Clinical Child Psychology and Psychiatry recent issues

Editorial: Organizational Matters

Brazier, A., Wren, B. — Wed, 16 Sep 2009 03:38:32 PDT

Enough's Enough: Conversations with Myself and Other Practitioners

Southall, A. — Wed, 16 Sep 2009 03:38:32 PDT

Amidst considerable media focus on the stresses and strains on health services personnel who choose to leave the service, the author interviewed child mental health colleagues about how they coped with organizational stress in the UK National Health Service (NHS). The themes that emerged suggest that clinical staff feel senior managers have lost touch with what is described as the primary task — that of caring for the children and families that use the service. Practitioners feel undervalued and overwhelmed by nonclinical activities. Although stressed, the kinds of coping mechanisms described are likely to maintain high levels of stress, rather than reduce them. It is suggested that the cognitive dissonance paradigm explains both the stressful nature of practitioner experience and the tendency for clinical staff to work even harder in circumstances of perceived oppression. Perceptual Control and general systemic theories may help provide a framework in which to understand the dynamic forces at work that maintain the clinical and senior management groups in a state of perpetual conflict.

Working Appreciatively to Improve Services for Children and Families

Onyett, S. — Wed, 16 Sep 2009 03:38:32 PDT

Service improvement approaches are described that specifically focus on appreciating the positive that individuals bring to contexts related to children and family services. This includes application of Solution-Focused approaches, Appreciative Inquiry and other approaches that promote a positive emotional climate and focus on what works. Their conceptual foundations are explored and particularly their value in supporting working well with complex adaptive systems. Specific applications described include leadership and management practice, work in school settings, engaging clinicians in healthcare improvement, establishing clinical networks, work with homeless youth, child protection and approaches to drawing out best practice and community development. The theme that unites is a focus on developing effective relationships at all levels and a pragmatic focus on what works so that we can find opportunities to do more of it.

Do Unconscious Processes Affect Educational Institutions?

Hinshelwood, R.D. — Wed, 16 Sep 2009 03:38:32 PDT

In this article I discuss the way that aspects of school and teaching have unconscious roots. Where anxiety about the process, for teachers and children, is high then there is the risk that unconscious defensive processes may occur resulting in institutionalized phenomena. These take the form of cultural attitudes and common practices which may not necessarily enhance the work and in some cases may actively interfere.

Test of Time: A Case Study in the Functioning of Social Systems as a Defence Against Anxiety: Rereading 50 Years On

Lawlor, D. — Wed, 16 Sep 2009 03:38:32 PDT

In this paper I revisit Isabel Menzies’s classic ‘nursing paper’ (I.E.P. Menzies [1960]. A case-study in the functioning of social systems as a defence against anxiety: A report on a study of the nursing service of a general hospital. Human Relations, 13, 95—121). I outline the main findings of the paper and connect it to the major theoretical developments made by the Tavistock Institute of Human Relations and consider the current relevance of the paper in the contemporary field of health and social care.

Soapbox: Interprofessional Working: Choice or Destiny?

Cooper, A. — Wed, 16 Sep 2009 03:38:32 PDT

This article suggests that there may be profound obstacles to our capacity to work together effectively across professional or disciplinary boundaries. These problems are rooted in our love of ourselves and our professions and our dislike of those not like us, dynamics which are also central to the production of our positive professional identities. Such a thickly textured notion of professional identity is at odds with contemporary health and welfare policy trends which stress ‘role performance’ as the start and finish of professional activity. Such shallow concepts of identity are an affront to the real ethical difficulties facing us as we struggle to move beyond professional narcissism and engage with the different professional ‘other’.

Visiting the Native Land

Sands, E. — Wed, 16 Sep 2009 03:38:32 PDT

A Controlled Clinical Evaluation of the Parents Plus Children's Programme: A Video-based Programme for Parents of Children Aged 6 to 11 with Behavioural and Developmental Problems

Coughlin, M., Sharry, J., Fitzpatrick, C., Guerin, S., Drumm, M. — Wed, 16 Sep 2009 03:38:32 PDT

This article describes the development and the clinic-based evaluation of the Parents Plus Children’s Programme (PPCP), a group-based video-modelling-assisted programme for parents of children aged 6 to 11 referred to a Child Mental Health Service with significant behavioural problems both with and without associated developmental difficulties. In evaluating the programme, a sequential block design was used to assign 74 parents of children referred to the service to the PPCP group (n = 42) or the Treatment as Usual (TAU) Comparison Group (n = 32). Assessment took place before and immediately following the 8-week intervention for both groups and at 5-month follow-up for the PPCP Group. Compared to the TAU Group postprogramme, the PPCP Group displayed significant reductions in total difficulties and conduct problems as measured by the Strengths and Difficulties Questionnaire, decreased parental stress, increased parental confidence and significant improvements in parent-defined problems and goals. These positive changes were maintained at 5-month follow-up for the PPCP group, in addition to further significant improvements in peer problems and prosocial behaviour. The analysis also suggests that the programme is more effective for parents of children with behavioural problems only, than for those with associated developmental difficulties. The strengths and limitations of the study are discussed, as well as the difficulties of conducting practice-based research.

Attachment Research and Eating Disorders: A Review of the Literature

O'Shaughnessy, R., Dallos, R. — Wed, 16 Sep 2009 03:38:32 PDT

The aim of this article is to review the clinical literature which examines the association between attachment patterns and eating disorders with a focus on anorexia nervosa, and to examine the varieties of methods and measures employed in attachment research. A literature review was carried out and the relevant articles are examined in terms of their contribution to this area. The literature indicates a number of important considerations when working with this group, including extreme separation anxiety and unresolved loss and trauma, and discusses the implications of these findings for treatment. The results also indicate conflicting evidence regarding associations between attachment style and eating disorder subgroup suggesting that severity of disorder matters more than eating disorder subtype. The different ways of investigating attachment patterns and experiences are explored in this paper. It is suggested that the attachment classification system runs the risk of reducing complex human experience to typologies and that qualitative research might help to address this problem.

Medically Unexplained Physical Symptoms in Children: Exploring Hospital Staff Perceptions

Furness, P., Glazebrook, C., Tay, J., Abbas, K., Slaveska-Hollis, K. — Wed, 16 Sep 2009 03:38:32 PDT

Many children present at GP surgeries with debilitating symptoms with no obvious physical cause and are then referred to acute settings for investigation. Research with GPs suggests caring for this group of patients presents a significant challenge, however, the impact upon the range of hospital staff with whom they have contact has been little studied. This study aimed to explore perceptions and experiences of caring for children with medically unexplained physical symptoms (MUPS) and their families among the paediatric staff at one large UK hospital Trust. Data demonstrated staff awareness that children affected by MUPS have complex needs and the perception that those needs resulted in extra demands and anxieties, especially regarding time management, care protocols and communication. There was a clear desire by general paediatric staff for more information and training from psychiatric services to help them care for this group. Results also revealed staff perceptions of the quality of current MUPS care and suggestions as to how this could be improved.

Understanding and Knowledge of Psychiatric Treatment Among Adolescents and Adults

Wed, 16 Sep 2009 03:38:32 PDT

We evaluated the level of adolescent psychiatric patients’ knowledge and understanding of their treatment in light of their competency to participate in decision-making processes related to their receiving treatment, and compared the adolescents’ levels of understanding and knowledge to those of adult psychiatric patients. The study group consisted of 30 adolescents and 30 adults who were randomly selected from the inpatients of our mental health center. Consenting participants were interviewed and their objective knowledge of psychiatric treatments was evaluated by a specially designed questionnaire. Adolescents knew significantly more about adverse effects of treatment and showed a higher level of comprehensive general knowledge. These data indicate that adolescents are no less knowledgeable than adults and should be regarded as competent partners in the process of therapeutic decision making.

A Qualitative Exploration of Children's Understanding of Indiscriminate Friendliness

Bennett, J., Espie, C., Duncan, B., Minnis, H. — Wed, 16 Sep 2009 03:38:33 PDT

Eight young people (aged 9—14) were interviewed about indiscriminately friendly behaviour. The majority of the sample had a history of maltreatment and placements within foster and care settings. These young people were described as indiscriminately friendly by clinicians, guardians and via the Relationships Problems Questionnaire. Interview transcripts were analysed using Interpretative Phenomenological Analysis, a qualitative methodology. Emergent themes were drawn from interview data which highlighted the young people’s experiences of rejection and feelings of insecurity within their social interactions. While being aware of the risks associated with speaking to strangers and the efforts of adults attempting to protect them from the potential danger associated with indiscriminate friendliness, this group of young people demonstrated a trust of new people and a craving for kindness from others. Evidence was also collected which showed that these children attempted to exert control over others during social contact. These findings offer clinicians an insight into the social interactions of this vulnerable group of children and offer considerations for clinical practice.

Letter to the Editors

Lask, B. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: Tiffany Field, The Amazing Infant: Touch Research Institute at the University of Miami School of Medicine. Oxford: Blackwell, 2007, 272 pp. ISBN 140515392X, {pound}18.99 (pbk)

Edge, J. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: Celia A. Brownell & Claire B. Kopp (Eds.), Socioemotional Development in the Toddler Years, Transitions and Transformations. New York: Guilford Press, 2007. 481 pp. ISBN 9781593854966, {pound}37.50 (hbk)

Bacon, H. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: E. Storch, G. Geffken, & T. Murphy (Eds.), Handbook of Child and Adolescent Obsessive-compulsive Disorder. Abingdon: Routledge, 2007. 432 pp. ISBN 0805862544. {pound}47.50 (pbk)

Gallop, C. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: Kim S. Golding, Nurturing Attachments: Supporting Children Who Are Fostered or Adopted. London: Jessica Kingsley, 2008, 239 pp. ISBN 9781843106142

Rushton, A. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: Lorraine Bell & Jenny Rushforth, Overcoming Body Image Disturbance: A Programme for People with Eating Disorders. Abingdon: Routledge, 2008, 146 pp. ISBN 9780415423304

Titley, M. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: Cathy A. Malchiodi (Ed.), Creative Interventions with Traumatized Children. London: Guildford Press, 2008, 332 pp. ISBN 9781593856151, {pound}25.95

Davies, J. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: Stephen J. Bagnato, Authentic Assessment for Early Childhood Intervention: Best Practices (Guilford School Practitioner Series). London: The Guilford Press, 2007. 315 pp. ISBN 1593854749. _27.00

Eaton, J. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: Evelyn M. Field, Bully Blocking: Six Secrets to Help Children Deal with Teasing and Bullying. London: Jessica Kinglsey Publishers, 2007, 254 pp. ISBN 9781--843105541. {pound}12.99

Farr, N. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: Keith Hawton, Karen Rodham, and Emma Evans, By Their Own Young Hand: Deliberate Self-harm and Suicidal Ideas in Adolescents. London: Jessica Kingsley, 2006. 264 pp. ISBN 1843102307. {pound}17.00 (pbk)

Hill, K. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: Patricia Crittenden, Raising Parents: Attachment, Parenting and Child Safety. Cullompton: Willan, 2008. 381 pp. ISBN 9781843924982. {pound}29.95

Peile, L. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: L. Seiler, Cool Connections with Cognitive Behaviour Therapy: Encouraging Self-Esteem, Resilience and Well-Being in Children and Young People Using CBT Approaches. London: Jessica Kingsley Publishers, 2008

Gallop, C. — Wed, 16 Sep 2009 03:38:33 PDT

Book Review: J. Derisley, I. Heyman, S. Robinson and C. Turner, Breaking Free from OCD: A CBT Guide for Young People and Their Families. London: Jessica Kingsley, 2008

Gallop, C. — Wed, 16 Sep 2009 03:38:34 PDT

Book Review: E. Tronick, The Neurobehavioral and Social-Emotional Development of Infants and Children. London: Norton, 2007. 571 pp. $55.00

Davies, J. — Wed, 16 Sep 2009 03:38:34 PDT

Editorial: Improvers, Adapters and Rejecters -- the Link between `Evidence-based Practice' and `Evidence-based Practitioners'

Midgley, N. — Wed, 10 Jun 2009 06:58:08 PDT

Social Functioning Difficulties in ADHD: Association with PDD Risk

Carpenter Rich, E., Loo, S. K., Yang, M., Dang, J., Smalley, S. L. — Wed, 10 Jun 2009 06:58:08 PDT

Although social difficulties are a common feature of Attention-Deficit Hyperactivity Disorder (ADHD), little is known about the diversity of social problems, their etiology, or their relationship to disorders of social behavior, such as autism or Pervasive Developmental Disorder (PDD). In 379 children and adolescents with ADHD, social functioning was assessed using the Child Behavior Checklist (Achenbach, 1991). Factor analysis and structural equation modeling revealed two factors that we labeled Peer Rejection and Social Immaturity. A factor reflecting `PDD risk' was defined from eight items of a separate screening instrument for PDD and examined for its association with these two social factors. There was a significant association with both factors, but the association was much stronger for the Social Immaturity (Standardized Beta [β ] = .51) than Peer Rejection (β = .29) factors. Social Immaturity was also associated with a greater number of hyperactive symptoms while high Peer Rejection was associated with increased aggression and lower IQ in the ADHD children.

An Evaluation of a Solution Focused Computer Game in Adolescent Interventions

Coyle, D., Doherty, G., Sharry, J. — Wed, 10 Jun 2009 06:58:08 PDT

Many adolescents experience difficulties with traditional face-to-face mental health care approaches. Personal Investigator (PI) is a 3D computer game specifically designed for use in adolescent interventions. The game implements a model of Solution Focused Therapy. It aims to assist in easing the difficulties experienced by adolescents with direct face-to-face approaches. In sessions a therapist and adolescent sit together at a computer and play PI. Issues raised in the game serve as a context for more detailed discussions between the therapist and client. This article describes a study in which PI was used with 22 adolescent clients, attending mental health care services due to a variety of difficulties. Whilst further trials are required, results indicate positive benefits of using PI. PI can help in building an effective client—therapist relationship, can assist in structuring sessions, and can assist in improving client engagement in the therapeutic process.

A Brief Group Intervention for Young Children with Feeding Problems

Haywood, P., Mccann, J. — Wed, 10 Jun 2009 06:58:08 PDT

A brief, yet comprehensive group feeding intervention is described involving parents and children under 5 attending four weekly group sessions followed by 1 month follow-up. Families were referred by community-based professionals for a range of feeding difficulties, however, they were not known to local child and adolescent health mental health services. These families were from Tower Hamlets in the East End of London and considered `hard to reach'. Having not previously accessed mainstream services, an outreach-based approach was required. The group involves a focused and structured approach using educational, psychological and behavioural techniques. In addition, weekly food tasks allowed important observation of parental and child behaviours in relation to food. Interventions and challenges were developed on the basis of parent reports and often contrasting observations during food tasks. A feeding questionnaire has been used to evaluate the four groups completed to date. A single case study is presented here with reference to outcome measures. This is an evolving project showing good initial results on the basis of individual measures and parental reports.

The Community Parent Education Program (COPE): Treatment Effects in a Clinical and a Community-based Sample

Thorell, L. B. — Wed, 10 Jun 2009 06:58:08 PDT

The present study is the first European evaluation of the Canadian parent training programme called Community Parent Education Program (COPE). In addition, it is the first to examine the effects of the COPE programme in different types of clinical and nonclinical samples. The main findings were that COPE was found to be effective in reducing conduct problems, hyperactivity/impulsivity, daily problem behaviours, parental stress, and lack of perceived parental control. However, the programme was not effective in reducing inattention, social competence deficits, or peer problems. Interestingly, the significant group effects were a result of significant differences between the two nonclinical intervention groups and the waiting-list control group, whereas the clinical intervention group did not differ significantly from the control group with regard to either child or parental variables. This points to the importance of evaluating parent training programmes in groups with different levels of severity so that parents are offered the type of training programme most suitable for their child's needs.

All in the Family: Integrating Attachment and Family Systems Theories

Crittenden, P. M., Dallos, R. — Wed, 10 Jun 2009 06:58:08 PDT

This article brings together ideas from attachment and systemic family therapy. There is both growing interest among systemic practitioners in the conceptual and empirical base of attachment theory and also the need for attachment theory to expand dyadic patterning to include its context in family functioning. We propose the Dynamic-Maturational Model (DMM) as being the most compatible and useful variant of attachment theory. With its emphasis on the functional nature of behavior, a dynamic view of development and change, and a focus on multiple attachments and representational systems, the DMM fits systemic concepts well. We propose that many apparent discrepancies between the theories will disappear if careful distinctions are made between observed behavior, functional explanations, and attributions. We conclude with theory-based recommendations for selecting treatment strategies. Several case examples that are theory based, counterintuitive, and tied to disorders that are difficult to treat are offered to give substance to our ideas.

Measurement of Posttraumatic Growth in Young People: A Review

Clay, R., Knibbs, J., Joseph, S. — Wed, 10 Jun 2009 06:58:08 PDT

The potential of the positive psychology perspective to change the focus of clinical research and practice has become increasingly recognized. A variety of new psychometric instruments informed by positive psychology are now available to mental health clinicians, providing them with tools to assess change across the spectrum of human functioning. One area of research and practice in which this is evident is in posttrauma work, where it is becoming more common to assess posttraumatic growth alongside posttraumatic stress. The majority of work on posttraumatic growth has been with adults, but the last few years have also seen a new body of research with children and adolescents. The aim is to review literature relating to the measurement of growth. It is concluded that several measures with acceptable psychometric properties now exist for the assessment of posttraumatic growth in children and adolescents.

Contact and Truth: The Unfolding Predicament in Adoption and Fostering

Loxterkamp, L. — Wed, 10 Jun 2009 06:58:08 PDT

It is now time to examine the crystallizing results of the social experiment of contact, direct and indirect, and to scrutinize the arguments supporting the predominant conviction that the benefits of regular contact are certain. Many adopted and fostered children who have suffered maltreatment at the hands of their birth parents have regular face-to-face meetings with them as well as routine communication in the form of cards or letters. It is commonly maintained that contact has to be beneficial because it is necessarily in the child's best interests in the long run, if not also immediately. But the predicament emerging from such cases of early maltreatment is that contact, the very thing that is meant to provide a remedy for harm, can itself be harmful and the likely cause of enduring emotional and psychological damage, even when it appears to be going well or well enough. Three recent cases seen in a clinical setting illustrate the experiences of children tormented by the effects of contact that is suffused with mendacity.

Complex Trauma, Impact on Development and Possible Solutions on an Adolescent Intensive Care Unit

Jonsson, P. V. — Wed, 10 Jun 2009 06:58:08 PDT

In order for us to begin to understand the effect of abusive experiences in childhood on young people's personality development and symptomatology, we have to draw upon a number of theories. The most important of these relate to attachment, mentalization, dissociation, trauma, and how abusive experiences affect the development of the individual and their developing brain. In this article I will share with you my attempts to understand the young people that come to stay on our intensive care unit and consider how these theories inform our understanding of them and the treatment approach that we try to provide.

Book Review: William E. Narrow, Michael B. First, Paul J. Sirovatka and Daniel A. Regier (Eds.), Age and Gender Considerations in Psychiatric Diagnosis: A Research Agenda for DSM-V. Arlington, Virginia: American Psychiatric Association, 2007. xviii + 362 pp. ISBN 9780890422953. {pound}29

Wilkinson, S. R. — Wed, 10 Jun 2009 06:58:08 PDT

Book Review: Robert L. Findling (Ed.), Clinical Manual of Child and Adolescent Psychopharmacology. London: American Psychiatric publishing, 2008. xxiii + 473 pp. ISBN 9781585622504. {pound}28

Wilkinson, S. R., Panjkovic, S. — Wed, 10 Jun 2009 06:58:08 PDT

Book Review: Debbie Hindle and Graham Shulman (Eds.), The Emotional Experience of Adoption: A Psychoanalytic Perspective. London: Routledge, 2008. 280 pp. ISBN 0415372763. {pound}23.99

Upright, H. — Wed, 10 Jun 2009 06:58:08 PDT

Book Review: Alicia F. Lieberman and Patricia Van Horn, Psychotherapy with Infants and Young Children: Repairing the Effects of Stress and Trauma on Early Development. New York and London: Guilford Press, 2008. 366 pp. ISBN 9781593856755 hardcover

Bacon, H. — Wed, 10 Jun 2009 06:58:08 PDT

Book Review: Stephen Briggs, Alessandra lemma and William Crouch (Eds.), Relating to Self-harm and Suicide: Psychoanalytic Perspectives on Practice, Theory and Prevention. London: Routledge, 2008. ISBN 9780415422574. {pound}19.99

Wright, J. — Wed, 10 Jun 2009 06:58:08 PDT

Book Review: M. Schleifer and C. Martiny, Talking to Children about Responsibility and Control of Emotions. Calgary: Detselig, 2006. ISBN 9781550593211

Kildea, S. — Wed, 10 Jun 2009 06:58:08 PDT

Book Review: Monica McGoldrick, Randy Gerson, and Sueli Petri, Genograms: Assessment and Intervention (3rd ed.). New York: Norton, 2008. 380 pp. US$27.00. ISBN 13 9780393705096

Bathgate, O. — Wed, 10 Jun 2009 06:58:08 PDT

Book Review: Dennis Lines, The Bullies: Understanding Bullies and Bullying. London: Jessica Kingsley, 2008, 224 pp. {pound}16.99. ISBN 9781843105787

Farr, N. — Wed, 10 Jun 2009 06:58:08 PDT

Book Review: Peter Appleton (Ed.), Children's Anxiety: A Contextual Approach. Hove: Brunner Routledge, 2008. 179 pp. {pound}24.99 (pbk). ISBN 9780415459440

Hunt, J. — Wed, 10 Jun 2009 06:58:08 PDT

Book Review: Dennis McCarthy (Ed.), Speaking About the Unspeakable: Non-verbal Methods and Experiences in Therapy with Children. London: Jessica Kingsley, 2008. {pound}16.99. ISBN 9781843108795

Jackson, G. — Wed, 10 Jun 2009 06:58:08 PDT

Book Review: Kate Adams, Brendan Hyde, and Richard Woolley, The Spiritual Dimension of Childhood. London: Jessica Kingsley, 2008. 160 pp. {pound}16.99. ISBN 9781843106029

Moss, D. — Wed, 10 Jun 2009 06:58:08 PDT

Book Review: Christopher G. Fairburn (Ed.), Cognitive Behaviour Therapy and Eating Disorders. New York: Guilford Press, 2008. 324 pp. {pound}27.00. ISBN 9781593857097

Tyson, C. — Wed, 10 Jun 2009 06:58:08 PDT

Editorial: Evaluating Interventions in Child Mental Health: The Importance of Care Provider and Contextual Influences

Kennedy, E. — Tue, 17 Mar 2009 08:19:28 PDT

Depression in Female Adolescents: An IPA Analysis

Shaw, S. K., Dallos, R., Shoebridge, P. — Tue, 17 Mar 2009 08:19:28 PDT

Six female adolescents participated in open-ended interviews regarding their experiences of depression. The transcripts of their interviews were explored using Interpretative Phenomenological Analysis (Smith, 1991). The analysis revealed three inter-connected super-ordinate themes which were: communication, hurt self, and difference. These themes centred on communication processes in participants' families and with peers, issues relating to shifts in identity through adolescence, and feelings of being damaged, distressed, and hurt. Amongst a range of potentially relevant perspectives, an attachment theory (Bowlby, 1969) orientation was found to be particularly relevant and helpful in interpreting the themes that captured these young women's experiences. Some implications for clinical practice are discussed.

Social Capital and Childhood Psychiatric Disorders: A Cross-sectional Study

Pearson, L. J., Oyebode, F. — Tue, 17 Mar 2009 08:19:28 PDT

The aim of this research was to determine whether social capital is associated with either the type or severity of psychiatric disorders of childhood, specifically, disorders of emotion and behaviour. Ninety parents of children between the ages of 4 and 18 years with an emotional disorder or behavioural disorder participated in the study. They completed two questionnaires: the Child Behaviour Checklist (to assess severity of disorder) and a questionnaire measuring social capital. There was no statistically significant association between total social capital score and either diagnosis or severity of illness. However, two components of social capital showed significant associations: `perceptions of the local area' was significantly associated with severity of illness and `social networks' with diagnosis. The findings of this study suggest that some components of social capital may be more important in relation to mental health than others.

Relationship Factors and Outcome in Child Anxiety Treatment Studies

Fjermestad, K. W., Mowatt Haugland, B. S., Heiervang, E., Ost, L.-G. — Tue, 17 Mar 2009 08:19:28 PDT

This study reviews 19 randomized controlled trials examining the association between three relationship factors — participation, treatment involvement, and therapeutic relationship — and outcome of cognitive-behavioral anxiety treatments for children and adolescents. In 12 studies, parent participation was considered as an independent variable compared to child-only participation. In three studies, parental involvement was measured. Child involvement was measured in one study. The child's perception of the therapeutic relationship was considered in three studies. Six studies found a significant positive effect of parent participation on diagnostic status, symptom level, or global functioning outcome measures. One study found a significant effect of parental involvement on global outcome measures. Another study found a significant positive association between child involvement and symptom measures and global functioning measures. No association was found between the quality of the child's perception of the therapeutic relationship and treatment outcome. Clinical implications are discussed.

Therapeutic Limits from an Attachment Perspective

O'Sullivan, L., Ryan, V. — Tue, 17 Mar 2009 08:19:28 PDT

This article applies attachment theory and relevant research to therapeutic limit setting and focuses particularly on child-centred, non-directive play therapy (NDPT) practice. We review the role of limits in therapeutic change and examine whether therapeutic limit setting exhibits properties similar to those evident in typical adult—child relationships, a topic not previously considered in the literature. The first section identifies properties considered inherent in optimal attachment relationships from a limit setting perspective, drawing particularly on Heard and Lake's (1997) extension of Bowlby's attachment theory. The next section discusses therapists' use of limit setting from an attachment standpoint, distinguishing features of therapeutic limit setting which reflect properties evident in sensitive adult—child attachments. Finally, implications for further research and practice in child therapy are explored.

Adolescents' Ability to Read Different Emotional Faces Relates to their History of Maltreatment and Type of Psychopathology

Leist, T., Dadds, M. R. — Tue, 17 Mar 2009 08:19:28 PDT

Emotional processing styles appear to characterize various forms of psychopathology and environmental adversity in children. For example, autistic, anxious, high- and low-emotion conduct problem children, and children who have been maltreated, all appear to show specific deficits and strengths in recognizing the facial expressions of emotions. Until now, the relationships between emotion recognition, antisocial behaviour, emotional problems, callous-unemotional (CU) traits and early maltreatment have never been assessed simultaneously in one study, and the specific associations of emotion recognition to maltreatment and child characteristics are therefore unknown. We examined facial-emotion processing in a sample of 23 adolescents selected for high-risk status on the variables of interest. As expected, maltreatment and child characteristics showed unique associations. CU traits were uniquely related to impairments in fear recognition. Antisocial behaviour was uniquely associated with better fear recognition, but impaired anger recognition. Emotional problems were associated with better recognition of anger and sadness, but lower recognition of neutral faces. Maltreatment was predictive of superior recognition of fear and sadness. The findings are considered in terms of social information-processing theories of psychopathology. Implications for clinical interventions are discussed.

Clinical Reasoning for Child and Adolescent Mental Health Practitioners: The Mindful Formulation

Havighurst, S. S., Downey, L. — Tue, 17 Mar 2009 08:19:28 PDT

This article outlines a systematic approach to the formulation of clinical problems for practitioners working with children and their families. Whilst assessments in child and adolescent mental health often use a range of theoretical and practical approaches for data collection, there are relatively few resources to assist the clinician in integrating this information to develop a formulation that leads to a well considered intervention plan. The formulation approach presented here was designed to assist in training child and adolescent clinicians in a method that facilitates the process of understanding complex cases. This is done by examining the patterns of strength and difficulty identified during an assessment and systematically providing an explanation for these using `the Four Ps' — predisposing, precipitating, perpetuating, and protective factors — to structure the clinician's thinking. Interventions that address patterns of strength and difficulty for each of the `Four Ps' are recommended when working with complex clients. This formulation approach may take more time than merely summarizing the case, but the benefits are a more comprehensive understanding of the client. This means that problems often associated with working with complex cases can be identified and addressed, reducing the risk of drop out, poor engagement or treatment failure.

Psychological Needs, Service Utilization and Provision of Care in a Specialist Mental Health Clinic for Young Refugees: A Comparative Study

Michelson, D., Sclare, I. — Tue, 17 Mar 2009 08:19:28 PDT

This study addressed psychological needs, patterns of service utilization and provision of care in a specialist mental health service for young refugees and asylum seekers in London. Comparisons were made between two groups with different levels of postulated mental health need: unaccompanied minors (UAMs; n = 49) and children accompanied to the UK by one or more primary caregivers (n = 29). Significant differences were observed in referral pathways, with UAMs more likely to be referred by social services and less likely to be referred from medical agencies. UAMs also attended fewer sessions during treatment, and missed a greater proportion of scheduled appointments. Contrary to prediction, group comparisons revealed similar levels of post-migration stress and overall psychological morbidity. However, UAMs experienced significantly more traumatic events prior to resettlement, and were more likely to exhibit symptoms of post-traumatic stress disorder (PTSD) than their accompanied peers. Despite their elevated risk of PTSD, UAMs were less likely than accompanied children to have received trauma-focused interventions. UAMs were also significantly less likely to have been treated using cognitive therapy, anxiety management and parent/carer training, as well as receiving fewer types of practical assistance with basic social needs. The clinical and service implications of these findings are discussed.

A School-Based Mental Health Intervention for Refugee Children: An Exploratory Study

Fazel, M., Doll, H., Stein, A. — Tue, 17 Mar 2009 08:19:28 PDT

This report describes an exploratory study of a school-based mental health service developed to address the psychological needs of refugee children. The service was made available in three schools and followed a consultative framework. Refugee children were discussed with the mental health team and children at greatest risk were seen. A questionnaire of psychological functioning was completed by teachers before and after the intervention. Data were collected on 47 refugee children and two control groups (ethnic minority and indigenous white children). Subgroup analyses compared children who were seen directly by the service with those for whom only consultation was provided. Refugee children had poorer overall adjustment at baseline particularly in the emotional and peer problem domains. The greatest improvements following the intervention were seen in hyperactivity for the refugee group and in peer problems for the refugees directly seen by the service. While further studies are necessary to assess its efficacy, this exploratory study indicates that an intervention which involves collaboration with teachers and parents, in an environment where children spend much of their time, can benefit vulnerable children.

Test of Time: What if Little Albert had Escaped?

Field, A. P., Nightingale, Z. C. — Tue, 17 Mar 2009 08:19:28 PDT

Watson and Rayner's (1920) `Little Albert' experiment has become one of the most famous studies in psychology. It is a staple of many general psychology textbooks and is part of the very fabric of the discipline's folklore. Despite this fame, the study has been widely criticized in the nearly 90 years since it was published for its lack of methodological rigour. This article attempts to evaluate the contribution of the `little Albert' study to modern clinical psychology by speculating on what theories and treatments of child anxiety would look like in a parallel universe in which the study never took place because `little Albert' escaped from the hospital in which Watson tested him.

Editorial Guide

Brazier, A. — Mon, 22 Dec 2008 06:35:54 PST

Editorial: Be (a) Patient

Brazier, A. — Mon, 22 Dec 2008 06:35:54 PST

The Diagnosis of Tourette's Syndrome: Communication and Impact

Rivera-Navarro, J., Cubo, E., Almazan, J. — Mon, 22 Dec 2008 06:35:54 PST

No study to date has investigated differences in perception regarding the manner in which a diagnosis of Tourette's Syndrome (TS) is communicated and the impact that this diagnosis can have on patients, as well as their relatives and physicians. The main objective was to explore the personal experiences regarding the communication and impact of a TS diagnosis on those who receive the diagnosis, their caregivers and physicians. A qualitative research methodology was used in this study, based on the use of focus groups (FGs). All health professionals, persons with TS and their relatives said that TS was difficult to diagnose. However, each group perceived different causes for the difficulty. Physicians cited the complexity of the symptoms, while the patients themselves noted the general lack of knowledge regarding the disease. In adittion, the physicians and the relatives both noted that the symptoms of TS were often hidden behind family guilt. The communication of the diagnosis to relatives of children with TS was not adequate because of poor understanding and interpretation of the clinical terminology. The most important conclusion was that the current method for communicating the diagnosis of TS to patients and relatives should be improved to facilitate better understanding and interpretation.

At-risk Mothers' Parenting Capacity: An Epistemological Analysis of Change Through Intensive Intervention

Worsham, N. L., Kretchmar-Hendricks, M. D., Swenson, N., Goodvin, R. L. — Mon, 22 Dec 2008 06:35:54 PST

Using an epistemological framework, we examine the process of change for two at-risk mothers participating in the Children's Ark, an innovative foster care program. The Children's Ark invited at-risk mothers who had lost custody of their children to live in a structured, supervised environment with their infants/toddlers while receiving intensive intervention. Focusing on two mothers who completed the program and regained custody of their children, we developed a coding system from Women's ways of knowing (Belenky, Clinchy, Goldberger, & Tarule, 1986) to analyze entry and discharge interviews, and as a means of exploring alternative conceptualizations to the helping professions' understanding of at-risk families. In terms of an epistemological framework, we found that mothers increased their capacity to acknowledge their own minds and voices and those of their children. Additionally, mothers came to recognize their capacity to generate knowledge, especially through dialogue and relationships with others. In conclusion, we discuss the utility of an epistemological perspective in describing and exploring change in at-risk mothers, including possible implications for practice.

Young Offenders' Experiences of Traumatic Life Events: A Qualitative Investigation

Paton, J., Crouch, W., Camic, P. — Mon, 22 Dec 2008 06:35:54 PST

This investigation aimed to look at how a group of young offenders attending an inner-city youth offending team experienced adverse and traumatic life events. A qualitative approach was used and semi-structured interviews were conducted with eight young offenders about their perceptions of difficult experiences and the effects of such events. The interviews were analysed using Interpretative Phenomenological Analysis (Smith, Jarman, & Osborn, 1999). Analysis of the accounts yielded a number of themes. Young offenders experienced violence at home, in the community and in custody. Instability and transitions emerged as important themes in relation to school and home. Deprivation was experienced both in terms of poverty and the literal and emotional absence of parents. A variety of cognitive, emotional and behavioural responses to adverse/traumatic experiences were identified, including a blocking out of painful experience and aggression to self and others. There were barriers to seeking or making use of professional support. Custody appeared to offer an opportunity to reflect on and re-evaluate life trajectory. The study concluded that greater consideration of trauma when carrying out assessments would enable `at risk' young offenders to be identified using clinical interviewing along side standardized measures to aid assessment of the complexity and uniqueness of the response to trauma.

Life-Threatening Food Refusal in Two Nine-Year-Old Girls: Re-Thinking the Maudsley Model

Rhodes, P., Prunty, M., Madden, S. — Mon, 22 Dec 2008 06:35:54 PST

While there is growing evidence for the efficacy of the Maudsley model of family-based treatment for anorexia nervosa, little is known concerning the most effective treatment for pre-adolescents with Eating Disorders Not Otherwise Specified (EDNOS). The presentation of case studies of children with EDNOS is important. Large-scale studies are difficult due to low incidence and the application of homogenous manualized approaches may be unsuitable to the wide range of potential disorders. The aim of this article is to present two detailed case studies of children with food avoidant emotional disorder, both presenting with life threatening food refusal. A flexible and individualized approach to family therapy was taken, resulting in the resumption of eating in less than seven weeks and four months respectively.

Guilt and Posttraumatic Stress Symptoms in Child Victims of Interpersonal Violence

Kletter, H., Weems, C. F., Carrion, V. G. — Mon, 22 Dec 2008 06:35:54 PST

Our objective was to examine the relationship between guilt and posttraumatic stress disorder (PTSD) symptoms in children with a history of interpersonal violence. Eighty-seven children between the ages of 5 and 16 years (mean age = 11.70 years) were administered the Clinician-Administered PTSD Scale for Children and Adolescents to assess for PTSD symptoms and associated features. Multiple regression analysis found that guilt over acts of commission or omission (behaviors the child performed or failed to perform during the event or to prevent it) was highly associated with PTSD severity. Derealization and changes in attachment were also significantly related to PTSD symptoms. Findings suggest that it may be important for clinicians to assess for associated features in traumatized children as these are associated with greater PTSD severity. Posttraumatic interventions may benefit from targeting these symptoms.

Characterizing Anxious Children with an Obsessive Difficult Temperament

Wood, H., Manassis, K., Owens, M., Garland, E. J. — Mon, 22 Dec 2008 06:35:54 PST

This exploratory study sought to characterize anxious children displaying an Obsessive Difficult Temperament (ODT), and examined features that may differentiate them from anxiety disordered, non ODT children. Participants comprised 67 children, aged 4 to 7 years, consecutively referred to an anxiety disorders clinic at an urban children's hospital. Retrospective categorization of the participants' temperament profile was undertaken, with 21 children appearing to display ODT. Groups were compared on the bases of child functioning (parent and clinician rated), the presence of comorbid disorders (based on structured interview), and parental stress and symptomatology. Participants with ODT were found to display a specific profile of temperament traits. Compared to non ODT participants, they showed a significantly poorer social functioning, more comorbid externalizing disorders, elevated levels of maternal stress, and increased maternal psychiatric symptoms. To conclude, anxious children expressing ODT present with significant impairments in functioning and require further investigation. Associated parental stress and impaired maternal psychosocial functioning are evident.

Exploring Young Women's Understandings of the Development of Difficulties: A Narrative Biographical Analysis

Brooks, E., Dallos, R. — Mon, 22 Dec 2008 06:35:54 PST

This article describes a qualitative research study which used in-depth interviews to elicit young women's narratives about the meanings they hold regarding the important experiences in their lives, and their understandings of the development of difficulties that have led them to be in contact with Child and Adolescent Mental Health Services (CAMHS). Five young women (aged 15—17 years) who were current users of CAMHS were interviewed. A narrative analysis was conducted on the data. The findings revealed how contact with services may have impacted on their developing sense of self during this important transitional period of their lives. The young women's stories differed in the extent to which they drew on themes of difficulties as indicators of illness or the result of difficult life events. Their sense-making appeared to be influenced by the relationships, contexts and discourses which they were exposed to and embedded within.

The Perpetuation of Patriarchy: The Hidden Factor of Gender Bias in the Diagnosis and Treatment of Children

Abell, S., Dauphin, B. — Mon, 22 Dec 2008 06:35:54 PST

The history of the mental health movement suggests that political and economic forces often have undue influence on the science of nosology. Given this situation, diagnostic categories which are applied disproportionately to a particular population segment may warrant reconsideration. While many scholars have questioned why a number of adult diagnostic categories are used disproportionately with females, few have examined why the diagnostic categories for children are applied with greater frequency to males. The authors suggest that gender bias in the diagnosis and treatment of children ultimately serves to foster patriarchy, by reinforcing existing patterns of maternal child rearing rather than promoting the goal of shared parenting.

A Commentary on `The Perpetuation of Patriarchy: The Hidden Factor of Gender Bias in the Diagnosis and Treatment of Children' by Steven Abell and Barry Dauphin

Timimi, S. — Mon, 22 Dec 2008 06:35:54 PST

Soapbox: In Defence of Weakness

Parker, J. — Mon, 22 Dec 2008 06:35:54 PST

Book Review: D. Hughes, Attachment-focused Family Therapy. New York: Norton, 2007. 288 pp. ISBN 0393705269

Dallos, R. — Mon, 22 Dec 2008 06:35:54 PST

Book Review: Janet Treasure, Grainne Smith, & Anna Crane, Skill-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method. London: Routledge, 2007. 228 pp. ISBN 9780415421583

Wiig, T. — Mon, 22 Dec 2008 06:35:54 PST

Book Review: Jeanne Magagna, Nancy Bakalar, Hope Cooper, Jaedene Levy, Christine Norman & Carolyn Shank (Eds.), Intimate Transformations: Babies with Their Families. London: Karnac, 2005. 242 pp. ISBN 1855753189

Alperovitz, S. — Mon, 22 Dec 2008 06:35:54 PST

Book Review: Nancy Boyd Webb (Ed.), Play Therapy with Children in Crisis: Individual, Group, and Family Treatment (3rd ed.). New York: The Guilford Press, 2007. 489 pp. ISBN 9781593854959

Farnfield, S. — Mon, 22 Dec 2008 06:35:54 PST

Book Review: D. Coch, G. Dawson, & K.W. Fischer (Eds.), Human Behavior, Learning, and the Developing Brain. New York: Guilford Press, 2007

Kenyon, S. — Mon, 22 Dec 2008 06:35:54 PST

Thanks to Assessors 2008

Mon, 22 Dec 2008 06:35:54 PST