THE EFFECTIVENESS OF FAMILY THERAPIES FOR SELECTED BEHAVIORAL DISORDERS OF CHILDHOOD

This article reviews the scientific evidence for the effectiveness of family-based aproaches in the treatment of selected childhood behavioral disorders. Although limitations certainly exist, family interventions have consitently improved child and, in some cases, parent functioning in families with children presenting with conduct disorder (CD) and autism. Parents and other family members also directly benefit from child-focused interventions, gaining in knowledge, child management skills, and attitudinal improvements. Longh-term follow-ups indicate that CD and autistic children achieved lasting gains. Similarly, the research on attention-deficit/hyperactivity disorder (ADHD) indicates that parent training improves child noncompliance and aggression yet does not consistently affect core symptoms of ADHD. There is no evidence that adding short-term family interventions improves ADHD child functioning beyond improvements from the use of psychostimulant medications. Some tentative support for family involvement in the treatment of childhood anxieties and fears is reviewed, but clear conclusions await future investigations. Finally, several methodological limitations and needed areas of research are discussed.     

Confronting Myths and Stereotypes About Borderline Personality Disorder

SUMMARY

The clinician treating a patient with borderline personality disorder (BPD) is often faced with complicated challenges, from making and communicating an accurate diagnosis, to implementing an appropriate, informed plan for treatment. Myths and stereotypes about BPD, and the individuals who may carry the diagnosis, likely complicate effective recognition and treatment of the disorder. BPD has been a controversial diagnosis among clinicians since its inception, and it is poorly understood among the general public. Pressures to avoid an explicit exploration of the diagnosis stemming from myths and stereotypes about the disorder can come from a number of sources, including other clinicians, family members and patients themselves. The results of minimizing or ignoring the contribution of borderline pathology may be detrimental. Clinical decisions based on outmoded thinking about diagnosis, prognosis, treatment efficacy, and availability of resources may deny patients optimal care. Integrating current findings into consideration of a BPD diagnosis and design of appropriate treatment, free of misconceptions about the condition, may help limit the untoward effects associated with failure to appreciate elements of borderline personality.     

Psychosocial interventions used to treat children with ADHD: safety and efficacy

Although stimulant therapy is the most common treatment for attention-deficit/hyperactivity disorder (ADHD) in children, it is not always effective in reducing behavioral symptoms. As a result, research on psychosocial interventions has progressed in recent years. This article provides a synopsis of psychosocial interventions for childhood ADHD, with an emphasis on basic behavior management principles, evidence-based interventions, and safety issues. Developmental issues that distinguish psychosocial interventions for children and adolescents are highlighted, and practical recommendations for collaborating with mental health professionals are provided.     

Long‐term use of methylphenidate continues to confer benefits

Patients continue to receive benefits from treatment for attention‐deficit/hyperactivity disorder (ADHD) with methylphenidate after long‐term use, researchers have found. Some patients may be withdrawn from the medication, however. Therefore, all patients should be assessed periodically to determine whether they continue to need the medication. The study, published in the American Journal of Psychiatry, was conducted because, while long‐term use of methylphenidate for children with ADHD is frequent clinical practice, its benefits are unclear. They looked at whether the medication remains beneficial after 2 years. Methylphenidate, a stimulant, has been controversial in some quarters because it is a controlled substance, However, the first‐line treatment for ADHD is psychostimulant medication, such as methylphenidate. How long children should take is is a question, but 60% of children receive stimulant treatment for ADHD for more than 2 years, and this is increasingly common, extending even into adolescence and adulthood. This is partly due to the awareness that ADHD is not a pediatric‐only condition. The study, “Continued benefits of methylphenidate in ADHD after 2 years in clinical practice: A randomized placebo‐controlled discontinuation study,” was published online May 21 by the American Journal of Psychiatry.     

Long-term safety of stimulant medications used to treat children with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a common mental health condition that affects children, adolescents, and adults. Because it is a chronic condition and typically requires effective treatment for several years or more, information on the benefits and risks of long-term pharmacotherapy for ADHD is vital to clinicians. This article reviews the emerging literature on the safety of long-term stimulant medications in ADHD-the most commonly prescribed medications for this condition. Common side effects, including cardiovascular effects, growth effects, and tics, are discussed, as well as treatment of children younger than age 6 and evidence of carcinogenic and reproductive effects.     

Attention Deficit Hyperactivity Disorder (ADHD) and Diverse Populations

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed behavioral disorder of childhood. Given the high prevalence of ADHD and its significant impact on children and families, it is important for social workers to understand and know how to respond. This paper looks at Attention Deficit Hyperactivity Disorder, explores its causes, and gives special attention to its effect on diverse populations. In addition, it discusses empirically supported treatment interventions used for children with ADHD, particularly the role of parent training in the management of ADHD. Finally, it discusses the applicability of using parent-training programs with diverse populations.     

Attention deficit disorder: Problems with preconceived diagnosis

The diagnosis of attention-deficit/hyperactivity disorder (ADHD) has become a household term with many inaccurate conceptions and expectations. The label is being applied to children with a broad range of mental health problems and developmental disorders. This study looks at the impact of preconceived diagnosis on assessment and treatment of children and adolescents. Alarming trends of overidentification of ADHD, which lead to inappropriate treatment and management, are identified. Other causes of the target symptoms are discussed. The impact of preconceived diagnosis on treatment outcome, patient functioning, and other areas are addressed. The need for greater community awareness of the broad spectrum of disorders of childhood and adolescence is identified.     

Borderline personality disorder: nursing interventions using dialectical behavioral therapy

Psychotherapeutic treatment of people with borderline personality disorder (BPD) is one of the greatest challenges confronting mental health professionals today. Clients with BPD are often difficult for nurses to work with, perhaps due to a lack of understanding of the underlying dynamics of the disorder. This article describes effective treatment strategies for BPD with a central focus on dialectical behavioral therapy (DBT). In typical mental health settings, nurses can effectively implement interventions using the concepts of DBT to help people with BPD build effective coping strategies and skillful behavioral responses for improved quality of life.     

DISCIPLINING DOMESTICITY: Framing the ADHD Parent and Child

This article is a qualitative analysis of the literature that has been directed at parents of children with attention deficit hyperactivity disorder (ADHD). The analysis explores the manner in which texts embodying etiological and treatment discourses surrounding ADHD and its diagnostic precursors (hyperactivity, hyperkinesis, minimal brain dysfunction, ADD, etc.) provide frameworks for an administration of discipline in domestic life. Through the examination of a cross-section of six popular ADHD parenting guides and supplemental textual data sources, this study analyzes how such texts gain credibility with their audience, "frame" the experience of ADHD, and prescribe methods in which the domestic sphere may regulate ADHD-related behaviors. The textual data for the present study should be understood as "ideological representations"(Smith 1990), the analysis of which resonates with much of the disciplinary critique in contemporary social theory, especially the work of Michel Foucault (1977).     

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.     

Briefly Noted

Researchers have found that attention‐deficit hyperactivity disorder (ADHD) may be a risk factor for developing smartphone addiction, based on the neurobiological substrates underlying each separately and those that are shared. The study found a greater than six times likelihood that children with ADHD also had smartphone addiction. The study looked at the prevalence of smartphone addiction and its association with depression, anxiety, and ADHD symptoms in a total of 4,512 South Korean middle and high school students, who completed surveys. There were 338 subjects (7.5%) in the smartphone addiction group. The odds ratio of the ADHD group compared to the non‐ADHD group for smartphone addiction was 6.43, the highest among all variables. The study, “The relationship between smartphone addiction and symptoms of depression, anxiety, and attention‐deficit/hyperactivity in South Korean adolescents” is published in the March issue of the Annals of General Psychiatry.     

Pediatric Bipolar Disorder: The Child Psychiatrist Perspective

This study’s objectives were to gain insight into reasons for the considerable rise in pediatric bipolar disorder (PBD) and what impact the new diagnosis of disruptive mood dysregulation disorder (DMDD) may have on child psychiatric treatment. A purposive sample of 10 child psychiatrists was interviewed for this qualitative study. Interviews were transcribed and coded for themes. Participants believe that PBD is often misdiagnosed and overdiagnosed, though their understandings of the reasons behind this vary. The majority attribute it to providers trying to help children who need services but do not fit a diagnostic category, and undertrained professionals diagnosing children. Most see DMDD as positive, though opinions on how it might impact children and treatment vary. All see family as vital in the treatment process. Participants in this exploratory study support a team approach and social workers have a key role as part of this team.     

Family Experience of Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) struggle with unbearable emotions that arise out of interpersonal difficulties. Self‐harm and suicidal behaviours serve to regulate these emotions and to gain a sense of well‐being and control in a treatment context where hospital admissions are avoided by mental health services. Clinician engagement with families may be constrained by their knowing the accepted etiology of the disorder, which includes a causal link with the family environment. Other constraining factors include the negativity of those with BPD toward their family, and their clinicians' diagnostic uncertainty or confusion. This qualitative study explored the experience of families whose close relative with BPD has a long history of self‐harm and/or suicide attempts. Family members were found to have chronic and traumatic stress. Family roles and relationships were strained, as were relationships between the family and the mental health system. The findings of this study indicate that treatment for BPD needs to adopt a systemic approach that considers individuals and their significant family relationships, as well as relationships between the family and treatment providers.     

Disordered gamblers with and without ADHD: the role of coping in elevated psychological distress

Attention-deficit/hyperactivity disorder (ADHD) is significantly more prevalent among disordered gamblers than in the general adult population. Despite this, it remains unclear whether co-occurring ADHD is associated with clinically significant differences that call for specialized assessments and treatment planning. The purpose of this article was to explore differences in psychological distress and coping strategies among individuals presenting to an outpatient gambling treatment centre with and without co-occurring adult ADHD. Participants (n = 99) were primarily female (69%) and Caucasian (86%) outpatient treatment-seeking disordered gamblers. At intake, individuals completed self-report measures of coping (Coping Inventory for Stressful Situations – Adult Form), psychological distress (Beck Depression Inventory II) and ADHD (Brown Attention-Deficit Disorder Scales – Adult Form). Results indicated that individuals with ADHD (n = 42) reported significantly more psychological distress and less adaptive coping strategies than those without co-occurring ADHD (n = 57). Mediation analyses showed that an ADHD diagnosis had an indirect effect on psychological distress via the mediator of maladaptive coping. Assessment and treatment should be tailored to address the variety of presentations of gambling disorder. Screening for ADHD at intake may be helpful in creating an individualized treatment plan for disordered gamblers.     

Relationship Between Childhood Sexual Abuse and Borderline Personality Disorder in Women Psychiatric Inpatients

The rclationshp between childhood sexual abuse (CSA) and borderline personality disorder (BPD) in 50 women psychiauic inpatients was examined. Inpatienfs were inletviewed using he Diagnostic Interview for Borderlines (Revised) (DIB-R). Women sexually abused as children (n = 30) scored significantly higher than those who were not (n = 20) on the total DIB-R and three of its four section scores. Women sexually abused as children were significantly more likely to have a definite diagnosis of BPD than women not sexually abused as children. who largely exhibited symptom patterns indicative of diagnoses other than BPD. An unexpected finding was that women sexually abused as children were more likely to have eating disorders than those who were not. Treatment for borderlines should explicilly address and validate the tremendous consequences of CSA on etiology and course of symptoms.     

How Does Borderline Personality Disorder Affect Parental Care?

This article seeks to find arguments based on research for the possibility of dealing with borderline personality disorders (BPDs). This is illustrated by the frequency with which children are removed from parents who have been given the diagnosis of BPD. The author favors the view that there are degrees of BPD. As a result, it is felt that psychological treatment can do much to reverse the symptoms of BPD, in many cases, if not all. Following the delineating of the research, the author presents strategies and procedures that seek to counteract the symptoms of BPD and when possible the eventual reinstatement of children with the parent.     

A Review of the Effectiveness and Mechanisms of Change for Three Psychological Interventions for Borderline Personality Disorder

The therapeutic uncertainty common in much of the early literature on borderline personality disorder (BPD) has given way to a growing research base with findings indicating the effectiveness of a number of psychological treatments. This article will review three major evidence-based treatments for BPD: dialectical behavior therapy, schema-focused therapy and mentalization-based treatment. While not a panacea, these treatments have provided, to differing degrees, a reasonable level of evidence indicating therapeutic effectiveness. The evidence base for each of these models is discussed as well as possible mechanisms of change. The article highlights similarities between the differing modalities as well as the features that distinguish the models. The article contends that increasing mentalization skills may be a common underlying factor in all treatments for individual with BPD. The authors conclude by discussing the difficulties and potential benefits of treatment integration.     

Borderline Personality Disorder

SUMMARY

Our knowledge about borderline personality disorder (BPD) has taken some unexpected turns: BPD is less stable, it is more genetic, and it is more treatable than we would ever have imagined even 15 years ago. These developments have profound implications for understanding and treatment of individuals with BPD.     

Parents of Children with Attention Deficit/Hyperactivity Disorder: A Meta-Synthesis,Part I

In 2011 6.4 million children in the United States ages four to 17 years had a diagnosis of Attention-deficit/hyperactivity disorder (ADHD). Quantitative studies have indicated that parenting stress for parents of children diagnosed with ADHD is high. This meta-synthesis compiled and analyzed a systematic review of the qualitative studies of parents’ lived experience of having a child with ADHD. Searches in online scholarly databases yielded an initial 1217 hits, which were narrowed down to seventy-three studies that met the criteria. A “meta-ethnography” framework was used for the synthesis. One major finding involved the emotional burden of caring for a child with ADHD. Parents struggled with a variety of intense and painful emotions as they attempted to manage family routines. Disciplining children only worked in a limited way and took constant effort throughout the day. The challenges of parenting spilled into other areas of the parents’ lives, such as their health, psychological, marital, and occupational functioning. Implications for practitioners are discussed, including the need to validate parental stress and the difficulty of applying behavioral management strategies with their children, the need for increased support of partner relationships, and the need to connect parents with support to prevent poorer outcomes for the child.     

Parent–Child Interactive Stress in Chinese Families with Children Who Have Attention-Deficit Hyperactivity Disorder

Child and Adolescent Social Work Journal - The situations of Chinese parents of children with attention deficit hyperactivity disorder (ADHD) and other related comorbidities are under-explored in...