Improvements in the quality of the parent-child relationship following treatment with an integrated family approach.

Objective: This study investigated changes in the emotional availability of the parent and the child in the dyadic relationship, parental reflective functioning, and parental perception of the relationship with their child following treatment with an integrated family approach in adult and child mental health care services. The aim of the study was to investigate if an integrated family approach in treatment contributes to good practice in mental health care. Background: Children of parents with a mental disorder are at increased risk for developing mental health problems themselves during lifetime. Infants are extremely vulnerable for environmental influences. Parents with mental disorders are at risk for mis-attuned behavior and non-optimal emotional availability. This increases the risk of adverse cascading effects on the parent-child relationship and child development. A secure parent-child relationship is an important protective factor against the intergenerational transmission of mental disorders. Although treatment of the parental mental disorder is important, it does not automatically change undesirable patterns in the parent-child relationship. Therefore, an integrated family approach to mental health treatment is recommended. Methods: This study involved a mixed methods design using questionnaires, an observation instrument and semi-structured interviews. The variables examined were the quality of the parent-child interaction, the parental perspective on their relationship with the child, their problems with child upbringing, and on their parental reflective functioning. The clinical sample consisted of 50 patients with a variety of mental disorders and their young children. Results: After finishing the integrated treatment the quality of the parent-child interaction had improved significantly. Likewise, we found a significant improvement in parental perception regarding the relationship with the child and the parental role. The majority of the parents interviewed showed that they were better able to mentalize about themselves, their child and their relationship with the child, but the data from the questionnaire showed mixed results regarding parents' reflective functioning. Conclusion: Treatment with an integrated family approach to mental health care in which the parental role of the patient, the young child, and the parent-child relationship are integrated in treatment, can be a valuable addition to the current practice of mental health care in which patients are commonly perceived as individuals.

Inhibitory performance, response speed, intraindividual variability, and response accuracy in ADHD.

OBJECTIVE: To determine the potential of inhibitory performance, response speed, and response accuracy and variability, measures central to the conceptualization of attention-deficit/hyperactivity disorder (ADHD), in distinguishing children with ADHD from healthy controls (HCs). METHOD: The stop signal paradigm was administered to 38 children with ADHD and 31 NCs. The stop signal reaction time (SSRT), mean reaction time (MRT), intraindividual coefficient of variation (ICV), and number of errors were used to predict diagnostic status. RESULTS: Univariate tests showed that the ADHD group performed worse than NCs on all of the dependent variables. Exploratory univariate analyses showed that oppositional defiant disorder comorbidity and ADHD type did not influence results except for the ICV, the effect for this variable (more variability in the ADHD group) being less pronounced for the Predominantly Inattentive type than for the Hyperactive-Impulsive and Combined types. A logistic regression model of the MRT, ICV, and number of errors combined showed best predictive performance, with the MRT contributing the most to group classification (56% of the variance). The final model (MRT, ICV, and number of errors) predicted 87% of the sample in the correct diagnostic category. Operating characteristics showed excellent sensitivity and specificity of 89.5% and 83.9%, respectively. CONCLUSIONS: Our results contrast with theoretical accounts emphasizing inhibitory control as the pivotal measure characterizing cognitive performance in ADHD. Results are discussed in the context of a delay aversion perspective of ADHD.