Clinical Child Psychology and Psychiatry

Being given a diagnosis of cancer is a significant and highly distressing event for both children and their families, but little research has been done to explore and understand children’s feelings. This study aims to understand from the child’s perspective what it feels like to be told you have cancer, with the hope that increased understanding can lead to improved communication and support for children and families. The study uses qualitative methodology. Six children aged 8–12 years with a new diagnosis of cancer took part in two semi-structured interviews at least one week apart. The interviews were conducted using the draw and write technique. The results were analysed using interpretative phenomenological analysis. The report describes the five super-ordinate themes that were identified; initially I felt shocked and scared, chemo is an awful thing, please talk to me; the more I know the better I feel, I will accept treatment and quickly get used to it because I know I will get better and, finally, my family are vital. Implications for clinical practice are discussed. The report highlights the research limitations and areas for future studies.

Functional somatic symptoms (FSS) emerge when the stress system is activated in response to physical or emotional stress that is either chronic or especially intense. In such cases, the heightened state of physiological arousal and motor activation can be measured through biological markers. Our team have integrated the use of biological markers of body state – respiratory rate, heart rate (HR) and heart rate variability (HRV) measurements – as a way of helping families to understand how physical symptoms can signal activation of the body’s stress systems. This study measured respiratory rates, HR and HRV in children and adolescents with FSS (and healthy controls) during baseline assessment to determine whether these biological markers were effective at differentiating patients with FSS. The study also implemented a biofeedback intervention during the assessment to determine whether patients with FSS were able to slow their respiratory rates and increase HRV. Patients with FSS had faster respiratory rates, faster HR, and lower HRV, suggesting activation of the autonomic nervous system coupled with activation of the respiratory motor system. Like controls, patients were able to slow their respiratory rates, but in contrast to controls, they were unable to increase their HRV. Our findings suggest that patients with FSS present in a state of physiological activation and struggle to regulate their body state. Patients with FSS are likely to need ongoing training and practice to regulate body state coupled with interventions that target regulatory capacity across multiple systems.

In Western society, identity formation is argued to be one of the key developmental tasks of adolescence. Despite implications for adolescent development, research into chronic illness (CI) onset during this period has been notably sparse. This study aimed to explore how diagnosis impacts on the developmental tasks of adolescence, what role adolescent-onset CI plays in identity formation, and how adolescents incorporate the diagnosis into their identity using a narrative analysis. Individual semi-structured interviews were carried out with eight young people aged 14 to 19years who lived with a diagnosis of a CI diagnosed between the ages of 12 and 16 years. Five core narrative themes emerged: walking a different path, tolerating contradiction, a changed interface with others, locating power and a fluid relationship. Narratives were considered to have been influenced by factors such as the interview context and dominant social narratives concerning health and illness. Adolescent-onset CI was found to have a significant, though not exclusively negative, impact on developmental tasks. The findings are discussed in relation to existing literature and potential clinical implications.

Recent years have shown a welcome trend in the number of people surviving cancer. The impact of cancer survival has focused primarily on the patient perspective, and limited research has explored the effect of parental cancer on children. No research to date can be found which explores children’s experiences of parental cancer from a narrative perspective yet the way in which people tell their story is associated with emotional wellbeing. Measures of attachment, resilience and trauma were completed by 10 children (six girls, four boys aged 10–18 years) all of whom have a mother with non-terminal cancer. Each child also completed a narrative interview where they spontaneously described their experiences. Interviews were analysed drawing on narrative and thematic approaches to ensure the structural and performative as well as content of the stories could be understood. Experiences were interpreted within the context of attachment, resilience and trauma. Clinically high levels of trauma were found within this group even for securely attached and resilient children. The narrative analysis corroborated this finding. Implications for services supporting families are discussed.

Adopted children and adolescents are at an increased risk of experiencing emotional, behavioural and relational difficulties compared to their non-adopted peers. This systematic review aimed to establish the effectiveness of interventions with adoptive parents on adopted children and adolescents’ psychological well-being, behavioural functioning and parent–child relationship. A systematic search was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), including studies that assessed the effects of interventions with adoptive parents on adopted child and adolescent outcomes. Electronic databases, key journals, grey literature sources, reference and citation lists were searched and published authors in the field were contacted; 19 papers describing 15 interventions were included. The findings from this review provide preliminary support for the use of interventions with adoptive parents for improving adopted children’s emotional and behavioural outcomes. However, overall, the studies were found to have a high risk of bias, and the significant heterogeneity across the studies limits the conclusions that can be drawn. Further research is required to provide conclusive recommendations regarding the effectiveness of interventions with adoptive parents on the outcomes of adopted children.

Few studies have reported on the quantity and quality of executive function (EF) deficits in young children referred to child psychiatric outpatient clinic with multiple psychiatric symptoms. We evaluated the EF deficits with the Attention and Executive Function Rating Inventory–Preschool (ATTEX-P) filled out by day care teachers for 4- to 7-year-old clinical group (n = 171) and reference group (n = 709). Family background information was collected from all families by parent questionnaire. Diagnoses of the referred children were collected from medical records. Clinical group exhibited higher mean ranks across the ATTEX-P Total score and all nine subscales than reference group (p < .001). Most of the children in the clinical group (58.5%) showed a significant amount of EF deficits (ATTEX-P Total score over clinical cut-off) including distractibility (55.6%) and impulsivity (53.8%) regardless of their diagnoses. In a multiple logistic regression model (controlling for age, gender and parental education), children in the clinical group had increased risk (odds ratio (OR)) = 10.6, 95% confidence interval (CI) = [6.88, 16.2], p < .001) for scoring over the clinical cut-off point on the ATTEX-P Total score. Assessment of EFs should be a routine part of the treatment plan in young children referred to child psychiatric outpatient clinic as it may guide the treatment choices.

This research investigated the prevalence of looked-after and adopted young people within a case file review of 185 young people referred to a UK gender identity development service over a 2-year period (1 April 2009 to 1 April 2011). Data were extracted from referral letters, clinical notes and clinician letters. Looked-after young people were found to represent 4.9% of referrals in this cohort, which is significantly higher than within the English general population (0.58%). Adopted young people represented 3.8% of referrals. In addition, the findings showed that looked-after young people were less likely to receive a diagnosis of gender dysphoria compared with young people living within their birth family. There were no statistically significant differences in the gender ratio or age of first gender dysphoric experience between groups. Looked-after and adopted young people were also not found to be experiencing greater impairment in overall functioning compared to other young people referred to the gender identity development service. In conclusion, there are a substantial proportion of referrals pertaining to looked-after or adopted young people, and it appears the referral route and process through the service may be distinct, particularly for looked-after young people. This may be understood by considering the possible complexities in the presentation of these groups, alongside the established higher levels of complexity generally for those experiencing feelings of gender dysphoria.

Maudsley Family-Based Treatment (FBT) is currently the best supported treatment for adolescents with anorexia nervosa (AN); however, little is known about whether it achieves its stated aim in the final phases of promoting the patient’s return to an expected developmental trajectory. This study aimed to explore the perspectives of young people and their parents regarding the developmental impact of AN, and the role of FBT in addressing developmental challenges. Young people (N = 12) who ceased FBT a minimum 1 year prior, and their parents (N = 12), completed face-to-face semi-structured interviews, and data were analysed using a narrative inquiry method. All the participants described AN as highly disruptive to adolescent development, with phase one of FBT accentuating this experience. In phases two and three, FBT helped facilitate adolescent development in three key ways: Supporting return to adolescent pursuits, facilitating autonomy and providing freedom to develop post-FBT. This study offers preliminary insights into the variety of developmental challenges and needs experienced by families, as well as approaches clinicians can take to supporting development in phases two and three of FBT.

Evidence-based parenting programmes are beneficial for children’s behavioural and emotional problems as well as parenting practices. Along with effectiveness, attendance affects the programme outcome and identification of risks associated with dropout may aid in development of special policy to increase engagement. In this study, we aimed to compare sociodemographics, parental attitudes, child behavioural and emotional problems of programme-completing and dropout parents from Level-4 Triple-P parenting programme applied at Child and Adolescent Mental Health Services (CAMHS). We also aimed to determine the attrition rate. In addition, we inquired whether there was a change in parenting styles and child behaviour and emotional problems before and after Level-4 Triple-P for the programme-completing parents at CAMHS. Results displayed that 52% (n = 58) of the parents who were significantly less educated, used hostile rejecting attitudes, and reported more hyperactive/inattentive behaviour in their children compared to the parents who competed the programme (p = 0.022, p = 0.016, p = 0.027, respectively) discontinued the programme. Parents who were able to complete the programme (n = 54) reported a reduction in over-parenting and improvements in children’s conduct problems along with overall stress levels before and after Triple-P (p = 0.009, p = 0.040, p = 0.023). Parents at risk of discontinuing parenting programmes may require special policy to be engaged since these programmes may offer significant benefits for parenting practices and, in turn, children’s well-being.

This article describes the development of a group-based therapeutic intervention for young people (YP) who have lived with domestic violence and abuse. The intervention was informed by interviews with 107 YP, focused on their experiences of coping, resilience and agency. The intervention draws on resources from systemic, creative and narrative approaches to group work, and aims to facilitate YP’s expression of distress in a way that recognizes that it is embodied, contextual and relational. The intervention also explores YP’s existing strategies for coping and maintaining a sense of agency, and works to harness, enhance and further develop those skills. We report on the pilot of this intervention, and its development and application across four European countries (the United Kingdom, Greece, Italy and Spain). We outline the goals, strengths and limitations of this group intervention, as well as the main challenges, hindrances and ethical dilemmas experienced by the research and intervention team. Implications for therapeutic practice and training are addressed.