Trauma in childhood and adolescence and impaired executive functions are associated with uncertain reflective functioning in mothers with substance use disorder

© 2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/).Aims: Impairments in reflective functioning are known to have adverse effects on the ability to display sensitive parenting as a caregiver. Several factors are associated with impairments in reflective functioning, such as impaired executive functioning and experienced trauma. We investigated how these factors contribute to an impaired reflective functioning style, such as pathological certain or uncertain reflective functioning. Extreme scores on these two subscales reflect two kinds of impairments in reflective functioning. We assessed executive functions, reflective functioning, and trauma in 43 mothers diagnosed with substance use disorders (SUD). Methods: Certain or uncertain reflective functioning were assessed using the Reflective Functioning Questionnaire 8 (RFQ-8). Executive functions and trauma were assessed by administering various questionnaires, interviews and neuropsychological tests. Results: High uncertain reflective functioning was more than six times as common (odds ratio) in mothers reporting high amounts of trauma in childhood and adolescence compared with mothers reporting low amounts of trauma. Impaired executive functions were also significantly associated with high uncertain reflective functioning. Certain reflective functioning did, however, not show any significant associations. Conclusion: When the SUD mothers give information about relational trauma in childhood and adolescence, it might therefore be worth investigating and addressing the potential tendency to have an uncertain reflective functioning style.publishedVersio

High levels of the openness trait are associated with better parental reflective functioning in mothers with substance use disorders

Aims: Mothers with substance use disorders (SUD) often show impairments in parental reflective functioning (PRF), which may have adverse effects on their capacity for sensitive caregiving. Parenting personality is also associated with caregiving. However, no studies have investigated how these individual factors may contribute to variance in PRF in mothers with SUD. In this study PRF and personality were assessed in 43 mothers with SUD. Methods: PRF was assessed by the Parent Development Interview. Personality traits were assessed by the Revised Neuroticism-Extraversion-Openness Personality Inventory. Results: The results indicate that higher levels of the Openness trait are associated with better PRF. Conclusion Mothers low in Openness may need more specific and situational training in interpreting mental states in their children. Highly open mothers with SUD will likely need more help distinguishing the child’s mental states from their own, and might need help to maintain mutuality and regulating the intensity of their responses to the child’s behavior.publishedVersio

Pregnancy and substance use - the Norwegian § 10-3 solution : ethical and clinical reflections related to incarceration of pregnant women to protect the foetus from harmful substances

Abstract Aims This article highlights ethical and clinical dilemmas of incarceration of pregnant drug addicts mandated by z 10–3 of the Norwegian Municipal Health and Care Services act. Material The material consists of two cases, Siri and Anna, and the ethical dilemmas posed by the use of z 10–3 in these cases. Methods Semi-structured in-depth individual interviews were conducted, audio-recorded and transcribed word for word. Transcripts were coded according to converging interests and possible ethical dilemmas and described in a case format. The practical and experiential consequences of the law are discussed in relation to the four main bioethical principles: respect for autonomy, non-maleficence, beneficence and social justice. These are supplemented by the principles of relational ethics. Results The application of z 10–3 may lead to situations which distort the psychological preparation for parenthood and strains the helping relationship. The four principles approach seems to be an insufficient tool in grasping the complexity of the situation. Conclusions Interventions to protect the foetus from the pregnant woman's use of substances demand elevated professional awareness of ethical and relational challenges and dilemmas. Relational ethics provides a framework to enhance reflexivity and a trusting therapeutic alliance. The potential for psychological change during pregnancy should be invested in. Hence, we suggest that during incarceration according to z 10–3, foetal protection and the promotion of parental competences should be given equal priority.publishedVersio

Pregnancy and substance use - the Norwegian § 10-3 solution : ethical and clinical reflections related to incarceration of pregnant women to protect the foetus from harmful substances

Abstract Aims This article highlights ethical and clinical dilemmas of incarceration of pregnant drug addicts mandated by z 10–3 of the Norwegian Municipal Health and Care Services act. Material The material consists of two cases, Siri and Anna, and the ethical dilemmas posed by the use of z 10–3 in these cases. Methods Semi-structured in-depth individual interviews were conducted, audio-recorded and transcribed word for word. Transcripts were coded according to converging interests and possible ethical dilemmas and described in a case format. The practical and experiential consequences of the law are discussed in relation to the four main bioethical principles: respect for autonomy, non-maleficence, beneficence and social justice. These are supplemented by the principles of relational ethics. Results The application of z 10–3 may lead to situations which distort the psychological preparation for parenthood and strains the helping relationship. The four principles approach seems to be an insufficient tool in grasping the complexity of the situation. Conclusions Interventions to protect the foetus from the pregnant woman's use of substances demand elevated professional awareness of ethical and relational challenges and dilemmas. Relational ethics provides a framework to enhance reflexivity and a trusting therapeutic alliance. The potential for psychological change during pregnancy should be invested in. Hence, we suggest that during incarceration according to z 10–3, foetal protection and the promotion of parental competences should be given equal priority

Pregnancy and substance use - the Norwegian § 10-3 solution : ethical and clinical reflections related to incarceration of pregnant women to protect the foetus from harmful substances

Aims This article highlights ethical and clinical dilemmas of incarceration of pregnant drug addicts mandated by z 10–3 of the Norwegian Municipal Health and Care Services act. Material The material consists of two cases, Siri and Anna, and the ethical dilemmas posed by the use of z 10–3 in these cases. Methods Semi-structured in-depth individual interviews were conducted, audio-recorded and transcribed word for word. Transcripts were coded according to converging interests and possible ethical dilemmas and described in a case format. The practical and experiential consequences of the law are discussed in relation to the four main bioethical principles: respect for autonomy, non-maleficence, beneficence and social justice. These are supplemented by the principles of relational ethics. Results The application of z 10–3 may lead to situations which distort the psychological preparation for parenthood and strains the helping relationship. The four principles approach seems to be an insufficient tool in grasping the complexity of the situation. Conclusions Interventions to protect the foetus from the pregnant woman's use of substances demand elevated professional awareness of ethical and relational challenges and dilemmas. Relational ethics provides a framework to enhance reflexivity and a trusting therapeutic alliance. The potential for psychological change during pregnancy should be invested in. Hence, we suggest that during incarceration according to z 10–3, foetal protection and the promotion of parental competences should be given equal priority

Internet-Based Cognitive Behavioral Therapy for Adults With ADHD in Outpatient Psychiatric Care : A Randomized Trial

OBJECTIVE: The purpose of the study was to evaluate an Internet-based cognitive behavioral therapy (iCBT) program targeting difficulties and impairments associated with adult ADHD. METHOD: Forty-five adults diagnosed with ADHD were randomized to either self-help (iCBT self-help format [iCBT-S]), self-help with weekly group sessions (iCBT group-therapy format [iCBT-G]), or a waiting-list control group. Treatment efficacy was measured at pre- and posttreatment and at 6-month follow-up. RESULTS: Intention-to-treat (ITT) analysis showed a significant reduction in ADHD symptoms for the iCBT-S group in comparison with the waiting-list controls at posttreatment, with a between-group effect size of d = 1.07. The result was maintained at 6-month follow-up. No significant difference was found at posttreatment or 6-month follow-up between the iCBT-S and iCBT-G groups. CONCLUSION: The findings show that a CBT treatment program administered through the Internet can be a promising treatment for adult ADHD. Limitations of the study design and directions for future research are discussed

Barnevernets ansvar for det ufødte liv - en utredning om meldeplikt, fostervern og tiltak overfor gravide

Oppdragsgiver: Barne-, ungdoms- og familiedirektoratetI 2019 ga Barne-, ungdoms- og familiedirektoratet Høgskolen i Innlandet i oppdrag å utrede spørsmål knyttet til barnevernets ansvar for det ufødte liv. Spørsmålene dreide seg om hva barnevernet og andre tjenester bør gjøre for gravide kvinner som lever i omstendigheter eller med tilstander som vekker bekymring for fosterets helse og det nyfødte barnets omsorgsvilkår. Utredningen omhandler to hovedspørsmål: Om det bør innføres en adgang eller plikt for helsepersonell til å melde bekymring til barnevernet ved nærmere definerte risikoforhold, og hvilke tiltak som i så fall bør settes inn overfor den gravide.Abstract: In 2019, the Norwegian Directorate for Children, Youth and Family Affairs (Bufdir) commissioned Inland Norway University of Applied Sciences to investigate issues related to the Child Welfare Service’s responsibility for unborn lives. The questions are directed towards what the Child Welfare Service and other services should do with pregnant women who live in circumstances or have conditions that raise concerns about the foetus’s health and the new-born child’s quality of care. This report deals with two main questions. One is whether health personnnel should be given an option or a duty to report concerns to the Child Welfare Service when they identify the presence of defined risk factors. The other considers what measures should be directed towards the pregnant woman if concerns are raised.publishedVersio

Barnevernets ansvar for det ufødte liv - en utredning om meldeplikt, fostervern og tiltak overfor gravide

I 2019 ga Barne-, ungdoms- og familiedirektoratet Høgskolen i Innlandet i oppdrag å utrede spørsmål knyttet til barnevernets ansvar for det ufødte liv. Spørsmålene dreide seg om hva barnevernet og andre tjenester bør gjøre for gravide kvinner som lever i omstendigheter eller med tilstander som vekker bekymring for fosterets helse og det nyfødte barnets omsorgsvilkår. Utredningen omhandler to hovedspørsmål: Om det bør innføres en adgang eller plikt for helsepersonell til å melde bekymring til barnevernet ved nærmere definerte risikoforhold, og hvilke tiltak som i så fall bør settes inn overfor den gravide

Adverse and adaptive childhood experiences are associated with parental reflective functioning in mothers with substance use disorder

Mothers with a substance use disorder (SUD) are at risk for maladaptive parenting practices, and have heightened likelihood of having experienced childhood adversity themselves. In addition, parental reflective functioning (PRF), a capacity underlying sensitive caregiving, is often low in mothers with SUD. This study examines the relationship between PRF and aversive (emotional, physical, sexual abuse and neglect) and adaptive (safety and competence) experiences, in different developmental phases (early childhood, latency, and adolescence) in mothers with a SUD. A sample of 43 mothers with small children were interviewed with the Parental Developmental Interview to assess PRF, and they completed the Traumatic Antecedents Questionnaire regarding aversive and adaptive experiences. In addition, we used the Hopkins Symptoms Checklist-10 to control for mental health status and a battery of neuropsychological tests to control for executive functions. Results indicated that adaptive experiences in early childhood were positively related to PRF, and that experience of emotional abuse was negatively related to PRF. When separating the group of mothers in two sub-groups based on PRF level, results showed that mothers with negative to low PRF had significantly more experiences of adversities in early childhood and latency, and significantly less adaptive experiences in early childhood, latency and adolescence, compared to mothers with moderate to high PRF. In addition, mothers with adequate to high PRF reported experiencing significantly more types of adaptive experiences, and significantly less adversities compared to mothers with negative to low PRF. Results are discussed in relation to developmental trauma, resilience, epistemic trust and mistrust.The project received financial support from The Research Council of Norway (NFR), grant number 213079/H10 and from Innlandet Hospital Trust.submittedVersio