Adolescent Mental Health Clinic Research Articles

Practitioner Review: Quality of life in child mental health – conceptual challenges and practical choices

The terms ‘quality of life’ (QoL) and ‘health related quality of life’ (HRQoL) are fraught with preconceptions, misconceptions and, frequently, confusion: How are these terms best defined? What are the best ways to measure them? These challenges, which are present even in the relatively well-studied fields of adult physical health, are magnified considerably when considered in the context of child and adolescent mental health. They are, however, concepts that are being increasingly discussed by child and adolescent mental health clinicians, researchers and service planners. The purpose of this review is to analyse and discuss the concept of QoL and HRQoL (for simplicity we will use the umbrella term QoL in this paper except when there is a need to draw more fine-grain distinctions) as they relate to child and adolescent mental health, and review the various reasons for measuring QoL in this population. The paper is divided into three main sections. First, we introduce the concept of QoL and draw out the issues raised with regard to the field of childhood mental health research and practice. Second, we discuss the range of challenges raised as we move from concept to measurement. Third, we review and contrast some of the many different measurement tools currently available.

Association of nail biting and psychiatric disorders in children and their parents in a psychiatrically referred sample of children

BackgroundNail biting (NB) is a very common unwanted behavior. The majority of children are motivated to stop NB and have already tried to stop it, but are generally unsuccessful in doing so. It is a difficult behavior to modify or treat. The objective of this study was to investigate the prevalence of co-morbid psychiatric disorders in a clinical sample of children with NB who present at a child and adolescent mental healthcare outpatient clinic and the prevalence of psychiatric disorders in their parents.MethodA consecutive sample of 450 referred children was examined for NB and 63 (14%) were found to have NB. The children and adolescents with nail biting and their parents were interviewed according to DSM-IV diagnostic criteria. They were also asked about lip biting, head banging, skin biting, and hair pulling behaviors.ResultsNail biting is common amongst children and adolescents referred to a child and adolescent mental health clinic. The most common co-morbid psychiatric disorders in these children were attention deficit hyperactivity disorder (74.6%), oppositional defiant disorder (36%), separation anxiety disorder (20.6%), enuresis (15.6%), tic disorder (12.7%) and obsessive compulsive disorder (11.1%). The rates of major depressive disorder, mental retardation, and pervasive developmental disorder were 6.7%, 9.5%, 3.2%, respectively. There was no association between the age of onset of nail biting and the co-morbid psychiatric disorder. Severity and frequency of NB were not associated with any co-morbid psychiatric disorder. About 56.8% of the mothers and 45.9% of the fathers were suffering from at least one psychiatric disorder. The most common psychiatric disorder found in these parents was major depression.ConclusionNail biting presents in a significant proportion of referrals to a mental healthcare clinic setting. Nail biting should be routinely looked for and asked for in the child and adolescent mental healthcare setting because it is common in a clinical population, easily visible in consultation and relatively unintrusive to ask about. If present, its detection can then be followed by looking for other more subtle stereotypic or self-mutilating behaviors.

The effectiveness of one session of therapy using a single‐session therapy approach for children and adolescents with mental health problems

This study applied a solution-focused single session therapy (SST) approach to all clients presenting to an urban child and adolescent mental health clinic over 14 months. The effectiveness of a single 2-hour assessment and treatment session in treating mental health problems was investigated using parent, teacher and clinician outcome measures. Teachers reported low levels of psychopathology at intake with no significant change 1 month after treatment. However, using parent and clinician measures, clinical levels of psychopathology were found at intake, with significant improvement 1 month after a single session of treatment. The effect sizes for these improvements measured medium to large, demonstrating observable improvement of clinical significance from the 1 session of SST treatment. Respondents reported 95% satisfaction with service. The study adds weight to the argument that a solution-focused SST approach can be effective for the treatment of children and adolescents with mental health problems. It recommends SST as the initial choice of treatment for these clients.

Violent deliberate self-harm amongst adolescent refugees

Investigation of frequency and characteristics of violent deliberate self-harm (DSH) amongst adolescents. Study was retrospective, over 3-year period, based on records of attendees at child and adolescent mental health clinics in North West London. Nine adolescents showed violent self-harm out of 982 DSH cases (frequency 0.92%). The nine cases included five female asylum seekers, who experienced war related events, were significantly more likely to have affective disorders and post-traumatic stress disorder (PTSD), compared with the four males (none asylum seekers), who were significantly more likely to have conduct and substance misuse disorders.

Comparing DSM-IV Types of ADHD Across Performance Domains: A Meta-Analysis

Since the DSM-IV criteria were published in 1994, the tripartite division of ADHD into Inattentive Type (IA), Hyperactive–Impulsive Type (HI), and Combined Type (C) has been a focus of ongoing debate. Some have argued that IA may be a separate disorder from the other two subtypes (e.g., Barkley, 2001). Others (e.g., Pelham, 2001) suggest that the subtypes, while somewhat distinct, nonetheless are similar in treatment response and performance on a range of psychological measures.

Adolescent Postabortion Groups: Risk Reduction in a School-Based Health Clinic

<p>A short-term postabortion group for adolescents was developed. Three groups were conducted in an adolescent mental health clinic within an urban high school-based health clinic. The clinical group experiences offered the adolescents an opportunity to integrate the experience of pregnancy and the abortion decision into their lives. At follow up, adolescents who participated in the postabortion counseling groups indicated that they chose and used a method of birth control, did not repeat an unplanned pregnancy, and remained in high school.</p>

Healthcare Professionals to Child and Adolescent Mental Health Clinicians: Developing a Generic Profession

anarkshire Child and Adolescent Mental Health Service (CAMHS) is a multidisciplinary community-based service in the central belt of Scotland for the children, young people and their families who live within the health board boundaries, a total population of 560,000. The CAMH service is delivered by four community-based teams each serving a defined geographical district. The current CAMH service has a staff complement of 29.6 WTE and a budget of £1,370,000, which represents 3.2% of the overall mental health budget. Child and adolescent mental health clinicians currently make up 15 WTE of the CAMHS staff group. This article describes how the service has continued to develop in spite of the significant national shortages of specialist child mental health professionals in all disciplines. It particularly focuses on the emergence of this new generic professional group whose professional backgrounds include specialist nursing, occupational therapy and social work. The child and adolescent mental health clinician structure offers: ■ an integrated career pathway for CAMHS professionals ■ retention as clinicians with increasing seniority, rather than a progression within a professional discipline which can only offer managerial positions ■ a framework of uniform pay, terms and L conditions which values and rewards the disparate professional training, qualifications and experience of senior clinicians ■ continuing professional development to consolidate changing specialist roles in order to meet more complex service demands.

Paddington Complexity Scale and Health of the Nation Outcome Scales for Children and Adolescents.

There is an increasing interest in measuring health care outcomes in mental health services for children as well as adults. We examined the sensitivity of the Paddington Complexity Scale (PCS) and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) in describing the intakes of child and adolescent mental health clinics. We carried out a prospective study of two out-patient units and one day patient unit, by means of questionnaires administered to clinicians, parents and children. Clinician-rated PCS and HoNOSCAs were obtained for 248 new attenders. Both proved sensitive to intake differences between clinics. There were correlations of moderate intensity (r = 0.6) between total PCS and HoNOSCA. There were weaker associations between these and parent/child rated measures of behaviour (r = 0.4 and 0.3), quality of life and self-esteem (r = 0.3 or less). Both PCS and HoNOSCA are useful for describing clinical profiles of children and adolescents receiving mental health services.

Attention-deficit hyperactivity disorder subtypes and comorbid disruptive behaviour disorders in a child and adolescent mental health clinic.

To assess demographic characteristics and patterns of comorbid disruptive behavior disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]) in subtypes of attention-deficit hyperactivity disorder (ADHD). One hundred youths consecutively referred to a community child and adolescent mental health clinic and subsequently diagnosed with ADHD by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria were evaluated. The diagnosis was made by a child psychiatrist and was based on information from physicians, parents, teachers, and diagnostic interviews with the youth and their parents. The major findings were: 1) ADHD combined (C) type was diagnosed in 78% of the subjects, while 15% had inattentive (1) type and 7% had hyperactive-impulsive (HI) type; and 2) patterns of comorbid disruptive behavioural disorders significantly differed among subtypes. Specifically, subjects with the I type showed lower rates of comorbid ODD than those with the C type (33% and 85%; P < 0.001) and HI type (33% and 100%; P = 0.005); subjects with the HI type displayed a higher prevalence of CD than those with the I type (57% and 0%; P = 0.005) and C type (57% and 8%; P = 0.003). These results should be considered tentative because the reliability of the diagnostic procedures was not formally assessed and the number of subjects in the I and HI groups was small. ADHD subtypes showed significant differences in the distribution of comorbid disruptive behaviour disorders. These results support the utility of ADHD subtypes but should be replicated with a larger sample of I and HI type subjects using more rigorous diagnostic methods.

Diagnostic groups in an adolescent treatment program.

.‘ vi ITIi INCREASING EMPHASIS Ofl community psycili,v ati’y and increasing demands for mental health services at all levels, professional manpower must be deployed with the greatest degree of effectiveness. Faced ijy the need to save professionals’ time and to shorten Waiting periods, our adolescent mental health clinic began group diagnostic evaluation for its young patients in February 1969. ihe clinic is a teaching and community service unit operated jointly by the District of Columbia Mental Health Administration and the department of psychiatry of Georgetown University School of