School Phobia

School phobia is a serious disorder affecting up to 5% of elementary and middle school children. Long-term consequences include academic failure, diminished peer relationships, parental conflict, and development of additional psychiatric disorders. Hiding behind such common physical symptoms as headaches, stomachaches, and fatigue, school phobia evades diagnosis with ease. Unraveling the problem of school phobia is challenging for the school nurse and is complicated by an overall lack of knowledge regarding the serious potential outcomes. The purpose of this article is to define school phobia, differentiate it from truancy, and highlight some interventions useful in the treatment of this increasingly common and potentially serious disorder.

[The development of the body schema]

The body schema as an acquired structure enables individuals to gain a representation of the different parts of their body without relying on external stimulations. When its development is disrupted a certain number of disorders can arise which have significant repercussions on the patients' daily lives. These dysfunctions can be managed in the framework of psychomotor rehabilitation.

Maternal stress, well-being, and impaired sleep in mothers of children with developmental disabilities: a literature review

Having children with developmental disabilities (DDs) requires a high level of caregiving responsibilities, and existing studies support that mothers of children with DDs experience high levels of maternal stress as well as poor sleep and well-being. Given the fact that the number of children with DDs has increased, an up-to-date literature review is necessary to identify factors associated with maternal stress, sleep, and well-being. In addition, understanding these factors and their relationships may provide better strategies in designing effective interventions that can reduce the burden in mothers of children with DDs. This review summarized 28 scientific research papers that examined maternal stress, sleep, and well-being in mothers of children with DDs in past 12 years. The study findings indicate that mothers of children with DDs experience higher levels of stress than mothers of typically developing children, and it remains high over time. In addition, these mothers often encounter depressive symptoms as well as poor sleep quality. The study results also reveal that there is a bidirectional relationship between maternal stress and depressive symptoms as well as between poor sleep quality and depressive symptoms. For example, higher stress mothers experienced more depressive symptoms. Mothers of children with DDs with poor sleep quality are significantly associated with more depressive symptoms. Child behavior problems were significantly associated with both maternal stress and depressive symptoms, but cautious interpretation is warranted due to the shared variance between child behavior problems, maternal stress, and depressive symptoms. Methodological guidelines for future research involve the use of reliable and valid instruments for the measurement of child behavior problems, maternal stress, and sleep. Recommendations for future research are included.

The B4 school check behaviour measures: findings from the Hawke's Bay evaluation

The Before (B4) School Check is a free health and development check delivered by specifically trained nurses to four year old children throughout New Zealand, aimed to identify and address any health, behavioural, social or developmental concerns that could affect a child's ability to get the most benefit from school. Reported here are the results of an evaluation of the B4 School Checks in Hawke's Bay, focusing specifically on children assessed at the 84 School Check with behaviour issues as determined by the Strengths and Difficulties Questionnaire (SDQ). Health Hawke's Bay (HHB) records were reviewed to understand the number and demographics of the children assessed with behaviour issues at the B4 School Checks up to 31 August 2011, and the interventions to which they were referred. Telephone Interviews were conducted with 36 parents/caregivers of these children to address the questions, what difference did the B4 School Check make to children assessed with behaviour issues and what aspects of the B4 School Check delivery contributed to successful outcomes for these children? Results showed that child behaviour issues in Hawke's Bay were identified in more boys than girls and concentrated in more deprived families. Māori children were represented in numbers disproportional to the regional population. The majority of referrals for child behaviour directed parents/caregivers to non-governmental organisations for family support and parenting programmes. Thematic analysis was applied to the qualitative data derived from the interviews with parents/caregivers and results indicated high levels of satisfaction with the B4 School Check for behaviour and the referred outcomes. Implications for nursing practice arise from these findings in that they identify factors which contribute to what does and does not work well for achieving successful outcomes from the B4 School Check for behaviour.

[Therapeutic gîtes in child psychiatry]

Therapeutic gîtes in child psychiatry. A therapeutic stay in a gîte is a project led by a multidisciplinary team. It enables children to experiment with the notion of pleasure and to develop their level of socialisation, their personality and their independence, outside the family environment. For caregivers, it provides a rich source of clinical material and strengthens the team dynamics.

[Night hospital, a complementary form of care]

In child psychiatry, part time night hospitalisation is an alternative which complements other forms of care such as day hospitals. In Saint-Cyr-au-Mont-d'Or, the development of these night stays is the outcome of a joint reflection carried out over several years.

Psychological well-being in parents of children with Angelman, Cornelia de Lange and Cri du Chat syndromes

BACKGROUND

The current study focuses on mothers and fathers of children with three rare genetic syndromes that are relatively unexplored in terms of family experience: Angelman syndrome, Cornelia de Lange syndrome and Cri du Chat syndrome.

METHOD

Parents of children with Angelman syndrome (n =15), Cornelia de Lange syndrome (n = 16) and Cri du Chat syndrome (n = 18), and a matched comparison group of parents of children with autism and intellectual disabilities (n = 20) completed questionnaires on both psychological distress (stress, anxiety, depression) and positive psychological functioning.

RESULTS

Parents of children with Angelman syndrome consistently reported the highest levels of psychological distress, and parents of children with Cornelia de Lange syndrome the lowest, with parents of children with Cri du Chat syndrome and autism scoring between these two. Positive psychological functioning was similar across the four aetiology groups.

CONCLUSIONS

Parents of children with rare genetic syndromes are at risk for high levels of stress and mental health problems. Methodological issues and the practical applications of these results are discussed.

[Hippotherapy in the paedopsychiatric care project]

Hippotherapy uses relationships with horses as a mediation method. The care treatment aims to act on the psychological functioning of children affected by relational disorders, especially in order to help the development of communication and emotions. A partnership has been established between the paedopsychiatric university centre at the CHRU in Tours (37) and a horse-riding centre.

Learning sets ... the way forward?

Community nursery nurses (CNNs) have increasingly important roles within clinical service delivery. Maintaining and enhancing their learning has not been extensively developed within the NHS. We report on a cost-effective, structured programme that focused on one aspect of their learning: managing childhood behaviour. Childhood behaviour problems place substantial demands on the health service. CNNs are increasingly recognised as being potentially in the front line for managing these issues. CNNs have excellent training within play skills but often have more limited training in managing childhood behaviour problems. Learning sets were developed and evaluated as effective in delivering training to CNNs on childhood behaviour. Our programme allowed CNNs to shape learning over a six-month period. It aimed to value existing skills and promote a learner-centred approach. This teaching method encouraged generic skills in exploring evidence-based approaches to clinical care. Learners valued collaboration and identified new clinical strategies that included standardisation of advice given.

A pilot evaluation study of the Solihull Approach

The Solihull Approach is a psychotherapeutic and behavioural model for health visitors and other professionals working with children and families to address sleeping, toileting, feeding and behavioural difficulties in young children. This pilot study used quantitative methods to assess the effectiveness of the Solihull Approach compared to standard health visitor practice. At assessment, the parent completed the short form Parenting Stress Index and a visual analogue scale rating how severe the problem was. The health visitor also completed a visual analogue scale rating their perception of the severity of the problem. This process was repeated at the end of the intervention and again at three months follow-up. Results showed statistically significant better outcome on five out of six measures for the experimental group. Results are discussed in context of a small sample size.

Integrating nursing care into systems of care for children with emotional and behavioral disorders

PROBLEM

Recent developments in providing care to children with emotional and behavioral disorders, especially those with serious emotional disturbance, have included the establishment of systems of care. Guided by a set of principles and values, these systems of care have organized and delivered services to children and families with complex needs. To date, nurses have not had a salient role in systems of care.

RESULTS

It is estimated that 20% of American children and adolescents have an emotional or mental disorder. As many as two thirds of these children are not receiving services. Systems of care have been funded to provide services for these children, particularly for the most severely affected. To date, nursing has not had a prominent role in these systems of care.

CONCLUSIONS

Based on their knowledge, skills, and holistic approach to care, nurses could better integrate nursing care into systems of care. Possible roles as case managers, primary therapists, in-home interventionists, and in educational programs are suggested.

Support for family carers of children and young people with developmental disabilities and challenging behaviour

BACKGROUND

This study gathered information about perceptions of family carers of children and young people with developmental disabilities and challenging behaviour of the help, support and treatment received from services and professionals.

METHODS

A total of 66 family carers completed postal questionnaires on the nature of, and their satisfaction with, services, professional help and advice received in respect of their family member's challenging behaviour.

RESULTS

Most carers were dissatisfied with support and services received. Almost half reported receiving no professional input or none that was helpful. Over two-thirds reported receiving respite care but, in a third of these, the child had been excluded because of challenging behaviour.

CONCLUSIONS

Families of children with challenging behaviour often do not receive services and supports that they find helpful. Treatments provided are not always evidence based. The 'rationing' of services creates a danger of inequality of access. We need a more proactive approach to identifying and meeting the need for family support.

The relationship between behavioral inhibition and time perception in children

PURPOSE

To test one component of Barkley's (1997) model of executive functions by examining the relationship between behavioral inhibition and time perception in children.

METHOD

Correlation analysis was used to determine the relationships between measures of behavioral inhibition and time perception for the entire sample, and for boys (n = 34) and girls (n = 26) separately.

FINDINGS

For both parent and child measures, behavioral inhibition and time perception scores were correlated for the total group and for girls. Child measure of behavioral inhibition and time perception were not correlated for boys.

CONCLUSIONS

The findings of this study support Barkley's theory and indicate a relationship between poor behavioral inhibition and poor time perception in children.

Filial Therapy for Children's Behavioral and Emotional Problems in Mainland China

TOPIC

Filial therapy as a therapeutic intervention to promote parent-child interaction and improve child's behavior across culture.

PURPOSE

To review the state of the science of filial therapy and explore whether filial therapy would be an effective parenting program in China.

SOURCES

Four research articles related to the impact of filial therapy, used with Chinese immigrants, Koreans, and Native Americans, were located in a search of nursing, medical, psychological, and social science literature.

CONCLUSIONS

The findings indicated that filial therapy is a culturally sensitive and effective intervention. The overall limitations, some recommendations for future research, and the discussion of efficacy of filial therapy in China were provided.

Evaluation of a health visitor-led sleep and behaviour clinic

Behaviour problems in children aged 0-5 are common and distressing; given a tendency to persist, early behaviour problems also foreshadow later ill-health. Reliance tends to be placed upon the health visitors and nursery nurse to provide advice and support to those experiencing difficulties with young children. This paper describes the evaluation of a new, second tier health visitor-led sleep and behaviour clinic in one inner London borough, introduced for those whose difficulties persist despite support from agencies such as Sure Start and Newpin and initial advice from health visitors and nursery nurses. The theoretical framework underpinning the initiative is behavioural and intervention is offered to those seeking help with a relatively specific parenting difficulty. Behaviour therapy involves working in partnership with the parent(s)/client, assessing and meeting needs through dialogue and action planning while providing appropriate advice and support. The therapy is consistent with the health visitor approach. Evaluation focused upon three aspects: audit of the clinic activities, effectiveness of the intervention according to parental perception of change in the child's behaviour and client satisfaction with the service. Findings suggest that the clinic is acceptable to parents of a wide variety of social and ethnic groups and successful in improving the behaviour of young children. This small study suggests that a specialist health visitor-led clinic offering behaviour therapy within a community setting represents a feasible development that is within the scope of existing resources.

Incorporating Florence Nightingale's theory of nursing into teaching a group of preadolescent children about negative peer pressure

Clinically based nurses often question the value of nursing theory, ultimately resulting in the reluctance to implement nursing theory into practice. This clinical practicum project successfully used Nightingale's primary tenets, such as building trust, self-assessment, and group leadership, as a theoretical framework in a nursing practice group for the purpose of teaching a group of preadolescent children about negative peer pressure. Preadolescent children are particularly vulnerable to peer group culture. Proactive strategies, as demonstrated through this project, can be used to positively influence children's behavior toward each other during the formative middle years. Group sessions addressed such topics as moral beliefs and values, bullying, and saying "no" to peer pressure and were structured using a variety of contemporary resources to develop interactive exercises that engaged the children and enhanced group communication. The children and their parents reported positive outcomes from the nurse-led group sessions.

Juvenile animal abuse: Practice and policy implications for PNPs

Animal abuse has long been recognized as a sign of family violence and a warning sign of future aggression in children and adolescents. As leaders in youth violence prevention, pediatric nurse practitioners need to be aware of the prevalence and types of juvenile animal cruelty and its relationship to human violence. In doing so, they can champion for health care and related policies for this disturbing problem, described by Ascione as an underreported and understudied issue that may add to the understanding and prevention of youth violence."[One of the most dangerous things that can happen to a child] is when the child who kills or tortures [an animal] is not caught, or if caught is not punished." -Anthropologist Margaret Mead

Online exclusive: behavioral adjustment of children and adolescents with cancer: teacher, parent, and self-report

PURPOSE/OBJECTIVES

To describe behavioral adjustment in children and adolescents with acute lymphoblastic leukemia (ALL) and to determine whether behavioral adjustment is correlated with cognitive and academic abilities.

DESIGN

Descriptive, cross-sectional design.

SETTING

Two pediatric oncology treatment centers.

SAMPLE

47 children and adolescents who had been receiving ALL therapy for at least one year or who were off therapy for no more than three years and their parents and teachers. Wechsler Intelligence Scale for Children-Revised (WISC-R) and Wide Range Achievement Test-Revised (WRAT-R) data were available on a subset of 17 subjects.

METHODS

Parent, teacher, and self-report Behavioral Assessment System for Children (BASC) ratings were used to measure behavioral adjustment. WISC-R measured cognitive abilities, and WRAT-R measured academic abilities. Demographic, family, and treatment-related data also were collected.

MAIN RESEARCH VARIABLES

Behavioral adjustment and cognitive and academic abilities.

FINDINGS

At least 20% of teacher ratings for somatization, learning problems, leadership, and study skills; parent ratings for somatization, adaptability, attention problems, withdrawal, anxiety, social skills, and depression; and self-report ratings for anxiety and attitude to school were in the at-risk range (i.e., presence of significant problems that require treatment). The majority of teacher BASC ratings were correlated significantly with WISC-R and WRAT-R scores. Self-report depression and social stress ratings were correlated significantly with some WISC-R and WRAT-R scores. Treatment-related experiences such as body image alterations and mental and emotional problems were associated with problematic behaviors, including depression, somatization, withdrawal, and social stress.

CONCLUSIONS

Youth with ALL are at risk for some behavioral adjustment problems, particularly anxiety, somatization, adaptability, attention, and withdrawal. Cognitive and academic abilities are associated with some dimensions of behavioral adjustment.

IMPLICATIONS FOR NURSING

Findings suggest the need for ongoing assessment of behavioral adjustment and cognitive and academic abilities of children with ALL. Behavioral interventions that target at-risk mannerisms, such as somatization, depression, anxiety, and social stress, are needed. Central nervous system treatment may contribute to behavioral adjustment problems, as well as to cognitive and academic problems. Strategies to improve academic abilities also may have a positive effect on behavioral adjustment.

Accuracy in Communication: A Contextual Approach to Child Behavior Assessment

This article analyzes the problem of accuracy of communication in clinical settings and argues that clinical language is replete with theoretical constructs that may not have shared meaning among speakers and listeners in mental health settings. It is suggested that mental health providers be trained in a contextually based data language. The value of such a data language employed in behavioral assessment is emphasized. The authors contend that events and behavior are products of the contextual environment; contextual variables are more accurately identified and agreed on; and the use of contextual variables in treatment intervention increases consequential validity. A developmental ecological approach, coupled with applied behavior analysis, are discussed and offered as a foundation on which clinical interventions should be planned and assessed. Using objective methods that yield demonstrable and meaningful outcomes can help improve children's mental health service delivery and the lives of children.

Planning a temperament-based parenting program for inner-city families

TOPIC

The design of a temperament-based parenting program for inner-city families.

PROBLEM

Selective intervention parenting programs are needed for children who are at high risk for developing behavioral problems. Planning should incorporate cultural considerations to ensure the program meets needs.

METHODS

A pilot study to assess psychometrics of instruments, obtain preliminary date, test feasibility, and verify appropriateness of the intervention. Reports of child temperament, behavior problems, and maternal distress were obtained from a sample of 244 inner-city mothers of school-age children.

FINDINGS

The three instruments showed adequate reliability with this sample. Attendance rate was 92% for the 18 mothers who participated in the parenting intervention. Focus groups supported the content of the program.

CONCLUSIONS

A pilot study can assist nurses to plan an intervention that responds appropriately to the specific strengths and needs of the community.