Perspectives on Behaviour

A Practical Guide to Effective Interventions for Teachers

Harry Ayers, Don Clarke, Anne Murray

• Publisher: David Fulton Publishers
• Year: 2015
• ISBN:
  9781136608568
• Edition: 2
• Topic: Bildung
• Subtopic: Bildung Allgemein

This book is a practical guide to the following eight perspectives on behaviour:

• biological - focusing on biological and biochemical processes in accounting for behaviour;
• behavioural (or behaviourist) - focusing on overt, observable and measurable behaviours and their reinforcement in accounting for behaviour;
• cognitive (or cognitive-behavioural) - focusing on cognitive processes (beliefs, attitudes, expectations and attributions) in accounting for behaviour; combines both the cognitive and the behavioural perspective;
• social learning - focusing on observational learning, perceived self-efficacy and expectancies in accounting for behaviour;
• psychodynamic - focusing on unconscious conflicts in early childhood as accounting for current behaviour;
• humanistic - focusing on low self-esteem and problems in coping with and exploring feelings in accounting for behaviour;
• ecosystemic - focusing on positive and negative interactions between teachers and students within the school and those that externally affect the school; these interactions are seen as accounting for behaviour;
• ecological - focusing on the influence of systems and the environment in accounting for behaviour.

The aim of the book is to enable the reader to develop a structured approach to emotional and behavioural problems by drawing on one or more of the above perspectives.

1 The biological perspective

This perspective is included solely for information for teachers so that they are aware of how developments in the field of biology relate to particular types of behaviour problems, most notably ADHD and autism.

Definition

The biological perspective considers mental disorders to have underlying physical or organic causes, e.g. schizophrenia. Mental disorders are characterised in terms of the medical model, which include pathology, symptoms, diagnosis and prognosis. There are various approaches within the perspective:

• Behavioural genetics: sees mental disorders and other behaviours as being significantly influenced by a person's heredity The aim of this approach through family comparisons and twin, adoption and linkage studies is to determine the degree to which behaviour is influenced by genes and the degree to which it is influenced by the environment. Many genetically influenced disorders appear to fit a diathesis-stress model, i.e. genetic makeup together with environmental stress produce a disorder. Behavioural genetics has evoked controversy in the form of disagreements over the results of twin and other studies and the replication of research.
• Brain biochemistry: sees some mental disorders and other behaviours as being influenced by abnormal biochemical reactions in parts of the nervous system. In particular certain types of neurotransmitters are believed to play a part in some mental disorders. Neurotransmitters are chemicals that facilitate electrical impulses between nerves in the brain. A number of neurotransmitters have been put forward as having a role in mental disorders, e.g. dopamine and serotonin. This is thought to be in terms of an excess or a deficit of a particular neurotransmitter. Psychopharmacology uses drugs to treat mental disorders which are thought to be influenced by imbalances of neurotransmitters. There are drug treatments for anxiety, depression and psychoses. Although these drugs can have positive effects they may also have unpleasant side effects, may not work for all patients and may treat the symptoms rather than the cause.
• Brain anatomy: sees some mental disorders and other behaviours as being influenced by abnormalities in the anatomy or structure of the brain. For example, schizophrenia has been connected to enlarged ventricles in the brain. Psychosurgery, the use of surgery to treat mental disorders, has a controversial history, e.g. prefrontal lobotomy. However it has been used in the form of a surgical procedure, cingulotomy, to disrupt pathways in the brain in order to decrease severe emotional stress as in obsessive-compulsive disorder. Usually these are measures of last resort where other treatments have failed.
• Endocrinology: sees some mental disorders and other behaviours as being influenced by dysfunctions of the endocrine system in the form of hormonal imbalances, e.g. low levels of activity in the thyroid can result in anxiety.

Evaluation of the biological perspective

This perspective tends to a reductionist viewpoint when it reduces mental disorders to being simply the result of abnormal biological processes. Cause and effect may be difficult to disentangle, as biochemical abnormalities may be the effect rather than the cause of a disorder. Furthermore one cannot necessarily conclude that the drug treatment of a disorder indicates it is a lack of that drug in the brain that is the cause of the disorder. This perspective also tends to emphasise the importance of genetic causes for disorders rather than environmental causes. Controversy has arisen over the degree to which heredity contributes to disorders and other behaviour. There appears to be an acceptance that both nature and nurture play a part but disagreement over how much.

Drug treatment is not always successful given that individual responses do differ, some benefiting, others showing adverse side effects and others displaying no improvement. In some cases symptoms are reduced but the causes remain. However, many people have benefited from drug therapy, for example in reducing the positive symptoms of schizophrenia, e.g. delusions and hallucinations. In the case of ADHD children have reduced their hyperactivity through taking the drug Ritalin.

Teachers should not conclude that all behaviour is biologically determined and therefore behaviour is inevitably fixed and unchangeable. Even where there is an assumed biological influence on behaviour this does not preclude psychological intervention, e.g. behavioural methods in the case of ADHD.

Biological assessment

Biological assessment focuses on brain dysfunctions or abnormalities and uses a variety of methods such as brain imaging techniques, neurochemical approaches, neuropsychological tests and psychophysiological measurements.

• Brain imaging techniques such as computerised axial tomography (CAT scans), magnetic resonance imaging (MRI) and positron emission tomography (PET scans) are used to investigate brain abnormalities and linkage with mental disorders.
• Neurochemical approaches depend on detecting and analysing the levels of neurotransmitters in the brain by for example looking for the metabolites of those neurotransmitters. The aim is to study the links between neurotransmitter levels and mental disorders.
• Neuropsychological tests are used to help assess mental disorders that are related to brain abnormalities; for example, the Halstead-Reitan battery of tests and the Luria-Nebraska battery are used to assess brain damage.
• Psychophysiological assessment measures electrical and chemical changes that are related to psychological states. Examples are electrocardiagrams, electroencephalograms (EEGs) and electromyograms.

With regard to biological assessment it is important to be aware that there are problems in interpreting the assessment results and that there is no necessary one-to-one correspondence between results of scans and tests and a particular psychological abnormality.

Biological treatment

Given that the biological perspective focuses on the links between brain biochemistry and mental disorders, then treatment is through application of the appropriate drug therapy. For example, anxiolytics (sedatives and tranquillisers) are used to treat anxiety and phobias; anti-depressants are used to treat depression and eating disorders; and anti-psychotics are used to treat schizophrenia.

It should be remembered that drug therapy can have adverse side effects related to the drug prescribed and that specific drugs do not necessarily work for everyone suffering from a particular mental disorder

ADHD (Attention Deficit Hyperactivity Disorder): an example of the biological approach to a behavioural disorder

Classification

This disorder or syndrome is characterised as one where an individual manifests overactivity, impulsivity and inattention. Children who suffer from this disorder will probably experience social and educational failure. Problems among the majority affected can continue into late adolescence and for some into adulthood. Adolescents affected are at risk of developing a conduct disorder and becoming substance abusers and delinquents.

A physician or psychiatrist using a diagnostic manual, DSMIV or ICD10, diagnoses ADHD. It is stated in both manuals that symptoms must be present in two settings, e.g. at home and school, for a diagnosis to be valid. Achenbach's Child Behaviour Checklist system can also be used to make a diagnosis.

The clinical characteristics are a brief attention span, distractibility, inability to foresee the consequences of one's actions, antisocial behaviour, excitability, risk-taking and poor school performance. There are problems with relationships with parents, teachers and peers. There are subtypes of ADHD, the inattentive and the hyperactive-impulsive. The hyperactive-impulsive subtype is characterised by extreme overactivity and aggression resulting in behavioural difficulties in school.

Depending on the diagnostic criteria prevalence rates for ADHD can vary from 1% to 19%. The prevalence rate is higher for boys than for girls and greater in preadolescence than in late adolescence. There is quite a high co-morbidity of ADHD with conduct and emotional disorders.

Causes

The biological perspective considers genetics, brain dysfunctions, neurotransmitter problems, diet and underarousal to be key factors in the causes of ADHD. Genetics suggests that children with ADHD have a predisposition to develop the disorder. Brain imaging techniques have not detected brain abnormalities and neurological assessment has not detected a pattern of cognitive processing problems in children with ADHD. The neurotransmitter hypothesis considers the symptoms of ADHD to be associated with neurotransmitter malfunctioning. Drug therapy with psychostimulants like Ritalin (methylphenidate) is believed to have a positive effect on abnormal neurotransmitter functioning. About 60% to 90% of children respond well to drug treatment but the positive effects disappear once it is terminated. Particular children with allergies to specific foods who have ADHD may improve if put on diets that exclude those foods. The underarousal theory suggests that children with ADHD are underaroused and as a result seek stimuli. Psychophysiological tests have indicated reduced psychophysiological responses to new stimuli.

Other, non-biological theories have been suggested in terms of specific deficits such as an inability to maintain attention, difficulties in inhibiting overactivity, an impulsivity that hinders the application of appropriate social and cognitive coping strategies and an inability to follow rules.

Assessment

The assessment or diagnosis of ADHD requires information to be obtained in both the home and school setting. It is suggested that a multidisciplinary assessment be undertaken in terms of gathering information on ability, educational attainment, behaviour and medical background. Checklists are recommended for assessing behaviour in school and in the home, e.g. Achenbach's (1991) Child Behaviour Checklist system. Paediatric medical assessment is also considered useful for identifying biological predisposing factors.

Formulation

The formulation will include information from the school and home, psychological tests and checklists and paediatric medicals. This information will be combined in a formulation.

Intervention

The biological intervention is through drug therapy, namely the prescription of psychostimulant medication, e.g. methylphenidate (Ritalin). Side effects can happen, e.g. loss of appetite and sleep disturbance and, in rare instances, tics. The drug is effective in most cases of children with ADHD. However, if the drug is discontinued the improvements end. Non-biological interventions include behavioural and cognitive methods. Operant techniques such as positive reinforcement programmes combined with response cost and time-out can be complementary to drug therapy. Teachers and parents can be trained in the use of operant techniques. Cognitive interventions include self-instructional training and anger management training; these too can be complementary to drug therapy.

Conclusion

The assessment and treatment of ADHD is from the biological perspective. Assessment is multi-disciplinary through medical and psychological approaches. The main cause of ADHD is believed to be disordered brain biochemistry. Drugs like Ritalin significantly improve concentration and behaviour. They can have side effects and if the drug is discontinued behaviour deteriorates. Other interventions are effective but usually in conjunction with drug therapy. ADHD provides a clear instance of the effectiveness of the biological approach to a behavioural disorder. However, interventions based on other perspectives, e.g. the behavioural and the cognitive, are also effective particularly combined with drug therapy.

Guidance for teachers

• Awareness of the biological perspective is essential in that emotional and behavioural difficulties may be in part or in full the result of neurobiological or physiological dysfunctions. Furthermore medical conditions and the side effects of drug treatments themselves may have negative behavioural consequences. Examination of medical records if possible may throw light on emotional and behavioural problems.
• A biological or genetic predisposition to an emotional or behavioural problem in itself does not necessarily preclude the influence of other non-biological factors, e.g. family conflict.
• Biological treatments do not preclude the use of other interventions, e.g. behavioural methods can be a useful adjunct to the prescription of Ritalin in the case of ADHD.

Autism: a disorder believed to have an underlying biological basis

Classification

This disorder describes children who manifest difficulties in social interaction, social communication and language development and who also display repetitive, obsessive and restricted patterns of behaviour. It is an example of a pervasive developmental disorder and was first identified by L. Kanner in 1943. It has a prevalence rate of 2-5 per 10,000 and it is more common in boys than girls, the ratio being 4:1. Intellectually about 75% of autistic children score below 70 on intelligence tests. Some children have high levels of achievement in specific areas, e.g. musical memory. Asperger's syndrome is similar to autism but is different in that there is no language delay or intellectual impairment.

With autism there are social, linguistic and behavioural deficits. There are impairments in social and peer relationships, attachment problems and a lack of empathy. Language development is delayed and characterised by echolalia, neologisms and pronoun reversal. Behaviour is characterised by stereotyped, repetitive, ritualistic, obsessive actions and restricted interests. There is often a desire to preserve routines and avoidance of change. L. Wing (1993) believes that autism can be classified into three sub-groups: aloof, passive and active-but-odd type.

Causes

There are three main theories of autism: psychodynami...