Profitieren psychisch erkrankte Eltern und psychisch belastete Kinder von einer gemeinsamen Eltern-Kind-Behandlung?

[Characteristics of the population of a parent-child unit: early interaction-based treatment as a chance in child and adolescent psychiatry]

BACKGROUND

In inpatient child psychiatric parent-child treatment, the child is admitted as a patient and the parents as accompanying persons. Due to the importance of parent-child interaction in the development and maintenance of mental disorders in children, parents are integrated more centrally in the treatment of children with emotional or behavioral disorders. In order to further expand this form of treatment in the future and to make it more effective, the characteristics of the previous utilization population of a child psychiatric parent-child unit in Tyrol were examined with regard to child symptomatology and the burden on parents.

METHODS

The Child Behavior Checklist 1 ½-5, Child Behavior Checklist 6-18R, and Tröster's (2011) Parent Stress Inventory scores of 96 parent-child pairs were used to examine child symptom expression and parent stress.

RESULTS

The 6-10 year old patients had higher T‑scores (M = 76.9, SD = 7.1) than the 0-5 year old patients (M = 63.1, SD = 12.4) on the CBCL total scale, t (50) = -3.52, p < 0.001. On the EBI total scale, the 0-5 year old patients and the 6-10 year old patients did not differ in terms of T‑scores, t (54) = -0.75, p = 0.459, as well as in the EBI child domain t (54) = -1.75, p = 0.087 and in the EBI parent domain, t (54) = 0.19, p = 0.846. Also, the four diagnostic groups did not differ in the EBI total scale, F (4,58) = 1.34, p = 0.266, nor in the parent domain of the EBI, F (4,58) = 1.44, p = 0.232, nor in the child domain of the EBI, F (4,58) = 2.81, p = 0.033.

CONCLUSIONS

Early identification and treatment of behavioral or mental disorders in very young children seems crucial to prevent long-term negative consequences as well as chronicity. Parent-child therapies should generally focus on identifying and changing current dysfunctional patterns of interaction between parent and child.

[Parent-Child Treatment in Child and Adolescent Psychiatry: Models and Clinical Implementation Using the Example of a Modular Parent-Child Ward]

The joint treatment of mentally ill children and their parents represents a special treatment concept in child and adolescent psychiatry. A study conducted by the Working Group (BAG) "Early Childhood" shows the current situation of care and possible models of child and adolescent psychiatric parent-child treatment in Germany. Using the parent-child ward of the Child and Adolescent Psychiatry Department in Magdeburg as an example, the combined treatment of mentally ill children and their parents is presented. The treatment approach consists of a three-week diagnostic phase, after which families are discharged again to their home environment followed by a five-week therapy block, for which the families have to be readmitted to the ward. With a focus on the parent-child relationship, the treatment concept - in contrast to regular child psychiatric treatments - is dynamically adapted to the quality of the parent-child interaction and not primarily related to the disorder of the children. First studies indicate the effectiveness of the special treatment setting and illustrate the efficiency of a joint treatment of parents and child, which, however, is associated with increased economic costs. Based on these results, the chances and limitations of parent-child wards are discussed and conclusions for parent-child treatment are drawn.

[DNVF-Discussion paper - Specificities, Challenges and Aims of Mental Health Service Research in Germany]

Research in mental health services in Germany is of increasing relevance. To this end, the recently founded "Mental Health Working Group" as part of the German Network of Health Services Research (DNVF) has written a discussion paper presenting key specifics, challenges, and goals of health service research in the field of mental health. Some research-relevant specifics in the area of mental health care, pragmatic challenges of research organization, ethical problems, and particular research topics in this field are presented and discussed critically.

A Scoping Review of Interventions Designed to Support Parents With Mental Illness That Would Be Appropriate for Parents With Psychosis

The experience of psychosis can present additional difficulties for parents, over and above the normal challenges of parenting. Although there is evidence about parenting interventions specifically targeted at parents with affective disorders, anxiety, and borderline personality disorder, there is currently limited evidence for parents with psychotic disorders. It is not yet known what, if any, interventions exist for this population, or what kinds of evaluations have been conducted. To address this, we conducted a scoping review to determine (1) what parenting interventions have been developed for parents with psychosis (either specifically for, or accessible by, this client group), (2) what components these interventions contain, and (3) what kinds of evaluations have been conducted. The eligibility criteria were broad; we included any report of an intervention for parents with a mental health diagnosis, in which parents with psychosis were eligible to take part, that had been published within the last 20 years. Two reviewers screened reports and extracted the data from the included reports. Thirty-eight studies of 34 interventions were included. The findings show that most interventions have been designed either for parents with any mental illness or parents with severe mental illness, and only two interventions were trialed with a group of parents with psychosis. After noting clusters of intervention components, five groups were formed focused on: (1) talking about parental mental illness, (2) improving parenting skills, (3) long-term tailored support for the whole family, (4) groups for parents with mental illness, and (5) family therapy. Twenty-three quantitative evaluations and 13 qualitative evaluations had been conducted but only eight interventions have or are being evaluated using a randomized controlled trial (RCT). More RCTs of these interventions are needed, in addition to further analysis of the components that are the most effective in changing outcomes for both the parent and their children, in order to support parents with psychosis and their families.

Wahrgenommene Belastung von Müttern sprachentwicklungsgestörter Kinder

Hintergrund Sprachentwicklungsstörungen beeinflussen nicht nur die betroffenen Kinder, sondern das gesamte familiäre Umfeld. Insbesondere Mütter sprachentwicklungsgestörter Kinder erleben hohe psychische und physische Belastungen.

Methode Es wurden n = 40 Mütter von sprachauffälligen und n = 39 Mütter von sprachunauffälligen Kindern zu einem Erhebungszeitpunkt untersucht. Anhand von multivariaten Varianzanalysen und Regressionsanalysen wurden Gruppenunterschiede und mögliche, das Belastungserleben beeinflussende, Prädiktoren ermittelt.

Ergebnisse Die Ergebnisse zeigen, dass Mütter von sprachlich auffälligen Kindern deutlich höhere Belastungswerte insbesondere hinsichtlich depressiver Symptome aufweisen als Mütter von unauffällig entwickelten Kindern.

Diskussion Die Behandlung und Förderung von Sprachentwicklungsstörungen sollte sich zukünftig nicht nur auf kindzentrierte Maßnahmen beschränken, sondern vermehrt auch Eltern gezielt in die Therapie integrieren.

Frühkindliche Prädiktoren externalisierender Verhaltensauffälligkeiten

Zusammenfassung. Externalisierende Verhaltensauffälligkeiten sind mit hohen gesellschaftlichen Kosten verbunden. Damit wirksame Präventions- und frühe Therapieprogramme entwickelt werden können, ist es notwendig, bereits in den ersten Lebensjahren Risiken für einen externalisierenden Entwicklungsverlauf zu identifizieren. In einer systematischen Literaturrecherche konnten aus 21 Publikationen zu 12 längsschnittlichen Geburtskohorten mit insgesamt 55 077 Kindern frühe Risiken bezogen auf eine elterliche Psychopathologie, einen niedrigen sozio-ökonomischen Status und ungünstige Eltern-Kind-Interaktionen identifiziert werden. Insbesondere eine mütterliche Depression, ein niedriger sozio-ökonomischer Status und ein harsches Erziehungsverhalten in den ersten Lebensjahren waren prädiktiv für externalisierende Verhaltensauffälligkeiten im Kindergarten und bei Schuleintritt. Implikationen für die klinische Praxis werden vorgestellt.

Gruppentherapie

Zusammenfassung. Gruppentherapie-Angebote bilden ein stark vernachlässigtes Thema im Rahmen der Versorgung psychisch erkrankter Kinder und Jugendlicher. Solche Angebote sollten nicht nur für die Förderung sozialer Kompetenzen, sondern bei Aufmerksamkeits- und Motivationsproblemen, einem auffälligen Arbeitsverhalten oder posttraumatischen Belastungsstörungen verfügbar sein und genutzt werden. Von großer Bedeutung ist auch, das entsprechende Format der Gruppenbehandlung für die einzelnen Anforderungen zu spezifizieren. Aktuell reichen die Angebote von der gruppentherapeutischen Intensivtherapie, der Kombination von Einzel- und Gruppentherapie, Summer-Camp-Maßnahmen, Eltern-Kind-Gruppen oder das parallele Angebot von Gruppen für Kinder und Eltern. Generell sind Gruppentherapie-Angebote einer Einzeltherapie in ihrer Wirksamkeit nicht unterlegen und Vorgehensweisen mit einem noch nicht hinreichend genutztem Potenzial.