Yesterday I attended ‘Parents’ Voices and their Experiences of Services’ at Friends Meeting House in Manchester. It was an opportunity to examine priorities for system, policy and practice change, drawing upon findings from research and was a very valuable day for reflective practice.
The event began with a short introduction by Safeguarding Survivor who chaired the conference with great confidence and professionalism. I know she was nervous but you couldn't tell and she did a brilliant job. If you aren't aware of her story, I recommend you read her blog. It offers great insight into the child protection system from a parents’ perspective and provides excellent advice for others whose children have been identified as ‘at risk’. Her work has been praised for its balance and value by Sir James Munby and you will soon be able to read more of her case after the court granted Louise Tickle (a freelance journalist) permission to publish details in a broadsheet newspaper. You can read the judgement at Family Law.
Siobhann and three mothers from The Mothers Apart project (Women Centre) Kirklees spoke about their book In Our Hearts. It presents open and honest accounts of initial separation, court proceedings, relationships with services, of mothers who have been able to have children returned to their care or contact increased, mothers who have no current contact at all and those for whom contact remains limited. It offers itself up as an aid and guide to learning for parents, families and professionals working in pursuit of child protection. As a result of co-production learning Mothers Apart have developed women centred working that recognises people as assets. Whilst every woman is different they have found that there are a number of common themes and, consequently, much of their work is about power.
Sean Haresnape (Principal Social Work Advisor) from Family Rights Group outlined a Parents Charter being developed in collaboration with parents and professionals, that sets out expectations of how services should engage with parents, whose children are subject to statutory interventions; and we heard from Declan, a father and care leaver who had his daughter placed with him following care proceedings.
Prof. Karen Broadhurst (Lancaster University) and Claire Mason (ISW & Lancaster University) presented preliminary findings from their 2 year study of birth mothers, their partners and children, within recurrent care proceedings under s.31 of the Children Act in England. The project hopes to confirm the national scale and pattern of recurrent proceedings together with the characteristics and service histories of parents caught up in this cycle. Statistical methods have been used to quantify recurrence and examine the relationship between recurrence and key explanatory variables. This has been complemented by qualitative components that include in-depth interview work with birth mothers in five local authority areas and in-depth profiling of a subset of randomly selected case files.
Through data mining they have found that 25% of women who have been through care proceedings will return within 7 years. Teenage motherhood is associated with a significant number of repeat care proceedings and Prof. Broadhurst questions whether the family court is the most appropriate setting for dealing with teenage parents.
Another facet of their research looks at the collateral consequences of care proceedings and asks who, once a court case has concluded, is there to support parents with the psychological, social and economic consequences of losing a child. Whilst the child and adopters/foster carers remain supported for a time by Social Workers and other services, there are no statutory support available to parents. This short-sighted approach demonstrates a lack of understanding of the collateral consequences and their cumulative impact which can drive women in to unhealthy relationships and successive pregnancies. In subsequent cases Local Authorities and Courts have been found to act more swiftly and are more likely to remove closer to birth, with adoption being the most likely outcome, compounding the cycle.
Similar concerns were raised last week by Sir James Munby when I attended the annual Family Justice Council debate in London. He said that it was “not fair on subsequent children that post adoption support isn't provided to birth parents” and “there is some substance to the question whether resources are adequately balanced between support for adoption and support for families”.
Finally, Prof. Kate Morris (Sheffield University) outlined the empirical research she and Prof. Brid Featherstone (University of Huddersfield) are conducting as part of Your Family Your Voice – an alliance of families and practitioners working to transform the system. Their work, looking at family experiences of multiple service use, highlights the profound difficulty families often find navigating their way through services.
At the end of the presentations we were asked to reflect upon what we had heard and identify what changes could be made to make the system a more humane one and minimise trauma for parents, children, their families – and also for practitioners. I invite you to do the same and participate in the research here.
The Munro Review highlighted that the only way to create a “child-centred” system was for social workers to have the time and the skill to undertake a great deal more direct work with children. NICE has also recommended that professionals take greater steps to actively involve children and young people in the process of entering care, changing placement, or returning home and a series of intervention tools should be considered to help guide decisions on interventions for children and young people. What this means is that there is a general consensus that there should be a greater focus on direct work in professional practice.
Direct work with children is a complex skill to master but the techniques can be relatively simple. Here are a couple of ideas that I have found to be effective in the past. In most cases all you need is pen, paper and time.
The 'Three Houses' technique was created by Nicki Weld and Maggie Greening in New Zealand (Weld 2008, cited by Turnell 2012) and is mentioned in the Munro review. It helps a child or family think about and discuss risks, strengths, and hopes. It is usually most effective with older children or with families where you are finding it difficult to devise an effective intervention plan and can be used with individuals or a group.
Taking three diagrams of houses in a row, Social Workers explore the three key assessment questions: 1) What are we worried about, 2) What’s working well and 3) What needs to happen/how would things look in a perfect world. Start by presenting the three blank houses to the child or they could draw their own. Beginning with the ‘House of Good Things’, the child is asked what the best things are about living in the house and questioning is directed around positive things that the child enjoys doing there. After this stage you should progress to discuss the ‘House of Worries’ and find out if there are things that worry the child in the house or things that they don’t like. Finally the ‘House of Dreams’ covers an exploration of thoughts and ideas the child has about how the house would be if it was just the way they wanted it to be. A description is built up detailing who would be present and what types of behaviours would occur.
The ‘Safety House’ tool was developed by Sonja Parker. It helps to represent and communicate how safe a child feels in their own home and what could be done to improve things. It can be used with children who are not currently living with parents in order to plan for reunification. Progress can also be assessed by changes in the safety house drawing and can be a key tool in the assessment of risk and safety planning.
Start with a picture of a house with a roof, path and garden. The house and garden are divided into sections and the child can describe who they would like to live with them, who can visit and stay over and who is not allowed to come into the house. Safety rules are devised and put into the roof of the house and details of what happens in the house and what people do can be discussed. The house can also be utilised as a readiness scale by using the path as an indicator of how ready they are to return home.
The faces technique involves asking the child to pick from a range of different facial expressions and assigning them to members of their family. It is a useful method for discovering how a child perceives their family and is likely to appeal to younger children or those at an earlier stage of development.
After explaining to the child that you want to know more about their family, show them some pictures of different facial expressions, making sure they understand each expression and the emotion it relates to. You could draw them yourself or use a professional set. I recommend the Todd Parr Feelings Flash Cards which are really attractive and accessible for young children. They’re also thick, sturdy and, most importantly, durable. For more developed children, you can select a wide range of expressions; for those at earlier stages of development, you might want to just use two or three (ie happy, sad and angry).
There are many other activities that are effective in direct work with children and young people. I will try to write more posts soon. Follow me on facebook or twitter so you don't miss them! In the meantime, you might like to take a look at Audrey Tate’s book, Direct Work with Vulnerable Children. It’s primarily a set of playful activities to create opportunities to engage children. Through these activities children are enabled to tell their stories and provide Social Workers with assessment and support opportunities.
Yesterday I posted about the origins of attachment theory. Draft guidelines by the National Institute for Health and Care Excellence (NICE) argue that health and social care providers should train all key workers in assessing attachment difficulties and parenting quality, for children in – or on the edge of – care. My personal experience of the Social Work Masters was that attachment was covered but in a rather one dimensional manner without the necessary critical analysis. In recent years, some assumptions have been challenged and this post will look at three of the main debates in the theories of attachment. These debates are ongoing and you will have to judge for yourselves.
Adult attachment styles are dictated by the mother-child relationship.
This assumption rests on the principle of monotropy, but recent reconceptualisations of attachment suggest that attachment might be more significantly influenced by multiple caregivers and relationships. There are three possible models:
Firstly, the Hierarchical model is the classic understanding of attachment theory, in which attachment is to a primary caregiver (the mother) and that this relationship is concordant with other attachment relationships, and mediates future relationships. This model derives from Bowlby’s and Ainsworth’s research.
Secondly, the Integrative model describes an alternative organisational structure in which the child integrates all of his/her attachment relationships into a single representation. In this model, by Van IJzendoorn et al. (1992) they suggest that all attachment relationships are equal and independent, and the quality of the combined relationships best predicts his/her developmental consequences. The entire extended network of attachments is a better predictor of attachment than family attachment style only.
Thirdly, the Independent model states that each attachment relationship brings an independent representation with qualitative differences, domain and person specific. For example, the child’s relationship with peers is more likely to be determined by the maternal attachment, whilst social competence, efficacy and adjustment is more likely to be determined by paternal attachment. The evidence for this model is less well-established, but Crittenden’s Dynamic Maturational Model uses a version of this as its basis (more on that later).
There is evidence, both for and against these models using cross-cultural studies, studies of attachment in adolescence, and inter-generational studies. It's probably too much to cover right now but I may cover it in another post at a later date.
A categorical classification system is the most accurate way to describe attachment styles.
The two most significant attachment measures are the Strange Situation Protocol, used with toddlers, and the Adult Attachment Interview. Both allocate individuals to one of four categories.
If you’re interested in finding out more about your own attachment style you might like to look at this online version of the Experiences in Close Relationships Scale, a test of attachment style. The ECR was created in 1998 by Kelly Brennan, Catherine Clark and Philip Shaver. It groups people into four different categories on the basis of scores along two scales. The inventory consists of thirty six that must be rated on how characteristic they are of you.
If you do complete the above questionnaire, you will be given a classification made on the basis of a dimensional conceptualisation of attachment, that looks like the one below. Fraley & Spieker (2003) have argued that this provides a more sensitive and ecologically valid assessment of individual attachment style.
Finally, Patricia Crittenden has elaborated further by creating a model of attachment called the Dynamic Maturational Model. Crittenden’s model assumes multiple frames of reference and context-dependent responses, centred around a cluster of sub-categories. So, instead of the individual being categorised, the individual has a set of strategies, which can be matched to a range on this sphere. She adheres very strongly to an evolutionary framework. To see an overview of her theory, take a look at this YouTube video where she gives a presentation, titled "The development of protective attachment strategies across the lifespan", at the BPS DCP Annual Conference in 2012:
Attachment style is set by 12-18 months
Bowlby’s original theory implied, partly by its focus on a single caregiver, that attachment style might be set quite early on, although he explicitly allowed for life events and circumstances to allow change. However, it was Ainsworth’s development of the Strange Situation Protocol that really reinforced the idea that attachment style is set by the time of primary individuation at or around 18 months. There is evidence to support this stability of attachment style, but it is not black and white.
Different studies have found that:
So, attachment classification certainly has predictive power, but not 100%. In adoption studies (See my previous post on Risk, Resilience and Adoption), children adopted before 12 months of age are only slightly more likely to be insecurely attached than children raised in birth families, whilst children adopted after 12 months are at significantly higher risk of insecure attachment, and disorganised attachment specifically.
There are many, many more debates around theories of attachment. Too many to cover in a short blog post. However, I hope this has given you a tiny introduction to current thinking around the topic. It is important that practitioners are aware of these issues so that they can assess for themselves how best to integrate them into practice. Unfortunately, I can't give you a definitive answer about which theory or approach is best. You'll need to make an educated judgement based upon your own knowledge, research and professional experience.
All social workers in the care system should be trained in recognising and assessing attachment, according to proposed guidelines.
The draft guidelines by the National Institute for Health and Care Excellence (NICE) argues that health and social care providers should train all key workers in assessing attachment difficulties and parenting quality, for children in – or on the edge of – care. I couldn't agree more and I'm a little disappointed that this isn't already the case. This post, covering the origins of attachment theory, will be the first in a short series on attachment and it's implications for social work practice.
Attachment theory is almost 75 years old. During this time, some elements have changed but the underlying principles remain as true now as then. In the 1940s and 50s John Bowlby worked with children who had been either separated from their parents as war orphans or evacuees or who had experienced significant adversity in their early life. He believed that these children went on to experience a range of emotional, behavioural and psychological difficulties as a result of their early experiences of loss and trauma.
Bowlby has been criticised for developing a normative theory of development based on non-normative experiences. He was trained in a psychoanalytic tradition, but was disillusioned by its intrapersonal focus; instead he was influenced by the important empirical discoveries happening around the same time. I’ll outline some of them below:
In his 1943 book, The Nature of Explanation, Kenneth Craik described the central nervous system as “a calculating machine capable of modelling or paralleling external events” and saw this as a basic feature of thought. He described the human or animal in this way:
This might seem obvious to us now but to John Bowlby it provided a pragmatic explanation to the adverse developmental outcomes he had seen in orphans and institutionalised children; more so than the psychoanalytic training of his background because Craik’s theory was outward looking; seeing the individual in context.
John Piaget described intellectual development as a process of adjustment and adaptation to the world. As part of this growth children have to go through a process of assimilation and accommodation. Assimilation involves the inclusion of new information into existing schema or internal working models. Accommodation happens when a child is not able to assimilate information into an existing schema and either has to change the schema or develop a new one.
Craik and Piaget were important for attachment theory because they explained how infants develop schemas or maps for future relationships based on prior experiences and learning.
Niko Tinbergen and Konrad Lorenz were ethologists studying the sociology of birds. Their careers travelled in parallel, influencing each other along the way. Lorenz was inspired to conduct a study involving goslings which ultimately led to the imprinting hypothesis. In this study Lorenz split a large hatch of goslings, leaving half with the mother and taking the other half and raising them himself. Over the course of their development the goslings quickly identified him as their primary attachment figure and followed him, copying his behaviour. He taught them to swim, he used to call them with a special horn for feeding time and they always followed him. When they were given the opportunity to return to their birth mother, they didn’t recognise her as such, instead preferring Lorenz. This taught us about the importance and probable biological nature of the bond between mother* and offspring, in which the mother, the primary attachment figure, is the one who provides physical and emotional care and nurture.
As a light break, you might enjoy the following Tom & Jerry cartoon where they, in a very flippant and simplified manner, explain the concept of imprinting.
Later, in the 1960s Harry Harlow carried out a series of lab based experiments on monkeys (seen at the top of this post), rearing them in total social isolation. The study, which was unquestionably cruel, showed that monkeys were preferentially seeking out a cloth mother for nurturing; spending up to 18 hours a day holding onto her and seeking out a wire mother only for food. All the means for a healthy development were available and yet the monkey showed severe damage as a result of their experiences. The study suggested that mammals need reciprocal nurturing and attachment as much as they need their physical needs met.
Bowlby hypothesised that since humans cannot survive without adult care our evolutionary history has selected pre-wired dispositions on both the part of the adult and the child that ensure human survival. From this basis, Bowlby developed a model of attachment that is monotropic (has a single attachment figure).
It’s focussed on survival of the individual and the species and is integrated with human development to both influence broader developmental outcomes and be influenced by individual and contextual factors. Within this model tasks are identified for care giver and child that promote reciprocity and ultimately autonomy. The goal is to maintain emotional and physical equilibrium of the child thus keeping their attachment systems settled, allowing exploration and learning. During periods of distress the attachment system is activated and takes priority over the exploratory system.
The regulation of emotion and behaviour are tasks that the care giver and child accomplish together through reliable, responsive and consistent care giving. The care giver provides the infant with the necessary up-regulation and down-regulation that the infant needs. Consequently, parents that are not attuned to the infants needs, and cannot reliably and consistently provide care, leave the child without the necessary external regulatory support. Over time this develops into a complex system which affects the way in which a child, and eventually adult, responds to their own needs and to those other others.
I hope you've found this post interesting. You might also be interested in my post on Attachment Based Family Therapy. I'll write more on the current debates in attachment and methods of assessment soon. Follow me on facebook and twitter so you don't miss them.
Risk, Resilience and Adoption
Originally researchers and practitioners imagined that resilience was born out of some temperamental factor, innate to a person and not amenable to change or intervention. Temperament was one of those factors but there are other important factors including education, cognitive ability, social support and economic resources.
In the second wave of resilience research theories of psychology started to come to the fore. Researchers incorporated theories of developmental psychology, considering the effects of timing in interaction between the different developmental variables. This allowed for a more subtle understanding of resilience in which trajectories were not foretold but could be influenced by the addition or subtraction of key variables.
In the third wave, resilience research started to focus on intervention to improve outcomes. This is a challenging area to study as resilience interventions can have distil outcomes in a range of different domains, not all of which are predictable. For instance, an intervention focused on education improvement might lead to a child one or two generations down the line not growing up in poverty.
In the fourth and current wave of research, existing findings have been reconsidered in the context of new data on genetics and neurobiology. This information provides us with new way to describe and analyse existing data rather than providing causal explanations per se.
One example of how gene/environment interaction research is influencing our understanding of risk and resilience is the theory of differential susceptibility put forward by Jay Belsky and Michael Pluess. They noted, as has also been seen in clinical and research practice, that children experiencing the same risks and the same environmental stresses were having differential outcomes. They queried whether the diathesis-stress model could adequately explain these variations.
Pre-natal and genetic risks are individual factors included on the Y axis whilst stresses or environmental influences are captured on the X axis. This is a classic model and has helped to inform many theories in clinical psychology. It also underpins political agendas around resourcing interventions in the early years of a child’s life. It is however, in its simplest format here, problematic. It gives the impression that stresses affect an individual in accumulative fashion, ignoring the effects of timing and development, the nature of stresses or concurrent resilience factors. The model focusses on many negative outcomes ignoring the moderating effect of positive influences.
Belsky and Pluess noted that what was additionally missing from this model was a recognition of the role of individual plasticity. Plasticity is a term used to describe the ability of the brain and its bio-behavioural network to respond to new information. Infants have high plasticity in order to accommodate new learning and develop rapidly. As we get older plasticity diminishes. An example of this is the capacity of a five year old versus a fifty-five year old to learn a new language. For the five year old this is an easy task with learning happening almost unconsciously. For the fifty-five year old acquisition of a new language will be possible but challenging, even with very deliberate learning.
When we include the concept of plasticity in our understanding of risk and resilience we make some interesting new discoveries. It also teaches us the importance of thinking about positive and negative influences and outcomes together. So, if we imagine a child who has experienced some significant adversity and yet appears to be coping we describe them as resilient and, indeed, they don’t suffer a catastrophic fall in the face of their difficulties but instead manage to maintain a reasonably even keel, perhaps even managing to make some slow progress along normative developmental lines. This child’s ability to resist the worst effects of the negative environment protects them; however, it also means that they don’t get the full benefit of a positive environment.
In contrast, some children don’t fare so well. In the face of adversity they have catastrophic outcomes. These children are called non-resilient. However, an important detail is being missed here. These children are showing plasticity in their development. In the face of a negative environment their outcomes are poor so they’re susceptible to the influences around them. What this also means is that if we give these children a positive environment with good resources they have to potential for a favourable outcome. So, what puts them at risk of an adverse outcome also gives them the opportunity of an incredibly positive outcome, and they may actually achieve more than those children who we’ve traditionally labelled as resilient.
Adoption is widely regarded as an effective intervention for children who’ve been born into families where there are significant risks associated with abuse, neglect, domestic violence, substance use or other multiple risks that prevent 'good enough' parenting. For children where there is the prospect of repatriation back into the family through improvements in parenting, fostering or institutional care can provide a good compromise position. However, children who have been fostered or are institutionalised tend to show high insecurity and attachments and general delays in development, suggesting this is not the best final solution. In that respect, adoption provides a much better option. Nonetheless we know that adopted children can have problems afterwards: they make slower progress at school; have more behavioural problems during middle childhood; and are more likely to be referred to child and adolescent mental health services.
In light of this IJzendoorn and colleagues conducted a meta-analysis, including 230,000 children who had been adopted or remained with their birth families, fostered or institutionalised to examine outcomes in height, weight, IQ, self-esteem, internalising problems; externalising behavioural problems; and attachment security.
What they found was what they describes as massive catch-up, particularly noticeable in height and weight but also IQ. Self-esteem showed no difference to children brought up in their birth families. Externalising problems were slightly more prevalent. Attachment security was lower than that for birth children at 47% compared to 60-70% in birth family children. But that is still twice as high as children who had been fostered or institutionalised. They concluded that adoption is a highly effective intervention building resilience and mitigating against the risks of an early challenging childhood 'if no other solutions are available'. Of note, this mata-analysis just looked at adoption as an intervention and because it covers a lot of studies we can cancel out the effects of more specialist or therapeutic interventions. Therefore, what we can see is that adoption has dramatic outcomes for children, reducing risk and increasing resilience.
A couple of weeks ago I was asked about the causes, symptoms and likely consequences of troublesome and antisocial behaviours in children and young people. I’ve put together this post to offer a little bit of insight and advice to parents and those working with children displaying these kinds of behaviours. I hope that this post will help you by:
Nearly all children and young people can react in an angry or aggressive way if they are provoked. This ability is essential for survival, otherwise people would have difficulty defending their need for space and food. That is not what this post is concerned with; rather we are looking at cases where children are aggressive and angry a lot of the time. Children that do this far more than others, and in a way that prevents them from making satisfying relationships and getting on with activities and schoolwork.
Before we get started I think it is important to firstly distinguish antisocial behaviour from the following:
Occasional acts of antisocial behaviour or temper outbursts, once a fortnight or month, can be very frustrating for parents or teachers. However, if the child is well adjusted, has friends and is doing okay at school: adults should react calmly and not make too big a deal of what has happened; respond quietly (shouting at the child and calling them names can do more damage than the child’s original outburst); stay calm and apply a consequence that lasts a short time but is important to the child (for example, taking away a mobile phone, grounding the child or stopping them watching TV); talk when both sides have calmed down, about what happened and try to find ways to stop it happening again in the future.
New antisocial behaviour in a previously well-adjusted child. This could include longer periods, up to a month or two, of aggression and moodiness in a previously reasonably adjusted child that after investigation seems to have a fairly obvious cause for the change in behaviour. For example: separating parents, failing an exam, breaking up with a boyfriend or girlfriend, moving to a new area or being bullied or abused. In these cases, adults should find a calm moment to talk to the child and discover what is on their mind; suggest possibilities to the child, as he or she may not be aware how upsetting an event has been; make the child feel that they are understood and there is sympathy for them; once the causes has been agreed, make plans for a more positive future. Usually the behaviour will settle down; if it doesn't, then a more significant problem should be considered.
Long-standing antisocial behaviour can be defined as a general pattern of antisocial behaviour that has been present for several months in children and young people. In younger children this pattern can include: being touchy, having tantrums and being disobedient; breaking rules, arguing and rudeness; deliberately annoying other people, hitting, fighting, and destroying property around the house or school; or, bullying other children.
If the pattern is persistent and serious enough to reduce the child’s ability to have a happy home life and/or get on at school, then the child is likely to meet criteria for oppositional defiant disorder.
In older children and teenagers this pattern can include: lying and stealing (including breaking and entering into houses) and cruelty to other people or animals; leaving the house without saying where they are going (staying away overnight without permission); skipping school (truancy) or breaking the law, drinking alcohol inappropriately or taking drugs inappropriately; being a member of a gang and/or carrying a weapon.
If the pattern is persistent and serious they are likely to meet criteria for a conduct disorder. The long-term consequences of a conduct disorder are often negative and the child may be at significant risk of: criminal and violent acts; misusing drugs and alcohol; leaving school with few qualifications; or becoming unemployed and dependent on state benefits. It is, therefore, important that those working with children and young people are able to identify those who are at risk so that effective interventions are available. If you are worried a child is displaying signs of oppositional defiant disorder or a conduct disorder you should seek a referral to CAMHS through the child’s GP.
Many children and adolescents behave in a difficult or aggressive way from time to time. However, a minority do this persistently for several months in a way that hurts other people emotionally or physically. This can result in poor relationships with family, friends and peers at school.
Young children may be very difficult to handle at home but perfectly well behaved at school. A small minority are the other way around. If problems persist they often spill out from home to include school and relationships with friends, who get fed up with the aggression. Bullying, for example, may happen during the school day or on the journey to and from school. Teenagers may go out into the local community in gangs and commit antisocial acts.
There are many possible underlying causes of persistent anti-social behaviour. The first step in assessment should be to speak with the child or young person about their behaviour as well as any upsetting external events in their life. Parents and teachers are also a great source of information and insight regarding a child’s well-being.
If a child has been performing worse than expected in school, it may be that they have a specific learning difficulty such as dyslexia with reading. It is not necessarily the case that poor performance is due to laziness and failure to apply themselves.
If a child is restless and fidgety, has difficulty sitting still and moves around more than other children, it is possible that they suffer from attention-deficit hyperactivity disorder (ADHD). If present, the child will also have a short attention span and difficulty concentrating. They will not be able to control themselves in a wide range of situations such as queuing up at school, or taking turns in conversation. Schools should be able to refer children displaying these behaviours for assessment by an educational psychologist.
If a child is persistently sad and miserable, it is possible that they are suffering from depression. If this is a concern you should request additional support through your GP. You may also find my article on Attachment Based Family Therapy useful.
Ineffective parenting is often a strong contributor, particularly if there is little warmth or positive encouragement; low involvement and poor supervision of the child’s activities and whereabouts; inconsistently applied consequences; or negative and harsh discipline. Certain types of parenting are more likely to lead to antisocial behaviour either initially, or in maintaining it. For example, through inconsistent discipline the child may learn that they often get what they want by misbehaving, which in turn reinforces the behaviour.
In many cases it may be that parenting is not ‘ideal’. This may arise simply out of exasperation, where the child is so annoying that the parents lash out angrily. Even if the original cause of the behaviour was an unhappy event, or a difficult temperament, if the child learns that he or she is rewarded by getting what they want through misbehaving they will do it more often. When children get little attention, they prefer to have negative attention than none at all. They will misbehave to gain the interest of the parent, even if through scolding or telling off. Reversing it provides a way forward for treatment.
The way to reverse bad behaviour is to help parents build a positive relationship with their child. The parent should be supported in making clear the behaviour they want from the child and reward them through attention, praise or other good things. When the child does not behave, parents should use calm limits with clear consequences. Minor misbehaviour should be ignored whilst there should be proportionate consequences if it is more serious.
Children must be given plenty of attention and encouragement for positive behaviour. This means instead of saying ‘stop running’ say something like “please walk slowly”, or “I really like it when you walk calmly”. If the child is making a mess at the dinner table, rather than saying “stop making such a mess”, you should give clear instructions as to what is desired and then praise them. These instructions are very clear and help the child understand what is required. Praise should be immediate as it allows the child to see a clear link between cause and effect.
Barefoot Social Work can provide support on effective interventions, and an action plan can be formulated for your child or young person. Usually these work by helping parents and others around the child set clear limits and encourage positive behaviour. However, sometimes they can also help the young person learn techniques to control their temper. It may be that parenting classes will be beneficial or a period of intensive one-to-one parenting support. Please get in touch if you require any additional advice.
Finally, it is important to note that if behaviour is suspected as being the result of abuse it is essential that concerns are reported to your local authority children’s safeguarding service.
Last week I started a 6 week course with the University of Edinburgh called The Clinical Psychology of Children and Young People. Child psychology is an area that particularly interests me and I'll post some of my own interpretations of how the material can be used in social work practice. I have studied it extensively in the past; however, I believe that as Social Workers we should continually refresh and build upon the knowledge that forms a basis for our practice. Like renewing a first aid certificate. I hope you find these posts interesting and helpful.
This week we looked a child and adolescent development, factors that influence development, and models of developmental psychopathology. An understanding of children’s development helps us to interpret children’s well-being and mental health, and taking a developmental approach is important as it helps us to spot and interpret a number of different patterns and behaviours. Furthermore, looking at developmental outcomes (milestones) allows us to see when development is atypical and helps us to identify ways in which the child may need supporting.
Children are qualitatively different from adults, they are not born as mini adults, and they are not born as empty vessels. They are complex in their development: some development occurs slowly and over time; other times development occurs rapidly such as in infancy and adolescence. To help, we can break it down into the following phases of development:
There are also different aspects of development:
Of course, the child develops as a whole and the different aspects of development do not occur in isolation. They all interact with one another. To understand this we look at patterns of development.
Development isn't always progressive. There are various patterns of continuous change. Sometimes development can be very rapid and sometimes change is slow and gradual.
At 18 months children start to engage in pretend play. Pretend play starts to decline during middle childhood as other forms of play become more prominent. This pattern of continuous development is often known as an inverted U function; where you can see that development increases and then declines.
You can also have U shaped continuous change where you see an apparent decline that actually leads to an improvement in development. Often this is true of cognitive development where a child’s behaviour may look like it is becoming more difficult but actually, cognitively, they are re-evaluating how to perform the task and then their performance improves.
Another pattern of development is stage changes. This is where you have changes in ability which seem to take quite a dramatic shift. A classic theory of stage changes is Piaget’s theory of development. He outlined four stages of cognitive development:
Piaget argued that each of these stages is typified by a new range of cognitive abilities or operations that allow children to cognitively perform at a different level.
There are many influences on development. Firstly, biological influences like genetics and the brain.
Genetics have a probabilistic relationship with development. They do not always determine or cause different developmental outcomes but they influence it through interacting with other genes and other things in our environments. An example of where genetics do have a direct link with development is in Down Syndrome. It’s a chromosomal abnormality that lead to a particular set of features and characteristics. Most genetic contributions are, however, probabilistic and they are seen as a risk or protective factors rather than direct causes.
Twin research studies have been helpful in assessing the relative role of genes versus environment. As a result some mental health conditions and difficulties have been found to have a genetic component to them. For example, schizophrenia, ADHD, Autism, developmental dyslexia. However, genes aren't the whole story they are just a part of it.
The Human Genome Project has helped to identify which genes or constellation of genes influence particular developmental and mental health outcomes. For example, we now know particular genes are involved with autism. We also know that some genes and combinations of genes act as protective factors as well.
Brain development is also a significant biological influence. We know that there are important growth spurts which occur in the brain, firstly in infancy, and then later in adolescence. In the first two years of life we know that the brain grows enormously; but even more important are all the connections that are made in the brain that are related to the experiences the child has both physically, socially and emotionally. The more experiences a child has the more connections are maintained. If those experiences don’t occur or are reduced then the synaptic connections are pruned. This means that early brain development in infancy is very much a product of the environment the child is in; but in turn that brain development itself offers developmental opportunities for the child.
The next major changes in brain development occur in adolescence which coincide with puberty. I’ll write a separate post on this later.
Biological influences are really important but the environments within which children live and the people they live with are crucial to their development. We refer to these as social and environmental factors. Not only do the people a child lives with influence the food they eat (whether they have enough), the house and community they live in but also the people around them give them opportunities to learn and improve their understanding of the world and themselves. Also the people around them help them to form relationships and emotional bonds with others which can last in the long term.
Social workers can use a tool (based on Bronfenbrenner’s Ecological systems theory) to assess a child’s social and environmental factors. A child can complete a task with concentric circles with them in the middle; identifying who they think are important to them. Most importantly you should ask the child why they feel they are important.
The third influencing factor on development is the interactions between biological, psychological and social influences. Most of a child’s development is influenced by both biological and social factors and how they interact. This area is often called the nature / nurture debate. For example, in early infancy, experiencing a loving, caring relationship with someone is crucial to the development of attachments. If this area is of particular interest you might like my posts on Psychology and Mental Health: Beyond Nurture and Nurture.
Finally, we looked at models of developmental psychopathology and it’s influences on mental health and well-being.
Developmental psychopathology focuses on normal and abnormal development and also adaptive and maladaptive processes. It shows us that there are a range of developmental trajectories that a child can take.
Compas and colleagues undertook a review of adolescent development and highlighted that there isn’t just one developmental pathway or trajectory. They identified five:
This model is important as it highlights that adolescent development doesn’t just have one pathway. There are a range of different pathways that young people can find themselves on depending on a range of different factors and influences.
Social Workers work with children and use skills based upon child development in their everyday practice. We observe children and learn something about how they’re developing and their well-being from our observations of them. We speak to children and learn about their development directly from them. We sometimes use little tasks and drawings and even short questionnaires and scales. If you'd like to find examples of scales and questionnaires that might be helpful in your practice please take a look at the tools section of this website.
Next week I'll be covering the topic of resilience. Please follow me on facebook or twitter so you don't miss it!
Adolescent 'behavioural problems' are a huge source of referrals for local authority children's services across the country, after parents and teachers struggle to find strategies that work. However, what is sometimes overlooked is that many rebellious and unhealthy behaviours or attitudes in teenagers can actually be indications of depression. The following are just some of the ways in which teens “act out” or “act in” in an attempt to cope with their emotional pain:
The Child and Adolescent Mental Health Service (CAMHS) has been the traditional route for support in the UK. However, waiting times and thresholds are at an all time high. More and more services are commissioned only for those children presenting with the signs and symptoms of a diagnosable disorder or condition which means that those struggling with less obviously acute or harder-to-label problems are often not eligible for treatment. As a result Children’s Social Workers are increasingly working to help families through what can be a very distressing time, and there is a renewed focus on specialised training to meet this need.
Attachment Based Family Therapy (ABFT) is a manualised, empirically informed, family therapy model specifically designed to target family and individual processes associated with adolescent depression. However, I have found it has strong applicability when working with all families with teenagers. It was first developed by Prof. Guy Diamond, Suzanne Levy and Gary Diamond; all of whom have received international acclaim for their work in this area.
The model is emotionally focused and provides structure and goals; thus, increasing the Social Workers intentionality and focus. It has emerged from interpersonal theories that suggest teenage depression can be precipitated, exacerbated, or buffered against by the quality of interpersonal relationships in families. It is a trust-based, emotion focused model that aims to repair interpersonal ruptures and rebuild an emotionally protective, secure-based, parent-child relationship.
Teenagers may experience depression resulting from the attachment ruptures themselves or from their inability to turn to the family for support in the face of trauma outside the home. The aim of ABFT is to strengthen or repair parent-child attachment bonds and improve family communication. As the normative secure base is restored, parents become a resource to help their child cope with stress, experience competency, and explore autonomy.
I believe it should be integrated into the practice of all children’s social workers. If you’d like to learn more you can buy the latest book, Attachment-Based Family Therapy for Depressed Adolescents, here.
I'm a Qualified Children's Social Worker with a passion for safeguarding and family support in the UK.