Borderline Children Research Articles

Development Toward the Latency Period: Splitting and the Need to Forget in Borderline Children, Originally Published in 1989 Volume 15 of Journal of Child Psychotherapy*

Development Toward the Latency Period: Splitting and the Need to Forget in Borderline Children, Originally Published in 1989 Volume 15 of Journal of Child Psychotherapy*

L’enveloppe transdisciplinaire dans l’accompagnement des enfants aux pathologies limites

BackgroundIn the clinical care of borderline children, the professionals can face their own limits and the ones of their practices. Though, these limits can be explored as boundary zones, transitionalized as scar tissues to form a containing envelope for these children. ObjectivesThis article questions the support of the holding and transitional functions of transdsciplinarity at different levels: that of the institution, the group, and the team of care workers; and questions the way in which these levels allow for the establishment of the transitional and holding processes. MethodOur starting point is the participative and clinical observation of children in a SESSAD, a specialized educative home-care service. The article uses a transdisciplinary perspective in order to shed light on the interlocking of different envelopes. Based on the study of the child's situation in multiple spaces of care, the article will focus on the different functions of transdisciplinary cooperative work in medico-social institution, especially in the case of children with borderline personality disorder, for whom the aspects of holding and transitionality are crucial. The transdisciplinary perspective will also allow for a reflection on other functions of this type of teamwork. ResultsThe article will examine the stakes of these layers of care starting from the soma of the child and ending with the institutional envelope, while paying close attention to the transdisciplinary approach of the team of professionals in these institutions. The article will lay the groundwork for a reflection on the functions of the transdisciplinary approach in pluri-professional institutions that care for subjects grappling with multiple, complex issues. Among these, the holding, transitional and cicatrizing functions will be particularly described and explored. ConclusionsThe article will treat the field opened by the transdisciplinary perspective as a way to potentialize the limits of mono-disciplinarity and pluri-disciplinarity to contain and transitionnalize the care for borderline children. In this way, this article opens the reflection about the other functions of this type of teamwork.

The impact of the Phonics Screening Check on grouping by ability: A ‘necessary evil’ amid the policy storm

This article examines the impact of a statutory assessment in England, the Phonics Screening Check (PSC), on classroom practices of grouping children by ‘ability’. Bearing in mind the argument that assessment is the rudder that steers the otherwise slow‐moving battleship of educational practice, it is argued that the PSC has altered how teachers organise their classes and curriculum in both the affected year group (Year 1, children aged 5–6) and in earlier and later years. Using data from a nationwide survey of teachers (n = 1,373), focus groups and in‐depth interviews with teachers, the article examines how this relatively new phonics assessment forms part of a ‘policy storm’ of pressures relating to accountability, which encourage teachers to place children in groups on the basis of ability, even when they have doubts about this practice and there is little evidence to suggest grouping improves attainment. Practices include grouping children within classes, across year groups or even across several year groups, by phase of phonics learning, guided by advice from bought‐in private phonics schemes. There is also evidence of ‘educational triage’, where borderline children become the focus, and increased use of interventions which involve withdrawing children. Overall, the article uses the PSC to demonstrate how, in times of multiple policy pressures, assessment can rapidly alter practice, in this case making grouping a ‘necessary evil’, as one teacher respondent argued.

Nutritional Status and Determinants of Malnutrition of Under Five Years of Age Children in Scattered Settlement of Tehsil Takht Bhai, Mardan, Pakistan

Objective: The main objective of the study was to measure the nutritional status of under five years of age children of scattered settlement in Tehsil Takht Bhai.Methods: A community based cross-sectional study was conducted in Tehsil Takht Bhai. All the children under 5 years of age were included in the study. The study population was the scattered settlements of Tehsil Takht Bhai. All children from 6-60 months were included in the study.Results: Data has showed that 26.7% population was malnourished in Takht Bhai community that was an alarming figure. The prevalence of malnutrition was very high in female as compare to male. In males the prevalence was 28%, while in females the prevalence was almost 42%.There is a positive association between malnutrition and different study variables.Conclusion: It was concluded that nutritional status of under five children was not satisfactory. The association of nutritional status with the mother’s working status shows that the prevalence of malnourished and border line children is very high in children whose mother were working. The prevalence of malnutrition is very high in children whose birth weight was low than those having normal birth weight.

Self-Esteem and Coping among Children with Borderline Intelligence and Average Intelligence

The aim of the study was to understand self esteem and coping among children with borderline intelligence and average intelligence. The sample consists of two groups, 30 children of borderline intelligence and 30 children of average intelligence in the age ranged of 8 to12 years and studying in 4th to 6th. Individuals with any major physical disability and psychological problem were not considered for the study. Self-esteem and coping scale were administered to the children with borderline intelligence and average intelligence. The scales were scored appropriately. Mean, SD and ‘t’ value were determined to compared difference between borderline intelligence and average intelligence children on self esteem and coping by using the t-test. Result confirmed that there were the children with average intelligence showed significantly less self esteem than children with borderline intelligence. As there was significant difference in self esteem between children with borderline intelligence and average intelligence, the results are not according to the hypothesis stated that there will be no significant difference in self-esteem between borderline intelligence and average intelligence children. The children with borderline intelligence show significantly less active coping than children with average intelligence. The children with borderline intelligence show significantly less avoid coping than children with average intelligence. The children with borderline intelligence show significantly less support coping than children with average intelligence. As there was significant difference in active coping, avoid coping and support coping between children with borderline intelligence average intelligence, the results are not according to the hypothesis stated that there will be no significant difference in support coping between borderline intelligence and average intelligence children.

Risk and protective factors in gifted children with dyslexia.

This study investigated risk and protective factors associated with dyslexia and literacy development, both at the group and individual level, to gain more insight in underlying cognitive profiles and possibilities for compensation in high-IQ children. A sample of 73 Dutch primary school children included a dyslexic group, a gifted-dyslexic group, and a borderline-dyslexic group (i.e., gifted children with relative literacy problems). Children were assessed on literacy, phonology, language, and working memory. Competing hypotheses were formulated, comparing the core-deficit view to the twice-exceptionality view on compensation with giftedness-related strengths. The results showed no indication of compensation of dyslexia-related deficits by giftedness-related strengths in gifted children with dyslexia. The higher literacy levels of borderline children compared to gifted children with dyslexia seemed the result of both fewer combinations of risk factors and less severe phonological deficits in this group. There was no evidence for compensation by specific strengths more relevant to literacy development in the borderline group. Accordingly, the findings largely supported the core-deficit view, whereas no evidence for the twice-exceptionality view was found. Besides practical implications, the findings also add to knowledge about the different manifestations of dyslexia and associated underlying cognitive factors at the higher end of the intelligence spectrum.Electronic supplementary materialThe online version of this article (doi:10.1007/s11881-015-0106-y) contains supplementary material, which is available to authorized users.

Alternative hybrid and staged interventional treatment of congenital heart defects in critically ill children with complex and non-cardiac problems.

IntroductionAn individually designed strategy of comprehensive alternative hybrid and staged interventional treatment (AHASIT) can be a reasonable alternative to conventional treatment of congenital heart defects, reduce the risk of cardiac surgery or interventions performed separately, and give an additional chance for critically ill children.AimTo present our experience and the results of AHASIT of severely ill or borderline children referred for surgery with the diagnosis of congenital heart defects.Material and methodsA group of 22 patients with complex cardiac and non-cardiac pathologies was retrospectively selected and analyzed. An individual preoperative severity scale was established for AHASIT patients, with one point for each of the following preoperative complications: prematurity, low body weight, cyanosis, intolerance to drug therapy, failed interventional treatment prior to admission, mechanical ventilation prior to the procedure, chronic respiratory failure and non-cardiac, mainly congenital malformations (congenital diaphragmatic hernia, lower extremity agenesia, duodenal atresia) and acquired problems (newborn edema, necrotic enterocolitis, intracranial hemorrhage, liver and renal failure, anemia and thrombocytopenia, infections or colonization with drug-resistant pathogens).ResultsThe analysis of the postoperative course showed that the patients with 5 AHASIT points or more had a more complicated postoperative course than the patients with 1 to 4 AHASIT points.ConclusionsThe AHASIT of pediatric congenital heart defects with complex and non-cardiac problems appeared to be an attractive option for selected severely ill patients. The strategy was found to be effective in selected neonates suffering from complex and accompanying non-cardiac pathologies, with positive final results of both cardiological intervention and planned surgery.

Asperger's Syndrome: A Mixed Picture

Diagnostic ambiguities surrounding Asperger's syndrome are discussed in a historical context; two main subtypes are distinguished according to whether coping mechanisms are predominantly obsessional or schizoid. A case is reported of a girl, later diagnosed with Asperger's syndrome, who originally showed many characteristics of autism, including echolalia. In the later stages of her treatment, she resembled borderline children in her anxious outpouring of florid fantasy. The transition from the first stage to the second was marked by a fantasy of the bodily projection of her mouth into the therapist. Drawings from the beginning of treatment suggested that the schizoid fantasies characteristic of the second stage were already present, although in unelaborated form. The case is discussed in the context of object relations theory and of historical controversies concerning the relationship of autism to childhood psychosis. It is suggested that the intimate psychodynamic knowledge of a child acquired during therapy can make a contribution to diagnostic classification.

French Norms and Validation of the Child Development Inventory (CDI): Inventaire du Développement de l’Enfant (IDE)

The aim of this study was to determine the French norms and examine the validity of a parent-report inventory: the Child Development Inventory (CDI), called "Inventaire du Développement de l'Enfant (IDE)" in French. This assesses the general level of a child's development in 8 developmental domains. The norms were determined for a community sample of 1287 children, aged 15 to 72 months. The score for the CDI general development scale correlates closely with chronological age (r = .89). The intra- and interobserver (mother vs teacher) agreements were .97 and .76. The 1-year stability coefficient between the developmental quotient (DQ) values was .81. Correlation between the DQ (CDI) and the IQ of psychometric individual test was high (r = .84). The sensitivity and specificity for detecting borderline children (IQ < 86) were 84% (95% CI = 72% to 92%) and 92% (95% CI = 84% to 97%), respectively. Therefore, the French version of the CDI, like the English one, provides a useful tool for measuring children's development.

Levels of analytic work and levels of pathology: The work of calibration

This paper identifies three points on a continuum of levels of analytic work and levels of meaning. The thinking arose out of many years of work with autistic and borderline children, who were not able, for reasons of profound ego impairment, to respond to the more traditional explanatory interpretation as a method of ascribing meaning. Their capacity for introjection was limited. The author suggests that a prior level – lending meaning via description or amplification – is more effective in helping them to think. The paper argues that this second method, where appropriate to the patient’s developmental and psychopathological level, need not be seen as inferior to or less complete than the former type. A third, more intensified level of work – an urgent insistence on meaning – is illustrated with a patient where the deficit was not only in the ego, but in the self and the internal object. The suggestion is that the issue at this third level – with emptied out patients – concerns, not thinking about feeling, nor even identifying feeling, but gaining access to feeling itself. The paper involves an attempt both to elaborate certain of the author’s earlier ideas on technique and to consolidate these into a wider schema of priorities.

Before the threshold: destruction, reparation and creativity in relation to the depressive position

Abstract In this paper, the author revisits the classic idea formulated by Hanna Segal that creativity takes place from a depressive position impulse to repair previous destruction wrought on internal parental objects. The author proposes that in the light of psychoanalytic work with deprived and borderline children, there may need to be a rider to this formulation. By suggesting the myths of Ariadne and Orpheus alongside that of Oedipus as aids to psychoanalytic understandings, a development is posited here which may coexist with or even precede depressive struggles. Dread and hope, the author suggests, accompany both the creative artist and the child on the path towards expression of creative impulses. Such impulses exist before a ‘depressive position’ arrival point, or may follow it, in a cyclical rather than linear development, as Britton – drawing on Bion – suggested. This does not diminish the importance of reparation both in the individual psyche and in creative work, but makes space for the possib...

Communication et langage du jeune enfant: actions de prévention précoce pour une intégration sociale réussie

The number of children with delayed language is increasing in vulnerable environment. Three types of preventing actions are proposed: screening, specific teaching to teachers and parents/children workshops. Coupling these 3 different approches allows to improve the language abilities of the children, and the children / teachers and children / parencts interactions. Material and methods: children were assessed by the means of 2 standardized tests, TVAP (Deltour 1998) and DPL3 (Coquet, 1996). The results permitted to define 3 groups: children without language disabilities (GR 1), borderline children (GR 2) and children with communicative and/or language impairment (GR 3). Teachers were submitted to a HANEN program (learning Language and Loving It). Parents were enrolled in a workshop on pragmatic interactions in language (CLSC orleans Québec). Children were post-tested using TVAP and DPL3. Results: children ciming from GR 1 an GR 2 displayed increased language abilities after the programs but no children from GR 3 (with language impairment).

Personality Disorders Over Time: Precursors, Course, and Outcome

Personality Disorders Over Time: Precursors, Course, and Outcome

Treating personality disorders in children and adolescents. A relational approach.

Introduction. Attachment and Reflective Function. Psychological Organization and the World of Mental Representations. Trauma, Vulnerability, and the Development of Severe Personality Disorders. Antisocial and Narcissistic Children and Adolescents. Histrionic and Borderline Children and Adolescents. Beginning Treatment: Creating a Secure Base and a Representational Mismatch. Early Stages of Treatment: Forming the Alliance and Enhancing Reflective Function. Middle and Late Stages of Treatment: Using Connection to Move toward Integration. Residential Treatment and the Continuum of Services. Pharmacological Treatment.

CHILDHOOD PRECURSORS OF BORDERLINE PERSONALITY DISORDER

The childhood precursors of borderline personality disorder are largely unknown. High-risk studies of "borderline children," as well as studies of the children of adult borderline patients, can shed light on the issue. Prospective research is needed to address these problems substantively.

Projective identification as a communication its grammar in borderline psychotic children

This paper distinguishes between the grammar of wishes in neurotic patients and the grammar of imperative needs in borderline patients. The treatment of a borderline psychotic boy 30 years ago was uninformed by subsequent developments in technique arising from the theory of projective identification as a communication rather than as an attack or a defense. Issues that need addressing in borderline patients, especially those who are children, include (a) developmental delay, (b) the distinction between defenses and overcomings in the paranoid position, (c) rectification fantasies of vengeance, and (d) rectification fantasies of justice and other moral imperatives.

Risk Factors for Borderline Pathology in Children

To examine risk factors associated with borderline pathology in latency-age children. The subjects were 98 children assessed for day treatment. Borderline subjects were identified in a chart review using the Child Diagnostic Interview for Borderlines, which divided the sample into borderline (n = 41) and nonborderline (n = 57) groups. Functional levels were assessed by Children's Global Assessment Scale scores. The risk factors were also rated by chart review; all subjects were given a cumulative abuse score and a cumulative parental dysfunction score. Both groups demonstrated severe functional impairment. The risk factors that differentiated the borderline group were sexual abuse, physical abuse, severe neglect, and parental substance abuse or criminality. Sexual abuse and severe neglect were significant in multivariate analysis. Cumulative abuse and cumulative parental dysfunction scores were both higher in the borderline group. The findings indicate that the risk factors in borderline children are similar to those found in adults.

Rorschach assessment of the borderline child

After nearly two decades of intensive investigation, adult borderline disorders have achieved wide currency, including a substantial psychological literature. The literature on the diagnostic psychological assessment of borderline children is, in contrast, quite sparse. This paper examines manifestations of childhood borderline conditions on the Rorschach, discusses them in light of current theoretical conceptualizations of adult borderline psychopathology, and explores the relationship between child and adult borderline disorders and the genesis of these conditions.

Factors associated with Borderline pathology in school-age children

The Diagnostic Interview for Borderlines as revised (DIB-R) for use with children and chart review was completed using the records of 54 children, ages 6 to 12 years, who had been admitted to a public psychiatric hospital. Based on the results of the DIB-R, the children were grouped as borderline and nonborderline. The two groups were then compared with regard to 52 independent variables which have historically been associated with the borderline diagnosis. Stepwise logistic regression was used to identify the cluster of diagnostic and independent variables which best discriminated the borderline subjects. Self-destructive behavior, irritable affect, anhedonia, and an externalizing disorder diagnosis at the time of admission accounted for 95.4% of the borderline children. These findings are in contrast to previous studies which have found an assortment of neuropsychological and/or neurological deficits and stressed the importance of a tendency toward psychotic regression on psychological testing as discriminative variables. The authors underscore the idea that borderline pathology may represent a spectrum of disorders and the need for a more specific psychiatric nosology in describing and diagnosing these children.

Childhood factors in the development of borderline personality disorder: The need for early intervention

Recent literature suggests a relationship between a childhood with abuse and neglect and a later development of borderline personality disorder. The general childhood atmosphere seems to be most important. This paper describes the symptom formation in abused children together with their relational problems. A possible relation between these children and “borderline children” is also delineated. The psychological changes in these children are portrayed from a relational point of view, which emphasizes their difficulties in establishing new relations. These children often enter a vicious circle in which they are rejected repeatedly when entering into different caring situations. Important factors in the care-taking and treatment of these children are considered, and both individual treatment and support of the care-givers are emphasized. The different factors are illustrated through a case study of a 6-year-old child in psychotherapy.