| 1. |
- Axberg, Ulf, 1961, et al.
(författare)
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Barn till föräldrar som har kontakt med vuxenpsykiatrin – hur har de det? Rapport från en nationell studie
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Psykisk ohälsa hos vuxna som depression, ångest eller bipolär sjukdom är idag ett be-tydande folkhälsoproblem. Många av de drabbade är föräldrar till minderåriga barn. Psykisk ohälsa hos föräldern påverkar barnens utveckling och välmående, men sam-bandet medieras av föräldraförmågan och relationen mellan barnet och föräldern. Sammantaget finns på gruppnivå en ökad risk att barnen också utvecklar psykiska problem, även om det inte behöver vara så i varje enskilt fall. Barns behov av information, råd och stöd ska enligt Hälso- och sjukvårdslagen beak-tas när en förälder lider av psykisk ohälsa. Det finns idag ett flertal interventioner som kan användas för att tillgodose detta behov. Samtidigt behöver man utvärdera hur dessa interventioner fungerar i Sverige. Denna rapport handlar om en kartläggning av hur barn vars föräldrar är patienter inom den specialiserade vuxenpsykiatrin har det med avseende på psykisk hälsa och generell familjesituation. Kartläggningen ingår i ett större forskningsprojekt vars syfte är att göra en utvärdering av interventioner (Beardslees familjeintervention, Föra barn på tal och reguljär behandling/övriga insatser) för stöd till barn i åldern 8 till 17 år med föräldrar med depression, dystymi, ångeststörning och/eller bipolär sjukdom. Totalt ingår föräldrar, både patienter och deras partners, till 88 barn i studien och 19 barn har gjort egna skattningar. De fick fylla i ett antal frågeformulär, där föräldrarna skattade barnens psykiska hälsa, sitt eget psykiska mående, sin generella livssituation, sin relation till eventuell nuvarande partner, sin upplevelse av att kunna hantera bar-nens beteende och olika aspekter av klimat och funktion i familjen. Barnen skattade sin egen psykiska hälsa samt vissa aspekter av klimat och funktion i familjen. Resultaten visar att föräldrar i vår studie rapporterar signifikant högre nivåer av psy-kisk ohälsa hos barnen än föräldrar i en normgrupp i den vanliga befolkningen. Barn rapporterar större symptombelastning än föräldrarna när det gäller emotionella pro-blem, hyperaktivitet/ouppmärksamhet och total problembelastning. De föräldrar som är patienter rapporterar som väntat lägre psykiskt välmående än sina partners, men även i partnergruppen finns det flera som uppger en egen psykisk problematik på klinisk nivå. Patienter och deras partner ger en samstämmig bedömning av sin re-lation; betydligt fler än i en normalgrupp anger bekymmersamt höga nivåer av stress i relationen. Insatser för barn som anhöriga ses ofta som indikerade preventioner i syfte att minska risken för psykisk ohälsa i vuxenåldern, men det finns utifrån studiens resultat mycket som talar för att det istället kan finnas behov av tidig behandling. Studien pekar på vikten av att man som professionell inom vuxenpsykiatrin i enlighet med lagstiftningen tar reda på om det finns barn i familjen, även ställer frågor om hur patienten upplever att barnet mår psykisk och fysiskt, vilka övriga personer som finns omkring barnet och hur tillgängliga de är som stöd för barnet, hur relationerna mellan olika familjemedlemmar är, samt hur föräldraskapet upplevs.
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| 2. |
- Axberg, Ulf, et al.
(författare)
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Barn till föräldrar som har kontakt med vuxenpsykiatrin - hur har de det? : Rapport från en nationell studie
- 2020
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Ingår i: Nationellt kompetenscentrum anhöriga. - 9789187731631
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Mental illness in adults such as depression, anxiety or bipolar disorder are nowadays a significant public health problem. Many of those with mental illness are parents of underage children. A parents’ mental illness affects children’s development and wellbeing, but this association is mediated by parental skills and the relation between child and parent. In summary, at a group level there is an increased risk that the children also develop mental illness, even if it does not need to be so in every individual case.Children’s need for information, advice and support has to be considered according to the Swedish Health Care Act if a parent is mentally ill. A number of different interventions are available that can be used in order to meet this need. At the same time, it has to be evaluated how these interventions work in a Swedish context.This report is about a study on how children with parents who are patients in adult psychiatry do with regard to mental health and general family situation. The study is part of a larger research project with the aim to evaluate interventions (Beardslee Family Intervention, Let’s talk about children and treatment as usual/other interventions) for support to children at 8 to 17 years of age who have parents with depression, dysthymia, anxiety and/or bipolar disease. In total, parents, both patients and their partners, of 88 children are included in the study and 19 children have also participated. They answered a number of questionnaires. Parents estimated their children’s mental health, their own psychological wellbeing, their life situation in general, their relation to their current partner, their experience of control of their child’s behavior and different aspects of family climate and function. Children reported their own mental health and some aspects of family climate and function.The results show that parents in our study report significantly higher levels of mental ill-health in their children than parents in a non-clinical norm group. Children report higher symptom load than parents concerning emotional problems, hyperactivity/inattention and total problem score. Those parents who are psychiatric patients report as expected lower psychological wellbeing than their partners, but also several partners indicate own psychological problems on a clinical level. Patients and their partners give a consistent estimation of their relation. Considerably more participants as compared to a normal group report concerning high stress levels in their relation.Interventions for children as next of kin are often regarded as indicated preventions that aim to decrease the risk for mental illness in adulthood, but the results of this study indicate that there may be need for early treatment instead.The study points out the importance that practitioners in adult psychiatry in agreement with the law find out if there are children in the family and even ask about how the patients perceive their child’s psychological and physical wellbeing, if there are other significant persons around the child and how available they are as a support for the child, how relations between other family members are and how parenthood is experienced.
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| 3. |
- Balldin, Stina, et al.
(författare)
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Video feedback combined with coordination meetings in school to reduce early disruptive behaviour problems (DBP)—A 1-year follow-up randomised controlled trial
- 2021
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Ingår i: Acta Paediatrica Scandinavica. - : Wiley. - 1651-2227 .- 0803-5253. ; 110:12, s. 3284-3293
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To compare long-term effects of a systemic school-based intervention, Marte Meo and Coordination Meetings (MAC), targeting 3- to 12-year-old children display- ing disruptive behaviour problems (DBP) in preschool or school, and service as usual (SAU). In addition, to examine whether social status (SS) affected the outcomes. Methods: In a randomised controlled design, teachers' and parents' ratings of 99 chil- dren's DBPs and mental health were collected before intervention and 1 year after post-test.Results: A significant time effect in school was found in both interventions, notably larger than at post-test in an earlier study. There was no difference between groups, SAU catching up with MAC. From teachers' reports, 53–70% of the children showed a positive change. SS did not affect the outcomes.Conclusion: School provides an already established setting to detect and intervene when young children begin to display DBP. Even if a long-term positive change in MAC did show more rapidly than in SAU, both interventions were equivalent for children from diverse social backgrounds.
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| 4. |
- Britt-Marie, Ljungström, et al.
(författare)
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Bottom-up and top-down approaches to understanding oppositional defiant disorder symptoms during early childhood: a mixed method study
- 2020
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Ingår i: Child and Adolescent Psychiatry and Mental Health. - : Springer Science and Business Media LLC. - 1753-2000. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Children with clinical levels of conduct problems are at high risk of developing mental health problems such as persistent antisocial behavior or emotional problems in adolescence. Serious conduct problems in childhood also predict poor functioning across other areas of life in early adulthood such as overweight, heavy drinking, social isolation and not in employment or education. It is important to capture those children who are most at risk, early in their development. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is commonly used in clinical settings, to identify children with conduct problems such as oppositional defiant disorder (ODD).This paper presents a cross-sectional study in a clinical setting, and describes behaviors in 3- to 8-year-olds with ODD. Our aim was to investigate whether there were problematic behaviors that were not captured by the diagnosis of ODD, using two different methods: a clinical approach (bottom-up) and the nosology for the diagnosis of ODD (top-down). Method Fifty-seven children with clinical levels of ODD participated in the study. The mothers were interviewed with both open questions and with a semi-structured diagnostic interview K-SADS. The data was analyzed using a mixed method, convergent, parallel qualitative/quantitative (QUAL + QUAN) design. For QUAL analysis qualitative content analysis was used, and for QUAN analysis associations between the two data sets, and ages-groups and gender were compared using Chi-square test. Results In the top-down approach, the ODD criteria helped to identify and separate commonly occurring oppositional behavior from conduct problems, but in the bottom-up approach, the accepted diagnostic criteria did not capture the entire range of problematic behaviors-especially those behaviors that constitute a risk for antisocial behavior. Conclusions The present study shows a gap between the diagnoses of ODD and conduct disorder (CD) in younger children. Antisocial behaviors manifest in preschool and early school years are not always sufficiently alarming to meet the diagnosis of CD, nor are they caught in their entirety by the ODD diagnostic tool. One way to verify suspicion of early antisocial behavior in preschool children would be to specify in the ODD diagnosis if there also is subclinical CD.
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| 5. |
- Britt-Marie, Ljungström, et al.
(författare)
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"Since his birth, I've always been old" the experience of being parents to children displaying disruptive behavior problems: a qualitative study
- 2020
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Ingår i: BMC psychology. - : Springer Science and Business Media LLC. - 2050-7283 .- 2050-7283. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Being parents of children who display disruptive behavior problems (DBP) can pose several challenges. Interventions for children with DBP are primarily outpatient group parent training (PT) programs. The purpose of this study was to explore how parents of children with disruptive behavior problems, diagnosed with oppositional defiant disorder (ODD), describe the difficulties they face in their family and parenting situations. METHODS: Nineteen parents of children aged 3 to 8years who had searched for help and signed up for a parent training program provided by Child and Adolescent Mental Health Service participated in the study. Semi-structured diagnostic interviews and a modified background interview adapted for the purpose of the study were conducted before parents entered the program. All children included in the study met the DSM criteria for ODD. The interviews were audiotaped and transcribed. Thematic analysis was used to examine, identify, and report patterns of meaning in the data. The analysis was conducted inductively using a contextual approach. RESULTS: Parents described their own vulnerability, how they were affected by the parent-child interaction, and the challenges they perceived in their parenting practices. The study contributes to an understanding of the complexity that parents of children with ODD perceive in everyday life. CONCLUSIONS: The parents in the study highlight the need to address parents' own mental health problems, parental alliance, capacity for emotion regulation, perceived helplessness as parents, lack of parental strategies, sense of isolation, and absence of supportive social networks. All these factors could be important when tailoring interventions aimed to help and support parents of children who display DBP, and specifically ODD.
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| 6. |
- Dahlberg, Anton
(författare)
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Capturing and addressing preschool children’s emotional and behavioural problems : Using parents’, teachers’ and children’s perspectives
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Emotional and behavioural problems (EBP) are among the most common mental health problems in preschool children. EBP are also associated with poor parent mental health. Untreated, EBP can persist or worsen over time. In order to capture and address preschool children’s EBP, we need scientifically valid instruments that can access the perspectives of informants from different contexts of the child. We also need cut-off values for questionnaires assessing EBP that are representative of the population. Parenting support is a recommended intervention for addressing EBP in preschool children. Most parenting support programmes have a solid evidence-base and show positive effects on child EBP and parent wellbeing. However, we need a better understanding of the children’s emotional and relational experiences, especially in relation to their parents. Further, although the implementation of evidence-based interventions is a complex matter with substantial impact on intervention success, few studies assess the implementation process of parenting programmes. The studies constituting this thesis focused on preschool children. The Strengths and Difficulties Questionnaire (SDQ) was assessed for capturing EBP. Study I assessed the construct validity of the SDQ and its five subscales, when rated by fathers and preschool teachers. Confirmatory factor analysis was applied to evaluate construct validity. Results indicated that the SDQ can be used as an instrument to measure EBP in preschool children, rated by parents and preschool teachers. In study II, we established Swedish norms for the SDQ for preschool children. Results suggested lower SDQ cut-offs for Swedish preschool children compared with other countries, and higher cut-offs for boys compared with girls. In study III, preschool children whose parents participated in a parenting programme were interviewed regarding their emotional and relational experiences at home. Data were analysed using qualitative content analysis. The children provided accounts of negative and positive interactions with their parents, elaborately describing a coercive cycle with escalating conflicts and lack of problem resolution. In study IV, the implementation of the parenting programme Triple P in a preschool setting was assessed using the RE-AIM framework. Results indicated a successful implementation that relied on customisation of the programme; assessment of the process from parent, staff, and organisation levels; interdisciplinary collaboration; and continuous work on securing maintenance over time. This thesis provides pieces to a complex puzzle of understanding and addressing child mental health problems, particularly EBP. Assessing EBP from different perspectives and promoting children’s voices are essential, as well as actively working with the implementation of evidence-based programmes.
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| 7. |
- de Haan, Anke, et al.
(författare)
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Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials
- 2024
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Ingår i: The Lancet Child and Adolescent Health. - 2352-4642. ; 8:1, s. 28-39
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Tidskriftsartikel (refereegranskat)abstract
- Background: Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. Methods: This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6−18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. Findings: We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=−13·17, 95% CI −17·84 to −8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=−0·15, 95% CI −0·29 to −0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms. Interpretation: This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress. Funding: Swiss National Science Foundation.
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| 8. |
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| 9. |
- Eriksson, Maria, 1969, et al.
(författare)
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Införandeår för risk-/skyddsintervju vid våld i familjen
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Under 2019 har dessa intervjuer införts i ordinarie socialtjänst under handledning från forskarteamet bakom modellen, genom ett så kallat införandeår finansierat av Socialstyrelsen. Införandeåret är en fortsättning av tidigare satsningar med särskilt fokus på att höja riskbedömningarnas kvalitet, särskilt inom den sociala barnavården. Syftet med föreliggande projekt var att pröva att införa iRiSk-intervjuerna inom ramen för ordinarie arbete i socialtjänsten, inom barnavårdsutredningar avseende barn som varit utsatta för våld, direkt och/eller bevittnat mellan barnets föräldrar. I syftet ingick att samla erfarenheter av införandet av betydelse för det fortsatta arbetet med att introducera iRiSk risk och skyddsintervjuer i ordinarie socialtjänst.
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| 10. |
- Eriksson, Maria, 1969-, et al.
(författare)
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Safeguarding Children Subjected to Violence in the Family: Child-Centered Risk Assessments
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:21
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Tidskriftsartikel (refereegranskat)abstract
- Assessing risk, planning for safety and security, and aiding recovery for children subjected to violence in a family setting is a complex process. The aim of the article is to synthesize the current research literature about risks for children subjected to violence in the family and outline an empirical base for a holistic and practically usable model of risk assessments placing the individual child at the center. Such assessments need to recognize four different areas of risk: (1) child safety, i.e., known risk factors for severe and dangerous violence aimed at both adults and children and how they play out in the individual case; (2) the child’s response in situations with violence; (3) the child’s perspective, especially fear and feelings of powerlessness in situations with violence; (4) developmental risks, e.g., instability in the child’s situation and care arrangements, lack of a carer/parent as a “secure base” and “safe haven”, the child developing difficulties due to the violence (e.g., PTSD), problems in parents’ caring capacities in relation to a child with experiences of, and reactions to, violence, and lack of opportunities for the child to make sense of, and create meaning in relation to, experiences of violence. In addition to the four areas of risk, the article emphasizes the importance of assessing the need for immediate intervention and safety planning in the current situation as regards safety, the child’s responses, the child’s perspectives, and long-term developmental risks.
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