Edgardo Menvielle

A feeding scale for research and clinical practice to assess mother—infant interactions in the first three years of life

The Feeding Scale provides a reliable rating of mother-infant/toddler interactions during a 20-minute feeding in a laboratory setting. The scale consists of 46 mother and infant behaviors, which are rated at the end of the feeding session. Observations of mother—infant interactions during two feedings separated by 2 weeks showed considerable stability. Five subscale scores are derived (1) Dyadic Reciprocity, (2) Dyadic Conflict, (3) Talk and Distraction, (4) Struggle for Control, and (5) Maternal Non-Contingency, Predictive validity of the Feeding Scale has been demonstrated and it discriminates between infants with and without feeding disorders as well as three diagnostic categories of feeding-disordered infants. The Feeding Scale can be used with infants and toddlers ranging in age from 1 month to 3 years.

An Affirmative Intervention for Families With Gender Variant Children: Parental Ratings of Child Mental Health and Gender

This is a report on parents who have children who exhibit gender variant behaviors and who contacted an affirmative program in the United States for assistance. All parents completed the Child Behavior Checklist, the Gender Identity Questionnaire, and the Genderism and Transphobia Scale, as well as telephone interviews. The parents reported comparatively low levels of genderism and transphobia. When compared to children at other gender identity clinics in Canada and The Netherlands, parents rated their childrens gender variance as no less extreme, but their children were overall less pathological. Indeed, none of the measures in this study could predict parents’ ratings of their childs pathology. These findings support the contention that this affirmative program served children who were no less gender variant than in other programs, but they were overall less distressed.

“You Have to Give Them a Place Where They Feel Protected and Safe and Loved”: The Views of Parents Who Have Gender-Variant Children and Adolescents

This study focused on the experiences of parents of gender-variant children and teens. The goal was to document issues faced by parents of kids with childhood gender-variant behaviors and/or gender-variant identity and to compile their wisdom. Telephone interviews were conducted with 43 parents of 31 youth (all who met the DSM criteria for Gender Identity Disorder) from across the United States. Parents were asked for a history of their childs gender, focusing on their experiences and their thoughts about how to parent gender-variant youth. Parents spoke about their gender beliefs, how they came to accept their child, and the main challenges they faced. The implications of these findings for gender-variant teens are discussed.

A Comprehensive Program for Children with Gender Variant Behaviors and Gender Identity Disorders

This article describes a clinical program designed to address broadly defined mental health needs of children who experience stress related to not fitting into normative gender types and argues for the need for integrated services that address the spectrum of gender variance. An array of services useful to children and their families is proposed. The article describes the clinical population served, common clinical and social problems, and a rationale for the interventions provided.

Randomized Trial of a Case Management Program for Assault-Injured Youth : Impact on Service Utilization and Risk for Reinjury

Objectives: The purposes of this study were to (1) assess receptiveness of families to violence prevention interventions initiated after an assault injury and (2) assess the effectiveness of a case management program on increasing service utilization and reducing risk factors for reinjury among assault-injured youth presenting to the emergency department. Design/Methods: A randomized controlled trial of youth, aged 12 to 17 years, presenting to a large urban hospital with peer assault injury was conducted. Youth and parents were interviewed at baseline and 6 months to measure service utilization, risk behavior, attitudes about violence, mental health, and injury history. Intervention: Intervention families received case management services by telephone or in person during 4 months by a counselor who discussed sequelae of assault injury and assessed family needs and facilitated service use. Controls received a list of community resources. Results: Eighty-eight families were enrolled; 50 (57%) completed both youth and parent follow-up interviews. Intervention and control groups were not significantly different at baseline on demographics, service utilization, and risk factors. Fighting was common in both groups. Most parents and youth identified service needs at baseline, with recreational programs, educational services, mentoring, and counseling as most frequently desired. There was no significant program effect on service utilization or risk factors for injury. Although intervention families were satisfied with case management services, there was no significant increase in service utilization compared with controls. Conclusions: Youth and parents were receptive to this violence prevention intervention initiated after an emergency department visit. This pilot case management program, however, did not increase service utilization or significantly reduce risk factors for injury. More intensive violence prevention strategies are needed to address the needs of assault-injured youths and their families.

Prevention of public health risks linked to bullying: a need for a whole community approach

Bullying is a very toxic psychosocial stressor associated with serious health problems and death, affecting both the victims and the bullies. This form of abuse or maltreatment occurs around the world and along the lifespan. Health professionals have the unique responsibility of promoting the development of community initiatives for the prevention of bullying and related health problems. This effort must include ongoing programs with elements of primary, secondary, and tertiary prevention. These programs should be supported and monitored by a public health policy with a strategy aimed at developing a whole community awareness about bullying and the related health risks, prohibiting bullying, and developing emotionally and physically safe environments in schools and workplace settings. Public health policy should mandate the monitoring, detection, and reporting of bullying incidents; provide guidance for school intervention; and offer guidelines for medical consultation.

Recognition and treatment of mental disorders in children: considerations for pediatric health systems.

General healthcare systems currently play an active role in the identification and treatment of children with mental disorders. As many as one-third of children identified and treated for mental health problems receive outpatient mental healthcare from primary care providers. Although some children do receive treatment, over half of those who need mental health care do not receive this service.Fortunately, current levels of unmet need for adequate care coincide with mounting scientific evidence to support the efficacious use of psychosocial, community-based, and pharmacological interventions. Scientific evidence indicates that the appropriate identification and treatment of mental disorders in childhood can reduce symptoms of child psychopathology, improve adaptive functioning, and sometimes serve as a buffer to further long-term impairment. However, mental health treatment can only be beneficial if it reaches those families in need, is amenable to clinical practice implementation, and is administered with an adequate dose.Future challenges lie in creating practice-relevant efficacious interventions to improve the identification of child mental health needs and to improve access to high quality, appropriate mental healthcare. Primary care settings will play an important role in this activity.Although many barriers exist, pediatric health systems will continue to play an important role in the identification and treatment of mental disorders in children. The quality of current pediatric mental healthcare could be enhanced by increased opportunities for physician training, a restructuring of current training efforts, an increased focus on patient engagement strategies, equitable care incentives and reimbursement, as well as an integrated view of physical and mental health.

Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents

Evidence indicates an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD). The clinical assessment and treatment of adolescents with this co-occurrence is often complex, related to the developmental aspects of ASD. There are no guidelines for clinical care when ASD and GD co-occur; however, there are clinicians and researchers experienced in this co-occurrence. This study develops initial clinical consensus guidelines for the assessment and care of adolescents with co-occurring ASD and GD, from the best clinical practices of current experts in the field. Expert participants were identified through a comprehensive international search process and invited to participate in a two-stage Delphi procedure to form clinical consensus statements. The Delphi Method is a well-studied research methodology for obtaining consensus among experts to define appropriate clinical care. Of 30 potential experts identified, 22 met criteria as expert in co-occurring ASD and GD youth and participated. Textual data divided into the following data nodes: guidelines for assessment; guidelines for treatment; six primary clinical/psychosocial challenges: social functioning, medical treatments and medical safety, risk of victimization/safety, school, and transition to adulthood issues (i.e., employment and romantic relationships). With a cutoff of 75% consensus for inclusion, identified experts produced a set of initial guidelines for clinical care. Primary themes include the importance of assessment for GD in ASD, and vice versa, as well as an extended diagnostic period, often with overlap/blurring of treatment and assessment.

An Affirmative Intervention for Families with Gender-Variant Children: A Process Evaluation

This is a report on a program for parents who have children who exhibit gender-variant behaviors and who contacted an affirmative program in the United States for assistance. All parents completed semi-structured telephone interviews. The data analysis proceeded in two phases, first as a grounded-theory analysis for themes that emerged from the data, and second as an examination of the data in light of the psychology of social exclusion. The results support the contention that parents who develop a supportive stance about their childs gender variance are diverse in their concerns and may or may not start from a position of rejection and attempts at normalization. In order to arrive to acceptance, parents go through a process of reassessment of previously held attitudes or beliefs, and this process is varied. Regardless of initial attitudes, most parents reported significant benefits, both to their self and their child, from their involvement with the program.

Transgender Children: Clinical and Ethical Issues in Prepubertal Presentations

The author, a co-founder and the Director of the Gender & Sexuality Psychosocial Program at Childrens National Medical Center in Washington, D.C., discusses clinical issues and interventions for prepubertal children with atypical gender development. He describes developmental issues related to concepts of gender for preadolescent children. The importance of working within the family system and helping the family to accept their child in order to become advocates for the child are discussed. Finally, some of the complicated issues surrounding the question of whether a child should begin to transition genders prior to reaching puberty are explored.