[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.

Adolescents and Body Modification for Gender Identity Expression.

As a matter of ethics and law, adults enjoy wide berth in securing hormonal and surgical interventions to align their bodies with their desired gender appearance. In contrast, the exercise of choice by minors is more constrained, because they can be less well situated to grasp the nature and consequences of interventions having life-long effects. Even so, some minors hope for body modifications prior to adulthood. Starting very young, some minors may assert atypical gender identity: those with female-typical bodies assert a male identity and those with male-typical bodies assert a female identity. This assertion of identity is atypical only in a descriptive sense, because it is uncharacteristic, not because it is normatively unacceptable. Not all minors persist in their atypical gender identities, but some do. For those who do, it is desirable to minimize unwanted secondary sex characteristics and to maximize desired secondary sex characteristics. I outline here a theory of respect for decisions by minors in regard to hormonal and surgical interventions that help align their bodies with their gender identity. Of particular ethical interest here are body modifications for fertility preservation since certain interventions in the body can leave people unable to have genetically related children. In general, I will show that the degree of respect owed to minors in regard to body modifications for gender identity expression should be scaled according to their decision-making capacities, in the context of robust practices of informed consent.

Capitalizing on Scientific Advances to Improve Access to and Quality of Children's Mental Health Care.

The majority of mental health problems begin in childhood or adolescence. The potential benefits of early identification and treatment of such problems are well established, and models of effective mental health interventions for children have proliferated in recent decades. However, barriers in access to care and challenges in assuring delivery of high-quality care significantly limit the public health impact of services for children and families. Specifically, the majority of children who need mental health care do not receive it, and when children are in care, many do not receive interventions that are most likely to have the greatest positive impact. A commitment to social justice requires significant improvement in access to care and quality of care to maximize human potential. The purpose of this manuscript is to highlight promising scientific advances in the development of effective mental health services for children and families, as well as the vexing challenges of actually delivering these services to those most in need. Key challenges to be discussed include disparities in access to care and quality of care, including race/ethnic disparities and complexities of navigating the multi-sector mental health service system for children, and difficulties in implementing effective intervention models more consistently in community care. The authors will propose practice and policy reform recommendations to address these challenges. Copyright © 2017 John Wiley & Sons, Ltd.

Consideraciones sobre el intervalo de vulnerabilidad de la adolescencia / Considerations for the definition of a interval of vulnerability/possibility in adolescence

En este artículo se explora la hipótesis de que si bien, la maduración relacionada con habilidades cognitivas alcanza su madurez entorno a la quincena primera de vida, la maduración de las habilidades sociales se retrasa hasta bien entrado los veinte. Nuestro objetivo es tratar de definir cuál es esa ventana de posibilidad/vulnerabilidad y cuál es la situación madurativa del joven en ese intervalo. En este contexto, argumentamos cómo la determinación del momento madurativo del cierre de la adolescencia tiene repercusiones sobre la valoración de la autonomía en la toma de decisiones de la persona. Concretamente señalamos aquellas vinculadas a la valoración de la autonomía del joven en cuestiones sanitarias, y también en responsabilidad penal. En las conclusiones ofrecemos algunos criterios educativos que puedan servir de orientación para la implementación tanto de políticas sociales como de programas educativos

This article explores the hypothesis that while maturation related cognitive abilities reaches maturity around the age of fifteen, maturation related social skills is delayed until well into the twenties. Our goal is to try to define what is the window of opportunity / vulnerability and what is the maturational status of the young in this interval. In this context, we argue how the maturational time of the closing of adolescence has an impact on the valuation of autonomy in decision-making of the person. Particularly, we figure out implications for the assessment of the autonomy of youth in health issues, and also criminal liability. In the conclusion, we offer some educational criteria that may provide guidance for implementing both social policy and educational programs

[Early detection to prevent mental illness during adolescence: ethical and theoretical considerations]. / Détection prévenante en santé mentale chez l'adolescent: considérations éthiques et théoriques.

In the face of changes that characterise adolescence, a number of youth experience ill-being, as part of a normal developmental process. For some of them, however, this ill-being may represent early signs of a psychopathological process. Regarding depression and psychosis, such early signs are non-specific, which complicates and delays treatment. In addition, issues such as stigmatization and unfamiliarity with these psychopathologies represent major obstacles to treatment access. Attempts to early detection, which involves identifying risk factors in order to provide support and follow-up, making an effort to take these clinical signs seriously, while at the same time avoiding to mistake a normal developmental process for a pathological condition.

Enfermedades mentales infantojuveniles: una mirada bioética del estigma al que conllevan / Child and youth mental illness: a look bioethics involving stigma

La bibliografía refiere que las creencias y actitudes que se le atribuyen a las enfermedades mentales tienen una estrecha relación con el comportamiento social hacia las personas con estas enfermedades. Objetivo: explorar las creencias y actitudes respecto a las enfermedades mentales de ni±os y adolescentes y analizarlas desde la perspectiva de la bioética. Material y Método: estudio exploratorio, prospectivo y cuantitativo. Se administró una encuesta a padres-tutores de ni±os-adolescentes con enfermedades mentales (EM) y a profesionales de la salud en el Hospital de Ni±os de la Santísima Trinidad. Los datos se analizaron por anßlisis de frecuencias. Resultados: en relación a las creencias si las EM son enfermedades como cualquier otra se encontró que para el 68,5% de padres-tutores y el 51,8% de profesionales de la salud nunca. El diagnóstico y tratamiento es percibido como un estigma por el 25,9% (p<0,01) de los profesionales de la salud, también identificaron temor y peligrosidad a las EM. El 42,8% de los ni±os-adolescentes fueron excluidos de la escuela y el 28,5% de actividades familiares...

Literature suggests that attitudes and beliefs generally attributed to mental illness (MI) have a strong relation with the social behavior towards people that suffer them. Objective: to explore attitudes and beliefs towards mental illness of children and adolescents, and analyze them from the bioethics perspective. Materials and methods: exploratory, prospective and quantitative study. A questionnaire was administered to parents-tutors of children-adolescents with mental disorders, and to healthcare professionals of the Hospital de Ni±os de la Santísima Trinidad. Data processing was performed by means of frequency analysis. Results: 68.5% of parents-tutors and 51.8% of healthcare professionals answered that mental disorders are never considered like any other illness. Diagnose and treatment are perceived as a stigma by 25.9% (p<0.01) of healthcare professionals, who also identified fear and dangerousness towards MI. 42.8% of children-adolescents were excluded from school and 28.5% from family activities...

[The contagion of adolescent suicide: cultural, ethical and psychosocial aspects]. / La contagion du suicide chez les adolescents: aspects culturels, éthiques et psychosociaux.

Suicide is the second leading cause of death among adolescents. The risk factors are many and varied. The contagion of suicide was raised as a potential cause of youth suicide. In support of this argument, we did a review of the literature on the possible contagion of adolescent suicide. Several types of situations can support this hypothesis : when a youth is faced with the suicide of a relative or close friend, when he lived in a community, through the media or via the Internet. The way suicide is reported in the press shows a correlation with increased incidence of suicide among adolescents. In summary, there is evidence increasingly obvious that the contagion is the source of some youth suicides. For this reason, it seems important that preventive measures are in place. However, although this mechanism has been instrumental in initiating the act, it is important to note that suicide is always the result of several factors including the personal history of the subject.

Moral competence as a positive youth development construct: a conceptual review.

Moral competence refers to the affective orientation to perform altruistic behaviors and the ability to judge moral issues logically. A five-stage theory of moral development is proposed. Both western and Chinese perspectives are incorporated in the elaboration of the characteristics of each stage. A brief review of the antecedents of moral competence is presented. The relationship between moral competence and adolescent developmental outcomes is also discussed. Some practical ways to promote moral competence are suggested. School-based programs may be effective in the promotion of moral competence provided it is based on all-round or whole-person development and the length of the program should be sufficiently long.

Validez y fiabilidad de un cuestionario abreviado para medir actitud autoritaria en adolescentes / Reliability and validity of a short questionnaire to measure authori-tarian attitudes in adolescents

Objetivo: Diseñar y validar una escala breve de medición del autoritarismo en la población adolescente. Método: Los ítems y las dimensiones se formularon adaptando, al contexto específico de la adolescencia, el concepto de actitud autoritaria (conjunto de creencias y sentimientos que inducen a discriminar y ejercer violencia sobre aquellos sujetos que se perciben diferentes). Inicialmente se identificaron 14 ítems correspondientes a las actitudes de tipo autoritario más habituales en el período adolescente (violencia entre iguales, sexismo y actitudes xenófobas). El cuestionario se administró a una muestra de 1960 alumnos pertenecientes a centros de Educación Secundaria. Resultados: Después de eliminar 3, de entre los 14 ítems iniciales, el modelo propuesto de 3 dimensiones mostró un buen ajuste a los datos (GFI= 0.96), tuvo uno elevada consistencia (alpha de Cronbach= 0.83) y confirmó su validez de constructo (AU)

Objective: Design and validate a short measurement scale of authoritarianism for teenagers. Methods: The items and dimensions were formulated to adapt the concepts related to authoritarian attitude (set of beliefs and feelings that induce to discriminate and exercise violence on those subjects that are perceived as different) to the specific context of adolescence. Initially, 14 items corresponding to the most habitual attitudes of authoritarian type in the teen period (gender tolerance, ethnic diversity tolerance and scholar violence attitudes) were identified. The questionnaire was provided to a sample of 1960 pupils belonging to Secondary Education Schools. Results: In the factorial analyses, 3 out of the 14 initial items were eliminated. The three dimensional model proposed here showed good adjustment (GFI= 0.96) and achieved high consistency (alpha of Cronbach= 0.83) confirming its construct validity (AU)

Making sense of adolescent decision-making: challenge and reality.

Few topics in pediatric bioethics are as vexing as decision-making. Decision-making in pediatrics presents challenges for children, parents, and physicians alike. The related, yet distinct, concepts of assent and consent are central to pediatric decision-making. Although informed consent is largely regarded as a worthwhile adult principle, assent has been, and continues to be, mired in debate. Controversial subjects include a meaningful definition of assent; how old children should be to assent; who should be included in the assent process; parental permission; how to resolve disputes between children and their parents; the relationship between assent and consent; the quantity and quality of information to disclose to children and their families; how much and what information children desire and need; the necessity and methods for assessing both children's understanding of disclosed information and of the assent process itself; reconciling ethical and legal attitudes toward assent; and finally, an effective, practical, and realistically applicable decision-making model.

No puede evitarlo, naci así. Las creencias de los adolescentes sobre el origen de la homosexualidad y el prejuicio sexual / She can not help it, she was born that way: Adolescents¡ beliefs about the origins of homosexuality and sexual prejudice

En este trabajo se examinaron las creencias de los adolescentes (N=1069) sobre el origen de la homosexualidad y cómo estas creencias se relacionan con sus juicios y razonamientos acerca de la homosexualidad, su grado de bienestar al interactuar con adolescentes gays y lesbianas, y sus juicios y razonamiento sobre la manera en que deben ser tratados. A partir del análisis de clases latente se establecieron cuatro perfiles sobre las creencias acerca del origen de la homosexualidad: elección/socialización temprana, elección, socialización y origen biológico. Los resultados muestran que los adolescentes que se basan en la socialización para explicar el origen de la homosexualidad tienden a evaluarla negativamente, se sienten menos cómodos al interactuar con iguales gays y lesbianas, y no suelen considerar que la exclusión y las burlas hacia gays y lesbianas sean algo negativo. En cambio, los adolescentes que utilizan argumentos biológicos tienden en menor medida a evaluar la homosexualidad como algo negativo, se sienten más cómodos al interactuar con gays y lesbianas y es más probable que evalúen la exclusión y las burlas como algo negativo. Además, los resultados muestran que las creencias sobre el origen se relacionan también con el tipo de razonamiento (moral, convencional, personal) que emplean los adolescentes ante estas cuestiones (AU)

This paper examined differences in American adolescents (n = 1069) beliefs about the origins of homosexuality and how these beliefs related to adolescents judgments and reasoning about homosexuality, their comfort interacting with lesbian and gay peers, and their judgments and reasoning about the treatment of lesbian and gay peers. Using Latent Class Analysis four origins cluster profiles were determined (choice/early socialization, choice, socialization, and biological). Results provide evidence that adolescents endorsing socialization beliefs about the origins of homosexuality were more likely to evaluate homosexuality as wrong, least comfortable interacting with lesbian and gay peers, and least likely to evaluate exclusion and teasing a lesbian or gay peer as wrong. Conversely, adolescent endorsing biological beliefs were least likely to evaluation homosexuality as wrong, most comfortable interacting with lesbian and gay peers, and most likely to evaluate exclusion and teasing as wrong. Further, the results provide evidence that origins beliefs were also related to the type of reasoning (moral, conventional, personal) that adolescents bring to bear on these issues (AU)

A psychoecological model of academic performance among Hispanic adolescents.

Although the number of students who complete high school continues to rise, dramatic differences in school success remain across racial/ethnic groups. The current study addressed Hispanic adolescents' academic performance by investigating the relationships of parental involvement, culturally responsive teaching, sense of school belonging, and academic self-efficacy and academic performance. Participants were 478 (51.5% female) Hispanic 7th graders in the US-Mexico borderlands. Based on Bronfenbrenner's ecological systems theory, a structural model was tested. Results showed that the proposed model was supported by demonstrating significant indirect effects of parental involvement, culturally responsive teaching, and sense of school belonging on academic performance. Furthermore, academic self-efficacy was found to mediate the relationships between parental involvement, culturally responsive teaching, and sense of school belonging and academic performance. The current study provides a useful psychoecological model to inform educators and psychologists who seek to meet the needs of Hispanic students.

Conducta suicida en niños y adolescentes. Aspectos éticos y morales / Suicidal behaviour in children and adolescents: moral and ethical aspects

Se realizó un estudio descriptivo y transversal sobre el intento suicida en pacientes pertenecientes a las áreas de salud Este y Julio A. Mella de la ciudad de Camagüey que ingresaron en la sala de Salud Mental del Hospital Pediátrico Eduardo Agramonte Piña. La muestra quedó constituida por 16 pacientes que realizaron intentos suicida en el período señalado. Los resultados muestran un alto predominio del sexo femenino (81,3%), los estudiantes externos (62,5%), seguido por los becados (31,2%). La escolaridad segundaria no terminada arrojó el mayor por ciento (56.2%) y las familias disfuncionales constituyen el mayor factor de riesgo similar a los conflictos en las relaciones familiares, ambos con un 75%. El objetivo de este estudio fue conocer el comportamiento de los intento suicidas en la edad de Infanto Juvenil durante el año 2002 en dos áreas de salud del municipio de Camagüey y valorar los aspectos éticos y morales de dicho proceder con la ayuda del enfoque de los estudios de Ciencia Tecnología Sociedad (AU)

It was carried out a descriptive and traverse study on suicidal attempts in patients belonging to Este and Julio A. Mella health areas in Camagüey city that were admitted to the Mental Health ward of Eduardo Agramonte Piña Pediatric Hospital. The sample was constituted by 16 patients that carried out suicidal attempts in the period. The results show a high prevalence of the feminine sex (81,3%), external students (62,5%), and those granted a scholarship (31,2%). Those who didn't finish high school account for the highest percent (56.2%) and dysfunctional families constitute number one risk factor together with family relationship conflicts, both with 75%. The objective of this study was to know the behavior of suicidal attempts in these age groups during the year 2002 in two health areas of Camagüey municipality and to value the ethical and moral aspects of this behavior with the help of the Science-Technology-Society Studies ' perspective (AU)

Perspectives of adolescents and their parents regarding service needs following a mild traumatic brain injury.

PRIMARY OBJECTIVE: Various guidelines have been developed to implement coherent and uniform management of persons with a mild traumatic brain injury (mTBI), but those have typically been developed for adults or children and may not address or meet the specific needs of adolescents. The purpose of this study was to explore the specific service needs of adolescents (12-18 years) after a mTBI. STUDY DESIGN: Qualitative phenomenological study. METHODS AND PROCEDURES: Individual semi-structured interviews were conducted with 15 adolescents and their parents who had received different levels of care from paediatric trauma centres within the previous 12 months. MAIN OUTCOMES AND RESULTS: All adolescents and parents expressed the need to receive information about the injury, its expected recovery and when to return to activities. Many adolescents reported wanting to be seen rapidly, by professionals who genuinely care about them and who acknowledge that they have specific needs that differ from those of younger children. Parents and, to a lesser degree, adolescents think that enhanced communication between the healthcare and school systems would be beneficial following a mTBI to assist in returning to demanding academic activities. CONCLUSIONS: Professionals involved in the management of adolescents with mTBI should be aware of their needs in order to provide optimal and developmentally appropriate services.

Suicidal attempt of a schoolgirl to demonstrate against the school teacher and try to make her quit the school.

UNLABELLED: A case of a 16-year-old schoolgirl who had admitted a demonstrative suicide attempt against her school teacher thus trying to make the teacher leave the school has been presented. During the observation period in the Emergency Department the nurse taking care of the patient overheard that during her talks with the friends, the girl had been continuously urging them to swallow the same set of tablets, call the ambulance and get admitted to the hospital. The anamnesis revealed that three schoolmates decided to get rid of one of the teacher from their school by accusing her of mental cruelty which had led them to suicidal attempts. It was done mainly because of the bad marks they had got from the teacher. The idea was undertaken by our patient due to many news transmitted in the newspapers and television during last months in which the teachers were blamed for a lot of incidents which had taken place in different schools in Poland. Despite the fact that in many of these events the teachers were both physically and mentally tormented by the pupils the opinions presented by mass-medias were always against them. Our patient said that in such circumstances it was supposed to be an easy way to solve all the problems with unlike teacher. CONCLUSIONS: The physicians should pay more attention on suicidal attempts causes specially in adolescents. Adolescents possess poor knowledge of the lethal potential of drugs, specially over-the-counter medications. The media have to take more responsibility for transmitting news concerning youth which should be more honest and verified.

Moral competence as a positive youth development construct: conceptual bases and implications for curriculum development.

Moral competence refers to the orientation to perform altruistic behavior and the ability to judge moral issues logically, consistently and at an advanced level of development. A brief review of the concepts of altruism and justice is presented. The gender and cultural issues are also discussed. The contents of moral competence program units include four major topics: (1) Fairness, (2) Proper conduct (mainly altruistic and prosocial orientation), (3) Responsibility and altruistic orientation, and (4) Integrity and fairness. The general goal is to help students to develop an altruistic orientation and a judgment structure of a high level of justice. This paper is part of the development of the positive youth development program in Hong Kong.

The palliative care nurse's role in supporting the adolescent child of a dying patient.

The aim of this article was to critically evaluate the author's role as a hospital-based palliative care nurse in supporting the adolescent child of a dying parent. The approach taken and the resources that were available have been reflected upon. The article explores whether it was possible to adapt the theory of bereavement support for those working with adults within the constraints of a busy acute hospital. It was found that although there were limitations to the amount of support the author could give within her role, there remains a window of opportunity for all healthcare professionals within this field to support parents in preparing their children for bereavement.

Shaping ethics: youth workers matter.

The authors propose that youth workers and educators committed to informing and shaping the ethical understandings of young people first need to explore and become aware of their own ethics. This requires front-line staff and caregivers to critically reflect on the impact their day-to-day choices and decisions have on youth. Once they become clearer about their own ethics and the consequences of their decisions, youth workers are then in a position to promote opportunities for youth to make ethical choices. The authors use observations and ideas from their experiences with the Minnesota Youth Work Institute. Their overarching aim is to promote ethical congruence between what is taught, how it is taught, and how it is practiced in daily work with youth.