bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Blanching and Vacuum Pulse Application on Osmotic Dehydration of Pear
Authors: Chafer M. , Gonzalez-Martinez C. , Fernandez B. , Perez L. , Chiralt A.
Published: November 2003

Osmotic dehydration of pear cylinders (var. blanquilla) was studied by analysing the effect of blanching pre-treatment and the application of a vacuum pulse on the kinetics and yield of the process and on product quality (colour and mechanical behaviour). Fresh and stem-blanched samples were treated with 65 Brix sucrose at atmospheric pressure and by applying a vacuum pulse (50 mbar for 5 min). The influence of the sugar gain and water loss fluxes, and the tissue structural response to the vacuum pulse, on the total mass and volume losses of the samples has been discussed. Blanching implied an increase in the mass transfer rate in pear tissue. Vacuum pulse in blanched samples resulted in more volume compression than sample impregnation with the external solution due to the sample softening by thermal effect and to the partial gas release during its thermal expansion. This provoked the greatest volume losses and a reductionof the ratio of sugar gain to water loss, where the highest values reached were for non-blanched samples submitted to vacuum pulse. Mechanical changes induced by treatments were similar inall cases, but colour hue and chrome were better preserved in samples treated by PVOD. Nevertheless, this treatment implied a transparency gain due to the sample gas release and so, samples become darker.
The Limits of the Medical Model in Child Psychiatry
Authors: Child Nick
Published: November 2003

Good science and clinical practice are based on sound logical thinking. The bioscientific ‘medical model’ is learned by doctors in their original training, then brought and adapted to the field of mental health by psychiatrists. This article uses ‘conduct disorder’ as a test and clarification of the rationale of the otherwise valuable medical model and the limits of its applicability in child psychiatry.
Chronic Fatigue Syndrome in Children and Adolescents: A Review Article
Authors: Richards Josephine
Published: November 2003

Clinicians have been describing individuals with chronic fatigue states for over 100 years, although chronic fatigue syndrome is often regarded as a modern disease. The aetiology of chronic fatigue syndrome is uncertain. For young individuals with chronic fatigue syndrome there are neither reliable prevalence figures nor scientific evidence concerning the effectiveness of treatments. Information obtained from research into adult individuals with chronic fatigue syndrome may be helpful but is not necessarily directly applicable to children and adolescents. Developmental factors and the influence of other family members on the course of the disorder in young sufferers should be considered. The uncertainties surrounding chronic fatigue syndrome should not deter child and adolescent mental health workers from becoming involved in the assessment and management of individual patients. The mainstay of treatment is rehabilitation with an emphasis on gradually increasing activities. Considerable attention will need to be given to engaging the young people and their families and working effectively with a multidisciplinary team. If mental health workers do not become involved in treating young people with chronic fatigue syndrome there is a risk that psychological factors will not be addressed and that chronic functional impairment will ensue.
‘Emplotment’: Letter Writing with Troubled Adolescents and their Families
Authors: Goldberg David
Published: November 2003

Writing letters is part and parcel of therapeutic work with troubled adolescents. This article proposes a strategy, ‘emplotment’, for use as a practical tool when constructing such letters. The concept of emplotment is developed from studies of how people develop stories about themselves. The aim of emplotment is to write, with the people involved, letters in a style which may allow the young person to evolve his or her own story at a later date, and hence improve outcomes. Finally emplotment is compared with ‘ Literary means to therapeutic ends’, the method developed by White and Epston.
Can Post-Traumatic Stress Disorder be Diagnosed in Adolescence without a Catastrophic Stressor? A Case Report
Authors: Weaver Andrew
Published: November 2003

This article describes an adolescent girl who, having experienced repeated emotional bullying at school, developed a psychological disorder. The case is discussed in relation to current views on traumatic events and subsequent disorders. It is suggested that the diagnostic criteria for post-traumatic stress disorder may need to be modified to include cases where the precipitating event is less than catastrophic.
Intensive Community Management of an Adolescent with Psychosis
Authors: Goldberg David , Floyd Alison , Lee-Jones Rachel , Lewis Sheila
Published: November 2003

The psychotic illness of a 16-year-old girl is described from both the professionals’ viewpoint and that of the adolescent. The article discusses issues raised during a community-based intervention which prioritized the prevention of hospitalization. Atypical features of the psychosis are used to highlight issues arising from such an intensive community approach.
Pediatric Team Meetings: The Mental Health Consultant’s Role
Authors: Williams Jane , de Maso David Ray
Published: November 2003

Pediatric team meetings for children with complex chronic or life-threatening illness have the potential to increase collaboration and communication among professionals and families, thereby improving the quality of care. This article defines four prevalent types of team meetings, describes the role of the mental health consultant and addresses issues, such as family inclusion and resistance to meetings, that may affect the occurrence and outcome of team meetings. Guidelines are offered to increase the effectiveness of the mental health professional working in pediatric healthcare facilities.
Is Anyone to Blame? Whom Families and their Therapists Blame for the Presenting Problem
Authors: Wolpert Miranda
Published: November 2003

Whom family members blame for their difficulties, and to what extent they blame them, is widely thought to affect their response to those difficulties. In addition, the extent to which parents experience themselves as being blamed by therapists is thought to influence their ability to make use of therapeutic intervention. Yet, despite frequent references in the clinical literature to the need to be sensitive to issues of blame, little attempt has been made to systematically investigate how blame arises naturally in therapeutic encounters. This article develops operational definitions of blame and of exoneration and uses them to undertake an exploratory study into how a sample of 10 families and their systemic therapists attribute blame and exoneration in relation to the presenting problem. Multidimensional scalogram analysis is used to explore how patterns of blame might possibly relate to service uptake. It is argued that as clinicians we may want to hone our sensitivity to the different ways that blame may be invoked in conversation in order to increase our therapeutic efficacy.
Why Do Children Drop-Out from Play Therapy?
Authors: Campbell Valerie A. , Baker David B. , Bratton Sue
Published: November 2003

Play therapy is a popular form of child psychotherapy that is used to treat a variety of childhood problems. Like other forms of child psychotherapy, treatment dropout is a problem that needs to be addressed. Drop-out from play therapy is more likely to occur among families headed by a single parent who is young and economically disadvantaged. Improving retention in play therapy requires that efforts be made to make services more accessible to families by considering the proximity of services, access to transportation and scheduling flexibility.
A School-Based Mental Health Service for Refugee Children
Authors: O’shea Bridget , Hodes Matthew , Down Gwynneth , Bramley John
Published: November 2003

This article describes a school-based mental health service established to help psychologically distressed refugee pupils. The primary school involved was situated in an inner London borough and had a high proportion of refugee and immigrant children. Teachers identified refugee pupils with psychological difficulties and referred them to an outreach mental health worker who provided treatment on the school site. In addition to clinical interview the strengths and difficulties questionnaire was used as an assessment and outcome measure. In total 14 children (12 boys) were referred to the project. The children had been exposed to high levels of past violence and losses, and experienced ongoing socio-economic adversity. The children mostly had disorders related to these adversities, but a small number also appeared to have specific learning or scholastic difficulties. The difficulties mostly presented in the class as inattention and over-activity. A range of psychological and family interventions were offered, which included seeing the teachers initially, the children alone and relatives. Overall children were helped by the intervention with a reduction in SDQ scores (21.3 to 15.7) and some children showed dramatic benefit. This model seemed acceptable to the children, families and school. The implications of the project are discussed.
Out-Patient Clinic Attendance Consent from Children and Young People: Ethical Aspects and Practical Considerations
Authors: Paul Moli , Foreman David M. , Kent Lindsey
Published: November 2003

There is a growing awareness of the importance of children’s participation in making decisions about their own health care. Although there have been calls for a change in the law regarding children’s consent to treatment, there is a limited amount of empirical research on this subject from clinical practice in the UK. We review some of the legal and ethical discussion on this subject, as well as related research. In our naturalistic survey at a Child and Adolescent Mental Health (CAMH) out-patient clinic, 4/42 consecutive cases were unaware of their appointment and 14/42 came unwillingly. The findings show that some children and young people do attend CAMH out-patient services unknowingly and unwillingly. This indicates that we should be ethically concerned about the involvement of children and young people in the consent process surrounding attendance and that the theoretical concerns about children’s consent need to be practically explored more fully in CAMH settings. Overriding young people’s objections to attendance can only be justified if the intervention offered has a sound empirical basis or if professionals can prove that parents overriding their child’s wishes have taken valid objections to the intervention into account.
Perceived Ideal Out-Patient Department and Hospital Ward for Children, Adolescents and their Families
Authors: Boswell Kathryn , Finlay Fiona , Jones Rosemary , Hill Patrick
Published: November 2003

For most professionals the opportunity to influence the design of a new hospital ward or out-patient unit comes once in a lifetime. The Royal United Hospital in Bath has recently commissioned a new children’s centre, which is scheduled to open in 2001. This article presents the results of a consultation exercise, undertaken by a team of health psychologists, which was designed to obtain the views of all members of the multi-professional team involved with children and families, as well as the service users themselves. The results of the consultation process have influenced the final design.
A Specialist Service for Children and Adolescents with Tourette’s Syndrome: Problems and Attempted Solutions
Authors: Wigley Kate , Mason Anne , Lambert Sarah , Collins Jane , Lask Bryan , Christie Deborah
Published: November 2003

We describe various components of a specialist service for children and adolescents with Tourette’s syndrome, and their parents. The clinical demand was such that the structure of the service has had to be changed several times. Support groups, one for the parents, one for the adolescents and one for the children have proved very helpful. A drop-in format, initially considered to be a useful way of coping with demand, has not worked well. These developments and changes are described and discussed, and future developments considered.
The Use of ‘As Required’ Medication on an Adolescent Psychiatric Unit
Authors: Bernard Paul , Littlejohn Ralph
Published: November 2003

This is a study of the use of ‘as required’ (prn) psychotropic medication in an in- patient unit for younger adolescents in the south of England. The case notes of 500 consecutive completed admissions over an approximately seven-year period were examined retrospectively. It was found that prn medication was administered during 60% of the 500 admissions. Regular medication was given infrequently. A limited range of types of medication was prescribed. A small number of admissions accounted for a large number of the administrations of prn medication. ‘Violence’, ‘running away’ and ‘stealing’ as reasons for admission were associated with an increased likelihood of receiving prn medication, as were longer duration of admission and non-Caucasian ethnic status. School non-attendance as a reason for admission was associated with a decreased likelihood of receiving prn medication. Medication was given more frequently in the evenings. Comparable amounts of medication were given at all stages of admission.
Conducting Child Assessments for Court Proceedings: The Use of Non-Directive Play Therapy
Authors: Ryan Virginia , Wilson Kate
Published: November 2003

This article considers the use of non-directive play therapy as an approach to assessing children and young people in the care system, focusing on expert assessments in court proceedings. It uses an account of sessions of non-directive play therapy undertaken with a nine-year-old boy to illustrate the way in which this method can provide clear indications of a child’s developmental status, wishes and feelings, as well as facilitating therapeutic change. The approach is compared with other approaches to clinical interviewing, particularly those involving a series of interviews, and to assessments using psychometric testing. Finally, while arguing for the advantages of the approach, the article considers some inherent dilemmas, which arise from the fact that the child’s communications are largely within the metaphor of play. Issues of clarifying and interpreting the play may be of greater importance than if the child has made direct verbal statements, although other approaches such as psychometric testing may carry similar dilemmas.
Assessment and Therapy with Children: Can Computers Help?
Authors: Calam Rachel , Cox Antony , Glasgow David , Jimmieson Phil , Larsen Sheila Groth
Published: November 2003

The use of computers in assessment and therapy with children is a relatively new field and one in which there is little research. This article reports on the development of a computer-assisted interview for children and the potential applications of this type of approach to helping children describe their experiences. The computer medium offers a number of important advantages in work with children: (i) its novelty and appeal for the child; (ii) the opportunity that it provides to take the focus of interaction off the one-to-one relationship of child and interviewer, introducing a shared external focus for attention and reducing stress on the child; and (iii) the controllability and structuring of the setting, both for the child and interviewer. The development of a computer-based interview format is described, as are pilot studies of the properties of the program. The use of the program in forensic, child care and therapeutic settings is discussed, together with its applicability to a range of forms of disability.
Parent Management Training as an Intervention to Promote Adequate Parenting
Authors: Golding Kim
Published: November 2003

The adequacy of parenting is of growing concern for clinicians, educators and politicians alike. This has been accompanied by a growth in parenting interventions. Parent management training is one of the most widely used interventions aimed at improving parenting skills. It has been evaluated extensively over a number of years. However, questions of optimal application within packages of intervention for behaviourally disturbed children remain. This article explores the theoretical basis, effectiveness and clinical implications of parent management training. It is concluded that parent management training needs to be provided based on an ecological model of family processes which addresses the extra-familial as well as the inter-familial variables affecting parenting.
Treatment of Post-Traumatic Stress Disorder in an Eleven-Year-Old Boy Using Imaginal and In Vivo Exposure
Authors: Abrahams Sharon , Udwin Orlee
Published: November 2003

This article evaluates the use of cognitive-behaviour therapy with an 11-year-old boy who developed post-traumatic stress disorder (PTSD) after witnessing a violent incident which culminated in the death of a relative. Treatment involved a combination of imaginal exposure to scenes from the traumatic incident and in vivo exposure to associated feared situations. The intervention resulted in considerable improvement in the three key features of PTSD: re-experiencing the event (intrusive thoughts, nightmares and flashbacks); avoidance of associated stimuli; and levels of arousal.
Clozapine in Childhood-Onset Schizophrenia: A Report of Five Cases
Authors: Malhotra Savita , Gupta Nitin , Singh Gagandeep
Published: November 2003

An open trial of clozapine was carried out in five patients with childhood-onset schizophrenia (COS). The standard protocol for administering and monitoring of clozapine was followed. Psychopathology was measured using the Brief Psychiatric Rating Scale and global clinical improvement was rated by a parent and two clinicians in each case. The level of improvement in positive symptoms was greater than that in negative symptoms with no effect on ritualistic behaviour. Global clinical improvement was substantial. No serious side-effects (seizures, agranulocytosis) were observed. The need to assess the differential clinical effects and establish the role of clozapine as a possible first choice antipsychotic in COS is highlighted.
A National Response to Paedophilia and Child Murder
Authors: Hayez Jean-Yves
Published: November 2003

In August 1996, Belgium was deeply shocked to learn of the rape and murder of several young girls by a group of paedophiles. In the wake of these events, the Belgian population displayed symptoms of collective emotional shock and bereavement. We endeavoured to come to terms with these feelings as a community. We immediately sent an open letter to all children, which was published in the country’s main newspapers. We then organized a group debriefing on national television on a very popular children’s programme. This article deals mainly with the processes involved in this debriefing session. Further complications later developed involving, among others, abused children and their families. In order to help them, in addition to individual interventions, we again used the press and radio and TV programmes. When the population eventually began to emerge from the shock and bereavement, we acted to prevent excesses by, among other things, writing an ‘open letter to child abusers’.
Joint Working between Child and Adolescent Mental Health Services and the Department of Social Services: The Leeds Model
Authors: Cottrell David , Lucey David , Porter Isobel , Walker Dawn
Published: November 2003

Government advice stresses the importance of inter-agency collaboration, particularly with regard to the protection of children. This article describes the development of productive and mutually supportive working relationships between health and social services in Leeds. A monthly, multidisciplinary prioritizing panel reviews all referrals from social services to therapeutic resources. In exchange for a reduction in referrals, through the process of prioritization, there is a much faster response to those referrals accepted. In addition, regular consultation and training is provided by senior health service staff to Social Services staff who are, of necessity, having to manage more cases without referral on. With time, the system has led to improved working relationships between the two organizations, an increase in therapeutic resources, and the development and sharing of good practice in child protection. In Leeds, working together has raised standards in child protection practice.
Getting it Right: A Dilemma of Multidisciplinary Working in a Paediatric Liaison Team
Authors: Procter Elizabeth , Loader Peter
Published: November 2003

Where diagnosis is uncertain much anxiety is generated, and in complex and confusing cases different members of a multidisciplinary team may elicit different information, pursue different lines of enquiry, and come to very different conclusions. The family will also have a set of beliefs and ideas about the illness, which may differ from the professionals’ view, and teams need to recognize that the child will be returned to that belief system on discharge. The following case study advocates including the family in some of the team meetings and listening to their viewpoint and belief system in order to obtain a more satisfactory outcome for the child.
Meeting the Psychosocial Impact of Facial Disfigurement: Developing a Clinical Service for Children and Families
Authors: Kish Veronica , Lansdown Richard
Published: November 2003

This article reviews a child and family service addressing the psychosocial impact of facial (and other visible) disfigurement. The stigma of disfigurement poses considerable challenges in maintaining self-esteem, building self-confidence and coping effectively with the intrusive (and often negative) reactions of others. The charity, Changing Faces, addresses the psychosocial impact of facial disfigurement, promotes better health care and seeks to raise public awareness about the impact of disfigurement. Its clinical service has evolved a model of care including a social skills training component and methods of social skills training, specifically for this client group. Evaluation suggests that this model is helpful and practical, enhancing coping skills and increasing confidence.
Psychosocial Study of a Surviving Conjoined Twin
Authors: Fitzpatrick Carol
Published: November 2003

Psychosocial functioning of an eight-year-old surviving conjoined twin is described. The twins were separated at three and a half years of age, one twin dying in the early post-operative period. Following an initial period of grief, the surviving twin has demonstrated remarkable resilience, coping with repeated hospitalizations, investigation and procedures without apparent psychological damage. She is currently attending mainstream school where, despite some physical disability, academically and socially she is on a par with other children in her class. It is likely that many factors have contributed to the normality of this twin’s psychosocial development to date, including family stability, committed effective parents who have a sustaining religious belief system, a supportive community and a personality style which is determined, positive and forward looking.
Bereavement: A Framework for those Working with Children
Authors: Melvin Diane , Lukeman Diane
Published: November 2003

This article aims to describe psychological factors which help or hinder coping with bereavement in childhood. Children can and do cope with the death of those close to them if they know what is happening and have the appropriate support to cope. However, children suffering from loss are likely to be in the care of adults who are also grieving and there is a need to support the adults and to mobilize other resources for the child. We discuss the timing and appropriateness of interventions from all those working with children and, in particular, for the child mental health and other specialist services in supporting children and families through the process of bereavement.
Promoting the Psychological Well-Being of Refugee Children
Authors: Davies Mike , Webb Elspeth
Published: November 2003

Meeting the mental health needs of Somali refugee children in Wales creates significant difficulties for service provision. Some case examples are provided. The children’s needs, the services received and the plight of refugee children are discussed in the context of the following key areas: (i) the child (aspects of development); (ii) the referred problem; (iii) the war/refugee context; (iv) Somali culture; and (v) the host culture. Developmental factors relating to the vulnerability of refugee boys in the host culture are identified. Based on their experiences and with the benefit of recent literature, the authors recommend a coordinated and culturally sensitive approach to the care of refugee children and their families.
Case Study: Selective Mutism in an Immigrant Child
Authors: Zelenko Marina , Shaw Richard
Published: November 2003

Selective mutism is a relatively rare psychiatric disorder that appears to be over-represented in immigrant children. In this article, we describe the treatment of a seven-year-old Mexican immigrant boy diagnosed with selective mutism. The case illustrates how individual and family dynamic hypotheses enhance our understanding of this condition and inform a model of treatment. Discussion focuses on the unique issues of the immigrant family and suggests strategies for intervention.
Bullying a Review: Presentations to an Adolescent Psychiatric Service and within a School for Emotionally and Behaviourally Disturbed Children
Authors: Salmon Gill , James Anthony , Cassidy Elizabeth Lisheen , Javaloyes M. Auxiliadora
Published: November 2003

This article reviews the literature on bullying with particular reference to associated psychiatric symptoms and presents data and case examples from an inpatient and outpatient adolescent service and a school for emotionally and behaviourally disturbed children (EBD school). Bullying or its effects do not seem to be a distinguishing factor among those admitted to an adolescent unit. In the outpatient group, however, being bullied is frequently a factor in the presentation of adolescents to psychiatric services, with depression being the diagnosis in over 70% of cases. In contrast, bullies and bully/victims were most likely to present with conduct disorders, which were frequently co-morbid with hyperkinetic disorder/attention deficit hyperactivity disorder (ADHD). Unsurprisingly, regardless of whether bully, victim, bully/victim or neither, the most common psychiatric diagnosis of the EBD school pupils who were interviewed was that of conduct disorder. This was sometimes co-morbid with AD(H)D but also seen alongside generalized anxiety disorder and major depressive disorder.

In an adolescent unit and in an EBD school, being bullied or a bully is an important factor associated with psychiatric symptomatology and should be regarded as a substantial mental and public health issue.
Reported Rates of Adherence to Medication Prescribed for Adolescents’ Symptoms of ADHD
Authors: Ohan Jeneva L. , Johnston Charlotte
Published: November 2003

Clinicians frequently describe incomplete adherence to stimulant medication as a limitation to the effectiveness of treating ADHD in adolescents. This study examined reported adherence among 44 adolescents prescribed medication for symptoms of attention deficit hyperactivity disorder (ADHD). Reports of medication adherence were obtained from adolescents and parents at two time points, approximately two months apart. Parent and adolescent reports indicated reasonable agreement, with parents and adolescents reporting high rates of adherence at both time points (medians ranged from 85 to 89% adherence). A small group of adolescents reported extremely low rates of adherence, but we were not able to distinguish this group from the remainder of the sample based on demographics. It is argued that the sample is generally representative of adolescents who are being prescribed medication for ADHD, and that the high adherence rates are valid. These findings imply that clinicians treating adolescents with ADHD should be cautious in assuming that medication adherence is an inevitable problem in this population.
Early-Onset Bipolar Disorder and ADHD: Diagnostic Confusion Due to Co-Morbidity?
Authors: Mc Nicholas Fiona , Baird Gillian
Published: November 2003

Bipolar disorder in children is more common than has been acknowledged previously. However, the clinical presentation, particularly when of early onset, is more often atypical, co-morbid with other conditions and lacking in discrete episodes compared with adult-onset illness. This article reviews the literature on pre-pubertal bipolar disorder, particularly when co-morbid with ADHD, using a Medline search and other sources. Four clinical cases are presented highlighting some of the diagnostic dilemmas associated with co-morbidity.
Pathological Play
Authors: Jureidini Jon
Published: November 2003

Play is critical to human physical and cognitive development, and disturbance in play can express itself as a distinct and specific form of psychopathology, pathological play. Play becomes pathological when it deviates from healthy play in one or more of three characteristic qualities: the relationship between playing and reality; the player’s experience of the play; and the relationship of the player to the objects of play (including self and other people, as well as inanimate objects). Healthy play accommodates to the real needs of self and others; pathological play avoids reality, through a narrow-minded preoccupation that allows individual needs to be subjugated to the creation of a pretence or narrative.
Outcome of Children Seen after One Parent Killed the Other
Authors: Kaplan Tony , Black Dora , Hyman Philippa , Knox Jill
Published: November 2003

A group of children ( N= 95) seen by our team at least one year previously for assessment after one parent had killed the other, was followed up by a postal questionnaire to the original referrer. Through this we examined a number of outcome variables including placement effects, the frequency of their contact with the surviving parent, the referrer’s view of the difference our intervention had made and their view on the child’s adjustment over time. We analysed the data to determine any associations between these factors to help us understand the difficulties these children face and to aid clinical decisions.
Timeholes: A Useful Metaphor when Explaining Unusual or Bizarre Behaviour in Children who Have Moved Families
Authors: Hobday Angela
Published: November 2003

Many psychological problems are present when children have moved families. The majority of such children have experienced trauma and loss. They can show sudden mood changes with extreme behavioural difficulties. The mood changes resemble affect flashbacks. Using metaphor to describe these episodes as ‘timeholes’, and giving guidance as to how to reduce them, has proved clinically useful. The description of a timehole and its link to other psychological reactions and appropriate interventions are discussed.
How Adolescents in Groups Transform Themselves by Embodying Institutional Metaphors
Authors: Goldberg David , Evans Peter , Hartman David
Published: November 2003

A range of therapeutic groups, held over a period of three years and facilitated by a community adolescent mental health service, is described. Factors in the success and failure of these groups are identified. Taking these factors into account, the following theory is constructed: adolescents in groups embody institutional metaphors by enacting metaphoric transformations. Implications for clinical practice are discussed.
Evaluation of Outcome in Child and Adolescent Mental Health Services: Children with Persistent Conduct Problems
Authors: Luk Ernest S.L. , Staiger Petra , Mathai John , Wong Lisa , Birleson Peter , Adler Robert
Published: November 2003

This article focuses on the evaluation of outcome in child and adolescent mental health services. We examined the outcomes of 46 children with persistent conduct problems by gathering at baseline and six months information from multiple informants on multiple domains including the functioning of the child, risk factors, and parents’ and children’s perceptions of the treatment process. A statistically significant reduction in oppositional/conduct symptoms was reported six months after the initial clinical contact. However, the majority of the group still scored within the clinical range. The various outcome measures are correlated to only a mild to moderate degree. Teachers did not notice the same degree of change at school, despite the changes noticed by parents. Symptom improvement and satisfaction with a service are two separate issues. Parents’ satisfaction was related to their perception of the therapist and the therapy offered. Their satisfaction was high if they perceived that the therapist was able to communicate well, show care and concern, and if the therapy was perceived as organized. Much can be learned from a comprehensive outcome measurement system within a mental health service.
Adolescents with Learning Disability and Psychiatric Illness: Two Case Reports
Authors: Barlow Fiona , Turk Jeremy
Published: November 2003

Adolescents with learning disability who have mental health problems often attract multiple diagnostic labels. The accretion of complexity in such instances increases with the number of diagnostic categories applied. We describe two case reports of adolescents with learning disability who developed acute psychiatric illnesses. We highlight the difficulties inherent in formulating such individuals’ problems. We also illustrate the difficulties in diagnosis in this population, the complexity of therapeutic interventions available and the particular need for consideration of the impact upon the young person and their family of diagnosing a psychiatric illness in addition to the learning disability. In our opinion, there may sometimes be a need for a highly specialized service for such individuals. However, much can be achieved by general child and adolescent mental health teams.
Child and Adolescent Mental Health Training for Primary Care Staff
Authors: Sebuliba Dorothy , Vostanis Panos
Published: November 2003

An inter-agency training programme in child and adolescent mental health for primary care staff has been developed in a UK area serving a general population of 900 000. This was initiated with a training needs and resources analysis across all the joint strategy partners (three local authorities, one health authority and the voluntary sector). Training is provided to inter-agency groups of professionals in 12 localities. To date, 150 staff have been through the two-day introductory/foundation course, which is complemented by three subsequent training days on the assessment and management of children and families. Staff evaluation ratings are presented. On the whole, primary healthcare staff rated their awareness of mental health issues and their knowledge of staff roles within child mental health services significantly higher, in contrast with education staff who rated these components lower. Inter-agency training has been achieved with some difficulties needing to be overcome, but the participants’ feedback indicates that the expected output is beginning to be realized. The implications of the project are discussed.
On Engaging with People in Early Childhood: The Case of Congenital Blindness
Authors: Sandler Anne-Marie , Hobson R. Peter
Published: November 2003

Congenitally blind children face profound difficulties in relating to people and things in the world around them. In this article we report observations of children in the Blind Nursery of the Anna Freud Centre (at that time named the Hampstead Child Therapy Centre) deemed to be congenitally blind, during the 1950s and 1960s. These observations highlight the far-reaching developmental implications of congenital blindness, and afford a fresh perspective on the nature and role of interpersonal engagement in the early development of sighted children.
Play between Aggressive Young Children and their Mothers
Authors: Landy Sarah , Menna Rosanne
Published: November 2003

There is a growing number of pre-schoolers presenting to clinics with high levels of aggression. These children are at risk of developing conduct disorder, especially when the symptoms are severe. Treatment for older children with aggressive symptoms has often relied on teaching their parents behavior management techniques and has ignored affective and relationship issues. After presenting observations of the play interactions of aggressive pre-schoolers with their mothers and other relevant research findings, this article explores important aspects of the parent-child interaction and affective relationship. These aspects include the mother's difficulty in tolerating and modulating the child's negative affect, reluctance to enter the play metaphor and failure to gradually move aggressive play to more pro-social themes. The importance of these interactions and affective relationship aspects and their contribution to the child's difficulty are discussed in light of their implications for treatment. Also, suggestions are made for caregivers working with these children to help them self-regulate and acquire appropriate cognitive strategies to contain the negative affects.
Selective Eating: Symptom, Disorder or Normal Variant
Authors: Nicholls Dasha , Christie Deborah , Randall Louise , Lask Bryan
Published: November 2003

Selective eating is the little studied phenomenon of eating a highly limited range of foods, associated with an unwillingness to try new foods. Common in toddlers, it can persist into middle childhood and adolescence in a small number of children, most commonly boys. When this happens social avoidance, anxiety and conflict can result. This article describes a sample of 20 children with selective eating who presented for help to a specialist eating clinic. We outline the presenting features and associated phenomena for the group, suggest an approach to treatment, and explore from a theoretical point of view where this symptom, disorder or normal variant fits into the spectrum of childhood eating difficulties.
Interviewing Abused and Traumatized Children
Authors: Mordock John B.
Published: November 2003

Interviewing young traumatized children, particularly those traumatized by physical and sexual abuse, is difficult, not only because of children's recall deficiencies, but more often because standard interviewing formats can be ineffective with economically disadvantaged and culturally different children. Economically disadvantaged children's exposure to different family interaction patterns and control-dominated childrearing styles can affect their ability to respond to both verbal and non-verbal interviewing techniques. In addition, normal children's familiarity with the material to be remembered, their motivation to remember, their cognitive style and their communication skill all influence interview outcomes. Suggestions are included for improving non-leading interview methods with young children using both verbal and non-verbal techniques.
A Helping Hand: Solution-Focused Brief Therapy and Child and Adolescent Mental Health
Authors: Wheeler John
Published: November 2003

Solution-focused brief therapy is a relatively new approach for Child and Adolescent Mental Health Services in the UK. While the approach lacks the support of outcome studies compared with more conventional approaches, it is argued that the model does offer some specific advantages, and relates well to the range of problems which present and the manner in which many clients use the service. An outline of the approach is provided, along with an overview of research and comments on contraindications. A variety of clinical examples is used to illustrate how the approach works in practice. Concluding comments question the manner in which new approaches gain acceptance.
Ill or Adolescent? Developing Group Work on an Adolescent Medicine Unit
Authors: Creswell Catharine , Christie Deborah , Boylan James
Published: November 2003

Children with chronic ill health have been reported to be at increased risk of difficulties with psychosocial adjustment, and it is likely that the risk may be exacerbated during adolescence, a turbulent time even without illness. Self-esteem, social communication and stress-management skills have been identified as protective factors. Two groups were designed to enhance these factors among inpatients on a specialist adolescent medicine ward. Outcomes of the groups in relation to meeting the learning aims and the young people’s opinions about the groups are discussed.
Surviving and Coping with Emotional Abuse in Childhood
Authors: Doyle Celia
Published: November 2003

Emotional abuse, even when it is the sole form of abuse, can be psychologically harmful, but there are a number of internal and environmental factors that may protect children from ultimate damage. External factors are of importance to practitioners because they are more amenable to positive change through intervention. The objective of the research was to explore what factors in emotionally abused children’s environments might be important in helping them cope with their abusive childhoods. The method of inquiry was through in-depth, unstructured interviews with 14 adults who had survived significant emotional abuse in childhood. Although a number of external factors was identified by the interviewees, the non-abusing parent did not feature as one of these factors. Other family members, including siblings, grandparents and, particularly aunts, provided support to the majority of interviewees. Friends, teachers and other professionals were all helpful, while religious groups had a positive role for some. Non-human lifelines such as pets, toys and books were important to several children. The implications of these findings for intervention are discussed.
Children’s Experiences of Traumatic Events: The Negotiation of Normalcy and Difference
Authors: Urman Michelle L. , Funk Jeanne B. , Elliott Robert
Published: November 2003

The purpose of this study was to examine the experience of childhood trauma. Aspects addressed were the children’s ‘trauma narratives’, how they told the story of what took place, and their current outlook after the trauma. Six participants, aged 9–13 years, who had experienced a traumatic event within the past two years, were administered a semi-structured interview. Participants’ traumatic events primarily consisted of traumatic loss. The data were then analyzed using grounded theory analysis. Results suggest that throughout the traumatic event, participants used a process of ‘negotiation’, in which they attended to both familiar or ‘normal’ aspects of everyday life, and the threatening or ‘different’ aspects of the trauma. This ‘negotiation’ process is a metaphor for participants’ ability to recognize both of these aspects of the traumatic event, and to maintain a balance between the two. This process continued to be used in children’s current post-trauma life experience. Participants described the post-trauma world as changed, and as not sharing aspects of normalcy from the pre-trauma world. This model of children’s experience of traumatic events suggests that in the treatment of traumatized children, it is necessary to broaden the definition of trauma to include sudden bereavement and the witnessing of violence.
A Psychosocial Support Programme for Children and Mothers in War
Authors: Dybdahl Ragnhild
Published: November 2003

This article describes the content and implementation of a psychosocial intervention programme that was found to have positive effects on mothers and children in Bosnia. The programme was designed to aid young children and their primary caregiver who were victims of war. The main aim was to promote the emotional, social and intellectual development and well-being of young children. The programme consisted of weekly group meetings for mothers over a five-month period and focused on coping with problems and promoting good mother–child interaction. The mothers were given information about child development, social interaction and trauma. Group leaders helped the mothers to conduct constructive discussions, share experiences and support each other. Lessons learnt from implementation of the programme are discussed.
Non-Directive Play Therapy with Children Experiencing Psychic Trauma
Authors: Ryan Virginia , Needham Christine
Published: November 2003

This article describes the process of a brief non-directive play therapy intervention by a trainee therapist with a nine-year-old child who had developed persistent stress reactions to a single traumatic event. An overview of the place of brief non- directive play therapy in the treatment of children and their families for post- traumatic stress disorder is given. Themes in the child’s therapy, and the therapist’s and the parents’ role are related to post-traumatic and attachment issues. Finally, implications for current therapeutic practise with traumatized children and their families are outlined.
Extreme Reactions to a Diagnostic Interview: Problems in Screening for Psychopathology in a Non-Referred Sample of School Children
Authors: Smith-Doyle Jacqueline , Bryant-Waugh Rachel
Published: November 2003

There are currently a number of diagnostic interviews designed to assess psycho- pathology in children according to the DSM and ICD diagnostic systems. There is very little research about the way in which children and adolescents experience these interviews or potential problems with diagnostic interviewing. The aims of this article are to describe some extreme reactions to a diagnostic interview conducted for research purposes, review the available literature on this subject, and discuss the implications of the current findings with regard to clinical research.
The Eating Disorder Belief Questionnaire: In-Patient Adolescent Scores
Authors: Bradford Roger , Rutherford Donna
Published: November 2003

This study sought to investigate the validity and use of the Eating Disorder Belief Questionnaire (EDBQ) with an in-patient sample of adolescents with anorexia nervosa ( n= 40). Results highlighted that participants were able to meaningfully complete the measure and that their scores were comparable with those reported for an adult out-patient eating disorder group. Participants EDBQ scores were significantly higher than those reported previously for ‘normal dieters’, patients with depression and ‘healthy’ controls, providing further evidence of the measure’s specificity in assessing anorexic cognitions. In light of the measure’s usefulness in assessing core beliefs and underlying assumptions in adolescents with anorexia nervosa, it is recommended that the EDBQ should be used as part of the clinical assessment of this client group.
Low-Dose Sertraline in Children with Obsessive-Compulsive Disorder
Authors: Procter Elizabeth , Mc Nicholas Fiona , Baird Gillian
Published: November 2003

Three case studies of children aged 11-12 years are reported in which very low doses (12.5 mg) of sertraline are compared with inactive placebo in a cross-over study, to see if low doses are effective in improving symptoms of obsessive-compulsive disorder (OCD). In these cases low doses of sertraline had a significant beneficial effect. To our knowledge, this is the first report of the use of very low doses in the treatment of children with OCD. Previous studies have used adult doses. These case reports should be viewed as offering initial encouragement to the use of low-dose sertraline in the treatment of children with pure OCD or co- morbid OCD, and encourage further studies with larger numbers of children. Although sertraline is not yet licensed for the treatment of OCD in this age group, it is a useful drug to consider. Given that adverse side-effects are dose related, and often result in premature discontinuation of medication, starting at a low dose, i.e. 12.5 mg may prove clinically effective in some children, avoid unnecessary side- effects and assist with treatment adherence and improved outcome.