Clinical Child Psychology and Psychiatry

An inter-agency training programme in child and adolescent mental health for primary care staff has been developed in a UK area serving a general population of 900 000. This was initiated with a training needs and resources analysis across all the joint strategy partners (three local authorities, one health authority and the voluntary sector). Training is provided to inter-agency groups of professionals in 12 localities. To date, 150 staff have been through the two-day introductory/foundation course, which is complemented by three subsequent training days on the assessment and management of children and families. Staff evaluation ratings are presented. On the whole, primary healthcare staff rated their awareness of mental health issues and their knowledge of staff roles within child mental health services significantly higher, in contrast with education staff who rated these components lower. Inter-agency training has been achieved with some difficulties needing to be overcome, but the participants’ feedback indicates that the expected output is beginning to be realized. The implications of the project are discussed.

Congenitally blind children face profound difficulties in relating to people and things in the world around them. In this article we report observations of children in the Blind Nursery of the Anna Freud Centre (at that time named the Hampstead Child Therapy Centre) deemed to be congenitally blind, during the 1950s and 1960s. These observations highlight the far-reaching developmental implications of congenital blindness, and afford a fresh perspective on the nature and role of interpersonal engagement in the early development of sighted children.

There is a growing number of pre-schoolers presenting to clinics with high levels of aggression. These children are at risk of developing conduct disorder, especially when the symptoms are severe. Treatment for older children with aggressive symptoms has often relied on teaching their parents behavior management techniques and has ignored affective and relationship issues. After presenting observations of the play interactions of aggressive pre-schoolers with their mothers and other relevant research findings, this article explores important aspects of the parent-child interaction and affective relationship. These aspects include the mother's difficulty in tolerating and modulating the child's negative affect, reluctance to enter the play metaphor and failure to gradually move aggressive play to more pro-social themes. The importance of these interactions and affective relationship aspects and their contribution to the child's difficulty are discussed in light of their implications for treatment. Also, suggestions are made for caregivers working with these children to help them self-regulate and acquire appropriate cognitive strategies to contain the negative affects.

A day-centre-based feeding programme is described in which families who have young children with severe and chronic eating problems attend for one morning once every two weeks for 12 attendances. It is a focused, change-directed programme that treats a wide range of eating problems. The approach is based on behavioural management strategies in a biopsychosocial model of assessment and treatment. The issues and choices in the development of this programme are discussed. An evaluation questionnaire directed specifically at outcome criteria for young children with feeding problems is included. Results of evaluations from parents and clinicians using this questionnaire indicate that it successfully identifies clinical change relevant to the goals of treatment. Data are presented on the outcome of intervention.

Selective eating is the little studied phenomenon of eating a highly limited range of foods, associated with an unwillingness to try new foods. Common in toddlers, it can persist into middle childhood and adolescence in a small number of children, most commonly boys. When this happens social avoidance, anxiety and conflict can result. This article describes a sample of 20 children with selective eating who presented for help to a specialist eating clinic. We outline the presenting features and associated phenomena for the group, suggest an approach to treatment, and explore from a theoretical point of view where this symptom, disorder or normal variant fits into the spectrum of childhood eating difficulties.

Interviewing young traumatized children, particularly those traumatized by physical and sexual abuse, is difficult, not only because of children's recall deficiencies, but more often because standard interviewing formats can be ineffective with economically disadvantaged and culturally different children. Economically disadvantaged children's exposure to different family interaction patterns and control-dominated childrearing styles can affect their ability to respond to both verbal and non-verbal interviewing techniques. In addition, normal children's familiarity with the material to be remembered, their motivation to remember, their cognitive style and their communication skill all influence interview outcomes. Suggestions are included for improving non-leading interview methods with young children using both verbal and non-verbal techniques.

Solution-focused brief therapy is a relatively new approach for Child and Adolescent Mental Health Services in the UK. While the approach lacks the support of outcome studies compared with more conventional approaches, it is argued that the model does offer some specific advantages, and relates well to the range of problems which present and the manner in which many clients use the service. An outline of the approach is provided, along with an overview of research and comments on contraindications. A variety of clinical examples is used to illustrate how the approach works in practice. Concluding comments question the manner in which new approaches gain acceptance.

A case study is presented which describes the application of soap opera material to demonstrate and practise the primary tasks of cognitive therapy with an adolescent girl with moderate learning disabilities. It is argued that soap operas provide a valuable learning opportunity as they are watched by a large proportion of the population, focus on the relationships between their characters, create an opportunity for the viewer to get to know the characters and, hence, speculate about their thoughts and feelings and predict their actions. The television medium also appears to aid attention and memory processes and is often inherently motivating for the viewer. It is argued that television is an under-used resource in our work, in particular when it comes to helping people to recognize emotions and understand the rules of interpersonal relationships.