BACKGROUND Despite their potential to influence treatment decisions, parents' beliefs and attitudes regarding attention deficit hyperactivity disorder (ADHD) have not been widely studied. This research examined relations between parents' beliefs and attitudes and their experiences with different treatments for their children's ADHD. METHODS Canadian parents of 73, 5- to 13-year-old, boys with ADHD completed questionnaires measuring beliefs about ADHD, attributions for ADHD behaviours, and treatment experiences. RESULTS Parents reported using primarily behaviour management and stimulant medications in treating ADHD. Approximately half of the families also used diet/vitamin therapies. Parents were knowledgeable about ADHD and held generally accurate beliefs. They saw ADHD symptoms as predominantly internal to the child and as relatively enduring and pervasive. Parents' beliefs were related to their use of different treatments and parents who used less empirically supported treatments were more likely to see ADHD behaviours as internal to the child, enduring and pervasive. CONCLUSIONS The findings highlight the importance of assessing parents' use of alternate treatments for ADHD and the potential role of parents' beliefs and attributions in shaping treatment choices.

Attempts to determine the characteristics of those individuals who drop out from psychotherapy have yielded few consistent findings. Clinically depressed adolescents who completed a course of brief group therapy were compared with those who failed to complete treatment. Although no differences were found on a number of clinical and demographic variables, those who dropped out were more likely to be one grade behind in school and to have a history of alcohol and/or drug abuse. The implications of these findings for research and practice are discussed.

We investigated the ability of a measure of self-image, two measures of depression, and demographic characteristics to predict the outcome of depressive symptoms. Subjects were 47 adolescents who were referred to outpatient treatment for depression. Subjects were assessed for depressive symptoms at three time periods. Self-image as measured by the Offer Self=image Questionnaire (OSIQ) was a significant predictor of depressive symptoms at both 3 months and 1 year. That was independent of initial levels of depression. The two most predictive scales from the OSIQ were the emotional tone and mastery of the external world scales. The results are consistent with previous research indicating the importance of self-image in adolescent depression. The implications of these findings for treatment of adolescent depression are discussed.

Compared two methods of evaluating methylphenidate (MPH) on measures of parental acceptance, satisfaction, and compliance with the treatment. Twenty-four 6- to 10-year-old children with Attention Deficit Hyperactivity Disorder (ADHD) were randomly assigned to either a blind, placebo-controlled medication trial (MT) or to a typical clinical procedures (TCP) evaluation that was nonblind and without a placebo control. Ratings of satisfaction were significantly higher in the MT condition than in the TCP condition; however, all parents became more accepting of MPH after participating in an evaluation. Both during the evaluation and at 6-week and 3-month follow-ups, approximately 20% of cases were not complying with treatment. However, rates of compliance did not differ between the MT and TCP conditions.

Two forms of short-term group therapy for depressed adolescents are compared. Adolescents were assigned to either a social skills training or therapeutic support group. Treatment outcome was based on self-report and semistructured clinical interviews for depression, measures of self-concept, and cognitive distortions. After treatment, adolescents in the therapeutic support groups showed significantly greater reductions in clinical depression and significant increases in self-concept compared with those in the social skills training group. These group differences were no longer evident at 9-month follow-up, as adolescents in the therapeutic support groups maintained their improvement, and adolescents in the social skills training groups caught up.

A clinical trial of methylphenidate/placebo on 39 patients is described. Fifteen of 20 parents not keen to give their child methylphenidate did give it, after the trial had shown it was effective. Five out of 19 parents keen to give their child methylphenidate were persuaded not to after it was shown that it was ineffective. Some of the difficulties with the trial are described for example, parents confusing the days the drug is to be given, parents and teachers not filling in the questionnaires and the resistance of certain professionals to giving medication. Patients seem to be more accepting of recommendations to give medication or not, after a medication/placebo trial demonstrated efficacy or lack of efficacy.

A selected review of the literature about short-term therapy and social skills as they may apply to depressed adolescents is presented. Two forms of group therapy are described. These are social skills and a traditional discussion group format. Some of the difficulties in establishing and evaluating a group therapy program are outlined.

Psychotic and nonpsychotic depressed adolescent inpatients were compared on demographic features, clinical characteristics, and symptom ratings derived from the Diagnostic Interview Schedule for Children. Their patterns of demographic and clinical characteristics were similar; however, psychotic patients were more likely to have a history of sexual abuse, to be more depressed, and to have more hypomanic symptoms in their recent past than nonpsychotic patients. Those with mood-incongruent features differed from those with mood-congruent features only by the higher frequency of hypomanic episodes in their recent past. These findings suggest that psychotic features are not only a marker for severe depression but also identify mild forms of bipolar disorder. J. Am. Acad. Child Adolesc, Psychiatry, 1988, 27,4:489–493.

Fifty-four consecutive admissions to an inpatient adolescent psychiatric unit were studied within 2 weeks of hospitalization. Of 54 subjects, 17 acknowledged a history of sexual abuse, intra- or extrafamilial (37.9% of girls, 24% of boys). Although the two groups did not differ in age, IQ, or occurrence of parental death, the sexually-abused group was of lower socioeconomic status and had had higher scores on psychosocial stressors in the past year. These patients had significantly greater severity of depressive symptoms, more hallucinations, had more suicide attempts, and were more likely to be referred for long-term inpatient treatment. Compared with the non-sexually victimized patients, the abused group also showed trends toward more conduct symptoms and more often required neuroleptic medication and longer hospital stays for acute management. The authors emphasize the importance of eliciting a history of sexual abuse from disturbed adolescents in an inpatient unit, especially when severe depressive symptoms are noted. Fifty-four consecutive admissions to an inpatient adolescent psychiatric unit were studied within 2 weeks of hospitalization. Of 54 subjects, 17 acknowledged a history of sexual abuse, intra- or extrafamilial (37.9% of girls, 24% of boys). Although the two groups did not differ in age, IQ, or occurrence of parental death, the sexually-abused group was of lower socioeconomic status and had had higher scores on psychosocial stressors in the past year. These patients had significantly greater severity of depressive symptoms, more hallucinations, had more suicide attempts, and were more likely to be referred for long-term inpatient treatment. Compared with the non-sexually victimized patients, the abused group also showed trends toward more conduct symptoms and more often required neuroleptic medication and longer hospital stays for acute management. The authors emphasize the importance of eliciting a history of sexual abuse from disturbed adolescents in an inpatient unit, especially when severe depressive symptoms are noted.

Journal of Child Psychology and PsychiatryVolume 28, Issue 3 p. 361-364 CHILDREN IN DIVORCE, CUSTODY AND ACCESS SITUATIONS: AN UPDATE Stuart Fine, Corresponding Author Stuart Fine University of British Columbia and Vancouver General Hospital, CanadaRequests for reprints to: Fine, Child Psychiatry clinic, Vancouver General Hospital, Vancouver BC, Canada VS21M90.Search for more papers by this author Stuart Fine, Corresponding Author Stuart Fine University of British Columbia and Vancouver General Hospital, CanadaRequests for reprints to: Fine, Child Psychiatry clinic, Vancouver General Hospital, Vancouver BC, Canada VS21M90.Search for more papers by this author First published: May 1987 https://doi.org/10.1111/j.1469-7610.1987.tb01757.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References Bilge, B. & Kaufman, G. (1983). Children of divorce and one-parent families: cross-culture perspectives. Family Relations, 32, 59–71. Bloom, B. L., Hodges, W. F., Kern, M. B. & McFaddin, S. C. (1985). A preventive intervention program for the newly separated-final evaluations. American Journal of Orthopsychiatry, 55, 9–26. Donovan, C. F. (1984). Life changes-divorce. British Medical Journal, 289, 597–600. Hetherington, E. M. (1979). Divorce-a child's perspective. American Psychology, 34, 851–858. Hetherington, E. M., Cox, M. & Cox, R. (1985). Long term effects of divorce and remarriage on the adjustment of children. Journal of the American Academy of Child Psychiatry, 24, 518–530. Hetherington, E. M., Cox, M. & Cox, R. (1979). Family intervention and the social emotional and cognitive development of children following divorce. In L. Vaughn & T. B. Brazelton, (Eds), The family setting priorities (pp. 89–128). New York : Science & Medical. Huntington, D. S. (1985). Theory & method: the use of psychological tests in research on divorce. Journal of the American Academy of Child Psychiatry, 24, 583–589. Kalter, N., Pickar, J. & Lesowitz, M. (1984). School-based development facilitation groups for children of divorce: a preventative intervention. American Journal of Orthopsychiatry, 54, 613–623. Kalter, N., Riemes, B., Brickman, A. & Chen, J. W. (1985). Implications of parental divorce for female development. Journal of the American Academy of Child Psychiatry, 24, 538–544. Kalter, N. (1977). Children of divorce in an outpatient psychiatric population. American Journal of Orthospsychiatry, 47, 40–51. Kanoy, K. W. & Cunningham, J. L. (1984). Consensus or confusion in research on children and divorce-conceptual and methodological issues. Journal of Divorce, 7(4), 45–71. L. A. Kurdeck, (Ed.) (1983). Children and divorce (pp. 83–87. San Francisco : Jossey-Bass. Santrock, W. J. & Warshak, R. A. (1979). Father custody and social development in boys and girls. Journal of Social Issues, 35, 112–125. Shamsie, J. (1985). Family breakdown and its effects on emotional disorders in children. Canadian Journal of Psychiatry, 30, 281–287. Steinman, S. (1981). The experience of children in a joint custody arrangement: a report of a study. American Journal of Orthopsychiatry, 51, 403–414. Steinman, S. B., Zemmelman, S. E. & Knoblauch, T. M. (1985). A study of parents who sought joint custody following divorce: who reaches agreement and sustains joint custody and who returns to court. Journal of the American Academy of Child Psychiatry, 24, 554–562. Stolberg, A. L. & Garrison, K. M. (1985). Evaluating a primary prevention program for children of divorce. American Journal of Community Psychology, 13, 111–124. Wallerstein, J. (1985a). Children of divorce-emerging trends. Psychiatric Clinics of North America, 8, 837–855. Wallerstein, J. (1985b) Children of divorce: preliminary report of a ten year follow-up of older children and adolescents. Journal of the American Academy of Child Psychiatry, 24, 545–553. Wallerstein, J. & Kelly, J. (1980). Surviving the breakup-how children and parents cope with divorce. New York : Basic Books. Waters, B. & Dimock, J. (1983). A review of research relevant to custody and access disputes. Australia and New Zealand Journal of Psychiatry, 17, 181–189. Zill, N. (1984). Happy, healthy and insecure. New York : Doubleday. Citing Literature Volume28, Issue3May 1987Pages 361-364 ReferencesRelatedInformation

Of 60 children and adolescents referred for assessment of depression, 11 cases were found which met diagnostic criteria for both conduct disorder and affective disorder. These 11 subjects could not be distinguished from those with major depression on the basis of psychiatric ratings of depressive symptoms—both diagnostic groups were characterized by multiple depressive symptoms of high severity. Psychiatric ratings also indicated that depressive symptoms were more severe in cases of conduct disorder with depression than in cases of dysthymic disorder. Child and adolescent self-reports of depression were consistent with this pattern of results.

The correspondence between child- and parent-reports of the child's depression was evaluated in a group of 60 children (ages 8–17 years) referred for psychiatric evaluation of depression. Children completed two self-report measures of depression, the Children's Depression Scale and the Children's Depression Inventory. In a separate interview parents completed a self-report scale evaluating depression in their child. Results indicated that children who met DSM-III criteria for major depression reported significantly more severe depressive symptoms than children who received other psychiatric diagnoses. In contrast, parent-reports of depression in their children failed to discriminate between children receiving different psychiatric diagnoses. While parents' ratings of depression in themselves was not related to their child's self-reports of depression, parents' ratings of their own depression correlated significantly with their perceptions of depression in their children. Results suggest that children and adolescents are capable of providing valid self-reports of depressive symptoms. Factors which may influence parent-reports are discussed.

From 60 patients referred for assessment of their depressive symptomatology, 13 were found to suffer from major affective disorder and 14 from dysthymic disorder. The results from self-rating scales (the Children's Depression Inventory and the Children's Depression Scale) were compared with the findings from diagnostic interviews (using DSM-III criteria). The large proportion of dysthymic disorders in this sample is compared to the low reported figure in most other samples and some comments about the possible usefulness of this diagnosis are made.

The relation between cognitive distortion and depression, found in adult affective disorders, has not previously been demonstrated in childhood affective disorders. Therefore, a Cognitive Bias Questionnaire for Children (CBQC) was developed to examine this relation in a sample of 39 psychiatrically disturbed children and adolescents. The depressed-distorted (DD) scale from the CBQC was significantly correlated with psychiatric and self-reported ratings of depression and could significantly discriminate affective from non-affective disorders. These results are discussed in terms of their limitations and in terms of other evidence suggesting that child, adolescent, and adult depressives share similar cognitive attributes.

The authors describe a pilot study on depressed children and adolescents, where the DSM-III diagnosis on clinical interviews is compared to the results from two self-rating scales on 35 children and adolescents referred to the researchers. These 35 subjects were seen as depressed by their primary helpers. The value of the self-rating scales is mentioned and the usefulness of the category “dysthymic disorder” is commented upon.

Teachers are affected by their own training and life experience. Some specific biases are: therapeutic preferences and attitudes to what is normal or abnormal behaviour. It is argued that teachers should be aware of their own biases and that they should know about their trainees’ life experiences and biases too. Some of the problems as to how child psychiatric trainees practise are emphasized and suggestions are made as to how these may be remedied.

Journal of Child Psychology and PsychiatryVolume 21, Issue 4 p. 353-361 CHILDREN IN DIVORCE, CUSTODY AND ACCESS SITUATIONS: THE CONTRIBUTION OF THE MENTAL HEALTH PROFESSIONAL Stuart Fine, Corresponding Author Stuart Fine*Requests for reprints to: Division of Child Psychiatry, Department of Psychiatry, University of British Columbia, 717 West 10th Avenue, Vancouver, B.C., Canada, V5Z 1L6.Search for more papers by this author Stuart Fine, Corresponding Author Stuart Fine*Requests for reprints to: Division of Child Psychiatry, Department of Psychiatry, University of British Columbia, 717 West 10th Avenue, Vancouver, B.C., Canada, V5Z 1L6.Search for more papers by this author First published: October 1980 https://doi.org/10.1111/j.1469-7610.1980.tb00039.xCitations: 11AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume21, Issue4October 1980Pages 353-361 RelatedInformation

ECURRENT R PAINS IN THE ABDOMEN, head and limbs, dizziness, fatigue and skin problems are common in adolescents and in many cases social stresses or intrafamilial pathology can be found to be a precipitating or a perpetuating factor. The prevalence of these functional complaints is hard to assess, as different clinics have different definitions of the presenting complaints and the final diagnosis. However, in one ambulatory care clinic for adolescents, 29% presented with functional complaints. In some of these, gross psychosocial reasons for disease were apparent.’ In a Danish study of 2000 children aged 619 yr, 14.4% suffered from recurrent abdominal pains and 20.6% from recurrent headaches over an 8 yr period. The abdominal pain reached a peak incidence at the age of 9 yr and the headaches at the age of 12 yr. The theories to elucidate the psychosocial factors causing somatic pain include the idea that imitation of parent’s complaints occurs. Also, there is frequently spasm of voluntary or involuntary muscle which may well cause pain. Anxiety can cause increased head muscle spasm, and intestinal spasms have been shown in children with recurrent abdominal pain. External stresses, internal stresses, and conflicts can all cause emotions such as anxiety or anger which can then manifest as somatic symptoms. The choice of the site of symptom may depend upon whether previous pathology has occurred in that area. Children tend to describe the somatic feelings of certain emotions as occurring in certain parts of the body.” Figure I may help to clarify these ideas. The adolescent may suffer because he has not managed to master some of the tasks with which his peers are struggling. Some of these tasks include establishing a new relationship with parents and authority figures, maintaining old and cstablishing new peer relationships, establishing a sexual identity, making some decisions about what he or she is going to do after leaving school and changing values especially in regard to what is meant by achievement and adjustment in society. If the adolescent has sufficient anxiety about several or one of these tasks somatic symptoms may occur. Some adolescents seem to be particularly aware of somatic sensations and they are concerned about changes in their body shape. They may be more than usually aware of the beating of their hearts, the noise of blood going through the arteries when their head is on the pillow, the presence of vitreous opacities in the eyes, the ease with which blushing occurs and the presence of any physical blemish like a pimple or a scar. Some individuals who complain of recurrent pains either in the

Family therapy and behavior therapy approaches to childhood obsessive-compulsive neurosis in two cases are described. One added feature is that the families seemed to obtain mutual support when they were interviewed together.