Children in Difficulty

A guide to understanding and helping

Julian Elliott, Maurice Place

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136504174
• Edition: 3
• Topic: Education
• Subtopic: Education General

Written by two leading experts in the field, this welcome third edition of Children in Difficulty: A guide to understanding and helping discusses some of the most common, yet incapacitating, difficulties that are frequently encountered by young children and adolescents.

This includes such topics as:

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• ADHD

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• disruptiveness and challenging behaviour in schools and classrooms

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• dyslexia and reading disability

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• eating disorders

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• oppositional defiance, conduct and attachment disorders

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• childhood depression

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• school refusal

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• developmental coordination disorder (dyspraxia)

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• less common mental health problems, such as bipolar disorder and obsessive compulsive disorder.

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• traumatic and stressful situations

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• drug and solvent abuse.

The third edition of this book includes brand new insights from the fields of genetics and neuroscience and ensures claims for the effectiveness of specific interventions are supported by rigorous, scientific evidence. By drawing upon high level scientific and clinical knowledge and distilling it in a way that is accessible to professionals from a range of child care disciplines, this book will be of significant value to those working in education, health or social care, and anyone who needs to be able to recognise and help children in difficulty.

Chapter 1
Introduction

There are few issues which can raise stronger feelings in the average person than those which relate to children. Be it outrage at their challenging behaviour, or distress at injury or neglect, adults quickly become moved by issues which involve children. Even more fascinating is the way that each person ‘knows’ how the situation or behaviour should be handled – and usually this means that the delinquent needs more punishment, or the hurt child needs more care. While such emotional responses are very understandable, they are not always the correct way to intervene in a situation to ensure that matters will be improved. A child’s functioning and development are influenced by many (at times, competing) influences, and any efforts to help must be informed by an understanding of these.

Influences upon development

Genetics and epigenetics

The genetic make-up inherited from their parents is increasingly seen as a significant influence on many diverse aspects of the child’s growth, development and ultimate functioning. The belief that problems located within the parents can be passed on to their children has been persuasive since biblical times. The advent of scientific study, and the work of Gregor Mendel, the Augustinian monk, gave a clear understanding of the principles of heredity, and prompted research into DNA and the chromosomes that are made from it.

Research into conditions such as Down syndrome has clearly shown that changes to the chromosomes can be responsible for some major, and sometimes profound, changes in functioning and development. However, research has also begun focusing upon the mechanisms and chemicals that take the information held in the DNA and translate it into the cell’s structure and function.

Studies of how interventions bring about their effect have shown that experiences influence the translation machinery of the gene, changing in some instances the expression of the gene and the genome itself. This is the essence of a gene x environment interaction. Trying to understand this process is the science of epigenetics.

Experience modifies the gene’s actions, creating changes in behaviour, and this is achieved by changing the mechanisms that translate the DNA information into the cell’s activity. One of the main mechanisms by which this is achieved is by altering the chemical make-up of the surface of the DNA. For instance, the phenomenon of cytosine methylation tends to silence that part of the gene (Jaenisch and Bird 2003), while a process called histone modification tends to activate it (Jenuwein and Allis 2001). A third epigenetic system has been identified, and this interferes with the chemical that transfers the gene’s instructions to the cell (messenger RNA) (Hamilton et al. 2002).

These epigenetic processes are tissue-specific and can be inherited, but they are also very prone to change by environmental experiences and factors. They appear to be particularly vulnerable to being altered at a number of key developmental points in the infant’s early development (Waterland and Michels 2007). For instance, early in life, diet is important in order to provide sufficient nutrients to permit the usual epigenetic processes to proceed. Of particular importance in this regard is folate, vitamin B12 and vitamin B6, with deficiencies being linked to impaired central nervous system development and a number of psychiatric conditions, including behavioural disturbances in childhood (Reynolds 2006).

Such changes can persist for the remainder of the cell’s life and may last for multiple generations, but this is achieved without any alteration to the original DNA sequence (Bird 2007). In some instances these changes can be transmitted through to subsequent generations. As we shall see when considering attachment (Chapter 4), this process is viewed as increasingly important in regulating maternal behaviour, and transmitting emotional states to the child. It is also implicated in the origin and persistence of numerous behavioural difficulties and psychiatric conditions (Tsankova et al. 2007).

However these changes need to be triggered, and it is environmental factors, and life events, which moderate or mediate these genetic influences on behaviour and functioning. Interestingly, although much of the focus has been upon the difficulties and problems that can result from the effect of the environment x gene interaction upon the developing brain, it is important to remember that these processes also make children susceptible to influence from positive experiences (Belsky and Pluess 2009). Indeed it is through such mechanisms that therapeutic interventions exert their effect, as they also alter the mechanisms of brain cell functioning (Meaney 2010).

Changes to specific brain cell functioning exert their influence through changes to the complex chemical and hormonal structures which control all of our bodily systems, and which in turn alter our emotions and behaviour. The detail and complexity of such elements make them beyond the scope of this text, but by way of illustration we can look at one particular body chemical: serotonin (or 5–HT). Work over the years has highlighted that this chemical plays a role in moderating emotional responses to adverse experiences throughout the animal kingdom (Steiner et al. 1997). Thus if there is any dysfunction in serotonin’s action then emotional problems are likely to arise. From this research has sprung a new family of medications to treat depression, the serotonin specific reuptake inhibitors (SSRI’s), which are discussed in Chapter 10.

The other aspects of brain development that need to be borne in mind are those of sensitive periods and brain plasticity. Sensitive periods of development are well recognised in many animals as points early in life when certain skills or abilities need to be acquired. If they are not acquired at this ‘critical period’, then it is more difficult, and perhaps impossible, to develop them later in life. So for instance, eyes need to receive light to develop the correct optical nerve networks (Weisel and Hubel 1965), and this is true for many other neural pathways as well. These critical periods have been highlighted as significant for human development (Bischof 2007), and are, for instance, especially significant in the development of attachment capacity (see Chapter 4).

Brain plasticity is the ability of the brain to adapt and change in response to experience. It appears to be at its greatest during early phases of development (Rueda et al. 2005) and may be associated with specific gene variations. The most promising of these is a variation of one of the genes which manages dopamine in the brain (DRD4 7-repeat allele), because this appears to make individuals more responsive to both positive and negative environmental influences (Belsky et al. 2009). There is a growing view that these two mechanisms make a powerful argument for seeking to recognise and intervene with difficulties at the earliest of ages, even if the difficulties are quite mild at that time (Dawson 2008).

Family functioning and dynamics

Although there is a major research focus upon genetic and biochemical mechanisms, and how they change function, their influence is dependent upon life experiences. The most significant of these for children is of course the environment in which they grow, and particularly the nature and quality of their family life. The general rules of positive family life can be easily stated with the four ‘C’s:

• Care and warmth;
• Consistency and predictability;
• Control and maintaining appropriate boundaries;
• Commitment.

For any chance of success, all four elements must be present in significant measure, but specific circumstances may require emphasis upon one strand for a period, e.g. a sick child tends to need more care, a wayward child more control. However although life’s events may require these changes of emphasis it is important to remember that even at such times all the elements need to be tangibly present, and the balance between the four needs to be present in reasonable degree if problems are to be managed or prevented.

Louise was 15 years of age and was having difficulties in school. When challenged by her teachers over trivial matters she would become angry and storm from the classroom. Her parents said that she had behaved like this at home ever since being a toddler. They added that when these episodes occurred at home they either gave in to her wishes or tried to calm her down by offering treats or rewards. The parents adopted this placating style when Louise was 18 months of age, because it was then that she was diagnosed as having a major hormonal problem, and the doctors said it would be dangerous for her if she became upset. Over the years the parents had continued to believe that Louise’s life would be in danger if she became too upset and so made every effort to avoid such situations ever arising.

Situations like these are not common. Too much control, which is not tempered by caring warmth, creates angry, and at times violent, children. Too little control, and the young person will live to the limit of that control, quickly exceeding it and usually only being pulled up by the limits which society imposes in the form of laws. Lack of parental commitment perhaps exerts the most detrimental effects for it removes the child’s sense of being claimed, and there is clear evidence that harsh, inconsistent and unresponsive parenting can continue to exert a very negative influence into their adult life (Hoeve et al. 2009).

As discussed in Chapter 4, the younger the child the more significant the impact of any negative parenting might be, and in this regard the first three years of life are seen as critical. With early care being so important it is pertinent to ask what the impact of working parents and early child care arrangements might have upon the child. Frequent separations from the primary parent weaken the sense of attachment, but positive engagement with a persistent and predictable adult helps mitigate the effects of the separations, although there is some evidence that such arrangements continue to exert a negative effect upon the child’s ultimate functioning (Bernal 2008).

However, we should not forget that family functioning is an interactive process. It is clear that difficult and challenging behaviour from a child increases a parent’s sense of stress, which places a significant demand upon their ability to cope. Stressed parents are, in turn, more likely to respond to their children in ways that increase or reinforce problem behaviour (Plant and Sanders 2007), further exacerbating the problem. As discussed in Chapter 6, issues such as parental separation and divorce can also exert a very negative effect upon a child’s current and future functioning.

Peer group influence

As all parents know, a child’s friendships exert considerable influence upon their functioning as they become older. Healthy peer relationships are important to a child’s development because they provide a context within which they learn social skills and develop coping mechanisms. Peer relationships also promote psychological well-being and a sense of positive self-esteem, and offer protection against negative comments by other peers. Positive peer relationships have also been shown to be associated with higher achievement and a cooperative rather than competitive style of functioning (Roseth et al. 2008).

However if the child is rejected or bullied by their peers, they are at risk of emotional and behavioural difficulties, both at the time and later in life. To reduce the sense of isolation, children who are bullied by peers will typically seek out others who are equally marginalised, which often puts them in a group of troubled and troublesome young people (Card and Hodges 2008).

Peer group influence is but one specific example of the impact which subculture can have upon the behaviour or emotional state of a child. A further example is the influence that specific school environments can exert upon children (Rutter et al. 1979). The school’s ethos exerts an effect upon the pupils’ behaviour – as well as the level of issues such as vandalism and graffiti – that is irrespective of the type of area from which the pupils are drawn.

Life experiences

As we have already seen, life experiences play a crucial role in shaping and developing a child’s make-up and nature. Exposure to adverse, stressful events, such as marital conflict, maternal depression and financial stress, have all been linked to emotional and behavioural problems, as well as cognitive deficits (Masten and Obradović 2006). Similarly, physical illnesses or disorders can exert direct effects upon emotional well-being. For instance, it is well known that children with epilepsy experience a significantly greater level of emotional disturbance than children without this condition (Meltzer et al. 2000), and similar increases are also noted in conditions such as asthma (Mrazek et al. 1998).

Children have less well developed mechanisms of coping with adverse events and so depend quite heavily on the adults around them for support and help. Thus the history of the child’s life often contains important clues about what influences have helped shape their present pattern of behaviour. T...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of figures
• 1 Introduction
• 2 The basics of being helpful
• 3 School refusal
• 4 Oppositional defiance, conduct and attachment disorders
• 5 Eating disorders
• 6 Traumatic and stressful situations
• 7 Neurodevelopmental disorders
• 8 Disruptiveness and challenging behaviour in schools and classrooms
• 9 Drug and solvent abuse
• 10 Depression
• 11 Dyslexia
• 12 Developmental coordination disorder (dyspraxia)
• Author index
• Subject index