High school students as therapeutic agents with young children experiencing school adjustment difficulties: The effectiveness of a filial therapy training model.

Filial therapy has been used since the early 1960s to train parents as therapeutic agents for children experiencing a broad range of social, emotional and behavioral difficulties. Using a pretest-posttest control group design, this study examined the efficacy of a filial therapy model in training high school students to be effective helpers with young children experiencing school adjustment difficulties. 32 high school students enrolled in a Peer Assistance and Leadership course titled PALs were trained to become therapeutic change agents for identified prekindergarten and kindergarten students. The PALs students received training and supervision in child-centered play therapy skills that they practiced in weekly play sessions with their assigned child. Results from the statistical analyses reveal that the experimental group of high school students receiving filial therapy training demonstrated a significant increase in their empathic interactions with children and that the experimental group of children receiving the play therapy intervention experienced a significant reduction in problem behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metaphor with an attitude: The use of The Mighty Morphin' Power Rangers television series as a therapeutic metaphor.

Argues that the television series, The Mighty Morphin' Power Rangers , is a prime example of the medium's influence and popularity with children. As such, children who relate to this program may bring its characters and plots into the play therapy setting. It is suggested that by understanding and utilizing the program, therapists can create powerful and meaningful therapeutic metaphors for child clients. An analysis of the program and its potential use in the play therapy setting is described. A case example involving a behavior disordered child successfully assisted with the use of this metaphor is provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ectopic eruption of maxillary first permanent molars in children with cleft lip

The main aims of therapy for inflammatory bowel disease (Crohn disease) in children and adolescents are (1) the induction and maintenance of remission, (2) the correction of nutrient deficits and (3) the restoration of growth and maturation. These goals are reached with the use of a combination of therapeutic methods, including pharmacologic agents, nutritional and psychological support, and surgical intervention. The commonly used drugs sulfasalazine, corticosteroids and metronidazole have all been shown to be safe and efficacious when given to children. Newer steroid preparations that are rapidly degraded either in the target tissue or elsewhere are being studied. Of these, budesonide currently shows promise as an efficacious drug with few side effects, but its use in children needs further study. Newer 5-amino-salicylate preparations such as Asacol have been shown to be effective in children, but the number of patients studied is small. Immunomodulatory drugs such as azathioprine and 6-mercaptopurine appear to be safe and efficacious for children; cyclosporine has been used infrequently to treat refractory Crohn disease in children. The use of other agents such as methotrexate, tacrolimus, monoclonal antibodies to cytokines, antibiotics and specific dietary products such as fish oils have not been intensively studied in children with Crohn disease. Nutritional therapy remains a mainstay of treatment because it corrects nutritional deficits, replaces losses and stimulates growth.     

The therapeutic use of ball play in psychotherapy with children.

Describes how ball play—noted as one of the earliest and most enduring forms of play—can be used as a directive play therapy technique to facilitate talk therapy with children. Four stages of the ball play therapy process are outlined: (1) rapport building, (2) creating a therapeutic context, (3) pacing and punctuating the dialogue, and (4) anchoring a solution. The author illustrates, using case examples, how the integration of ball play with talk therapy can be an effective intervention in psychotherapy with children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual and group psychotherapy of childhood aggression: A comparison of outcomes and processes.

The purpose of this study was to compare outcomes and processes of a therapeutic intervention to reduce children's aggressive behavior, delivered in individual and group formats. Children in 15 small groups (n?=?71) and 15 individual treatment children were compared in a pre–post experimental and control design. The Achenbach self-report behavior checklist and teachers' evaluations were used to measure outcomes. To assess outcome results further, the process of change was qualitatively analyzed. In addition, the therapeutic processes were compared using Hill's counselor and client verbal response modes system. Results concerning outcomes indicated reduced aggression of treated children compared with wait-list children, with no differential impact of the format of treatment. The analyses of stages of change supported the similarity in outcomes. Results concerning process variables indicated differences in both therapist and client verbal responses. In therapists' responses, directives were used more in groups and self-disclosure was used more in individual therapy. In clients' responses, most variables were more frequently used in individual therapy. Experiencing was more frequent in group therapy, and there was no difference in insight and simple responses… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic approaches to children in residential treatment: Changes from the mid-1950s to the mid-1970s.

Describes changes during the past 20 yrs in the role and therapeutic functions of psychologists in a residential treatment center for children. The older therapeutic approaches, which focused on psychoanalytically oriented psychotherapy, the child therapist's relations with parents, and psychotherapy with psychotic children are compared with innovative approaches currently employed, including family therapy, behavior therapy with psychotic children, and a recently instituted treatment known as "unit therapy." These newer therapeutic roles have affected the training of psychology interns and the work of staff psychologists and have led to changes in interpersonal perceptions among psychologists and nonprofessionals who are now recognized as playing a more significant role in the therapeutic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stroke therapy in children

OBJECTIVE: To evaluate the treatment modalities used in children (ages 1-18 years) with cerebral infarction. BACKGROUND: [corrected] Cerebrovascular disease in children is more common than once suspected but its treatment has not been rigorously studied. MATERIAL AND METHODS: We reviewed all cases of cerebral infarction at the James Whitcomb Riley Hospital for Children at the Indiana University Medical Center from 01.01.80 to 31.12.95. RESULTS: Ninety-three children who experienced ischemic strokes were followed over the past fifteen years. Fifty-seven males and thirty-six females comprised the sample. Mean age was 6.9 years at the time of stroke. No medication or surgical intervention was the therapeutic recommendation in 44% of patients. For cardioembolic strokes, warfarin was used later in the course for a few patients who went on to have atrial fibrillation or valve replacement. Aspirin was used in all patients with carotid artery dissections. Aspirin was used in most children with Moya-Moya, with calcium channel blockers and surgical intervention used in later cases. Exchange transfusion followed by monthly transfusion and chelation therapy has been the treatment of choice for children with cerebral infarction complicating sickle cell disease. CONCLUSIONS: In most instances, treatment was widely disparate, probably reflecting the lack of firm therapeutic guidelines for this age group, with a better understanding of the etiology and pathophysiology of strokes in children, multicenter, international, randomized therapeutic trials based strictly on an etiological basis should be organized in the future.     

Therapy of Crohn's disease in childhood

The aim of therapy in Crohn's disease in childhood is to induce and to maintain a remission of disease activity so that normal growth and development of the child may occur. Enteral nutrition may now be recommended as the first-line treatment for most children with Crohn's disease. However, the evidence for remission is better for children with Crohn's disease of the small intestine rather than of the large intestine. There is evidence that amino acid feeds (elemental), whole protein (polymeric) and protein hydrolysate feeds (semi-elemental) may all be successful. Such a therapeutic approach can lead to healing of the mucosa and down-regulation of inflammation. However, in some cases surgery is required, particularly in children with growth failure and delayed puberty. Drug therapy also continues to have a role in therapy especially with severe colonic disease.     

What Is Therapeutic in Child Therapy? I. Therapeutic Engagement.

The author presents a beginning statement toward a multidimensional model of therapeutic action in psychoanalytically informed child therapy. This model highlights the central role of affect in clinical work with children. Two broad principles of therapeutic change are proposed: (a) the enhancement of the child's positive affects and his or her expectation of affirming responsiveness and (b) the development of increased tolerance for painful and distressing affects. Each principle offers a means of engagement of children in the therapeutic process and an experience-near understanding of the clinical efficacy of child therapy as well as a rationale for therapeutic interventions with families. Together, these modes of affective engagement promote increased resilience in the child when faced with emotional distress and help arrest malignant intrapsychic and interpersonal development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing equinus in children with cerebral palsy: electrical stimulation to strengthen the triceps surae muscle

A new therapeutic proposal for the management of equinus in children with cerebral palsy is to strengthen the calf muscles instead of weakening them surgically. Prior research indicates that in children with cerebral palsy the triceps surae muscle is weak and needs strengthening. Neuromuscular electrical stimulation (NMES) was used as an adjunct to physical therapy. A portable NMES unit with a hand-held remote switch stimulated an active muscle gait cycle. Results are discussed for four children, who showed improved gait, balance, posture, active and passive ankle range of motion, and foot alignment. The toe walkers became plantigrade and the equinovalgus posture of the foot decreased. Spasticity did not increase.     

Supporting affect regulation in children with multiple disabilities during psychotherapy: A multiple case design study of therapeutic attachment.

In a controlled multiple case design study, the development of a therapeutic relationship and its role in affect regulation were studied in 6 children with visual disabilities, severe intellectual disabilities, severe challenging behavior, and prolonged social deprivation. In the 1st phase, children had sessions with an experimental therapist stimulating therapeutic attachment, alternating with a control therapist providing positive personal attention only. In the 2nd phase, both therapists applied behavior therapy. Clients sought more proximity to the experimental therapist compared with the control therapist. Psychophysiological arousal (respiratory sinus arrhythmia and pre-ejection period) was lower when the experimental therapist applied behavior modification than when the control therapist did. Despite prolonged social deprivation, the attachment behavioral system appeared responsive to stimulation. The effects on affect regulation may explain the synergy between psychotherapy based on interpersonal and behavior modification approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intravenous aminophylline dosage. Use of serum theophylline measurement for guidance

A practical method for monitoring serum theophylline concentrations has been used to investigate intravenous aminophylline dosage requirements. Initial serum theophylline concentrations were found to vary widely and correlate poorly with drug history. Aminophylline loading doses determined from these values more frequently resulted in drug concentrations in the therapeutic range (10 mug to 20 mug/ml) than when therapy was given without knowledge of serum theophylline concentrations. Continuous intravenous aminophylline therapy administered in a standardized dosage (0.9 mg/kg/hr in adults and 1.0 mg/kg/hr in children) produced variable and often excessive serum concentrations. This resulted from variable drug clearance rates, which in adults averaged 0.64 +/- 0.38 ml/kg/min (mean +/- SD), only half that previously reported. These observations suggest that it is not possible to achieve optimal therapeutic aminophylline dosage without monitoring serum theophylline concentrations.     

Therapy of complex I deficiency: peripheral neuropathy during dichloroacetate therapy

A therapeutic trial with polyvitamins and dichloroacetate (DCA) in combination with thiamine in a 13-year-old girl with complex I deficiency is reported. The polyvitamin therapy included thiamine, riboflavin, ascorbate, coenzyme Q 10 and carnitine. This therapeutic regine was used over a period of 17 months without any effect. Although DCA lowered the lactate concentration in blood and CNS--measured by magnetic resonance spectroscopy--no clinical benefit was achieved. After 20 weeks of DCA therapy a distal polyneuropathy with areflexia developed although 100 mg thiamine daily as comedication was given from the beginning of DCA therapy. Nerve conduction velocity of the peroneal nerve was not detectable, sensible evoked potentials of the tibialis posterious nerve were normal. This side-effect resolved completely within 6 months after omission of DCA. Our observation suggests a direct toxic effect of DCA only on the peripheral nervous system in our patient since several cerebral MRI and magnetic resonance spectroscopy studies showed no abnormalities. CONCLUSION. DCA lowers the lactate concentration in children with complex I deficiency of the respiratory chain in a dose of 100 mg/kg body weight without clinical benefit. Reversible peripheral polyneuropathy may develop under DCA therapy despite thiamine medication.     

Let's play: Inclusion of a play therapy course or program into a graduate curriculum.

Considering a resurgence of interest in play therapy as an important therapeutic approach for working with both children and adults, strategies are offered for inclusion of a play therapy course or program in a graduate curriculum. These strategies include suggestions for intra-university considerations, information-gathering surveys, play therapy demonstration, and association with an established play therapy professional organization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The challenge of creative children: Implementing their divergency in the service of therapy.

Treatment of creative children in therapy is quite challenging because they are often unresponsive to traditional approaches, especially if the therapeutic techniques limit their sense of self-control and divergent thought. A strategy is suggested, based upon the premise that the child's creativity should be employed in the service of his or her own therapy. The meaning of the gift of creativity is discussed throughout the therapy process by the examination of four principal themes. The child's divergent thinking is employed in designing the therapeutic milieu through application of five preferred clinical techniques. The strategy is then exemplified in an extended case study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of BRIAC for evaluating therapeutic effectiveness

Forty-six children in eight different psychotherapeutic settings were evaluated at the beginning and at the end of a 12-month period by means of the Behavior Rating Instrument for Autistic Children (BRIAC). The younger children (3 to 6 years of age) were initially more severely disturbed and improved significantly more than the older children (7 to 9 years of age). The large, bleak, custodial residential center produced significantly less improvement in the children than did the other settings. However, among good programs--i.e., those which were sensitive to the behaviors and needs of the children and which were skillfully implemented by a dedicated and attentive staff--there was little evidence of differences in therapeutic effectiveness regardless of whether the therapy was behavior modification, education, psychoanalytically oriented relationship therapy, or activity therapy.     

The evaluation of process and outcome in individual child psychotherapy.

The purpose of this study was to demonstrate the use of an objective method for the evaluation of therapy process and outcome in cases of individual child psychotherapy. Fourteen children ranging in age from 4 to 6 years were videotaped during the first and eighth sessions in interaction with their therapists. Approximately half the children received psychodynamic play therapy whereas the other half received client-centered play therapy. Using the Play Therapy Observational Instrument (PTOI) of Howe & Silvern (1981), videotapes were scored on 19 items. Data was reduced to 3 clusters: emotional discomfort, quality of interaction with the therapist, and beneficial fantasy play. No significant differences were obtained between therapeutic approaches. However, the PTOI was found to be sensitive to mean behavioral and verbal changes in the children from session one to session eight. Hence it appears that the PTOI scales offer clinicians a method of reviewing, tracking and assessing the process and outcome of their therapy work with children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An initial look at the outcomes for dynamic play therapy.

Recent reviews of play therapy have identified that inclusion of parents in the intervention improves outcomes. This article presents an initial study of the changes in problem behavior when children and their families are provided dynamic play therapy. Dynamic play therapy is a family intervention developed by the author in which families are helped to develop collaborative play together using art, drama, movement, storytelling, and video making. Results suggest that child behavior does improve, that parents report the development of a positive therapeutic alliance with the therapist, and that this alliance is associated with outcome. This study used an action research approach and was conducted in an ongoing child guidance clinic. Discussion of the limits and merits of this approach is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)