[Voluntariness in Outpatient Psychotherapy with Children and Adolescents]. / Über die Freiwilligkeit in der ambulanten Kinder- und Jugendlichenpsychotherapie.

Voluntariness in Outpatient Psychotherapy with Children and Adolescents Voluntariness is no selective construct in psychotherapy with children and adolescents. Generally psychotherapy is utilized under external pressure, at least partially. At any rate it is crucial to painstakingly analyze the motivation for change and possible obstacles to motivation. On that basis different strategies to foster motivation for change can be applied. Problems regarding the efficiency of voluntary or involuntary utilization of outpatient psychotherapy for children and adolescents should be subjects to further research.

Complejidad, conflicto armado y vulnerabilidad de niños y niñas desplazados en Colombia / Complexity, armed conflict, and vulnerability of displaced children in Colombia

Este trabajo tiene como objetivo realizar una reflexión acerca de la vulnerabilidad de los niños y niñas víctimas del conflicto armado en Colombia. Para ello se recurriro al principio de auto-eco-organización y de Bucle inter-retroactivo. La violencia es un fenómeno complejo de múltiples interacciones, de características no-lineales y tendencia auto-eco-organizativa que afecta la noción de sujeto y altera el modo como los niños y niñas interpretan el mundo y sus interacciones.

This paper aims to carry out a reflection on the vulnerability of children, who are victims of the armed conflict in Colombia. This was used at the beginning of the self-eco-organization and the inter-retroactive loop. Violence is a complex phenomenon of multiple interactions, non-linear features, and a self-eco-organizational tendency, which affects the notion of subject and alters the way that children interpret the world and their interactions.

Navigating ethical issues with electronic health records in developmental-behavioral pediatric practice.

The increasing use of electronic health records (EHRs) allows for sharing of information across clinicians, quick access to laboratory results, and supports for documentation. However, this environment raises new issues of ethics and privacy, and it magnifies other issues that existed with paper records. In developmental-behavioral pediatrics (DBP) practice, which relies heavily on a team approach to blend pediatrics, mental health, and allied health, these issues are even more complicated. In this review, we highlight the ethical and privacy issues in DBP practice related to EHR use. Case examples illustrate the potential risks related to EHR access, confidentiality, and interprofessional collaboration. Suggestions to mitigate some of the ethical and privacy issues associated with EHRs at both an administrative level and a clinician level are included. With the expected increase in the adoption of EHRs by DBP clinicians in the near future, professional standards will need to be defined, and novel technological solutions may offer additional safeguards. Until then, professionals and organizations are responsible to uphold the standards of ethical practice while promoting effective information exchange to facilitate clinical care.

Why do parents enroll their children in research: a narrative synthesis.

OBJECTIVE: Recent legislation mandating the inclusion of children in clinical trials has resulted in an increase in the number of children participating in research. We reviewed the literature regarding the reasons parents chose to accept or decline an invitation to enroll their children in clinical research. METHODS: We searched for qualitative studies, written in the English language that considered the experiences of parents who had been invited to enrol their children in research. SCOPUS and Web of Knowledge electronic databases and reference lists of retrieved articles and review papers were searched. Retrieved articles were synthesised using the narrative synthesis method. RESULTS: 16 qualitative studies exploring the experiences of parents living in five countries whose children had a range of health conditions of varying severity were included. The health status of the child appeared to influence parents' reasons for participation. Parents whose children had life threatening conditions often considered they had no choice but to participate and many welcomed the innovation offered through research participation. Such parents also viewed the risks of research less negatively than those whose children were healthy or in the stable stage of a chronic condition. This raises questions regarding the voluntariness of informed consent by such parents. CONCLUSIONS: A tailored approach is needed when discussing research participation with parents of eligible children. While parents of healthy children may be more open to discussions of altruism, those whose children have life threatening illnesses should be given adequate information about the alternatives to, and risks of, research participation.

[Child psychiatry, the question of a kiss]. / Pédopsychiatrie, le bisou en questions.

What should child psychiatry care workers do when a child spontaneously embraces or kisses them? This questioning goes far beyond the fact of kissing and raises the question of the nature of the healthcare relationship and environment. While theoretical knowledge is necessary, it is not sufficient for achieving phronesis or "practical wisdom".

Healthcare decisions: a review of children's involvement.

Children's rights, their ability to consent to treatment and their involvement in healthcare decisions have received considerable attention in recent years. There is some evidence to suggest that when children are involved in the decision-making process, they retain a sense of control over their situation. However there are still unresolved issues related to a child's right to decide and nurses may be confused about the extent to which children can and should be involved in decision-making. A code of practice for involving children in decisions was first suggested in 2001 and there is still a need for a consistent, structured and robust method of ensuring that children are included in the decision-making process at all stages of their health care.

Parents' perspectives on having their children interviewed for research.

We describe parents' perspectives on research interviews with their children with single gene conditions. One hundred forty-two parents were interviewed between 2002 and 2003 in a larger study using a qualitative descriptive design. Two questions from the semi-structured interview guide were used to identify parents' perspectives about future interviews. Almost all of the parents said they would allow an interview with their children, but some parents specified stipulations. These stipulations included: focusing on age-appropriate information, limiting information with child, considering input from parents, and providing a child-oriented environment. Knowing this information, researchers can prepare to work more collaboratively with parents and include them more fully in the research process.

Ethical issues in child psychopharmacology research and practice: emphasis on preschoolers.

INTRODUCTION: Psychoactive drug prescription for preschoolers has increased over the past decade and has been a controversial topic for those who prescribe, regulate, and research the use of psychotropics in this population. Children and adolescents are deemed vulnerable populations, at risk of being harmed by unethical or suboptimal practice and research and are in need of special protection. Historically, preschoolers have been therapeutic and research "orphans," excluded from pharmacological studies so that the evidence base for their treatment has to be extrapolated from other ages. Within the past few decades, several ethical principles guiding pediatric psychopharmacological research have been developed. The same principles could effectively guide the treatment of these patients. CONCLUSION: Further studies are needed to elucidate the safety and effectiveness of psychotropics, and sound ethical guidelines for their involvement in psychiatric research are needed. This article reviews some challenges facing mental health care providers involved in prescribing or researching the use of psychoactive drugs in preschoolers. Some of these challenges are general to medical treatment and research with children, and others are particular to child psychopharmacological treatment and research.

Attention-deficit/hyperactivity disorder: are we medicating for social disadvantage? (For).

The diagnosis of attention-deficit/hyperactivity disorder (ADHD) is based on well defined criteria, which describe a number of symptoms. It is important to consider the context of the symptoms, in terms of the influence of the child's family and school. Although stimulant medications benefit selected children they may not benefit all children with symptoms of ADHD. The incidence of ADHD increases with social disadvantage. There is a potential danger of using stimulant medication alone to treat children with complex psychosocial problems, associated with social disadvantage, including Aboriginal children. We desperately need better training in the management of ADHD and better access to child psychiatrists.

Promoting children's ethical development through social and emotional learning.

In today's climate of increased emphasis on measuring achievement through high-stakes testing, academic subjects are too often divorced from the social context in which they are taught. We know that learning is a social process. In fact, many educators and other youth development practitioners recognize that social, emotional, and ethical development cannot be ignored in the name of better academic preparation, especially in the face of data showing that students are more disengaged than ever before. Social and emotional learning (SEL) offers educators and other youth development personnel a framework for addressing students' social and emotional needs in systematic way. SEL is the process of acquiring the skills to recognize and manage emotions, develop caring and concern for others, establish positive relationships, make responsible decisions, and handle challenging situations effectively. Research has shown that SEL has an impact on every aspect of children's development: their health, ethical development, citizenship, academic learning, and motivation to achieve. This chapter profiles one school in Illinois that has been implementing SEL programming for a number of years. The authors provide evidence of the impact of SEL on school climate, student behavior, and attitudes. Ultimately the authors see this as fostering the kind of understanding of the larger world that leads young people to make ethical choices. They propose that the lessons learned are applicable to a wide variety of settings, including other schools, after-school programs, and summer camps.

Giving youth the social and emotional skills to succeed.

WINGS for Kids is a nonprofit organization based in Charleston, South Carolina, that aims to supply the social and emotional learning (SEL) component into existing programs for school-aged children and thereby assist them to recognize and manage emotions, care about others, make good decisions, behave ethically and responsibly, build satisfying relationships, and avoid negative behaviors. The author, who is the founder and CEO of WINGS, traces the ethos of the organization to her own life experiences as well as her observations of low-income children and families more generally. She describes the strategies and practices that characterize the WINGS approach to SEL. The chapter focuses on the progress made by one boy, who arrived at WINGS at the age of seven, got into disputes from the very first day, and was eventually ejected from the WINGS program but later earned his way back with a commitment to change. He sustained his involvement for a number of years and became an exemplar of what the author states they are trying to accomplish.

Incentives for children in research.

PURPOSE: To describe the challenges of using incentives for children in research. ORGANIZING FRAMEWORK: A discussion of incentives in the context of recruitment for research, including a review of the literature, a description of the types of incentives used with children and their families, factors influencing choice of incentives and ethical considerations. Recommendations to guide decisions about incentives are proposed. CONCLUSIONS: Since the 1997 mandate from the U.S. National Institutes of Health that investigators provide justification for excluding children, researchers have become more willing to include children. Whether all parts of the research process pertain to children without careful consideration and adaptation is unclear. One area lacking clarity is the use of incentives to encourage participation in research. The issue of incentives for children or parents should be considered early in the design of the research proposal, with attention to developmental age, ethical considerations, purpose of the research, and burden to the child and family.

Aspectos do desenvolvimento sociomoral da criança / Children´s sociomoral development

O artigo analisa o tema da formação sociomoral da criança nas teorias de J. Piaget e E. Turiel. Inicialmente, expomos o trabalho de Piaget, estudando os jogos sociais infantis: o julgamento da intenção e conseqüência, a mentira, o furto e a noção de justiça. Em seguida, mostramos o trabalho de Turiel, que considera que a criança organiza seu conhecimento social em interação com o fenômeno social, levando à formação de dois domínios: o convencional e o moral. Apresentamos críticas a essas duas abordagens e concluímos que, passados quase setenta anos de trabalho original de Piaget, ele continua atual.

The article studies the point about the children and teenager´s sociomoral development in the theories of J. Piaget and E. Turiel. Initially, we present Piaget´s work, considering some children social game: the judgment of intentions and its effects, lie, robbery and the notion of justice. Afterwards, we present the theory of Turiel, who considers that a child organizes his social knowledge in interaction with social phenomenon. This reality drives to the development of two dominions: the conventional and the moral. We present critical views over these two approaches, and we conclude that, even after almost seventy years, Piaget´s original work is still valid.