Cognitive Behavioural for Children and Young People with Depression

March 5, 2016 by

Depression: Cognitive Behaviour Therapy with Children and Young People

  1. Verduyn, J. Rogers & A Wood

Hove, East Sussex: Routledge

 

Depression is no stranger to those of us who live in Hong Kong. It is sometimes and associated difficulty in children with ADHD and other developmental difficulties such as autism spectrum disorders. As an Educational/Child psychologist, I heartily recommend this book, which brings us closer to a comprehensive understanding of Cognitive Behaviour Therapy (CBT) for depression. With user-friendly and well-referenced content, it is useful for clinicians, researchers and even parents.

 

This book is a welcome addition to the increasing number of books on CBT for children. The focus is on CBT for depression and it is clear that the authors have both a comprehensive understanding of the literature and lots of clinical experience with children and adolescents with depression. The book strikes a good balance between offering content and structure for therapy sessions, whilst highlighting when this might be difficult and what the alternatives might be. There are several features that make it user friendly: key information is presented in boxes, whilst the main text is well referenced, appealing to both clinicians and researchers. The case examples make it clear that CBT can be used effectively with complex cases, and the verbatim examples of how to introduce different topics or strategies distil the key message that needs to be put across to the young person. The worksheets (also downloadable) are similar to those found in other CBT books, but the clinician prompt sheets are less common but equally well written and look very useful. In addition to the chapters on key aspects of CBT for depressed young people, there are useful chapters on involving parents, special issues such as bereavement and trauma, and on dealing with common problems in therapy.

 

I highly recommend this book for those working with children and adolescents with depression or those interested in researching the area.

Filed Under: Counselling/Therapy Approaches

BOOK REVIEW: The Dyslexia Debate

December 7, 2015 by

Dyslexia is a general term for disorders that involve difficulty in learning to read or interpret words, letters, and other symbols, but that do not affect general intelligence. It has been the subject of scientific for more than 100 years but its nature and treatments remain debated for educational psychologists all over the world, including Hong Kong. To understand dyslexia, I recommend reading The Dyslexia Debate, 2014 J.G. Elliott & E.L Grigorenko.  

 

Elliott and Grigorenko take on the task of reviewing the field and conclude that ‘the term (dyslexia) has surely outgrown its conceptual and diagnostic usefulness’. Writing the foreword, Vellutino, one of the pioneers of dyslexia research, concurs and prefers to use terms like ‘poor’ or ‘struggling’ readers. The argument that the authors present is that there are no clear cut criteria for dyslexia, there is no cognitive, genetic or neutral evidence that sets those with dyslexia apart form ‘poor readers’, and there is nothing special about the treatments that follow ‘diagnosis’. On the other hand, the authors are clear that there are many children who struggle significantly with learning to read and write and require educational support to prevent a downward spiral of low achievement and poor self esteem. So why not embrace the concept of dyslexia as validated by empirical research, and retain a term that opens the door to intervention for many children and young people?

 

The book continues with the authors presenting their arguments on dyslexia, such as researchers do not agree about the features of dyslexia. However, this begs the question of which researchers and what is the quality of the research they refer to? Unfortunately, too many published studies are not cast within an appropriate developmental perspective, include participants who do not fulfill rigorous criteria for reading disability, which do not report the reliability of their measures. The arguments put forward different perspectives of dyslexia which enables readers to gain an in depth knowledge of the subject.

 

So how can the dyslexia debate be advanced? First we must start by acknowledging where we want to be. Professionals need to be arguing for clarity surrounding the criteria for what dyslexia is and what it is not. Scientists also need to be talking to policy makers about evidence- based approaches to the teaching of literacy, and the characteristics of those who are at high risk of reading difficulties. This will help all children who struggle to respond to quality teaching of reading to be identified and appropriate arrangements made to enable them to succeed.

Filed Under: Communicating with Children, Counselling/Therapy Approaches, Dyslexia, Hong Kong

Assessing language skills in young children

November 30, 2015 by

Language and communication skills are essential to children’s ability to engage in social relationships and access learning experiences. Children with autism/asperger’s syndrome as well as Dyslexia may have difficulties with language development. Hence, it is a skill that is often an important part of assessments by Educational Psychologists in Hong Kong in order to determine the developmental progress of a child.

 

In a recent article in the Journal of Child and Adolescent Mental Health. It is found that current screening measures do not meet psychometric pre-requisites (psychometrics = design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and personality traits)  to identify language problems. A range of articles is reviewed to identify issues which practitioners and researchers should consider when assessing language skills. There are significant challenges in the interpretation of language assessments, where socioeconomic status, language status and dialect, hearing impairment and test characteristics impact results. The range of articles shows that psychometrically sound assessments of language are an essential component of developing effective and efficient interventions. Regular monitoring of language is preferable, as one- off screening has limited power to predict later performance because children’s developmental paths vary. Hence, a combination of language performance measures is a better indicator of language problems and disorders than single measures of component skills.

 

To conclude, the language system is complex, it composed of a number of subcomponents and the language paths of preschool children vary substantially. As such, the development of reliable and valid assessments is challenging, but they are of central importance for studying typical and atypical development. Research studies continue to enhance our understanding of the language development process and aid our identification of children who experience persistent language disorders and the factors that are associated with these. The assessment of narrative skills and dynamic assessment were highlighted as new developments. The current review has aimed to provide the necessary information to make informed decisions about assessing the language competencies of preschool children.

Filed Under: ADHD, Asperger Syndrome, Communicating with Children, Counselling/Therapy Approaches, Dyslexia, Hong Kong

10 Things Parents and Teachers Should Know about ADHD

November 23, 2015 by

Core symptoms of ADHD

  • Hyperactive- impulsive: impaired ability to slow down and hold back
  • Inattention: impairments in prioritizing what to pay attention to, maintaining focus, block out distractions, remembering. Symptoms of inattention are usually most persistent and most problematic.
  • Symptoms get worse in situations that require sustained attention or mental effort or those that lack novelty and personal appeal (listening to teachers/ parents, classroom seatwork, homework, lengthy reading or listening activities, monotonous, repetitive tasks) .

 

The symptoms of inattention are most prominent

Many people think that all persons with ADHD have hyperactive impulsive behaviors that they have difficulty controlling. In fact it is the persons problems with focusing, concentrating, listening to directions, blocking out distraction, staying organized and working within time constraints that usually have the biggest interference with a person’s functioning.

 

 

ADHD is a spectrum disorder. Symptoms range from mild to severe. Key part of assessment is determining how much the symptoms have a negative effect on social, school or occupational functioning.

 

 ADHD people need more scaffolding than average

Scaffolding refers to a variety of instructional techniques used to move students progressively toward stronger understanding and, ultimately, greater independence in learning. In early childhood, caregivers perform functions for the child. Showing, directing, helping, reminding, coaching and critiquing are means of scaffolding. Examples include, walking, getting dressed, crossing street, riding bike, driving car. Scaffolding is gradually withdrawn, as child becomes able to (or is forced to) perform these functions for self. In adolescence and adulthood scaffolding provided by: friends, teachers, coaches, spouses, supervisors and computers.

 

 

Prevalence and demographics of ADHD

  • All level of IQ, but most would be average or above
  • 70%- 90% male
  • Found in all countries and ethnic groups
  • Highly heritable (87%)

 

Types of proven treatments for ADHD

 

  • Parent/ Teacher training about ADHD
  • Parent training in child management (young children)
  • Parent/ Teacher training in behavior management
  • Adult input with self monitoring
  • Medication

 

 

Important considerations for teachers

 

ADHD is a biologically based disability that is treatable, but not curable. The goal of school intervention is to contain and manage the symptoms. ADHD is not due to lack of skill or knowledge, but is a problem of sustaining attention, effort, and motivation and inhibiting behavior in a consistent manner over time. ADHD symptoms are particularly bad when consequences are delayed, weak or absent and material is perceived as uninteresting. It is harder for ADHD students to do the same social behavior expected of other students. ADHD children need increased adult direction, structure, more frequent and salient

consequences, and accommodations, for assigned work.  The most effective behavioral interventions for improving school performance are those applied within the school setting.

 

What can teachers do to help?

  • Keep a disability perspective (an explanation, not an excuse)
  • Interact on positive level as frequent as possible (immediate, frequent, consistent feedback about behavior and performance)
  • Anticipate problem situations and structure for success
  • Make sure you have attention before giving directions (say child’s name before giving directions to the group)
  • Use desirable activities as reinforcer for work production and appropriate behavior
  • Break things into small units (less problem on a page)

 

Importance of Behavioral and Combination Interventions

Ongoing behavioral interventions may increase the possibility of tapering off medication if it is being used or stopping them as children age.

 

 

What to do if I feel someone I work with has ADHD and needs help?

  • Consult with colleagues and see if they see the problem as well
  • Suggest professional assessment and describe observed problems in specific behavioral terms
  • Don’t get caught up in deciding what treatment should be obtained
  • Teachers should not tell parents their child needs medication.
Filed Under: ADHD, Counselling/Therapy Approaches

Transgender youth- current theory and practice

November 17, 2015 by

Recently, under the presidency of Obama, same sex marriage has become legal in a number of states in America. President Obama also became the first United States president to use the word transgender as he called for respect and protections for socially marginalized people during the State of the Union address. Transgender is an umbrella term for people whose gender identity and/ or gender expression differs from the gender assigned to them at birth. As a result, through social media and the press, a lot of attention is paid to people whose gender identity and/ or expression does not correspond to traditional norms. Famous transgender adult figures include Caitlyn Jenner, Laverne Cox (from the hit TV series Orange Is The New Black) etc. Even in Hong Kong parents consult with educational or clinical psychologists about transgender issues. In my own practice I do get these sort of referrals and thus it is important for professionals to upgrade their knowledge of transgender issues to help parents and individual adolescents understanding.

 

After some research, I found that there is some evidence that hormone blocker treatment improve a number of mental health outcomes for gender variant/ gender nonconforming adolescents. At the same time, some scholars and clinicians see the need to study this treatment’s long- term effects and argue that this treatment may make it difficult for children who change their mind and want to go back to the gender assigned at birth. We need more research to answer many questions surrounding hormone blockers and cross- hormonal treatment in young people, including the treatment’s effect on the developing brain, bone health, and the related risks for diabetes, hypertension and other chronic mental illnesses. However, one of the biggest obstacles in investigating the effect of hormone treatment is that we don’t fully understand exactly how gender identity develops. Although evidence suggests that children who persistently and strongly present with gender variant/ gender nonconforming at a very young age are more likely to maintain transgender identity into adulthood, clinicians are presently unable to make reliable predictions about which of the young gender variant/ gender nonconforming children will grow up to be transgender adults. And there is no official epidemiological research that exists to provide us with the prevalence of gender variant and gender nonconforming children and youth.

 

Clinical practice with gender variant/ gender nonconforming children can be divided into two main groups. One approach, which can be understood as corrective, is built around promotion of normative/ traditional gender identifications and expressions, and uses behavioral; methods and family training to help children identify with gender assigned to them at birth, in order to reduce stigma and transgender identity. The other approach, which is conceptualized as supportive/ affirming, focuses on supporting and building family and child resilience, counteracting stigma and other environmentally invalidating events, and allowing children to express gender in a way that feels authentic to them. No empirical studies supporting the efficacy of one type of treatment over the other treatment are available and treatment recommendations are based mostly on expert opinion rather than on any scientific outcome data. Most clinicians would support the latter approach especially with an older child. This is the official view of many organizations such as the National Association of School Psychologists.

 

It may be medically and therapeutically indicated for some transgender and other gender diverse children and adolescents to transition from one gender to another using any of the following: change of name, pronoun, hairstyle, clothing, pubertal suppression, cross- sex hormone treatment, and surgical treatment. Engaging in any of these methods is a big step for both the individual child or adolescent as well as for the family. Helping children and families through this process is also a huge challenge for professionals in this emerging area of mental health treatments. All clinicians that work with children and adolescents should seek to increase their knowledge of transgender issues.

Filed Under: Counselling/Therapy Approaches Tagged With: