Factors thought to maintain children and young people’s mental health problems

From Alan Carr’s Handbook of Child and Adolescent Clinical Psychology (2nd ed) pp. 62-70:

Family system factors

  • Inadvertent reinforcement, e.g., frequently inquiring about mood or commenting on negative conduct
  • Insecure attachment, whereby children don’t experience carers as a secure base
  • Coercive interaction, e.g., escalating negative interaction leading to withdrawal and relief, reinforcing behaviour just before relief
  • Over-involvement, parental criticism and emotional over-involvement
  • Disengagement, low frequency carer-child interaction
  • Inconsistent parental discipline, leading to problems internalising rules
  • Confused communication, e.g., indirect rather than direct communication
  • Triangulation (not always negative), e.g., a “coalition” where one carer is peripheral
  • Chaotic organisation
  • Absent carer
  • Carer relationship discord

Parental factors

  • Parents with similar problems as child act as a role model maintaining the behaviour
  • Resources for parenting compromised by mental health issues or criminality
  • Misinterpreted crying (interpreted as intentionally punishing carer)
  • Low self esteem
  • External locus of control
  • “Immature defences”
  • Unemployment (failure to meet financial needs; impact on status)
  • Boredom in work
  • Excessive stress in work
  • Role strain with parallel “homemaking” and working

Social network factors

  • Lack of social support, e.g., lack of positive interactions with extended family/friends
  • Chronic life stress
  • Unsuitable education placement, e.g., understaffed schools
  • “Deviant” peer-group e.g., peers using drugs
  • Community problems, e.g., social disadvantage, racism, social exclusion, high crime rates

Problem maintaining treatment system factors

  • Family members’ denial of problems
  • Poor working alliance with clinicians
  • Rejection of formulation and/or treatment plan
  • Failure of communication between MDT members
  • Failure of inter-agency network
  • Conflicting formulations in multidisciplinary team and inter-agency work
  • Culturally insensitive clinicians

Also flip side of these, protective factors, such as good physical health, high intellectual ability, high self-esteem, humour, positive engagement with treatment agencies, protective peer group, …

More on “context aware” systems

Erickson (2002) argues that “context awareness” is motivated by a desire for systems to take action, autonomously, leaving us out of the loop. The ability to do so accurately requires a lot of intelligence to draw inferences from the available sensors.  Erickson reckons the project is doomed to failure. However, he thinks we might make some progress if humans are brought back into the loop and given the contextual data in rawer form so they can interpret it and take appropriate action themselves. Not sure. The example he gives can easily be modified to reveal potentially damaging information about a user’s whereabouts and actions:

“Lee has been motionless in a dim place with high ambient sound for the last 45 minutes. Continue with call or leave a message.”

Reminds me of the impressive-looking thesis by Nora Balfe (2010) on a safety critical railway signalling systems.  For instance from the conclusions:

“Feedback from [the system] was … found to be very poor, resulting in low understanding and low predictability of the automation. As signallers cannot predict what the automation will do in all situations they do not feel they can trust it to set routes and frequently step in to ensure trains are routed in the correct order. In the observation study, the differences found between high and low interveners in terms of feedback, understanding and predictability confirm the importance of good mental models in the development and calibration of trust…”


Balfe, N.(2010) Appropriate automation of rail signalling systems: a human factors study. PhD thesis, University of Nottingham.

Erickson, T. (2002). Some problems with the notion of context-aware computing: Ask not for whom the cell phone tolls. Communications of the ACM, 45(2), 102-104.

Some problems with context awareness

Nice list of examples of past problems, from Erickson (2002):

  • Spying a newsrack, Tom pulls his rented car to the side of the street and hops out to grab a paper. The car, recognizing the door has just closed and the engine is running, locks its doors.
  • In the midst of her finely honed closing pitch, Susan’s prospective clients watch intently as her screensaver kicks in and the carefully crafted text of her slide slowly morphs into flowing abstract shapes that gradually dissolve into blackness.
  • “What a cretin,” Roger mutters as the CEO finishes his presentation, unaware, for the moment, that the high-tech speaker phone in the table’s center has triangulated on his whisper and upped its gain to broadcast his remark to the meeting’s remote audience.


Thomas Erickson (2002). Some problems with the notion of context-aware computing: Ask not for whom the cell phone tolls. Communications of the ACM, 45(2), 102-104.