Some techniques for working with resistant families of adolescents

This paper reviews some of the causes of resistance in families of adolescents being seen in conjoint family therapy. Two main types of resistance are described: resistance due to excessively high anxiety and resistance due to excessively low anxiety. Techniques for dealing with such resistance are then discussed: first, directive techniques designed to lower or heighten anxiety and secondly, strategic techniques designed to exploit resistance to a therapeutic end.     

Assumptions and beliefs in adolescents with anorexia nervosa and their mothers

A pilot study examined the specific cognitive content of female adolescents with anorexia nervosa. The relationship between daughter and mother concerns, and concerns in mothers, also were investigated. All participants completed a measure of assumptions and negative self-beliefs related to eating disorders. Adolescents with anorexia nervosa scored more highly on all subscales of the measure than nonclinical adolescent controls. There were significant daughter- mother relationships on two subscales in the clinical, but not the nonclinical, group. However, the two groups of mothers did not differ on any subscale. Possible explanations for the findings, and implications for treatment and research, are briefly considered.     

Therapists' experiences of cognitive remediation therapy for anorexia nervosa: implications for working with adolescents

Cognitive Remediation Therapy (CRT) is a novel intervention developed for adults with anorexia nervosa (AN), which aims to improve "cognitive flexibility" and "holistic processing" thinking styles (Tchanturia et al., 2008; Tchanturia & Hambrook, 2009). The present study uses a qualitative approach to examine therapists' accounts of their work with inpatients suffering with AN. The objective of this study is to gain a broader understanding of how CRT has been implemented and utilized in daily life by this patient group. Therapists' letters were positive and motivational; acknowledging patients for their achievements while outlining some of the difficulties and emotions that patients experienced. Findings highlight that the majority of patients' difficulties related to their metacognitive ability and in transferring the skills to real life. Themes also concerned the processes and stages of CRT, where patients gradually drew skills from the intervention prior to making changes in their own lives. The implications of this approach for working with adolescents with eating disorders are explored. It is hoped that this study will help understanding of how CRT can be used as a treatment for AN; and how it could be developed for future work with young people.     

Perceptions of family relationships in adolescents with anorexia nervosa and their unaffected sisters

The family relationships of patients with anorexia nervosa (AN) have been extensively studied over recent years. However, using case-control designs with unrelated controls is subject to various cultural and familial biases. Studying subjective differential perceptions of family relationships in sister-pairs discordant for the disorder may overcome some of these limitations. The aim of the present study was therefore, to investigate subjective perceptions of family environments in a clinically ill sample of female adolescent patients with acute AN and in their healthy sisters using the Subjective Family Image Test. We found significantly lower perceived individual autonomy and higher perceived cohesion in patients compared with their sisters but no difference in perceived emotional connectedness. Lower perceived individual autonomy of the ill children resulted mainly from their relationships with mothers but also in part from their relationships with fathers. This observed pattern might contribute to the maintenance of the disorder and should be addressed in individual and family interventions. Accepted: 15 April 2002 Correspondence to A. Karwautz, MD, Prof.     

Temperament in adolescents with anxiety and depressive disorders and in their families

Aim of this study was to investigate whether specific temperamental features were associated with anxiety and depressive disorders in adolescents, in their siblings and in their parents. Thirty adolescents with Anxiety disorders and 25 with both Anxiety and Depressive disorders were compared to 25 adolescents with learning disorders and to 28 normal subjects. Temperament in subjects and relatives was assessed by their parents with the EAS questionnaire. Subjects with Anxiety and Anxiety-Depression and their siblings showed higher scores on Emotionality and Shyness than Learning Disability and Normal subjects. Mothers and fathers of subjects from the Anxiety-Depression group had the highest Emotionality score. These findings suggest that both Emotionality and Shyness are prominent temperamental features in adolescents with anxiety with or without depression, and in their parents and siblings.     

Therapeutic alliance and family-based treatment for adolescents with anorexia nervosa

This pilot study examines the role of therapeutic alliance in relation to weight gain and change in psychological measures during family-based treatment for adolescent anorexia nervosa (AN). Our sample consisted of 14 adolescents with AN and their families. Therapeutic alliance was measured using the System for Observing Family Therapy Alliances Scale. Those adolescents who attained at least 85% of their ideal body weight at the end of treatment had parents who showed a stronger therapeutic alliance with the therapist during the second session of treatment, while adolescents who were remitted on psychological measures showed a higher therapeutic alliance between themselves and the therapist early in treatment. It appears that therapeutic alliance plays an important role in outcome in family-based treatment for AN. Further study is needed in this area to explore the role of the therapist in creating and maintaining a strong therapeutic alliance.     

Impacts of children with troubles on working poor families: mixed-method and experimental evidence

Mixed-method and experimental data on working poor families and children with troubles participating in the New Hope anti-poverty experimental initiative in Milwaukee are described. Sixty percent of these families had at least one child who had significant problems (learning, school achievement and/or behavior, home behavior, retardation, other disabilities). Control group families with children who had troubles had more difficulties in sustaining their family routine than did New Hope experimental families. In the context of the many other challenges these parents face, adaptation to children with troubles does not stand out as sharply compared to middle-class European American families. There is less family adaptation specifically due to, or in response to, the troubled child, and more adaptation to the struggles of making ends meet.     

Correction to: Next generation Europe: a recovery plan for children,adolescents and their families

European Child & Adolescent Psychiatry - A correction to this paper has been published: https://doi.org/10.1007/s00787-021-01801-x     

Detection and importance of laxative use in adolescents with anorexia nervosa

OBJECTIVE: The frequency of laxative use in adolescents with anorexia nervosa is poorly described. This study of adolescents with anorexia nervosa examined self-report and biochemical screening methods for the detection of laxative use, the pattern of laxative use in this population over time, and the associated medical complications and psychopathology. METHOD: Forty-three consecutive patients with anorexia nervosa were studied. Initial assessment encompassed psychiatric history, medical examination, and administration of the Eating Disorders Examination, Child Behavior Checklist, and Youth Self-Report. Biochemical investigations, including random urinary laxative screening, were performed at assessment and follow-up. RESULTS: The frequency of laxative use from self-report alone was 12%; combined with urine screening it was 19%. The frequency of laxative use increased to 32% with prospective follow-up. Medical complications were associated with laxative use at follow-up. Laxative use was associated with longer duration of disease and with higher scores on the Eating Disorders Examination subscale Eating Concern. CONCLUSIONS: Laxative use is common among adolescents with anorexia nervosa, and the risk of associated medical complications increases over time. Biochemical screening will improve detection of laxative use. Longer duration of illness and greater Eating Concern scores are associated with increased risk of laxative use, and monitoring patients at increased risk is important.     

Starving the brain: structural abnormalities and cognitive impairment in adolescents with anorexia nervosa

Anorexia nervosa (AN) is one of the most common chronic illnesses afflicting adolescent girls and is associated severe medical complications. The structural abnormalities found in the brain of adolescents with AN are among the earliest and most striking physical consequences. In the past, it had been assumed that the brain abnormalities found in patients with AN reverse with weight-recovery. Recent evidence has shown that not all of these changes are completely reversible with weight recovery. To date, very little is known about the functional significance of these brain abnormalities. Several studies have shown that cognitive dysfunction is also a common feature of AN. Although current evidence suggests that there may be some degree of improvement in cognition with weight-recovery, it is unclear whether cognition recovers fully or equally across all neuropsychological domains. Furthermore, it remains unknown whether the reported functional consequences are associated with these structural brain changes. This article will review the current literature on structural brain abnormalities and cognitive dysfunction in adolescents with AN.     

A comparison of the psychological evaluation of adolescents with anorexia nervosa and of adolescents with conduct disorders

Cognitive and projective psychological tests were administered to ten inpatient adolescents with anorexia nervosa and ten inpatient adolescents with conduct disorders. All subjects were selected on the basis of race, sex and overall intelligence. Results indicate that there are high numbers of neuropsychological deficits in both groups, but that neuropsychological deficits are especially numerous in the anorexia group. The two groups showed striking similarities in terms of some psychological functions, but results indicate that some aspects of personality style in the two groups are significantly different. A significant finding was that there were far more suicidal indicators on the Rorschach records of the anorectic group as compared with those found on the records of the conduct disorder group.     

The intellectual functioning of adolescents with anorexia nervosa and bulimia nervosa

The aim of this study was to investigate the intellectual functioning of a large group of eating disordered adolescents in order to test two hypotheses, viz, that the intellectual functioning of eating disordered adolescents conforms to the normal distribution, and that eating disordered adolescents do not perform better in verbal abilities than in nonverbal abilities. Standard intelligence tests were applied to 190 consecutive out- and inpatients with eating disorder diagnoses. The results were compared with those of a group of patients with other disorders, similar in age, sex, SES, and year of admission. The IQ of the eating disordered patients was significantly higher than that of patients in the comparison group. Patients in the comparison group and bulimic patients, but not anorexic patients, showed better nonverbal than verbal intellectual performance.     

Adoptive and biological families of children and adolescents with ADHD

OBJECTIVE: Using an adoption study design, the authors addressed the issue of genetics in attention-deficit hyperactivity disorder (ADHD). METHOD: This study examined the rates of ADHD and associated disorders in the first-degree adoptive relatives of 25 adopted probands with ADHD and compared them with those of the first-degree biological relatives of 101 nonadopted probands with ADHD and 50 nonadopted, non-ADHD control probands. RESULTS: Six percent of the adoptive parents of adopted ADHD probands had ADHD compared with 18% of the biological parents of nonadopted ADHD probands and 3% of the biological parents of the control probands. CONCLUSION: Results of this study lend support to the hypothesis that ADHD has a genetic component.     

Heart rate variability in adolescents with functional hypothalamic amenorrhea and anorexia nervosa

Aim of this study consisted in assessing the 24-h heart rate variability (HRV), a measure of autonomic nervous system (ANS) imbalance, in 21 adolescents with functional hypothalamic amenorrhea (FHA, 11 normogonadotropic, N-FHA, and 10 hypogonadotropic, Hy-FHA) compared to 21 patients with anorexia nervosa (AN) and 21 controls. As expected, subjects with AN showed a significant dysregulation in multiple HRV parameters, while Hy-FHA patients presented with a dysregulation in a few domains (SDNN, HFr), which was not present in girls with N-FHA, who showed values largely similar to controls. FHA might represent part of the AN biological spectrum, and a link between these two conditions might exist, possibly related to the degree of psychological and/or hormonal dysfunction.