Family therapy for rule-breaking behavior in adolescents

The paper presents the clinical experience of the author with families of adolescents who display non-aggressive externalizing symptoms: truants from school, staying late in the streets, non-compliance at home, petty thefts, etc. The reduction of these symptoms is an important prevention of adolescents’ delinquency and social failure. The paper offers arguments for the application of family therapy as a first choice. A program of family interventions, based on developmental approach is described, aiming at changes of parent – adolescent relationships on the level of attachment, on the level of communication and problem-solving, and on the level of narratives and beliefs. Ways to establish a therapeutic relationship with the family and techniques for the improvement of therapy’s effectiveness are discussed.======================Статья обобщает клинический опыт автора с семьями подростков, демонстрирующих неагрессивные экстернализирующие симптомы: непосещение учебных занятий, опоздание вечером, несоблюдение правил семьи, мелкие кражи и др. Устранение этих симптомов является важной мерой предотвращения делинквентности и социального неуспеха подростков. Работа обосновывает применение семейной психотерапии в качестве психологической интервенции первого выбора. Представлена программа семейной психотерапии, основанная на понимание проблем с точки зрения развития и направленная на изменение отношений между родителями и подростками на уровне привязанности, на уровне общения и решений проблем и на уровне историй и взглядов. Обсуждаются способы установления терапевтической связи с семьей и техники повышения эффективности семейной терапии

Mental health disparities between Roma and non-Roma children in Romania and Bulgaria

The Roma population, one of the largest minority groups in Europe, experience discrimination and stigma associated with marginalized social position. Few studies have examined mental illnesses in the Roma, and none have examined the Roma children. The present study estimates mental health and behavioral disorders among Roma children in comparison to non-Roma children in educational institutions. Data were drawn from the School Children Mental Health Study in Europe (SCHME) study in Romania (Roma children identified by parent report, N = 70; non-Roma, N = 925) and Bulgaria (Roma children identified by exclusively-Roma schools, N = 65; non-Roma, N = 1312). The Strengths and Difficulties Questionnaire was given to the parents and teachers to measure child mental health; children reported on their mental health through the Dominique Interactive. Control covariates included child sex and age, and parental characteristics when parent reports were available. Based on the child’s own report, Roma children had a higher odds of any internalizing disorder (OR = 2.99, 95% C.I. 2.07–4.30), phobias (OR = 4.84, 95% C.I. 3.19–7.35), separation anxiety disorder (OR = 2.54, 95% C.I. 1.72–3.76), generalized anxiety disorder (OR = 2.95, 95% C.I. 1.75–4.96), and major depressive disorder (OR = 3.86, 95% C.I. 2.31–6.37). Further Roma children had a higher odds of any externalizing disorder (OR = 2.84, 95% C.I. 1.78–4.54), oppositional defiant disorder (OR = 3.35, 95% C.I. 1.93–5.82), ADHD (OR = 2.37, 95% C.I. 1.26–4.46), and conduct disorder (OR = 3.63, 95% C.I. 2.04–6.46). Based on the report of teachers, Roma children had higher odds of emotional problems (OR = 2.03, 95% C.I. 1.20-3.44), peer-relational problems (OR = 2.76, 95% C.I. 1.73-4.41) and prosocial behavior (OR = 2.75, 95% C.I. 1.75-4.33). Roma children experience a higher burden of mental health problems compared with their non-Roma counterparts. Attention to child health and mental health among the Roma is urgently needed, as these children experience a constellation of health problems associated with poverty as well as experiences of stigma and discrimination

Parental Smoking in the Vicinity of Children and Tobacco Control Policies in the European Region

Objective: To ascertain patterns of parental smoking in the vicinity of children in Eastern and Western Europe and their relation to Tobacco Control Scale (TCS) scores. Methods: Data on parental smoking patterns were obtained from the School Child Mental Health Europe (SCMHE), a 2010 cross-sectional survey of 5141 school children aged 6 to 11 years and their parents in six countries: Germany, Netherlands, Lithuania, Romania, Bulgaria and Turkey ranked by TCS into three level categories toward tobacco control policies. Results: A slightly higher proportion of Eastern compared to Western European mothers (42.4 vs. 35.1%) were currently smoking in but the difference was not statistically significant after adjusting for maternal age and maternal educational attainment. About a fifth (19.3%) and a tenth (10.0%) of Eastern and Western European mothers, respectively, smoked in the vicinity of their children, and the difference was significant even after adjustment for potential confounders (p less than 0.001). Parents with the highest educational attainment were significantly less likely to smoke in the vicinity of their children than those with the lowest attainment. After control of these covariates lax tobacco control policies, compared to intermediate policies, were associated with a 50% increase in the likelihood of maternal smoking in the vicinity of children adjusted odds ratio (AOR) = 1.52 and 1.64. Among fathers, however, the relationship with paternal smoking and TCS seems more complex since strict policy increases the risk as well AOR = 1,40. Only one country, however belongs to the strict group. Significance: Tobacco control policies seem to have influenced maternal smoking behaviors overall to a limited degree and smoking in the vicinity of children to a much greater degree. Children living in European countries with lax tobacco control policies are more likely to be exposed to second hand smoking from maternal and paternal smoking

Country-level and individual correlates of overweight and obesity among primary school children: a cross-sectional study in seven European countries.

BACKGROUND: The present study aims to estimate childhood overweight and obesity prevalence and their association with individual and population-level correlates in Eastern and Western European countries. METHODS: Data were obtained from the School Children Mental Health in Europe, a cross-sectional survey conducted in 2010 in Italy, Germany, the Netherlands, Romania, Bulgaria, Lithuania and Turkey. The sample consists of 5,206 school children aged 6 to 11 years old. Information on socio-demographics, children's height and weight, life-style and parental attitude were reported by the mothers. Country-level indicators were obtained through several data banks. Overweight and obesity in children were calculated according to the international age and gender-specific child Body Mass Index cut-off points. Multivariable logistic regression models included socio-demographic, lifestyle, mothers' attitude, and country-level indicators to examine the correlates of overweight. RESULTS: Overall prevalence was 15.6% (95% CI = 19.3-21.7%) for overweight and 4.9% (95% CI = 4.3-5.6%) for obesity. In overweight (including obesity), Romanian children had the highest prevalence (31.4%, 95% CI = 28.1-34.6%) and Italian the lowest (10.4%, 95% CI = 8.1-12.6%). Models in the pooled sample showed that being younger (aOR = 0.93, 95% = CI 0.87-0.97), male (aOR = 1.24, 95% CI = 1.07-1.43), an only child (aOR = 1.40, 95% CI = 1.07-1.84), spending more hours per week watching TV (aOR = 1.01, 95% CI =1.002-1.03), and living in an Eastern Country were associated with greater risk of childhood overweight (including obesity). The same predictors were significantly associated with childhood overweight in the model conducted in the Eastern region, but not in the West. Higher Gross Domestic Product and Real Domestic Product, greater number of motor and passenger vehicles, higher percentage of energy available from fat, and more public sector expenditure on health were also associated with lower risk for childhood overweight after adjusting for covariables in the pooled sample and in the east of Europe, but not in the West. CONCLUSIONS: Prevalence rates of overweight and obesity in school children is still high, especially in Eastern regions, with some socio-demographic factors and life-styles associated with being overweight. It is also in the Eastern region itself where better macro-economic indicators are related with lower rates of childhood overweight. This represents a public health concern that deserves special attention in those countries undertaking economic and political transitions

Journal of Affective Disorders

Background Bullying involvement is associated with suicidal ideation among adolescents, yet there are no studies examining this issue among younger children. Methods The School Children Mental Health in Europe study was conducted in seven countries in 2010 using similar methods to collect cross-sectional data from children, parents, and teachers. Suicidal ideation and thoughts of death were assessed using the Dominic Interactive among children. Parent and teacher reports were used to determine bullying involvement. The sample comprised n = 5,183 children ages 6 to 11 identified as bullies (n = 740, 14.3%), victims (n = 945, 18.2%), bully-victims (n = 984, 18.2%) and not involved in bullying (n = 2,514, 48.5%). Multivariate logistic regressions were used to assess the association of bullying involvement with suicidal ideation and thoughts of death. Results Suicidal ideation was reported by 13.3% of those not involved in bullying, 17.1% of victims, 19.6% of bullies and 24.4% of bully-victims. Similarly, thoughts of death were reported by 19.0% of victims, 24.3% of bullies, and 25.0% of bully-victims. Children identified as being involved were more likely than those not involved to report suicidal ideation in bivariate analyses. When controlling for psychopathology and for maternal distress among other factors, the association remained significant for bullies (AOR=1.30, 95%CI=1.01–1.66), bully-victims (AOR=1.54, 95%CI=1.22–1.94), but not for victims (AOR=1.02, 95%CI=0.80–1.30). Limitations The study is cross-sectional. The assessment of bullying may have underestimated victimization. Conclusions The association of bullying involvement and child suicidal ideation is present among elementary school children across Europe, using multiple informants to avoid shared variance biases, and adjusting for key factors.European Unio

The school children mental health in Europe (SCMHE) project: design and first results

Background : The School Children Mental Health in Europe (SCMHE) project aims to build up a set of indicators to collect and monitor children's mental health in an efficient and comparable methodology across the EU countries. It concerns primary schools children aged 6 to 11 years a range where few data are available whereas school interventions are promising. Methods : Three informants were used: parents, teachers and children. In selecting instruments language, instruments were selected according to the easiness to translate them: SDQ (Strengths and Difficulties Questionnaire) for parents and teachers and DI (Dominic Interactive). A two-step procedure was used: schools randomization then six children by class in each grade. Results : 9084 children from seven countries (Italy, Netherlands, Germany, Romania, Bulgaria, Lithuania, and Turkey) completed the Dominic Interactive in their own language. 6563 teachers and 6031 parents completed their questionnaire, and a total of 5574 interviews have been completed by the 3 informants. The participation rate of the children with parents in the participating schools was about 66.4%. As expected teachers report more externalised problems and less internalised problems than parents. Children report more internalised problems than parents and teachers. Boys have consistently more externalised problems than girls and this is the reverse for internalised problems. Combining the diverse informants and impairment levels children with problems requiring some sort of mental health care were about 9.9%: 76% did not see any mental health professional: 78.7% In Eastern countries 63.1% in Western Europe

The association between mental health problems and asthma among European school children

Background and objectives: To examine the prevalence of two ISAAC (International Study of Asthma and Allergies in Childhood) asthma indicators in 7 European countries and their relationship with mental health disorders in children 6–12 years. Methods: A cross-sectional survey of 5712 school children aged 6–12 years using a video Self-administered instrument: Dominic Interactive and the Strengths and Difficulties Questionnaire (SDQ) for parents and teachers. Asthma indicators were 12 month “Wheezing or whistling in the chest” (WWC) and “Severe Asthma” (SA) based on number of attacks of wheezing, sleep disturbance due to wheezing, and limits to speech. Results: On average 7.31% of the children had WWC, from 15.09% in Turkey to 1.32% in Italy; SA 2.22% on average ranged from 4.78% in Turkey to 0% in Italy. Generalized Anxiety Disorder (GAD) from child self-reports was significantly associated with WWC and SA even after adjustment for covariates. Based on parent and teacher combined reports, emotional problems were found to have significant associations with 12-month WWC after adjustment, as well as “any problems” which summarized externalizing and internalizing disorders Emotional, hyperactivity, conduct disorders were not associated with SA. Conclusion: Asthma indicators very much differ across countries. Asthma indicators are associated with childhood GAD. Childhood self-reported mental health seems more related to Asthma indicators than parents/teachers combined reports.European Commissio