Child Symptomatology Research Articles

Ressonâncias do inconsciente materno e familiar na sintomatologia infantil e no setting analítico à luz de um caso clínico

This study aims to discuss the importance for a child therapist to keep a binocular vision which both prioritizes listening to the inner world of his/her little patient and the interferences of the family and maternal unconscious in the child symptomatology and in the analytic setting. From the perspective that the infant's inner world is also, although not only, built by the parental unconscious demand, the further purpose of this study is to demonstrate how, in this clinical case, the symptoms of the child were influenced by maternal unconscious conflicts and by the parental care modality existing in such family.

A comparison of the emotional and behavioral problems of children of patients with cancer or a mental disorder and their association with parental quality of life

ObjectiveTo compare the emotional and behavioral problems of children of patients suffering from cancer or a mental disorder and their association with parental quality of life. MethodsA total of 223 children from 136 families and their 160 parents were investigated from multiple perspectives in a cross-sectional study. The consistency of different adjustment reports between family members was examined. Through mixed models, the differences between parental HRQoL and the children's symptomatology were studied with regard to the type of parental illness. The prediction of children's adjustment through parental HRQoL was further examined. Additionally, gender and age of the children were considered. ResultsHalf of the children exhibited psychosocial problems. Gender and age differences were independent of the type of parental disease. In families with parental cancer, the reports of children's adjustment were more consistent between family members than in families where a parental mental disorder was present. We found differences in HRQoL between families with mentally ill parents and those with parental cancer patients. Specifically, the healthy partners of mentally ill parents showed worse HRQoL compared with healthy partners of cancer patients. Healthy parents' reduced HRQoL was associated with worse adjustment in their children, regardless of the type of parental illness, but this result was not found for ill parents. ConclusionFamily members confronted with parental cancer or mental disorders are more burdened compared with those from the “normal” population, independently of the type of disease. Our results indicate that the type of a parental disease has no direct effect on children's adjustment. However, there are disease-specific effects on parental HRQoL, which are associated with children's adjustment.

Supporting the Mental Health of Children by Treating Mental Illness in Parents

CME Educational Objectives 1. List parental risk factors for the development of psychopathology in children. 2. Describe the relationship between treatment of maternal psychopathology and level of child symptomatology. 3. Understand family risk factors for psychopathology in children with chronic medical illness. Psychiatrists who treat adult patients with children can practice preventatively by considering the potential impact of treatment interventions on the mental health and resiliency of their patients’ offspring. Parental psychopathology is associated with increased risk of a wide range of social, cognitive, and behavioral problems in children. 1 Genetic and environmental factors likely contribute, although which parental factors influence resilience in children remains largely unknown. Resilience is an interactive phenomenon, and significant heterogeneity exists in the individual child’s response to environmental influences. Despite exposure to serious adversities known to result in negative child outcomes, some children seem to do relatively well. Unraveling protective versus risk factors can help identify determinants of resilience as it relates to both mental and physical health outcomes in offspring.

A comparison of IGPT-EMDR and TF-CBT for treating abused children's PTSD and depression symptomatology

A comparison of IGPT-EMDR and TF-CBT for treating abused children's PTSD and depression symptomatology

The Relation Between Co-rumination, Maternal Depressive Symptoms and Child Psychopathology

Little is known about which processes explain the well-established link between maternal and child symptomatology. Interpersonal coping processes may be worth exploring, as depressed mothers have characteristic coping styles that may influence interactions with their children. We examined two interpersonal coping processes as potential factors explaining how depressive symptomatology in mothers impacts child psychopathology: parent-child co-rumination (dwelling on negative affect, over-analyzing problems) and impaired problem-solving. We analyzed 198 aggressive children (most of whom also had elevated internalizing symptoms) who engaged in structured discussions with their mothers. Coders rated the extent to which dyads problem-solved and co-ruminated during discussions, and mothers filled out questionnaires assessing maternal and child symptoms. Path analysis tested whether higher levels of co-rumination and poor problem-solving statistically mediated the relation between depressive symptoms in mothers and child internalizing and externalizing behaviour. Maternal depressive symptomatology was correlated with greater child symptoms, higher rates of co-rumination and poorer problem-solving. Statistical mediation was non-significant. Results support the established link between maternal depression and child psychopathology, and suggest that dysphoric mothers and their children engage in maladaptive coping interactions.

Contribution of attachment security to the prediction of internalizing and externalizing behavior problems in preschoolers victims of sexual abuse

ObjectivesThis study pursued three objectives: provide a descriptive behavioral profile of preschool-aged children having disclosed sexual abuse (SA); assess their attachment representations; and explore whether SA characteristics and child attachment security can predict children's symptomatology, while controlling for parental psychological distress. MethodParents consulting a specialized medical clinic in Montreal following the child's disclosure of sexual abuse (n=116) completed measures regarding parental psychological distress (Échelle de Détresse Psychologique de l’Enquête de Santé Québec; Préville, Boyer, Potvin, Perrault, & Légaré, 1992) and behavioral and psychological problems concerning their preschool-aged children (3 to 6 years) (Child Behavior Checklist for Ages 11/2–5 (CBCL) (Achenbach & Rescorla, 2000a). Children responded to a semi-structured interview assessing their attachment representations (Attachment Story Completion Task; Bretherton, Oppenheim, Buchsbaum, & Emde, 1990). Data concerning SA characteristics were provided by medical records (History of Victimization Form; Wolfe, Gentile, & Boudreau, 1987). ResultsSecure attachment was observed in 58.6% of the children evaluated, and 73.3% of the children had experienced a very severe SA. Parental psychological distress, the intra-familial nature of the sexual abuse experienced, and disorganised/disoriented child attachment were found to predict clinical levels of internalizing behavior problems. Clinical levels of externalizing behavior problems were predicted by child age, avoidant attachment and disorganized/disoriented attachment. ConclusionsDisorganised/disoriented attachment brings a unique contribution to the prediction of sexually abused preschoolers’ clinical internalizing and externalizing difficulties, beyond SA characteristics (type and severity) and parental psychological distress. This underscores the importance of attachment representations in the prediction of emotional and behavioural difficulties in sexually abused children. Practice implications: clinical intervention for sexually abused preschoolers should focus on personal and familial variables, namely attachment security and the quality of parent–child relationships.

Exposure to Maternal- and Paternal-Perpetrated Intimate Partner Violence, Emotion Regulation, and Child Outcomes

The current study examined the relationship of maternal- and paternal-perpetrated intimate partner violence (IPV) to children’s internalizing and externalizing symptomatology. Mother-child dyads (N = 53; child ages 8–11) reported maternal- and paternal-perpetrated IPV exposure and measures of child symptomatology. Results demonstrated that: (a) maternal- and paternal-perpetrated IPV have similar but not identical relations with child outcomes, (b) mothers’ and children’s reports of paternal-perpetrated IPV were positively related, (c) mother and child report of maternal- and paternal-perpetrated IPV related to child emotional and behavior problems, and (d) emotion dysregulation mediated the link between IPV exposure and child outcomes. Notably, findings differed by reporters. Results support emotion dysregulation as one mechanism through which IPV exposure may lead to child behavior problems, with implications for clinical intervention.

Opinion des mères tunisiennes concernant le premier épisode psychotique de leur enfant

Initiating psychiatric treatment depends on several factors including clinical, personal, familial and economic factors. In the case of a first psychotic episode in an adolescent, parents, especially mothers, have a critical role in initiating psychiatric treatment for their child. In this study, we investigated mothers' beliefs about their child's first psychotic episode. Participants were adolescents consulting the department of Child and Adolescent Psychiatry of the Razi hospital in Tunisia. They were aged from 12 to 19 years at the onset of their medical follow-up. Their diagnoses were schizophrenia, schizoaffective disorder and schizophreniform disorder according to DSM-IV. A questionnaire was submitted to patients' mothers after their approval. It was divided into two parts. The first part was used to collect information on socio-demographic and clinical characteristics of the mothers and their children. The second part was composed of the following four questions in Tunisian dialect: (1) what did you think was the matter when you first noticed psychotic symptoms in your child? (2) what was the main reason for which you thought psychiatric treatment was necessary? (3) what obstacles did you perceive in initiating psychiatric treatment? (4) do you have any advice or suggestions for caregivers on how they could facilitate an early start of treatment? Twenty-two mothers were included. The mean age of the mothers at onset of the follow-up of their child was 42 years (SD: 4.81). Ten mothers had never been schooled, five had primary school level, four had secondary school level, three had bachelor's degree and two had a diploma of doctorate; 63.6% of the mothers were housewives. The mean age of patients was 13.77 years at the start of their medical follow-up (SD= ± 2.14). Most of the patients were male (14 males for eight girls). Most patients were diagnosed as having schizophrenia (91%); 4.5% were diagnosed with schizoaffective disorder and 4.5% with schizophreniform disorder. The duration of untreated psychosis (DUP) was 11.5 months. Longer duration of untreated psychosis was associated with male gender (P=0.008). A significant relationship was also found between long DUP and stigmatization of mental hospital and psychiatry (respectively P=0.04 and P=0.05). Most of the mothers did not think that their child initially suffered from a psychotic disorder. In 63.3%, the cause of the child's symptomatology was attributed to spirit possession. The others reasons for seeking psychiatric treatment were: behavioral disorder in 77.3%, inefficacity of traditional practices in 54.5%, and patient refusal (40.9%). Stigmatization of the Razi hospital, the unique psychiatric hospital in the country, and of psychiatry in general were evoked by mothers as the main obstacles in initiating psychiatric treatment in more than half of the cases (70%). Others obstacles were: fear of side effects of psychiatric treatment (50%), patient refusal (40.9%), inaccessibility to psychiatric services (31.8%) and fear of an addiction to psychotropic agents (31.8%). Thirty-six percent of mothers underlined the need to consult in the occurrence of school difficulties or any change in the child's behavior; 27% proposed educational and anti-stigmatizing campaigns about the signs of early psychosis through radio, newspapers, cinema, and TV media advertisements. Making teachers and educators sensitive to psychosis was proposed by 13.6% of mothers; 9.1% thought that diagnostic skills should be improved in general practitioners. Knowledge of attitudes of mothers towards the illness of their child prior to psychiatric treatment and towards the start of treatment is essential for the development of interventions for reducing duration of untreated psychosis.

Child maltreatment and allostatic load: Consequences for physical and mental health in children from low-income families

Child maltreatment and biomarkers of allostatic load were investigated in relation to child health problems and psychological symptomatology. Participants attended a summer research day camp and included 137 maltreated and 110 nonmaltreated low-income children, who were aged 8 to 10 years (M = 9.42) and racially and ethnically diverse; 52% were male. Measurements obtained included salivary cortisol and dehydroepiandosterone, body mass index, waist-hip ratio, and blood pressure; these indicators provided a composite index of allostatic load. Child self-report and camp adult-rater reports of child symptomatology were obtained; mothers provided information on health problems. The results indicated that higher allostatic load and child maltreatment status independently predicted poorer health outcomes and greater behavior problems. Moderation effects indicated that allostatic load was related to somatic complaints, attention problems, and thought problems only among maltreated children. Risks associated with high waist-hip ratio, low morning cortisol, and high morning dehydroepiandosterone also were related to depressive symptoms only for maltreated children. The results support an allostatic load conceptualization of the impact of high environmental stress and child abuse and neglect on child health and behavioral outcomes and have important implications for long-term physical and mental health.

A Randomized Controlled Trial of Sertraline to Prevent Posttraumatic Stress Disorder in Burned Children

This study evaluated the potential benefits of a centrally acting selective serotonin reuptake inhibitor, sertraline, versus placebo for prevention of symptoms of posttraumatic stress disorder (PTSD) and depression in burned children. This is the first controlled investigation based on our review of the early use of a medication to prevent PTSD in children. Twenty-six children aged 6-20 were assessed in a 24-week double-blind placebo-controlled design. Each child received either flexibly dosed sertraline between 25-150 mg/day or placebo. At each reassessment, information was collected in compliance with the study medication, parental assessment of the child's symptomatology and functioning, and the child's self-report of symptomatology. The protocol was approved by the Human Studies Committees of Massachusetts General Hospital and Shriners Hospitals for Children. The final sample was 17 subjects who received sertraline versus 9 placebo control subjects matched for age, severity of injury, and type of hospitalization. There was no significant difference in change from baseline with child-reported symptoms; however, the sertraline group demonstrated a greater decrease in parent-reported symptoms over 8 weeks (-4.1 vs. -0.5, p=0.005), over 12 weeks (-4.4 vs. -1.2, p=.008), and over 24 weeks (-4.0 vs. -0.2, p=0.017). Sertraline was a safe drug, and it was somewhat more effective in preventing PTSD symptoms than placebo according to parent report but not child report. Based on this study, sertraline may prevent the emergence of PTSD symptoms in children.

Changes in women's alcoholic, antisocial, and depressive symptomatology over 12 years: a multilevel network of individual, familial, and neighborhood influences.

In a sample of 273 adult women and their families, we examined the effects of women's psychopathology history, their social support, their husbands' and children's symptomatology, family stress, and neighborhood environment on their alcohol problems, antisocial behavior, and depression over a 12-year period during their 30s and early 40s. Women's alcohol problems and antisocial behavior decreased but their depression symptoms increased over time. Women's disorder history and their partners' parallel symptomatology were associated with their symptoms. For women's antisocial behavior, their own history of alcoholism and their partners' alcohol problems were also significant risk factors. Higher levels of social support were associated with lower levels of depression in women. Children's externalizing behavior was positively correlated with their mothers' alcohol problems and antisocial behavior, whereas children's internalizing behavior was positively correlated with their mothers' depression. Neighborhood residential instability was associated with higher levels of alcoholic and depressive symptomatology in women. Intervention efforts might target women with young children by improving social support, educational or professional training opportunity, access to family counseling, and neighborhood environment.

Asthma severity, child security, and child internalizing: Using story stem techniques to assess the meaning children give to family and disease-specific events.

Children with persistent asthma are at increased risk for mental health problems. Although mechanisms of effect are not yet known, it may be that children are less trusting of the family as a source of support and security when they have more severe asthma. This study tested whether asthma severity is related to children's perceptions of insecurity in the family, and whether insecurity is in turn associated with child adjustment. Children (N = 168; mean age = 8 years) completed story stems pertaining to routine family events (e.g., mealtimes) and ambiguous but potentially threatening asthma events such as tightness in the chest. Responses were evaluated for the extent to which appraisals portrayed the family as responding in cohesive, security-provoking ways. Asthma severity was assessed by both objective lung function testing and primary caregiver report. Caregivers reported child symptomatology. Beyond medication adherence, caregiver education, and child age and gender, greater asthma severity predicted more internalizing and externalizing symptoms. Greater asthma severity, assessed using spirometry (but not parent report), was related to less secure child narratives of the family, which in turn related to more child internalizing symptoms. Results suggest that asthma can take a considerable toll on children's feelings of security and mental health. Furthermore, given the difficulty in assessing young children's perceptions, this study helps demonstrate the potential of story stem techniques in assessing children's appraisals of illness threat and management in the family.

Negative and atypical story content themes depicted by children with behaviour problems

Specific thematic content arising from children’s doll play is often considered to give clinically meaningful information regarding their mental state, but has received little systematic enquiry. This exploratory study examined the negative and atypical content themes in the attachment story narratives of children with behaviour problems, and their associations with child symptomatology and parental depressed mood. Videotaped mother-child attachment doll play completions of 77 children from a clinical sample were blind coded for negative content themes. Mothers completed questionnaires for maternal depression and child behaviour. Children rating positive for behaviour disorder were more likely to represent maternal injury, role reversal and marked maternal sadness. Severe behavioural symptoms were associated with more pervasive negative themes. Half of the overall sample depicted child accidents and maternal unresponsiveness, whereas child aggression, child anger and maternal absence were rare. Girls with depressed mothers showed an absence of particular negative representations (e.g., child sadness) compared to boys. Specific atypical themes are associated with the extent of child psychopathology and may be modified by exposure to maternal depressed mood. The methodological limitations in this exploratory study are also discussed.

Erratum to: Parental Anxiety and Child Symptomatology: An Examination of Additive and Interactive Effects of Parent Psychopathology

Erratum to: Parental Anxiety and Child Symptomatology: An Examination of Additive and Interactive Effects of Parent Psychopathology

Parenting behaviors and posttraumatic symptoms in relation to children's symptomatology following a traumatic event

Child- and caregiver-report about parenting behaviors, and caregiver-report of their own symptoms were examined in relation to children's symptomatology following a potentially traumatic event (PTE) among 91 youth. Child-report of hostile and coercive parenting was a salient predictor of child posttraumatic stress disorder (PTSD), internalizing symptoms, and personal adjustment. Caregivers' own trauma symptoms predicted caregiver-report of child PTSD, internalizing and externalizing symptoms, but not child-reported child symptoms. Implications for assessment and intervention following exposure to a PTE are emphasized.

Parental Anxiety and Child Symptomatology: An Examinzation of Additive and Interactive Effects of Parent Psychopathology

The current study examined relations between parent anxiety and child anxiety, depression, and externalizing symptoms. In addition, the study tested the additive and interactive effects of parent anxiety with parent depression and externalizing symptoms in relation to child symptoms. Forty-eight parents with anxiety disorders and 49 parents without any psychiatric disorder participated with one of their children (ages 6 to 14 years; 46.4% male; 75.8% Caucasian). Parent anxiety was related to both child anxiety and depression, but not child externalizing symptoms. Hierarchical regression analyses showed that only parent externalizing symptoms had additive effects, beyond parent anxiety symptoms, in relation to child anxiety symptoms. Further, parent anxiety symptoms moderated the relationship between parent and child externalizing symptoms, such that the strength of this relationship was reduced in the presence of high levels of parent anxiety symptoms. Results of this study illuminate the role of parent comorbidity in understanding relations between parent and child symptoms.

Child–therapist alliance and clinical outcomes in cognitive behavioral therapy for child anxiety disorders

Few studies have examined the link between child-therapist alliance and outcome in manual-guided cognitive behavioral therapy (CBT) for children diagnosed with anxiety disorders. This study sought to clarify the nature and strength of this relation. The Therapy Process Observational Coding System for Child Psychotherapy - Alliance scale (TPOCS-A; McLeod, 2005) was used to assess the quality of the child-therapist alliance. Coders independently rated 123 CBT therapy sessions conducted with 34 children (aged 6-13 years) diagnosed with anxiety disorders. Parents reported on children's symptomatology at pre- mid-, and post-treatment. A stronger child-therapist alliance early in treatment predicted greater improvement in parent-reported outcomes at mid-treatment but not post-treatment. However, improvement in the child-therapist alliance over the course of treatment predicted better post-treatment outcomes. The quality of the child-therapist alliance assessed early in treatment may be differentially associated with symptom reduction at mid- and post-treatment. Results underscore the importance of assessing the relation between alliance and outcome over the course of therapy to clarify the role the child-therapist alliance plays in child psychotherapy.

Therapeutic Assessment With Children: A Pilot Study of Treatment Acceptability and Outcome

Therapeutic Assessment (TA) with children is a hybrid of psychological assessment and short-term intervention. It uses the ongoing process and results of psychological assessment to enhance parents' understanding of their child and to facilitate change. Clinical reports and single case studies suggest that TA with children is an acceptable and effective brief intervention. However, no aggregate data have been published to support this claim. This pilot study investigated the acceptability and preoutcome–postoutcome of TA with 14 clinically referred children with emotional and behavior problems and their parents. Results indicated high treatment acceptability as well as significantly decreased child symptomatology and enhanced family functioning as reported by children and mothers. In addition, mothers demonstrated a significant increase in positive emotion and a significant decrease in negative emotion pertaining to their children's challenges and future. The findings, although limited due to the design and small sample size, support assertions from published single case studies that TA is possibly an efficacious child and family intervention for children with emotional and behavioral problems and should be studied in a larger, comparison design.

“Why Won't My Parents Help Me?”: Therapeutic Assessment of a Child and Her Family

We present a case study of a child's psychological assessment using the methods of Therapeutic Assessment (TA). The case illustrates how TA can help assessors understand the process and structure of a family by highlighting how maladaptive family processes and interactions impact a child's development. It also illustrates how TA with a child can serve as a family intervention. In this case, it became apparent that the child's social difficulties were significant, not minor as initially reported by the parents, and were rooted in an insecure attachment, underlying depression, an idiosyncratic view of the world, and longing for attention, all of which were hidden or expressed in grandiose, expansive, and off-putting behaviors. In addition, the familial hierarchy was inverted; the parents felt ineffective and the child felt too powerful, leading to enhanced anxiety for the child. Intervention throughout, punctuated by the family session and feedback sessions, allowed the parents to develop a new “story” about their child and for the child to experience a new sense of safety. Following the TA, the parents and child indicated high satisfaction, enhanced family functioning, and decreased child symptomatology. Subsequent family therapy sessions allowed the family to further implement the interventions introduced in the TA.

Multi-informant assessment of maltreated children: Convergent and discriminant validity of the TSCC and TSCYC

Objective This study examined the convergent and discriminant validity of two trauma symptom measures, the Trauma Symptom Checklist for Children (TSCC) [Briere, J. (1996). Trauma Symptom Checklist for Children (TSCC). Odessa, FL: Psychological Assessment Resources] and the Trauma Symptom Checklist for Young Children (TSCYC) [Briere, J. (2005). Trauma Symptom Checklist for Young Children (TSCYC). Odessa, FL: Psychological Assessment Resources]. Methods Children's scores on the TSCC and their caretakers’ ratings on the TSCYC were analyzed in a study of 310 children presenting to one of two child abuse treatment centers. Results TSCC and TSCYC scales generally converged in their assessment of symptomatology in maltreated children. Equivalent scales measuring anxiety, depression, anger, dissociation, and sexual concerns were generally most correlated with one another. Similarly, the Posttraumatic Stress-Intrusion (PTS-I) scale of the TSCYC correlated highest with the Posttraumatic Stress (PTS) and Anxiety (ANX) scales of the TSCC, the TSCYC Posttraumatic Stress-Arousal (PTS-AR) scale was correlated with the TSCC ANX scale, and the TSCC PTS scale was most correlated with the TSCYC ANX, PTS-I, and Sexual Concerns (SC) scales. The TSCYC Posttraumatic Stress-Avoidance scale was unrelated to any TSCC scale. Discriminant function analysis revealed that the TSCC PTS scale was the best single predictor of sexual abuse-related PTSD status as identified by the TSCYC. Conclusions The TSCC and TSCYC display moderate convergent and discriminant validity with respect to one another, despite different information sources. Nevertheless, the relatively small association between relevant TSCC and TSCYC scales indicates that different symptom informants may have different perspectives on the child's symptomatology; an outcome that may be beneficial when both measures are administered simultaneously. Practice implications These results reinforce the notion that both child- and parent/caretaker report measures should be used in the evaluation of traumatized children, so that multiple sources of information can be considered simultaneously. In the current context, administration of the TSCC to the child and the TSCYC to the caretaker, when appropriate (i.e., in children 8–12 years of age) may yield more clinical information on the child's symptomatology than either measure would alone—perhaps especially in cases when one of the two respondents under- or over-reports the child's distress.