Phobic Child Research Articles

Effectiveness of audiovisual distraction eyewear and computerized delivery of anesthesia during pulp therapy of primary molars in phobic child patients.

Objectives:The aim of this study is to assess the effectiveness of audiovisual distraction technique with video eyewear and computerized delivery system-intrasulcular (CDS-IS) during the application of local anesthetic in phobic pediatric patients undergoing pulp therapy of primary molars.Materials and Methods:This randomized, crossover clinical study includes 60 children, aged between 4 and 7-year-old (31 boys and 29 girls). Children were randomly distributed equally into two groups as A and B. This study involved two treatment sessions of pulp therapy, 1-week apart. During treatment session I, group A had an audiovisual distraction with video eyewear, whereas group B had audiovisual distraction using projector display only without video eyewear. During treatment session II, group A had undergone pulp therapy without video eyewear distraction, whereas group B had the pulp treatment using video eyewear distraction. Each session involved the pulp therapy of equivalent teeth in the opposite sides of the mouth. At each visit scores on the Modified Child Dental Anxiety Scale (MCDAS) (f) were used to evaluate the level of anxiety before treatment. After the procedure, children were instructed to rate their pain during treatment on the Wong Bakers’ faces pain scale. Changes in pulse oximeter and heart rate were recorded in every 10 min.Results:From preoperative treatment session I (with video eyewear) to preoperative treatment session II (without video eyewear) for the MCDAS (f), a significant (P > 0.03) change in the mean anxiety score was observed for group A. Self-reported mean pain score decreases dramatically after treatment sessions’ with video eyewear for both groups.Conclusion:The use of audiovisual distraction with video eyewear and the use of CDS-IS system for anesthetic delivery was demonstrated to be effective in improving children's cooperation, than routine psychological interventions and is, therefore, highly recommended as an effective behavior management technique for long invasive procedures of pulp therapy in young children.

Professional paths over six decades researching and practicing play

Reflecting on more than a half century of research and clinical practice, we focus on one feature of the human condition, our ability to engage in mental imaginative representations. Our research deals with pretend play of children, and adult thought focusing on possible worlds, potential social interactions, stream of consciousness, and planful action sequences. We point to ways research on play, imagination, and self-systems, may be incorporated into clinical practice. Two cases representing how research affected treatment in a toilet phobic child, and treatment with an adult manifesting anxiety and depression are discussed. In both cases, we highlight how the use of imagination, in particular, affected the outcomes.

Co-Creativity and Interactive Repair

My comments focus on a consideration of three issues central to child psychoanalysis stimulated by rereading the classic paper by Berta Bornstein, "The Analysis of a Phobic Child: Some Problems of Theory and Technique in Child Analysis": (1) the importance of "co-creativity" and its use in analysis to repair disruptions in the mother-child relationship; (2) working analytically with the "inner world of the child "; and (3) the fundamental importance of multiple simultaneous meaning-making processes. I begin with a discussion of current thinking about the importance of interactive processes in developmental and therapeutic change and then lead to the concepts of "co-creativity" and interactive repair, elements that are missing in the "Frankie" paper. The co-creative process that I outline includes multiple contributions that Frankie and his caregivers brought to their relationships--his mother, his father, his nurse, and even his analyst. I then address the question of how child analysts can maintain a central focus on the inner world of the child while still taking into account the complex nature of co-creativity in the change process. Finally, I discuss insights into the multiple simultaneous meaning-making processes in the analytic relationship to effect therapeutic change, including what I call the "sandwich model," an attempt to organize this complexity so that is more accessible to the practicing clinician. In terms of the specific case of Frankie, my reading of the case suggests that failure to repair disruptions in the mother-child relationship from infancy through the time of the analytic treatment was central to Frankie's problems. My hypothesis is that, rather than the content of his analyst's interpretations, what was helpful to Frankie in the analysis was the series of attempts at interactive repair in the analytic process. Unfortunately, the case report does not offer data to test this hypothesis. Indeed, one concluding observation from my reading of this classic case is how useful it would be for the contemporary analyst to pay attention to the multifaceted co-creative process in order to explain and foster the therapeutic change that can occur in analysis.

Discussion of Berta Bornstein's “The Analysis of a Phobic Child”

Bornstein's paper is a true psychoanalytic study of a child, if ever there was one. The fine tracing and discussion of the technical detail, together with the clarity and exposition of the theoretical underpinning make it a truly deep and thorough study and a model for those of us doing this work and trying to understand what indeed we do and why. I should say that although I have read the writings of the (then) Hampstead Clinic's borderline workshop (Kut Rosenfeld and Sprince, 1965), I had not read this outstanding paper by Berta Bornstein, and I wish I had done so long ago. I shall begin with some comments about psychoanalytic theory and then go on to discuss Bornstein's abundant and fascinating analyses of technique. I shall conclude with some observations on the child's psychopathology.

The Analysis of a Phobic Child: Some Problems of Theory and Technique in Child Analysis

This paper attempts to clarify some theoretical and technical aspects of child analysis by correlating the course of treatment, the structure of the neurosis, and the technique employed in the case of a phobic boy who was in analysis over a period of three years. The case was chosen for presentation: (1) because of the discrepancy between the clinical simplicity of the symptom and the complicated ego structure behind it; (2) because of the unusual clearness with which the patient brought to the fore the variegated patterns of his libidinal demands; (3) because of the patient's attempts at transitory solutions, oscillations between perversions and symptoms, and processes of new symptom formation; (4) because the vicissitudes and stabilization of character traits could be clearly traced; (5) and finally, because of the rare opportunity to witness during treatment the change from grappling with reality by means of pathological mechanisms, to dealing with reality in a relatively conflict-free fashion.

The Psychoanalytic Process and the Development of Insight in Child Analysis: A Case Study

This paper describes a segment of the analysis of an aggressive latency-age child. The data demonstrate the relationship between the establishment of a psychoanalytic process (the analysis of transference, defense, and resistance), the development and nature of insight in the child, and the resulting therapeutic change. Examination of the process shows that the therapeutic gains were a result of insights acquired by the child, particularly his awareness of painful affects that had been warded off. This case is compared with Bornstein's treatment of a phobic child who manifested severely "out-of-control" behavior.

School phobia: the importance of prompt intervention.

School nurses, teachers, administrators, and child study team members annually are confronted with the recurring problem of how to help school phobic children cope with and resolve the fears and anxieties that beset them. In their efforts to aid the phobic child, school personnel must communicate with concerned parents who oftentimes view the school as the primary source of the problems evidenced by their child. Because of the dearth of literature on school phobia, school personnel frequently are uncertain of the proper approach in dealing with the phobic child and the family. The importance of prompt treatment, and the need for good communication among those concerned with the phobic child, are addressed in this article. The manifestation of this disorder is described and theories and intervention methods are reviewed.

The School Phobic Child and Special Services Providers: Guidelines for Early Identification

Background issues related to the children and youth who have the anxiety disorder known as school phobia are discussed. An approach is offered to assist special services providers with early identification of children who might have this disorder. In this article, the approach is reflected as a set of 25 behavioral indicator guidelines. In addition, an overview of the psychosocial characteristics of school phobia are considered.

Systematic desensitization, muscle relaxation and visual imagery in the counterconditioning of four-year-old phobic child

A four-year-old boy with a severe phobia for loud sudden noises was successfully treated with behavior modification utilizing muscle relaxation and in vivo conditioning in six sessions. The question of theoretical importance was whether muscle relaxation and systematic desensitization by imagining feared stimuli could successfully be employed to treat a phobia in a child this young. The literature does not, to the author's knowledge, contain any reports of the combined use of muscle relaxation and imagination of fear-producing stimuli for treating phobic children of such a young age.

Family Treatment of a School Phobic Child

Family Treatment of a School Phobic Child

FAMILY TREATMENT OF A SCHOOL PHOBIC CHILD.

The present study grew out of two years' experience in treating a family with a phobic child. The referral had originally been made because the boy refused to attend school.^*Interviews were once a week with the entire family. There were periods when one member or another was seen individually by himself, but these latter visits were generally in addition to the usual family visits. The proposition in this paper is that the child's phobia is a symbolic public expression of breakdown in the equilibrium of the family. The pathologic interaction of the family members prior to the onset of the phobia is described. This interaction, although interfering with creative growth or growth in self-esteem in each individual, did serve the defensive purpose of keeping anxiety within tolerable limits and allowing the family to keep functioning as a unit. The events that led to a disruption

The Analysis of a Phobic Child

(1947). The Analysis of a Phobic Child. The Psychoanalytic Study of the Child: Vol. 3, No. 1, pp. 181-226.