Assessing communication in children with psychiatric and communication disorders

This article presents issues related to the communication assessment of children with psychiatric and communication disorders. Challenges inherent in assessing this population are discussed. Frequently used assessment instruments and procedures are described. Consideration is given to the assessment of very young or low-functioning children and older or high-functioning children.     

Approaches to recognition and management of childhood psychiatric disorders in pediatric primary care

Psychiatric disorders occur in 14% to 20% of American children and adolescents and are a leading cause of disability among them, yet fewer than one in five of these children are recognized. The most common psychiatric disorders presenting to pediatricians include ADHD, anxiety disorders, depression, substance-use disorders, and conduct disorder, Approaches to recognition include screening for psychosocial concerns using specific questions in the clinical interview, and using brief, written questionnaires. Case vignettes illustrate comprehensive treatment planning for children with psychiatric disorders in the primary care context. As psychopharmacologic treatments and the new subspecialty of pediatric psychopharmacology take on growing importance, the traditional oversight role of the pediatrician and effective communication among referring and consulting physicians remain critical to quality care.     

Maternal depression and child adjustment: A longitudinal analysis.

This study examined the relation between maternal depression and child adjustment. Two major issues were addressed. First, to assess the specificity to depression of observed child adjustment difficulties, four groups of female subjects were included: clinically depressed psychiatric patients, nondepressed psychiatric patients, nondepressed medical patients, and nondepressed nonpatients. Second, to assess the stability of the observed effects, data were collected early in the patients' treatment and again approximately 8 weeks later. The results indicated that the depressed mothers described their children as having various behavior problems; interestingly, interviewers also rated these children as demonstrating disturbed behavior. Although the offspring of the depressed mothers were the most impaired children in the sample, the lack of significant differences between children of the depressed and the nondepressed psychiatric patients suggests that child adjustment is more strongly related to the presence of maternal psychopathology than it is to diagnostic status. Finally, children of the psychiatric patients continued to demonstrate problems at the second assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of maternal depression in perceptions of child maladjustment.

We investigated (a) the relation of maternal depression to perceptions of externalizing and internalizing disorders in children and (b) quality of communication in a mother–child interaction task as a function of maternal depression and perceptions of the child. 64 children of unipolar or bipolar mothers, chronic medically ill or normal mothers were studied; clinical diagnoses, children's reports, and teachers' ratings served as objective criteria of children's maladjustment. Maternal depression defined by current symptomatology on the Beck Depression Inventory and by psychiatric status was not associated with misperceptions of psychopathology. Maternal depression interacted with children's actual behaviors to predict mothers' perceptions: nondepressed mothers were less accurate reporters of problems in children than were depressed mothers. Depressed mothers who perceived maladjustment in their disturbed children made more negative comments in interactions than did nondepressed mothers of disturbed children. The apparent mutual impact of mothers' and children's maladjustment requires fuller exploration in offspring studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Communicative intervention for children with psychiatric and communication disorders

Many children and adolescents with psychiatric disorders exhibit severely compromised language and social communication systems. The nature and scope of their deficits make a multidisciplinary team approach essential to management in which improved functional and socially appropriate communication is a primary goal. For this reason SLPs generally play a key role in the intervention process and share responsibilities for the planning, coordination, and implementation of instructional-educational goals.     

Language, communication, and transference in child analysis. I. Selective mutism: the medium is the message

Selective mutism is a psychiatric condition in which children stop speaking to all except their closest family members. Analytic material from a 4 1/2-year-old selectively mute child demonstrates how his symptom of mutism was embedded in a character structure in which not only verbal dialogue but play and other nonverbal communication were disrupted. Because communication was severely limited, I modified my analytic technique. Despite obstacles to communication, conflicts from different developmental levels were revived in the transference. Even in these difficult circumstances, analytic work in the transference resulted in significant change.     

Sexual risk among African American girls: Psychopathology and mother–daughter relationships.

Objective: To examine the associations among mental health problems, maternal monitoring and permissiveness, mother–daughter communication and attachment, and sexual behaviors among African American girls receiving outpatient psychiatric care. Youths with mental health problems report higher rates of HIV-risk behavior than do their peers, and African American girls have higher rates of sexually transmitted infections than do girls of all other racial groups. Method: A sample of 12- to 16-year-old African American girls (N = 266, mean age = 14.46 years) and their female caregivers (73% biological mothers) completed computerized assessments of girls' mental health symptoms, maternal monitoring and permissiveness, and mother–daughter communication and attachment. Girls indicated their sexual risk behaviors (vaginal/anal sex, consistent condom use, number of partners). Results: African American girls who reported clinically significant externalizing problems, more permissive parenting, less open mother–daughter sexual communication, and more frequent mother–daughter communication were more likely to report having had vaginal and/or anal sex. Sexually active girls with greater maternal attachment were less likely to report inconsistent condom use. Conclusions: Findings revealed important risk and protective factors for African American girls in psychiatric care. HIV-prevention programs may be strengthened by improving mother–daughter relationships and communication and by reducing girls' mental health problems. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Brain damage and abnormal behaviour in children

Behavioural problems in children with suspected brain damage may present considerable diagnostic and management problems. Methods of assessment are still imprecise and minor degrees of brain damage are seldom detectable. Data from clinical studies highlight the interrelationship between environmental and organic factors in the pathogenesis of disturbed behaviour. Children from large families of low socioeconomic status, who are subject to parental neglect, are particularly susceptible to the development of psychiatric disorder in the presence of brain damage.     

The presence of psychiatric consultations in relation to divorce

In this study all couples who during a period of 1 year were divorced at a Swedish district court, and who had children living at home, were examined for psychiatric consultations before, during and after the divorce period. Psychiatric consultation was defined as having a psychiatric record at the only psychiatric clinic in the catchment area. The divorced couples were compared with a matched group of married people. The results showed that there was a 4.1-fold higher risk for divorced men and a 2.5-fold higher risk for divorced women of acquiring a psychiatric record. The increased rate of psychiatric consultations was evident before as well as after the divorce period, but was most striking during the divorce period. A greater proportion of men than women started and continued to experience their psychiatric problems before and during the divorce period, while women more often started and continued to experience their psychiatric problems during the divorce period and afterwards.     

Adoption: psychiatric risk and/or protective factor?

Epidemiologic studies reveal that adoptees are overrepresented in referrals to child psychiatric facilities as well as show more often psychiatric disturbances compared with their nonadopted peers. Therefore the adoptive status is indicating a psychiatric risk. To explain the underlying mechanisms it seems useful to comprehend the adoption as a process. The adoptees' situation must be described as bearing multiple risks. On the other hand the adoption itself can be seen as a protective factor too. It nevertheless can produce additional problems. In order to enhance the success in therapy these adoption-specific risk factors witch can deteriorate the relationship between the adoptive parents and their children must be considered.     

Reducing conduct problems among children exposed to intimate partner violence: A randomized clinical trial examining effects of Project Support.

This study was a randomized clinical trial of Project Support, an intervention designed to reduce conduct problems among children exposed to intimate partner violence. Participants were 66 families (mothers and children) with at least 1 child exhibiting clinical levels of conduct problems. Families were recruited from domestic violence shelters. The Project Support intervention involves (a) teaching mothers child management skills and (b) providing instrumental and emotional support to mothers. Families were randomly assigned to the Project Support intervention condition or to an existing services comparison condition. They were assessed on 6 occasions over 20 months, following their departure from the shelter. Children in families in the Project Support condition, compared with those in the comparison condition, exhibited greater reductions in conduct problems. Mothers in the Project Support condition, compared with those in the comparison condition, displayed greater reductions in inconsistent and harsh parenting behaviors and psychiatric symptoms. Changes in mothers’ parenting and psychiatric symptoms accounted for a sizable proportion of Project Support’s effects on child conduct problems at the end of treatment. Clinical and policy implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy for children. Institutional management of psychiatric cases in minors

The history of the approach to children with psychiatric problems is reviewed. The author insists in elaborating a diagnosis based in a clinical history, a physical and neurological examination, and the necessary tests. Factors of importance are: the indirect clinical history, the observation of the child, the first emotional contact with him, the exploring of his fantasies (three wishes) and the observation of his drawings, paintings and models. The child is sent to audiology, phoniatry or neurology specialists if his case requires it. Treatment can include psychiatric medication, psychotherapy or both.     

Diagnosis and differential diagnosis of sleep disorders in children

Sleep disorders in children are very common and their impact on emotional and cognitive functions is considerable. Clinical work necessitates an interdisciplinary access to the subject because the scope of sleep medicine is related to various medical disciplines (e.g. paediatric neurology, pulmology and child psychiatry). Although many sleep problems are seen in both children and adults diagnoses, symptoms and pathogenetic factors are quite different in the two groups. In childhood especially parent-child interactional factors and developmental aspects of the sleep architecture and the sleep-wake cycle have to be taken into account leading to different diagnostic and therapeutic approaches. In this article we focus on important developmental aspects of childrens' sleep problems. Their relationship to neurologic, paediatric and psychiatric diseases is demonstrated and finally clear indications to diagnostic procedures, especially polysomnography, are given.     

Significance of family relations for coping with psychological disorders--results of an empirical study of therapy prognosis of children and adolescents with psychological disorders

The importance of family relations for the therapy of psychiatric disorders in children and adolescents is discussed reporting results from an empirical study carried out in an inpatient sample of a child and adolescent psychiatric unit with regard to the quality of mother-child resp, father-child relation and its influence on coping processes. Whether adolescents suffering from a psychiatric disorder are able to cope with their problems during the course of a therapy, depends on their individual and social resources. Therapy outcome is to a great extent influenced by the emotional quality of their family relations. Hostility and rejection as well as unstructured and disorganized parental behavior contribute to a negative outcome. A differentiated analysis shows further that the relation between the adolescents and their fathers is particularly important for therapy prognosis. Nevertheless, one has to consider the respective relations with both parents for therapy prognosis, as problems with one parent may be partly compensated by a good relationship with the other parent. Finally, the cooperation between parents and clinical staff is discussed. Data and experiences show that interest and readiness of parents (mothers as well as fathers) for a close cooperation are higher than generally expected.     

Engaging depressed patients in psychotherapy: Integrating techniques from motivational interviewing and ethnographic interviewing to improve treatment participation.

Treatment dropouts and high "no show" rates are vexing problems for practicing psychologists and the populations they serve. This article describes a one-session intervention based on principles derived from motivational interviewing and ethnographic interviewing designed to improve depressed patients' participation in subsequent psychiatric treatment. The authors explain the rationale for developing an engagement intervention, describe the intervention itself, and present case vignettes based on a pilot study evaluating the feasibility and acceptability of administering the intervention to depressed mothers whose children suffer from psychiatric illness. The article includes strategies that may be implemented in clinical practice to improve patients' participation in treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children of affectively ill parents: a review of the past 10 years

OBJECTIVE: To review the literature investigating the effects of parental affective illness on children over the past decade. METHOD: A computerized search of articles published over the past 10 years was completed. Articles were reviewed and relevant studies are presented. RESULTS: Over the course of the past 10 years a number of longitudinal studies have confirmed that children of affectively ill parents are at a greater risk for psychiatric disorders than children from homes with non-ill parents. Life table estimates indicate that by the age of 20 a child with an affectively ill parent has a 40% chance of experiencing an episode of major depression. Children from homes with affectively ill parents are more likely to exhibit general difficulties in functioning, increased guilt, and interpersonal difficulties as well as problems with attachment. Marital difficulties, parenting problems, and chronicity and severity of parental affective illness have been associated with the increased rates of disorder observed in these children. CONCLUSION: The presence of depression in parents should alert clinicians to the fact that their children also may be depressed and therefore in need of services. J. Am. Acad. Child Adolesc.     

Experimental studies on the infectivity of Anguillicola crassus third-stage larvae (Nematoda) from paratenic hosts

Speech, language, and communication disorders are prominent reasons for referrals to a child development center. From 1984 to 1988, 1,090 preschool children were referred to our child development center, which serves the Tel Aviv metropolitan area. Of all referrals, 432 (41%) were primarily due to speech, language, and communication problems. After exclusion of those with IQ < 50 and those with non-language-related disabilities, 323 children remained. The children were classified into different subtypes of developmental language disorders and autistic spectrum disorders. The main developmental language disorder subtypes were combined expressive-receptive (49%) and expressive (44%). Central processing deficits were less common, occurring in 20 (7%) of the children. Parents of children with developmental language disorders had educational levels similar to those of parents of children referred to the child development center for other causes. However, parents of children with infantile autism had higher educational levels than parents of children with developmental language disorder or parents of children referred for other causes (P < .001). Our results reflect the distribution of language and related problems in an unselected population of preschool children referred to a child development center.     

Psychological-educational intervention for autistic children]

A "TEACCH" experience conducted in Lyon, France, with autistic children within the framework of an infant-juvenile psychiatric intersectory is described here: the proposal for an individualized educational project stems from the developmental possibilities of each child; taking children into care is inspired by Schopler's proposals: in a structured environment the child is placed in an educational setting; alternatives to verbal communication are also proposed to the children, who for the most part are non verbal. At the same time, work with families is put into place: it consists of support in the taking in charge by the parents on a daily basis of the handicap of the child: a broad place is given to the harmonization of help to the child in his different life contexts. Contribution and limits of this work are also discussed: the child's capacity to relax, the improvement of his relational capacities and his autonomy are noteworthy; restoration of quality of life and relation with families is clear; the child's mental deficit is obviously a limiting factor.