Week 11 Flashcards
Early childhood dev problems
Sleeping problems, toileting problems, ASD, learning
disorders
Starting kinder, school
Middle childhood dev problems
CD, ADHD, anxiety, somatic complaints
School success, peer relationships
Adolescence dev problems
Depression, eating disorders, OCD, schizophrenia
Transition to secondary school, peers, body image
Early adulthood
Depression, anxiety, substance use, personality disorders
Tertiary study, employment, intimate relationships,
parenting
Middle adulthood
Depression, anxiety, post-natal depression
Parenting, financial stressors, separation/divorce, care of
own parents, loss of parents
Older adults
Depression, dementia
Retirement, health declines, loss of partner
Conceptualising and validating child interventions
Historically:
One treatment fits all approach – “uniformity myth”
Practitioner (rigid) adherence to one theoretical viewpoint
Conceptualising and validating child interventions
More recently
Recognition of therapist effects
Recognition of comorbidity
Empirically supported treatments
Evidence-Based Practice
Important to consider equifinality
Challenges of efficacy studies:
Parent willingness to allow child to be part of trial
( many don’t want their kids in there. Might for payment or free child therapy)
Exclusion criteria in RCTs limits participants to those without comorbidities
Treatment fidelity in trials not necessarily carried over to
practise
- we tightly control what we do in an RCT, real therapy often less controled.
Research samples often do not have as severe symptomatology as clinical samples
Problems with dissemination to “real world” clinics
Evaluation of interventions for
children and adolescents
(Weis, 2014)
Despite challenges
Evaluations of efficacy: meta-analyses consistently show
moderate to large effect sizes
Efficacy of therapy for children similar to efficacy of therapy for adults
As with adult therapy outcomes, can not conclude that one type of therapy is best overall.
Conclusions from meta-analyses of efficacy studies:
Behavioural therapies tend to yield greater effect sizes
- behaviourists are more likely to apply beh therapies to problems with a beh underpinning
- beh ther lends itself well to rigorous RCTs
Treatments tend to work better for adolescents compared to children
Treatment equally efficacious for internalising and externalising disorders
Children show global and specific improvements
- If you target a specific behavioural issue or symptom within treatment, they tend to show improvements in that but also in other areas.
Effectiveness studies
Effect sizes much lower than efficacy studies.
Most therapy not delivered under same conditions as
efficacy studies
High therapist workloads
Lack of training in empirically supported interventions
Complexity and diversity in most clinics
Knowledge of normal development is essential
To distinguish normal from pathological behaviour
Understanding of developmental context, e.g., current
psychosocial tasks
Cognitive and emotional development is taken into account
dev transitions vs transactional processes
Consideration of developmental transitions
e. g., to primary school
- kids are in a context, interacting with other people. The other people are influenced by others. All complex and connected.
Consideration of transactional processes
Suggests importance of others, e.g., parents, peers
Developmental Psychopathology Approach:
Implications for intervention
Link intervention planning to understanding of pathogenic
processes
(Shirk et al., 2011, cited in Kerig, et al., 2012)
Case formulation: Clinician’s theoretical formulation of the
developmental issues underlying the child’s problem
Match the formulation of the pathological process to the most relevant change process
Case Formulation – “5Ps”
Presenting problem
Predisposing factors - historical, biological factors
Precipitating factors - why me, now? current triggers
Perpetuating factors - things that maintain the problem
Protective factors - things that help protect against risk
Interventions with Children:
Cross-cultural Considerations
(Kerig, et al., 2012
Cultural differences in pathology
e.g., due to hostility and prejudice associated with racism
Cultural differences in treatment
e.g., involvement of families, involvement of therapist from own cultural group
Cultural differences in knowledge (clinician being culturally competent)
Culturally responsive treatments - Modified to create a better fit with the individual
Common factors in therapy
Unconditional positive regard: acceptance
Congruence: genuineness
Empathy: attempt to understand the world from the client’s perspective
Working with children and families
(from: AusParenting Program, Parenting Research Centre)
General principles
Take a strength based approach
Recognise family strengths
Normalise challenges and experience
- others have experienced this, others are now
Model problem-focused approach
- helping people to help themselves. What have you tried to do before? have you thought of trying something else?
Developmental perspective
- teachers do this normally, so they need to convey to first time parents what’s normal or abnormal in kids.
Acceptance of diversity
- Respect values, beliefs, traditions
Psychodynamic Approach:
Classic Psychoanalysis
(Kerig et al., 2012)
Conceptual model:
Freud’s psychosexual stages
Psychopathology originates in the psychosexual stages, in which the child who is unable to master psychosexual anxieties defends against them
Therapeutic process:
Undoing of defense mechanisms that inhibit self-awareness and emotional growth
Ego Psychology
Kerig et al., 2012
Conceptual model:
Erikson’s psychosocial stages
Behavioural and emotional problems arise when child is
struggling with conflicts, e.g., struggling with identity
confusion in adolescents
Therapeutic process:
Assist child to gain mastery over conflicts
Objects Relations Theory
(Kerig et al., 2012
Conceptual model:
Disruptions in interpersonal relations lead to psychopathology, e.g., parenting that leads to disruptions in development of autonomous self - provide people with choices
Therapeutic process:
Therapeutic relationship is essential
Supplying a corrective emotional experience aimed at helping development return to its natural course
Psychoanalytic Approach:
Psychodynamic Developmental Therapy Approach (PDTA)
Conceptual model:
Failures in early attachment relationships deprive child of the social experiences that lead to positive, undistorted view of self and relationships
(Fonagey & Target, 2009, cited in Kerig, et al., 2012)
Therapeutic process:
Supplying a corrective experience
aimed at helping development of more complete and accurate representations of the self and other
Psychoanalytic Approach
Empirical support
Limited research conducted compared to CBT interventions
Success for PDTA for depression, anxiety, phobias, PTSD,
ODD, CD, ADHD
(Fonagey & Target, 2009, cited in Kerig, et al., 2012)
APS (2018)
Level II evidence for psychodynamic therapy for inpatients
with mixed CD and emotional problems (12-19 years)
Level II evidence for bulimia (14-18 years)
Humanistic Approach
Kerig et al., 2012
Conceptual model:
Based on the work of Carl Rogers
Unconditional positive regard associated with adjustment
Conditions of worth associated with maladjustment in children
Therapeutic process:
Unconditional positive regard in therapy can undo the damage of conditional love
Humanistic Approach
Empirical support
Strong support for warmth, support, acceptance for promoting child outcomes in therapy
(Shirk & Burwell, cited in Kerig et al., 2012)
Meta-analyses suggest similar effect sizes for play therapies generally, and humanistic therapy effect sizes tend to be larger compared to non-humanistic play therapies (Kerig et al.,2012)
Behaviour Therapies
Conceptual model:
- Focus on changing current behaviours
- Application of general principles of behaviour change
- Incorporates empirical approach in intervention, e.g.,ABAB designs (baseline, intervention, b, i)
Developmental Dimension:
- Behaviour therapy has been criticised for being ahistorical, i.e, ignoring the past
- More recently do incorporate developmental considerations
- Cognitive capacity of the child
- Developmental tasks
- Developmental context, e.g., role of peers in adolescence
Behaviour Therapies
(Kerig et al., 2012)
Therapeutic process:
Therapeutic process:
Classical Conditioning, e.g., systematic desensitisation for phobia
Operant Conditioning, i.e., contingency management (beh reinforcement e.g. star charts)
Observational Learning, i.e., modelling
Family context:
e.g., Parent Management Training (Patterson, 1982)
Behaviour Therapies
Empirical support:
APS (2018)
Level I evidence for ADHD (6-18 years)
Level I evidence for Sleep Disorders (0-5 years)
Level I evidence for Enuresis (3-16 years)
Level I evidence for “Family Intervention” for CD and ADHD
“Family Interventions”: Incorporate Parent Training based on Behavioural principles
Cognitive Therapies
Conceptual model:
Behavioural and emotional problems result from dysfunctional and maladaptive beliefs
Like behavioural approach, focus on specific observable behaviours, and systematically monitor change
Often incorporate behavioural elements (CBT)
e.g., practising new skills in real world environments, reinforcement for completion of homework/practise tasks
Therapeutic process:
Target the dysfunctional and maladaptive beliefs that guide
behaviour
e.g., Cognitive therapy for Anxiety Disorder
Coping Cat, Coping Koala, FRIENDs
Cognitive-Behavioural Therapies
Empirical support:
APS (2018)
Level I evidence for CBT for PTSD, SAD, CD, OCD, in children and adolescents; depression (12-18 years)
Level II evidence for CBT for depression (7-12 years), GAD (7-17 years), specific phobia (7-17 years).
Using treatment manuals: Creativity and flexibility important Consideration of developmental level Consideration of individual differences Consideration of culture
Family Systems Approach
Conceptual model:
Psychopathology of an individual serves a function in the family system
Therapeutic process:
Facilitate change in the family systems
Family Systems Approach
Empirical support for focus on families
APS (2018)
Level II evidence for Multisystemic Family Focused therapy (MST) for adolescents (11 to 18 years of age) with externalising behaviour problems
Level I evidence for Multidimensional Family Therapy (MDFT) for substance use in adolescents (11 to 18 years of age)
MDFT includes components drawing from cognitive and behavioural perspective
Prevention
Preventative efforts can be conceptualised along a continuum
- Primary prevention:
Universally delivered to reduce risk - Secondary prevention:
Early identification of problems: “early intervention”
At-risk groups identified - Tertiary prevention:
Intervention to prevent problems from worsening
Boundary between tertiary prevention and “intervention” is not a clear one, particularly for childhood problems
From Resilience Research to
Intervention and Prevention
Identify protective factors
-> Design program
Reciprocal relationship between research and theory
- Theoretical resilience research
- Program development
- Program evaluation
- Testing of theoretical models
Assets and protective factors
Across many studies and different methodologies:
high degree of consistency in the factors that predicted
good outcomes in children at risk
Individual
Family
Community
Cultural and societal characteristics
Child characteristics
Social and adaptable temperament in infancy
Good cognitive abilities and problem-solving skills
Effective emotional and behavioural regulation strategies
Positive view of self self-confidence; high self-esteem, self-efficacy
Positive outlook on life (hopefulness)
Hope, faith, sense of meaning in life, religious affiliation
Characteristic valued by society and self talents, sense of humour, attractiveness to others
Family characteristics
Stable and supportive home environment
Low level of parental conflict
Close relationship to responsive caregiver
Authoritative parenting style
Positive sibling relationship
Supportive connections with extended family
arents involved in child’s education
Parents individual qualities (as for child)
Socioeconomic advantages
Post-secondary education of parent
Hope, faith or religious affiliations
Community characteristics
High neighbourhood quality
Safe neighbourhood
Low level of community violence
Affordable housing
Access to recreational centres
Clean air and water
Effective schools
Well-trained and well-compensated teachers
After-school programs
School recreational resources (sports, music, art)
Employment opportunities for parents and teens
Good public health care
Access to emergency services (police, fire, medical)
Connections to caring adult mentors and pro-social peers
Cultural and societal characteristics
Protective child polices
- child labour, child health and welfare
Value and resources directed toward education
Prevention and protection from oppression or political violence
Low acceptance of physical violence
Child focus:
What might resilience programs include?
Individual Family Community Cultural and Societal What would the programs developed and/or delivered by psychologists focus on? What would a good program “look” like? Types of components, activities, broader initiatives How delivered?
Individual characteristics
Social and adaptable temperament in infancy
Good cognitive abilities and problem-solving skills
Effective emotional and behavioural regulation strategies
Positive view of self
self-confidence; high self-esteem, self-efficacy
Positive outlook on life (hopefulness)
Faith and sense of meaning in life
Characteristic valued by society and self
talents, sense of humour, attractiveness to others
Family characteristics
Stable and supportive home environment
Low level of parental conflict
Close relationship to responsive caregiver
Authoritative parenting style
Positive sibling relationships
Supportive connections with extended family
Parents involved in child’s education Parents individual qualities (as for child) Socioeconomic advantages Post-secondary education of parent Faith or religious affiliations
Community characteristics
High neighbourhood quality Safe neighbourhood Low level of community violence Affordable housing Access to recreational centres
Clean air and water
Effective schools
Well-trained and well-compensated teachers
After-school programs
School recreational resources (sports, music, art)
Employment opportunities for parents and teens
Good public health care
Access to emergency services (police, fire, medical)
Connections to caring adult mentors and pro-social peers
Cultural and societal characteristics
Protective child polices
child labour, child health and welfare
Value and resources directed toward education
Prevention and protection from oppression or political violence
Low acceptance of physical violence
Older adult focus:
What might resilience programs include?
Individual
Family
Community
Cultural and Societal
What would the programs developed and/or delivered by
psychologists focus on?
What would a good program “look” like?
Types of components, activities, broader initiatives
How delivered?
