Toward a standard of care for child ADHD: implications for marriage and family therapists

In this article, we briefly review the etiology of Attention Deficit Hyperactivity Disorder (ADHD) and describe the most current scientifically supported theory about the nature of this disorder. Based on the research literature, several organizations have established standards of care for its diagnosis and treatment, which involves a multimodal strategy for treatment at the biological, individual, family, school, and community levels. Assessment and treatment guidelines are provided for Marriage and Family Therapists (MFTs), and specific areas of competency are proposed for MFTs who are working with children who have ADHD.     

Caseworkers' perspective on risk factors in the family environment influencing mothers' difficulties in meeting children's needs

ObjectivesThis study examines, from the caseworkers' point of view, which needs of children are the most difficult for parents in neglectful contexts to respond to and which risk factors make this response more difficult.MethodA sample of 55 parents being followed by child protection services for neglect or high risk of neglect accepted to participate in the study. Their caseworker filled out a grid regarding the response provided to the children's needs and the risk factors in the family environment.ResultsThe results indicate that the children's age is related to the difficulties of responding to their needs. The caseworkers are particularly concerned about guidance and boundaries provided to preschool-age children, but less so about that provided to school-age children. When the children's age is controlled for, parents' mental health problems explains a significant proportion of the variance in parents' response to their children's need for stimulation, emotional warmth, and guidance and boundaries. Caseworkers' worries about drug and alcohol misuse also explain a significant proportion of their concerns about the mothers' ability to ensure their child's safety.ConclusionCaseworkers are more worried about the parental response offered to preschool children than to school-age ones. However, a constant and coherent response to growing children is still important for their developmental trajectories. Moreover, mental health and substance abuse explain caseworkers' concerns about mothers' engagement toward their child. These data raise questions about which type of services to offer, because intervening in families where parents deal with personal issues while addressing child neglect is complex.     

Constructing Monothetic and Polythetic Typologies By the Heuristic Method*

Past students of heuristic types such as the ideal or constructed types have often proposed that empirical cases be studied by comparison with the heuristic type. However, they have provided no specific guidelines for such comparison, and critics have deemed the operation unfruitful. Such guidelines are provided here, based on the monothetic-polythetic distinction. Each empirical case is initially assigned to a monothetic type, then later a decision can be made about whether to collapse to polytheticism. Both general and specific guidelines for delimiting types are provided. A distinction is made between theoretical and mechanical methods of type construction, and examples are provided. Methods of choosing variables for a typology are also discussed.     

A Rock and a Hard Place:

This paper discusses the importance of fieldwork in preparing students for practice with clients from diverse cultural backgrounds and the difficulties encountered in rural, culturally homogenous settings. A survey of undergraduate fieldwork coordinators provided information about how minority content is integrated into field seminars and the fieldwork experience. The findings indicated that a variety of methods are used in the seminar and field experience. A discussion of the limitations of these methods and recommendations for alternative approaches are provided.     

From the streets to assisted living: perceptions of a vulnerable population

The rapid growth of assisted-living facilities is paralleled by the necessity to understand the needs of the people living in them. A hallmark challenge for individuals who are poor and disabled, and often marginalized from mainstream society, is maintaining integrity and being a whole person, rather than a sum of broken parts. A key to maintaining this integrity is the ability to find stable housing and support systems. The inner-city assisted-living facility in this study is unique in that all of its residents are funded by Medicaid. The residents have complex needs related to histories of homelessness, mental illness, drug and/or alcohol addiction, and chronic illness. The purpose of this study was to explore the needs of this vulnerable population as they adapt to a new home and a new concept of assisted, yet independent, living. Structured interviews with key informants and oral survey questionnaires with residents provided quantitative and qualitative data about physical and mental health status, social support, perception of control, psychological wellbeing, and life satisfaction. This study provided valuable insights into the challenges inherent in providing a high quality of life in assisted living for a vulnerable population with diverse needs.     

Walk-in clinic counselling for emotional regulation with low-needs youth on the autism spectrum

A single-session consultation model for low-needs youth on the autism spectrum is presented with the mental health concern of emotional self-regulation, a common issue in family psychotherapy. This research is contextualised within the growing field of short-term therapy as it intersects the growing demand to therapeutically address clients on the autism spectrum. The treatment intervention is delineated through five sequential phases within the walk-in clinic setting for the practitioner clinician. A rationale, overview, and instruction for the practitioner clinician utilising this novel model is provided through a case study format. By using a more structured and integrated approach to treatment, organised through an externalised metaphor, it is suggested that the current model will be more effective for this specific clinical population. Additionally, a case illustration is provided that scaffolds the treatment model, which includes table formats and pictures. The case study illustrates the self-regulation map metaphor visually and interactively linking client challenges, strategies, and motivations simultaneously on multiple electronic devices in session. Relevant works were selected to explore the effectiveness of single-session consultation models for those presenting on the autism spectrum. Treatment interventions for specific clinical populations are recommended, especially within walk-in clinic therapy. This clinical research introduces a paradigm shift towards therapeutically addressing emotional self-regulation with low-needs youth on the spectrum through virtual, interactive technology.     

Mental health needs assessment of children and adolescents

Needs assessment is essential input for program planning. Little data are, however, available about the various approaches and whether strategies for needs assessment are viable. It was found by an inexpensive methodology that opinions about the importance of various services, opinions about the potential acceptance of services, services provided, and the total need for services are interrelated. A hybrid approach that utilized data from teachers and the people that provide mental health services was also a practical means to obtain information about the unmet needs of children and adolescents in the country. Data supported the value of this technique for the assessment of the unmet needs of children and adolescents. Thus, an inexpensive methodology can provide useful information from multiple perspectives.     

An education intervention for families of people with schizophrenia in China: development and evaluation

In China, nurses and physicians are the main care providers for people with schizophrenia. This care is provided primarily in institutions because community services are in their infancy, and families carry the burden of care. In the absence of published nursing research in the area, this article reports the rigorous development and evaluation of a culturally sensitive patient/family intervention, which was implemented in a large psychiatric hospital in Beijing, China. A random sample of 15 nurses responded to an open-ended questionnaire to explore what they believed people with schizophrenia and their family members should learn. A convenience sample of 51 family members who lived with a person with schizophrenia were also interviewed to explore what they understood and needed to know about schizophrenia. Common learning needs were integrated with the literature and presented as the Comprehensive Patient/Family Education Guide, which was implemented with an experimental group of 42 family members, while a control group of 45 received the usual hospital treatment. The effect of the intervention was evaluated by interviewing a random sample of 19 of the family members. The results revealed some useful information for the future planning and implementation of such programs, and although focused on a Chinese sample, do offer insights for nurses around the world.     

Longitudinal measurement models in evaluation research: Examining stability and change

This article provides an introduction to the use of Confirmatory Factor Analysis to test measurement invariance and stability in longitudinal research. The approach is illustrated through examples representing: (a) one construct, two measurement waves; (b) one construct, three waves; (c) two constructs, two waves; and (d) comparison of treatment and control groups in pre-post designs. Basic issues in establishing measurement invariance over time, across treatment groups, and within measurement waves are discussed. Estimates of the stability coefficients that are corrected for measurement error and method variance associated with each specific measured variable are provided. Establishing measurement invariance is a critical requirement for making inferences about treatment effects and changes in constructs over time.     

Strain Trauma: Effects on Symptom and Character Development in an Eight Year Old Girl

The concept of traumatic strain is reviewed and illustrated with case material from the treatment of an 8-year-old girl. Clinical formulation about the impact of strain trauma upon this girl’s development is provided to further highlight the literature on the subject.Danille Drake is affiliated with Baltimore-Washington center for Psychoanalysis and Clinical Social Work Institute, Washington, DC.     

A New Approach to Evaluating the Quality of Measurement Instruments: The Split‐Ballot MTMM Design

Two distinctly different quantitative approaches are used to evaluate measurement instruments: the split‐ballot experiment and the multitrait‐multimethod (MTMM) approach. The first approach is typically used to indicate whether variation in the method causes differences in the response distribution; the second approach evaluates the reliability and validity of different methods. The new approach, suggested in this paper, combines the more attractive features of both methods. The strength of the split‐ballot experiment is its use of independent random samples from the same population to provide information about differences in response distributions. This is also possible with the new approach, but this approach provides more detailed information about the reasons for the differences. The MTMM approach provides information about reliability and validity on the basis of repeated observation of the same traits using different methods. This information is also provided by the new design. The difference is that the new approach reduces the need for repeated observations of the same trait. Each sample is provided with a different combination of only two methods and the complete model with all methods is estimated as a multiple‐group model. This reduces the burden for respondents and also reduces memory and order effects. Alternative designs and estimation methods are discussed, their efficiency is analyzed, and illustrations are provided .     

Treatment Engagement Using Motivational Interviewing for Low-Income, Ethnically Diverse Mothers with Postpartum Depression

Postpartum depression (PPD) places women, and their children, at risk for many untoward outcomes including lack of responsivity, low self-efficacy, and insecure infant attachment. Especially at risk for untreated PPD are low-income, ethnically diverse mothers. Seeking and accepting treatment for depression may be impeded by the many psychological and social barriers that mothers may bring with them. Obstacles might include a lack of resources (e.g., lack of transportation or child care), stigma, distrust, and a lack of knowledge about stress and depression. To reduce these and other barriers to treatment, this paper points to the value of utilizing motivational interviewing techniques to engage and retain low-income, ethnically diverse women for treatment of PPD. Following a review of PPD and related barriers to treatment, a case study is presented with example dialogue. The suggestions for practice represent starting points for effective engagement of women in any number of treatments provided by social and health services settings. With federal mandates to screen for depression in many settings and to provide treatment, using motivational interviewing may be an effective prelude to treatment adherence.     

Integrative Symptom-Focused Dynamic Psychotherapy

The advent of the relational perspective in psychoanalytic theory has opened up exciting new prospects for integrative psychotherapy. My own integrative model draws on self psychology and attachment theory for ideas about development and treatment, but also posits the need for active techniques at times to help with troubling symptoms. In addition to using interventions from behavioral and cognitive behavioral traditions, my treatment approach has been evolving to include a variety of mindfulness based strategies. In this article I focus on interventions I use most often to help patients with two major domains: self regulation (which includes affect management and perspective on the self), and self-initiated behavior change. Case examples illustrating the interplay of symptom-focused work and more dynamic exploration are provided.     

A Continuum of Male Controls and Violence against Women: A Teaching Model

Abstract

The prevalence and severity of violence against women is a critical issue for social work educators to address. This article describes a teaching model that educators can use to educate social work students and professionals about the widely existing, severe, subtle and overt forms of male controls and violence against women. Forms of male controls and violence against women discussed include: sexist language, gender-biased research, differential treatment, street hassling, sexist media, pornography, sexual harassment, battering, sexual assault, and femicide. Results presented are from an evaluation of a three hour workshop for professionals and from a qualitative analysis of student comments after a weekend class which used this model. Evaluation of this model suggests that participants found the content to be useful and relevant to their social work practice and education. Resource lists are provided to give educators a starting point for learning more about male controls and violence against women.     

Sexual Abuse Images in Cyberspace: Expanding the Ecology of the Child

Cyberspace has added a new dimension to the ecology of children made the subjects of sexual abuse images distributed online. These images cannot be permanently removed and can continue to circulate in cyberspace forever. A review of the current literature suggests that helping professionals are not consistently aware of or do not probe possibilities of online sexual victimization in the investigation, assessment, and treatment of child sexual abuse. Nor is this issue adequately addressed in their education and training. There are gaps in the literature regarding how to identify and provide treatment for these children. New assessment and treatment targets are needed to enhance existing practice approaches. A contemporary ecological model that incorporates an explicit consideration of the cybersystem is provided as a starting point for practitioners to be aware of the possibility that images of child sexual abuse were recorded and distributed online.     

Integration and alternatives: Some current issues in psychoanalytic theory

The first great bridge between psychoanalysis and social work came with the concepts of ego psychology which provided a synthesis between the worlds of the social order and the psychological depths. Current psychoanalytic theorists now question whether any one psychological theory is sufficient to describe the complexity of human experience, and suggest that each theory has a piece of the truth because it states something that is correct about the patient at a particular time in the treatment. Adherence to multiple theories makes a complex problem for the clinical practitioner, who must decide from which perspective to respond to the clinical material of the moment. Psychoanalytic theorists are also questioning the degree to which it is actually the content of the therapist's interpretations which brings about change in the patient. This article suggests that these developments in psychoanalysis, with their emphasis on therapeutic flexibility and the importance of the relationship will renew and reinvigorate the bridge between psychoanalysis and clinical social work.An earlier version of this paper was presented at the First Clinical Conference of the National Federation of Societies for Clinical Social work.     

Alcohol education provided to opioid treatment program patients: results of a nationwide survey

Alcohol-related problems are especially common among opioid treatment program (OTP) patients, suggesting that educating OTP patients about alcohol and its harmful effects needs to be a priority in OTPs. Using data collected in interviews with a nationwide U.S. sample of OTP directors (N = 200) in 25 states, we identified factors that differentiate OTPs that provided this education to all OTP patients from those that did not. Findings indicate that these factors include (1) providing this education in a greater variety of ways, (2) having a larger percent of staff knowledgeable about alcohol-related issues, (3) having a director who views alcohol issues as a high priority, and (4) having a written OTP policy.