Clinical characteristics, methods of treatment and outcome in School Refusal have been investigated. School refusal/phobia has been reported in the literature not to be a true clinical entity with a uniform aetiology, psychopathology, course, prognosis and treatment, but rather a collection of symptoms or a syndrome occurring against the background of a variety of psychiatric disorders. Aetiological and precipitating factors also vary with age, psychosocial level of development and personality factors in the individual child, family structure and function, and the school setting. Data were collected retrospectively from 20 cases treated at the Child and Family Unit, Red Cross War Memorial Children's Hospital, Cape Town during a specific time period. Analysis of the data revealed a gender distribution of 11 boys and 9 girls; 1 girl, 5 - 8 years old and 11 boys and 8 girls 9 - 13 years old. One Asian, no Black, 13 Coloured and 6 White children were represented. A large section of the sample population represented the lower socio-economic group as determined by parental qualification and occupation. Most of the families tended to consist of more than 2 children (5 member families). Family dysfunction was recorded in all but one case, with evidence of a recognizable psychiatric disorder also recorded quite frequently in the nuclear family members. Educational difficulties were recorded in a third of the sample together with below average total IQ scores in virtually all the subjects evaluated. The bulk of referrals were from medical practitioners and relatively few from schools. Refusal to attend school was of relatively short duration in three-quarters of the sample. Most of the cases were first time school refusers. Accompanying symptoms or problems were mainly anxiety or depression - related whereas significant associated events were mainly family - oriented. Psychiatric disorders diagnosed most often were anxiety and affective disorders with overlap of the 2 conditions recorded in half the sample. Response to treatment was positive in two thirds of the sample and a combination of treatment methods proved to be the most successful treatment plan. School refusal as investigated in this study, was well represented in a population of children treated at a Child Psychiatric Out-Patient Unit. A high rate of resemblance on various aspects of school refusal was recorded between the study sample and reports in the literature reviewed.

by Chung-Kwong Wong. / Thesis (M.D.)--Chinese University of Hong Kong, 1990. / Includes bibliographies. / Title Page / Dedication / Table of Contents --- p.iii / Abstract --- p.ix / List of Pictures and Figure --- p.xiii / List of Tables --- p.xiv / Acknowledgements --- p.xviii / Statement of Originality --- p.xxi / Chapter PART I --- INTRODUCTION AND BACKGROUNDS TO THE STUDY / Chapter CHAPTER ONE --- INTRODUCTION AND OVERVIEW OF THE THESIS --- p.2 / Chapter CHAPTER TWO --- CHILD PSYCHIATRIC EPIDEMIOLOGY: CONCEPTUAL AND METHODOLOGICAL ISSUES --- p.7 / "Definition of ""Caseness""" --- p.7 / Classification of Specific Psychiatric Syndromes --- p.9 / Sampling --- p.12 / Sources of Information --- p.13 / Data Acquisition Through Questionnaires --- p.16 / Data Acquisition Through Interviews --- p.17 / The Multi-stage and the Multi-method Approach --- p.19 / Statistical Presentations --- p.20 / Summary --- p.20 / Chapter CHAPTER THREE --- PREVALENCE OF CHILD PSYCHIATRIC MORBIDITY： A CROSS-CULTURAL PERSPECTIVE --- p.22 / Some Earlier and More Problematic Studies --- p.22 / Some Earlier and Better Designed Studies --- p.24 / Chapter (1) --- The Buffalo Study (U.S.) --- p.24 / Chapter (2) --- The Isle of Wight and London Studies (U.K.) --- p.25 / Chapter (3) --- The Newcastle Studies (U.K.) --- p.26 / More Recent Studies --- p.28 / Chapter (1) --- The Ontario Child Health Study (Canada) --- p.28 / Chapter (2) --- The Queensland Study (Australia) --- p.29 / Chapter (3) --- The Dunedin Study (New Zealand) --- p.29 / Chapter (4) --- The North Troendelag County Study (Norway) --- p.31 / Chapter (5) --- The Puerto Rico Study (U.S.) --- p.32 / Chapter (6) --- Other Studies --- p.33 / Summary --- p.34 / Chapter CHAPTER FOUR --- THE PURSUIT OF AETIOLOGICAL FACTORS --- p.35 / The Search for Aetiological Factors - General Conceptual Issues --- p.35 / The Search for Aetiological Factors ´ؤ General Methodological Issues --- p.41 / Normal and Psychiatrically Disturbed Children 一 a Comparison of Their Families --- p.42 / The Search for Aetiological Factors - the Life Event Approach --- p.45 / Summary --- p.48 / Chapter CHAPTER FIVE --- THE PREVALENCE OF PSYCHIATRIC MORBIDITY AMONG CHINESE CHILDREN --- p.50 / Psychiatric Morbidity among Chinese Children --- p.50 / Summary --- p.54 / Chapter CHAPTER SIX --- CHILD PSYCHIATRY IN HONG KONG: HISTORICAL AND CLINICAL PERSPECTIVES --- p.55 / A Historical Perspective of Child Psychiatry in Hong Kong --- p.55 / The Child and Adolescent Psychiatric Unit at The Prince of Wales Hospital --- p.58 / Chapter (1) --- Clinical Practice --- p.60 / Chapter (2) --- Undergraduate Teaching --- p.66 / Chapter (3) --- Postgraduate Training and Training of Other Professional Disciplines --- p.67 / Chapter (4) --- Research --- p.67 / Summary --- p.68 / Chapter PART II --- THE STUDY: PSYCHIATRIC MORBIDITY AMONG CHILDREN FROM A PRIMARY SCHOOL IN A LOWER MIDDLE SOCIAL CLASS AREA IN HONG KONG / Chapter CHAPTER SEVEN --- "THE STUDY: THE RESEARCH HYPOTHESES, THE SAMPLE AND THE METHOD" --- p.70 / The Research Hypotheses --- p.70 / Description of the Sample --- p.71 / The First Stage of the Study --- p.73 / Chapter (1) --- The Design of the Multiple Criterion Screening Procedures --- p.69 / Chapter (2) --- The Individual Components of the Multi-component Scale --- p.78 / Chapter (3) --- The Cut-off Point on the Aggregate Score of the Multi-component Scale --- p.81 / Chapter (4) --- The Specific Probing Questions --- p.82 / Chapter (5) --- Missing Cases --- p.83 / The Second Stage of the Study --- p.84 / Chapter (1) --- The Second Stage Sample --- p.84 / Chapter (2) --- The Diagnostic Interview --- p.84 / The Third Stage of the Study --- p.86 / Chapter (1) --- The Third Stage Sample --- p.86 / Chapter (2) --- Interview by Medical Students --- p.86 / Aspects of Diagnosis --- p.87 / An Appraisal of the Method --- p.87 / Summary --- p.88 / Chapter CHAPTER EIGHT --- ASSESSMENT OF THE SCREENING PROCEDURES --- p.89 / "Definition of ""Caseness""" --- p.89 / An Overall Evaluation of the Screening Procedures --- p.90 / An Evaluation of the Individual Components of the Screening Procedures --- p.95 / Constructing Simplified Screening Procedures --- p.104 / Discussion --- p.108 / Chapter (1) --- An Overall Appraisal of the Performance of the Screening Procedures --- p.108 / Chapter (2) --- A Cross-Cultural Comparison of the Screening Procedures --- p.109 / Chapter (3) --- Simplified Alternatives of the Screening Procedures --- p.112 / Chapter (4) --- Alternative Research Approaches to Designing Child Psychiatric Screening Procedures for Hongkong --- p.113 / Summary --- p.114 / Chapter CHAPTER NINE --- THE PREVALENCE OF PSYCHIATRIC MORBIDITY --- p.116 / Aspects of Diagnosis --- p.117 / Chapter (1) --- Classification of Specific Psychiatric Syndromes --- p.117 / Chapter (2) --- The Level of Adaptive Functioning --- p.121 / Chapter (3) --- The Duration of Morbidity --- p.122 / Calculation of Prevalence Rates and Confidence Limits --- p.123 / Prevalence Rates of Specific Psychiatric Syndromes --- p.125 / Discussion --- p.131 / Chapter (1) --- An Appraisal of the Method --- p.131 / Chapter (2) --- The Cross´ؤCultural Similarities --- p.135 / Chapter (3) --- The Controversial Case of the Hyperkinetic Syndromes --- p.137 / Chapter (4) --- The Cross-Cultural Differences --- p.139 / Chapter (5) --- The Subclinical Cases: Implications for Preventive Psychiatry --- p.140 / Chapter (6) --- Representativeness of the Sample and the Generalizability of the Results --- p.141 / Summary --- p.142 / Chapter CHAPTER TEN --- ASSOCIATED ABNORMAL PSYCHOSOCIAL SITUATIONS --- p.144 / Definitions of the Psychosocial Aetiological Factors --- p.145 / Statistical Approaches --- p.148 / The Psychosocial Aetiological Factors in the Sample --- p.150 / Discussion --- p.162 / Chapter (1) --- An Appraisal of the Method --- p.162 / Chapter (2) --- Abnormal Psychosocial Situations in Emotional Disorder and the Two Conduct Disorders in Boys --- p.166 / Chapter (3) --- Abnormal Psychosocial Situations in Conduct Disorders and the Hyperkinetic Syndromes in Boys --- p.168 / Chapter (4) --- Current Abnormal Psychosocial Situations and Emotional Disorder in Girlsi The Gender Factor --- p.171 / Chapter (5) --- Abnormal Psychosocial Situations and Subclinical Cases --- p.172 / Chapter (6) --- The Chinese Approach to Parenting and Socialization - the Influence of Culture --- p.173 / Summary --- p.175 / Chapter CHAPTER ELEVEN --- IMPLICATIONS FOR THE DEVELOPMENT OF CHILD PSYCHIATRY IN HONG KONG --- p.177 / Treatment of Psychiatrically Disturbed Children --- p.177 / Prevention --- p.178 / Undergraduate Medical Education --- p.180 / Research --- p.180 / Child and Adolescent Psychiatry as an Independent Subspecialty in Hong Kong --- p.181 / Summary --- p.182 / Chapter CHAPTER TWELVE --- CONCLUSION --- p.184 / Methodology --- p.184 / Salient Aspects of the Results --- p.186 / Implications for the Future --- p.187 / References --- p.189 / Chapter Appendix --- Selected Publications by the Author --- p.215

The study aimed to investigate childhood adversity in a sample of clients with first-episode psychosis. The mediating impact of dissociation and early maladaptive schemas and moderating effect of social support were investigated. The study (N = 42) assessed childhood adversity using the Parental Bonding Instrument and the Childhood Trauma Questionnaire. Early Maladaptive Schema were measured using the Young Schema Questionnaire (Short form), the Dissociative Experiences Scale (2nd Edition) measured Dissociation and the Social Support Questionnaire assessed the quality and size of each participant’s social network. Correlational, mediation and moderation analyses were used. There were high levels of childhood adversity within this sample. Dissociation did not mediate the relationship between childhood adversity and psychosis. Some early maladaptive schemas concerned with unrelenting standards and insufficient self-control mediated the relationship between adversity and psychosis, in particular hallucinations. Social support, in terms of both quality and quantity was an important moderator between childhood adversity and psychosis. The study supports the notion that childhood adversity is a risk factor for psychosis and highlights some evidence about specific mediating and moderating mechanisms.

The present study investigated parental attachment insecurity, specifically Insecure-Anxious and Avoidant attachment styles, and their relationship to children’s ADHD symptoms of hyperactivity, inattention and aggression. The study used a between­ subjects, correlational (cross­sectional) design and quantitative data was collected using reliable and valid self-report questionnaires. Data was analysed using SPSS 19.0. There were no significant differences in attachment insecurity or attachment styles between parents of ADHD and non-ADHD children. However a highly significant association was found between parental attachment insecurity and child aggression, and a moderate association with hyperactivity. There was no significant effect of attachment style, but the study was underpowered and a larger sample size may have differentiated specific effects of parental attachment style. The study used a largely non-clinical sample, with children who were low risk and significantly less impaired than the ADHD participants. A higher risk population would have potentially brought some of the trends of association between parental attachment and child symptoms to significant levels. The study concluded that parental insecure attachment, specifically Dual/Disorganised attachment style, contributes to the emotional environment that increases risk of child aggression and hyperactivity, however methodological limitations were acknowledged. Clinical implications were drawn and recommendations made for future research.

Children and adolescent psychiatric inpatients (n = 25) versus staff (n = 35) milieu perceptions were measured with the Ward Atmosphere Scale (WAS) Form K (Kids). The perceptions were compared with previous data collected in 1981, 1982, and 1984 on the same unit. The 1993 staff and patients continued to perceive the unit as a therapeutic environment despite recent restrictions on length of stay due to health care reform. The views of the staff and patients were found to be divergent but less so than in previous years. Additionally, the more seriously ill a patient was determined to be, the more negatively he or she perceived the environment. Differences in perceptions between day shift versus night shift and administrative versus non-administrative staff were also found and discussed. Staff perceptions versus their ideal conceptions were also investigated and compared with those of the 1984 staff. The 1994 staff was found to more closely approximate their ideals than the 1984 staff.

The purpose of this study was to investigate whether parent therapy experience and gender influenced men's and women's attitudes toward seeking mental health treatment. Participants included 207 women and 212 men ages 18 to 30 years attending Western Kentucky University. Participants completed a demographics survey and the Inventory of Attitudes Toward Seeking Mental Health Treatment. Results indicated that more favorable attitudes toward seeking mental health services were exhibited by participants who reported that a parent attended therapy. Additionally, a gender difference in attitudes toward mental health services was uncovered, in that women were found to display more positive attitudes toward seeing therapy than men. Results also indicated that women whose mothers only attended therapy had more favorable attitudes towards mental health treatment than women whose fathers only attended therapy. Although not reaching a level of statistical significance, the study also uncovered a trend for men whose fathers only attended therapy to display greater levels of Indifference to Stigma than males whose mothers only attended therapy. Finally, as assessed in the demographics survey, as the relationship quality with the mother increased, individuals' attitudes toward mental health services became more positive.

The purpose of this study was to gain an understanding of the structured and evidence-based assessment tool/method The Brief Child and Family Phone Interview (BCFPI) trough a social psychology perspective of conversation. The aim was especially to seek an understanding of the method considering aspects of children’s participation. The research question was: how do the method users apprehend the advantages and the limitations of the BCFPI method considering aspects of children’s participation. The study was carried out trough a qualitative analyze and sex respondents in two child psychiatry clinics in Sweden were interviewed. A symbolic interactionistic perspective were used to analyze the results. The results showed that it was mostly advantages that were discussed and only a few limitations were presented. No reflections about children’s participation were expressed. Together the results and analyze contributed to an understanding of the BCFPI method as a restricted method considering social psychology perspectives and perspectives of children’s participations. One interpretation of the results showed that much focus was on the effectiveness of the method. In the future it could therefor be significant to reflect upon social psychology aspects as well as aspects of children’s participation regarding the BCFPI method.

<p>The purpose of this study was to gain an understanding of the structured and evidence-based assessment tool/method The Brief Child and Family Phone Interview (BCFPI) trough a social psychology perspective of conversation. The aim was especially to seek an understanding of the method considering aspects of children’s participation. The research question was: how do the method users apprehend the advantages and the limitations of the BCFPI method considering aspects of children’s participation. The study was carried out trough a qualitative analyze and sex respondents in two child psychiatry clinics in Sweden were interviewed. A symbolic interactionistic perspective were used to analyze the results. The results showed that it was mostly advantages that were discussed and only a few limitations were presented. No reflections about children’s participation were expressed. Together the results and analyze contributed to an understanding of the BCFPI method as a restricted method considering social psychology perspectives and perspectives of children’s participations. One interpretation of the results showed that much focus was on the effectiveness of the method. In the future it could therefor be significant to reflect upon social psychology aspects as well as aspects of children’s participation regarding the BCFPI method.</p>

Section A is a literature review evaluating the role of Therapetuic Care Workers (TCWs) and Therapeutic Foster Carers (TFCs) working relationally with a sub-group of Looked After Children (LAC) who are highlighted as having intense emotional and behavioural needs. These LAC are thought to benefit from living in specialist, therapeutic placements where carers work relationally. However, to date, there is no known review evaluating relational residential interventions or the role of TCWs and TFCs. Therefore, literature exploring the theoretical underpinnings of the work, and the emotional impact and protective factors involved in the carer role is considered. Implications for future research and clinical practice are suggested. Section B describes a qualitative study which explores how TCWs experience their role and their perceptions of the potential benefits for LAC. A qualitative design using Interpretative Phenomenological Analysis (IPA; Smith, Flowers & Larkin, 2009) was applied. Methods. Nine TCWs currently working in one of two therapeutic communities were interviewed. Results. Five master themes were identified: ‘Therapeutic group living’; ‘Importance of carer-child relationships’; ‘Working with the unconscious’; ‘Personal meaning of professional role’, and ‘Children’s progress’. Participants considered that forums for reflection were crucial to their ability to think clearly and analytically about the children, and utilised psychodynamic concepts to gain insight into the children’s inner worlds. TCWs’ increased self-awareness was central to this process. Participants also reported experiencing their role as emotionally challenging. One focus of reflection was on the small steps of progress the children were perceived to achieve. Conclusions. Overall, the findings suggested a synergy between relevant theory, descriptive accounts of therapeutic childcare, and TCWs’ perceptions of their role. New information regarding the personal investment of TCWs and internalisation of the framework of practice was identified. Further research is needed to extend the evidence-base. The clinical implications of the findings are discussed.

Thesis (Ph. D.)--University of Oregon, 2007. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 103-108). Also available for download via the World Wide Web; free to University of Oregon users.