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Diana Laufenberg presents a TED talk on teaching kids to learn.

Most developmental disorders are diagnosed on the basis of behavior alone.  However, they originate in the brain – why not use brain imaging to try to confirm diagnoses?  Up to 50% of children dealing with what seems to be autism, may actually be dealing with a particular type of brain seizures.  Knowing that means that we can treat those seizures effectively, and a previously pervasive developmental disorder becomes something that is significantly less chronic.

Infants require consistent and reliable care, reflection, touch and soothing to meet their attachment needs. Remember Harlow’s monkey craving the soothing of the cloth “mother” when it was scared? Infants and children are the same. The best intentioned caregiver can meet and exceed their child’s physical and safety needs, but if touch and visual and auditory reflection, like mimicking an infants frown and saying “oh you’re grumpy” when they cry, are missing from the earliest times in a child’s life they are put at a massive disadvantage when it comes to developing not only internal skills like object permanence and emotional regulation, but also external social skills, like empathy and basic morality (Perry, 2006; Santrock, 2007).

Harlow’s monkeys who were denied a cloth mother did not thrive. Nor did the children in orphanages or American hospitals during the 1940s and 50s with their focus on sterile environments and minimizing parental involvement. Not being touched as an infant is traumatic. Not being soothed or mimicked as an infant is traumatic. Obviously, physical and sexual violations as an infant are traumatic.

Harlow's Distressed Monkey

Poor little guy! He just wants to be cuddled!

Much of the research on moral development largely ignores the influence of trauma, neglect and abuse. Kohlberg and Selmen got it right with their ideas about the construction of morality and empathy as being more important than the actual choices people make (Damon, 2008) but in both of these constructions, the paramount role that early attachment processes, or lack thereof, plays in establishing the framework from which to build morality was ignored. Kids and adults who lack early attachment objects often grow up either unaware or unable to provide effective attachment objects to their children or others around them.

This would not really matter, were it not for attachment being the basis for development of empathy and regard for others.  In talk of oxytocin, the bonding chemical, coercive cycles, and the intellectual battle between nature and nurture as the clincher in developmental outcomes, we are missing the forest for the trees (Granic, 2006; Public Library of Science, 2007; Santrock, 2007).  Under girding all of these factors (bonding, reciprocal interactions, goodness of fit versus responsiveness of care), is attachment.  If a child is not adequately attached to a, or possibly a couple, primary caregivers, their likelihood of developing these skills and getting reinforcement out of using them is decreased dramatically.

In short, when securely attached caregivers’ hearts are warmed when their child smiles at them, even though they same smiley baby kept them up all night, on a neurological level, caregivers’ limbic systems release oxytocin and endorphins and on a whole person level, suddenly all of the hours awake seem worth it.  These caregivers are likely to continue to provide physically responsive care and cuddles largely because it feels good to do so.  Their children are more likely to grow up with secure attachments and secure internal objects from which to move out into the world.  They have the early frameworks necessary for the development of moral behaviors.  In fact, due in large part to the social feedback offered by primary attachment objects, being good feels good.  Being bad feels bad.   They are more likely to be good and avoid being bad because it literally feels concordant.   Conversely, children who do not receive the same sort of responsive, validating care from a caregiver infancy often lack the clearly defined and integrated internal object that is necessary to recognize that others also have feelings, that are sometimes conflicting, but equally valid (Engler, 2006).

Just as the informed caregiver would never really expect a preschooler to be able to engage in mutual perspective taking, an attachment informed caregiver would not expect an adolescent, who is at a preschool developmental level to hold the opinions of two different people at once. Effective practitioners address a primary underlying mechanism of morality through awareness of attachment needs and processes.

An early attachment disruption is incredibly damaging, but it is not a death sentence.  Children who demonstrate a lack of empathy, low behavioral functioning, and/or odd social behaviors resultant from an early history of neglect can developmentally “catch up” from experiencing the crucial aspects of their development that were missing: touch, rhythm, soothing, patting, and so forth.  They will then age developmentally, as opposed to chronologically, and develop moral skills at developmentally appropriate times as opposed to chronologically appropriate times (Perry, 2006; Santrock, 2007).  In helping insecurely attached kids develop morality, practitioners must address attachment.

Damon, W., Lerner, R.M. (ed.) (2008). Child and adolescent development: An advanced course. John Wiley & Sons: Hoboken, NJ.

Engler, B. (2006) Personality Theories. (7th ed.) Houghton Mifflin Company: Boston, MA

Granic, I., Patterson, G.R. (2006) Toward a comprehensive model of antisocial development: A dynamic systems approach. Psychological Review, 113(1), 101-131

Perry, B.D., Szalavitz, M. (2006) The boy who was raised as a dog: and other stories from a child psychatrist’s notebook. Basic Books: New York, NY

Public Library of Science (2007, November 8) Empathy and Oxytocin Lead to Greater Generosity. ScienceDaily. Retrieved April 6, 2010, from http://www.sciencedaily.com /releases/2007/11/071107074321.htm

Santrock, J. (2007) Adolescence. 12th ed.  McGraw-Hill: New York, NY

Melanie Klein - Founder of Object Relations Theory

One rarely discussed element of attachment is the internal object. When children interact with responsive caregivers as infants, they learn not only that the world around them is safe, but that they are safe. Their image, or internal object, becomes integrated. They can experience happiness, sadness, anger and fear in step, knowing all at once that they are still present and safe. When those integrated infants become adolescents, those who have experienced identity crisis, explored, and made a decision within a given domain, are described as “achieved” by James Marcia. Soares’ of the flexible goal-seeker seems to fit well with both Marcia’s identity process and Object Relations’ conceptualization of the categories of the internal object (2005; Engler, 2006; Santrock, 2007).

The “flexible” problem solver described by Soares can deal with threats to their competence and validate their internal object by responding in situationally appropriate ways (2005). With the validation of their internal object, they develop intrinsic goals, thusly increasing their competence at conceptual learning (Vansteenkiste, 2005).

Both the Soares and Vansteenkiste studies were completed on early adolescents, ages 11-14 and 11-12 respectively (2005). Most adolescents do not reach identity achievement in many domains until later on in adolescence or early adulthood. Is it reasonable to expect young adolescents to demonstrate identity achievement and its parallel, flexible goal setting? Although flexible goal setting and intrinsic motivation has been demonstrated to be effective at learning more conceptual than rote frameworks, does teaching conceptually increase intrinsic motivation and flexible goal setting? If those two behavioral outputs increases, does integration of the internal object also increase?

Further research is needed before any conclusions can be drawn. However, if it is found that conceptual learning is one route to a more cohesive self object, I imagine that freed from the constraints of standardized testing, more educators would turn to student directed projects than rote memorization of required knowledge. Exploring whether or not the self object can be repaired or enhanced through engagement with the production of meaning will also change the current paradigm for education and especially, mental health treatment.

Due to the high correlation between attachment disruption and mental illness, I imagine treatment planning that intentionally includes service to others. How could the mental illness paradigm shift if standardized treatment for a variety of mental illnesses included serving the less fortunate? In short, where does meaning production, through education, goals or service, fit with recovery from a traumatic or invalidating infancy?

Engler, B. (2006) Personality Theories. (7th ed.) Houghton Mifflin Company: Boston, MA

Santrock, J. (2007) Adolescence. 12th ed. McGraw-Hill: New York, NY

Soares, I., Lemos, M. S., & Almeida, C. (2005) Attachment and motivational strategies. Adolescence , 40(157), 129-154.

Vansteenkiste, M., Simons, J., Lens, W., Soenens, B., & Matos, L. (2005) Examining the motivational impact of intrinsic versus extrinsic goal framing. Child Development , 76(2), 483 – 501.

Research has explored both the role of family relationships and peer relationships on gendered social development.  Studies show that adults interact differently with babies dressed in pink (a “girl” color) than babies dressed in blue (a “boy” color).  When entering a room with a baby dressed in blue, adults tend to play more actively and rough house more with the child.  When the same child is dressed in pink, adults tend to play in more soothing ways, cooing and cradling the infant as opposed to tickling it or tossing it in the air.  As boys and girls grow up in America they are socialized into their gender roles.  Boys learn that they are made of “snips, snails and puppy dog tails” while girls consist of “sugar and spice and everything nice.”  When boys fall, they are encouraged to “be tough.”  When girls fall, they are checked in with, dusted off and cuddled (Santrock 2007).  In the midst of all of these interactions, boys learn that vulnerable emotions are to be at best contained, at worst stifled.  Either of those extremes can be epitomized by either the police officer containing their emotions in crisis to best serve, or on the other end, a male with a high need for expression, who societally isn’t allowed to do so.  Girls seem to be taught that vulnerable emotions are at best, experienced by a group, at worst, tools for manipulation.

In the midst of those interactions, boys and girls are also developing peer relationships.  In those peer relationships, Deborah Tannen identified that boys tend to use report talk, while girls tend to use more rapport talk.  Report talk is defined by what is going on, while rapport talk is what does it feel like.  Report talk is built on a hierarchical structure, while rapport talk is built on a structure of egalitarian connection (2001).  Egalitarian structuring lends itself more towards the sharing of vulnerable emotions.  If one is trying to prove superiority over a competitor, being seen as susceptible is a liability.  In contrast, being seen as imperfect or needing fits with a connective social structure because it compels the maternal within to protect and soothe. In the midst of these co-occurring processes, what is it that then compels females toward greater emotional intelligence than males?

Both responses can be adaptive as long as they don’t begin and end with the expression or nonexpression of emotion.  According to Kennedy-Moore, cognitive moderation is a requirement to effective emotional regulation and social intelligence (2005).  Does the Bar-On Emotional Quotient Inventory Youth Short Version consider the cognitive processing in determining emotional intelligence?  Do peer or caregiver relationships plays a greater role in emotional development across the genders?

Harrod, N.R. & Scheer, S.D. (2005) An exploration of adolescent emotional intelligence in relation to demographic characteristics.  Adolescence.  40(159).  503-512

Kennedy-Moore, E. & Watson, J.C. (1999) Expressing emotion: myths, realities and therapeutic strategies. The Guilford Press: New York, NY

Santrock, J. (2007) Adolescence. 12th ed.  McGraw-Hill: New York, NY

Tannen, D. (2001) You just don’t understand: women and men in conversation. Harper Paperbacks: New York, NY

Children and adolescents depend not only on the relationships they have with their parents and peers for normative and validating experience (Field 2002), but they also seem to depend on relationships with non-parental adults (Rishel 2005).  For very young children, at the beginning of their grade school years, forming relationships with adults is something that may seem to come naturally.  They may seem to idolize the adults around them, or at the very least, their eagerness for learning as identified by Freud and Piaget, make them into children who are easy to nurture.  However, how many of those early non-parental relationships are long term?  Although research may not yet exist to demonstrate this unequivocally, it makes intuitive sense that long term relationships would be more vital than fleeting ones to a child’s continuing sense of self.  Working from that assumption, one can begin to piece together the importance of relationships with grandparents, aunts and uncles in determining the self-concept of both the young child and developing adolescent.

Considering the importance of non-parental adults in the development of normative self-concept flies in the face of traditional Freudian psychoanalytic approaches.  Whereas Freud was solely interested in the parental influence in how it affected psychosexual development, new research compels the practitioner to also consider the interaction between psychosocial and intrapsychic factors.  Development of the concept of self within others is a relatively new psychological construct.  How will the conceptualizations of self as interpsychic processes change how philosophy and practice view normative development?

Considering the role of the self-concept also flies in the traditional behavioral psychology.  To Skinner, the personality was a black box, unobservable and thus unimportant to creating change.  Although many of the practices developed for use specifically with young children focus on the role of behavioral interventions (sticker charts, token systems, ect), considering interpsychic processes, like interactions with significant adults, flies in the face of this philosophical standpoint.  What is more important, fidelity to a particular philosophical paradigm or fidelity to the client?  In other words, do we make our tools fit our box, or get a box that fits our tools?

Church, E.B. (2004) Joining the group: how kids learn to be themselves with others. Scholastic Parent and Child. September. 76

Field, T., Diego, M. & Sanders, C. (2002). Adolescents’ parent and peer relationships. Adolescence. 37(145).  121-130

Rishel, C., Sales, E. & Koeske, G.F. (2005) Relationships with non-parental adults and child behavior. Child and Adolescent Social Work Journal. 22(1).  19-34

(CNN) — The medical journal The Lancet on Tuesday retracted a controversial 1998 paper that linked the measles, mumps and rubella (MMR) vaccine to autism.

The study subsequently had been discredited, and last week, the lead author, Dr. Andrew Wakefield, was found to have acted unethically in conducting the research.

The General Medical Council, which oversees doctors in Britain, said that “there was a biased selection of patients in The Lancet paper” and that his “conduct in this regard was dishonest and irresponsible.”

The panel found that Wakefield subjected some children in the study to various invasive medical procedures such as colonoscopies and MRI scans. He also paid children at his son’s birthday party to have blood drawn for research purposes, an act that “showed a callous disregard” for the “distress and pain” of the children, the panel said.

After the council’s findings last week, The Lancet retracted the study and released this statement.

“It has become clear that several elements of the 1998 paper by Wakefield et al. are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were ‘consecutively referred’ and that investigations were ‘approved’ by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.”

-from CNN

What a great day for science, kids’ welfare, and parents.

Kids learn more formal social skills from their parents, but the bulk of their social learning seems to come from siblings or peers of their cohort.  By helping kids form cooperative relationships with each other from an early age, parents help kids adjust and maintain cooperative relationships into adulthood.  For parents of only children, using playdates or daycare may be an important tool towards developing their children’s social skills.

When I worked with clients dealing with Reactive Attachment Disorder, I saw some really interesting patterns in their styles of play.  As adolescents, they still seemed to demonstrate more parallel play styles than cooperative or even pretend play.  I attribute this to the disruption in their early development.  Although I’m not a parent, how do any of you remember your children’s social development occurring?

University of Illinois at Urbana-Champaign (2010, January 15). Siblings play formative, influential role as ‘agents of socialization’. ScienceDaily. Retrieved January 16, 2010, from http://www.sciencedaily.com­ /releases/2010/01/100115112104.htm

Popular culture would have me believe that parents hate the amount of homework their children are given, believe that the homework they are given takes away from family time, and the amount of time children spend doing their homework takes away from recreation and family time.  However, a recent study put out by the University of Nebraska-Lincoln found that parents generally support the amount of homework their middle school aged kids are given and know how to help them complete it.  One area that could use improvement, according to the study, is communication between parents and school staff about homework and any issues that come up.  Another area of concern is the trend in which some parents will complete their children’s work for them, as opposed to helping them check it or teaching them to figure the answers out from the textbook or other examples.

University of Nebraska-Lincoln (2009, August 20). Contrary To Popular Belief, Parents OK With Kids’ Homework Loads. ScienceDaily. Retrieved August 23, 2009, from http://www.sciencedaily.com­ /releases/2009/08/090820124048.htm

As of this year, there are 800,000 children in foster care in the United States.  Most of those children are removed from their birth homes due to severe neglect, abuse or trauma.  When children spend the early years of their lives in traumatic or neglectful situations, they are more likely to develop mental health issues.  Not surprisingly then, foster care alumni (adults who grew up within the foster care system) have disproportionately higher rates of mental health issues.  However, according to a study found in Child Welfare, the actual rate of mental health issues and comorbid physical symptoms floored me.  In comparison to the general population, where 64% experiences depression that is comorbid with other mental health issues or physical symptoms like heart disease, cancer, or diabetes, 98% of foster care alumni experience comorbid depression.  94% experience comorbid Post Traumatic Stress Disorder.

Even when children are removed from traumatic situations early, they continue to deal with significant consequences of that early trauma as adults.  Granted, it should be expected that children who came from abusive or traumatic situations have behavioral or mental health issues.  (I don’t say that as a matter of judgment, simply as a matter of survival.*)  However, I would think that when children are removed from their homes and put into the child welfare system, regular mental health checks and timely follow-up would be mandatory.  Apparently, timely follow-up may be the missing piece of the puzzle.  75% of children who enter the foster care system with serious and obvious clinical impairment will not have received mental health service 12 months following their intake.

In light of these sobering statistics, child welfare systems are expanding their services.  Treatment Foster Homes and additional services are becoming more readily available.  When these children have access to mental health coverage through their insurance, they use it.  In California, although children in foster care represent only 4% of the state-sponsored health insurance, they use 43% of all expenditures.  Expanding the availability of mental health coverage would seem to be a necessary portion of the solution.

Pecora, P.J. Jensen, P.S., & et. Al (2009). Mental health services for children placed in foster care: an overview of current challenges.  Child Welfare. 88(1).  5-25.

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