CYP Flashcards
Developmental expectations and concern areas: Early childhood
Developmental: Attachment, Language/ Communication, Core independence
Concerns: Sleeping/ Feeding/ Toileting Intellectual abilities Speech & Language Social communication
Developmental expectations and concern areas: Middle childhood
Development: Self-control, academic achievement/ learning, peer relationships, rule-governed conduct
Concerns: Conduct/ Oppositional problems ADHD/ Specific Learning Difficulties Anxiety disorders
Developmental expectations and concern areas: Adolescence
Development: Transition to secondary school/ academic learning/
close relationship & friendships/ self-identity/ growing independence
Concerns: Mood related concerns Eating disorder related concerns Addictions Psychosis
‘A problem is a problem’ depending on:
- Developmental and sociocultural norms for child’s age/ developmental stage
- Intensity, frequency, severity, duration/ persistence of difficulties
- Distress to self or others
- Impact/ impairment on functioning or development
Developmental/Child-focused assessment::
- Presenting problem(s) & its history
- Prenatal, perinatal, & early postnatal history
- Medical history
- Developmental milestones
- Personality, social, emotional, behavioral history
- Learning/ Educational/ School history
Family-focused assessment:
Parental history
Siblings
Medical, genetic, developmental, psychological, abuse/ neglect in family
Expectations about assessment/family’s perceptions of child “problems”
Assessment of family roles/ relationships
Genogram
Structure/roles/rules/relationships
Parenting/partner/connections
Life-cycle issues
Assessment exploring broader systems
School/peers
Social network
Services
Culture, religion, neighbourhood
Assessment methods:
interviews
checklists
neuropsychological
Child vs Adult formulation
- Systems’ and social context assessment & integrated systemic formulation essential
- Increased integration of data from multiple informants; more interactional perspectives
- Comprehensive developmental, attachment, medical, social/ interpersonal, educational & cultural history
4P Conceptualization grid
individual (biological) individual (psychological) social (family/firends) social (society/culture)
Predisposing, precipitating, perpetuating, protective
Common fears / anxiety by developmental period:
- Loud noises, separation, strangers
- Dark, animals, separation, imaginary creatures/ monsters, thunder/ lightening
- Dark, animals, separation, imaginary creatures/ monsters, thunder/ lightening
Animals, injuries, natural disasters, supernatural fears, staying alone - Social acceptance/ peer rejection, test/ school performance, death, natural disasters, future
Typical onset of anxiety disorders:
- seperation anxiety, specific phobias
- GAD
- Panic disorder, social anxiety, OCD
When might anxiety be a concern?
NO immediate threat/ danger
Developmentally uncommon
Excessive, intense, persistent, recurrent/ repeated
Interfering with life & developmentally appropriate activities; clinically significant distress; impairs/ disrupts development
Anxiety may also be expressed by:
- Crying
- Tantrums
- Clinging
- Withdrawal
- Irritability/ anger/ “on edge”
- School refusal
- Somatic complaints (sleep, tummy/ headaches, appetite)
- Selective Mutism
Sociocultural considerations in anxiety in CYP
- Higher incidence in girls likely due to genetic vulnerabilities and gender role orientations
- Ethnicity and culture can affect expression, developmental course & interpretation of anxiety
- Cultures that favour inhibition and compliance may heighten stress and fears in CYP
Shared features of anxiety disorders across development in CYP & adults targeted in interventions
Physiological arousal
Hypervigilance to danger
Threat/ worry thoughts; overestimation of danger & its consequences
Avoidance, safety & reassurance-seeking behaviours
Is CBT effective for CYP?
CBT effective for children 5-7 years, but better with children > 10
Younger children
• More behavioral focus
• More parental involvement
Developmental & systemic considerations for CYP CBT
Developmentallyrelevantgoals
• Externalizing the problem
– The problem is the problem, the child is not the problem!
• Targeting: child and parental/ family/ system triggering and
maintaining processes
• Strategies/ Approach:
– Appropriate, simplified language/ analogies/ metaphors
– Self-praise, encouragement, rewards, self-encouragement, modelling
– Play/ puppets/ technology/ art/ games/ role plays
Working with Emotions:
Affective Education/ monitoring
- feelings cards
- stories, cartoons
- thermometers
Working with behaviors:
- fear hierarchy and exposure
- Skills building: ROLE PLAYS, Modelling, Practice/ Rehearsal & Problem Solving
Working with thoughts:
Identifying Negative Automatic Thoughts Diaries, Thought Detective/ Catcher Stories Drawings, Cartoons, Stick People Questionnaires/Charts Role plays
Externalising:
ADHD
Conduct Disorders
Oppositional Defiant Disorder
Assessment of ODD/ CD
Comprehensive assessment
NEED MULTIPLE INFORMANTS & METHODS/SETTINGS
•Symptoms, N, frequency, severity, onset, duration
• Developmental, medical & MH history
• Impairments in other areas of functioning?
• Family structure & parenting
• School/ peers/ social factors
Assessment of ODD/ CD: parent/ family
Blow by blow account of parent-child interactions (consider observation)
Parenting practices: positive and negative discipline/ boundaries/ positive involvement/ supervision
Emotional availability & care/ abuse
Relationships between family members/ parental mental health
ODD / CD Conceptual Basis for Parenting interventions
Grounded in models of parent-child interaction
– Patterson’s model of coercive interaction
– Social Learning / Observational Learning Theory
– Behavioural/ Learning Theory principles
Main approaches of Parenting programmes based on behavioural/ social learning
- Teaching
- Modeling/ Demonstration
- Vignette videos with group discussions
- Role plays and rehearsal
- Coaching/ Bug in the ear
- Practice at home and reflections in next session
ODD / CD parenting pyramid
Use liberally: empathy, attention/involvement, play, problem solving, listening, talking
- coaching, praise, encouragement, rewards, celebrations
moderate: clear limits, household rules, consistent follow through
less: ignore, distract, redirect
limited: consequences
Child-focused interventions
Targeting social, thinking and/ or problem solving skills/ cognitive processes
