in the line of duty on September 11, 2001. Literature on CTG, its treatment, and adolescent development will be discussed. The application of client-centered treatment to CTG will be highlighted by the case description and diagnostic findings prior to, during, and following treatment.
Subject(s)
Bereavement , Person-Centered Psychotherapy/methods , Stress Disorders, Post-Traumatic/therapy , Terrorism/psychology , Adaptation, Psychological , Adolescent , Adolescent Development , Child , Child Reactive Disorders/psychology , Child Reactive Disorders/therapy , Family Therapy , Father-Child Relations , Female , Fires/prevention & control , Grief , Homicide/psychology , Humans , Life Change Events , Models, Psychological , New York City , Occupations , Psychology, Adolescent , Psychotherapeutic Processes , Stress Disorders, Post-Traumatic/psychologyABSTRACT
In this paper, we consider the effect of attachment disruptions on severe adjustment problems in school-age boys. Three groups of 9-11-year-old boys were sampled based on their degree of risk for adjustment difficulties: (1) boys in regular classrooms, (2) boys in regular classrooms who are at risk due to poverty, and (3) boys who have been placed in special education classrooms as a result of serious emotional disturbance (SED). Attachment disruptions were categorized according to the severity of major separations from the biological mother. SED children experienced significantly more severe disruptions of their relationships with their biological mothers and fathers than either the high-risk or comparison boys. Teachers' ratings indicated that both the high-risk and SED boys experienced more externalizing symptoms than comparison boys in regular classrooms. However, SED children were most clearly discriminated from their high-risk and comparison counterparts by higher levels of dissociative symptoms. Regression analyses indicated that children who had experienced maternal attachment disruptions were more likely to show dissociative symptomatology in the classroom setting and were more likely to develop dependent relationships with their teachers after risk group status, child age and family structure were controlled. Implications of these findings for the treatment of SED children are discussed.
Subject(s)
Affective Symptoms/psychology , Child Reactive Disorders/psychology , Object Attachment , Affective Symptoms/therapy , Child , Child Reactive Disorders/therapy , Dissociative Disorders/psychology , Faculty , Humans , Male , Mother-Child Relations , Psychology, Child/methods , Regression Analysis , Socioeconomic FactorsABSTRACT
O presente trabalho estuda 100 casos de consultoria em psiquiatria infantil no HSL-PUCRS, avaliando, além de variáveis sócio-demográficas, diagnósticos clínicos mais prevalentes nos casos em que foi solicitada consultoria e participação predominante das especialidades médicas...
Subject(s)
Humans , Child , Child, Hospitalized/psychology , Child Psychiatry , Referral and Consultation/statistics & numerical data , Child Reactive Disorders/diagnosis , Child Reactive Disorders/therapyABSTRACT
OBJECTIVE: Proactive, school-based psychological testing for emotional distress and depression was employed 6 months after a bushfire disaster. The service provision aim was to provide children with the greatest emotional distress the relatively limited therapeutic resources available in the post-disaster environment. Specific hypotheses were tested: that the prevalence of emotional distress and depression would be elevated 6 months post disaster; that emotional distress would be correlated with traumatic events; and that depression would be related to experiences of loss. METHOD: Six months after a bushfire disaster grade 4, 5, and 6 students (n = 601) participated in screening using a test battery measuring emotional distress, depressive symptoms and trait anxiety. RESULTS: Twelve percent (n = 72) of children experienced severe emotional distress 6 months after the bushfire. Rates of depression were similar to rates in non-traumatised child community samples. Multivariate analysis suggested that emotional distress was significantly associated with trait anxiety, evacuation experience, the perception that parents may have died during the bushfire, and depressive symptoms. Depressive symptoms were associated with total distress score, trait anxiety and perception of threat to the parents. CONCLUSIONS: Substantial mental health morbidity was identified 6 months after a bushfire disaster. The usefulness of post-disaster service provision influenced by proactive screening is discussed and reasons for further research highlighted.
Subject(s)
Child Reactive Disorders/diagnosis , Depression/diagnosis , Fires , Psychotherapy , Stress Disorders, Post-Traumatic/diagnosis , Adaptation, Psychological , Adolescent , Child , Child Reactive Disorders/psychology , Child Reactive Disorders/therapy , Depression/psychology , Depression/therapy , Female , Follow-Up Studies , Humans , Male , Mass Screening , New South Wales , Personality Inventory , School Health Services , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapyABSTRACT
Going through a life-threatening illness as a child or adolescent is a tremendously stressful experience for the entire family. Although the majority of survivors do go on to adjust and function well, some have ongoing problems. These problems include evidence of posttraumatic stress, learning difficulties, depression, and anxiety. Their parents appear to be even more severely affected, possibly because they had a better appreciation at the time of the true dangers posed by the illness and the treatment. Little is yet known about their siblings, although it is clear that the acute stage of illness and treatment effects the entire family. Areas needing study include the long-term sequelae on siblings of survivors, as well as a better understanding of the precipitants and mediators of the problems noted in survivors and parents. Only then can interventions and preventative measures be undertaken and tested. Also needed is a better understanding of the impact of cultural differences on precipitants, mediators, and symptoms.
