Interventions for parents and families a developmental psychopathology perspective

Philip A. Fisher and Elizabeth A. Stormshak

Prenatal and early childhood family interventions Family interventions in the preschool years Family interventions in the school-aged years Family interventions involving adolescents Cultural issues m.family interventions Conclusions Chapter, References

Several decades ago, a chapter on the types of treatment available for psychological disorders of childhood and adolescence would probably have been quite fragmented. The diversity of observed problems, and the extent to which these problems were conceptualized from within different theoretical frameworks, led to the development of a multitude of therapies that shared only limited conceptual overlap. Sroufe (1) has argued that this situation may have arisen out of a reliance on an overly simplistic analogue of a medical model of childhood psychopathology, within which 'discrete and distinctive' disorders were identified, and problems were considered to be strictly endogenous in origin. That the field has become considerably more integrated in recent years may largely be attributed to the emergence of the new discipline of 'developmental psychopathology'. (1.,2)

Developmental psychopathology provides a coherent perspective from which to examine psychosocial maladjustment in childhood and adolescence. It also carries with it assumptions about interventions designed to address such maladjustment. In particular, we suggest that there are six assumptions inherent in approaches that fall within this approach.

1. Problems may be conceptualized along a developmental continuum. Specific symptoms emerge at particular ages or stages in the development process in response to an interaction between the biopsychosocial processes at work within the individual and the input experienced from the environment. Thus, interventions with a young person of a specific age should be developmentally appropriate.

2. In evaluating whether a particular process or behaviour is indicative of pathology, comparisons should be made with normal development. Physical aggression, for example, is not unusual in young children, and it is only through socialization that children learn alternative ways of expressing negative emotion. Thus, in deciding whether to intervene, the focus is on how a child's behaviour compares with that of his or her same-aged peers.

3. Because of the many normal changes that occur across childhood and adolescence, it is not useful to conceptualize pathology in terms of functioning at a single time point. Rather, the emphasis should be upon understanding the 'trajectory' of a child's behaviour across time. There is evidence that certain symptom profiles follow a fairly consistent and predictable path across time. (3) Interventions should focus on deterring the young person from trajectories indicative of risk, rather than on the alleviation of symptoms observed or reported at the outset of treatment.

4. Because of the emphasis on the interaction between the child and his or her environment, this fourth underlying assumption of developmental psychopathology-based interventions is that they should be ecologically valid, i.e. they should address both the child and the context of the child. In particular, attention should be devoted to developing interventions that impact the family or home environment. This focus arises out of evidence suggesting that the family is one of the most proximal influences on child behaviour,(4) and that by targeting the family one is likely to impact the adjustment of the child. It is also important to note that schools have been an additional focus for interventions based on the developmental psychopathology approach, especially for older children. (5,6)

5. Also consistent with the ecological perspective is the concept that when interventions include individuals from different cultures, consideration should be given to the extent to which the intervention is culturally appropriate for members of those groups. Concepts of wellness and pathology differ across cultures, as do the roles of child and parent. In order for interventions to be effective, they must incorporate these differences.

6. Just as empirical research has played a central role in the emergence of developmental psychopathology as a discipline, it must also play a central role in the evaluation of interventions based on this approach. Before interventions can be implemented on a wide-scale basis, they must be shown to influence dependent variables of importance. In particular, interventions should be considered effective to the extent that they can be shown to alter the risk trajectories of children and adolescents.

In this chapter, we describe interventions for parents and families that fall within a developmental psychopathology framework. In particular, we focus on interventions that have been developed to reduce conduct problems or antisocial behaviour among children at four stages of development: prenatal and neonatal children, preschool-aged children, latency-aged children, and adolescents. Our decision to focus on conduct problems is due to the clarity with which the antisocial life-course trajectory has been articulated by researchers. (3,4) However, it is important to recognize that there are many other family-based interventions currently in use to address a variety of problems, and that there are more interventions in various stages of development and evaluation. Those we have chosen to highlight are well developed and have empirical support, but there are many others that limitations of space prevent us from describing. Those with a psychodynamic orientation may question whether the approaches described here can be effective without specifically addressing the emotional development of the parents. Our response to this is, first, that the empirical support for these approaches includes long-term follow-up in many cases and that the positive impact of these programmes appears to be retained over time. Second, from a more anecdotal perspective, we would suggest that by targeting specific parenting issues, family dynamics and functioning of both parent(s) and child seem to be affected. Thus, there may be an indirect impact of these approaches on parental emotional development.

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