Children and Adolescent Mental Health

1. Children and Adolescent Mental Health Lecture 2 – Child development and Adolescence

2. Aims • Quick Recap on last week’s lecture • Look at child development • Look at what happens to a child at key stages in development. • Focus on Adolescence

3. 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

4. “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)

5. 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 child’s 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)

6. 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.

7. Today’s 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 children’s 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/psychological, 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 child’s growth.

8. 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 child’s 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.

9. 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 couldn’t 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.

10. 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

11. 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 child’s 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

12. 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

13. 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 aren’t meant leads to issues of either dependency and neediness or high levels of independence. From 18 months to 3 ½ years – was Freud’s Anal Stage – about self-control. Negatives here could lead to being overly rigid or highly disorganised.

14. ‘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-insecure attachment. • When the attachment phase begins and ends is open to debate but psychologists agree on two things: first, it is crucial to the child’s 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.

15. 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)

16. 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.

17. 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.

18. 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.

19. 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 aren’t 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.

20. 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).

21. 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

22. 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.

23. 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

24. 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

25. 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.

26. 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 one’s 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.

27. 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.

28. 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.blogspot.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: Everybody’s Business Cardiff: WAG World Health Organisation (2005) Child and Adolescent Mental health Policies and Plans’ Singapore: WHO