Search

The recent death of our colleague and friend Professor Sir Michael Rutter has quite rightly been greeted by an outpouring of gratitude and respect from distinguished commentators across the globe working in diverse fields of the basic, social and clinical sciences as well as from clinicians and policy makers. These have without exception highlighted his seminal role as a pioneer, perhaps The Pioneer, of the application of the scientific method to the study of child and adolescent mental health and disorder – the father of evidence‐based Child Psychiatry and the most influential voice in the new field of Developmental Psychopathology (Stevenson, 2022). In this editorial, we will attempt to build on these commentaries. We will parse Mike's scientific contributions to our field, in order to identify the personal characteristics and intellectual modus operandi that made him such a uniquely important figure, whose influence will resonate through the many fields he influenced for decades to come. We will also attempt something of a reframing of that contribution. Our thesis being that, although he never agitated for it politically or even stated it as a goal explicitly, Mike's work was motivated by a desire for social reform and created the scientific catalyst for such reform to occur. [ABSTRACT FROM AUTHOR]

Background: Behavioural problems are common in early childhood, and can result in enduring costs to the individual and society, including an increased risk of mental and physical illness, criminality, educational failure and drug and alcohol misuse. Most previous research has examined the impact of interventions targeting older children when difficulties are more established and harder to change, and have rarely included fathers. We are conducting a trial of a psychological intervention delivered to families with very young children, engaging both parents where possible.Methods: This study is a two-arm, parallel group, researcher-blind, randomized controlled trial, to test the clinical effectiveness and cost-effectiveness of a parenting intervention, Video Feedback Intervention to Promote Positive Parenting and Sensitive Discipline (VIPP-SD) for parents of young children (12-36 months) at risk of behavioural difficulties. VIPP-SD is an evidence-based parenting intervention developed at Leiden University in the Netherlands which uses a video-feedback approach to support parents, particularly by enhancing parental sensitivity and sensitive discipline in caring for children. The trial will involve 300 families, who will be randomly allocated into either an intervention group, who will receive the video-feedback intervention (n = 150), or a control group, who will receive treatment as usual (n = 150). The trial will evaluate whether VIPP-SD, compared to treatment as usual, leads to lower levels of behavioural problems in young children who are at high risk of developing these difficulties. Assessments will be conducted at baseline, and 5 and 24 months post-randomization. The primary outcome measure is a modified version of the Preschool Parental Account of Child Symptoms (Pre-PACS), a structured clinical interview of behavioural symptoms. Secondary outcomes include caregiver-reported behavioural difficulties, parenting behaviours, parental sensitivity, parental mood and anxiety and parental relationship adjustment. An economic evaluation will also be carried out to assess the cost-effectiveness of the intervention compared to treatment as usual.Discussion: If shown to be effective, the intervention could be delivered widely to parents and caregivers of young children at risk of behavioural problems as part of community based services.Trial Registration: ISRCTN Registry: ISRCTN58327365 . Registered 19 March 2015. [ABSTRACT FROM AUTHOR]

The article by Ng and Weisz () on how to build a science of personalized intervention for youth mental health is ambitious and wide-ranging, being packed with penetrating analyses and imaginative proposals that set the agenda for psychotherapeutic research for years to come. It is driven by the desire to make therapy more effective, and underpinned by the notion that if therapy can be fitted more closely to individual characteristics, results will be better. [ABSTRACT FROM AUTHOR]

Background: The concept of differential susceptibility has challenged the potential meaning of personal traits such as poor ability to regulate emotions. Under the traditional model of diathesis/stress, personal characteristics such as liability to angry outbursts are seen as essentially disadvantageous, emerging under duress in a way that is maladaptive. In contrast, with differential susceptibility, there is the same poorer functioning under adverse conditions but, under favorable conditions, individuals with the trait function better than those without it. To date, there have been limited studies on response under positive environments. We used the experimental power of an intervention trial to test the differential susceptibility hypothesis that children with emotional dysregulation would show greater response to an experimentally induced improvement in their parenting environment. Methods: Data were from the SPOKES trial (ISRCTN 77566446), a randomized controlled trial of 112 school children who were 5-6-years old, screened for elevated levels of oppositionality, randomized to parenting groups or control; 109 (97%) were followed-up a year later. Using DSM-IV oppositional-defiant symptoms, children were divided into an Emotionally-Dysregulated type (ED, n = 68) and a Headstrong type ( n = 44). The parenting intervention was the Incredible Years program supplemented by positive strategies to use when reading with children. Assessment of conduct problems and parenting was by semistructured interviews. Results: At follow-up, parents of Emotionally-Dysregulated and Headstrong children allocated to the intervention showed significant improvements in their parenting strategies to an equal extent compared to parents in the control group. However, the Emotionally-Dysregulated children showed a significantly greater decrease in conduct problems between intervention and control groups (treatment effect-size 0.84 standard deviations) than the Headstrong (es 0.20 SD), p = 0.04. Conclusions: Using the power of a controlled experiment, this study showed that children who exhibited Emotionally-Dysregulated behavior pretreatment were more responsive to improvements in parental care that were experimentally induced. The findings extend prior work on differential sensitivity in suggesting that children exhibiting irascibility and emotionality may show greater susceptibility to the caregiving environment, and may identify a subset of children who respond better to existing treatments. [ABSTRACT FROM AUTHOR]

Background: There is an urgent need for effective, affordable interventions to prevent child mental health problems in low- and middle-income countries.Aims: To determine the effects of a universal pre-school-based intervention on child conduct problems and social skills at school and at home.Method: In a cluster randomised design, 24 community pre-schools in inner-city areas of Kingston, Jamaica, were randomly assigned to receive the Incredible Years Teacher Training intervention (n = 12) or to a control group (n = 12). Three children from each class with the highest levels of teacher-reported conduct problems were selected for evaluation, giving 225 children aged 3-6 years. The primary outcome was observed child behaviour at school. Secondary outcomes were child behaviour by parent and teacher report, child attendance and parents' attitude to school. The study is registered as ISRCTN35476268.Results: Children in intervention schools showed significantly reduced conduct problems (effect size (ES) = 0.42) and increased friendship skills (ES = 0.74) through observation, significant reductions to teacher-reported (ES = 0.47) and parent-reported (ES = 0.22) behaviour difficulties and increases in teacher-reported social skills (ES = 0.59) and child attendance (ES = 0.30). Benefits to parents' attitude to school were not significant.Conclusions: A low-cost, school-based intervention in a middle-income country substantially reduces child conduct problems and increases child social skills at home and at school. [ABSTRACT FROM AUTHOR]

Behaviour problems and poor literacy levels are each independently associated with a lower quality of life in childhood, and carry forward to predict much poorer outcomes in adulthood. Longitudinal surveys show that the dimensions of parenting that influence child behaviour and child literacy differ. The aspects of parenting that promote good behaviour concern the quality of the relationship, for example giving warmth and encouragement while calmly enforcing clear limits. In contrast, the aspects that promote literacy are regular reading with the child in a manner that is sensitive to their ability level. To help children with difficulties, there are many evidence-based parenting programmes to improve parent–child relationship quality, but very few address literacy. This paper reviews evidence on these issues, illustrated by our own previous preventive trials that combined a parenting programme addressing relationships (Incredible Years; IY) with a new parenting programme addressing literacy (Supporting Parents on Kids Education; SPOKES). Because this combination improved both child behaviour and literacy, a new randomized controlled trial called Helping Children Achieve is underway to disentangle the mode of action of each component by comparing the effects of: (1) a relationship programme alone (IY); with (2) a literacy programme alone (SPOKES); (3) both combined; and (4) an information helpline (control group). The results are not yet known but should answer whether programmes that target relationships also improve child literacy, and whether programmes that target literacy also improve behaviour. The findings will inform strategies to reduce social inequality and help young children achieve their potential. [ABSTRACT FROM PUBLISHER]

Improving the parent–child relationship by using strategies based on social learning theory has become the cornerstone for the treatment of conduct problems in children. Over the past 40 years, interventions have expanded greatly from small, experimental procedures to substantial, systematic programmes that provide clear guidelines in detailed manuals on how practitioners should implement the standardised treatments. They are now widely disseminated and there is a great deal of empirical support that they are very effective for the majority of cases. However, evaluations of even the best of these evidence-based programmes show that a quarter to a third of families and their children do not benefit. What does the practitioner then do, when a standard social learning approach, diligently applied, doesn’t work? We argue that under these circumstances, some of the major theories of child development, family functioning and individual psychology can help the skilled practitioner think his or her way through complex clinical situations. This paper describes a set of practical strategies that can then be flexibly applied, based on a systematic theoretical analysis. We hold that social learning theory remains the core of effective parent training interventions, but that ideas from attachment theory, structural family systems theory, cognitive-attribution theory, and shared empowerment/motivational interviewing can each, according to the nature of the difficulty, greatly enrich the practitioner’s ability to help bring about change in families who are stuck. We summarise each of these models and present practical examples of when and how they may help the clinician plan treatment. [ABSTRACT FROM AUTHOR]

Background: Persistent antisocial behaviour is the most common mental health problem in childhood and has widespread effects, yet little is known about what it costs.Aims: To identify the costs incurred by children with antisocial behaviour in the UK, and who pays these costs.Method: Eighty children aged 3-8 years referred to mental health services were studied using the Client Service Receipt Inventory for Childhood.Results: The mean annual total cost was pound 5960 (median 4597, range 48-19 940). The services used were mainly the National Health Service, education and voluntary agencies, but the greatest cost burden, pound 4637, was borne by the family. Higher cost was predicted by more severe behaviour and being male.Conclusions: The annual cost of severe antisocial behaviour in childhood in the UK is substantial and widespread, involving several agencies, but the burden falls most heavily on the family. Wider uptake of evidence-based interventions is likely to lead to considerable economic benefits in the short term, and probably even more in the long term. [ABSTRACT FROM AUTHOR]

Features books and videotapes about child psychology and psychiatry. 'Video: HoNOSCA: Health of the Nation Outcome Scales for Children and Adolescents. Video Workshop'; 'Teaching With Confidence: A Guide to Enhancing Teacher Self-esteem,' by D. Lawrence; 'The Welfare of the Child. The Principle of the Law,' by K. O'Halloran.

Although living standards have increased in the past 40 years, children's behaviour problems have become worse. Good parenting can help by maximising children's potential and promoting resilience. Effective programmes are available that improve parenting, but unfortunately ineffective approaches are still used widely. A new National Academy for Parenting Practitioners has been set up in England, which offers free training in evidence-based interventions and conducts research to increase their effectiveness. [ABSTRACT FROM AUTHOR]

The previous number of Child and Adolescent Mental Health (vol. 7, no. 1, p. 3) reported the quantitative results of the 2001 survey of 182 readers of this journal (under its former name, Child Psychology and Psychiatry Review). This showed that our journal was the one most widely read by respondents and that, by and large, they found most sections interesting and relevant. The results were pleasing for the Association and all the staff who labour hard to produce CAMH. However, to improve further we need to be sensitive to what readers say — in current terminology, to respond to the opinions of our users. Here we report in a more qualitative fashion your freely expressed opinions and ideas. [ABSTRACT FROM AUTHOR]

Provides information on books relevant to child psychology. 'Attention Deficit Hyperactivity Disorder,' by G.D. Kewley; 'In the Long Run...Longitudinal Studies of Psychopathology in Children'; 'Marriage, Divorce and Children's Adjustment,' second edition, in the Development Clinical Psychology and Psychiatry Series, volume 14.

Editorial. Discusses changes in the journal `Child and Adolescent Mental Health'. Author's resignation as editor of the journal; Changes in the journal during the author's term; Challenges faced by the journal's editors.

Introduces a series of articles on the psychological aspects of children's play. Importance of play in a clinical therapeutic relationship; Anthropological perspective on play.

The article presents a study which investigates the effects of Callous-unemotional (CU) personality traits on the mental health of children and adolescents. In this study, parents were interviewed to determine the presence of CU traits in a sample of British children and adolescents and were asked to complete a questionnaire to measure children's psychopathology. Results reveal that CU traits were associated with conduct and emotional problems among children and adolescents.