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Emotional and Behavioural
Problems in Children
Counselling and Family Therapy:
Applications and Interventions By M.S. Ahluwalia
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Contents
1. Introduction to Emotional and Behavioural Problems in Children
2. Identification and Assessment
3. Management
4. Family-based Intervention
5. Specific Issues
Emotional
and
Behavioural
Problems
in
Children
10
Emotional and Behavioural Problems in Children
11
Introduction
to
Emotional
and
Behavioural
Problems
in
Children
• Children and adolescents experience a range of
emotional disturbances and have a variety of
behavioural disturbances. These disturbances
are put under the categories of syndromal
emotional and behavioural disorders.
• Children can be anxious, depressed, fearful,
aggressive, hostile, can have scholastic
backwardness, psychosomatic problem,
severe mental illness etc.
• In the majority of childhood psychological
disturbances or problems, the family has
varied role to play.
Important aspects of the family system
which influence children’s psychosocial
development and adjustment
- Family environment
- Quality of parental relationship
- Disciplining style
- Interpersonal communication within family
- Family reactions to child’s behaviour
pattern
- Experience of stress in the family
- Problem-solving mechanisms used by the
family.
Psychologically and Emotionally Heathy Children
12
Introduction
to
Emotional
and
Behavioural
Problems
in
Children
• Children spend their time in studies, play activities,
interacting with parents, siblings, and peer group and other
such activities.
• If they are emotionally healthy, they:
• get involved in these activities and enjoy them,
• remain cheerful and satisfied,
• tend to listen to their parents and teachers,
• concentrate well in their studies,
• are well adjusted,
• grow up as well integrated individuals with positive
characteristics.
• A psychologically healthy child experiences sense of
achievement, affection, and affiliation which promotes
further healthy development and adjustment.
Factors which contribute to healthy
psychosocial development of children
- Temperament of the child
- Quality of parenting
- Home environment
- Child’s competence
- Adequate positive experiences
- Adequate resources
- Optimal role models within and
outside family etc.
Emotionally Disturbed and Maladjusted Children
13
Introduction
to
Emotional
and
Behavioural
Problems
in
Children
• Unlike psychologically healthy and well-adjusted
children, there are children who are emotionally
disturbed and have variety of behavioural problems.
• These children have difficulty in adjusting with both
home environment and school environment.
• Emotional and behavioural problems in children are seen
related to:
• activity,
• academic skills,
• emotions,
• psychosomatic manifestation,
• conduct,
• sexuality, and
• addiction.
Due to their emotional and behavioural
problems, these children:
- don’t relate well with their family
members, siblings, and friends
- don’t participate in and enjoy play
activities
- experience difficulties with their
academics
- suffer many aches and pains,
- failure in school
- non-rewarding situations around them
- severe adjustment problems.
c
Contents
1. Introduction to Emotional and Behavioural Problems in Children
2. Identification and Assessment
3. Management
4. Family-based Intervention
5. Specific Issues
Emotional
and
Behavioural
Problems
in
Children
14
Identification and Assessment
15
Identification
and
Assessment
• Early identification and proper assessment of psychological disturbances in the
child help in effective management and effective family counselling.
• The counsellor/therapist needs to make specific effort to identify the:
• nature and type of problems
• possible determinants of the problems
• maintaining factors
• effects of the problems, and
• various positive factors in the child and environment which can be further promoted as
part of counselling strategies.
Sources of Emotional and Behavioural Problems
16
Identification
and
Assessment
Sources of Emotional and Behavioural Problems in Children and Adolescents can be:
Child-related
• Like
• poor intelligence
• sensory defects
• mild brain damage
• acquired defects
Family-related
oParents who are:
oquarrelsome and difficult,
overy anxious and ambitious -
expect too much from child
oare indifferent to the child,
ouse excessive punishment.
oSibling rivalry and jealousy
oFinancial problem at home
oParental interpersonal
problems, and
oUnusual home environment
(conflict, extra-marital
relationship, and alcoholism)
School-related
• Academic pressure or stress,
• Punitive and critical teacher,
• Bully classmate or senior etc.
Other environmental
situations related
• Factors present in
neighbourhoods, which may
create psychological problems
in children.
• Example:
• bad company,
• conflict with
neighbourhood,
• inequality,
• violence etc.
How to Identify and Assess
17
Identification
and
Assessment
• Identifying that a child is suffering from emotional and behavioural problems is essential for a
counsellor. Some problems can be identified easily but some problems require specific skills and
techniques in order to identify them.
• A counsellor can look for some indicators of emotional and behavioural problems in children
such as:
• Presence of any of these indicates possibility of emotional and behavioural problems.
Frequent
absence from
school
Irregularity in
homework
Poor in play
and
recreational
activities
Staying alone
Complaints of
aches and pains
during classes
Complaints
from others
regarding
his/her
conduct
Poor test
performances
Not attentive in
the class
Being irritable,
stubborn,
and/or
aggressive
Refusal to go
out of home
Frequent
crying spells
Frequent fights
with friends
and/or siblings
Poor appetite
and/or sleep
Methods of Identifying and Assessing Problems of Children
18
Identification
and
Assessment
• Observation of child’s behaviour
• Academic performance of the child
• Use of screening tools: Mental Health
Screening Questionnaire can be used for
identification of psychological problems or
mental health problems in children.
• Interview the Parent’s
• Psychological/behavioural testing: helps
in identification and assessment of the
nature and the severity of the problem.
Assessment of children’s problems also
includes scaling the:
- Intensity
- Frequency
- Antecedents or triggers
- Immediate and long-term consequences
of specific behavioural or emotional
problems.
Visual Analogue Scale is the simplest
method for assessing severity of problems.
Identifying the source of the problem
19
Identification
and
Assessment
• Once it is identified that a child is likely to have
emotional and/or behavioural problems, a systematic
effort should be made to explore the sources of these
problems through an interview with the child, the
parents and other significant persons.
• C/FT must try to establish a convincing explanation
about the relationship between the sources of the
problems and the emotional and behavioural
manifestations of the problems in the child.
• This explanation must be based on the elicited facts
and not on assumptions or any kind of bias.
Family Factors to be
Explored
- Communication
- Problem Solving
- Interpersonal Relations
- Rewarding Experiences
- Stressors
Identifying the Aspects of Family Structure and Functioning
20
Identification
and
Assessment
In order to use family-based intervention strategy, it is vital to explore the important
aspects of family structure and functioning which have significant influence on
children’s emotional and behavioural problems including:
Quality of
interpersonal
relations among the
members
Interaction and
communication
pattern
Disciplining and
controlling
mechanisms
Problem-solving
strategy
Regulation of
emotions
Availability of
rewarding/ non-
rewarding experiences
within the family
Presence of aberrant
situations*
*like domestic violence, alcoholism, mental illness, chronic and disabling physical problems, ongoing stress
c
Contents
1. Introduction to Emotional and Behavioural Problems in Children
2. Identification and Assessment
3. Management
4. Family-based Intervention
5. Specific Issues
Emotional
and
Behavioural
Problems
in
Children
21
Management
22
Management
1
Play Therapy
2
Behaviour Therapy
3
Cognitive Therapy
4
Supportive Therapy
5
Parent Training
6
Family Therapy
1. Play Therapy
23
Management
• Play therapy is a form of psychodynamic therapy, which
provides children an opportunity to deal with their emotional
difficulties and develop control over their external problematic
behaviour.
• In play therapy, play is used as an adjunct to as well as a
vehicle of communication between the child and the therapist.
• The child is introduced to specific play setting with different play
materials with the aim of achieving a therapeutic effect with a
cathartic resolution of conflict or tension through the child’s
play.
• Play helps the child develop and sustain relationship with the
therapist, which has central therapeutic significance.
• In guided play therapy, the therapist guides the child’s play in
an effort to help the child achieve psychological integration.
Play therapy as used by Axiline
(1947) is considered as most
effective play therapy for
children. Based on the Rogerian
concept of ‘Client-centered
therapy’ Axiline’s play therapy
uses play to reflect back to the
child his states, wishes, or
convictions without attempting
interpretations of unconscious
motives or conflicts.
2. Behaviour Therapy
24
Management
• Behaviour therapy assumes that most
behaviour develops and is maintained
according to the principles of learning.
Therefore, behaviour can be modified with the
help of the same learning principles.
• In behaviour therapy, observable target
behaviour is attempted to be changed with
the help of different behavioural
techniques.
Behavior
Therapy
a set of related assumptions, principles, and techniques rooted in learning
theories, used to change human behaviour.
Behavioural Techniques
- Modelling
- Shaping
- Exposure
- Behavioural practice
- Differential reinforcement
techniques
- Time-out etc.
3. Cognitive Therapy
25
Management
• Cognition plays a very important role in the way individuals feel and act, and
this is true for children too.
• Cognitive therapy believes that behavioural and emotional problems are a
result of dysfunctional, irrational beliefs and distorted cognition.
• Identification and exploration of irrational and dysfunctional cognition and
intervention to make it functional and rational are the essence of cognitive
therapy.
Cognition
the process and manner of interpreting experiences and events around us
and assigning meanings to these events.
4. Supportive Therapy
26
Management
• Many a times individuals are so entrapped in their psychological disturbances that
they find it difficult to handle situations on their own; they need encouragement,
guidance, and support to sort out their problems and to deal with their
difficulties.
• Supportive therapy helps such individuals come out of their sufferings effectively.
• In supportive therapy, the therapist:
• focuses on the present situations and sufferings and
• helps the client by providing opportunity to ventilate, share, and release pent-up
feelings
• by providing guidance, suggestion, encouragement for positive action, education,
clarification, and environmental manipulation.
5. Parent Training
27
Management
• Parent training empowers parents to deal with emotional and behavioural
problems of children through the process of parenting.
• Parents are trained by the therapist to:
• Attend to the positive behaviour of the concerned child
• Reward positive behaviour
• Ignore some of the unwanted and maladaptive behaviour, and
• Exercise control and punishment for highly undesirable behaviour.
• Use behavioural techniques: positive reinforcement, distraction, punishment, and skills
training.
6. Family Therapy
28
Management
• Structure of family, quality of relationship among the family members, quality of
communication, emotional bond, value system, conflict resolution, disciplining pattern,
rituals and taboos of the family have significant influence on the mental health and psychological
problems of the family members.
• Family therapy attempts to look at the problems of any member as manifestation of dysfunction
in family system including disruption of bond, communication problem, disruption of
boundary, pathological handling of conflicts, and other such difficulties within the family.
• Nature and sources of interpersonal conflicts and their manifestations within the family are
identified, explored and measured and relevant interventions are made in family therapy with the
participation of each significant unit of the family.
• Different techniques are used in family therapy including behaviour techniques, cognitive and
problem-solving techniques.
c
Contents
1. Introduction to Emotional and Behavioural Problems in Children
2. Identification and Assessment
3. Management
4. Family-based Intervention
5. Specific Issues
Emotional
and
Behavioural
Problems
in
Children
29
Family-based Intervention
30
Family-based
Intervention
1
Psychoeducation
2
Communication
Training
3
Behavioural
Management
Training
4
Parenting Skills
Training
Next
1. Education to the Family (1/2)
31
Family-based
Intervention
>>
Psychoeducation
• Often parents have difficulties in accepting that their child has emotional and/or
behavioural disturbances and requires counselling/family therapy.
• Such difficulties may arise due to stigma, ignorance, fear and guilt due to their perceived
contribution/ role in the development of problems in the child, and some other worries parents have.
• C/FT is required to be aware of such reasons for parents’ resistance to acceptance.
• Acknowledgement of the fact that the child has problems and needs specific
intervention sets appropriate ground for help seeking behaviour of the parents and
significant others.
• It also ensures proper compliance to the process of counselling and therapy.
• Parents of disturbed children need to be educated by the counsellor so that they can understand the
nature of problems the child has and possible remedies for these problems.
• Acknowledgement of problems and acceptance of responsibility for solution are
prerequisite for the family for initiating the process of counselling.
1. Education to the Family (2/2)
32
Family-based
Intervention
>>
Psychoeducation
What should be explained?
Counsellor must explain to the parents the:
- problem of the child
- factors that are contributing to and
maintaining the problem
- solution available
- their role and responsibility in
helping the child to come out of the
problems
- importance of parenting and family
environment in controlling child’s
problems etc.
While educating the family, the counsellor should:
- Communicate in simple understandable language
- Allow adequate time for information to set in
- Show confidence, acceptance and patience
- Satisfy their queries
- Avoid argument
- Tell them with clarity that it is not their fault
- Wait for their reaction and respect their
reactions
- Assure reasonable commitment
- Avoid false promises
- Help them take appropriate decisions regarding
intervention
Family-based Intervention
33
Family-based
Intervention
1
Psychoeducation
2
Communication
Training
3
Behavioural
Management
Training
4
Parenting Skills
Training
Next
Importance of Proper and Healthy Communication
34
Family-based
Intervention
>>
Communication
Training
• Proper and healthy communication between parents, children, and other significant family members
plays an important role in maintaining sound psychosocial development of children.
• Faulty communication creates difficulties and spoils relationships and subsequently contributes to
emotional and behavioural problems.
• Adult to adult faulty communication has devastating impact on children.
• Simple, direct, and focused communication is considered better than difficult, indirect, and vague
communication.
• Critical comments and hostility areconsidered unhealthy from mental health point of view.
• Pathogenic communication between parents and other adult family members provides a model for
children to emulate.
• Hostile, critical, vague, and unnecessarily elaborative communication from parents or others to the
child, may lead the child to be angry or hostile or confused or stressed.
Thus, communication training is an important area to work with in counselling of affected family.
Process of Communication Skills Training
35
Family-based
Intervention
>>
Communication
Training
Identify faulty
aspects of
communication
in the family
Clearly explain
the link
between
communication
and its
consequences
to the family
• Indirectly
• Without putting
any blame on
anybody
Suggest
appropriate
ways of
communication
Encourage
family members
to practice.
Family-based Intervention
36
Family-based
Intervention
1
Psychoeducation
2
Communication
Training
3
Behavioural
Management
Training
4
Parenting Skills
Training
Next
Behavioural Management Training
37
Family-based
Intervention
>>
Behavioural
Management
Training
• Behavioural management is an
essential aspect of helping a
family with an emotionally and
behaviourally disturbed child
through counselling and family
therapy.
• Counsellor must help
parents/family members learn
skills to manage behavioural
problems of children by
explaining and demonstrating
simple procedures to them.
Components of Behavioural Management Training
- Behavioural analysis and assessment to record
nature, frequency, severity, origin, and
maintenance of behavioural problems in children.
- Identification and attention to positive
behaviour
- Reward for positive behaviour,
- Weakening or elimination of maladaptive
behaviour using appropriate behavioural
techniques.
Recording Behaviour
38
Family-based
Intervention
>>
Behavioural
Management
Training
• Parents may be trained to record following aspects of behavioural problems in
children:
• Nature
• Frequency
• Severity
• Origin
• Maintenance
• This can be done using standardised formats like A-B-C or behaviour record.
• This recording and analysis helps the parents understand:
• where intervention is needed, at A or C level and
• how one’s behaviour is changing over time with intervention.
Sample ABC Record Sheet
39
Family-based
Intervention
>>
Behavioural
Management
Training
Antecedents (A) Behaviour Problem (B) Consequence (C)
Situation immediately
before problem
behaviour has occurred
Exact description of what
is expressed as problem
behaviour.
Situation after the
problem behaviour has
occurred.
Sample Behaviour Record Form
40
Family-based
Intervention
>>
Behavioural
Management
Training
Description of Problem
Behaviour
Frequency of Occurrence Per Day
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6
Family-based Intervention
41
Family-based
Intervention
1
Psychoeducation
2
Communication
Training
3
Behavioural
Management
Training
4
Parenting Skills
Training
Next
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Parenting
The process of providing complete care to the
child, to foster the child’s physical, emotional,
social, occupational, and interpersonal growth
and competencies.
42
Parenting
43
Family-based
Intervention
>>
Parenting
Skills
Training
• In order to provide adequate parenting, parents must ensure that the child gets adequate
attention, affection, stimulation, exposure, reward, and encouragement.
• Three Ls: Principle of ‘love, limitation, and let them grow’ is a highly recommended
strategy for parents to facilitate sound psychological development of children.
• Parenting children and adolescents today demands specific interactional skills. A
healthy parent-child interaction helps:
• parents create a conducive contextual environment for their children to grow and mature;
• children to:
• build enough confidence and self-esteem,
• develop competence and life skills
• expand potentials to their maximum.
• protect against a variety of negative conditions including conflicts, stress, anxiety, addiction,
violence, rage, failure and maladjustment.
Impact of Different Parenting Approaches
44
Family-based
Intervention
>>
Parenting
Skills
Training
Specific parenting behaviour and skills have been examined, particularly in relation to the
development of aggressive and disruptive behaviour.
• Parents of aggressive children are characterized as highly punitive and critical to their
children and more likely to attribute their children’s misbehaviour to more
dispositional, intentional and stable causes compared to parents of non-problem
children.
• These attributional processes tend to become more pronounced over time.
• Child-focussed, responsive, and moderately controlling parenting attitudes have
been positively associated with self-esteem, academic achievement, cognitive
development and fewer behavioural problems.
• Parents of children with emotional and behavioural problems need to be encouraged and
guided to opt and use such parenting style.
Guidelines for Interacting with Children (1/4)
45
Family-based
Intervention
>>
Parenting
Skills
Training
Counsellors can use the following as guidelines for interacting with children to suggest to
parents of disturbed children:
• Accept that your child has grown-up to the stage where one’s independent identity
begins to develop.
• Remember that your child has a strong need to be independent and to have own personal space.
• Teenagers have a lot of inside work to do that does not relate to you; allow them some freedom to
complete their work.
• Observe and notice their interests and respect them both in words and in action.
• Be available and emotionally involved with your teenager.
• Tell your teenager that you are always there to support and help whenever there is difficulty.
• Spend time with your teen-aged child discussing and sharing together.
• Convey in clear words to your teenager that he/she is important for you and you care for him/her.
Guidelines for Interacting with Children (2/4)
46
Family-based
Intervention
>>
Parenting
Skills
Training
• Remind teenagers that they are studying and working hard for themselves, not for you.
Yes, tell them that you feel happy and satisfied seeing them study hard.
• Be flexible in setting guidelines for your teenager by allowing reasonable negotiations
but be firm in their enforcement.
• Validate and support emerging mature and autonomous behaviour of your child.
• Help them take their own decisions, after providing them with necessary information.
• Look for and find opportunities to praise, congratulate, reward, and respect your teen-age child.
• Listen to them and ask questions.
• Allow some responsibilities to them and trust their capability.
• Validate and encourage their own capacity to cope.
• Help them learn from their mistakes through self-reflection and discussion.
Guidelines for Interacting with Children (3/4)
47
Family-based
Intervention
>>
Parenting
Skills
Training
• Avoid labelling, judging, and devaluing.
• Don’t take interactions personally.
• Help them ask and explore important questions.
• Support their dreams, while helping them to plan, organize, and follow activities to
completion.
• Ask if something is wrong when behaviour changes.
• Respect (you don’t have to like) their peer choices.
• Low-key, accepting, calm parents hear more. Kids keep talking to them.
• Permit conflict and guide discussions.
• Help adolescents develop disciplined conformity to society’s rules and expectations.
• Value stimulating conversations with different points of view.
Guidelines for Interacting with Children (4/4)
48
Family-based
Intervention
>>
Parenting
Skills
Training
• Encourage them to adopt a personal value system.
• Remember and remind them that adolescence is a process.
• Foster a sense of comfortable continuity.
• Let them set the pace and timing of close and distant interactions
Children are different temperamentally, they have age specific psychological needs, and
adolescents often have lots of anxiety related to their own development, career, future,
relationships and physical appearance.
Parents need to learn that a balanced understanding of all these facts and use of appropriate
guidelines will help them to interact effectively with the child.
Family Based Counselling and Therapy
49
Family-based
Intervention
>>
Parenting
Skills
Training
It is important that counselling and therapy provided in case of emotional and
behavioural problems in children and adolescents should be family based:
• Child’s emotional and behavioural problems could well be a manifestation of
dysfunction in family system.
• It sets the ground for appropriate involvement of parents and other family
members
• It ensures proper compliance to the process of counselling and therapy.
c
Contents
1. Introduction to Emotional and Behavioural Problems in Children
2. Identification and Assessment
3. Management
4. Family-based Intervention
5. Specific Issues
Emotional
and
Behavioural
Problems
in
Children
50
Specific Issues
51
Specific
Issues
1
Cultural Sensitivity
2
Referral to Specialist
3
Optimisation of
Expectations
4
Mental Health of the
Parents
5
Maintenance of
Professional
Relationship
1. Cultural Sensitivity
52
Specific
Issues
• Counsellor/therapist must be sensitive to the cultural values of your clients.
• In the absence of adequate cultural sensitivity, counsellors are likely to be
unsuccessful in their endeavours.
2. Referral to Specialist
53
Specific
Issues
• The counsellor should have adequate clarity about her or his professional
liabilities and limitations.
• Objective assessment of the severity and complexity of problems of the child is
essential and given the possibility of diagnosable psychological problems, the
counsellor must be able to decide and suggest referral to a specialist.
• If the given child has signs of depression, expresses suicidal wish, harms himself, is
hostile and violent, has experienced severe trauma or abuse, is suffering from a
long time, has severe behavioural disturbances; the counsellor should prepare
the parents of the child and/or other family members for consulting a
specialist e.g. Psychiatrist.
3. Optimisation of Expectations
54
Specific
Issues
• Often parents of disturbed children keep and display unrealistically high expectations
from the counsellor.
• And often, counsellors are influenced by the expectations of parents and they also set
their expectations high.
• Unrealistic or too much expectation may lead to frustration and a sense of failure.
• Therefore, counsellor should always try to keep his/her expectation from the
counselling at optimal or realistic level.
• Counsellor should also help parents to keep their expectations realistic by educating
them about the nature of problems and what can be achieved through various methods.
Optimized
Expectations
Expectations being neither too low nor too high.
4. Mental Health of the Parents (1/2)
55
Specific
Issues
• While identifying problems in children, a careful attempt to recognize mental health
problems in parents is highly advisable in the interest of effective management of
children’s problems.
• Mental health of parents influences mental health of children by:
• affecting the environment in the family
• providing a particular role model
• shaping quality of parenting process
• affecting parent-child bond in particular manner, and
• influencing their involvement in help seeking process.
• A parent suffering from anxiety may not be able to provide secure attachment with the
child; similarly a parent with depressive disorder may not be able to offer adequate
parenting, and a parent with alcohol or substance abuse problem will not be able to keep
the family environment healthy or provide an ideal role model for the child.
4. Mental Health of the Parents (2/2)
56
Specific
Issues
• Mental illness in parents can:
• be a contributory factor for emotional or behavioural problems in children,
• negatively affect intervention process,
• trigger non-compliance to counselling/family therapy techniques, and
• further complicate the situation of the child.
• Hence a careful scanning of parental mental health is necessary for the counselling
process to attain its goal.
5. Maintaining of Professional Relationship
57
Specific
Issues
• A mutually trusting, supporting,
warm, and confidential relation
between the counsellor and the client
is essential for effective counselling.
• It is also necessary for the
counsellor/therapist to work with
the client within professional
boundaries.
• When personal elements enter a
professional relation; it no longer
remains a professional relation and
loses its professional effect on the
client.
Points to keep in mind while Practicing
Counselling
- Work with a specific time frame
- Have a fixed time for the session
- Always focus on your target for the session
- Allow only relevant aspects of discussion in the
session
- End session on time
- Appreciate client for cooperation
- Never take undue advantage of client’s position
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Emotional and Behavioural Problems in Children - Counselling and Family Therapy Applications and Interventions - Psychology Super Notes

  • 1. Emotional and Behavioural Problems in Children Counselling and Family Therapy: Applications and Interventions By M.S. Ahluwalia Psychology SuperNotes 1
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  • 10. c Contents 1. Introduction to Emotional and Behavioural Problems in Children 2. Identification and Assessment 3. Management 4. Family-based Intervention 5. Specific Issues Emotional and Behavioural Problems in Children 10
  • 11. Emotional and Behavioural Problems in Children 11 Introduction to Emotional and Behavioural Problems in Children • Children and adolescents experience a range of emotional disturbances and have a variety of behavioural disturbances. These disturbances are put under the categories of syndromal emotional and behavioural disorders. • Children can be anxious, depressed, fearful, aggressive, hostile, can have scholastic backwardness, psychosomatic problem, severe mental illness etc. • In the majority of childhood psychological disturbances or problems, the family has varied role to play. Important aspects of the family system which influence children’s psychosocial development and adjustment - Family environment - Quality of parental relationship - Disciplining style - Interpersonal communication within family - Family reactions to child’s behaviour pattern - Experience of stress in the family - Problem-solving mechanisms used by the family.
  • 12. Psychologically and Emotionally Heathy Children 12 Introduction to Emotional and Behavioural Problems in Children • Children spend their time in studies, play activities, interacting with parents, siblings, and peer group and other such activities. • If they are emotionally healthy, they: • get involved in these activities and enjoy them, • remain cheerful and satisfied, • tend to listen to their parents and teachers, • concentrate well in their studies, • are well adjusted, • grow up as well integrated individuals with positive characteristics. • A psychologically healthy child experiences sense of achievement, affection, and affiliation which promotes further healthy development and adjustment. Factors which contribute to healthy psychosocial development of children - Temperament of the child - Quality of parenting - Home environment - Child’s competence - Adequate positive experiences - Adequate resources - Optimal role models within and outside family etc.
  • 13. Emotionally Disturbed and Maladjusted Children 13 Introduction to Emotional and Behavioural Problems in Children • Unlike psychologically healthy and well-adjusted children, there are children who are emotionally disturbed and have variety of behavioural problems. • These children have difficulty in adjusting with both home environment and school environment. • Emotional and behavioural problems in children are seen related to: • activity, • academic skills, • emotions, • psychosomatic manifestation, • conduct, • sexuality, and • addiction. Due to their emotional and behavioural problems, these children: - don’t relate well with their family members, siblings, and friends - don’t participate in and enjoy play activities - experience difficulties with their academics - suffer many aches and pains, - failure in school - non-rewarding situations around them - severe adjustment problems.
  • 14. c Contents 1. Introduction to Emotional and Behavioural Problems in Children 2. Identification and Assessment 3. Management 4. Family-based Intervention 5. Specific Issues Emotional and Behavioural Problems in Children 14
  • 15. Identification and Assessment 15 Identification and Assessment • Early identification and proper assessment of psychological disturbances in the child help in effective management and effective family counselling. • The counsellor/therapist needs to make specific effort to identify the: • nature and type of problems • possible determinants of the problems • maintaining factors • effects of the problems, and • various positive factors in the child and environment which can be further promoted as part of counselling strategies.
  • 16. Sources of Emotional and Behavioural Problems 16 Identification and Assessment Sources of Emotional and Behavioural Problems in Children and Adolescents can be: Child-related • Like • poor intelligence • sensory defects • mild brain damage • acquired defects Family-related oParents who are: oquarrelsome and difficult, overy anxious and ambitious - expect too much from child oare indifferent to the child, ouse excessive punishment. oSibling rivalry and jealousy oFinancial problem at home oParental interpersonal problems, and oUnusual home environment (conflict, extra-marital relationship, and alcoholism) School-related • Academic pressure or stress, • Punitive and critical teacher, • Bully classmate or senior etc. Other environmental situations related • Factors present in neighbourhoods, which may create psychological problems in children. • Example: • bad company, • conflict with neighbourhood, • inequality, • violence etc.
  • 17. How to Identify and Assess 17 Identification and Assessment • Identifying that a child is suffering from emotional and behavioural problems is essential for a counsellor. Some problems can be identified easily but some problems require specific skills and techniques in order to identify them. • A counsellor can look for some indicators of emotional and behavioural problems in children such as: • Presence of any of these indicates possibility of emotional and behavioural problems. Frequent absence from school Irregularity in homework Poor in play and recreational activities Staying alone Complaints of aches and pains during classes Complaints from others regarding his/her conduct Poor test performances Not attentive in the class Being irritable, stubborn, and/or aggressive Refusal to go out of home Frequent crying spells Frequent fights with friends and/or siblings Poor appetite and/or sleep
  • 18. Methods of Identifying and Assessing Problems of Children 18 Identification and Assessment • Observation of child’s behaviour • Academic performance of the child • Use of screening tools: Mental Health Screening Questionnaire can be used for identification of psychological problems or mental health problems in children. • Interview the Parent’s • Psychological/behavioural testing: helps in identification and assessment of the nature and the severity of the problem. Assessment of children’s problems also includes scaling the: - Intensity - Frequency - Antecedents or triggers - Immediate and long-term consequences of specific behavioural or emotional problems. Visual Analogue Scale is the simplest method for assessing severity of problems.
  • 19. Identifying the source of the problem 19 Identification and Assessment • Once it is identified that a child is likely to have emotional and/or behavioural problems, a systematic effort should be made to explore the sources of these problems through an interview with the child, the parents and other significant persons. • C/FT must try to establish a convincing explanation about the relationship between the sources of the problems and the emotional and behavioural manifestations of the problems in the child. • This explanation must be based on the elicited facts and not on assumptions or any kind of bias. Family Factors to be Explored - Communication - Problem Solving - Interpersonal Relations - Rewarding Experiences - Stressors
  • 20. Identifying the Aspects of Family Structure and Functioning 20 Identification and Assessment In order to use family-based intervention strategy, it is vital to explore the important aspects of family structure and functioning which have significant influence on children’s emotional and behavioural problems including: Quality of interpersonal relations among the members Interaction and communication pattern Disciplining and controlling mechanisms Problem-solving strategy Regulation of emotions Availability of rewarding/ non- rewarding experiences within the family Presence of aberrant situations* *like domestic violence, alcoholism, mental illness, chronic and disabling physical problems, ongoing stress
  • 21. c Contents 1. Introduction to Emotional and Behavioural Problems in Children 2. Identification and Assessment 3. Management 4. Family-based Intervention 5. Specific Issues Emotional and Behavioural Problems in Children 21
  • 22. Management 22 Management 1 Play Therapy 2 Behaviour Therapy 3 Cognitive Therapy 4 Supportive Therapy 5 Parent Training 6 Family Therapy
  • 23. 1. Play Therapy 23 Management • Play therapy is a form of psychodynamic therapy, which provides children an opportunity to deal with their emotional difficulties and develop control over their external problematic behaviour. • In play therapy, play is used as an adjunct to as well as a vehicle of communication between the child and the therapist. • The child is introduced to specific play setting with different play materials with the aim of achieving a therapeutic effect with a cathartic resolution of conflict or tension through the child’s play. • Play helps the child develop and sustain relationship with the therapist, which has central therapeutic significance. • In guided play therapy, the therapist guides the child’s play in an effort to help the child achieve psychological integration. Play therapy as used by Axiline (1947) is considered as most effective play therapy for children. Based on the Rogerian concept of ‘Client-centered therapy’ Axiline’s play therapy uses play to reflect back to the child his states, wishes, or convictions without attempting interpretations of unconscious motives or conflicts.
  • 24. 2. Behaviour Therapy 24 Management • Behaviour therapy assumes that most behaviour develops and is maintained according to the principles of learning. Therefore, behaviour can be modified with the help of the same learning principles. • In behaviour therapy, observable target behaviour is attempted to be changed with the help of different behavioural techniques. Behavior Therapy a set of related assumptions, principles, and techniques rooted in learning theories, used to change human behaviour. Behavioural Techniques - Modelling - Shaping - Exposure - Behavioural practice - Differential reinforcement techniques - Time-out etc.
  • 25. 3. Cognitive Therapy 25 Management • Cognition plays a very important role in the way individuals feel and act, and this is true for children too. • Cognitive therapy believes that behavioural and emotional problems are a result of dysfunctional, irrational beliefs and distorted cognition. • Identification and exploration of irrational and dysfunctional cognition and intervention to make it functional and rational are the essence of cognitive therapy. Cognition the process and manner of interpreting experiences and events around us and assigning meanings to these events.
  • 26. 4. Supportive Therapy 26 Management • Many a times individuals are so entrapped in their psychological disturbances that they find it difficult to handle situations on their own; they need encouragement, guidance, and support to sort out their problems and to deal with their difficulties. • Supportive therapy helps such individuals come out of their sufferings effectively. • In supportive therapy, the therapist: • focuses on the present situations and sufferings and • helps the client by providing opportunity to ventilate, share, and release pent-up feelings • by providing guidance, suggestion, encouragement for positive action, education, clarification, and environmental manipulation.
  • 27. 5. Parent Training 27 Management • Parent training empowers parents to deal with emotional and behavioural problems of children through the process of parenting. • Parents are trained by the therapist to: • Attend to the positive behaviour of the concerned child • Reward positive behaviour • Ignore some of the unwanted and maladaptive behaviour, and • Exercise control and punishment for highly undesirable behaviour. • Use behavioural techniques: positive reinforcement, distraction, punishment, and skills training.
  • 28. 6. Family Therapy 28 Management • Structure of family, quality of relationship among the family members, quality of communication, emotional bond, value system, conflict resolution, disciplining pattern, rituals and taboos of the family have significant influence on the mental health and psychological problems of the family members. • Family therapy attempts to look at the problems of any member as manifestation of dysfunction in family system including disruption of bond, communication problem, disruption of boundary, pathological handling of conflicts, and other such difficulties within the family. • Nature and sources of interpersonal conflicts and their manifestations within the family are identified, explored and measured and relevant interventions are made in family therapy with the participation of each significant unit of the family. • Different techniques are used in family therapy including behaviour techniques, cognitive and problem-solving techniques.
  • 29. c Contents 1. Introduction to Emotional and Behavioural Problems in Children 2. Identification and Assessment 3. Management 4. Family-based Intervention 5. Specific Issues Emotional and Behavioural Problems in Children 29
  • 31. 1. Education to the Family (1/2) 31 Family-based Intervention >> Psychoeducation • Often parents have difficulties in accepting that their child has emotional and/or behavioural disturbances and requires counselling/family therapy. • Such difficulties may arise due to stigma, ignorance, fear and guilt due to their perceived contribution/ role in the development of problems in the child, and some other worries parents have. • C/FT is required to be aware of such reasons for parents’ resistance to acceptance. • Acknowledgement of the fact that the child has problems and needs specific intervention sets appropriate ground for help seeking behaviour of the parents and significant others. • It also ensures proper compliance to the process of counselling and therapy. • Parents of disturbed children need to be educated by the counsellor so that they can understand the nature of problems the child has and possible remedies for these problems. • Acknowledgement of problems and acceptance of responsibility for solution are prerequisite for the family for initiating the process of counselling.
  • 32. 1. Education to the Family (2/2) 32 Family-based Intervention >> Psychoeducation What should be explained? Counsellor must explain to the parents the: - problem of the child - factors that are contributing to and maintaining the problem - solution available - their role and responsibility in helping the child to come out of the problems - importance of parenting and family environment in controlling child’s problems etc. While educating the family, the counsellor should: - Communicate in simple understandable language - Allow adequate time for information to set in - Show confidence, acceptance and patience - Satisfy their queries - Avoid argument - Tell them with clarity that it is not their fault - Wait for their reaction and respect their reactions - Assure reasonable commitment - Avoid false promises - Help them take appropriate decisions regarding intervention
  • 34. Importance of Proper and Healthy Communication 34 Family-based Intervention >> Communication Training • Proper and healthy communication between parents, children, and other significant family members plays an important role in maintaining sound psychosocial development of children. • Faulty communication creates difficulties and spoils relationships and subsequently contributes to emotional and behavioural problems. • Adult to adult faulty communication has devastating impact on children. • Simple, direct, and focused communication is considered better than difficult, indirect, and vague communication. • Critical comments and hostility areconsidered unhealthy from mental health point of view. • Pathogenic communication between parents and other adult family members provides a model for children to emulate. • Hostile, critical, vague, and unnecessarily elaborative communication from parents or others to the child, may lead the child to be angry or hostile or confused or stressed. Thus, communication training is an important area to work with in counselling of affected family.
  • 35. Process of Communication Skills Training 35 Family-based Intervention >> Communication Training Identify faulty aspects of communication in the family Clearly explain the link between communication and its consequences to the family • Indirectly • Without putting any blame on anybody Suggest appropriate ways of communication Encourage family members to practice.
  • 37. Behavioural Management Training 37 Family-based Intervention >> Behavioural Management Training • Behavioural management is an essential aspect of helping a family with an emotionally and behaviourally disturbed child through counselling and family therapy. • Counsellor must help parents/family members learn skills to manage behavioural problems of children by explaining and demonstrating simple procedures to them. Components of Behavioural Management Training - Behavioural analysis and assessment to record nature, frequency, severity, origin, and maintenance of behavioural problems in children. - Identification and attention to positive behaviour - Reward for positive behaviour, - Weakening or elimination of maladaptive behaviour using appropriate behavioural techniques.
  • 38. Recording Behaviour 38 Family-based Intervention >> Behavioural Management Training • Parents may be trained to record following aspects of behavioural problems in children: • Nature • Frequency • Severity • Origin • Maintenance • This can be done using standardised formats like A-B-C or behaviour record. • This recording and analysis helps the parents understand: • where intervention is needed, at A or C level and • how one’s behaviour is changing over time with intervention.
  • 39. Sample ABC Record Sheet 39 Family-based Intervention >> Behavioural Management Training Antecedents (A) Behaviour Problem (B) Consequence (C) Situation immediately before problem behaviour has occurred Exact description of what is expressed as problem behaviour. Situation after the problem behaviour has occurred.
  • 40. Sample Behaviour Record Form 40 Family-based Intervention >> Behavioural Management Training Description of Problem Behaviour Frequency of Occurrence Per Day Day 1 Day 2 Day 3 Day 4 Day 5 Day 6
  • 42. Super-Notes Super-Notes PsychoTech Services PsychoTech Services Psychology Learners Psychology Learners FREE IGNOU Help Center FREE IGNOU Help Center The Real Happiness Center The Real Happiness Center Parenting The process of providing complete care to the child, to foster the child’s physical, emotional, social, occupational, and interpersonal growth and competencies. 42
  • 43. Parenting 43 Family-based Intervention >> Parenting Skills Training • In order to provide adequate parenting, parents must ensure that the child gets adequate attention, affection, stimulation, exposure, reward, and encouragement. • Three Ls: Principle of ‘love, limitation, and let them grow’ is a highly recommended strategy for parents to facilitate sound psychological development of children. • Parenting children and adolescents today demands specific interactional skills. A healthy parent-child interaction helps: • parents create a conducive contextual environment for their children to grow and mature; • children to: • build enough confidence and self-esteem, • develop competence and life skills • expand potentials to their maximum. • protect against a variety of negative conditions including conflicts, stress, anxiety, addiction, violence, rage, failure and maladjustment.
  • 44. Impact of Different Parenting Approaches 44 Family-based Intervention >> Parenting Skills Training Specific parenting behaviour and skills have been examined, particularly in relation to the development of aggressive and disruptive behaviour. • Parents of aggressive children are characterized as highly punitive and critical to their children and more likely to attribute their children’s misbehaviour to more dispositional, intentional and stable causes compared to parents of non-problem children. • These attributional processes tend to become more pronounced over time. • Child-focussed, responsive, and moderately controlling parenting attitudes have been positively associated with self-esteem, academic achievement, cognitive development and fewer behavioural problems. • Parents of children with emotional and behavioural problems need to be encouraged and guided to opt and use such parenting style.
  • 45. Guidelines for Interacting with Children (1/4) 45 Family-based Intervention >> Parenting Skills Training Counsellors can use the following as guidelines for interacting with children to suggest to parents of disturbed children: • Accept that your child has grown-up to the stage where one’s independent identity begins to develop. • Remember that your child has a strong need to be independent and to have own personal space. • Teenagers have a lot of inside work to do that does not relate to you; allow them some freedom to complete their work. • Observe and notice their interests and respect them both in words and in action. • Be available and emotionally involved with your teenager. • Tell your teenager that you are always there to support and help whenever there is difficulty. • Spend time with your teen-aged child discussing and sharing together. • Convey in clear words to your teenager that he/she is important for you and you care for him/her.
  • 46. Guidelines for Interacting with Children (2/4) 46 Family-based Intervention >> Parenting Skills Training • Remind teenagers that they are studying and working hard for themselves, not for you. Yes, tell them that you feel happy and satisfied seeing them study hard. • Be flexible in setting guidelines for your teenager by allowing reasonable negotiations but be firm in their enforcement. • Validate and support emerging mature and autonomous behaviour of your child. • Help them take their own decisions, after providing them with necessary information. • Look for and find opportunities to praise, congratulate, reward, and respect your teen-age child. • Listen to them and ask questions. • Allow some responsibilities to them and trust their capability. • Validate and encourage their own capacity to cope. • Help them learn from their mistakes through self-reflection and discussion.
  • 47. Guidelines for Interacting with Children (3/4) 47 Family-based Intervention >> Parenting Skills Training • Avoid labelling, judging, and devaluing. • Don’t take interactions personally. • Help them ask and explore important questions. • Support their dreams, while helping them to plan, organize, and follow activities to completion. • Ask if something is wrong when behaviour changes. • Respect (you don’t have to like) their peer choices. • Low-key, accepting, calm parents hear more. Kids keep talking to them. • Permit conflict and guide discussions. • Help adolescents develop disciplined conformity to society’s rules and expectations. • Value stimulating conversations with different points of view.
  • 48. Guidelines for Interacting with Children (4/4) 48 Family-based Intervention >> Parenting Skills Training • Encourage them to adopt a personal value system. • Remember and remind them that adolescence is a process. • Foster a sense of comfortable continuity. • Let them set the pace and timing of close and distant interactions Children are different temperamentally, they have age specific psychological needs, and adolescents often have lots of anxiety related to their own development, career, future, relationships and physical appearance. Parents need to learn that a balanced understanding of all these facts and use of appropriate guidelines will help them to interact effectively with the child.
  • 49. Family Based Counselling and Therapy 49 Family-based Intervention >> Parenting Skills Training It is important that counselling and therapy provided in case of emotional and behavioural problems in children and adolescents should be family based: • Child’s emotional and behavioural problems could well be a manifestation of dysfunction in family system. • It sets the ground for appropriate involvement of parents and other family members • It ensures proper compliance to the process of counselling and therapy.
  • 50. c Contents 1. Introduction to Emotional and Behavioural Problems in Children 2. Identification and Assessment 3. Management 4. Family-based Intervention 5. Specific Issues Emotional and Behavioural Problems in Children 50
  • 51. Specific Issues 51 Specific Issues 1 Cultural Sensitivity 2 Referral to Specialist 3 Optimisation of Expectations 4 Mental Health of the Parents 5 Maintenance of Professional Relationship
  • 52. 1. Cultural Sensitivity 52 Specific Issues • Counsellor/therapist must be sensitive to the cultural values of your clients. • In the absence of adequate cultural sensitivity, counsellors are likely to be unsuccessful in their endeavours.
  • 53. 2. Referral to Specialist 53 Specific Issues • The counsellor should have adequate clarity about her or his professional liabilities and limitations. • Objective assessment of the severity and complexity of problems of the child is essential and given the possibility of diagnosable psychological problems, the counsellor must be able to decide and suggest referral to a specialist. • If the given child has signs of depression, expresses suicidal wish, harms himself, is hostile and violent, has experienced severe trauma or abuse, is suffering from a long time, has severe behavioural disturbances; the counsellor should prepare the parents of the child and/or other family members for consulting a specialist e.g. Psychiatrist.
  • 54. 3. Optimisation of Expectations 54 Specific Issues • Often parents of disturbed children keep and display unrealistically high expectations from the counsellor. • And often, counsellors are influenced by the expectations of parents and they also set their expectations high. • Unrealistic or too much expectation may lead to frustration and a sense of failure. • Therefore, counsellor should always try to keep his/her expectation from the counselling at optimal or realistic level. • Counsellor should also help parents to keep their expectations realistic by educating them about the nature of problems and what can be achieved through various methods. Optimized Expectations Expectations being neither too low nor too high.
  • 55. 4. Mental Health of the Parents (1/2) 55 Specific Issues • While identifying problems in children, a careful attempt to recognize mental health problems in parents is highly advisable in the interest of effective management of children’s problems. • Mental health of parents influences mental health of children by: • affecting the environment in the family • providing a particular role model • shaping quality of parenting process • affecting parent-child bond in particular manner, and • influencing their involvement in help seeking process. • A parent suffering from anxiety may not be able to provide secure attachment with the child; similarly a parent with depressive disorder may not be able to offer adequate parenting, and a parent with alcohol or substance abuse problem will not be able to keep the family environment healthy or provide an ideal role model for the child.
  • 56. 4. Mental Health of the Parents (2/2) 56 Specific Issues • Mental illness in parents can: • be a contributory factor for emotional or behavioural problems in children, • negatively affect intervention process, • trigger non-compliance to counselling/family therapy techniques, and • further complicate the situation of the child. • Hence a careful scanning of parental mental health is necessary for the counselling process to attain its goal.
  • 57. 5. Maintaining of Professional Relationship 57 Specific Issues • A mutually trusting, supporting, warm, and confidential relation between the counsellor and the client is essential for effective counselling. • It is also necessary for the counsellor/therapist to work with the client within professional boundaries. • When personal elements enter a professional relation; it no longer remains a professional relation and loses its professional effect on the client. Points to keep in mind while Practicing Counselling - Work with a specific time frame - Have a fixed time for the session - Always focus on your target for the session - Allow only relevant aspects of discussion in the session - End session on time - Appreciate client for cooperation - Never take undue advantage of client’s position
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