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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.

Little is known about adoptive parents' experiences of and satisfaction with statutory child and adolescent mental services (CAMHS) in the UK, nor of parental concerns about their adopted children's mental health and well-being. Ninety-eight adoptive parents completed an online survey about their satisfaction with services as well as their mental health concerns for their child currently and retrospectively at the point of adoption. Parental concerns were diverse, and many overlapped with issues that CAMHS could normally help with. Attachment was the primary concern initially, but this decreased over time in placement; while challenging behaviour was the highest rated current concern, along with aspects of general functioning such as peer relations, social skills and education. Unexpectedly, trauma was a relatively low concern at both timepoints. There were very high levels of dissatisfaction with CAMHS, evident across questions of access, engagement and quality of services, all at levels much higher than typically reported by general samples. Adoptive parents' substantial dissatisfaction with CAMHS occurred despite an apparent fit between many parental concerns and the kinds of services typically offered in CAMHS. There remains a significant challenge to develop a shared understanding between parents and services of adopted children's needs, especially given the absence of data about adopted children's mental health and wellbeing problems. [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]

Parents are increasingly expected to supplement their children's school-based learning by providing support for children's homework. However, parents' capacities to provide such support may vary and may be limited by the experience of depression. This may have implications for child development. In the course of a prospective, longitudinal study of children of postnatally depressed and healthy mothers, we observed mothers (N=88) and fathers (N=78) at home during maths homework interactions with their 8-year-old children. The quality of parental communication was rated and analysed in relation to child functioning. The quality of communication of each of the parents was related to their mental state, social class and IQ. While postnatal depression was not directly related to child development, there was some evidence of the influence of maternal depression occurring in the child's school years. Different aspects of parental communication with the child showed specific associations with different child outcomes, over and above the influence of family characteristics. In particular, child school attainment and IQ were associated with parental strategies to encourage representational thinking and mastery motivation, whereas child behavioural adjustment at school and self-esteem were linked to the degree of parental emotional support and low levels of coercion. Notably, the influence of maternal homework support was more strongly related to child outcome than was paternal support, a pattern reflected in mothers' greater involvement in children's schools and school-related activities. Some parents may need guidance in how to support their children's homework if it is to be of benefit to child functioning.

Background: The evidence suggests an increased risk of developing anxiety problems in children of anxious parents. The current study explored the feasibility and acceptability of an intervention with anxious parents of young children, to inform the possibility of further trials. Methods: Participants were recruited through primary and secondary care psychological services and social media. Participants who had a current or recent anxiety disorder and a child aged 12–47 months were included. Assessments of parental and child outcomes occurred at baseline, after the intervention (week‐2) and follow‐up (week‐8). The intervention was delivered in a small group format, in two sessions, one week apart, using videoconferencing. Results: Out of 32 participants, 30 (94%) attended the full intervention. All found the intervention acceptable and reported it as useful and relevant. There was a reduction in parental depression (MD = 2.63, 95%CI 1.01–4.26), anxiety (MD = 3.93, 95%CI 2.49–5.37) and stress (MD = 4.60, 95% CI 3.02–6.18) and increases in parenting confidence. Conclusions: The online group intervention was feasible and acceptable. There were moderate to large effects on parental mental health and no adverse effects on children (decline on outcome measures). This indicates that intervening early in parenting with anxious parents is possible and warrants further investigation to establish prevention efficacy with a larger, controlled trial. [ABSTRACT FROM AUTHOR]

Clinical practitioners are frequently encouraged, through literature, training, and policy, to learn, understand, refer to and use their knowledge of attachment theory and research when working to meet the needs of children and families. However, there has been very little empirical study of how practitioners understand and perceive the relevance of attachment concepts and methods. Q-methodology was used to examine the perceptions of attachment knowledge and its applications for practice among 30 UK clinicians working with children and an international group of 31 attachment researchers. Factor analysis revealed three perspectives, described as: i) pragmatic, developmental, and uncertain, ii) academic, and iii) autodidactic and therapeutic. Participants agreed on core tenants of theory, their aspirations for clinical practice and the inaccessibility of current assessment measures for practitioners. Yet they diverged on their understandings of attachment insecurity, disorganisation, and the implications of both for various aspects of child development. [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]

This article investigates the relationship between mother and child depression. Topics include child development, cognitive style, self esteem, and hostility.

Previous research suggests that adopted children are at a greater risk of experiencing psychological and behavioural difficulties or accessing mental health services than non-adopted peers and that post-adoption variables are significant risk and protective factors producing this situation. This review seeks to summarise the post-adoption variables associated with adopted children's mental health or behavioural difficulties to inform future research and shape interventions. A search for publications that assess associated risk and protective factors using Web of Science, Psychinfo, Medline and Sociological Abstracts identified 52 studies that met rigorous methodological criteria. Children's and adolescents' mental health and behavioural outcomes were associated with parent, parent–child and wider family factors and by contextual variables. The findings highlight the importance of focusing on the multitude of systemic factors surrounding a child following adoption. Clinical implications and direction for future research are discussed. [ABSTRACT FROM AUTHOR]

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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]

The extent to which therapist adherence to guidelines and clinician skill or competence may play a role in the prediction of therapeutic outcomes remains inconclusive. This systematic literature review and meta-analysis considers whether adherence or competence predicts youth outcome in child and adolescent psychotherapy, and whether there are any identifiable factors which moderate the strength or direction of this relationship. A systematic literature search identified 35 studies in 52 papers. The studies contained 29 effect sizes for the relationship between adherence and outcome, while nine effect sizes were extracted for competence, and a further five effects measured a composite of adherence and competence constructs, referred to as fidelity in this report. The meta-analysis indicated a small but significant relationship between therapist adherence and outcome, although the small size of effect suggests that outcomes are likely to be more strongly associated with factors other than adherence. No significant relationship was identified between competence or composite fidelity and outcome. Although variance was observed in effect sizes, no significant moderation by client group, intervention type, or implementation measure informant was identified. Further study is needed to understand the specific circumstances under which adherence and outcome are related. [ABSTRACT FROM AUTHOR]

Background: With the number of children being placed in the care of local authorities increasing, the need to recruit and retain foster carers is essential. Compassion fatigue is recognised as a negative effect for professionals working with adults and children who have experienced trauma. This study aims to confirm the proof of concept within foster carers and to explore the potential risks associated with intent to continue fostering, overall job satisfaction and psychological factors (avoidant coping) that could be targets for interventions. Methods: In total, 131 foster carers completed an online survey including self-report measures of compassion fatigue and associated risk factors. Results: Results confirm the existence of compassion fatigue among foster carers with rates in line with previous studies on other professionals working with children. High compassion fatigue was associated with lower intent to continue fostering and lower job satisfaction. Avoidant cognitive styles of psychological inflexibility and thought suppression were associated with compassion fatigue. Conclusion: The confirmation of compassion fatigue among foster carers and the potential risks to job retention are important findings for social care. The associations with avoidant cognitive styles have clinical implications for potential interventions. Recommendations for further research and the limitations of this study are also discussed. [ABSTRACT FROM AUTHOR]

Early life experiences leave a mark on a child’s emotional, social and cognitive development. It is well established that children adopted from psychosocially depriving institutions have difficulties in executive functioning and social communication ability, but this type of research has not been replicated in children adopted from foster care. In this study, 30 primary school aged UK adoptees without a history of institutionalisation completed an assessment of their intellectual, executive functioning and social communication abilities. Compared to children of a similar age in the general population, the adopted group showed elevated emotional and behavioural difficulties on a parental report measure (Strengths and Difficulties Questionnaire, SDQ). They performed statistically poorer on two of three computerised executive functioning tests (CANTAB Intra-Extra Dimensional Shift and Spatial Working Memory) and elevated scores were observed on a parental report measure of executive functioning (Behavior Rating Inventory of Executive Functioning, BRIEF). A strong negative correlation was found between age of adoption and BRIEF scores controlling for ADHD symptoms; no other pre- or post-adoption variables strongly correlated with executive functioning. Although all participants scored below cut-off on an autism screening measure (Social Communication Questionnaire, SCQ), a moderate positive correlation was observed with age of adoption. The identified elevation in emotional, behavioural and executive functioning difficulties is in line with previous research examining children adopted from institutions; however, the observed negative correlation between BRIEF scores and age of adoption is contrary to previous evidence. Limitations and implications for future research are discussed. [ABSTRACT FROM AUTHOR]

In many child services across health, education and social care, ‘attachment disorder’ is a popular description and explanation for complex presentations of children who have been neglected or maltreated and is frequently used to describe fostered and adopted children. Very often the use of this term bears little resemblance to the established diagnostic systems, nor indeed to attachment theory as conceptualised by Bowlby. Its misuse can lead professionals to overlook commoner and more treatable conditions, to the detriment of the children. In fact both reactive and disinhibited attachment disorders are rare, but are becoming better characterised by high quality research. Poor understanding about the attachment disorder construct can pose particular problems for clinicians working with adopted children. The current paper briefly reviews the practical difficulties with the attachment disorder diagnosis as applied to adopted children and uses four case studies taken from a specialist Adoption and Fostering Service to highlight some of the problems for services working with adopted children. Finally, we propose some provisional recommendations for the assessment and treatment of adopted children and their families, which aim to be consistent with attachment theory as well as with the existing evidence base on wider child mental health problems. [ABSTRACT FROM PUBLISHER]

The cutting-edge scientific research that is emerging regarding the neurobiological consequences of early maltreatment and neglect is highly relevant for thinking about the diverse needs of adopted and fostered children. Knowledge about the science has an important role to play in many areas, from child care proceedings to the mental health and educational needs of adopted children and young people. However, the science is complex and it is difficult to provide a succinct but valid summary of the rapidly expanding literature to guide practice. Indeed, there has been some concern from the scientists themselves that the research can be too easily misunderstood. The purpose of this article is to review some of the more recent research on the neurobiological consequences of maltreatment. A narrative is developed that pays due respect to the complexity of the findings, while drawing out practical implications for professionals working with adopted and fostered children. In particular, the notion of differential susceptibility and its consequences for individual differences in response to early negative environments is described. The science also stresses the inter-relatedness of the biological systems affected and, in turn, their dynamic relationships with environments over time. The article reviews the research relating to neuroscience, physiology and genetics in particular, before describing some animal research to integrate the various neurobiological consequences of maltreatment over the course of development, and which reveal implications for interventions. [ABSTRACT FROM PUBLISHER]

An attachment-sensitive formulation is presented for a 9-year-old adopted girl with a complex presentation of oppositionality, separation anxiety, and attachment problems. Session-by-session observational data of an evidence-based treatment demonstrates the transactional nature of the carer-child interactions that drove an improvement in attachment behaviors, as well as oppositional and anxiety symptoms at home. Most importantly, a placement in imminent danger of breakdown was stabilized, allowing the child more time to negotiate a reliable attachment to her new carer. Thus, the evidence-base can be used to develop personalized treatment packages for complex adoption cases consistent with the relevant practice parameters. [ABSTRACT FROM AUTHOR]

Individuals with social phobia display social information processing biases yet their aetiological significance is unclear. Infants of mothers with social phobia and control infants' responses were assessed at 10 days, 10 and 16 weeks, and 10 months to faces versus non-faces, variations in intensity of emotional expressions, and gaze direction. Infant temperament and maternal behaviours were also assessed. Both groups showed a preference for faces over non-faces at 10 days and 10 weeks, and full faces over profiles at 16 weeks; they also looked more to high vs. low intensity angry faces at 10 weeks, and fearful faces at 10 months; however, index infants' initial orientation and overall looking to high-intensity fear faces was relatively less than controls at 10 weeks. This was not explained by infant temperament or maternal behaviours. The findings suggest that offspring of mothers with social phobia show processing biases to emotional expressions in infancy. [ABSTRACT FROM AUTHOR]