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How have children been treated throughout history?
historically had low status, used as labourers and those with behavioural problems seen as possessed, cruelty to animals illegal before cruelty to children
When was the UN convention on the Rights of the Child introduced?
established in 1989, adopted in NZ in 1993
What does the UN convention say on the rights of children?
children have to right to survival, to develop to their fullest potential, access education, protection from harmful influences, abuse and exploitation, participate fully in family, cultural and social life, have their views, wants and needs respected
What is Erikson's theory of child development?
5 stages of development, disruption to stages can impact development leading to issues in later life
What are Erikson's stages of development?
trust vs mistrust, autonomy vs shame and doubt, initiative vs guilt, industry vs inferiority, identity vs role confusion
What is trust vs mistrust (first stage of development)?
first year of life, feeling of trust developed in an environment where child feels physically comfortable and experiences a minimal amount of fear, depends on quality of parent-child relationship, sets stage for seeing the world as a safe place, way child is interacted with early on can impact brain development, main influence - parents
What is autonomy vs shame (second stage of development)?
1-3 years, after gaining trust infants feel safe to assert autonomy/independence, foster autonomy, beginnings of self-confidence/self-esteem, high restraint/punishment during infancy can lead to sense of shame and self-doubt, can develop a sense of shame if not meeting parents expectations or not being encouraged
What is secure attachment?
believe needs will be met by parents, come back to parents as safe space
What is insecure attachment?
anxious or avoidant attachment
What is anxious attachment?
child does not want to leave parent, low autonomy ie clingy child
What is avoidant attachment?
high autonomy, parent not seen as safe space
What is scaffolding?
helping children to positively develop skills
What is initiative vs guilt (third stage of development)?
3-5 years old, interested in learning and engaging with the world, initiative adds to autonomy, developing a sense of responsibility increases initiative, scaffolding important eg ask/say/do eg building a sandcastle, children need to feel comfortable trying things, failing and trying again, guilt feelings may arise if child made to feel irresponsible or too anxious about successfully meeting challenges, some children naturally more anxious/afraid of failing
What is industry vs inferiority (fourth stage of development)?
middle and late childhood 5-12 years, supporting children in passions/interests, teachers important in child's sense of self, initiative leads to contact with new information leading to knowledge
What is identity vs role confusion (fifth stage of development)?
adolescence (around 12-18 years), more concerned about how they appear to others, more about identity and developing positive identity, positive identity develops when adolescent feels they have a clear role and positive path to follow in the future/adult life, role confusion occurs if a positive future is not identified, higher rates of depression/anxiety if no path/positive future identified
Who are the key influence on children's development in the trust vs mistrust (first stage)?
parents
Who are the key influence on children's development in the autonomy vs shame/doubt (second stage)?
parents and siblings
Who are the key influence on children's development in the initiative vs guilt (third stage)?
parents, siblings and other family members
Who are the key influence on children's development in the industry vs inferiority (fourth) stage?
parents, siblings, other family members, school
Who are the key influence on children's development in the identity vs role confusion stage (fifth stage)?
parents, siblings, other family members, school, and peers - main influencing factor for identity
What does Brofenbrenner's ecological model include?
individual, family, school/community, wider society influences on development
What is Brofenbrenner's ecological model?
individual factors eg temperament - anxious, more sensitive to failure, different influences on development in wealthier vs poorer communities, goodness of fit - how well parent and child fir together eg sporty parent and crafty child, focus on accepting child for who they are, community - whether people feel a part of the community, whether children feel safe, school - more influential later on
What factors influence abnormal child development?
biological, psychological, social
What are biological factors that can influence abnormal child development?
genes eg mental illness has a genetic component/increases risk, gene x environment interactions, in utero eg disrupted brain development from substance use during pregnancy eg fetal alcohol syndrome, brain structure - ADHD brains work differently eg differences in neurotransmitters and brain structure, head injuries/illness can influence development eg hypoxia, certain disorders more prevalent in certain genders
What are psychological factors that can influence abnormal child development?
temperament (personality) eg novelty seeking, harm avoidance - influences how we respond to the environment and how the environment responds to us, self-esteem, coping - children respond to stress/trauma differently based on ability to regulate emotions and cope with stress, emotion regulation, cognition/thoughts
What is emotion regulation?
understanding, experiencing and modulating emotions
What is CBT based on?
idea that how we think about a situation influences how we respond
What are social factors that can influence abnormal development?
family environment - eg positive/toxic environment, modelling - children learn by watching others eg dealing with conflict through aggression, interaction between child and environment, peers, school, community/culture/neighbourhood, media - messages about what is ideal
What do all children need for optimal development?
an environment sensitive to their unique needs and abilities, places appropriate limits to help them develop self control, eg goodness of fit, teaching children right from wrong, consistent rules and boundaries
What are the consequences of inconsistent discipline?
more inconsistent discipline, more likely children were to have difficulty with self regulation
What are ACEs?
adverse childhood experiences
How do ACEs influence brain development?
significantly influence brain development, and lead to social, cognitive, or emotional impairment
What are some examples of ACEs?
abuse - emotional, physical, sexual, psychological, neglect, household dysfunction eg parent with a mental illness/in jail, domestic violence
What does the presence of ACEs do?
can lead to chronic over activation of the stress response (toxic stress), more ACEs a child experiences the greater the likelihood of poorer outcomes eg poor academic achievement, time off work, mental illness, substance abuse, crime, poverty, poor physical health (dose response)
What did the growing up in NZ study show?
over 50% of children had experienced at least one ACE, did poorer on cognitive tests, dose response - more ACEs, worse outcomes
What are the differences between children with secure and insecure relationships with caregivers?
children with more secure relationships with caregivers - minimal stress hormone activation when frightened by a strange event, insecure relationships - significant activation of stress response, view parents/the world as a safe space
What are some ways to prevent the long term effects of ACEs?
supporting development of responsive caregiver-child relationships, helping children and caregivers build life skills eg planning, self regulation, reducing household stress eg basic needs met, no substance use or domestic violence in the home
What were the most protective factors against the long-term effects of ACEs?
strength of mother-partner relationship and parental health
What are the two approaches to classifying disorders?
dimensional and categorical
What is the dimensional approach to classifying disorders?
everyone has characteristics to varying degrees, people rated as above or below average, most people in middle less people at extremes
What are some issues with the dimensional approach?
difficult to use in practice, how people rate someone can differ eg cultural norms around expressing emotions may impact ratings, can depend on context eg cultural context or situation eg different ratings from parents and teachers for children's behaviour, depends on understanding of normal eg normal development
What is the categorical approach?
distinctive categories that are black and white, either meet specific criteria or don't
What are some issues with the categorical approach?
most people don't fit neatly into categories, symptoms may only appear in some situations eg ADHD diagnosis - have to meet 6 out of 9 symptoms, what about sub-threshold levels may still have significant impacts, doesn't explain why symptoms are occurring, different causes and treatments, symptoms can have multiple causes eg ADHD or anxiety may have similar symptoms
What is the DSM-5?
categorical, based on research and field trials, driven by psychiatric field, input from clinical psychology
What are the criticisms of the DSM-5?
categorical, interrelationships and overlap - may be diagnosed with different disorder eg ADHD, anxiety may be better explained by overarching things eg difficulty regulating emotions, individualistic, access to treatment - diagnose people to provide treatment and access to funding, sub-threshold categories/without diagnosis - unable to access services, ignores influence of family/environment surrounding people, deficit based model
What are different assessment techniques?
interviews, psychological testing
What does an interview consist of?
developmental history eg birth/pregnancy complications, developmental milestones eg certain delays linked to certain disorders, family characteristics, family history eg certain disorders, racism, trauma, family dynamic, collateral information - where does the behaviour occur, broad assessment eg what has happened to cause the issue and what is keeping it going, important for treatment and stopping the issue
What do interviews assess?
current problem eg when it started, how severe, how often, what makes it worse/better, how it has changed over time, impact on others - want to reduce negative impact on others eg children with behavioural difficulties struggling to make friends at school, assessment informs treatment
What is psychological testing?
screening - questionnaires that can be administered quickly eg CBCL, checklists, developmental eg meeting developmental milestones, personality/temperament eg anxiety/failure-aversive, IQ - lower intellectual functioning can affect many things eg social interactions, achievement, neuropsychological testing - broader cognitive abilities, tests are normed/can compare clients scores to others in the population eg similar age
What are the features of evidence based practice?
psychological assessments and treatments are based on evidence, have to justify treatment being given, difficult compared to medical model eg only a certain number of medicines/treatments for same issues, clients with same disorder may have very different symptoms/treatments, most people have multiple diagnoses - can make it difficult
What is evidence based practice?
integration of the best available research with clinical experience in the context of patient characteristics, culture and preferences, finding balance between research and what is best for the client, culture - important, can't understand someone outside of culture, client needs to want to do treatment eg exposure therapy for anxiety
What is the NGC (US)?
government driven resource, evidence based clinical practice guidelines
What is the NICE (UK)?
independent organisation, lots of advisory groups which collect data off people with conditions and lived experience, guidelines for evidence based practice
What is the hierarchy of evidence based practice?
level 1-4/grade A-C, lower down on hierarchy - may be an unusual disorder or new treatment, level 1 - RCT, is new treatment better or the same, ideally want one RCT, GPP - no evidence, based on clinical practice
What is important when selecting treatments for clients?
trying to design evidence based treatments that are effective for the individual, important to consider context in which individual is functioning when assessing and designing treatment plans
What are the four overarching principles in the psychologists ethical code of practice?
respect for dignity of persons and peoples, responsible caring, integrity of relationships, social justice
What is the overarching idea in the psychologists ethical code of practice?
do no harm - don't want someone to be worse off after seeing you eg people experienced trauma, are treatments making it worse/causing more distress
What is an example of respect for dignity of persons and peoples?
always need to remain professional and respectful, have clear boundaries and not show any biases, opinions and choices of clients may not match your values but still have to respect choices and work with worldview/understand without judgement eg in corrections
What is a way to ensure you are giving the best care?
supervision from another psychologist
What is transference?
situation/something about client reminds you of something in your personal life, can influence how you interact with that client
What is responsible caring?
whether you are the best person to work with client, eg if you can't get past biases/transference may be better to refer to another psychologist, labelling and feedback - may be useful by allowing access to services/understanding of what's been going on, may also be a self-fulfilling prophecy - need to ensure labelling isn't linked with someone's identity/negatively impact them
What is integrity of relationships?
need to be clear with clients/family what you offer, can't have relationships with patients at any point due to power dynamics, therapeutic relationship can feel very intimate for some people eg patients, need to have clear boundaries
What is social justice?
know someone is at risk of harm to others or themselves, have a duty to look after and warn wider society, things confidential up until a point
What is confidentiality?
always want to be very clear about confidentiality right at the start of assessment to ease some anxiety about who will have access to information, clients may not be comfortable telling you some things without knowing, also need to state limits/client aware of where information is going eg drug use but report going to probation officer, want to keep up good therapeutic relationship, can't tell people what clients say, limits when there is risk to themselves or others eg suicide attempt, drink driving, child abuse, domestic violence
When do psychologists break confidentiality?
when someone is at risk of harming themselves or others, if a patient appears before the court a search warrant may be issued - police can take files on patient but information can not directly be used as evidence, make sure to maintain respect in notes/reports, offending or completed suicide - police can access notes, important to check in with them and make sure there's a safety plan
What is the mental health act?
compulsory assessment and treatment, can be used to ensure patients at imminent risk to themselves or others are assessed and treated, always try to have patients volunteer for assessment and treatment but if not able to and it is their/others best interest can be admitted under mental health act, family must be involved and consulted in process, related to risk of harm to self and others, generally a last resort
What happens in reporting child abuse?
anyone over 18 legally required to report serious child abuse and protect children from harm, for less serious abuse - can seek supervision eg advice from colleagues/oranga tamariki, can also get anonymous advice without disclosing personal information, better to err on side of reporting rather than not reporting, can be done in a way that relationship with parents left intact eg framed as you can see the parent is struggling and oranga tamariki a way of gaining support, safety of child takes precedence
What is the main principles of oranga tamariki?
operates on principle of supporting the family to care for the child, only takes matters to family court as a last resort, focus on finding solutions for the family to meet the needs and rights of the child
What happens in assessments with children?
interviewing child - child viewed as client when working with children and families, interviewing family members frequently/actively involved in child's life eg parents, siblings, grandparents, interview teacher, collect rations, administer neuropsychological tests if appropriate to referral eg learning difficulties
What are some important considerations when working with children and families?
less influenced by parents as children get older, more influenced by peers, some things they may not want parents to know eg smoking weed, however may be contributing to difficulties - parents may need to know, need to understand environment - parents and teachers may interact with child in a way that exacerbates things/reinforces behaviour
What is important to be aware of when assessing children?
culture really important eg eye contact - may be autism spectrum disorder however in some cultures eye contact with superior/older people culturally inappropriate, can find out more about what is important to them, age - ensure developmentally appropriate, need to use open questions - tendency to give answer they think you want, sex - some disorders more prevalence, appearance - what does it say about how well they are cared for
What are some observations when assessing children (personal appearance)?
signs they're being looked after or looking after themselves, height - meeting developmental milestones, underweight/overweight, clothing - clean or tattered, signs of malnutrition, body odour, breath smells of alcohol, signs of conditions eg anorexia, marks on body eg bruises, evidence of self harm, looking tired/upset
What are some observations when assessing children (behaviour)?
non-verbal - vision, hearing, motor skills, important for differential diagnosis - is that child not listening or can they not hear, eg before considering odd or adhd - can they see and hear well, waiting room behaviour - what are parent and child doing/interactions, eg child getting up and out of chair/driven by motor, relaxed or tense relationship, is parent on phone ignoring child, child quite clingy
What is the purpose of the assessment for children?
to obtain information needed to make decisions beneficial to child and family - don't need to collect everything, want to remain focused on problem, important to recognise possible effects of assessment on child and family eg educational assessment - parents may be worried what will happen if their child is diagnosed with a learning difficulty, children may be worried about being different,
What are some important examiner skills?
being prepared - examining referral and all available information before they arrive, paying attention to health difficulties, sensitivities, responses to past professionals - may have had negative experience with psychologist/health system in the past, think of how you introduce self - important for them to understand your role and what you offer
What are some other important examiner skills?
children may not want to engage with you one on one at the start - may want to do first session with parents, in older children - can ease apprehension about what will happen eg special classes, therapy, related to informed consent, discuss any concerns/anxieties about process and outcomes, flexibility - adjusting to child's needs, having a bag of tricks eg strategies with one child may not be effective with another, eg adhd children may have different symptoms and be unmedicated, can let them sit on floor, play with a toy, self awareness - understanding own personality, biases, attitudes etc and how that influences how you're working with client
What are some more examiner skills?
being aware of shortcomings and always being open for feedback, allowing yourself to be observed and critiqued, always engage in active supervision, listening to yourself - noticing emotions, behaviours and learning to effectively manage them, monitoring body language, tone etc, taking on feedback from sessions eg children's comments, always be willing to refer on patient if not appropriate, adapting appearance/being approachable
What happens in formulating a case?
taking all of the assessment information and putting it into the context of the family, temperament, developmental stage, predisposing factors, trying to understand why a child is behaving in a certain way requires understanding and putting together clinical history and family environment eg what is going on, what were predisposing factors, what are the things keeping it going
What are predisposing factors?
longer term factors that may have influenced the development of the issues eg genetic factors, temperament, predisposition eg family history of anxiety
What are precipitating factors?
more recent events eg why has this client come to see me now rather than 5 years ago eg parents getting separated, child moving schools
What are perpetuators?
things maintaining the problem eg child having a tantrum in the supermarket for chocolate, mum bays chocolate bar - reinforcing behaviour
What are some treatment examples for the child?
changing the problem and turning it into a skill, teaching skills so that client can go out and manage on their own, eg skills and strategies to manage big emotions, inattention, name skill eg lion self, eg don't want to be separated from parent at drop off - skill = being brave and managing big emotions, can get them t understand benefits of solving problem eg enjoy time with friends, everyone uses consistent language about the skill so child knows when to use it, get them to think about other times they used skill, reward focused, understanding there will be good and bad days
What are some treatment examples for parents?
teaching causes of behaviour issues eg genetics, family environment - reinforcing behaviour, escalation - parents behaviour not escalating the situation, reinforcing desirable behaviour, modelling - getting parents to understand children will model their behaviours, consistent discipline, clear instructions and consequences, no emotional messages or using guilt, ineffective punishment, beliefs and expectations, other influences eg in family/outside the home, want to foster positive relationship between child and parents
What is psychoeducation?
getting parents to understand why the child is behaving in this way/causes of behaviour problems, making the parents/child feel like it isn't their fault either, can help them understand treatment and why it would be beneficial
What is another treatment approach to use with parents (helping the child)?
developing positive relationship with child, encouraging desirable behaviour - eg for some children only getting attention for misbehaving, some attention better than no attention, can use behaviour charts, teaching new skills or behaviours - ask/say/do
What is another treatment approach to use with parents (managing misbehaviour)?
establishing clear ground rules, use direct discussion around rule breaking, ignoring minor misbehaviour, giving clear instructions, gaining child's attention, giving them time to cooperate, praising them, no cooperation - back up instructions with clear consequences, using quiet time, using time out for serious misbehaviour - in another room which is not interesting but is safe, explain why they're going into time out, and use 1 minute per age eg 8 years = 8 minutes
What are some family survival tips?
not arguing in front of children, working as a team, getting support eg networks of friends, family behaviour management groups, having breaks - parent needs to be calm and manage own emotions before responding to child
What are some treatment approaches for teachers?
home school contract, laying out what rules are and sticking to rules, classroom, placement - maybe child needs to be in certain place in classroom to help them better manage behaviour, reward system - eg rewarded at home for good school behaviour, work with child's needs eg allowing them to take breaks, go on errands
What are the three subtypes of ADHD?
predominantly inattentive, predominantly hyperactive, combined subtype
What are the behavioural symptoms of hyperactivity?
squirms and fidgets, can't stay seated, runs/climbs excessively, can't play/work quietly, on the go/driven by a motor, talk excessively
What are the behavioural symptoms of impulsivity?
blurts out answers, interrupting, struggling to wait turn
What are the behavioural symptoms of inattention?
carelessness, not listening, not following through on tasks, forgetful in daily activities, can't organise, avoids/dislikes tasks requiring sustained mental effort, loses important items, difficulty sustaining attention, easily distractible, often have difficulty with working memory but may have children with visuospatial abilities/higher in some domains and weaker in others,
What is one thing that is really difficult for children with adhd?
being given multi-part instructions eg first you have to do this, then you have to do this etc
What are the DSM-5 criteria for ADHD?
have to meet 6 out of 9 symptoms, must be present before age 12 (neurodevelopment disorder), occur across two or more setting eg home and school (know it is not due to environment), must cause impairment eg impact social, academic and occupational functioning, inconsistent with developmental level and not better explained by another disorder
What is ADHD?
highly heritable/genetic link - up to 80% heritability particularly from father to son, evidence from twin studies, impacts brain structure and functioning eg dopaminergic genes linked with adhd, begins in childhood, developmental in nature, behavioural, cognitive and social functioning impacts, children with adhd constantly growing but at slower rate eg 1/3 behind peers, stimulants act on neurotransmitters eg dopamine
What happens to adhd over the lifespan?
symptoms appear to taper off, lots of preschoolers are impulsive but this tapers off, developmental delay eg 9 year old with adhd functioning as a typical 6 year old, persisters - adults who continue to have adhd, resisters - adults with adhd who don't show symptoms/show different symptoms, symptoms may change across lifespan eg hyperactive - combined - inattentive
What are the developmental trends in adhd (children -> adults)?
motor hyperactivity, high frustration, impulsivity, easily distracted, inattentiveness, shifts activities, easily bored, impatient, restlessness, adults with adhd may seek more active jobs, getting a diagnosis can improve long term outcomes, children diagnosed early are more likely to be diagnosed with hyperactive adhd -> combined type -> inattentiveness (later eg adolescence/adults), idea that symptoms reduce/plateau over time but may just learn skills to cope
What did Marakovitz and Campbell (1998) find?
preschool children identified as inattentive/hyperactive, only 1/3 met the criteria at age 6, only 2/3 of the non-remitters (1/3) met the criteria at age 9, some children may meet criteria for adhd but not develop adhd, big drop off between 3 and 6, lots of people may meet symptoms but only some have impairment eg social, academic, etc
What did Gordon et al. (2006) find about impairment in children with adhd?
only 33% of children aged 6-17 (school aged) met the full diagnostic criteria for adhd and impairment criteria
What did Healey et al. (2008) find about impairment with adhd in children?
used different impairment cut points, 75th to 90th percentile (more impaired than 75% to 90% of people) and reduced the number of preschool children meeting criteria for adhd by 46-77%
