Violent children and structural violence: Re-signaling ‘RAD Kids’ to inform the social work professions

This article critically examines representations of children diagnosed with Reactive Attachment Disorder, or “RAD Kids”, and their construction as dangerous subjects. Based on ethnographic research within attachment therapy clinics, and among adoptive families, social workers, and medical professionals in the U.S. and Russia, the author suggests that notions of danger associated with “RAD Kids” actually reflect a social anxiety about the contexts of structural violence in which we are attempting to build families and raise children at the turn of the 21st century. The author culturally and historically contextualizes the signaling of “RAD Kids” as violent within literature on moral panics over children and youth. She explores how these representations function as an attempt to “resignal” public anxieties about the difficulties associated with building families through adoption, and especially, the adoption of formerly institutionalized children. The article provides a model for thinking about complex relationships between children, pathology, and power to inform the social work professions, and particularly practice with children diagnosed with RAD.     

Relational Troubles and Semiofficial Suspicion: Educators and the Medicalization of “Unruly” Children

Using an interview‐based analysis of the accounts of interactions between educators, parents, and clinicians, this study explores educators' roles in interpreting childhood troubles as the medical phenomenon of attention deficit‐hyperactivity disorder (ADHD). The analysis of interviews shows how children's “personal” troubles become understood as “relational” ones, prompting increasingly sophisticated social responses. I argue that the institution of education, operating in a clinical capacity but lacking the legitimate authority to assign ADHD diagnoses, plays a hybridized, semiofficial role in the medicalization process. This assertion informs a critique of the “informal/official” dichotomy found in the sociology of deviance lexicon, and furthers previous positions in the sociology of mental health that have implicated school representatives in the social construction of behavior disorders.     

Fathers' encounters with the Child Welfare Service

In this article, we examined fathers who were or had been in contact with the Child Welfare Services in Norway. All of the fathers included in this study had children with women who were unable to take care of them, either because of substance abuse or mental health problems. Hence, the fathers had the primary responsibility for the children. We looked at how these fathers experienced being met and assessed as caregivers by the Child Welfare Service, as well as how they experienced their own competency as caregivers. To explore these themes, seven fathers who were in contact with or had recently been in contact with the Child Welfare Service were interviewed. The discourses on fatherhood, inspired by Scourfield (2003), were used as a framework for the analysis, and interpretive phenomenological analysis (IPA) was used to analyse the interviews. We found the fathers' experiences to be considered within the discourses on “fathers as a threat”, “fathers as irrelevant” and “fathers as better than mothers”. In addition, we shed light on topics such as the cultural lag, being single-handedly responsible for the children, and the fathers' views on what is important in their contact with the children.Our goal was to increase awareness about fathers who are in contact with the Child Welfare Service so that they are met in a way that helps to support them in their role as fathers for the benefit of their children.     

A learning collaborative approach to training school-based health providers in evidence-based mental health treatment

Collaborative care models among pediatric primary care and child and adolescent mental health providers are increasingly emphasized to improve quality of and access to mental health services. The current case example of a multi-site clinical training opportunity in school-based collaborative care settings illustrates the success of a learning collaborative approach to improve children's mental health care in schools. Quality improvement data from participating sites indicated an increase in use of evidence-based practices (i.e., “core skills”) and an improvement in quality service delivery indicators for children's mental health (i.e., screening, risk assessment, diagnostic processes, associated diagnostic coding, use of core skills, associated procedural coding, and follow-up assessment and referral) over time. Clinician self-report and chart review data are supplemented by qualitative data from site leader interviews conducted following completion of the project. Implications for mental health workforce development to improve the quality of care to children and adolescents in schools and other community mental health settings are discussed.     

The Social Process Behind Inequalities in Children's Mental Health: Incorporating an Illness Career Framework

More advantaged children (both in terms of social class and racial/ethnic membership) appear protected from symptoms of mental health problem, but a pattern has emerged in which these children who tend to have better mental health are more likely to be diagnosed with certain mental health disorders. These patterns have led some researchers and professionals to wonder if the qualifications for diagnosis are culturally biased or might unfairly favor the mental health needs of more advantaged individuals in society. Evidence that White and middle‐class children are more likely to be diagnosed with certain mental health disorders raises important and legitimate concerns about the mental health profession, but this problem of social advantage leading to mental health diagnosis has often overlooked the role of social process in how children become diagnosed. Mental health diagnoses represent the culmination of a process that involves several stages and requires initiation and (often times) persistence on the part of the individual being diagnosed. This idea of process has previously been referred to as the “illness career,” and applying this logic to the study of children opens the door for renewed inquiry into understanding who is and who is not diagnosed with a mental health problem.     

Listening to Older Adult Parents of Adult Children With Mental Illness

This article uses qualitative research and narrative analysis to examine the experience of women age 55 and older who are parents caring for adult children with mental illness. Knowledge about the conflicts of older parents with dependent children is underdeveloped. In this study, analysis of women's stories about parenting in later life reveal that the women have two sets of feelings: wanting to be free from the responsibility of caregiving and feeling responsible to continue the support and protection of their adult vulnerable children. The women's conflicts are palpable and are found in the ideational themes of the narratives, as well as the structure of how the narratives are spoken. The discussion highlights the relevance of the theory of ambivalence for clinical practice when working with older women who are caregivers for their adult dependent children.     

Children residing with no parent present

Although foster care and Temporary Assistance for Needy Families “child-only” caseloads have fallen from heights in the 1990s, detailed household relationship data from panels of the Survey of Income and Program Participation (SIPP) establish that the share of children residing with no parent present (NoPP) has been rising for decades. Characteristics of NoPP children and the composition and poverty rates of their households are traced over time. Most NoPP spells are found to last 2 years or more. Special attention is paid to “informal care” children, the majority of NoPP children not in contact with foster care or income support programs designed to assist children with no parent present and provide access to health care. By several measures of well-being, informal care children occupy a margin between all children and other NoPP children. Children residing with only one parent are at higher risk of entering NoPP status than those with both parents present.     

Small-dollar accounts,children's college outcomes,and wilt

This is paper four of four in the Small-Dollar Children's Savings Account series, which studies the relationship between children's small-dollar savings accounts and college enrollment and graduation. This series of papers examines three important research questions using different subsamples: (a) Are children with savings of their own more likely to attend or graduate from college? (b) Does dosage (i.e., having no account, only basic savings, savings designated for school [of less than $1, $1 to $499, or $500 or more]) matte? And (c) is having savings designated for school more predictive than having basic savings alone? In this study we use a sample of children who expect to graduate college prior to leaving high school as a way of looking at wilt. In this study “wilt” occurs when a child who expects to graduate from college while in high school does not graduate college by 2009. Using propensity score weighted data from the Panel Study of Income Dynamics (PSID) and its supplements we created multi-treatment dosages of savings accounts and amounts to answer the previous questions. We find that in the aggregate children who expect to graduate college prior to leaving high school (high-expectation children) and who designate savings for school of $500 or more are about two times more likely to graduate college than high-expectation children with no account. High-expectation low- and moderate-income (LMI) children who designate school savings of $1 to $499 and $500 or more are about three times more likely to graduate college than LMI children with no account. Further, high-expectation black children who have school savings of $500 or more are about two and half times more likely to graduate from college than their counterparts with no savings account.     

Emerging adult identity following adolescent experiences with psychotropic medications: A retrospective study

This study examines the perceptions of mental illness identity among a group of emerging adults based on their retrospective experiences with diagnoses and psychotropic medication use during their earlier formative adolescent years. A short questionnaire was administered via online social media platforms to volunteers between the ages of 19 and 30 and who self-identified as having taken psychotropic medication between the ages of 12 and 18 (N = 46). Correlation analysis revealed that several variables were associated with a stronger illness identity, including participant’s happiness with their medication experiences, the belief that medication made them more like their “true” selves, and the belief that their diagnosis was accurate. Content analysis of participant narratives suggested themes related to discontinuation and barriers to adherence. These results contribute to the growing knowledge base around lived experiences of psychiatric medication use and suggest further study on how to advance more informed and compassionate mental health care.     

Mental Health Consumer and Carer Participation in Professional Education: ‘Getting There Together’ for Children of Parents with Mental Illness and Their Families

Abstract

‘Getting There Together’ is a professional education seminar developed as a collaborative project by professionals, mental health consumers and carers aimed at service providers who work with children of parents with mental illness and their families. The need for such professional education concerning this group is well recognised and the project reported herein was initiated by a reference group of professionals, consumers and carers focusing on children of parents with mental illness in the Eastern region of Melbourne (Victoria, Australia). The project began and continued as a collaborative effort during development and implementation, which ensured the experience, point of view and voice of consumers and carers was central to the material prepared, and at the time of seminar presentations. Seminar participants were from the family welfare, child care and supported housing sectors. Seminar participants found the first person accounts of consumers and carers the most helpful aspects of the seminars because they gave new insights into the experiences of carers and of mental health consumers as parents, as well as an understanding of ‘… the whole family, and how the child fits into the picture’.     

A Qualitative Study of “fa’a’amu” Kinship Care Experiences in Tahiti

“Fa'a'amu” is a type of adoption commonly found in French Polynesia involving open, informal adoption arrangements, in which the child maintains ties to the family of origin. Although the function that child circulation plays in Oceanic societies has been widely documented by anthropologists, the implications of fa'a'amu at the individual level have yet to be examined. To address this gap, an exploratory qualitative study was conducted to 1) examine the lived experiences of adults who were fa'a'amu as children, and 2) identify experiences and characteristics associated with positive psychosocial and mental health outcomes in adulthood. The sample consisted of 22 Tahitian adults, who had been fa'a'amu during childhood. Applying a developmental and attachment lens, we explored how participants experienced relationships with birth and adoptive families, and how being fa'a'amu impacted their sense of well-being, attachment, identity, and belonging. Data was collected through The Adult Attachment Interview and the Fa'a'amu Experience Interview, which were coded using thematic analysis. Factors associated with positive outcomes in adulthood included early age at adoption, sensitive fa'a'amu parents, positive or benign relationships with birth parents, and respect between fa'a'amu and birth families. Factors associated with emotional distress included late age at adoption, abandonment and rejection, exploitative fa'a'amu parents, and conflict between birth and fa'a'amu families.     

A Comparative Analysis of Adoptive Family Functioning with Gay,Lesbian, and Heterosexual Parents and Their Children

Abstract

The objectives of this comparative study were to examine adoptive family functioning with a sample of gay, lesbian, and heterosexual adoptive parents and their children. The results suggested that parent sexual orientation is not a significant predictor of adoptive family functioning, adopted child's behavior, and parent's perceptions of helpfulness from family support networks. Furthermore, a regression analysis suggested the following variables were associated with higher levels of family functioning: adoptive parents who were previously foster parents and children who had more previous placements prior to adoption. Lower family functioning was associated with children adopted through CPS; with children who had mental health diagnoses, learning disorders, or other handicapping conditions; and with children who were in a higher grade in school. The results of this comparative study of adoptive families support the need for more methodologically rigorous research that includes gay and lesbian adoptive parents along with heterosexual parents.     

Construction d'un problème public autour du dopage et reconnaissance d'une spécialité médicale

The formation of a professional specialty — sports medicine — is described with emphasis on how drug abuse has become a public issue. This notion's itinerary is traced between 1955 and 1999 so as to show how doctors with different profiles and activities successively raised the issue of “doping”. The objectives of medicine, as it was being applied to sports, gradually changed. At the start, the intention was to cure, a view that celebrated the virtues of practicing a sport and it condemned using drugs. A new field of medical competence was opened with the “biological preparation of performances”, which, though presented as an alternative to using drugs, blurred the boundaries with doping. Medical positions became polarized: on the one side, a science of training took shape around the physiology of physical efforts, which made it possible to intensify activities while optimizing them thanks to rest periods; and on the other side, clinicians who, in closer contact with the everyday life of players, both understood the requirements ensuing from a continuous renewal of performances and tended to favor taking “products” for “curative” purposes. Sports medicine was legitimated as a medical specialty on two grounds: the one, obvious, sets doping at odds with health; and the other, aberrant from the viewpoint of health but nonetheless accepted, associates intensive sports with health.     

Innocence, Perversion, and Heather's Two Mommies

This paper begins by untangling the twisted threads linking homosexuality and childhood in the mind of America, and explaining how contemporary constructions of homosexuality have become entwined with modern conceptions of childhood. The author draws on the literature on the invention of childhood and especially the pioneering work of Jonathan Silin to show how the entrenchment of capitalism and arrival of compulsory schooling have created a hegemonic form of family and produced a child at once innocent and ignorant. The author then probes the construction of the homosexual in the late 19th century and uncovers interconnections between this new social typology and representations of childhood. By examining how these linkages are historically embodied in incidents of sex panic, the author argues that the psyches of lesbians and gay men who are in relationship with children (as parents, teachers, coaches . . .) are often suffused with anxiety and self-doubt. Hence a gay movement emerges rife with hyper-traditional representations of children and youth. Contemporary queer representations of childhood are then explored through a focus on children's books designed for the offspring of lesbian and gay parents. The author suggests that contemporary gay advocacy, which attempts to dislodge perversion as the central representation of homosexuality, will be unsuccessful until activists abandon tactics that infantilize children and perpetuate a vision of childhood as vulnerable, innocent, and unknowing.     

‘No one believed us: no one came to help’: caregivers' experiences of violence and abuse involving children with fetal alcohol spectrum disorder

Child and adolescent-to-parent violence and abuse (CAPVA) refers to abusive and violent behaviours by children towards their parents or primary caregivers. The abuse and harmful behaviours can include a full range of physical, emotional, verbal, financial, and material actions over prolonged periods of time, from childhood to young adulthood. Parents and caregivers of children with neuro-developmental conditions are vulnerable to CAPVA, and little research has been undertaken exploring the experiences of caregivers of children with fetal alcohol spectrum disorder (FASD). In Aotearoa New Zealand, 56 caregivers were interviewed using semi-structured interviews, and over half identified significant levels and impacts of CAPVA, including dealing with physical violence and frequent emotional abuse. Health and stress issues were present in all caregivers interviewed. Caregivers also identified how systemic ignorance and a lack of understanding from caring professionals led to parent blaming, a sense of shame and isolation. Yet, caregivers also showed resilience and implemented strategies of de-escalation and distraction. More specialised practice is needed in this emerging field of family violence and in how to support families with children who have FASD.     

Homelessness,housing instability,intimate partner violence,mental health,and functioning: A multi-year cohort study of IPV survivors and their children

Abstract

Homelessness and housing instability frequently accompany intimate partner violence and can negatively impact health and functioning. When children are exposed to homelessness or housing instability their ability to develop and function is compromised. The purpose of this study is to examine the differential impact of homelessness and unstable housing on health and functioning of women and their children over a 2-year period. Two hundred and seventy-seven mothers reporting intimate partner violence (stalking, physical, or sexual violence by an intimate partner) were asked about housing stability, abuse, risk for murder, mental health, employment/wages, and their child's functioning over a 2-year period. Outcomes of mothers reporting homelessness and unstable housing were compared to mothers reporting stable housing. Over one-third (36%) of the mothers reported at least one episode of unstable housing over the 2-year period and 11% reported homelessness. Measures of maternal mental health and child functioning were worse for both unstably housed and homeless women, compared to stably housed women, with a higher risk for sexual abuse and risk for murder for homeless women. New models of rapid rehousing are needed that address not only the housing problems of women who have experienced intimate partner violence but also the mental health and safety issues that the women and their children face.     

Between badness and sickness: Reconsidering medicalization for high risk children and youth

Most of the sociological literature about “troubling” children and youth focuses on how the scientific authority of medical experts, with a discourse of sickness, has come to displace the moral authority of justice enforcement officials and their rhetoric of badness as arbiters of childhood pathology. Yet my experience working with high-risk children and youth during a post-MSW fellowship strongly suggests that discourses of badness have not supplanted discourses of sickness. Indeed, these discourses remain deeply intertwined with implications for the way we conceptualize troubling children and youth, for the treatment we prescribe, and for how children and youth understand themselves. Discussing two composite cases to illustrate how negotiations of badness and sickness unfold, I argue that shifts in attributions of badness and sickness follow predictable patterns generally occurring in response to: (1) changes in the context (whether the child is at home, school, or in a treatment setting); (2) changes in an actor's interests or role (parents may attribute troubling behaviors as badness at home but frame them as sickness with people outside the family); and/or (3) changes in external structures of time (e.g. the end of the school year or the end of a Medicaid authorization). In conclusion, I consider the implications of partial medicalization and these patterns of narrative negotiations for future research and practice.     

No one is listening: Members of the Deaf community share their depression narratives

This exploratory case study conducted in Manitoba, Canada examined a unique social justice issue in the field of mental health, namely, how Deaf adults, all American Sign Language first-language users who were diagnosed with Depression, manage their symptoms in a mental health system that is based on spoken, not signed communication. Using in-depth individual interviews, and a hand-drawn Person and Environment Map, this study offers rich in-depth narratives of the experiences and challenges faced by members of the Deaf community seeking mental health assessment and intervention.     

RISING AUTISM PREVALENCE: REAL OR DISPLACING OTHER MENTAL DISORDERS? EVIDENCE FROM DEMAND FOR AUXILIARY HEALTHCARE WORKERS IN CALIFORNIA

Autism is a development disorder that has increased in prevalence from 0.5 to 14.7 per 1,000 children over 1970–2010. Using annual wages and provider counts from the American Community Survey and information from 21 regional development centers in California, we estimate the labor demand for auxiliary health providers. We focus on this subset of providers because, unlike physicians and psychologists who can diagnose autism, these workers cannot induce their own demand. If the incidence of autism is increasing independently of other mental disorders, then the demand for auxiliary health providers should increase, leading to higher wages and labor supply. Otherwise, the increase in autism diagnosis is merely displacing other mental disorders. We find that a 100% increase in autism cases increases the wages of auxiliary health workers over non‐autism health occupations by 8–11% and the number of providers by 9–14%. Furthermore, we find that one of every three new autism diagnoses is merely supplanting mental retardation diagnoses, but does not displace other mental disorders. These estimates suggest that at least part of the increase in autism diagnoses, about 50–65%, reflects an increase in the true prevalence of the disorder. (JEL L11, J2, J3)