Billions of mental health care dollars for millions of children and adolescents in need has garnered significant attention within the behavioral health industry to reduce costs while improving treatment efficacy through the identification and implementation of evidence based practices with youth populations requiring therapeutic services. This hermeneutic phenomenological qualitative research approach in the field of psychology is a consumer driven one in the world of business. Line by line context and discourse analyses, which included both a prior and inductive coding, of the verbiage and phraseology of 10 boys and 10 girls, aged 8-12, actively engaged in outpatient psychotherapy, formed the foundation for 31 themes that captured a shared experience or a consumer driven “view inside the therapist’s office.” These results are represented through 6 main themes indicating that a) “knowledge fosters investment” upon entry into and initiation of mental health services when therapists and parents recognize that b) “words have power to facilitate success,” only if, guided by childhood development but chosen thoughtfully for each child. Further, c) “therapy is therapy across the lifespan,” such that therapeutic care for minors deemed legally dependent reflected treatment for legally independent persons with implementation methods influenced by age. Lastly, age, as a definitive factor, impacted the means by which the youth in my study experienced d) “autonomy… and developed e) “therapeutic rapport…” in references to e) “boundaries…” that mitigate the entire treatment experience. The outcomes of this study offer the research and practice community opportunity to move children from the “object” of the treatment to “agents” in their treatment by respecting the ideas expressed by youth themselves.

Doctor of Philosophy (Phd) / Despite general agreement that severely emotionally disturbed children and adolescents are an "at risk" group, and that ongoing evaluation and research into the effectiveness of services provided for them is important, very little outcome evaluation actually takes place. The absence of well-conducted and appropriately interpreted studies is particularly notable for day or residential treatment programs, which cater for the most severely emotionally disturbed youths. This thesis outlines the main areas of conceptual, pragmatic and methodological confusion and neglect which impede progress in research in this area. It argues for plurality of data analytic strategies and research designs. It then critically reviews the reported findings about the effectiveness of day and residential treatment in specialist facilities, and the predictors of good outcomes for this treatment type. This review confirms that there is very little to guide practice. Having argued for the legitimacy of its methods and the necessity to address basic questions, the thesis reports the results of a naturalistic study based on data accumulated during a decade-long evaluative research program taking place at Arndell Child and Adolescent Unit, Sydney. The study addresses the question of what child, family and treatment variables predict outcome for 159 children and adolescents treated at this facility from 1990 to 1999. Statistically significant results with large effect size were obtained. Among the most disturbed subgroup of forty three children, (a) psychodynamic milieu-based treatment was shown to be more effective than the “empirically-validated” cognitive-behavioural treatment which superseded it in 1996, and (b) children from step-families showed better outcome than those from other family structures. Furthermore, it was found for the study sample as a whole that severe school-based problem behaviours were associated with a limited trajectory of improvement in home-based problem behaviour. These results are discussed with regard to implications for treatment, research methodology, policy and further studies.

The main aim of this study is to examine how characterizations of persons in books for children and adolescents relate to traditional sex role patterns and to determine if there is any difference in this respect between books for girls and books for boys as well as between popular books and quality books.Eight books for girls, eight books for boys, and four books for both girls and boys are examined. From these books 8,268 adjectives, adverbs, and participles which characterize persons or aspects of persons were excerpted. These excerpts have been categorized with regard to syntactic function into attributive adjectives, predicative adjectives, and adverbials, and with regard to meaning as to membership in semantic fields on different levels.The most frequent syntactic category in the material is "predicative" (42.8%), followed by "attributive" (33.4%). Female characters are more often described by predicative adjectives than are male characters, while the opposite is true of attributive adjectives. The choice of syntactic category seems to be determined more by what property or state the lexical item refers to, however, than by the sex of the character described.The semantic fields with the largest number of excerpts are MENTAL PROPERTIES AND STATES (32.9%), SOCIABILITY (15.0%), DRESS AND APPEARANCE (14.7%), and PACE AND MOVEMENTS (11.4%). These fields also dominate within the different categories of books and the descriptions of female and male characters respectively.Traditional sex role patterns are most obvious in characterizations of role characters with respect to their role in society and their relation to other people. Female characters are, e.g., almost exclusively described with respect to their private lives, while male characters are described in terms of their position in society. In the books for boys male characters are attributed a negative or rejecting attitude to their environment, while female characters are attributed a more positive or accepting attitude.The most traditional impression of the opposite sex is conveyed by the books for boys-to the extent that any such impression is conveyed at all by these books. The books for boys have very few female characters and very few descriptions of them. In general, male characters dominate in the books and it is clearly shown that to be a boy or man is more highly regarded than to be a girl or woman.No general differences between popular books and quality literature emerged from the analyses performed. Traditional sex role patterns are equally pronounced in the two types of books, even if there are differences between individual books. / digitalisering@umu

The main purpose of the present study to examine the relationship between psychological preparation, attitudes toward hospital and health professionals, social support, ways of coping and sociodemographic variables with preoperative anxiety, post-intervention anxiety and post-operation anxiety in children anticipating an operation in child surgery clinic. In addition, the relationship between the anxiety level of child and anxiety level of mother was examined. The sample consisted of sixty children and their mothers. Data was collected utilizing the state form of the State-Trait Anxiety Inventory for iv Children (STAI-C), Attitudes Toward Hospital and Health Professionals Scale, Social Support Scale, KIDCOPE, and the state form of the State-Trait Anxiety Inventory (STAI) for mothers. Results of variance analysis showed that there was a significant decrease in anxiety scores from pre-operation, post-intervention to post-operation periods in treatment groups (information/ information together with mother/ interview). However, no significant difference was found among the control group. Children who received information alone and children who were informed together with mothers and children who were merely interviewed were found to demonstrate lower levels of anxiety than children in control group in post-intervention period. Children in the pre-operation period, were found to have less positive attitude than post-operation period in information group. Children who received information alone or children informing together with mothers, reported using positive coping and blame &amp / anger more than children in the mere interview and the control group. Also children in control group had significantly higher scores on avoidance subscale than other three treatment groups. The results were discussed within the context of relevant literature.

Fragestellung: Sowohl die Childhood Group der International Obesity Task Force (IOTF) als auch die European Childhood Obesity Group (ECOG) empfehlen den Body-mass-Index als Beurteilungskriterium für Übergewicht und Adipositas bei Kindern und Jugendlichen. Im Erwachsenenalter erfolgt die Definition von Übergewicht und Adipositas anhand fester Grenzwerte, bei der Beurteilung von Kindern und Jugendlichen müssen die alters- und geschlechtsspezifischen Veränderungen des BMI berücksichtigt werden. Methode: Unter Heranziehung von 17 bereits durchgeführten Untersuchungen aus verschiedenen Regionen Deutschlands wurden BMI-Perzentile für Kinder und Jugendliche erstellt. Die Berechnung der Perzentile basiert auf den Körperhöhen- und Körpergewichtsdaten von 17.147 Jungen und 17.275 Mädchen im Alter von 0–18 Jahren. Ergebnisse und Schlussfolgerung: Die vorgestellten Perzentile sollten als Referenz für deutsche Kinder und Jugendliche angewendet werden. Die Arbeitsgemeinschaft „Adipositas im Kindes- und Jugendalter“ (AGA) hat in ihren Leitlinien die Anwendung der hier vorgestellten 90. und 97. Perzentile zur Definition von Übergewicht und Adipositas empfohlen. / Objectives: Both the Childhood Group of the International Obesity Task Force (IOTF) and the European Childhood Obesity Group (ECOG) recommend to use the body mass index (BMI = weight in kilograms/height in meter2) to evaluate overweight and obesity in children and adolescents. Whereas it is customary with adults to use fixed cut off points to define overweight and obesity, in children and adolescents age and sex specific developmental changes in BMI need to be addressed, which are due to physiological alterations of fat mass. Method: Because a national reference population for children and adolescents does not exist in Germany, a BMI reference data set was compiled. Therefore measurements of height and weight from 17 different regional studies including 17147 boys and 17275 girls aged 0 to 18 years were used. Results and conclusions: We recommend the use of the presented percentiles as reference to asses under- and overweight (obesity) in German children and adolescents. In the guidelines of the “Arbeitsgruppe Adipositas im Kindes- und Jugendalter”(AGA) the 90th and 97th BMI percentiles as calculated in this reference population are proposed as cut-off points for the definition of overweight and obesity in German children and adolescents.

Background: Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany. Objectives: The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation. Methods: The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7–17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/ hyperactivity disorder (FBBHKS, Conners’ Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined. Results Overall, 14.5% of the children and adolescents aged 7–17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed. Conclusions: The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.

Major depression is a serious mood disorder affecting more than 120 million people worldwide, irrespective of their race or socio-economic status. This psychiatric disorder is predicted to become the second leading cause of disability by the year 2020, second only to heart diseases in the global population, without distinguishing differences in the incidence within defined age groups. Depression is known to affect people across all age groups, including children, adolescents, adults and geriatrics, although older age is associated with an increased susceptibility to major depression and other psychiatric conditions. Until the 1970‘s depression during childhood and adolescence was thought to be uncommon or non-existent. Recent epidemiological studies have demonstrated that there is a persistent escalation in the prevalence of depression in children and adolescents. Accordingly, the number of prescriptions for drugs to treat this disorder in juveniles has escalated significantly. With our current limited understanding of the safety and long-term effects of treatment with antidepressants, the clinician is left making decisions without sound evidence of safety. In addition, psychotropic drugs may affect neurodevelopment during childhood and adolescence and may consequently modulate susceptibility to psychiatric disorders later in life. The objective of the current study was to investigate the effects of early-life (pre-natal and postnatal) chronic treatment with venlafaxine, a dual action serotonin-noradrenalin reuptake inhibitor, during the developmental phase of the serotonin and norepinephrine pathways in stress-sensitive rats on measures of cognition, anxiety-like and depressive-like behaviour later in life. The study also investigated which age shows optimal behavioural changes later in life, following the above mentioned administration of venlafaxine. In addition we also determined the effects that the administration of venlafaxine has on the levels of monoamines l-norepinephrine (l-NE) and serotonin (5-HT) in the prefrontal cortex and the hippocampus. A number of translational animal models of psychiatric disorders have been described and validated, and is suitable for such investigations. For the current study we used stress-sensitive Flinders Sensitive Line (FSL) rats and their controls, Flinders Resistant Line (FRL) rats. Pregnant dams were injected subcutaneously for 14 days with 10 mg/kg venlafaxine or saline from pre-natal day 15 (ND-15) to ND-01. New-born pups were then injected subcutaneously with 3 mg/kg venlafaxine or saline for 14 days from postnatal day 3 (ND+03) to ND+17. These doses were determined from previous studies reported in literature. Four rat treatment groups of both FSL and FRL rats received injections during pre-natal + postnatal ages as follows: saline + saline, venlafaxine + saline, saline + venlafaxine and venlafaxine + venlafaxine. Following the drug treatments, all rat groups were housed under normal conditions until the indicated time to be subjected to a battery of behavioural tests, including the novel object recognition test (nORT), locomotor activity test (Digiscan®), elevated plus maze (EPM) and forced-swim test (FST), scheduled on either ND+35, ND+60 or ND+90. Separate treatment groups were used for each age group. After the behavioural tests animals were decapitated, the brains removed and the prefrontal cortex and hippocampus dissected out. These were analysed at a later stage using an HPLC with electrochemical detection to determine the levels of the monoamines l-NE and 5-HT. All animal procedures were approved by the Ethics Committee of the North-West University (approval number: NWU-00045-10-S5), and are in accordance with the recommendations of the National Institutes of Health guide for the care and use of laboratory animals. The data from the current study suggest that in general FRL rats were not influenced by the early-life treatment with venlafaxine, as observed in the nORT, EPM or FST on ND+35, ND+60 or ND+90. There was minimal changes seen in the immobile behaviour in the FST of FRL rats that received prenatal venlafaxine. As expected, depressive-like behaviour in the FST was significantly enhanced in FSL rats relative to corresponding FRL rat groups as observed at ND+35 and ND+60, but not ND+90. Importantly, depressive-like behaviour was reversed following pre- and postnatal treatment with venlafaxine in FSL rats at ND+60, relative to the corresponding FRL rat groups. Reversal of depressive-like behaviour in FSL rats were not observed at ND+35 or ND+90, suggesting a delayed response that is reversed later in adulthood. The data from the nORT, Digiscan® or EPM did not reveal any significant differences between the various FSL treatment groups, including at ND+60. The current study therefore demonstrated that the treatment regimen employed had a transient effect on depressive-like behaviour later in life and suggested that genetic susceptibility plays an important role in the treatment of depression. This was suggested by the venlafaxine-induced decrease in immobile behaviour exhibited by FSL rats at ND+60 in the FST, and the subsequent increase in immobile behaviour at ND+90. In general, the most significant venlafaxine-induced effects were seen in FSL rats, suggesting genetic susceptibility plays an important role. / MSc (Pharmacology), North-West University, Potchefstroom Campus, 2014

Doctor of Philosophy (Phd) / Despite general agreement that severely emotionally disturbed children and adolescents are an "at risk" group, and that ongoing evaluation and research into the effectiveness of services provided for them is important, very little outcome evaluation actually takes place. The absence of well-conducted and appropriately interpreted studies is particularly notable for day or residential treatment programs, which cater for the most severely emotionally disturbed youths. This thesis outlines the main areas of conceptual, pragmatic and methodological confusion and neglect which impede progress in research in this area. It argues for plurality of data analytic strategies and research designs. It then critically reviews the reported findings about the effectiveness of day and residential treatment in specialist facilities, and the predictors of good outcomes for this treatment type. This review confirms that there is very little to guide practice. Having argued for the legitimacy of its methods and the necessity to address basic questions, the thesis reports the results of a naturalistic study based on data accumulated during a decade-long evaluative research program taking place at Arndell Child and Adolescent Unit, Sydney. The study addresses the question of what child, family and treatment variables predict outcome for 159 children and adolescents treated at this facility from 1990 to 1999. Statistically significant results with large effect size were obtained. Among the most disturbed subgroup of forty three children, (a) psychodynamic milieu-based treatment was shown to be more effective than the “empirically-validated” cognitive-behavioural treatment which superseded it in 1996, and (b) children from step-families showed better outcome than those from other family structures. Furthermore, it was found for the study sample as a whole that severe school-based problem behaviours were associated with a limited trajectory of improvement in home-based problem behaviour. These results are discussed with regard to implications for treatment, research methodology, policy and further studies.

Syftet med denna studie är att undersöka hur HVB-personal på olika hem i Stockholm arbetar med ensamkommande flyktingbarn rörande barnens kulturer och traditioner samt ta reda på hur personalen arbetar för att integrera flyktingbarn in i vad de upplever vara ett svenskt samhälle. Studien har även till syfte att ta reda på ifall HVB- personalen upplever att det finns problematik kring att integrera barnen samtidigt som de måste ta hänsyn till ursprunglig kultur och tradition hos barnen. Uppsatsen grundar sig i en kvalitativ ansats av tio intervjuer med personal som arbetar på olika HVB-hem. Med hjälp av de teoretiska begreppen gräsrotsbyråkratier, systemintegration, social integration, kultur, kulturmöte och kulturkrockar men även tidigare forskning visar resultat och analys ett sammanhängande mönster. Resultaten visade att HVB-personalen i hög grad värderar hänsynstagande till de ensamkommande flyktingbarnens/ ungdomarnas kulturer och traditioner under integreringsprocessen. De främst återkommande punkterna som personalen menar är viktigast att ta hänsyn till rörande kultur och tradition är barnens/ ungdomarnas; värderingar, religioner, högtider och ursprungliga språk. HVB-personalen upplever att deras huvudsakliga mål som HVB-personal är att integrera barnen/ ungdomarna till det svenska samhället. Tillvägagångsätten för att integrera barnen beskrivs som ett vardagligt arbete som omfattar personalens engagemang i att vägleda, informera barnen/ ungdomarna om samhällets viktiga organ så som att gå i skolan eller att lära dem skillnaderna mellan rätt och fel enligt Sveriges normer och värderingar. Begreppet integrering handlar för våra respondenter sammanfattningsvis om att flyktingbarnen/ ungdomarna tar del av ett nytt samhälle och blir en del av det. Studien visade avslutningsvis att spänningar/ obalans kunde uppstå vid integreringen av barnen/ ungdomarna som resultat av kulturskillnader och kulturkrockar men även på grund av skilda tolkningar av arbetsuppgifter för personal. / The purpose of this study is to investigate how staff from residential care homes in Stockholm work with unaccompanied refugee children/ adolescents concerning the children's/ adolescents cultures and traditions. The study also aims to find out how the staff work to integrate refugee children/ adolescents into what they perceive to be a Swedish society. Lastly the study also aims to find out if the staff experienced problems concerning the integration of the children/ adolescents while they have to take their original culture and tradition into account. The essay is based on a qualitative approach of ten interviews with staff working in different residential homes in Stockholm. With the help of the theoretical concepts grassroots bureaucracies, systems integration, social integration, culture, culture meeting and cultural clashes but also previous research showing results and analysis of a coherent pattern. Results showed that staff and their perceived values take into account of the unaccompanied refugee children/ adolescents different cultures and traditions during the integration process. Values, religions, traditions and the original language were described as the most important parts to take into consideration when focusing on the children’s/ adolescent’s cultures and traditions. Approaches to integrate the children was described as a main objective and a casual work which includes staff involvement in guiding, informing the children/ adolescents of society's major institutions such as going to school or to teach them the difference between right and wrong according to Swedish standards and values. Further the concept of integration according to our respondents, means that the refugee children and adolescents take part of a new society and become a part of it. Finally, the study showed that stress or imbalance could arise during the integration of children/ adolescents as a result of perceived cultural differences and cultural conflicts but also because of different interpretations of the duties of staff.

Made available in DSpace on 2016-12-12T20:34:13Z (GMT). No. of bitstreams: 1 GLEIDISMARA 1.pdf: 117907 bytes, checksum: 001d62da118ecff2b16680fbf28fe4aa (MD5) Previous issue date: 2005-12-12 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study, presented in the Masters program in Education and Culture of the State University of Santa Catarina (UDESC), sought to understand teachers perceptions about Commercial Sexual Exploitation of Children and Adolescents in the municipality of Florianópolis. The guiding issues of this study focused on a search to unveil the reflections of this perception on pedagogical activities with victims of such violence. The work also sought to identify, based on the discourse of teachers, suggestions for confronting sexual exploitation, understanding the educator as a defender of the rights of children and adolescents, and as a citizen who transforms reality. The study first portrays the world experienced by the researcher as an educator, psychologist and employee of the Federal Public Ministry, considering that her experience is permeated by conflicts about this problem both in the educational process and in therapeutic practice. The theoretical support for the research reveals that sexual rights are human rights, and thus supported by Brazilian and international legislation. Sexual exploitation is clearly a violation of rights that requires systematic intervention to punish the violators. By means of this dissertation I intend to offer society, especially those committed to the effective protection of sexually exploited subjects, material that can assist in the reflections, debates and programs to eradicate this heinous form of obtaining pleasure and profit. Understanding the school as a special place of information and education about sexual identity that can significantly contribute to the construction of a culture of peace, five teachers were interviewed who performed various functions in public schools located in the periphery of Florianópolis. The theoretical-philosophical-methodological route to phenomenology was based principally on the works of The data collected in the interviews were analyzed according to the five steps proposed by Giorgi, enriched by the sixth step proposed by Comiotto. Based on the analysis of the interviews, three essential concepts were revealed: I A look at oneself, when meeting the other: The perception of the multiple violence that is felt; II Confronting sexual exploitation is everyone s responsibility; III- The construction of a culture of peace: suggestions for confronting the commercial sexual exploitation of children and adolescents. The work also intends to create elements that can assist in the development of public policies that provide psychological and social services to the victims of commercial sexual exploitation and that assist teachers in the prevention and confrontation of sexual exploitation / O presente trabalho, apresentado no curso de Mestrado em Educação e Cultura, da Universidade Estadual de Santa Catarina- UDESC, buscou compreender a percepção de educadoras sobre a Exploração Sexual Comercial de Crianças e Adolescentes no município de Florianópolis. As questões norteadoras deste estudo enfatizaram a procura do desvelamento dos reflexos desta percepção, na ação pedagógica, junto aos sujeitos vítimas de violência. O trabalho também procura elencar, à partir dos discursos das educadoras, sugestões de enfrentamento à exploração sexual, visualizando o educador como defensor dos direitos da infância e da adolescência, bem como cidadão transformador da realidade. Inicialmente, relata o mundo vivido pela pesquisadora como educadora, psicóloga e servidora do Ministério Público Federal, considerando que sua vivência foi permeada de conflitos a cerca dessa problemática tanto no processo educativo, quanto na prática terapêutica. No diálogo com os cúmplices teóricos, ficou evidenciado que os direitos sexuais são direitos humanos, portanto amparados na legislação nacional e internacional, e que a exploração sexual é uma violação de direitos, requerendo uma intervenção sistêmica para punição dos aliciadores. Por meio dessa dissertação pretende proporcionar à sociedade, especialmente aos comprometidos com a efetiva proteção aos sujeitos explorados sexualmente, material de apoio que possa auxiliar nas reflexões, debates e programas de erradicação desta forma hedionda de obtenção de prazer e lucro. Entendendo a escola como um espaço privilegiado de informação e formação da identidade sexual que poderá significativamente contribuir na construção da cultura de paz, foram entrevistadas cinco educadoras que desempenham variadas funções em escolas públicas localizadas na periferia de Florianópolis. Foi utilizado como caminho teórico-filosófico-metodológico a fenomenologia, baseada principalmente nas obras de Merleau-Ponty, seguindo os passos básicos do método fenomenológico. Os dados coletados nas entrevistas foram analisados seguindo os cinco passos de Giorgi, enriquecidos pelo sexto passo proposto por Comiotto. A partir da análise das entrevistas, fluíram três essências, são elas: I - Um olhar para si, no encontro com o outro: A percepção das múltiplas violências sentidas; II - Enfrentamento à exploração sexual: um compromisso de todos; III- A construção de uma cultura de paz: sugestões de enfrentamento à exploração sexual comercial de crianças e adolescentes. O trabalho pretende também criar subsídios ao desenvolvimento de políticas públicas que possibilitem o atendimento psicológico e social às vítimas de exploração sexual comercial e que auxiliem o educador na prevenção e no enfrentamento da exploração sexual .