Category: Mental Health

What is the Chinese Society of Psychiatry?

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Introduction

The Chinese Society of Psychiatry (CSP; Chinese: 中华医学会精神病学分会; lit. ‘Chinese Medical Association Psychiatry Branch’) is the largest organisation for psychiatrists in China.

It publishes the Chinese Classification of Mental Disorders (“CCMD”), first published in 1985. The CSP also publishes clinical practice guidelines; promotes psychiatric practice, research and communication; trains new professionals; and holds academic conferences.

Origins and Organisation

The organisation developed out of the Chinese Society of Neuro-Psychiatry, which was founded in 1951. This separated into the Chinese Society of Psychiatry and Chinese Society of Neurology in 1994. Since then, successive committees have run the organisation, currently the 3rd Committee, which started in 2003, whose president is Dongfeng Zhou. The CCMD is now on its third revision.

The official journal of the CSP is the Chinese Journal of Psychiatry (中华精神科杂志).[2] The Society held its seventh annual academic conference in 2006. The Society is a member of the World Psychiatric Association.

As of 2005, the CSP had 800 members.

Brief History

In 2001, the CSP declassified homosexuality and bisexuality as a mental disorder. However, the organization specified that, “although homosexuality was not a disease, a person could be conflicted or suffering from mental illness because of their sexuality, and that condition could be treated”, according to Damien Lu, founder of the Information Clearing House for Chinese Gays and Lesbians. Reportedly, this loophole is used to promote conversion therapy in China.

Beginning in 2014, the CSP began collaborating with the McLean Hospital. The purpose of the programme is to share research cross-culturally between specialists in psychotic and mood disorders.

Controversy

The Chinese Society of Psychiatrists (CSP) has been criticised for alleged complicity in the government’s political abuse of psychiatry towards Falun Gong practitioners – including by detaining individuals via diagnosing adherents as “political maniacs” or with “Qi Gong psychosis”. Antipsychotic drugs were wrongly prescribed to practitioners.

In 2004, the CSP agreed on a joint response with the World Psychiatric Association to the allegations. According to the CSP, certain psychiatrists had “failed to distinguish between spiritual-cultural beliefs and delusions” due to “lack of training and professional skills”, and this led to misdiagnoses. However, they claimed this was not a systematic issue and invited the WPA to correct the problem.

The WPA stated, “What has become clear… has been the need to assist Chinese colleagues in matters concerning forensic psychiatry, medical ethics, patients’ rights, mental health legislation, diagnosis and classification, to help them improve the care of mentally ill in China and prevent future abuses.” Arthur Kleinman, a psychiatrist at Harvard University, said he believed the claims about systematic abuse of psychiatry were exaggerated, while acknowledging that it did occur in some cases. Abraham Halpern, a psychiatrist at New York Medical College and board member of the Friends of Falun Gong, USA, criticised the WPA for not demanding an investigative mission in China.

A follow-up review of the controversy was written by Alan A. Stone, a professor of psychiatry and president of the American Psychiatric Association, and published in the Psychiatric Times. Stone determined that psychiatrists in China were generally poorly trained and did not receive the sort of medical training which was standard in the West. Stone said this was cause for the misdiagnoses.

What is the Gatsby Charitable Foundation?

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Introduction

The Gatsby Charitable Foundation is an endowed grant-making trust, based in London, founded by David Sainsbury in 1967.

Background

The organisation is one of the Sainsbury Family Charitable Trusts, set up to provide funding for charitable causes. Although the organisation is permitted in its Trust Deed to make general grants within this broad area, its activities have generally been restricted to a limited number of fields. At the time of writing, these fields are:

  • Science and Engineering Education.
  • Plant science.
  • Neuroscience.
  • Poverty alleviation in Africa.
  • The arts.
  • Public policy.

However, these categories may change from time to time.

Amongst its activities, the Gatsby Charitable Foundation funds the Gatsby Computational Neuroscience Unit at University College London, the Sainsbury Management Fellowships, the Institute for Government based in Carlton House Terrace, and the Sainsbury Laboratory. It has long funded the Centre for Mental Health but is mostly withdrawing that funding in 2010. More recently, the foundation has become a co-sponsor of the University Technical Colleges programme, in conjunction with the Baker Dearing Trust.

According to the OECD, the Gatsby Charitable Foundation’s financing for 2019 development increased by 40% to US$18.9 million.

What is the Blackthorn Trust?

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Introduction

Blackthorn Trust is a UK charity in Maidstone, Kent which offers specialist therapies and rehabilitation through work placements in the Blackthorn Garden.

They offer help to people with mental health difficulties, chronic pain and type 2 diabetes. The charity’s work is based on the work of Rudolf Steiner (an Austrian philosopher, social reformer), and the charity aims to assist individuals to progress towards their full potential.

Brief History

In 1983, Dr David McGavin was in general practice in Maidstone. Through his work in the local community, he found out that conventional medicine was not able to help patients with chronic illness and were becoming increasingly passive and inactive, which was not helpful for their illness. He then met Hazel Adams (an art therapist) working on anthroposophical principles of Rudolf Steiner. As they worked on few of the Dr McGavin’s most severe patients, several noted improvements were made. More therapists were brought into the small practise but this became impractical. So he decided to set up a new trust and a new medical centre.

Blackthorn Medical Centre

This is owned by the Blackthorn Trust and part of it rented to the Practice. It was built in 1991, designed by Camphill Architects (from the Camphill Movement) and opened in December. As a result of the fundraising and hard work of patients, their families and friends, local and national industry, grant making trusts and the National Health Service. They may be prescribed anthroposophic medication and one of a number of anthroposophic therapies which are available on a one-to-one or group basis. These include biographical counselling, eurythmy therapy, rhythmical massage (developed by Ita Wegman) or art therapy. Therapies are offered at the discretion of the doctor.

It provides the usual family doctor services for around 7,200 people and is a GP training practice. Blackthorn Trust rents its premises via the NHS to the primary care team and the complementary practitioners.

The centre and trust is partially funded by the NHS, but needs to raise an additional £100,000 per year to cover its running costs. This is achieved by grants, donations, bequests and fund raising activities (including selling produce from the garden).

Blackthorn Garden

On the site of the grounds of the former psychiatric hospital of Oakwood Hospital, it occupies 22 acres and is under the direction of the Trust Management Team. Founded in 1991 and funded by the Trust. It has a flower garden, greenhouse and lath house (a framework of treated lumber covered with plastic netting, giving shade and protection for young plants). The lath house is a relic from the mental asylum. There is also a very large vegetable garden, a craft room for art therapy, a Cafe and kitchen serving organic lunches.

The garden has up to 60 people working in the garden per week.

In 1995, the garden and its therapies were evaluated by the Centre for Mental Health.

The aims of the garden:

  • To establish a place of rehabilitation through work for the mentally ill in the community.
  • To create a place of social integration and cultural activity in the Barming District of Maidstone.
  • To encourage the meeting and working together of the various disciplines concerned with mental health and community care.

The garden is opened, Monday to Saturday, 9:30 am to 3:30 pm. On Saturdays, workshops are open to the general public.

The garden also has a shop (run by volunteers) selling second-hand clothes and other used items.

The trust has various events during the year including Spring Fair, Summer Fair, Christmas Fairs. Selling local handmade crafts and specialist food stalls as well as the traditional stalls.

Funders

The local community and the people of Kent, Abbey National Trust, Alchemy Trust, Aylesford Samaritan Benevolent Fund, Big Lottery Fund, Esmée Fairbairn Foundation, European Social Fund, The Hambland Foundation, Hayward Foundation, Interreg IIIa, Smith’s Charity, Invicta Community Care NHS Trust, Kent Social Services, Kimberly Clark PLC, Lankelly Chase, Lloyds TSB PLC, Mental Health Foundation, The Percy Bilton Charity, The Pilgrim Trust, Rochester Bridge Trust, Smith Kline Beecham PLC, South East Regional Health Authority, Tudor Trust, West Kent Health Authority and Wimpy PLC.

Awards

  • Leisure and Outdoor Furniture Association (LOFA) Charity Award 1999.
  • NHS Beacon Training Practise 1999/2000.
  • Joint Winner HRH Prince of Wales Award for ‘Good Practice in Integrated Health’ 2001 and 2002.
  • Finalist in 2003 NHS Health & Social Care Awards, patient-centred cancer care section.
  • Royal College of General Practitioners (RCGP)/ Leonard Cheshire / RCGP 2009 Disability Care Award.

Visits

  • Julia Cumberlege, Baroness Cumberlege Minister of Health (1992-1997) for the House of Lords.
  • Nigel Crisp Chief Executive NHS (2000-2006).
  • Jonathan Shaw (politician) Labour Minister for Disabilities in Department for Work and Pensions (2008-2010), in 2012 after losing his seat he has now become a Blackthorn Trust Member.
  • Charles, Prince of Wales.

What is the Centre for Mental Health (UK)?

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Introduction

The Centre for Mental Health is an independent UK mental health charity. It aims to inspire hope, opportunity and a fair chance in life for people of all ages with or at risk of mental ill health.

The Centre acts as a bridge between the worlds of research, policy and service provision and believes strongly in the importance of high-quality evidence and analysis. It encourages innovation and advocates for change in policy and practice through focused research, development and training.

Brief History

The Centre for Mental Health began in March 1985 as the National Unit for Psychiatric Research and Development (NUPRD). It was founded by the Gatsby Charitable Foundation, an independent grant-making trust set up by Lord Sainsbury of Turville to ‘advance education and learning in the science and practise of mental health care, to promote research into mental health and publish the useful results and to assist the provision of mental health care for those in need of it’. The aim was for NUPRD to tackle these issues by working in a different way to other organisations. NUPRD was initially staffed by a small group of people working in an office at Lewisham Hospital. After 1989, it was renamed the Research and Development for Psychiatry (RDP), moving into the current offices on Borough High Street.

RDP eventually became the ‘Sainsbury Centre for Mental Health’ in February 1992. It was at the centre of developing and helping to implement the National Service Framework for Mental Health, and in 1995, evaluated the Blackthorn Trust garden (in Maidstone, Kent) and its therapies for two years.

From 2006, the Centre changed its work to focus on mental health and employment, in which it already had an established programme, as well as a new area of work on mental health and the criminal justice system. A new look and logo were subsequently introduced in 2007 to accompany this change in focus.

The Gatsby Charitable Foundation, one of the Sainsbury Family Charitable Trusts, provided the Centre’s core funding each year from 1985 until 2009, when it announced that it would begin to spend out its funds, its annual grant to the Centre ceasing the following year. A final grant covering three years was then announced by the foundation in the summer of 2010. The charity has since been known as the Centre of Mental Health.

Focus

  • Criminal justice: Identifies effective methods of supporting and diverting people with mental health problems in the criminal justice system.
  • Employment: Develops and promotes new ways of helping people with mental health problems get and keep work.
  • Recovery: Helps mental health services across the UK to support people more effectively to make their own lives better on their own terms.
  • Children: Undertakes work which aims to improve the life chances of children through the support they need early in life.
  • Mental and Physical Health: Recognises the strong association between mental and physical ill health and works with partners to review the evidence on cost of co-morbidities, as well as carrying out related research on liaison psychiatry.
  • Workplace training: Train managers and staff to understand, identify and support people with depression and anxiety at work.

What is Alloplastic Adaptation?

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Introduction

Alloplastic adaptation (from the Greek word “allos”, meaning “other”) is a form of adaptation where the subject attempts to change the environment when faced with a difficult situation. Criminality, mental illness, and activism can all be classified as categories of alloplastic adaptation.

The concept of alloplastic adaptation was developed by Sigmund Freud, Sándor Ferenczi, and Franz Alexander. They proposed that when an individual was presented with a stressful situation, they could react in one of two ways:

  • Autoplastic adaptation: The subject tries to change themselves, i.e. the internal environment.
  • Alloplastic adaptation: The subject tries to change the situation, i.e. the external environment.

Origins and Development

These terms are possibly due to Ferenczi, who used them in a paper on “The Phenomenon of Hysterical Materialization” (1919,24). But he there appears to attribute them to Freud (who may have used them previously in private correspondence or conversation). Ferenczi linked the purely “autoplastic” tricks of the hysteric…[to] the bodily performances of “artists” and actors.

Freud’s only public use of the terms was in his paper “The Loss of Reality in Neurosis and Psychosis” (1924), where he points out that “expedient, normal behaviour leads to work being carried out on the external world; it does not stop, as in psychosis, at effecting internal changes. It is no longer autoplastic but alloplastic”.

A few years later, in his paper on “The Neurotic Character” (1930), Alexander described “a type of neurosis in which…the patient’s entire life consists of actions not adapted to reality but rather aimed at relieving unconscious tensions”. Alexander considered that “neurotic characters of this type are more easily accessible to psychoanalysis than patients with symptom neuroses…[due] to the fact that in the latter the patient has regressed from alloplasticity to autoplasticity; after successful analysis he must pluck up courage to take action in real life”.

Otto Fenichel however took issue with Alexander on this point, maintaining that “The pseudo-alloplastic attitude of the neurotic character cannot be changed into a healthy alloplastic one except by first being transformed, for a time, into a neurotic autoplastic attitude, which can then be treated like an ordinary symptom neurosis”.

Human Evolution

Alloplasticity has also been used to describe humanity’s cultural “evolution”. Man’s “evolution by culture…is through alloplastic experiment with objects outside his own body….Unlike autoplastic experiments, alloplastic ones are both replicable and reversible”.

In particular, “advanced technological societies…are generally characterized by “alloplastic” relations with the environment, involving the manipulation of the environment itself”.

What is the Association for Behavioural and Cognitive Therapies?

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Introduction

The Association for Behavioural and Cognitive Therapies (ABCT) was founded in 1966.

Its headquarters are in New York City and its membership includes researchers, psychologists, psychiatrists, physicians, social workers, marriage and family therapists, nurses, and other mental-health practitioners and students. These members support, use, and/or disseminate behavioural and cognitive approaches.

Brief History

ABCT was founded in 1966 under the name Association for Advancement of Behavioural Therapies (AABT) by 10 behaviourists who were dissatisfied with the prevailing Freudian/psychoanalytic model (Its founding members include: John Paul Brady, Joseph Cautela, Edward Dengrove, Cyril Franks, Martin Gittelman, Leonard Krasner, Arnold Lazarus, Andrew Salter, Dorothy Susskind, and Joseph Wolpe). The Freudian/psychoanalytic model refers to the Id, Ego, and Superego within each individual as they interpret and interact with the world and those around them. Although the ABCT was not established until 1966, its history begins in the early 1900s with the birth of the behaviourist movement, which was brought about by Pavlov, Watson, Skinner, Thorndike, Hull, Mowrer, and others – scientists who, concerned primarily with observable behaviour, were beginning to experiment with conditioning and learning theory. By the 1950s, two entities – Hans Eysenck’s research group (which included one of AABT’s founders Cyril Franks) at the University of London Institute of Psychiatry, and Joseph Wolpe’s research group (which included another of AABT’s founders, Arnold Lazarus) in South Africa – were conducting important studies that would establish behaviour therapy as a science based on principles of learning. In complete opposition to the psychoanalytic model, “The seminal significance of behaviour therapy was the commitment to apply the principles and procedures of experimental psychology to clinical problems, to rigorously evaluate the effects of therapy, and to ensure that clinical practice was guided by such objective evaluation”.

The first president of the association was Cyril Franks, who also founded the organisation’s flagship journal Behaviour Therapy and was the first editor of the Association for Advancement of Behavioural Therapies Newsletter. The first annual meeting of the association took place in 1967, in Washington, DC, concurrent with the American Psychological Association’s meeting.

An article in the November 1967 issue of the Newsletter, entitled “Behaviour Therapy and Not Behaviour Therapies” (Wilson & Evans, 1967), influenced the association’s first name change from Association for Advancement of Behavioural Therapies to Association for Advancement of Behaviour Therapy because, as the authors argued, “the various techniques of behaviour therapy all derive from learning theory and should not be misinterpreted as different kinds of behaviour therapy…”. This issue remains a debate in the field and within the organization, particularly with the emergence of the term “cognitive behavioural therapies.” This resulted in yet another name change in 2005 to the Association for Behavioural and Cognitive Therapies.

The Association for Advancement of Behavioural Therapies/Association for Behavioural and Cognitive Therapies has been at the forefront of the professional, legal, social, and ethical controversies and dissemination efforts that have accompanied the field’s evolution. The 1970s was perhaps the most “explosive” and controversial decade for the field of behaviour therapy, as it suffered from an overall negative public image and received numerous attacks from the press regarding behaviour modification and its possible unethical uses. In Gerald Davison’s (AABT’s 8th president) public “Statement on Behaviour Modification from the AABT”, he asserted that “it is a serious mistake … to equate behaviour therapy with the use of electric shocks applied to the extremities…” and “a major contribution of behaviour therapy has been a profound commitment to full description of procedures and careful evaluation of their effects”. From this point, AABT became instrumental in enacting legislative guidelines that protected human research subjects, and they also became active in efforts to educate the public.

Mission Statement

The ABCT is an interdisciplinary organisation committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition. These aims are achieved through the investigation and application of behavioural, cognitive, prevention, and treatment. While primarily an interest group, ABCT is also active in:

  • Encouraging the development, study, and dissemination of scientific approaches to behavioural health.
  • Promoting the utilisation, expansion, and dissemination of behavioural, cognitive, and other empirically derived practices.
  • Facilitating professional development, interaction, and networking among members.

Professional Activities

Through its membership, publications, convention and education committees, the ABCT conducts a variety of activities to support and disseminate the behavioural and cognitive therapies. The organization produces two quarterly journals, Behaviour Therapy (research-based) and Cognitive and Behavioural Practice (treatment focused), as well as its house periodical, the Behaviour Therapist (eight times per year). The association’s convention is held annually in November. ABCT also produces fact sheets, an assessment series, and training and archival videotapes. The association maintains a website on which can be found a “Find-a-Therapist” search engine and information about behavioural and cognitive therapies. The organisation provides its members with an online clinical directory, over 30 special interest groups, a list serve, a job bank, and an awards and recognition programme. Other offerings available on the website include sample course syllabi, listings of grants available, and a broad range of offerings of interest to mental health researchers.

Mental Health Professionals

The training of mental health professionals has also been a significant priority for the association. Along with its annual meeting, AABT created an “ad hoc review mechanism” in the 1970s through the 1980s whereby a state could receive a review of a behaviour therapy programme. This led to the yearly publication of a widely used resource, “The Directory of Training Programmes”. With growing concerns over quality control and standardisation of practice, the certification of behaviour therapists also became an issue in the 1970s. This debate led to the development of a Diplomate in behaviour therapy at APA and for those behavioural therapy practices from a more radical behavioural perspective, the development of certification in behaviour analysis at the master level.

An ongoing debate within the association concerns what many consider to be a movement away from basic behavioural science as the field has attempted to advance and integrate more and more “new” therapies/specialisations, particularly the addition of cognitive theory and its variety of techniques. John Forsyth, in his special issue of Behaviour Therapy] entitled “Thirty Years of Behaviour Therapy: Promises Kept, Promises Unfulfilled”, summarised this opposition as follows:

“(a) cognition is not behaviour, (b) behaviour principles and theory cannot account for events occurring within the skin, and most important, (c) we therefore need a unique conceptual system to account for how thinking, feeling, and other private events relate to overt human action”.

The field’s desire to maintain its scientific foundations and yet continue to advance and grow, was reflected in its most recent discussion about adding the word “cognitive” to the name of the association.

Many notable scholars have served as president of the association, including Joseph Wolpe, Arnold Lazarus, Nathan Azrin, Steven C. Hayes, and David Barlow. The current executive director of the ABCT is Mary Jane Eimer, CAE. For a wealth of historical specifics (governing bodies, lists of editors, past presidents, award winners, SIGs, and conventions from the past 40 years) see ABCT’s 40th anniversary issue of the Behaviour Therapist.

About Behavioural and Cognitive Therapies

Cognitive and behavioural therapists help people learn to actively cope with, confront, reformulate, and/or change the maladaptive cognitions, behaviours, and symptoms that limit their ability to function, cause emotional distress, and accompany the wide range of mental health disorders. Goal-oriented, time-limited, research-based, and focused on the present, the cognitive and behavioural approach is collaborative. This approach values feedback from the client, and encourages the client to play an active role in setting goals and the overall course and pace of treatment. Importantly, behavioural interventions are characterized by a “direct focus on observable behaviour”. Practitioners teach clients concrete skills and exercises – from breathing retraining, to keeping thought records to behavioural rehearsal – to practice at home and in sessions, with the overall goal of optimal functioning and the ability to engage in life fully.

Because cognitive behavioural therapy (CBT) is based on broad principles of human learning and adaptation, it can be used to accomplish a wide variety of goals. CBT has been applied to issues ranging from depression and anxiety, to the improvement of the quality of parenting, relationships, and personal effectiveness.

Numerous scientific studies and research have documented the helpfulness of CBT programmes for a wide range of concerns throughout the lifespan. These concerns include children’s behaviour problems, health promotion, weight management, pain management, sexual dysfunction, stress, violence and victimisation, serious mental illness, relationship issues, academic problems, substance abuse, bipolar disorder, developmental disabilities, autism spectrum disorders, social phobia, school refusal and school phobia, hair pulling (trichotillomania) and much more. Cognitive-behavioural treatments are subject randomised controlled trials and “have been subjected to more rigorous evaluation using randomised controlled trials than any of the other psychological therapies”. There is discussion of using technology to determine diagnosis and host interventions according to research done by W. Edward Craighead. This would be done using “genetic analysis” and “neuroimaging” to create more individualised treatment plans.

Special Interest Groups

The ABCT has more than 40 special interest groups for its members. These include groups for issues involving African-Americans, Asian-Americans, Hispanics and other ethnic groups such as children and adolescents; couples; gay, lesbian, bisexual and transgender people; students; military personnel; and the criminal justice system. The ABCT works within these groups to overcome addictive behaviours and mental illnesses that may cause negativity in these groups life. A group that the ABCT has supported well is the special interest group of the criminal justice system. The ABCT helps provide the prison system with knowledge of how to more humanely treat those who committed crimes and give people the proper care and attention to become great citizens.

An Overview of Mental Health in China

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Introduction

Mental health in China is a growing issue. Experts have estimated that about 173 million people living in China are suffering from a mental disorder.

The desire to seek treatment is largely hindered by China’s strict social norms (and subsequent stigmas), as well as religious and cultural beliefs regarding personal reputation and social harmony. While the Chinese government is committed to expanding mental health care services and legislation, the country struggles with a lack of mental health professionals and access to specialists in rural areas.

Brief History

China’s first mental institutions were introduced before 1849 by Western missionaries. Missionary and doctor John G. Kerr opened the first psychiatric hospital in 1898, with the goal of providing care to people with mental health issues, and treating them in a more humane way.

In 1949, the country began developing its mental health resources by building psychiatric hospitals and facilities for training mental health professionals. However, many community programs were discontinued during the Cultural Revolution.

In a meeting jointly held by Chinese ministries and the World Health Organisation (WHO) in 1999, the Chinese government committed to creating a mental health action plan and a national mental health law, among other measures to expand and improve care. The action plan, adopted in 2002, outlined China’s priorities of enacting legislation, educating its people on mental illness and mental health resources, and developing a stable and comprehensive system of care.

In 2000, the Minority Health Disparities Research and Education Act was enacted. This act helped in raising national awareness on health issues through research, health education, and data collection.

Since 2006, the government’s 686 Program has worked to redevelop community mental health programs and make these the primary resource, instead of psychiatric hospitals, for people with mental illnesses. These community programs make it possible for mental health care to reach rural areas, and for people in these areas to become mental health professionals. However, despite the improvement in access to professional treatment, mental health specialists are still relatively inaccessible to rural populations. The program also emphasizes rehabilitation, rather than the management of symptoms.

In 2011, the legal institution of China’s State Council published a draft for a new mental health law, which includes new regulations concerning the rights of patients to not to be hospitalised against their will. The draft law also promotes the transparency of patient treatment management, as many hospitals were driven by financial motives and disregarded patients’ rights. The law, adopted in 2012, stipulates that a qualified psychiatrist must make the determination of mental illness; that patients can choose whether to receive treatment in most cases; and that only those at risk of harming themselves or others are eligible for compulsory inpatient treatment. However, Human Rights Watch has criticised the law. For example, although it creates some rights for detained patients to request a second opinion from another state psychiatrists and then an independent psychiatrist, there is no right to a legal hearing such as a mental health tribunal and no guarantee of legal representation.

Since 1993, WHO has been collaborating with China in the development of a national mental health information system.

Current Situation

Though China continues to develop its mental health services, it still has a large number of untreated and undiagnosed people with mental illnesses. The aforementioned intense stigma associated with mental illness, a lack of mental health professionals and specialists, and culturally-specific expressions of mental illness may play a role in the disparity.

Prevalence of Mental Disorders

Researchers estimate that roughly 173 million people in China have a mental disorder. Over 90 percent of people with a mental disorder have never been treated.

A lack of government data on mental disorders makes it difficult to estimate the prevalence of specific mental disorders, as China has not conducted a national psychiatric survey since 1993.

Conducted between 2001 and 2005, a non-governmental survey of 63,000 Chinese adults found that 16 percent of the population had a mood disorder, including 6% of people with major depressive disorder. Thirteen percent of the population had an anxiety disorder and 9 percent had an alcohol use disorder. Women were more likely to have a mood or anxiety disorder compared to men, but men were significantly more likely to have an alcohol use disorder. People living in rural areas were more likely to have major depressive disorder or alcohol dependence.

In 2007, the Chief of China’s National Centre for Mental Health, Liu Jin, estimated that approximately 50% of outpatient admissions were due to depression.

There is a disproportionate impact on the quality of life for people with bipolar disorder in China and other East Asian countries.

The suicide rate in China was approximately 23 per 100,000 people between 1995 and 1999. Since then, the rate is thought to have fallen to roughly 7 per 100,000 people, according to government data. WHO states that the rate of suicide is thought to be three to four times higher in rural areas than in urban areas. The most common method, poisoning by pesticides, accounts for 62% of incidences.

It is estimated that 18% of the Chinese population, about 244 million people believe in Buddhism. Another 22% of the population, roughly 294 million people believe in folk religions which are a group of beliefs that share characteristics with Confucianism, Buddhism, Taoism, and shamanism. Common between all of these philosophical and religious beliefs is an emphasis on acting harmoniously with nature, with strong morals, and with a duty to family. Followers of these religions perceive behaviour as being tightly connected with health; illnesses are often thought to be a result of moral failure or insufficiently honouring one’s family in current or past life. Furthermore, an emphasis on social harmony may discourage people with mental illness from bringing attention to themselves and seeking help. They may also refuse to speak about their mental illness because of the shame it would bring upon themselves and their family members, who could also be held responsible and experience social isolation.

Also, reputation might be a factor that prevents individuals from seeking professional help. Good reputations are highly valued. In a Chinese household, every individual shares the responsibility of maintaining and raising the family’s reputation. It is believed that mental health will hinder individuals from achieving the standards and goals- whether academic, social, career-based, or other- expected from parents. Without reaching the expectations, individuals are anticipated to bring shame to the family, which will affect the family’s overall reputation. Therefore, mental health issues are seen as an unacceptable weakness. This perception of mental health disorders causes individuals to internalise their mental health problems, possibly worsening them, and making it difficult to seek treatment. Eventually, it becomes ignored and overlooked by families.

In addition, many of these philosophies teach followers to accept one’s fate. Consequently, people with mental disorders may be less inclined to seek medical treatment because they believe they should not actively try to prevent any symptoms that may manifest. They may also be less likely to question the stereotypes associated with people with mental illness, and instead agreeing with others that they deserve to be ostracised.

Lack of Qualified Staff

China has 17,000 certified psychiatrists, which is 10% of that of other developed countries per capita. China averages one psychologist for every 83,000 people, and some of these psychologists are not board-licensed or certified to diagnose illnesses. Individuals without any academic background in mental health can obtain a license to counsel, following several months of training through the National Exam for Psychological Counsellors. Many psychiatrists or psychologists study psychology for personal use and do not intend to pursue a career in counselling. Patients are likely to leave clinics with false diagnoses, and often do not return for follow-up treatments, which is detrimental to the degenerative nature of many psychiatric disorders.

The disparity between psychiatric services available between rural and urban areas partially contributes to this statistic, as rural areas have traditionally relied on barefoot doctors since the 1970s for medical advice. These doctors are one of the few modes of healthcare able to reach isolated parts of rural China, and are unable to obtain modern medical equipment, and therefore, unable to reliably diagnose psychiatric illnesses. Furthermore, the nearest psychiatric clinic may be hundreds of kilometres away, and families may be unable to afford professional psychiatric treatment for the afflicted.

Physical Symptoms

Multiple studies have found that Chinese patients with mental illness report more physical symptoms compared to Western patients, who tend to report more psychological symptoms. For example, Chinese patients with depression are more likely to report feelings of fatigue and muscle aches instead of feelings of depression. However, it is unclear whether this occurs because they feel more comfortable reporting physical symptoms or if depression manifests in a more physical way among Chinese people.

Misuse

According to various scholars, China’s psychiatric facilities have been manipulated by government officials in order to silence political dissidents. In addition to misuse by the state psychiatric facilities in China are also misused by powerful private individuals who use the system to advance their personal or business ends. China’s legal system lacks an effective means of challenging involuntary detentions in psychiatric facilities.

Chinese Military Mental Health

Overview

Military mental health has recently become an area of focus and improvement, particularly in Western countries. For example, in the United States, it is estimated that about twenty-five percent (25%) of active military members suffer from a mental health problem, such as PTSD, Traumatic Brain Injury, and depression. Currently, there are no clear initiatives from the government about mental health treatment towards military personnel in China. Specifically, China has been investing in resources towards researching and understanding how the mental health needs of military members and producing policies to reinforce the research results.

Background

Research on the mental health status of active Chinese military men began in the 1980s where psychologists investigated soldiers’ experiences in the plateaus. The change of emphasis from physical to mental health can be seen in China’s four dominant military academic journals: First Military Journal, Second Military Journal, Third Military Journal, and Fourth Military Journal. In the 1980s, researchers mostly focused on the physical health of soldiers; as the troops’ ability to perform their services declined, the government began looking at their mental health to provide an explanation for this trend. In the 1990s, research on it increased with the hope that by improving the mental health of soldiers, combat effectiveness improves.

Mental health issue can impact active military members’ effectiveness in the army, and can create lasting effects on them after they leave the military. Plateaus were an area of interest in this sense because of harsh environmental conditions and the necessity of the work done with low atmospheric pressure and intense UV radiation. It was critical to place the military there to stabilize the outskirts and protect the Chinese citizens who live nearby; this made it one of the most important jobs in the army, then increasing the pressure on those who worked in the plateaus. It not only affected the body physically, like in the arteries, lungs, and back, but caused high levels of depression in soldiers because of being away from family members and with limited communication methods. Scientists found that this may impact their lives as they saw that this population had higher rates of divorce and unemployment.

Comparatively, assessing the mental health status of the People’s Liberation Army (PLA) is difficult, because military members work a diverse array of duties over a large landscape. Military members also play an active part in disaster relief, peacekeeping in foreign lands, protecting borders, and domestic riot control. In a study of 11,000 soldiers, researchers found that those who work as peacekeepers have higher levels of depression compared to those in the engineering and medical departments. With such diverse military roles over an area of 8.4 million square kilometres (3.25 million square miles), it is difficult to gauge its impacts on soldiers’ psyche and provide a single method to address mental health problems.

Researches have increased over the last two decades, but the studies still lack a sense of comprehensiveness and reliability. In over 73 studies that together included 53,424 military members, some research shows that there is gradual improvement in mental health at high altitudes, such as mountain tops; other researchers found that depressive symptoms can worsen. These research studies demonstrate how difficult it is to assess and treat the mental illness that occurs in the army and how there are inconsistent results. Studies of the military population focus on the men of the military and exclude women, even though the number of women that are joining the military has increased in the last two decades.

Chinese researchers try to provide solutions that are preventative and reactive, such as implementing early mental health training, or mental health assessments to help service members understand their mental health state, and how to combat these feelings themselves. Researchers also suggest to improve the mental health of the military members, programmes should include psychoeducation, psychological training, and attention to physical health to employ timely intervention.

Implementation

In 2006, the People’s Republic Minister for National Defence began mental health vetting at the beginning of the military recruitment process. A Chinese military study consisting of 2500 male military personnel found that some members are more predisposed to mental illness. The study measured levels of anxious behaviours, symptoms of depression, sensitivity to traumatic events, resilience and emotional intelligence of existing personnel to aid the screening of new recruits. Similar research has been conducted into the external factors that impact a person’s mental fortitude, including single-child status, urban or rural environment, and education level. Subsequently, the government has incorporated mental illness coping techniques into their training manual. In 2013 leak by the Tibetan Centre for Human Rights of a small portion of the People’s Liberation Army training manual from 2008, specifically concerned how military personnel could combat PTSD and depression while on peacekeeping missions in Tibet. The manual suggested that soldiers should:

“…close [their] eyes and imagine zooming in on the scene like a camera [when experiencing PTSD]. It may feel uncomfortable. Then zoom all the way out until you cannot see anything. Then tell yourself the flashback is gone.”

In 2012, the government specifically addressed military mental health in a legal document for the first time. In article 84 of the Mental Health Law of the People’s Republic of China, it stated, “The State Council and the Central Military Committee will formulate regulations based on this law to manage mental health work in the military.”

Besides screening, assessments and an excerpt of the manual, not much is known about the services that are provided to active military members and veterans. Analysis of more than 45 different studies, moreover, has deemed that the level of anxiety in current and ex-military personnel has increased despite efforts of the People’s Republic due to economic conditions, lack of social connects and the feeling of a threat to military livelihood. This growing anxiety manifested in both 2016 and 2018, as Chinese veterans demonstrated their satisfaction with the system via protests across China. In both instances, veterans advocated for an increased focus on post-service benefits, resources to aid in post-service jobs, and justice for those who were treated poorly by the government. As a way to combat the dissatisfaction of veterans and alleviate growing tension, the government established the Ministry of Veteran Affairs in 2018. At the same time, Xi Jinping, General Secretary of the Communist Party of China, promised to enact laws that protect the welfare of veterans.

What is the Behaviour Analysis of Child Development?

Published on by Andrew Marshall1 Comment

Introduction

The behavioural analysis of child development originates from John B. Watson’s behaviourism.

Brief History

In 1948, Sidney Bijou took a position as associate professor of psychology at the University of Washington and served as director of the university’s Institute of Child Development. Under his leadership, the Institute added a child development clinic and nursery school classrooms where they conducted research that would later accumulate into the are that would be called “Behaviour Analysis of Child Development”. Skinner’s behavioural approach and Kantor’s interbehavioural approach were adopted in Bijou and Baer’s model. They created a three-stage model of development (basic, foundational, and societal). Bijou and Baer looked at these socially determined stages, as opposed to organising behaviour into change points or cusps (behavioural cusp). In the behavioural model, development is considered a behavioural change. It is dependent on the kind of stimulus and the person’s behavioural and learning function. Behaviour analysis in child development takes a mechanistic, contextual, and pragmatic approach.

From its inception, the behavioural model has focused on prediction and control of the developmental process. The model focuses on the analysis of a behaviour and then synthesizes the action to support the original behaviour. The model was changed after Richard J. Herrnstein studied the matching law of choice behaviour developed by studying of reinforcement in the natural environment. More recently, the model has focused more on behaviour over time and the way that behavioural responses become repetitive. it has become concerned with how behaviour is selected over time and forms into stable patterns of responding. A detailed history of this model was written by Pelaez. In 1995, Henry D. Schlinger, Jr. provided the first behaviour analytic text since Bijou and Baer comprehensively showed how behaviour analysis – a natural science approach to human behaviour – could be used to understand existing research in child development. In addition, the quantitative behavioural developmental model by Commons and Miller is the first behavioural theory and research to address notion similar to stage.

Research Methods

The methods used to analyse behaviour in child development are based on several types of measurements. Single-subject research with a longitudinal study follow-up is a commonly-used approach. Current research is focused on integrating single-subject designs through meta-analysis to determine the effect sizes of behavioural factors in development. Lag sequential analysis has become popular for tracking the stream of behaviour during observations. Group designs are increasingly being used. Model construction research involves latent growth modelling to determine developmental trajectories and structural equation modelling. Rasch analysis is now widely used to show sequentially within a developmental trajectory.

A recent methodological change in the behavioural analytic theory is the use of observational methods combined with lag sequential analysis can determine reinforcement in the natural setting.

Quantitative Behavioural Development

The model of hierarchical complexity is a quantitative analytic theory of development. This model offers an explanation for why certain tasks are acquired earlier than others through developmental sequences and gives an explanation of the biological, cultural, organisational, and individual principles of performance. It quantifies the order of hierarchical complexity of a task based on explicit and mathematical measurements of behaviour.

Research

Contingencies, Uncertainty, and Attachment

The behavioural model of attachment recognises the role of uncertainty in an infant and the child’s limited communication abilities. Contingent relationships are instrumental in the behaviour analytic theory, because much emphasis is put on those actions that produce parents’ responses.

The importance of contingency appears to be highlighted in other developmental theories, but the behavioural model recognises that contingency must be determined by two factors:

  • The efficiency of the action; and
  • That efficiency compared to other tasks that the infant might perform at that point.

Both infants and adults function in their environments by understanding these contingent relationships. Research has shown that contingent relationships lead to emotionally satisfying relationships.

Since 1961, behavioural research has shown that there is relationship between the parents’ responses to separation from the infant and outcomes of a “stranger situation.”. In a study done in 2000, six infants participated in a classic reversal design (refer to single-subject research) study that assessed infant approach rate to a stranger. If attention was based on stranger avoidance, the infant avoided the stranger. If attention was placed on infant approach, the infant approached the stranger.

Recent meta-analytic studies of this model of attachment based on contingency found a moderate effect of contingency on attachment, which increased to a large effect size when the quality of reinforcement was considered. Other research on contingency highlights its effect on the development of both pro-social and anti-social behaviour. These effects can also be furthered by training parents to become more sensitive to children’s behaviours, Meta-analytic research supports the notion that attachment is operant-based learning.

An infant’s sensitivity to contingencies can be affected by biological factors and environment changes. Studies show that being placed in erratic environments with few contingencies may cause a child to have conduct problems and may lead to depression (see Behavioural Development and Depression below). Research continues to look at the effects of learning-based attachment on moral development. Some studies have shown that erratic use of contingencies by parents early in life can produce devastating long-term effects for the child.

Motor Development

Since Watson developed the theory of behaviourism, behaviour analysts have held that motor development represents a conditioning process. This holds that crawling, climbing, and walking displayed by infants represents conditioning of biologically innate reflexes. In this case, the reflex of stepping is the respondent behaviour and these reflexes are environmentally conditioned through experience and practice. This position was criticised by maturation theorists. They believed that the stepping reflex for infants actually disappeared over time and was not “continuous”. By working with a slightly different theoretical model, while still using operant conditioning, Esther Thelen was able to show that children’s stepping reflex disappears as a function of increased physical weight. However, when infants were placed in water, that same stepping reflex returned. This offered a model for the continuity of the stepping reflex and the progressive stimulation model for behaviour analysts.

Infants deprived of physical stimulation or the opportunity to respond were found to have delayed motor development. Under conditions of extra stimulation, the motor behaviour of these children rapidly improved. Some research has shown that the use of a treadmill can be beneficial to children with motor delays including Down syndrome and cerebral palsy. Research on opportunity to respond and the building of motor development continues today.

The behavioural development model of motor activity has produced a number of techniques, including operant-based biofeedback to facilitate development with success. Some of the stimulation methods such as operant-based biofeedback have been applied as treatment to children with cerebral palsy and even spinal injury successfully. Brucker’s group demonstrated that specific operant conditioning-based biofeedback procedures can be effective in establishing more efficient use of remaining and surviving central nervous system cells after injury or after birth complications (like cerebral palsy). While such methods are not a cure and gains tend to be in the moderate range, they do show ability to enhance functioning.

Imitation and Verbal Behavior

Behaviourists have studied verbal behaviour since the 1920s. E.A. Esper (1920) studied associative models of language, which has evolved into the current language interventions of matrix training and recombinative generalisation. Skinner (1957) created a comprehensive taxonomy of language for speakers. Baer, along with Zettle and Haynes (1989), provided a developmental analysis of rule-governed behaviour for the listener. and for the listener Zettle and Hayes (1989) with Don Baer providing a developmental analysis of rule-governed behaviour. According to Skinner, language learning depends on environmental variables, which can be mastered by a child through imitation, practice, and selective reinforcement including automatic reinforcement.

B.F. Skinner was one of the first psychologists to take the role of imitation in verbal behaviour as a serious mechanism for acquisition. He identified echoic behaviour as one of his basic verbal operants, postulating that verbal behaviour was learned by an infant from a verbal community. Skinner’s account takes verbal behaviour beyond an intra-individual process to an inter-individual process. He defined verbal behaviour as “behaviour reinforced through the mediation of others”. Noam Chomsky refuted Skinner’s assumptions.

In the behavioural model, the child is prepared to contact the contingencies to “join” the listener and speaker. At the very core, verbal episodes involve the rotation of the roles as speaker and listener. These kinds of exchanges are called conversational units and have been the focus of research at Columbia’s communication disorders department.

Conversational units is a measure of socialisation because they consist of verbal interactions in which the exchange is reinforced by both the speaker and the listener. H.C. Chu (1998) demonstrated contextual conditions for inducing and expanding conversational units between children with autism and non-handicapped siblings in two separate experiments. The acquisition of conversational units and the expansion of verbal behaviour decrease incidences of physical “aggression” in the Chu study and several other reviews suggest similar effects. The joining of the listener and speaker progresses from listener speaker rotations with others as a likely precedent for the three major components of speaker-as-own listener – say so correspondence, self-talk conversational units, and naming.

Development of Self

Robert Kohelenberg and Mavis Tsai (1991) created a behaviour analytic model accounting for the development of one’s “self”. Their model proposes that verbal processes can be used to form a stable sense of who we are through behavioural processes such as stimulus control. Kohlenberg and Tsai developed functional analytic psychotherapy to treat psychopathological disorders arising from the frequent invalidations of a child’s statements such that “I” does not emerge. Other behaviour analytic models for personality disorders exist. They trace out the complex biological-environmental interaction for the development of avoidant and borderline personality disorders. They focus on Reinforcement sensitivity theory, which states that some individuals are more or less sensitive to reinforcement than others. Nelson-Grey views problematic response classes as being maintained by reinforcing consequences or through rule governance.

Socialisation

Over the last few decades, studies have supported the idea that contingent use of reinforcement and punishment over extended periods of time lead to the development of both pro-social and anti-social behaviours. However research has shown that reinforcement is more effective than punishment when teaching behaviour to a child. It has also been shown that modelling is more effective than “preaching” in developing pro-social behaviour in children. Rewards have also been closely studied in relation to the development of social behaviours in children. The building of self-control, empathy, and cooperation has all implicated rewards as a successful tactic, while sharing has been strongly linked with reinforcement.

The development of social skills in children is largely affected in that classroom setting by both teachers and peers. Reinforcement and punishment play major roles here as well. Peers frequently reinforce each other’s behaviour. One of the major areas that teachers and peers influence is sex-typed behaviour, while peers also largely influence modes of initiating interaction, and aggression. Peers are more likely to punish cross-gender play while at the same time reinforcing play specific to gender. Some studies found that teachers were more likely to reinforce dependent behaviour in females.

Behavioural principles have also been researched in emerging peer groups, focusing on status. Research shows that it takes different social skills to enter groups than it does to maintain or build one’s status in groups. Research also suggests that neglected children are the least interactive and aversive, yet remain relatively unknown in groups. Children suffering from social problems do see an improvement in social skills after behaviour therapy and behaviour modification (refer to applied behaviour analysis). Modelling has been successfully used to increase participation by shy and withdrawn children. Shaping of socially desirable behaviour through positive reinforcement seems to have some of the most positive effects in children experiencing social problems.

Anti-Social Behaviour

In the development of anti-social behaviour, aetiological models for anti-social behaviour show considerable correlation with negative reinforcement and response matching (refer to matching law). Escape conditioning, through the use of coercive behaviour, has a powerful effect on the development and use of future anti-social tactics. The use of anti-social tactics during conflicts can be negatively reinforced and eventually seen as functional for the child in moment to moment interactions. Anti-social behaviours will also develop in children when imitation is reinforced by social approval. If approval is not given by teachers or parents, it can often be given by peers. An example of this is swearing. Imitating a parent, brother, peer, or a character on TV, a child may engage in the anti-social behaviour of swearing. Upon saying it they may be reinforced by those around them which will lead to an increase in the anti-social behaviour. The role of stimulus control has also been extensively explored in the development of anti-social behaviour. Recent behavioural focus in the study of anti-social behaviour has been a focus on rule-governed behaviour. While correspondence for saying and doing has long been an interest for behaviour analysts in normal development and typical socialisation, recent conceptualisations have been built around families that actively train children in anti-social rules, as well as children who fail to develop rule control.

Developmental Depression with Origins in Childhood

Behavioural theory of depression was outlined by Charles Ferster. A later revision was provided by Peter Lewisohn and Hyman Hops. Hops continued the work on the role of negative reinforcement in maintaining depression with Anthony Biglan. Additional factors such as the role of loss of contingent relations through extinction and punishment were taken from early work of Martin Seligman. The most recent summary and conceptual revisions of the behavioural model was provided by Johnathan Kanter. The standard model is that depression has multiple paths to develop. It can be generated by five basic processes, including: lack or loss of positive reinforcement, direct positive or negative reinforcement for depressive behaviour, lack of rule-governed behaviour or too much rule-governed behaviour, and/or too much environmental punishment. For children, some of these variables could set the pattern for lifelong problems. For example, a child whose depressive behaviour functions for negative reinforcement by stopping fighting between parents could develop a lifelong pattern of depressive behaviour in the case of conflicts. Two paths that are particularly important are:

  1. Lack or loss of reinforcement because of missing necessary skills at a developmental cusp point; or
  2. The failure to develop adequate rule-governed behaviour.

For the latter, the child could develop a pattern of always choosing the short-term small immediate reward (i.e. escaping studying for a test) at the expense of the long-term larger reward (passing courses in middle school). The treatment approach that emerged from this research is called behavioural activation.

In addition, use of positive reinforcement has been shown to improve symptoms of depression in children. Reinforcement has also been shown to improve the self-concept in children with depression comorbid with learning difficulties. Rawson and Tabb (1993) used reinforcement with 99 students (90 males and 9 females) aged from 8 to 12 with behaviour disorders in a residential treatment program and showed significant reduction in depression symptoms compared to the control group.

Cognitive Behaviour

As children get older, direct control of contingencies is modified by the presence of rule-governed behaviour. Rules serve as an establishing operation and set a motivational stage as well as a discrimintative stage for behaviour. While the size of the effects on intellectual development are less clear, it appears that stimulation does have a facilitative effect on intellectual ability. However, it is important to be sure not to confuse the enhancing effect with the initial causal effect. Some data exists to show that children with developmental delays take more learning trials to acquire in material.

Learned Units and Developmental Retardation

Behaviour analysts have spent considerable time measuring learning in both the classroom and at home. In these settings, the role of a lack of stimulation has often been evidenced in the development of mild and moderate mental retardation. Recent work has focused on a model of “developmental retardation,”. an area that emphasizes cumulative environmental effects and their role in developmental delays. To measure these developmental delays, subjects are given the opportunity to respond, defined as the instructional antecedent, and success is signified by the appropriate response and/or fluency in responses. Consequently, the learned unit is identified by the opportunity to respond in addition to given reinforcement.

One study employed this model by comparing students’ time of instruction was in affluent schools to time of instruction in lower income schools. Results showed that lower income schools displayed approximately 15 minutes less instruction than more affluent schools due to disruptions in classroom management and behaviour management. Altogether, these disruptions culminated into two years worth of lost instructional time by grade 10. The goal of behaviour analytic research is to provide methods for reducing the overall number of children who fall into the retardation range of development by behavioural engineering.

Hart and Risely (1995, 1999) have completed extensive research on this topic as well. These researchers measured the rates of parent communication with children of the ages of 2-4 years and correlated this information with the IQ scores of the children at age 9. Their analyses revealed that higher parental communication with younger children was positively correlated with higher IQ in older children, even after controlling for race, class, and socio-economic status. Additionally, they concluded a significant change in IQ scores required intervention with at-risk children for approximately 40 hours per week.

Class Formation

The formation of class-like behaviour has also been a significant aspect in the behavioural analysis of development. This research has provided multiple explanations to the development and formation of class-like behaviour, including primary stimulus generalisation, an analysis of abstraction, relational frame theory, stimulus class analysis (sometimes referred to as recombinative generalisation), stimulus equivalence, and response class analysis. Multiple processes for class-like formation provide behaviour analysts with relatively pragmatic explanations for common issues of novelty and generalisation.

Responses are organised based upon the particular form needed to fit the current environmental challenges as well as the functional consequences. An example of large response classes lies in contingency adduction, which is an area that needs much further research, especially with a focus on how large classes of concepts shift. For example, as Piaget observed, individuals have a tendency at the pre-operational stage to have limits in their ability to preserve information. While children’s training in the development of conservation skills has been generally successful, complications have been noted. Behaviour analysts argue that this is largely due to the number of tool skills that need to be developed and integrated. Contingency adduction offers a process by which such skills can be synthesized and which shows why it deserves further attention, particularly by early childhood interventionists.

Autism

Ferster (1961) was the first researcher to posit a behaviour analytic theory for autism. Ferster’s model saw autism as a by-product of social interactions between parent and child. Ferster presented an analysis of how a variety of contingencies of reinforcement between parent and child during early childhood might establish and strengthen a repertoire of behaviours typically seen in children diagnosed with autism. A similar model was proposed by Drash and Tutor (1993), who developed the contingency-shaped or behavioural incompatibility theory of autism. They identified at least six reinforcement paradigms that may contribute to significant deficiencies in verbal behaviour typically characteristic of children diagnosed as autistic. They proposed that each of these paradigms may also create a repertoire of avoidance responses that could contribute to the establishment of a repertoire of behaviour that would be incompatible with the acquisition of age-appropriate verbal behaviour. More recent models attribute autism to neurological and sensory models that are overly worked and subsequently produce the autistic repertoire. Lovaas and Smith (1989) proposed that children with autism have a mismatch between their nervous systems and the environment, while Bijou and Ghezzi (1999) proposed a behavioural interference theory. However, both the environmental mismatch model and the inference model were recently reviewed, and new evidence shows support for the notion that the development of autistic behaviours are due to escape and avoidance of certain types of sensory stimuli. However, most behavioural models of autism remain largely speculative due to limited research efforts.

Role in Education

One of the largest impacts of behaviour analysis of child development is its role in the field of education. In 1968, Siegfried Englemann used operant conditioning techniques in a combination with rule learning to produce the direct instruction curriculum. In addition, Fred S. Keller used similar techniques to develop programmed instruction. B.F. Skinner developed a programmed instruction curriculum for teaching handwriting. One of Skinner’s students, Ogden Lindsley, developed a standardized semilogrithmic chart, the “Standard Behaviour Chart,” now “Standard Celeration Chart,” used to record frequencies of behaviour, and to allow direct visual comparisons of both frequencies and changes in those frequencies (termed “celeration”). The use of this charting tool for analysis of instructional effects or other environmental variables through the direct measurement of learner performance has become known as precision teaching.

Behaviour analysts with a focus on behavioural development form the basis of a movement called positive behaviour support (PBS). PBS has focused on building safe schools.

In education, there are many different kinds of learning that are implemented to improve skills needed for interactions later in life. Examples of this differential learning include social and language skills. According to the NWREL (Northwest Regional Educational Laboratory), too much interaction with technology will hinder a child’s social interactions with others due to its potential to become an addiction and subsequently lead to anti-social behaviour. In terms of language development, children will start to learn and know about 5-20 different words by 18 months old.

Critiques of Behavioural Approach and New Developments

Behaviour analytic theories have been criticized for their focus on the explanation of the acquisition of relatively simple behaviour (i.e. the behaviour of nonhuman species, of infants, and of individuals who are intellectually disabled or autistic) rather than of complex behaviour. Michael Commons continued behaviour analysis’s rejection of mentalism and the substitution of a task analysis of the particular skills to be learned. In his new model, Commons has created a behaviour analytic model of more complex behaviour in line with more contemporary quantitative behaviour analytic models called the model of hierarchical complexity. Commons constructed the model of hierarchical complexity of tasks and their corresponding stages of performance using just three main axioms.

In the study of development, recent work has been generated regarding the combination of behaviour analytic views with dynamical systems theory. The added benefit of this approach is its portrayal of how small patterns of changes in behaviour in terms of principles and mechanisms over time can produce substantial changes in development.

Current research in behaviour analysis attempts to extend the patterns learned in childhood and to determine their impact on adult development.

Professional Organisations

The Association for Behaviour Analysis International has a special interest group for the behaviour analysis of child development.

Doctoral level behaviour analysts who are psychologists belong to American Psychological Association’s division 25: behaviour analysis.

The World Association for Behaviour Analysis has a certification in behaviour therapy. The exam draws questions on behavioural theories of child development as well as behavioural theories of child psychopathology.

What is Single-Subject Research?

Published on by Andrew Marshall2 Comments

Introduction

Single-subject research is a group of research methods that are used extensively in the experimental analysis of behaviour and applied behaviour analysis with both human and non-human participants. Principal methods in this type of research are: A-B-A-B designs, Multi-element designs, Multiple Baseline designs, Repeated acquisition designs, Brief experimental designs and Combined designs.

These methods form the heart of the data collection and analytic code of behaviour analysis. Behaviour analysis is data driven, inductive, and disinclined to hypothetico-deductive methods.

Experimental Questions

Experimental questions are decisive in determining the nature of the experimental design to be selected. There are four basic types of experimental questions: demonstration, comparison, parametric, and component. A demonstration is “Does A cause or influence B?”. A comparison is “Does A1 or A2 cause or influence B more?”. A parametric question is “How much of A will cause how much change or influence on B?”. A component question is “Which part of A{1,2,3} – A1 or A2 or A3… – causes or influences B?” where A is composed of parts that can be separated and tested.

The A-B-A-B design is useful for demonstration questions.

A-B-A-B

A-B

An AB design is a two-part or phase design composed of a baseline (“A” phase) with no changes and a treatment or intervention (“B”) phase. If there is a change then the treatment may be said to have had an effect. However, it is subject to many possible competing hypotheses, making strong conclusions difficult. Variants on the AB design introduce ways to control for the competing hypotheses to allow for stronger conclusions.

Reversal or A-B-A

The reversal design is the most powerful of the single-subject research designs showing a strong reversal from baseline (“A”) to treatment (“B”) and back again. If the variable returns to baseline measure without a treatment then resumes its effects when reapplied, the researcher can have greater confidence in the efficacy of that treatment. However, many interventions cannot be reversed, some for ethical reasons (e.g. involving self-injurious behaviour, smoking) and some for practical reasons (they cannot be unlearned, like a skill).

Further ethics notes: It may be unethical to end an experiment on a baseline measure if the treatment is self-sustaining and highly beneficial and/or related to health. Control condition participants may also deserve the benefits of research once all data has been collected. It is a researcher’s ethical duty to maximise benefits and to ensure that all participants have access to those benefits when possible.

A-B-C

The A-B-C design is a variant that allows for the extension of research questions around component, parametric and comparative questions.

Multi-element

Multi-element designs sometimes referred to as alternating-treatment designs are used in order to ascertain the comparative effect of two treatments. Two treatments are alternated in rapid succession and correlated changes are plotted on a graph to facilitate comparison.

Multiple Baseline

The multiple baseline design was first reported in 1960 as used in basic operant research. It was applied in the late 1960s to human experiments in response to practical and ethical issues that arose in withdrawing apparently successful treatments from human subjects. In it two or more (often three) behaviours, people or settings are plotted in a staggered graph where a change is made to one, but not the other two, and then to the second, but not the third behaviour, person or setting. Differential changes that occur to each behaviour, person or in each setting help to strengthen what is essentially an AB design with its problematic competing hypotheses.

Repeated Acquisition

In addition to multiple baseline designs, a way to deal with problematic reversibility is the use of repeated acquisitions.

Brief

A designed favoured by applied settings researchers where logistical challenges, time and other limits make research difficult are variants of multi-element and A-B-A-B type designs.

Combined

The combined design has arisen from a need to obtain answers to more complex research questions. Combining two or more single-case designs, such as A-B-A-B and multiple baseline, may produce such answers.

Multiple-Probe

Popular in Verbal Behaviour research, the multiple-probe research design has elements of the other research designs.

Changing-Criterion

In a changing-criterion research design a criterion for reinforcement is changed across the experiment to demonstrate a functional relation between the reinforcement and the behaviour.