Child Psychiatrists and Psychologists: Enhanced Collaboration in Primary Care.

Psychiatry and psychology have a long history of competition that too often interferes with the collaboration that can characterize complementary contributions to our common missions. We hope this article will inspire our disciplines to expand on this collaboration, for the sake of our children and families, our communities, our colleagues, and honestly, ourselves. We are better together than apart. This text is a blueprint for the assumptions, attitudes, skills, and advocacy that can make this partnership healthy and successful.

Da ludoterapia não-diretiva à ludoterapia centrada na criança - desenvolvimento histórico / From non-directive play therapy to child-centered play therapy - historical development / De la terapia de juego no-directiva a terapia de juego centrada en el nino - desarollo histórico

O desenvolvimento da Abordagem Centrada na Pessoa foi dividido em fases que apresentam as atitudes que fazem parte da relação terapêutica, independente do público atendido. Contudo, na especificidade da psicoterapia infantil, o desenvolvimento teórico e prático da própria abordagem aponta para a existência de peculiaridades. Este estudo tem como objetivo apresentar, através de uma revisão narrativa de literatura, fundamentada na hermenêutica filosófica de Gadamer, as possíveis características relativas ao atendimento de crianças a partir de um retorno às fases da ACP. Discutimos os fundamentos iniciais do atendimento com crianças em Rogers ena perspectiva clássica de Axline, compreendendo como a ludoterapia com crianças se caracteriza nas fases não-diretiva, reflexiva, experiencial e pós-rogeriana. Discutimos sobre propostas contemporâneas nos contextos europeu, estadunidense e brasileiro. Concluímos que essa delimitação do atendimento infantil possibilita uma percepção mais clara das mudanças e aprimoramentos em relação aos trabalhos pioneiros de Rogers e Axline, sempre tendo como eixo a dimensão relacional e a tendência ao crescimento como motor do processo terapêutico.

The development of the Person-Centered Approach was divided into phases that presents the attitudes that are part of therapeutic relationship, regardless of the public served. However, in the specificity of child psychotherapy, the theoretical and practical development of the approach points to the existence of peculiarities. This study aims to present, through narrative literature review, based on Gadamer's philosophical hermeneutics, the possible characteristics related to the child therapy, starting from a return to the PCA phases. We discuss the foundations of child therapy in Rogers and Axline's classic perspective, understanding how child play therapy is characterized in non-directive, reflective, experiential and post-Rogerian phases. We discuss contemporary proposals in the European, American, and Brazilian contexts. We conclude that this delimitation enables a clearer perception of changes and improvements amongst to the Rogers and Axline's pioneering work, always having as its axis the relational dimension and the tendency to growth as a motor of the therapeutic process.

El desarrollo del Enfoque Centrado en la Persona se dividió en fases que presentan las actitudes de la relación terapéutica, independiente del público. Sin embargo, en la especificidad de la psicoterapia infantil, el desarrollo teórico y práctico del enfoque en sí mismo apunta la existencia de peculiaridades. Este estudio tiene como objetivo presentar, a través de una revisión narrativa de la literatura, basado em la hermenéutica filosófica de Gadamer, las posibles características de la psicoterapia con niños, desde el retorno a las fases de ECP. Discutimos los fundamentos de la psicoterapia con niños en Rogers, la perspectiva clásica de Axline, comprendiendo como la terapia de juego com los niños se caracterizan em las fases no directiva, reflexiva, experiencial y pos-rogeriana. Discutimos propuestas contemporáneas en los contextos europeo, estadounidense y brasileño. Concluimos que esta delimitación permite una percepción más clara de los cambios y mejoras en relación con los trabajos pioneros de Rogers y Axline, teniendo siempre como eje la dimensión relacional y la tendencia al crecimiento como motor del proceso terapéutico.

Young children conform more to norms than to preferences.

As members of cultural groups, humans continually adhere to social norms and conventions. Researchers have hypothesized that even young children are motivated to act conventionally, but support for this hypothesis has been indirect and open to other interpretations. To further test this hypothesis, we invited 3.5-year-old children (N = 104) to help set up items for a tea party. Children first indicated which items they preferred but then heard an informant (either an adult or another child) endorse other items in terms of either conventional norms or personal preferences. Children conformed (i.e., overrode their own preference to follow the endorsement) more when the endorsements were framed as norms than when they were framed as preferences, and this was the case whether the informant was an adult or another child. The priority of norms even when stated by another child opposes the interpretation that children only conformed in deference to adult authority. These findings suggest that children are motivated to act conventionally, possibly as an adaptation for living in cultural groups.

Nuevas texturas en el espacio psicoterapéutico con niños: inclusión-irrupción de la virtualidad / New textures in the psychotherapeutic space with children: inclusion-irruption of virtuality / Noves textures a l'espai psicoterapèutic amb nens: inclusió-irrupció de la virtualitat

psicoterapéutica con niños en tiempos de confina­miento, así como los desafíos al encuadre y la técnica que requiere el dispositivo virtual. Toma como ejes para repensar esta praxis en construcción los aspectos relacionados con el vínculo terapéutico dentro de la dinámica transferencial-contratransferencial, el lugar del cuerpo en el nuevo marco temporal y espacial y los mediadores terapéuticos emergentes en esta situación clínica

This paper sets out to think about some aspects of the psychotherapeutic clinic with children during the lockdown period, as well as the challenges to the framing and the technique required by the virtual device. It takes as axes to rethink this building praxis, the aspects related to the therapeutic bond within the transferential-countertransferential dyna­mics, the place of the body in the new temporal and spatial framework, and the emerging therapeutic mediators in this clinical situation

El present treball es plan­teja pensar alguns aspectes de la clínica psicoterapèutica amb nens en temps de confinament, així com els desafiaments a l'enquadrament I a la tècnica que requereix el dispositiu virtual. Pren com a eixos per repensar aquesta pràctica en construcció els aspectes relacionats amb el vincle terapèutic dins de la dinàmica transferen­cial-contratransferencial, el lloc del cos en el nou marc temporal I espacial I els mediadors terapèutics emergents en aquesta situació clínica

Making a good mental health diagnosis: Science, art and ethics.

BACKGROUND: There are limitations to psychiatric classification, which affects the utility of diagnosis in general practice. OBJECTIVE: The aim of this article is to explore the principles of science, art and ethics to create clinically useful psychiatric diagnoses in general practice. DISCUSSION: Psychiatric classification systems provide useful constructs for clinical practice and research. Evidence-based treatments are based on the classification of mental illnesses. However, while classification is necessary, it is not sufficient to provide a full understanding of 'what is going on'. A good psychiatric diagnosis will also include a formulation, which provides an understanding of the psychosocial factors that provide a context for illness. Experiences such as trauma and marginalisation will change the illness experience but also provide other forms of evidence that shape therapy. Diagnoses also carry ethical implications, including stigma and changes in self­concept. The science, art and ethics of diagnosis need to be integrated to provide a complete assessment.

The relationship between integrated pediatric psychology and primary care visit length, revenue, content over 24 months.

Introduction: Integrating behavioral health providers into pediatric primary care to provide behavioral health (BH) services is both effective and efficient; however, the impact of pediatric integrated services on the operational and financial outcomes of primary care provider (PCP) visits has not been thoroughly investigated. The present study examined whether length of practice integration predicts the relationship between BH content addressed in a PCP visit, visit length, and revenue generation. Method: A total of 1,209 pediatric encounters with 25 PCPs across 7 primary care offices in a predominantly rural health system were abstracted for the presence or absence of BH content, visit length, duration of integration, and revenue. χ2 analyses and the generalized linear model framework were used to address the study objectives. Results: Integration was associated with more PCP visits with a BH topic discussed at 6-11 months of integration but not at 14-24 months. Visits with a BH topic were longer than medical-only visits and shorter when a practice was integrated for 6-11 months but not at 14-24 months of integration. Public insurance and integration were associated with lower revenue generation per minute. Visit content was not associated with PCP revenue. Discussion: Results suggest a relationship between integration and the operational and financial outcomes of PCP visits. This study shows that initial efficiencies or improvements (e.g., time, cost, content) associated with integrating BH may be lost over time. Future studies should evaluate sustainability in relation to program impact. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The role of spatial and spatial-temporal analysis in children's causal cognition of continuous processes.

Past research has largely ignored children's ability to conjointly manipulate spatial and temporal information, but there are indications that the capacity to do so may provide important support for reasoning about causal processes. We hypothesised that spatial-temporal thinking is central to children's ability to identify the invisible mechanisms that tie cause and effect together in continuous casual processes, which are focal in primary school science and crucial to understanding of the natural world. We investigated this in two studies (N = 107, N = 124), employing two methodologies, one shorter, the other more in depth. Further tasks assessed spatial-temporal (flow of liquid, extrapolation of relative speed, distance-time-velocity), spatial (two mental rotation, paper folding), verbal (expressive vocabulary), and nonverbal (block design) ability. Age dependent patterns were detected for both causal and predictor tasks. Two spatial-temporal tasks were unique and central predictors of children's causal reasoning, especially inference of mechanism. Nonverbal ability predicted the simpler components of causal reasoning. One mental rotation task predicted only young children's causal thinking. Verbal ability became significant when the sample included children from a wide range of socioeconomic backgrounds. Causal reasoning about continuous processes, including inferences of causal mechanism, appears to be within the reach of children from school entry age, but mechanism inference is uncommon. Analytic forms of spatial-temporal capacity seem to be important requirements for children to progress to this rather than merely perceptual forms.

Evaluation of the teaching recovery techniques community-based intervention for accompanied refugee children experiencing post-traumatic stress symptoms (Accompanied refugeeS In Sweden Trial; ASsIST): study protocol for a cluster randomised controlled trial.

BACKGROUND: Refugee children have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue for years after resettlement. The Accompanied refugeeS In Sweden Trial (ASsIST) aims to evaluate a community-based intervention, called 'Teaching Recovery Techniques' (TRT), for accompanied refugee minors experiencing PTSD symptoms. METHODS/DESIGN: A cluster randomised controlled trial will be conducted in which participants will be randomly allocated to one of the two possible arms: the intervention arm (n=113) will be offered the TRT programme and the waitlist-control arm (n=113) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; c.8 weeks after randomisation) and follow-up (T3; c.20 weeks after randomisation). ETHICS AND DISSEMINATION: Ethical approval was granted by the Regional Ethical Review Board in Uppsala (Ref. 2018/382) (24th February 2019). Results will be published in scientific journals. TRIAL REGISTRATION DETAILS: ISRCTN17754931. Prospectively registered on 4th June 2019.

Las buenas prácticas en la atención psicológica infanto-juvenil ante el COVID-19 / No disponible

No disponible

Psychological care in children and adolescents with type 1 diabetes in a real-world setting and associations with metabolic control.

BACKGROUND: International guidelines recommend psychosocial care for children and adolescents with type 1 diabetes. OBJECTIVE: To assess psychological care in children and adolescents with type 1 diabetes in a real-world setting and to evaluate associations with metabolic outcome. METHODS: Delivery of psychological care, HbA1c, and rates of severe hypoglycemia and diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes from 199 diabetes care centers participating in the German diabetes survey (DPV) were analyzed. RESULTS: Overall, 12 326 out of 31 861 children with type 1 diabetes were supported by short-term or continued psychological care (CPC). Children with psychological care had higher HbA1c (8.0% vs 7.7%, P<.001) and higher rates of DKA (0.032 vs 0.021 per patient-year, P<.001) compared with children without psychological care. In age-, sex-, diabetes duration-, and migratory background-matched children, HbA1c stayed stable in children supported by CPC during follow-up (HbA1c 8.5% one year before psychological care started vs 8.4% after two years, P = 1.0), whereas HbA1c was lower but increased significantly by 0.3% in children without psychological care (HbA1c 7.5% vs 7.8% after two years, P <.001). Additional HbA1c-matching showed that the change in HbA1c during follow-up was not different between the groups, but the percentage of children with severe hypoglycemia decreased from 16.3% to 10.7% in children receiving CPC compared with children without psychological care (5.5% to 5.8%, P =.009). CONCLUSIONS: In this real-world setting, psychological care was provided to children with higher HbA1c levels. CPC was associated with stable glycemic control and less frequent severe hypoglycemia during follow-up.

Adapting social conditioned place preference for use in young children.

OBJECTIVE: Social-emotional processing is key to daily interactions and routines, yet a challenging construct to quantify. Measuring social and emotional processing in young children, children with language impairments, or non-verbal children, presents additional challenges. This study addresses a pressing need for tools to probe internal responses such as feelings, drives, and motivations that do not rely on intact language skills. METHODS: In this study, we extend our recent success of inducing conditioned place preference (CPP) in children to demonstrate the success of using a social unconditioned stimulus in the CPP paradigm in both typically developing children (n = 36) and in children with a diagnosis of autism spectrum disorder (n = 14). RESULTS: This is the first study to demonstrate successful social conditioned place preference in the human population. Both typically developing children and children with autism spectrum disorder demonstrate significant social conditioned place preference by spending significantly more time in the room paired with social interaction following training. CONCLUSIONS: Significant heterogeneity of CPP scores in both groups of children indicates that social motivation is expressed along a continuum, and that the CPP paradigm may provide a more comprehensive characterization of social motivation beyond a diagnosis of an autism spectrum disorder for each child.

Fútbol y psicoanálisis: una experiencia entre varios

En el Centro de Salud Mental Nº 1 de la Ciudad de Buenos Aires, el equipo de Niños Tarde comenzó en 2018 a integrar a los niños en tratamiento a un taller de fútbol, pensado como un espacio en el cual pudieran jugar con otros, y posibilitar múltiples transferencias e intervenciones. Se describe cómo fueron desarrollándose las actividades de este dispositivo.

Health-related quality-of-life in children with cystic fibrosis aged 5-years and associations with health outcomes.

BACKGROUND: The impact of early cystic fibrosis (CF) on health-related quality-of-life (HRQOL) in preschool children is poorly characterised, and data on relationships between HRQOL and health outcomes in young children with CF are limited. We aimed to characterise and compare parent-proxy and child-reported HRQOL and evaluate relationships with clinical outcomes at age 5-years. METHODS: Subjects were participating in the multi-centre Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) trial investigating BAL-directed versus standard CF therapy. Children aged 5-years and their parents rated HRQOL using the Pediatric Quality of Life Inventory (PedsQL™) and Cystic Fibrosis Questionnaire-Revised (CFQ-R) questionnaires. RESULTS: PedsQL and CFQ-R questionnaires were completed by 141 primary caregivers and 135 and 130 children, respectively. There were no differences in HRQOL between children randomised to BAL-directed versus standard CF therapy. Children with CF rated worse HRQOL than healthy children and there was poor parent-child concordance across HRQOL domains. Nutritional status, CF-CT scan score, forced expiratory volume in 1-second (FEV1), and pulmonary exacerbations correlated with HRQOL at age 5-years. FEV1 z-scores positively correlated with parent-proxy HRQOL in CFQ-R Respiratory (p = 0.018), Physical (<0.001), Emotional (p = 0.007) subscales and PedsQL Total-score (p = 0.021), Physical (p = 0.019) domains. Pulmonary exacerbation rates were inversely associated with parent-proxy CFQ-R Respiratory (p = 0.004), Physical (p = 0.022), PedsQL Total (p = 0.009) and Physical (p = 0.009) scores. CONCLUSION: Parent-reported HRQOL is a meaningful clinical endpoint to evaluate interventions in young children. Parent and child HRQOL reports provide different, complementary information. A preschool version of the CFQ-R is needed to assess relationships between HRQOL and clinical outcomes in young children.

Occupational Therapy Practitioners' Knowledge, Comfort, and Competence Regarding Youth Suicide.

Suicide rates for young people are climbing in the United States and worldwide. Increasing rates of youth suicide are of concern to occupational therapy (OT) practitioners in pediatric settings, yet the profession's role in this area is poorly defined. To understand OT practitioners' awareness and needs related to youth suicide, we administered a survey including objective (e.g., knowledge of suicide-related facts) and subjective items (open- and close-ended questions) related to youth suicide to 134 OT practitioners working in pediatric settings. Only 5.2% of respondents correctly answered four items about youth suicide facts and only 32% reported they had received suicide-focused education. Just under half (45%) of respondents were able to identify all best practice responses to clinical scenarios related to youth suicide; older practitioner age was the only significant predictor of best practices. OT practitioners in pediatric settings would benefit from youth-focused suicide education and training.

Can rapport building strategies, age, and question type influence preschoolers' disclosures of adult wrongdoing?

In the present experiment, we examined preschoolers' disclosures of a secret as a function of rapport building strategies used in Scandinavian field settings (verbal rapport building vs. prop rapport building), age in months (33-75 months) and question type (open-ended free recall invitation vs. suggestive questions). Fifty-three preschoolers (M = 60.5 months old, SD = 11.4) witnessed a researcher break a toy and were asked to keep the toy breakage a secret. The children were thereafter interviewed about the incident. Overall, 18.9% of the children disclosed the secret after an open-ended free recall invitation. The disclosure rate rose to 83% after the final phase of the interviews when questions containing suggestive details were asked of the children. Notably, we did not observe any significant effects as a function of manipulating rapport building strategy. A linear regression model showed that child age (in months) significantly predicted the amount of reported details, with younger preschoolers reporting fewer details compared to older preschoolers. Age also predicted the amount of correct details, but not the amount of incorrect details. No age differences were found with regard to children's disclosure tendencies or proportion of central details about the secret. Methodological limitations and practical implications will be addressed.

Annual Research Review: Ecological momentary assessment studies in child psychology and psychiatry.

BACKGROUND: Enhancements in mobile phone technology allow the study of children and adolescents' everyday lives like never before. Ecological momentary assessment (EMA) uses these advancements to allow in-depth measurements of links between context, behavior, and physiology in youths' everyday lives. FINDINGS: A large and diverse literature now exists on using EMA to study mental and behavioral health among youth. Modern EMA methods are built on a rich tradition of idiographic inquiry focused on the intensive study of individuals. Studies of child and adolescent mental and behavioral health have used EMA to characterize lived experience, document naturalistic within-person processes and individual differences in these processes, measure familiar constructs in novel ways, and examine temporal order and dynamics in youths' everyday lives. CONCLUSIONS: Ecological momentary assessment is feasible and reliable for studying the daily lives of youth. EMA can inform the development and augmentation of traditional and momentary intervention. Continued research and technological development in mobile intervention design and implementation, EMA-sensor integration, and complex real-time data analysis are needed to realize the potential of just-in-time adaptive intervention, which may allow researchers to reach high-risk youth with intervention content when and where it is needed most.

First steps toward an understanding of procedural fairness.

In four experiments, we tested whether 20-month-old infants are sensitive to violations of procedural impartiality. Participants were shown videos in which help was provided in two different ways. A main character provided help to two other agents either impartially, by helping them at the same time, or in a biased way, by helping one agent almost immediately while the other after a longer delay. Infants looked reliably longer at the biased than at the unbiased help scenarios despite the fact that in both scenarios help was provided to each beneficiary. This suggests that human infants can attend to departures from impartiality and, in their second year, they already show an initial understanding of procedural fairness.

Factor structure of the Friends and Family interview.

The aim of this study was to specify the latent construct structure of the Friends and Family Interview (FFI: Steele & Steele, 2005) based on its dimensional scale coding protocol. The FFI is a semi-structured interview measuring attachment in middle childhood. We analyzed data from 341 FFI interviews with children aged 7-12 years, recruited in the Scandinavian Öresund Region. Exploratory Factor Analysis revealed a three-component model as best fitting the data. The first component, denoting attachment security, gathered all dimensional scales for evidence of secure base/safe haven regarding mother/father and coherence in the child's narrative style, along with scales regarding reflective functioning, self-perception, and social functioning. The second component comprised preoccupying feelings of anger, but also derogation. The third component gathered all scales coding idealization. Inter-relations among the components were consistent with attachment theory, and respondents' scores for all three components differed significantly across the four categorical attachment classifications. Affect regulation of negative emotion through anger and through derogation co-occurred, and was distinct from regulation through maintaining a belief that things are better than they appear (idealization). These two affect regulation strategies appeared commonly when reflective functioning, and an organized self-perception, and positive peer relations were less in evidence. The multi-dimensional FFI coding system appears to measure successfully these diverse features of the child's narrative provided in response to the interview. Overall, our findings support the construct validity of the FFI and provide further evidence of its usefulness for assessing attachment in middle childhood and early adolescence.