Extensive surgical excision of large hemispheric “malignant” astrocytoma in a 6-week-old infant

A massive hemispheric high-grade astrocytoma, diagnosed in a 6-week-old infant, was totally excised by means of two craniotomies. The child is still alive and well with minimal neurological dysfunction 1.5 years after operation. This case report illustrates the benefit of aggressive surgical excision (without radiation or chemotherapy) of massive malignant neonatal astrocytomas. While surgical deficits may be minimized by the plasticity of the developing nervous system, extensive excision may yield occasional long-term palliation.     

Reparenting and deparenting as a paradigm for psychiatric residential treatment

Psychiatric residential treatment for adolescents can be conceptualized as a process of reparenting and deparenting. In psychiatric treatment, there is a division between artificially created forms of treatment (such as individual or group therapy) and the real experience of daily life which can be seen in the therapist's real relationship with the adolescent (reparenting) and daily experience in the milieu. The designation of parental functions (granting of privileges, allowances, status changes, management, and coordination) to the therapist creates the satisfactions and creative conflicts necessary for reparenting. The theoretical basis of this work lies in Alexander's work on the corrective emotional experience, but also has roots in current object relations thinking. The patient is re-exposed under more favorable conditions to situations he could not handle in the past. By adequate nurturance, deficits are corrected. The therapist must assume an attitude different from that which the parent assumed toward the child in the original conflict situation. Repetition of the same mistakes must be prevented by better understanding, good supervision, and controlled affectivity. Deparenting has a theoretical ground in learning theory. The therapist refuses to reinforce the patient's present state of adjustment by refusing to make the response the patient forcefully evokes, and then there is a possibility of new choices.An earlier version of this paper was presented at the 35th Annual Meeting of the American Association of Psychiatric Services for Children, Washington, D.C., February 1984.     

Predictors of Caregiver Participation in an Engagement Strategy to Increase Initiation into a Family-Based Preventive Intervention

Previous studies have shown that engagement strategies can help increase enrollment and initiation of families in evidence-based preventive programs under natural service delivery settings. However, little is known about factors that predict completion of these engagement strategies. This study aimed to examine predictors (i.e., perceived need, perceived barriers, and sociocultural context) of caregiver participation in an evidence-based engagement call strategy. This call was expected to increase initiation into a school-based, family-focused prevention program. In addition, this study examined engagement call completion as a predictor of program initiation among already enrolled families. Participants included ethnically diverse families recruited from three Title I schools (n = 413) who were randomized to receive the prevention program. Results showed that interparental conflict—an indicator of perceived need—was associated with an increased likelihood of completing the engagement call. Furthermore, caregivers from low-socioeconomic status (SES), foreign-born, Spanish-speaking, Hispanic families were more likely to complete the call relative to those from low- and mid-SES, US born, English-speaking, ethnically diverse families. Importantly, engagement call completion was associated with an increased likelihood of program initiation. These findings provide limited support that families with higher perceived needs are more likely to participate in an evidence-based engagement call strategy. Results suggested that the call strategy provides a promising way to reduce attrition from family prevention programs, which is commonly observed between enrollment and initiation. Project Number: R01 DA035855; Date of Registration: 06/15/2014.