Transcript Adversity and anti-social behaviour

Islington
Primary Care Trust
The normative development of children
between six and ten years
Dr Eileen Vizard FRCPsych
Consultant Child and Adolescent Psychiatrist, NSPCC
&
Honorary Senior Lecturer, University College London
The Michael Sieff Foundation Conference
21st & 22nd September 2010
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Outline of Presentation
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•
•
•
•
Lifespan Development
Child & Environment
Child Developmental models
Normative Child Development
Developmental Milestones
Assessment of Child Development
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Ontogeny recapitulates phylogeny’
Ernst Haeckel(1866) Thomas Huxley (1868)
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Lifespan Development
• Some truth in these early theories but Haeckel’s
theory largely discredited
• However, brain development stages may
recapitulate human brain evolution:
• ‘ “Inside-out” and “Bottom-up”
• Higher/Complex areas control the more reactive
primitive lower parts of the brain—less reactive, more
thoughtful and less impulsive
• Lower-Excitatory
• Higher-Modulating’
De Brito 2009
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Lifespan Development
5
8 Ages of Man
Erikson 1950
Ego
Integrity
vs
Despair
H
Maturity
G
Generativity
vs
stagnation
Adulthood
F
Intimacy
vs
Isolation
Young
Adulthood
E
Identity
vs
Role
confusion
Puberty
D
Industry
vs
Inferiority
Latency
C
Locomotor
-genital
Initiativ
e
vs
guilt
B
Muscularanal
Autonomy
vs
Shame,
doubt
A
Oral
sensory
Basic trust
vs
mistrust
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Lifespan Development
• Lifespan process of change
Rutter & Rutter 1993
• Much development occurs in early childhood
and adolescence
Steinberg & Schwartz 2000; RCPsychs 2006
• Brain development continues in young adult life
Blakemore & Choudhury 2006
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Child & Environment
Societal
Community
Relationship
Individual
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Child & Environment
What do we know about links between:
• ‘Nature’ (brain development)
• ‘Nurture’ (environment – abuse &
neglect/care & protection)
• ‘Resilience’ (child)
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Child & Environment
Brain development
De Brito 2009
• ‘The maturation of grey matter is best described as
a constant “push and pull”. New pathways grow, while
others are pruned back
• Pruning is greatly influenced by experience, so it really
is a case of “use it or lose it”!
• This makes the brain extremely versatile, and able to
Make changes depending on the demands of the
environment.’
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Child & Environment
Brain development
De Brito 2009
• ‘Windows of vulnerability = critical time during
which brain hones particular skills or functions
• Different windows for different brain regions
• If the chance to practise a skill is missed during
The window, a child may never learn it (or be
impaired) ‘
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Child & Environment
Studies show adverse effects on the
developing brain from abuse and neglect on:
• Brain structure
• Brain function
McCrory et al 2010
But............there is also evidence of ‘catch up’
with brain development when ‘nurture’ improves
And...........child resilience moderates between
nature and nurture
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Normative Child Development
• Positive developmental change occurs
across the lifespan notably birth to mid twenties
• Will these developmental changes occur
regardless (are they hard wired) or can the
environment impact on child development?
• Why do some children survive & recover from
major traumas but others succumb?
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Attachment Theory
John Bowlby 1907-1990
Child Psychiatrist,
Psychoanalyst
Animal ethology model for
mother child attachment
relationships
Psychoanalytical theory to
understand the emotional
aspects of attachment
Separation & loss impact
‘A 2 year old goes to the
Hospital’
Bowlby, Robertson &
Rosenbluth 1952
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Child Developmental
Models:
Attachment Theory
Attachment is:
Any form of behaviour that
results in a person
attaining or maintaining
proximity to some other
differentiated and
preferred individual,
usually conceived as
stronger and wiser
Bowlby, 1973
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Child Developmental Models: Attachment Theory
‘The photograph shows an
infant rhesus monkey with
two artificial mothers to
which it can cling (see
p.74).
It has chosen the one on the
right which is covered with a
soft towelling in preference
to the one on the left made
of wire.
Both are pivoted so that the
weight of the monkey
depresses a switch and the
amount of time spent
clinging to each can be
recorded.’ Broadhurst 1963
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‘In the photograph on the
right, the infant rhesus
monkey is shown
demonstrating the greater
importance of mother –
infant contact over food (see
p.74).
It is reaching across from the
cloth ‘mother’ to which it is
clinging to reach the milk
supplied, in this case, by the
wire one’
Broadhurst 1963
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Child Developmental Models: Attachment Theory
................Working with
deprived and desperate
children evokes extremely
strong maternal or paternal
responses in professionals
.......Severe deprivation
can’t be ‘cuddled better’ –
emotional healing is needed first
.........Profound meaning of
touch for deprived (‘touch
hungry’/indiscriminately
attached) children
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Child Developmental Models: Attachment Theory
Konrad Lorenz 1960
Austrian zoologist
re-discovered ‘Imprinting’
by baby animals
Graylag geese hatched &
divided into 2 groups: 1.
Mother 2. Lorenz
1. Chicks hatched with
mother immediately
started to follow her
around
2. Chicks hatched with
Lorenz did the same
and remained
‘attached’ to him long
after hatching
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Other Child Developmental Models:
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Many theories in psychology characterize development in terms of stages:
Jean Piaget developed a complex stage theory of cognitive development to
describe how children reason and interact with their surroundings
• Lawrence Kohlberg applied and extended Piaget's stages to describe how
individuals develop moral reasoning
• Sigmund Freud analyzed the progression of an individual's unconscious
desires as occurring through psychosexual stages
• Anna Freud described developmental stages in a child’s early life based on her
experiences in the Hampstead War Nurseries
• Erik Erikson expanded on Freud's psychosexual stages, defining eight
psychosocial stages that describe how individuals relate to their social world
• Margaret Mahler's psychoanalytic developmental theory contained three
phases regarding the child's relationship to others, known as object relations
• Dodge’s social information processing model describes ways in which child
responds to the environment
** See Royal College of Psychiatrists’ 2006 report for a review of normal child
development and child developmental models
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Normative Child Development
1.
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PHYSICAL DEVELOPMENT
Physical maturity & psychological maturity do not correlate
2.
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INTELLECTUAL DEVELOPMENT
Average I.Q. does not mean mature judgment
3.
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EMOTIONAL DEVELOPMENT
Mid to late teens for development of emotional maturity, self
control, deferring gratification, insight, empathy, remorse etc
4.
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SOCIAL DEVELOPMENT
Social factors associated with moral development & with
delinquency
Full moral development in adult life not childhood
•
RCPsychs 2006
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Normative Child Development –
Physical Development
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Physical Change, Posture and Large Movements
5 years
7-8 years
• Runs lightly on toes
• Active and skilful climbing,
sliding, swinging, digging
and various ‘stunts’.
• Skips on alternative feet
• Dances to music
• Can Stand on one foot 8-10
seconds
• Can hop 2-3 yards forwards
on each foot separately
• Grips strongly with each
hand
• Can bounce a ball on floor
several times. Can ride a
bicycle
• Can hop, jump, run skip, and
throw
9-10 years
• Increasing strength
• Participation in individual
and team sports
11-12 years
• Onset of Puberty
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Reproduced from J. Aldgate, D. Jones, W. Rose & C. Jeffery (2006). The developing world of the child. London, UK: Jessica
Kingsley Publishers
PHYSICAL DEVELOPMENT
Growth & development charts
can give vital indications that
a child’s physical
development is/is not age
appropriate.
The neglected/failure to thrive
child or the very obese child
may show a dramatic
improvement on percentile
scores when moved into a
good foster home.
This can be evidential ‘gold
dust’ in care proceedings.
Training in understanding
growth & development charts
is needed for those acting as
experts in care proceedings.
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Normative Child Development –
Intellectual Development
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Understanding and Intellectual Capacity
5 years
7-8 years
9-10 years
• Beginning sense of values,
right versus wrong, fairness
• Can evaluate own
capabilities with some
accuracy
• Counts to ten
• Begins to develop an ability
to regulate own behaviour
(ability to wait, check
aggression)
• Increasing curiosity
• Emerging morality, and
concerns about others
opinions of others
• Recognises that the whole
comprises its parts
• Now ‘talks to him/herself’ –
inner speech as part of
growing understanding
• Memory capacity well
established
• Several strategies for
memorising events and facts
• Increase in logical thinking
• Capacity for inference
develops
11-12 years
• Can reason about
hypothetical events
• Awareness of other’s
different perspectives
• Conscience becomes
increasingly refined
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Reproduced from J. Aldgate, D. Jones, W. Rose & C. Jeffery (2006). The developing world of the child. London, UK: Jessica
Kingsley Publishers
INTELLECTUAL
DEVELOPMENT
‘Intelligence is a
psychological trait found in
all individuals across all
cultures and populations.
Intelligence is measured
as IQ (intelligence
quotient) using
standardised instruments
which give a designated
mean of 100 with a range
of scores from 20 to over
150.’
RCPsychs 2006
IQ of <120 = Superior
IQ of > 70 = L.D.
Learning Disability
strongly correlated with
psychiatric disorders and
with offending behaviour
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Rutter et al 1998
INTELLECTUAL DEVELOPMENT
• Assessment of Cognitive Functioning,
including an IQ assessment, by a Clinical
Psychologist should be an essential prerequisite of the assessment of a young child
with complex needs, e.g. for Care
proceedings.
• Given the co-morbidity for Psychiatric
disorders, a Psychiatric assessment should
also be done, taking on board the results of
the Cognitive assessment, particularly any
Learning Disability noted.
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Normative Child Development –
Emotional Development
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EMOTIONAL DEVELOPMENT
Is dependent on several factors including
cognitive development and parenting
Ability to defer gratification
Impulse control
Monitoring own thoughts & behaviour
Understanding the consequences of own
behaviour & impact of this on others
Understanding complex abstract ideas such
as ambivalence or mixed feelings
Learning to make good moral judgments
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Normative Child Development –
Social Development
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SOCIAL DEVELOPMENT
According to Piaget,
this young child is in
the sensorimotor
stage and primarily
explores the world
with senses rather
than through mental
operations.
Her ability to
communicate with
others is steadily
improving at this
time along with her
hearing & speech.
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Hearing and Speech
5 years
7-8 years
9-10 years
• Speech fluent and
grammatical
• Articulation correct except
for residual confusions of
s/f/th and r/l/w/y groups
• Love stories and acts them
out in detail later
• Gives full name, age and
home address
• Gives age and (usually)
birthday
• Defines concrete nouns by
use
• Asks meaning of abstract
words
• (12 ‘high frequency’ picture
vocabulary or word lists,
third cube test, six
sentences)
• Can tell left from right,
corrects own grammar
• Verbally expresses fantasies,
and needs, and wishes
• Start of puns, riddles and
word games
• Expresses ideas with
complex relationship
elements
• Increasingly subtle use of
language to express thought,
feelings, categories of things
and comparisons between
them
11-12 years
• Reading capacity now
increasingly important for
new information
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Reproduced from J. Aldgate, D. Jones, W. Rose & C. Jeffery (2006). The developing world of the child. London, UK: Jessica
Kingsley Publishers
Social Development
• By ages 6-10 years old most children have
developed considerable social skills
• They will still communicate through play
which will become collaborative
• They have moved from a more egocentric
stage of development to taking an interest in
others’ behaviours, feelings and thought
processes
• They are still struggling with complex abstract
ideas and they lack the ability to take a long
term view of life
• Stable personality traits are emerging
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Social Behaviour, Relationships and Play
5 years
• Uses knife and fork
• Washes and dries face and
hands, but needs help and
supervision for rest
• Undresses and dresses alone
• General behaviour more
sensible, controlled and
responsibly independent
• Domestic and dramatic play
continued from day to day
• Plans and builds
constructively
• Floor games very
complicated
• Chooses own friends
• Co-operative with
companions and understands
needs for rules and fair play
• Appreciates meaning of
clock time in relation to
daily programme
• Tender and protective
towards other children and
pets. Comforts playmates in
distress
7-8 years
• Develops peer and best
friend relationships
• Beginning capacity for
empathy and concern about
others
• Moods more stable
• Gender identity now well
established
9-10 years
• Best friends become
increasingly important
• Mood now normally
regulated and stable
11-12 years
• May develop animal phobias
• Increasing importance of
peer friendships, based on
shared values and
understanding
• Well established empathic
concern for others
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Reproduced from J. Aldgate, D. Jones, W. Rose & C. Jeffery (2006). The developing world of the child. London, UK: Jessica
Kingsley Publishers
Developmental Milestones
• Most development occurs in early childhood and
adolescence and follows recognised developmental
stages or milestones at different ages
Steinberg & Schwartz 2000; RCPsychs 2006
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Developmental Progression
Age Period
Principal aspects of change and growth
Infancy
• Attachment to caregivers
• Gross and fine motor skills
• Communication and early language
• Increasingly complex expressions of emotion
• Differentiation of self from others
• Self control and compliance
Middle Childhood
• Developing friendships with peers
• Increasing complex physical capabilities and coordination
• Capable of long periods of concentration
• Moods becoming more stable, beginning of capacity for empathy and worry
• Developing sense of values (right versus wrong, what is fair, etc.)
• Beginning to regulate behaviour appropriately in different settings
• Able to communicate ideas and expressions of wishes
• Literacy and numeracy skills become established
Adolescence
• Forming a cohesive sense of self-identity
• Increasing ability to reason about hypothetical events
• Forming close friendships within and across gender
• Academic achievement (learning skills required for further education and work)
• Frequently questioning the belief system with which brought up
• Period of experimentation
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Reproduced from J. Aldgate, D. Jones, W. Rose & C. Jeffery (2006). The developing world of the child. London, UK: Jessica
Kingsley Publishers
Assessment of Child Development
• To be undertaken by trained staff
• To include mental health, paediatric,
educational and social work inputs
• To address strengths & difficulties
• To assess parenting capacity, child
developmental needs & environmental factors
• To include direct physical and emotional
assessment of the child in question, not just
‘tick box’ questionnaires
• A model exists................................ (DoH 2000)
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Department of Health. Department for Education and Employment
and Home Office. Framework for the assessment of children in need
and their families. London: Stationery Office, 2000.
CHILD
Safeguarding &
Promoting
Welfare
Family & Environmental Factors
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Assessment of Child Development
• This model can (and should) be modified as
needed for sub-groups of children with
special needs........................
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NCATS Emerging Severe Personality Disorder (ESPD) Assessment Triangle
(Vizard et al 2007; Vizard 2010) Based on DoH Assessment Framework 2000
•Pre-natal and birth history
•Neuro-cognitive profile
•Early difficult temperament
•Developmental delays
•Unresponsive to punishment
•Poor social skills;
callous-unemotional traits;
lack of empathy
•Severe behavioural
problems –
Torturing animals,
sadism, physical
and sexual
assaults on
others
•IQ < 70
CHILD
Safeguarding &
Promoting
Welfare
6+ changes to home placement
Parental mental health
Parental childhood abuse
Parental time in care
Child removed to LA care
Insecure attachment
Inconsistent parenting
Family & Environmental Factors
Cross-generational family history/genetics of ASPD/psychopathy and developmental disorders;
Cruelty/sexual abuse of animals; Child exposed to domestic violence; Schedule 1 offenders in family;
Inadequate sexual boundaries; Adult sadistic and sexually perverted behaviour
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Assessment of Child Development
• The key issue is that all aspects of the
assessment ‘triangle’ should be addressed in
assessment of a child’s development
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From………….
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To...............................
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Conclusions
• A good grounding in child development
will allow practitioners and policy makers
to identify those children most at risk of
developmental delay and most in need of
early intervention
• Early intervention can rescue the most
developmentally challenged children from a
lifetime of potential underachievement and
greatly improve their life chances
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Key References
Aldgate, J., Jones, D., Rose, W. & Jeffery, C. (Eds) (2006). The developing world of the
child. Jessica Kingsley Publishers. London, UK.
Blakemore, S-J. & Choudhury, S. (2006). Development of the adolescent brain: implications
for executive function and social cognition. Journal of Child Psychology & Psychiatry. 47,
296-312
Bowlby, J (1979). The Making and Breaking of Affectional Bonds. Tavistock Publications
Limited, 11 New Fetter Lane, London, EC4P 4EE
Broadbent, P.L. (1963). The Science of Animal Behaviour. Penguin Books. Middlesex,
England
De Brito, S. (2009). Maltreatment & Trauma. Impact on Brain Structure and Function.
Presentation given to the Neuroscience and Intervention Conference, UCL, 31st October.
Department of Health. Department for Education and Employment and Home Office (2000).
Framework for the assessment of children in need and their families. London: Stationery
Office.
Erikson, E. (1050). Eight ages of man. In Childhood and Society. Harmondsworth. Penguin.
239-266
McCrory, E., De Brito, S. & Viding, E. (2010). Research Review: The neurobiology and
genetics of maltreatment and adversity. The Journal of Child Psychology and Psychiatry.
Piaget, J. (1932). The Moral Judgment of the Child. New York. Harcourt.
Royal College of Psychiatrists (2006). Child Defendants. OP56. www.rcpsychs.org.uk
Rutter, M. & Rutter, M. (1993). Developing: Challenge and Continuity across the Lifespan.
Penguin. London.
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