Children's dreams: Their meaning and use in clinical practice

Children begin dreaming sometime in the first year of life. Young children have a limited ability to distinguish dreams from reality or fantasy until they approach school age. Through childhood and adolescence, children's dreams tend to reflect representations of typical developmental issues, wish fulfillment themes, and environmental stimuli.In addition to the manifest content, the latent meaning and associations of children's dreams also reflect the ego functioning of the child and are of extreme clinical value. Understanding these meanings can assist in our usual process of assessing emotional disturbances, locating the unconscious nature of the conflicts, and assessing the therapeutic relationship.     

Children with serious emotional disturbance: the impact of poverty and receipt of public assistance on behavior, functioning, and service use

The present study examines the associations between poverty status, receipt of public assistance, service use, and children's mental health. Using a sample of children with serious emotional disturbances, findings from logistic regressions indicated that although no significant associations were found between poverty status and emotional or behavioral problems, families living below the poverty threshold were more likely to receive fewer services, even after controlling for receipt of Medicaid or SSI. Significant associations were also found for child's age, race/ethnicity, caregiver education, Medicaid and TANF receipt, child and family mental-health-risk factors. Poor families were more likely to have older children, be non-white, have fewer years of education, receive public assistance, and have more family mental-health-risk factors, but less child mental-health-risk factors. While a higher percentage of nonpoor families received medication management and residential treatment services, more poor families received support services such as transportation and flexible funds. Implications for the findings are discussed.     

Comparing the health status of low-income children in and out of foster care

Children in foster care face poverty, family dysfunction, neglect, and abuse, with high rates of chronic health, emotional, and developmental problems. This study compared the overall health status of a group of children entering foster care with a group of Medicaid-eligible children living with their parents, matched for age and gender. It identified significantly more health and developmental problems in children in foster care than in the comparison group. Possible contributors to the higher percentage of problems among foster care children may be that the foster children have more problems related to the underlying risk factors resulting in placement, or that the foster care physicians conducted a more comprehensive assessment or had lower clinical thresholds. Further research is necessary to identify and treat the problems of this high-risk group.     

Therapy Outcome with Children in Foster Care: A Longitudinal Study

The present paper describes a naturalistic study of therapy with children in foster care. The goal was to attempt to begin to understand what happens to children in foster care while they are in therapy. The functioning of all children referred for therapy in a foster care agency was assessed as rated by different informants at different points in time over an 18-month period. These children present with low-level behavior problems but the level and type of problem they present with depends on the person rating the child and the child’s gender and age. Two thirds of the children improve and do so within the early stages of therapy. One third of the children do not improve. The distinguishing feature of this group appears to be the high level of aggressive behaviors reported at intake. Results suggest that improvement depends on the eye of the beholder. These findings are discussed and recommendations for therapeutic and systemic practice are made. The importance of using multiple informants when evaluating the treatment needs of children in care is pointed out as is the need to rethink therapeutic strategies with children that present with high levels of aggressive behavior at intake and show no improvement after the first 6 months of therapy.     

The Emotional and Educational Functioning of Children Living with Maternal HIV/AIDS and Substance Use

The rates of HIV infection among women in the U.S. have risen dramatically in the past decades, affecting not only women as individuals, but also women as mothers and caregivers. Waning maternal physical and psychological resources, coupled with poverty and possible familial substance use, place children of HIV-infected women at behavioral and developmental risk. This study compared the emotional and educational functioning of HIV-uninfected children, 6–15 years of age, living with an HIV-infected mother who used substances to a comparison group of children living with maternal substance use only. Results indicate that children whose mothers are HIV-infected and use substances have poorer emotional functioning when their mother experiences HIV-related symptoms compared to the comparison group. Paradoxically, results also indicated that target group children were significantly less likely to be rated as disruptive during the interview than the control group children. Implications for practice are discussed.Cynthia Devane Fair, Associate Professor is affiliated with Department of Human Services, Elon University, USA     

Long-Term Effects of Treatment for Gender Identity Disorder of Childhood

To evaluate the durability of behavioral treatment effects for gender identity disorder of childhood. 29 prepubescent boys aged 4 to 13 years at initial referral were assessed by an independent clinical psychologist before any treatment was offered and again for follow-up at a mean of 4 years and 3 months later. Initial and follow-up clinical ratings on severity of cross-gender behavior and cross-gender identity were transformed into scores representing percentage of potential improvement. Regression analysis indicated that completion of individualized behavioral treatment significantly accounted for long-term improvement in both gender behavior and gender identity. Age in months at initiation of treatment, number of months of treatment received, number of months from initial assessment to follow-up, and full scale I.Q. were additional independent variables considered as potentially important in regard to treatment outcome. Younger subjects received more severe initial diagnoses, were more likely to have completed treatment, and showed the greatest improvement. This study provides the longest independent follow-up assessment of the behavioral treatment of male children with gender identity disorder.     

The Youngest Victims of Violence: Examining the Mental Health Needs of Young Children Who Are Involved in the Child Welfare and Juvenile Justice Systems

Children placed in the state’s custody due to neglect, abuse or maltreatment are one of America’s most vulnerable populations. Seventy-five percent of child victims of maltreatment are under the age of 12. Not only is their suffering a problem, these children are also at increased risk for delinquent behavior later in life. While research has documented the potential long-term consequences of child abuse and neglect, the mental health needs of young children involved in the foster care and juvenile justice systems have been largely overlooked. This study examined the social, emotional and behavioral difficulties of 670 children, age 3–11, who were involved in the child welfare and juvenile justice systems. Children in this study were living in residential treatment facilities, group homes, foster care homes or were receiving intensive home-based services. To assess the children’s mental health needs caregivers completed the parent form of the Strengths and Difficulties Questionnaire (Goodman, Journal of Child Psychology and Psychiatry 38:581–586, 1997). The findings indicated a high prevalence of mental health problems, with 81 % of the children in the sample having a total difficulties score in the borderline or abnormal range and 90 % of the children having borderline or abnormal scores on at least one of the subscales (conduct, emotional, peer or attention problems). When characteristics such as gender, race and age were considered significant differences were found among boys and girls, Caucasian and minority children, and age groups. The findings highlight the importance of mental health assessment and interventions that are gender and culturally sensitive and developmentally appropriate.     

The early home environment and developmental outcomes for young children in the child welfare system

The quality of the early home environment is predictive of young children's subsequent cognitive, academic, and behavioral functioning. Limited research has focused on the effects of the early caregiving environment on the functioning of young children involved with the child welfare system. This study investigated the influence of children's home environments (i.e., number of children in the home, number of moves the child experienced, level of cognitive stimulation, and level of emotional support) during the first 2 years of life on their preschool developmental outcomes (i.e., cognition, language, social skills, and behavior problems).As anticipated, a high-quality early home environment promoted the well-being of preschool children who had entered the child welfare system as infants. Children who lived with greater numbers of children incurred more compromised cognitive, language, behavioral, and social outcomes. No significant associations emerged between the total number of placements and developmental outcomes; children who remained in the same home during infancy (typically the birth family home) had more compromised developmental outcomes in every domain except behavioral problems.Both cognitive stimulation and emotional support in the home predicted higher cognitive and language scores, decreased behavioral problems, and increased social skills. Early out-of-home placement and lack of emotional support interacted to predict children's behavioral problems. These findings are considered in the context of extant research and policy relevant to young children in the child welfare system.     

The reproduction of gender: housework and attitudes towards gender equality in the home among Swedish boys and girls

The housework Swedish girls and boys age 10 to 18 do, and their attitudes towards gender equality in the home are studied. One aim is to see whether the work children do is gendered and if so, whether they follow their parents', often gendered, pattern in housework. A second aim is to see whether children's attitudes are influenced by their parents' attitudes and practices. When it comes to issues like these, Sweden is of special interest because in 1995, Sweden was appointed the most gender equal country in the world by the United Nations. The data used were the Swedish Child Level of Living Survey 2000 (see http://www.sofi.su.se/LNU2000/english.htm), a data set that includes extensive first-hand information from both children and their parents. The results indicate that girls and boys in two-parent families are more prone to engage in gender atypical work the more their parent of the same sex engages in this kind of work. The fact that girls still do more housework than boys in all families independent of, among other things, the parental division of housework and the mother's educational level indicates that housework to some extent signifies gender also to children. However, no clear relation is found between the parents' division of work and the child's attitude towards gender equality in the home. Neither is there any clear relation between the parents' attitude towards gender equality in the home and the children's attitude to the same topic.     

Sexually abused children's perceptions of family functioning

A clinical sample of 76 children in a day and residential treatment facility was administered the McMaster Family Assessment Device (FAD) at time of admission. Interviews with therapists enabled identification of students who had been sexually abused prior to admission. A comparison group of children who had not been sexually abused was selected to match age, grade level and gender of the sexually abused children. ANOVA yielded significant differences on the dimensions of problem-solving, roles, and general functioning, with the direction of the effect indicating greater pathology among the sexually abused group. Analyses of differences between victims of intrafamilial or extrafamilial abuse yielded significance in affective responsivity, affective involvement, and general functioning, with greater enmeshment and dysfunction reported by the victims of intrafamilial abuse. Some gender differences were also noted, with females reporting greater general dysfunction in their families. Implications of this research as supportive of current clinical beliefs about family functioning are offered.     

Relationships between maternal adult attachment security, child perceptions of maternal support, and maternal perceptions of child responses to sexual abuse

This study assessed the relationships between maternal adult attachment style, children's perceptions of maternal support following disclosure of sexual abuse, and maternal perceptions of children's behavioral and emotional responses to sexual abuse among African-American child sexual abuse victims aged 4 to 12 (n=96) and a comparison group of non-abused subjects (n=100). Mothers with insecure attachment styles reported significantly higher rates of internalizing behaviors in their sexually abused children than did securely attached mothers. Among mothers of non-abused children, those with insecure adult attachment styles reported significantly higher rates of externalizing behaviors shown by their children in comparison with mothers with a secure adult attachment style. Mothers with insecure adult attachment styles also reported higher rates of overall behavior problems in their non-abused children that approached statistical significance. Sexually abused children's perceptions of maternal support were not related to maternal attachment style nor to child functioning. Contrary to our prediction, mothers of sexually abused children did not show lower rates of secure attachments when compared to mothers of non-sexually abused children. Our findings indicate that fostering parent- child attachment is important in order to decrease the risk for behavior problems and symptomatology in sexually abused children.     

Intergenerational Exchanges of Middle‐Aged Adults With Their Parents and Parents‐In‐Law in Korea

The authors investigated patterns of support exchanges between Korean adult children and their parents and parents‐in‐law, gender differences in these patterns, and implications of children's marital quality for exchange patterns. Data were from a nationally representative sample of married adults (N = 920, age 30–59 years) with at least 1 living parent and 1 living parent‐in‐law. Latent class analysis was applied to 12 indicators of exchanges (financial, instrumental, emotional support given to and received from parents and parents‐in‐law). Five classes of exchanges were identified, 3 showing balanced patterns of exchanges with parents and parents‐in‐law across three types of support and 2 classes with unbalanced patterns (e.g., giving instrumental and financial but not emotional support). The findings revealed variability in intergenerational exchange patterns, with a mix of patrilineal traditional and balanced patterns. Significant associations of exchange patterns with adult children's marital quality suggest the importance of balanced exchanges with parents for marriage.     

Children of Adolescent Mothers: Cognitive and Behavioral Status at Age Six

The cognitive and behavioral status at age six years of 185 children of adolescent mothers (60.5% boys) were assessed using the mother (CBCL) and teacher (TRF) report forms of the Child Behavior Checklist and the Bracken Basic Concepts Scale. There was evidence for impairment in all areas of functioning. More than half of the sample exceeded the borderline clinical cutoff (T = 60) on either the CBCL or TRF Total Problem score, and nearly half the sample had Bracken scores that were more than 1 SD below the normative mean. Only 26.9% of the children were in the normal range on all three measures. These results are discussed in terms of implications for social work practice with children and adolescent mother families.     

Children's Appraisals of their Experiences in Out-of-Home Care

Few studies have asked children directly about their experiences in out-of-home care. This study uses data collected from 180 nine- to-11-year-old children currently in out-of-home care who were asked about their perceptions and appraisals of out-of-home care. Analysis of variance and chi-square analyses were used to examine whether children's appraisals of their lives following removal from their families of origin differ as a function of age, gender, race/ethnicity, type and severity of maltreatment, length of time in out-of-home care, placement type, attachment to current caregivers, and rating of current caregiver/home. Youth who were sexually and emotionally abused, youth who were satisfied with their current caregivers and placements, and girls were more likely to state that their lives would have been worse had they remained with their families of origin. Youth who were physically abused were more likely to report that their lives would have remained the same. Children living in group care were more likely than those living in family foster care or with kin to report that their lives would have been better had they remained with their families of origin. Differences were not found between children living in family foster care and those living with kin nor did children's appraisals differ based on age, race, ethnicity, length of time in out-of-home care, neglect, or severity of maltreatment.     

Family systems functioning,family health roles,and utilization of physical health services

The purpose of the study reported here is to determine the relationship between family systems functioning, family health role, and family utilization of health services. The research is based in the Circumplex Model of Marital and Family Systems (Olson, Sprenkle, & Russel, 1979). Family functioning variables include family level of cohesion, family adaptability, and family type, as measured by FACES II. Family health role (i.e., leadership role and acceptance of sick role) and utilization of health services are measured by scales of the investigator-developed Family Health Questionnaire. The sample consists of 140 parents of 70 families, composed of two parents with children under 25 years of age living at home. Analysis reveals significant relationships between the family level of adaptability and acceptance of the sick role, in conjunction with significant gender and gender interaction effects. There are no significant differences between family cohesion levels or family typologies with the health variables.Su An Arnn Phipps is an Assistant Professor at the University of Oklahoma College of Nursing Graduate Program, Tulsa, 700 N. Greenwood, Tulsa, OK 74106. Her research interests include family systems functioning and family physical health, couples' infertility experience, and fathers' role(s) in family health. She received her Ph.D. from Oklahoma State University in Family Relations and Child Development.     

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.     

Homelessness as one component of housing instability and its impact on the development of children in poverty

The number of families with children living in poverty and experiencing housing instability and homelessness has increased dramatically over the last two decades. Current public policy decisions will lead to further increases. Understanding the impact of this instability on the emotional, behavioral, and cognitive development of children is imperative. Few studies critically examine the effects of instability on both domiciled and homeless children. This research examined the effects of homelessness and housing instability on 133 children 8 to 12 years of age living in poverty. Results indicate that whether a child is currently homeless is not as significant as overall stability which may have a long ranging effect on a child's future development.