The Clinical Psychology of Children and Young People

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.  

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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:

1. Development happens between conception and birth
2. Infancy, between birth and two years, is a time of rapid growth in every aspect of development. By two and a half children are usually half their adult height. 
   
3. Early, middle and late childhood, between the ages of three and ten years, is a time of refinement of motor skills and huge cognitive changes. 
4. Early, middle and late adolescence, between the ages of eleven and twenty, is a period when children moving away from the family and into independent adulthood.  

There are also different aspects of development:

1. Physical development – Motor coordination, fine motor coordination, growth in height and brain development. Physical development can be quite easily observable but not necessarily. 
2. Social and emotional development – friendships children make, relationships they have with their parents and peers, how they feel about the social world they're in, and how they manage their emotions
   
3. Cognitive development (Cognition) – Thought processes, such as memory, reasoning, and attention. Much of it is unobservable and it can be difficult to detect. 
   

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:

1. Sensory motor stage between birth and two years. 
   
2. Pre-operational stage between three and seven years.
   
3. Concrete operations between seven and eleven years.
   
4. Formal operational between eleven and fifteen years.
   

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:

1. Stable adaption - A young person shows few problems
   
2. Stable maladaption - A young person shows continual difficulties through a childhood and into adolescence.
   
3. Adolescent decline - A young person may not have previously been experiencing difficulties and then in adolescence difficulties began. 
   
4. Adolecent turnaround - A young person may have been experiencing problems as a child and then in adolescence something happens to lead them on a more adaptive pathway. 
   
5. Adolecent limited maladaption - A young person in mid adolescence can begin to have difficulties psychologically that are resolved before then end of adolescence. 
   

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!