Working with Children and Adolescents Flashcards Preview

PSY4406 Psychological Assessment and Intervention > Working with Children and Adolescents > Flashcards

Flashcards in Working with Children and Adolescents Deck (24):
1

According to Theodore (2017) what 6 broad themes does contact between children/adolescents and psychologists centre around?

  • 6 broad themes:
    1. Crises (suicidal behaviour, school violence, grief)
    2. Educational concerns and learning disabilities
    3. Psychopathology
    4. Psychosocial Adjustment (social skills, stress, coping, divorce)
    5. Physiological health conditions (obesity, asthma, diabetes, Tourettes)
    6. Neuropsychological conditions (Austism Spectrum, traumatic brain injury)
  • Common issues;
    • Anxiety and depression; often expressed through outbursts, anxiety focus on future, depression on past

 

 

2

Outline the Developmental Perspective of childhood development according to Sattler

  • The interplay of genetic disposition and environment follow a non-random form and direction. 
  • Rate and timing of particular development show intra-individual differences (language vs physical development) and inter-individual differences (compared to peers)
  • Change is both qualitative (appearance of new processes) and quantitative (changes in magnitude of capacity)
    • By 2 years, most begin to develop expressive language
    • By 7 years thought processes become more systematic 
  • Emphasises Bio-Psycho-Social factors which interact
  • Maladaptive behaviours result from mismatch between needs and environment

3

Outline the Normative-Developmental Perspective of childhood development according to Sattler

  • The Normative-Developmental Perspective is an extension of the developmental perspective where changes in cognitions, affect and behaviour are considered relative to peers.
    • Cognition = Mental processes incl perception, reasoning, memory
    • Affect = experience of emotion
  • Consider the influence of:
    • Demographic variables; age, gender SES
    • Developmental Variables; language, motor, social skills
    • Influence of Prior Development
  • Normative Data is used to establish reasonable treatment goals, guide in selecing target behaviours, compare information across sources, identify abnormal levels of functioning

4

Outline the Cognitive Behavioural Perspective of childhood development according to Sattler

  • Focusses on the importance of cognitions and the environment as major determinents of emotion and behaviour (ABC perspective)
    • Cognition = Thoughts and processing of information. Inc values and beliefs, negative self statements, hypersensitivity to others, low self concept
    • Environmental Contingencies = setting/context (eg temp, noise), natural reinforcers (food, contact), distractors (crowds, cold) 
  • Empirical Validation is emphasised throughout assessment and treatment
    • Functional behavioural assessment = Target antecedents and consequences

5

Outline the Family Systems Perspective of childhood development according to Sattler

  •  Focus on the structure and dynamics of a family as determinents of a child's behaviour. 8 Elements:
    1. Structure; characteristics of the members
    2. Function; tasks the family performs for its members
    3. Assigned and shared roles; responsibilites of each member
    4. Modes of Interaction; style of interaction
    5. Resources; health, finance, skills
    6. Family History; stressors and outlook
    7. Life Cycle; stage of family unit (age of children, parents)
    8. Individual members history
  • Parts of a family are interrelated and cannot be understood in isolation. Sum is greater than the parts, and the total function shapes behaviour of the individual and vice versa.

6

What is the eclectic approach to assessment of childhood development according to Sattler?

  • The eclectic approach offers a framework rather than a perspective
  • Emphasises four main factors
    • Indivual, familial and environmental factors are critical in childhood development
    • Children are shaped by the environment and genetic constitution
    • Observed behaviour may not always reflect childrens potentials
    • Children also shape their environment

7

What 10 Factors can be utilised to increase engagement with children?

  1. Setting: Make the space child friendly (toys, books, furniture), including waiting room
  2. Environment:  Consider that children can be noisy, how this might affect other clients
  3. Language: Use age appropriate language suited to the child's level
  4. Tone: Don't talk down or patronise
  5. Timing: Avoid times when the child may be tired or miss out on favourite activities
  6. Length: Be conscious of the attention span, take breaks
  7. Flexibility; Adapt to the child, work on the floor, follow their lead
  8. Demeanour: Be relaxed, curious, open to their ideas 
  9. Characteristics; Patience, Warmth, Respect, Understanding, Assertiveness, Adaptability, Creativity
  10. Pop Culture: Knowledge of age appropriate culture (careful not to be daggy)

8

What are some considerations during the first session with a child and how can you address them?

  • Client Autonomy: It is unlikely the child was involved in the decision to go to therapy. 
    • They may believe themselves to be defective
    • They may be frightened
    • They may not understand what is happening
  • Techniques
    • Do not include the adult in the first session
    • Prepare two client consent forms; the formal one for the adult, and a simple one for the child.
      • "I understand that I can say no at any time"
      • "I understand that X may tell other adults what I say if something needs to be done"

9

What are some tips for explaining the need for parents to not stay in the therapy room?

  • Remember that although the parents may be paying, the child is also a client
    • When necessary to calm a younger child, minimise verbal and non verbal involvement.
    • Children and adolescents tend to speak more freely away from parents 
  • When parents insist;
    • reassure them that concern is natural,
    • explain method and treatment plan
    • arrange check in sessions,
    • reassure that in case of risk you will communicate
    • Most of all, assure them that their child is in a safe environment

10

According to Taylor and Adelman, what are some considerations when enlisting a parent's support in children's mental health treatment?

  • Barriers to Parental Motivation:
    • negative perceptions of mental illness,
    • negative feelings about the therapist,
    • practicality of access,
    • demands of treatment
  • Use consent agreements to manage motivation:
    • Involve parents in decisions (whether to bring the child on 1st consult, which therapist, time frame),
    • Share assessment info to agree upon a definition of the problem
  • Maintaining Involvement
    1. Ensure parents feel related to the therapist
    2. Enhance value of involvement by inclusion of ongoing participation
    3. Provide continuing support for learning and growth
  • Always
    1. Help all parties appreciate the value of alliances,
    2. Listen to all persepectives
    3. Validate feelings

11

What changes occur to the brain during adolesence? 

  • The brain continues to develop into the 20s
  • Pre-Frontal Cortex; peak grey matter is puberty onset, significant synaptic pruning occurs during adolescence
  • Social Cognition: Medial pre-frontal cortex activity reduces in adolecence (different cognitive strategy)
    • Perspective taking task: adolescent problem solving intact but perspective tacting is still developing 
  • Limbic System: Reward for risk taking is hypersensitive during adolescence (while decision making in Prefrontal Cortex is still developing)

12

According to Sekelman (2015) what 6 things should be done when working with adolescents?

  1. Avoid diagnostic labels where possible.  Seek to understand the adolescent's perspective.
  2. Avoid repeating unsuccessful encounters with other therapists: Ask what worked and didn't and what was upsetting
  3. Remember that adolescents feel misunderstood and dismissed; remain open-minded and ask how they feel things are going 
  4. Be flexible and willing to improvise.
  5. Consider autonomy invite adolescents to take the lead in defining treatment goals.  
  6. Your role is guide not expert: Respect that adolescents have the strengths and resources to initiate healthy change.  

  

13

According to Orygon, what are some important considerations when encountering barriers to engagement with adolescents?

  • Why is the behaviour occuring?
    • Development may not have caught up with demands (difficulty expressing themselves)
    • Negative interpersonal experiences and traumas
    • Stressors and medication
    • Belief therapy will not support them or that you are there to help others
    • Practical barriers (language, culture, cost)
  • What if you can't engage despite best efforts?
    • Don't force the issue
    • Consider onward referral or alternative treatment plans
    • Leave the door open

14

According to Orygen what are the 10 core principles for dealing with challenging behaviours?

  1. Adopt a non-blaming stance and try to understand their perspective
  2. Don't take the behaviour personally
  3. Reassure them that you are here to support them
  4. Always work from a recovery oriented approach and explore their strengths
  5. Check in regularly to make sure you are on track
  6. Ask if there are practical things you can help with (ie centrelink)
  7. Consider transference and counter-transference
  8. Involving parents and peers may help if the young person is open to it
  9. Always try to conduct a risk assessment
  10. Practice self care, use supervision, avoid burnout

15

What are some techniques for dealing with specific types of challenging behaviours?

  • Reluctant/Resistent Behaviour
    • Acknowledge and normalise the difficulty
    • Try to explore why they are resistent
    • Consider practical, cognitive, language, and culture barriers
    • Empathise if the young person feels coerced
    • Ask if there is any way you can make them more comfortable (pet?)
  • Self-Harm
    • Explore the function of the self harm (open and curious)
    • Reassure them you won't remove their coping mechanism
    • Balance confidentiality and risk 
  • Aggression
    • Protect yourself and others from harm
    • Be clear, respectful and agree as much as possible
    • Give choices and be clear about consequences
  • Intoxication
    • Treat as health not moral issue
    • Always assess mental state and risk (if low risk, reschedule)
    • Be mindful that drugs are often seen as a solution not problem
  • Chaotic Behaviour
    • Be clear and concise
    • Conduct an MSE
    • Be practical and obtain collateral info

16

What are the four pillars of assessment according to Sattler?

  • Multimethod assessment: obtain information from several sources and methods such as:
    • Norm Referenced Measures; Standardised on a clearly defined group. Each score reflects a rank.
      • Economical and efficient
      • Valuable when evaluating strengths and deficits
    • Interviews; both child and care-givers
      • provides context and historical information to understand assessments
    • Behavioural Observation
      • ABC approach, inform intervention targets
    • Informal Assessment; Supplement other measures
      • eg role playing, written language samples, self monitoring

17

According to Sattler what are the 11 steps in the assessment process?

  1. Review referral information; clarify any ambiguity
  2. Decide whether to accept referral; are you competent in required factors (might be better suited to a medical specialist)
  3. Obtain relevant background information; context and history; background questionnaire
  4. Consider the influence of Relevant Others;  interview parents, siblings, teachers etc
  5. Observe the child in several settings
  6. Select and administer test battery; consider referal Q, child's age/characteristics, prior tests
  7. Interpret the Assessment Results; never rely solely on formal scores
  8. Develop intervention strategy and recommendations; consider environment and available services
  9. Write a report
  10. Meet with parents, child (if appropriate)
  11. Follow up on recommendations and conduct reevaluation

18

Outline six commonly used assessments for cognitive ability in children

  • Bayley Scales of Infant and Toddler Development; 1 month -4 years
  • Stanford Binet Scales; 2-85years
    • General IQ + 5 facets
  • Weschler Intelligence Scales Children; 6-16 years
    • Has Australian Norms, both full and abreviated forms
    • Very lengthy and involved
  • Wide Range Achievement Test; 5-75 years
    • academic achievement in reading, spelling arithmatic
  • Wide Range Assessment of Learning and Memory; 5-90 years
    • Ability to memorise verbal and visual info
  • NEPSY; 3-16 years
    • Neurolopsychological functioning 
    • 6 domains; Executive function/attention, language, memory/learning, sensorimotor, visuospatial processing, and social perception

19

Outline three commonly used behavioural measures and some general limitations

  • Child Behaviour Checklist (CBCL); 
    • 1.5-5years and 6-18 years
    • Parent-report, Teacher-report, self-report (11-18yrs)
    • Items based on DSM-5, grouped into 3 subscales (internalising, externalising and total) 
  • Behaviour Rating Inventory of Executive Functioning (BRIEF); useful for neurological conditions eg autism
    • 5-18 years
    • Parent and teacher report versions
    • 8 clinical scales grouped into behavioural regulation and Metacognition indices
  • Adaptive Behaviour Assessment System (ABAS); useful for developmental delays, disability, impairment
    • Birth to 89years
    • Parent, teacher and adult forms
    • 11 adaptive behavioural skills, grouped into Conceptual, Social and Practical
  • Common Limitations:
    • Cultural, Reporter or Examiner Bias
    • Time/cost
    • Sensitivity to environment (noise/distraction)

20

What were the findings of Chopita et al's updated review of evidence based treatments for children?

  • Anxiety and Avoidance; greatest diversity in study characteristics
    • CBT and exposure based variants
    • "Minimal Support" for various others
  • Attention and Hyperactivity
    • Best evidence for Self-Verbalisation and Behaviour therapy + medication
    • Parent Management Training
  • Austism Spectrum
    • Intensive Behavioural Treatment and Intensive Communication Training
  • Depression/Withdrawal;
    • CBT+variants, Family Therapy
  • Disruptive Behaviour;
    • Parent Management Training
  • Eating Problems;
    • Level 2; CBT and Family + variants
  • Substance Use;
    • Family Therapy
  • Traumatic Stress;
    • CBT with parents
    • Minimal for play and psychodrama

21

What are the current trajectories for research on interventions for adolescents and children?

  • Regular Updates based on the last 5-7 years of evidence
  • Chopita et al;
    • Movement towards effectiveness
    • Movement towards comprehensiveness as opposed to sufficiency
    • Require info on components and processes, idiographic outcomes, long term follow up

22

According to Feindler, what factors contribute to adolescent aggression and and how is it assessed?

  • Contributing factors
    • Individual; male, minority, genetic hyperacticity, impulsivity, substance use
    • Cognitive distortions regarding interpersonal interactions
    • Impaired moral reasoning and empathy
  • Assessing Anger
    • Self-report inventories; vulnerable to bias so don't use alone
    • The Hassal Log; self monitoring too to 
      • Determine ABCs
      • Provide script for roleplay
      • Self recording tool
      • Teach self observation
      • Prompt self reinforcement

23

According to Feidler, what are some key interventions for anger in adolescents?

  • Teen Anger Management Education (TAME)
    • Still being developed for use in both clincial and educational settings
    • DBT elements + recognition/response to anger
  • Cognitive behavioural Anger Management Training (AMT) individual or group
    • Physiological (arousal recognition and reduction), cognitive (antecendents and restructuring) and behavioural (communicaition skills) components
  • Aggression Replacement Training (ART)
    • Social Skills Training, Anger Control training and Moral Reasoning

24

What is involved in eliciting and evaluating core beliefs in CBT?

  • Core Beliefs; Linked to early life experiences, considerd absolute and often simplistic
    • Three main themes (in depression)
      • Helpless (I am vulnerable)
      • Unlovable (I am unwanted)
      • Worthless (I am a waste)
  • Eliciting Core Beliefs;
    • Downward arrow technique; follow the thought to the end (then what Qs)
    • Activating core beliefs often associated with emotional distress
  • Testing a Negative Core Belief;
    • Socratic dialogue, establish evidence
  • Identifying and strengthening a new core belief
    • Will take a long time to change, continue gathering evidence for it