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This research aimed to explore how clinical psychologists respond to child safeguarding dilemmas, with special attention to the role of psychology in child welfare. Transcripts from 20 semi‐structured interviews with clinical psychologists working in Child and Adolescent Mental Health Services in England were analysed using a qualitative framework approach. In these interviews, two family case vignettes were used to examine how psychologists respond to child safeguarding dilemmas. We identified three overarching themes: operating within a system of stretched resources; characterising who is considered 'supportable' by psychological services; and challenges around conceptualising and responding to risk. Clinical psychologists viewed social services as responsible for family cases with safeguarding concerns and were reluctant to engage in high‐risk cases where stability in the home was not yet established. They saw their role in child welfare primarily as sense‐makers for families, by offering a contextualised explanation/formulation for the presenting difficulties. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorders (ASDs), attention deficit hyperactivity disorder (ADHD) and disinhibited and reactive attachment disorders (RAD/DAD) often experience socioemotional problems. Elucidating a clear picture of these profiles is essential. Strengths and Difficulties Questionnaires (SDQs) were analysed from cohort of children with ASD (n = 1430), ADHD (n = 1193), and RAD/DAD (n = 39). Kruskal–Wallis Tests and network analytic techniques were used to investigate symptom profiles. Children with ASD experienced more emotional problems, peer problems and fewer prosocial behaviours. Children with ADHD and RAD/DAD had higher levels of hyperactivity and conduct problems. Overall, ASD and ADHD networks were highly correlated (rs = 0.82), and we did not observe a statistically significant difference in terms of global Strength. [ABSTRACT FROM AUTHOR]

Clinical judgement is a crucial part of autism and attention deficit hyperactivity disorder (ADHD) assessments. This study aims to harness insights from psychology and sociology to explore clinical perspectives and assessment practices of autism and attention deficit hyperactivity disorder. Qualitative interviews were conducted with health care professionals (n = 17). Interviews were conducted between January and May 2019. Data were analysed using a thematic approach. Themes were sorted into two interrelated categories (1) approaches to diagnosis (2) elements of diagnosis. Approaches to diagnosis were comprised of the following subthemes: nature of diagnosis, application of diagnosis: natural and pragmatic, revisiting conceptualisations: sub-optimal practice & unhelpful diagnoses, autism and attention deficit hyperactivity disorder. Elements of diagnosis contained three related subthemes: contextualising standardised assessments, triangulating material, organisational factors. There is sometimes a pragmatic as well as nosological dimension to diagnosis. Competing desires for consistency and utility add further complexity to neurodevelopmental assessment. Autism and attention deficit hyperactivity disorder are common behaviourally diagnosed conditions. One of the key aspects of diagnosis is clinical judgement. Yet despite decades of research, it is only in recent times that researchers have started exploring clinicians' perspectives on diagnosing these conditions. We aimed to add to this body of knowledge by conducting interviews with 17 experienced health care professionals in the United Kingdom to hear their perspectives on diagnosing autism and attention deficit hyperactivity disorder. Clinicians reflected that for some children and young people, diagnosis is reasonably straightforward; however, in other situations, decisions are made on more pragmatic grounds (i.e. will this be helpful). We identified some differences of opinion between professionals and organisation which adds to the complexity of applying a diagnosis. We recommend several areas for future research and point to some practical and philosophical implications of the work. [ABSTRACT FROM AUTHOR]

Within the United Kingdom, domestic violence and abuse (DVA) is the most commonly identified factor within child in need assessments, with rates increasing in recent years in addition to 'lockdown'‐related spikes. This article examines the representation of DVA in local child safeguarding policies using Bacchi's (2009) 'What is the problem represented to be?' approach. Policies were collected from the websites of all the child safeguarding partnerships of England in July 2021. In total, we identified 59 policies. These policies are designed to guide local responses to DVA across services and thus have potential for substantial impact on practice across health and social care. Our results suggest that local DVA policy in England exists within a conceptual framework which spotlights the individual and lacks attention to their context. We argue that these policies focus on adults, neglecting attention to children within their own safeguarding policies. This is through children being peripheralized within the conceptualisation of 'victim' and the assessed adult risk being used as a proxy measure for the risk to child. Demographic discussions build an image of DVA as an issue that can affect anyone, but with little acknowledgement of the vulnerabilities facing proportions of the population and their complexities – when such vulnerabilities are discussed, they are individualised and viewed in absence of their societal causes, potentially eclipsing critical elements of a child's experience of DVA. The implications of our results are wide‐ranging but suggest a need to refocus on children and their context within local DVA policy. [ABSTRACT FROM AUTHOR]

Background: Staff member's views and attitudes can have a significant impact on people with an intellectual disability. This study explores staff attitudes and experiences of people with an intellectual disability's expression of relationships and sexuality across service providers in Ireland. Methods: Staff (n = 86) from service providers (n = 5) completed the Attitudes to Sexuality Questionnaire‐Individuals with an Intellectual Disability (ASQ‐ID) and open‐ended questions. Results: Multidirectional significant differences were noted on staff attitudes to sexuality based on demographic factors, that is, age, education, as well as non‐demographics, for example, attendance at training, and active practising of religion. Qualitatively, three themes emerged: "Unsupported and Frustration"; "Taboo Subject Matter" and "Vulnerability and Access to Education". Staff reported a lack of service supports, dominant conservative cultures and people with an intellectual disability's vulnerability. Conclusion: This study highlights the need for improved service practices and enhanced provisions for staff and the people with an intellectual disability that they support. [ABSTRACT FROM AUTHOR]

Objectives: "Attachment difficulties" is an umbrella term often used to describe various forms of non-secure attachment. Differentiating "attachment difficulties" from autism spectrum disorder (hereafter autism) and attention deficit hyperactivity disorder (ADHD) has been characterized as challenging. Few studies have explored how this happens in practice, from the perspective of professionals. Design: Qualitative study. Methods: We conducted in-depth semi-structured interviews with (n = 17) healthcare professionals from five NHS Foundation Trusts in the United Kingdom. Participants were recruited using a combination of snowballing, convenience and purposive sampling. Data were analyzed using a thematic approach. Results: We identified six interrelated themes that might reflect difficulties with differential conceptualization. These include: a clinical lexicon of attachment; approaching attachment with caution; contextual factors; perceived characteristic behaviors; assessing attachment and adjacent supports; spotlighting intervention and dual conceptualization. Conclusion: Our results indicate some of the ways suspicions around attachment are raised in practice. We advocate for more dialogue between research and practice communities on issues of differential conceptualization. We call for collaboration between a panel of experts consisting of attachment and neurodevelopmental orientated practitioners and researchers, to clarify issues around differentiating between attachment difficulties, ASD, and ADHD. [ABSTRACT FROM AUTHOR]

Attachment concepts are used in diverging ways, which has caused confusion in communication among researchers, among practitioners, and between researchers and practitioners, and hinders their potential for collaboration. In this essay we explore how attachment concepts may vary in meaning across six different domains: popular discourses, developmental science, social psychological science, psychiatric diagnosis, psychotherapy, and child welfare practice. We attempt to typify these forms of attachment discourse by highlighting points of convergence, divergence, and relay between the different domains. Our general conclusions are that diversity in the use of attachment concepts across different domains of application has been largely unrecognised, and that recognition of these differences would reduce confusion, help identify sites where infrastructure needs to be developed to support coordination, and strengthen opportunities for collaboration to mutual benefit. We suggest that academic attachment discourse would benefit from clarification of core terminology, including: "attachment", "internal working model", "trauma", and "dysregulation". [ABSTRACT FROM AUTHOR]

Accessible summary: This paper is about how parents adjust to parenting their child who has a developmental disability.We spoke to parents about their experiences and developed a theory to help explain how parents adjust when their child has a developmental challenge.As well as describing the stress, that parents experience, this theory also captures the fulfilment and sense of purpose that parents experience as they parent their child.This research is important because it helps explain what happens for parents after their child's diagnosis and provides suggestions on how services can improve to help families. This paper describes a study exploring the parental response to the diagnosis of their child's developmental disability. A classic grounded theory methodology was used to analyse data comprising 19 interviews and 11 memoirs written by parents. The theory explains how parents adjust to champion their child, who has been identified as having a developmental challenge. At the heart of becoming a champion is a psychological process in which parents refine their perspectives on disability awareness, their aspirations and parenting capacity as they develop their championing skills. Refining perspectives and championing are influenced by two factors: the nature of the child's challenges and service factors. The theory of Confident Championing offers a multivariant model that explains the dynamic nature of the adjustment process, capturing both the stress and the fulfilment and sense of purpose that parents experience. [ABSTRACT FROM AUTHOR]

Many healthcare systems are organised such that General Practitioners (GPs) often have a key role in identifying autism spectrum disorders (hereafter collectively referred to as autism) in children. In this review, we explored what GPs know about autism and the factors that influence their ability to identify and manage care for their patients with autism in practice. We conducted a systematic narrative review using eight electronic databases. These included Embase and MEDLINE via Ovid, Web of Knowledge, PsycINFO via Ebscohost, PubMed, Scopus, ProQuest Dissertations and Thesis, and Applied Social Sciences Index and Abstracts (ASSIA) via ProQuest. Our search yielded 2,743 citations. Primary research studies were included, and we did not impose any geographical, language or date restrictions. We identified 17 studies that met our inclusion criteria. Studies included in the review were conducted between 2003 and 2019. We thematically synthesised the material and identified the following themes: the prototypical image of a child with autism; experience, sources of information, and managing care; barriers to identification; strategies to aid in identification; and characteristics that facilitate expertise. Together, the findings from this review present a mixed picture of GP knowledge and experiences in identifying autism and managing care for children with the condition. At one end of the continuum, there were GPs who had not heard of autism or endorsed outmoded aetiological theories. Others, however, demonstrated a sound knowledge of the conditions but had limited confidence in their ability to identify the condition. Many GPs and researchers alike called for more training and this might be effective. However, framing the problem as one of a lack of training risks silences the array of organisational factors that impact on a GP's ability to provide care for these patients. [ABSTRACT FROM AUTHOR]

Child maltreatment in the family context is a prevalent and pervasive phenomenon in many modern societies. The global perpetration of child abuse and neglect stands in stark contrast to its almost universal condemnation as exemplified in the United Nation's Convention on the Rights of the Child. Much work has been devoted to the task of prevention, yet a grand synthesis of the literature is missing. Focusing on two core elements of prevention, that is, antecedents for maltreatment and the effectiveness of (preventative) interventions, we performed an umbrella review of meta‐analyses published between January 1, 2014, and December 17, 2018. Meta‐analyses were systematically collected, assessed, and integrated following a uniform approach to allow their comparison across domains. From this analysis of thousands of studies including almost 1.5 million participants, the following risk factors were derived: parental experience of maltreatment in his or her own childhood (d =.47), low socioeconomic status of the family (d =.34), dependent and aggressive parental personality (d =.45), intimate partner violence (d =.41), and higher baseline autonomic nervous system activity (d =.24). The effect size for autonomic stress reactivity was not significant (d = −.10). The umbrella review of interventions to prevent or reduce child maltreatment showed modest intervention effectiveness (d =.23 for interventions targeting child abuse potential or families with self‐reported maltreatment and d =.27 for officially reported child maltreatment cases). Despite numerous studies on child maltreatment, some large gaps in our knowledge of antecedents exist. Neurobiological antecedents should receive more research investment. Differential susceptibility theory may shed more light on questions aimed at breaking the intergenerational transmission of maltreatment and on the modest (preventive) intervention effects. In combination with family‐based interaction‐focused interventions, large‐scale socioeconomic experiments such as cash transfer trials and experiments with vouchers to move to a lower‐poverty area might be tested to prevent or reduce child maltreatment. Prevalence, antecedents, and preventive interventions of prenatal maltreatment deserve continuing scientific, clinical, and policy attention. Read the Commentary on this article at doi: 10.1111/jcpp.13175 [ABSTRACT FROM AUTHOR]

Research related to parental satisfaction with early intensive behavioral intervention (EIBI) remains limited. A 35-item questionnaire called the parental satisfaction scale-EIBI (PSS-EIBI) was developed with four subdomains (child outcomes, family outcomes, quality of the model, and relationship with the team). Study 1 assessed levels of satisfaction for 48 parents with their child's EIBI program after approximately 1 year of intervention. Study 2 examined the relationship between parental satisfaction, length of child participation in EIBI, and the relationship between parental satisfaction and actual outcomes for their child as assessed by the Verbal Behavior Milestones Assessment and Placement Program after approximately 2 years. Results indicate that parental satisfaction with EIBI was consistently high in all four domains of the PSS-EIBI in both studies. Parental satisfaction was found to be associated with gains in child functioning after 1 year of intervention. [ABSTRACT FROM AUTHOR]

Background: Mental health disorders have a negative impact on the individual, society and global economy. The prevalence of mental disorders is increasing in young people, if unaddressed, they may develop into severe and chronic illnesses. Despite this, research into youth mental health recovery is limited. The current study aims to develop a theoretical framework of recovery in youth mental health and identify what facilitates this process. Methods: Fourteen parents of children engaged with the Child and Adolescent Mental Health Service were interviewed in relation to their understanding of youth mental health recovery. The transcripts of these interviews were analysed using the constructivist grounded theory approach. Results: A theoretical model of youth mental health was developed. The model provides an understanding of (a) the characteristics of youth mental health recovery, (b) the facilitators of recovery and (c) the barriers to recovery. The theory suggests that due to developmental factors youth mental health recovery occurs within the ecological context of complex social systems. Conclusions: The theory reflects elements of existing developmental and recovery research and provides a novel understanding of youth mental health recovery. This model may inform social, government and service attitudes and policy, and highlights areas for future research. [ABSTRACT FROM AUTHOR]

Background: A sense of disconnection for people who are suicidal seems to be a key construct of previous literature. Therapists’ ways of encountering and understanding people who are suicidal have not been previously researched in depth using qualitative methodologies. Aims: The current study aims to develop a theoretical framework for the role played by connectedness in relation to suicide based on the perspectives of psychotherapists working in the field of suicide intervention. Method: Psychotherapists (N = 12) from a suicide intervention service in Ireland were interviewed in relation to connectedness and suicide. The interviews were analysed using Constructivist Grounded Theory. A tentative theoretical model for connectedness in relation to suicide was developed. Results: Therapists view self-disconnect as at the core of suicidality and note that toxic relationships also play a critical role. Therapeutic connection can present as a life-saving paradox for people who are suicidal. Risk of death and therapeutic endeavour may present as challenging dynamics for working with people who are suicidal. Some discussion points include the worth of self-compassion development for people who are suicidal, the rephrasing of “psychotherapy” when trying to save someone’s life and the emphasis on relationship skills for all healthcare professionals who encounter people who are suicidal. Clinical or methodological significance of this article: This article is one of the first in which therapists are interviewed about their understandings of suicide and the processes of suicide in the therapeutic space. It offers novel insights about how people who are suicidal present in therapy and what may be contributing to this presentation. The research also gives insights on the struggles for therapists working with people who are suicidal and who may be ambiguous about the prospect of therapy and connecting. The study also offers important direction for future studies in relation to what requires further discussion and exploration regarding engaging in therapy with people who are suicidal. In addition, the current study can offer previously unexplored insights regarding suicide and therapy that may have the potential to assist in future intervention for people who are risk of killing themselves. [ABSTRACT FROM AUTHOR]

Current national policy in the Republic of Ireland advocates for the inclusion of students with learning difficulties in mainstream schools. With Asperger’s syndrome (AS) specifically, it is essential that teachers understand the syndrome and are well versed in appropriate approaches to effectively create an inclusive environment for these students in the mainstream classroom. This paper explores teacher knowledge and understanding of AS while also exploring what affects their confidence in educating students diagnosed with the syndrome. Data collection pre-dated changes to the DSM-V and as such AS is used throughout this paper. A survey was distributed nationally to a random sample of qualified post-primary school teachers. The findings revealed that teachers did not appear to possess an adequate level of knowledge and understanding in relation to the syndrome. Continued professional development programmes in the area appeared to have minimal effect, with those completing programmes scoring only marginally better than those who did not (2.85%). These findings are of concern if these teachers are then expected to foster an inclusive environment, particularly when a high proportion of teachers have previously taught a student diagnosed with the syndrome and their knowledge remains limited. [ABSTRACT FROM PUBLISHER]

Background: Aquatics is an under-researched but possibly appropriate form of activity for people with severe to profound intellectual disabilities (SPIDs).Aim: The current pilot study investigates the suitability of an aquatics programme for service users with SPIDs.Method: Four service users with SPID completed an 8-12-session aquatics programme. Front-line staff ( N = 6) were interviewed after the programme to explore its suitability. A thematic analysis of the interviews was utilized.Results: The thematic analysis unearthed main themes of effects, facilitators, barriers, strengths and needs.Conclusion: Aquatics can be an appropriate and beneficial form of physical activity for people with SPIDs, but there are many barriers to participation. Tailored programmes are required. Further investigation of the experiences of people with SPIDs in relation to physical activity is recommended. [ABSTRACT FROM AUTHOR]

Psychological distress as experienced by higher education students is of major concern because of its potential to adversely impact academic performance, retention, mental health and lifestyle. This paper reports a mixed method investigation of student self-reported psychological distress and help-seeking behaviour. The sample comprised all students (n = 1557) registered on undergraduate nursing/midwifery and teacher education programmes at an Irish university. Participants (n = 1112) completed the General Health Questionnaire (GHQ) to determine their self-reported psychological distress and the Lifestyle Behaviour Questionnaire to examine sources of distress, lifestyle and demographic variables. Individual interviews (n = 59) explored student experiences of psychological distress and their help-seeking behaviours. Forty two percent of respondents exceeded the GHQ threshold ≥5, which signifies risk of mental or physical health problems. Sources of distress included academic, financial and psychosocial stressors. Regression analysis identified that demographic, programmatic and lifestyle variables predicted GHQ scores. Despite the distress experienced, students were reluctant users of support services. Many actively avoided seeking help. These findings raise serious concerns about the extent of psychological distress among this population. They also alert education providers to be vigilant for student psychological distress and to provide effective interventions, cognisant of the impact of stigma on help seeking. [ABSTRACT FROM AUTHOR]

To help maintain the right of children with an intellectual disability to grow up in their family home, this study explored Romanian mothers' experiences of overcoming the many challenges to the provision of care to assure a high quality of life for their child. Studied were mothers' experiences upon being told by a professional that their child had a disability and of their experiences of caring for their children at home in the context of Romanian disability legislation and contact with local Disability Commissions. The data, obtained via an exploratory qualitative study, were based upon eight interviews with mothers of children with disabilities carried out with the assistance of a bilingual interpreter. Interviews were transcribed and analyzed using Interpretative Phenomenological Analysis. Two themes of 'uncertainty' and 'disempowering bureaucracy' were parsed from mothers' various experiences. Due to various sociocultural barriers and unclear communication, mothers experienced uncertainty surrounding the diagnosis of their child's condition. In light of this uncertainty and the ambivalent attitudes of professionals, mothers experienced disempowering bureaucracy while striving to meet the annual requirements of their local Disability Commission. The study revealed gaps in the disclosure process of an intellectual disability that lead to uncertainty among the mothers toward professionals. The disempowering bureaucracy connected to the local Disability Commission impeded mothers access to community support and contributed toward a lack of understanding of the needs of their child. [ABSTRACT FROM AUTHOR]

Poor diet, physical inactivity, tobacco smoking and alcohol consumption are major risk factors for chronic disease and premature mortality. These behaviours are of concern among higher education students and may be linked to psychological distress which is problematic particularly for students on programmes with practicum components such as nursing and teaching. Understanding how risk behaviours aggregate and relate to psychological distress and coping among this population is important for health promotion. This research examined, via a comprehensive survey undergraduate nursing/midwifery and teacher education students’ (n = 1557) lifestyle behaviour (Lifestyle Behaviour Questionnaire), self-reported psychological distress (General Health Questionnaire) and coping processes (Ways of Coping Questionnaire). The results showed that health- risk behaviours were common, including alcohol consumption (93.2%), unhealthy diet (26.3%), physical inactivity (26%), tobacco smoking (17%), cannabis use (11.6%) and high levels of stress (41.9%). Students tended to cluster into two groups: those with risk behaviours (n = 733) and those with positive health behaviours (n = 379). The group with risk behaviours had high psychological distress and used mostly passive coping strategies such as escape avoidance. The potential impact on student health and academic achievement is of concern and suggests the need for comprehensive health promotion programmes to tackle multiple behaviours. As these students are the nurses and teachers of the future, their risk behaviours, elevated psychological distress and poor coping also raise concerns regarding their roles as future health educators/promoters. Attention to promotion of health and well-being among this population is essential. [ABSTRACT FROM PUBLISHER]

Background: Psychological distress among higher education students is of global concern. Students on programmes with practicum components such as nursing and teacher education are exposed to additional stressors which may further increase their risk for psychological distress. The ways in which these students cope with distress has potential consequences for their health and academic performance. An in-depth understanding of how nursing/midwifery and teacher education students experience psychological distress and coping is necessary to enable higher education providers to adequately support these students. Methods: This mixed method study was employed to establish self-reported psychological distress (General Health Questionnaire), coping processes (Ways of Coping Questionnaire) and lifestyle behaviour (Lifestyle Behaviour Questionnaire) of a total sample (n = 1557) of undergraduate nursing/midwifery and teacher education students in one university in Ireland. Individual interviews (n = 59) provided an in-depth understanding of students experiences of psychological distress and coping. Results: A significant percentage (41.9%) of respondents was psychologically distressed. The factors which contributed to their distress, included study, financial, living and social pressures. Students used varied coping strategies including seeking social support, problem solving and escape avoidance. The positive relationship between elevated psychological distress and escape avoidance behaviours including substance use (alcohol, tobacco and cannabis) and unhealthy diet is of particular concern. Statistically significant relationships were identified between “escape-avoidance” and gender, age, marital status, place of residence, programme/year of study and lifestyle behaviours such as diet, substance use and physical inactivity. Conclusion: The paper adds to existing research by illuminating the psychological distress experienced by undergraduate nursing/midwifery and teacher education students. It also identifies their distress, maladaptive coping and the relationship to their lifestyle behaviours. The findings can inform strategies to minimise student distress and maladaptive coping during college and in future professional years. [ABSTRACT FROM AUTHOR]

This article presents the lived experience perspective of adult mental health (MH) service users of Irish origin receiving treatment from culturally diverse MH professionals. The current study applied Grounded Theory principles to explore the service users' experiences of MH service and being treated by ethnically diverse professionals within it. The aim of the research was to focus on the quality of the therapeutic process. The project is based on nine comprehensive interviews exploring the service users' experiences of their journey to recovery. Four core themes emerged: (1) treatment and recovery, (2) positive service attributes, (3) negative service attributes along with appreciation and (4) acceptance of cultural diversity. The subthemes of: positive, empowering therapeutic relationship with the service provider and trust in the expertise of the professional, regardless of the service provider's nationality, pervaded through other issues. Initial apprehension of cultural difference in relation to e.g. language was among the findings encountered. This and other results in relation to the service users' experience of cultural diversity among clinicians are discussed and suggestions for further research offered. [ABSTRACT FROM PUBLISHER]

The authors conducted a study to address gaps in the literature regarding parents' experiences of the transition of their child from special education to postschool mainstream services. Specifically, this study sought to explore the nature, factors, and psychological impact of their child's transition to post-school services. To achieve these aims, a qualitative, grounded theory approach was employed in which semi-structured interviews were conducted with a small sample of parents of children with mild intellectual disability living in the southern region of Ireland. The results indicated that the transition process was generally experienced as stressful, uncertain, and problematic, particularly in terms of the bureaucratic aspects. The experiential shift from school to vocational training and employment emerged as the most salient in parents' perceptions. Parents also identified a range of factors that served as barriers and supports of the transition process, in which the role of the parent emerged as a key facilitative factor. The findings suggest that considerable gaps remain between policy and service provision in Ireland regarding transition planning and postschool services for young adults with intellectual disabilities and their families, often posing barriers to successful transitions. [ABSTRACT FROM AUTHOR]