Scholarly rumors: Citation analysis of vast misinformation regarding parental alienation theory.

Misinformation is widespread in political discourse, mental health literature, and hard science. This article describes recurrent publication of the same misinformation regarding parental alienation (PA), that is, variations of the statement: "PA theory assumes that the favored parent has caused PA in the child simply because the child refuses to have a relationship with the rejected parent, without identifying or proving alienating behaviors by the favored parent." Ninety-four examples of the same misinformation were identified and subjected to citation analysis using Gephi software, which displays the links between citing material and cited material. The recurrent misinformation reported here is not trivial; these statements are significant misrepresentations of PA theory. Plausible explanations for this trail of misinformation are the psychological mindset of the authors (i.e., confirmation bias) and the authors' writing skills (e.g., sloppy research practices such as persistent use of secondary sources for their information). The authors of this article recommend that publications containing significant misinformation should be corrected or retracted.

The Five-Factor Model for the Diagnosis of Parental Alienation.

Although the phenomenon that we know as parental alienation (PA) had been described in the mental health and legal literature for many years, it was given its name-parental alienation syndrome-by Richard Gardner in 1985. As time went on, most writers abandoned the use of the word syndrome and simply referred to this mental condition as parental alienation. The definition of PA is a mental state in which a child-usually one whose parents are engaged in a high-conflict separation or divorce-allies strongly with one parent (the favored parent) and rejects a relationship with the other parent (the alienated parent) without a good reason. Of course, it is a major loss for a child to experience the removal of a parent from their life in that manner. The purposes of this commentary are to explain definitions and distinctions related to PA; describe the Five-Factor Model (FFM) for the identification of PA; and offer clinical, legal, and training implications stemming from an understanding of PA.

Definitions and terminology regarding child alignments, estrangement, and alienation: A survey of custody evaluators.

Parental alienation (PA) is a highly consequential family dynamic that causes harm to children and parents. While many mental health and legal professionals agree that PA is common and potentially very harmful to children, there is still the appearance that there is controversy and discord in the field. The purpose of this study was to test the extent of consensus in the field regarding the basic tenets of PA theory. Specifically, 11 key terms related to PA were identified through expert input and preliminary field-testing. An on-line survey was created specifically for the study to assess level of agreement with these key terms among custody evaluators. This profession was selected because of their high degree of training and experience with a variety of family conflict situations; 119 child custody evaluators selected as members of a professional custody evaluator listing (88% response rate) rated their endorsement of these 11 key definitions with response options including: strongly agree, agree, neither agree nor disagree, disagree, and strongly disagree. Results revealed that roughly 80% of respondents agreed or strongly agreed with each of the 11 definitions. These results demonstrate a high degree of consensus and should guide future trainings of legal and mental health professionals to ensure a common language and understanding of this phenomenon.

Measuring the Difference Between Parental Alienation and Parental Estrangement: The PARQ-Gap.

Parental alienation (rejection of a parent without legitimate justification) and realistic estrangement (rejection of a parent for a good reason) are generally accepted concepts among mental health and legal professionals. Alienated children, who were not abused, tend to engage in splitting and lack ambivalence with respect to their parents; estranged children, who were maltreated, usually perceive their parents in an ambivalent manner. The hypothesis of this study was that a psychological test-the Parental Acceptance-Rejection Questionnaire (PARQ)-will help to distinguish severely alienated from nonalienated children. The PARQ, which was used to identify and quantify the degree of splitting for each participant, was administered to 45 severely alienated children and 71 nonalienated children. The PARQ-Gap score-the difference between each child's PARQ: Father score and PARQ: Mother score-was introduced and defined in this research. Using a PARQ-Gap score of 90 as a cut point, this test was 99% accurate in distinguishing severely alienated from nonalienated children. This research presents a way to distinguish parental alienation from other reasons for contact refusal. The PARQ-Gap may be useful for both clinicians and forensic practitioners in evaluating children of separating and divorced parents when there is a concern about the possible diagnosis of parental alienation.

An Objective Measure of Splitting in Parental Alienation: The Parental Acceptance-Rejection Questionnaire.

Both clinicians and forensic practitioners should distinguish parental alienation (rejection of a parent without legitimate justification) from other reasons for contact refusal. Alienated children-who were not abused-often engage in splitting and lack ambivalence with respect to the rejected parent; children who were maltreated usually perceive the abusive parent in an ambivalent manner. The purpose of this study was to assess the usefulness of the Parental Acceptance-Rejection Questionnaire (PARQ) in identifying and quantifying the degree of splitting, which may assist in diagnosing parental alienation. Results showed that severely alienated children engaged in a high level of splitting, by perceiving the preferred parent in extremely positive terms and the rejected parent in extremely negative terms. Splitting was not manifested by the children in other family groups. The PARQ may be useful for both clinicians and forensic practitioners in evaluating children of divorced parents when there is a concern about the possible diagnosis of parental alienation.

Practice parameter for the assessment and treatment of children and adolescents with depressive disorders.

This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice.

Bad nature, bad nurture, and testimony regarding MAOA and SLC6A4 genotyping at murder trials.

Recent research-in which subjects were studied longitudinally from childhood until adulthood-has started to clarify how a child's environment and genetic makeup interact to create a violent adolescent or adult. For example, male subjects who were born with a particular allele of the monoamine oxidase A gene and also were maltreated as children had a much greater likelihood of manifesting violent antisocial behavior as adolescents and adults. Also, individuals who were born with particular alleles of the serotonin transporter gene and also experienced multiple stressful life events were more likely to manifest serious depression and suicidality. This research raises the question of whether testimony regarding a defendant's genotype, exposure to child maltreatment, and experience of unusual stress is appropriate to present during the guilt or penalty phases of criminal trials, especially when capital punishment is a consideration. The authors present their experience in genotyping criminal defendants and presenting genetic information at criminal trials.

An evidence-based approach for estimating present and future damages from child sexual abuse.

This article illustrates the use of evidence-based practice to develop conclusions for a forensic report. The authors present a case vignette in which an early adolescent boy was sexually abused by an employee of a private school, and a lawsuit ensued. They explain how to utilize relevant research regarding the prognosis of victims of sexual abuse to address the forensic issues of psychological injury and future damages. It is notable that the two authors, who have at times testified on opposite sides of similar cases, were able to agree on conclusions that were based on relevant published research.

Associations between Exposure to Alienating Behaviors, Anxiety, and Depression in an Italian Sample of Adults.

The aim of this study was to examine associations between exposure to alienating behaviors (ABs) and anxiety and depression as mediated through psychological maltreatment and parental bonding in a sample of Italian adults in the community. Five hundred and nine adults were given a measure of exposure to ABs, the Baker Strategy Questionnaire; the Psychological Maltreatment Measure; the Parental Bonding Instrument; the State-Trait Anxiety Inventory-Y; and the Beck Depression Inventory-II. Exposure to ABs was associated with psychological maltreatment, which was associated with parental bonding, which was associated with each of the three mental health outcomes: depression, state anxiety, and trait anxiety. The authors conclude that exposure to ABs in childhood represents a risk factor for subsequent poor mental health.

Child Affected by Parental Relationship Distress.

OBJECTIVE: A new condition, "child affected by parental relationship distress" (CAPRD), was introduced in the DSM-5. A relational problem, CAPRD is defined in the chapter of the DSM-5 under "Other Conditions That May Be a Focus of Clinical Attention." The purpose of this article is to explain the usefulness of this new terminology. METHOD: A brief review of the literature establishing that children are affected by parental relationship distress is presented. To elaborate on the clinical presentations of CAPRD, four common scenarios are described in more detail: children may react to parental intimate partner distress; to parental intimate partner violence; to acrimonious divorce; and to unfair disparagement of one parent by another. Reactions of the child may include the onset or exacerbation of psychological symptoms, somatic complaints, an internal loyalty conflict, and, in the extreme, parental alienation, leading to loss of a parent-child relationship. RESULTS: Since the definition of CAPRD in the DSM-5 consists of only one sentence, the authors propose an expanded explanation, clarifying that children may develop behavioral, cognitive, affective, and physical symptoms when they experience varying degrees of parental relationship distress, that is, intimate partner distress and intimate partner violence, which are defined with more specificity and reliability in the DSM-5. CONCLUSION: CAPRD, like other relational problems, provides a way to define key relationship patterns that appear to lead to or exacerbate adverse mental health outcomes. It deserves the attention of clinicians who work with youth, as well as researchers assessing environmental inputs to common mental health problems.

Practice parameter for the assessment and treatment of children and adolescents with substance use disorders.

This practice parameter describes the assessment and treatment of children and adolescents with substance use disorders and is based on scientific evidence and clinical consensus regarding diagnosis and effective treatment as well as on the current state of clinical practice. This parameter considers risk factors for substance use and related problems, normative use of substances by adolescents, the comorbidity of substance use disorders with other psychiatric disorders, and treatment settings and modalities.

Symptom Checklist-90-Revised scores in adult children exposed to alienating behaviors: an Italian sample.

This study addresses a particular form of child psychological maltreatment, exposing a child to alienating behaviors in the context of a high degree of conflict between the parents. The objective of this research was to identify retrospectively the alienating behaviors that occurred in an Italian sample of children and the reported associated psychosocial symptoms. Seven hundred and thirty-nine adults in Chieti, Italy, completed an anonymous and confidential survey regarding their childhood exposure to parental alienating behaviors and measures of current symptomatology. About 75% of the sample reported some exposure to parental alienating behaviors; 15% of the sample endorsed the item, "tried to turn me against the other parent." The results revealed strong and statistically significant associations between reported exposure to parental alienating behaviors and reports of current symptomatology.

Practice parameter for use of electroconvulsive therapy with adolescents.

Electroconvulsive therapy (ECT) may be an effective treatment for adolescents with severe mood disorders and other Axis I psychiatric disorders when more conservative treatments have been unsuccessful. ECT may be considered when there is a lack of response to two or more trials of pharmacotherapy or when the severity of symptoms precludes waiting for a response to pharmacological treatment. The literature on ECT in adolescents, including studies and case reports, was reviewed and then integrated into clinically relevant guidelines for practitioners. Mood disorders have a high rate of response to ECT (75%-100%), whereas psychotic disorders have a lower response rate (50%-60%). Consent of the adolescent's legal guardian is mandatory, and the patient's consent or assent should be obtained. State legal guidelines and institutional guidelines must be followed. ECT techniques associated with the fewest adverse effects and greatest efficacy should be used. The presence of comorbid psychiatric disorder is not a contraindication. Systematic pretreatment and posttreatment evaluation, including symptom and cognitive assessment, is recommended.

Practice parameter for the assessment and treatment of children and adolescents with enuresis.

Enuresis is a symptom that is frequently encountered in child psychiatric evaluations. Careful assessment is required to identify specific urologic, developmental, psychosocial, and sleep-related etiologies. For most children with enuresis, however, a specific etiology cannot be determined. Treatment then involves supportive approaches, conditioning with a urine alarm, or medications--imipramine or desmopressin acetate. The psychosocial consequences of the symptom must be recognized and addressed with sensitivity during the evaluation and treatment of enuresis.

Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults.

This practice parameter describes treatment with stimulant medication. It uses an evidence-based medicine approach derived from a detailed literature review and expert consultation. Stimulant medications in clinical use include methylphenidate, dextroamphetamine, mixed-salts amphetamine, and pemoline. It carries FDA indications for treatment of attention-deficit/hyperactivity disorder and narcolepsy.

Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint.

This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also presents guidelines that have been developed in response to professional, regulatory, and public concern about the use of restrictive interventions with aggressive patients with regard to personal safety and patient rights. The literature on the use of seclusion, physical restraint, mechanical restraint, and chemical restraint is reviewed, and procedures for carrying out each of these interventions are described. Clinical and regulatory agency perspectives on these interventions are presented. Effectiveness, indications, contraindications, complications, and adverse effects of seclusion and restraint procedures are addressed. Interventions are presented to provide more opportunities to promote patient independence and satisfaction with treatment while diminishing the necessity of using restrictive procedures.

Child custody evaluations.

Because divorce is so common, it is important for our society to find ways to minimize the psychological trauma that is experienced by children of divorced parents. Ideally, divorcing parents would not fight so much over the children, in front of the children, and through the children. When disputes do arise regarding custody, visitation, and parenting plans, mental health professionals can assist the judges who make the final decisions by performing competent custody evaluations. These evaluations should be conducted in a systematic manner, should consider several critical factors in an unbiased manner, and should result in recommendations that promote the best interests of the children. In most cases, the goal is for each child to have strong, healthy relationships with both parents. After conducting an evaluation, it is usually possible to make recommendations regarding custody, parenting arrangements, and forms of counseling and therapy that should be helpful to the family members. It is important to communicate these recommendations in an articulate manner, whether verbally or in the written report.

Concealment of psychopathology in forensic evaluations: a pilot study of intentional and uninsightful dissimulators.

Dissimulation is the concealment of genuine psychiatric symptoms in an attempt to present a picture of psychiatric health. In this pilot study, the authors set out to demonstrate that defendants may conceal psychiatric illness even in forensic settings, contrary to their apparent self-interest. They reviewed their records for forensic assessments of dissimulators and malingerers and classified dissimulators as "intentional" or "uninsightful" depending on whether their concealment of symptoms appeared to be a volitional act or driven by a lack of insight. Although there were obvious diagnostic differences, the only other significant difference between malingerers and dissimulators was that malingerers were more likely to be facing charges related to financial crimes. Uninsightful dissimulators were significantly older than were intentional dissimulators. Uninsightful dissimulators were also more likely to be psychotic, particularly delusional and schizophrenic, than were intentional dissimulators. While forensic psychiatrists are vigilant in attempts to detect malingering, these data suggest that they should be equally vigilant regarding the possibility of dissimulation. Although further study is indicated, it appears that dissimulators are a heterogeneous group.