Child Psychiatry History PowerPoint PDF

A Brief History: What do we know: Mental disorders are brain disorders. Mental disorders are developmental disorders. The beginning of child psychiatry date back to the late 19th century in Europe. In 1887, Emminghaus, a German psychiatrist, pioneered child and adolescent psychiatry, par...

A Brief History: What do we know: Mental disorders are brain disorders. Mental disorders are developmental disorders. The beginning of child psychiatry date back to the late 19th century in Europe. In 1887, Emminghaus, a German psychiatrist, pioneered child and adolescent psychiatry, particularly by defining important cornerstones of developmental psychopathology in his publication on childhood mental illness titled [The Mental Disorders of Childhood]. In 1899, the term [child psychiatry] was used as a subtitle in Manheimer’s monograph [The Mental Problems of Childhood].  TROUBLED CHILDREN IN THE NINETEENTH CENTURY Mental illness in children during the nineteenth century was negligible. It was generally believed that children’s minds were too unformed to absorb the permanent disfiguration required by insanity. Primarily, such children were discussed as case reports of extraordinary children with bizarre behavior. Although the practical aspects of care of mentally ill children are unclear, many physicians were writing about the concept of what they then referred to as “insanity” in young people.  INTELLECTUAL DISABILITY AND THE RISE OF INTELLIGENCE TESTING Professional work on intellectually disabled children, described as “mentally defective,” “feebleminded,” or “idiots,” was much more common, as well as more organized. French researcher Alfred Binet and his student Theodore Simon developed the first modern intelligence test in 1905. The test was unusual in that it attempted to quantify intelligence and was based on data from real children, representing a departure from strict theorizing. In 1916, Lewis Terman modified Binet’s original intelligence test and introduced the Stanford-Binet revised edition. Intelligence testing in early twentieth-century America was an inherently eugenicist project. CHILD STUDY AND THE DESCRIPTION OF NORMAL DEVELOPMENT As researchers like Goddard focused on identifying abnormal children, other researchers directed their attention to understanding the processes of normal child development. As childhood began to be recognized as a special stage of life in the late nineteenth century. The professional figurehead of the movement was Clark University psychologist Gesell Stanley Hall, who identified the period of adolescence as a transitional one between childhood and adulthood. Child researchers like Gesell not only sought to describe child development; they also became coveted sources of advice for new parents during the rise of what historian Rima Apple has called “scientific motherhood,” or the idea that mothers were incapable of raising their children properly without consulting expert scientific advice on the matter.  In 1937 the first international conference for child and adolescent psychiatry. child and adolescent psychiatry was recognized as a medical specialty in 1953 with the founding of the American Academy of Child Psychiatry (now American Academy of Child and Adolescent Psychiatry, AACAP). Michael Rutter The First comprehensive population survey of 9- to 11-year-olds. child psychiatry witnessed major theoretical and intervention breakthroughs in terms of a paradigm shifts toward a socio-therapeutically orientated pedagogy.  CHILD SAVING AND THE MENTAL HYGIENE MOVEMENT Beginning in the mid-nineteenth century, an enthusiastic generation of reformers, many of them women, became concerned with ensuring the physical and emotional well-being of neglected or mistreated children. By the late nineteenth century, reform efforts swelled into a full- fledged “child saving” movement, which focused on improving the welfare of dependent and neglected children by ( ending child labor, promoting compulsory progressive education, providing school lunches, and creating a multitude of agencies designed to help dependent children). Meanwhile, the mental hygiene movement was bringing psychiatry out of the asylum and into the larger community, shifting its attention from treatment to prevention.  CHILD GUIDANCE AND RESIDENTIAL Initially child guidance clinics TREATMENT were intended to treat delinquent, typically working class children, who were referred there from juvenile courts. Almost immediately, however, clinic professionals began to identify a new population of patients: “predelinquent” children. These typically middle class “troublesome” or “problem” children had minor emotional and behavioral problems ranging from enuresis to temper tantrums and truancy. Most importantly, they had a better prognosis than delinquent children, many of whom came from poverty and tended to be repeat offenders. The efforts of mental hygiene experts, including child guidance professionals, to identify and treat a vast, previously unidentified population of “troublesome” children had many consequences, both expected and unexpected.  INSTITUTIONALIZING A NEW PROFESSION In the 1920s, psychiatrists who wanted to work with children could have participated in training programs associated with child guidance clinics, funded by the mental hygiene-oriented Commonwealth Fund and the Rockefeller Foundation. At the same time, child psychiatrists were building institutions to more formally organize their 1960s, 1970s—today: Since the 1960s and 1970s, particular attention has been paid to the classification of child and adolescent psychiatric disorders. As a consequence, DSM-IV13 and ICD-1014 have distinguished certain symptomatologies into “childhood” and “adult” disorders.  A MENTAL HEALTH “CRISIS” Only 12 years after child psychiatry was recognized as a subspecialty, mental health policymakers announced that there was a crisis in child mental health. The “crisis” in child mental health, experts believed, was primarily due to a large number of troubled children who were racial minorities from socioeconomically disadvantaged backgrounds. In part, this concept was driven by the theory that these children were raised in a “culture of poverty” characterized by pathologic families who deprived their children of the sensory and cultural stimuli required for normal development.  A BIOLOGIC APPROACH Psychopharmaceuticals were latecomers to child psychiatry. The first modern psychopharmaceuticals were introduced into adult psychiatry in the 1950s. Yet few psychiatrists were employing medications for children until the 1980s, perhaps because treatment models remained focused on family dynamics and in many cases, retained an analytic grounding. By the 1990s, medications had become a routine part of child psychiatric practice. Both adult and child psychiatrists devoted new efforts to understanding the biologic basis of mental illness, looking for its basis in genetic inheritance and documenting its fundamental alteration of neurologic function The heritability of childhood mental illness were particularly prominent in the field of autism research. Continue… Despite the dramatic advances in scientific knowledge regarding childhood mental illnesses and their treatment over the past 20 years, only a small fraction of children suffering from mental illnesses receive treatment.” The inability to provide mental health services to children who need them most is a function of multiple factors, including: 1) a shortage of child psychiatrists. 2) lack of insurance parity. 3) reduced public funds available to children without the means to otherwise obtain treatment. Developmental Theorists: Newborn to Adolescence Sigmund Freud (1856–1939): (The Father of Psychoanalysis), developed psychoanalytic theory. One of Freud’s main beliefs, is that behaviors resulting from ineffective personality development are unconscious. Freud believed that human behavior is motivated by repressed sexual impulses and desires and that childhood development is based on sexual energy (libido) as the driving force.  Developmental Theorists: Newborn to Adolescence Freud conceptualized personality structure as having three components:  The id: is the part of one’s nature that reflects basic or innate desires such as pleasure-seeking behavior, aggression, and sexual impulses. The id seeks instant gratification, causes impulsive unthinking behavior, and has no regard for rules or social convention.  Ego: is the balancing or mediating force between the id and the superego. The ego represents mature and adaptive behavior that allows a person to function successfully in the world.  Superego: is the part of a person’s nature that reflects moral and ethical concepts, values, and parental and social expectations; therefore, it is in direct opposition to the id. Freud believed that anxiety resulted from the ego’s attempts to balance the impulsive instincts of the id with the stringent rules of the superego. Developmental Theorists: Newborn to Adolescence Behavior Motivated by Subconscious Thoughts and Feelings. Freud believed that the human personality functions at three levels of awareness: 1. Conscious: refers to the perceptions, thoughts, and emotions that exist in the person’s awareness, such as being aware of happy feelings or thinking about a loved one. 2. Preconscious: refers to that thoughts and emotions are not currently in the person’s awareness, but he or she can recall them with some effort for example, an adult remembering what he or she did, thought, or felt as a child. 3. Unconscious: is the realm of thoughts and feelings that motivates a person even though he or she is totally unaware of them. This realm includes most defense and some instinctual drives or motivations. According to Freud’s theories, the person represses the memory of traumatic events that are too painful to remember into the unconscious.  Developmental Theorists: Newborn to Adolescence A Freudian slip: is a term use to describe slips of the tongue—for example, saying “You look portly today” to an overweight friend instead of “You look pretty today.” Freud’s Dream Analysis: Freud believed that a person’s dreams reflect his or her subconscious and have significant meaning, though sometimes the meaning is hidden or symbolic. Dream analysis: is a primary technique used in psychoanalysis, involves discussing a client’s dreams to discover their true meaning and significance.  Developmental Theorists: Newborn to Adolescence Another method used to gain access to subconscious thoughts and feelings is free association, in which the therapist tries to uncover the client’s true thoughts and feelings by saying a word and asking the client to respond quickly with the first thing that comes to mind. Ego Defense Mechanisms: Freud believed that the self, or ego, uses ego defense mechanisms, which are methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events. Most defense mechanisms operate at the unconscious level of awareness. DEVELOPMENTAL THEORISTS: NEWBORN TO ADOLESCENCE Sigmund Freud’s attempts to understand the underlying patterns of neurosis, soon led him to the analysis of early childhood development. This approach became particularly evident in [Three Contributions to the Theory of Sexuality] and [The Interpretation of Dreams]. The writing [Analysis of a Phobia in a Five- Year-Old Boy; Little Hans] represented the beginning of child psychotherapy. Developmental Theorists: Newborn to Adolescence Five Stages of Psychosexual Development: Freud based his theory of childhood development on the belief that sexual energy, termed libido, was the driving force of human behavior. He proposed that children progress through five stages of psychosexual development:  Oral (birth to 18 months)  Anal (18–36 months)  Phallic/Oedipal (3–5 years)  Latency (5–11 years or 13 years)  Genital (11–13 years) Developmental Theorists: Newborn to Adolescence B. Karen Horney (1885–1952): (psychoanalytic social theory): was a psychoanalyst and one of the very few early female theorists. she believed that the causes of abnormal behaviors or mental illness were related to ineffective mother-child bonding. Horney emphasized that it is the responsibility of the parents to provide that safe and secure environment. Karen Horney developed the psychoanalytic social theory where she strongly believed that a person’s childhood contributed and influenced a child’s personality in later life.  Developmental Theorists: Newborn to Adolescence 1. Erik Erikson (1902–1994): Erik Erikson was a psychoanalyst, who extended Freud’s work on personality development across the life span while focusing on social and psychological development in the life stages. Erikson described eight psychosocial stages of development. In each stage, the person must complete a life task that is essential to his or her well-being and mental health. These tasks allow the person to achieve life’s virtues: Hope Purpose Fidelity Love Caring Wisdom  Developmental Theorists: Newborn to Adolescence 2. Jean Piaget (1896–1980): Jean Piaget believed that human intelligence progresses through a series of stages based on age, with the child at each successive stage demonstrating a higher level of functioning than at previous stages. Piaget strongly believed that biologic changes and maturation were responsible for cognitive development. Piaget believed that intelligence consists of coping with the environment. Piaget’s theory suggests that individuals reach cognitive maturity by middle to late adolescence. Piaget’s theory is called Cognitive Development. Cognitive means the ability to reason, make judgments, and learn. Developmental Theorists: Newborn to Adolescence Piaget’s four stages of cognitive development are as follows: 1. Sensorimotor—birth to 2 years: The child develops a sense of self as separate from the environment and the concept of object permanence, He or she begins to form mental images. 2. Preoperational—2 to 6 years: The child develops the ability to express self with language, understands the meaning of symbolic gestures, and begins to classify objects. 3. Concrete operations—6 to 12 years: The child begins to apply logic to thinking, understands spatiality and reversibility, and is increasingly social and able to apply rules; however, thinking is still concrete. 4. Formal operations—12 to 15 years and beyond: The child learns to think and reason in abstract terms, further develops logical thinking and reasoning, and achieves cognitive maturity.  Developmental Theorists: Newborn to Adolescence 3. Lawrence Kohlberg (Development of Moral Judgment) (1927– 1987): He believed in Piaget’s theories, but he perceived that very young people have the ability to understand and judge right and wrong. His true interest was in the mechanisms people use to justify their decisions. Kohlberg’s theory is called the Development of Moral Judgment. Kohlberg believed that these stages build on the learning achieved from the stage before it. Therefore, the stages must be experienced in the exact order, and one is not to backtrack, or revert to a previous stage. Developmental Theorists: Adolescence to Adulthood A. Harry Stack Sullivan (Interpersonal Relationships and Milieu Therapy): Harry Stack Sullivan an American psychiatrist who extended the theory of personality development to include the significance of interpersonal relationships. Sullivan believed that one’s personality involves more than individual characteristics, particularly how one interacts with others. He thought that inadequate or non-satisfying relationships produce anxiety, which he saw as the basis for all emotional problems. Five Life Stages: Sullivan established five life stages of development:  Infancy  Childhood  Juvenile  Preadolescence  Adolescence  DEVELOPMENTAL THEORISTS: ADOLESCENCE TO ADULTHOOD Sullivan also described three developmental cognitive modes of experience: 1. The prototaxic mode: characteristic of infancy and childhood, involves brief, unconnected experiences that have no relationship to one another. Adults with schizophrenia exhibit persistent prototaxic experiences. 2. The parataxic mode: begins in early childhood as the child begins to connect experiences in sequence. The child seeks to relieve anxiety by repeating familiar experiences, though he or she may not understand what he or she is doing. Sullivan explained paranoid ideas and slips of the tongue as a person operating in the parataxic mode. 3. The syntaxic mode: begins to appear in school-aged children and becomes more predominant in preadolescence, the person begins to perceive him or herself and the world within the context of the environment and can analyze experiences in a variety of settings. Maturity may be defined as predominance of the syntaxic mode DEVELOPMENTAL THEORISTS: ADOLESCENCE TO ADULTHOOD Sullivan Therapeutic Community or Milieu: Sullivan credited with developing the first therapeutic community or milieu with young men with schizophrenia. The concept of milieu therapy: involved clients’ interactions with one another, including practicing interpersonal relationship skills, giving one another feedback about behavior, and working cooperatively as a group to solve day-to-day problems. Sullivan coined the term participant observer for the therapist’s role, meaning that the therapist both participates in and observes the progress of the relationship.