bluuebunny/crossref_metadata_2025 huggingface dataset:
Case Study: Treatment Adherence in a 13-Year-Old Deaf Adolescent Male
Authors: Shaw Richard J. , Palmer Laura , Hyte Holly , Yorgin Peter , Sarwal Minnie
Published: November 2003

This article describes the case of a 13-year-old deaf adolescent male with end-stage renal disease presenting with incomplete adherence to his medical treatment regimen. There is a review of the factors affecting his treatment adherence, including developmental, communication and psychiatric issues. The article includes a description of an in-patient treatment intervention comprising educational, organizational and behavioral components, as well as the individual and family psychiatric treatment of the patient’s co-morbid psychiatric illness. Adaptations to the treatment intervention that were made to address the patient’s communication difficulties are also discussed.
A Personal History of Childhood Sexual Abuse: Parenting Patterns and Problems
Authors: Cross Wendi
Published: November 2003

Childhood sexual abuse (CSA) is shockingly common among women in the USA and is particularly prevalent among female psychiatric patients. Despite theoretical accounts and empirical evidence that developmental history, especially child abuse, plays a significant role in parenting skills, there are no reports of parenting interventions with mothers with CSA histories. This article reviews the available reports of parenting problems among mothers with CSA histories, and presents clinical case material to illustrate the complexities of treating mothers with CSA histories and their children. Preliminary recommendations for interventions with mothers at risk for intergenerational abuse and mental health problems among their children are outlined.
Good Children Presenting with Conversion Disorder
Authors: Kozlowska Kasia
Published: November 2003

Current conceptualizations of conversion disorder in childhood draw from a range of theoretical perspectives. A large subset of children afflicted with conversion disorder has recurrently been described as ‘good’, ‘helpful’, ‘compliant’, ‘high- achieving’ and ‘conscientious’. Family characteristics noted in this group include high family expectations, inarticulate family relationships and hostility towards psychological explanations with an over-emphasis on medical aetiology. Physicians experience parental displeasure and anxiety in the form of demands for investigations and treatment, and feel pressure to comply with parental requests. Like physicians, good children with conversion disorder also feel compelled to satisfy their parents. As children, they are even less able to openly disagree with parental views or expectations, and manage their fear of parental rejection, hostility, anger or displeasure through compulsive compliance. This article discusses the contributions of attachment theory to our understanding of relationship patterns in families of extremely good compliant children and expands Taylor’s concept of ‘intolerable predicaments’. The development of the ‘compulsive compliant’ attachment strategy is discussed, and its application to the theory and treatment of children with conversion disorder is examined. Case vignettes are presented.
Behavioral Problems in School-Aged Children of Mothers with HIV/AIDS
Authors: Bauman Laurie J. , Camacho Sheila , Silver Ellen J. , Hudis Jan , Draimin Barbara
Published: November 2003

This study examined the relationships between selected risk and resistance factors and maternal reports of child behavior problems on the Child Behavior Checklist (CBCL) in families affected by maternal HIV/AIDS. Data were obtained from 193 mothers with late-stage HIV/AIDS who were included in a sample consecutively recruited from the New York City Division of AIDS Services Income Support to participate in Project Care, a randomized trial of a permanency planning intervention. Each mother reported on one HIV negative index child 5–12 years of age. Child behavior problems were related significantly to the mother’s psychological distress and marginally to her having illness-related activity restrictions, but not to other measures of maternal physical health, stigma or disclosure of her HIV to the child. Two child dispositional factors, productivity and independence, and two family factors, adaptability and a good parent–child relationship, were related to better child functioning, but family cohesion was a risk factor for poorer adjustment in this sample. These are likely to be key target variables useful to policy makers in planning programs to assist these children in coping successfully with their mother’s illness.
A Longitudinal Study of the Impact on Young Children of Maternal HIV Serostatus Disclosure
Authors: Murphy Debra A. , Marelich William D. , Hoffman Dannie
Published: November 2003

A longitudinal analysis of the psychological well-being of 81 young children ages 6–11 living with their HIV symptomatic or AIDS diagnosed mothers was conducted. Specifically, the relationship among mothers’ disease severity, maternal disclosure of HIV, and children’s psychological well-being was investigated. The children were assessed over three time points (i.e. baseline assessment, 6- month and 1-year follow-up). Two categories of maternal disclosure (disclosed before baseline, no disclosure at any of the three time points over 1-year), and two categories of disease severity (< 500 T-cell count across all assessments, 500+) were created. A series of 2 × 2 × 3 repeated measures MANOVAs was used to assess the effects of the maternal disclosure and disease severity across time on children’s psychological well-being. Results showed significant within-group time effects for child depression, suggesting a decrease in depression over time. Interaction results of time and maternal disclosure revealed only a few significant changes over time. However, significant decreases over time for child depression were noted among children whose mothers’ CD4 cell counts remained at 500+ across the three assessment periods. Implications for future research and for psychosocial needs of these families are discussed.
Diagnostic Disclosure to HIV-Infected Children: How Parents Decide when and what to Tell
Authors: Lester Patricia , Chesney Margaret , Cooke Molly , Whalley Patrick , Perez Berenice , Petru Ann , Dorenbaum Alejandro , Wara Diane
Published: November 2003

The objective of this study was to assess parental decision-making about illness disclosure to human immunodeficiency virus (HIV)-infected children. This is a cross-sectional study of 51 children with HIV infection based on parent interviews, child cognitive testing, clinical assessments and medical records. Only 43% of children had been told their HIV diagnosis. Qualitative analysis of parental decision- making about illness disclosure varied by child developmental level. Factors influencing parental decision to disclose the child’s HIV status including parental communication style, parental illness, child’s rights, treatment adherence, child questions and provider pressures, whereas concerns about HIV stigma and potential emotional distress were most frequently identified as reasons for non- disclosure. Central decision-making factors for parental HIV disclosure and reported outcomes of disclosure are described. Pediatric HIV disclosure represents a complex task for parents caring for the HIV-infected child, one in which the child’s development and the family’s community should be considered in the setting of a potentially stigmatizing infectious illness.
Patterns of HIV Status Disclosure to Perinatally HIV-Infected Children and Subsequent Mental Health Outcomes
Authors: Mellins Claude Ann , Brackis-Cott Elizabeth , Dolezal Curtis , Richards Ana , Nicholas Stephen W. , Abrams Elaine J.
Published: November 2003

Increasing numbers of perinatally HIV-infected children are surviving into their teens and beyond. Research and clinical reports suggest that many HIV-infected children, particularly those younger than 13 years, do not know they are HIV infected owing to parental concerns about the impact on their mental health. This study examines patterns of HIV status disclosure to 77 perinatally HIV-infected ethnic minority children (aged 3–13 years), and explores the association between knowledge of HIV status and emotional and behavioral outcomes. The majority of children in this study (70%) did not know their HIV status. On average, children who knew their HIV status were older and tended to have lower CD4%. Child knowledge of HIV status was not associated with gender, ethnicity, caregiver education, parent–child relationship factors, type of placement (biological vs adoptive), or other health status indicators. As hypothesized, HIV status disclosure to infected children did not result in increased mental health problems. There was a statistical trend for children who knew their HIV status to be less depressed than children who did not know. Also, greater social disclosure (e.g. communication of child’s status to family and friends) was found when the child had an AIDS diagnosis or lower CD4%, as well as when the caregiver was HIV negative, African American and not the child’s biological parent. In conclusion, pediatric HIV infection remains a highly stigmatized issue that is difficult to discuss with the infected child and others. Yet, contrary to the beliefs of many caregivers, disclosure did not result in increased mental health problems.
Picking Up the Pieces: Caregivers of Adolescents Bereaved by Parental AIDS
Authors: Rotheram-Borus Mary Jane , Leonard Noelle R. , Lightfoot Marguerita , Franzke Laura H. , Tottenham Nim , Lee Sung-Jae
Published: November 2003

This study describes caregivers of adolescents whose parents died of AIDS and examines how caregivers perceive the impact of raising bereaved adolescents. For adolescents bereaved by AIDS, 65 non-parental caregivers were recruited and assessed twice over 6 months. Most caregivers (89%) were female members of the extended family, 49% were married and 29% were employed. Caregivers were older and more likely to be employed than parents with HIV (PWH), but were similar in ethnicity, partnership and financial status, and religiosity. Caregivers had generally been selected by the parent prior to death (66%) and most caregivers (75%) had at least moderate involvement in the care of the youth prior to parental death. Caregiver–youth relationships were stable (91%) over a 6-month period. Caregivers were significantly less emotionally distressed than PWH had been. Caregiver burden was rated as moderate; the number of positive caregiver–youth relationships decreased significantly over 6 months. Family caregiving is a common, ongoing and stable relationship in families coping with AIDS.
Parenting on Shifting Sands: The Transfer of Responsibility for Safely Managing Danger
Authors: Eltringham Simon , Aldridge Jan
Published: November 2003

This article discusses the concept of danger in childhood and adolescence, from the perspectives of Eriksonian and attachment theory. Three questions are considered: (i) where is the danger in a young person’s environment; (ii) is the young person able to identify it; and (iii) does the parental protection provided safely support development and the growing maturity of adolescence? Such questions should provide a framework to inform clinical assessment, add insight to intervention, and ultimately facilitate the safe transfer of responsibility, for the identification and best management of danger, from parent to emerging young adult.
How Professionals Think about Contact between Children and their Birth Parents
Authors: Harris Rita , Lindsey Caroline
Published: November 2003

Professionals’ beliefs about contact between birth parents and children placed permanently with alternative carers, and the influence these have on their recommendations, are described. A small qualitative study using interpretative phenomenological analysis (IPA) was used to explore the meanings that professionals, including judges, guardians ad litem, psychologists and psychiatrists, bring to their assessments of whether contact should take place. Professionals were using similar ideas and terms in different ways. The authors recommend greater consistency and clarity in the use of concepts. Participants described contradictions within their own beliefs about whether contact was indicated or not, which led to dilemmas about their recommendations. Self-reflective practice in the assessment and recommendations made about contact is proposed to address these dilemmas.
Attachment Theory, Loss and Trauma: A Case Study
Authors: Zelenko Marina A. , Benham Anne
Published: November 2003

This article discusses applications of attachment theory and theories of bereavement to the treatment of trauma with loss of the mother in young children. The article suggests guidelines that may be useful in clinical work with these difficult cases. Clinical application of the guidelines is illustrated by discussion of the therapeutic work with a 3-year-old boy who at the age of 21/2years survived an automobile accident in which his mother died.
A Behavioural Pattern of Irritability, Hostility and Inhibited Empathy in Children
Authors: Evans Ian M. , Heriot Sandra A. , Friedman Alice G.
Published: November 2003

Although childhood aggression and conduct problems receive much clinical and research attention, important variations in function underlying the common syndromes are less often analysed. In this article, we describe a particular pattern of behaviour in young children, which we have occasionally observed in various clinical contexts. The critical feature of this pattern is that the children are described by those who know them well as interpersonally negative, often revealing spiteful, hostile behaviours, particularly towards parents or siblings. The general temperamental pattern is one of irritability, so that the children have a disgruntled, irascible disposition. Although their behaviour can escalate to apparently unprovoked, and sometimes severe, aggressive acts that suggest a lack of feeling towards others, the children have no deficit in empathy. Instead, either their own need for anger reduction is greater than any concern for others, or, being vengeful, they are aware that their actions will be hurtful to others. We make comparisons with the critical features of established clinical syndromes, and speculate as to how the proposed pattern might be a functional explanation for some individual children whose behaviour otherwise fits standard diagnostic classifications. Possible temperamental and family relationships factors are proposed that might contribute to this pattern of hostile mood, particularly parenting practices that could be perceived as unfair by the child.
Parental Assessments of the Efficacy of Risperidone in Attention Deficit Hyperactivity Disorder
Authors: Bramble D. J. , Cosgrove P. V.F.
Published: November 2003

A postal survey was undertaken of the parents of 326 patients with severe and complex forms of attention deficit hyperactivity disorder (ADHD) to obtain their views of the efficacy and safety of risperidone augmentation therapy. Replies were received from parents of 170 patients (mean age: 14.3; SD: 4.4; range: 4–27 years). The results revealed an overall symptomatic improvement resulting from the risperidone therapy: 92% of parents and 100% of the prescribing clinician’s ratings indicated a net benefit of treatment (on a visual analogue rating scale); a good adherence rate (81%); low rates of significant adverse effects (8%); and a reduction of reported offending rates (overall 93% reduction comparing rates before and during risperidone therapy in 30 patients). Furthermore, most parents feared that their offspring would become ‘uncontrollably aggressive’ (84%) and ‘un- manageable’ (74%) should the risperidone therapy be stopped abruptly. It is concluded that risperidone augmentation appears to represent a well-tolerated and effective means of helping children and young adults with complex and severe forms of ADHD. However, its ‘off-label’ use in this context requires a high level of clinical caution at present.
Conduct Problems, Substance Use and Social Anxiety: A Developmental Study of Recovery and Adaptation
Authors: Wilson Jeffrey J. , Steiner Hans
Published: November 2003

To evaluate the individual developmental significance of disruptive behavior during adolescence, a 16-year-old boy in day treatment for substance abuse was examined. Over the course of 12 weeks, this youth was evaluated in group, individual and family therapy. Before developing conduct disorder symptoms and substance abuse, he was found to have a biological predisposition toward anxiety, and a premorbid history of anxiety and depression. The role of these conduct problems and substance use in alleviating this youth’s isolation and loneliness are considered, as are the maladaptive consequences of these behaviors. The importance of developmental factors in the determination of his behavior, and their significance in treatment planning, are discussed. Although the current definitions of conduct and substance use disorders are useful and valid, attention to individual contextual factors may enhance the clinical utility of these categories.
Acute Psychological Reactions of Children and Adolescents after the Marmara Earthquake: A Brief Preliminary Report
Authors: Abali Osman , Tüzün üMran , Göktürk üLkü , An gürkan Kag , Alyanak Behiye , Görker Işik
Published: November 2003

An earthquake took place in August 1999 in the Marmara region of Turkey. A psychiatry team from Istanbul arrived two weeks later. Children and adolescents under 19 years of age were evaluated by a child and adolescent psychiatrist. A semi-structured clinical interview was administered to every patient presented. In addition, a non-structured, clinical interview was administered. One hundred and two children and adolescents were interviewed. The most frequent complaint was a ‘fear of being alone’ (96%), and the most common diagnosis given to these patients was acute stress disorder (74.5%). A considerable number of children started experiencing severe psychological symptoms immediately after the earthquake. Psychological support and treatment should be started as soon as possible, in such circumstances.
‘The Ailment’– 45 Years Later
Authors: Gairdner Wendy
Published: November 2003

Teams involved in offering inpatients psychiatric treatment are often subject to internal misunderstandings and intense feelings of rivalry and powerlessness. This can damage their ability to offer effective treatment to patients. A classic article, The Ailment by Tom Main, gives an account of an investigation of the experience of nurses treating a group of patients who evoked such feelings and offers a psychoanalytic understanding of the dynamics that underlie such difficulties. It is suggested that teams treating children and adolescents are particularly prone to outbreaks of The Ailment. There is a continuing need to create an atmosphere of trust and respect in which team members are encouraged to be open with each other. Such openness is essential if we are to be able to offer an effective experience of containment in which our patients can be helped to move towards healthier psychological functioning.
Child Psychotherapy in the Baby Clinic of a General Practice
Authors: Daws Dilys
Published: November 2003

This article is based on 20 years’ experience of once-weekly work by a child psychotherapist in a general practice baby clinic. Mental illness makes up much of a general practitioner’s workload, with 23% of the population of the UK consulting each year for such problems. Early intervention prevents later problems and this article describes the part that can be played by a child psychotherapist. Where infants are concerned, serious disturbances of feeding, sleeping, crying and difficulty in bonding confront doctors and health visitors continuously. We have found during brief psychotherapeutic work with the families of sleepless infants that large numbers of parents have anxieties about separation; most have experienced traumatic bereavement or loss. A very few meetings from, say, two to five, can achieve useful results. Because the child psychotherapist is available at their family health (or ‘baby’) clinic, ordinary, and also deprived, families have access to him/her. Brief case examples are given. As well as working clinically, the child psychotherapist attempts to support a psychodynamic approach for the primary care professionals. Doctors and health visitors in the community struggle every day, perhaps more than anyone, with body–mind issues. Regular contact with a psychoanalytically trained worker assists them in understanding the emotional meanings of some patients’ symptoms, and the feelings aroused in themselves by patients. As primary care becomes more stressful, it is essential for this work on the practice’s own ground to develop.
On Being an Ill Parent
Authors: Altschuler Jenny , Dale Barbara
Published: November 2003

Limited research and clinical attention has been paid to the experience of being an ill parent, so that parents are given little support in preparing for the effect their illness might have on their children. In this article, we explore how parents manage being a patient and a parent at the same time, focusing on three themes which have emerged: parental fears that illness renders them less fit to meet the needs of their children; dilemmas about balancing self-care with the care of others; and how the illness can evoke feelings that relate to previous trauma, influencing their responses to their children in the present. We highlight how these issues do not happen in isolation, but in the context of ongoing intimate, family relationships. We suggest that if they are not addressed, parents and children are left unprepared to meet the demands which illness poses. Finally, we examine the implications for clinical work in this area.
Children of Divorcing Families: A Clinical Perspective
Authors: Dowling Emilia , Gorell-Barnes Gill
Published: November 2003

This article describes a project based on a service provided to families going through the divorce process and its aftermath. As divorce figures increase, a growing proportion of children will experience its effects and some will have that experience more than once. If present trends continue, one in four children will experience the divorce of their parents before they reach the age of 16. Research in this field is relatively recent and the evidence is controversial. Some studies conclude that children of divorce do worse than those in intact families in several aspects of their development. Other studies suggest that it is the combination of divorce with other factors that makes a difference in terms of children’s development. The model described includes interviewing children and parents separately as well as offering family interviews. Particular attention is paid to the children’s perspective as our clinical experience shows that in the acute aftermath of divorce, there is a conflict between the parents’ own needs and their ability to think about the children’s needs. Issues emerging from the interviews, such as the loyalty bind in which children often find themselves and the need for a coherent story of the parents’ separation, are discussed. Clinical examples illustrate a way of working towards a more cooperative method of parenting in order to meet the needs of the children.
Multiple Families in Mind
Authors: Rustin Margaret
Published: November 2003

This article addresses the particular nature of the internal worlds of adopted children and their families, and the ways in which ongoing relationships are affected by these internal factors. The complexity of family life lived in the shadow of often multiple painful prior experiences of families is described. Clinical examples are used to explore issues of ‘contact’, the placement of siblings, the impact of parental trauma on a child’s development as seen in psychotherapy, and the opportunities for ‘working through’ afforded by adoption. The article suggests the potential helpfulness of individual psychoanalytic psychotherapy for adopted children and their parents in coping with psychic pain.
Lessons from a Psychotherapy Outcome Study with Sexually Abused Girls
Authors: Trowell Judith , Kolvin Israel
Published: November 2003

In this article, we address diverse issues arising during the course of a psychotherapy outcome study for sexually abused girls. These issues relate to the organization and management of a comparison study, implications for professionals involved, the training needs and supervision requirements of staff, case management and implications for clinical services.
Doubly Disadvantaged: Providing a Psychotherapeutic and Educational Service to Children with Complex Disorders and their Families
Authors: Mc Fadyen Anne
Published: November 2003

In this article I describe a clinical approach to meeting the needs of a group of children with complex disorders and their families in a day unit setting. These children have both psychiatric disorders and learning disabilities. I propose a way of conceptualizing the complex aetiological factors involved, the diversity of need, and the fit with possible therapeutic provision, which has the potential to function as a model for services to this group of children and their families. This model represents a multifaceted approach which encompasses biological, behavioural, pharmacological, psychoanalytic and systemic principles of assessment and intervention.
Working with Bosnian Medical Evacuees and their Families: Therapeutic Dilemmas
Authors: Papadopoulos Renos
Published: November 2003

This article outlines some key elements of therapeutic work with a group of Bosnian medical evacuees and their families. The unusual feature of this work has been the fact that the clients had not requested any psychological assistance and the therapist had to adapt to this fact and develop ways of dealing with it. The approach followed emphasizes the importance of ‘therapeutic presence’ instead of imposing formal psychotherapy, and is characterized by an avoidance of psychologizing the evil nature of war atrocities and pathologizing political dimensions. Six central dilemmas which therapists and clients face in connection with this type of work are identified and discussed, and suggestions are offered for developing appropriate therapeutic strategies in these contexts.
Children in Lesbian-Led Families: A Review
Authors: Tasker Fiona
Published: November 2003

There are an increasing number of children who are being brought up in lesbian- led families. Research on non-clinical samples of children raised in lesbian-led families formed after parental divorce, together with studies of children raised in families planned by a single lesbian mother or lesbian couple, suggest that growing up in a lesbian-led family does not have negative effects on key developmental outcomes. In many ways family life for children growing up in lesbian-led families is similar to that experienced by children in heterosexual families. In other respects there are important distinctions, such as different types of family forms and the impact of social stigma on the family, that may influence how clinicians approach therapeutic work with children in lesbian mother families.
Brief Work with Under-Fives: A Psychoanalytic Approach
Authors: Barrows Paul
Published: November 2003

This article describes some of the principles informing a psychoanalytically orientated approach to brief therapy with parents and under-fives. A short account is given of the history of this approach, followed by an extended clinical illustration. The advantages and limitations of the approach are discussed and some of the features that are most typical of this kind of work are described.
What Changes are of Value in Severely Disturbed Children?
Authors: Wiener Andrew , Withers Keri , Patrick Matthew , Bradley Elizabeth
Published: November 2003

Useful outcome research must use measures that are relevant to the clinical group in question. A literature review identified that little effort has been made to identify which areas of outcome are important for severely disturbed children with complex disorders, who are in day treatment. For a group of such children attending a psychiatric–educational day unit, this study set out to identify, at a qualitative level, which areas of change were valued by carers, teachers and clinicians. The results suggest that for children with severe psychiatric and educational problems a useful intervention need not involve large changes in the child. It was more important that the child’s informal and formal care network: carers, teachers, clinical staff and the professionals in other agencies, were able to reach a common understanding of the child’s difficulties, develop similar expectations of the child’s needs, and be able to agree on appropriate future plans for the child.
Inadmissible Evidence: An Example of Projective Identification
Authors: Balbernie Robin
Published: November 2003

Sometimes our patients cause us to struggle with emotions and sensations that are invaders, they come from elsewhere and yet feel as if they are our sole possession. The same thing occurs in many different settings. This experience of projective identification can influence the recipient and he or she then becomes the changed person in the mind’s eye of the initiator. One of the reasons for psychotherapists to be in analysis during their training is that this gives them a better chance of being aware when such psychological parasites are present. And one of the reasons that theoretical models are important is that they can help us to decode what we feel at such times.

In this paper I describe an example of projective identification from work with a 6-year-old adopted boy, where I found myself almost completely unable to function for several sessions.

A traumatic past experience belonging to my patient, which he could have had no conscious knowledge of, had been pushed out of his unconscious to lodge in mine; and then, in turn, I acted out a version of that experience.
Speaking Ill of the Dead: Parental Suicide as Child Abuse
Authors: Wright Barry , Partridge Ian
Published: November 2003

Many authors have written about the psychological consequences for the survivors when a family member commits suicide. Most clinicians use bereavement as a paradigm for planning therapeutic interventions. We have not been able to find any articles which recognize that the experience may be a form of child abuse. We believe that using the model of child abuse as well as traditionally used models of bereavement and trauma may be helpful when understanding the child’s predicament and planning therapeutic interventions. Two cases, involving four children, illustrate this perspective.
The Variation and Variability of Tourette Syndrome: A Single Case Study Approach
Authors: Vogt Ann , Carroll Annemaree
Published: November 2003

The case is presented of a 12-year-old boy who was diagnosed with Tourette syndrome (TS) when he was 8 years of age. The variability of symptoms manifested with the syndrome and the comorbidity of other related disorders were explored by developmental history, parent interviews, survey results, functional analysis and direct observations. The article considers the individual variability of symptoms and the ramifications of this variability in caring for a child with TS. It discusses the difficulties with intervention because of the inherent characteristics of the disorder. The case argues for more expansive attention to be given to a psycho- educational approach in meeting the needs of children with TS.
Turning Child and Adolescent Mental-Health Services into Learning Organizations
Authors: Birleson Peter
Published: November 2003

In the past few years, the business management literature has seen an exponential rise in articles on the concept of the Learning Organization. This organizational form is said to encourage innovation and creativity, improve adaptation and capacity for change, and enhance the commitment of staff. The model has been applied in a Child and Adolescent Mental-Health Service with some promising indications that it does indeed support experimentation, eclecticism and openness to change. This article provides an introduction to recent management literature on organizational design, and outlines some of the theory and practice of building structures and cultures which support ongoing evaluation and continuous quality improvement.
How Clinical Pathways Can Be Useful: An Example of a Clinical Pathway for the Treatment of Anorexia Nervosa in Adolescents
Authors: Lock James
Published: November 2003

This article reports on the development of a clinical pathway for the treatment of acutely ill adolescents with anorexia nervosa in a hospital setting. The role of clinical pathways in standardizing health care and in controlling costs is reviewed. The evolution of the clinical pathway for treating adolescents with anorexia nervosa is described. The pathway’s utility in describing changes in clinical practice is also reported.
Pediatric Psychiatric Pretransplant Evaluation
Authors: Shaw Richard J. , Taussig Heather N.
Published: November 2003

Review of the literature on the adult psychiatric pretransplant evaluation suggests that transplant programs routinely use psychosocial evaluations as a component of their assessment and to screen transplant recipients. Despite the increasing availability of organ transplantation in the pediatric population, there is a paucity of literature describing or empirically validating the pediatric psychiatric pretransplant evaluation. In this article, we describe the protocol for the assessment of pediatric organ transplant recipients used at Lucile Salter Packard Children’s Hospital at Stanford. We outline both the assessment protocol and relevant domains of inquiry. We conclude with recommendations for further research and the development of standardized assessment measures designed for the pediatric population.
Hospital Protocol for the Evaluation of Munchausen by Proxy
Authors: Sanders Mary J.
Published: November 2003

The objective of this article is to describe guidelines for creating a hospital protocol for the evaluation, reporting, and treatment of Munchausen by Proxy in the hospital setting, in order to maximize care and minimize legal risks. The creation of a multidisciplinary team is suggested to evaluate and treat the family. Specific aspects of evaluation are addressed. Discussion focuses on risk management and decreasing liability while providing appropriate care to patients, both in the hospital and in the courtroom.
Managing Very Poor Adherence to Medication in Children and Adolescents: An Inpatient Intervention
Authors: Anderson Carolyn A. , Collier Julie A.
Published: November 2003

Poor adherence with medical care is a relatively common problem in pediatric patients, with potentially serious side-effects. This article describes a four-phase inpatient intervention program for such cases. Patients are first identified and admitted to the unit: careful preparation is essential in this phase. In the assessment phase, factors related to the illness and treatment regimen, as well as characteristics of the individual child and family, are evaluated to determine their contributions to the adherence problem. In the third phase, an intervention program is implemented, consisting of: (i) education of the patient and family regarding the illness and medical regimen; (ii) improvement of self-management skills; (iii) behavioral intervention using contingent reinforcement; and (iv) treatment of additional barriers to adherence such as psychopathology and family dynamics. The fourth phase focuses on transfer of care to home through gradually increasing the patient’s and family’s responsibility for care.
Premenarcheal Versus Postmenarcheal Anorexia Nervosa: A Comparative Study
Authors: Arnow Bruce , Sanders Mary J. , Steiner Hans
Published: November 2003

Onset of anorexia nervosa prior to menarche is rarely encountered and little is known about clinical and psychological differences between this group and the more typical postmenarcheal patient. This cross-sectional investigation compared 26 premenarcheal patients with 69 with secondary amenorrhea. Menarcheal status was confirmed with Tanner scaling obtained via pediatric examination. Duration of illness was equal among the groups. Differences between the groups included higher internal locus of control and need for approval through socially desirable behavior among premenarcheal patients. In addition, premenarcheal patients scored significantly lower on several subscales of the Eating Disorders Inventory. These findings suggest that some of the features associated with anorexia nervosa, including reward dependence, pseudomaturity, and ego-syntonicity (i.e. apparent absence of distress despite the seriousness of the symptoms) are amplified in premenarcheal patients. Methodological problems and clinical implications are discussed.
Somatization as an Indicator of Trauma Adaptation in Long-Term Pediatric Cancer Survivors
Authors: Erickson Sarah , Steiner Hans
Published: November 2003

The objective of this study was to assess the level of somatization symptoms in long-term pediatric cancer survivors and to measure associated functional correlates, trauma symptoms, and personality characteristics. Forty cancer survivors completed self-report questionnaires measuring somatization, trauma symptoms, personality traits and defenses, a general clinical interview, and a structured interview for PTSD. Half (51%) the eligible participants participated in the study. Their mean somatization score fell between a nonclinic patient population and a psychiatric population. Somatization scores correlated with general adjustment in the negative direction and with PTSD scores in the positive direction. The majority of participants met at least partial current PTSD symptoms. These survivorsdemonstrate high levels of restraint, repressive defensiveness, denial and impulse control, and a low level of reported distress. Somatization appears to serve as an indicator for other trauma-related disturbances. Years after treatment, the relatively high levels of current PTSD and trauma-associated symptoms reflect the long-term deleterious impact of having cancer as a child. Because these survivors demonstrate avoidance and a repressive adaptive style but admit somatoform symptoms, the latter may be an essential way to detect and treat trauma-related distress in this population.
Community Child Mental-Health Services: A Framework for the Development of Parenting Initiatives
Authors: Day Crispin , Davis Hilton
Published: November 2003

There is considerable variation in the structure, style and content of parenting initiatives in the UK. While there has been a rapid expansion of such programmes, there is no clear framework for systematic provision and no strong evidence base for their effectiveness. This discussion article briefly reviews the position of parenting initiatives in the UK. It then goes on to describe the development of a tiered child mental-health service and some of the recent initiatives undertaken by the North Southwark Community Child and Family Service. This primary child mental-health care service aims to increase the effectiveness and availability of child mental-health promotion, prevention, early and continuing intervention. It is proposed that this type of service framework can be used to ensure the development of coherent, targeted and collaborative parenting initiatives.
Resistant Depression in Childhood and Adolescence
Authors: James A.
Published: November 2003

A proportion of children and adolescents with major depressive disorder (MDD; DSM-IV) fail to respond to first-line psychological therapies. This article outlines the available biological therapies and their usage.
Contact between Children Placed Away from Home and their Birth Parents: A Reanalysis of the Evidence in Relation to Permanent Placements
Authors: Ryburn Murray
Published: November 2003

This article offers a critique of the work of Quinton, Rushton, Dance and Mayes (1997) concerning the merits, for the various parties, of the maintenance of contact between children living temporarily or permanently apart from their parents. It contests their view that there is no research based evidence to support the practice of maintaining contact in these placements, and suggests that for a number of reasons their analysis of available evidence is fundamentally flawed. In particular this article questions their view of what the foundations for evidence-based practice should be, highlights central omissions in their review of the research and challenges the accuracy of some of their reporting. It also suggests that a grounded historical perspective on post placement practice would regard the severance of birth relative links, rather than their preservation, as representing what Quinton and his colleagues describe in their article as a ‘social experiment’.
Contact between Children Placed Away from Home and their Birth Parents: Ryburn’s ‘Reanalysis’ Analysed
Authors: Quinton David , Selwyn Julie , Rushton Alan , Dance Cherilyn
Published: November 2003

Ryburn has critically reviewed our article on the research issues in the study of contact between children placed away from home and their birth parents (Quinton, Rushton, Dance, & Mayes, 1997). We argue that Ryburn seriously misrepresented our position. He also presented a ‘reanalysis’ of the studies we discussed, supplemented with references to other studies that we did not quote, which aimed to show that our conclusions were wrong. In this article we respond to Ryburn’s critique and raise questions concerning his interpretation of data and methods of reviewing that suggest that his conclusions from the research are unreliable.
Containing Failure: Consultancy to a Residential Centre for Adolescents
Authors: Huffington Clare
Published: November 2003

This article presents a case study from the author’s experience as consultant to a short-stay residential centre for adolescents. The different phases of the work, with the staff group, management team and manager alone, are described. The themes and issues the work raises for consultancy to agencies working with adolescents are explored against the background of unprecedented change in provision of child-care services. The most appropriate target group for consultancy, adolescence, and failure and working with experience in the here-and-now are themes which are discussed.
Surgery Experienced as Sexual Abuse: A Case of Pre-Pubescent Sexual Offending and Hypospadias
Authors: Morgan John F. , Mezey Gillian C.
Published: November 2003

A substantial minority of sexual offences against children are carried out by children. This article examines a case of pre-pubescent sexual offending associated with repeated reconstructive surgery to the penis, in the treatment of the congenital deformity hypospadias. Although the surgery involved was appropriate, the patient appeared to experience it as a form of recurrent sexual abuse. Subsequently the patient escalated from exhibitionism to contact sexual offences which cognitive-behavioural treatment failed to modify. We discuss the case with reference to concepts of trauma-organized systems, with a particular focus on the timing and context of surgery. We suggest that this case demonstrates that repeated genital surgery in a child may be experienced as childhood sexual abuse even with sensitive management. It emphasizes the roles of aggression and social validation in sexual offending, and it supports the proposed inclusion of ‘Sexual Arousal Disorder of Childhood’ in DSM-IV and ICD-10.
A Support Group for Parents of Children with Hyperkinetic Disorder: An Empowerment Model
Authors: Adesida Oyebode , Foreman David
Published: November 2003

Parents face significant stresses and problems when their child suffers with a disabling condition, such as the hyperkinetic disorder. Empowering parents, by providing a facilitative social system, can help enhance their competence in coping with their child’s disability. The use of a support group setting format for this purpose is described. Perceived benefits included: (i) emotional support in sharing experiences with a peer group,(ii) reduction of the sense of isolation,(iii) provision of information on the management and services regarding the hyperkinetic disorders and (iv) better relations with their children because of increased knowledge.
Treatment of Obese Children: A New Rationale
Authors: Braet Caroline
Published: November 2003

The treatment of moderately overweight children should focus on changes in eating styles rather than on dietary restraint. An educational programme has been designed with the aim of normalizing eating behaviours in a child-friendly way and without the prescription of a strict diet, and is illustrated with a case-report of a 12-year-old boy. The programme is based on the principles of cognitive-behavioural therapy. Strong emphasis is put on the therapeutic goal: self-regulation of a healthy life style.
Characterization of Erucamide Profiles in LLDPE Films: Depth-Profiling Attempts Using FTIR Photoacoustic Spectroscopy and Raman Microspectroscopy
Authors: Sankhe Shilpa Y. , Janorkar Amol V. , Hirt Douglas E.
Published: November 2003

This research focuses on mapping the concentration profile of erucamide in LLDPE film. Attenuated Total Reflectance (ATR) FTIR and FTIR microspectroscopy (FTIR-mS) have both been used previously to map concentration profiles in polymer films. However, ATR-FTIR spectroscopy is restricted to the near-surface region of a film while FTIR-mS works well in the film bulk but has deficiencies near film surfaces. Two other techniques, Raman microspectroscopy (R-mS) and FTIR photoacoustic spectroscopy (FTIR-PAS), reportedly work well for depth-profiling in polymers with micron or submicron resolution. Experiments were conducted with R-mS and FTIR-PAS to attempt to quantify the spatial distribution of erucamide in LLDPE film. The amide I carbonyl peak was identified from neat erucamide powder for both R-mS and FTIR-PAS. That peak was not observed with R-mS for film containing erucamide, even for films with a relatively high erucamide loading (1 wt.%). However, FTIR-PAS could detect statistically significant differences in erucamide concentration as a function of penetration depth, indicating that FTIR-PAS may be used as an effective depth-profiling tool for the erucamide-LLDPE system.
Effect of Test Conditions and Pet Surface Treatment on Moisture Barrier of Multilayer Metallized Film Structures
Authors: Murray Lee , McCarry Pat
Published: November 2003

Water vapor transmission rate (WVTR) testing on multilayer packaging films containing aluminum metallized polyester showed that barriers can be adversely affected by exposures to high levels of humidity. While it is a common industry practice to test and report results at 90% RH and 38 C, more realistic test conditions provide a more accurate prediction of barrier performance. WVTR results varied with the substrate surfaces beneath the aluminum metal coatings and were also dependent on which sample surface was exposed to the moist test gas. Modern test equipment and standard test methods permit testing conditions that more closely resemble the end-use conditions.