Mentalization in children exposed to parental methamphetamine abuse: relations to children's mental health and behavioral outcomes.

This study examined the mentalization capabilities of children exposed to parental methamphetamine abuse in relation to symptom underreporting, mental health, and behavioral outcomes. Twenty-six school-aged children in foster care participated in this study. Mentalization was assessed using the My Family Stories Interview (MFSI), a semi-structured interview in which children recalled family stories about a happy, sad or scary and fun time. An established scale of the Trauma Symptom Checklist for Children (TSCC), a self-report measure, provided information on children's symptom underreporting. The Child Behavior Checklist (CBCL), completed by the children's foster caregivers, assessed children's mental health and behavioral outcomes. Children with higher mentalization were significantly less prone to underreport symptoms. These children had fewer mental health problems and were rated by their foster caregivers as more socially competent. The findings underscore that mentalization could be an important protective factor for children who have experienced parental substance abuse.

Assessing parenting risk within the context of severe and persistent mental illness: Validating an observational measure for families with child protective service involvement.

Women with severe and persistent mental illness (SMI) face formidable challenges as parents. While many raise their children to adulthood, others struggle considerably in the parenting role. In cases where there is child protective service involvement, an assessment may be requested to establish what risks an individual with SMI poses as a parent. Unfortunately, many current approaches to parenting assessments have serious methodological problems. One problem is a lack of valid and reliable measures to assess the parenting behavior of individuals with SMI who have child protective service involvement. In an effort to improve the quality of parenting assessments for this vulnerable group, this study drew on a sample of mothers with SMI who had lost custody of a child to examine the reliability and validity of the Child and Adult Relational Experimental Index (CARE-Index), an observational measure of parenting behavior. Independent and trained raters achieved a high level of reliability on the measure. Mothers' ratings on the measure also were associated with children's interactive behavior and with an estimation of risk based on a multifaceted, comprehensive assessment. The measure's relation to estimation of risk remained significant when two other predictors of risk, maternal caregiving attitudes and insight into mental illness, were considered. Taken together, the findings suggest that the measure can provide reliable, valid, and independent information on parenting behavior that could inform comprehensive, multifaceted assessments of parenting risk.

Intimate Partner Violence Is Associated with Suicidality Among Low-Income Postpartum Women.

BACKGROUND: Although intimate partner violence (IPV) during perinatal period is more common than during other maternal health conditions, it receives less attention within research on maternal mortality rates. Given the risks for maternal mortality because of suicidality, the purpose of this investigation is to examine the risk of suicidal ideation (SI) among postpartum women exposed to IPV. MATERIALS AND METHODS: In this cross-sectional study, participants were recruited between May 2005 and March 2007 from primary care clinics in São Paulo, Brazil. A total of 701 postpartum women were included in the analysis. Postpartum SI was assessed using the clinical interview schedule-revised. IPV was assessed using a structured questionnaire previously validated in Brazilian populations. Crude and adjusted risk ratios with 95% confidence intervals (95% CI) were estimated using Poisson regression with robust variance to examine the association between IPV and the risk for postpartum SI. RESULTS: The prevalence of postpartum SI was 4%. Among those with postpartum SI, 70% reported IPV during the postpartum period. Compared with non-IPV counterparts, postpartum women who reported IPV had an increased risk for SI (relative risk [RR] 7.25, 95% CI: 3.23-16.27). In the fully adjusted model, the risk for SI remained significantly higher for women who experienced IPV than for those who did not (RR 3.02, 95% CI: 1.29-7.07). CONCLUSIONS: Postpartum women exposed to violence had a threefold greater risk of having suicidal thoughts.

Case series: mental health needs and perspectives of rural children reared by parents who abuse methamphetamine.

OBJECTIVE: This case-based, mixed-methods study was undertaken to understand the perspectives and mental health needs of rural children exposed to parental methamphetamine abuse. METHOD: Participants were 23 children involved with a state child protective agency because of parental methamphetamine abuse. A semistructured interview provided information on children's perspectives of their families. Information on children's mental health needs was obtained from the Child Behavior Checklist and Trauma Symptom Checklist. Case records and caseworker reports provided information on children's family experiences. RESULTS: Children described emotional pain; few social resources for coping with emotions, problem solving, or talking about their experiences; and avoidant or passive coping skills. Sixty-five percent of children evidenced significant dissociative or posttraumatic symptoms on standardized assessments; 57% had other significant emotional and behavioral problems. Challenges to understanding children's perspectives included children's perceptions that talking about methamphetamine abuse was taboo and underreporting of significant symptoms on the Trauma Symptom Checklist. CONCLUSIONS: The high rate of mental health problems suggests the need for nontraditional strategies for services delivery in rural areas that are targeted toward these vulnerable children. Early identification and treatment of mental health problems should be a priority. Clinicians should be alert to the complexities in assessing children's mental health needs.

[Risk assessment of neglect and maltreatment in infants and toddlers. Chances of early preventive intervention]. / Risikoeinschätzung bei Vernachlässigung und Kindeswohlgefährdung im Säuglings--und Kleinkindalter--Chancen früher beziehungsorientierter Diagnostik.

The German child protection system lacks of interdisciplinary and standardized procedures for screening and diagnosing child maltreatment as well as for service delivery. Evidence based assessments of risk-screening in combination with consensus-based models for risk-judgement seem to predict the best possible results. A central part of determining whether an infant is at risk is to evaluate various domains of parental competencies and skills. In particular assessment procedures based on attachment research have proven to be practically and methodologically relevant. These include interactive and video-based observational methods as well as parental representations as sources of information for risk assessment. Attachment based intervention and treatment programs are effective, especially with regard to enhancing paternal sensitive behavior. However, these programs need to be adapted to delivery for specific risk groups. Overall an interdisciplinary approach with regard to the programs as well as to the training of the professionals has to be taken into account.

Heinz Werner: His Life, Ideas, and Contributions to Developmental Psychology in the First Half of the 20th Century.

The author provides an overview of Heinz Werner's life and contributions to the field of developmental psychology during the first half of the 20th century. She focuses on his early work in Vienna and Munich as well as his tenure at the Psychological Institute in Hamburg, up through the time when he became a named Professor in Psychology at Clark University. Recognized as one of the founders of developmental psychology, Heinz Werner worked in the areas of perceptual development, comparative psychology, and symbol formation. Versatile in rigorous experimental methodologies, and in observational and phenomenological methodologies, Werner's approach to development stood in contrast to other approaches of development, both past and current. For Werner, development was a heuristic, a way of looking at processes in a variety of domains, including ontogeny, phylogeny, microgenesis, biology, developmental psychopathology, neuropsychology, and comparative psychology. Werner viewed development as proceeding from a state of relative globality and lack of differentiation to a state of increasing differentiation, articulation, and hierarchical integration, but he also stressed that individuals can function at different developmental levels under different times and conditions. Werner's holistic, organismic, comparative, and contextual approach to development transcended interdisciplinary boundaries, allowing him to study the interrelatedness between thought, language, feeling, perception, and culture.

Dysregulation of the Caregiving System in the Context of Maternal Depression: The Role of Mistrust in the Development and Causation of Abusive Parenting Behavior.

OBJECTIVE: This qualitative, case-based study drew on attachment and ethological theories to explore the role of mistrust, a severe attachment attitude, in the development and causation of abusive parenting behavior in mothers with severe, recurrent depression. METHOD: The study analyzed a priori codes from redacted comprehensive assessments of eight women with depression and child protective services involvement to explore how mistrust was expressed; its links to extreme defenses and reported childhood experiences; and its consequences for relationships and help seeking. Analyses also identified specific stimuli that elicited abusive parenting behaviors and explored the context of depression in relation to women's attachment and caregiving histories and mental health care follow-through. RESULTS: Linked to suppressed feelings of vulnerability, mistrust was expressed in suspicions about support and in feelings of abandonment and betrayal. It was associated with an absence of support, family violence, role reversal, and parental mental illness. Mistrust affected mothers' ability to maintain supportive relationships and to get help for their depression, which was a persistent part of their lives. A child's cries, lack of support, partner abuse, and threats of abandonment triggered abusive parenting behavior, likely by tapping into core attachment pains related to unacknowledged longings for support. Unprepared to deal with these feelings, mothers became frustrated and redirected or displaced their anger onto their children. CONCLUSIONS: Mistrust may play a role in the dynamics of abusive parenting in mothers with severe, recurrent depression. Early identification and preventive intervention efforts that address this attitude could be beneficial for parenting.

Physical and Psychological Aggression towards a Child among Homeless, Doubled-up, and Other Low-income Families.

This study examines the extent of adverse parenting behaviors among low-income families with children and determines whether housing instability, measured by homelessness and doubling up with relatives or friends due to economic hardship, increases the likelihood of physical and psychological aggression towards a child, after considering the contribution of other relevant characteristics. Using data from 3 waves of the Fragile Families and Child Wellbeing Study, this study followed 2,332 low-income children in 20 large U.S. cities. Multivariate analyses involved logistic regression with generalized estimating equations. Adverse parenting behaviors were common among all low-income families regardless of their having experienced housing instability. Nonetheless, mothers with a homeless or doubled-up episode reported higher rates of physically and psychologically aggressive behaviors towards a child compared to the housed group. Having a homeless episode was significantly associated with a greater likelihood of reporting a high level of physical aggression towards a child. Child's behavioral issues, maternal depression, and parental stress also contributed to adverse parenting behaviors. Findings suggest that housing instability can be a marker of adverse parenting behaviors and service professionals need to respond to parenting needs as well as housing needs for families in unstable housing. Areas of future research were discussed.

Perspectives on Physical Activity Among People with Multiple Sclerosis Who Are Wheelchair Users: Informing the Design of Future Interventions.

BACKGROUND: People with advanced multiple sclerosis (MS) are less physically active than those with milder forms of the disease, and wheelchair use has a negative association with physical activity participation. Thus, wheelchair users with MS are doubly disadvantaged for accruing the benefits of physical activity and exercise. Appropriate physical activity and exercise interventions are needed for this population. METHODS: We undertook a qualitative study to explore the meanings, motivations, and outcomes of physical activity in wheelchair users with MS. We sought to understand daily opportunities to accumulate physical activity and exercise, and to identify perceived barriers, facilitators, and benefits that might inform the design of future interventions. RESULTS: We interviewed 15 wheelchair users (mean age, 52 ± 8.8 years; n = 12 women). Data were transcribed and analyzed to identify and explore common themes. Our first theme was the reduced opportunity to participate in physical activity due to participants' dependence on mobility devices, environmental adaptations, and tangible support. Our second theme was the importance of incorporating physical activity and exercise into the everyday environment, highlighting the need for adaptive exercise and accessible environments. This indicated the need to incorporate behavior change modulators into physical activity and exercise interventions for those with advanced MS. Health-care professionals played an important role in promoting increased physical activity and exercise participation in those with advanced MS. CONCLUSIONS: Our findings may inform future interventions to increase initiation and maintenance of physical activity and exercise among people with advanced MS.