Clinical Child Psychology and Psychiatry最新文献

Functional non-epileptic attacks (FNEA) are seizure like activities that occur without any organic cause. Although a debilitating and costly disorder, there is much debate within the clinical literature on the causes and prognosis of FNEA, as well as possible effective psychological interventions. This is especially true for FNEA occurring in paediatric populations. Limited evidence to date suggests that acceptance and commitment therapy (ACT) shows promise and has pragmatic benefits in the context of functional disorders for adults. This case study provides information of a brief (8-session) ACT protocol targeting FNEA and associated emotional difficulties in a 12-year child. Treatment aimed to promote psychological flexibility and reduce functional interference of FNEA symptoms using ACT consistent techniques. Post-treatment, the child demonstrated reliable/clinical recovery in psychological flexibility, symptom interference and anxiety, as well as a marked reduction in the frequency of FNEA episodes. The majority of these gains were evidenced at 5-month follow-up. Such promising findings need to be tempered by methodological considerations.

Exposure to adverse childhood experiences is a risk factor for the development of serious psychiatric and somatic illness. Although trauma-focused therapy is effective in reducing symptoms, not all children benefit from it. To improve treatment efficacy, the children's perspective on what they perceive as helpful versus hindering is necessary. This study aimed, retrospectively, to explore how children exposed to family violence experienced treatment at the Child and Adolescent Mental Health Service. Seventeen children and youths were interviewed 4-5 years after treatment. The thematic analysis resulted in five themes: confusion, the need to feel heard, fear of consequences, feelings of pain, and identifying oneself as an agent. The results emphasize the importance of the therapeutic relationship, and that trust, genuine interest, and reciprocity are necessary for the child to engage in treatment. However, neither the child's own agency nor external obstacles such as continuous exposure to abuse should be underestimated in terms of the child's engagement.

This study explored the feasibility and initial efficacy of a sensorimotor intervention to improve symptoms of attention-deficit/hyperactivity disorder (ADHD). Twenty-seven children (ages 8-12 years) with ADHD and their parents participated in an 8-week group intervention based on The Alert Program® for Self-Regulation (AP). Families were taught to recognize child arousal states and to use sensorimotor strategies to manage levels of alertness. Parent and teacher reports of child attention symptoms were collected at baseline, before and after intervention. Objective ratings of child problem behaviours and use of sensorimotor strategies during computerized tasks of visual and auditory attention were also coded before and after intervention. Parents and children endorsed high acceptability and satisfaction for the AP treatment. Parental ratings indicated increased knowledge and use of sensorimotor strategies, and decreased child ADHD symptoms at home from pre-AP to post-AP. However, no significant changes in child outcomes were reported by teachers. Unexpectedly, observed child problem behaviours during the visual attention task increased from pre-AP to post-AP. The AP was received positively by parents and children with improvements in regulation strategies and child attention at home, but more work needs to be done to generalize the effects to school and other peer settings.

A Book Review of 'Basics of Child Neuropsychology: A Primer for Educators and Clinicians' by Stephen R. Hooper.

Background: Traumatic experiences can lead to posttraumatic stress disorder (PTSD). For young children, even minor, inconspicuous looking events can lead to posttraumatic stress symptoms. Trauma-focused treatment with Eye Movement Desensitization and Reprocessing (EMDR) offers children an age-adapted intervention to help them successfully process traumatic experiences. So far, there has been a lack of well evaluated trauma-focused treatments for young children.

Methods: These case series examine the effectiveness of a short-term treatment with EMDR therapy for children showing PTSD symptoms after experiencing a single incident induced trauma. Five children between 5 and 10 years of age who developed PTSD after a single incident trauma received a manualized EMDR treatment for 6 weeks (mean number of sessions: seven including a mean number of EMDR sessions: 3.4). Posttraumatic stress symptoms were assessed prior to treatment, following treatment and at a 3-month follow-up with standardized instruments for caregivers and children.

Results: PTSD symptoms decreased for all children after completing the treatment from clinical to non-clinical level. Reductions in vegetative hyperarousal, fears and clinging behaviour were achieved. Furthermore, reductions in the parental stress levels, as well as a recovery of everyday routine and everyday stability were observed.

Conclusion: Short-term EMDR treatment appears to be a promising treatment for single incident trauma in young children providing a potentially successful quick and safe psychological treatment for children. Results contribute to the knowledge of feasibility and acceptability of short-term, trauma-focused treatments of children with EMDR. Replication of the results of these case series in larger samples using a randomized controlled design is warranted.

Research on the relationship between sluggish cognitive tempo (SCT) and scores on neuropsychological tests (such as those measuring processing speed and reaction time) is inconclusive, and the association between SCT and motor incoordination and dysgraphia has not been objectively investigated. Mothers of 413 elementary school children (6-12 years of age) rated their children on the Pediatric Behavior Scale (PBS), which yields psychological problem scores, including SCT. Children were administered an extensive battery of neuropsychological tests assessing processing and performance speed, working memory, immediate and delayed recall, sustained attention, response inhibition, cognitive flexibility, fine motor manipulative skill, verbal fluency and retrieval, set shifting, and interference control, as well as intelligence and reading and math achievement. Only three of the 19 correlations between SCT and neuropsychological scores were significant, and all involved graphomotor tests (two timed and one untimed). In regression analysis, the strongest independent predictor of SCT was the maternal PBS incoordination factor score, followed by ratings of autism, inattention, and depression. Neuropsychological test scores did not contribute significantly more to predicting SCT. Among the incoordination PBS factor items, clumsy and draws or writes poorly were significant SCT predictors. Our novel and unexpected findings showed that motor incoordination was a stronger correlate of SCT than other variables assessed in our study, including those previously linked with SCT. Future SCT research needs to include measures of incoordination and dysgraphia in order to replicate and expand upon the current findings. Our results suggest that SCT traits are not reliably measured by currently available neuropsychological tests.

Objectives: This study aimed to understand the experiences of youth who had been prescribed antipsychotics but did not have psychosis, mania, autism spectrum disorder, or developmental disability.

Methods: Twenty-three qualitative telephone interviews were conducted with youth aged 11-18 who had been prescribed an antipsychotic medication but did not have a diagnosis of psychotic disorder, bipolar disorder, autism spectrum disorder, or developmental disability. Participants were recruited from four U.S. healthcare systems participating in the pragmatic trial Safer Use of Antipsychotics in Youth (SUAY). Interviews were recorded, transcribed and analyzed using template analysis techniques.

Results: Prior to initiating an antipsychotic medication, most participants experienced behavioral health crises; many felt that they had no options other than to start the medication. Other core themes included: (1) antipsychotics had both positive psychosocial outcomes, such as improvement of family life, and adverse effects, such as drowsiness or weight gain, (2) antipsychotics were only one part of a broader treatment plan, (3) efforts were made to maximize benefits and minimize side effects through careful titration, (4) feedback from friends and family was important in the decision to continue.

Conclusions: The findings provide valuable insights into how to engage youth in conversations around the use of antipsychotics.

Background: Challenges to implementating interventions for adolescent depression exist. Exploring the perceptions of key stakeholders in the treatment of adolescent depression is essential for improving implementation . This study aimed to explore psychological therapists' perceptions of, and experiences treating, adolescent depression to identify future avenues for exploration.

Method: Data were collected opportunistically via a survey integrated within an e-learning package about adolescent depression.

Results: Participants believed that adolescent depression was characterised by adolescents' lack of understanding, isolation, and a lack of hope and knowledge. Participants overcame engagement barriers by building trust. Following the e-learning, participants expressed increased understanding of the risk factors associated with adolescent depression and of assessment using different measures. Several key areas for future research to explore were identified and discussed, including (1) whether clinicians of different modalities or at different career stages have difference perceptions, (2) how to meaningfully engage adolescents in treatment and (3) how to train clinicians on different modalities so patients have a choice over their treatment.

Conclusion: This study demonstrates the value of knowledge gained from understanding psychological therapists' perceptions and illustrates how this can contribute to the improved treatment of adolescent depression.

Background: Anxiety disorders are among the most common psychiatric disorders in childhood and can develop as early as the preschool years. Therefore, providing young children who display early signs of anxiety with skills to prevent the development of later psychopathology is invaluable. The current study evaluates the effectiveness of Fun FRIENDS, an anxiety prevention and resilience program for young children.

Method: Fifty-seven kindergartners across three classrooms participated in a 15-week anxiety prevention program and teachers completed a behavioral screening measure and anxiety questionnaire at pre, post, 3 month, and 10-month follow-up assessment points.

Results: Anxiety positively correlated with emotional symptoms, peer difficulties, and total difficulties at pre-intervention. Anxiety symptoms decreased from pre-intervention to follow-up. Additionally, prosocial behaviors improved and moderated the relationship between pre-and post-intervention anxiety symptoms.

Conclusions: These findings yield promising implications regarding the effectiveness of prevention and intervention programs on increasing social emotional skills and reducing anxiety symptoms in young children.

This naturalistic study investigated treatment outcomes of Dutch dialectical behaviour therapy for adolescents (DDBT-A) in a sample of 93 adolescents (95.4% female, mean age = 16.20 years) presenting with borderline characteristics, treated at Levvel (a Dutch mental health institution). From baseline to posttreatment significant decreases were found on severity of the borderline symptoms, passive coping style, internalizing and externalizing behavioural problems, and a significant increase on self-worth. Overall, three different therapy formats (outpatient, part-time therapy, and day therapy) showed similar improvements at posttreatment. Concluding, DDBT-A seems promising in reducing borderline related symptoms for adolescents.