Managing Family Accommodation of OCD in the Context of Adolescent Treatment Refusal: A Case Example

Family accommodation is a common and widely studied phenomenon in families of youth with obsessive‐compulsive disorder (OCD). Family accommodation has been associated with increased symptom severity, poorer functional outcomes, and reduced treatment response. While family accommodation is increasingly targeted in family‐based treatment of OCD, there are cases where youth refuse treatment. In these circumstances, parent‐focused treatments that target reduction of family accommodation can be used to improve outcomes for youth with OCD. This case study illustrates the conceptualization and treatment of family accommodation in childhood OCD in the context of treatment refusal. Treatment was implemented without explicit involvement of the child. Parents reported moderate improvement in OCD symptoms at the end of treatment and a decrease in overall parent–child conflict. The findings illustrate how exposure and response principles can be implemented without direct involvement of the child in cases where youth show low motivation or refusal of treatment.     

IMPLEMENTATION OF A COMMUNITY‐BASED FAMILY‐CENTERED PROGRAM IN PORTUGAL: A MULTIPLE CASE STUDY EVALUATION

Family‐centered, community‐based programs are particularly suited to support families with at‐risk children or maltreated children and achieve family preservation or reunification. In these child protection and child welfare cases, assessment is of great importance to inform decision making. But the implementation of services to support the families change and its evaluation in real settings is not without challenges. The Integrated Family Assessment and Intervention Model (IFAIM) was designed to conduct assessment and intervention with multichallenged families with at‐risk or maltreated children and support the activities of the child protection system. In this article, we describe a pragmatic, focused on improvement, action research multicase study of the process and outcome of IFAIM's first implementation. Multiple factors affected implementation, namely, factors related with the teams, the organizations, and the communities. An improved model of implementation based on the evaluation results is proposed.     

Family well‐being and disabled children: A psychosocial model of disability‐related child behaviour problems

Background: When parents receive a diagnosis that their child is disabled, many families adjust to this healthily and cope well, but others do not. Feelings of hopelessness, social isolation of the family within the community and child behaviour problems have all been reported. While utilization of social support systems is well documented in the literature as being a significant factor in family coping and adjustment to the child's disability, less attention has been focused on the role of psychological factors. Objective: This theoretical study aims to address this inbalance by integrating perspectives from a social model of disability with psychological research on the role of cognitive change in families' coping and adjustment to having a disabled child, and thus to produce a new psychosocial model of disability‐related child behaviour problems. Method: Negative societal attitudes to disability identified by a social model of disability are interpreted with respect to how they might translate to parent views of their disabled child within the family. Resultant parenting beliefs and their possible implications for family interaction, child behaviour and family health and well‐being are explored within this new framework. Conclusions: The psychosocial model of disability‐related child behaviour problems provides a useful conceptual framework that has both clinical and research implications for professionals working with families with disabled children.     

Utilising Family‐Based Designs for Detecting Rare Variant Disease Associations

Rare genetic variants are thought to be important components in the causality of many diseases but discovering these associations is challenging. We demonstrate how best to use family‐based designs to improve the power to detect rare variant disease associations. We show that using genetic data from enriched families (those pedigrees with greater than one affected member) increases the power and sensitivity of existing case–control rare variant tests. However, we show that transmission‐ (or within‐family‐) based tests do not benefit from this enrichment. This means that, in studies where a limited amount of genotyping is available, choosing a single case from each of many pedigrees has greater power than selecting multiple cases from fewer pedigrees. Finally, we show how a pseudo‐case–control design allows a greater range of statistical tests to be applied to family data.     

VARYING TREATMENT INTENSITY IN A HOME‐BASED PARENT AND CHILD THERAPY PROGRAM FOR FAMILIES LIVING IN POVERTY: A RANDOMIZED CLINIC TRIAL

This study addressed the question of whether increasing the intensity of a parent and child therapy program would improve results for young children with significant behavior problems from families living in poverty. Children were randomly assigned to either a standard condition or an intensity condition that provided 50% more treatment over a standard 8‐week treatment period. Based on multiple parent‐report, direct observation, and clinician‐report measures of the children and their caregivers, both groups improved on all measures from pretest to posttest and from pretest to follow‐up. No differences in outcomes were found between the standard and intensity groups at posttest or follow‐up. These counterintuitive results are discussed within the parent and child intervention literature. Also, the heuristic potential of this study to encourage continued research with this challenging population is addressed.     

Predictors of family participation in a multiple family group intervention for aggressive middle school students

The authors examine predictors of family participation in the G.R.E.A.T. Families Program of the Multisite Violence Prevention Project (MVPP), a four‐site collaboration examining student, teacher, and family interventions for middle school students. Teachers recruited two cohorts of sixth grade students, recognized as being aggressive and influential with their peers, and their families into a voluntary, 15‐session weekly program. Among the 643 families that consented (66%), the mean number of sessions attended was 8.13, with almost half (48.3%) attending 11 or more sessions. Linear mixed models (LMMs) were developed to predict the number of sessions attended based on a cluster of demographic variables and scales designed to measure aggression, problem behaviors, family factors, and other psychosocial constructs. Three of the nine clusters held significance when associated with attendance: level of aggression as rated by the child (negative association), parent–child bond (negative association), and level of child victimization (positive association). Somewhat surprisingly, the variance component due to interventionist turned out to be small and to constitute a nonsignificant component of the overall variability in attendance. Results suggest that family recruitment for multiple family group programs can be achieved with substantial effort and that resources available for recruitment might be differentially applied across families based on predictors of attendance. © 2010 Wiley Periodicals, Inc.     

Unambiguous identification of <Emphasis Type="Italic">JC polyomavirus</Emphasis> strains transmitted from parents to children

Summary. JC polyomavirus (JCV), the etiological agent of progressive multifocal leukoencephalopathy, is ubiquitous in humans, infecting children asymptomatically, then persisting in renal tissue. It has been proposed that JCV is transmitted mainly from parents to children through long-term cohabitation. The objective of this study was to further elucidate the mode of JCV transmission. In 5 families, we selected parent/child pairs between whom JCV was probably transmitted (judged on the basis of the identity of a 610-bp JCV DNA sequence between the parent and child). We established 5 to 9 complete JCV DNA clones from the urine of each parent or child. The complete sequences of these clones were determined and compared in each family. Nucleotide substitutions were detected in 4 parents and 1 child, and sequence rearrangements (deletions or duplications) were found in 2 parents and 2 children. Phylogenetic comparison of the detected sequences indicated that the diversity of JCV DNA sequences was generated in each family (i.e. not caused by multiple infection). We found that in 4 of the 5 families, a sequence detected in the parent was completely identical to one in the child. These findings provided further support for the proposed mode of JCV transmission, i.e. parent-to-child transmission during cohabitation.     

Development of a multisystemic parent management training intervention for incarcerated parents,their children and families

The majority of men and women prison inmates are parents. Many lived with children prior to incarceration, and most have at least some contact with their children and families while serving their sentences. Because prison populations have increased in the United States, there has been a renewed interest in finding ways not only to reduce recidivism, but also to prevent incarceration in the first place, particularly among the children of incarcerated parents. Positive family interaction is related to both issues. The ongoing development of a multisystemic intervention designed to increase positive family interaction for parents and families involved in the criminal justice system is described. The intervention package currently includes a prison‐based parent management training program called Parenting Inside Out (PIO); a prison‐based therapeutic visitation program; and complementary versions of PIO designed for jail and probation and parole settings. Work on other components designed for justice‐involved parents, children and for caregivers during reunification from prison is ongoing. Program development has occurred within the context of strong support from the State department of corrections and other key governmental and non‐profit sector groups, and support systems have been established to help maintain the interventions as well as to develop complementary interventions, policies and procedures.     

An exploratory genetic analysis: Associations between parent depression symptoms,child temperament,and the serotonin transporter gene polymorphism (5HTTLPR)

Child temperament has been shown to be biologically based and heritable; however, genetic association studies of temperament have been fairly inconclusive, and the role that parental depressive symptoms play is largely unexplored in this context. The relationship between parent depressive symptoms and the child temperament dimensions of fear and activity level (AL ) were examined in 100 sibling pairs 2.5–5.5 years of age and their mothers. Parent reports of child temperament and parent self‐reports of depressive symptoms were obtained from families, as well as DNA samples from each child during their lab visit. Associations between the serotonin transporter gene (SLC6A4 ) polymorphism 5‐HTTLPR /rs25531 and the phenotypic variables were also explored. Parent depressive symptoms were significantly related to higher child AL , but minimally associated with fear outcomes. More powerful regression analyses revealed that parent depressive symptoms, child gender, and child age predicted child AL , but only child gender and age predicted child fear. In our exploratory candidate gene analyses, the low‐expressing genotypes of the 5‐HTTLPR /rs25531 polymorphism predicted child fearfulness, but not child AL . Our phenotypic findings indicate that a child with at least one parent with depressive symptoms is more likely to have higher AL , and results of the initial genetic analyses show that the 5‐HTTLPR /rs25531 polymorphism is associated with child fearfulness. Future research employing larger samples, observational assessments, and related child behavioral maladjustment measures will further clarify these findings.     

Divorce: Using Psychologists’ Skills for Transformation and Conflict Reduction

The litigious divorce process often leaves children with parents who are at “war” and have little ability to coparent effectively. This article discusses some of the Alternative Dispute Resolution (ADR) processes designed to lessen conflict both before and after divorce. It also addresses the important work of psychologists serving in the roles of child therapists and reunification clinicians doing the difficult work of helping to heal fractured child‐parent relationships. Ethical challenges are addressed and future directions for applied research are suggested.     

Family processes among Latino Early Head Start families: Understanding the role of caregiver acculturation

The Family Stress Model (FSM) provides a framework for how economic pressure can impact family processes and outcomes, including parent's mental health, parenting, and child problem behaviors. Although the FSM has been widely replicated, samples disproportionately impacted by poverty, including early childhood samples and in particular Latino families with young children, have been largely excluded from FSM research. Therefore, among a sample of Latino Early Head Start children (N = 127), the current study evaluated a modified FSM to understand the direct and indirect pathways among economic pressure, parental depression, parenting self‐efficacy, the parent–child relationship, child problem behaviors, and parental acculturation. Results showed that the majority of the direct FSM pathways were well‐replicated among Latino caregivers of young children. Further analyses illuminated how some pathways were replicated among more but not among less‐acculturated Latino parents. Implications for future FSM research with Latino families as well as for parent‐focused interventions are discussed.     

The child's active role in mother–child,father–child psychotherapy: A psychodynamic approach to the treatment of relational disturbances

The short‐term mother–child and father–child psychoanalytic psychotherapy assumes that children develop specific types of relationships with each parent, as well as with the parenting couple. The model integrates an intra‐psychic, object‐relational view with an interpersonal perspective to the treatment of relational disturbances in childhood. The same therapist meets with the mother–child, father–child dyads on a weekly basis, along with regular meetings with the parental dyad. The model focuses on the developmentally prelatency child's need for the active participation of both parents in the here‐and‐now shared experiences of the therapeutic process. The participants express, in interactions and in enactments, various contents and meanings of their specific patterns of relations. The therapist addresses the behaviours as well as the meanings of relations, thus promoting reflective understanding and experiential changes in self, other, and self‐other relations. The child's active and different participation with each parent is the main change‐promoting factor. The child uses mainly the medium of play to express his/her needs and to mobilize the therapist's help. The therapist's access to the different dyads is utilized to better understand the explicit and implicit relational themes. The therapist supports the co‐construction of new and different behaviour patterns and the co‐creation of additional meanings to representations. The setup fosters the child's active participation in each dyad's growth‐promoting changes.     

A family perspective on parental psychosis: An interpretative phenomenological analysis study

Objectives

While one third of people with a psychotic disorder are a parent, there has been little research to date examining the consequences of this from a whole family perspective. This study investigates families where a parent has experienced an episode of psychosis and compares and contrasts the family members' perspectives.

Design

This study was rooted in phenomenology and data were derived from in-depth semi-structured interviews.

Methods

Parents with a psychotic disorder who had a child aged between 3 and 11 in a UK NHS Trust were invited to take part in the study. Semi-structured interviews were conducted with these parents, with their child (if they were between the ages of 8 and 11), and with their partner or another close family member. Data were analysed using multiperspectival interpretive phenomenological analysis (m-IPA).

Results

Thirteen participants took part comprising of five parents, four children, three partners and one grandmother. Four themes were developed using m-IPA: (1) Parental psychosis impacts the whole family, (2) Psychosis and my role as a parent, (3) Secrecy and concealment surrounding parental psychosis, and (4) Pressures and vulnerabilities within the family system.

Conclusion

Psychosis had a negative impact on all family members and secrecy existed between family members. The children in particular only had partial information about their parent's mental illness, which left them worried and confused. More work is needed to support these families to explain psychosis to the children.     

Successful Therapist–Parent Coaching: How In Vivo Feedback Relates to Parent Engagement in Parent–Child Interaction Therapy

Although behavioral parent training is considered efficacious treatment for childhood conduct problems, not all families benefit equally from treatment. Some parents take longer to change their behaviors and others ultimately drop out. Understanding how therapist behaviors impact parental engagement is necessary to improve treatment utilization. This study investigated how different techniques of therapist in vivo feedback (i.e., coaching) influenced parent attrition and skill acquisition in parent–child interaction therapy (PCIT). Participants included 51 parent–child dyads who participated in PCIT. Children (age: M = 5.03, SD?=?1.65) were predominately minorities (63% White Hispanic, 16% African American or Black). Eight families discontinued treatment prematurely. Therapist coaching techniques during the first session of treatment were coded using the Therapist–Parent Interaction Coding System, and parent behaviors were coded with the Dyadic Parent–Child Interaction Coding System, Third Edition. Parents who received more responsive coaching acquired child-centered parenting skills more quickly. Therapists used fewer responsive techniques and more drills with families who dropped out of treatment. A composite of therapist behaviors accurately predicted treatment completion for 86% of families. Although group membership was correctly classified for the treatment completers, only 1 dropout was accurately predicted. Findings suggest that therapist in vivo feedback techniques may impact parents’ success in PCIT and that responsive coaching may be particularly relevant.     

IMPACT OF THE DARE TO BE YOU FAMILY SUPPORT PROGRAM: COLLABORATIVE REPLICATION IN RURAL COUNTIES

Rural families often have unmet needs for services to strengthen family functioning and promote optimal youth development. Community needs assessments conducted at 2 rural sites led to a community‐university collaboration that implemented the DARE to be You (DTBY) program for families and youth aged 9 years at one site and aged 13 years at the second site. Families in the DTBY intervention, in contrast to a matched comparison group, evinced significantly greater gains in parent self‐efficacy, effective child‐rearing practices (i.e., more democratic and less coercive), and positive parent‐child relationships. As well, changes to community assets were documented in the form of increased human services to strengthen families. The results are discussed in terms of the utility of community–university partnerships to help strengthen rural families and promote community social capital.     

ME MANDÓ A TRAER: WEAK “STRONG TIES” IN LATINA IMMIGRANTS’ SOCIAL NETWORKS

The impact of social capital in immigrant communities is well acknowledged. However, research has heavily relied on quantitative studies and has tended to emphasize its positive impact. There has been a paucity of qualitative research that examines the complex dynamics of accessing support from social networks, especially when it entails family reunification and trauma. Twenty‐eight Latina immigrant women participated in an interview focused on traumatic and stressful experiences that included questions about accessing support from informal networks. Women used the expression “me mandó a traer” (I was brought in) when describing others' involvement in their immigration decision and initial settlement. This expression captured the ambivalence of receiving assistance from relatives or friends and also their challenges accessing support in a context of family reunification, scarce resources, and trauma exposure. This study contributes to the literature on immigrants' individual social capital further expanding a nuanced understanding of family reunification experiences.     

Evidence for parent of origin effect in late‐onset Alzheimer disease

Evidence for a parent of origin effect in Alzheimer disease was obtained from a sample of 148 sibships on which affection status of the parents was sought using family history interviews. The parent study recruited families with two or more affected sibs for late onset AD utilizing rigorous diagnostic criteria. In 74 families, there was evidence of an affected parent, 49 maternal and 25 paternal. Genome scan data were analyzed for the sample as a whole and for the maternal and paternal families separately, using Genehunter‐ASM. Seven regions with Z_lr scores ≥2 were identified, four in maternal families (chr. 10,12,19,20) and three in paternal families (chr. 1,7,13). With the exception of the chromosome 10 finding, analysis by parent of origin greatly increased evidence of linkage in areas showing no linkage in the overall analyses. For example, a chr. 12 region reached a LOD = 2.29 among maternal families whereas the same region showed a LOD = 0.3 when all families were analyzed together. The strongest findings among maternal families (chr. 10 and 12) were followed up with fine mapping that resulted in an increase in maximum LOD scores from 2.7–3.2 on chr. 10, and 2.29–2.42 on chr. 12. These analyses highlight the importance of parent of origin effects in late‐onset AD families and identify several genomic regions that may include genes linked to late‐onset AD specific to disease transmission from the mother and require further investigation. © 2002 Wiley‐Liss, Inc.     

Do parental perceptions and motivations towards genetic testing and prenatal diagnosis for deafness vary in different cultures?

Surveys of attitudes of individuals with deafness and their families towards genetic testing or prenatal diagnosis have mostly been carried out in the West. It is expected that the perceptions and attitudes would vary amongst persons of different cultures and economic background. There is little information on the prevailing attitudes for genetic testing and prenatal diagnosis for deafness in developing countries. Therefore, this study evaluates the motivations of Indian people with inherited hearing loss towards such testing. Twenty‐eight families with history of congenital hearing loss (23 hearing parents with child/family member with deafness, 4 couples with both partners having deafness and 1 parent and child with deafness) participated in a semi‐structured survey investigating their interest, attitudes, and intentions for using genetic and prenatal testing for deafness. Participants opinioned that proper management and care of individuals with deafness were handicapped by limited rehabilitation facilities with significant financial and social burden. Nineteen (68%) opted for genetic testing. Twenty‐six (93%) expressed high interest in prenatal diagnosis, while 19 (73%) would consider termination of an affected fetus. Three hearing couples, in whom the causative mutations were identified, opted for prenatal diagnosis. On testing, all the three fetuses were affected and the hearing parents elected to terminate the pregnancies. This study provides an insight into the contrasting perceptions towards hearing disability in India and its influence on the desirability of genetic testing and prenatal diagnosis. © 2012 Wiley Periodicals, Inc.