Clinical Child Psychology and Psychiatry

The use of complementary and alternative medicine (CAM) as a treatment for children diagnosed with attention deficit-hyperactivity disorder (ADHD) is widespread, but little is known on the effectiveness of many such therapies. This study investigated meditation as a family treatment method for children with ADHD, using the techniques of Sahaja Yoga Meditation (SYM). Parents and children participated in a 6-week programme of twice-weekly clinic sessions and regular meditation at home. Pre- and post-treatment assessments included parent ratings of children’s ADHD symptoms, self-esteem and child–parent relationship quality. Perceptions of the programme were collected via parent questionnaires and child interviews. Results showed improvements in children’s ADHD behaviour, self-esteem and relationship quality. Children described benefits at home (better sleep patterns, less anxiety) and at school (more able to concentrate, less conflict). Parents reported feeling happier, less stressed and more able to manage their child’s behaviour. Indications from this preliminary investigation are that SYM may offer families an effective management tool for family-oriented treatment of childhood ADHD.

The aim of this single-case study was to identify early forms of interpersonal relatedness in a child with autism and to examine changes in these forms over a period of 3 years. The child was videotaped in a standard therapeutic setting with a clinician. Observations made by the clinician were accompanied by quantitative data drawn from videotaped recordings. Both sources highlighted an increase in dyadic forms of relating. There was no conclusive evidence for change in the level of triadic relating. The authors discuss the need to distinguish between deviant and delayed functioning and the importance of assessing the exact level of developmental delay in social relatedness. Attention to these areas promises a more precise definition of the social deficit in autism and may serve as a means to investigate its ‘mutability’.

People with eating disorders often have some associated social difficulties. Given that friendships are of particular importance during adolescence, and that maintaining friendships during in-patient admission seems to aid the process of rehabilitation, there is a need for interventions that address friendship issues to form part of in-patient treatment programmes for adolescents with eating disorders. A group-work approach has been identified to address friendship issues within this context. The rationale for a Friends Group, key elements of the group and related issues are discussed. Patients’ experiences are reported and case examples provided to illustrate the function and value of the group.

This article presents exploratory research on the feasibility of non-directive play therapy for children with autism. Video recordings of 16 sessions of play therapy with a 6-year-old boy with severe autism were analysed qualitatively and quantitatively. The study concluded that this child was able to enter into a therapeutic relationship and demonstrated attachment behaviour towards the therapist. Key areas of improvement were in the child’s development of autonomy and pretend play, while ritualistic behaviours showed only mild improvement. Changes in therapy were concurrent with the changes reported by the boy’s mother at home of increased independence and empathy. One implication of this preliminary research is that non-directive play therapy may enhance and accelerate emotional/social development of children with severe autism. More research is urgently needed; non-directive play therapy and behavioural treatments may complement one another to provide an overall treatment plan for children with severe autism.

This study examined the association between family engagement and consumer satisfaction for the seriously emotionally disturbed children and adolescents admitted to an in-patient psychiatric unit in a large medical center. Participants were 45 male and female in-patients, aged 7–17, and their parents. At the time their child was discharged, parents completed a demographic questionnaire, the Achenbach Child Behavior Checklist, and the Inpatient Parental Satisfaction Index. At the same time, the child’s psychiatrist completed the Family Engagement Questionnaire. Results indicated that engagement is related to satisfaction, prior in-patient treatment is negatively related to engagement, and satisfaction with prior in-patient services is highly predictive of satisfaction with current services. At 9-month follow-up, 32% of the sample had been re-hospitalized. Rehospitalization was associated with poorer engagement in treatment and lower parent ratings of satisfaction with care. These results suggest the existence of a group of patients who undergo repeat hospitalizations with poor levels of engagement in their care.

People with Apserger’s syndrome understand and respond to the world in a very different way from other people. Individual psychotherapy can be an important approach, in addition to other therapies and case management, for children with Asperger’s syndrome. A frame of reference for the therapeutic relationship with Asperger individuals is described. This addresses the perspective of those with Asperger’s as well as the perspective of others in their lives. The cognitive concepts theory of mind, central coherence, and executive functioning are briefly reviewed with an emphasis on how they help us to understand the Asperger mind, and with examples of their presentation and use in clinical assessment and psychotherapy. Perspective, intention, and awareness, as they relate to the therapeutic interventions, are illustrated with brief vignettes.

This study describes the characteristics of the young people who use the full range of child and adolescent psychiatric in-patient units in England and Wales. Consultant psychiatrists or key workers were asked to complete a structured schedule about every resident on a census day – 19 October 1999. Schedules were returned from 71 of the 80 units in England and Wales, concerning 663 residents. Residents aged 13 or under had a wide range of diagnoses and more were male (58%). In contrast, two-thirds of residents aged 14–18 were categorized into one of three diagnostic groups – eating disorder, schizophrenia, delusional or psychotic disorders or mood disorders – and about two-thirds were female. In-patients had more severe problems than a group of young people using community services, particularly with hallucinations and delusions, emotional and related problems and problems of self-care and independence. The range of disorders treated by these units demonstrates the need for a range of specialist in-patient services to be available to children and adolescents in all regions.

Positive patient outcomes are related to patient satisfaction and the meaningfulness of their hospital experience. Limited attention has been paid to how adolescent psychiatric in-patients experience their treatment course. This study was developed to examine how hospitalized adolescents experience the treatment milieu during an acute hospitalization in a crisis stabilization unit. The study consisted of a survey administered to 105 in-patients at the time of their discharge from the unit. The most meaningful experiences were those in which adolescents focused on issues related to hospitalization and learned skills for breaking problems down into manageable pieces which included setting realistic and achievable goals. Males and females did not significantly differ in their experience of the unit. Identifying the adolescents’ needs and teaching them goal-setting appears to be very important in acute in-patient care. Adolescents reported peer contact and goal-setting work to be the most meaningful experiences.

This article describes the case of a 13-year-old male Tourette’s syndrome patient who developed separation anxiety disorder during combined treatment with risperidone and tiapride. In the 1980s, neuroleptic separation anxiety syndromes in patients with Tourette’s syndrome were described, and an association between the neuroleptic medication and the induced separation anxiety disorder in our patient seems probable. We conclude that future investigations of atypical anti-psychotics and their possible tendency to elicit separation anxiety are essential. Physicians should pay attention to the occurrence or exacerbation of separation anxiety in patients with Tourette’s syndrome who are receiving either typical or atypical neuroleptics.