Child Guidance Clinic Research Articles

The satisfaction of clients to child and adolescents guidance clinic (A qualitative research)

The satisfaction of clients to child and adolescents guidance clinic (A qualitative research)

Presidential address: Early parent-infant interaction and mental health.

The importance and meaning of early mother-infant interaction and their possible connection with developmental psychopathology and child psychiatry practice are presented. In an experimental study healthy mothers and their infants were kept together immediately after delivery instead of separating them. Correlation was found between early interactive behavior and later outcome measurements. Other effects of early contact were evaluated with the help of interviews, questionnaires, developmental screening, analyses of videotapes, and are discussed. In another study the outcome of a longitudinal, prospective 30-year follow-up on a group of former infant-patients at the Child Guidance Clinics in Stockholm was the subject of investigation. A major finding was that some 60% of this very young population suffered from a number of serious difficulties and problems later on, which is not very encouraging.

Psychiatric morbidity pattern in a child guidance clinic

Background: There is a paucity of Indian studies on psychiatric morbidity in children. Present work was undertaken in a child guidance clinic in armed forces. Methods: Retrospective analysis of 213 patients who attended a child guidance clinic was done. Results: Majority (n=138) were boys. 55.9% were referred from paediatric outpatient department while medical officers in periphery referred 38.5%. The diagnoses was mental retardation in 30.97%, behavioral and emotional disorders in 23.06% and neurotic, stress related and somatoform disorders in 15.98% cases.

Frankwood E. Williams (1883–1936)

FRANKWOOD E. WILLIAMS was convinced that the new science of human nature would not only provide treatment methods for severe and persistent forms of mental illness but also intervention strategies for their prevention. During his association with the National Committee for Mental Hygiene from 1916 to 1931 (the last 9 years of which he served as medical director), Williams stimulated, guided, and oversaw the implementation of a wide range of preventive methods. The National Committee was founded in 1909 by Clifford W. Beers, who had spent 3 years in mental hospitals, and Adolf Meyer, by then the foremost American psychiatrist. It aimed to increase the status of psychiatry, placing the discipline on a sound scientific footing by arranging funding for medical research and improving the care provided to individuals institutionalized in mental hospitals. At that time, there were no effective treatments for severe and persistent forms of mental illness. The Committee therefore embraced the ideal of prevention as the most effective measure to decrease the incidence of mental illness. Williams had studied medicine at the University of Michigan in Ann Arbor and specialized in psychiatry at one of the first hospitals established for the scientific study of mental illness in the United States. His teacher, Albert M. Barrett, adhered to a strictly somatic approach within psychiatry, as did E. E. Southard, director of the Boston Psychopathic Hospital, where Williams spent 2 years after the completion of his studies in 1913. Southard was also known for his interest in social issues such as alcoholism and criminality, issues that also became of interest to Williams. During the first decade of operation, the psychiatrists associated with the National Committee conducted a number of surveys that demonstrated the social significance of mental illness. Williams participated in a survey of prisons in the county of New York that showed that a significant percentage of individuals confined in them suffered from mental illness.1 Among recidivists, the number was even higher. To Williams, these findings indicated that judges and jail keepers were dealing with mental illness without any insight into its nature. These findings inspired the psychiatrists of the National Committee to develop clinics for the treatment of juvenile delinquents. With early intervention, it was thought, a life of crime could be prevented. In the 1920s, mental hygienists became interested in childhood as the period during which preventive measures could most effectively be implemented. In 1925, Williams traveled to Vienna to undergo psychoanalysis with Otto Rank, who at that time was one of Sigmund Freud’s closest disciples. According to Williams, Freud’s psychoanalysis indicated that virtually all problems later in life were caused by difficulties in early childhood. To prevent these problems, intervention strategies that targeted early childhood were needed. The National Committee oversaw the establishment of a dozen Child Guidance Clinics where parents confronted with troublesome children could ask for help. Williams actively promoted progressive education because he believed that only a complete transformation of the educational system could make it congruent with the demands of emotional development. He was also actively involved in the establishment of several college mental hygiene programs in the belief that college students, the future leaders of society, needed to be free of emotional problems.2 At the time Williams wrote “Finding a Way in Mental Hygiene,” he had already announced his resignation from the National Committee and had come to doubt the effectiveness of its programs. He recognized that to realize the sometimes utopian ideals of the mental hygiene movement, only the complete reorganization of American society along the lines of the science of human nature would do. He began to spend most of his time conducting psychoanalytic psychotherapy, which he had come to see as the only effective way to change human nature. In 1929, the stock market crashed, which was followed by a worldwide economic depression. For most mental hygienists, the consequences of the Depression were disconcerting and at times even alarming. Because of widespread economic insecurity, the incidences of depression, anxiety, and suicide were at an all-time high. To counter this, they argued that structural instead of individualized measures were urgently needed. In 1931, Williams visited the Soviet Union and was astounded by what he witnessed in the carefully maintained villages designed for visitors from the West, where a life of plenitude, happiness, and mental health was enjoyed by all. Williams returned as a convert to the Soviet cause and championed its accomplishments during the remaining 5 years of his life.3 He had never been aware of the atrocities of Stalin’s regime and died in the conviction that the ideals of the mental hygiene movement could be achieved through structural and political means only.

Child Guidance and Mental Health in the Netherlands

In the Netherlands, as in the United States, the introduction of the concept of ‘mental health’ in education is closely related to the development of a network of child guidance clinics. The first of these was established in Amsterdam in 1928. However, a substantial movement to actively promote mental health did not come into existence until after the Second World War. Unlike in the USA, at the time in the Netherlands the school was considered of only little importance in the crusade for the prevention of mental illness. Teachers and school physicians alike were at the same time recognized as helping forces in the promotion of mental strength and conceived of as inadequately equipped to diagnose problem children. The tradition of labelling the school as a sick‐making institution appears to have been an important asset for the child guidance clinics’ lobby to successfully discredit the institution. Parents’ educational competence was likewise undermined by the infiltration of child‐psychiatric theory, concepts and categories of discourse. The mental health movement promoted an attitude towards the family that was even more disturbingly ambiguous. On the one hand the family was considered a most powerful medicine against what was consistently diagnosed as the moral crisis of society. On the other hand contemporary child‐psychiatric theory pointed at parenting as the prime seedbed of neurosis. Inspired by Sol Cohen’s new cultural history of education the author traces the origins and the initial success of the child guidance approach as part of a larger process of ‘medicalization’, accompanied by ‘neurotization’ as an effect of the growing influence of psychoanalysis. She argues that these processes created the conditions for the Dutch child guidance clinics to monopolize the care, treatment and knowledge of problem children. After discussing the growing ambiguity as to parents’ and the school’s competence in preventing mental illness, the establishment and early development of the Dutch child guidance clinics are described. Finally, an analysis is given of the clinics’ diagnoses and treatment of ‘difficult’ children at the height of the mental health movement’s success, immediately after the war. The child guidance clinics’ work was presented as a blessing for individuals, for society and for the public purse. The self‐image of the institution emphasized its role in the prevention of adult crime and psychiatric treatment. Moreover, the clinics were supposed to prevent much more expensive hospitalization of children in reformatories and children’s homes. In reality, however, they selected for treatment primarily those cases that fitted their approach. In doing so, they could further promote the belief in the mental health movement’s central idea of mental illness as a widespread disease. The child guidance clinics’ lobby succeeded in providing itself with a key role in the theatre of children’s mental health, the expert answer to what was conceived of as a serious crisis in society. Moreover, the lobby claimed to be the solution to the existing ambiguities as to the family and the school as child‐rearing milieux. Therefore, the way the child guidance clinics succeeded in promoting their own approach at the expense of the status and competence of other educational professions and institutions was both enabled by medicalization and neurotization and was itself another step in these processes.

Survey of sleep problems amongst Singapore children in a psychiatric setting

Sleep problems are common among children and range from transient ones to chronic problems like snoring, somnambulism and bedwetting. Sleep problems in turn impact on children's health, learning, school performance, quality of life and are often closely related to mental health problems. Population based surveys have also revealed a strong association between sleep problems and behavioral and emotional symptoms in children. The objectives of our study were to estimate the prevalence of sleep problems in children and adolescents attending psychiatric services in Singapore and to identify the correlates of sleep problems in this population. A total of 490 parents/guardians accompanying their children to the child guidance clinic consented to complete a questionnaire, which was used to collect both sociodemographic data and the frequency of sleep problems. These included sleep starts, confusional arousal, sleep talking, bruxism, sleep walking, sleep terrors, nightmares, sleep paralysis and nocturnal enuresis. Psychiatric diagnosis was determined from case record survey of the participating subjects. About 62.2% (95% CI 57.8%-66.6%) of the children suffered from at least one problem. Girls were significantly more likely to suffer from sleep problems when compared with boys (chi(2)=8.5, P<0.005). The significant predictors for sleep problems were gender, diagnosis of developmental disorders and a family history of sleep problems. The study highlights the need for child and adolescent psychiatrists to inquire about sleep problems since sleep disturbances of children are frequent and may not be self-reported.

An ‘enigma to their parents’: the founding and aims of the Notre Dame Child Guidance Clinic, Glasgow

An ‘enigma to their parents’: the founding and aims of the Notre Dame Child Guidance Clinic, Glasgow

Effectiveness of individualized education program for slow learners

To evaluate the effectiveness of an individualized education program for children with scholastic backwardness. Among the children attending a Child Guidance Clinic for scholastic backwardness, 12 of them who were diagnosed as slow learners based on current level of academic functioning and IQ and 6 children having mild mental retardation were given individualized education for a period of two months. Independent assessors evaluated the academic functioning at the beginning of the training and at the end. The results showed that the children had significant improvement in their academic functioning and self esteem after the training. The present experiment can be a model to set up a resource room in normal schools to provide individualized education to children who are slow learners.

Art Therapy as Emotional and Spiritual Medicine for Native Americans Living with HIV/AIDS

This article describes the intricate challenges of bringing mental health services to isolated, guarded urban HIV-positive Native Americans suffering from chronic trauma-related illnesses and imbalances, depression, anxiety, substance abuse, thought disorders and trauma-based characterological disorders. It explores the integration of art therapy. Bowen Family Systems Therapy and in-home therapy in the Family & Child Guidance Clinic's attempt to provide support to a population that has profound distrust for “services and treatment,” and no historical context for psychotherapy. Changing the paradigm of thought is essential to providing services that respect culture and history as well as addressing current presenting issues. Art therapy and in-home therapy support those community members who are flooded emotionally, but have difficulty speaking about their internal processes.

Children of Color: Psychological Interventions With Culturally Diverse Youth, 2nd ed.

Children of Color: Psychological Interventions With Culturally Diverse Youth, 2nd ed.

Recursos e adversidades no ambiente familiar de crianças com desempenho escolar pobre

O objetivo deste artigo foi investigar recursos promotores de desenvolvimento e circunstâncias de vida adversas no ambiente familiar de crianças encaminhadas para atendimento psicológico em razão do baixo desempenho escolar, em comparação com dois grupos de crianças não encaminhadas, um com desempenho escolar pobre e outro com bom desempenho. Participaram 60 crianças de 7 a 11 anos e suas mães, selecionadas em uma clínica-escola de psicologia e uma escola pública. Do ambiente familiar foram obtidos 12 indicadores de recursos e sete de adversidade. Da criança avaliou-se: nível intelectual, desempenho escolar e comportamento. Em relação aos demais grupos, as crianças encaminhadas mostraram mais problemas de comportamento e seu ambiente familiar, menos recursos promotores do desenvolvimento, bem como indícios de maior dificuldade dos pais em lidar com a criança. Sugerem-se estratégias de apoio às famílias que buscam ajuda em serviços da comunidade para lidar com a dificuldade escolar de seus filhos.

Stress and anxiety in parents of mentally retarded children

Background:Studies comparing the stress perceived by parents of mentally retarded and normal children are limited.Aim:(i) To find whether there exists a difference in the perceived stress between both the parents of mentally retarded children, (ii) to study whether these stresses occur more frequently in parents of mentally retarded children compared with those of normal children, and (iii) to find any correlation between the severity of perceived stressors and the anxiety state of these parents.Methods:This study was conducted in the Child Guidance Clinic of a tertiary care psychiatry hospital. The study sample, comprising 180 subjects, was categorized as: group A (60 parents of profound to moderately mentally retarded children), group B (60 parents of mild to borderline mentally retarded children) and group C (60 parents of children with normal intelligence), which served as the control group. Each parent was evaluated using the Family Interview for Stress and Coping (FISC) in Mental Retardation, and the Hamilton Anxiety Rating Scale (HARS).Results:Parents in group A had a significantly higher frequency of stressors and level of anxiety as compared to those in groups B and C. A positive correlation was found between the level of anxiety and stressors.Conclusion:Multifaceted factors made parents in groups A and B more vulnerable to stress compared with parents in the control group.

Cultural Features as Advantageous to Therapy: A Singaporean Perspective

Singapore is a nation comprised of a multicultural, multiethnic population. When working with non-Western clients, cultural differences are sometimes experienced as obstacles to therapy. However, it is important to note that many features of Asian culture and lifestyle can be protective and unique solutions can be derived from the individual or family’s culture and context. This article hopes to add to the existing literature through a discussion of how systemic therapy is amenable to the Singaporean context and how specific cultural features of the Singaporean Chinese, while presenting at times as obstacles to therapy, can also be seen as potential strengths and employed as resources when working with these families.

Linking theory and technique in a systems approach to learning problems in disadvantaged children

The paper describes a programme for disadvantaged children with learning problems (due to factors other than cognitive deficits), at the University of Cape Town (UCT) Child Guidance Clinic, developed in the absence of subsidised services for children in need of remediation of scholastic skills. In collaboration with teacher trainees from the Cape Technikon, the programme intervenes on a cognitive and an emotional level. The learning problem is conceptualised in the context of the dysfunctional systems in which the children have been raised — the post apartheid socio-cultural environment, the family and the school. The paper illustrates the complexities in working with learning problems and focuses on the emotional aspects of the problem in particular. It highlights the importance of the development of the capacity to self regulate, and the containment of feelings in all the systems involved — the family, the school and the staff in the program. The aim is to further each child's ability to learn, in relation to his potential.

Prevalence of trauma, PTSD, and dissociation in court-referred adolescents.

This study examines the prevalence of trauma, posttraumatic stress disorder (PTSD), and dissociative symptoms in adolescents. The sample consisted of 76 females and 76 males, between the ages of 12 and 18, referred to the Child Guidance Clinic of the Superior Court of the District of Columbia for a psychological evaluation. Two sets of analyses were conducted. One set included the entire sample; the second set excluded those individuals whose listed referral problem included only being a victim of abuse. Results of the study suggest a high prevalence of trauma in both genders; however, females had significantly higher rates than those reported in males. Similarly, female adolescents demonstrated significantly higher prevalence rates of PTSD symptoms compared with their male counterparts in the entire sample and showed a trend toward significance in the analysis of the subsample. There was a low prevalence of dissociative symptoms across both genders.

Children's Mental Health — Everyone's Business

uring the last 10 years or so, there has been a remarkable rise of interest in children’s mental health. This is good news – and we shouldn’t be too shy to celebrate, nor too afraid to dwell on a worry or two lest, in ignoring them, we find the rise begin to fall. Broadly speaking, up until the early 1990s child mental health was pretty much hidden within the preserve of the specialist professional groups. This is not to say that little was going on. A great deal about children was being learned and practised. From Freud onwards, major advances in psychoanalysis, developmental psychology, behavioural and cognitive therapy and family and group therapy were bringing to life our understanding of the minds of children. Of course, much more needed to be known (and still does) but there was undoubtedly an exhilarating sense of inquiry into the nature of children’s mental health problems and family dynamics and into how interventions could be improved to bring about change in people’s troubled lives. What was lacking, however, was any real concerted desire to make these developments known to the wider public. Children’s mental health was simply not a political issue. The fact that it lay at the heart of so many of the prevailing social problems such as crime, drug misuse, teenage pregnancy and homelessness simply didn’t seem to ring a bell. At the time poverty, child welfare and child protection were the key political preoccupations but the concept of child mental health didn’t hit the headlines. If anything, the term carried with it something pejorative – as if it was stigmatising to associate the words ‘child’ and ‘mental health’. What was clearly needed was an effort to make more of a hue and cry about what was known and what was being done – a promotional campaign that would help to make the public more aware. YoungMinds, which I and others formed in the late 1980s, played a major role in taking forward this campaign. Most of us came from within the child guidance movement which in the mid-twentieth century was very involved in D developing multi-disciplinary working. In addition to YoungMinds various similar movements were afoot in the USA and some European countries, and in the UK certain key people proved critical in taking forward the agenda. Virginia Bottomley, for example, secretary of state for health from 1992 to 1995, was a former psychiatric social worker in child guidance clinics in London. Other leading figures at this time were Dr Richard Williams, a consultant child psychiatrist and director of the NHS Health Advisory Service, Dr Bob Jezzard, also a child psychiatrist, employed as a senior adviser in the Department of Health, and Dr Zarrina Kurtz, a public health consultant who had a particular interest in child development and children’s mental health problems. I myself was a child psychotherapist working in child guidance and residential treatment. Together, with one or two others, we joined up almost as if by accident. In effect, we shined as a kind of virtual multi-disciplinary team! We all set about in our own ways to build up and tell the story of the states that children’s minds could get into, of the prevalence of their mental health problems and of the predicament of those who tried to serve them. Most importantly, we brought to much greater light the invaluable findings of Professor Michael Rutter’s and Professor Philip Graham’s epidemiological research in the 1970s. It was, of course, not by chance that the first seminal review of child and adolescent mental health services produced by the Health Advisory Service (1995) was entitled Together We Stand. Let us take just a brief review of what is currently going on. First and foremost, the government now openly acknowledges the existence of child and adolescent mental health services (CAMHS) and is committed to investing considerable sums of money in them and also to introducing an infrastructure designed to support a more systematic and forwardmoving programme. All of this is quite unprecedented and I think it is true to say that the national child and adolescent mental health service is not the Cinderella service it once was some 12 or so years ago. It may not yet be in the prince’s arms, and the ugly sisters are still around, but at least it’s in the court!

‘What Do I Have to Come Here for, I’m Not Mad?’ Children’s Perceptions of a Child Guidance Clinic

Children’s views as service users are being increasingly sought and valued. A pictorial critical incident technique was developed to gain insights into the perceptions and experiences of children and young people ( n= 30, ages 5–15 years) attending a child and adolescent outpatient mental health service for the first time. The methodology proved effective in eliciting children’s views, both positive and negative. Findings show age differences in clients’ anxieties about attending. The degree to which children and young people felt involved in the process of assessment also varied with age. In general, children and young people felt more positive when leaving the clinic compared with when they first arrived. Salient aspects of the initial visit emerged which may not have been tapped using a questionnaire or rating scale. Findings are discussed in the context of service delivery issues and the development of child-focused preparatory information.

The merits of a Child Guidance Clinic – every Educational Psychology Service should have one

The merits of a Child Guidance Clinic – every Educational Psychology Service should have one

Attention deficit hyperactivity disorder.

To identify ADHD children, to show the prevalence of the disorder in the age group of 5-12 years and to study their socio-demographic variables, associated medical and co-morbid psychological problems. This is a cross-sectional case study of ADHD children presenting to a child guidance clinic in a busy pediatric hospital over a one year period. The diagnosis of ADHD was based on DSM IV criteria. Of the 238 children referred, 37 were diagnosed as ADHD. 64.9% of the referrals were from pediatricians. The prevalence of ADHD in pediatric clinic was 15.5%, the inattention subtype was predominant. The mean age of boys and girls with ADHD was 8.49 years and 6.82 years respectively. The male to female ratio was 6.4:1. Majority of patients were from middle socio-economic status belonging to Hindu families. 27.0% of children had developmental problems. Oppositional defiant disorder was the most prevalent while depression was the least prevalent co morbid problem. ADHD is prevalent in India and the bunch of these children are mostly presenting to the pediatrician. They need to be aware of the profile of this disorder for early detection and intervention.

Conversation with Conan Kornetsky.

Conversation with Conan Kornetsky.