Parental Alienation Syndrome: A Developmental Analysis of a Vulnerable Population

1. Parental alienation syndrome is the systematic denigration by one parent of the other parent with the intent of alienating the child. 2. Parents who engage in alienating activity have experienced loss, leading to depression, anger, and aggression. The family system experiences loss during divorce and is adversely affected by the alienating activities of one parent. 3. Understanding the dynamics of parental alienation syndrome will position the nurse to recognize it as a symptom of depression and dependence, and bring care to the vulnerable population.

Treatment of nonepileptic psychogenic events in adolescent patients using the systems model for intervention

Nonepileptic psychogenic events in children, adolescents and adults can be difficult to treat. Using a systems framework intervention method resulted in significant reduction in nonepileptic psychogenic events. This method provides for a continuous flow of interaction, feedback and modification among the health care team, family and community. Common goals and plans are defined and implemented with a mechanism for feedback and modification. Using a systems model approach in educating the caregivers resulted in immediate and long-term reduction in nonepileptic psychogenic events.

A randomized trial of a nursing intervention to promote the adjustment of children with chronic physical disorders

OBJECTIVE

This study was conducted to determine whether a specialized form of nursing could help prevent or reduce psychosocial maladjustment among children, aged 4 to 16 years, with chronic physical disorders. In contrast to other studies, nurses were chosen to provide the intervention based on their central role in health care and the appropriateness of their training for this task.

METHODOLOGY

A clinical trial was conducted in which 332 children and their families were randomly assigned either to receive this specialized nursing for a 1-year period, or to remain in the control condition. The children were all active outpatients in nine clinics at the Montreal Children's Hospital. Three measures of psychosocial functioning administered before and after the intervention were the basis for assessing its efficacy. The measures included the behavior problems profile of the Achenbach Child Behavior Checklist, the Personal Adjustment and Role Skills, completed by the parents, and two versions of the Self-Perception Profile (Harter) for children aged 4 to 7 years and 8 to 16 years.

RESULTS

Differences between groups were examined both categorically and quantitatively. In the former, the percent of children with clinical scores (those above or below a cut-off indicative of maladjustment) at baseline and postintervention were compared. In the latter, the mean scores at the end of the trial were analyzed using analysis of covariance with the baseline scores as covariates. Statistically significant positive differences were found in the domain of anxiety/depression on the Personal Adjustment and Role Skills, and in the areas of scholastic competence, behavior, and global self-worth on the Harter.

CONCLUSION

The results indicate that this intervention helps children with chronic disorders by preventing or reducing maladjustment. Most university-prepared nurses already have the basic skills required to achieve these results; only a modest investment in reorientation may be needed. Thus, other pediatric centers should be able to replicate these findings and thereby take a major step toward improving the lives of children with chronic disorders.

Family stress, social support, violence, and sons' behavior

Although the low income, female-headed, inner-city family has been repeatedly linked to child behavior problems, the family processes related to child misbehavior in this high risk group have not been identified. In a group of predominantly African American inner-city low-income mothers who lived alone with their children, the relationships between family stress, social support, mothers' conflict resolution tactics, and sons' behavior were examined using the family stress adaptation model, and potential nursing interventions were identified. The sample of low-income, inner-city mother-alone families reported more family stress and less social support than normative White Anglo-Saxon Protestant families. Family violence rates did not differ between the sample and nationally representative normative groups. Thirty-nine percent of sons, referred to the study because of school difficulties, were reported to have behavior problems requiring additional assessment. Analysis confirmed the fit of sample data to the model and identified family stress as the best site for nursing intervention for these high-risk families.

Behavioural work with pre-school children in the community

As many as 25 per cent of pre-school children are regarded by their parents as having behaviour problems. Such problems can continue into the school-age years. Behaviour difficulties in a young child can have implications for the mother's health and for family relationships. Pam Pritchard evaluates a specialist health visiting initiative to tackle child behaviour disturbance.

Behaviour disturbance: routine assessment of children at three years

Behavioural problems in pre-school children can be a major source of parenting and family anxiety. Early identification through routine screening can prevent problems escalating, writes Paul Stallard. It can also offer an opportunity to reassure anxious parents. Here he describes a behaviour checklist used by health visitors in Bath district to identify and help parent deal with behaviour problems in their young child.

Mothers' perceptions of sibling adjustment and family life in childhood chronic illness

Researchers who study the effects of chronic illness on well siblings have generally focused on individual characteristics and their relationships with psychological adjustment. More recently, researchers suggest that sibling adjustment can be best understood within the context of the family. The purpose of this study was to examine variations in sibling behavioral adjustment in relation to mothers' perceptions of the illness experience and family life. Based on mothers' ratings on the behavior problem scale of the Child Behavior Checklist (CBCL), five siblings considered poorly adjusted and five very well-adjusted siblings were compared with respect to mothers' reports of individual family member's response to illness, illness management, parenting philosophy, presence of other stressors, availability of social supports, and impact of illness on family members and family life. Two major differences were found between mothers who rated healthy siblings either poorly or very well adjusted: (a) effects of illness on the healthy sibling, the ill child, and the marital relationship and (b) perceived controllability of the chronic illness. Devising ways of helping mothers feel confident in managing their child's illness is integral to creating an environment that promotes optimal development of their ill child and the child's siblings.

Oh, Suzanna! A nursing challenge

Suzie, a ten year old child well known on our pediatric neuroscience ward at a children's hospital in British Columbia, was admitted in August 1991 for continuing seizures and unmanageable behaviour after her fourth epilepsy surgery. She was to remain with us for a total of nine months. Very soon, it became apparent that we had an untenable situation on the ward. On the one hand, seizure control was poor and Suzie required hospitalization to adjust her medications and to treat frequent episodes of status epilepticus. On the other hand, her behaviour was seriously disruptive to other patients and staff, as well as presenting a safety concern. Negative behaviours fell into three categories--disinhibition, aggression and hyperactivity. Through slides and video tape, we will introduce Suzie and describe the progression of her disease. We will discuss, using a Nursing Case Management Model, how we took over her care, accessed community resources and eventually even accompanied her to Montreal for a right hemispherectomy. The "Suzie Experience" forced administration and staff to devise creative solutions and empowered nurses on the ward to implement new and unique strategies.

Social competence of school-aged children with chronic illnesses

This study examines social competence among 67 chronically ill children, aged 7 to 14 years, whose families participated in a grounded theory study of how families define and manage a child's chronic illness. Child Behavior Check List ratings (Achenbach & Edelbrock, 1983) by both fathers and mothers indicated a significantly greater risk for social competence difficulties among the chronically ill children as compared with the normative sample. Case vignettes, drawn from extensive interviews with family members, are used to show contrasting styles of family management and child coping and to suggest nursing interventions aimed at fostering social competence.

Parent education in preventing behaviour problems

The 'parent education package' (PEP) uses a combination of leaflets and health visitor intervention to help parents prevent the development of behaviour problems in their children. In evaluating PEP Kevin Hewitt et al found that, though popular with parents, the programme produced no actual behaviour change in their children. The results suggest that a successful prevention programme should perhaps focus on encouraging parents to think more positively about their children.

Are fathers' views important?

A survey by health visitors of the behaviour of children between the ages of three and eight revealed that mothers consistently rate children's behaviour as significantly more problematic and more intense than fathers do. Both mothers and fathers viewed the behaviour of boys as more difficult than girls. Pamela Mack, Karen Trew discuss the value of using a behaviour checklist as one aide in the assessment of childhood behaviour problems, with particular emphasis on the importance of involving fathers.

Behavioral disturbances among medically hospitalized school-age children

The purpose of this study was to examine the behavioral disturbances of medically hospitalized school-age children. Seventy-six school-age children, between the ages of 8 and 12, were the subjects. The children's usual prehospital behavior was reported by their mothers who completed the Child Behavior Checklist (CBCL). The hospitalized children were compared with the standardized nonclinical norms on the CBCL. Fifty-one percent of the children scored in the clinical range on one or both of the broad bands measuring behavioral disturbances: 21% on externalizing symptoms and 47% on internalizing symptoms. Total behavior problems and externalizing behavior were slightly associated with low socioeconomic status but not with the number of previous hospitalizations. Internalizing problems were not related to socioeconomic status nor the number of previous hospitalizations. The need for specialized mental health services to this population is discussed.

Maternal, environmental, and temperamental characteristics of toddlers with and toddlers without sleep problems

Sleep problems of young children are a common behavioral concern of parents. Thirty parents of toddlers with sleep problems (SP) and 30 parents of toddlers without sleep problems (WSP) were studied to ascertain differences in maternal, environmental, and temperamental characteristics. The Sleep Behavior Inventory and The Toddler Temperament Scale provided data identifying certain environmental and temperamental characteristics that may influence the development and/or maintenance of sleep problems. Implications of these findings for anticipatory guidance and counseling are discussed.

Behavior modification in pediatric hemodialysis

This article reports the results of a behavior modification approach for managing disruptive and noncompliant behaviors in four male hemodialysis patients ranging in age from 10 to 16 years. Each patient demonstrated some improvement in either behavior or health status during the intervention and 76.7% of available token reinforcers were earned. The intervention was inexpensive and well-accepted by the patients, families, and staff. Guidelines for the planning, implementation, and evaluation of such interventions are presented.

Interactions of mothers and fathers with conduct problem children: comparison with a nonclinic group

The purpose of this study was to compare the interactions of clinic-referred mothers and fathers with their conduct problem children with those of nonclinic "normal" parents and their children without problems in terms of their expression of positive and negative affect. Forty parents and their 20 children participated. Results indicated that clinic mothers and fathers exhibited significantly increased negative verbal behaviors with their children than nonclinic parents. Valence scores also indicated clinic mothers had significantly more negative nonverbal affect behaviors than nonclinic mothers. Clinic children exhibited significantly less positive verbal and nonverbal affect behaviors with their mothers than nonclinic children. Valence scores indicated that clinic children exhibited more negative nonverbal behaviors with both mothers and fathers in comparison to nonclinic children.