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Child and Adolescent Mental Health

Impact factor: 0.635 Print ISSN: 1475-357X Online ISSN: 1475-3588 Publisher: Wiley Blackwell (Blackwell Publishing)

Subjects: Clinical Psychology, Psychiatry

Most recent papers:

  • Dimensions of difficulty in children reported to have an autism spectrum diagnosis and features of extreme/‘pathological’ demand avoidance.
    Elizabeth O'Nions, Essi Viding, Caroline Floyd, Emma Quinlan, Connie Pidgeon, Judith Gould, Francesca Happé.
    Child and Adolescent Mental Health. October 12, 2017
    Background A subset of individuals with autism spectrum disorder (ASD) resemble descriptions of extreme/‘pathological’ demand avoidance, displaying obsessive avoidance of everyday demands and requests, strategic or ‘socially manipulative’ behaviour and sudden changes in mood. Investigating challenging presentations using dimensional description may prove preferable to identifying subgroups. However, there remains an imperative to explore which behavioural traits appear most problematic to inform quantitative investigation. This study provides an in‐depth exploration of parent perspectives on maladaptive behaviour in children reported to have an autism spectrum diagnosis and features of extreme/‘pathological’ demand avoidance. Method Parents completed a tailored semistructured interview about their child's behaviour, focusing on difficulties relevant to descriptions of extreme/‘pathological’ demand avoidance. The 26 interviews rated as scoring above threshold for ‘substantial’ features of extreme/‘pathological’ demand avoidance on relevant indicators were analysed qualitatively using a general inductive approach. Results New themes that emerged from these data included attempts by the child to control situations and others’ activities. Avoidance behaviours in this sample could be described as ‘strategic’ rather than ‘manipulative’. A range of factors, including a negative emotional response to demands, but also phobias, novelty, and uncertainty, were perceived to play a role in triggering extreme behaviour. Conclusions These descriptions highlight the importance of systematically measuring noncompliance, attempts to control situations and others' activities, and extreme mood variability in individuals with ASD. These dimensions represent important targets for intervention, given their considerable impact on daily life.
    October 12, 2017   doi: 10.1111/camh.12242   open full text
  • ‘The challenges of sharing information when a young person is experiencing severe emotional difficulties’: implications for schools and CAMHS.
    Tania Hart, Michelle O'Reilly.
    Child and Adolescent Mental Health. October 06, 2017
    Background Supporting the education of children and young people with complex emotional mental health difficulties requires schools to have knowledge of their needs. Exchanging information about less visible mental health difficulties is, however, known to be complex. Exploring the perceptions of young people experiencing problems can explicate some of this complexity and identify solutions. Yet their views are rarely given credence in this context. Methods The findings were derived from a broader qualitative study exploring the school experiences of young people, aged 14–16 years, identified by CAMHS as having severe emotional difficulties. Their parents’ and teachers’ perceptions were also explored. Data were collected via semistructured interviews and analysed using thematic analysis. Results Findings demonstrated that young people experiencing emotional difficulties need to feel safe about exchanging private information pertaining to their mental health. Teachers having a basic knowledge of mental health promoted their safety as this ensured confidentiality. Participants reported that CAMHS practitioners needed to be more proactive regarding the practicalities of exchanging information. Conclusions Arguably, teachers need to have basic knowledge of mental health and schools need clearer mental health confidentiality guidance. CAMHS also have responsibility in identifying more information exchange mechanisms and young service users and parents can play a part in this.
    October 06, 2017   doi: 10.1111/camh.12245   open full text
  • Socioemotional developmental surveillance in young children: monitoring and screening best identify young children that require mental health treatment.
    Brian Barger, Catherine Rice, Andrew Roach.
    Child and Adolescent Mental Health. October 05, 2017
    Background Widely recommended socioemotional developmental surveillance methods include monitoring and development screening techniques. Currently, very little research has compared the effectiveness of monitoring and screening together, and existing research primarily focuses on the relationship between surveillance techniques and referrals or receipt of early intervention (EI). This study investigates the relationship between monitoring and screening and mental health treatment receipt in 3–5 year olds. Methods The authors conducted logistic regression analyses on data from the National Surveys of Children's Health (NSCH; 2007) and NSCH (2011/2012) on the odds of mental health treatment receipt in children aged 3–5 years of age who either received (a) screening only, (b) monitoring only, (c) both monitoring and screening, or (d) no monitoring or screening. Sociodemographic control variables were also considered. Results In both 2007 and 2011/2012 datasets, monitoring and screening together was the best predictor of mental health treatment receipt. Neither screening alone nor monitoring alone was associated with mental health treatment receipt. Conclusions Children who received monitoring and screening together had the greatest odds of treatment receipt compared with children receiving screening only, monitoring only, or no monitoring or screening.
    October 05, 2017   doi: 10.1111/camh.12240   open full text
  • Mitigating depression among orphaned and vulnerable adolescents: a randomized controlled trial of interpersonal psychotherapy for groups in South Africa.
    Tonya R. Thurman, Johanna Nice, Tory M. Taylor, Brian Luckett.
    Child and Adolescent Mental Health. September 26, 2017
    Background Children and adolescents affected by HIV are at elevated risk of depression, yet research on related interventions in this population is scarce in sub‐Saharan Africa. This study sought to examine the effects of interpersonal psychotherapy for groups (IPTG) on depressive symptomology among orphaned and vulnerable adolescents in South Africa. Method A cluster randomized controlled trial wherein adolescents ages 14–17 enrolled in community‐based programming for HIV‐affected and vulnerable families were randomly assigned by geographic cluster to participate in a 16‐session IPTG intervention or the standard of care (n = 489). Baseline and postintervention surveys conducted with enrollees included standardized depression screening. Utilizing an intent‐to‐treat design, mixed effects models were performed to examine treatment effects for all participants and potential moderators including gender and baseline depression level (Clinical Trials registration: NCT02386878). Results While 23% of adolescents in the intervention group did not attend any IPTG sessions, average attendance was 12 out of 16 possible sessions among participants. The intervention was not associated with changes in depression symptomology. Conclusions Results underscore the importance of mitigating participation barriers prior to intervention roll‐out and the need for increased evidence for psychological health interventions to mitigate depression among orphaned and vulnerable adolescents. This intervention and the study selectively targeted at‐risk adolescents versus using diagnostic mental health criteria for enrollment; more research is needed to identify the potential benefits and disadvantages of these approaches.
    September 26, 2017   doi: 10.1111/camh.12241   open full text
  • Exploring the feasibility and acceptability of a school‐based self‐referral intervention for emotional difficulties in older adolescents: qualitative perspectives from students and school staff.
    Lynn McKeague, Nicola Morant, Emily Blackshaw, June S. L. Brown.
    Child and Adolescent Mental Health. August 24, 2017
    Background Adolescents with emotional difficulties need accessible, acceptable and evidence‐based mental health interventions. Self‐referral workshops (DISCOVER workshops) were offered to stressed 16‐ to 19‐year olds in 10 Inner London schools. Method Semistructured interviews were conducted with three groups of participants: students who attended a 1‐day workshop (n = 15); students who initially showed interest in the DISCOVER workshop programme, but decided not to take part (n = 9); and school staff who helped organise the programme in their schools (n = 10). Students were purposively sampled to ensure that those from Black and minority ethnic (BME) backgrounds were represented. Data were analysed using thematic analysis. Results The accounts generally indicate that the delivery and evaluation of this intervention is perceived as feasible and acceptable. Students, including those from BME backgrounds, described the setting as suitable and reported that the workshop helped them develop new understandings of stress and how to handle it. They expressed a preference for engaging and interactive activities, and valued a personalised approach to workshop provision. School staff felt that the workshop was in line with school values. They described some logistical barriers to providing the workshops in school settings, and expressed a desire for more information about the workshop in order to provide follow‐up support. The main reason students gave for nonparticipation was limited time. Conclusions Findings are discussed in relation to increasing the feasibility of implementing school‐based psychological interventions and the value of providing access to mental health support in schools.
    August 24, 2017   doi: 10.1111/camh.12234   open full text
  • What constitutes ‘good practice’ in early intervention for psychosis? Analysis of clinical guidelines.
    Paolo Corsico, Michelle Griffin‐Doyle, Ilina Singh.
    Child and Adolescent Mental Health. August 08, 2017
    Background Early Intervention in Psychosis (EIP) services have been implemented with the dual aims of preventing harmful outcomes associated with early‐onset psychosis and improving prognosis. However, concerns have been raised regarding the ethical implications of involving young people in EIP services. One way to ensure high ethical standards and promote good practice in EIP delivery is through governance of clinical practice. This study aimed to investigate the normative dimensions of good practice in EIP through examination of clinical guideline documents published in England over the past 15 years. Methods A total of 14 clinical guidelines and relevant policy documents for EIP were retrieved and analysed using a mixed inductive and deductive thematic approach. Themes were derived from the data itself, whereas the development of broader categories was performed through a constant comparison with the scientific literature describing ethical issues in EIP. Results Ethical touchpoints of good practice in EIP included both procedural and substantive factors, which were seen to be interdependent and mutually constitutive. These ethical touchpoints were largely implicit in the documents analysed. Procedural requirements of EIP service delivery consisted of norms and rules pertaining to EIP service structure, adherence to codes of ethics, inclusivity, patient and family centredness and appropriate treatment provision. Substantive factors consisted of moral attributes that should be cultivated by healthcare professionals working in EIP: competency, empathy, sensitivity and trustworthiness. Conclusions We argue that, to ensure good practice in EIP, procedural and substantive ethical expectations embedded in EIP guideline documents should be made explicit in EIP service and care delivery. We suggest that the procedural and substantive factors highlighted in this paper contribute useful dimensions for the eventual evaluation of good practice in EIP services across England.
    August 08, 2017   doi: 10.1111/camh.12229   open full text
  • Review: The impact of pediatric mental health care provided outpatient, primary care, community and school settings on emergency department use – a systematic review.
    Scott W. Kirkland, Amir Soleimani, Amanda S. Newton.
    Child and Adolescent Mental Health. July 19, 2017
    Background Increases in emergency department (ED) visits for pediatric mental health care point to a need to understand the impact of mental health services in relation to emergency‐based care. This systematic review examined the impact of mental health services delivered in outpatient, primary care, community and/or school settings on ED use and costs for ED‐based mental health care. Method Two electronic databases and gray literature were searched. Eligible studies consisted of randomized/controlled clinical trials or cohort studies examining the effects of mental health services on ED use and costs for this care. Two reviewers independently screened the studies for relevance and study quality. Relative risks (RR), risk differences (RD), or mean differences (MD) were calculated for each study's primary outcome with 95% confidence intervals (CI). Meta‐analysis was deferred due to substantial heterogeneity. Results Six studies were included. Overall risk of bias in the studies ranged from low, unclear, to high. The majority of programs had no effect on ED visits for mental health care. A school‐based program was found to reduce the risk of ED visits for any reason during use (RD, −8.0%; 95% CI: −15.2%, −0.9%); however, these visits were not specific to mental health. Three studies examined costs. A wrap‐around clinical management program was associated with higher average ED costs per patient per month ($20.07 US dollars) compared to usual outpatient care; other studies reported no cost differences. Conclusions At this time, there is limited evidence to suggest outpatient, primary care, community and/or school‐based mental health services impact ED use and costs for mental health care. Additional studies are needed.
    July 19, 2017   doi: 10.1111/camh.12230   open full text
  • Review: Prevention of anxiety among at‐risk children and adolescents – a systematic review and meta‐analysis.
    Peter J. Lawrence, Sally M. Rooke, Cathy Creswell.
    Child and Adolescent Mental Health. July 10, 2017
    Background Anxiety disorders are common, often start in childhood and run a chronic course. As such there is a need for effective prevention. Methods We conducted a systematic review and meta‐analyses of randomized, controlled trials to prevent the onset of anxiety disorders in ‘at risk’ young people. Diagnostic and symptom outcomes were examined. Putative moderators were tested as was publication bias. Results We included 16 trials (2545 young people). Two trials reported diagnostic outcomes, and significant effects were found for these at end‐of‐programme (RR = .09, 95%CI = .02 to .16), 6‐ (RR = .17, 95%CI = .06 to .27) and 12‐month (RR = .31, 95%CI .17 to .45) follow‐ups. Based on 16 trials, improved anxiety symptoms were significant compared to nonattention controls only, with small effect sizes reported by young people at the end‐of‐programmes, 6‐ and 12‐month follow‐ups; and by parents at the end of the programmes and 12‐, but not 6‐, month follow‐ups. There was no evidence of significant moderation or publication bias. Conclusions Fourteen studies included children and young people who presented with elevated anxiety symptoms, but anxiety disorder was not ruled out in the participants in these studies. Hence, these studies might be reporting results of mixed prevention/early intervention programmes. Prevention programmes that target developmental risk factors, not only disorder maintaining factors, appear most promising. The clinically meaningful impact of anxiety disorder prevention programmes remains unknown.
    July 10, 2017   doi: 10.1111/camh.12226   open full text
  • The Sheffield Learning Disabilities Outcome Measure: a factor analysis.
    Lauren Delahunty, Fiona McCrohan, Gill Kidd.
    Child and Adolescent Mental Health. April 27, 2017
    Background The Sheffield Learning Disabilities Outcome Measure (SLDOM) is routinely used across clinical services in the UK, despite not yet showing evidence of psychometric reliability or validity. However, it is reported that the SLDOM demonstrates good face validity, and represents a valuable tool for providing useful information around the parent‐child relationship in the context of having a child with a Learning Disability (LD). Method This study involved 263 parents or carers of a child with LD who completed the SLDOM. Data from this study were subjected to factor analysis. Results These findings suggest that the SLDOM could be viewed as a tool that measures two concepts: (1) internal factors central to the parent/carer in relation to having a child with LD and (2) external factors in terms of the context and environment surrounding a child with LD. To our knowledge, this study is one of the first to investigate the psychometric properties of the SLDOM. Conclusions This has implications in terms of building evidence to support the clinical and research use of this tool; to provide evidence‐based clinical services, and overall, to gain a better understanding of patients and their families, which will allow for optimum service provision.
    April 27, 2017   doi: 10.1111/camh.12222   open full text
  • Review: Longitudinal trajectories of child and adolescent depressive symptoms and their predictors – a systematic review and meta‐analysis.
    Lori Shore, John W. Toumbourou, Andrew J. Lewis, Peter Kremer.
    Child and Adolescent Mental Health. April 19, 2017
    Background With depression predicted to contribute to an increased disease burden in coming decades, prevention efforts have become increasingly important. In order to prevent depression it is valuable to identify and classify longitudinal patterns of depressive symptoms across development, ideally beginning early in childhood. To achieve this, longitudinal studies are increasingly using person‐centered data‐analytic methods to model subgroups with similar developmental patterns (trajectories) of depressive symptoms. Method A search was completed for English language studies that longitudinally modeled depressive symptom trajectories in nonclinical populations with a baseline age of <19 years. Study characteristics were extracted, prevalence rates and risk factors were summarized, a random‐effect meta‐analysis was undertaken, and risk of bias analysis completed. Results Twenty studies published between 2002 and 2015 were included. Participants were recruited at ages 4 through 17 (average age 12.34) and followed longitudinally for an average of 7.45 years. Between 3 and 11 trajectory subgroups were identified. A random pooled effect estimate identified 56% [95% Confidence Interval (CI) 46–65%] of the sampled study populations (N = 41,236) on ‘No or low’ depressive symptom trajectories and 26% (CI 14–40%) on a ‘Moderate’ trajectory. ‘High’, ‘Increasing’, and ‘Decreasing’ depressive symptom subgroups were evident for 12% (CI 8–17%). Moderate symptoms were associated with poorer adjustment and outcomes relative to low symptom groups. ‘High’ or ‘Increasing’ trajectories were predominantly predicted by: female gender, low socioeconomic status, higher stress reactivity; conduct issues; substance misuse, and problems in peer and parental relationships. Conclusions The review highlighted consistent evidence of subgroups of children and adolescents who differ in their depressive symptom development over time. The findings suggest preventative interventions should evaluate the longer term benefits of increasing membership in low and moderate trajectories, while also targeting reductions in high‐risk subgroups. Considerable between‐study method and measurement variation indicate the need for future trajectory studies to use standardized methods.
    April 19, 2017   doi: 10.1111/camh.12220   open full text
  • Prolonged breastfeeding for 24 months or more and mental health at 6 years of age: evidence from the 2004 Pelotas Birth Cohort Study, Brazil.
    Carlos Alberto Delgado, Tiago N. Munhoz, Iná S. Santos, Fernando C. Barros, Alicia Matijasevich.
    Child and Adolescent Mental Health. April 17, 2017
    Background There is scarce and conflicting evidence on medium‐ to long‐term effects of prolonged breastfeeding on child behavior. Method A population‐based birth cohort study started in 2004 in the city of Pelotas, Southern Brazil. Children were followed up at 3, 12, 24, and 48 months and 6 years of age. Breastfeeding duration was determined based on information collected around the time of weaning. Psychiatric disorders were assessed using the Development and Well‐Being Assessment (DAWBA). Children who were never breastfed were excluded from the analysis. Crude and adjusted analyses were performed using Poisson regression with robust variance. Results Data on breastfeeding and mental health at the age of 6 years were available for 3377 children. Prevalence of breastfeeding for 24–35 months and ≥36 months was 16.1% (95% CI: 14.8–17.3) and 8.1% (95% CI: 7.2–9.1), respectively. Prevalence of psychiatric disorders among those who were breastfed for <24 months, 24–35 months and ≥36 months was 12.4% (95% CI: 11.1–13.7), 13.1% (95% CI: 10.4–16.2) and 12.3% (95% CI: 8.7–16.8), respectively. No association was found between breastfeeding for 24 months or more and psychiatric disorders among children aged 6 years both in the crude and adjusted analyses. Conclusions In this cohort there was no association between breastfeeding for 24 months or more and an increased prevalence of psychiatric disorders at the age of 6 years. Studies analyzing the medium‐ and long‐term effects of prolonged breastfeeding for 2 years or more are scarce and further research is needed regarding this practice.
    April 17, 2017   doi: 10.1111/camh.12224   open full text
  • Social anxiety and interpretation bias: examining clinical and subclinical components in adolescents.
    Yura Loscalzo, Marco Giannini, Anne C. Miers.
    Child and Adolescent Mental Health. April 08, 2017
    Background This study aimed to examine whether different components of interpretation bias are clinical or dimensional features of adolescent social anxiety. The study analyzed the components of this bias at a subclinical level of Social Anxiety Disorder (SAD) and compared these with a clinical sample of adolescents with SAD. Method Adolescents in the age range 13–17 years participated. A group with SAD (n = 30) was compared with a group with subclinical SAD (n = 60), and a non‐socially anxious group (n = 95). Results Negative interpretation bias for social situations was found to be a dimensional aspect of social anxiety. In contrast, belief in negative interpretations of social situations appears to be a clinical feature. Contrary to expectations, endorsement of positive interpretations did not differ between the three groups. Conclusions The results suggest that a screening instrument based on negative interpretations of social situations could be useful to detect adolescents at‐risk of developing SAD. In a clinical setting, the belief in negative interpretations and the presence of the bias in nonsocial situations should also be considered.
    April 08, 2017   doi: 10.1111/camh.12221   open full text
  • The battle of living with obsessive compulsive disorder: a qualitative study of young people's experiences.
    Carly Keyes, Lizette Nolte, Timothy I. Williams.
    Child and Adolescent Mental Health. April 04, 2017
    Background There has been an abundance of studies that have employed quantitative methods to research obsessive compulsive disorder (OCD) and its neurobiology and neurochemistry. However, there appears to be a paucity of research investigating how OCD is experienced by those living with the diagnosis, particularly young people. Method A qualitative cross‐sectional semistructured interview design was used to address this lack of research. Ten young people, aged 14–17 years old, with a diagnosis of OCD were recruited from Child and Adolescent Mental Health Services in the United Kingdom. Thematic analysis was used to analyse the data. Results Four themes were identified: ‘Traumatic and stressful life events’, ‘Responses to signs of OCD’, ‘The battle of living with OCD’ and ‘Ambivalent relationship to help’. Young people reported experiencing stressful or traumatic life events prior to obsessive and compulsive behaviour. OCD behaviours were misunderstood by the young people and others, leading to delays in finding help. A sense of shame among the young people led them to keep their OCD secret due to feeling ‘crazy’. The all‐encompassing nature of OCD led the young people to withdraw socially. Most of the young people experienced an inner conflict between fighting and giving in to the compulsions. Conclusions Traumatic experiences may be an important factor in the development of OCD for young people, which might indicate a direction for prevention. The sense of shame and stigma needs addressing if young people are to access help earlier. Education of the public, medical professionals and educators should be a priority.
    April 04, 2017   doi: 10.1111/camh.12216   open full text
  • Prevalence and factors of self‐corrective intention among Hong Kong secondary school students who are self‐assessed Internet addiction cases.
    Joseph T.F. Lau, Anise M.S. Wu, Kit‐man Cheng, Vincent W.S. Tse, Mason M.C. Lau, Xueying Yang.
    Child and Adolescent Mental Health. April 03, 2017
    Background Adolescent Internet addiction (IA) is prevalent. No study, however, has applied the health belief model (HBM) to investigate issues on IA nor investigated factors associated with intention to correct one's perceived IA problem (self‐corrective intention). Such information facilitates design of related interventions, which are warranted. Methods This cross‐sectional study surveyed 9,618 Chinese secondary school students in Hong Kong; 4,111 (42.7%) self‐assessed that they had IA (self‐assessed IA cases); 1,145 of these self‐assessed IA cases (27.9%) were also classified as IA cases (concordant IA cases), as their Chen Internet Addiction Scale score exceeded 63. Results The prevalence of self‐corrective intention among these two subsamples was only 28.2% and 34.1%, respectively. In the self‐assessed IA subsample, the HBM constructs including perceived susceptibility to IA [adjusted odds ratio (ORa) = 1.24, 95% CI = 1.16, 1.34], perceived severity of IA (ORa = 2.28, 95% CI = 2.09, 2.48), perceived benefits for reducing Internet use (ORa = 1.21, 95% CI = 1.18, 1.24), self‐efficacy to reduce Internet use (ORa = 1.07, 95% CI = 1.03, 1.11), and cues to action to reduce Internet use (ORa = 1.15, 95% CI = 1.11, 1.20) were positively, while perceived barriers for reducing Internet use (ORa = 0.95, 95% CI = 0.94, 0.97) were negatively, associated with self‐corrective intention. Similar factors were identified in the concordant IA subsample. Conclusions A large proportion of the students perceived that they had IA but only about one‐third intended to correct the problem. Future interventions may consider altering students’ HBM constructs, and focus on the segment of concordant IA with self‐corrective intention, as they show readiness for changes.
    April 03, 2017   doi: 10.1111/camh.12219   open full text
  • National time trend changes in psychotropic medication of child and adolescent psychiatric inpatients across Finland.
    Kim Kronström, Lauri Kuosmanen, Heikki Ellilä, Anne Kaljonen, Andre Sourander.
    Child and Adolescent Mental Health. March 30, 2017
    Background There have been no comprehensive studies on trends in psychotropic medication use in child and adolescent inpatient settings. The aim of this nationwide study was to report changes in the psychotropic medication given to child and adolescent psychiatric inpatients across Finland and the factors associated with those changes. Methods We asked the psychiatrist responsible for each inpatient to complete a questionnaire that included questions about the pharmacological treatment and background information. The data were collected on all inpatients on one selected study day in 2000 and 2011. Changes in the use of regular psychotropic medication were studied by comparing the data on 504 patients in 2000 and 412 patients in 2011. Results The study showed that there had been a significant increase in the use of psychotropic medication from 2000 to 2011. According to the multivariate analysis, the increase in psychotropic medication was associated with the study year (in 2000 39%, in 2011 58%), but could not be explained by changes in diagnostic profiles, age distribution, suicidality, violence or the Children′s Global Assessment Scale scores. The use of combined psychotropic medication increased from 9% in 2000 to 25% in 2011. The increase in the use of antipsychotics among child inpatients was particularly noteworthy, with an increase from 10% to 32%. Conclusions There is a need for evidence‐based studies to clarify recommendations for indications and treatment practices when using psychotropic medication in children and adolescents. Cross‐cultural studies of the use of psychotropic medication are warranted.
    March 30, 2017   doi: 10.1111/camh.12217   open full text
  • Reflecting on what ‘you said’ as a way of reintroducing difficult topics in child mental health assessments.
    Nikki Kiyimba, Michelle O'Reilly.
    Child and Adolescent Mental Health. March 25, 2017
    Background In child and adolescent mental health assessments, questions are integral to the process. There has been limited research focused on the assessment process, or on how questions are constructed within this clinical environment. Methods We examined 28 naturally occurring initial assessments, with particular attention to how practitioners used questions in their communication with children and young people. We utilised conversation analysis to examine the data. Results Analysis revealed a particular type of question preface used to reintroduce a prior topic. This was achieved through the use of ‘you said x’ as a foundation for asking a follow‐up question and demonstrated active listening. Conclusions Arguably, this approach is a useful way of gathering assessment‐relevant information in a child‐centred way.
    March 25, 2017   doi: 10.1111/camh.12215   open full text
  • Patterns of referral and waiting times for specialist Child and Adolescent Mental Health Services.
    Joanna Smith, Richard G. Kyle, Brigid Daniel, Gill Hubbard.
    Child and Adolescent Mental Health. February 09, 2017
    Background During 12‐month period (2012/13) around 21,480 children and young people (CYP) were referred to Child and Adolescent Mental Health Service (CAMHS) in Scotland (NHS Scotland, 2013, Child and Adolescent Mental Health Services waiting times in Scotland). At the end of September 2012, there were 3,602 CYP still waiting for ‘start of treatment’ or ‘removal from the waiting list’, 375 (10%) CYP had waited over 26 weeks and 1,204 (33%) CYP had waited over 18 weeks (NHS Scotland, 2013, Child and Adolescent Mental Health Services waiting times in Scotland). Referral source, referral reason and the sociodemographic characteristics of CYP are not routinely collected, and therefore, associations between these factors and wait times for ‘start of treatment’ or ‘removal from the waiting list’ (i.e. the referral outcome) are unknown. Method In this exploratory study, a retrospective analysis of referral data was conducted in one CAMHS. Data for 476 referrals between 1st May 2013 and 31st May 2014 were initially analysed to define categories for each of the following key variables: referral source, referral reason and referral outcome. Data on CYP sociodemographic characteristics were extracted from referral records, including age, gender and postcode, from which Scottish Index of Multiple Deprivation quintile of residence was derived. Descriptive statistics were calculated for referral source, referral reason and CYP sociodemographic characteristics. Regression models were then built to determine predictors of a referral being rejected by CAMHS and waiting time for referrals accepted by CAMHS. Data were analysed in SPSS (Version 20). Results Of the 476 referrals, 72% (n = 342) were accepted and 12% (n = 59) were rejected. Most referrals were made by general practitioners. Just under a third of referrals to CAMHS (31%) were for CYP with emotional and behavioural difficulties. The odds of being rejected by CAMHS were significantly higher if referred by teachers and for CYP with emotional and behavioural difficulties. Age and referral reason were significant independent predictors of waiting time after referral to CAMHS, with CYP referred for hyperactivity/inattention waiting significantly longer. Conclusions Policymakers should consider ways to foster dialogue and collaboration between different groups of professionals making and accepting referrals to CAMHS in order to improve timely access to appropriate mental health support services for CYP. Research is urgently needed to investigate the experiences of CYP who are either rejected by CAMHS or wait lengthy periods of time before starting their treatment with CAMHS.
    February 09, 2017   doi: 10.1111/camh.12207   open full text
  • Using patient‐reported outcome measures to improve service effectiveness for supervisors: a mixed‐methods evaluation of supervisors' attitudes and self‐efficacy after training to use outcome measures in child mental health.
    Mary Fullerton, Julian Edbrooke‐Childs, Duncan Law, Kate Martin, Isabelle Whelan, Miranda Wolpert.
    Child and Adolescent Mental Health. January 24, 2017
    Background Patient‐reported outcome measures (PROMs) are recommended by healthcare systems internationally, but there are a number of barriers to implementation. The aim of this research was to examine the impact of training supervisors in using PROMs on clinical practice, given the importance of leadership when changing behaviour. Method Data included pre–post questionnaires from 42 supervisors, interviews after training with six supervisees and nonparticipant observations of nine video‐recorded supervision sessions. Results After training, supervisors had more positive attitudes to administering PROMs and using feedback from PROMs and had higher levels of self‐efficacy about using PROMs in supervision. Conclusions Findings are in line with the growing body of evidence that training child mental health staff to use PROMs may be associated with changes in attitudes, self‐efficacy and use of PROMs.
    January 24, 2017   doi: 10.1111/camh.12206   open full text
  • Clinical change after the implementation of the Choice and Partnership Approach within an Australian Child and Adolescent Mental Health Service.
    Jonine N.L. Naughton, Matthew Carroll, Soumya Basu, Darryl Maybery.
    Child and Adolescent Mental Health. January 20, 2017
    Background The Choice and Partnership Approach (CAPA) model has been implemented widely into Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom and similar health systems in Australia and New Zealand. This study investigated whether the implementation of the CAPA model was related to changes in client clinical outcomes and response times within a regional Australian CAMHS. Method Multiple measures of time, clinical diagnosis, contact and outcomes were collected at intake and discharge for 33 clients prior to and 77 following the implementation of CAPA. Results A two‐tailed t‐test showed that the significantly reduced waiting time was associated with the timing of CAPA implementation. The Health of the Nation Outcome Scales for Children and Adolescents information subscale showed a significant post‐CAPA implementation improvement. A chi‐square test for independence showed that the CAPA model group had significantly more initial clinical appointments. Conclusions After the implementation of CAPA, the flow of young people through the service improved, with children and adolescents being seen in a more timely manner. The findings highlighted that the greater client throughput did not negatively impact upon clinical outcomes. Further prospective research with the completion of multi‐informant outcome measures is recommended.
    January 20, 2017   doi: 10.1111/camh.12208   open full text
  • Navigating an unfamiliar world: how parents of young people who self‐harm experience support and treatment.
    Anne Stewart, Nicholas D. Hughes, Sue Simkin, Louise Locock, Anne Ferrey, Navneet Kapur, David Gunnell, Keith Hawton.
    Child and Adolescent Mental Health. December 19, 2016
    Background Self‐harm in young people is a common reason for contact with clinical services. However, there is little research focusing on parents’ perspectives of care following self‐harm. The aim of this study was to explore parents’ experiences of treatment and support for the young person and for themselves. Methods A qualitative design was used to explore parents’ perspectives. Semi‐structured narrative interviews were conducted across the UK with 37 parents of young people who had self‐harmed. Thematic analysis was undertaken to identify themes relating to how parents experienced the help and treatment received. Results Parents reported differing reactions to contact with helping services. Many found these helpful, particularly in keeping the young person safe, developing a trusting relationship with the young person, encouraging skills in managing self‐harm and giving them an opportunity to talk about and find solutions to their difficulties. They spoke about the importance of practical help including prompt access to care, the right intensity of care, practical strategies and information and support. Some aspects of services were perceived as unhelpful, particularly a judgmental approach by professionals, lack of early access to treatment, inadequate support or failure to listen to the perspective of parents. Conclusions Parents’ views highlight the need for clinicians to consider carefully the perspective of parents, involving them wherever possible and providing practical help and support, including written information. The need for training of clinicians in communicating with young people and parents following self‐harm is also highlighted.
    December 19, 2016   doi: 10.1111/camh.12205   open full text
  • Review: Low self‐esteem and internalizing disorders in young people – a systematic review.
    Lisa Keane, Maria Loades.
    Child and Adolescent Mental Health. December 15, 2016
    Background Cognitive behavioural therapy for low self‐esteem (LSE) has shown promise as a trans‐diagnostic model for treating mental health difficulties in adults. To ascertain the potential value of this treatment approach in working with young people with internalizing disorders, we need to develop our understanding of LSE within these mental health conditions. The aim of this review is to explore (a) the co‐occurrence of clinically significant anxiety/depression and LSE in young people (aged 18 years and younger), and (b) the association between LSE in childhood and adolescence and mental health difficulties in later adolescence and emerging adulthood. Method A systematic search of three electronic databases (PsychInfo/Pubmed/Google Scholar) was conducted to identify relevant studies. Results Ten studies examining the association between LSE and clinically significant anxiety/depression in young people met the inclusion criteria, as did eight studies investigating the association between LSE in young people with internalizing difficulties in later adolescence/emerging adulthood. Although relatively few studies were identified, studies consistently supported the co‐occurrence of LSE and internalizing disorders in young people, particularly in young people with co‐morbid anxiety and depression. LSE in childhood and adolescence appears to be a relatively weak predictor of the development of anxiety and depression in later adolescence and early adulthood. Conclusions Further research investigating the relationship between low self‐esteem and mental health difficulties in young people and its implications for treatment in this age group is indicated.
    December 15, 2016   doi: 10.1111/camh.12204   open full text
  • Association between bullying behavior, perceived school safety, and self‐cutting: a Japanese population‐based school survey.
    Shoko Hamada, Hitoshi Kaneko, Masayoshi Ogura, Aya Yamawaki, Junko Maezono, Lauri Sillanmäki, Andre Sourander, Shuji Honjo.
    Child and Adolescent Mental Health. November 25, 2016
    Background No previous population‐based studies have examined associations between self‐cutting, perceived school safety, and bullying behavior among East Asian adolescents. Method We examined whether bullying, victimization, and perceived school safety were associated with self‐cutting by getting 1865 students with a mean age of 13.9 years (standard deviation 0.2 years) to complete questions on these variables. Psychiatric problems were assessed with the Strengths and Difficulties Questionnaire. Results About 5.6% of males and 11.9% females had practiced self‐cutting and when we controlled these results for psychiatric symptoms, self‐cutting was associated with being both a bully and a victim among males and females. In addition, self‐cutting was independently associated with perceived school safety among females. Those who felt unsafe at school and were victimized were much more likely to engage in self‐cutting. Conclusions Self‐cutting among Japanese adolescents was linked with bullying behavior and feeling unsafe at school. Secure school environments and school‐based antibullying programs could help to prevent adolescent self‐injurious behavior.
    November 25, 2016   doi: 10.1111/camh.12200   open full text
  • A case control and follow‐up study of ‘hard to reach’ young people who suffered from multiple complex mental disorders.
    Nigel Camilleri, Dorothy Newbury‐Birch, Paul McArdle, Deborah D. Stocken, Tony Thick, Ann Le Couteur.
    Child and Adolescent Mental Health. November 23, 2016
    Background Innovations Project (IP) was a new multidisciplinary team based within an inner city, walk‐in health centre, North East England (throughout 2011). The aim was to describe the social and mental disorders of the hard to reach young people (HTRYP) from the IP and compare with a matched sample who attended a Community Mental Health Team (CMHT) and follow‐up both samples 24 months after discharge. Methods A retrospective review of clinical case notes of YP who attended the IP and CMHT. A 24‐month (postdischarge) follow‐up evaluation of the mental state and social function of the YP in both groups using Health of the Nation Outcome Scales for Child and Adolescent Mental Health (HoNOSCA) and Children's Global Assessment Scale (CGAS). Results Thirty‐six referrals were accepted over a one‐year period by the IP, 31 met criteria for the HTRYP, 15 were offered individually tailored therapy. The HTRYP who were more deprived compared to the CMHT matched sample (n = 115), experienced a higher median number of mental disorders (n = 3 compared to CMHT n = 1), higher severity scores and lower levels of social function (HTRYP HoNOSCA mean: 19.1 (95% CI 15.9–22.2) and CMHT mean: 11.2 (95% CI 2.0–23.0) p = <.001, and HTRYP CGAS mean: 51.0 (95% CI 46.0–56.2) and CMHT mean: 58.9 (95% CI 52.9–64.8), p = .05). The HTRYP made significantly greater improvement compared to CMHTYP; (HoNOSCA p = <.001 and CGAS p = <.002) at discharge. A total of 13 HTRYP and 9 CMHT YP attended the follow‐up review at 24 months. There was substantial variability in terms of social function between the YP within each sample. Conclusions The term ‘HTR’ describes a state that may be often temporary, as opposed to lifelong. A bespoke service offering a developmental theoretical framework, regular reviews and an individualised care plan, was able to engage and had the potential to reduce morbidity suffered by HTRYP.
    November 23, 2016   doi: 10.1111/camh.12202   open full text
  • Victimisation in urban primary schools of high‐poverty areas: associations with health‐related quality of life, depression and social support.
    John M. Hyland, Pauline K. Hyland, Catherine M. Comiskey.
    Child and Adolescent Mental Health. November 23, 2016
    Background Although a widespread issue, research on victimisation among primary school children in high‐poverty regions is limited. The aim of this research was to explore victimisation incidence and associated mental health correlates from first‐wave data of the ‘Healthy Schools’ programme in a high‐poverty urban region. Method The study explored victimisation incidences among 458 Irish primary school children and associations with depression, health‐related quality of life (HRQoL) and social support. Results Victimisation (33.8%) was consistent with recent literature. On the stand‐alone victimisation question, victims scored lower on all HRQoL subscales compared with nonvictims. Further categorisation revealed that frequent victims scored lower on four of these subscales, compared with nonvictims. Furthermore, over half of children felt that their school was not doing enough to combat school aggression. Conclusions Although from a high‐poverty area, rates were consistent with data from more affluent areas. Results stress an importance on specific school aggression behaviours when measuring victimisation rates, along with corresponding health consequences. Future research should continue to adopt the behaviour‐based assessment of victimisation to provide an overall picture of the problem.
    November 23, 2016   doi: 10.1111/camh.12201   open full text
  • Parental and child factors associated with participation in a randomised control trial of an Internet‐assisted parent training programme.
    Sturla Fossum, Terja Ristkari, Charles Cunningham, Patrick J. McGrath, Auli Suominen, Jukka Huttunen, Patricia Lingley‐Pottie, Andre Sourander.
    Child and Adolescent Mental Health. November 10, 2016
    Background Parental training is an effective way to treat and prevent children's conduct problems, but knowledge of who participates in such initiatives is limited. Method This study examined child and family factors associated with participation in an Internet‐assisted parent training programme. The parents of 4‐year‐old children with high levels of disruptive behaviour in a region of Finland were offered the opportunity to participate in a randomised controlled trial of the Strongest Families Smart Website intervention (SFSW). The participants and nonparticipants were compared using the Strengths and Difficulties Questionnaire (SDQ), duration of child problems and information about family demographics, which were routinely collected prior to randomisation to the SFSW and control group. Results We found that 464 (64.5%) of the 709 parents of children fulfilling the screening criteria, participated. In the multivariable analysis, nonparticipation was most strongly associated with a child only having minor difficulties [odds ratio (OR): 2.1; 95% confidence interval (CI): 1.5–3.0] and a shorter duration of problems, for less than 12 months (OR: 1.7, 95% CI: 1.2–2.5), after controlling for other child factors. Nonparticipation was significantly associated with mothers spending a shorter time in the education system (OR: 1.6, 95% CI: 1.2–2.3) after controlling for other parental factors. Conclusions A larger percentage of parents of children with longer lasting and more severe problems seemed to be motivated to participate in this remote parent training programme. Future studies on how to encourage parents with shorter duration of education to participate in early intervention programmes are warranted.
    November 10, 2016   doi: 10.1111/camh.12193   open full text
  • Health care provider responses to initial parental reports of autism spectrum disorder symptoms: results from a nationally representative sample.
    Lucy Barnard‐Brak, David Richman, Kathryn Ellerbeck, Rosario Moreno.
    Child and Adolescent Mental Health. November 07, 2016
    Background Health care provider (HCP) responses to initial parental report of autism spectrum disorder (ASD) symptoms were examined in relation to latency to diagnosis and child chronological age at diagnosis. Method Secondary data analyses were conducted for a sample of 1384 parents of children with ASD utilizing data from the National Survey of Children with Special Health Care Needs (NS‐CSHCN, 2009–2010 National Survey of Children with Special Health Care Needs, 2009) and the Centers for Disease Control and Prevention Pathways to Diagnosis and Services (CDC PDS, Survey of pathways to diagnosis and services, 2011). Results Approximately 44% of the sample experienced predominantly delayed HCP responses, 38% experienced predominantly proactive responses, while the remaining 18% experienced a relatively even mix of delayed and proactive responses across HCPs. With regard to outcomes correlated with the type of HCP response, individuals exposed to proactive HCPs were diagnosed with ASD almost a year earlier for child chronological age than individuals exposed to mixed HCPs. This difference increased beyond a year between individuals receiving proactive HCPs versus individuals experiencing delayed HCPs. Finally, after controlling for socioeconomic status, parent‐reported severity of ASD symptoms, and age at time of referral, proactive HCP was correlated with decreased time to diagnosis from parental first report of ASD symptoms. Conclusions Results are discussed with regard to increasing proactive HCP responses to parental first concerns of ASD symptomology versus a mix or delayed responses.
    November 07, 2016   doi: 10.1111/camh.12194   open full text
  • Affect recognition among adolescents in therapeutic schools: relationships with posttraumatic stress disorder and conduct disorder symptoms.
    Shabnam Javdani, Naomi Sadeh, Geri R. Donenberg, Erin M. Emerson, Christopher Houck, Larry K. Brown.
    Child and Adolescent Mental Health. November 07, 2016
    Background Posttraumatic stress disorder (PTSD) and conduct disorder (CD) symptoms often co‐occur in adolescence, but little is known about whether they show common or distinct emotional processing deficits. Method We examined the effects of PTSD and CD symptoms on facial affect processing in youth with emotional and behavior problems. Teens enrolled in therapeutic day schools (N = 371; ages 13–19) completed a structured diagnostic assessment and the Diagnostic Analysis of Nonverbal Accuracy‐2 facial affect recognition task. Results Posttraumatic stress disorder symptoms were associated with deficits in the recognition of angry facial expressions, specifically the false identification of angry faces as fearful. CD symptoms were associated with greater difficulty correctly identifying sadness. Conclusions Findings suggest specificity in the relationships of PTSD and CD symptoms with emotional processing.
    November 07, 2016   doi: 10.1111/camh.12198   open full text
  • Perceived treatment barriers and experiences in the use of services for obsessive–compulsive disorder across different ethnic groups: a thematic analysis.
    Sarah Kolvenbach, Lorena Fernández de la Cruz, David Mataix‐Cols, Natasha Patel, Amita Jassi.
    Child and Adolescent Mental Health. October 26, 2016
    Background Patients from ethnic minority backgrounds are underrepresented in clinical settings. Factors like cost of treatment, poor knowledge of the health system, geographic availability of services, lack of mental health literacy, differences in health beliefs, and social barriers have been identified as reasons for these inequalities. The aim of this study was to identify and compare barriers that parents from different ethnic groups face when accessing specialist services for obsessive–compulsive disorder (OCD) for their children. Method Ten parents from White backgrounds and 10 from ethnic minority backgrounds were recruited from the National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, London, United Kingdom. They were interviewed about their opinions and experiences when accessing treatment. Results Using thematic analysis, several common barriers for both groups were identified. These included a lack of knowledge of OCD, lack of resources within the health system, previous negative experiences, lack of trust in the mental health system, lack of time and financial issues, no support out of hours, bullying, and inconvenient location of services. In addition, there were several barriers that were endorsed by ethnic minority groups but not by the parents from White backgrounds, namely stigma and discrimination from within their communities, shame and denial, a general lack of trust in the health system by their cultural group, different beliefs about mental health issues, and discrimination from within the system. Conclusions Policy‐makers and clinicians should be aware of the additional barriers minority patients may face in accessing treatment and should support interventions designed to overcome them.
    October 26, 2016   doi: 10.1111/camh.12197   open full text
  • Mentalization and depressive symptoms in a clinical sample of adolescents and young adults.
    Martino Belvederi Murri, Gabriella Ferrigno, Simona Penati, Caterina Muzio, Giulia Piccinini, Marco Innamorati, Federica Ricci, Maurizio Pompili, Mario Amore.
    Child and Adolescent Mental Health. October 25, 2016
    Background Increasing evidence supports that mentalization deficits may have a role in the genesis of young age depression; however, few studies examined this issue in clinical populations. Methods Outpatients aged 14–21, suffering from various psychiatric disorders, were assessed using the Mentalization Questionnaire (MZQ), the Beck Depression Inventory (BDI), and the Childhood Trauma Questionnaire (CTQ), using data from age‐matched healthy students for comparison. The relationship between CTQ, MZQ, and BDI scores was examined at the cross‐sectional level, including mediation analyses, and longitudinally, in a subsample who underwent a psychotherapy intervention. Results Of 83 subjects, 33 (39.8%) had mentalization levels that were 1 standard deviation below those of comparison subjects. In the whole sample, the levels of mentalization were inversely associated with BDI (r = −.68, p < .001) and CTQ scores (r = −.30, p = .006). Moreover, MZQ scores mediated a large part of the effect of childhood trauma on depression (total effect: 10.6, 95% CI: 5.3, 15.9; direct effect: 6.5, 95% CI: 2.1, 10.8; indirect effect: 4.1, 95% CI: 1.5, 7.4). This effect was almost entirely explained by the Affect Regulation subscale. In patients re‐evaluated after four sessions (n = 37), the decrease in BDI scores correlated with the increase in MZQ scores (r = .40, p = .02). Conclusions In a juvenile clinical sample, deficits of mentalization abilities were associated with the severity of depression and explained part of the depressogenic effects of childhood trauma.
    October 25, 2016   doi: 10.1111/camh.12195   open full text
  • Collaborative youth mental health service users, immigration, poverty, and family environment.
    Lucie Nadeau, Vanessa Lecompte, Janique Johnson‐Lafleur, Annie Pontbriand, Cécile Rousseau.
    Child and Adolescent Mental Health. October 25, 2016
    Background This article examines the association between immigration, poverty and family environment, and the emotional and behavioral problems reported by youth and their family receiving mental health (MH) services within a collaborative care model in a multiethnic neighborhood. Method Participants in this study were 140 parent–child dyads that are part of an ongoing longitudinal project looking at the association between individual, familial, social and organizational factors, and outcomes of youth receiving MH services in local health and social service organizations in the Montreal area. Measures included in this study were collected at the initial phase of the longitudinal project (Time 0). Parents completed a sociodemographic questionnaire and the Family Environment Scale (FES), and both parents and children completed the Strength and Difficulties questionnaire (SDQ). Results Results suggest that the family environment, especially family conflicts, has a significant role in the MH problems of children seeking help in collaborative MH services. In this specific population, results also show a trend, but not a statistically significant association, between poverty or immigration and emotional and behavioral problems. They suggest as well that boys show more MH problems, although this could be a contamination effect (parents’ perspective). Conclusions The results support the importance of interventions that not only target the child symptomatology but also address family dynamics, especially conflicts. Collaborative care models may be particularly well suited to allow for a coherent consideration of family environmental factors in youth mental health and to support primary care settings in addressing these issues.
    October 25, 2016   doi: 10.1111/camh.12196   open full text
  • Patient reported outcome measures in child and adolescent mental health services: associations between clinician demographic characteristics, attitudes and efficacy.
    Julian Edbrooke‐Childs, David Barry, Irene Mateos Rodriguez, Danae Papageorgiou, Miranda Wolpert, Joerg Schulz.
    Child and Adolescent Mental Health. October 14, 2016
    Background Policy recommends using patient reported outcome measures (PROMs), yet their use is persistently low. Our aim was to examine the association between PROM use and clinician demographic characteristics, attitudes and efficacy. Method A sample of N = 109 clinicians completed an online survey. Results Clinicians who reported higher levels of use of cognitive behaviour or humanistic approaches had higher levels of PROM use than clinicians who reported lower levels of use of these approaches. Clinicians who reported having received training had higher levels of self‐efficacy regarding PROMs than clinicians who reported not having received training, but the effects of training on PROM attitudes and use were not significant. Still, clinicians with more positive attitudes or self‐efficacy regarding PROMs had higher levels of PROM use than clinicians with less positive attitudes or self‐efficacy regarding PROMs. Conclusion Clinicians should be supported to have the knowledge, skills and confidence to effectively use PROMs in their clinical practice.
    October 14, 2016   doi: 10.1111/camh.12189   open full text
  • Application of the Strengths and Difficulties Questionnaire Added Value Score in evaluating the effectiveness of Functional Family Therapy within local authority social work services.
    John Marshall, Russell Hamilton, Nicole Cairns.
    Child and Adolescent Mental Health. October 06, 2016
    Background As ‘Blueprints’ evidence‐based programmes, such as Functional Family Therapy (FFT), originating from the United States, are increasingly implemented in Social Work services, the importance of assessing their effectiveness in a UK context is crucial. To do this, it is not always practical for services to commission randomised control trials or quasi‐experimental control trials. The Strengths and Difficulties Questionnaire (SDQ) Added Value Score has been shown to have utility in the evaluation of intervention programmes by controlling for regression to the mean, attenuation and the shifting nature of most childhood psychopathology. Method The SDQ Added Value Score was used to assess the effectiveness of FFT in two local authorities in Scotland. One hundred and sixty‐four families who had finished FFT completed the Strengths and Difficulties Questionnaire, the Outcome Questionnaire and the Client Outcome Measure at pre‐ and postintervention. Results Both parents' and adolescents' average psychosocial distress scores significantly decreased on all measures after FFT and many of the scores postintervention fell to a range equivalent with the general population. Furthermore, calculation of the SDQ Added Value Score indicated that adolescents' mean total difficulties scores were lower following FFT than what would have been expected had this intervention not been received, producing an effect size that compares favourably to other interventions. Conclusions Functional Family Therapy has been identified as an effective intervention for improving the psychosocial functioning of high‐risk adolescents and their families.
    October 06, 2016   doi: 10.1111/camh.12190   open full text
  • Self‐efficacy as a mediator of the relationship between parental closeness and suicidal ideation among Malaysian adolescents.
    Shin Ling Wu, Siti Nor Yaacob.
    Child and Adolescent Mental Health. October 04, 2016
    Background Suicide has become a serious worldwide mental health problem, including Asian countries. Suicidal ideation happens prior to the actual suicidal behaviour; thus, identifying the roots of suicidal ideation is vital. This study investigated the relationships between parental closeness, self‐efficacy and suicidal ideation among adolescents in Malaysia. The mediation effect of self‐efficacy on the relationship between parental closeness and suicidal ideation was also examined. Method A total of 684 school‐going adolescents aged 14–17 years old were recruited via multistage cluster sampling. Bivariate analysis was conducted using Pearson's correlation analysis. The mediation model was tested using SPSS macro developed by Preacher and Hayes. Results The results showed that mother closeness, father closeness and self‐efficacy had significant negative correlation with suicidal ideation. Specifically, self‐efficacy emerged as a partial mediator in the relation between mother closeness and suicidal ideation. Self‐efficacy also fully mediated the relationship between father closeness and suicidal ideation. Conclusions The findings implied that mother closeness had stronger correlation with adolescents' suicidal ideation compared to father closeness, while self‐efficacy plays an important role in the relationship between parental closeness and suicidal ideation. Prevention and intervention efforts by practitioners dealing with adolescents' mental health issues, specifically on suicidal ideation, should seriously consider providing them with skills to enhance mother–adolescent relationship and their self‐efficacy.
    October 04, 2016   doi: 10.1111/camh.12188   open full text
  • Trends in parent‐ and teacher‐rated mental health problems among 10‐ and 11‐year‐olds in Great Britain: 1999–2012.
    Leslie Morrison Gutman, Heather Joshi, Michael Parsonage, Ingrid Schoon.
    Child and Adolescent Mental Health. August 12, 2016
    Background Previous evidence indicates that mental health problems are becoming more common for adolescents. Less is known about whether these trends have continued and there has been no study to date which has specifically focused on early adolescents over a sufficiently long period. This study examines changes in parent‐ and teacher‐reported mental health problems among 10‐ and 11‐year‐olds in 1999, 2004 and 2012 in Great Britain. Method Parent and teacher ratings of the Strengths and Difficulties Questionnaire were used to compare the prevalence of conduct problems, hyperactivity/inattention, emotional problems, peer problems and total difficulties among 10‐ and 11‐year‐olds in three nationally representative British samples assessed in 1999 (n = 1904), 2004 (n = 1348) and 2012 (n = 11,397). Results Teacher reports showed improving trends for boys’ and girls’ mental health from 1999 to 2012, particularly for externalizing behaviours (i.e. conduct problems and hyperactivity/inattention). Parent reports, on the other hand, identified only one area of sustained improvement between 1999 and 2012, namely hyperactivity/inattention among boys. Although parent reports of girls’ mental health indicate improving trends from 1999 to 2004, they also suggest worsening mental health from 2004. Conclusions These findings suggest that perceptions of emotional and behavioural problems vary by the gender of the adolescent, the context in which they are observed or by whom they are reported.
    August 12, 2016   doi: 10.1111/camh.12179   open full text
  • Can we improve parent attitudes and intentions to access computer‐based therapies for their children and adolescents?
    Grace M. Sweeney, Caroline L. Donovan, Sonja March, Sandra D. Laurenson.
    Child and Adolescent Mental Health. August 02, 2016
    Background As gatekeepers, parents can improve the uptake of mental health services among youth. This article asked whether providing parents with a presentation on computer‐based therapies is a feasible strategy to improve their knowledge, attitudes and uptake intentions. Method Parents completed a survey before, and immediately after, viewing a presentation on computer‐based therapies or an active control. Results Parents who viewed the computer‐based presentation reported significantly greater improvements in knowledge, perceived helpfulness, perceived benefits and intentions to access computer‐based therapies; and a significantly greater reduction in perceived problems, compared to active controls. Conclusions Information‐ and demonstration‐based presentations are a feasible method for improving attitudes towards computer‐based therapies for youth among parents in the community.
    August 02, 2016   doi: 10.1111/camh.12180   open full text
  • Clinical characteristics of adolescents referred for treatment of depressive disorders.
    Faith Orchard, Laura Pass, Tamsin Marshall, Shirley Reynolds.
    Child and Adolescent Mental Health. July 15, 2016
    Background Adolescence is a period of increased risk for the development of depression. Epidemiological and clinical studies suggest that the phenomenology of depression may differ during childhood and adolescence. However, participants in these studies may not reflect depressed young people referred to routine clinical services. The aim of this paper was to describe referrals for depression to a UK routine public healthcare service for children and adolescents with mental health difficulties. Method This paper describes a consecutive series of adolescents (N = 100, aged 12–17 years), referred for depression to a routine public healthcare child and adolescent mental health service, in the south of England. Young people and their caregivers completed a structured diagnostic interview and self‐report measures of anxiety and depression. Results Fewer than half of young people referred for depression met diagnostic criteria for a depressive disorder. The key symptoms reported by those with depression were low mood or irritability, cognitive disturbances, sleep disturbances and negative self‐perceptions. Suicidal ideation was common and was considerably higher than reported in other studies. Caregiver and young person's accounts of adolescent symptoms of depression and anxiety were uncorrelated. Caregivers also reported fewer symptoms of depression in their child than adolescents themselves. Conclusions These data have direct relevance to the design and delivery of public mental health services for children and adolescents. However, we do not know how representative this sample is of other clinical populations in the UK or in other countries. There is a need to collect routine data from other services to assess the needs of this group of high‐risk adolescents.
    July 15, 2016   doi: 10.1111/camh.12178   open full text
  • Frequency of occurrence of specific reading disorder and associated psychiatric comorbidity in a sample of Egyptian primary school students.
    Mona M. El Sheikh, Marwa A. El Missiry, Hisham A. Hatata, Walaa M. Sabry, Abdul Aala A. El Fiky, Heba I. Essawi.
    Child and Adolescent Mental Health. July 14, 2016
    Background Specific reading disorder (dyslexia) is common in primary school students. Data on prevalence rates in Egypt are needed along with better screening tools to guide future research. We aimed to estimate the frequency of dyslexia in a sample of fourth and fifth graders. Method A cross‐sectional study was conducted in Eastern Cairo through multistage random selection of students from three governmental primary schools. A total of 586 students were recruited. Only 567 students fulfilled the inclusion criteria; they were subjected to screening by Goodenough Draw‐a‐Man test for intellectual quotient (IQ), the Reading Disability Test of Nasra Gilgil (RDT) to identify dyslexic children, Wechsler Children Intelligence Scale for thorough detection of IQ, and the Kiddie Schedule for Affective Disorders and Schizophrenia (K‐SADS‐PL) to detect psychiatric comorbidity. Results The frequency of occurrence of specific reading disorder (dyslexia) was 11.3% among the studied sample of Egyptian primary school students. The gender ratio was nearly 1.3:1 boys to girls. Comorbidity with other psychiatric disorders was found in 57.8% of the sample. Attention deficit hyperactivity disorder (ADHD) was present in 33%, generalized anxiety disorder in 21.6%, and major depressive disorder in 16.2% of patients. Conclusion Dyslexia was prevalent in fourth and fifth graders. A meaningful presence of ADHD, anxiety, and depressed mood was detected in students. There is a need for better screening and awareness for early intervention and service provision. The cross‐sectional design, lack of collateral information, and records precluded inference of casualty. The lack of rural comparator and samples from other governorates limit generalization of results.
    July 14, 2016   doi: 10.1111/camh.12174   open full text
  • Transitioning care‐leavers with mental health needs: ‘they set you up to fail!’.
    Sarah Butterworth, Swaran P. Singh, Max Birchwood, Zoebia Islam, Emily R. Munro, Panos Vostanis, Moli Paul, Alia Khan, Douglas Simkiss.
    Child and Adolescent Mental Health. June 29, 2016
    Background Children in the UK care system often face multiple disadvantages in terms of health, education and future employment. This is especially true of mental health where they present with greater mental health needs than other children. Although transition from care – the process of leaving the local authority as a child‐in‐care to independence – is a key juncture for young people, it is often experienced negatively with inconsistency in care and exacerbation of existing mental illness. Those receiving support from child and adolescent mental health services (CAMHS), often experience an additional, concurrent transfer to adult services (AMHS), which are guided by different service models which can create a care gap between services. Method This qualitative study explored care‐leavers’ experiences of mental illness, and transition in social care and mental health services. Twelve care‐leavers with mental health needs were interviewed and data analysed using framework analysis. Results Sixteen individual themes were grouped into four superordinate themes: overarching attitudes towards the care journey, experience of social care, experience of mental health services and recommendations. Conclusions Existing social care and mental health teams can improve the care of care‐leavers navigating multiple personal, practical and service transitions. Recommendations include effective Pathway Planning, multiagency coordination, and stating who is responsible for mental health care and its coordination. Participants asked that youth mental health services span the social care transition; and provide continuity of mental health provision when care‐leavers are at risk of feeling abandoned and isolated, suffering deteriorating mental health and struggling to establish new relationships with professionals. Young people say that the key to successful transition and achieving independence is maintaining trust and support from services.
    June 29, 2016   doi: 10.1111/camh.12171   open full text
  • Post‐traumatic stress symptoms and post‐traumatic growth among children and adolescents following an earthquake: a latent profile analysis.
    Chen Jieling, Wu Xinchun.
    Child and Adolescent Mental Health. June 28, 2016
    Background Pathological and beneficial outcomes have been documented in children and adolescents exposed to disasters, but the patterns of the outcomes are not known. This study was conducted to identify patterns of post‐traumatic stress symptoms and post‐traumatic growth and examine the predictors for the patterns among children and adolescents following an earthquake. Method Self‐reported measures (post‐traumatic stress symptoms, post‐traumatic growth, disaster exposure, and social support) were assessed among a total of 618 participants (age 12.26 ± 2.75) at 8 months post disaster. Latent profile analysis was utilized to identify the patterns of post‐traumatic stress symptoms and post‐traumatic growth, and multinomial logistic regressions were conducted to examine the predictors for the patterns. Results Three patterns were identified. Most of the participants fell into the Thriving pattern and smaller proportions fell into either the Resilient or Stressed and Growing pattern. Loss and injury, subjective fear, and social support could predict the membership in patterns of post‐traumatic stress symptoms and post‐traumatic growth. Conclusions Practitioners are suggested to identify the pattern of post‐traumatic stress symptoms and post‐traumatic growth for different children and adolescents, and provide the service targeting their needs.
    June 28, 2016   doi: 10.1111/camh.12175   open full text
  • Is emotional lability a marker for attention deficit hyperactivity disorder, anxiety and aggression symptoms in preschoolers?
    Jenna Maire, Cédric Galéra, Eric Meyer, Julie Salla, Grégory Michel.
    Child and Adolescent Mental Health. June 16, 2016
    Background Emotional lability (EL) is frequent in school‐aged children with attention deficit hyperactivity disorder (ADHD) and is associated with more frequent comorbidities and more severe impairment. However, little research has investigated the association between EL, ADHD and comorbid symptoms in preschoolers. This study assessed dimensional EL in preschoolers and its link with ADHD symptoms (e.g. hyperactivity‐impulsivity and inattention) and behavioural and emotional problems (e.g. aggression and anxiety). Method One hundred and fifty‐four preschoolers aged 3–6 years old were rated on questionnaires by parents. EL was assessed with the index from the Conners Rating Scale‐Revised and behavioural and emotional problems with an adapted version of the Social Behavior Questionnaire. Multiple linear regressions analyses were conducted. Results Higher EL was associated with higher hyperactivity‐impulsivity, inattention, anxiety and aggression problems. After controlling for other behavioural and emotional problems and sociodemographic variables, EL remained associated with hyperactivity‐impulsivity and anxiety. Conclusions Emotional lability seems to be a potential marker for ADHD symptoms with internalizing problems in preschoolers and could be a target for diagnosis and early interventions. This finding should be treated with caution as the study was limited by the low response rate of the participants and consequently the small sample size.
    June 16, 2016   doi: 10.1111/camh.12168   open full text
  • Alliance and adherence in a systemic therapy.
    Aurelie M.C. Lange, Rachel E.A. Rijken, Marc J.M.H. Delsing, Jan J.V. Busschbach, Joan E. Horn, Ron H.J. Scholte.
    Child and Adolescent Mental Health. June 14, 2016
    Background The client–therapist working alliance is a key contributor to effective adult psychotherapy. However, little is known about its role in family and systemic therapy. Moreover, few studies have assessed alliance longitudinally or have investigated how it interrelates with other process variables, such as therapist adherence (i.e. the extent to which the therapist adheres to the treatment protocol or manual). We hypothesised that alliance and adherence interrelate over the course of the therapy. Method This study investigated the bidirectional associations between alliance and therapist adherence using cross‐lagged panel analyses for a sample of 1970 adolescents and their families participating in Multisystemic Therapy (MST). A number of client characteristics were included as moderators, namely demographic characteristics, type and severity of adolescent problem behaviour, and whether or not the MST treatment was court ordered. Alliance and adherence were scored by the primary caregiver through telephone interviews at monthly intervals during treatment. Results Alliance in 1 month predicted therapist adherence in a subsequent month. Adherence only predicted subsequent alliance during the middle part of the treatment process. The results were not moderated by any of the client factors. Conclusions The results suggest that alliance and therapist adherence may reinforce one another during therapy. Although alliance may facilitate the development of therapist adherence, adherence may subsequently deepen and consolidate the client–therapist alliance. These results are independent of client characteristics.
    June 14, 2016   doi: 10.1111/camh.12172   open full text
  • Impact of a mindfulness‐based stress reduction program from the perspective of adolescents with serious mental health concerns.
    K. Jessica Van Vliet, Allison J. Foskett, Jennifer L. Williams, Anthony Singhal, Florin Dolcos, Sunita Vohra.
    Child and Adolescent Mental Health. June 10, 2016
    Background While studies on mindfulness‐based stress reduction (MBSR) for youth have recently emerged, there is a shortage of research on how adolescents from clinical populations experience MBSR. The purpose of this qualitative study was to explore the impact of MBSR from the subjective perspective of adolescents with serious mental health concerns. Method Adolescents (n = 28) from a residential treatment center participated in an adapted 8‐week MBSR program in which they learned a range of mindfulness skills and were encouraged to apply the skills to their everyday lives. At the end of the program and at a 3‐month follow‐up, the youth participated in semistructured interviews in which they were asked to describe the impact of the program from their perspectives. Basic interpretive qualitative analysis methods were used to code the data and to group the codes into higher level themes. Results Six main themes were found, including improved mood, enhanced relationship to self, increased self‐control, improved problem‐solving, awareness of the present, and enhanced interpersonal relationships. Discussion Results from this study suggest that the MBSR program was perceived as beneficial both in the short‐term and follow‐up in several aspects of emotional, cognitive, and interpersonal functioning.
    June 10, 2016   doi: 10.1111/camh.12170   open full text
  • Parent and child psychopathological symptoms: the mediating role of parental emotion dysregulation.
    Zhuo Rachel Han, Xuemei Lei, Jing Qian, Peipei Li, Hui Wang, Xutong Zhang.
    Child and Adolescent Mental Health. May 20, 2016
    Background Parental psychopathological symptoms have been associated with a number of child psychological problems, yet little research has examined the role of parental emotion dysregulation on the intergenerational transmission of psychopathological symptoms. This study aims to examine the relationship between parents' and children's psychopathological symptoms with a focus on the mediating mechanism of parental emotion dysregulation on these relationships. Methods Eighty‐nine Chinese parents and their school‐age children between the ages of 7 and 12 (49 males, M age = 8.79, SD = 1.81) participated in the study. In the initial phase of the study, parents filled out a series of questionnaires reporting their own psychopathological symptoms via SCL‐90 and difficulties with emotion regulation via Difficulties in Emotion Regulation Scale. After 9 months, the parents reported their children's internalizing and externalizing problems via Child Behavior Checklist, and the children self‐reported anxiety symptoms via Screen for Child Anxiety Related Emotional Disorders in the second phase of the study. Results The results showed that parental emotion dysregulation played an important role as a mediator of the relationship between parental psychopathological symptoms and child internalizing problems and separation anxiety, which indicates that parents' mental health problems were significantly associated with their difficulties with emotion regulation, which in turn led to more internalizing problems and separation anxiety in their children. However, we did not find a mediating effect of parental emotion dysregulation on the links between parent psychopathology and child externalizing problems or other types of self‐reported anxiety symptoms. Conclusions Our findings highlighted the importance of implementing more psycho‐education programs that specifically target parents' emotion regulation abilities in both community and clinical settings to ameliorate the intergenerational transmission of psychopathological symptoms between generations.
    May 20, 2016   doi: 10.1111/camh.12169   open full text
  • Survey of schools’ work with child and adolescent mental health across England: a system in need of support.
    Helen Sharpe, Tamsin Ford, Suzet Tanya Lereya, Chris Owen, Russell M. Viner, Miranda Wolpert.
    Child and Adolescent Mental Health. May 08, 2016
    Background With evidence of rising need around mental health in young people, cuts in specialist health provision and increasing recognition of the central role of schools in supporting young people with mental health problems, it is important to understand the provision of mental health support currently available in schools, the nature of the relationship with health and other providers of child and adolescent mental health (CAMH) services, and what are the key barriers to accessing support. Method The study was a convenience sample survey of 577 school staff from 341 schools in England. Participants completed an online survey about the provision of specialist mental health support in their school, including what support is available, who provides it, and perceived barriers to supporting the mental health of young people. Data were linked to publicly available data on school characteristics. Results Over two thirds of schools reported having some specialist support available, with specialist provision more common in secondary schools. Staff training and whole‐school approaches were the most frequently employed specific approaches. Support was most often provided by educational psychologists, followed by counsellors. School staff particularly valued support and feedback within the schools context. The most frequently cited barrier to mental health support was the limited capacity of specialist CAMH services. Conclusions The results suggest a need to enhance the availability of specialist support for mental health both within schools and in CAMH services.
    May 08, 2016   doi: 10.1111/camh.12166   open full text
  • The impact of caregiver treatment satisfaction upon child and parent outcomes.
    Mary Acri, Lindsay A. Bornheimer, Lauren Jessell, Hanni B. Flaherty, Mary M. McKay.
    Child and Adolescent Mental Health. May 02, 2016
    Background Parental perceptions about treatment influence their child's engagement in and ongoing utilization of mental health services, but less is known about the association between caregiver expectancies and family outcomes. The literature is particularly lacking with families of color, who are at high risk for the onset and perpetuation of disruptive behaviors. Methods The purpose of this study was to examine caregiver treatment satisfaction among 320 youth of color aged 7–11 and their families who were assigned to either a Multiple Family Group intervention or services‐as‐usual condition. Caregiver stress was measured by the Parenting Stress Index‐Short Form full scale and child oppositional defiant behaviors were measured using the Iowa Connors Rating Scale–Oppositional/Defiant subscale both at baseline and post‐test. Satisfaction with treatment was measured using the Metropolitan Area Child Study process measures program satisfaction subscale at post‐test. Results The two main effects models that focused on satisfaction with treatment were predictive of parental stress and child oppositional defiant behaviors independently. Satisfaction with treatment accounted for 31% of the variance in child oppositional behavior and 24% of parental stress improvements across time, holding all covariates constant. Conclusions Our findings support previous research that shows parental expectancies, including treatment satisfaction, are powerful mechanisms of treatment outcomes for children with disruptive behavior disorders as well as parental emotional health. Furthermore, parental expectancies may be enhanced by the involvement of families in the development of treatment approaches for children and a greater focus on caregiver emotional health for the benefit of the family as a whole.
    May 02, 2016   doi: 10.1111/camh.12165   open full text
  • Mental health provision in schools: priority, facilitators and barriers in 10 European countries.
    Praveetha Patalay, Laura Giese, Miloš Stanković, Catriona Curtin, Bettina Moltrecht, Dawid Gondek.
    Child and Adolescent Mental Health. April 27, 2016
    Background Although schools are a key setting for the provision of mental health support for young people, little is known about the facilitators and barriers for providing such support. This study aimed to collect information from schools in 10 European countries regarding the priority given to mental health support for students, existence of a mental health‐related school policy, links with relevant external agencies, schools’ perceptions on whether they are providing sufficient mental health support and the barriers to provision of mental health support. Methods Data from 1346 schools were collected in France, Germany, Ireland, the Netherlands, Poland, Serbia, Spain, Sweden, United Kingdom and Ukraine through an online survey. Results Around 3% of the surveyed schools indicated that mental health provision was not a priority, compared to 47% indicating that it was a high/essential priority. More than half the surveyed schools did not implement a school policy regarding mental health. Half the surveyed schools reported not providing sufficient support with the key barriers identified including limited staff capacity, funding, access to specialists and lack of national policy and less than a third of schools reported good or excellent links with local mental health services. However, the responses varied by country with 8–19% between‐country variation across the study outcomes. Secondary schools reported significantly better links with agencies, were more likely to have a school policy and were less likely to indicate having sufficient existing support compared to primary schools. Privately funded schools reported that mental health support was a higher priority and identified less barriers to provision compared to publicly funded schools. Conclusions This study provides an up‐to‐date and cross‐country insight into schools’ perceptions regarding priority given to mental health support and the barriers they face in providing sufficient mental health and wellbeing support for their students. The cross‐country comparisons allow for a better understanding of the relationships between policy, practice and implementation and provide a platform for shared experiences and learning.
    April 27, 2016   doi: 10.1111/camh.12160   open full text
  • A school consultation intervention for adolescents with ADHD: barriers and implementation strategies.
    Margaret H. Sibley, Sandra Olson, Candance Morley, Mileini Campez, William E. Pelham.
    Child and Adolescent Mental Health. April 08, 2016
    Background Academic impairment is among the most troubling domains of impairment for adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). Method This investigation presents results of a yearlong academic intervention delivered to adolescents with ADHD (N = 218) by engaging school staff as interventionists through behavioral consultation with an outside mental health professional. Results The intervention was coordinated successfully in some cases, but not in others. The principal challenge to intervention coordination was sustaining monthly contact between consultants and interventionists (38.5% success rate) and scheduling in‐person consultation meetings with interventionists (40.0% success rate). Implementation of the intervention was enhanced when the student (a) attended a public (vs. private) school, (b) had an IEP or Section 504 plan in place, (c) was in middle school (vs. high school), (d) had a parent who communicated regularly with the school, and (e) had a special education support staff member or counselor (vs. teacher or administrator) as a school interventionist. Conclusions Considering these data, recommendations are provided for effective coordination of academic interventions for adolescents with ADHD.
    April 08, 2016   doi: 10.1111/camh.12159   open full text
  • A pilot randomized controlled trial comparing computer‐assisted cognitive rehabilitation, stimulant medication, and an active control in the treatment of ADHD.
    Saeed Azami, Alireza Moghadas, Faramarz Sohrabi‐Esmrood, Morteza Nazifi, Mahdieh Mirmohamad, Fatemeh Hemmati, Ameneh Ahmadi, Pariya Hamzeh‐poor, Saeedeh Khari, Kimberley Lakes.
    Child and Adolescent Mental Health. April 07, 2016
    Background This research aimed to compare computer‐assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of ADHD using a multiarm parallel design. Methods Thirty‐four boys with ADHD, aged 7–12, were randomly assigned to either CACR (n = 12), MED (n = 11), or PCACR (n = 11). However, the study was not blinded and medication doses might be suboptimal given the lack of titration. Continuous performance test, Tower‐of‐London, forward/backward digit span, span board, Raven's progressive matrices, and SNAP‐IV were completed at baseline, posttest, and follow‐up. Results Computer‐assisted cognitive rehabilitation outperformed both MED and PCACR on backward digit span at posttest and PCACR at follow‐up. CACR outperformed PCACR and MED on forward digit span at posttest and PCACR at follow‐up. CACR outperformed MED on span board at posttest. CACR outperformed PCACR and MED on Raven's matrices at posttest. CACR and PCACR scored lower than MED on ADHD‐PHI at posttest. CACR scored lower than MED on ADHD‐C at posttest. Conclusions Immediately after interventions, CACR improved certain simple executive functions (EFs) as much as active stimulant medication. On complex EFs, CACR was superior to active stimulant medication and PCACR. CACR reduced behavioral symptoms of ADHD more than active stimulant medication. However, at 3‐month follow‐up, maintenance of the CACR gains was weak.
    April 07, 2016   doi: 10.1111/camh.12157   open full text
  • Readability of clinical letters sent from a young people's department.
    Elena McAndie, Anne Gilchrist, Boolang Ahamat.
    Child and Adolescent Mental Health. April 01, 2016
    Background Writing directly to patients or copying letters to them is common practice in Child and Adolescent Mental Health Services (CAMHS). If the intention is to increase young people's understanding and collaboration in their health care, then the readability of such letters is important. The aim of this study was to reassess the readability of letters sent to patients from the Young People's Department at Royal Cornhill Hospital since it adopted the choice and partnership approach (CAPA). Method Readability of clinical letters was measured using indices available in Microsoft Word. Results were compared to readability thresholds. Results Most letters sent to patients were still not easily readable. Conclusions Awareness of easily accessible readability formulae has not led to acceptable levels of readability in letters. More needs to be done to investigate patients’ views and improve communication.
    April 01, 2016   doi: 10.1111/camh.12158   open full text
  • Caught in the eye of the storm: a qualitative study of views and experiences of planned drug holidays from methylphenidate in child and adolescent ADHD treatment.
    Kinda Ibrahim, Carsten Vogt, Parastou Donyai.
    Child and Adolescent Mental Health. March 18, 2016
    Background Attention deficit hyperactivity disorder (ADHD) can be treated with stimulant medication such as methylphenidate. Although effective, methylphenidate can cause serious side‐effects, including suppressed appetite, growth retardation and sleep problems. A drug holiday is a deliberate interruption of pharmacotherapy for a defined period of time and for a specific clinical purpose, for example for appeasing side‐effects. While some international guidelines recommend introducing drug holidays in ADHD treatment, this is not practised routinely. Our aim was to examine the views and experiences of planned drug holidays from methylphenidate with adults who have responsibility for treatment decisions in children and adolescents with ADHD. Method In‐depth interviews were carried out. Child and Adolescent Mental Health Services practitioners (n = 8), General practitioners (n = 8), teachers (n = 5) and mothers of children with ADHD (n = 4) were interviewed in a UK setting. Interview transcripts were analysed using grounded theory. Results Methylphenidate eases the experience of the child amid problems at home and at school and once started is mostly continued long term. Some families do practise short‐term drug holidays at weekends and longer term ones during school holidays. The decision to introduce drug holidays is influenced by the child's academic progress, the parents' ability to cope with the child, as well as medication beliefs. Trialling a drug holiday is thought to allow older children to self‐assess their ability to manage without medication when they show signs of wanting to discontinue treatment prematurely. Conclusions Planned drug holidays could address premature treatment cessation by enabling adolescents to assess repercussions under medical supervision.
    March 18, 2016   doi: 10.1111/camh.12156   open full text
  • An investigation into GPs' perceptions of children's mental health problems.
    Chris Owen Jacobs, Maria Elizabeth Loades.
    Child and Adolescent Mental Health. January 30, 2016
    Background Mental health disorders in children are common. General practitioners (GPs) have a significant role in the detection of these disorders, yet there is lack of evidence to assess this ability. This study aimed to explore GPs' recognition of children's mental health problems, examining GPs' ability to identify both a common emotional and behavioural disorder. Method Between November 2014 and March 2015, an online survey‐based questionnaire measure was used, composed of a series of six clinical vignettes designed to assess GPs' mental health literacy with respect to children of primary school age. This included recognition accuracy, rating of problem severity, and degree of concern about hypothetical cases, described in the vignettes. Results Of the 97 participants, all identified the clinical level separation anxiety disorder and 97.9% identified the clinical level oppositional defiant disorder. Nonparametric analyses identified a significant difference (Z = −5.44, p < .0001, r = .55) in the GPs' concern for the child with clinical oppositional defiant disorder versus the concern for the child with clinical separation anxiety disorder. Participants were significantly more concerned about a boy presenting with clinical separation anxiety (Z = −7.18, p < .001, r = .72) than a girl. Also, participants were significantly more concerned about a boy presenting with clinical level oppositional defiance (Z = −7.79, p < .001, r = .79). Conclusion This study shows the majority of GPs can identify a primary school child with clinical level symptoms of either a common emotional or behavioural disorder described in a written vignette. However, GPs were more concerned when the child was male or displaying symptoms of a behavioural disorder.
    January 30, 2016   doi: 10.1111/camh.12143   open full text
  • What is special about a Paediatric Liaison Child and Adolescent Mental Health service?
    M Elena Garralda, Karmen Slaveska‐Hollis.
    Child and Adolescent Mental Health. January 22, 2016
    Background The paediatric population is known to be at high risk for psychiatric problems. Paediatric liaison child/adolescent mental health services (PL‐CAMHS) have been developed to help increase recognition and management of psychiatric morbidity in the paediatric setting. This report describes clinical activity by a psychological medicine PL‐CAMHS and considers specificity by comparing this with community/general CAMHS activity. Method Clinical information was obtained on consecutive patients seen by a PL‐CAMHS in a UK tertiary specialist hospital. Where feasible this was compared with published data on national/community CAMHS work. Results Data was obtained on 800 patients (mean age 11.9, SD 3.8). Most referrals came from a variety of paediatric teams, nearly two‐thirds were for psychosomatic problems or difficulties adjusting to physical illness. The majority had an ICD‐10 psychiatric diagnosis (mostly adjustment, mood and anxiety, and somatoform disorders); problems were often complex and in about half, family difficulties were also noted; one‐third had received prior mental health treatment. Virtually all children were seen by the PL service within a month of referral and only 2% of families failed to attend for assessment. Some level of clinical improvement was noted for the majority. There were indications of differences from national/community CAMHS work in referral source, take up rates and psychiatric diagnoses. Conclusions Paediatric liaison child and adolescent mental health services users commonly have characteristic psychiatric problems, interventions appear potentially effective and the work is specific and complementary of community CAMHS. Thus PL‐CAMHS make a distinct contribution to the provision of truly comprehensive CAMHS.
    January 22, 2016   doi: 10.1111/camh.12146   open full text
  • The association of organized and unorganized physical activity and sedentary behavior with internalizing and externalizing symptoms in Hispanic adolescents.
    Lila Asfour, Maryann Koussa, Tatiana Perrino, Mark Stoutenberg, Guillermo Prado.
    Child and Adolescent Mental Health. December 17, 2015
    Background Literature suggests that physical activity (PA) and sedentary behavior may be associated with adolescent mental health symptoms. A gap in the literature is whether different types of PA have unique impacts on internalizing and externalizing symptoms. This study separately assesses the association of organized PA, unorganized PA, and sedentary behavior with internalizing and externalizing symptoms. Method This study analyzed baseline data from a randomized controlled trial of a preventive intervention with 575 Hispanic adolescents. Using separate multivariable linear mixed models, the relationship between the independent variables of PA and sedentary behavior and the dependent variables of internalizing and externalizing symptoms was evaluated. Results Organized PA was not associated with internalizing or externalizing symptoms; however, higher levels of unorganized PA were associated with greater internalizing and externalizing symptoms. Increased sedentary behavior was also associated with higher levels of externalizing symptoms, but not internalizing symptoms. Conclusions Implications of this study highlight the need to examine types of PA separately as they may differentially influence adolescent mental health symptoms. Potential explanations for these findings and suggested further analyses are discussed.
    December 17, 2015   doi: 10.1111/camh.12139   open full text
  • Service users as the key to service change? The development of an innovative intervention for excluded young people.
    Sally Zlotowitz, Chris Barker, Olive Moloney, Charlotte Howard.
    Child and Adolescent Mental Health. November 09, 2015
    Background Excluded young people, especially those affected by street gangs, often have complex unmet needs and high levels of health and social inequalities. This paper outlines the development of Music & Change, an innovative and comprehensive intervention accessible to young people, which aimed to holistically meet the mental health and other needs of its participants and ultimately to reduce offending rates. Its central principle was coproduction and partnership with its potential users. Method The setting was an inner‐city housing estate; the core group of participants was 15 young people aged 16–22 years. The intervention used contemporary music skills (e.g. DJ‐ing and lyric writing) and other coproduced project activities as a vehicle to build relationships with practitioners and address young people's multiple needs. Data were gathered using a focused ethnography, largely from field notes, and analysed using thematic analysis in order to ascertain users’ perceptions of its delivery. Results Young people identified six key principles of the intervention, such as the need for consistent relationships with trusted staff, mental health support to be wrapped round other youth‐led activities and local service delivery within their safe territories. Conclusions Music & Change was valued by young people who do not easily engage with professionals and services. The findings led to the development of the ‘Integrate’ model, which is using these coproduced principles to underpin several new pilot projects that aim to address the health and social inequalities of excluded young people.
    November 09, 2015   doi: 10.1111/camh.12137   open full text
  • Acceptability, reliability, referential distributions and sensitivity to change in the Young Person's Clinical Outcomes in Routine Evaluation (YP‐CORE) outcome measure: replication and refinement.
    Elspeth Twigg, Mick Cooper, Chris Evans, Elizabeth Freire, John Mellor‐Clark, Barry McInnes, Michael Barkham.
    Child and Adolescent Mental Health. November 03, 2015
    Background Many outcome measures for young people exist, but the choices for services are limited when seeking measures that (a) are free to use in both paper and electronic format, and (b) have evidence of good psychometric properties. Method Data on the Young Person's Clinical Outcomes in Routine Evaluation (YP‐CORE), completed by young people aged 11–16, are reported for a clinical sample (N = 1269) drawn from seven services and a nonclinical sample (N = 380). Analyses report item omission, reliability, referential distributions and sensitivity to change. Results The YP‐CORE had a very low rate of missing items, with 95.6% of forms at preintervention fully completed. The overall alpha was .80, with the values for all four subsamples (11–13 and 14–16 by gender) exceeding .70. There were significant differences in mean YP‐CORE scores by gender and age band, as well as distinct reliable change indices and clinically significant change cut‐off points. Conclusions These findings suggest that the YP‐CORE satisfies standard psychometric requirements for use as a routine outcome measure for young people. Its status as a free to use measure and the availability of an increasing number of translations makes the YP‐CORE a candidate outcome measure to be considered for routine services.
    November 03, 2015   doi: 10.1111/camh.12128   open full text
  • Alternatives to inpatient care for children and adolescents with mental health disorders.
    Ka Ho Robin Kwok, Sze Ngar Vanessa Yuan, Dennis Ougrin.
    Child and Adolescent Mental Health. September 23, 2015
    Background Intensive community services may provide an alternative to inpatient care but there is little systematic evidence of their efficacy. This article provides a systematic review of randomized controlled trials (RCTs) reporting efficacy of intensive community services versus inpatient care in youth. Method Data sources were identified by searching Medline, PsychINFO and EMBASE databases as of December 2014. RCTs comparing intensive community services versus inpatient care in children and adolescents (through age 18) were included. Results Six unique RCTs including 569 youth were identified. The RCTs examined the efficacy of specialist outpatient treatment, multisystemic therapy, day patient treatment, intensive home treatment and supported discharge services versus inpatient care. Using intensive community services was associated with clinical improvements similar to inpatient care in most studies. Where differences in clinical outcomes existed, they tended to favour intensive community treatment. Using intensive community services was associated with shorter hospitalizations, lower costs and greater patient satisfaction. There were no independent replications of the results. Few studies investigated the use of intensive community treatment as an alternative to inpatient care in children and adolescents with severe immediate risk to self and others. Conclusions Intensive community services appear to be a viable alternative to inpatient care. Independent replication of results achieved by specific intensive community treatment models is a research priority.
    September 23, 2015   doi: 10.1111/camh.12123   open full text
  • Moderators of intensive cognitive behavioral therapy for adolescent panic disorder: the roles of fear and avoidance.
    R. Meredith Elkins, Kaitlin P. Gallo, Donna B. Pincus, Jonathan S. Comer.
    Child and Adolescent Mental Health. September 08, 2015
    Background Research supports the efficacy of intensive cognitive behavioral therapy (CBT) for the treatment of adolescent panic disorder with or without agoraphobia (PDA). However, little is known about the conditions under which intensive treatment is most effective. The current investigation examined the moderating roles of baseline fear and avoidance in the intensive treatment of adolescent PDA. Methods Adolescents with PDA (ages 11–17; N = 54) were randomized to either an intensive CBT treatment (n = 37) or a waitlist control condition (n = 17). PDA diagnosis, symptom severity, and number of feared and avoided situations were assessed at baseline and 6‐week posttreatment/postwaitlist. Hierarchical regression analyses examined the relative contributions of treatment condition, number of baseline feared or avoided situations, and their interactions in the prediction of posttreatment/waitlist PDA symptoms. Results The main effect of intensive CBT on posttreatment PDA symptoms was not uniform across participants, with larger treatment effects found among participants with lower, relative to higher, baseline levels of fear and avoidance. Conclusions Findings help clarify which adolescents suffering with PDA may benefit most from an intensive treatment format.
    September 08, 2015   doi: 10.1111/camh.12122   open full text
  • Review: Effectiveness of mindfulness in improving mental health symptoms of children and adolescents: a meta‐analysis.
    Kannan Kallapiran, Siew Koo, Richard Kirubakaran, Karen Hancock.
    Child and Adolescent Mental Health. August 06, 2015
    Background Mindfulness‐based interventions (MBIs) are increasingly used in the management of various mental health disorders in children and adolescents. However, there is limited evidence about the efficacy of various interventions used. Method A systematic review was performed to examine the effects of different MBIs on mental health symptoms and quality of life in both clinical and nonclinical samples of children and adolescents using data from only randomized control trials. The studies were also assessed for quality. Based on the type of MBI, study population, and control arm we had three comparisons for meta‐analyses. Results Fifteen studies were included in the qualitative analysis but only 11 trials with comparable interventions and controls were included for meta‐analyses. Mindfulness‐based stress reduction/mindfulness‐based cognitive therapy arm was more effective than nonactive control in the nonclinical populations. Acceptance commitment therapy was comparable to active treatments in patients in the clinical range. Other MBIs were also effective improving anxiety and stress but not depression in nonclinical populations compared to nonactive control. Conclusions Mindfulness‐based interventions can be effective in children and adolescents with mental health symptoms. As there were significant limitations these results must be interpreted with caution.
    August 06, 2015   doi: 10.1111/camh.12113   open full text
  • Modulation of prefrontal‐cingulate connectivity in affective processing of children with experiences of ostracism.
    Chang‐hyun Park, Ji‐Eun Lee, Young‐Hoon Kim, Ki‐Tae Kim, Young‐Joo Kim, Kyoung‐Uk Lee.
    Child and Adolescent Mental Health. July 28, 2015
    Background The anterior cingulate cortex (ACC) has been shown to be involved in emotional distress induced by social exclusion and the ventrolateral prefrontal cortex (VLPFC) in the regulation or inhibition of the distress. Here, we examined modulation of effective connectivity between the regions in response to emotional feedback in children with experiences of ostracism in their everyday life. Methods In functional magnetic resonance imaging experiments, 10 ostracized children and 11 control children were provided emotional feedback inducing negative or positive affective states. We employed effective connectivity analysis to explore connectivity models comprising the VLPFC and ACC, and to estimate connectivity parameters over the models. Results In spite of psychological impacts on the ostracized children, behavioral data showed that their emotional responses did not deviate from the control children in response to the emotional feedback. The VLPFC to ACC connectivity was modulated only in the ostracized children, such that the modulation may help them regulate their emotional responses. Conclusions The findings suggest that the effects of ostracism experiences on affective processing can be revealed in terms of modulation of prefrontal‐cingulate connectivity.
    July 28, 2015   doi: 10.1111/camh.12114   open full text
  • Dialectical behavior therapy for nonsuicidal self‐injury and depression among adolescents: preliminary meta‐analytic evidence.
    Nathan E. Cook, Maggie Gorraiz.
    Child and Adolescent Mental Health. July 08, 2015
    Background Dialectical behavior therapy (DBT) has proven effective in reducing symptoms and behaviors related to Borderline Personality Disorder. More recently, it has been modified and applied to adolescents struggling with regulating their emotions and who may engage in impulsive, self‐destructive behaviors, including nonsuicidal self‐injury (NSSI). However, there is limited research evidence regarding the effectiveness of DBT for reducing NSSI behavior and depression among adolescents. Given the high suicide risk associated with NSSI and its association with depression, this is clearly an important focus of clinical and research attention. Method This meta‐analysis sought to offer preliminary evidence regarding the effectiveness of DBT to treat NSSI and depression in adolescents. Twelve published studies were included; all 12 reported pre‐ and post‐treatment measures of depression and six of these studies reported pre‐ and post‐treatment measures of NSSI. Results The weighted mean effect size for NSSI was large (g = 0.81, 95% CI = 0.59–1.03); the weighted mean effect size for depression was small (g = 0.36, 95% CI = 0.30–0.42). Conclusions Intervention effects for both outcomes were positive, suggesting decreased NSSI and improvement in depressive symptoms for adolescents following a course of DBT. However, given considerable limitations in the research base available for meta‐analysis, these findings are preliminary and tentative. Limitations in the current knowledge base and suggestions for future research are discussed.
    July 08, 2015   doi: 10.1111/camh.12112   open full text
  • The association between parental imprisonment and the mental health of Palestinian adolescents.
    Amer Shehadeh, Gerrit Loots, Johan Vanderfaeillie, Ilse Derluyn.
    Child and Adolescent Mental Health. June 26, 2015
    Background Since 1967, the Palestinian Occupied Territories are marked by a protracted political conflict. During this conflict, about one fifth of the Palestinian population has been detained; a considerable part of them having children outside prison. Although parental detention negatively impacts children's psychological well‐being, little is known about this impact within contexts of protracted armed conflict. Therefore, this study aimed at gaining insight into the impact of parental detention onto adolescents' psychological well‐being. Method Of 314 (11‐ to 18‐year old) Palestinian adolescents who took part, the fathers of 204 adolescents were detained in Israeli prisons. The adolescents completed two self‐report questionnaires: the UCLA‐PTSD‐Reaction Index, investigating symptoms of posttraumatic stress, and the Strengths and Difficulties Questionnaire, looking at overall psychological problems. Several hierarchical regression analyses investigated mental health differences between both the groups, and possible associations between sociodemographic characteristics and the witnessing of the father's arrest, and the mental health outcomes. Results Parental detention largely impacted adolescents' mental health, with one fifth to two thirds of the adolescents reporting considerable mental health problems. Witnessing the arrest of the father even increased this risk considerably. Above, girls, younger adolescents, participants living in refugee camps, and those living with extended families also reported higher scores on both questionnaires. Conclusions Detention of fathers in the context of protracted armed conflicts has a large impact on adolescents' mental health. Besides an overall plea to end armed conflicts as fast as possible, the study also delineates considerable implications for the support and care for these adolescents and their families.
    June 26, 2015   doi: 10.1111/camh.12111   open full text
  • Development and validation of the Healthy‐Unhealthy Music Scale.
    Suvi Saarikallio, Christian Gold, Katrina McFerran.
    Child and Adolescent Mental Health. May 18, 2015
    Background Music is an integral part of life in youth, and although it has been acknowledged that musical behavior reflects broader psychosocial aspects of adolescent behavior, no measurement instruments have been specifically designed for assessing musical engagement as an indicator of adolescent wellbeing and/or symptomatology. This study was conducted in order to develop and validate a scale for assessing musical engagement as an indicator of proneness for depression in youth. Method Items were developed based on the literature and a prior grounded theory analysis and three surveys (N = 54, N = 187, N = 211) were conducted to select, refine, test, and validate the items. Scale structure was investigated through interitem correlations, exploratory and confirmatory factor analyses (EFA, CFA), and concurrent validity was tested with correlations to depression and wellbeing. Results The final Healthy‐Unhealthy Music Scale (HUMS) consists of 13 items that are divided into Healthy and Unhealthy subscales. Cronbach's alpha coefficients were .78 for Healthy and .83 for Unhealthy. The concurrent validity of the HUMS was confirmed through correlations to wellbeing, happiness and school satisfaction on one hand and depression, rumination, and stress on the other. Conclusions The HUMS is as a promising instrument for screening musical engagement that is indicative of proneness for depression in youth.
    May 18, 2015   doi: 10.1111/camh.12109   open full text
  • The role of parental and peer attachment relationships and school connectedness in predicting adolescent mental health outcomes.
    Jeremy Oldfield, Neil Humphrey, Judith Hebron.
    Child and Adolescent Mental Health. May 18, 2015
    Background Adolescent attachment relationships with parents and peers and the sense of connectedness with the schools attended have been established as salient predictors of psychological well‐being. Few studies, however, have assessed the relative importance of each attachment or connectedness relationship and how they interrelate to influence mental health outcomes. Method A total of 203 adolescents (11–16 years) completed self‐report measures of parental and peer attachment (Inventory of Parental & Peer Attachment – Revised; Gullone & Robinson, ); school connectedness (Psychological Sense of School Membership; Goodenow, ); conduct problems, emotional symptoms and prosocial behaviour (Strengths and Difficulties Questionnaire; Goodman, ). Results Multiple regression analyses demonstrated that more insecure parental attachment (although not peer attachment or school connectedness) predicted conduct problems and emotional difficulties. Peer attachment and school connectedness were significant predictors of prosocial behaviour, whereas parental attachment was not. A mediational analysis revealed that peer attachment and school connectedness both mediate the relationship between parental attachment and prosocial behaviour. No significant moderation effects of either peer attachment or school connectedness on the relationship between parental attachment and mental health outcomes were found. Conclusions Different attachment and connectedness relationships, although related, predict adolescent mental health outcomes in distinct ways. Improving parental attachment may have particular salience in reducing negative behaviours such as conduct problems and emotional difficulties, whereas improving peer attachment and school connectedness could be important for the display of prosocial behaviour.
    May 18, 2015   doi: 10.1111/camh.12108   open full text
  • Effectiveness of brief school‐based, group cognitive behavioural therapy for depressed adolescents in south west Nigeria.
    Tolulope Bella‐Awusah, Cornelius Ani, Ademola Ajuwon, Olayinka Omigbodun.
    Child and Adolescent Mental Health. April 18, 2015
    Background There is paucity of evidence‐based psychological interventions for depressive disorders in Africa, more so among depressed children and adolescents. This study aimed to determine the effects of a school‐based cognitive behavioural therapy programme (CBT) on depressed adolescents in South West Nigeria. Methods Forty students who scored 18 or above on the Beck Depression Inventory (BDI) were recruited from two schools (20 from each school). One school was designated intervention and the other a wait‐list control school. Five weekly sessions of group CBT programme were conducted in the intervention school. Primary outcome measure was the Beck Depression Inventory, and secondary outcome measures were the Short Mood and Feelings Questionnaire and the Impact Supplement of the Strengths and Difficulties Questionnaire. Results Controlling for baseline scores and other confounders, the intervention group had significantly lower depressive symptoms scores on the BDI and SMFQ 1 week post intervention with large effect sizes. The intervention group maintained the treatment effect with significantly lower depression scores 16 weeks post intervention compared with their baseline scores. The effect sizes remained large. The intervention and control groups did not differ in their SDQ impact supplement scores post intervention, but the intervention group improved significantly on this measure at 16 weeks. Conclusions To our knowledge, this is the first study of a school‐based group CBT programme for depressed adolescents in Africa. The programme showed good feasibility and promising effectiveness.
    April 18, 2015   doi: 10.1111/camh.12104   open full text
  • Prevalence of traumatic events and risk for psychological symptoms among community and at‐risk children and adolescents from Bangladesh.
    Farah Deeba, Ronald M. Rapee.
    Child and Adolescent Mental Health. April 02, 2015
    Background Children from developing countries are more vulnerable to traumatic experiences and more likely to suffer a range of psychological problems than children from developed countries. Method The current paper describes a survey of 1360 children and adolescents from Bangladesh who were selected either from the general community or through a range of social service organizations. Children completed a checklist of traumatic events and questionnaires to assess symptoms of PTSD, anxiety and depression. Results Children from both samples reported high levels of exposure to traumatic events, both via direct experience and indirectly. Direct experiences with intentional, man‐made events were more frequently reported by children from support services while trauma from natural disasters was more common among community children. Psychological symptoms were significantly higher within children from social support services. The strongest predictors of psychological symptoms were age, gender, sample source and exposure to man‐made direct traumas. Conclusion The results point to the common occurrence of traumatic events and their emotional consequences among children and adolescents from Bangladesh and indicate the need to develop effective and accessible mental health services for Bangladeshi children and adolescents.
    April 02, 2015   doi: 10.1111/camh.12093   open full text
  • Crowell problem solving procedure: a psychometric analysis of a laboratory measure of the caregiver–child relationship.
    Ginny Sprang, Carlton Craig.
    Child and Adolescent Mental Health. December 02, 2014
    Background Many decades of research demonstrates that the presence of and perceived quality of the parent–child bond can impact a child's health, mental health, and interpersonal trajectory for a lifetime (Weinfield, Sroufe, Egeland, & Carlson, 1999 Handbook of attachment: Theory, research, and clinical applications. New York: Guilford Press, 68; Lieberman, Infant Mental Health Journal, 25, 336, 2004). However, investigations regarding the utility of methods to evaluate the quality and nature of caregiver–child interactions are limited. Using clinical data from 151 caregiver–child dyads, this study examines the psychometric properties of the Crowell Problem Solving Procedure Rating Scale using exploratory factor analysis. Additionally, the predictive validity of the coding system was examined via comparisons with the Parent–Infant Relationship Global Assessment Scale (PIRGAS). Findings The child and adult scales were each psychometrically defined by a single factor that was internally consistent and well‐defined conceptually by the representative items. High internal consistency for each scale provides support for the reliability of the rating scale, and suggests that the Crowell scores can be useful as two separate scales measuring a child's affective presentation and caregiver responsiveness, but also collectively as a total score assessing overall relational functioning. Aspects of the caregiver–child relationship were significantly related to PIRGAS scores on the child and adult domains. Conclusions The results of this study suggest the Crowell Problem Solving Procedure Rating Scale is a brief tool, with good internal consistency, that can assess a wide range of young children, in a clinical setting.
    December 02, 2014   doi: 10.1111/camh.12082   open full text
  • Identifying the interactional processes in the first assessments in child mental health.
    Michelle O'Reilly, Khalid Karim, Victoria Stafford, Ian Hutchby.
    Child and Adolescent Mental Health. October 09, 2014
    Background A comprehensive assessment is essential to contemporary practice in child and adolescent mental health. In addition to determining diagnosis and management, it is seen as important for clinical engagement and forming a therapeutic relationship. However, there has been little research on the processes which occur during this interaction, particularly in first assessments. Method Twenty‐eight naturally occurring child mental health initial assessments were video recorded and subjected to the basic principles of the conversation analytic method. Results Several processes were identified in a typical child and adolescent mental health assessment. These included introductions, reasons for attendance, problem presentation, decision‐making and session closure. Conclusions Initial assessments provide a platform for all future engagement with services and an understanding of the processes occurring within this setting is important for the eventual outcomes, particularly in respect to new ways of working such as the Choice and Partnership Approach (CAPA).
    October 09, 2014   doi: 10.1111/camh.12077   open full text
  • Nonsuicidal self‐injury as an affect‐regulation strategy and the moderating role of impulsivity.
    Rossella Di Pierro, Irene Sarno, Marcello Gallucci, Fabio Madeddu.
    Child and Adolescent Mental Health. April 18, 2014
    Background Nonsuicidal self‐injury (NSSI) is used to cope with negative affect states. We investigated the association between impulsivity and this affect‐regulation process. Method Affect states associated with NSSI and impulsivity traits were evaluated in 30 Italian adolescent self‐injurers (63.3% female, mean age = 16.63, SD = 0.56). Results Nonsuicidal self‐injury was associated with decreases in affective arousal, but impulsivity moderated other affective changes. High impulsivity was associated with increases in negative high‐arousal affects after NSSI, whereas low impulsivity was associated with increases in positive affects after NSSI. Conclusion Impulsivity traits influenced the success or failure of the NSSI affect‐regulation process.
    April 18, 2014   doi: 10.1111/camh.12063   open full text
  • Behavioural treatment recommendations in clinical practice guidelines for attention‐deficit/hyperactivity disorder: a scoping review.
    Isabelle A. Vallerand, Anna L. Kalenchuk, John D. McLennan.
    Child and Adolescent Mental Health. April 10, 2014
    Background The extent of behavioural treatment recommendations described in attention‐deficit/hyperactivity disorder (ADHD) practice guidelines has not been examined. Method A scoping review identified eight agency‐based ADHD practice guidelines. Key components of behavioural treatment recommendations were summarized. Results All guidelines mentioned behavioural treatment as a consideration for managing ADHD, however, the extent to which they were detailed varied. Most guidelines provided lists of behavioural techniques but with minimal specifics regarding treatment delivery. Conclusions There is far less detailing of behavioural approaches compared to pharmacological treatments for ADHD. Greater detailing of evidence‐based behavioural approaches may foster improved delivery of high‐quality behaviour treatment.
    April 10, 2014   doi: 10.1111/camh.12062   open full text
  • A longitudinal examination of emotion regulation: pathways to anxiety and depressive symptoms in urban minority youth.
    Johanna B. Folk, Janice L. Zeman, Jennifer A. Poon, Danielle H. Dallaire.
    Child and Adolescent Mental Health. March 15, 2014
    Background Difficulty regulating emotions is a symptom of many psychological disorders yet little research has examined the longitudinal relations of particular facets of emotion regulation (ER) that may differentiate between internalizing symptoms. Method At‐risk youth (n = 102; 44.1% boys, 77.5% Black; Mage = 9.65) and caregivers (n = 74; 87.1% mothers) participated in a 2‐year longitudinal study. Children reported on their ER, and children and caregivers on symptomatology. Results Different patterns, varying by emotion facet (dysregulation, inhibition, coping) and type (anger, sadness, worry), predicted anxiety and depression symptoms. Conclusions Anxiety and depression are entities with distinct patterns of emotion‐related antecedents.
    March 15, 2014   doi: 10.1111/camh.12058   open full text
  • Taming the adolescent mind: a randomised controlled trial examining clinical efficacy of an adolescent mindfulness‐based group programme.
    Lucy Tan, Graham Martin.
    Child and Adolescent Mental Health. February 28, 2014
    Background Mindfulness interventions with adolescents are in the early stages of development. This study sought to establish efficacy of a mindfulness‐based group intervention for adolescents with mixed mental health disorders. Method One hundred and eight adolescents (ages 13–18) were recruited from community mental health clinics and randomised into two groups (control vs. treatment). All participants received treatment‐as‐usual (TAU) from clinic‐based therapists independent of the study. Adolescents in the treatment condition received TAU plus a 5‐week mindfulness‐training programme (TAU+Mi); adolescents in the control group received only TAU. Assessments including parent/carer reports were conducted at baseline, postintervention and 3‐month follow‐up. Results At postintervention, adolescents in the mindfulness condition experienced significant decrease in mental distress (measured with the DASS‐21) compared to the control group (Cohen's d = 0.43), and these gains were enhanced at 3‐month follow‐up (Cohen's d = 0.78). Overall outcomes at 3 months showed significant improvement for adolescents in the mindfulness condition; in self‐esteem, mindfulness, psychological inflexibility and mental health, but not resilience. Parents/carers also reported significant improvement in their adolescent's psychological functioning (using the CBCL). Mediation analyses concluded mindfulness mediated mental health outcomes. Conclusions Increase in mindful awareness after training leads to improvement in mental health and this is consistent with mindfulness theory. The mindfulness group programme appears to be a promising adjunctive therapeutic approach for clinic‐based adolescents with mental health problems.
    February 28, 2014   doi: 10.1111/camh.12057   open full text
  • The impact of motor development on typical and atypical social cognition and language: a systematic review.
    Hayley C. Leonard, Elisabeth L. Hill.
    Child and Adolescent Mental Health. February 08, 2014
    Background Motor development allows infants to gain knowledge of the world but its vital role in social development is often ignored. Method A systematic search for papers investigating the relationship between motor and social skills was conducted, including research in typical development and in Developmental Coordination Disorder, Autism Spectrum Disorders and Specific Language Impairment. Results The search identified 43 studies, many of which highlighted a significant relationship between motor skills and the development of social cognition, language and social interactions. Conclusions This complex relationship requires more attention from researchers and practitioners, allowing the development of more tailored intervention techniques for those at risk of motor, social and language difficulties.
    February 08, 2014   doi: 10.1111/camh.12055   open full text
  • Attachment disorders versus more common problems in looked after and adopted children: comparing community and expert assessments.
    Matt Woolgar, Emma Baldock.
    Child and Adolescent Mental Health. January 22, 2014
    Background Attachment disorders in adopted and fostered children may be overdiagnosed and could obscure more common disorders. Methods A case note review of 100 referrals to a specialist adoption and fostering service compared community referrals with the specialist assessments of attachment disorders. Results Attachment disorders were identified four times more often in community referrals versus the specialist service, but this only partly explained the significant under‐identification of more common disorders in the community, especially for neurodevelopmental factors and conduct disorder by up to 10‐fold. Conclusions The relevant practice parameters are discussed and implications for service models for adopted and fostered children reviewed.
    January 22, 2014   doi: 10.1111/camh.12052   open full text
  • Posttraumatic stress symptoms and structure among orphan and vulnerable children and adolescents in Zambia.
    Itziar Familiar, Laura Murray, Alden Gross, Stephanie Skavenski, Elizabeth Jere, Judith Bass.
    Child and Adolescent Mental Health. December 12, 2013
    Background Scant information exists on posttraumatic stress disorder (PTSD) symptoms and structure in youth from developing countries. Methods We describe the symptom profile and exposure to trauma experiences among 343 orphan and vulnerable children and adolescents from Zambia. We distinguished profiles of posttraumatic stress symptoms using latent class analysis. Results Average number of trauma‐related symptoms (21.6; range 0–38) was similar across sex and age. Latent class model suggested three classes varying by level of severity: low (31% of the sample), medium (45% of the sample), and high (24% of the sample) symptomatology. Conclusions Results suggest that PTSD is a continuously distributed latent trait.
    December 12, 2013   doi: 10.1111/camh.12050   open full text
  • Linking lack of care in childhood to anxiety disorders in emerging adulthood: the role of attachment styles.
    Adriano Schimmenti, Antonia Bifulco.
    Child and Adolescent Mental Health. December 09, 2013
    Background Emotional neglect can be characterized as cold or critical parenting and denotes a parent intentionally or unintentionally overlooking the signs that a child needs comfort or attention and ignoring its emotional needs. Parental emotional neglect is widely posited as an antecedent of anxiety disorder, with attachment researchers arguing for anxious–ambivalent attachment style as a mediating factor. Method Childhood experience of neglect and abuse, including antipathy (cold, critical parenting), attachment styles, and anxiety disorders were assessed in a high‐risk sample of 160 adolescents and young adults by means of interview measures. Results Antipathy was associated with 12‐month prevalence of anxiety disorders in the sample. Anxious–ambivalent attachment scores statistically mediated the relationship between antipathy and anxiety disorders. Conclusions Clinicians treating anxiety disorders in youths need to consider that emotional neglect in childhood in the form of antipathy could lead to anxious–ambivalent internal working models operating around fear of rejection and fear of separation.
    December 09, 2013   doi: 10.1111/camh.12051   open full text
  • Innovations in Practice: The efficacy of nonviolent resistance groups in treating aggressive and controlling children and young people: a preliminary analysis of pilot NVR groups in Kent.
    Mary Newman, Catrin Fagan, Rebecca Webb.
    Child and Adolescent Mental Health. December 09, 2013
    Background Conduct disorders and adolescent violence have been found to be a significant problem in the United Kingdom. Method Nonviolent Resistance (NVR) Parenting Groups were piloted in Kent to address the demand on CAMHS for young people with this issue, and preliminary analysis on outcome measures was conducted. Results A significant difference in a positive direction was found on all but one of the measurements used. Conclusion Findings suggest that using NVR methods in a group format is an effective intervention for these families. De‐escalation and acts of unconditional love were rated by parents as the most useful interventions.
    December 09, 2013   doi: 10.1111/camh.12049   open full text
  • A randomized controlled trial of a home and school‐based intervention for selective mutism – defocused communication and behavioural techniques.
    Beate Oerbeck, Murray B. Stein, Tore Wentzel‐Larsen, Øyvind Langsrud, Hanne Kristensen.
    Child and Adolescent Mental Health. October 25, 2013
    Background Randomized controlled psychosocial treatment studies on selective mutism (SM) are lacking. Method Overall, 24 children with SM, aged 3–9 years, were randomized to 3 months treatment (n = 12) or wait list (n = 12). Primary outcome measure was the School Speech Questionnaire. Results A significant time by group interaction was found (p = .029) with significantly increased speech in the treatment group (p = .004) and no change in wait list controls (p = .936). A time by age interaction favoured younger children (p = .029). Clinical trail registration: Norwegian Research CouncilNCT01002196. Conclusions The treatment significantly improved speech. Greater improvement in the younger age group highlights the importance of an early intervention.
    October 25, 2013   doi: 10.1111/camh.12045   open full text
  • Why are children and adolescents referred for psychiatric assessment without fulfiling diagnostic criteria for any psychiatric disorder?
    Gyöngyvér Dallos, Ágnes Keresztény, Mónika Miklósi, Júlia Gádoros, Judit Balázs.
    Child and Adolescent Mental Health. October 25, 2013
    Background Clinicians often experience that children are referred for psychiatric evaluation without fulfiling the diagnostic criteria of any psychiatric disorders. This study investigates factors that might lead children to psychiatric referral without any psychiatric disorder. Method Children/adolescents who were referred for psychiatric assessment (referred group) (n = 418, mean age = 10.82 years, SD = 3.81) and a control group (n = 48, mean age = 10.38 years, SD = 3.77) were evaluated by the Mini International Neuropsychiatric Interview Kid (MINI Kid) and the Erfassung der Lebensqualität Kindern und Jugendlichen (Measure of Quality of Life for Children and Adolescents). The referred group was further divided into two subgroups: referred subgroup without MINI Kid diagnosis (n = 61) and referred subgroup with MINI Kid diagnosis (n = 357). Subjects less than 18 years old were included and there was no lower age limit. Results Attention‐deficit/hyperactivity disorder (ADHD) symptoms significantly increased the odds for referral as social phobia symptoms significantly decreased the odds for psychiatric referral. Regarding quality of life (QoL), the control group showed significantly less impairment when compared with the referred group; the two referred subgroup with and without diagnosis did not differ significantly. Conclusions ADHD symptoms, even in a subthreshold level and impaired QoL represent risk factors for psychiatric referral in children. Secondary prevention of children should target to screen subthreshold ADHD symptoms and QoL.
    October 25, 2013   doi: 10.1111/camh.12046   open full text
  • Does family drawing assess attachment representations of late‐adopted children? A preliminary report.
    Cecilia Serena Pace, Giulio Cesare Zavattini, Renata Tambelli.
    Child and Adolescent Mental Health. October 09, 2013
    Background Attachment representations of late‐adopted children have usually been measured by attachment narratives or observational procedures. Recently an attachment‐based coding system for family drawings was developed by attachment researchers and it was used both with clinical and nonclinical samples, but it has never been used with adoptees. Method This study examined the differences between attachment representations of 29 late‐adopted children aged 5–7 years (M = 6.35, 51.7% girls) and 12 non‐adopted peers as assessed by family drawings, controlling for demographic variables and children's cognitive status. The attachment‐based coding system of family drawings included three levels: (1) 24 individual markers, (2) eight global rating scales (1–7 points), and (3) four attachment categories (secure, avoidant, resistant, and disorganized). Results Late‐adopted children assessed with the family drawings were more insecure on the attachment categories and achieved lower scores on positive global ratings such as the Vitality/Creativity and Family Pride/Happiness scales, higher scores on the Role Reversal scale, and a tendency toward higher scores on the Bizarreness/Dissociation scale. No difference emerged between the two groups regarding the individual markers. Conclusions Family drawing seemed to be a useful tool for classifying attachment representations, and able to capture underlying mental states that it was hard for late‐adopted children to express in words.
    October 09, 2013   doi: 10.1111/camh.12042   open full text
  • Dissemination and implementation of child–parent psychotherapy in rural public health agencies.
    Erin R. Barnett, Harriet J. Rosenberg, Stanley D. Rosenberg, Joy D. Osofsky, George L. Wolford.
    Child and Adolescent Mental Health. October 01, 2013
    Background Early trauma exposure can have long‐term negative health effects. Few young children receive evidence‐based trauma treatment. This article explores the feasibility of implementing Child–Parent Psychotherapy (CPP), an evidence‐based intervention, in rural public health agencies. Method Twenty‐three clinicians across four agencies were trained. Training outcomes and implementation barriers and facilitators were assessed. Results One hundred twelve client–caregiver dyads began the year‐long treatment; 50% are currently enrolled or have completed treatment. Barriers and facilitators to implementation were identified. Conclusions CPP is feasible to implement in rural community mental health agencies. Important lessons were learned related to planning, implementation, and sustainability.
    October 01, 2013   doi: 10.1111/camh.12041   open full text
  • We don't know how to help: an online survey of school staff.
    Pooky Knightsmith, Janet Treasure, Ulrike Schmidt.
    Child and Adolescent Mental Health. August 19, 2013
    Background Eating disorders (ED) have a peak rate of onset in school‐aged children. Little is known about teachers’ experiences of ED. Method A total of 826 school staff completed an online questionnaire exploring their Eating Disorder experiences. Responses were analysed using content analysis principles. Results 74 per cent of respondents’ schools had received no training on ED, 40% did not know how to follow up pupils’ Eating Disorder concerns and 89% of respondents felt uncomfortable teaching pupils about ED. Conclusions School staff feel ill‐equipped to support ED. Training in the recognition, support and teaching of ED would be welcomed and could improve outcomes for young people.
    August 19, 2013   doi: 10.1111/camh.12039   open full text
  • Psychopharmacological treatment of young people with substance dependence: a survey of prescribing practices in England.
    Johanna Bateman, Eilish Gilvarry, Maria Tziggili, Ilana B Crome, Kah Mirza, Paul McArdle.
    Child and Adolescent Mental Health. July 30, 2013
    Backround Prescribing for substance‐dependent youth requires expert knowledge of developmental and contextual issues and use of largely unlicensed medicines. This first national survey aimed to determine the nature of pharmacological treatments delivered in England including the extent of maintenance therapy, supervised consumption and specialties prescribing. Method Data were gathered regarding opiate substitutes & other medications prescribed for opiate, alcohol & benzodiazepine dependence, drug & alcohol relapse prevention and comorbidities. Evidence of distinct approaches to younger compared with older adolescents was sought. Results The overall response rate was 73%. The majority treated were over 16 years. 85% treatments were opiate substitute therapies; many received longer term maintenance therapy. Prescribing for alcohol dependence & comorbidity was low; the largest prescribing group were General Practitioners. Conclusions Questions remain about the scale of youth dependence, the use of substitute agents in maintenance treatment and the number of adolescent addiction specialists in the treatment cadre.
    July 30, 2013   doi: 10.1111/camh.12013   open full text
  • Change in metabolic parameters and weight in response to risperidone monotherapy in young children with nonpsychotic disorders: a prospective open‐label study.
    Burcu Ersoz Alan, S. Ebru Cengel Kultur.
    Child and Adolescent Mental Health. July 15, 2013
    Background This study investigates changes in metabolic parameters in prepubertal children after 14–16 weeks of treatment with low‐dose risperidone. Method Thirty‐one children (mean age 5.46 ± 1.98 years) were treated with risperidone (0.25–1 mg/day; 0.01–0.07 mg/kg/day). Patients were excluded if they were using any medication other than risperidone or were diagnosed with any medical problem in addition to a non‐psychotic disorder. Results Weight (Δ: 2.51 ± 1.94 kg), height (Δ: 0.03 ± 0.04 cm), BMI (Δ: 0.82 ± 1.4), BMI percentile (Δ: 9.72 ± 16.40), BMI z‐score (Δ: 0.33 ± 1.03), triglyceride (Δ: 1.50 ± 23.97 mg/dl), very low density lipoprotein (Δ: 2.99 ± 4.76 mg/dl), insulin (Δ: 3.07 ± 3.38 mIU/ml), and leptin (Δ: 3.02 ± 4.69 ng/ml) were significantly increased (p < .05). Conclusion The metabolic side effects of risperidone must be carefully monitored in prepubertal children.
    July 15, 2013   doi: 10.1111/camh.12033   open full text
  • Review: The consequences of early institutionalization: can institutions be improved? – should they?
    Robert B. McCall.
    Child and Adolescent Mental Health. June 04, 2013
    Background and scope The focus of this review is on institutionalized children, one of the most inequitably and severely treated groups of children. Although institutions vary, many share some common characteristics, including large groups, high children:caregiver ratios, many and changing caregivers and caregiver‐child interactions that lack warm, sensitive, contingently‐responsive and child‐directed behaviours. Resident children develop poorly physically, mentally and social‐emotionally, but those adopted from institutions display substantial catch‐up growth in many domains of development. If they are adopted at an early age, there have been no long‐term consequences of institutionalization yet measured; but if institutionalization is prolonged, they display higher rates of long‐term deficiencies and problems in many domains. Methods This review is based on a database search of the literature, focusing on the development of children while residents, and the development of post‐institutionalized children who have been transitioned from institutions to family care. It also draws on the reports and findings of the St. Petersburg–USA Orphanage intervention. Findings A combination of theories pertaining to attachment (especially caregiver attachment to the infant–toddler), chronic stress and genetics may explain these outcomes. It appears that caregiver–child interactions are a major contributor to children's outcomes and interventions in institutions that improve such interactions produce substantial increases in children's physical, mental and social‐emotional development, including for children with disabilities. Conclusions Deinstitutionalization and the creation of comprehensive professional child welfare systems emphasizing family care alternatives is a preferred goal, but this is likely to take many low‐resource countries decades to develop. If substantial numbers of children remain in institutions despite best efforts to find families for them, improving the institutions might help to provide all the children with the best care possible under the circumstances.
    June 04, 2013   doi: 10.1111/camh.12025   open full text
  • ‘My teacher saved my life’ versus ‘Teachers don't have a clue’: an online survey of pupils’ experiences of eating disorders.
    Pooky Knightsmith, Helen Sharpe, Olivia Breen, Janet Treasure, Ulrike Schmidt.
    Child and Adolescent Mental Health. April 26, 2013
    Background Eating disorders (ED) have a peak rate of onset in school‐aged children. Little is known about pupils’ experiences of ED within a school setting. Method Five hundred and eleven 11‐ to 19‐year‐old school pupils completed an online questionnaire exploring their experiences of ED (72% female, 28% male). Responses were analysed using content analysis principles. Results Of the participants, 38% had a current or past ED, 49% of these had never received a formal diagnosis. Of the respondents, 59% saw a need to raise ED awareness. Only 7% would confide in a teacher about an ED. Conclusions Efforts are needed to break down barriers to disclosure and support teachers to play an effective role in the detection and early intervention for ED.
    April 26, 2013   doi: 10.1111/camh.12027   open full text
  • A controlled evaluation of the ‘FRIENDS for Life’ emotional resiliency programme on overall anxiety levels, anxiety subtype levels and school adjustment.
    Alish Rodgers, Sandra Dunsmuir.
    Child and Adolescent Mental Health. April 26, 2013
    Background Anxiety constitutes the most common form of psychopathology in childhood and adolescence. Methods This randomised controlled study evaluated the ‘FRIENDS for Life’ school‐based Cognitive Behavioural Therapy programme on overall anxiety, anxiety subtypes and school adjustment. Sixty‐two students aged 12–13 completed measures of anxiety and school adjustment before, immediately after and 4 months after completing the programme. Parents and teachers also rated the students on overall anxiety levels and school adjustment respectively. Results The intervention group's ‘overall anxiety’ and specifically ‘separation anxiety’ reduced significantly during the programme and continued to decrease at the 4‐month follow‐up. Conclusions A significant negative correlation was found between anxiety and school adjustment. The professional implications of these findings are discussed.
    April 26, 2013   doi: 10.1111/camh.12030   open full text
  • Student help seeking from pastoral care in UK high schools: a qualitative study.
    Sarah Kendal, Philip Keeley, Peter Callery.
    Child and Adolescent Mental Health. April 26, 2013
    Background Little is known about high school students' perceptions of school‐based pastoral support. This study aimed to explore this in the context of a high school–based emotional support project. Methods Qualitative interviews explored perspectives on help seeking of students (N = 23) and staff (N = 27) in three UK high schools where a pastoral project was introduced. Data were analysed thematically. Results Student peer groups perceived help seeking as a sign of weakness. However, students valued learning skills in managing emotions and friendships. Staff expressed concerns about students' ability to help seek proactively, and highlighted organisational influences on pastoral support. Conclusions Increasing student control over the process, and involving trusted staff, could encourage help seeking in high school. It is possible to access the views of students who do not help seek, to improve understanding of help‐seeking behaviour.
    April 26, 2013   doi: 10.1111/camh.12029   open full text
  • Maternal mental distress influences child outcomes in brief parent training.
    John Kjøbli, Ane Nærde, Gunnar Bjørnebekk, Elisabeth Askeland.
    Child and Adolescent Mental Health. April 08, 2013
    Background Brief parent training (BPT) promotes effective parenting in parents of children with conduct problems. As previous research has provided inconsistent results, this study explored the impact of maternal mental distress on outcomes of BPT. Method Participants included 216 families randomized to BPT or a comparison group. Results Maternal distress negatively predicted five of eight outcomes, regardless of intervention allocation. Low‐maternal distress predicted lower conduct problems (parent‐ and teacher‐reported), whereas high distress predicted higher teacher‐reported conduct problems in BPT relative to comparisons. Conclusions Refinement of interventions to help children with conduct problems and distressed mothers should be prioritized.
    April 08, 2013   doi: 10.1111/camh.12028   open full text
  • ADHD and functional somatic symptoms: structural equations of a conceptual model.
    Rodrigo Serra Giacobo, Maria Claustre Jané, Albert Bonillo, Francisco Javier Arrufat, Eva Araujo.
    Child and Adolescent Mental Health. March 14, 2013
    Aims To examine the effect of anxiety and parental overprotection on functional somatic symptoms (FSS) in children with attention deficit hyperactivity disorder (ADHD). Method Seventy‐six children and adolescents (aged 6–17) with ADHD and their parents completed a clinical interview about psychiatric and somatic symptoms. Parents also reported about parenting styles. Structural equation modeling (SEM) was used. Results The generalized anxiety, overprotection, and specific phobia variables each had a direct effect on FSS. Conclusions Anxiety symptoms and parental overprotection may play a role in the development of FSS in children with ADHD. Further research is necessary to corroborate our findings.
    March 14, 2013   doi: 10.1111/camh.12026   open full text
  • Experiences of young people in a 16–18 Mental Health Service.
    Ben Harper, Joanne M. Dickson, Ros Bramwell.
    Child and Adolescent Mental Health. March 02, 2013
    Background 16–18‐year‐old young people experience a relatively high incidence of mental health problems but there is a paucity of research on their experience of mental health services (MHS). Method To gain understanding of young people's experiences of 16–18 MHS, we used qualitative Interpretative Phenomenological Analysis. Ten young people in two 16–18 MHS were interviewed about experiences of using MHS. Results Five superordinate themes emerged from the data analysis, ‘Power Differentials’, ‘Parental Involvement’, ‘Developmentally Attuned Services’, ‘Developing Self‐Expression’, ‘Continuity and Loss of Relationships’. Conclusions Respondents valued developmentally appropriate MHS and emphasised the value of continuity in therapeutic relationships.
    March 02, 2013   doi: 10.1111/camh.12024   open full text
  • Predicting length of stay and readmission for psychiatric inpatient youth admitted to adult mental health beds in Ontario, Canada.
    Shannon L. Stewart, Chester Kam, Philip Baiden.
    Child and Adolescent Mental Health. February 25, 2013
    Background The purpose of this study was to examine demographic, background, and psychopathology variables that predict length of stay and readmission among youth with mental health needs. Method We analyzed data on 2445 youth who were admitted into adult psychiatric beds in Ontario, Canada. Multiple regression was used to examine length of stay, whereas logistic regression was used to examine the predictors of readmission. Results Youth were likely to stay longer in hospital if they were older, were boys, had a diagnosis of schizophrenia, mood disorders, eating disorders, personality disorders, and intellectual disability. Education, discharged against medical advice, and a diagnosis of adjustment disorders were all associated with shorter length of stay. Age, living in a group home or assisted care, a diagnosis of schizophrenia, mood disorders, and intellectual disability predicted readmission. Conclusion Strategies to improve current psychiatric services (e.g. how to reduce psychiatric hospital readmissions) are discussed.
    February 25, 2013   doi: 10.1111/camh.12022   open full text
  • Prospective evaluation of the pyramid plus psychosocial intervention for shy withdrawn children: an assessment of efficacy in 7‐ to 8‐year‐old school children in Northern Ireland.
    Áine E. McKenna, Tony Cassidy, Melanie Giles.
    Child and Adolescent Mental Health. February 15, 2013
    Background Social withdrawal is known to precede and contribute to the development of internalization problems in shy children. This study examined the efficacy of a selective primary school‐based psychosocial intervention for withdrawn children. Method The sample comprised 82 Primary 4 children aged between 7 and 8 years from 7 schools across Northern Ireland. There were 31 children in the comparison group (50.6% male) and 57 children received the intervention (41.7% male). A 2 × 2 mixed‐model design was used: group (intervention group vs. comparison group) × 3 time points (pre‐ vs. 10 postintervention vs. 12‐week follow‐up) with repeated measures on the time factor. Teachers completed the SDQ at the three time points to assess participants' socio‐emotional health status. Results Pyramid participants showed greater reductions than the comparison group on the Emotional Symptom and Peer Problem factors following the intervention and their scores did not return to baseline levels at follow‐up. Pyramid attendance accounted for approximately 12% and 9% of the variance in the Emotional Symptom and Peer Problems decreases respectively. Conclusions Pyramid Plus helped to alleviate internalization problems in participants and initially had a positive impact on social re‐integration. The incorporation of cognitive restructuring techniques may be a necessary intervention modification to affect participants' emotion regulation strategies.
    February 15, 2013   doi: 10.1111/camh.12023   open full text
  • Psychopathology among youths who were victims of documented childhood maltreatment.
    Ricardo J. Pinto, Ângela C. Maia.
    Child and Adolescent Mental Health. February 11, 2013
    Background There is an established relationship between childhood maltreatment and later psychopathology, but most studies have used self‐reports and only consider a small number of experiences. The main aim of this study was to examine predictors of psychopathology by comparing two sources (official records vs. self‐reports) of ten different childhood adversities among youths who were identified by Child Protective Services (CPS). We also used a comparison group that was not identified by CPS. This study also compared, in terms of psychopathology, three groups of respondents (under‐report; agreement; and over‐report) based on the discrepancy between the two sources of childhood adversity. Method The sample included 136 youths, ages 14–23 years, identified by CPS prior to age 12 as being maltreated and who lived with their family for at least 5 years. The comparison group included 80 youths. Results The identified youths were not different from the comparison group in global psychopathology. Psychopathology was associated only with the total amount of self‐reported adverse experiences, with depressive symptoms being predicted by both documented and self‐reported sexual abuse. Females reported and had more documented adversities, presenting an increased risk for psychopathology. The under‐report group had a higher mean of documented experiences and a lower mean in psychopathology. Conclusions Despite the limitations of a self‐report methodology, our findings attest to its contribution in predicting health outcomes. Professionals from CPS need to be thorough when assessing and documenting the multiple experiences that may co‐occur in a household, paying particular attention when young girls are involved, as the experience of sexual abuse has been shown to be independently associated with later risk of developing depressive symptoms. This process may increase the appropriateness of the chosen interventions.
    February 11, 2013   doi: 10.1111/camh.12020   open full text
  • Innovations in Practice: exploring an intensive meditation intervention for incarcerated youth.
    Elizabeth S. Barnert, Samuel Himelstein, Sarah Herbert, Albert Garcia‐Romeu, Lisa J. Chamberlain.
    Child and Adolescent Mental Health. February 11, 2013
    Background We examined the experiences of incarcerated adolescent males (N = 29) who participated in a one‐day meditation retreat and 10‐week meditation programme. Method Self‐report surveys assessing mindfulness, self‐regulation, impulsivity and stress; behavioural assessments; and focus group data were examined. Results We observed significantly higher scores in self‐regulation (p = .012) and psychometric markers demonstrated psychological enhancement. No behavioural change was observed. Six themes emerged: enhanced well‐being, increased self‐discipline, increased social cohesiveness, expanded self‐awareness, resistance to meditation and future meditation practice. Conclusions Early evidence suggests that meditation training for incarcerated youth is a feasible and promising intervention.
    February 11, 2013   doi: 10.1111/camh.12019   open full text
  • Bipolar disorder in children and adolescents.
    Boris Birmaher.
    Child and Adolescent Mental Health. February 11, 2013
    Background The existence of bipolar disorder (BP) in youth is controversial. Methods The current evidence regarding the diagnosis of BP in youth was reviewed. Results BP is a recurrent familial disorder that occurs in 1–3% of youth, particularly in adolescents. Except for subsyndromal BP, the prevalence of BP‐I is similar across most countries. Due to the child's immaturity, the presence of comorbid disorders, and divergent interpretations of manic symptomatology, it is difficult to diagnose BP in youth. Youth with subsyndromal mania and family history of BP, are at high risk to develop BP‐I and BP‐II. Both the full‐syndromal BP and subsyndromal BP are associated with significant psychosocial difficulties and increased risk for use of substances, suicidality, legal problems, and services utilization. Conclusion Bipolar disorder exists in youth, but it is difficult to diagnose. The recurrent nature and psychosocial morbidity associated with this illness during critical developmental stages call for comprehensive longitudinal evaluation and accurate recognition and treatment because delays in treatment are associated with poor outcome.
    February 11, 2013   doi: 10.1111/camh.12021   open full text
  • Factors related to advanced stages of change in a clinical sample of adolescents.
    Andrew Taylor, Shannon L. Zaitsoff, Ashley Paterson.
    Child and Adolescent Mental Health. December 24, 2012
    Background The purpose of the present study was to examine the factors predicting a greater motivation to change in a clinical sample of adolescents. Method A total of 107 adolescents participated in this research prior to beginning outpatient treatment. Participants completed a modified version of the Motivational Stages of Change for Adolescents Recovering from an ED, the Difficulties in Emotional Regulation Scale and the Behavioral Assessment System for Children–Self‐Report. Results More advanced stages of change were associated with better parent–adolescent relationships and better emotional regulation. Conclusion Incorporating parents in treatment to enhance parent–adolescent relationships and instructing parents in emotional regulation techniques to assist the adolescent may enhance their motivation to recover.
    December 24, 2012   doi: 10.1111/camh.12016   open full text
  • Child and parent engagement in the mental health intervention process: a motivational framework.
    Gillian King, Melissa Currie, Patricia Petersen.
    Child and Adolescent Mental Health. December 14, 2012
    Background This article proposes a conceptual model of child and parent engagement in the mental health intervention process. Method A scoping review was performed of articles on predictors of engagement in mental health interventions, the effectiveness of engagement interventions, and interpersonal aspects of care. A comprehensive search of PsycINFO and PsycARTICLES was performed for literature published in English from 2000 to 2012. Results Based on the review, a motivational framework is proposed in which engagement is defined as a state comprised of a hopeful stance, conviction, and confidence, brought about when therapists optimize engagement processes of receptiveness, willingness, and self‐efficacy. Conclusions Implications concern the need to help clients understand what to expect from the therapy process, and to educate therapists about engagement strategies.
    December 14, 2012   doi: 10.1111/camh.12015   open full text
  • Anxiety symptoms in adolescents at risk for psychosis: a comparison among help seekers.
    Niklas Granö, Marjaana Karjalainen, Virve Edlund, Erkki Saari, Arja Itkonen, Jukka Anto, Mikko Roine.
    Child and Adolescent Mental Health. December 06, 2012
    Background Several studies have reported on how anxiety disorders and anxiety symptoms are already present before the onset of psychosis. However, anxiety disorders are typically studied in these studies at diagnosis‐level. The aim of present study was to investigate the profile of anxiety symptoms in subjects at risk of developing psychosis and to compare the anxiety profile with those who are not at risk. Method Data were collected at Helsinki University Central Hospital (HUCH) by an early detection and intervention team. Of 185 help‐seeking respondents, between 12 and 18 years of age, 59 adolescents were classified as being at risk of psychosis and 126 as not being at risk via an interview conducted by a validated at‐risk assessment tool (PROD). Anxiety was measured using the Beck Anxiety Inventory (BAI). Results The anxiety total sum score was higher in the at‐risk group for psychosis (mean 8.33 vs. 13.34, p = .000). Both subfactors of the anxiety scale, cognitive anxiety (p = .000) and somatic anxiety (p = .000), differed significantly by risk status. After using the Bonferroni correction for multiple analysis, items of relax (p = .000), nervous (p = .002), losing control (p = .000) and faint (p = .002) had statistically significant higher mean scores in the group at risk of psychosis. In logistic regression analysis, being female (p = .015) and the subfactor relating to cognitive anxiety (p = .044) significantly explained the at‐risk status for psychosis. Conclusions Adolescents at risk for psychosis have a higher level of anxiety compared with other help‐seeking adolescents. These results should be considered in clinical practice.
    December 06, 2012   doi: 10.1111/camh.12012   open full text
  • Childhood sexual abuse: community‐based treatment practices and predictors of use of evidence‐based practices.
    Jennifer Czincz, Elisa Romano.
    Child and Adolescent Mental Health. December 03, 2012
    Background Cognitive behavior therapy with abuse‐focused components is empirically supported for children/adolescents who have experienced childhood sexual abuse (CSA). We examined the extent to which community‐based psychologists use evidence‐based practices (EBP) for CSA and identified predictors of EBP use. Method Psychologists (N = 231) providing CSA treatment services to children/adolescents in Ontario (Canada) were identified through the first census of child and adolescent psychology clinicians registered with the College of Psychologists of Ontario. Participants completed a questionnaire on treatment strategies, sociodemographics, work setting, treatment provision, and attitudes toward EBP. Data were collected between December 2009 and June 2010. Results The majority (78%) of psychologists providing CSA services reported never having received training in specific treatment approaches for this population. Only 5% of psychologists received training in the EBP of trauma‐focused cognitive behavior therapy. Multiple regressions indicated that age, theoretical orientation, continuing education, and attitudes predicted the use of an empirically based intervention for CSA. Conclusion Study findings show that few community‐based psychologists have received training in specific treatment approaches for CSA victims and very few are trained to deliver EBP for this population. There are ethical concerns about the practice of psychologists who are untrained and unsupervised doing this work. Research findings, which underline the need for training, supervision, and continuing education, need to be translated into clinical practice.
    December 03, 2012   doi: 10.1111/camh.12011   open full text
  • Child and family factors associated with teacher‐reported behavior problems in young children of substance abusers.
    Nicola A. Conners‐Burrow, Angela Kyzer, Joy Pemberton, Lorraine McKelvey, Leanne Whiteside‐Mansell, James Fulmer.
    Child and Adolescent Mental Health. October 30, 2012
    Background We examined child and family factors associated with teacher‐reported behavior problems in 79 children of substance abusers (COSAs). Method Using regression models, we examined the impact of four family risk factors, cumulatively and individually, on children's behavior and explored children's engagement of adults as a protective factor. Results More than half (55%) of children had clinically elevated behavior problems. Cumulative family risks were associated with increased problems, whereas the presence of a father in the home and the child's ability to engage adults were protective. Conclusions These findings may help explain the variation in behavioral outcomes of COSAs.
    October 30, 2012   doi: 10.1111/camh.12010   open full text
  • Insomnia in adolescents: prevalence, help‐seeking behaviors, and types of interventions.
    Ka‐Fai Chung, Katherine Ka‐Ki Kan, Wing‐Fai Yeung.
    Child and Adolescent Mental Health. October 16, 2012
    Background Little is known about the DSM‐IV diagnosis of insomnia among adolescents. Their help‐seeking behaviors and self‐help strategies for insomnia remain largely unclear. Method A cross‐sectional, interview‐based study of 290 Chinese adolescents. Results The prevalence of insomnia symptoms was 40%, among which 9.3% had DSM‐IV insomnia. Primary insomnia accounted for 7.9%, whereas insomnia associated with psychiatric disorders constituted 1.4%. Adolescents with DSM‐IV insomnia had more severe and frequent insomnia, higher GHQ scores, and were more likely to have a history of sleep paralysis than those with insomnia symptoms alone. About 22% of adolescents with insomnia symptoms sought help and 32% attempted various strategies to improve sleep. Conclusions Many adolescents were troubled by insomnia, but they seldom sought help from healthcare professionals or received proper treatments.
    October 16, 2012   doi: 10.1111/camh.12009   open full text
  • Negative automatic thoughts and emotional and behavioural problems in adolescence.
    Eirini Flouri, Constantina Panourgia.
    Child and Adolescent Mental Health. October 12, 2012
    Background The aim of this study was to test whether maladaptive cognitions or difficulties in emotion regulation mediate the association between change in number of adverse life events (i.e. change in life stress) and emotional and behavioural problems in adolescence. Method Our sample consisted of 557 young people, aged 10–19 years from a state secondary school in London. We fitted a multiple mediator model to contrast five mediators: three maladaptive cognitions (negative cognitive errors, negative automatic thoughts, and dysfunctional attitudes) and the two emotion regulatory processes of cognitive reappraisal and expressive suppression. We adjusted for gender, age, ethnicity, special educational needs and family poverty. Results Taken as a set, our mediators explained the effect of change in life stress on adolescent emotional and behavioural problems. However, cognitive reappraisal, expressive suppression, dysfunctional attitudes and negative cognitive errors did not contribute to the indirect effect above and beyond negative automatic thoughts. Conclusions Only negative automatic thoughts mediated the association between change in life stress and emotional and behavioural problems. This suggests the possibility that negative automatic thoughts is the pathway through which an increase in life stress may lead to emotional and behavioural problems in adolescents.
    October 12, 2012   doi: 10.1111/camh.12004   open full text
  • Burden of proof: the evidence clinicians require before implementing an intervention.
    Brian Allen, Natalie E. Armstrong.
    Child and Adolescent Mental Health. October 12, 2012
    Background Greater implementation of evidence‐based practice for children and adolescents is a current emphasis in the mental health field; however, there is a need to understand how best to disseminate these interventions and convince community clinicians to use them. Method A sample of 255 clinicians reported on the likelihood that they would use an intervention given various types of evidence. Results Case studies and clinical trials with an active or placebo control group scored as the most preferred types of evidence; however, more positive attitudes toward evidence‐based practice predicted preferences for clinical trials, but were not related to case studies. Conclusion Implementation of evidence‐based practice may be improved by greater dissemination of case studies demonstrating the use of these interventions in ‘real world’ settings. In addition, fostering a greater appreciation of research‐derived interventions among clinicians appears necessary.
    October 12, 2012   doi: 10.1111/camh.12005   open full text
  • Parenting and problem behaviors in children of substance abusing parents.
    A. Kathleen Burlew, Candace Johnson, Stephanie Smith, Alexis Sanders, Ritchie Hall, Beatrice Lampkin, Mary Schwaderer.
    Child and Adolescent Mental Health. October 11, 2012
    Background This study examined parenting practices, parental stress, and problem behaviors among urban Children of Substance Abusing Parents. Method One hundred and seven children completed the Child Rating Scale and the Children's Depression Inventory. Parents completed the Parenting Practices Scale‐Parent Version, Parenting Stress Index, and internalizing and externalizing scales on the Parent Observation of Classroom Adaptation. Results Structural Equation Modeling findings support an indirect effects pathway in which unfavorable parenting practices predict parental stress and parental stress predicts internalizing and externalizing behaviors. Conclusion The results argue for assessing parental stress and including activities to improve the parent‐child bond in family intervention programs.
    October 11, 2012   doi: 10.1111/camh.12001   open full text
  • Adolescent's preferred modes of delivery for mental health services.
    Sally Bradford, Debra Rickwood.
    Child and Adolescent Mental Health. October 11, 2012
    Background Mental health interventions for young people are increasingly being delivered online. This is occurring due to an assumption that young people prefer online interventions because they address some of the well‐established help‐seeking barriers. Method A self‐report questionnaire investigating preferences for mental health care delivery was administered to a nonclinical sample of 231 young people aged 15–19. Results The strongest help‐seeking intention in response to a scenario describing symptoms of depression was for face‐to‐face services, followed by not seeking help at all. Only 16% expressed a preference for online treatment. Conclusion The assumption that a majority of young people will prefer online delivery of mental health treatment was not supported, although boys showed a stronger relative preference for online modes.
    October 11, 2012   doi: 10.1111/camh.12002   open full text
  • Social and emotional aspects of learning (SEAL) for secondary schools: implementation difficulties and their implications for school‐based mental health promotion.
    Ann Lendrum, Neil Humphrey, Michael Wigelsworth.
    Child and Adolescent Mental Health. October 11, 2012
    Background Increasing concern about adolescent mental health problems has resulted in schools being identified as central sites for their prevention (PsycInfo; ERIC 2000–2012). In this context, SEAL for secondary schools was launched in 2007. Method The implementation strand of the national evaluation of secondary SEAL comprised longitudinal case studies of nine schools and used multiple methods and data sources, including interviews, observations and document review. Results Implementation was variable, both within and between schools; barriers were identified at programme, teacher and school levels. Conclusions Implementation issues identified have implications for SEAL and school‐based mental health prevention and promotion interventions more generally.
    October 11, 2012   doi: 10.1111/camh.12006   open full text
  • Does it help to talk about tics? An evaluation of a classroom presentation about Tourette syndrome.
    Claire Nussey, Nancy Pistrang, Tara Murphy.
    Child and Adolescent Mental Health. October 09, 2012
    Background Tourette syndrome (TS) is a poorly understood condition characterised by motor and vocal tics. It may affect children's social functioning at school. This study examined the impact of a psychoeducational intervention (classroom presentation) from multiple perspectives. Method We used a mixed‐methods, multiple case‐study design with interviews, focus groups and self‐report questionnaires. Four children with TS, their parents, teachers and classmates (n = 100) took part. Results Questionnaire data showed an increase in classmates' knowledge and positive attitudes about TS postintervention. Qualitative data revealed two overarching themes: the impact on classmates in terms of enabling prosocial behaviours, and the impact on the child in terms of their embracing having TS. Conclusion A brief psychoeducational intervention enhances knowledge and attitudes of classmates towards children with TS, and improves how children with TS feel about the condition. Further research is needed to evaluate this approach with larger samples of children and to identify mechanisms of change.
    October 09, 2012   doi: 10.1111/camh.12000   open full text
  • Positive communication moderates the relationship between corporal punishment and child depressive symptoms.
    Amber R. Wimsatt, Paula J. Fite, Stevie N. Grassetti, Jamie L. Rathert.
    Child and Adolescent Mental Health. September 03, 2012
    Background Findings are few and mixed regarding the moderating influence that supportive parenting might have on the link between corporal punishment and child depressive symptoms. Method A multiple regression model was estimated to examine proposed relationships in a 1‐year longitudinal community‐recruited sample of 89 children (56% male; 9–12 years). Results High levels of corporal punishment in tandem with high levels of supportive communication were associated with the highest levels of depressive symptoms. Conclusions Although supportive parenting behaviors have been shown to be beneficial for child outcomes, when considering a stress‐process framework, simultaneous experiences of harsh and positive parenting may yield more negative outcomes.
    September 03, 2012   doi: 10.1111/j.1475-3588.2012.00682.x   open full text
  • Understanding the effectiveness of school‐based interventions to prevent suicide: a realist review.
    Vasumathi Balaguru, Juhi Sharma, Waquas Waheed.
    Child and Adolescent Mental Health. August 09, 2012
    Background Schools appear an obvious place to deliver suicide prevention interventions for children and adolescents. The complexity of suicide interventions lead to a paucity of good quality evidence. An alternate approach of information gathering is needed to identify and collate evidence from existing interventions. Scope We completed a realist review of school‐based suicide interventions. This is a novel method of understanding complex interventions that uses an iterative approach. In this review, we attempt to clarify and lay out what type of suicide intervention programme might be useful in schools, based on the local needs and context. Conclusion It is possible to develop and implement an evidence‐based suicide intervention in schools by understanding the different processes that can contribute to success or failure of these interventions in a real‐world setting.
    August 09, 2012   doi: 10.1111/j.1475-3588.2012.00668.x   open full text
  • How do schools promote emotional well‐being among their pupils? Findings from a national scoping survey of mental health provision in English schools.
    Panos Vostanis, Neil Humphrey, Natasha Fitzgerald, Jessica Deighton, Miranda Wolpert.
    Child and Adolescent Mental Health. July 06, 2012
    Background Schools play an important role in promoting child mental health, but little is known about the approaches they undertake. Methods A scoping survey in England, involving 599 primary and 137 secondary schools. Results Although two thirds of school approaches focused on all pupils, these were predominantly reactive, rather than preventive interventions. They were also largely not evidence‐based, were instead based on a plan while open to adaptation. Gaps were identified in teacher training and support. Conclusions The findings have implications on the use of preventive versus reactive approaches, staff training and consultation, use of evidence‐based practice in schools and joint care pathways.
    July 06, 2012   doi: 10.1111/j.1475-3588.2012.00677.x   open full text
  • Psychiatric disorders in an urban sample of preschool children.
    Olafur O. Gudmundsson, Pall Magnusson, Evald Saemundsen, Bertrand Lauth, Gisli Baldursson, Gudmundur Skarphedinsson, Eric Fombonne.
    Child and Adolescent Mental Health. June 25, 2012
    Background To increase limited epidemiological knowledge of early childhood psychopathology, a study of prevalence estimates and demographic correlates of psychiatric disorders was conducted in a sample of preschool children. Methods In a two‐stage study, parents of 339 children aged 4–6 years who came for a medical check‐up at three primary care centres in Reykjavik were invited to participate. First, the participants were screened with Brigance Screens and the Strengths and Difficulties Questionnaire (SDQ) for parents and teachers. Subsequently, the children were tested with a short version of Wechsler Preschool and Primary Scales of Intelligence – Revised and their parents were interviewed with the Schedule for Affective Disorders and Schizophrenia for School Aged Children Present and Lifetime Version. Weighted prevalence estimates were calculated and logistic regression was used to analyse the association between risk factors and psychiatric disorders. Results Of those invited to participate, 317 (93.5%) were included in the screening and of those, 131 received a full diagnostic assessment. The final study sample included 151 girls (47.6%) and 166 boys (52.4%) who represented 11.6% of the total birth cohort in Reykjavik. Weighted prevalence of DSM‐IV psychiatric disorders was 10.1% (95% CI 6.7–13.5%) and 57/317 or 18.0% (95% CI 13.8–22.2%), including elimination disorders. Anxiety disorders (5.7%) and attention deficit hyperactivity disorder (3.8%) were the most common disorders in this preschool sample. Poor physical health of parents and higher education was associated with DSM‐IV psychiatric disorders of the children. SDQ Total Difficulties score was associated with male gender and poor physical health of parents. Conclusions This study indicates that psychiatric disorders in preschool children are common and may be correlated with parental health factors.
    June 25, 2012   doi: 10.1111/j.1475-3588.2012.00675.x   open full text
  • Stigma in school‐based mental health: perceptions of young people and service providers.
    Hayley Bowers, Ian Manion, Despina Papadopoulos, Emily Gauvreau.
    Child and Adolescent Mental Health. June 19, 2012
    Background Mental health affects one in five young people, with the majority avoiding help due to stigma. In this study, young people's (n = 49) perception of stigma as a barrier to accessing school‐based mental health services was compared with that of service providers (n = 63), along with the perceived extent of mental health problems and availability of school‐based mental health resources. Method Participants completed a survey or interview. EBSCO and PubMed databases were used for the duration of this study, from August 2010 to September 2011. Results A greater proportion of young people versus providers reported stigma as the largest barrier to accessing mental health services. In addition, most young people reported that school‐based mental health resources were scarce. Conclusions These results emphasize the need for young people's involvement in mental health initiatives.
    June 19, 2012   doi: 10.1111/j.1475-3588.2012.00673.x   open full text
  • Service user perspectives of multiagency working: a qualitative study with children with educational and mental health difficulties and their parents.
    Michelle O'Reilly, Panos Vostanis, Helen Taylor, Crispin Day, Cathy Street, Miranda Wolpert.
    Child and Adolescent Mental Health. June 19, 2012
    Background Recent policies recommend effective joint working between health and education; however, the views of service users are underrepresented, particularly opinions of young children. Method The project was operational from 2005–2008 when interviews were conducted with parents and children. The children were attending CAMHS for mental health and educational difficulties. Results Results indicated that they had a positive view of multiagency working. They consider that joint working is limited by a number of problems and make recommendations for improvement. Conclusions Findings indicate that more effective communication between agencies is needed and this should be provided for parents in an accessible language. This has implications for training professionals together.
    June 19, 2012   doi: 10.1111/j.1475-3588.2012.00674.x   open full text
  • The influence of an anti‐stigma intervention on adolescents' attitudes to schizophrenia: a mixed methodology approach.
    Marina Economou, Lily E. Peppou, Klio Geroulanou, Eleni Louki, Irene Tsaliagkou, Dimitris Kolostoumpis, Costas N. Stefanis.
    Child and Adolescent Mental Health. May 10, 2012
    Background This study aimed at exploring adolescents' attitudes to schizophrenia and the impact of an educational intervention on improving them, by employing a mixed methodology. Method A total of 1081 secondary‐school students were randomly allocated to a control and intervention condition. Stigma endorsement was assessed by a free association card and a questionnaire, before and 2 weeks after the intervention. Results The intervention yielded substantial changes in students' beliefs, attitudes and social distance levels as well as in their associations with the term ‘severe mental illness’. Conclusions Educational interventions can contribute substantially to preventing consolidation of unfavourable attitudes towards mental illness.
    May 10, 2012   doi: 10.1111/j.1475-3588.2012.00669.x   open full text
  • The role of gender in the relationship between physical activity, appearance evaluation and psychological distress.
    Tommy Haugen, Bjørn Tore Johansen, Yngvar Ommundsen.
    Child and Adolescent Mental Health. May 10, 2012
    Background Based on previous research, the aim of this cross‐sectional study was to examine the indirect effect of physical activity on psychological distress through appearance evaluation. The indirect effect was hypothesized to be conditional on gender, with the effect being more profound among females than among males. Method A total of 2055 adolescents (Mage = 15.3) completed a self‐report questionnaire. Results Physical activity was indirectly related to psychological distress through appearance evaluation in both males and females, but the indirect effect was stronger for females than for males. Conclusions Physical activity may prevent distress through enhanced appearance evaluation.
    May 10, 2012   doi: 10.1111/j.1475-3588.2012.00671.x   open full text
  • Parental and children's report of emotional problems: agreement, explanatory factors and event‐emotion correlation.
    Nathalie Michels, Barbara Vanaelst, Elke Stoppie, Inge Huybrechts, Karin Bammann, Stefaan Henauw, Isabelle Sioen.
    Child and Adolescent Mental Health. May 10, 2012
    Background As often only parents are addressed, studying parent‐child agreement and its explanatory factors is crucial in gaining accurate information on young children's emotional problems. Method Parental and children's reports of children's emotional problems (anger, anxiety, sadness) and children's reports of life events were gathered between February and June, 2010 from 464 Belgian nonclinical children 5–10 years old. Results Children reported more emotional problems than their parents. Parental underestimation was higher in the case of girls, older children, nontraditional family structures and authoritative parenting style. Furthermore, life events and emotional problems were significantly correlated only when using children's reported emotions. Conclusions In our nonclinical children, interviewing both parents and children on children's emotional problems is necessary and parent‐child disagreement can partially be explained by child or family characteristics.
    May 10, 2012   doi: 10.1111/j.1475-3588.2012.00672.x   open full text
  • Child mental health and service needs in Iraq: beliefs and attitudes of primary school teachers.
    Abdul Kareem Al‐Obaidi, Brett D. Nelson, Ghazwan Al Badawi, Madelyn Hsiao‐Rei Hicks, Anthony J. Guarino.
    Child and Adolescent Mental Health. May 08, 2012
    Objective To survey Iraqi primary school teachers' beliefs and attitudes about mental health and behavioural problems of children. Methods From 10 primary schools in Baghdad, 148 teachers were surveyed using a closed‐response questionnaire to assess beliefs and attitudes regarding students' mental health and behavioural problems, needs, resources and limitations to teaching. Results Disruptive behaviours were rated as main problems by the largest proportions of teachers. In‐service training on ‘identifying students with social, emotional, or behavioural problems’ and ‘effective behaviour management’ was rated very important by 70% of teachers. Most teachers received no training on mental health during their teaching career. There was low reported availability of a wide range of school‐based mental health resources. Conclusions Teachers in Iraq report substantial mental health and behavioural problems in primary school children and identify high unmet need for school‐based mental health programmes and training.
    May 08, 2012   doi: 10.1111/j.1475-3588.2012.00670.x   open full text
  • Parent experiences of a specialist intervention service for mental health difficulties in children with autistic spectrum disorder.
    Cara Kingston, Charlotte Hibberd, Ann Ozsivadjian.
    Child and Adolescent Mental Health. April 19, 2012
    Background Mental health problems are increasingly being recognised as a significant health need for people with autism spectrum disorder, but few specialist services are available. This study explored parents’ experiences of a specialist autism spectrum psychological intervention service located within a broader Neurodevelopmental and Social Communication Disorders Team. Method Forty‐nine parents completed a telephone based survey designed to assess experiences of a specialist intervention service. Results High levels of satisfaction were reported. Parents reported aspects of the service that they found most useful. Conclusion Most parents reported satisfaction with the service and suggested improvements were used to guide service development.
    April 19, 2012   doi: 10.1111/j.1475-3588.2012.00667.x   open full text
  • Long‐term effects of a universal prevention program for depression in children: a 3‐year follow‐up study.
    Shoji Sato, Shin‐ichi Ishikawa, Yasuko Togasaki, Akiko Ogata, Yoko Sato.
    Child and Adolescent Mental Health. April 10, 2012
    Background The present study evaluates the long‐term effects of a universal prevention approach for depression in children. It looks into the 2‐ and 3‐year follow‐ups of previously reported postintervention and 1‐year outcomes. Method One hundred and eighty‐nine 3rd grade (8–9 years old) children participated in a five‐session, school‐based, universal prevention program designed to encourage social skills and peer support. The study was conducted from 2006 to 2009 in two public schools in Miyazaki, the south main island of Japan. Results Depressive symptoms decreased significantly from the pre to the postintervention periods, and this effect was maintained. Furthermore, children in the prevention group showed significantly lower depression than the normative sample. Conclusions This study reveals the beneficial long‐term effects of a universal approach.
    April 10, 2012   doi: 10.1111/j.1475-3588.2012.00665.x   open full text
  • Are we reaching them yet? Service access patterns among attendees at the headspace youth mental health initiative.
    Roger Patulny, Kristy Muir, Abigail Powell, Saul Flaxman, Ioana Oprea.
    Child and Adolescent Mental Health. April 04, 2012
    Background Australian young people have a high prevalence of mental health problems but low rates of service use. This article examines whether the Australian National Youth Mental Health Foundation, headspace, has helped redress this through providing youth‐specific services. Method The article compares headspace service use demographics with population data from the Australian Survey of Mental Health and Wellbeing from 2007. Results Headspace has improved access relative to the population, particularly among males and socially and economically excluded young people. Conclusions Despite overall successes, certain ethnic and age groups appear under‐represented and in need of more careful targeting by youth mental health services.
    April 04, 2012   doi: 10.1111/j.1475-3588.2012.00662.x   open full text
  • Health‐related quality of life: cross‐informant agreement of father, mother, and self‐report for children and adolescents in outpatient psychotherapy treatment.
    Katharina Weitkamp, Judith Daniels, Sandra Rosenthal, Georg Romer, Silke Wiegand‐Grefe.
    Child and Adolescent Mental Health. March 08, 2012
    Background To study the cross‐informant agreement between father, mother harm avoidance and child rating of health‐related quality of life (HRQoL) in a psychiatric sample. Methods Data were obtained from 127 children and adolescents (aged 6–18) commencing outpatient psychotherapy treatment, mainly for anxiety, depressive, and externalising disorders. A total of 100 mothers, 69 fathers harm avoidance and 76 children (aged 11 years and older) filled out questionnaires. HRQoL was measured with the KIDSCREEN‐27. Results Cross‐informant agreement was moderate to high between parents and moderate to low between father–child and mother–child pairs. Both parents reported lower HRQoL than the children themselves. Standardised discrepancies correlated with gender, overall and internalising pathology, as well as harm avoidance to a small degree. Conclusions Although there was moderate‐to‐high correspondence, mother and father reports were not interchangeable. When collecting a single‐parent proxy rating on the child's HRQoL, researchers should be aware of the additional potential source of variance due to differing concordance of father and mother with the child's self‐report especially for peer relations.
    March 08, 2012   doi: 10.1111/j.1475-3588.2012.00656.x   open full text
  • Implementing routine outcome measures in child and adolescent mental health services: from present to future practice.
    Martin J Batty, Maria Moldavsky, Pooria Sarrami Foroushani, Sarah Pass, Michael Marriott, Kapil Sayal, Chris Hollis.
    Child and Adolescent Mental Health. March 02, 2012
    Background Routine outcome measurement (ROM) in CAMHS is supported by U.K. Government policy. However, little is known about how measures are used in practice. Method Data describing use of ROM, knowledge and attitudes regarding implementation were collected using a regional case‐note audit, online survey and stakeholder workshop. Results While the principle of ROM was supported by stakeholders, baseline and follow‐up outcome measurement occurred in less than a fifth of cases. Barriers to implementation included lack of training and resources, clinicians' perceptions of the limitations of existing measures and lack of regular feedback of outcome data. Conclusions Implementation of ROM may be facilitated by session‐by‐session measures with immediate feedback to clinicians and patients.
    March 02, 2012   doi: 10.1111/j.1475-3588.2012.00658.x   open full text
  • Screening for adolescent depression in paediatric care: validity of a new brief version of the Center for Epidemiological Studies Depression Scale.
    Kathrin Pietsch, Antje‐Kathrin Allgaier, Barbara Frühe, Anne Hoyler, Sabine Rohde, Gerd Schulte‐Körne.
    Child and Adolescent Mental Health. February 20, 2012
    Background The study assessed the criterion validity of the 15‐item version of the Center for Epidemiological Studies Depression Scale (CES‐D‐15) as a screening instrument in paediatric care. Method A total of 327 patients (13–16 years) completed the CES‐D‐15 and a diagnostic interview serving as gold standard diagnosis for validation. Results Receiver operating characteristics yielded an overall accuracy of area under the curve (AUC) = .90 (95% CI [.85, .95]) for the detection of any depressive disorder. At the optimal cut‐off point of 14, sensitivity (.85) and specificity (.84) were good. Conclusions The CES‐D‐15 is a promising tool for paediatricians to enhance the recognition rate of juvenile depression.
    February 20, 2012   doi: 10.1111/j.1475-3588.2012.00650.x   open full text
  • Review: Psychopathology in childhood epilepsy.
    Colin Reilly, Elizabeth Kent, Brian G.R. Neville.
    Child and Adolescent Mental Health. February 20, 2012
    Background Population‐based studies of psychopathology are important in childhood epilepsy given that there is a spectrum of severity with regard to the impact of epilepsy and associated behavioural/psychiatric difficulties. Method Population‐based studies in childhood epilepsy which have focused on global measures of psychopathology and rates of specific behavioural and psychiatric disorders were reviewed with respect to prevalence of disorders and possible correlates of difficulties. Clinic‐based studies and meta‐analyses were reviewed where they added to an understanding of the correlates or treatment of psychopathology in childhood epilepsy. The systematic review methodology was based on a search of PubMed from January 1980 to June 2011. Results Children with epilepsy are at significantly higher risk for a range of behavioural and psychiatric disorders including attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), depressive and anxiety disorders. Available evidence suggests that these difficulties are under‐recognised and there have been few studies focussing on interventions to treat these behavioural and psychiatric issues in childhood epilepsy. Conclusion Population‐based studies suggest high rates of psychopathology in childhood epilepsy. As a result children with epilepsy need close monitoring with regard to the presence of behavioural difficulties. There is a need for studies on how such difficulties can be best managed so that affected children and their families can maximise their quality of life.
    February 20, 2012   doi: 10.1111/j.1475-3588.2012.00648.x   open full text
  • Early Recognition and Assessment.
    Crispin Day.
    Child and Adolescent Mental Health. February 17, 2011
    There is no abstract available for this paper.
    February 17, 2011   doi: 10.1111/j.1475-3588.2011.00597.x   open full text