The beginning of Clinical Psychology It takes place in 1896, the year in which Witmer founded the first psychological clinic for the treatment of specific problems of children and adolescents. He is considered the founder of the discipline. Witmer’s interest in applying psychological knowledge was considered premature by his contemporaries, who considered themselves more researchers than clinicians. This situation caused a stoppage that lasted until the middle of the 20th century.
Historical evolution of clinical child psychology
The signs are found at the end of the XVII century when a change occurs in the conception of childhood and adolescence, with a greater increase in concern for its development. In 1801, the “wild child of Aveyron” was given to Itard for treatment, with the aim of training in social skills and the mastery of instrumental learning.
The first interventions in children and adolescents are part of the context of the psychology of learning in their first period of development, marked by the Russian reflexologists and psychologists of North American tradition. Such important aspects as the knee reflex (Twitmer), Krasnogorski (conditioning of a swallowing response), Mateer and his investigation of the acquisition of forgetting, discrimination training and inhibition of the conditioned reflex were studied.
Burnham He described classical conditioning as the fundamental contribution to pedagogy and mental hygiene. The works of Jones, Watson and Rayner constitute a basic precedent for therapeutic interventions in children and adolescents. Mower initiated treatment in a group of children with nocturnal enuresis.
After the Second World War and until the middle of the 20th century, child and adolescent therapeutic intervention will be fundamentally mediated by the “Holy Trinity”: a social worker who interviewed parents, a psychologist who administered and applied evaluation tests, and a psychiatrist. who applied the treatment.
Psychological approaches after the Second World War.
- South African School (Wolpe): Applications of systematic and technical desensitization of emotional images.
- English school (Eysenck)
- North American School (Skinner)
Prevalence of Childhood Psychopathology
They affect boys more than girls (this is not true for emotional disorders such as depression or anxiety disorders). Vital importance of psychosocial factors. Regarding the age of onset, there is a worse prognosis the younger the age at onset of the disorder.
Developmental disorders, developmental delays and eating disorders can be detected at an early age. Attention deficit hyperactivity disorders are usually found shortly before or after schooling. Anxiety disorders appear at any age.
Depression, schizophrenia and eating disorders They begin around adolescence. Regarding diagnosis, there is a group of diagnostic categories that usually begin during infancy, childhood or adolescence.
Characteristics Child Psychopathology
A child does not usually interpret himself as needing help, but rather it is the parents, teachers, pediatrician, etc., who detect behavior that they consider inappropriate and request the intervention of an expert.
According to Evans and Nelson The age and degree of development reached by the boy or girl must be considered when making a diagnosis and choosing a treatment. The emphasis on observation and recording of overt behavior should be emphasized by the therapist.
These facts are:
- The specificity of the behavior in relation to the situation is greater the younger the child is.
- The conceptualization of a behavior as problematic, both by default and excess, is related to the conception that adults have of the problem.
- Until the age of 10-11, children do not acquire the skills of self-observation and evaluation. Very limited possibility of making psychophysiological records.
There are two basic considerations that must be take into account the therapist:
- Regarding the characteristics of the child/adolescent: Stop at the evaluation of cognitive abilities, language development, past and current biological determinants, chronological age and family characteristics.
- Regarding the characteristics of the treatment to be applied: Know the level of prior training that may be required, both from the therapist and the co-therapists, as well as the amount and type of technical resources required.
Diagnostic groups of Child Psychopathology
Mental retardation: It is characterized by an intellectual capacity below average (IQ close to 70 or lower).
Pervasive developmental disorders: These consist of profound generalized deficiencies in multiple areas of development. They include:
- autistic disorder
- Rett disorder
- Childhood disintegrative disorder
- Asperger’s disorder Pervasive developmental disorder not otherwise specified
Learning disorders
Academic performance below what is expected for the age, level of intelligence and education received. Includes:
- Reading disorder
- Calculation disorder
- Writing disorder
- Unspecified learning disorder
Communication disorders
Those related to language and speech deficits include:
- Expressive language disorder
- Mixed receptive-expressive language disorder
- Phonological disorder
- Stuttering
- Unspecified communication disorder.
DISORDERS OF MOTOR SKILLS AND MOTOR HABITS
- Developmental coordination disorder
ATTENTION DEFICIT DISORDERS AND DISRUPTIVE BEHAVIOR
- Attention deficit hyperactivity disorder
- Disruptive behavioral disorders
- Pica disorders
- Rumination disorders
- Eating disorder of infancy or childhood
Emotion disorders
Tic disorders
- Disorders that present vocal and/or motor tics
- Tourette’s disorder
- Chronic motor or vocal tic disorder
- Transient tic disorders
- Unspecified tic disorder
Other disorders
- Selective mutism
- Reactive infancy and childhood attachment disorder
- Stereotyped movement disorder
- Unspecified infancy, childhood and adolescence disorder
Types of classifications in Child Psychopathology
Clinics: The DSM-IV distinguishes childhood disorders from general disorders by a single criterion:
- the age of onset The ICD-10 classification indicates sections corresponding to childhood psychopathology.
- F70-79: Mental retardation
- F80-89: Disorders of psychological development
- F90-98: Behavioral and emotional disorders that usually begin in childhood and adolescence
Empirical: Use of instruments to measure behaviors, which are applied to adults who care for children and adolescents. ACHENBACH develops an empirical classification (classifies disorders based on the results of multi-axial research)
- Axis I: CBCL Parent Report
- Axis II: Report from TRF teachers
- Axis III: Cognitive evaluation>Ability Tests
- Axis IV: Physical examination
- Axis V: Direct evaluation of the child.
Evaluation in Child Psychopathology
The most used evaluation strategy is the general clinical interview, usually using semi-structured interviews, but there are also structured interviews that allow more objective information to be collected (DICA, DISC-R).
Systematized observation: It is a very deep elaboration of what is going to be observed. Projective tests have been widely used, although currently less so:
- Rorschard test
- Drawing of the Human Figure
- Draw a person
- House-Tree-Person Test, CAT.
Intelligence tests are widely used:
- Fourth edition of the Stanford-Binet,WPPSI-R,WISC
- Kaufman Assessment Battery for Children
Development scales:
- Kaufman Infant Development Scales.
- Neuropsychological evaluation: Halstead Neuropsychological Test,Luria-Nebraska Neuropsychological Battery Children’s Revision
To evaluate functional disability or degree of impairment that causes psychopathology in the child: Children’s Global Assessment Scale (CGAS) and Child and Adolescent Functional Assessment Scale (CAFAS) Evaluation of social support: Child and Adolescent Social Suport Scale
Treatment in Child Psychopathology
Close collaboration with parents Level of family stress or coexistence of disorders with parents INDIVIDUAL AND GROUP PSYCHOTHERAPY Arminda Aberasturi was the creator of child psychoanalysis in Argentina Slavson:
- He created a specific group psychotherapy model for children.
- Exclusion criteria: Frank and decompensated psychosis Alcohol and drug abuse Violent adolescents incapable of controlling their impulses.
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