Childhood Developmental Disorders Flashcards
Learning Objectives:
- awareness of social learning theory and attachment theory and how it relates to assessment and formulation of a child’s mental health.
- understand some of the complexities of applying different psychological theories to children and adolescents
- have knowledge about how a clinical psychologist
- makes an assessment (using theories and aetiology)
- understands childhood mental health disorders (formulation/diagnosis) using a biopsychosocial model
Background to childhood developmental disorders…
Albert Einstein
“Everybody is a genius, but if you judge a fish by its ability to climb a tree, it will live its whole life believing it is stupid”
What you believe about what a child’s ability defines where they can get to, sets an abstract ceiling to what their abilities are (for themselves and their teachers)
When thinking about child development and who a person is, it really comes down to what you are measuring and what the criteria is
Need to understand child behaviour in the context of development…
- if the behaviour causes harm
- deprivation of benefit
- results from the failure of an internal mechanism
… then it is of concern
Prevalence Rates of Childhood Developmental Disorders
–> WHO (2003) 20% of adolescence may experience a mental health problem in any given year
–> Kessler et al (2005) 50% of mental health problems are established by age 14 and 75% by age 24
–> Children’s Society (2008) 10% of children and young people (aged 5-16) have a clinically diagnosable mental health problem, yet 70% of children and adolescents who experience mental health problems have not had appropriate interventions at a sufficiently early age
Factors that Complicate Diagnosis and Assessment of Prevalence
- Research
- Research into children not as extensive as research in adults (ethics, hard to recruit, cultural beliefs at the time that children don’t get mental health problems, often only short-term funding, rely on parents/carers to bring children to services, reliant on gathering data from a population that is hard to capture) - Genetics and environment
- These factors determine how our brains develop, epigenesis (change in genetic expression as a result of environmental influences) also causes further individual differences within development - Limited language expression
- e.g. in ASD, rely on observations to determine whether someone is developing typically - Diagnosis is dependent on individual being able to communicate with practitioner and articulate how they experience the distress their problem is causing them
- (children are often not the person highlighting the problem, rely on adults to help them spot things that are difficult, children can say they are fine and to leave them alone) - Children may lack self-knowledge
- might be unable to understand what they’re feeling, often struggle to differentiate feelings of anxiety from feelings of depression - Diagnostic criteria changes
- how static are these particular developmental difficulties in the first place if they get revised so much and new ones added? e.g. Asbergers syndrome is no longer a recognised diagnosis - been absorbed into the wider spectrum, may cause issues in conceptions of conditions - Have to consider what is normal for a particular age when considering what might be clinically relevant behaviour
- (bed wetting past 5 years old may be symptom of psychological distress, but before 5 this is quite common)
Common Developmental Issues in Children
- -> Externalising Disorders
- outward directed behavioural problems
- characterized by impulsivity, disruptiveness and poorly controlled behaviour, include ADHD and CD
- more common in early-middle childhood
- expect children of certain ages to have poor self-control, to throw temper tantrums or disrupt ongoing activities by filing to show restraint, by school age this usually changes, if not may indicate ADHD or CD
- Egger et al (2006) 5% of school-age children are estimated to be diagnosed with ADHD
- Dodge (1991) suggests individuals with CD develop an information processing bias, interpret benign actions of others as hostile
- -> Internalising Disorders
- inward directed problems
- include anxiety and depression
- more common in childhood-adolescence
- often see anxiety in young children i.e. when first starting school (separation anxiety) can be healthy, more important to consider the functioning and whether or not it impairs the child, in which case it would be a disorder and may serve as the basis for future anxiety conditions
- most common obsession themes in OCD in children are contamination, asymmetry and exactness
In reality the two are much more intertwined, often behaviour is a communication of how we are feeling internally
–> Manassis & Monga (2001) Anxiety and depression are often comorbid in childhood
–> Muris et al (1998) What a child worries about is determined by their age, number of worries increase with age
Risk vs Resilience
What makes one person more vulnerable and another person more resilient?
–> Genetics (family history of anxiety or depression) – are more at risk but can be resilient if they don’t have the same level of deterioration in mental health
–> Dispositional – Self consciousness, self-esteem
–> Cognitive- depressive negative cognitions, depressive attributional style
–> Emotion regulation (catastrophising, upset very easily, more difficult to regulate and handle mental health difficulties)
–> Attachment (secure = good IWM of working relationships, acts as a buffer against other stress or environmental things)
–> Parenting style (authoritarian) – parents may be detached, rejecting, overly controlling, overprotective or demanding, each of these may cause anxiety and maladjustment in the child (Rapee, 1997)
–> Family resources and poverty
–> Domestic violence, children exposed to domestic violence (listening, watching or victim) have an almost 50% risk of accompanying mental health needs Young children are frightened, worried for parents, don’t want to leave parent on their own if they are at risk of abuse, feel they need to help them out, may also have issue of missing information as parent may not wish to disclose abuse to clinician
–> Trauma – significant risk factor, events can trigger bouts of anxiety and distress
–> Stress – Major life events, chronic illness e.g. asthma or eczema reduce quality of life and increase childhood anxiety
…These individually do not necessarily make a young person have mental health difficulties, but if you stack them up its accumulative, the more difficulties in any of these areas the more likely they are to struggle
Childhood Psychopathology as the Precursor for Adult Psychopathology
- Childhood disorder may persist into adulthood in the same form
- Childhood psychopathology may have an adverse effect on subsequent development and indirectly lead to different forms of maladjustment in later life or render the individual vulnerable to life stressors
- Childhood trauma and abuse can affect childhood but may also serve as the basis for the development of long-term psychological maladjustment (major depression, personality disorders, somatic disorders, dissociative disorders, ED and sexual and gender disorders)
–> Childhood psychopathology will have an important influence on adult mental health, but the nature of this influence is not always direct and not always in the same form as the childhood difficulties
Theoretical Approaches to Explaining Childhood Developmental Disorders
Main focus is on cognitive factors and early parent-child interactions
–> Cognitive
Information processing styles, misunderstandings that can happen in cognitive processing
–> Behavioural
Behaviourism:
- classical and operant conditioning
- positive reinforcement model, as you get older you start to think more for yourself, has less of an impact
- -> Skinner
- Human behaviour is much more complex (than animal behaviour), learning does not necessarily lead to a change in behaviour, cognitive theorists state behavioural theory doesn’t account for attention adequately enough, humanists argue behavioural theory doesn’t account for free will and internal influences (mood, thoughts, feelings)
Behaviourism:
Social Learning Theory
- -> Bandura
- direct reinforcement cannot account for all types of learning, theory adds social element arguing that people can learn information and behaviours by watching others and imitating them Modelling Children learn from their role models behaviour (often parents but also other children) and things they see and watch around them, may explain why children of parents with anxiety are 7x more likely to develop anxiety disorders themselves
SLT + Behavioural Combined
Operant conditioning tells us that if a behaviour is reinforced it is more likely to occur again
SLT tells us that children learn how to behave in some situations by modelling their caregivers
The combination of these principles in action can explain why some children develop behaviours and problems
Attachment Theory:
- Winnicott
- Bowlby (innate need, buffer, IWM)
- Attachment styles
- Imp. to remember
Winnicott –> Found children who remained in the cities with their loved ones, despite being threatened with bombs on a daily basis, fared better than the children who were moved to the safety of the countryside away from their loved ones - proximity of loved one was more important than their physical safety in terms of mental well-being
Bowlby (1969) –>
- suggests an innate need to form attachment bonds, attachment develops through turn taking (serve and return), attachment behaviours serve to keep caregiver close – improves child’s chances of survival, lasting psychological connectedness, need to have an understanding of a healthy relationship when you’re younger in order to have one in later life
- secure attachment and emotional reciprocity = psychological buffer (foundation to emotional development and understanding of relationships), been shown to have better health outcomes later in life such as improved emotion regulation skills, greater capacity for empathy and for turn-taking
> Importance of IWM
Produces child’s expectations of self and others, guides behaviour, relationships and emotional development (template)
- important to remember in practice we can have several attachment styles depending on the caregiver in question (anxious with one parent but secure with another)
Attachment styles: Ainsworth (1970)
Secure, Ambivalent, Avoidant Main
& Solomon (1990) Disorganised
Attachment styles are just categories, nobody falls very neatly into one or the other, can be insecure and be pulled out i.e. as a result of moving house and not knowing anybody, are all on a bit of a spectrum and the IWM as a template is not a definite predictor (deterministic to suggest it is)
Attachment Theory:
Secure attachment cycle
Baby rests - experiences discomfort or need - protests (e.g. crying) - mother responds and soothes - baby develops trust - baby plays and interacts with mother…
Cycle happens thousands of times, develops a set way of
thinking about the world
In the case of neglect the cycle is interrupted, don’t get behavioural reinforcement that when they cry somebody
comes, or when they do they shout at them, physiology gets changed, calming effect and trust does not happen
A secure attachment and emotional reciprocity from the caregiver have been shown to have better health outcomes later in life, such as improved emotion regulation skills, greater capacity for empathy and for turn taking
Theoretical Integration
Haven’t found a single theory that can identify what’s really going on
- child psychopathology goes beyond the emphasis of each single-cause theory
- need an inter-disciplinary understanding (biopsychosocial) is required, need to look at different areas of a child’s life
Need to take a developmental perspective, need to look at
- endogenous (genetics/temperament style of the child)
- and exogenous factors (environmental e.g. SES, bereavement, witnessed violence, racial discrimination, traumatic experiences)
…to try and make sense of the ‘whole child’
e.g. Ask about hobbies etc, e.g. they go to dance every week and have no problems… investigate that… find out more about a variety of factors
Encourage practitioners to take their time, try not to come up with a simple solution, often it’s not the case that one small thing went wrong to cause the issue
Complexity Thinking (or Systems Thinking)
–> Russell L Ackoff
The search for simple – if not simple-minded – solutions to complex problems is a consequence of the inability to deal effectively
Need to take time when working with young people and to look at the different areas
- don’t try come up with a simple solution and blame it on one small thing that went wrong, there is a context
- need to be empathetic so the young person doesn’t feel so much pressure
- need to think about the systems in an individuals life (family, school, society) and
- how adverse life experiences can build up
Also need to acknowledge that life events meaning very little to an adult can be extremely stressful for a child
