Dissertations / Theses on the topic 'Child adolescent therapy'

Children and parents who visited child and adolescent psychiatry (CAP) for the first time were interviewed in the presence of their therapists about the first meeting. The interview was intended to make the attendants describe in their own words what the meeting was like for them. The interview was repeated after six months to get complementary information. Research assistants, reflectors, helped the interviewer to prevent from bias and to hold on to the theme. The grounded theory approach was utilised in papers I, II, and III, and qualitative content analysis was used in paper IV. Children appreciated the therapist being in an active as well as in a more passive but alert position, moving between asking adjusted questions and including the parents. The therapists’ skill of listening was also important to them. For the parents, it was important what happened between their child and the therapists. They questioned their own role and presence. Also, they focused on the plan for the meeting and for the coming process. Certain things that happened in the dialogue were useful after the meeting. The results indicate that what was helpful was connected to family therapy matters rather than psychiatric ones. The therapists balanced between a psychiatric and a family therapeutic position, and it was a dilemma for them how to best fulfil their assignment in the organisation as they perceived it. Two competing discourses were found in the first meeting; Structuring, which stood for structure, planning and expertise, while Collaboration represented negotiations of how to work together, empowerment and emotional aspects. The Structuring discourse tended to dominate. Both discourses consisted of valuable elements that needed to be included to ensure that the atmosphere would not be too strict or too flexible. The findings are tentative because of the lack of studies to compare to, and because of the few interviews made.
Det första möte som sker mellan familjemedlemmar och personal antas ha stor betydelse för hur den fortsatta kontakten artar sig. Det är ett tillfälle när var och en kan vara öppen för intryck och nyfiken på hur kommunikationen utvecklas och vilken hjälp som ska till. Förutsättningarna för mötet är etablerade på många plan. Föräldrarna och barnen har tidigare erfarenheter av både personliga och professionella kontakter, och de har förväntningar på vad som ska eller bör ske under det första samtalet. Personalen befinner sig i ett sammanhang där de har förväntningar på sig från organisationen. De har utbildning och erfarenhet och har anammat organisationens kultur och vanor i större eller mindre utsträckning. Både inom det psykiatriska eller det psykoterapeutiska området har det varit brist på studier som rör det första samtalet mellan professionell och patient/klient. Detta väckte ett intresse att studera området närmare. Syftet med studien var därför att försöka ta reda på mer om det första mötet ansikte mot ansikte mellan personal och familjemedlemmar. Vad händer där och hur upplevs det här mötet av dem som deltar? Ytterligare ett syfte var att försöka ta reda på vilka diskurser som påverkar det som sker mellan deltagarna. Vilka underliggande meningar har deltagarnas tankar och sätt att bete sig, och som har förankring i allmänna föreställningar om hur ett möte av det här slaget går till? Hur framträder det i deltagarnas kommunikation med varandra? För att finna svar på dessa frågor gjordes forskningsintervjuer inom två veckor respektive sex månader efter det första mötet på BUP (barn- och ungdomspsykiatrin). Vid intervjuerna deltog de som varit närvarande vid det första samtalet, d v s personal, föräldrar och barn. Intervjuaren hade till sin hjälp forskningsassistenter, reflektörer, vars uppgift var att bidra till att alla fick komma till tals och att man höll fokus på hur det var under det första samtalet. Fyra delstudier genomfördes. I de tre första användes analysmetoden grundad teori, och i den fjärde kvalitativ innehållsanalys. Den första delstudien lyfte fram barnens perspektiv. Barnen uppskattade om behandlarna befann sig ömsom i en aktiv ömsom i en passiv position, där de samtidigt var alerta i förhållande till barnen. De gillade att behandlarna å ena sidan anpassade sig och sina frågor till barnen och å andra sidan tog med föräldrarna i samtalet. Behandlarnas förmåga att lyssna och att hjälpa barnen att uttrycka sig var viktig för barnen. De tog också upp vikten av att behandlarna höll reda på tiden, så att samtalet inte blev för långt för dem. För föräldrarna, i delstudie II, visade det sig vara avgörande vad som skedde mellan deras barn och behandlarna. De ifrågasatte sin egen roll i mötet, och var tveksamma till om de borde vara närvarande eller inte. Dessutom var de inriktade på hur upplägget av samtalet såg ut och hur den fortsatta planeringen skulle bli. Vissa teman och yttranden i dialogen kunde vara till nytta för samspelet därhemma. Fynden i delstudien antyder att det som var till hjälp snarare låg på ett familjeterapeutiskt plan än ett psykiatriskt. I delstudie III framkom att behandlarna nedtonade sin egen insats och lyfte fram det viktiga i familjemedlemmarnas bidrag till hur mötet blev. Behandlarna balanserade mellan ett psykiatriskt och ett familjeterapeutiskt förhållningssätt. De mest tillfredsställande arbetsuppgifterna rörde att lyssna på barns och föräldrars berättelser och att hitta sätt att uppmuntra och stödja deras vägar till att må och fungera bättre. De önskade möta familjemedlemmarna på deras villkor, men hade också att samla information för bedömning och fortsatt planering. Det innebar ett dilemma för dem hur de bäst skulle kunna uppfylla de uppgifter som de uppfattade att BUP-organisationen gett dem. Två konkurrerande diskurser framträdde i delstudie IV. De var inflätade i varandra och stod att finna hos var och en av parterna barn, föräldrar och behandlare. Det syntes pågå balanserande eller konkurrens mellan de sociala röster som ingick i diskurserna. Diskursen Strukturering innehöll sociala röster som rörde exempelvis inramning av mötet, expertis och kategoriseringar medan diskursen Samarbete inriktades mot aspekter som öppenhet, sam-skapande och en utvidgad dialog. Om diskursen Strukturering skulle överväga blev följden antingen ett undertryckande och okänsligt förhållningssätt och diskursen Samarbete skulle om den övervägde kunna skapa ett otydligt eller alltför flexibelt förhållningssätt. Den förra diskursen tycktes dominera, men båda diskurserna syntes innehålla delar som behövdes för att det första mötet skulle uppfattas som givande. Fynden i studien är preliminära av två skäl. Dels finns få eller inga studier att jämföra med; dels var antalet intervjuer begränsat.

This dissertation uses a modified systematic literature review to look at working with parents and carers within child and adolescent psychotherapy, and to consider this tasks relationship to therapeutic outcomes for children and adolescents. The topic is important because psychotherapy with children and adolescents inevitably involves additional relationships. The literature indicates the way this undertaking has been regarded has varied through the history of psychodynamic child and adolescent psychotherapy. Numerous writers reflect on the ongoing neglect and absence of systematic thinking in relation to the task of work with parents and carers. This lack of attention is understood to have been influenced by the traditional model of child and adolescent psychotherapy where the source of the child or adolescent’s distress or difficulty was regarded as being primarily intrapsychic. What is now known regarding the current and active nature of the child or adolescent’s relationship with the parent or carer, and the power and persistence of the parent-child bond has resulted in an acknowledgement of the need for a more equitable balance of focus between internal and external factors. In acknowledging that the external can no longer be seen as peripheral there are compelling clinical reasons to work with parents and carers. This undertaking should not be seen as dependant on the therapist’s orientation or interest. The significant scope of possibilities for work with parents and carers within child and adolescent psychotherapy is explored; however there is a lack of data relating to the clinical effectiveness of these approaches. The future need is for systematic thinking, and the development of practice guidelines for this clinical task.

Psychology
Ph.D.
Research supports shared neurological, cognitive, and environmental features among youth with sleep-related problems (SRPs) and anxiety. Despite overlap in interventions for SRPs and anxiety, little is known about the secondary benefit on SRPs following anxiety-focused treatment. The present study examined whether SRPs improved following cognitive-behavioral therapy (CBT) for youth with anxiety disorders. It also examined whether variables that may link anxiety and sleep problems (e.g. pre-sleep arousal, family accommodation, sleep hygiene) changed across treatment, and whether said changes predicted SRPs at posttreatment. Youth were diagnosed with anxiety at pretreatment and received weekly CBT that targeted their principal anxiety diagnosis at one of two specialty clinics (N = 69 completers, Mage = 10.86, 45% males). Youth completed a sleep diary between pretreatment and session one and again one week prior to posttreatment. All other measures were administered in the first session and at the posttreatment assessment. Results indicated that parent-reported SRPs improved from pre- to post-treatment and that treatment responders yielded greater improvement than nonresponders. Specific areas of bedtime resistance and sleep anxiety showed significant improvement. Youth reported lower rates of SRPs and no pre- to post-treatment changes. Pre-sleep arousal and parental accommodation decreased over treatment but did not predict lower SRPs at posttreatment. However, higher accommodation positively correlated with greater SRPs. Sleep hygiene evidenced no change and did not mediate accommodation and posttreatment SRPs. Clinical implications for the treatment of anxious youth are discussed and suggestions for future research are offered.
Temple University--Theses

A quimioterapia é uma das abordagens terapêuticas para o tratamento do câncer e, no caso específico das crianças e adolescentes, a mais frequente, de forma individual ou associada a outras modalidades. Tem sido fonte de preocupações, questionamentos e dúvidas, tanto por parte das crianças e adolescentes quanto de seus familiares, por seus efeitos colaterais físicos e psicológicos. O presente estudo tem por objetivo compreender como as crianças e os adolescentes com câncer vivenciam a experiência da quimioterapia, a partir de seus próprios relatos, visto que, ao conhecer suas demandas e sentimentos, podemos incorporá-los ao plano de cuidados de enfermagem e contribuir para uma assistência qualificada e dirigida à qualidade de vida da criança, do adolescente e de sua família. Exploratório e com análise qualitativa dos dados este estudo contou com a participação de 10 crianças e adolescentes entre oito e 18 anos, em diferentes momentos da terapêutica quimioterápica. Para a coleta dos dados, utilizamos como instrumentos a entrevista semiestruturada e a observação livre, complementadas com dados do prontuário dos sujeitos em questão. A análise do material empírico seguiu a técnica de análise de conteúdo. Após a caracterização dos sujeitos da pesquisa, os resultados foram agrupados ao redor de três grandes temas, seguidos dos respectivos subtemas: a doença, compreendendo a trajetória até o diagnóstico e o conhecimento sobre a doença; a quimioterapia, a partir do impacto do tratamento, as características dos quimioterápicos e a visão do processo e, por fim, a rede de apoio que incluiu a família, os amigos e a religião. O estudo nos permitiu compreender que, para as crianças e adolescentes, a experiência da quimioterapia está intimamente ligada à experiência do câncer, sendo impossível entender a dimensão da terapêutica sem antes compreender a base desta questão, o câncer infanto-juvenil. Lembrada, principalmente por seus efeitos colaterais e o sofrimento, a quimioterapia causa, de imediato, um forte impacto, deixando sobressair o medo. Passado este primeiro impacto, principalmente das alterações físicas, as preocupações dirigem-se à recuperação da doença, ou seja, à cura. Mencionam que o câncer interrompe uma vida até então normal e provoca dúvidas quanto ao futuro e mesmo o presente. Em contrapartida, com o tempo, relatam que o processo terapêutico, incluindo a quimioterapia, levou-os a valorizar mais a vida. Brincar, ter a família e os amigos por perto, buscar Deus, conhecer a doença e enfrentá-la, se envolver em todo o processo e, acima de tudo, acreditar no sucesso foram estratégias utilizadas durante a quimioterapia, terapêutica sofrida, restritiva, mas acima de tudo, responsável pela cura da criança e do adolescente.
Chemotherapy is one of the therapies used in cancer treatment. Separately or associated to other therapies, it is the most frequently used to treat children and adolescents. Due to its physical and psychological collateral effects, it has been source of preoccupations, questions and doubts, both for children and adolescents as well as their relatives. This exploratory and qualitative study aimed to understand how children and adolescents with cancer experience chemotherapy, from their own reports. Knowing their demands and feelings permits to incorporate them to the nursing care plan and contributes to a quality care, targeting the quality of life of children, adolescents and their families. Participants were 10 children and adolescents between 8 and 18 years of age, on different moments of chemotherapy. Data collection was done through semi-structured interview and free observation, added by data from subjects patient files. Analysis of the empirical material was done through content analysis. After characterization of the research subjects, results were grouped into three themes and their respective subthemes: disease, understanding the trajectory to diagnosis and knowledge about the disease; chemotherapy, the treatment impact, characteristics of chemotherapeutic drugs and the view of the process and, lastly, the support network, which includes family, friends and religion. The study permitted to understand that, for children and adolescents, the chemotherapy experience is closely related to the cancer experience, and it is impossible to understand the dimension of the therapy without previously understanding the basis of the issue: child and juvenile cancer. Chemotherapy is mainly reminded by its collateral effects and suffering. It has a strong impact on participants, showing the fear caused by it. After the initial impact, mainly due to physical changes, preoccupations are related to disease recovery, that is, cure. They mention that cancer interrupts what was so far a normal life and causes doubts regarding the future and even present life. On the other hand, according to their reports, treatment, including chemotherapy, made them value life more. Playing, being close to family and friends, searching for Good, knowing and facing the disease, getting involved in the process and, above all, believing in success, were the strategies used during chemotherapy, which is a restrictive therapy, that causes suffering, but which is primarily responsible for children and adolescent cure.

Clinical characteristics, methods of treatment and outcome in School Refusal have been investigated. School refusal/phobia has been reported in the literature not to be a true clinical entity with a uniform aetiology, psychopathology, course, prognosis and treatment, but rather a collection of symptoms or a syndrome occurring against the background of a variety of psychiatric disorders. Aetiological and precipitating factors also vary with age, psychosocial level of development and personality factors in the individual child, family structure and function, and the school setting. Data were collected retrospectively from 20 cases treated at the Child and Family Unit, Red Cross War Memorial Children's Hospital, Cape Town during a specific time period. Analysis of the data revealed a gender distribution of 11 boys and 9 girls; 1 girl, 5 - 8 years old and 11 boys and 8 girls 9 - 13 years old. One Asian, no Black, 13 Coloured and 6 White children were represented. A large section of the sample population represented the lower socio-economic group as determined by parental qualification and occupation. Most of the families tended to consist of more than 2 children (5 member families). Family dysfunction was recorded in all but one case, with evidence of a recognizable psychiatric disorder also recorded quite frequently in the nuclear family members. Educational difficulties were recorded in a third of the sample together with below average total IQ scores in virtually all the subjects evaluated. The bulk of referrals were from medical practitioners and relatively few from schools. Refusal to attend school was of relatively short duration in three-quarters of the sample. Most of the cases were first time school refusers. Accompanying symptoms or problems were mainly anxiety or depression - related whereas significant associated events were mainly family - oriented. Psychiatric disorders diagnosed most often were anxiety and affective disorders with overlap of the 2 conditions recorded in half the sample. Response to treatment was positive in two thirds of the sample and a combination of treatment methods proved to be the most successful treatment plan. School refusal as investigated in this study, was well represented in a population of children treated at a Child Psychiatric Out-Patient Unit. A high rate of resemblance on various aspects of school refusal was recorded between the study sample and reports in the literature reviewed.

Barns mentala ohälsa ökar kraftigt. Barnpsykoterapi med inslag av fri lek, här kallad lekterapi, har under många år varit den traditionella behandlingen av barn i behov av psykoterapi. För att ha en möjlighet att kunna jämföras vetenskapligt med andra dokumenterade behandlingsmetoder behöver evidensen för lekterapi som behandlingsmetod undersökas, stärkas liksom spridas.  Syftet med föreliggande uppsats är att undersöka kunskapsläget inom lekterapi som behandlingsmetod inom barnpsykoterapi.  Totalt 41 studier har granskats systematiskt enligt evidensbaserad medicinsk metod. Tjugoen av dem poängbedömdes medan övriga 20 delades upp i temagrupper för att visa ett ytterligare djup och bredd av de analyserade studierna. Tretton studier av de 21 poängbedömda fick minst 80% av totalpoängen, gradering I, och sju stycken graderingen II, d. v. s. 70-80% av max poängen. Enligt internationell praxis av gradering av evidensstyrka för slutsatser, visar två studier, eller fler, med ett högt bevisvärde eller god systematisk översikt på ett starkt vetenskapligt underlag som ger god evidens. Som ett bifynd visade sig 16 av de 41 studierna även ha en direkt anknytning till affektiv neurovetenskaplig forskning.  Rekommendationen är att använda barnpsykoterapi med fri lek för barn som ska behandlas vid mental ohälsa.

The present investigation evaluated the efficacy of a Cognitive-Behavioural Therapeutic Approach for the anger management of three adolescent males. The study is noteworthy because it utilised essential features of Beck's Cognitive Therapy in the cognitive restructuring phase of treatment. Previous studies have commonly employed Rational Emotive Therapy's disputation of irrational beliefs for this phase. For this reason it is considered to be an original contribution to the literature. A multiple (three) single-case study research design was employed. The three adolescents, aged 13 to 17 years, attended seven to nine one-hour counselling sessions over a two to three month period. Pre-, post-treatment and long-term followup psychometric measures of aggression and anecdotal reports of anger-control were obtained from parents and teachers. Self-reports in the affective and cognitive domain, progress in therapy, psychometric measures (aggressive behaviour subscale of the Child Behaviour Checklist, Adapted Novaco Anger Inventory and Piers-Harris Children's Self-Concept Scale) and continuous (including pre-, post-treatment and long-term follow-up) assessments of the frequency of angry outbursts were obtained. Counsellor assessments of cognitive homework and behaviour in therapy were also made. Results reveal marked reductions in the average daily frequencies of angry outbursts in all cases by post-treatment and treatment effects were maintained throughout the three-month follow-up period. It was concluded that the cognitive-behavioural therapeutic approach warrants further investigation as it is proposed that it is a comprehensive and efficacious treatment for male adolescent anger problems.

Dois estudos avaliaram o impacto e o processo de um modelo de grupoterapia cognitivo-comportamental para 49 meninas vítimas de abuso sexual com idade entre 9 e 16 anos. O Estudo I avaliou: o impacto do modelo na redução de sintomas de depressão, stress, ansiedade, transtorno do estresse pós-traumático (TEPT) e crenças distorcidas sobre o abuso e o efeito do tempo de espera por tratamento nestes sintomas; a manutenção do impacto da grupoterapia após 6 e 12 meses do término; e os fatores preditores para a resposta à grupoterapia. Os resultados, obtidos através do teste t para amostras pareadas apontaram que o modelo de grupoterapia apresentou impacto positivo, reduzindo significativamente os sintomas avaliados; o efeito da espera entre os grupos não revelou diferença significativa; os efeitos terapêuticos se mantiveram após um ano; e, os fatores preditores da resposta à grupoterapia foram: idade de início do abuso, presença de estupro e sintomas de revivência do TEPT antes da grupoterapia. O Estudo II avaliou o processo terapêutico a partir da análise clínica descritiva de dois casos, considerando as participantes que obtiveram escores extremos na análise da redução de sintomas. Os resultados apontaram que a idade de início do abuso, forma de abuso, experiência de abrigamento, resposta ao treino de inoculação do estresse e percepções de culpa foram aspectos que diferenciaram a resposta à grupoterapia. O modelo avaliado se mostrou efetivo para tratamento de meninas vítimas de abuso sexual.
Two studies assessed the effectiveness impact and process of a cognitive behavioral group therapy model applied to 49 female children and adolescents victims of sexual abuse (9-16 years). The Study I evaluated: the impact of the model in the reduction of symptoms of depression, anxiety, stress, post-traumatic stress disorder (PTSD) and the beliefs on the abusive experience and the effect of being in a waiting list for treatment in these symptoms; the permanence of the group therapy effects impact in a 6 and 12 months follow ups; the predictors factors for a group therapy response. The results, analyzed through the test t, revealed: the model showed positive impact, reducing the evaluated symptoms; the effect of being in the waiting list did not reveal significant difference in both groups; the therapeutic impact were maintained through the follow ups; the predictor factors for a response to group therapy were: age of the sexual abuse, rape presence and re-experiencing symptoms of the PTSD before the group therapy. The Study II assessed the therapeutic process using a two cases clinic analysis, considering the participants that obtained extremes scores in the analysis of symptoms reduction. The results pointed out to: the age of the sexual abuse, rape presence, sheltering, response the stress inoculation training and self perceptions of blame were aspects that explained the different response to the group therapy. The model was effective to the treatment of the girls victims of sexual abuse.

The aim of this thesis is to provide the field of child and adolescent mental health with an understanding, from young people’s perspectives, of being assessed and having decisions made about their interventions by clinicians within the Child and Adolescent Mental Health Service (CAMHS). In order to obtain this understanding it is important to explore how young people experience both the CAMHS assessment process and being recommended interventions. Therefore, paper one consists of a literature review in which nine studies regarding young people’s experiences of being assessed in a mental health service were critically appraised and synthesised. Common themes were discovered across the papers around the therapeutic relationship, pre-conceived views and information and communication. The literature review highlighted that young people’s experiences of being recommended interventions following a CAMHS assessment had not been considered within the literature. Furthermore, Government aims and the literature showed the importance of young people being included in decisions regarding their care. Therefore, paper two presents a qualitative study exploring young people’s experiences of being assessed and recommended Dialectical Behaviour Therapy (DBT) by CAMHS clinicians. Six young people from a CAMHS setting DBT group were interviewed. Transcripts were analysed using Interpretative Phenomenological Analysis (Smith, Flowers & Larkin, 2009) four super-ordinate themes and seven sub-themes were identified. Super-ordinate themes demonstrated the importance of the clinician in assessment and recommendation, that young people can experience anxiety before an assessment, young people value being part of decisions and being offered choice about treatment recommendations, and that the interviews reflected CAMHS experiences. Paper three provides two executive summaries of paper two, for the purposes of sharing the study’s findings with the young people who took part and for their parents/guardians. Therefore, part one of paper three will be presented in an age appropriate and user friendly format for young people.

Child sexual abuse (CSA) is prevalent in South Africa and, along with the stigma often endured following the abuse, can have lasting effects on sense of self. There have been few studies into how survivors of CSA construct identity or, specifically, how music therapy may afford such construction. Using a multiple case study design, this research investigated how three adolescent survivors of CSA, who took part in individual music therapy processes, constructed their identities through the techniques afforded them in sessions. All three participants had experienced multiple trauma, most notably abandonment/orphanhood, and this appeared to impact on their exploration of identity in sessions. Findings showed that the main affordances of music therapy for participants were the mastery experienced in relation to certain techniques (which appeared to support confidence and further exploration), and the use of symbolism (promoting the exploration of difficult experiences, as well as affording participants experimentation with preferred identities).
Dissertation (MMus)--University of Pretoria, 2018.
Music
MMus
Unrestricted

There is a high prevalence of child sexual abuse (CSA) in India and the UK (Laccino, 2014). However, there is a lack of research on culturally-specific aspects of psychotherapy offered to child and adolescent survivors of CSA in both these countries. Therapeutic interventions with sexually abused children raise complex concerns due to the heterogeneity based on the developmental stage of children; varied impact, presenting difficulties and needs; and characteristics of abuse, age, gender, ethnicity and cultural factors. Numerous therapeutic interventions for CSA have been documented, with varying theoretical constructs, structure, content and outcome (Reavey & Warner, 2001), ranging from cognitive behavioural, psychoanalytic, humanistic and feminist paradigm (Misurell, Springer, & Tryon, 2011). Most of these approaches do not provide sufficient guides to therapy (Reavey & Warner, 2001). Few of these are widely studied and clinically accepted, while most lack empirical evidence. Although existing studies conclude that therapy is better than no treatment, there is lack of consensus on treatment characteristics important in child and adolescent sexual abuse therapy (Hetzel-Riggin, Brausch, & Montgomery, 2007). Further, little is known about culturally-specific holistic and coherent responses to CSA. A Constructivist Grounded Theory (Charmaz, 2006) study was conducted to investigate therapeutic approaches practiced by professionals in India and the UK with child and adolescent survivors of CSA, and to understand the factors that govern the choice of an approach or model adopted. In-depth, semi-structured interviews were undertaken with 32 professionals (16 each in India and the UK) from different settings including statutory, voluntary and private sector. NVIVO 10 was used for data management and analysis of the digitally recorded and transcribed interviews. Although there is a growing emphasis on evidence-based therapies, with most empirical studies focussing on traditional forms of psychotherapy, the actual practice of the professionals interviewed reflected a more fluid, flexible, multi-modal, ecological and integrative approach to CSA-therapy. The findings indicate that the therapeutic interventions progress through four different phases, based on the goals identified by professionals. The goals in turn are influenced by the socio-cultural context, structural factors, and/or trauma understanding of the professionals. Four phases identified in the study are: 1. Social Action Framework, with the goal to identify silenced and invisible children, particularly in a culture of silence and suppression in India; 2. Stabilisation and Resilience Building Framework, found to be practiced in India and the UK, with the goal to ensure safety and build the foundation for ensuing phase of therapy; 3. CSA-Trauma Resolution Framework, where the goal is to uncover the sexual abuse details to facilitate recovery and reintegrate the traumatised child, more visible in therapeutic practice in the UK; and 4. Maintenance and Relapse Prevention Framework, with the goal to prevent relapse and protect from revictimisation and future developmental difficulties. These phases may be mutually exclusive, follow a linear trajectory, or there may be a back and forth movement from one phase to the other. These four phases were integrated to construct a culturally relevant, ecological-based theoretical model of CSA therapy with child and adolescent survivors.

This study was designed to determine the effectiveness of group activity therapy as a school based intervention with fourth and fifth grade preadolescents with learning disabilities experiencing behavior problems. The group activity therapy intervention followed humanistic principles and was designed to address the cognitive and social emotional needs of this population. The preadolescents were provided a variety of developmental appropriate materials and activities to encourage self expression and group interaction. The 24 volunteer preadolescents were randomly assigned to the experimental group (n=12) and to the control group (n=12). The treatment group preadolescents were divided into groups of three and participated in group activity therapy one hour per week for 12 weeks. The participants were assigned to groups according to individual needs and personality traits. The control group received no treatment during the study. Pre and post test data were collected from parents using the Child Behavior Checklist (CBC) and the Behavior Assessment Scale for Children (BASC). Analysis of Covariate (ANCOVA) was utilized to determine statistical significance between the treatment group and the control group on the post-test means for each hypothesis. In each case, the post-test specified in each hypothesis was used as the dependent variable and the pre-test as the covariate. Specifically, the preadolescents in the treatment group showed statistically significant decreases in total behavior problems on the BASC (p=.05) and decreases in internalizing problems on both the BASC and CBC (p=.03, p=.05, respectively). While not statistically significant, positive trends were noted on the CBC total behavior scale (p=.08) and on the CBC externalizing scale (p=.09). In addition, Cohen's d effect size was calculated for each hypothesis and post hoc analysis of the subscales to determine practical significance of the treatment on the experimental group when compared to the control group. A large treatment effect size was found on the BASC (d=.91) and CBC (d=.82) total behavior problems scales and on the BASC (d=1.03) and CBC (d=.90) internalizing problems scales. A moderate to large treatment effect size (d=.78) was found on the CBC externalizing problems scale and a medium treatment effect size (d=.53) was found on the BASC externalizing problems scale. Qualitative data was also examined to determine clinical significance of the intervention. This study determined that group activity therapy is an effective intervention for preadolescents diagnosed with a learning disability.

A oxigenoterapia domiciliar é uma terapêutica de extrema importância na faixa etária pediátrica que visa garantir o desenvolvimento pôndero-estatural e cognitivo de crianças hipoxêmicas, bem como prevenir e atenuar o desenvolvimento da hipertensão pulmonar secundária (HPS). OBJETIVO: Descrever a população de crianças e adolescentes em oxigenoterapia domiciliar prolongada (ODP), quanto às suas características demográficas, clínicas, laboratoriais, relativas ao uso do oxigênio (O2) e tempo de sobrevida após início da ODP. Comparar os grupos de pacientes com e sem HPS, em relação às características supracitadas e analisar comparativamente os custos em relação ao uso do concentrador versus cilindro de O2. MÉTODOS: Trata-se de um estudo descritivo retrospectivo de uma coorte de 165 pacientes, cujos dados relativos a um período 2002-2009 foram coletados de prontuários e de questionários aplicados aos pacientes e/ou acompanhantes. Os dados sobre custos foram cedidos pelo Núcleo de Assistência Domiciliar Interdisciplinar do HC-FMUSP. A variável contínua (idade de início do uso de O2) foi descrita através de sua mediana, valores máximo e mínimo. As demais variáveis (nominais), foram descritas através de suas frequências. As análises do tempo de uso do O2 e sobrevida foram feitas através da curva de Kaplan-Meier. Na comparação dos subgrupos com e sem HPS, as frequências (período de uso do O2 e intensidade do fluxo) foram comparadas através do teste do Qui-quadrado; e as curvas de Kaplan-Meier, por meio do teste Logrank. Nas análises, foi usado o software estatístico SPSS 13.0 e adotado um nível de significância de 5%. O custo médio mensal do programa foi calculado a partir das médias mensais de pacientes, segundo o tipo de sistema utilizado (concentrador ou cilindro) no período de um ano. RESULTADOS: A maioria dos pacientes (68%) residia no Município de São Paulo; 53% eram do sexo masculino e a idade de início da ODP variou de 0,1 a 21, 5 anos (mediana: 3,6 anos), sendo que cerca de um terço da casuística iniciou o uso do O2 no primeiro ano de vida. Os principais diagnósticos da doença crônica de base foram: fibrose cística (22%), displasia broncopulmonar (19%), bronquiolite obliterante (15%) e neuropatias crônicas (12%). A ODP foi contínua em 65% dos pacientes, sendo que 87% utilizavam fluxos inferiores a 2 L/min. O dispositivo para administração de O2 mais utilizado foi a cânula nasal (87%), e o sistema provedor foi o concentrador de O2 (58%). A mediana do tempo de uso do O2 foi de 7 anos. A mediana do tempo de sobrevida dos 165 pacientes após início da ODP foi de 13,4 anos. Dos 33 pacientes submetidos aos testes de função pulmonar, 70% apresentaram distúrbio ventilatório obstrutivo grave. O hemograma foi realizado em 150 pacientes. Destes, 37% eram anêmicos e 17%, policitêmicos; os demais apresentaram valores hematimétricos normais. O ecocardiograma foi realizado em 134 pacientes; destes, 51% apresentaram hipertensão pulmonar secundária (HPS). Foi encontrada associação estatisticamente significante entre presença de hipertensão pulmonar e necessidade de maiores fluxos de oxigênio (p = 0,011) bem como presença de hipertensão pulmonar e tempo de uso do O2 mais prolongado (p = 0,0001). O tempo de sobrevida dos grupos com e sem HPS após início da ODP não apresentou diferença estatisticamente significante (p = 0,3445). No tocante aos custos relativos ao tipo de sistema provedor de O2 utilizado, o custo médio mensal do programa utilizando concentradores foi de R$ 4.176,80 e utilizando cilindros foi de R$ 9.396,00. CONCLUSÕES: Nesta casuística a ODP foi empregada em distintas doenças crônicas, com maior frequência de pacientes na faixa etária de lactentes e período pré-escolar. As doenças predominantes foram: fibrose cística, displasia broncopulmonar e bronquiolite obliterante. O tempo de ODP para os pacientes com estas patologias foi relativamente prolongado. A HPS foi frequente nos pacientes em ODP, e a sua presença, comparativamente aos pacientes sem HPS, ocasiona a necessidade de maiores períodos de tratamento e incremento de fluxos de oxigênio, sem interferência na sobrevida. Possivelmente o uso de concentradores de O2, ao invés de cilindros, em programas de ODP para pacientes pediátricos, reduza os custos de maneira significativa
The home oxygen therapy is extremely important in the pediatric age group that aims to ensure the weight, height and cognitive development of hypoxemic children, as well as prevent and mitigate the development of secondary pulmonary hypertension (SPH).OBJECTIVE: This study aimed to describe the population of children and adolescents in prolonged home oxygen therapy (LTOT) as their demographic characteristics, clinical, laboratory, concerning the use of O2, and survival time after onset of ODP. Compare patient groups with and without SPH in relation to the characteristics mentioned above and analyze comparatively the costs in relation to the use of concentrator versus O2 cylinder. Cost data were provided by the Interdisciplinary Center for Home Care. METHODS: This is a retrospective descriptive study of a cohort of 165 patients, whose data covering a period from 2002 to 2009 were collected from medical records and questionnaires applied to patients or caregivers. The continuous variable (age of onset of O2) was described by its median, maximum and minimum values. The other variables (nominal), were described by their frequencies. Analyses of time use of O2 and survival were evaluated by the Kaplan-Meier method. In comparing the groups with and without SPH, the frequency (period of use of O2 and intensity of flow) were compared using the Chi-square and Kaplan-Meier, using log rank test. In the analysis, we used the statistical software SPSS 13.0 and adopted a significance level of 5%. The average monthly cost of the program was calculated from the monthly average of patients, according to the type of system (concentrator or cylinder) during one year. RESULTS: Most patients (68%) resided in Sao Paulo city, 53% were male. The age of onset of LTOT ranged from 0.1 to 21,5 years (median 3.6 years), and about a third of the series initiated the use of O2 in the first year of life. The main diagnoses of chronic illness were: cystic fibrosis (22%), bronchopulmonary dysplasia (19%), bronchiolitis obliterans (15%) and chronic neuropathies (12%). The ODP was continuous in 65% of patients, 87% used flows of less than 2 L/min. The device for administration of O2 consisted of a nasal cannula (87%), and the system provider was the O2 concentrator (58%). The median duration of use of O2 was 7 years. The median survival time of 165 patients after initiation of LTOT was 13.4 years. Of the 33 patients tested for lung function, 70% had severe obstructive respiratory disorder. Blood counts were performed in 150 patients. Of these, 37% were anemic,17% polycythemic, and the others showed normal hematological values. Echocardiography was performed in 134 patients, of which 51% had SPH. Statistically significant association was found between the presence of pulmonary hypertension and need for greater flows of oxygen (p = 0.011) and presence of pulmonary hypertension and longer duration of O2 use (p = 0.0001). The survival time of patients with and without HPS after initiating LTOT was not statistically significant (p = 0.3445).Concerning the costs for the type of O2 system provider used, the average monthly cost of the program using concentrators was R$ 4,176.80 and using cylinder was R$ 9,396.00. CONCLUSIONS: In this sample LTOT has been employed in various chronic diseases with a greater frequency of patients in the age range of infants and preschool period. The predominant diseases were: cystic fibrosis, bronchopulmonary dysplasia, and bronchiolitis obliterans. The period of LTOT for patients with these diseases was relatively prolonged. The SPH was common in patients on LTOT, and their presence compared to patients without SPH, causes the need for greater periods of treatment and increase the flow of oxygen, without interference on survival. Possibly the use of O2 concentrators, instead of cylinders in LTOT programs for pediatric patients, may reduce costs significantly

This qualitative research explored the impact that art therapy and attachment focused treatment may have on a child or adolescent with complex trauma. Literature was reviewed to explore complex trauma in children and adolescents, as well as explore treatment models that include but are not exclusive to art therapy and attachment focused treatment. The current study utilized interviews, as subjects were invited to engage in the art process and discussion with the intent to discover new, in-depth meaning about treating complex trauma in children in adolescents. Data collected from interviews revealed gaps in the mental health system and how art therapy assisted in providing a bridge for the clients to improve their ability to navigate a complex system. Art therapy was found to assist in forming secure attachment for the client, a primary function in the treatment process. Findings also suggested that art therapy provided clients with tools for communication to explore and express their external and internal experiences in a safe environment. Findings further demonstrated the importance of establishing a therapeutic relationship with children and adolescents with complex trauma as essential for maintenance of progress in treatment.

Under åren 2008-2010 pågick ett familjeprojekt på barn- och ungdomspsykiatriska kliniken i Stockholm. Tjugofyra familjer skrevs in i projektet och sex behandlare medverkade. Projektets struktur byggde på att familjer, även syskon, till de inskrivna patienterna i högre grad än i vanlig slutenvård skulle närvara och delta i vården. Sessionerna var av en intensitet av tre timmar per dag, tre dagar i veckan, i tre veckor. Genom en kvalitativ studie med intervjuer med ett antal av de som var med, inventeras projektets genomförande och konsekvenser. De som svarat redogör för positiva förändringar, i synnerhet vad gäller relationerna i familjen. Föräldrarna uttrycker att de fått en annan förståelse för sitt barn och barnen att de känner sig mer förstådda. Samarbetet mellan familjerna och de professionella på kliniken verkar ha haft stor betydelse. Självskattningar på Client Satisfaction Questionnaire bekräftar de allmänt goda behandlingsresultaten.
During the years 2008-2010 a family treatment project was run at the child and adolescent psychiatric clinic in Stockholm. Twentyfour families were enrolled in the project and six therapists were involved. The project involved families, including siblings, related to the identified patients to a greater extent than in conventional inpatient care. The sessions had an intensity of three hours a day, three times a week, for three weeks. Through a qualitative study involving interviews with a sample of the participants the experiences and consequences of the project was explored. Respondents described positive changes, especially as regards the relations in the family. Parents expressed that they acquired a different understanding of their children while the children felt more understood than before. The collaboration between the families and the professionals at the clinic seems to have been of great significance to the participants. Ratings on the Client Satisfaction Questionnaire corroborate the positive results of the interviews.

Introdução: O equilíbrio é a capacidade de um indivíduo em controlar seu corpo no espaço e mantê-lo estável, mesmo quando submetido a algum tipo de perturbação. A postura se refere ao alinhamento dos segmentos corporais com o mínimo de estresse e tensão sobre os músculos e ligamentos, mantendo condições adequadas para realizar os movimentos. A integração do sistema neuromuscular é necessária para manter o equilíbrio, a postura, bem como a função miccional adequada. Várias alterações, incluindo, genética, hormonal, comportamental, distúrbios do sono, déficits sensoriais e neuromotores são associados à enurese noturna; em nossa prática clínica, observamos também uma alteração consistente na postura nessas crianças. Como a postura e o sistema de controle de equilíbrio são fortemente ligados, este estudo teve como objetivo investigar a postura e o equilíbrio em crianças e adolescentes com enurese noturna. Material e métodos: O estudo incluiu crianças e adolescentes com idades entre 7 e 16 anos; 65 com diagnóstico de enurese noturna monossintomática (ENM); 46 com enurese noturna não monossintomática (ENNM) pareadas em idade com 60 crianças assintomáticas (CTRL). Os participantes foram subdivididos em faixas etárias: A (7-11 anos de idade) e B (12-16 anos de idade). Integração sensorial e ajuste postural compensatório foram utilizados para inferir o equilíbrio, que foi avaliado utilizando uma plataforma de força eletrônica (100 Hz) para calcular a área do deslocamento do centro de pressão (COP). O COP é o ponto resultante da ação de forças verticais aplicados sobre a placa de força. A integração sensorial foi avaliada com o participante em pé, em uma tentativa de 60 segundos para cada uma das quatro condições sensoriais: (1) olhos abertos, superfície estável; (2) olhos fechados, superfície estável; (3) olhos abertos, superfície instável; (4) olhos fechados, superfície instável. O ajuste postural foi avaliado usando um cinto de tração posterior com uma carga equivalente a 4% de peso corporal, sendo esta liberada de maneira inesperada, de modo a produzir uma perturbação postural que foi observada durante os 8 segundos subsequente. A postura foi avaliada colocando marcos anatômicos reflexivos sobre a espinha ilíaca ântero-superior (ASIS), a espinha ilíaca póstero-superior (EIPS), o trocânter maior (GT) e o maléolo lateral (LM). Uma fotografia foi adquirida enquanto o participante permaneceu parado. Os ângulos foram obtidos a partir de conexões dos marcadores, utilizando o software para avaliar as seguintes variáveis: ante/retroversão da pelve e ante/retropulsão da pelve. A mobilidade do quadril foi medidas utilizando a goniometria manual. Resultados: Os grupos ENM e ENNM não apresentaram diferenças nas quatro condições sensoriais avaliadas. Deste modo continuamos seguimos a análise apenas com um grupo enurético comparado a um grupo controle. O GE/A apresentou maior área de deslocamento do COP em relação ao GC/A nas quatro condições sensoriais, enquanto o GE/B nas condições sensoriais 1, 2 e 4 quando comparado ao GC/B. Na avaliação do ajuste postural não houve diferença entre os grupos GE e GC para os subgrupos A e B mostrando que reagiram da mesma forma à perturbação. Embora tenha reagido igualmente à perturbação como averiguado em t1, o grupo GE/A comportou-se diferentemente do GC/A praticamente em todos os demais tempos. Em relação à postura e, mobilidade do quadril os grupos GE apresentou anteversão pélvica acentuada e extensão do quadril diminuída quando comparados ao GC em ambas faixas etárias. Conclusão: Crianças enuréticas apresentaram alterações no equilíbrio, na postura e, na mobilidade do quadril em relação à crianças do grupo controle
Introduction: Balance is the ability of an individual to control their body in space keeping it stable, even when submitted to any type of disturbance. Posture refers to the alignment of the body segments with minimal stress and strain on the muscles and ligaments, maintaining proper conditions to perform movements. The integration of the neuro-muscular system is required for maintaining balance, posture and for adequate voiding function. Various alterations, including the genetic, hormonal, behavioral, sleep disturbances, neuro-motor and sensory deficits are associated with nocturnal enuresis in children; in our clinical practice, we have observed a consistent alteration in their posture. Because posture and the balance control system are strongly connected, this study aimed to investigate posture and balance in children and adolescents with nocturnal enuresis. Material and methods: The study included children and adolescents aged between 7-16 years, 65 with monosymptomatic nocturnal enuresis (ENM); 46 with non-monosymptomatic nocturnal enuresis (ENNM) and 60 asymptomatic children (CTRL). The participants were divided into two age subgroups: A (7-11 years old) and B (12-16 years old). Sensory integration and compensatory postural adjustment were used to infer the balance that was assessed using an electronic force plate (100 Hz) to calculate the area of the center of pressure (COP) displacement. The COP is the point that results from the action of vertical forces projected onto the force plate. Sensory integration was analyzed using a 60-second trial with the participantes standing under four conditions: (1) eyes open, stable surface; (2) eyes closed, stable surface; (3) eyes open, unstable surface; (4) eyes closed, unstable surface. Postural adjustment was assessed using a posterior belt traction with 4% of body weight and unexpected release of it to produce a controlled postural perturbation followed by adjustments observed during 8 seconds. Posture was assessed by placing reflective anatomical landmarks on the anterior superior iliac spine (ASIS), the posterior superior iliac spine (PSIS), the greater trochanter (GT) and the lateral malleolus (LM). A photograph was acquired while the subject stood quietly. The angles were obtained from landmark connections using software to assess the following posture variables: pelvis ante/retroversion and pelvis ante/retropulsion. The hip mobility was measured using goniometry. Results: ENM and ENNM groups not showed difference in the four sensorial conditions. Thus we still follow the analysis with a only enuretic group compared to a control group (CG). The EG/A showed a greater area of COP displacement compared to the GC/A in all sensorial conditions, while EG/B in sensorial conditions 1, 2 and 4 when compared with CG/B. In the evaluation of postural adjustment no difference between EG and CG for subgroups A and B showing that reacted the same way to the disturbance. Although it has also responded to the disturbance as ascertained at t1, the EG/A behaved differently from GC/A virtually all other times. Regarding posture an hip mobility the EG and CG showed higher angles of pelvic anteversion and lower hip extension than CG. Conclusions: Enuretic children showed alterations in balance, posture with forward inclination of the pelvis, diminished mobility of hip and lower flexibility of spine

Sexual abuse of children and adolescents has reached pandemic proportions in Namibia. It is widely recognised that this traumagenic experience could have a profound and long-lasting effect on survivors. Nevertheless, few survivors in Namibia access therapy; often because of non-disclosure or non-reporting, being socioeconomically disadvantaged and the overburdened public sector therapists. This study set out to explore how adolescent survivors use the Nine Figure Picture Story (9FPS) embedded within the context of Gestalt Healing tasks. A variety of play therapy experiments was used to raise the clients’ awareness and to evoke their therapy stories (as these relate to Gestalt therapy) and their trauma stories (by means of the 9FPS). The researcher-therapist hoped that the study would enhance the understanding of the meaning-making of sexually abused adolescent clients, and in doing so, contribute to therapeutic practice in Namibia and elsewhere. Research which aims to uncover personal meaning-making and hear the voice of the participants already suggests that the qualitative paradigm would be apposite. An exploratory case study was conducted in Namibia between August 2010 and November 2010. Two adolescent survivors of sexual abuse who met the eligibility criteria were drawn from the population by means of nonprobability sampling. The sample was heterogeneous: one participant was a survivor of chronic intrafamilial rape; the other of a single incident, extrafamilial child sexual abuse (CSA). The data corpus included six and ten recorded therapeutic sessions with the two clients respectively; transcribed intake and termination semi-structured interviews with the parents; the researcher’s process and observation notes; and the clients’ objets d'art and Therapy diaries. To capture the tapestry of CSA accurately and holistically, the stories of the two participants were first analysed individually and thereafter synthesised into a theoretical comparative analysis. Trustworthiness was enhanced by means of investigator, theory, data and methodological triangulation. A number of safety, beneficence and non-maleficence measures contributed to the ethicality of this sensitive research. The research uncovered that, despite their differences, the two participants presented with posttraumatic signs and patterns often reported in the literature. Most insightful was how the survivors disavowed the CSA to become “not me” (Joyce & Sills, 2006: 92). As it relates to neurobiological hypotheses, it was revealed that the tactile and visuospatial Gestalt play therapy, specifically the 9FPS, seemed to access and address the fragmented, non-sequenced and non-verbal trauma memory. It was found that the 9FPSs gave the unfinished business from the past a miniaturised dimension in the present and that the “differentiated unity” (Reynolds, 2005: 162) enhanced its assimilation into the self.
Thesis (M.A. (Psychology))--North-West University, Potchefstroom Campus, 2012

As many as one in five children and adolescents may suffer from a mental health disorder, yet there are barriers that often prevent children from receiving optimal treatment. The current study explores the influence of practitioner license type, therapy modality, diagnosis, age, and gender on mental health therapy for children and adolescents. Data was provided by Cigna, a leading health care insurance provider in the United States. Participants include 106,374 boys (53.2%) and 93,753 girls (46.8%) ages 3 to 18 (M = 12.1, SD = 3.9) who were treated in outpatient facilities throughout the United States of America. Results indicate that there are differences in dropout, recidivism, cost, and treatment length by provider license, therapy modality, diagnosis, age, and gender. Specifically, results suggest that marriage and family therapists have the lowest percent recidivism and are among the lowest in terms of dropout and cost effectiveness. The results also suggest that family therapy is more cost effective than individual or mixed therapy and that mixed therapy has a much lower percent dropout than individual or family therapy. Analysis by diagnosis suggests a potential severity scale based on dropout, recidivism, and number of sessions. There are also significant differences in dropout and recidivism by age suggesting that younger children are more likely to dropout of treatment. These results provide valuable information about mental health treatment of children and adolescents. Specifically, utilizing a family based approach may help reduce the total length of treatment while utilizing a mixed mode approach to therapy may help reduce the risk of dropout from treatment. Also, some diagnoses appear to be more difficult to treat, with higher percentages of dropout and requiring more time and money for successful treatment. Limitations and future directions are discussed.

Relatório de Estágio elaborado no âmbito do I Curso de Mestrado em Enfermagem em Associação na Área de Especialização de Enfermagem de Saúde Mental e Psiquiatria, reportando a realização de dois estágios (hospitalar e comunitário) que fundamentam a aquisição e desenvolvimento de competências especificas do enfermeiro especialista baseadas na experiência na prestação de cuidados à criança e adolescente. Enquanto processo autoformativo, considera-se a teoria de Patricia Benner para ilustrar a experiência. A prática em contexto hospitalar incluiu a implementação da Atividade Terapêutica Dança e Movimento, baseada na metodologia 5 Rhythms e cujos resultados mostram ser benéficos na aplicação com grupos de crianças e adolescentes; ABSTRACT: Internship Report from the 1st Masters Course in Nursing in Association in the Area of Specialization in Mental Health and Psychiatric Nursing, reporting the accomplishment of two internships (hospital and community) that reflect the acquisition and development of nurse specialist specific skills, based on an experience of a children and adolescents care setting. As a self-learning process, Patricia Benner's theory is used to illustrate the experience. The practice in the hospital context included the implementation of a Therapeutic Activity Dance/Movement, based on the methodology of Rhythms 5 and whose results show the benefits in the application with groups of young people.

Background: Although rare relative to adult cancers, cancer is still the leading cause of disease-related death in children in developed countries, including Canada. Few studies have specifically examined the epidemiology and public health significance of diagnosis and treatment delays in childhood cancer. This study aimed to investigate the nature of delays in care for children and adolescents with cancer in Canada and to assess the potential impact of such delays on clinical outcomes.
Study Design: I conducted a prospective cohort study to investigate the delays of cancer symptoms reporting, diagnosis, and treatment in children between 0-19 years of age in Canada. This study used a database from Health Canada's Treatment and Outcomes component of the Canadian Childhood Cancer Surveillance and Control Program.
Methodology: Patients were identified from 17 paediatric cancer centres across Canada. Subjects included in this study were residents of Canada, aged less than 20 years, diagnosed with a malignant tumour and had information on date of first symptoms, diagnosis, treatment and outcome available. Descriptive statistics and regression techniques (linear, logistic and Cox regression) were used as appropriate. I measured the individual impact of patient and provider delays on disease severity and prognosis by using judicious control for potential confounding mechanisms and mediating factors.
Study Findings and Significance: By measuring various types of delays in Canada, I found that varying lengths of patient and referral delay, across age groups, types of cancers, and Canadian settings, are the main contributors to diagnosis, HCS and overall delay. Factors relating to the patients, the parents, healthcare and the cancer may all exert different influences on different segments of cancer care. I also found a negative association between diagnosis delay and disease severity for lymphoma and CNS tumour patients. Furthermore, I found that diagnosis and physician delay had a negative effect, while patient delay had a positive effect, on survival for patients diagnosed with CNS tumours. The information provided from this study may form the basis for new effective policies aimed at eliminating obstacles in cancer the diagnostic and care trajectories for Canadian children with cancer and for improving their prognosis.

AFRIKAANS: Die doel van hierdie studie is om te verken of die Ericksoniaanse terapiebenadering met sandspelterapie gekombineer kan word om kinders en adolessente wat depressiewe gedrag toon, te ondersteun. Die studie is uitgevoer deur middel van gevallestudies waar kinders en adolessente wat depressiewe gedrag toon, ondersteun is deur middel van die Ericksoniaanse benadering tot sandspelterapie. Die motivering vir hierdie studie hou verband met jarelange interaksie met kinders wat emosionele ontwikkelingsteurnisse ervaar het wat beperkend was met betrekking tot die bereiking van hul volle potensiaal. Ek wou dus ondersoek instel na die moontlikheid om die Ericksoniaanse terapie-benadering met sandspelterapie te kombineer in die behandeling van kinders en adolessente wat depressiewe gedrag toon. My navorsing was daarop gerig om ‘n moontlike kennisbydrae te lewer tot die gebruik van die gekombineerde benadering met kinders en adolessente wat depressie as ontwikkelingsteurnis ervaar. ‘n Teoretiese raamwerk is gebruik wat uit verskillende teorieë bestaan het as 'n lens waardeur ek data geanaliseer en interpreteer het. Die ekologiese teorie, sisteemteorie en transteoretiese model is tydens die studie as teoretiese raamwerk bespreek. ‘n Intervensiestudie gekombineer met ‘n gevalstudie as navorsingsontwerp is tydens my studie gebruik. Ek het kwalitatiewe datainsamelingstegnieke in die onderhawige studie geïmplementeer ten einde die navorsingsprobleem en bevindinge deurtastend te ondersoek en te beskryf. Die data-analisestrategieë wat in die studie geïmlementeer was, berus op Creswell (2003) en Creswell (2005) se benaderings (Sien bl. 109). In antwoord op my primêre navorsingsvraag, het ek tot die gevolgtrekking gekom dat die Ericksoniaanse benadering in kombinasie met sandspelterapie wel van waarde mag wees vir sommige kinders en adolessente wat depressie as ontwikkelingsteurnis ervaar.
ENGLISH: The aim of this study was to investigate the possibility of combining the Ericksonian method with sandplay therapy to support children and adolescents with depression as developmental disorder. The aforementioned was executed by examining case studies in which children and adolescents that showed depression was supported by the Ericksonian method to sandplay therapy. This study was motivated by the researcher’s interaction with children that showed emotional developmental disorders and where these developmental disorders delayed the attainment of their potential. One of the reasons for my research was the potential contribution of knowledge towards the use of the combined method with children and adolescents whom experience depression as developmental disorder. The echological theory, systems theory and trans-theoretical model was used as theoretical framework for my study. I made use of an intervention study combined with a case study during the research. In order to investigate and describe the research problem and findings I implemented qualitative data-collection strategies.
Thesis (PhD)--University of Pretoria, 2011.
Educational Psychology
unrestricted

Introdução: A enurese (EN) é uma condição clínica de etiologia multifatorial com característica de perda de urina intermitente no período noturno que promove uma dificuldade ao convívio social da criança/adolescente e pode ser afetada pela presença de comorbidades e por imaturidade do sistema nervoso na regulação central sobre o funcionamento vesical. O conjunto de eventos promotores do episódio da enurese, desde o enchimento vesical durante o sono até a deflagração do esvaziamento vesical involuntário sem acordar constitui-se no foco principal de abordagem clínico-laboratorial e terapêutica. Objetivo: Estudar o impacto de uma avaliação multidisciplinar do indivíduo com enurese noturna monossintomática (ENM) sobre a eficácia terapêutica dos métodos tradicionalmente utilizados em sua abordagem, assim como comparar, pela polissonografia (PSG), os efeitos da intervenção sobre a estrutura do sono. Método: Estudo prospectivo de crianças de 6 a 17 anos incompletos, com ENM, diagnosticada por avaliação multidisciplinar utilizando anamnese estruturada com enfoque nefropediátrico, exame clínico, diários das eliminações, ultrassonografia de rins e vias urinárias, análises laboratoriais de sangue e urina, exame neurológico, diário do sono, questionários de avaliação do sono e polissonografia, avaliação psicológica de distúrbios do comportamento pelo CBCL e da qualidade de vida pelo PedsQL 4.0 e avaliação fisioterapêutica do equilíbrio. Condições crônicas e genéticas constituíram exclusão do protocolo. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do HCFMUSP de número 0649/10 e apoio da FAPESP (2011/17589-1). Das 140 crianças/adolescentes ingressantes, foram excluídos 58 (41,4%) por comorbidades não tratáveis e/ou não aderência ao protocolo, 82/140 (58,6%) pacientes com ENM foram incluídos para intervenção terapêutica em três grupos de tratamento (alarme, desmopressina e alarme com desmopressina). A resposta à intervenção terapêutica foi avaliada no período pós-intervenção imediato (após seis meses de tratamento) e tardio (após 12 meses da suspensão do tratamento). A PSG foi realizada pré e pós-tratamento para análise comparativa da estrutura do sono. Resultados: Dos 82 pacientes, com idade média de 9,5 anos (? 2,6), 62 eram do sexo masculino (75,6%). Diagnosticou-se antecedente familiar de EN em 91,1% considerando parentes de 1° e 2° graus, constipação em 81,7% e apneia leve/moderada em 40,7%. A avaliação fisioterapêutica realizada na fase pré-intervenção demonstrou presença de alteração no controle do equilíbrio nos pacientes com enurese. A associação entre os fatores reconhecidos na abordagem clínica inicial e a gravidade da enurese (% de episódios/mês) na fase préintervenção, apresentou significância para prematuridade (p=0,03). Previamente à randomização, após abordagem clínica de constipação e/ou terapia comportamental simples, verificou-se cura de 7/82 pacientes. Foram randomizados para tratamento nas três modalidades de intervenção 75 pacientes. Durante a fase de intervenção ocorreram 14/75 (18,7%) desistências, principalmente no grupo alarme (p=0,00). Verificou-se nos 61 pacientes em tratamento, sucesso inicial (resposta completa e parcial) em 56,6% do grupo alarme, 70% do grupo desmopressina e 64% do grupo combinado (p=0,26). Sucesso contínuo (SC) ocorreu em 70% do grupo Alarme, 84,2% do grupo Desmopressina e 100% do grupo combinado (p=0,21). A recidiva ocorreu em 3/20 (15%) pacientes do grupo Alarme e 1/19 (5,2%) do grupo Desmopressina. O sucesso terapêutico se associou a redução nos escores de problemas de comportamento e melhora dos escores de qualidade de vida dos pacientes. A análise comparativa do sono pré e pós-intervenção nos pacientes com e sem alarme demonstrou aumento dos microdespertares (p=0,00), diminuição da eficiência do sono (p=0,02), diminuição de N2 (p=0,00) no grupo alarme. Conclusão: A enurese é um distúrbio multifatorial que exige uma abordagem diagnóstica estruturada. No presente estudo, a abordagem terapêutica utilizando três metodologias de intervenção demonstrou eficácia semelhante. Os benefícios associados ao sucesso terapêutico são amplos, sugere-se, no entanto, que a terapia com alarme possa repercutir negativamente na estrutura do sono
Introduction: Enuresis (NE) is a clinical condition of multifactorial etiology with intermittent nocturnal urine loss characteristic at night that leads to difficulties in child / adolescent social interaction. It can be affected by comorbidities and by immaturity of the central nervous system in the regulation of bladder function. The range of events of the bedwetting episode, from bladder filling until the involuntary triggering of bladder emptying during sleep, constitutes the main focus for clinical-laboratory and therapeutic approach. Objective: To study the impact of a multidisciplinary assessment of the patient with monosymptomatic nocturnal enuresis (MNE) on the therapeutic efficacy of the interventions traditionally used in its approach, and to compare, by polysomnography (PSG), the effects of intervention on sleep structure. Method: Prospective study of children, of 6 to 17 incomplete years, with MNE diagnosed by multidisciplinary assessment, based on: pediatric nephrology - oriented structured history, clinical examination, kidney and urinary tract ultrasound, laboratory tests of blood and urine and daily bladder and intestinal elimination diaries; neurological examination, sleep diary and sleep questionnaires and PSG; psychology evaluation using CBCL and PedsQL 4.0 questionnaires; physiotherapic evaluation of balance. The study was approved by the HCFMUSP Ethics Committee in Research of number 0649/10 and was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Grant # 2011/17589-1. Of the 140 children/adolescents entering the study, 58 (41.4%) were excluded because of non - treatable comorbidities and / or nonadherence to study protocol, 82/140 (58.6%) patients with MNE were included for therapeutic intervention in three treatment groups (alarm, desmopressin and alarm with desmopressin). The response to therapeutic intervention was evaluated in the immediate and late post-intervention period, respectively after six of treatment and after 12 months of posttreatment follow-up. Pre and post intervention PSG were compared to evaluate therapy impact on the structure of sleep. Results: Of 82 patients, 62 were male (75.6%) with mean age of 9.5 years (± 2.6). Family history of NE was diagnosed in 91.1% of first and second degree relatives, constipation in 81.7% and mild/moderate apnea in 40.7%. The physical therapy preintervention evaluation identified an alteration in the balance control of the MNE patients. In the pre-intervention phase, an association of prematurity with severity of enuresis (% of episodes/month) (p = 0.03) was identified. Enuresis cure was achieved, prior to randomization, after clinical approach to constipation and / or simple behavioral therapy, by 7/82 patients, 75 patients were randomized to treatment with three modes of intervention. During the intervention phase, a dropout rate of 14/75 (18.7%) patients was verified, especially in the alarm group (p = 0.00). Initial success (complete and partial response) was observed in 56.6% patients of the alarm group, 70% of the desmopressin group and 64% of the combined group (p = 0.26). Continued success (SC) occurred in 70% patients of the alarm group, 84.2% of desmopressin group and 100% of the combined group (p = 0.21). Recurrence occurred in 3/20 (15%) patients of the alarm group and 1/19 (5.2%) of desmopressin group. Therapeutic success was associated with a reduction in scores for behavioral problems and with improvement of patients\' quality of life scores. The comparative analysis between pre and post-intervention sleep structure parameters, in patients treated with and without alarm, showed increased arousals (p=0.00), decreased sleep efficiency (p = 0.02), decreased N2 (p = 0.00) in the alarm group. Conclusion: Enuresis is a multifactorial disorder that requires a structured diagnostic approach. In the present study, three therapeutic intervention methodologies demonstrated similar efficacy. The benefits associated with treatment success are multiple; the present study data suggest, however, that alarm therapy can have a negative effect on sleep structure

Orientador: Marcos Tadeu Nolasco da Silva
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A Síndrome de Imunodeficiência Adquirida (Aids) é atualmente uma doença crônica, controlável graças à Terapia Antirretroviral de Alta Atividade (TARV). Em um contexto de acesso universal ao tratamento, a adesão do paciente torna-se um fator limitante e desafiador. Este estudo teve como objetivo avaliar a prevalência da nãoadesão à TARV em uma coorte de crianças e adolescentes com o uso de instrumentos complementares, bem como identificar e compreender os fatores associados a ela. Casuística e Métodos: Estudo analítico, observacional, prospectivo do tipo corte transversal. A população foi composta por 108 pacientes infectados pelo Vírus da Imunodeficiência Humana (HIV) em TARV (60 meninos), com idades entre 8 e 19 anos. A adesão foi avaliada por meio de um questionário padronizado, consulta a registros de dispensação de farmácia (RDF) e uma escala de auto-eficácia. Foram entrevistados os responsáveis pela administração da medicação, cuidadores ou pacientes. Indivíduos que receberam menos de 95% das doses prescritas nas 24 horas ou nos 7 dias anteriores à entrevista, ou que apresentaram um intervalo maior que 37 dias no RDF nos três meses anteriores à entrevista, foram considerados não-aderentes. A escala de auto-eficácia forneceu um escore contínuo, com amplitude de 0 a 100. Foi avaliada a associação de variáveis independentes ligadas a condições demográficas, clínicas, imunológicas, virológicas, e psicossociais aos desfechos de adesão. Na análise estatística univariada foi utilizada a determinação de Odds Ratios (OR) para a comparação entre variáveis categóricas, o teste de Mann-Whitney para a comparação entre variáveis contínuas e categorias, e determinado Coeficiente de Correlação de Spearman (rs) para a comparação entre variáveis contínuas. Resultados foram considerados significativos com valor de p _ 0,05. Para o controle de variáveis de confundimento, foi utilizada a análise multivariada com o uso de regressão logística. O estudo foi aprovado pelo Comitê de Ética em Pesquisa em Seres Humanos da Faculdade de Ciências Médicas da Universidade Estadual de Campinas. Resultados: A prevalência de não-adesão variou entre 11,1% (pacientes não aderentes por 3 instrumentos), 15,8% (auto-relato de 24 horas), 27,8% (auto-relato semanal), 45,4% (RDF) e 56,3% (ao menos um dos 3 desfechos). Os auto-relatos de 24 horas e 7 dias, quando comparados ao RDF, mostraram baixa sensibilidade (29% e 43%, respectivamente) e alta especificidade (95% e 85%, respectivamente). As seguintes variáveis independentes apresentaram associação estatisticamente significativa com a não-adesão na análise univariada, de acordo com o instrumento: Auto-relato de 24 horas: dificuldade de administração pelo cuidador (OR = 9,11; IC95% = 2,87 - 28,98); paciente não-praticante de religião (OR = 2,76; IC95% = 0,92 - 8,32); intolerância à medicação (OR=4,61; IC95% =1,47 - 14,42); renda per capita (medianas de US$ 137,91 vs US$ 208,33; p = 0,016); número de ITRNs com mutações de resistência (medianas de 6 vs 1; p = 0,016); Auto-relato de 7 dias: dificuldade de administração pelo cuidador (OR = 2,91; IC95% = 1,05 - 8,12; administração da TARV pelo paciente (OR = 3,59; IC95% = 1,47 - 8,78); cuidador com 8 ou menos anos de escolaridade (OR = 3,25; IC95% = 1,03 - 10,30); paciente com mais de 8 anos de escolaridade (OR = 3,70; IC95% = 1,41 - 0,70); idade do paciente (medianas de 13,94 vs 12,94; p = 0,03); renda per capita (medianas de US$ 131,67 vs US$ 201,39; p = 0,009); Registro de dispensação de farmácia: dificuldade de administração pelo cuidador (OR = 3,19; IC95% = 1,11 - 9,17); administração da TARV pelo paciente (OR = 2,70; IC95% = 1,15 - 6,33); falha de controle virológico (OR = 3,70; IC95% = 1,67 - 8,33); falta a consulta nos últimos 6 meses (OR = 3,27 IC95% = 1,38 - 7,78); paciente nãopraticante de religião (OR = 2,47 IC95% = 1,10 - 5,57); cuidador não-praticante de religião (OR = 3,19; IC95% = 1,36 - 7,50); cuidador com emprego fora do domicílio (OR = 2,27; IC95% = 1,05 - 4,92); renda per capita (medianas de US$ 166,67 vs US$ 222,22; p = 0,014); As seguintes variáveis independentes apresentaram associação estatisticamente significativa com a não-adesão na análise multivariada, de acordo com o instrumento: Auto-relato de 24 horas: intolerância à medicação (OR = 9,11; IC95% = 2,87 - 28,98); Auto-relato de 7 dias: dificuldade de administração pelo cuidador (OR = 2,91; IC95% = 1,05 - 8,12); administração da TARV pelo paciente (OR = 3,59; IC95% = 1,47 - 8,78); classe socioeconômica C+D (3,54; 0,97 - 2,85); Registro de dispensação de farmácia: falha de controle virológico (OR = 3,73; IC95% = 1,68 - 8,31); falta a consulta nos últimos 6 meses (OR = 3,27 (IC95% = 1,38 - 7,78); cuidador não-praticante de religião (OR = 3,19; IC95% = 1,36 - 7,50); O escore de auto-eficácia teve mediana de 95,20 (11,90 - 100) e mostrou associação significativa com dificuldade de administração da medicação pelo cuidador (mediana de 78,5 vs 95,2; p = 0,001), falha de controle virológico (mediana de 90,4 vs 100; p = 0,001), administração da TARV pelo paciente (mediana de 89,8 vs 95,2; p = 0,05), falta à consulta nos últimos seis meses (mediana de 86,3 vs 100, p < 0,001), categoria clínica N, A ou B (mediana de 90,47 vs 100; p = 0,018), paciente não praticante de religião (mediana de 90,4 vs 95,2, p = 0,037), orfandade (mediana de 95,2 vs 90,4 p = 0,05), relação CD4/CD8 (rs = 0,220; p = 0,025), número de classes de antirretrovirais com resistência viral (rs = 0,583; p < 0,001), número de ITRNs com resistência viral (rs = 0,44; p = 0,009), renda per capita (rs = 0,302; p = 0,001), Escore PedsQL domínio emocional (rs = 0,265; p = 0,007). Conclusão: Na população estudada, observou-se alta prevalência de falha de adesão à TARV, com maior sensibilidade de detecção pela análise da retirada de medicamentos na farmácia. Adicionalmente, observou-se associação entre os escores de auto-eficácia e as categorias de adesão. Os instrumentos utilizados mostraram-se complementares na identificação de fatores de risco para a não-adesão. Com o objetivo de eliminar variáveis de confundimento, sete fatores foram identificados como associados a dificuldade de adesão: intolerância à medicação, dificuldade de administração da medicação pelo cuidador, responsabilidade de administração medicação pelo próprio paciente, classe socioeconômica mais baixa, ausência de controle virológico, cuidador não praticante de religião e faltas às consultas
Abstract: Background: The Acquired Immunodeficiency Syndrome (Aids) is currently a chronic disease, manageable by Highly Active Antiretroviral Therapy (HAART). In a setting of universal access to treatment, patient adherence arises as a limiting and challenging issue. This study aimed to evaluate the prevalence of nonadherence to HAART in a cohort of children and adolescents, using complementary instruments, and also identify and understand associated factors. Patients and Methods: Observational, analytical, prospective, cross-sectional study. The study population comprised 108 Human Immunodeficiency Virus (HIV) -infected patients on HAART (60 boys), from 8 to 19 years-old. Adherence was evaluated by a standardized questionnaire, pharmacy refill data (PRD) and a self-efficacy scale. Patients or caregivers were interviewed (whoever was in control of medicine administration). Patients who received less than 95% of prescribed doses in the 24 hours of 7 days before the interview, or who had a record of an interval of more than 37 days between refills, were considered nonadherent. The self-efficacy scale provided a continuous score, varying from 0 to 100. The association between adherence outcomes and independent variables related to demographical, clinical, immunological, virological and psychosocial conditions was estimated. Statistical analysis was performed with the use of Odds Ratios (OR) for comparison between categorical variables, Mann-Whitney test for comparison between continuous variables and categories, and Spearman Correlation Coefficient (rs) for comparison between continuous variables. Results were considered statistically significant if p _ 0.05. Confounding variables were controlled by multivariate analysis with logistic regression. The study was approved by the Human Research Ethics Committee of the State University of Campinas Faculty of Medical Sciences. Results: Nonadherence prevalence varied from 11.1% (nonadherent patients in 3 instruments), 15.8% (24-hour self-report), 27.8% (7-day self-report), 45.4% (PRD) and 56.3% (at least one of the outcomes). Self-reports from 24 hours and 7 days, when compared to PRD, showed low sensitivity (29% and 43%, respectively) and high specificity (95% and 85%, respectively). The following independent variables showed statistically significant association with nonadherence on univariate analysis, according to each instrument: Twenty-four hour self-report: difficulty of ministration by caregiver (OR = 9.11 ; 95%CI = 2.87 - 28.98); lack of religious practice by patient (OR = 2.76; 95%CI = 0.92 - 8.32); medication intolerance (OR=4.61; 95%CI =1.47 - 14.42); per capita income (median US$ 137.91 vs US$ 208.33; p = 0.016); number of nucleoside/nucleotide analogues (NRTIs) with resistant mutations (median 6 vs 1; p = 0.016); Seven-day self-report: difficulty of ministration by caregiver (OR = 2.91; 95%CI = 1.05 - 8.12; HAART ministration by the patient (OR = 3.59; 95%CI = 1.47 - 8.78); caregiver with 8 or less years of school attendance (OR = 3.25; 95%CI = 1.03 - 10.30); patient with 8 or more years of school attendance (OR = 3.70; 95%CI = 1.41 - 0.70); patient age (median 13.94 vs 12.94; p = 0.03); per capita income (median US$ 131.67 vs US$ 201.39; p = 0.009); Pharmacy refill data: difficulty of ministration by caregiver (OR = 3.19; 95%CI = 1.11 - 9.17); HAART ministration by the patient (OR = 2.70; 95%CI = 1.15 - 6.33); lack of virological control (OR = 3.70; 95%CI = 1.67 - 8.33); missed consultations in the former 6 months (OR = 3.27 (95%CI = 1.38 - 7.78); lack of religious practice by patient (OR = 2.47 (95%CI = 1.10 - 5.57); lack of religious practice by caregiver (OR = 3.19; 95%CI = 1.36 - 7.50); caregiver working outside the home (OR = 2.27; 95%CI = 1.05 - 4.92); per capita income (median US$ 166.67 vs US$ 222.22 ; p = 0.014); The following independent variables showed statistically significant association with nonadherence on multivariate analysis, according to each instrument: Twenty-four hour self-report: medication intolerance (OR = 9.11; 95%CI = 2.87 - 28.98); Seven-day self-report: difficulty of ministration by caregiver (OR = 2.91; 95%CI = 1.05 - 8.12); HAART ministration by the patient (OR = 3.59; 95%CI = 1.47 - 8.78); socioeconomical classes C+D (3.54; 0.97 - 2.85); Pharmacy refill data: lack of virological control (OR = 3.73; 95%CI = 1.68 - 8.31); missed consultations in the former 6 months (OR = 3.27 (95%CI = 1.38 - 7.78); lack of religious practice by caregiver (OR = 3.19; 95%CI = 1.36 - 7.50); The self-efficacy score had a median of 95.20 (11.90 - 100) and showed significant association with difficulty of ministration by caregiver (median 78.5 vs 95.2; p = 0.001), lack of virological control (median 90.4 vs 100; p = 0.001), HAART ministration by patient (median 89.8 vs 95.2; p = 0.05), missed consultations in the former 6 months (median 86.3 vs 100, p < 0.001), clinical categories N, A or B ( median 90.47 vs 100; p = 0.018), lack of religious practice by patient (median 90.4 vs 95.2, p = 0.037), being orphan (median 95.2 vs 90.4 p = 0.05), CD4/CD8 ratio (rs = 0.220; p = 0.025), number or antiretroviral classes with resistance (rs = 0.583; p < 0.001), number of NRTIs with resistance (rs = 0.44; p = 0.009), per capita income (rs = 0.302; p = 0.001), PedsQL score, emotional domain (rs = 0.265; p = 0.007). Conclusion A high prevalence of HAART nonadherence was observed in the study population, being pharmacy refill data the most sensitive measurement. Additionally, an association was observed between adherence outcomes and self-efficacy scores. The instruments employed showed complementarity in the recognization of nonadherence risk factors. Aiming to eliminate confounding variables, seven factors were identified as associated to lack of adherence: medication intolerance, difficulty of ministration by the caregiver, ministration of medicines by the patient, lower socioeconomic class, lack of virological control, lack of religious practice by the caregiver and missed consultations
Mestrado
Saude da Criança e do Adolescente
Mestre em Ciências

The overarching aim of this research project is to identify a comprehensive and detailed outline of the systemic therapist competences in the Norwegian child and adolescent mental health (BUP) that target the psychosocial difficulties that are categorized as associated abnormal psychosocial situations in the multiaxial classification of child and adolescent psychiatric disorders/axis 5 (ICD-10). The project is based on twelve qualitative in-depth interviews with six experienced systemic family therapists, fieldwork observations of the therapists (participants) in practice and an analysis of the Norwegian Directorate of Health’s guidelines for child and adolescent mental health institutions. The specific research questions for this research project are: 1. In the context of child and adolescent mental health, what are the different competences in a systemic family therapy approach that address the associated abnormal psychosocial situations? 2. What are the legally binding requirements in the Norwegian Directorate of Health’s (2008) guidelines for child and adolescent mental health? 3. How does systemic family therapy interconnect with the Norwegian Directorate of Health`s (2008) guidelines for child and adolescent mental health? Grounded theory (GT) was chosen as the main methodology for this study. During the analysis, the following six overarching categories were identified: (1): legally binding requirements; (2) the importance of ethical and contextual awareness in systemic therapy; (3) the systemic therapist’s stance; (4) therapeutic processes; (5) therapeutic practices; and (6) session-specific features. Challenges, such as limiting the systemic approach to six overarching competences, are discussed alongside this study’s strengths and limitations, and suggestions for future research are presented. The detailed outline of the systemic therapist competences and the legally binding requirements in the Norwegian Directorate of Health’s guidelines was compiled into a “map of competences”. The findings show that the legally binding requirements interconnect and overlap with the identified systemic competences, although their wording and their inclusion of diagnosis can challenge the systemic ideas of using a non-pathologizing language. The map of competences is intended to be applied as a tool for clinical supervision, clinical practice, education and training in family therapy. This research may also facilitate a “bridge-building process” between mental health and postmodern systemic ideas.

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Financiadora de Estudos e Projetos
The inclusion of children and adolescents in the mental health field was late and there s a gap between demand and offer of assistance in the field. Currently, there are actions to implement a policy on mental health of children and adolescents seeking to build a network of services, which main actions are the implementation of Psychosocial Care Centers for Children and Youth (CAPSi) and building strategies for intersectorial articulation between health mental and sectors that assist children and adolescents. The occupational therapist (OT) is a professional who makes up the team of CAPSi and is present in the process of effective actions aimed at this population. There are still few national and international studies published over the actions of the OT in child and adolescent mental health. This study aimed to characterize the inclusion of OT in CAPSi and identify the actions taken by them with users. Furthermore, it aimed to characterize the specific dynamics of CAPSi; characterize the users cared by occupational therapists in CAPSi; identify, by the perspective of occupational therapists, if CAPSi respond to Brazilian public policies of child and adolescent mental health; and identify possible gaps during graduation for OT work in the field of child and adolescent mental health. This is a descriptive study, with quantitative and qualitative approach. A total of 24 occupational therapists inserted in 18 units CAPSi the State of São Paulo participated on this study. To data collection, it was used a questionnaire, with presentation of open and closed questions. It was found that 26 of 38 units CAPSi in the State of São Paulo have occupational therapist in your staff. It was found that groups and workshops are the main programs, projects and activities offered to users and groups are the main actions to relatives. The participants assess that, even with limitations, the actions taken in the units respond to the proposals of Brazilian public policies and SUS. The only actions, which characterize the specificity of occupational therapy, undertaken by occupational therapists are related to the tools used by this professional such as analysis of activity, social inclusion and activities in daily life, as the focus on activities of daily living. It was found that the actions of occupational therapists are guided by aspects related to users such as their needs and diagnosis. Regarding gaps during graduation, the participants pointed out the insufficient content of basic/clinical disciplines on child and adolescent mental health. It s Indicated the need to reflect on the CAPSi not being the only equipment responsible for assisting the child and youth with psychological distress, necessitating the realization and consolidation of intersectoral actions to achieve psychosocial rehabilitation. It is believed that this study will assist the knowledge produced in the field of child and adolescent mental health, knowledge about the practices and training of occupational therapists in this field, as well as contribute to reflections about public policy and improving interventions.
A inserção da criança no campo da saúde mental ocorreu tardiamente e há uma defasagem entre a demanda e a oferta de assistência no campo. Atualmente, existem ações para implantar uma política de saúde mental infanto-juvenil que buscam a construção de uma rede de serviços, cujas ações principais são a implantação de Centros de Atenção Psicossocial Infanto-juvenil (CAPSi) e a construção de estratégias de articulação intersetorial da saúde mental com os setores que assistem crianças e adolescentes. O terapeuta ocupacional (TO) é um dos profissionais que compõe a equipe dos CAPSi e está presente neste processo de efetivação de ações voltadas para esta população. Ainda são poucos os estudos nacionais e internacionais publicados sobre as ações do TO em saúde mental infanto-juvenil. Este estudo objetivou caracterizar a inserção do TO nos CAPSi e identificar as ações desenvolvidas pelos mesmos junto a clientela atendida. Além disso, teve como objetivos específicos caracterizar a dinâmica de funcionamento dos CAPSi; caracterizar os usuários atendidos pelos terapeutas ocupacionais nos CAPSi; identificar, através da ótica dos terapeutas ocupacionais, se os CAPSi respondem às políticas públicas brasileiras de saúde mental infanto-juvenil; e identificar possíveis lacunas durante a graduação para a atuação do TO no campo da saúde mental infanto-juvenil. Trata-se de um estudo descritivo, com abordagem quanti-qualitativa. Participaram 24 terapeutas ocupacionais inseridas em 18 unidades de CAPSi do Estado de São Paulo. Para a coleta de dados, utilizou-se um questionário com 55 questões, com apresentação de perguntas fechadas e abertas. Verificou-se que 26 de 38 unidades de CAPSi existentes no Estado de São Paulo possuem TO em seu quadro de funcionários. Em relação aos programas e projetos desenvolvidos nas unidades, os resultados revelaram que os grupos e oficinas constituem os principais programas oferecidos aos usuários e os grupos são as principais ações voltadas aos familiares. As participantes avaliam que, ainda que com limitações, as ações desenvolvidas nas unidades respondem às proposições das políticas públicas brasileiras e do SUS. As ações únicas, que caracterizam a especificidade da terapia ocupacional, desenvolvidas pelas participantes estão relacionadas à análise da atividade, a inserção social e as atividades no cotidiano, como o enfoque nas atividades de vida diária. Verificou-se que as ações dos terapeutas ocupacionais são norteadas por aspectos relativos aos usuários como, por exemplo, suas necessidades e diagnóstico. Em relação às lacunas de conhecimento teórico ou prático durante a graduação que dificultaram as ações junto a esta população no campo da saúde mental, as participantes apontaram o conteúdo insuficiente de disciplinas específicas e/ou clínicas em saúde mental infanto-juvenil. Indica-se a necessidade de refletir sobre o CAPSi não ser o único equipamento responsável pela assistência a população infanto-juvenil com sofrimento psíquico, sendo necessário a efetivação e consolidação das ações intersetoriais para a concretização da reabilitação psicossocial. Acredita-se que este estudo colaborará para o conhecimento produzido no campo da saúde mental infanto-juvenil, para o conhecimento sobre as práticas e sobre a formação do TO nesse campo, assim como contribuirá para reflexões acerca das políticas públicas e o aprimoramento das intervenções.

Children with autism typically present with sensory processing difficulties that affect their ability to relate to people. This qualitative study focused on exploring the sensory processing of children with autism and their mothers, using a frame of reference of sensory integration theory. The purpose of the study was to help mothers gain knowledge and understanding into their own sensory processing so that they could develop a better understanding of their child&rsquo
s sensory processing in order to facilitate better mother-child relationships. An evaluation tool, the Sensory Profiles by Dunn (1999) and the Adolescent/Adult Sensory Profile by Brown &
Dunn (2002) was used as the instrument for gathering information on sensory processing. The population consisted of ten sets of mothers and their children with autism who attend Vera School for Learners with Autism. The Sensory 
rofiles was completed to investigate the phenomenological issues regarding the sensory modulation aspects of the parent-child relationship. Each mother received individual feedback on their own and their child&rsquo
s sensory processing. Two focus groups were then conducted with the mothers to determine the value of the information gained from the 
rofiles. Data consisted of two audio taped feedback from the focus group. Data was analysed for emerging themes. The three major themes that emerged were, (a) You realize 
ow similar you are to your child, (b) I also have needs (c) They walk away and leave you with this wreck of a child. The findings of the study suggest that an understanding of 
ensory processing can influence the mother-child relationship positively.

There is a large amount of research on BPD which highlights the pervasive and distressing nature of this disorder along with its resulting high financial cost to services. Previous research exploring intervention options for BPD have found DBT to beneficial in reducing parasuicidal behaviour and it is acknowledged as the intervention of choice for adults. The research evidence on ‘what works’ for adolescents with BPD is limited, although DBT is an intervention offered in clinical practice. This study aims to contribute to the research on the effectiveness of DBT by exploring adolescents’ experience of receiving this therapy. Five participants took part in the study and verbatim transcripts from their interviews were analysed using Thematic Analysis. The aim of the analysis was to develop understanding on what adolescents found to be the most and least helpful aspects of DBT and to help ascertain whether participants viewed this therapy as effective in reducing their presenting difficulties. Results identified four main themes which were constructed from the data set; ‘Clinical Picture’, ‘Deciding to start DBT’, ‘Evaluation of DBT’ and ‘Change’, with each theme containing between two and six sub-themes. The themes were seen to connect with each other to represent participants’ journey through therapy. Clinical implications of the research indicate that clinicians play an important role in the process of therapy and contribute to both positive and negative experiences. It appears there is a need for clinicians working with this client group to be appropriately trained and skilled to provide flexible care. In addition the findings from the current study suggest DBT did not target the multiple and varied problems the adolescents presented with, resulting in on-going difficulties and high levels of disengagement and drop-out rates. Whilst participants felt the intervention contained positive elements, overall they reported dissatisfaction with the outcome of therapy. Services may therefore need to consider alternative or additional intervention options to target adolescents’ presenting difficulties and help improve their quality of life.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Fisioterapia
Introdução: a escoliose é caracterizada por uma alteração estrutural anatómica tridimensional, avaliada através do ângulo de Cobb. A escoliose idiopática do adolescente (EIA) é um dos tipos de escoliose mais comum. Objetivo: analisar a eficácia dos métodos Schroth e Pilates na redução do ângulo de Cobb na EIA. Metodologia: a pesquisa foi feita a partir das bases de dados PubMed e PEDro, foram incluídos artigos publicados a partir de 2015, e avaliados metodologicamente segundo a escala Critical Appraisal Skills Programme (CASP). Resultados: nesta revisão foram incluídos 6 estudos, com 220 participantes com idades compreendidas entre 13 e 21 anos, sendo 186 do género feminino e 34 do género masculino. A aplicação do método Schroth, de um modo isolado ou associada a outras técnicas terapêuticas, assim como o método de Pilates, são efetivas na diminuição dos ângulos da curvatura. A sua efetividade aumenta quando são supervisionados por fisioterapeutas. Conclusão: a aplicação dos métodos Schroth e Pilates pode contribuir para a redução do ângulo de Cobb nas escolioses idiopáticas dos adolescentes.
Introduction: scoliosis is characterized by a three-dimensional anatomical structural alteration, assessed through the Cobb angle. Adolescent idiopathic scoliosis (AIS) is one of the most common types of scoliosis. Objective: to analyze the effectiveness of the Schroth and Pilates methods in reducing the Cobb angle in AIS. Methodology: the research was carried out from the PubMed and PEDro databases. Articles published since 2015 were included and evaluated methodologically according to the Critical Appraisal Skills Program (CASP) scale. Results: 6 studies were included in this review, with 220 participants aged between 13 and 21 years old, 186 of whom were female and 34 who were male. The application of the Schroth method, in an isolated way or associated with other therapeutic techniques, as well as the Pilates method, are effective in decreasing the curvature angles. Their effectiveness increases when they are supervised by physical therapists. Conclusion: the application of the Schroth and Pilates methods can contribute to the reduction of the Cobb angle in adolescent idiopathic scoliosis.
N/A

Introduction: Insulin Pump Therapy has gained worldwide acceptance for the treatment of Type 1 diabetes mellitus (T1D), offering a new method of insulin delivery, which circumvents the need for Multiple Daily Injections (MDI). It is thought to improve quality of life (QoL) by facilitating an increase in lifestyle flexibility, independence and glycaemic control (Scottish Intercollegiate Guidelines Network, 2010; National Institute for Clinical Excellence, 2008). These benefits have resulted in the National Health Service (NHS) Scotland pledging funding of at least £1million to deliver insulin pumps to under 18s (Scottish Government, 2012). Currently, investigations regarding the impact of Insulin Pump Therapy on QoL have resulted in conflicting findings (Barnard et al., 2007). This study aims to explore the impact of Insulin Pump Therapy on the QoL of children and adolescents, using Interpretative Phenomenological Analysis. Method: Eight participants with T1D, aged between 8 and 13 years and using an insulin pump, were recruited from the Glasgow Royal Hospital for Sick Children Diabetes Clinic. Each participant completed an in-depth interview, which explored their beliefs and attitudes towards Insulin Pump Therapy including its impact on their QoL. Results: Analysis of the transcripts led to the identification of six super-ordinate themes: ‘Physical Impact’, ‘Mood and Behaviour’, ‘Lifestyle Flexibility’, ‘Practicalities’, ‘Peer Reactions’, and ‘Support’. It is suggested that these six factors are not mutually exclusive and together inform the complexity of individuals’ experiences and the impact that the insulin pump has had on many aspects of their lives. These findings suggest a framework to help clinicians understand how young people with T1D perceive and conceptualise their treatment regimes. Conclusions: There was general agreement amongst participants that switching to Insulin Pump Therapy resulted in improvements to their QoL. Additional concerns were outlined but reportedly none of the participants regretted switching to an insulin pump.

Background: Long term survival of children living with HIV due to improved early access to antiretroviral therapy (ART) is contributing to a growing population of adolescents living with perinatally acquired HIV (PHIV+) at risk of developing chronic multisystem comorbidity. There is limited knowledge on the overall burden, progression and causes of morbidity in PHIV+ adolescents, especially in resource limited settings. Much of what is known about morbidity in PHIV+ adolescents relates to single organ system pathology and there is a lack of a holistic approach to PHIV+ adolescents and their overall health. The aim of this PhD project was therefore to investigate the spectrum and determinants of chronic morbidity, the progression of disease and intercurrent illness in PHIV+ adolescents on ART over a 4- year period. Methods: This was a prospective study of participants enrolled in the Cape Town Adolescent Antiretroviral Cohort (CTAAC), a longitudinal cohort study, that recruited 515 PHIV+ adolescents and 110 HIV negative (HIV-) adolescents matched by age from 7 health care sites in Cape Town, South Africa. Eligibility criteria included PHIV+ adolescents who were aged 9-14 years, who had been on ART for at least 6 months and were aware of their HIV status. All adolescents and caregivers gave informed consent/assent. Participants were followed 6-monthly with questionnaires, clinical examination with detailed pulmonary (lung function), neurocognitive (magnetic resonance imaging and a battery of neurocognitive tests), cardiovascular (echocardiogram and ECG) and laboratory investigations. Analyses for each specific objective of the PhD were developed. Three analyses used data from the enrolment visit and were primarily descriptive and two were longitudinal and examined the incidence of hospitalizations, QuantiFERON conversion (an interferon gamma release assay used to measure Mycobacterium tuberculosis infection) and Tuberculosis (TB) disease. Results: Five hundred fifteen PHIV+ and 109 HIV- participants had a median follow-up of 4.1 years (IQR: 3.7–4.6). At enrollment, PHIV+ adolescents had a median duration of ART of 7.6 years (IQR: 4.6–9.2), median CD4 count of 713 cells/mm3 (IQR: 561.0–957.5) and 387 (75%) had a viral load of <50 copies/mL. Neurocognitive impairment was present in more than half of the PHIV+ cohort (56.3% vs. 45.3% in HIV-, p=0.05) but renal impairment was rare (2.3% in PHIV+ vs. 2.1% in HIV-, p=0.89). Microalbuminuria was also rare (8.0 in PHIV+ vs. 9.0% in HIV-, p=0.80). Respiratory or cardiac impairment were more common in PHIV+ adolescents than in HIV- participants (27.1% vs. 14.7%, p=0.01 and 46.1% vs. 33.7%, p=0.03, respectively). Multisystem impairment (defined as impairment of ≥ 3 systems) was uncommon, with only 10% of PHIV+ adolescents having 4-system impairment. Metabolic abnormalities, such as insulin resistance (IR), were relatively common but IR rates did not differ compared to HIV- adolescents (18 vs. 20%, p= 0.17). Incidence rates for hospitalization were 6.6 per 100-person-years (PY) in PHIV+ adolescents, three times that of HIV- adolescents. Sixty percent of hospitalization episodes were due to non-infectious causes and 24% due to infectious causes, of which pneumonia and TB were the predominant causes. PHIV+ adolescents had a substantially higher incidence of TB disease than HIV- adolescents (2.2/100 PY, 95% CI 1.6-3.1 vs. 0.3/100 PY, 95% CI 0.04-2.2), despite a similar rate of TB infection, as measured by QuantiFERON positivity. TB disease was associated with low CD4 counts and high viral loads in PHIV+ adolescents. Conclusion: Chronic single system morbidity experienced by PHIV+ adolescents on ART was common and merits further study, as this population begins to engage in adult lifestyle factors, such as smoking and alcohol use, that may compound these abnormalities. However, multisystem morbidity was relatively rare. In addition, in a relatively small percentage of adolescents there were subclinical metabolic abnormalities (IR and microalbuminuria) that may result in increased morbidity especially with regards to diabetes and cardiovascular disease in later life. The high burden of hospitalization and intercurrent disease, mainly due to TB, could be prevented by proven strategies, such as TB preventive therapy and ensuring adherence to optimal ART regimens.

Anxiety disorders; such as separation anxiety disorder, generalized anxiety disorder, social phobia and specific phobia, are widespread in children and adolescents. Cognitive behavioral therapy (CBT) has been shown to be effective in reducing excessive fears and anxieties in children and adolescents. Research has produced equivocal findings that involving parents in treatment of child anxiety enhances effects over individual CBT (ICBT). The present dissertation study examined whether parental involvement can enhance individual treatment effect if the parent conditions are streamlined by targeting specific parental variables. The first parent condition, Parent Reinforcement Skills Training (RFST), involved increasing mothers’ use of positive reinforcement and decreasing use of negative reinforcement. The second parent condition, Parent Relationship Skill Training (RLST), involved increasing maternal child acceptance and decreasing maternal control (or increasing autonomy granting). Results of the present dissertation findings support the use of all three treatment conditions (ICBT, RLST, RFST) for child anxiety; that is, significant reductions in anxiety were found in each of the three treatment conditions. No significant differences were found between treatment conditions with respect to diagnostic recovery rate, clinician rating, and parent rating of child anxiety. Significant differences between conditions were found on child self rating of anxiety, with some evidence to support the superiority of RLST and RFST to ICBT. These findings support the efficacy of individual, as well as parent involved CBT, and provide mixed evidence with respect to the superiority of parent involved CBT over ICBT. The conceptual, empirical, and clinical implications of the findings are discussed.

Phobic and anxiety disorders are one of the most common, if not the most common and debilitating psychopathological conditions found among children and adolescents. As a result, a treatment research literature has accumulated showing the efficacy of cognitive behavioral treatment (CBT) for reducing anxiety disorders in youth. This dissertation study compared a CBT with parent and child (i.e., PCBT) and child group CBT (i.e., GCBT). These two treatment approaches were compared due to the recognition that a child’s context has an effect on the development, course, and outcome of childhood psychopathology and functional status. The specific aims of this dissertation were to examine treatment specificity and mediation effects of parent and peer contextual variables. The sample consisted of 183 youth and their mothers. Research questions were analyzed using analysis of variance for treatment outcome, and structural equation modeling, accounting for clustering effects, for treatment specificity and mediation effects. Results indicated that both PCBT and GCBT produced positive treatment outcomes across all indices of change (i.e., clinically significant improvement, anxiety symptom reduction) and across all informants (i.e., youths and parents) with no significant differences between treatment conditions. Results also showed partial treatment specific effects of positive peer relationships in GCBT. PCBT also showed partial treatment specific effects of parental psychological control. Mediation effects were only observed in GCBT; positive peer interactions mediated treatment response. The results support the use CBT with parents and peers for treating childhood anxiety. The findings’ implications are further discussed in terms of the need to conduct further meditational treatment outcome designs in order to continue to advance theory and research in child and anxiety treatment.

This thesis follows a paper based format where papers 1 and 2 are stand-alone papers prepared for submission to the Journal of Pediatric Psychology. The relevant submission guidelines are included in the Appendix. Paper One: The purpose of this systematic review was to assess the effects of family-centred interventions for children and adolescents with Type 1 diabetes and review the bias associated with included studies. The review summarises the outcome measures which consisted of HbA1cs, hospital admissions for diabetic ketoacidosis (DKA), adherence, and family relationships including diabetes-related conflict. Research studies that were randomized controlled trials were selected to maximise the quality of information reviewed. Electronic searches of the OVID database using MEDLINE, PsycINFO, EMBASE, and CENTRAL were searched from their start dates until May 2012. Nine studies were located and assessed with the Cochrane risk of bias tool. Two studies were excluded from further analysis due to serious concerns about bias of their results. The remaining 7 had their findings summarised in a narrative statement, which indicated that family-centred interventions significantly improved HbA1cs, reduced DKA admission rates, improved adherence, and enhanced family relationships including reduced conflict. Family-centred interventions appear to be effective in enhancing health and psychological outcomes. The interventions however, were mainly in clinical settings and delivered by trained professionals. Given the importance of the family relationships in diabetes control, a need exists for interventions to have a more flexible setting and method of delivery, remain viable and demonstrate sustainability. Paper two: Clinic based interventions in type 1 diabetes have shown improvements in family relationships and metabolic control, but have limited reach. Therefore, a self-directed intervention was evaluated. Recruitment occurred through national advertising with diabetes charities, and the randomized controlled trial was conducted via online data collection. Parents of adolescents (aged 11-17) with diabetes were randomized to usual care (n = 37) or intervention (n = 42) using computerised block randomization, with researchers blinded to block size. The 10 week intervention involved the Self-directed Teen Triple P (Positive Parenting Program) workbook (10x1hour modules) and Chronic Illness tip sheet. Primary outcomes of diabetes-related family conflict and parenting stress were assessed pre and post-intervention. Intention-to-treat analysis was undertaken (n = 79), due to increased attrition from the intervention group. Intervention significantly improved diabetes related conflict, but not parental stress, compared to usual care. Followup analyses will assess maintenance effects and impact on metabolic control. Paper three: This paper was a Critical Evaluation, the purpose of which was to consider the findings from both papers, highlight additional and unexpected outcomes, place the research in the wider context, explore limitations of the thesis, and to discuss implications for future work.

O momento ideal para a extubação de crianças graves é ainda difícil de ser avaliado. A razão entre espaço morto e volume corrente (Vd/Vt), como valor preditiva de extubação bem sucedida, já foi testada em adultos e crianças. O objetivo deste trabalho foi avaliar a eficácia do Vd/Vt, como preditivo do sucesso da extubação, em crianças de uma UTI pediátrica geral. Após aplicação dos critérios de inclusão e exclusão, testou-se o Vd/Vt em 86 pacientes extubados num período de 16 meses. Nos estudos estatísticos o índice Vd/Vt médio não discriminou os grupos de falha e sucesso na extubação nas análises uni e multivariada. O valor do índice, com corte em 0,65, foi limitado na sensibilidade e especificidade e mediano na razão de verossimilhança. O estudo sugere que o índice Vd/Vt, pode ser considerado como complementar aos dados de avaliação clínica no momento da extubação.
The ideal moment for extubation of critically ill children is still difficult to determine. The dead-space : tidal volume ratio (Vd/Vt) has been tested as predictor of extubation failure in adults and children. The purpose of this study was to evaluate the efficacy of the Vd/Vt as a predictor of the success of extubation in children admitted to a pediatric intensive care unit. After the inclusion and exclusion criteria, 86 patients were studied during 16 months. The statistical study revealed that the mean Vd/Vt was not able to discriminate between failure and success of extubation in the multivariate analysis. The utility of the Vd/Vt was limited, in terms of sensibility and specificity, using a cutoff of 0,65, but was medially satisfactory in the likelihood ratio. This study suggests that the Vd/Vt can only be considered as complementary to the routine clinical evaluation prior to extubation.

Despite calls for increased Adoption Communication Openness (ACO) within the adoptive family, research indicates that families still struggle to accomplish the recommended elements and levels of openness. What could be holding families back from this key process? Three focus groups comprised of 17 adoptive parents of early adolescents (aged 10-14) who were age 0-2 at the time of placement were thematically coded. This inductive analysis revealed the complexity rooted in being —sometimes successfully and sometimes not—communicatively open. Four key themes emerged painting a vivid and rich picture of: a) the breadth and depth of this experience; b) the work entailed; c) the emotionality of it; and d) the grief and loss embedded in it. These results strengthen the understanding of the lived-experience of the adoptive parent thus magnifying the call for not only further research into what drives ACO in the family, but also consistent and supportive pre- and post-adoption services and clinical work.

Les adolescents difficiles préoccupent de plus en plus nos politiques et interrogent particulièrement les différents professionnels œuvrant auprès d'eux (travailleurs sociaux, psychologues, etc.). Ces jeunes sont essentiellement repérés par notre société au travers de leurs actes oppositionnels et délinquants, voire violents, mais moins pour leurs souffrances pourtant multiples. Les spécialistes du soin et du travail social cherchent par ailleurs à pouvoir prendre en charge cette jeunesse et leurs familles de façon la plus adaptée possible en fonction des problématique relevées. La Protection de l'Enfance repère les enfants et adolescents en danger dans leur environnement et/ou dans leur famille et propose des placements et des accompagnements médico-sociaux et éducatifs par le biais de l'Aide Sociale à l'Enfance ou de la Protection Judiciaire de la Jeunesse. Notre étude s'intéresse à l'évaluation de la trajectoire des adolescents accueillis au sein de l'association Second Souffle proposant des séjours de rupture à des jeunes en grandes difficultés sociales, scolaires, familiales et personnelles. Ainsi, nous avons étudié l'évolution éducative et psychopathologique de 47 adolescents et adolescentes ayant participé à des séjours courts et longs en France et à l'étranger.

This study tested the utility of three different models of personality, namely the social and personality model, the pathological personality traits model, and the psychological dysregulation model, in predicting overt aggression, relational aggression, and delinquency in a sample of detained boys (ages 12 to 18; M age = 15.31; SD = 1.16). Results indicated that the three personality approaches demonstrated different unique associations with aggression and delinquency. The psychological dysregulation approach, composed of behavioral dysregulation, emotional dysregulation, and cognitive dysregulation, emerged as the overall best predictor of overt aggression, relational aggression, and delinquency. After controlling for the Big Five personality traits, psychological dysregulation accounted for significant variance in overt aggression and delinquency, but not relational aggression. After controlling for callous-unemotional traits and narcissistic traits, psychological dysregulation also accounted for significant variance in overt aggression, relational aggression, and delinquency. Psychological dysregulation did not account for significant variance in aggression or delinquency after controlling for borderline traits. The pathological personality traits approach, comprised of callous-unemotional traits, narcissistic traits, and borderline traits performed second best. In particular, within this approach borderline traits accounted for the most unique variance, followed by narcissistic traits, then callous-unemotional traits. Borderline traits accounted for significant variance in overt aggression, relational aggression, and delinquency when controlling for the Big Five traits, but not after controlling for psychological dysregulation. Narcissistic traits only accounted for significant variance in overt aggression and relational aggression after controlling for the Big Five personality traits, but not after controlling for psychological dysregulation. CU traits only accounted for significant variance in overt aggression after controlling for the Big Five personality traits, but not after controlling for psychological dysregulation. The social and personality model, represented by the Big Five personality traits accounted for the least amount of variance in the prediction of aggression and delinquency, on its own, and when pitted against the other two personality approaches. The exception was that the Big Five personality traits accounted for significant variance in relational aggression beyond narcissistic traits, as well as psychological dysregulation. These findings have implications for assessment and intervention with aggressive and antisocial youth.

碩士
國立臺中教育大學
諮商與應用心理學系碩士班
96
Children with mental retardation are a great attack to family system. This study aims to investigate the effect of family art therapy upon parent child relationship,which forms between the parent and adolescent sibiling of children with mental retardation. The qualitative study is mainly used in this study. The data was collected and interpreted from art-making process, artworks interpretation and interviews. Twelve family art therapy interventions were conducted in the study. The researcher makes an attempt to depict the parent-child interaction on family with mental retardation child. The major findings of this study were summarized as follows: 1.The family realizes the estranged parent-child interaction through creating process. 2.The family becomes conscious of close interaction through creations. 3.Creating process provides family a communicative way. 4.Creating is an empowerment process which provides parents to show their ability. 5.The family discovers their inner resource and developing love power.

Pre-adolescent females are at an increased risk for the development of depression; therefore, it is important to understand the factors that contribute to the development and maintenance of depression in this population. Previous research indicates that cognitive style, including beliefs about the self, world, and future, is a vulnerability to the development and maintenance to depression. Research has found that cognitive style is malleable until early adolescence, at which time it begins to solidify and become more difficult to alter. Both parent-child relationships and family messages have been found to be associated with depression and previous research indicates that these factors may contribute to the development of a negative cognitive style. The purpose of the current study was to expand previous research by examining the roles of family functioning, perceived family messages and the cognitive triad in the development of depression for early adolescent girls. The study also explored whether family functioning and perceived family messages contributed to the development of girls’ cognitive style (cognitive triad). The study additionally evaluated the proposed model across two ethnic groups (Hispanic, Caucasian) as well as across age (9-10, 11-14) and grade (4-5, 6-8) groups. Participants included early adolescent girls (age 9-14) at risk for the development of, or diagnosed with, a depressive disorder (N = 198). Family functioning, family messages, cognitions, and depressive symptoms were obtained via girls’ self-report on a variety of questionnaires. Results from latent variable structural equation modeling indicated a significant direct effect of family functioning on perceived family messages, of perceived family messages on girls’ cognitive triad, and of girls’ cognitive triad on depressive symptoms. Furthermore, family functioning had a significant indirect effect on girls’ cognitive triad while both family functioning and perceived family messages had a significant indirect effect on girls’ depressive symptoms. No significant differences were found in the model pathways across ethnicities (Hispanic, Caucasian); however, the cohesion factor loading that was an aspect of family functioning was significantly different across groups, with Hispanic girls’ perceptions of family cohesion having a stronger association with family functioning than Caucasian girls. This finding seemingly indicates that cultural components may impact family attributes that are important to family functioning and, thus, role in the development and maintenance of depression in early adolescent girls. No significant differences were found between age or grade groups. Supplemental analyses, in which the model was investigated while controlling for depression, highlighted that the model was not driven by depressive symptoms (i.e. distorted perceptions). Implications, limitations, and areas for further research are discussed.
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abstract: ABSTRACT The experience of grief and loss is a process that can be extremely distressing to anyone, regardless of age. This may be especially true for youth. This study was designed and conducted to determine the effects of a therapy dog as a therapeutic adjunct in Child Life interventions with adolescents experiencing grief and loss. Subjects were randomly assigned to one of two groups. The intervention consisted of 3 sessions with a Certified Child Life Specialist (CCLS) to address grief. Group 1 (N=14) was the control group, meeting only with the CCLS. Group 2 (N=13) was the experimental group and met with the CCLS with a therapy dog present during the sessions. Participants completed a pre-test and post-test of the Children's Mood Questionnaire. At the end of each session, subjects completed a Therapeutic Engagement Questionnaire. The pet therapy group experienced a significant improvement in mood scores on the Children's Mood Questionnaire following the intervention. However, there were no significant differences between groups on the Therapeutic Engagement Questionnaire during any of the 3 sessions. The data collected from this study indicate that the addition of a therapy dog in grief interventions with adolescents may improve mood outcomes.
Dissertation/Thesis
M.S.W. Social Work 2011