Childhood: Clinical and School Psychology – Lecture summary (UNIVERSITY OF AMSTERDAM)
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Fear refers to the emotional response to real or perceived immediate threat. Anxiety refers to the anticipation of future threat. Phobia refers to being fearful or anxious about or avoidant of a certain object or situation. There is no specific cognitive ideation.
There are four symptoms of anxiety:
The purpose of anxiety is to alarm one of danger (1), prepare the body to act quickly (2) and keep distance from the danger (3). There is no strict boundary between typical and deviant anxiety. Therefore, the four d’s need to be evaluated when assessing anxiety.
What a child is afraid of changes with age. Children may be more afraid of animals due to their magical thinking. They may be afraid of the dark because of their inability to control it. At seven or eight years old children start to become more concerned with the future.
There is an increase in the prevalence of any anxiety disorders from the age of 11. There is a strong decline in separation anxiety disorder after the age of 10. For phobias, the prevalence can reach up to 16% in adolescence.
Children who suffer from anxiety disorders will be clinging (1), show physical complaints (2), have sleep problems (3), concentration problems (4), avoid certain situations (5), demonstrate a lot of ‘just in case’ behaviour (6), feel small (7), get angry (8), get easily upset (9), demonstrate perfectionism (10), stay home from school (11), lie (12) and alarm adults (13). There is comorbidity between ADHD and anxiety disorders.
Behavioural inhibition refers to inhibited behaviour. As an infant, there is high reactivity to stimuli (e.g. crying). In preschool, these children do not approach strangers (1), stare at strangers (2) and stays close to the mother (3). Modelling behaviour is stronger in the same-sex parent.
There are several risk factors for anxiety disorders:
Risk factors in the microsystem include a lot of parental control and rejection. Risk factors in the chronosystem include negative life events (e.g. domestic violence; bullying). School can also be a risk factor as several aspects increase the risk for anxiety disorders:
It is important to assess why school refusal developed. This can be done by making a functional analysis (i.e. determining the function of school refusal).
There are several protective child factors for anxiety:
There are also several protective system factors for anxiety:
There are three routes to anxiety:
There are three types of biases.
A cognitive bias is typically implicit and can maintain anxiety as it leads to avoidance. Avoidance provides relief from the anxiety-inducing object in the short-term but leads to an increase in anxiety over the long-term as there is no development of coping with anxious situations. A personal fable refers to the tendency to believe that no one has ever experienced what one is experiencing. Imaginary audience refers to the idea that everyone is looking at you. This may be relevant to the development of social anxiety disorder.
There is comorbidity between anxiety and depression and this can be explained by the tripartite model. This states that there are three factors that are relevant in both disorders.
According to the model, both disorders are characterized by a lot of negative affectivity. However, anxiety also has increases in physiological hyperarousal and depression has a decrease in positive affectivity.
It is essential to adapt language use to the client in psychoeducation. There are several components of psychoeducation:
The goal of psychoeducation is to visualize the anxiety symptoms and elucidate how they are related. To do this, one can make an anxiety circle. This refers to a circle of how anxiety can be maintained by the stressors and the current behaviours. It is also possible to focus on cognition and how faulty thinking patterns can lead to anxiety (e.g. worrying as a coping mechanism; underestimating self-competence).
One treatment for anxiety disorders is systematic desensitization and it occurs in several steps:
Disorder | SEPARATION ANXIETY DISORDER |
Clinical description | Developmentally inappropriate intense feelings of distress upon separation of the caregiver lasting for at least four weeks. The disorder manifests itself before the age of 18. 6 is considered early onset. School refusal is common. |
Symptoms | At least three of the following for at least four weeks:
Repeated physical complaints when separation is anticipated. |
Course | It is more frequent in females and is comorbid with GAD, depression and somatic complaints. It may be a precursor for increased risk for disorders in adulthood. |
Aetiology | Mothers often have a history of anxiety disorders. Overprotectiveness and reinforcement of the child’s avoidance behaviours can maintain the disorder. |
Assessment and treatment | Treatment includes cognitive behavioural interventions (e.g. Coping Cat), focussing on coping skills or exposure. |
Disorder | SELECTIVE MUTISM |
Clinical description | A reluctance to verbalize when expected lasting at least one month. It is not the response to weak language skills or a speech problem. |
Course | Children often outgrow it but it can be a risk factor for social anxiety disorder. |
Aetiology | The onset is associated with the beginning of formal schooling. Negative affectivity (1), behavioural inhibition (2), parental history of shyness (3), social isolation (4) and indicators of social anxiety are risk factors (5). |
Assessment and treatment | Treatment includes behavioural methods (1), systematic desensitization (2) and modelling (3). |
Disorder | PHOBIAS AND FEARS |
Clinical description | These children experience a persistent and significant fear of an object or place that does not have a reasonable basis. There is frequent avoidance and exposure may elicit strong physiological responses. The focus of the fear is the anticipation of harm and there is a strong desire to escape. |
Symptoms | This includes excessive reactions to encountering a feared object or situation and can include the following:
|
Course | More females than males have phobias. Situation-specific phobias develop later than phobias related to environmental concerns. The number of fears decreases with age but worries tend to escalate. |
Aetiology | Anxious attachment (1), family characteristics (2), exposure to conditioning experiences (3), parent psychopathology (4), family communication styles (5), parenting practices (6) and attachment history are risk factors. Protective behaviours may lead a child to not learn how to cope with distressing circumstances. |
Assessment and treatment | Treatment includes systematic desensitization (1), modelling (2), reinforced practice (3) and exposure (4). In-vivo exposure is most effective although the models can be videotaped. |
Disorder | SOCIAL ANXIETY DISORDER |
Clinical description | A pervasive fear of embarrassment or humiliation that leads to avoidance of social or performance situations. The fear must be present in front of peers as opposed to only in front of adults. |
Symptoms | In situations where people feel that they may be scrutinized excessive fear and anxiety may be:
|
Course | The onset is typically in adolescence and there is an increased risk for a lower quality of life and school dropout. People often do not seek treatment. It is more common in children with GAD and their GAD is often more severe. |
Aetiology | There typically is evidence of normal social interaction with familiar people and pervasive fear across situations. Parental communication (1), attachment (2), parenting style (3), first-degree relatives with social anxiety disorder (4) and behavioural inhibition (5). People with behavioural inhibition typically experience more social rejection. |
Assessment and treatment | Treatment includes systematic desensitization (1), exposure (2), modelling (3), reinforced practice (4) and social skills training (5). |
Disorder | PANIC ATTACKS |
Clinical description | A sudden overwhelming fear that penetrates thoughts, feelings and sensations. The attacks last about 10 minutes. |
Symptoms | It consists of at least four of the following symptoms:
|
Course | It is more common in adolescents and age of onset is typically between the age of 15 and 19. It can be triggered by specific phobias or can be the response to separation anxiety disorder. |
Aetiology | Negative affect (1), anxiety sensitivity (2), separation anxiety (3) and other anxiety and depressive disorders (4) are a risk factor. Panic attacks may occur from the interaction between temperament and attachment issues. It may also be the result of misinterpretation of bodily sensations. |
Disorder | PANIC DISORDER |
Clinical description | A persistent fear of recurrent panic attacks. |
Symptoms | In the month after a panic attacks, the following symptoms are demonstrated:
|
Course | The onset is typically between late adolescence and early thirties. It more common in females than in males and the disorder tends to be chronic when it onsets in adolescence. |
Aetiology | A first-degree relative with panic disorder and irregular activity of norepinephrine is a risk factor. |
Assessment and treatment | Treatments include cognitive behavioural treatment (1), SSRIs (2) and anti-depressant drugs which restore levels of norepinephrine (3). |
Disorder | AGORAPHOBIA |
Clinical description | Avoidance of certain situations in which people feel like they cannot escape if something (e.g. panic attack) happens there. |
Symptoms | The avoidance of two or more possible situations:
|
Course | It is more common in females than in males. The onset is typically in late adolescence or early adulthood. People often develop the disorder after a panic attack or a panic disorder. |
Aetiology | The family situation often lacks warmth and is high on parental overprotection. There is a strong biological component and it is associated with negative life events. |
Assessment and treatment | Treatment includes systematic desensitization (1), participant modelling (2) and reinforced practice (3). |
Disorder | GENERAL ANXIETY DISORDER |
Clinical description | There is no specific focus of worry but pervasive worry that generalizes across situations and topics. There is excessive worry and an inability to control the worry. It is associated with perfectionistic tendencies and people may require excessive reassurance. |
Symptoms | The following symptoms are included in the diagnosis for 6 months:
|
Course | It is often comorbid with separation anxiety disorder in adolescence and adulthood. It is also comorbid with phobia or depression. |
Aetiology | A malfunction in the neurotransmitter GABA (1), genetics (2), anxious interpretation style (3), self-blame (4) and anxious parents (5) are risk factors. |
Assessment and treatment | The Coping Cat programme can be used as treatment. A child with anxious parents does not benefit from CBT unless the parents are also included. |
Disorder | OBSESSIVE-COMPULSIVE AND RELATED DISORDER |
Clinical description | Obsessive thoughts and compulsive behaviours. The compulsive behaviours are attempts to neutralize the anxiety caused by the obsessive thoughts. |
Course | More females than males have OCD and males have an earlier onset. Hoarding symptoms are more common among older adults but can occur in adolescence. |
Aetiology | A family history of Tourette’s disorder (1), malfunction of the caudate nuclei (2), low levels of serotonin (3) and a dysfunction in the orbital region of the prefrontal cortex (4) are risk factors. |
Assessment and treatment | Treatments include behavioural programmes (1), medical management (2), exposure and response prevention (3) and CBFT (4). |
A case formulation refers to a hypothesis about why the problem behaviour exists and how it is maintained. This should be based on the longevity of the problems (1), consistency of problematic behaviour across situational contexts (2) and family history (3). Problematic behaviour is characterized by the four d’s:
The duration should also be taken into account. Clinical decisions are often taken based on measures of intensity (1), duration (2) and frequency of the behaviour relative to the norm. To have a valid diagnosis, several things need to be taken into account:
It is essential to take the developmental stage of a child into account when assessing behaviour. According to Erikson, children develop through psychosocial stages with socioemotional tasks that must be mastered to allow for positive growth across the lifespan (e.g. trust vs. mistrust). Behavioural theories state that behaviour is shaped by associations (i.e. contingencies) resulting from positive and negative reinforcement.
There are three questions that need to be answered by the clinician after assessment:
The adaptation theory states that early attachment relationships have an impact throughout the lifespan. Triadic reciprocity refers to the dynamic system between the person, the environment and behaviour where all three influence each other.
Family systems theory states that the family is a system made up of subsystems (e.g. parent and child; parent and parent). The behaviours in a system are aimed at maintaining or changing boundaries, alignment and power. A family’s degree of dysfunction can be determined by boundaries that are poorly or inconsistently defined.
The DSM is a categorical diagnostic system. It makes use of clear-cut categories as this is needed for health care service (e.g. insurance). However, there are several problems with this:
Fear refers to the emotional response to real or perceived immediate threat. Anxiety refers to the anticipation of future threat. Phobia refers to being fearful or anxious about or avoidant of a certain object or situation. There is no specific cognitive ideation.
There are four symptoms of anxiety:
The purpose of anxiety is to alarm one of danger (1), prepare the body to act quickly (2) and keep distance from the danger (3). There is no strict boundary between typical and deviant anxiety. Therefore, the four d’s need to be evaluated when assessing anxiety.
What a child is afraid of changes with age. Children may be more afraid of animals due to their magical thinking. They may be afraid of the dark because of their inability to control it. At seven or eight years old children start to become more concerned with the future.
There is an increase in the prevalence of any anxiety disorders from the age of 11. There is a strong decline in separation anxiety disorder after the age of 10. For phobias, the prevalence can reach up to 16% in adolescence.
Children who suffer from anxiety disorders will be clinging (1), show physical complaints (2), have sleep problems (3), concentration problems (4), avoid certain situations (5), demonstrate a lot of ‘just in case’ behaviour (6), feel small (7), get angry (8), get easily upset (9), demonstrate perfectionism (10), stay home from school (11), lie (12) and alarm adults (13). There is comorbidity between ADHD and anxiety disorders.
Behavioural inhibition refers to inhibited behaviour. As an infant, there is high reactivity to stimuli (e.g. crying). In preschool, these children do not approach strangers (1), stare at strangers (2) and stays close to the mother (3). Modelling behaviour is stronger in the same-sex parent.
There are several risk factors for anxiety disorders:
About 5% of the children and 2.5% of the adults are diagnosed with ADHD. There are several requirements for a diagnosis:
There are three subtypes:
Children with the inattentive presentation are often misdiagnosed and misunderstood. It is often misinterpreted as a lack of motivation. The children may be characterized by a sluggish information processing style and there are problems with focused or selective attention. These children are unable to filter essential from non-essential details. This lack of attention may result from information overload and the inability to selectively limit the focus of attention. They have poor performance on tests because of this problem with attention and their poor concept of time and time management.
Children with the hyperactive-impulsive presentation experience academic problems due to their impulsive nature. They emphasize speed over accuracy and approach tasks incorrectly because they do not wait for all instructions. They are at social risk due to their impatient nature and they often have poor social skills and difficulties making and maintaining friends. They often gravitate towards other rule-breaking children.
A difficult temperament (1), poor sleep patterns (2), excessive activity (3), irritability (4) and a difficulty soothing the child when they are upset (5) are risk factors in infancy for the development of ADHD. During toddlerhood, the child may demonstrate higher levels of underregulated behaviours and a lack of self-control may persist during the transition to preschool.
The symptom presentation of ADHD differs with age. Inattention symptoms are consistent over time but the hyperactive/impulsive symptoms decrease over time. There is
.....read moreAutism spectrum disorder (ASD) is a neurodevelopmental disorder with five criteria:
Symptoms of autism may not manifest themselves in early development if there is a mild version of the disorder. Most children with ASD will demonstrate difficulties in the key symptom clusters but the symptomatology and severity differ. The severity is based on support needed. This ranges from support to very substantial support.
In ASD, there is abnormal language development and several language difficulties are associated with ASD. The child with ASD:
There are several symptoms of Asperger’s syndrome:
While many people with Asperger’s syndrome see it as part of their identity, it was removed from the DSM-5 together with PDD-NOS (1), childhood disintegrative disorder (2) and autistic disorder (3). Asperger’s may not be severe enough to classify as part of the autistic spectrum. However, Asperger’s syndrome may be a separate category due to differences in language development.
.....read moreThe WISC-IQ test measures the following:
The focus of an IQ test is on school-based skills (e.g. language; math; understanding; spatial skills; planning; problem-solving; logical skills) and it also measures acquired knowledge and skills. This means that an IQ test does not only measure potential but also current intelligence. It is important to assess whether deficits are the results of lack of opportunities (i.e. deprivation) or limitations in capacity.
There is not a perfect relationship between school performance and IQ as school performance may be lower than somebody’s IQ due to socio-emotional circumstances (e.g. being bullied) or other issues making school performance more problematic (e.g. dyslexia).
An IQ score is not a school advice in the Netherlands. The schools give an advice and CITO scores and IQ scores could change this advice. The traditional view of giftedness holds that a child with an IQ of 130 is gifted. The current view of giftedness holds that there needs to be high ability but not necessarily an IQ score of 130 or higher. Somebody is not only gifted if somebody has potential but also if this person shows gifted behaviour.
According to Renzulli, giftedness does not depend on a single criterion (e.g. IQ) but refers to the interaction between three clusters of traits;
This definition is applicable to any valuable area of performance (e.g. music; arts) and not just academics. People who are gifted score above average on each of the clusters but not necessarily in the superior range. Whether somebody is gifted depends on the needs and values of a culture.
Persistence in the accomplishment of ends (1), integration toward goals (2), self-confidence (3) and freedom from inferiority feelings (4) are personality factors that predict achievement among individuals with high intellect.
While intelligence on IQ test is relatively stable it does not say anything about development. Giftedness focuses on exceptional behaviour. Gifted children need educational opportunities that are normally not provided in regular instruction. However, this may be needed for all children but the outcomes differ depending on talent.
According to Gardner, there are multiple intelligences. This includes the following:
According to this view, giftedness includes a biopsychological potential to process information. This can be activated by the appropriate cultural setting (e.g. teachers should present lessons through a variety of methods, such as music).
Sternberg’s
.....read moreMultilingualism refers to speaking multiple languages. It is not just a technical task which only requires a cognitive dimension as it also has emotional, social and cultural significance. There are three dimensions for describing people’s associations with the languages they speak:
Simultaneous multilingualism (i.e. balanced bilingual) refers to learning the first and second language simultaneously. Both languages are learned in the home environment and the level of both languages is maximal depending on socioeconomic status and input. Successive multilingualism (i.e. functional bilingual) refers to learning the first language first and the second language after mastering the first one. The first language is learned in the home environment whereas the second language is learned at school or work. The level of the first language is maximal but the level of the second language varies. This multilingualism can be domain-specific (e.g. only reading; only speaking).
Lower order processes refer to the level of letter and word recognition. Higher-order processes refer to the comprehension of the content of text. Efficient lower-order processes allow to allocate optimal attention to the interpretation of meaning communicated in the text. Metacognitive skills in reading refer to the ability to use strategies to regulate the reading process.
When learning a language at home, exposure to the best language is essential. It appears as if the first language skill can predict second language learning early on in life. This could help with early diagnoses of reading and spelling problems of the second language. There are several theories as to how the first language influences learning the second:
In a structural model of languages, there are relations between skills in language one and language two. Lower
.....read moreSpecific learning disabilities are detrimental to one’s well-being. The repeated academic failure associated with this continues to haunt people for years after formal schooling.
A specific learning disability originally included a discrepancy-based definition. This included a discrepancy between IQ and achievement (e.g. high IQ, low reading achievement). However, the degree of discrepancy is arbitrary. This definition favours older children and children with a higher IQ. It is failure-based (e.g. waiting for children to show failure in academics).
The current definition is focused on identification with response to intervention (RTI). It includes achievement in key academic areas that is substantially below the age norm and in excess of sensory deficit (1), linguistic processes (2), attention (3) and memory (4). The prevalence rate is about 2% to 10%.
There are often social deficits in people with SLD but this may be because they get rejected and neglected by peers more often. People with SLD typically have low self-esteem and a poor self-esteem.
The DSM-5 definition of a specific learning disorder includes the following:
The DSM-5 uses a discrepancy definition but not an IQ-discrepancy definition. There are three specifiers for severity:
Positive psychology interventions (PPI) aim to enhance well-being by increasing positive affect, cognition and behaviour (e.g. developing hope; mastery of life). This includes teaching coping skills. This approach holds that dyslexics have unique strengths and there needs to be a focus on this. However, not all dyslexics have unique strengths and their problems need to be addressed. Positive behavioural interventions (PBI) are more common and focus on providing remedies for the problematic behaviours associated with a specific learning disorder. Changing one’s mindset can help in alleviating the negative aspects of a specific
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