Screening for pediatric bipolar disorder in primary care

A child or adolescent with pediatric bipolar disorder (PBD) is at higher risk for suicide, violence, and impaired psychosocial functioning. The prevalence of diagnosed PBD has increased 40-fold in less than 2 decades, leading some to believe that PBD is inaccurately diagnosed. Complicating this issue, disagreements exist among clinicians as to the utility of current screening methods. The assessment picture is further muddied by the high rate of comorbid psychiatric conditions. A literature review was performed to describe the present understanding of PBD and identify current practices of screening for the disorder. Although screening tools are available, the literature suggests they lack validity. Awareness, a thorough interview, and expedient referral may assist clinicians in making a correct diagnosis. Accurate assessment will help ease the psychological and economic burden of PBD.     

Cognitions and Distress in Caregivers after Their Child's Sexual Abuse Disclosure

The impact of child sexual abuse on children is well documented, but few studies have examined the impact of a child's sexual abuse disclosure on maternal caregivers. The studies that have been conducted suggest that parental response postdisclosure is variable. The present study examined the association between maternal attributions and abuse-specific cognitions with depression and trauma symptoms postdisclosure. Participants included 68 nonoffending maternal caregivers of children between the ages of 3 and 17 years who experienced child sexual abuse. Findings indicated that caregivers' abuse-specific cognitions were the best predictor of self-reported symptoms of depression after controlling for general negative attributions. These findings suggest that in order to reduce caregivers' distress and to enhance their support of their children, it is important to assess and treat caregivers' abuse-specific cognitions.

     

Child Advocacy Center Based Group Treatment for Child Sexual Abuse

The present study examines initial symptom presentation among participants, outcomes, and social validity for a group treatment for child sexual abuse delivered at a child advocacy center. Participants were 97 children and their nonoffending caregivers who were referred to Project SAFE (Sexual Abuse Family Education), a standardized, 12-week cognitive-behavioral group treatment for families who have experienced child sexual abuse. Sixty-four percent of children presented with clinically significant symptoms on at least one measure with established clinical cutoffs. Caregivers of children who presented with clinically significant symptoms reported more distress about their competence as caregivers. Children who presented as subclinical were more likely to have experienced intrafamilial sexual abuse. Posttreatment results indicated significant improvements in functioning for all children who participated in treatment, with greater improvements reported for children who initially presented with clinically significant symptoms. Overall, the program was rated favorably on the posttreatment evaluation of social validity.     

A qualitative study of collaboration between guardians ad litem and caseworkers in the child welfare system

Various agencies and professionals in the child welfare system work together to prevent and treat child maltreatment. Prior research suggests their ability to collaborate is related to outcomes for children and families and agencies often implement strategies to improve collaboration. However, a review of the literature indicated a lack of research on collaboration between Guardians ad litem (GALs) and child protective services caseworkers. Examination of this relationship is warranted considering federal law mandates GALs be appointed for children in all court-involved child protection cases. This qualitative study begins to address this gap by exploring the GAL perspective on factors that promote or inhibit collaboration between themselves and caseworkers. Interviews were conducted with 12 GALs in a mountain region state. Participants emphasized five individual-level factors that impact the frequency and quality of collaboration with caseworkers. These include frequent and open communication, mutual respect, understanding the other's role and responsibilities, having an open mind, and valuing collaboration. Participants described in detail how these factors facilitate collaboration despite the organizational and systemic obstacles to working together. The findings may help explain why collaboration does not necessarily occur in frontline practice despite the presence of organizational policies and procedures intending to improve collaboration. These findings have several implications for improving GAL–caseworker collaboration in order to better serve children and families in the child welfare system.     

The experiences and outcomes of children in foster care who were removed because of a parental disability

The purpose of this study is to examine the experiences and outcomes of children in the foster care system in the United States who were removed from their homes at least partially in relation to their parent's or caretaker's disability. This study uses administrative data from the 2012 year of the Adoption and Foster Care Reporting System (AFCARS), the federal reporting system that collects case-level data on all children in foster care through state and tribal IV-E agencies. While this administrative dataset doesn't collect data on parental disability, it does collect data on parental disability as a removal reason for children in foster care. In 2012, 19.0% of children in foster care had parental disability indicated as at least one removal reason, and 5.18% had parental disability indicated as their sole removal reason. Logistic regression was used to explore how a removal reason of parental disability correlated with removal manner, type of placement, location of placement, current case plans, discharge reasons and termination of parental rights. T-tests were used to compare children with and without parental disability as a removal reason in regards to number of placements, age at removal, length of time since last removal, length of stay in current placement, and total days in foster care. As foster children could have multiple removal reasons, analyses were conducted separately for children with parental disability as at least one removal reason, and those with parental disability as their sole removal reason. Findings indicate that children who have parental disability as a removal reason have different experiences in child welfare and different child welfare outcomes than those without parental disability as a removal reason. While the AFCARS removal reason of parental disability is not a proxy for parental disability, the study points to a need for closer attention to parental disability within the child welfare system to ensure appropriate services and supports, as well as fair treatment.     

Have child maltreatment and child placement rates declined?

It is argued that the actual incidence of child maltreatment remains elusive and is, in fact, indeterminate. Factors that might be reflected in variations in child maltreatment rates, other than child harm or endangerment at least partially attributable to caretakers, are explored. But since most children residing in foster care in the United States have been placed there for the alleged reasons of child abuse and neglect, we might expect trends over time in the rate of alleged maltreatment to have some bearing on the out-of-home placement population rate. On the contrary, it is shown that the child placement population rate has risen in recent years, even though the overall child maltreatment rate has not. Based on existing data, the child placement population in the United States is calculated to have been nearly one million children on any given day in 2011, higher than at any point throughout the previous century. Brief comparisons are made with child maltreatment and child placement trends in other countries.     

A National Survey of Child Advocacy Center Directors Regarding Knowledge of Assessment,Treatment Referral,and Training Needs in Physical and Sexual Abuse

Mental health services are a core component of child advocacy centers in the United States. Child advocacy center directors were surveyed about (a) trauma and posttraumatic stress disorder; (b) referral criteria for treatment of abuse victims; (c) evidence-based treatments for abused children; (d) reliable, valid, and normed measures helpful in assessment; and (e) training needs. Directors accurately identified posttraumatic stress disorder symptoms, but additional symptoms were misidentified. Directors identified best practices for assessment and treatment, but they misidentified non-evidence-based practices. Primary reasons for referral for services included severity of abuse and emotional response of the child. However, referrals based on assessment findings were not a high priority. Directors expressed some training needs for staff consistent with issues identified in the study.     

Bipolar disorder in children

This article presents an overview of bipolar disorder (BPD) in children, a condition that only recently has been recognized as a legitimate diagnosis. Bipolar disorder in children is underrecognized for many reasons including lack of awareness, diagnostic confusion, and the different clinical picture in children. Available data strongly suggest that prepubertal childhood BPD is a non-episodic, chronic, rapid cycling, mixed manic state. It may be comorbid with attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) or it may demonstrate features of ADHD and CD, further complicating recognition and subsequent treatment. Treatment issues are discussed, and some reasons for the urgency of early recognition and treatment are explained.     

A study of disabled children and child protection in Scotland — A hidden group?

This paper is based on analysis of data collected for a study, commissioned by the Scottish Government, which examined child protection work with disabled children. At a conceptual level, the paper draws on Goffman's frame analysis and on different models of disability. Focus groups were conducted with five Child Protection Committees (40 individuals) and semi-structured interviews with a further 21 practitioners from social work, education, health services, third sector organisations and the police. The findings show that, for various reasons, abuse of disabled children may go undetected. Where it is suspected, effective action does not always follow, for example, where practitioners over-empathise with parents. When child protection work is undertaken, disabled children may remain relatively invisible in terms of participation and professional focus. It is suggested that the ways in which practitioners and managers “frame” disabled children has implications for how abuse is responded to and how well these children are protected. Participants also “framed” disability in different ways, and it is suggested that a social relational model seems particularly applicable. In conclusion, in many respects disabled children experiencing abuse may remain absent from or to some extent hidden within child protection services in Scotland. While some creative work is taking place, considerable changes are required to make child protection services accessible to all disabled children, sensitive to their needs and respectful of their rights.     

Improving child welfare services with family team meetings: A mixed methods analysis of caseworkers' perceived challenges

Various forms of family team meetings have been increasingly employed in child welfare systems to empower families and provide effective individualized services through community partnerships. However, many family team meetings often fail to achieve their intended goals mainly due to ongoing challenges that team members face. Using data from a survey of caseworkers, this study examined dynamic processes of family team meetings to improve child welfare service outcomes, specifically focusing on caseworkers' perceived challenges. Also, responses to an open ended question were reviewed using content analysis to identify similar or different challenges encountered by diverse team members. Survey data were analyzed using path analysis and found that logistical barriers tended to decrease both family and stakeholder engagements, which in turn made child welfare services less accessible, less utilized, and less effective for children and families. Content analysis revealed that caseworkers perceived disagreement/conflict and knowledge deficits about child welfare as common challenges for all team members. This paper concludes with practice implications suggesting ways to minimize challenges identified and maximize the effectiveness of a family team meeting.     

Forensic Interviews for Child Sexual Abuse Allegations: An Investigation into the Effects of Animal-Assisted Intervention on Stress Biomarkers

The use of therapy animals during forensic interviews for child sexual abuse allegations is a recommendation by the Therapy Animals Supporting Kids Program to help ease children’s discomfort during the forensic interview process. Based on this recommendation, this study incorporated a certified therapy canine into the forensic interview process for child sexual abuse allegations. This study investigated changes in salivary cortisol, immunoglobulin A, blood pressure, and heart rate as a result of forensic interview phenomenon (e.g., outcry) incorporating animal-assisted intervention versus a control condition in children (N = 42) interviewed for alleged child sexual abuse. The results supported significantly greater heart rate values for the control group (n = 23) who experienced sexual contact and/or indecency than the experience of aggravated sexual assault compared to no difference in HR for the intervention group (n = 19). The results suggest that the presence of the canine in the forensic interview may have acted as a buffer or safeguard for the children when disclosing details of sexual abuse. In the intervention group, children’s HR was lower at the start of the forensic interview compared to the control group. Finding an effect of having a certified handler–canine team available during the forensic interview on physiological measures of stress has real-world value for children, child welfare personnel, and clinical therapists. It is suggested that animal-assisted intervention be expanded to children facing other types of trauma and to treatment programs for child survivors of sexual abuse.     

Local realities: a frontier perspective on child protection team practice

This article presents a case study of a child protection team in a frontier county in Montana. Narratives from individual and group interviews highlight team members' experiences and the structuring of team practice in their frontier community, the power and challenge of community culture and history, and the interplay of constructions of children and child abuse as key elements that influence and shape team practice. This exploration suggests a framework for rethinking child protection team practice in diverse locations.     

Marital Conflict and Children's Emotional Security in the Context of Parental Depression

Evidence has emerged for emotional security as an explanatory variable linking marital conflict to children's adjustment. Further evidence suggests parental psychopathology is a key factor in child development. To advance understanding of the pathways by which these family risk factors impact children's development, the mediational role of emotional security for children with parents who have potentially clinical levels of depression compared to children whose parents have lower levels of symptomatology was examined (i.e., moderated mediation). Participants included 297 families assessed annually for 3 years. Paternal depression moderated pathways, such that marital conflict was associated with greater child emotional insecurity 2 years later in the context of paternal depression. Testing alternative pathways, emotional insecurity mediated relations between maternal depression and externalizing problems.     

Body-Related Emotions in Posttraumatic Stress Disorder Following Childhood Sexual Abuse

Traumatic experiences are associated with emotions such as anxiety, shame, guilt, disgust, and anger. For patients who have experienced child sexual abuse, these emotions might be triggered by perceptions of their own body. The aim of this study was to investigate the extent of the association of the body to traumatic experiences and to discern the emotions linked to trauma-associated body areas. Ninety-seven female participants were assigned to four groups: post-traumatic stress disorder following child sexual abuse with co-occurring borderline personality disorder, post-traumatic stress disorder following child sexual abuse without co-occurring borderline personality disorder, borderline personality disorder without post-traumatic stress disorder, and healthy controls. Participants rated 26 body areas regarding their association with trauma and 7 emotions. Emotions were assessed by questionnaires. Results suggest that specific areas of the body are associated with trauma and linked to highly aversive emotions. In post-traumatic stress disorder patients, the areas associated with highly negative emotions were the pubic region and inner thighs. Thus, the patient’s body may act as a trigger for traumatic memories.     

The Cognitive Impact of Sexual Abuse and PTSD in Children: A Neuropsychological Study

Sexual abuse is known to have an impact on both child and adult mental health, but the neuropsychological basis of this effect is still largely unknown. This study compared neuropsychological test results from a group of 76 children, 13 of them sexual abuse victims with symptoms of post-traumatic stress disorder, 26 victims of sexual abuse who showed no symptoms post-traumatic stress disorder, and 37 controls. The groups were matched by age, sex, socioeconomic status, and educational level. Child sexual abuse was associated with reduced ability to inhibit automatic responses measured by the Stroop test regardless of post-traumatic stress disorder status. These findings indicate possible attentional inhibition difficulties in child victims of sexual abuse, which may help explain psychopathology associated with the experience.     

Taking stock: parents' reasons for and against having a third child

In developed countries with below-replacement fertility, the proportion of people who have at least three children make a substantial difference to the aggregate level of fertility. This study, based on 40 in-depth interviews with Australian parents of two children, analyses what factors influence the decision to have a third child. Using a grounded theory method of qualitative analysis, the study finds that parents who have decided to stop at two children are more able to articulate their reasons than are parents who are considering having a third child. The reasons for stopping include age and health; work and finances; and the capacity to parent another child. The weighing up of multiple factors is evidence of parents taking stock of personal and financial resources when making complex family formation decisions. The reasons for having a third child are expressed with far less elaboration and are more guarded and personal. We conclude that there is less shared or familiar language for articulating the value of family relationships. The contemporary context is one in which parents are attempting to manage risks related to having children, including the personal and financial implications of time out of the workforce. This study finds a persistent story of limited resources among parents of two children. Policies aimed at increasing fertility need to address this perception of limited resources through direct measures like affordable childcare and more generally through greater government and community support for families.     

Prevention of Mental Health and Behavior Problems Among Sexually Abused Aboriginal Children in Care

This agency-based study explored the preventive impact of a multi-method intervention program for children in care who had been sexually abused. Participants were Aboriginal children of the Stól:lö Nation in British Columbia, Canada. It suggested that such programs offered in child welfare contexts could actually prevent many mental health and behavioral problems that otherwise would be more prevalently experienced by such traumatized children in care.     

Prevention of child maltreatment in high-risk rural families: A randomized clinical trial with child welfare outcomes

Few studies have specifically examined prevention of child maltreatment among higher-risk populations in rural communities. The overarching goal of this study was to conduct a randomized clinical trial of SafeCare augmented for rural high-risk population (SC+) compared to standard home-based mental health services (SAU) to examine reductions in future child maltreatment reports, as well as risk factors and factors proximal to child maltreatment. Parents (N = 105) of young children (5 years or less) who had identifiable risk of depression, intimate partner violence, or substance abuse were randomized to SC+ or SAU. Participants randomized to SC+ were more likely to enroll (83% vs. 35% for SAU) and remain in services (35 h vs. 8 h for SAU). SC+ (for participants who successfully completed services) may have had limited impact on child welfare reports during service provision. Further, SC+ had fewer child welfare reports related to DV than SAU. Parent self-reports of parenting behaviors, risk factors, and protective factors did not demonstrate significant sustained program impact. Limitations include power constraints related to sample size. Promising next steps entail future trials with larger sample sizes examining service compliance and further augmentation of SafeCare to bolster service impact and address risk and protective factors.     

Parent and Child Therapy (PACT) In Action: An Attachment‐Based Intervention for a Six‐Year‐Old With a Dual Diagnosis

This case study explores Parent and Child Therapy (PACT), an attachment‐based intervention for mothers and children experiencing intractable relationship distress originally developed by Heather Chambers (a Child Psychotherapist and Family Therapist working in New Zealand). We describe the use of PACT with a mother—child dyad presenting a history of severe abuse and neglect. The child had been diagnosed with Conduct Disorder and co‐morbid Attention Deficit Hyperactivity Disorder. We consider the themes arising in the therapy, the emotional process experienced by the mother and child, the initial outcome and 10‐month follow up. The case study indicates that PACT can be learned and used by practitioners outside of the team that conceptualised and developed it. The case highlights the links between externalising difficulties and attachment disorganisation and points to PACT as a promising treatment for the chronic sequelae of early interpersonal childhood trauma. The need for research and possible directions of this research are discussed.