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Lecture 3

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PSY345 (3) May 14, 2013 The Early Childhood Years  First years of childhood crucial  Chronological timeline of events  Research comes from developmental psychology – development of language, emotional connection, attachment  Anecdotal evidence child developed because of early exposure  Research tell us that all the experiences of early life are very important  Neuropsychology- child born-nervous system is very flexible –changes in synaptic transmission are more likely when the child is young  This flexibility allows for opportunities for learning – gradual decline in ability to learn  Older NS solidifies- less amenable  Example of language – child can learn a huge vocabulary simply by exposure  Early stimulation affects the development of intelligence, personality, self worth (know this from “normal” children)  Stimulation (great parenting) is very important – seen by kids in orphanages how deprivation can effect children  Child born with a disability (intellectual disability) , developmental delay (Pervasive developmental disorders such as autism)  Very important to intervene with that child  “normal” children just pick up language but children with developmental delays – cannot sufficiently do this on their own  Should intervene in the early years – longer wait can reduce the child’s learning and improvement  Ex. Autistic children can be non verbal – intervention within the first few years will help – may not be able to communicate verbally but will lead to some improvement  Evidence shows how crucial early intervention is for children with these kinds of disabilities  Child problems (muscular control) - physical problem / physiological problem → early stimulation ( teach to walk, crawl, sit up) get them to be as active as possible – may help them learn it all  For younger children- OHIP responsible not the school board  services of people with disabilities – money shouldn’t be an object – money zero sum game  Early intervention makes economic sense – bringing up kids to meet their potential , communicate better – save services that would have been used later on and for the rest of the child’s life  Behavioral management – susceptible behavioral problems- grown up – commit crime , jail , hospital for the rest of their lives- saving money with early intervention – can avoid these types of problems and situations  Canadian government recognizes – willing to pay What services are available?  Infant development programs – often run my cities , municipalities  Smaller programs belong to cities- similar networks of programs of child welfare (children aid societies)  Legislation – don’t have the same as the same type as IDEA  Programs develop from the city / government  Ministry of health apply from grants – partnerships with the private sector  Organization/ agencies help facilitate the care of infants who have development delay  School board takes over at 4-5 years of age  Kindergarten – don’t go through much assessment, don’t do much until their in JK/SK  IDP –childhood programs –services till 6  Serve kids who are at risk  Johnny -7 years- isn’t walking?- normal kids are but might be at risk  Premature babies – risk for a variety of development programs, higher risk for autism  Kids don’t yell out their own diagnoses – concerns/observations parents have made  Parents see other kids and don’t see their kids doing the same kinds of normal things  Social services (occupational therapy) not medical services (pediatrician) The process of checking if there are any problems a) General practitioner are not experts in child development – do an examination to check for any concerns – if a cause for concern then referral made b) Refer to pediatrician- specializes in childhood and all aspects including illnesses (childhood illnesses c) Refer to other services- intervention services Goals 1. Optimize child’s functioning level- not cure the child (doctor not these agencies), no cure for these problems – Autism, Down’s syndrome, ADHD, learning disability- not necessarily a sick person, doesn’t have a virus – may have an impairment but not a disease. By optimizing functional level stimulate, expose and educate the children →push them as much as they can 2. Help parents with information and support- no one thinks that they will have a child with a disability – it is devastating- who do they go to? These agencies help 3. Aid the parent to use resources to help their child Target Population Who these agencies give priority to first? They have waitlists Most needy are prioritized for one on one session, while the less needy are assigned to group sessions Different from school system- diagnoses, eligible for an IP, the same types of laws Government must provide for health services – surgery- waitlist for some time Established Risk - Risk is already there – child has a disorder or a particular development delay - What the trajectory is going to be like, what are the challenges going to face, know the child is going to go through because of diagnosis - Diagnosed medical disorder (down’s syndrome= chromosomal) - Can be diagnosed through amniocentesis - Know what / which needs – maximize his/her potential - Example → FASD – different case not chromosomal disorder but because of toxicity(drank during pregnancy) - May be normal at moment of conception but disturbed ( neurological development) →brain disorder results in all kinds of negative outcomes/ challenges - Children can also have problems when mothers are addicted to cocaine Biological Risk - During birthing process – key negative events, complications - Anoxia – lack of oxygen during birthing process, brain does not receive an adequate supply of blood with an appropriate level of oxygen – cell neurological death - Any stress or trauma during birth process – the birth process takes too long-child and mother stress - Umbilical cord wrapped around neck of baby, bum comes out first in childbirth - Child who needed C (cesarean)- section but didn’t get it at the right time - Apparently quite normal → early negative events - Child is at risk - Secondary priority for access to services - Early symptoms – not sleeping, feeding properly or symptoms could appear later- they don’t appear at all until child goes to school (hard time understanding concepts) – some of these early events correlate with ADHD & learning disabilities - Early screening tools – research is contested - If general practitioner/ pediatrician expect negative events – follow on weekly. biweekly visits to survey what’s going on with child- if anything’s wrong - If not , consider the child to be pretty normal Psychological Risk - Example → mom is a teenager, deadbeat dad - Environment problems, primary rearing environment - Bottom end of rearing environment- add to that a child who has ADHD – may not be diagnosed in while at school even (hard to diagnose) - Difficulties during development processes/ trajectories - Combinations of risk – biological risk combined with poor rearing environment – parents have problems and can’t cope – children end up being apprehended into care by childcare services - Combination of two risk categories is too much - When child is difficult, parents find it hard to cope - Intervention when not necessary – giving too much attention to the child – they grow up believing they have some kind of problem Intervention Approaches  Family centered- not in general better than any other particular type of intervention approach  Depends on the type of service being provided – clientele predicament  Client-centered and service provider – directly helps such as when your something happens to your tooth or your arm is broken  Psychological intervention: family environment – need to go to therapy – which one is a better type of therapy? Family centered or client centered? It’s not clear  Everything’s fine at home but mom is still unhappy – may need Client-centered –CBT  You need to change because everyone around you is objectively good  Family problem –disruption in the home-dysfunctional  Dad is never home, mom needs help-feels belittled ,no support to do the right thing  Need couple centered or/and family centered therapy  Therapy is particularly suited for different types of issues  Example – infant not walking – needs physical , occupational  Speech / cognitive psychologist who comes in to work with the child once or twice a week  Family Centered therapy – different  Mediator model – the psychologist/ therapist teaches / trains family to help the child – teaches to mediate and ways of family therapy  Why is this advantageous model? Child with family – therapy has a better effect when it is done by a parent  Not psychotherapy →different type of approach – expose the child to more language (talk to the child more- during feeding for example)  Consistent communication – classically conditioning the child  Link the sound /word to what the mom is saying and doing  Infant feeding time – one on one interaction between mom/dad and child  This interaction does not necessitate an occupation therapist  Type of therapy and education required Why is it better for parents to provide the therapy? 1. Parents have a lot of time with the child – they are there all the time 2. Type of intervention allows for parents to take the initiative- they can do it and doesn’t necessitate professional intervention 3. Not only an intervention but simply improving parents as well- improve parenting behavior – make them better parents 4. Cheaper and more affordable –it’s much more natural for the child to have this type on intervention work much better for these kids rather than intervention with a professional staff  There can be problems with this type on intervention using parents – they may not follow recommendations , don’t trust the agency staff , cultural differences (girls don’t need to go to school in some cultures so doesn’t matter if not developing intellectually, parents may be in denial about the child having a disability , simply don’t like the strategies recommended  Staff can’t go to the child’s house for an assessment or observation (in home visits) if there is no consent to do so or if they are no invited  Children’s Aid Society – court order to go in the house – need a very good reason for that  Bad reaction between family and agency  Have to be fair with the family  Psychosocial risk- if the child is neglected  Agency must the family know in advance – if during the home visit – abuse or neglect is suspected – they have an obligation to the law to report it  In contrast a good trusting relationship will benefit the family and the child  An example of a home visit situation – open refrigerator – empty – what if the first priority is to feed the child to survive- taking time out for stimulating the child isn’t as important as food  Services finds food for family – food bank  “enabling mom and dad to do what they need to” Services include - Assessments →child goes in for a formal diagnosis - Planning with parents → IFSP – individuals’ family service plans – this is how you’ll pay rent, food, therapy child is going to get him/ her on track - Plan for the family as well as the child - In home programs →heavy course load – once in a while or so may be too little - Office visits → for the parents and the child - Counseling → to the parents - Case management → services different agency staff provides- managing all of them, behavioral therapy, external agency (find all of the services for food, transportation) - Parent support g
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