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PubMed1992

Linking empirically based theory and evaluation: the Family Bereavement Program.

Evaluated the effects of a theoretically derived program to prevent mental health problems in children who had experienced the death of a parent. The program was designed to improve variables in the family environment which were specified as mediators of the effects of parental death on child mental health. The evaluation design involved the random assignment of families to either an intervention or control group. The program led to parental ratings of increased warmth in their relationships with their children, increased satisfaction with their social support, and the maintenance of family discussion of grief-related issues. The program also led to parent ratings of decreased conduct disorder and depression problems and overall problems in older children. Significant correlations between the family environment variables and child mental health problems provided further empirical support for the theory underlying the program. Implications for program redesign were derived by reconsidering the adequacy of the program components to change theoretically mediating variables.

Adaptation, Psychological↗
PubMed1988

Multiple personality disorder in childhood.

Multiple Personality Disorder (M.P.D.) has been diagnosed in adults and adolescents at an almost exponential rate over the last 10 years in contrast to the previous 100 years. Childhood M.P.D., a more recently recognized entity, has been identified both by retrospective patient reports and actual child case reports, of which we were able to note 12 in total, 4 of which may be more accurately described as "incipient M.P.D." Given the apparently rapid response to treatment compared to adults and the high morbidity caused by the adult form of the disorder, the authors recommend a "high index of suspicion" and the use of screening questionnaires to detect cases of M.P.D. in high risk populations of children. Although the natural history of M.P.D. is not known, early identification and treatment could lower the number of cases of childhood M.P.D. that become established as adult cases and decrease the associated morbidity of the disorder in both children and adults. More research is needed to establish prevalence, etiology and effective treatment methods.

Abreaction↗
PubMed2003

[One cannot be careful enough in the choice of one's parents--on the biopsychosocial development of adaptation systems for distress in Homo sapiens].

Actual results of brain research show that we might have more than one system to cope with distress. The most archaic one might be the system freeze/dissociation. The second one is the system attachment/relationship/herd/support. Articles by Allan N. Schore show that the central regulation of the self, the affects, and the interpersonal relations are impaired permanently by relational traumata/attachment traumata during early childhood. Jaak Panksepp differentiates the distress systems panic versus fear. On the one side we find the cluster panic--periaqueductal gray PAG--lateral septum--gyrus cinguli--glutamate--opioids--attachment--parasympathetic autonomic nerve system--trophotorphic state--hypometabolism--freeze reaction--dissociation, on the other side the cluster fear--enemy--sympathetic autonomic nerve system--ergotrophic state--hypermetabolism--fight and flight--cognition and learning. It can be helpful for therapy strategies to differentiate these systems.

Adaptation, Psychological↗
PubMed1989

Immigrant children: psychiatric disorder, school performance, and service utilization.

Data from the Ontario Child Health Study were used to examine the strength of association between child immigrant status and child psychiatric disorder, poor school performance, and use of mental health/social services. Bivariate results indicate that immigrant children are not at increased risk for psychiatric disorder or poor school performance and that they use mental health and social services significantly less often than do their nonimmigrant peers. Implications of the findings are explored.

Acculturation↗
PubMed1986

Developmental and psychosocial considerations in pediatric dermatology practice.

The psychologic implications of childhood skin disorders have received too little attention. Viewing these conditions in a broader developmental framework could facilitate practice by improving the doctor-patient relationship, increasing compliance rates, and enhancing professional satisfactions. Several key developmental points and concepts are relevant to pediatric dermatologic practice.

Adolescent↗
PubMed1979

Psychologic adjustment of siblings of children with chronic illness.

Although numerous references are made to the stressful, deleterious effects of chronic or terminal illnesses and handicaps on the siblings of pediatric patients, very few studies have been conducted using comparison groups. The present study compared the adjustment of 3- to 13-year-old siblings of pediatric hematology (N = 62), cardiology (N = 57), and plastic surgery patients (N = 37) with healthy siblings (N = 46). The adjustment measure was an objective, paper-and-pencil measure of children's emotional and behavioral problems, the Louisville Behavior Checklist. On analyses of covariance, the patient groups were more likely to show symptoms of irritability and social withdrawal, and the differences between illness groups approached significance on measures of fear and inhibition. Among the younger children, ages 3 to 6, there were significant group differences, with the siblings of patients undergoing plastic surgery showing the highest level of general psychopathology. Among children ages 7 to 13, male siblings of patients with blood disorders were more likely to show signs of emotional disturbance than female siblings. No group differences were noted on measures of aggression or learning problems. Significant interactions between sex and age relationship to the child were noted on scales of social withdrawal, inhibition, immaturity, and irritability.

Adolescent↗
PubMed1994

[The child of divorce as collusive partner substitute].

For children the parental divorce creates a risk for their psychological development. When referred to the child psychiatrist because of their conduct disorder these children are often compared by their custodial parents with the absent parent. As a clinically useful concept the concept of collusive partner substitute can explain the underlying intrapsychic as well as the interpersonal defense mechanisms. With reference to a case report the author demonstrates how a collusive dyadic relationship of the parents which ends because of divorce may continue with the help of the child in the role of a collusive partner substitute.

Adolescent↗
PubMed1983

The long-term psychological adjustment of children treated for congenital dislocation of the hip.

Eighty-one children previously treated for congenital dislocation of the hip (CDH) before the age of 5 were followed up several years after their treatment, and their psychological adjustment was compared with that of 3 other groups; (i) 44 children who had experienced a single hospital admission of less than a week before the age of 5; (ii) 26 children who had experienced 2 or more hospital admissions, the first being before the age of 5; and (iii) 51 children who had no experience of hospital admission. All 4 groups were similar in composition in terms of sex ratio, age at follow-up, family size, birth order, parental age and social situation. Psychological adjustment was measured by means of Rutter's questionnaires for parents and teachers. In addition, the children completed a Schonell reading test. Both the parental and the teacher's questionnaires selected more disordered children in the CDH group. The CDH group also had a higher total score and more health and behaviour problems than did the single admission group on the parental questionnaire. On the teacher's questionnaire they were more antisocial than the single and no admission groups combined. No significant differences were found on the reading test. While the overall impression is that the CDH group are poorly adjusted, there is some suggestion that it is the younger children who are contributing to this effect.

Adaptation, Psychological↗
PubMed2003

[Child psychiatric documentation in child visitation and custody disputes--results of a survey].

In the last decade, increasing divorce rates, a joint custodial concept, and a deficient legal situation of non-married fathers have been involuntarily provoking cases of a parent with child custody alienating that child in order to exclude the other parent from visitations and educational participation. Medical certificates are frequently of fateful importance in child custody litigation. In an mail survey conduced in six German cities, N = 133 child psychiatrists were asked about the frequency in which they issue such certificates, what certificates contained, what recommendations were made, and where possible the reasons why the other parent was not included in the diagnostic process. According to the results 74.4% of those surveyed were asked to issue such medical certificates at least once in the year prior to the survey; 42% of the psychiatrists stating that the other parent never or only sometimes participated. The symptoms most frequently certified were behavioural disorders (46%), aggression (34%), problems in school/ADD (28%), anxiety (26%), bed-wetting (23%), depression (21%), and psychosomatic reactions (20%). Outlining the characteristics of alienated children and of alienating parents, of "natural" and of "induced" stress-symptoms in children after parental separation, the article provides physicians and institutions of the health system with support to prevent medical certificates being abused in child custody litigation. Some fundamental guidelines are presented as to what aspects and should be explored and which persons referred to before certificates are issued to parents, social workers or judges of family law courts.

Adolescent↗
PubMed2005

Toward evidence-based treatment: child-parent psychotherapy with preschoolers exposed to marital violence.

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.

Case Management↗
PubMed2003

Refugee families during asylum seeking.

The mental health of refugee families with children during the asylum period is a neglected research area in psychiatry. The present paper describes the situation of 10 refugee families residing at an asylum centre in Finland. Case vignettes are presented to illustrate the situations of these families. The study shows a high rate of depressive and post-traumatic stress disorder-related symptoms among adult refugees. The case vignettes suggest that during the asylum period, many children and adult members of the family are not in a post-traumatic situation, but they live constantly in a distressing situation. The foremost distress amongst the asylum seekers appeared to be fear of deportation and separation from family members. Most of the adults and all children had not received any psychiatric or psychotherapeutic assessment or treatment. It is likely that current procedures for dealing with the asylum seekers contributes to the level of stress, family confusion and psychiatric problems in already traumatized refugee families.

Acculturation↗
PubMed1985

[Anamnesis in child psychology. Analysis of the technic. Its diagnostic and therapeutic value].

Author wishes to demonstrate that partially not directed interview based on free association of ideas and memories is one of the indispensable parts of exploration for the gathering of exact data in Infantile Psychiatry. Use of another technique, perhaps more "scientific" paradoxically risks leaving to one side and ignoring closest pathogenesis to the first causes of the illness and with it forfaits the possibility of administering a treatment which may consider the etiology of the disorder. To illustrate this postulate, the author chooses the area of precocious infantile anorexia and examines the gathering of data in successive interviews; why the new data are radically changing the initial etiopathogenic hypothesis which are being elaborated in the course of the interviews and why the selected treatment is being modified in a essential way. This technique not only requires an important time investment but a respectful listening altitude on the part of the consultant as well limiting to a minimum his interventions and transmitting a feeling of security to parents and child which makes possible his free remembrance activity and with it, the emergence of pathogenic emotions. On the other hand therapeutic yield in real terms the efficient psychotherapeutic intervention "mutant" as some authors would say, are highest in these moments: "Iron is best shapable when red-hot".

Anorexia↗
PubMed1995

Association between CMD signs and symptoms, oral parafunctions, race and sex, in 4-6-year-old African-American and Caucasian children.

The associations between oral parafunctions, signs and symptoms of craniomandibular disorders (CMD), race, and sex were analysed in recordings from 203 4-6-year-old African-American and Caucasian children. Significant correlations were found between bruxism, nail biting, thumb sucking and most of the CMD signs and symptoms. There were also significant associations between most of the signs and symptoms and race, while significant association with sex was found only regarding headache, TMJ sounds and chewing pain. Significant associations were found between most CMD signs and TMJ sounds supporting the view that joint sound recordings have diagnostic value. There were also significant associations between the pain variables recorded by questionnaire and those recorded by palpation, which indicates that reliable data can be obtained by interviewing children as young as five. The results of this study support the concept that oral parafunctions have a significant role in the aetiology of CMD. The results also show that race and sex need to be considered when analysing the possible aetiological role of oral parafunctions in CMD. Longitudinal studies, beginning with low age groups are needed to better determine the role of childhood oral parafunctions in CMD aetiology.

Black People↗
PubMed1995

Prevalence of signs and symptoms of craniomandibular disorders and orofacial parafunction in 4-6-year-old African-American and Caucasian children.

Children, 4-6 years old, 153 Caucasian and 50 African-American, from a pre-school and kindergarten programme in a low income industrial area, who participated in a voluntary oral health examination, were questioned and examined for signs and symptoms of craniomandibular disorders (CMD) and of oral parafunctions. Most of the CMD signs and symptoms were mild. Eight per cent had recurrent (at least 1-2 times per week) TMJ pain, and 5% had recurrent neck pain, African-American children more often than Caucasian children (P < 0.05). Seventeen per cent had recurrent headache. Three per cent had recurrent earache. Pain or tiredness in the jaws during chewing was reported by 25% of the children, more often by African-American than by Caucasian children (P < 0.001) and more often by girls than by boys (P < 0.05). Pain at jaw opening occurred in 10% of the children, more often in the African-American than in the Caucasian group (P < 0.001). Thirteen per cent of the children had problems in opening the mouth. Deviation during opening was observed in 17% and reduced opening in 2%. Reduced lateral movements, locking or luxation were not observed in any child. Palpation pain was found in the lateral TMJ area in 16%, in the posterior TMJ area in 25%, in the temporalis and masseter areas in 10%, and pain for all regions was found more often in the African-American than in the Caucasian children (P < 0.01). Thirty-four per cent of the African-American, and 15% of the Caucasian children admitted to having ear noises (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Black People↗
PubMed1982

Mass hysteria among schoolchildren. Early loss as a predisposing factor.

On May 21, 1979, an outbreak of illness spread swiftly among elementary school students in a Boston suburb. Of 224 boys and girls attending an assembly, 34 were hospitalized with severe dizziness, weakness, hyperventilation, headache, nausea, and abdominal pain. Sudden remission of symptoms, preponderance in girls, and failure of an extensive epidemiological investigation to detect an organic cause indicated mass hysteria. To test the hypothesis that previous loss influenced a child's vulnerability to current loss and predisposed that child to mass hysteria, we compared the incidence of family disruption in the hospitalized children with that in the nonhospitalized children. A significantly higher rate of parental divorce (P less than .00005) and death within the family (P less than .0005) occurred among the hospitalized children. These findings suggest a relationship between childhood loss and susceptibility to mass hysteria.

Adolescent↗
PubMedDate not supplied

Psychological issues among children of hereditary breast cancer gene (BRCA1/2) testing participants.

Children growing up in hereditary breast cancer families may experience diminished psychological well-being. In addition to coping with having a cancer-affected parent or close relatives, these children may focus on their own health risks in light of shared genetic information. While knowledge of a parent's BRCA1/2 negative status may allay a subset of children's worries and fears about cancer, others could experience distressing thought patterns over positive test results. The purpose of this preliminary study is to explore conceptions of health, cancer risk, and psychological adjustment among children in families suggestive of carrying BRCA1/2 susceptibility genes. As part of a longitudinal investigation of the outcomes of BRCA1/2 testing in adults, 20 children of a highly select group of 15 mothers (80% previously affected by breast/ovarian cancer) completed a self-report survey of their beliefs and opinions regarding cancer and genetic testing, stress and worry about cancer, and anxiety, depression, and behavior problems. All information was completed at baseline, prior to the mother's receipt of her genetic test result. The data did not suggest unusually elevated cancer worries or psychological adjustment problems in these children at this point in the parental genetic testing process. However, children with more psychological distress symptoms did experience more frequent thoughts of becoming sick and greater cancer worries. To the extent that learning about a parent's positive test result could exacerbate these tendencies, recommendations to promote child psychological and family communications research that monitor such responses are offered.

Adolescent↗