BRADLEY SK and CARTER B. Nursing Inquiry 2011; 18: 303–312 Deconstructing child and adolescent mental health: questioning the ‘taken‐for‐granted’…We present a critical deconstructive reading, seeking to problematise ‘taken‐for‐granted’ assumptions in child and adolescent mental health (CAMH). The start point for this critical reading is conventional ‘history‐telling’ within CAMH. The aim is not to take issue with the detail in such histories but to critically examine the texts, so as to highlight constructions that structure the (...) presentation of conventional histories and possible purposes that such constructions may serve. The argument is that such conventional histories leave key questions not just unanswered, but unconsidered – a tendency that can be seen throughout the CAMH literature more generally. Therefore, we then pursue critical discussion of how ‘taken‐for‐granted’ constructions of CAMH enabled psychiatry to successfully expand its power and influence to establish hegemony over ‘problem children’. We do not claim any closure to this critical reading; that is, we do not claim that our critical deconstructive reading is the only reading possible. Similarly, it is not presented in any sense as ‘final word’. Rather our hope for this work is that it might stimulate readers to question the ‘taken‐for‐granteds’ that we present, and indeed others that they might identify themselves. In so doing, it is our hope that creative dialogue might ensue. (shrink)

In everyday conversations, people put forward versions of events and provide supporting evidence to build a credible case. In environments where there are potentially competing versions, case-building may take a more systematic format. Specifically, we conducted a rhetorical analysis to consider how in child mental health settings, families work to present a credible ‘doctorable’ reason for attendance. Data consisted of video-recordings of 28 families undergoing mental health assessments. Our findings point to eight rhetorical devices utilised (...) in this environment to build a case. The devices functioned rhetorically to add credibility and authenticate the case being built, which was relevant as the only resource available to families claiming the presence of a mental health difficulty in the child was their spoken words. In other words, the ‘problem’ was something constructed through talk and therefore the kinds of resources used were seminal in decision-making. (shrink)

With the recent expansion of child mental health research, more attention is being paid to the process of informed consent for research participation. For the consent to be truly informed, it is necessary that the relevant information be both disclosed and actually understood. Traditionally, much effort has gone to ensuring the comprehensiveness of consent/assent documents, which have progressively increased in length and complexity, whereas less attention has been paid to the comprehensibility of these documents. Available data indicate (...) that many parent and children have difficulties appreciating the research nature of treatment studies and that a higher level of formal education among the parents is associated with a greater degree of understanding. Promising approaches to achieving truly informed research participation have emerged, such as additional time for parents to meet with the researchers and using postexplanation questionnaires for identifying issues in need of further clarification. Research is needed to develop and test strategies for improving the effectiveness of the informed consent process in child mental health. (shrink)

This extended literature review proposes to present the trends in the therapeutic alliance, outcomes, and measures in the last decade within the premises of individual cognitive behaviour therapy and its innovations, used as an interventional measure in the context of child and adolescent mental health setting. A brief background of the rationale for conducting this literature search is presented at the start. This is followed by the methodology and design which incorporates the inclusion and exclusion criteria and (...) the basis for the same. The critical appraisal of the primary studies is presented in the literature review section with a brief description of the summary features of the studies in the study tables followed by the results and discussion of the study findings. To summarise, the literature review of primary studies conducted in the last decade demonstrates the need for further research to be conducted both in the field of CBT in children and therapeutic alliance, competence, and therapy outcomes, integrating perspectives in child development, carer alliance, and the social construct theory in children, to allow for further innovations in CBT in the context of increasing challenges in the current times of exponentially developing technology and its utility without compromising the quality of therapy. In conclusion, recommendations are made as a guideline for future studies and research in this field. (shrink)

This article explores Stanley Cavell’s ordinary aesthetics through a close reading of one passage inThe Claim of Reason. This close reading leads to the suggestion that educating our aesthetic sense and responsiveness has ethical implications, especially as these relate to the mental health crisis in schools. The article draws implications for individuals in caring relationships with young people, suggesting that Cavell’s thinking on ordinary aesthetics is a powerful tool in our time.

This paper examines the concept of confidentiality and the quality of the relationship between young people experiencing mental health problems and social workers supporting them. The nature of a therapeutic intervention brings into focus the rigidities and complexities in adhering to agency and professional guidelines on confidentiality. The paper highlights the tensions and ethical dilemmas in making decisions about risk and whether, when, and how to breach confidentiality.

In this chapter we argue that the four principles of medical ethics -- beneficence, non-maleficence, respect for autonomy and justice (Beauchamp & Childress, 2001; Gillon, 1985), a new Family Interest Principle (introduced below) and a consideration of ‘capacity’ provide a reasoned practice guide for work with mothers experiencing health problems, focussing here on mental health when a parent is a patient. Our concern is the relationship of the clinician with a parent and through the parent their (...) class='Hi'>child. Ethics of service provision or services planning (e.g. Culyer, 2001; McLachlan, 2005; see also Newbigging and Paul, chapter xxx), or the provision of other services (e.g. education, child protection) although intensely relevant to this area are not addressed in this chapter nor will we deal with the complex aspects of medical ethics relating to the treatment of children (Baines, 2008). We use the term ‘parent’ to refer to any adult person who fulfils a substantive parental role with a child. Defining what counts as a family will in certain circumstances be contentious. There are diverse patterns of family arrangements that may be influenced by cultural, political economic and temporal factors. For the purposes of our discussion, we define a family in terms of its role in childrearing, as a group of at least one adult and at least one child, living together in long term relationships on an ongoing basis with vested interest in the well being of each of the family members. (shrink)

According to the hardiness model and the perspective of different treatment by parents, this study developed and validated a moderated mediation model to explore the direct effect of hardiness on the mental health of Chinese funded college students, the mediating role of social support, and the moderating role of only-child /non-only-child status. A hardiness scale, mental health scale, and perceived social support scale were used to examine information on 673 Chinese FCSs. Hardiness had a (...) significantly positive effect on the mental health of FCSs. Mediation analysis indicated that social support mediated the relationship between hardiness and the mental health of FCSs. The moderated mediation model analysis indicated that the OC/NOC status moderated the second half of the mediation model. The results suggest that the hardiness model is applicable to FCSs from China and elucidate the internal influence mechanism between hardiness and mental health. On the basis of the findings of this study, suggestions are presented in this paper for college education management. (shrink)

Parents play an integral role in the mental health service provision of children and adolescents, and they can have significant effects on the outcomes of youth. A growing body of research has linked parents’ own mental health status to numerous outcomes for their children, and recent guidelines have emerged recommending the assessment of parent psychopathology when treating child patients. However, these recommendations present a range of ethical considerations. Mental health professionals must determine if (...) the assessment of a parent is empirically supported and that an assessment procedure appropriate for parents can be feasibly implemented. They must also respect the autonomy and confidentiality of parents while ensuring that assessment findings can be translated to meaningful benefits for child patients. This article details and discusses each of these concerns within the context of the relevant principles and standards of the 2016 American Psychological Association’s Code of Ethics. Further, it provides guidelines, relevant clinical examples, and an applied model for mental health professionals to consider the ethical implications of assessing parent mental health when serving child patients. (shrink)

Child and adolescent researchers must balance increasingly complex sets of ethical, legal, and scientific standards when investigating child and adolescent mental disorders. Few guidelines are available. One mechanism that provides the investigator immunity from legally compelled disclosure of research records is described. However, discretion must be exercised in its use, especially with regard to abuse reporting, voluntary disclosure of abuse, and protection of research data. Examples of discretionary issues in the use of the certificate of confidentiality are (...) provided. (shrink)

Mental health surveys are used extensively in epidemiological research worldwide. The ethical questions that arise regarding their risk of causing psychological distress or other potential harm have not been studied in the general population. We have investigated how study participants serving as controls in a population-based study perceived an anonymous postal questionnaire focusing on mental health and wellbeing. Parents were contacted from the Swedish Census Bureau as part of a larger follow-up study on palliative care conducted (...) in 2001. Eligible parents had a child of the same gender, year of birth and were from the same counties in Sweden as parents who had lost a child to cancer. Five percent reported being negatively affected. The principle negative effect on participants was that self-reflection reminded them of their difficulties. Of the 418 respondents, 52% reported that they were positively affected by study participation and 95% perceived the inquiry as valuable. These findings support the use of population-based controls in future research. (shrink)

BackgroundMental illness among Malaysian children is gradually reaching a fundamentally alarming point as it persistently shows increasing trend. The existing literature on the etiologies of children’s mental illness, highlights the most common cause to be ineffective or impaired parenting. Thus, efforts to combat mental illness in children should focus on improving the quality of parenting. Documented interventional studies focusing on this issue, particularly in Malaysia, are scarce and commonly report poor treatment outcomes stemming from inconvenient face-to-face instructions. Consequently, (...) proposing an accessible online and digital-assisted parenting program is expected to reach a larger number of parents, as it can overcome substantial barriers. Hence, this study aims to develop a universal digital-assisted preventive parenting intervention called DaPI, that aims to enhance mental health of children in Malaysia.MethodsA total of 200 parents of children aged 10–14 years will be recruited and randomized into two groups either intervention or waitlist-control based on a 1:1 ratio for a duration of 8 weeks. Those in the intervention group will receive eight sessions of the DaPI program that focus mainly on parenting and children’s mental health. The primary outcome of this study will essentially focus on the changes in parent-reported parenting behavior and parental self-efficacy. The secondary outcome will be changes in children’s mental health. Assessments will be arranged pre- and post-intervention as well as at the 1-month follow-up. Analyses will be conducted using a paired t-test and multivariate analysis of covariance.DiscussionThe expected outcome will be the establishment of DaPI in promoting children’s mental health by targeting changes in parenting behavior and parental self-efficacy in Malaysia. Findings from this study will be beneficial for policymakers to invest in parenting programs that could provide support to parents in enhancing their child’s overall development.Clinical trial registration[www.irct.ir], identifier [IRCT20211129053207N1]. (shrink)

Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment.Methods: Multilevel multinomial regression analysis controlling for (...) age, gender, ethnicity, and referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 years] using anonymised administrative data from young people's mental health services.Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement. Similarly, they were less likely to transfer or end treatment for other reasons than by case closure due to mutual agreement.Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services. (shrink)

Despite its profound importance for individuals and populations, children’s mental health remains under-appreciated as a public policy priority, to a degree that violates children’s rights. Using a working definition of policymaking as collective ethical decision-making for the one and the many, we elaborate by describing an individual child’s story and reviewing the pertinent population health research evidence. We then outline three central public health ethical challenges: addressing the high prevalence and impact of childhood mental (...) disorders; addressing the avoidable social adversities that underlie many childhood mental disorders; and addressing stark shortfalls in prevention and treatment services for children. We end with discussing opportunities for progress, including addressing the attendant children’s rights issues. (shrink)

Social anxiety is highly prevalent in adolescents and is often associated with great individual suffering and functional impairment. Psychiatric comorbidity is common and further adds to this burden. The purposes of this study were: (1) to describe the occurrence of diagnosed and self-reported social anxiety among 8,199 Norwegian adolescents aged 13–19 years who participated in the population-based Young-HUNT3 study (2006–2008); (2) to examine associations between sociodemographic characteristics and different subgroups of social anxiety; and (3) to describe the psychiatric health (...) comorbidities among adolescents diagnosed with social anxiety disorder (SAD). In total, 388 (5.9%) of the adolescents screened positive for SAD and were invited into a diagnostic interview, performed by professional nurses, using Anxiety Disorders Interview Schedule for DSM IV: child version (ADIS-C) (response rate = 54.6%). A SAD diagnosis was indicated in 106 individuals (50% of the interview subjects), and more than two-thirds of the adolescents diagnosed with SAD had one or more comorbid psychiatric disorders. Higher mean scores of self-reported social anxiety symptoms, poor self-rated health, sleep problems, poor family economic situation, low physical activity, and having sought professional help within the last year were associated with higher odds of being in the screening positive subgroup. Screening positive subjects who did not meet for a diagnostic interview did not differ notably from the rest of the screening positive group in terms of these sociodemographic characteristics. Based on our results and the fact that individuals with social anxiety often fear interview situations, the use of ADIS-C, screening questions and self-reports seem to be sufficient when aiming to identify epidemiologically representative cohorts of adolescents at risk of social anxiety. (shrink)

Most mental health research largely ignores or minimises gender and age differences in depression. In ‘Don't mind the gap: Why do we not care about the gender gap in mental health?’, Patalay and Demkowicz identify a dearth of research on the causal factors of depression in young women. They attribute this to an over-reliance on biological accounts of gender differences in depression. Patalay and Demkowicz conclude that a person-centred approach that meaningfully engages with the reports of (...) young women with depression is more likely to expose the social drivers of depression that impact this group. This commentary focuses on Patalay and Demkowicz's call to examine the patient's lived experience. We argue that there is an urgent need to reflect upon the methodologies involved in examining lived experience and how they can be best utilised. Ultimately, we advocate for an approach known as ‘phenomenological psychopathology’, through a phenomenological investigation of depression in young women, we can go some way towards closing the gender gap. (shrink)

Background: The brief generic Multicultural Quality of Life Index is a culturally informed self-report 10-item questionnaire used to measure health-related quality of life. QoL is an important outcome measure in guiding healthcare and is held as a substantial parameter to evaluate the effectiveness of healthcare. Attention Deficit Hyperactivity Disorder in children might negatively influence the parents’ QoL. Having a validated questionnaire to measure QoL for this population will therefore be a vital first step in guiding healthcare for parents of (...) children with ADHD. We aimed to examine the reliability and validity of the Norwegian version of the MQLI in a sample of parents of children with ADHD.Methods: In a cross-sectional study, 128 parents of children with ADHD were recruited from four outpatient clinics within the Child and Adolescents Mental Health Services in Norway. They completed the MQLI along with an alternative well-being scale, the Five-item World Health Organization Well-being Index, and a form including demographic variables. Reliability and validity of the MQLI were examined. We conducted a factor analysis and calculated internal consistency and the correlation between the MQLI and the WHO-5.Results: Factor analysis of the parents reported MQLI yielded a one-factor solution. For the MQLI, Cronbach’s alpha was 0.73. The correlation between the two measures of MQLI and WHO-5 was high, reflecting convergent validity since the association between the two measures was strong.Conclusion: Results from this study support the reliability and validity of the Norwegian version of the MQLI for assessment of quality of life in parents of children with ADHD with good psychometric properties. Study findings support the use of the questionnaire in CAMHS. (shrink)

BackgroundThe present study examined the efficacy of the Michigan Model of Infant Mental Health-Home Visiting infant mental health treatment to promote the socioemotional wellbeing of infants and young children. Science illuminates the role of parental “co-regulation” of infant emotion as a pathway to young children’s capacity for self-regulation. The synchrony of parent–infant interaction begins to shape the infant’s own nascent regulatory capacities. Parents with a history of childhood adversity, such as maltreatment or witnessing family violence, and (...) who struggle with symptoms of post-traumatic stress may have greater challenges in co-regulating their infant, thus increasing the risk of their children exhibiting social and emotional problems such as anxiety, aggression, and depression. Early intervention that targets the infant–parent relationship may help buffer the effect of parental risk on child outcomes.MethodsParticipants were 58 mother–infant/toddler dyads enrolled in a longitudinal randomized control trial testing the efficacy of the relationship-based IMH-HV treatment model. Families were eligible based on child age and endorsement of at least two of four socio-demographic factors commonly endorsed in community mental health settings: elevated depression symptoms, three or more Adverse Childhood Experiences parenting stress, and/or child behavior or development concerns. This study included dyads whose children were born at the time of study enrollment and completed 12-month post-baseline follow-up visits. Parents reported on their own history of ACEs and current posttraumatic stress disorder symptoms, as well as their toddler’s socioemotional development.ResultsMaternal ACEs predicted more toddler emotional problems through their effect on maternal PTSD symptoms. Parents who received IMH-HV treatment reported more positive toddler socioemotional wellbeing at follow-up relative to the control condition. The most positive socioemotional outcomes were for toddlers of mothers with low to moderate PTSD symptoms who received IMH-HV treatment.ConclusionResults indicate the efficacy of IMH-HV services in promoting more optimal child socioemotional wellbeing even when mothers reported mild to moderate PTSD symptoms. Results also highlight the need to assess parental trauma when infants and young children present with socioemotional difficulties. (shrink)

This book presents a unique classification and review of various mental health and learning issues. The authors link current education and child and youth mental health reforms to make the case for improving services to address barriers to learning.

Scholars increasingly point toward schools as meaningful contexts in which to provide psychosocial care for refugee children. Collaborative mental health care in school forms a particular practice of school-based mental health care provision. Developed in Canada and inspired by systemic intervention approaches, collaborative mental health care in schools involves the formation of an interdisciplinary care network, in which mental health care providers and school partners collaborate with each other and the refugee family (...) in a joint assessment of child development and mental health, as well as joint intervention planning and provision. It aims to move away from an individual perspective on refugee children’s development, toward an engagement with refugee families’ perspectives on their migration histories, cultural background and social condition in shaping assessment and intervention, as such fostering refugee empowerment, equality, and participation in the host society. Relating to the first stage of van Yperen’s four-stage model for establishing evidence-based youth care, this article aims to engage in an initial exploration of the effectiveness of a developing school-based collaborative mental health care practice in Leuven, Belgium. First, we propose a detailed description, co-developed through reflection on case documents, written process reflections, intervision, an initial identification of intervention themes, and articulating interconnections with scholarly literature on transcultural and systemic refugee trauma care. Second, we engage in an in-depth exploration of processes and working mechanisms, obtained through co-constructed clinical case analysis of case work collected through our practice in schools in Leuven, Belgium. Our descriptive analysis indicates the role of central processes that may operate as working mechanisms in school-based collaborative mental health care and points to how collaborative mental health care may mobilize the school and the family-school interaction as a vehicle of restoring safety and stability in the aftermath of cumulative traumatization. Our analysis furthermore forms an important starting point for reflections on future research opportunities, and central clinical dynamics touching upon power disparities and low-threshold access to mental health care for refugee families. (shrink)

The COVID-19 pandemic’s effects on mental health interact with preexisting health risks and disparities to impact varying populations differently. This study explored the relationship between demographic variables, distress and mental health, and vulnerability factors for COVID-19. An online cross-sectional study was conducted from 18 June to 17 July 2020, reflecting the impact of early phase COVID-19 pandemic and related shelter-in-place measures in the United States. Participants were adults residing in the United States, with substantial subsamples (...) of American Indian, Asian American, African-American, and Hispanic and/or Latinx participants, as well as people with disabilities and sexual minorities. Outcomes measured were depression, hopelessness, somatic complaints, anxiety-related disorders, locus of control, and a novel measure of pandemic-related distress. Data were analyzed using analyses of covariance, chi-square test, and correlation coefficients. Generally, younger individuals, and those with less financial power—across all identities—suffered more distress. When controlling for age, lower financial power was associated with higher scores on the Center for Epidemiologic Studies Depression Scale-Revised, Beck Hopelessness Scale, Patient Health Questionnaire-15, Screen for Child Anxiety Related Emotional Disorders for Adults Panic Disorder, SCARED-A generalized anxiety disorder, SCARED-A obsessive–compulsive disorder, and the COVID-19 Pandemic Distress restriction/disconnection scale. In addition, disparities were found, in general, for marginalized identities by gender, sexual orientation, and disability status. Importantly, each ethnicity subsample showed a unique pattern of relationships between COVID-19 risk variables and mental health symptoms. The results support the hypothesis that any pandemic may amplify preexisting social and financial disparities. Overall, interventions at the clinical, governmental, or health equity level should take into consideration the needs of vulnerable groups. (shrink)

BackgroundThe SARS-COVID-19 pandemic and its associated disease control restrictions have in multiple ways affected families with young children, who may be especially vulnerable to mental health problems. Studies report an increase in perinatal parental distress as well as symptoms of anxiety or depression in children during the pandemic. Currently, little is known about the impact of the pandemic on infants and their development. Infant regulatory problems have been identified as early indicators of child socio-emotional development, strongly associated (...) with maternal mental health and the early parent–infant interaction. Our study investigates whether early parenthood under COVID-19 is associated with more maternal depressive symptoms and with a perception of their infants as having more RPs regarding crying/fussing, sleeping, or eating, compared to mothers assessed before the pandemic.MethodsAs part of a longitudinal study, 65 women who had given birth during the first nationwide disease control restrictions in Northern Germany, were surveyed at 7 months postpartum and compared to 97 women assessed before the pandemic. RPs and on maternal depressive symptoms were assessed by maternal report. Number of previous children, infant negative emotionality, and perceived social support were assessed as control variables.ResultsCompared to the control cohort, infants born during the COVID-19 pandemic and those of mothers with higher depressive symptoms were perceived as having more sleeping and crying, but not more eating problems. Regression-based analyses showed no additional moderating effect of parenthood under COVID-19 on the association of depressive symptoms with RPs. Infant negative emotionality was positively, and number of previous children was negatively associated with RPs.LimitationsDue to the small sample size and cross-sectional assessment, the possibility for more complex multivariate analysis was limited. The use of parent-report questionnaires to assess infant RPs can support but not replace clinical diagnosis.ConclusionsThe pandemic conditions affecting everyday life may have a long-term influence on impaired infant self- and maternal co-regulation and on maternal mental health. This should be addressed in peripartum and pediatric care. Qualitative and longitudinal studies focusing on long-term parental and infant outcomes under ongoing pandemic conditions are encouraged. (shrink)

RESUMEN Introducción: Son escasos los servicios en salud mental dentro del contexto escolar que permitan una integración intersectorial para superar la brecha de falta de asistencia en salud mental en la población infanto - juvenil, aun cuando, es en la escuela donde se detectan mayoritariamente los problemas de salud mental. Objetivo: Comentar el uso de servicios de salud mental en el ambiente escolar en relación con los trastornos mentales y trastornos subumbrales. Método: El presente resultado se (...) obtiene a partir del “Estudio de Prevalencia Comunitaria de Trastornos Psiquiátricos y Utilización de Servicios de la Población Infanto-Juvenil Chilena”. La muestra estuvo representada por sujetos entre 4 y 18 años. La información sobre el uso de servicio de salud mental se recogió con una versión modificada de la Escala Service Assesment for Children and Adolescent. Se realizó un modelo de regresión logística para analizar cinco áreas del uso de servicios en el ambiente escolar, las cuales se correlacionaron con diagnósticos de trastorno mentales y trastorno subumbral de ansiedad, disruptivo y depresión en el último año. Resultados: Las escuelas se enfrentan a grandes desafíos sobre cómo proporcionar apoyo efectivo de salud mental para los estudiantes, que presentan algún tipo de trastorno mental o trastorno subumbral. Discussión: Las instituciones educativas requieren ser visualizadas como una entidad que podría satisfacer las necesidades que se advierten de manera urgente en atención, prevención y promoción de problemas mentales en la población infanto- juvenil, si se vinculan de forma más directa con los servicios de salud mental. ABSTRACT Introduction: Mental health services are scarce within the school context that allow intersectoral integration to overcome the gap in mental health care in the child and adolescent population, being the school where mental health problems are mostly detected. Objective: to know the use of mental health services in the school environment in relation to mental disorders and subthreshold disorders. Method: The present secondary study is carried out from the "Study of Community Prevalence of Psychiatric Disorders and Utilization of Services of the Chilean Child-Youth Population". The sample was represented by subjects between 4 and 18 years old. Information on the use of mental health service was collected with a modified version of the Service Assessment Scale for Children and Adolescents. A logistic regression model was performed to analyze five areas of the use of services in the school environment, which were correlated with diagnoses of mental disorders and subthreshold anxiety, disruptive and depression disorder in the last year. Results: Schools face great challenges on how to provide effective mental health support for students, who present some type of mental disorder or subthreshold disorder. Discusion: Educational institutions need to be visualized as an entity that could meet the needs that are urgently noticed in attention, prevention and promotion of mental problems in the child and adolescent population, if it is linked more directly with health services. (shrink)

Untangling the Surrogacy WebSurrogacy agreements represent unique legal questions that must be answered with great care. In Australia we had the recent “Baby Gammy” scandal that involved an international surrogacy agreement and claims of abandonment of a child with Down’s syndrome. This story served to reinforce concerns that surrogacy turns children into a commodity that can be put to one side if expectations are not met. Of course, surrogacy agreements do not always end in this manner and often the (...) outcome is positive. There are, however, underlying legal questions regarding the status of the child, with some children, born as the result of international surrogacy agreements, being practically stateless when the nation of the commissioning parents refuses to issue passports to allow the children to return “home” with their “parents.” Where the relationship is local, however, and there is clear legislation, the issues can be less problematic but can become complex where a party wishes .. (shrink)

These two companion volumes provide a comprehensive review and critical evaluation of the major DSM-III and DSM-III-R child disorders. Their major goal is to provide diagnostic and assessment guidelines that are based on scientific literature in specific clinical domains. Each chapter contains a discussion of the historical background of a particular diagnosis, definitional issues, a critical but selective review of the literature addressing the diagnosis in question, proposed changes in the diagnostic criteria based on the available literature, and proposed (...) assessment models and methods based on the designated criteria. Given the scientific bases for many of these discussions of diagnostic criteria, these two volumes will serve professionals and graduate students in a wide variety of fields: clinical child psychology, child psychiatry, pediatrics, pediatric and school psychology, special education, social work, and other child mental health specialties. (shrink)

These two companion volumes provide a comprehensive review and critical evaluation of the major DSM-III and DSM-III-R child disorders. Their major goal is to provide diagnostic and assessment guidelines that are based on scientific literature in specific clinical domains. Each chapter contains a discussion of the historical background of a particular diagnosis, definitional issues, a critical but selective review of the literature addressing the diagnosis in question, proposed changes in the diagnostic criteria based on the available literature, and proposed (...) assessment models and methods based on the designated criteria. Given the scientific bases for many of these discussions of diagnostic criteria, these two volumes will serve professionals and graduate students in a wide variety of fields: clinical child psychology, child psychiatry, pediatrics, pediatric and school psychology, special education, social work, and other child mental health specialties. (shrink)

Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services. Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of (...) this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. (shrink)

Understanding Child and Adolescent Behaviour in the Classroom is a vital guide for pre-service and in-service teachers, providing the tools to respond effectively and ethically to child and adolescent behaviour that is of concern. In this innovative book, expert authors offer 'positive rules' that will assist educators in their classroom practice. Key practical issues that are addressed include: • Building a purposeful and emotionally and psychologically positive classroom culture • Recognising and responding to children who present with social, (...) emotional and behavioural difficulties • Using research to inform and enrich classroom practice around student conduct • Working collegially to respond to the social, emotional and/or behavioural needs of individual students, including those needs associated with poor mental health and/or child protection Cutting-edge research from psychology, behavioural science and education is accessibly presented to help develop professional expertise and knowledge in the area of child and adolescent behaviour. (shrink)

A deaf lesbian couple who chose to have a deaf child receive a lot of criticismA deaf lesbian couple in the US deliberately tried to create a deaf child. Sharon Duchesneau and Candy McCullough hoped their child, conceived with the help of a sperm donor, would be deaf like the rest of the family. Their daughter, five year old Jehanne, is also deaf and was conceived with the same donor. News of the couple choosing to have a (...) deaf child has only been revealed with the birth of their son Gauvin.1–4To increase their chance of having a deaf baby the women sought a deaf sperm donor from a sperm bank but were told that congenital deafness is “precisely the sort of condition” that disqualifies would-be donors. Rather than dismiss the idea they found their own sperm donor by asking a deaf friend who comes from a family with five generations of deafness.1The women, both professionals in the mental health field, insist that they would still love …. (shrink)

The period from birth to twelve years is crucial in a child's development and can significantly impact future educational success, resilience and participation in society. Health and Wellbeing in Childhood, 2nd edition provides readers with a comprehensive foundation in health and wellbeing education across key priority areas, covering physical, social and emotional learning and development. This edition has been thoroughly updated to include the latest research and resources and incorporates expanded material on diversity, mental health (...) and contemplative practice. Learning is supported through a suite of features including key terms, case studies, links to curriculum documentation, reflective activities and end-of-chapter questions. A new instructor companion website features a curated suite of reading materials, extension questions and sample responses. Written by an expert author team comprised of leading academics and practitioners, Health and Wellbeing in Childhood equips readers with the knowledge and skills to promote and implement effective practice in the field. (shrink)

The onset of the Covid-19 pandemic has disrupted the lives of families in the United States and across the world, impacting parent mental health and stress, and in turn, the parent-child relationship. Music is a common parent-child activity and has been found to positively impact relationships, but little is known about music’s role in parent-child interactions during a pandemic. The current study utilized an online questionnaire to assess the use of music in the home of (...) young children and their parents in the United States and Canada during Covid-19 and its relationship with parents’ affective attachment with their child. Musical activity was high for both parents and children. Parents reported using music for both emotion regulation and to socially connect with their children. Parent-child musical engagement was associated with parent-child attachment, controlling for relevant parent variables including parent distress, efficacy, education, and parent-child engagement in non-musical activities. These results indicate that music may be an effective tool for building and maintaining parent-child relationships during a period of uncertainty and change. (shrink)

Raising a child with an autism spectrum disorder (ASD) is a stressful experience and has been associated with poor maternal mental health and increased maternal emotional distress. However, the experiences of fathers of children with ASD are largely unexplored and the coping strategies these men employ to cope with the challenges they face have received little research attention. This research aimed to explore the phenomenological experiences of fathers of preschool children with ASD by gaining a better understanding (...) of the manner in which these individuals attempted to cope with their situation. A multiple, single-case study design was employed and five participants were recruited via two local paediatric practices. Semi-structured interviews were conducted with the participants and data were analysed making use of Interpretative Phenomenological Analysis (IPA). This analysis yielded three superordinate themes, which were labelled as follows: (a) the experience of fathering a child with ASD, (b) challenges of fathering a child with ASD, and (c) coping with fathering a child with ASD. The results suggest that the fathers of children with ASD experience their parental role as stressful. The participants in the current study related the stress they experienced to a number of challenges associated directly with their children’s behaviour, as well as to the effects that parenting a child with ASD had on their own wellbeing and functioning. The participants reported making use of a number of coping strategies in order to deal with the challenges they faced. The participants used both problem-focussed and avoidant coping strategies. The results are discussed and recommendations made with regard to future research. (shrink)

Capacity and competence in the field of child and adolescent psychiatry are complex issues, because of the many different influences that are involved in how children and adolescents make treatment decisions within the setting of mental health. This article will examine some of the influences which must be considered, namely: developmental aspects, the paradoxical relationship between the need for autonomy and participation and the capacity of children, family psychiatry, and the duty of care towards children and adolescents. (...) The legal frameworks relevant to consideration of consent and competence will be briefly considered, as well as some studies of children's consent, participation and competence. A case vignette will be used as a focus to consider the complexity of the issue of competence in child and adolescent psychiatry, in the particular mental disorder of anorexia nervosa. (shrink)

The principle of the child's right to an open future was first proposed by the legal philosopher Joel Feinberg and developed further by bioethicist Dena Davis. The principle holds that children possess a unique class of rights called rights in trust—rights that they cannot yet exercise, but which they will be able to exercise when they reach maturity. Parents should not, therefore, take actions that permanently foreclose on or pre-empt the future options of their children, but leave them the (...) greatest possible scope for exercising personal life choices in adulthood. Davis particularly applies the principle to genetic counselling, arguing that parents should not take deliberate steps to create physically abnormal children, and to religion, arguing that while parents are entitled to bring their children up in accordance with their own values, they are not entitled to inflict physical or mental harm, neither by omission nor commission. In this paper, I aim to elucidate the open future principle, and consider whether it is applicable to non-therapeutic circumcision of boys, whether performed for cultural/religious or for prophylactic/health reasons. I argue that the principle is highly applicable to non-therapeutic circumcision, and conclude that non-therapeutic circumcision would be a violation of the child's right to an open future, and thus objectionable from both an ethical and a human rights perspective. (shrink)

Most children and families have not had direct contact with child psychological and psychiatric experts. Instead they encounter developmental theories, etiological explanations and depictions of childhood disorders through indirect channels such as newspapers. Drawing on actor–network theory, this article explores two child psychological and psychiatric modes of ordering children’s mental health discernible in Sweden’s largest morning newspaper, Dagens Nyheter, during the years 1980 to 2008: a psychodynamic mode and a neuro-centered mode. In the article I show (...) how these two relatively contemporaneous modes greatly differed in how they enacted children’s mental health. The psychodynamic mode stressed the parents’ role in structuring and affecting the child’s unconscious and saw them as the primary cause of any mental illness. In contrast, the neuro-centered mode highlighted that mental issues were related to the child’s brain and proposed different solutions depending on whether the child’s brain functioned in a ‘normal’ or ‘atypical’ manner. Each mode moreover suggested differing contexts to their discussions, with the psychodynamic mode solely discussing the parental milieu while the neuro-centered mode mainly focused on how society affected children with ‘atypical’ brains. The two modes thus had significantly diverging implications for the reader on how to understand and manage children and their psychological well-being. I further argue in the article for the relevance of actor–network theory in historical studies of psychology and psychiatry. (shrink)

Parents and guardians in child protection systems are in unequal power relationships with child protection practitioners. This relationship is experienced as exclusionary or even oppressive by many parents and guardians. For families and communities in the child protection system who experience intersectional discrimination and disadvantage, such as people with intellectual disabilities and First Nations people, this unequal relationship and subsequent potential exclusion and oppression can be even more profound. A growing body of literature indicates that advocacy can (...) assist in addressing unequal relationships in other contexts, such as involuntary mental health. This paper explores the role of representational advocacy in supporting parents in child protection settings through a case study of an advocacy service in Victoria, Australia. Using a human rights framework to guide the analysis, the paper highlights how advocacy can help support rights, but that broader structural change will be required to consistently uphold the rights of parents. (shrink)

Mental health practitioners, assessing children for possible psychiatric conditions, need to probe sensitive matters. We examine practitioners’ use of questions which try to clarify a given issue by offering alternative descriptions of how things are: one bland, and the other clearly undesirable in some way. The undesirable states of affairs can be described in serious terms or, while still undesirable, in less serious ones. We find that if an undesirable state of affairs is described in seriously negative terms, (...) it tends to be put as the first item in the pair of alternatives. We argue that this version of the familiar ‘optimistic questioning’ practice ensures that were the negative case to be chosen, it would be in spite of it being the more interactionally difficult answer to give. That makes the answer diagnostically more reliable. We discuss the pros and cons use of this practice in the environment of triage. (shrink)

Child poverty leads to various negative consequences, including low self-esteem, which is a risk factor for mental illness, suicide, or poor academic achievement. However, little is known about why child poverty leads to low self-esteem. We aimed to elucidate the association of child poverty and low self-esteem based on the ecological model, which includes family-level, school-level, and community-level factors. Data were obtained from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in (...) 2016, and participants included 1,652 children in fourth grade (534 pairs), sixth grade (530 pairs), and eighth grade (588 pairs) living in Adachi City, Tokyo. A questionnaire survey was implemented to assess child poverty, parental mental health, parental involvement with children, parental social capital by caregivers, and self-esteem and school social capital by children. The structural equation model was applied to elucidate the association between child poverty and low self-esteem, using family-level (parental mental health and parental involvement with children), school-level (school social capital), and community-level (parental social capital) factors. Child poverty was associated with low self-esteem. Child poverty leads to poor parental involvement, which can be indirectly associated with poor parental mental health and poor parental social capital, and poor parental involvement was directly or indirectly associated with low self-esteem through poor school social capital. To mitigate the impact of child poverty on low self-esteem, comprehensive health policies targeting family-level (parental mental health and parental involvement with children), school-level (school social capital), and community-level (parental social capital) factors may be effective. (shrink)

Previous studies have found that serum lipid levels independently associate with mental health problems in adulthood. However, little is known about the association between serum lipid levels and positive aspects of mental health such as resilience and self-esteem, which develop in adolescence. The aim of this study is to examine the association between serum lipid levels and resilience and self-esteem in Japanese adolescents. Data were pooled data from the Adachi Child Health Impact of Living (...) Difficulty study in 2016 and 2018, a school-based, cross-sectional study in Adachi City, Tokyo, Japan. Resilience of the child was assessed by caregivers, and self-esteem was self-identified via questionnaires. Serum lipid levels [total cholesterol, low-density lipoproteins, and high-density lipoproteins ] were assessed in school health checkup, in addition to height and weight measurements. Multiple linear regression was applied to investigate the association between standardized serum lipid levels and resilience and self-esteem. LDL showed inverse association with resilience [β = −1.26, 95% confidence interval = −2.39 to −0.14] after adjusting for child’s BMI, month of birth, sex, absence of parent, household income, caregiver’s mental health, and lifestyle. We also found an inverse association of total cholesterol and higher LDL cholesterol with self-esteem. HDL cholesterol was not associated with resilience and self-esteem. Among Japanese adolescent, total and LDL cholesterol may be biomarkers of resilience and self-esteem. (shrink)

Child sexual exploitation and abuse has grave implications for the mental health and wellbeing of children and young people. It has been linked to a wide range of difficulties which may extend into adulthood. School-based prevention programs that aim to raise awareness are popular, however, have historically lacked robust and consistent evaluation. The purpose of the present study was therefore to explore young people’s experiences of attending a school-based theater-in-education program, and the impact this had on their (...) awareness and understanding of CSEA. Four focus groups of between four to six participants each were conducted with young people from two co-educational State schools in the United Kingdom. The approach of Template Analysis was used to analyze the data, and revealed a number of themes related to the superordinate themes of “Information and Detail Delivered” and “Format and Timing.” The results suggest that participants gained new awareness and understanding of aspects related to CSEA, including other forms of exploitation, as well as how to avoid harm and what to do “if bad things happen.” Participants further reported that the theater performance/live element of the program was particularly impactful, feeling that this was delivered to them at the right time, but suggesting that younger people would also benefit from the important messages. In addition, areas for improvement were identified in terms of the delivery of the program, and the issue of victim blaming. Findings are discussed with a view to practical implications and directions for future research. (shrink)

Through a case study, this paper addresses ethical issues and dilemmas faced by a Family Therapist working in a Child and Adolescent Mental Health Service (CAMHS) in the National Health Service. When there are legal and societal obligations on parents/carers to ensure that the needs of children and young people are met within a family context, working with a young person in a health care setting oriented to the individual raises ethical dilemmas around consent. When (...) the values of young people and their parents conflict, legal, ethical and political issues can be raised. These have implications for the duties of health care professionals and the rights, interests and autonomy of the individual young people and their parents. The importance of justice to CAMHS practitioners' ethical decision-making about when to prioritize the individual over the family, or vice versa, is emphasized. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When a Conflict Collapses on a Child: An (Aborted) Medical Evacuation of a Hazara Toddler During the Kabul Airport Blast and the Taliban TakeoverAyesha AhmadI work in the capacity of an academic researching conflict in Afghanistan. My commitment is rooted in the firm terrain of friendships that merged into sisterhood of the Afghan terrain spaning decades of war but which is also the home of poetics and legacies (...) that refuse to be clouded by the traumas of the land.As a medical ethicist situated in global health, I perceive the inadequate focus on recognising the mental health needs born from living in war as a moral injustice and a form of silencing the suffering. This injustice should be held by the geopolitical hands that play the chords of conflict.However, such research is all too often concluded before it can develop as too dangerous, or too risky, or even as unethical because potential participants are perceived (often, unjustifiably so) to be too vulnerable.Another peril of research is the boundary drawn between a particular experience of the research objective and the life experience of the research participant. Connecting as a researcher and in a personal capacity, I fell into a chasm unseen in the context from where I work in London, United Kingdom.I remember the evening before Kabul city fell to the forced control of the Taliban. My friends reminisced during a nightfall reflection on the battles where the city walls had barricaded its inhabitants from centuries of invaders trying to access the valley of a city surrounded by mountains. Kabul city is a haven for war. Its geographic location makes it desirable to conquer, but part of its desirability is because of how the mountains envelop where the languages, ethnicities, religions, and stories of the Silk Road have settled and rested. Once conquered, the city protects you. And Kabulis felt safe. And to that end, on that fateful night, we ended our conversation in the confidence of hope; that Kabul city would not fall, and with the heart of the country still intact, Afghanistan would be saved.The dawn arrived and so did the approach of the Taliban to the city gates. There were frantic and rapid whispers that transformed into screams. And then the moment came, the Taliban were within the city walls.The juxtaposition between the regular London traffic heaving and breathing, and the frantic, panicked sounds of horns and vehicles fleeing in Kabul that I heard through WhatsApp audios in the background to friends narrating their journey home, was as stark as the peace and war they both echoed. [End Page 167]Soon the stories started speaking, pleading, paining, pressuring—stories seeking survival. In the dawn, instead of the sun breaking the sky, I broke the morning to a friend during a telephone conversation who had just awoken and had not yet received the news. I told my friend that the Taliban were in Kabul city. The reaction was grief, just like the grief I had heard in their voice a few months prior when their beloved father had passed away and entered the grave before they had breathed the new dawn. In the dusk, instead of the moon shining upon the city, women, families, and children were sheltering from the darkness of the grave closing amid their breathing bodies.Then, the blast came. In the energy of the quest for safety, people, walking like pilgrims, surrounded Kabul airport, queuing like worshippers. Prayers died. Hell rose. The waiting crowd was fired upon. The air did not offer breath; instead, a final moment of the sound of war that had blighted lives.In the crowd was a family who I dedicate this article to. I write the story of the father, the mother, the daughter, and the son of that day. The family was Hazara, a disputed and discriminated ethnic minority in Afghanistan, of a legacy traced to the invasion of Genghis Khan, the founder of the Mongol Empire. Theirs is a story of travellers and a soil of stories; a particularly profound story because the parents had specialised in geology and were experts of the stones of their long heritage. Yet, still, they... (shrink)

A child is a developing person with evolving capacities that include autonomy, mental capacity and capacity to assume responsibility. Hence, children are entitled to participatory rights in South Africa as observed in the Children’s Act 38 of 2005. According to section 129 of the Act a child may consent to his or her own medical treatment provided that he or she is over the age of 12 years and is of sufficient maturity and decisional capacity to understand (...) the various implications of the treatment including the risks and benefits thereof. However, the Act does not provide a definition for what qualifies as ‘sufficient maturity’ nor does it stipulate how health professionals ought to assess the decisional capacity of a child. In addition, South Africa is a culturally diverse country. The Western liberal notion of autonomy may not necessarily find equal prominence in the mores of people with a different worldview. Hence we demonstrate a few salient comparisons between legal liberal moral theory and African communitarianism as pertinent to the autonomy of the child. Children are rights-holders by virtue of their humanity. Their dignity as individual human persons affords them the entitlement to human rights as contemplated under the Constitution of the Republic of South Africa. However, contrary to the traditional Western notion of individual autonomous persons African societies hold a communalistic notion of person hence there is less regard for individual autonomy and rights with more emphasis on the communal good and maintaining the continuity of relationships and interdependencies shared within a community. A child considered in this view is not regarded as a full person. This implies that decisions concerning the child, including consent to medical treatment are discussed and determined by the community to which the child belongs. Lastly, in this article, we draw on the notion of capacity for responsibility to produce a pragmatic definition of sufficient maturity. It seems reasonable to suggest a move away from a general legal age of consent for medical treatment toward more individualised, context-specific approaches in determining the maturity of a child patient to consent to medical treatment. Perhaps, decision-making with respect to consent to the medical treatment of a child belonging to a traditional African community where the notion of a person is embedded in communitarianism ought to involve the child’s parents/guardians/caregivers where possible provided that the best interests of the child are awarded priority. (shrink)

Since 2019, the COVID-19 pandemic, as a global public health emergency, has led to stringency measures of various degrees worldwide. As these measures such as social distancing measures and mandatory lockdown are intended to minimize social mobility, they have exerted remarkable impact on individuals’ mental health, particularly, adolescents and children. The mental health problems caused include fear, anxiety, sense of isolation and development of more maladaptive behaviors due to prolonged lockdown and restricted interpersonal contact. However, (...) well adaption status and stable interpersonal relationships play an important role in maintaining and promoting the mental health of adolescents and children. This study aims to gain a new sight of understanding of the mental health quality of Chinese adolescents during the COVID-19 Pandemic in terms of adaptation and interpersonal quality. The study is based on a survey on a total of 7,318 junior and senior high school students aged 12–18 years in various regions of China, and intended to examine the differences in adolescent mental health quality by sociodemographic variables such as gender, grade, urban and rural areas, only child, and parental education level. Our study finds that Chinese adolescents show an overall good adaptation and interpersonal quality during the lockdown. However there exists disparity across different categories in developmental patterns of adaptation and interpersonal quality. In addition, good family environment, moderate financial and emotional support, higher parental education level, etc. contribute to the cultivation and improvement of adolescents’ mental health quality. Finally, we suggest that the government and researchers should pay more attention to adolescents’ mental health issues in terms of adaption status and interpersonal relationships during the COVID-19 pandemic, especially for disadvantaged social groups such as girls, younger students, and low-income family students. (shrink)