Multifamily Therapy for Adolescents With School Refusal: Perspectives of the Adolescents and Their Parents

Introduction: School refusal is an important public health concern in adolescent psychiatry increasing over the past several years (5% of child and adolescent psychiatry consultations in France). Multifamily therapy has developed over 30 years. Its efficacy is validated in adult, child and adolescent psychiatry, including for children at risk of school exclusion. In this study, we aimed to explore the adolescents and their parent's experience of a multifamily therapy treatment of school refusal with a qualitative method.Materials and Methods: This qualitative study is based on an Interpretative Phenomenological Analysis approach. We conducted 15 semi-structured interviews, participants were adolescents (n = 6) and their parents (n = 9) who experienced multifamily therapy in an adolescent department in Paris. Data analysis was performed independently by two researchers.Results: For the six families, school was a source of suffering, system paralysis and social exclusion. Families reported painful emotions and separation anxiety. For teenagers, multifamily therapy increased self-confidence and allowed group experience. For parents, it gave support and relieved from feelings of stigmatization and guilt. Parents became more aware of their adolescent's suffering and their insight. They all considered that multifamily therapy improved intra-family communication and expression of emotion. Participants highlighted the benefits of intergenerational interactions, activities, group and guidance from therapists.Discussion: Multifamily therapy uses therapeutic tools from both family therapy (joining, resonance, family competence, and metacommunication) and group therapy (use of media, identity device, and mirror reactions). Parents expect school solutions from multifamily therapy and question how psychiatric treatment can deal with school, school refusal being therefore understood as a social functioning disorder.

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The Child and Adolescent Psychiatric Assessment (CAPA)

Psychological Medicine ◽

10.1017/s003329170003498x ◽

1995 ◽

Vol 25 (4) ◽

pp. 739-753 ◽

Cited By ~ 349

Author(s):

A. Angold ◽

M. Prendergast ◽

A. Cox ◽

R. Harrington ◽

E. Simonoff ◽

...

Keyword(s):

Psychiatric Disorder ◽

Adolescent Psychiatry ◽

Psychiatric Patients ◽

Diagnostic System ◽

Child And Adolescent ◽

Child And Adolescent Psychiatry ◽

Diagnostic Interview ◽

Structured Interviews ◽

Psychiatric Assessment ◽

Definition Of

SYNOPSISGreat advances have been made during the last 20 years in the development of structured and semi-structured interviews for use with psychiatric patients. However, in the field of child and adolescent psychiatry there have been weaknesses in the specification and definition of both symptoms and the psychosocial impairments resulting from psychiatric disorder. Furthermore, most of the available interviews for use with children have been tied to a single diagnostic system (DSM-III, DSM-III-R, or ICD-9). This has meant that symptom coverage has been limited and nosological comparisons have been inhibited. The Child and Adolescent Psychiatric Assessment (CAPA) represents an attempt to remedy some of these shortcomings. This paper outlines the principles adopted in the CAPA to improve the standardization, reliability and meaningfulness of symptom and diagnostic ratings. The CAPA is an interviewer-based diagnostic interview with versions for use with children and their parents, focused on symptoms occurring during the preceding 3 month period, adapted for assessments in both clinical and epidemiological research.

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Child and Adolescent Psychiatry

Oxford Assess and Progress: Psychiatry ◽

10.1093/oso/9780199665662.003.0018 ◽

2014 ◽

Author(s):

Louise Morganstein ◽

Jonathan Hill

Keyword(s):

Young People ◽

Adolescent Psychiatry ◽

Separation Anxiety ◽

Age Groups ◽

Child And Adolescent ◽

Child And Adolescent Psychiatry ◽

Emotional Wellbeing ◽

Children And Young People ◽

Therapeutic Modalities ◽

Adult Psychiatry

Child and adolescent psychiatry is the medical specialty that works with children, young people, and families with emotional and behavioural problems. As children and young people are still developing and growing, their emotional wellbeing and functioning needs to be thought about in this context, making it different from adult psychiatry. Communication with people of all ages is vital within the specialty and information from a wide variety of sources, including parents or carers, school, and peers, is used to inform the clinical picture, in addition to history-taking and direct observations of the child’s behaviour. Play is often used to understand younger children’s thoughts and feelings. In theory, the specialty covers children and young people from birth up to the teenage years, although different services cover slightly different age ranges. The spectrum of difficulties covered within the specialty include psychiatric disorders also seen in adults (such as psychosis); problems specific to the age group (such as separation anxiety); lifelong conditions which start in childhood (such as ADHD); and conditions that may present in different ways in childhood or adolescence (such as phobias). Approaches to treatment include psychopharmacological interventions, and numerous therapeutic modalities including family therapy and CBT, which can be modified for different age groups. Most work is community based, although there are specialist inpatient units which offer on-going educational opportunities to young people who need the intensive support and risk reduction of a hospital admission. Work tends to be done within MDTs using a range of knowledge and expertise to offer the most appropriate care.

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Pathological Internet Use—An Important Comorbidity in Child and Adolescent Psychiatry: Prevalence and Correlation Patterns in a Naturalistic Sample of Adolescent Inpatients

BioMed Research International ◽

10.1155/2018/1629147 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Martin Fuchs ◽

David Riedl ◽

Astrid Bock ◽

Gerhard Rumpold ◽

Kathrin Sevecke

Keyword(s):

Young People ◽

Adolescent Psychiatry ◽

Internet Use ◽

Psychiatric Treatment ◽

Child And Adolescent ◽

Child And Adolescent Psychiatry ◽

Problematic Internet Use ◽

Control Group ◽

Pathological Internet Use ◽

School Sample

Background. Few studies have examined the prevalence of problematic internet use (PIU) in young people undergoing inpatient treatment in child and adolescent psychiatry centers. The aims of our study were thus (a) to assess the frequency of comorbid PIU in a sample of adolescent psychiatric inpatients and compare it with a control group of nonreferred adolescents and (b) to gain insights into correlations between PIU and psychiatric comorbidities. Methods. 111 child and adolescent psychiatry inpatients (CAP-IP, mean age 15.1±1.4 years; female : male 72.4% : 27.6%) undergoing routine psychodiagnostics were screened for the presence of PIU. The widely used Compulsive Internet Use Scale (CIUS) was chosen for this purpose. Prevalence rates of PIU were then compared to matched nonreferred control subjects from a school sample. Additionally, comorbidities of inpatients with PIU were compared to inpatients without PIU. Results. Our inpatient sample showed a much higher prevalence of PIU than that found in previous populational samples of young people. Compared with a matched school sample, addictive internet use was 7.8 times higher and problematic internet use 3.3 times higher among our adolescent sample. PIU was significantly associated with characteristic patterns of psychopathology, that is, suicidality, difficulties in establishing stable and consolidated identity, and peer victimization. Conclusion. PIU among adolescents undergoing inpatient psychiatric treatment is much more frequent than among their peers in the general population and is associated with specific patterns of psychopathology.

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Absence from School and Mental Health

The British Journal of Psychiatry ◽

10.1192/bjp.161.2.154 ◽

1992 ◽

Vol 161 (2) ◽

pp. 154-166 ◽

Cited By ~ 66

Author(s):

Ian Berg

Keyword(s):

Mental Health ◽

Adolescent Psychiatry ◽

School Attendance ◽

Child And Adolescent ◽

Child And Adolescent Psychiatry ◽

Physical Illness ◽

Present Knowledge ◽

School Refusal ◽

Social Impairment ◽

Causative Factors

Severe school attendance problems, which once commanded a great deal of attention in child and adolescent psychiatry, have fallen from favour and are increasingly viewed as varieties of social impairment which may accompany disorders such as anxiety disturbances in the case of school refusal and conduct disturbances in the case of truancy. It is argued that this relegation of school attendance difficulties may have gone too far. As presenting complaints, albeit sometimes masked by apparent physical illness, they still have much to recommend them as indicators of a wide variety of present and future problems: educational, social, family, legal, medical, and, last but not least, psychiatric. Prevalence, features, causative factors, outcome, and management are discussed. Particular attention is paid to DSM and ICD classification. Gaps in present knowledge are indicated.

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