Psychotropic Medications and Children

childrenpills-e1463156827980by Jen L’Insalata

Historically children’s psychiatric treatment was comparable to those of adult populations. Diagnostic features were assumed to take on the same aspects of adult psychiatric features and therefore treatment was approached in the same manner. Contemporary views observe that emotional stress experienced by children and adolescents is due largely to situational experience. In these cases non-medication based treatment and psychotherapeutic interventions produce the best outcomes. However, research does take into consideration that many adult psychological and psychiatric disorders have their onset during childhood and can result in progressive neurobiological impairment. In the case of Bipolar disorder, Schizophrenia, and attention deficit/hyperactivity disorder (ADHD), pharmaceutical intervention is necessary to prevent neurological degradation (Preston, O’Neal, & Talaga, 2013).

Research surrounding the efficiency of two or more psychotropic medications is still limited and often time children are prescribed a combination of pharmaceutical agents to medicate disorders. The most common polypharmacy regimens include an antidepressant and a stimulant in combination with an antipsychotic and relate to the co-occurrence of a mood disorder and ADHD (Comer, Olfson, & Mojtabai, 2010).

Controversial Aspects

When medicating children there is no true informed consent and it is often the parents who facilitate the decision for medication treatment. In such instances, it becomes easier for parents to view the disorder as a chemical imbalance and ignore environmental components such as family dysfunction. Parents may rule out the need for psychological treatment in exchange for an easy chemical solution (Preston, O’Neal, & Talaga, 2013).

Many psychotropic medications have adverse side effects including addiction, which at an early age can lead to lifelong struggles with prescription abuse.  Stimulants such as Ritalin used to treat ADHD and benzodiazepines such as Xanax used to treat anxiety (Preston, O’Neal,  & Talaga, 2013) are among the most commonly abused prescription drugs among children and adolescents.

Pre-pubescent children have a higher hepatic rate then children who have entered puberty. Medication dosages prior to puberty are often metabolized faster and require a higher dose. Once a child enters puberty the dosage must continue to be monitored closely for toleration and side effects (Preston, O’Neal, & Talaga, 2013).

Parents often ignore the child’s beliefs and views surrounding medication and may have private consultations regarding treatment with doctors. When working with children it is important to address the child’s concerns surrounding psychotropic medication and mental health stigma (Preston, O’Neal, & Talaga, 2013). Doing so no only ensures that the child will comply with medication treatment, but also provide education and awareness to the outcome of their disorder.

Integrated treatment

The use of psychotropic medication in children is on the rise and in conjunction, doctors are moving toward a polypharmaceutical regime to manage childhood psychological distress. This is largely due to an emphasis of symptom reduction and the increasing number of psychiatrists specializing in pharmacotherapy. Emphasis and access to psychosocial interventions is sometimes limited, expensive (Comer, Olfson, & Mojtabai, 2010), and time consuming.

The Affordable Care Act of 2010 established the health home program for children with emotional disorders aimed at helping children meet both health and developmental goals. Aspects focus on behavioral health, education, child-welfare, and juvenile justice to create a continuum of care that care child and family focused. Policies aim at prevention and continued care while also controlling the cost of child psychiatric care. Aspects emphasize substance abuse and mental health issues that are common among children and adolescents and aim to prevent complications leading to behavioral health problems as adults (de Voursney, & Huang, 2016).

It is estimated that childhood mental health problems cost aproxamiatly 12.2 billion dollars annually and are some of the most prevalent concerns surrounding health, productivity, and crime. Conditions such as oppositional defiant and conduct disorder, substance abuse, post-traumatic stress disorder, anxiety and depression, and bipolar disorder (de Voursney, & Huang, 2016) lead to involvement in criminal and illegal activity, as well as social and societal dysfunction.

Stigmas surrounding the diagnosis of childhood mental health concerns inhibit the identification of children who may be at higher risk and the improper or inadequate treatment. The goal of the Affordable Care Act is to ensure continuity between a child’s home and school life to ensure therapeutic intervention as well as medical intervention (de Voursney, & Huang, 2016).

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References

Comer, J. S., Olfson, M., & Mojtabai, R. (2010). National Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996–2007.Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 1001–1010. http://doi.org.library.capella.edu/10.1016/j.jaac.2010.07.007

de Voursney, D., & Huang, L. N. (2016). Meeting the mental health needs of children and youth through integrated care: A systems and policy perspective. Psychological Services, 13(1), 77-91. doi:10.1037/ser0000045

Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2013). Handbook of clinical psychopharmacology for therapists (7th ed.). Oakland, CA: New Harbinger. ISBN: 9781608826643.

Theories of Moral Development

moral
Jen L’Insalata

Morality is often defined as an individual’s ability to judge and understand what is right and wrong and then to act in accordance to what they judge to be right. An individual’s moral and belief system influence their behaviors. Behaviors aligned with personal beliefs and morals help to build self-concept and self-esteem (Broderick, & Blewitt, 2010).

A child’s early sense of morals are influenced by a system of rewards and punishment established by the caregiver. Young children will act in accordance of with the egocentric self to meet the standards of their primary caregiver and avoid punishment. Perspective-taking improves and parental established morals give way to a conscience that intertwines emotions, cognition, and behavior (Broderick, & Blewitt, 2010).

Despite cultural and religious influences on morality, there are several universal component that establish good morals. Generally speaking, morality take into account the concern for others, a sense of justice and fairness, honesty and trustworthiness, and self-control (Broderick, & Blewitt, 2010). Feelings of morality and actions are often at a conflict and moral conduct appears to be determined more by situational assessment then by moral reasoning (Broderick, & Blewitt, 2010).

Several theories surrounding moral development exist. Freud discussed in his Psychoanalytic Theory that infants and young children are driven by the impulses of the self-serving id. The superego emerges and establishes a source of morals around preschool age (Broderick, & Blewitt, 2010). Freud believed these morals stemmed from an internalized system of rewards and punishments driven by parental conflict. Around the age of three, vague sexual desires toward the parent of the opposite sex and leads to an internal conflict and competition with the parent of the same sex. The solution to this conflict is to identify with the dominant same sex parent in order to be like them and satisfy this sexual longing (Broderick, & Blewitt, 2010). Morals are established by imitating the same sex parent’s actions.

Later research has failed to support Freud’s Psychoanalytic predictions. Finding show that children as young as eighteen to twenty-four months are capable of understanding empathy. This is inconsistent with Freud’s timeline for the emergence of the id ego and superego (Broderick, & Blewitt, 2010). Toddlers do however preform pro-social actions as a willingness to comply with the authority of their parents. The Psychoanalytic Theory associates this compliance with a fear of the same sex parental conflict. This concept contradicts research establishing that secure attachment and warm affectionate parental styles forester pro-social behavior and moral development (Broderick, & Blewitt, 2010).

Cognitive Theories of moral development center on the works of Piaget, Kohlberg, and Gilligan and emphasize changes in logical thinking at the core of moral development. Piaget theorized that there are three stages to moral development, premoral, heteronomous, and autonomous (Broderick, & Blewitt, 2010). In studies, Piaget presented children with moral dilemmas and asked them to assess the behavior of the protagonist or the rules of a game. During the premoral stage, infants have no concern for rules and often make up their own rules to serve an egocentric purpose. Around age five, children enter the heteronomous stage and view morals and rules through a realist perspective. They view rules at concrete and never to be broken. Violation of rules requires immediate justice and punishment. During middle childhood socialization and perspective-taking abilities become more refined. The child transitions into the autonomous stage and views morals as a social agreement to promote fairness. Rules can be modified and amended to serve a higher social purpose (Broderick, & Blewitt, 2010).

Kohlberg expanded on Piaget’s theory and assessed moral development beyond childhood into adulthood. Kohlberg based much of his work off philosophical concepts of morality referenced in Plato’s The Republic (Jorgensen, 2006) which morality is centered on justice. Utilizing unconventional philosophical scenarios, Kohlberg established three levels of moral reasoning each broken into stages. The preconventional level corresponds with Piaget’s heteronomous stage and established that children follow rules to avoid punishment and judgment from a superior authority during stage one. During stage two, children follow rules to serve their own interest, however may include the interests of others (Broderick, & Blewitt, 2010).  The conventional level is reached during adolescence and young adulthood. In stage three, social relationships become moral motivators and shared interests trump personal interest. Stage four focuses on social and societal order. Morals and behaviors at this stage are motivated by contributions to society, responsibility, and laws (Broderick, & Blewitt, 2010).  The postconvetional levels focus on universal standards of justice, democratic principles, and individual rights. Stage five establishes a moral social contract and is reached around adulthood. Stage six takes a more theoretical approach and addresses abstract concepts of social justice (Broderick, & Blewitt, 2010).

Research supports both Piaget and Kohlberg and shows that children indeed pay attention to the consequences and punishments surrounding moral violations and older children pay more attention to the intent of the protagonist to establish moral basis (Broderick, & Blewitt, 2010).  However finding show that children have a greater capacity for focusing on intentions and moral reasoning then given credit in the theories of Piaget and Kohlberg. Studies also show that preschoolers are able to differentiate between an intentional lie and a mistake and judge the liar more harshly (Broderick, & Blewitt, 2010).  Piaget believed that children believed all rules to be handed down from a superior authority. Children do however show a philosophical understanding of the difference between moral rules, conventional rules, and cultural rules. Children have the capacity to view cultural rules as arbitrary, but adhere more strictly to personal self-governed rules (Broderick, & Blewitt, 2010). Thus demonstrating that children have the understanding moral context.

Gilligan often criticized Kohlberg stating that his description of moral reasoning focused primarily on cerebral components of justice, ignoring the care and concern involved in moral reasoning (Jorgensen, 2006). Gilligan argued that morals developed on different trajectories for males and female. Women are more inclined to introduce sympathy, empathy and compassion into moral reasoning, whereas males utilize justice as an emphasis for moral reasoning (Broderick, & Blewitt, 2010).  This feminine viewpoint has earned Gilligan criticism question her bias in her approach to moral reasoning (Jorgensen, 2006).

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References:

Jorgensen, G. (2006). Kohlberg and Gilligan: duet or duel?. Journal Of Moral Education, 35(2), 179-196. doi:10.1080/03057240600681710

Broderick, P. C., & Blewitt, P. (2010). The life span: Human development for helping professionals (3rd ed.). Boston, MA: Allyn & Bacon. ISBN: 9780137152476

Freud and Attachment

boy and gearsJen L’Insalata

Freudian psychoanalytic theory presents concepts which have shaped and influenced many aspects of the field of psychology. Much of Freud’s theory was developed from observations and case studies of many of his own patients. He is often criticized for a lack of experimental investigation and hypothesis testing throughout his theory and an over emphasis placed on psychosexual components (Feist, Feist, & Roberts, 2013). Yet despite the criticism, Freudian psychoanalysis explores ways in which unconscious motivations influence personality and behavior and still maintains relevancy in psychological practice today.

Freud explored how unconscious motivations influence emotional states, personality and outward manifestations of behavior. According to Freud, such motivation have root in past experience (Feist, Feist, & Roberts, 2013). In essence behavior is shaped by an unconscious struggle to reduce emotional tensions caused by our past traumas.

A core component of psychoanalytic theory emphasizes maladaptive coping mechanisms such as defense mechanisms and repression (Feist, Feist, & Roberts, 2013). Individuals who experience trauma often utilizes maladaptive defense mechanisms to reduce psychological tension. Often, individuals suffering from severe PTSD repress memories of the traumatic event. This is a temporary solution which allows the individual to function in immediate aftermath. According to Freud, manifestations of the unconscious repression manifest in recurrent dreams commonly experienced by individuals suffering from PTSD (Feist, Feist, & Roberts, 2013). Psychoanalytic theory can be applied in the treatment of severe trauma as the individual begins to bring the unconscious to light and acknowledge their past experiences.

Attachment theory places emphasis on the earliest of childhood experiences and emphasizes ways in which infants form bonds with their caregivers. As much of Feud’s theory relies heavily on early childhood and past experiences, concepts of personality and behavior manifestations focus heavily on such bonds. Freud believed that attachment centered on a child’s identification with the same sex parent and their desire to be with the opposite sex parent. Freud theorized that these unconscious sexual desires manifested in overcoming what he called the Oedipus and Electra complex (Feist, Feist, & Roberts, 2013). Successful resolution of the unconscious sexual motivators in such complexes allow for secure attachment bonds to parents and healthy interpersonal relationships in the future.

Although the Oedipus and Electra complex are highly discredited, Freud’s theory paved the way for his contemporaries to explore the relationship between healthy and secure attachments to caregivers. Early childhood attachments are viewed as an underlying component in many theories on healthy human functioning and interpersonal behavior. Attachment theory serves as a heavily emphasized component in developmental and behavioral psychology.

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References

Feist, J., Feist, G. J., & Roberts, T. (2013). Theories of personality (8th ed.). New York, NY: McGraw-Hill.