Wirksamkeit elternzentrierter Interventionen bei Kindern im Alter von zwei bis zwölf Jahren

[Partnership and family aspects of cancer]

Cancer is not only a challenge for the patient, but can also be associated with psychosocial distress for relatives, especially partners and minor children. Although studies on the long-term effects of cancer on partners, the partnership, and child development are still rare, there are indications that the psychological distress on relatives may become chronic, and that parental illness is a risk factor for a child to develop mental disorders. In addition, a deterioration in partnership satisfaction also increases the risk of separation.Psycho-oncology care should therefore not only consider the patient's psychosocial burden but also that of the partner, as well as its effect on the partnership. Appropriate offers, for example to increase partnership and sexual satisfaction, communication, or dyadic coping, should be made. Children should also be treated as relatives in care. Focusing on both the child's distress and on improving the parent-child relationships and parenting behavior can help children to cope with parental illness in the long term. Thus, cancer should be viewed on the individual, dyadic, and family level, and psychosocial care services should be provided at all levels.

Journey of a psychiatric nurse: Growing up with parents with mental illness

WHAT IS KNOWN ON THE SUBJECT?: The parent-child relationship has a significant impact on children's mental health. Families with individuals with mental illness constitute a high-risk group in the community. It can be challenging for children to cope with issues related to having parents with mental illness. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper explains the feelings, thoughts and experiences of a psychiatric nurse whose parents both have a mental illness and emphasizes the positive and negative effects of growing up in such a situation. The effects of growing up with parents with mental illness should be addressed as a whole. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The narrative highlights the impact that parents with mental illness have on children. Psychiatric nurses are in a key position to provide children whose parents have a mental illness with timely and continuous help in developing coping and support mechanisms.

Taking Care Triple P for Foster Parents With Young Children in Foster Care: Results of a 1-Year Randomized Trial

Young children with a history of maltreatment or neglect in foster families often confront their caregivers with particularly challenging behaviors. This may lead to more parenting stress, an increased risk for the child in foster care to experience further maltreatment, and placement disruptions. We conducted a randomized controlled trial to investigate the efficacy of a parent group training tailored to the special needs of foster families. We hypothesized significant short- and long-term improvements regarding foster parents' parenting competencies, child mental health problems, and related outcomes. Eighty-one families with 87 children in foster care aged 2 to 7 years participated in the trial. For the intervention study, 44 randomly selected families (54%) were offered to participate in the parent group training. Intervention and control group families were reassessed three times over a period of 1 year. Contrary to our expectations, we found no advantages of the intervention group compared with the usual care control group on any outcome measure. Instead, we found some significant changes in both groups across time. Placement into foster care is associated with some favorable outcomes for children in foster care. Additional support for foster families beyond the services delivered in the youth welfare system to foster parents was not associated with more favorable outcomes. The present intervention is likely associated with a low risk of harm but also with a high likelihood of a lack of significant benefits for foster parents and their young children going beyond feeling satisfied about the delivered services. Participating foster families showed favorable baseline results on parenting measures which may have impeded intervention effects to unfold on these proximal variables.

Therapieprozesse in der Kinder- und Jugendlichenpsychotherapie

Zusammenfassung. Theoretischer Hintergrund: Die Psychotherapieforschung zu therapeutischen Wirkfaktoren bei Kindern steckt in den Kinderschuhen. Mit dem Stundenbogen für Kinder und Jugendliche Patientenversion (SBKJ-P) wurde ein entsprechendes Messinstrument entwickelt. Die erfassten Wirkfaktoren sind Problemaktualisierung, Ressourcenaktivierung, Problembewältigung, motivationale Klärung als auch Rolle der Eltern und therapeutische Allianz. Fragestellung: Untersucht werden die Faktorstruktur, interne Konsistenz und konvergente Validität. Methode: Die Stichprobe umfasst 123 Kinder und Jugendliche (62 Mädchen) im Alter zwischen 7 und 18 Jahren ( MW = 13.1, SD = 3.03). Ergebnisse: Die Ergebnisse zeigen, dass der SBKJ-P ein verständliches, reliables und valides Instrument für die Prozess- und Verlaufsmessung von allgemeinen therapeutischen Wirkfaktoren darstellt. Diskussion und Schlussfolgerung: Der SBKJ-P erlaubt eine zuverlässige Einschätzung der Qualitätssicherung im psychotherapeutischen Prozess.

Psychiatric Disorders and Distal 21q Deletion-A Case Report

Partial deletion of chromosome 21q is a very rare genetic condition with highly variable phenotypic features including heart defects, high or cleft palate, brain malformations (e.g., cerebral atrophy), developmental delay and intellectual disability. So far, there is very limited knowledge about psychiatric disorders and their effective treatment in this special population. To fill this gap, the authors present the case of an initially five-year-old girl with distal deletion (del21q22.2) and comorbid oppositional defiant disorder (main psychiatric diagnosis) covering a period of time of almost four years comprising initial psychological/psychiatric assessment, subsequent treatment with Parent-Child Interaction Therapy (PCIT), and follow-up assessments. Post-intervention results including a 19-month follow-up indicated good overall efficacy of PCIT and high parental satisfaction with the treatment. This case report makes a substantial contribution to enhancing knowledge on psychiatric comorbidity and its effective treatment in patients with terminal 21q deletion. Moreover, it emphasizes the necessity of multidisciplinarity in diagnosis and treatment due to the variety of anomalies associated with 21q deletion. Regular screenings for psychiatric disorders and (if indicated) thorough psychological and psychiatric assessment seem to be reasonable in most affected children, as children with developmental delays are at increased risk of developing psychiatric disorders. As demonstrated with this case report, PCIT seems to be a good choice to effectively reduce disruptive behaviors in young children with partial deletion of chromosome 21q.

Treatment of child externalizing behavior problems: a comprehensive review and meta-meta-analysis on effects of parent-based interventions on parental characteristics

This is the first meta-meta-analysis examining the effects of parent-based interventions for children with externalizing behavior problems on parental characteristics (parenting, parental perceptions, parental mental health, parental relationship quality). Parent training interventions are recognized as evidence-based interventions for the treatment of externalizing behavior problems, although meta-analytic effects are heterogeneous. The objective of the present study was to comprehensively combine meta-analytic results on parent training interventions to arrive at valid effect predictions. Electronic databases were searched (PsycINFO, Medline, PubMed). In total, 11 meta-analyses were included that mainly comprised parents of children under the age of 13 years. Analyses were based on random effects models. Effect estimates were transformed to standardized mean differences (SMD) and corrected for primary study overlap. Results revealed a significant moderate overall effect for parenting (SMD 0.53) as well as for parents' report of parenting (SMD 0.60) and parental perceptions (SMD 0.52). Effects remained stable to follow-up. Results for observational data, parental mental health and parental relationship quality were small and only partially significant. Considerable heterogeneity within results was revealed. Overall, parent training interventions proved to be effective in improving parental characteristics for parents of children with externalizing behavior problems. Effectiveness was stronger regarding characteristics explicitly targeted by interventions. The findings should encourage health-care providers to apply evidence-based parent training interventions.

Die Rolle von Partnerschaft, Erziehung und Elternstress beim Problemverhalten von Kindern im Vorschulalter

Zusammenfassung. Das Elternhaus bildet für Kinder, insbesondere in jüngeren Lebensjahren, den zentralen Lebensraum. Dabei sind Eltern die ersten und engsten Bezugspersonen und tragen für die Entwicklung und Entfaltung der Kinder Verantwortung. Die vorliegende Fragebogenstudie untersucht bei N = 81 Elternteilen und ihren Kindern im Alter von 3 bis 6 Jahren (M = 5.22 J., SD = 0.86) den Zusammenhang von Partnerschaftszufriedenheit, positiven sowie negativen Erziehungsverhaltensweisen und Elternstress auf das kindliche Problemverhalten. Multiple Regressionsanalysen zeigen, dass der negative Zusammenhang zwischen der Partnerschaftszufriedenheit und dem kindlichen Problemverhalten vollständig über das negative Erziehungsverhalten bzw. den Elternstress vermittelt wird. Die Ergebnisse unterstützen somit die Spillover-Hypothese und nicht die Kompensationshypothese. Insgesamt legen die Befunde zudem den Schluss nahe, dass negatives Erziehungsverhalten mehr negative Verhaltensweisen der Kinder begünstigt, als positives Erziehungsverhalten dieses vermeidet.

Elternverhalten als Schutzfaktor gegen aggressives und oppositionelles Verhalten der Kinder?

Zusammenfassung. Elternverhalten spielt in Theorien zur Entstehung externalisierenden Verhaltens eine wichtige Rolle und Elterntrainings werden als Maßnahme zur Prävention und Verringerung der Symptome empfohlen. Im vorliegenden Review wird die empirische Basis dieser Theorien und Empfehlung überprüft. Effekte des Elternverhaltens auf längsschnittliche Veränderungen der Symptome sind im Mittel sehr gering. Kleine bis moderate Effekte findet man, wenn man Veränderungen externalisierender Symptome in Folge von Veränderungen des Elternverhaltens (durch Elterntrainings) analysiert. Hier sind sogar große Effekte zu erwarten bei vorab deutlich erhöhten externalisierenden Symptomen und Defiziten im Elternverhalten. Diskutiert werden Gründe für diese unterschiedlichen Effekte und Schlussfolgerungen für die Praxis.

Elternarbeit im Kontext der Angstbehandlung von Kindern

Zusammenfassung. Angststörungen sind im Kindes- und Jugendalter weit verbreitet. Die kognitive Verhaltenstherapie (CBT) hat sich als Intervention der Wahl erwiesen. Neben Psychoedukation, kognitiven Techniken und Expositionsübungen ist auch die therapeutische Arbeit mit den Eltern eine häufig eingesetzte Methode. In der vorliegenden Übersichtsarbeit wird der Frage nachgegangen, ob der Einsatz von Elternarbeit in der Therapie mit ängstlichen Kindern die Effektivität der Intervention steigert. Im Rahmen eines systematischen Reviews wurden 25 Studien identifiziert, die von wenigen Elternsitzungen bis hin zu reinen Elterntrainings ein großes Spektrum der Elternarbeit bei Kindern mit einer Angststörung abdecken. Es zeigt sich, dass die CBT Wartekontrollgruppen hinsichtlich der Remissionsrate der Angststörungen generell überlegen ist. Behandlungsansätze, die neben der kindbezogenen Intervention ein Elterntraining enthalten, erweisen sich nicht wirksamer im Vergleich zu ausschließlich kindbezogenen Interventionen. Mögliche Erklärungen für das Ausbleiben der Wirksamkeitssteigerung und daraus resultierende Konsequenzen werden diskutiert.

[Dialectical behavior therapy approaches with disruptive behavior disorders]

Disruptive behaviour disorders comprise the diagnosis conduct disorder (CD) and in adults the diagnosis antisocial personality disorder (APD). CD is seen as a difficult-to-treat disorder with a high risk for persistent behavioral problems. In addition, CD is seen as the precursor to antisocial personality disorder (Kretschmer et al., 2014). Dialectical behavior therapy (DBT) was originally developed by Marsha Linehan (1991) for the treatment of borderline personality disorder, but because of the core deficits in emotion regulation in disruptive behavior disorders, DBT is also increasingly being recommended for the treatment of CD and APD. This review presents DBT adaptions for the forensic setting and for the treatment of CD/APD. Clinical implications are discussed.

Universal parent training as a supplement to inpatient psychiatric treatment for children and adolescents

Parent trainings constitute an effective method to target aspects of parenting in child and adolescent psychiatric and psychotherapeutic care. Past research has mainly been conducted in outpatient contexts, with parents of children with externalizing disorders and often included only small sample sizes. The aim of the current study was first to assess the effectiveness of a novel parent training which is characterized by a universal approach, an open group concept, and short duration, and second to identify variables that have an influence on the effectiveness. A sample of n = 151 parent-child dyads treated in an inpatient clinic was included in the study and randomly assigned to a treatment group and a waiting-list control group. As dependent measures served child behavior problems, dysfunctional parenting, parental mental health, and parental self-efficacy measured with parent-rated questionnaires prior to the training, post training and 3 months after discharge of the clinic. Additionally, a parent-child-interaction observation was conducted and rated by blind raters. Results indicated a general inpatient treatment effect on all dependent measures assessed with questionnaires. An additional effect of the parent training was only shown for parenting and parental mental health with the treatment group revealing better outcomes post training and at follow-up. No effects were found for the measures assessed by interaction observation. Out of a number of variables, only a low monthly income was associated with a higher reduction of dysfunctional parenting. Results indicate that parent training does not contribute additionally to standard inpatient care with respect to child behavior, but does have an influence on parental well-being, which might have a positive effect on the long run.

[Parent-child interaction therapy (PCIT)]

Parent-child interaction therapy (PCIT), a manualized evidence-based intervention, was originally developed to treat disruptive behavior problems in children aged 2–6 years. It is also considered to be an evidence-based intervention for physical abuse among children. Moreover, PCIT has proved to be effective for attention deficit hyperactivity disorder, autism spectrum disorder, separation anxiety disorder, and depression. Thus, it could become the first evidence-based, transdiagnostic intervention method for 2–6-year-old children. PCIT is based on attachment theory as well as learning theory, combining aspects of play therapy and behavior therapy. It consists of two treatment phases: child-directed interaction (CDI) and parent-directed interaction (PDI). In both phases parents are taught special skills. When interacting with their child parents practice these skills and are live coached by the therapist. CDI aims at improving the parent-child relationship and is the basis for PDI. In CDI, parents learn to follow their child’s lead as long as the child shows appropriate behavior. In PDI, parents practice effectively taking the lead wherever necessary. On average, it takes about 15–20 sessions to complete PCIT, which can be terminated as soon as the parents demonstrate a mastery of the skills, when child disruptive behavior has been reduced to clearly normal levels, and when the parents have become confident in managing child behavior on their own.

Psychische Kindergesundheit

Zusammenfassung. Psychische Störungen gehören heute zu den häufigsten Krankheitsbildern im Kindes- und Jugendalter. Die Befragung zum seelischen Wohlbefinden und Verhalten (BELLA-Kohortenstudie) wurde als Modul zur psychischen Gesundheit des repräsentativen Kinder- und Jugendgesundheitssurveys Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS) konzipiert. Ziel dieser längsschnittlich angelegten Kohortenstudie ist es, Erkenntnisse zur psychischen Gesundheit von Kindern und Jugendlichen in Deutschland zu gewinnen. In diesem Beitrag werden das Studiendesign sowie die Erhebungsverfahren kurz berichtet und Implikationen für die klinische Praxis ausgeführt.

Elternarbeit und Elterntraining

Immer mehr Familien suchen professionelle Unterstützung bei der Erziehung ihrer Kinder. Interventionen unter engem Einbezug der Eltern sind eine gute Möglichkeit, die Beziehung von Eltern und ihren Kindern positiv zu gestalten, die Entwicklung der Kinder zu fördern und Verhaltensauffälligkeiten zu reduzieren. Im Themenschwerpunkt wird ein Überblick über die aktuelle Evidenz von Elternarbeit und Elterntraining in der Behandlung (und auch Prävention) von kindlichen Verhaltensauffälligkeiten und zur Reduzierung von dysfunktionalen Erziehungspraktiken gegeben. Trotz überzeugender Evidenzlage für verschiedene Elterntrainings (insbesondere Triple P, PCIT, Incredible Years) ist das Angebot an frühen, evidenzbasierten Interventionen und indizierten Präventionsangeboten unter engem Einbezug der Eltern gegenwärtig noch nicht zufriedenstellend und sollte unbedingt weiter ausgebaut werden.