Ch 17 Clinical Child/Adolescent Psychology Flashcards
Clinical Child Psychology
an area of specialization within clinical psychology focusing on issues of children
pediatric psychology
a speciality area within clinical child psychology focusing on the mental and physical health of children with medical conditions
Disorders of Childhood
common among children - ADHD, conduct disorder, oppositional disorder, and separation anxiety disorder
some may be diagnosed with disorders that are more common in adults - depression, PTSD, eating disorders, etc - but diagnofstic criterial are adjusted
children’s psychological problems are divided into two broad classed
- externalizing disorders
2. internalizing disorders
externalizing disorders
when a child “acts out” and often becomes disruptive
- e.g. ADHD, conduct disorders, and oppositional defiant disorders
internalizing disorders
often less noticeable such as maladaptive thoughts and feelings
- e.g. depression and anxiety
why do some children develop psychological disorders and some don’t?
resilience and vulnerability
- children from similar environment and experiences have very different kinds or degrees of psychological or behavior problems
resilience
in psychodynamic psychotherapy, client behavior that impedes discussion or conscious awareness of selected topics or emotions
vulnerability
in contrast to resilience, the tendency to experience psychological problems in the presence of risk factors
risk factors that contribute to a child’s vulnerability
- environmental factors
- parental factors
- child (internal) factors
environment factors
poverty, serious emotional conflict among parents, single parenthood, and excessive number of children in the home, neighborhood or community factors, and poor schooling
parental factors
poor parental physical/mental health, low parent IQ, and hypercritical tendencies in the parents
- the more psychological problems parents have, the more psychological problems their children are likely to have
- siblings relationship also have an impact
child (internal) factors
medial problems, difficult temperament, low IQ, poor academic achievement, and social skills deficits
risk factors that contribute to a child’s resilience
- external support
- inner strengths
- interpersonal problem-solving skills
- interventions by clinical child psychologists can enhance these factors, effectively making child more resilient to current/future stressors
external support
“I Have”
- people in my family I can trust and who love me
- people outside my family I can trust
- limits to my behaviors
inner strength
“I Am”
- a person most people like
- generally a good boy/girl
- an achiever who plans for the future
interpersonal and problem solving skills
“I Can”
- generate new ideas or new ways to do things
- work hard at something until it is finished
- see the humor in life
it matters whether children believe they can change their personality traits – IMPLICIT THEORY
whether characteristics are fixed or malleable
Fixed (Entity Theory)
- “I am shy, and there’s nothing I can do about it”
- most likely to lead to mental health props (meta-analysis of 7 studies found that kids 4-19 yo had more frequent and more severe psychological diagnoses, both internalizing and externalizing, if they held a fixed/entity theory about themselves
Malleable (Incremental Theory)
- “I am shy, but I can overcome it”
developmental perspective
an essential aspect of clinical child psychology whereby clinicians understand the child’s behavior within the context of the child’s developing stage
- problems of childhood may take on different meanings and call for different clinical interventions depending on their commonality for children at a given age
- e.g. child smoking at 7 vs 17 yield for different severity of problem
a comprehensive assessment
assessment of a child must consider:
- the presenting problem
- development
- parents/family
- environment
the presenting problem
what exactly is the problem and is the problem recognized by all parties?
development
what is the child’s current state of physical, cognitive, linguistic, and social development? any abnormalities?
parents/family
what are the relevant characteristics of the child’s parent or parents? what style of parenting is used?
environment
what is the child’s larger environment outside of the family? any recent major events that may factor into current problems?
clinical child psychologist may receive different answers to these questions from different people in the child’s life, therefore, it is important to rely on more than one source of info when assessing a child
through
- multisource
- multimethod
- multisetting approach
multisource assessment
involves parties such as parents, relatives, teachers, other school’s personnel, and child
- relying on one source risk a one-sided/incomplete perspective of the problem
multimetod assessment
involves the use of different methods of data collection such as interviews, pencil-and-paper instruments completed by the child/those who knows the child well, direct observations, etc
multisetting assessment
acknowledges that sometimes children’s problems pervade all facets of their lives, but sometimes are specific to certain situations
- wise to solicit data from home, school, clinician’s office, and other relevant settings
assessment methods
- interviews
- behavioral observations
- behavior rating scales
- self-report scales
- projective/expressive techniques
- intellectual tests
assessment methods: interviews
- interview the child as well as those who know the child well (informants)
- est rapport is vital: helps gain trust
assessment methods: behavioral observations
- the direct, systematic observation of a client’s behavior in the natural environment; also known as naturalistic observation
- can involves reactivity (a problem whereby the client’s behavior may change simply bc of his or her awareness of the presence of the observer)
- strong reactivity may lead to invalid data
- analogue direct observation: takes place in a clinic room where the real-world situation in which the problem behavior arises
assessment methods: behavior rating scales
- standardized forms that parents, teachers, or other adults complete regarding the cild’s presenting problems
- consists of a list of behaviors, each of which is followed by a range of responses from which the respondents chooses the one most applicable to the child
- advantages: convenience, inexpensiveness, and objectivity
- disadvantages: restrict respondent from elaborating on responses and the possibility that the scale items do not adequately capture the cild’s problem behavior
assessment methods: self-report scales
- assessment techniques that are completed directly by the client, assumes that client’s reading level, attention span, and motivation to complete the test is approperiate
- commonly used in adolescent than in younger children
- scale is similar to that of adults (e.g. MMPI, MCMI)
assessment methods: projective/expressive techniques
- e.g. Rorschach Inkblot Method, sentence-completion, etc
Projective
- TAT: thematic apperception test, storytelling test ft animals rather than human characters, where young children tells a story
- TEMAS: tell-me-a-story, designed as a culturally sensitive alternative to the TAT
Expressive
- responds with drawing
assessment methods: intellectual tests
IQ tests and achievement tests assess intellectual functioning
- e.g. WISC-IV: Wechsler Intelligence Scale for Children
frequency / use of specific assessment techniques
- interviews very common
- with younger children, behavior rating scales completed by adults are more common
- with older children, self-report measures are more common
- WISC is most common across children and adolescents
psychotherapy with children and adolescents
- therapy for children/adols may look/sond different than adults but techniques used are often of the same underlying theories
- children should not be mistaken for miniature adults
- necessary to adjusts therapy for children
- cannot think that children are there willingly, that they want to change, etc
- children come to therapy with informants
- build therapeutic alliance with both child and parents
cognitive-behavior therapies for children (CBT)
- represent movement toward evidence-based treatment
- CBT found beneficial for variety of disorders incl depressing and ADHD
- but also strongly supported for anxiety disorders
- along with OCD, panic disorders, phobia, etc
delivery methods
- Bravery Bingo: exposure exercise - phobic child earns a token to be placed not the Bingo board for each successful exposure on the anxiety hierarchy
- Mr. OCD: practice externalized OCD - kids practice cognitive restructuring by refuting a puppet (Mr. OCD) who exhibits flawed logic (monster’s gonna get you tonight) by offering more sound logical statement (monster never gotten you before so he’s not going to tonight either)
- Coping cat: learns coping skills; externalizing anxiety - giving it a name to separate it from self
two specific forms of treatment lean towards behavioral side of CBT
- social skills training
- applied behavior analysis (ABA)
social skills training
therapists teach kids behaviors that improve interactions with others
- e.g. how to start a conversation, how to join other kids who are already interacting, etc
applied behavior analysis (ABA)
relies on operant condition principles like reinforcement, punishment, shaping, and extinction
ABA therapist helps a child identify and define specific behavior to target
- goal is to increase (positive) behavior or decrease (negative) behavior
self-instructional training
- developed by Donald Meichenbaum
- originally for impulsive and disruptive children to control behavior
- form of cognitive therapy in which children are taught to “talk through” situations in which their behavior might be problematic to increase the likelihood that they will use a preferred behavior instead
- sequence of steps by which children hear instructions aloud and gradually incorporate those instructions into their own thinking
- “designed to nurture a problem-solving attitude and to engender specific cognitive strategies that clients can use at various phases of their stress response
parent training
form of behavioral therapy in which therapists teach parents to use techniques based on conditioning to modify problematic behavior in their children
- utilizes parents as the primary agents of change for their children // parents are the most influential in their kids success
- typically includes education of parents, behavioral definition of problem, functional analysis, contingency management, and other essential comments of behavioral therapy
play therapy
- typically used with younger children (preschool or elementary school age)
- allows children to communicate via actions with objects such as dollhouses, action figures, and toy animals rather than words to reveal their emotional concerns and attempts to solve them
- be culturally sensitive
play therapy has 3 functions (Brems, 2008)
- the formation of important relationships
- disclosure of feelings and thoughts
- healing
the formation of important relationships
forming a therapeutic alliance with child
i.e. therapeutic relationship
disclosure of feelings and thoughts
kids acting out feelings/thoughts
i.e. expressing emotions, acting out anxieties
healing
build coping skills
i.e. acquiring coping skills, experimenting with new behaviors
play therapy: psychodynamic theory
- a form of psychotherapy with children in which a child’s play symbolically communicates important unconscious processes occurring within the child’s mind
- therapist acts as both the participant and observer
- goal: make the unconscious conscious
- unconscious is conveyed through play, and it’s the therapist’s job to infer these unconscious issues and make the child more consciously aware of them
- making unconscious conscious
play therapy: humanistic theory (“child-centered” play theory)
- a form of psychotherapy with children emphasizing reflection of feelings int he context of a genuinely emphatic and unconditionally accepting therapeutic relationship to facilitate self-actualization
- involves the same activities as psychodynamic play therapy
- goal: reflect on child’s feelings which may be expressed indirectly through play activities
- facilitate self-actualization
- reflect on feelings
How well dos psychotherapy for children and adolescents work?
- in general, psychotherapy for children and adolescents is quite efficacious/successful
- 60-65% of kids with CBT treatment no longer need/have psych problems
- most meta-analyses find various approaches to be equally effective
- cognitive-behavioral approaches slightly more efficacious
- some specific therapies (cognitive-behav) have been found efficacious with specific disorders (e.g. externalizing disorders, anxiety disorders, depression, etc)
