Clinical Child Psychology and Psychiatry

The objective of this study was to explore young children’s views on the impact of chronic illness on their life in order to inform future development of a patient-based self-report health outcome measure. We describe an approach to facilitating self-report views from young children with chronic illness. A board game was designed in order to obtain qualitative data from 39 children with a range of chronic illness conditions and 38 healthy controls ranging in age from 3 to 11 years. The format was effective in engaging young children in a self-report process of determining satisfaction with life and identified nine domains. The board game enabled children aged 5–11 years with chronic illness to describe the effects of living with illness on home, family, friends, school and life in general. It generated direct, non-interpreted material from children who, because of their age, may have been considered unable or limited their ability to discuss and describe how they feel. Obtaining this information for children aged 4 and under continues to be a challenge.

Sickle cell disease is a recessively inherited blood disorder associated primarily with black communities within the UK. This study investigated the experiences of adolescent boys with this condition. Eight participants were interviewed and their responses analysed using Interpretative Phenomenological Analysis. The emergent themes were watchfulness, holding onto normality, and connecting and disengaging. This analysis illustrated connections between physical symptoms, emotional responses and the development concerns of this participant group. The findings have implications for the nature and style of the delivery of health care services.

Pruritus is prevalent in children with atopic dermatitis and associated with effects on mood, quality of life, sleep, scholastic performance, social and family functioning. In this study a 7-year-old African American female with severe atopic dermatitis, itching and pain refractory to multiple systemic and topical medications was referred for treatment. At baseline, the patient scratched to the point of bleeding, despite maximal doses of anti-histamines, antidepressant and topical therapies. The patient became progressively shy, anxious, and her scholastic performance suffered. A literature review prompted the implementation of a multi-modal program of family cognitive behavioral therapy, imagery, aromatherapy, drawing, and biofeedback. The results were that decreased itch, scratching, pain, and anxiety were seen within the first month. Fewer lesions and episodes of bleeding were observed with almost complete skin clearance by the fourth month. The article concludes that a short-term, integrative program including psychological, complementary and alternative medicine (CAM), and medical therapies may represent a novel, efficacious approach for children suffering from severe atopic dermatitis.

Background: Severe food allergy has potentially life threatening consequences. Despite the significant impact on quality of life for families affected by food allergy, there is still relatively little known about the psychosocial experience in this area, especially with regards to the parenting experience.

Objectives: This study focused on the following areas of parental experience: (1) having a young child with severe food allergy; (2) perception of the effect of food allergy on family relationships; (3) managing the challenges associated with severe food allergy.

Methods: Eight mothers of children with severe food allergy completed semi-structured interviews. Interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA), a qualitative methodology.

Results: Three superordinate themes emerged from the analysis: (1) Parental adjustment—re-establishing an “even keel”; (2) It’s a big responsibility: Living with risk; (3) Identity and the social aspects of allergy.

This article focuses on the most psychologically salient findings within each of these superordinate themes.

Conclusion: Mothers in this study shared similar concerns to mothers of children with other chronic illnesses. It is recommended that the experience of allergy should be viewed in the wider family context with specific consideration given to parental coping and anxiety. Services could better meet the psychological and social needs of those affected by allergy.

Currently service user involvement in routine outcomes monitoring has been minimal, particularly in Children’s services. There needs to be a more sustained effort to involve service users because of the valuable information that they could provide for service development and improvement. Focus groups were conducted with service users, including parents, carers and young people from a London CAMHS. Their views were elicited on routine outcomes monitoring in general, three specific approaches and suggestions about what else might be important to capture when measuring outcomes. The focus groups raised a number of issues pertinent to routine outcomes monitoring in general, including the reliability of answers, the need for the measures to reflect more than just a tick-box approach and that different people will have different perspectives. Analysis also focused on feedback about the three specific measures discussed. It is important that service users are involved in the process of outcome measurement, from the development of measures, to their application in therapeutic encounters and in service development. Outcome monitoring needs to become a more collaborative process in order that services are measuring what service users think is important, as most would agree that a service should deliver the outcomes that its users want to see.

Although a number of researchers have explored the help-seeking pathways of individuals with psychosis, there has been little focus on the experience of illness and services in the under-18 age group. It was our aim to examine by qualitative means the experience of first-episode psychosis and the experience of accessing effective treatment, from two perspectives – that of the adolescents and that of their primary caregivers. A general inductive approach was used to analyse interviews with 12 young people receiving treatment for psychosis, and 12 carers. We found that lack of awareness of mental illness prevented access to early effective treatment. Young people relied on others to access help, and the emotional impact on caregivers was great. Experience of services was mixed, and recommendations were made for both service providers and service users. We discuss the results particularly in relation to developmental and cultural considerations and conclude that there is a need for education about mental illness and normal adolescent development on an individual and societal level.

Mindfulness-based cognitive therapy (MBCT) is a relatively new intervention that has been developed to help people with recurrent depression stay well in the long term. Although there is evidence that depression impacts negatively on parenting, little is known regarding MBCT’s potential impact on parenting. This study used a qualitative design to explore how parents with a history of recurrent depression experience their relationships with their children one year after MBCT. We interviewed 16 parents who had participated in MBCT as part of a randomized controlled trial (RCT) (Kuyken et al., 2008). Thematic analysis was used to identify prevalent themes in parents’ accounts, including: (i) emotional reactivity and regulation; (ii) empathy and acceptance; (iii) involvement; (iv) emotional availability and comfort; and (v) recognition of own needs. Based on these exploratory findings, we suggest that some components of MBCT may help parents with a history of depression with emotional availability, emotion regulation and self-care and set out avenues of further research.

This study investigated the influence of drug-company funding on websites about attention-deficit hyperactivity disorder (ADHD). Websites in the top 60 for either Google or Yahoo!Xtra with information about causation and treatment were analysed. Likert scales, based on those used in previous similar studies, were developed to rate aetiological explanations and recommended treatment approaches, on a dimension from psycho-social to biological. Overall, the quality of information on websites was poor with a strong bias towards bio-genetic aetiological explanations of ADHD. Twenty-one of the 57 websites (37%) were funded by drug companies. The drug-company funded (DCF) websites were significantly more likely than non-DCF websites to recommend medication rather than psycho-social treatments. The selective lack of consideration of psycho-social treatments by DCF websites is discussed in relation to the relevant research literature, including the evidence in favour of a multimodal approach. The findings, which are consistent with previous similar studies in relation to websites about adult mental health problems, confirm that the pharmaceutical industry is seeking to influence public opinion via the internet.

The education system makes special provision for “looked after children”. However, once adopted these children become invisible. Adopted children are often placed in their new families when they are already of school age. School is yet another transition alongside that of home, food, language and social milieu which an adopted child has to manage together the pain of the loss of the biological family and its culture. This article focuses on the importance for CAMHS practitioners to work closely with schools and adoptive parents to help children manage their lives in school. Alongside the difficulties they face in learning, many adopted children need help in managing friendships and in concentrating on what is required of them in school. Adults may be ignorant of the day to day experiences of racism and questions about mothers, fathers, brothers and sisters that can throw an adopted child into confusion. This chapter draws on clinical experience to describe some of the difficulties that arise for parents and children in managing the education system

This article describes a study that was designed to examine the impact of brief psychoanalytic psychotherapy with children under-five years of age and their families. The work took place in a Child and Adolescent Mental Health Service (CAMHS) in England, to which children are routinely referred with a range of behavioural and emotional problems. The study examined the hypothesis that through formulating the emotional forces that underpin the family’s here-and-now experiences and bringing into the frame the child’s perspective, a shift in the parents’ states of mind from being less reactive and more reflective would be observed. Further, the less reactive parental state would result in the child feeling more contained, and impact positively in relation to symptom presentation. Using clinical description and quantitative data drawn from the videotaped clinical material the hypothesis was tested on seven families. The prediction was borne out, significantly so in relation to the parents being less blaming and more reparative in their comments. Parental reports also highlighted that six of the seven children exhibited a significant reduction / termination of symptoms for which they had been originally referred. The therapeutic process underlying these results is considered.