[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.

Application of a relational frame theory account of psychological flexibility in young children / Aplicación de una aproximación a la flexibilidad psicológica basada en la teoría del marco relacional en niños

BACKGROUND: Acceptance and commitment therapy (ACT) is a contextual behavior therapy based on relational frame theory (RFT), a functional contextual approach to human language and cognition. The main aim of ACT is to promote psychological flexibility, which has been defined in middle-level terms. The current study proposes that a recently developed RFT account of psychological flexibility might facilitate the adaptation of ACT to the work with young children. METHOD: A case study with a 5-year-old boy presenting problematic anger is presented to illustrate the previous suggestion. The intervention consisted of a brief ACT protocol applied in four, 20-min sessions and a token economy at the service of promoting psychological flexibility. The ACT protocol involved a multipleexemplar training in framing own ongoing experiences through deictic and hierarchical relations and transforming the discriminative functions of those experiences by relating them to rules that progressively specified longer term and symbolic, positive consequences. RESULTS: The intervention was shown to be highly effective in reducing the anger episodes, and the results were maintained during the one year of follow-up. CONCLUSIONS: This study supports the feasibility of the RFT account of psychological flexibility to adapt ACT to the work with young children

ANTECEDENTES: la terapia de aceptación y compromiso (ACT) es una terapia contextual basada en la teoría del marco relacional (RFT), una aproximación funcional-contextual al lenguaje y la cognición. El objetivo de ACT es incrementar la flexibilidad psicológica, que ha sido definida en términos de nivel medio. Este estudio propone que una aproximación a la flexibilidad psicológica basada en la RFT podría facilitar la adaptación de ACT en el trabajo con niños. MÉTODO: se presenta un estudio de caso con un niño de 5 años con ira problemática tratado con un protocolo de ACT aplicado en cuatro sesiones de 20 minutos y una economía de fichas al servicio de promover flexibilidad psicológica. El protocolo consistió en un entrenamiento en múltiples ejemplos en enmarcar la propia experiencia en curso a través de relaciones deícticas y jerárquicas y transformar sus funciones discriminativas al relacionarla con reglas que progresivamente especificaban consecuencias positivas, simbólicas y a más largo plazo. RESULTADOS: la intervención mostró ser altamente eficaz en reducir los episodios de ira, manteniéndose los resultados durante el año de seguimiento. CONCLUSIONES: este estudio apoya la viabilidad de la aproximación a la flexibilidad psicológica basada en la RFT para adaptar ACT en el trabajo con niños

The effect of relational training on intelligence quotient: a case study / El efecto del entrenamiento en comportamiento relacional sobre el cociente de inteligencia: un estudio de caso

BACKGROUND: Relational training protocols based on Relational Frame Theory (RFT) are showing promising results in increasing intelligence quotient. This case study aimed at analyzing the effect of a training protocol in fluency and flexibility in relational responding on intelligence quotient with a 4-year-old child. METHOD: The child's cognitive and psychomotor development was evaluated before and after the implementation of the training protocol using the McCarthy's Aptitudes and Psychomotricity Scale (MSCA). The training protocol consisted of a multiple-exemplar-training (MET) in relational framing in accordance with COORDINATION (Phases 1 and 2), OPPOSITION (Phase 3 and 4), and COMPARISON (Phases 5 and 6). The MET protocol was implemented in approximately 12 hours throughout five and one half months. RESULTS: The training was effective in establishing relational responding in OPPOSITION and COMPARISON frames as well as in promoting fluency and flexibility in all the three types of trained relations. After this training, the child showed an increase above 1.5 SD in the General Cognitive Index of the MSCA (from 106 to 131). CONCLUSIONS: This case study adds further empirical evidence of the potential of RFT training to improve cognitive abilities and intelligence

ANTECEDENTES: los protocolos de entrenamiento relacional basados en la Teoría del Marco Relacional (TMR) están mostrando resultados prometedores en el incremento del cociente de inteligencia. El objetivo de este estudio de caso fue analizar el efecto de un entrenamiento en fluidez y flexibilidad en comportamiento relacional sobre el cociente de inteligencia en un niño de 4 años. MÉTODO: se evaluó el desarrollo cognitivo y psicomotor del niño a través de las Escalas de Aptitudes y Psicomotricidad de McCarthy (MSCA). La intervención consistió en un entrenamiento relacional en múltiples ejemplos para enmarcar en COORDINACIÓN (Fases 1 y 2), OPOSICIÓN (Fases 3 y 4) y COMPARACIÓN (Fases 5 y 6). El entrenamiento se aplicó en 12 horas aproximadamente durante cinco meses y medio, y resultó eficaz en generar comportamiento relacional para enmarcar en OPOSICIÓN y COMPARACIÓN y en promover fluidez y flexibilidad en los tres marcos relacionales. RESULTADOS: el niño mostró un incremento superior a 1.5 DT en el Índice Cognitivo General del MSCA (de 106 a 131). CONCLUSIONES: este estudio añade evidencia al potencial de los entrenamientos basados en la TMR para mejorar las habilidades cognitivas e inteligencia

Analyzing data from a fuzzy rating scale-based questionnaire. A case study / Análisis de datos de un cuestionario basado en la escala de valoración fuzzy. Estudio de caso

BACKGROUND: The fuzzy rating scale was introduced to cope with the imprecision of human thought and experience in measuring attitudes in many fields of Psychology. The flexibility and expressiveness of this scale allow us to properly describe the answers to many questions involving psychological measurement. METHOD: Analyzing the responses to a fuzzy rating scale-based questionnaire is indeed a critical problem. Nevertheless, over the last years, a methodology is being developed to analyze statistically fuzzy data in such a way that the information they contain is fully exploited. In this paper, a summary review of the main procedures is given. RESULTS: The methods are illustrated by their application on the dataset obtained from a case study with nine-year-old children. In this study, children replied to some questions from the well-known TIMSS/PIRLS questionnaire by using a fuzzy rating scale. The form could be filled in either on the computer or by hand. CONCLUSIONS: The study indicates that the requirements of background and training underlying the fuzzy rating scale are not too demanding. Moreover, it is clearly shown that statistical conclusions substantially often differ depending on the responses being given in accordance with either a Likert scale or a fuzzy rating scale

ANTECEDENTES: la escala de valoración difusa se introdujo para abordar la imprecisión inherente al pensamiento humano y la experiencia al medir actitudes en muchos campos de la Psicología. La flexibilidad y expresividad de esta escala permiten describir apropiadamente las respuestas a la mayoría de las cuestiones que involucran mediciones psicológicas. MÉTODO: analizar las respuestas a cuestionarios basados en dicha escala supone un problema crítico. No obstante, en los últimos años se está desarrollando una metodología específica para el análisis estadístico de datos difusos que explota toda la información disponible. En este trabajo se recoge un resumen de los procedimientos más relevantes. RESULTADOS: los métodos se ilustrarán mediante su aplicación a los datos de un estudio realizado con niños de nueve años. En él, los niños han respondido a algunas cuestiones del conocido cuestionario TIMSS/PIRLS recurriendo a un formulario basado en la escala de valoración difusa y en formato impreso o digital. CONCLUSIONES: en primer lugar, el estudio muestra que los requisitos previos de formación y entrenamiento para cumplimentar tal formulario son poco exigentes. En segundo lugar, se verifica que a menudo las conclusiones estadísticas difieren sustancialmente dependiendo de que las respuestas se den según escala Likert o de valoración difusa

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.

Exclusión social y cultura: El papel de las normas de grupo, identidad de grupo y justicia / Social exclusion and culture: The role of group norms, group identity and fairness

Este artículo revisa la literatura sobre la exclusión social en la infancia y la adolescencia, con un enfoque sobre la exclusión basada en la cultura en la que las normas, la identidad y la justicia son factores importantes. La investigación reciente ha examinado las opiniones del niño acerca de la imparcialidad de la exclusión en diferentes contextos sociales, identificando los factores que contribuyen a legitimar o rechazar la exclusión de los miembros de los grupos externos. En todas las culturas, los factores de importancia son el sexo, la raza, la etnia y la cultura. Se revisan los resultados actuales y se apuntan las posibles áreas de investigación (AU)

This paper reviews the literature on social exclusion in childhood and adolescence, with a focus on exclusion based on culture in which norms, identity, and fairness are salient factors. Recent research has examined children’s views about the fairness of exclusion in different social contexts, identifying the factors that contribute to legitimizing or rejecting the exclusion of members of out-groups. Across cultures, factors of relevance include gender, race, ethnicity, and culture. We review current findings and point to areas for new research (AU)

Derived control by compound and single stimuli in a matching-to-sample task in children / Control derivado ejercido por estímulos compuestos y simples en una tarea de igualación a la muestra en niños

A matching-to-sample procedure was used to investigate whether 9-year-old children would demonstrate the emergence of a derived compound-sample conditional discrimination following training in four interrelated single-sample conditional discriminations and vice versa, as adults did in previous studies. In Experiment 1, three out of three children demonstrated the emergence of a compound-sample conditional discrimination following training in four single-sample conditional discriminations. In Experiment 2, two out of three children acquired a compound-sample conditional discrimination and they demonstrated the emergence of four single-sample conditional discriminations; one of them did so only after being exposed to a remediation training and testing procedure. Training variables that facilitated discrimination emergence in both directions are discussed. In general, results showed that the sophisticated learning skills that are supposedly possessed by adults are not required to demonstrate the two types of derived control under study (AU)

Se empleó un procedimiento de igualación a la muestra para investigar si niños de 9 años mostrarían la emergencia de una discriminación condicional de muestra compuesta a partir del entrenamiento de cuatro discriminaciones condicionales de muestra simple interrelacionadas, y viceversa, tal como hicieron participantes adultos en investigaciones previas. En el Experimento 1, tres de tres niños mostraron la emergencia de una discriminación condicional de muestra compuesta tras ser entrenados en cuatro discriminaciones condicionales de muestra simple. En el Experimento 2, dos de tres niños adquirieron una discriminación condicional de muestra compuesta y a continuación ambos mostraron la emergencia de cuatro discriminaciones condicionales de muestra simple; uno de ellos solo lo hizo tras haber sido expuesto a un procedimiento de entrenamiento y prueba específicamente diseñado para ello. Las características del entrenamiento que facilitaron la emergencia de discriminaciones en ambas direcciones son discutidas. En general, los resultados demostraron que las sofisticadas habilidades de aprendizaje que supuestamente poseen los adultos no son necesarias para mostrar el tipo de control de estímulos derivado que se estudió (AU)

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.