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24 - Dyslexia and dyscalculia
- Edited by Helmut Remschmidt, Philipps-Universität Marburg, Germany
- Translated by Peter Matthias Wehmeier, Helen Crimlisk
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- Book:
- Psychotherapy with Children and Adolescents
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- 17 May 2010
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- 16 August 2001, pp 413-427
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Summary
Introduction
Dyslexia (also known as specific reading and spelling disorder) and dyscalculia (also known as specific disorder of arithmetical skills) influence performance at school to a great extent. Dyslexia usually leads to conflicts not only at school but also at home. Many additional psychological symptoms may occur, resulting sometimes in serious psychiatric disorders (Esser, 1990).
The many psychiatric and behavioural sequelae of dyslexia are generally of a ‘neurotic’ nature. Thus, symptoms arise as a result of conflicts between the desire to achieve at school, and the difficulty in fulfilling this expectation. Eventually, the child is unable to cope with the excessive demands and constant failure, and there is a resultant loss of self-esteem. Thus a vicious circle is established (Fig. 24.1), usually involving the school, parents and the peer group.
The conflicts I to IV in Fig. 24.1 directly affect the child. The child is less involved in conflict V, unless other children side with the dyslexic child in opposition to the school. Secondary symptoms are usually similar regardless of whether the child suffers from dyslexia or dyscalculia. Thus, the approach to treatment must be broad: after assessment and diagnosis, patients should be treated with a specific treatment programme aimed at their specific problem (reading, writing, arithmetic skills), but, in addition, individual psychotherapy may be required for any accompanying mental or behavioural symptoms (Skinner, 1998). Parents or families should be included in treatment, and in order to optimize results treatment programmes should be coordinated with the school.
Treatment of dyscalculia differs to some extent from the treatment of dyslexia in several points.
20 - Substance abuse and addiction
- Edited by Helmut Remschmidt, Philipps-Universität Marburg, Germany
- Translated by Peter Matthias Wehmeier, Helen Crimlisk
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- Book:
- Psychotherapy with Children and Adolescents
- Published online:
- 17 May 2010
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- 16 August 2001, pp 327-343
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Summary
The management of children and adolescents with substance abuse or addiction is a common field for child and adolescent psychiatrists (Washton, 1996). More than 150 000 children and adolescents in Germany are involved with substance abuse or addiction. The estimated total number of individuals with alcohol addiction in Germany is between 1.5 and 2.5 million. Additionally, 200 000–500 000 individuals are addicted to medication and 100 000–120 000 to illicit drugs. The fact that individuals with substance abuse or addiction constitute the largest group of patients undergoing psychiatric treatment facilities highlights the enormous challenge to child and adolescent psychiatry in terms of preventive work. More than 700 000 children live with an alcohol-dependent parent. The risk of these children also becoming alcohol dependent is high. The percentage of those children and adolescents between 14 and 18 years old, associated with drug-related crimes, e.g. registered as suspects by the police, has ranged between 8% and 25% during the last 25 years. Psychiatric disorders due to substance abuse or addiction frequently require child and adolescent psychiatric treatment. It is likely that a high percentage of affected children and adolescents already had another disorder before the beginning of substance abuse or addiction. In many cases of substance abuse or addiction, co-morbidity is sufficiently severe that social work and psychological assistance alone are insufficient. Substance abuse and addiction, including co-morbid psychiatric disorders, require prevention, psychiatric treatment and rehabilitation, areas in which child and adolescent psychiatry services bear a significant responsibility.
The disorders associated with psychoactive substance abuse and addiction are complicated.
33 - Day-patient psychotherapy
- Edited by Helmut Remschmidt, Philipps-Universität Marburg, Germany
- Translated by Peter Matthias Wehmeier, Helen Crimlisk
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- Book:
- Psychotherapy with Children and Adolescents
- Published online:
- 17 May 2010
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- 16 August 2001, pp 552-567
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Summary
The term ‘partial hospitalization’ is used to describe treatment of children and adolescents which is undertaken only during the day (‘day-patient treatment’) or night (‘night-patient treatment’). Although night treatment is not particularly relevant in this age group, day-patient treatment has become increasingly important (Dopfner, 1993a). Day-patient treatment offers the many advantages of inpatient treatment, whilst allowing patients to spend the late afternoons, nights, and weekends in their usual home environment.
Indications and preconditions for day-patient treatment
Indications
The following indications for day-patient treatment have been suggested (Remschmidt, 1992; Remschmidt and Schmidt, 1988).
Avoidance of hospitalization
Day-patient treatment may be appropriate when outpatient treatment is impossible, has been only partially or unsuccessful, despite inpatient treatment being deemed unnecessary. This group may include children with emotional disturbance, hyperkinetic disorder, minimal brain dysfunction and severe specific learning disorders (such as dyslexia and dyscalculia). Day-patient treatment is particularly recommended when children are at risk of developmental disturbance or difficulties at school or work where the family is unable to provide sufficient support.
Curtailment of inpatient treatment
Day-patient treatment should be considered as a secondary treatment step in children who initially required inpatient treatment. Earlier discharge is often possible provided subsequent day-patient facilities are available, e.g. in psychosis, organic behavioural disorder due to brain dysfunction, anorexia nervosa. Day-patient treatment may also be appropriate in the process of gradual reintegration into the family and school or work.
Refusal of inpatient treatment
In some cases, inpatient treatment may be considered advisable, but is refused by the patient or his parents. In such cases day-patient treatment may be an acceptable option.
34 - Home treatment
- Edited by Helmut Remschmidt, Philipps-Universität Marburg, Germany
- Translated by Peter Matthias Wehmeier, Helen Crimlisk
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- Book:
- Psychotherapy with Children and Adolescents
- Published online:
- 17 May 2010
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- 16 August 2001, pp 568-576
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Summary
Definition and concept
Home treatment involves therapeutic work with children, adolescents and families in their own familiar environment. Treatment may be undertaken in a natural, foster or adoptive family, residential home or group, or other institution which cares for children and adolescents. The term ‘home treatment’ does not imply any specific therapeutic approach, but may include a variety of techniques combined in a treatment plan. In practice, behavioural therapy and parent training are the most frequently used methods in home treatment. It is possible, however, to utilize other treatment methods in certain circumstances, if there is a more appropriate method for the disorder, symptoms are not severe, and there is sufficient motivation and support present.
Home treatment is based on the following general principles.
(i) The place in which treatment is undertaken is the patient's usual environment. Both diagnostic assessment and therapy are undertaken in the patient's home.
(ii) Sessions are undertaken by one or more therapists who visit the patient regularly. These include specific interventions involving the patient and his parents.
(iii) The patient's parents or care-givers often act as co-therapists. It is therefore essential that they are well informed and receive appropriate support from the therapist.
(iv) The course and improvement of symptoms in the patient and his family will usually be empirically evaluated. Standardized tests, questionnaires and specific problem-orientated notes can be very helpful.
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13 - Parent training
- Edited by Helmut Remschmidt, Philipps-Universität Marburg, Germany
- Translated by Peter Matthias Wehmeier, Helen Crimlisk
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- Book:
- Psychotherapy with Children and Adolescents
- Published online:
- 17 May 2010
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- 16 August 2001, pp 212-233
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Summary
Parent training is a specific and systematic approach to cooperating with parents. Cooperation with parents is an essential part of treatment in child and adolescent psychiatry and should not be neglected (Briesmeister and Schaefer, 1998).
Parent training requires a positive therapeutic attitude. It has been shown that psychotherapy is most effective when the family's psychosocial situation is promising and the family is willing to support treatment (Mattejat and Remschmidt, 1991).
A normal family is a protective factor for a child's psychological development. This beneficial effect can be used to support therapy. However, parents also bear the responsibility of directing treatment when problems arise. As long as the child lives in a family, the family will influence the child's development to a greater extent than any other care-givers or educators. Parents are an integral part of a child's environment, and changes in parental behaviour have a significant influence on the way the child experiences his environment.
Parents who are concerned about abnormal behaviour in their child will usually seek professional help. Simultaneously, parents will be grateful if their competence as parents is acknowledged by professionals. As professionals, we usually rely on parents' competence in child-raising and request their cooperation when we undertake psychotherapy. Studies looking at parent training have shown that many parents are able to acquire some psychotherapeutic techniques and use them effectively to support their child's development (Innerhofer, 1977; Warnke and Innerhofer, 1978; Briesmeister and Schaefer, 1998).
The interaction between the therapist and parents should be considerate, tolerant, empathic, supportive and without reproach. The family's need for help may be understood as an opportunity to give up outdated and superfluous values and attitudes in order to improve outlook on life, develop new interests, aims, skills and options.