1. What effect might misdiagnosis have on children lives?
Diagnosing Young Children 0 unread of 0 messagesView Full Description
As you have learned this week, diagnosing psychiatric disorders in children is a tricky business. Mental health professionals must consider many factors when diagnosing, not the least of which is what might happen if a child were to be misdiagnosed.
1. What effect might misdiagnosis have on children lives?
One recent hot controversy in the field of child psychiatry/psychology is over the prevalence of Bipolar disorder in young children and teens. Trust me when I tell you that there are competent professionals on both side of the fence who feel very strongly about this issue.
Please click on the link below and carefully read the articles:
http://www.cbsnews.com/stories/2007/09/28/60minutes/main3308525.shtml
Obviously, something went wrong with the treatment of Rebecca Riley. Rather than focusing on this specific case, however, I’d like for us to discuss the larger issue related to the benefits and risks of diagnosing and treating young children with psychiatric disorders (e.g., ADHD, Conduct Disorder, Bipolar, Depression, etc…). Try to argue on both the “pro” and the “con” side.
2. Why should or should not we diagnose young children?
3. What age is “too young” to diagnose, or is there no age limit?
4. What are the cons of giving diagnoses too young to children?
5. What are the pros and cons of using psychiatric medication with young children?
Support your opinions with research, not just on “word of mouth” or personal experience.
300 Level Forum Grading Rubric
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Met initial post deadline (Wednesday)
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Initial post is at least 300 words
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LESSON READING
Introduction
In this lesson, we will look at how the great variations in children’s behaviors evolve. We will achieve this by looking at how morality develops, and the behavioral, cognitive and emotional aspects of morality. We will explore how prosocial and altruistic behaviors develop, and then how aggression develops in children, and how to alleviate it. Thereafter we will investigate developmental psychopathology. We will look at the three major categories of childhood disorders: undercontrolled disorders, overcontrolled disorders and pervasive developmental disorders.
Morality
Why do some children bully, lie and cheat, while others withdraw, and yet others excel and thrive? To understand why there is such a great variation in children’s behavior, we need to look at how children are socialized. Recall that the role of socialization is to impart desirable values onto children, which they internalize, so they can experience satisfaction when they abide by social rules, and discomfort when they do not. This personal standard of conduct can be referred to as morality.
Morality has three components that help us understand how aggression and altruism develop. The cognitive component of morality is the knowledge of what is good and bad, the emotional component is how individuals feel about situations and decisions they make, and the behavioral component of morality is how individuals behave.
Cognitive Aspects of Moral Development
Piaget and Kohlberg saw moral reasoning as a function of cognitive development.
Piaget (1932) proposed that children pass through three stage of moral development.
PREMORAL
MORAL REALISM
MORAL RECIPROCITY
Kohlberg (1969, 1985) refined and expanded on Piaget’s theory, proposing that people go through six stages of moral development.
PRECONVENTIONAL MORALITY, STAGE 1
PRECONVENTIONAL MORALITY, STAGE 2
CONVENTIONAL MORALITY, STAGE 3
CONVENTIONAL MORALITY, STAGE 4
POSTCONVENTIONAL MORALITY, STAGE 5
POSTCONVENTIONAL MORALITY, STAGE 6
Check out this video on Kohlberg’s famous moral dilemma:
Now watch this video to see how different aged children reason:
Social Conventions
Social conventions include rules of etiquette such as table manners, forms of greeting and address, and dress codes. Studies have found that from a young age – around three years old – children can differentiate between morality and social conventions (Turiel, 2006). Cross-cultural studies have shown that from the age of three, children consistently see moral violations as harming others, and social convention violations as disruptive or impolite; furthermore, social conventions are seen as relative while moral rules do not change across cultures (Helwig, 2006; Turiel, 2006; Wainryb, 2006).
Interestingly, teenagers generally agree that parents may regulate their moral behavior, but not social convention issues, such as their spending habits, dress code and friends (Smetana, 1995, 2005).
Behavioral Aspects of Moral Development
· MORAL JUDGEMENT AND BEHAVIOR
· SELF-REGULATION
· MORAL SELF
· DISCIPLINE TECHNIQUES
A child’s moral judgement is not always consistent with their moral behavior because behavior can be irrational and impulsive. As age increases, moral judgement and moral behavior becomes more consistent. Parents and other socializing agents can enhance children’s moral behavior by using democratic reasoning and explanation as a form of discipline, as well as discussions about people’s feelings (Hoffman, 2000; Parke, 1977; Walker, Hennig, & Krettenauer, 2000).
Emotional Aspects of Morality
When people believe that they have violated a moral code, they generally feel shame, guilt and remorse. Research has shown that females feel more guilt than males, which may be attributable to gender stereotypes in which females are expected to be more dependent, submissive and prosocial (Zahn-Waxler, 2000). Children who feel more guilt and shame also experience more fear and are inhibited. Children who do not experience guilt and shame are fearless and are not deterred from violating rules.
Knowledge Check
1Question 1
A child who behaves in a certain way to please their parents is in which stage of Kohlberg’s moral development?
The conventional stage.
The stage of moral reciprocity.
The postconventional stage.
The preconventional stage.
I don’t know
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Prosocial and Altruistic Behavior
Altruism is the unselfish concern for the well-being of others, while prosocial behavior has more practical and/or egoistic motivations for promoting others’ well-being (Eisenberg, Fabes, & Spinrad, 2006). Prosocial behavior begins in infancy as babies become distressed in response to others’ distress. Young children learn to share their toys, comfort others and offer assistance.
As children grow older, they show more prosocial behaviors. Cognitive maturity is associated with prosocial behavior as children develop the capacity to accurately identify and respond to people’s cues (Zahn-Waxler, Schiro, Robinson, Emde & Schmitz, 2001). As children develop, they may require less reciprocation or reward for their prosocial behaviors, at which point altruism emerges.
Determinants of Prosocial Behavior
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· Gender Differences in Prosocial Expectations
Eisenberg et al. (2006) found that gender stereotyping results in pronounced differences in the prosocial behaviors children display. Parents generally expect girls to be more prosocial and polite than boys, by expressing helping behaviors such as comforting, sharing, and empathy.
Aggression
Aggression is the intention to cause harm to others. We began the lesson by asking why some children bully others. While young children may display instrumental aggression when they fight and squabble over toys, older children display more hostile aggression, which is personal and involves ridiculing, attacking, criticizing or tattle-taling (Dodge, Coie, & Lynam, 2006).
The ability to infer another’s intents and motives enables children to recognize when someone wants to harm them. However, not all children have the ability to accurately infer this intent. Aggressive children have less ability to accurately infer intent, and retaliate to attacks by perceived tormentors. Aggressive children are attacked more often than nonaggressive children, and see the world as hostile and threatening (Dodge & Frame, 1982).
REACTIVE AGGRESSION
PROACTIVE AGGRESSION
Ideally, aging means that individuals learn to resolve conflict in more constructive ways. However, older children and adults may revert to verbal aggression because as children age, physical aggression is less acceptable. Interestingly, high childhood aggression is highly correlated with criminal convictions later in life, and playground fist fights may evolve into vandalism, criminal activity and homicide. In fact, aggressive children were found in later life to have been arrested more for drunk driving and spousal abuse, had more unstable careers and relationships, and had more problems in parenting (Bushman & Huesmann, 2001; Caspi, Elder, & Bem, 1987; Huesmann, Eron, Lefkowitz, & Walder, 1984; Kokko & Pulkkinen, 2000).
Males are more physically aggressive, whereas females are more relationally aggressive.
RELATIONAL AGGRESSION
The Determinants of Aggression
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· Biological Factors
Individuals may be biologically predisposed to aggression. Studies have determined that identical twins showed more similar aggressive behavior that fraternal twins (Dionne, Tremblay, Boivin, Laplante, & Perusse, 2003; Rhee & Waldmann, 2002). Hormones also play a role in aggression, and violent offenders have been found to have higher testosterone levels than other offenders (Brooks & Reddon, 1996). Even when environmental factors like child-rearing practices were controlled, testosterone levels were linked to aggression in girls and boys (Tremblay et al., 1998).
Serotonin, a neurotransmitter, was found to be negatively related to aggression levels in violent criminals, but most of these criminals came from conflict-ridden homes, thus showing the relationship between biological and environmental factors (Herbert & Martinez, 2001; Moffit & Caspi, 2006).
Controlling Aggression
It is a myth that aggression builds up and can be released by acts of violence. Even therapy groups may suggest punching a pillow. However, research indicates that rather than reducing aggression, these acts exacerbate it (Mallick & McCandless, 1996). The social information-processing approach suggests another perspective on how to relieve aggression. Dodge et al. (2006) argue that people become aggressive because they are socially unskilled and cannot solve problems effectively.
Hudley and Graham (1993) for instance found that teaching aggressive children how to solve interpersonal problems led to a decrease in their violent behaviors. Other studies have found that showing empathy to aggressive children has similar positive results (Laible et al., 2000; Strayer & Roberts, 2004). The Conduct Problems Prevention Research Group (2004) provided interpersonal training for aggressive children and their parents, which resulted in significant social, emotional and academic improvements and less aggression.
Knowledge Check
Question 1
Please select the correct statement.
Females engage more in reactive aggression while males engage more in physical aggression.
Since certain studies found that identical twins have more similar prosocial and aggressive behaviors than fraternal twins, we can deduct that behavior is genetically determined.
Prosocial behavior is altruism.
Aggression can be reduced by teaching children, parents and families interpersonal skills.
I don’t know
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Developmental Psychopathology
The medical view of psychopathology is that it occurs due to faulty physiological and intrapsychic or mental processes. While certain disorders do have biological causes, developmental psychologists argue that the medical model is inadequate, because it does not account for environmental influences.
Abnormal behavior is behavior that causes distress to the individual and/or others, and places the individual and/or others in danger. When children appear to be experiencing distress, developmental psychopathology can be used to help them. Developmental psychopathology investigates maladaptive or disordered behavior by focusing on the following four principles (Cicchetti & Toth, 2006).
Identifying Who is the Problem
If an adult refers a child for psychological help, therapists should investigate whether it is the child or adult who has the problem and needs the therapy. In many cases, the adult may be the source of the problem or have a distorted or discriminatory view of the child (Bauer & Twentyman, 1985; Cicchetti & Toth, 2006). For instance, abusive parents often attribute their problems to the child.
ORIGIN AND CAUSES
CONTEXTUALIZATION
EARLY BEHAVIORS
RICK AND PROTECTIVE FACTORS
Classification of Child Psychopathology
Most psychological theories see adult psychological functioning as being seeded in childhood. Despite this, far less research on child psychology has been conducted than on adult psychology, and the question of how to classify childhood psychopathology arises.
DIAGNOSTIC APPROACH
EMPIRICAL APPROACH
Psychological Disorders in Children
· UNDERCONTROLLED DISORDERS
· OVERCONTROLLED DISORDERS
· PERVASIVE DEVELOPMENTAL DISORDERS
Undercontrolled disorders reflect the lack of control children have over their behaviors, and include attention deficit/hyperactivity disorder and conduct disorders. This category refers to disobedience, compliance and aggression, and generally relates to how others are disturbed by the child – that is, social judgements.
Knowledge Check
Question 1
In the mental health field, abnormal behavior is:
Behavior that is different to children of the same age.
Behavior that is unusual.
Behavior that causes distress to the child/others and/or that puts the child/others in danger.
All of the above.
I don’t know
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Undercontrolled Disorders: Conduct Disorders
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· Conduct Disorders
Conduct disorders are undercontrolled disorders, where the rights of others are violated on a continual basis. If the law is broken, the child or adolescent is said to be a delinquent. Substance abuse is not classified as a childhood disorder in the DSM, but because drug and alcohol use is so prevalent, especially in adolescents with conduct disorders, we will discuss it here.
Uncontrolled Disorders: Attention Deficit/Hyperactivity Disorder
· ATTENTION DEFICIT / HYPERACTIVITY DISORDER (ADHD)
· CAUSES
· MEDICATIONS
· BEHAVIOR THERAPY
Certain mental health professionals argue whether attention deficit/hyperactivity disorder (ADHD) should fall under the category of conduct disorders. Nevertheless, ADHD leads to disruptions in the home, peer group and classroom, because of the child’s overactivity, impulsivity, poor attention and often, violation of rules. Consequently, children with ADHD are often rejected by peers and labelled by adults as problematic, and experience low self-esteem. More boys suffer with ADHD than girls.
Adolescents may grow out of the overactivity, but often the inattention lasts, making it difficult for teachers and parents to keep the individual focused on tasks. Impulsivity may also last, causing the individual to act in ways that have long term detrimental effects. Rule violations are also a common feature of ADHD that can have long term negative consequences.
Overcontrolled Disorders: Depression
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· Diagnosing Depression
Clinical depression is diagnosed if there are cognitive and behavioral changes in the child. Cognitive functioning of a depressed individual involves slowed thinking, problems concentrating, feelings of worthlessness, hopelessness and guilt, and thinking about suicide and death. Depressed children may show a range of emotions, moods and behaviors, that include withdrawal, dejection, loss of interest, loss of pleasure, irritability, sadness, change in
Depression in Childhood
If any of these symptoms continue for more than two weeks, the child may be diagnosed with depression in childhood. Depression occurs more in girls than boys, and is rarely diagnosed in children under the age of ten. However, as the child’s cognitive capacity develops throughout adolescence, depression is experienced more fully and is diagnosed more frequently.
appetite, lack of concentration, lower grades and somatic complaints such a
s Suicide
Suicide is the third-leading cause of teenage death in the U.S. (American Psychological Association, 2016). While depression may cause many suicides and suicide attempts, an accumulation of environmental factors is also linked with suicide. These environmental factors include poverty, loss of family members or important relationships, conflict, divorce, loss of traditional culture, drug and alcohol use, limited opportunities, being caught in an embarrassing or delinquent situation, and real or imagined illness (Jellinek & Snyder, 1998).
Economic Level
While poverty has been referred to many times throughout this course as a cause of developmental problems, research by psychologists Csikszentmihalyi and Schneider (2000) established that wealthier teenagers and young adults are less happy than their poorer counterparts, and are at risk for several mental health issues. Other studies on children of affluent parents have found similar results. For example, Luthar (2003, 2006) and Luthar and Latendresse (2005) found that affluent children abused significantly more substances than poorer peers, and had higher rates of depression and anxiety than the national average.
Children from affluent families may experience extreme pressure to achieve, and may have perfectionistic tendencies or unsupportive, perfectionistic parents. Mental health problems are linked to mothers who are emotionally or physically absent, as well as lack of supervision after school.
Emotional Support
Lack of social and emotional support is a big factor in suicide. Alienation from family, peers and important relationships can make individuals feel helpless, unsupported and isolated.
stomachaches and headaches.
Other Factors
Like suicide, depression is caused by many factors. These include insecure attachments, loss of parental affection, parental conflict, lack of social support, peer rejection, and traumatic life events. When one or both parents are depressed, children are more likely to experience depression, fear, anxiety, social problems, low self-esteem, conduct disorders, attention deficit disorders and academic failure (Embry & Dawson, 2002; Hammen, 2005).
Pervasive Developmental Disorders: Autism Spectrum
· AUTISM
· CHALLENGES
· ASPERGER’S SYNDROME
· CAUSE AND TREATMENT
More boys than girls have autistic disorders. Autism disorders are categorized along a spectrum of severity, and are characterized by social and communicative impairments. Individuals with autism may be averse to human contact and unable to interact. Individuals with autism require sameness either in the environment or in repetitive behaviors, and they are resistant to change.
These children also usually avoid eye contact, and depending on the severity, may lack speech and emotional responses and completely ignore other people. While research has shown that severely autistic individuals are aware of people, they do not respond to people. They often prefer inanimate objects to people, and lack attachment and empathy, because they may not understand that mental states exist and are linked to people’s behavior (Baron-Cohen, 1995).
Since an autistic individual may not be able to connect that a person’s behavior reflects mental states like knowledge or expectations, this makes it impossible to engage in an interaction. Approximately fifty percent of autistic individuals lack verbal and nonverbal language or have bizarre language (Dawson et al., 2004). They may not understand others’ body language, gestures and facial expressions. They may not respond to their name, or to other people’s distress.
Many autistic children need help to function. They often engage in obsessive self-stimulatory behavior which is thought to provide sensory stimulation. While most autistic children have low IQs, they may have phenomenal abilities usually in computers or mathematics – a syndrome called savant.
Watch this amazing video on savants with autism and neurological disorders: https://www.youtube.com/watch?v=WZsJ6BtOh60
Asperger’s syndrome falls onto the autism spectrum. Individuals with Asperger’s syndrome have affective and social limitations, but can usually successfully complete their schooling.
The cause of autism is unknown, but it is thought that it is biological. Autism occurs more commonly in identical than fraternal twins, and is thought to be one of the most heritable psychiatric disorders (Rutter, 2007). Environmental factors also play a role, and toxic substances, particularly mercury, can trigger autism.
It is not easy to treat autism. Medication may reduce hyperactivity, but there is no medication that treats the core symptoms, and side effects are aversive (Myers, 2007). Operant behavior therapy can be used to reward positive behaviors, and teach children self-care skills. Early intervention, working in the child’s home environment, involving and training family, and teaching sign rather than oral language have been associated with better outcomes (Clarke, 2001).
The cause of autism is unknown, but it is thought that it is biological. Autism occurs more commonly in identical than fraternal twins, and is thought to be one of the most heritable psychiatric disorders (Rutter, 2007). Environmental factors also play a role, and toxic substances, particularly mercury, can trigger autism.
It is not easy to treat autism. Medication may reduce hyperactivity, but there is no medication that treats the core symptoms, and side effects are aversive (Myers, 2007). Operant behavior therapy can be used to reward positive behaviors, and teach children self-care skills. Early intervention, working in the child’s home environment, involving and training family, and teaching sign rather than oral language have been associated with better outcomes (Clarke, 2001).
Knowledge Check
Question 1
Intervention programs for the childhood psychopathologies discussed in this lesson should:
Teach other people how to treat the child.
Use a multisystem approach.
Remove all environmental stressors.
Target the child.
I don’t know
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Conclusion
This lesson explored how morality, altruism, aggression and developmental psychopathology develop in children. We began by looking at Piaget’s and Kohlberg’s theories on moral development, social conventions and the various aspects of moral development. We also looked at the development of prosocial, altruistic and aggressive behavior. We then moved onto developmental psychopathology and explored the three major categories of childhood disorders, which included conduct disorders, depression and autism.
In this course on child and adolescent development, we began by exploring various developmental theories, how to conduct research, heredity and the environment and prenatal development and birth. We also explored the development of newborns and children, and sexual maturation in puberty. Thereafter, we looked at emotional development, attachment, and the development of language and communication. We also discussed Piaget’s theory of cognitive development, Vygotsky’s sociocultural theory of cognitive development, and information-processing perspectives of cognitive development.
After we had developed an understanding of cognitive development, we progressed to learning about intelligence, achievement and the environment, and the vital role the family plays in child and adolescent development. We also learned about the vital role of peer interactions, peer acceptance and friendship in development. We took a look at the differences between the genders, gender stereotyping and androgyny. In our final lesson, we covered how children develop moral values through socialization, and how altruism and aggression develop. The course was completed by examining three major childhood disorders through the lens of developmental psychopathology.
KEY TERMS
References
American Psychological Association. (2016). Teen Suicide. Retrieved from http://www.apa.org/research/action/suicide.aspx
Anderson, C. A., Gentile, D. A., & Buckley, K. E. (2007). Violent video game effects on children and adolescents: Theory, research, and public policy. New York, NY: Oxford University Press.
Barkley, R.A. (2000). Taking charge of ADHD. New York: Guilford Press.
Baron-Cohen, S. (1995). Mind-blindness: An essay on autism and theory of mind. Cambridge, MA: MIT Press.
Bauer, W. D., & Twentyman, C. T. (1985). Abusing, neglectful, and comparison mothers’ responses to child-related and non-child-related stressors. Journal of Consulting and Clinical Psychology, 53, 335–343.
Beck, J., and Wade, M. (2004). Got game: how the gamer generation is reshaping business forever. Cambridge, MA: Harvard University Press.
Beutler, L. E., & Malik, M. L. (2002). Rethinking the DSM: A psychological perspective. Washington, DC: American Psychological Association.