review for theories

review for t-1 10/21/11

Saturday, October 22, 2011



example of completed genograms

under each person, fill in information for full picture. consider asking* how far in school did they go?* were they involved in the military?* any big gaps in income levels for family members?* at what age did the leave home? How did they leave the F.O. home. (did they go to their own place - or another relative?)* anyone ever make the news?


Definition:

Temperament refers to our inborn personality traits, which are genetic in nature. The different ways infants interact with and react to the their environment and experiences are reflective of their temperament, or behavioral style.

In general, temperaments exist as they are prior to birth and are a component of an individual’s personality. Although it is thought that temperaments are genetically determined, personalities as a whole are a combination of temperaments and experiences that shape and influence a person’s development.

- unusual personal attitude or nature as manifested by peculiarities of feeling, temper, action, etc., often with a disinclination to submit to conventional rules or restraints.

(emotion regulation)


Since the 1950's hundreds of scientific studies* of temperament have shown that temperament is an important factor in child growth, health and development. The nine characteristics are: ! Activity level-the amount of physical motion exhibited during the day

! Persistence-the extent of continuation of behavior with or without interruption

! Distractibility-the ease of being interrupted by sound, light, etc unrelated behavior

! Initial Reaction-response to novel situations, whether approaching or withdrawing

! Adaptability-the ease of changing behavior in a socially desirable way

! Mood-the quality of emotional expression, positive or negative

! Intensity- the amount of energy exhibited in emotional expression

!Sensitivity-the degree to which the person reacts to light, sound, etc.

!Regularity-the extent to which patterns of eating, sleeping, elimination, etc. are consistent or inconsistent from day to day.

*Temperamental characteristics can be measured by researchers and clinicians in several ways, including interviews, behavioral observations and questionnaires.


Knowledge about temperament and individuality can be useful in several ways.

First, educating parents, teachers and professionals about the existence of individual differences in temperament and ways to deal with these differences can be valuable. Differences are not necessarily the result of a condition or disorder. Many parents feel responsible for, and guilty about having a spirited child, and are relieved to know that their child is normal and they are not responsible for causing the child's behavioral patterns.

Second, it is helpful to know the specific patterns of behavioral individuality to allow those working with the youngster to 'tune in' to their behavioral style. Often caregivers have a general idea about the child's temperament, but ratings on a standardized temperament measure can improve everyone's focus, and there are often surprises (for example, the inability to adjust quickly is often seen as high persistence rather than gradual adaptability). Furthermore discrepancies between perceptions and actual behaviors are important to understand.

Third, with an accurate assessment of the child's behavior, specific changes can be planned and implemented by those working with the youngster. These interventions can improve the 'fit' between the youngster and environment, reducing stress and improving adjustment

Fourth, to learn this approach gives another way in which you can translate more traditional ways of knowing into current means of intervention.

Why


Temperament-Based Intervention: Re-examining Goodness of FitSandra Graham McClowry, Eileen T. Rodriguez, and Robyn Koslowitz New York University, USA

Temperament-based intervention presupposes that certain behavioral expressions of temperament are positive, beneficial and to be encouraged, while others are negative and to be discouraged. Such assumptions, however, are rooted in culturally-laden beliefs about which traits are which. Culture is both descriptive and prescriptive, explicating the way things are and the way things should be. It relays the underlying assumptions about the nature of the self, agency, and the social world (Cushman, 1995; Geertz, 1973; Shweder, 2003). In any given culture, there are both unwritten and codified rules that reflect an underlying shared understanding of the world. For example, in North American and many other Western cultures, the implicit expectation is that assertiveness is of value and should be promoted. Accordingly, these cultures promote assertive behavior in a variety of ways, as demonstrated by social-skills programs that identify assertiveness as an optimal prosocial behavior (for example, see Goldstein & McGinnis, 1997; McGinnis & Goldstein, 1997). In other more collectivist cultures, such as China, inhibited or shy behavior is perceived as an expression of social competence that is encouraged by adults (Chen, Rubin, & Li, 1995, 1997; Kerr, 2001). Consequently, the curriculum of a temperament-based intervention in China would emphasize different social skills than one in North America.http://www.insightsintervention.com/publications/articles/McClowry-EJDS.pdf

PITFALLS


Text


stage age risk factor for coa

Trust v. Mistrust 1st yr Parental depravation, emotional unavailability due to drain of

alcoholism, inconsistent nurturing (critical).

Autonomy v.Doubt 2-4 Limit setting either excessive leading to self - doubt or

extremes in discipline resulting in timidity.

Initiative v. Guilt 4-7 Unpredictable parenting leads to suppression of child’s

creative urges, resulting in guilt. Role model of parent.

Industry v. Inferiority 7-11

Parental lack of interest (to achievements, etc.) leads to sense of uselessness/failures, accomplishments are meaningless. School work ignored or not completed.

Learned Identity v. Diffusion 12-14 Extreme negative identification with a family identity as

disorganized overshadows adolescent’s ability to carve out as and individualIntimacy V.

Isolation*14 to young adulthood

Failure of parental roles lead to inability to share and be open, resulting in an inability to form primary relationships.

Generatively v. self-absorption adulthood

Depravation in learning how to form primary relationships produces shallow connections, carrying over to next generation.

Integrity v. Despair

senior years Blaming other’s for life’s misfortunes leads to despair

* commonly known as separation/individuation

Erikson’s developmental stages as they relate to COA


In the fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Copyright 1994 " The diagnostic criteria for Reactive Attachment Disorder of Infancy or Early Childhood is defined as:

A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2):

• (1) Persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hyper vigilant, or highly ambivalent and contradictory responses (e.g., the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness)

• (2) Diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures)

B. The disturbance in Criterion A is not accounted for solely by developmental delay (as in Mental Retardation) and does not meet criteria for a Pervasive Developmental Disorder.)

C. Pathogenic care as evidenced by at least one of the following:• (1) Persistent disregard of the child's basic emotional needs for comfort, stimulation, and affection.• (2) Persistent disregard of the child's basic physical needs.• (3) Repeated changes of primary caregiver that prevent formation of stable attachments (e.g.,

frequent changes in foster care).

D. There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).Specify type:• Inhibited Type: if Criterion A1 predominates in the clinical presentation.• Disinhibited Type: if Criterion A2 predominates in the clinical presentation.



Developmental History: Angelo (5 this month) is the younger of two children born to his biological mother. He has an older half sister, Katerina (age 8). At 18 months of age, Angelo was put into the custody of his paternal grandmother (KM). Levels of neglect (both physical and emotional) and chaos (various care takers, including his older sister) were such that Angelo was not yet speaking or walking. His hair was thin and he appeared malnourished. By 8/12/05, Angelo had had 13 cavities and 4 root canals. Both birth parents have substance abuse histories, and both were actively using at the time Angelo was placed in the care of Mrs. __________.

Behaviorally, Angelo demonstrated self-abusive behaviors (head banging, placing sharp object in nose, ears, mouth, hitting walls, etc) violent behavior towards others (throwing, kicking, biting) and extreme mood lability.He needed to control interactions, and presented as 'rigid and tense.' Verbally he made self-deprecating remarks such as "I'm stupid." Angelo also had nightmares and could not sleep through the night.

He was also sensitive to textures of clothing, aromas of food, loud noises, bright lights, and sought increased sensory input - such as jumping, running, banging walls, touching and smelling things. He was impulsive. His one self-soothing skill seemed to be watching television. (individual sessions with client through county dept. of mh)

Legal: Meetings with lawyers for grandparents, child advocate re: psycho-education on RAD. Use of AAI with ‘other’ grandfather to rule him out at a safe guardian or supervisor for visitations. Testified 2x’s at hearings. Funded though grant- CPS.

Grandparents: Weekly individual meeting - DBT used as way of teaching neutrality, learning their own emotional landscapes. One grandparent always took part in session. Phone contact prior to sessions if agenda had changed from earlier contact. Private Insurance

School: Training teachers & teachers aides - how RAD is different from Conduct Disorder.How to validate feelings. How to stay neutral and in control (no bargaining). Bi-monthly, with phone contact available for specific situational support. Funding though IEP


Why is attachment important?

The quality of care experienced in the first years of a child’s life determines the quality of a child’s attachment relationships and this can have a life-long impact. The quality of the attachment relationship that forms between a child and his or her caregiver early in life can have a significant impact on a child’s later social, emotional, behavioral and cognitive development.

Research indicates that troubled or insecure attachment can contribute to a child experiencing: behavioral problems such as aggressive behavior, conduct problems and antisocial behavior; emotional problems such as anxiety and difficulty with emotion regulation; social problems such as poor peer interactions and rejection; and cognitive difficulties including low competence and academic functioning.

Early insecure attachment starts the individual along a developmental pathway that could lead to mental health problems, depending on later experiences. On the other hand, early secure attachment contributes to good psychological health through increased resilience, by providing children with the ability to deal well with, or recover from, difficult experiences later in life.

It is therefore essential that prevention and/or intervention happen early, to ensure that every child has the best possible chance in life.*

*We now know how to help all along the developmental spectrum


Piagetʼs Stages of Cognitive DevelopmentStage Characterized by

Sensory-Motor (Birth-2 yrs.)

Differentiates self from objects Recognizes self as agent of action and begins to act intentionally: e.g. pulls a string to set mobile in motion or shakes a rattle to make a noise Achieves object permanence: realizes that things continue to exist even when no longer present to the sense (pace Bishop Berkeley)

Pre-operational (2-7 years)

Learns to use language and to represent objects by images and words Thinking is still egocentric: has difficulty taking the viewpoint of others Classifies objects by a single feature: e.g. groups together all the red blocks regardless of shape or all the square blocks regardless of color

Concrete operational (7-11 years)

Can think logically about objects and events Achieves conservation of number (age 6), mass (age 7), and weight (age 9) Classifies objects according to several features and can order them in series along a single dimension such as size.

Formal operational (11 years and up)

Can think logically about abstract propositions and test hypotheses systematically Becomes concerned with the hypothetical, the future, and ideological problems


Documents

review for theories