Jean Mercer

Physiological correlates of painful stimulation in preterm infants

Objective:The study investigates the physiological responses of preterm infants to procedures that are routinely performed in intensive care nurseries. Changes in heart rate, respiration rate, and oxygen saturation were examined as indicators of the level of discomfort experienced by the infants during the procedures. Design:Clinical descriptive. Systematic observations of the infants were conducted during periods of rest as well as during routine interventions. Setting:All observations were recorded from monitored preterm infants in the intensive care units of two urban hospitals. Patients:Thirty-five preterm infants 24–30 weeks gestational age and weighing <2,000 g at birth. Data were collected from all infants in the units who met the weight criterion. Interventions:The researchers observed the infants while the intensive care nursery staff were performing routine care procedures. Observations were made during procedures that adults would consider to be painful, such as injection, heel stick, tape removal, and squeezing of the heel to induce blood flow after heel stick, as well as nonpainful procedures, such as handling, temperature taking, alcohol swabbing, patting, taping a tube, feeding, and placing a pacifier. Main Outcome Measures:Heart rate, respiration rate, and oxygen saturation were recorded from infant monitors. Mean values of the three measures during procedures were compared with mean values before and after procedures. Results:Significant differences (p <0.001) were found among pre-, peri-, and postprocedures for all three outcome measures. Heart rate and respiration rate means were significantly (p < 0.001) higher during procedures that adults consider to be painful than in those regarded as nonpainful. Oxygen saturation was lower (p <0.001) for painful procedures thatn for nonpainful procedures. Gender and infant size comparisons yielded inconclusive results. Conclusion:The outcome measures appear to be reliable indices of preterm infant responses to painful stimulation.

Holding Therapy and Dyadic Developmental Psychotherapy Are Not Supported and Acceptable Social Work Interventions: A Systematic Research Synthesis Revisited

This article re-examines material discussed in a recent systematic research synthesis by Craven and Lee. The authors find that two of the interventions for foster children discussed by Craven and Lee were erroneously classified as supported by evidence of efficacy, and one, holding therapy, is shown to be potentially physically harmful to children. Detailed evidence is offered to show that holding therapy and dyadic developmental psychotherapy are not appropriately categorized as supported and acceptable interventions.

Deliverance, demonic possession, and mental illness: some considerations for mental health professionals

This paper outlines an unconventional treatment for mental illness, the exorcism or deliverance ritual used by Pentecostals and some other charismatic Christians. Deliverance beliefs and practices are based on the assumption that both mental and physical ills result from possession of the sufferer by demons, and are to be treated by the expulsion of those demons. Deliverance practitioners claim to treat schizophrenia, ADHD, and Reactive Attachment Disorder, and believe that these problems are related to sins either of the person in treatment or of an ancestor. Clinicians and counsellors dealing with clients who partially or completely espouse deliverance beliefs may need to understand their worldviews and to discuss their belief system before managing to engage them in conventional mental health treatments. Unusual ethical problems may also be met in the course of such work.

Examining Circle of Security™ A Review of Research and Theory

The Circle of Security™ interventions are psychosocial treatments intended to increase maternal sensitivity and thus child attachment security in infants and young children. A small number of publications have reported empirical research on outcomes of these treatments. This article reviews the research evidence, plausibility, theoretical background, and generalizability of Circle of Security, and concludes that these interventions are plausible emerging treatments, presently weakly supported by research evidence, but potentially able to receive support from further research. The commercialization of Circle of Security is discussed as a possible obstacle to independent research. The current level of research support is described as similar to support for other interventions for young children.

Examining Dyadic Developmental Psychotherapy as a Treatment for Adopted and Foster Children: A Review of Research and Theory

Dyadic developmental psychotherapy (DDP) is a mental health intervention intended primarily for children with problematic attachment histories. It has received increased attention in the United Kingdom and the United States in the last few years. DDP has been publicized as a research-supported treatment, but a review of research shows that it does not meet ordinary standards for this category. In addition, DDP appears to be based on a number of questionable metaphors that have been used in attempted explanations of personality development and mental illness. Some unanswered questions about the background assumptions of DDP are presented. Caution about this method of therapy is recommended.

Child Psychotherapy Involving Physical Restraint: Techniques Used in Four Approaches

This paper describes four forms of child psychotherapy that are unusual in their use of physical restraint as a therapeutic technique rather than simply as a safety procedure. Detailed information about these approaches was derived from published material, from training and parent education videotapes, and in one case from testimony in the trial of two practitioners following the death of a child during restraint. Caution in referring families to these types of therapies is advised, and it is suggested that parent education is important when families learn of restraint-oriented treatments through the Internet.

Examining DIR/Floortime™ as a Treatment for Children With Autism Spectrum Disorders: A Review of Research and Theory

Purpose: To review and assess theory and research supporting DIR/Floortime™, a method proposed for treatment of young children with autism spectrum disorders (ASD). Methods: Published materials describing the principles of DIR/Floortime™ were evaluated. Published outcome research articles were assessed for the adequacy of their design and implementation and the extent to which their conclusions were supported. Results: The theoretical basis of DIR/Floortime™ appears to be generally plausible. Of the 10 outcome research articles in print, all concluding that DIR™ effectively treated ASD, five provided a comparison group, or used a randomized design, or did both. These studies failed to equalize the duration and frequency of DIR™ and the comparison treatment. Conclusions: DIR™ can be considered by social work practitioners as a possibility for evidence-based practice (EBP), but not as an evidence-based treatment (EBT). Further outcome research needs to concentrate not only on randomized design but on other design issues.

International Concerns About Holding Therapy

Holding therapy (HT), an alternative intervention for treatment of childhood mental illness, uses physical restraint as a treatment mode, not just as a safety measure. Although one systematic research synthesis (Craven & Lee, 2006) categorized HT as an effective and supported social work intervention, analysis by other authors (Lilienfeld, 2007; Mercer & Pignotti, 2007; Pignotti & Mercer, 2007) contradicted this view and assessed HT as a potentially harmful treatment as well as one unsupported by evidence of effectiveness. A recent review of research in German as well as English has confirmed the latter conclusion (Mercer, 2013). Documentaries and training videos demonstrating HT have shown children screaming, crying, and physically resisting experiences that appear to be painful and frightening. A personal communication from a young woman who experienced HT as a child noted the dread she experienced as she heard other children scream; as an adult, she was treated for an anxiety disorder that was thought to be related to her HT experience. Robert Zaslow, the originator of HT practices, warned that bruising was to be expected (Zaslow & Menta, 1975), and surrendered his professional license following a serious injury to an adult patient. HT exists in two distinct forms. One, sometimes referred to as Attachment therapy (AT) or by other terms, involves uncomfortable physical restraint by several therapists or by parents, and employs adjuvant methods such as limiting of diet and toilet use. This method, HT/AT, has been associated with a number of child deaths (Mercer, Sarner, & Rosa, 2003). It was once used for treatment of autism (Zaslow & Menta, 1975), but more recently is generally used as a treatment for reactive attachment disorder. The second HT form is carried out by parents with the coaching of therapists, and employs face-toface restraint of children by parents, either with a small child on the parent’s lap or with the parent lying prone on a supine older child. This method may be called HT/WP, as it is based on the techniques of Martha Welch (Welch, 1989; Welch et al., 2006) and Jirina Prekopova (Prekop, 1983 [Prekopova is the feminine form of the name, as used in Czech]). HT/WP is intended for treatment of autism, oppositional behavior, and reactive attachment disorder. It does not appear to have been associated with adjuvant methods or with child deaths. HT in both forms appears to have originated in the United States but has spread internationally as a treatment for autism and for attachment disorders. In response to the spread of HT, concerned individuals from the United States, the United Kingdom, the Czech Republic, and Russia have formed the International Working Group on Abuses in Child Psychotherapy with the goal of public and professional education about HT and prevention of its use. The group met in London on April 20, 2013. The present article summarizes background information and the presentations made at the conference, which without exception argued against the use of HT.

Holding therapy in Britain: historical background, recent events, and ethical concerns

Holding therapy, an intervention often used in the treatment of foster and adopted children, has been rejected by professional groups on grounds of lack of evidentiary support and of potential harmfulness. Nevertheless, some British proponents have continued to advocate its use. Is this support brought about by the familiarity of concepts used in this treatment? This article reviews the history of related concepts and methods in Britain. It is concluded that a long history of British involvement with related ideas may have encouraged approval of holding therapy, but that ethical concerns argue against its use.

Variables Affecting Time Between Childbirth and the Establishment of Lactation

The relationship between attitudinal and experiental factors and lactation was investigated. A nurse interviewed 100 white mothers ranging in age from 19-37 soon after the births of their children. The questionnaire inquired into each mothers parity experience with breastfeeding time in labor physical and emotional complications during and after delivery preparation for childbirth and desire to breastfeed immediately after delivery. The mean number of days reported between birth and the beginning of lactation was 3.14 with a standard deviation of 1.06. The timing of the 1st breastfeeding experience had a strong relationship to the length of time which passed between birth and lactation. The 20 mothers who began to breastfeed soon after birth lactated earlier than those mothers who did not nurse the infant until later. The 37 mothers who received no drugs lactated earlier than those who were medicated. None of the other factors studied was significantly related to the interval between birth and lactation.