Children and Adolescent Mental Health

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Children and Adolescent Mental Health

• Lecture 2 Child development and Adolescence

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Aims

• Quick Recap on last weeks lecture
• Look at child development
• Look at what happens to a child at key stages in
  development.
• Focus on Adolescence

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Recap

• Looked at key theorists - Maslow, Brazzelton and
  the Human Givens - and discussed what we need to
  make sure we are happy/content
• Considered the idea that all behavioural issues
  are responses to socio/biological/economic
  deficiencies and that once those deficiencies
  identified, ways forward were possible.
• Began to discuss what the needs of children were

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• Mental health problems and mental disorders in
  young people can devastate the lives of those
  affected and destroy the quality of the life of
  those around them. Society pays a high price in
  terms of social disruption, education failure,
  ill health, anti-social behaviour and hard cash
  for failure to tackle these problems effectively.
  Links between childhood disorders and adult
  mental health problems are now well established.
  (WAG, 2001)

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Context

• Children and adolescents with good mental health
  are able to achieve and maintain psychological
  and social well-being.
• Good mental health of children and adolescents is
  crucial for their active social and economic
  participation. (WHO, 2005)
• There is still stigma and discrimination attached
  to mental health disorders it is poorly
  understood as are those who suffer from them
• Specific mental disorders occur and certain
  stages of development.
• High degree of continuity between child and
  adolescent disorders and adult ones.
• Effective intervention can reduce the burden of
  mental health disorders on individual and the
  family/community.
• An overriding consideration is that the childs
  development stage can influence his/her degree of
  vulnerability to disorders, how the disorder is
  expressed and how best treatment should be
  approached. (WHO, 2005 p2)

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Mental Health What do we mean?

• 10 20 of young people suffer from mental
  health disorders.
• 10 of 5-16 year olds have been diagnosed with a
  mental health disorder. (ONS) In USA it is 20 of
  children.
• Disorders include ADHD, anxiety disorders, post
  traumatic stress disorder behavioural problems
  bullying depression eating disorders OCD
  psychotic disorders and substance abuse.

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Todays Premise

• Majority of mental health issues are a response
  to a lack of something or someone and are
  linked to child development.
• Learning about child development helps us
  understand and respond more appropriately to
  childrens behaviours.
• While the majority of children develop in a the
  same way, they hit milestones at different
  rates.
• Child development is made up of four interrelated
  domains Physical/biological, Cognitive/psychologi
  cal, social/emotional and sexuality/gender
  identity. (Oswait, 2008)
• Understanding child development is also about
  understanding the impact of society, culture,
  status and family on a childs growth.

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Key Theorists

• Plato (380 350 BC) children born with
  knowledge that awaits activation.
• John Locke (1632 1704) idea of infant as a
  blank slate, a tabula rasa. Environment could
  direct a childs mind any way.
• Jean Jacques Rousseau (1712 1778) first to
  write about first 5 years as being distinct from
  rest of childhood also it was a series of
  stages.
• Friedrich Froebel (1782 -1852) - children were
  individual needed a degree of freedom as well
  as structure. Idea of circle time best known
  for emphasis on guided play.
• John Dewey (1859 1952) Like Froebel.
  Believed early education should be child centred.

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• Maria Montessori (1870 1952) - Believed in an
  orderly progression of learning and discounted
  play, fantasy and free drawing.
• Erik Erikson (1902 1994) Believed in the
  Eight Stages of Man each stage has a particular
  issue to be resolved or accomplished before
  moving satisfactorily to the next stage.
• Piaget (1896 1980) believed children
  construct their own knowledge
• Vygotsky (1896 1934) Believed you couldnt
  separate social learning from cognitive learning.
  Introduced the zone of proximal development.
• Howard Gardner (1943 - ) maintained people have
  at least seven or eight separate kinds of
  intelligence.

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Child Development

• Research by Scottish Executive Education
  Department 2001
• First Three Months
• Need constant human attention that is sensitive
  to their changing needs
• Carers regulate their emotion through touch
• Carers facilitate an active, purposive state of
  mind
• Consistent care is offered in a quiet, secure
  environment with opportunities for rest,
  immediate response to distress or expressions of
  need
• Familiar and companionable intimacy

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Children 3 - 12 months

• Increasing pleasure from moving, vocal play and
  song
• Relationships formed through these interactions
• Enjoy movement (expression) and praise
• Benefit from expressive play with caregivers (not
  reliant on toys)
• Child developing self-esteem and pride in
  accomplishments. Carers must share
  unconditionally in childs pleasure and growing
  social confidence
• Must be consistent care given by one adult or a
  very small number of adults able to form a warm
  relationship with the child

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Children in their Second Year

• Infants develop shared understanding and memory
  which prepares for the learning of language and
  symbols
• Vocabulary grows as does gestures, behaviours and
  imitations
• Enjoy imitating peers and sharing and talking
  about discoveries
• Research shows 18 - 20 months child develop new
  awareness of meanings of others and can react
  emotionally to this
• Can also be disturbed by differences between
  emotional relationships they experience at home
  and in day care

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What is key in this time?

• Piaget Sensory Motor Stage (0 2 years)
  Schemas Babies begin to learn to understand
  some of the information and object permanence
  but still ego centric.
• According to Erikson the main conflict of this
  time (0-18monts) is basic Trust vs Mistrust. If
  a child is receives correct care he/she will
  develop trust, confidence and security. If not,
  he/she may develop insecurity, worthlessness and
  a general mistrust of the world.
• According to Freud 0- 18 months is the Oral
  stage of development. If needs arent meant leads
  to issues of either dependency and neediness or
  high levels of independence. From 18 months to 3
  ½ years was Freuds Anal Stage about
  self-control. Negatives here could lead to being
  overly rigid or highly disorganised.

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Attachment Theory

• lasting pscyhological connectedness between
  human beings (Bowlby, 1969)
• Bowlby believed that earliest bonds formed by
  children with their caregivers have huge impact
  that continues through life.
• Mary Ainsworth did further study in 1970s. Her
  research showed three types of attachement
  secure-attachment, ambivalent-insecure attachment
  and avoidant insecure attachement.
• Main and Solomon (1986) added disorganized-insecur
  e attachment.
• When the attachment phase begins and ends is open
  to debate but psychologists agree on two things
  first, it is crucial to the childs development
  that attachment happens during the first year
  second, it is in the first two years that a child
  learns about independence and dependence and
  finds a healthy balance between the two.

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What happens to children without secure
attachment?

• Research suggests children with
  oppositional-defiant disorder, conduct disorder
  or post-traumatic stress disorder frequently
  display attachment problems.
• Insecure attachments influence the developing
  brain, which in turn affects future interactions
  with others, self-esteem, self-control, and the
  ability to learn and to achieve optimum mental
  and physical health.
• Research shows children with disrupted and
  anxious attachment not only display emotional and
  social problems but there are also consequences
  on the developing brain.
• The neurobiological consequences of emotional
  neglect can leave children behviourally
  disordered, depressed, apathetic, slow to learn
  and prone to chronic illness. (Skoufalos, 2011)

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Children from 3 - 5

• Children begin to experience a desire to copy the
  adults around them and take initiative in play
  situations.
• Also begin to explore the world more why?
  becomes a key question for the child.
• Child has the opportunity to build self-esteem
  and autonomy as he/she begins to learn right from
  wrong.

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What is key in this time?

• Piage Pre-operational stage ( 2 7 years)
  thought processes developing vocabulary
  expanding have animism and moral realism.
• Erikson this is the time of Initiative vs
  Guilt. Looks at psychological features of
  conflict between child and parents.
• Freud this is the phallic stage all about
  morality and sexual identification. If not
  navigated successfully can lead to
  promiscuous/amoral behaviour or
  asexual/puritanical behaviour.

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Needs of Middle Childhood

• (approx 6 - 10 years)
• Children enter larger culture (schooling)
• Spend more and more time with non-family members
• Supervision no longer primarily from parents
• Freedom puts greater demands on good behaviour
• Development
• Master fundamental skills considered important by
  culture
• Develop self-awareness
• Develop skills in planning, coordinating and
  evaluating and modifying
• Ability to reflect and to see from alternate
  point of view.

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What is Key at this time

• Piaget overlap with pre-operational stage and
  (7yrs 11) Concrete operational stage. thought
  process more rational. Child has ability to
  develop logical thought and learn that objects
  arent always the way they appear to be.
• Erikson key conflict is Industry vs
  Inferiority. Very social stage of development
  if there are unresolved feelings of inadequacy or
  inferiority, it can lead to problems in terms of
  competence and self esteem.
• Freud 6 till puberty the latency stage.
  According to Freud, not much going on as sexual
  and aggressive drives are less active.

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Adolescence Who Am I?

• Time of abstract thought and awareness of society
  around them.
• Huge physical changes taking place.
• Have to construct an identity that will provide a
  firm basis for adulthood.
• Identity involves deliberate choices and
  decisions, particularly about work, values,
  ideology and commitments to people and ideas.
• Adolescents failing to integrate all these
  aspects or feeling unable to choose, are
  threatened by/ with Identity diffusion (role
  confusion).

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Issues of Gender

• Males spend more time in groups (Benson,1990)
• Males have larger peer networks
• Females friendships involve more intimacy
• Males less like to disclose thoughts and feelings
  to their friends or seek advice
• Females establish intimacy through self
  disclosure males through shared activity but
  both predict emotional closeness

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Conflict Resolution

• More conflict occurs between male friendship
  groups
• Difference in conflict resolution males through
  physical force, females through strategy
• As age, males more likely to recommend forgetting
  the problem females talking about it.

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Developmental Needs of Adolescents

• Rapid physical maturation, intellectual growth
  and skills to meet social demands
• More unsupervised time.
• Erik Erikson young person strives to bring
  together elements of psychological, social and
  intellectual self to form identity
• identity vs role confusion - developing sexual,
  cultural and career identities

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Adolescents Need

• Opportunities to form secure relationships with
  caring peers and adults
• Safe and attractive places to be
• Opportunities to develop relevant life-skills
• Opportunities to contribute to their communities
• Opportunities to feel competent by highlighting
  effort rather than competition
• Opportunities to try new challenges in a safe
  environment

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What is key at this stage?

• Piaget (11yrs 16) formal operations stage
  able to think in the abstract children can
  reason beyond a world of concrete realities.
• Erik Erikson young person strives to bring
  together elements of psychological, social and
  intellectual self to form identity
• Freud puberty to adulthood is the genital stage
  not fixed earlier. This is the person who has
  worked it out! Any problems earlier down the
  stages, causes fixations at that stage.

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• Psychologists emphasize how important it is for
  the young to master developmental tasks during
  their early teens
• Havighurst, (1952) felt that the healthy
  unfolding of personality demands mastery of the
  following
• Accepting ones physique and learning to cope
  with a masculine or feminine role
• Forming new relationships with peers of both
  sexes
• Realizing emotional independence from parents and
  other adults
• Achieving assurance of economic independence
• Selecting and preparing for a vocation.
• Developing intellectual skills about being a
  citizen
• Desiring and achieving socially responsible
  behaviour.
• Preparing for marriage and family
  responsibilities
• Cultivating values in harmony with a realistic
  and scientific world picture.

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Conclusions

• Mental Health issues and childhood development go
  hand in hand.
• It is vital, therefore, for practitioners to know
  what is happening during each stage of childhood
  development so this can inform reactions.
• The good mental health in children and
  adolescents is vitally important to individuals,
  families and society as a whole.

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References

• Ainsworth, M (1978) Patterns of Attachment
  Hillsdale, NJ Erlbaum
• Bowlby, J (1969) Attachment attachment and loss
  New York Basic Books
• Erikson, E (1968) Identity Youth and crises. New
  York Norton
• Robert J. Havighurst,(1952) Developmental Tasks
  and Education New York Longmans
• Oswait, A (2008) Developmental Changes,
  www.mentalhelp.net accessed 3rd October 2011.
• Skoufalos, N (2011) Chronic Illness and
  Attachment http//psychologyofchronicillness.blo
  gspot.com (accessed 3rd October 2011)
• United States. ACT (2003) Teach Carefully How
  Understanding Child Development Can Help Prevent
  Violence Washington APA
• Welsh Assembly Governemtn (2001) Child and
  Adolescent Mental Health Services Everybodys
  Business Cardiff WAG
• World Health Organisation (2005) Child and
  Adolescent Mental health Policies and Plans
  Singapore WHO