What is School Psychology?

Introduction

School psychology is a field that applies principles from educational psychology, developmental psychology, clinical psychology, community psychology, and behaviour analysis to meet the learning and behavioural health needs of children and adolescents.

It is an area of applied psychology practiced by a school psychologist. They often collaborate with educators, families, school leaders, community members, and other professionals to create safe and supportive school environments.

School psychologists primarily work with students who have learning disabilities, behavioural difficulties, mental disorders, and other health issues. They carry out psychological testing, psychoeducational assessment, intervention, prevention, counselling, and consultation in the ethical, legal, and administrative codes of their profession.

Background

School psychology dates back to the beginning of American psychology in the late 19th and early 20th centuries. The field is tied to both functional and clinical psychology. School psychology actually came out of functional psychology. School psychologists were interested in childhood behaviours, learning processes, and dysfunction with life or in the brain itself. They wanted to understand the causes of the behaviours and their effects on learning. In addition to its origins in functional psychology, school psychology is also the earliest example of clinical psychology, beginning around 1890. While both clinical and school psychologists wanted to help improve the lives of children, they approached it in different ways. School psychologists were concerned with school learning and childhood behavioural problems, which largely contrasts the mental health focus of clinical psychologists.

Another significant event in the foundation of school psychology as it is today was the Thayer Conference. The Thayer Conference was first held in August 1954 in West Point, New York in Hotel Thayer. The 9 day-long conference was conducted by the American Psychological Association (APA). The purpose of the conference was to develop a position on the roles, functions, and necessary training and credentialing of a school psychologist. At the conference, forty-eight participants that represented practitioners and trainers of school psychologists discussed the roles and functions of a school psychologist and the most appropriate way to train them.

At the time of the Thayer Conference, school psychology was still a very young profession with only about 1,000 school psychology practitioners. One of the goals of the Thayer Conference was to define school psychologists. The agreed upon definition stated that school psychologists were psychologists who specialise in education and have specific knowledge of assessment and learning of all children. School psychologists use this knowledge to assist school personnel in enriching the lives of all children. This knowledge is also used to help identify and work with children with exceptional needs. It was discussed that a school psychologist must be able to assess and develop plans for children considered to be at risk. A school psychologist is also expected to better the lives of all children in the school; therefore, it was determined that school psychologists should be advisors in the planning and implementation of school curriculum. Participants at the conference felt that since school psychology is a specialty, individuals in the field should have a completed a two-year graduate training program or a four-year doctoral programme. Participants felt that states should be encouraged to establish certification standards to ensure proper training. It was also decided that a practicum experience be required to help facilitate experiential knowledge within the field.

The Thayer Conference is one of the most significant events in the history of school psychology because it was there that the field was initially shaped into what it is today. Before the Thayer Conference defined school psychology, practitioners used seventy-five different professional titles. By providing one title and a definition, the conference helped to get school psychologists recognised nationally. Since a consensus was reached regarding the standards of training and major functions of a school psychologist, the public can now be assured that all school psychologists are receiving adequate information and training to become a practitioner. It is essential that school psychologists meet the same qualifications and receive appropriate training nationwide. These essential standards were first addressed at the Thayer Conference. At the Thayer Conference some participants felt that in order to hold the title of a school psychologist an individual must have earned a doctoral degree.

The issues of titles, labels, and degree levels are still debated among psychologists today. However, APA and NASP reached a resolution on this issue in 2010.

Social Reform in the Early 1900s

The late 19th century marked the era of social reforms directed at children. It was due to these social reforms that the need for school psychologists emerged. These social reforms included compulsory schooling, juvenile courts, child labour laws as well as a growth of institutions serving children. Society was starting to “change the ‘meaning of children’ from an economic source of labour to a psychological source of love and affection”. Historian Thomas Fagan argues that the preeminent force behind the need for school psychology was compulsory schooling laws. Prior to the compulsory schooling law, only 20% of school aged children completed elementary school and only 8% completed high school. Due to the compulsory schooling laws, there was an influx of students with mental and physical defects who were required by law to be in school. There needed to be an alternative method of teaching for these different children. Between 1910 and 1914, schools in both rural and urban areas created small special education classrooms for these children. From the emergence of special education classrooms came the need for “experts” to help assist in the process of child selection for special education. Thus, school psychology was founded.

Important Contributors to the Founding

Lightner Witmer

Lightner Witmer has been acknowledged as the founder of school psychology. Witmer was a student of both Wilhelm Wundt and James Mckeen Cattell. While Wundt believed that psychology should deal with the average or typical performance, Cattell’s teachings emphasized individual differences. Witmer followed Cattell’s teachings and focused on learning about each individual child’s needs. Witmer opened the first psychological and child guidance clinic in 1896 at the University of Pennsylvania. Witmer’s goal was to prepare psychologists to help educators solve children’s learning problems, specifically those with individual differences. Witmer became an advocate for these special children. He was not focused on their deficits per se, but rather helping them overcome them, by looking at the individual’s positive progress rather than all they still could not achieve. Witmer stated that his clinic helped “to discover mental and moral defects and to treat the child in such a way that these defects may be overcome or rendered harmless through the development of other mental and moral traits”. He strongly believed that active clinical interventions could help to improve the lives of the individual children.

Since Witmer saw much success through his clinic, he saw the need for more experts to help these individuals. Witmer argued for special training for the experts working with exceptional children in special educational classrooms. He called for a “new profession which will be exercised more particularly in connection with educational problems, but for which the training of the psychologist will be a prerequisite”.

As Witmer believed in the appropriate training of these school psychologists, he also stressed the importance of appropriate and accurate testing of these special children. The IQ testing movement was sweeping through the world of education after its creation in 1905. However, the IQ test negatively influenced special education. The IQ test creators, Lewis Terman and Henry Goddard, held a nativist view of intelligence, believing that intelligence was inherited and difficult if not impossible to modify in any meaningful way through education.] These notions were often used as a basis for excluding children with disabilities from the public schools. Witmer argued against the standard pencil and paper IQ and Binet type tests in order to help select children for special education. Witmer’s child selection process included observations and having children perform certain mental tasks.

Granville Stanley Hall

Another important figure to the origin of school psychology was Granville Stanley Hall. Rather than looking at the individual child as Witmer did, Hall focused more on the administrators, teachers and parents of exceptional children He felt that psychology could make a contribution to the administrator system level of the application of school psychology. Hall created the child study movement, which helped to invent the concept of the “normal” child. Through Hall’s child study, he helped to work out the mappings of child development and focused on the nature and nurture debate of an individual’s deficit. Hall’s main focus of the movement was still the exceptional child despite the fact that he worked with atypical children.

Arnold Gesell

Bridging the gap between the child study movement, clinical psychology and special education, Arnold Gesell, was the first person in the United States to officially hold the title of school psychologist, Arnold Gesell. He successfully combined psychology and education by evaluating children and making recommendations for special teaching. Arnold Gesell paved the way for future school psychologists.

Gertrude Hildreth

Gertrude Hildreth was a psychologist with the Lincoln School at Teacher’s College, Columbia then at Brooklyn College in New York. She authored many books including the first book pertaining to school psychology titled, “Psychological Service for School Problems” written in 1930. The book discussed applying the science of psychology to address the perceived problems in schools. The main focus of the book was on applied educational psychology to improve learning outcomes. Hildreth listed 11 problems that can be solved by applying psychological techniques, including: instructional problems in the classroom, assessment of achievement, interpretation of test results, instructional groupings of students for optimal outcomes, vocational guidance, curriculum development, and investigations of exceptional pupils. Hildreth emphasized the importance of collaboration with parents and teachers. She is also known for her development of the Metropolitan Readiness Tests and for her contribution to the Metropolitan Achievement test. In 1933 and 1939 Hildreth published a bibliography of Mental Tests and Rating Scales encompassing a 50-year time period and over 4,000 titles. She wrote approximately 200 articles and bulletins and had an international reputation for her work in education.

Issues Related to School Psychology

Intervention

One of the primary roles and responsibilities of school psychologists working in schools is to ensure the interventions they utilise effectively address students’ behaviour problems. Issues arise when school psychologists do not select interventions with sufficient research-based evidence in being effective for the individual with whom they are working. School psychologists, as researchers and practitioners, can make important contributions to the development and implementation of scientifically based intervention and prevention programmes to address learning and behavioural needs of students (National Association of School Psychologists (NASP).

There is a concern with implementing academic and behavioural interventions prior to the determination for special education services, and it has also been proposed that MTSS (Multi-Tiered Systems of Support) may address these concerns. The National Association of School Psychologists (NASP) recognises the need for evidence-based prevention and intervention practices to address student learning, social emotional development, behavioural performance, instructional methodology, school practices, classroom management, and other areas salient to school-based services and improving student outcomes (National Association of School Psychologists (NASP). Intervention and prevention research needs to address a range of questions related not only to efficacy and effectiveness, but also to:

  • Feasibility given resources (e.g. time, money, staffing);
  • Acceptability (e.g. teacher, student, and community attitudes toward intervention strategies);
  • Social validity (the relevance of targeted outcomes to everyday life of students);
  • Integrity or fidelity (the extent to which individuals responsible for implementing an intervention can do so as intended by its designers); and
  • Sustainability (extent to which school staff can maintain the intervention over time, without support from external agents).

A specific example of an intervention that has recently become popular among school psychologists is the School-wide Positive Behavioural Interventions and Supports (PBIS). Authorised under IDEA, the PBIS offers a “preventative, positive, and systemic framework or approach to affect educational and behavioural change” and can be used in the support of Tiers 1-3 in the education system. Research from single-case design studies and group studies demonstrates that the intervention can result in a reduction of major disciplinary infractions and aggressive behaviour, improvement in academic achievement, an increase in prosocial behaviour, a reduction in bullying behaviour reported by teachers, and much more. Through consistent and strong implementation fidelity, PBIS can provide school psychologists opportunities to assist the administration, teaching staff, and students in broad and specific ways.

Prevention

A way in which school psychologists can help students is by creating primary prevention programmes. Information about prevention should also be connected to current events in the community.

Issues with Assessment Process

Empirical evidence has not confirmed biases in referral, assessment, or identification; however, inferences have been made that the special education process may be oversimplified. The National Research Council has called attention to the questionable reliability of educational decision making in special education as there can be vast numbers of false positives and/or false negatives. Misidentified students in special education is problematic and can contribute to long term negative outcomes.

During the identification process, school psychologists must consider ecological factors and environmental context such as socioeconomic status. Socioeconomic status may limit funding and materials, impact curriculum quality, increase teacher-to-student ratios, and perpetuate a negative school climate.

Technological Issues

With the ever growing use of technology, school psychologists are faced with several issues, both ethical and within the populations they try to serve. As it is so easy to share and communicate over technology, concerns are raised as to just how easy it is for outsiders to get access to the private information that school psychologists deal with everyday. Thus exchanging and storing information digitally may come under scrutiny if precautions such as password protecting documents and specifically limiting access within school systems to personal files.

Then there is the issue of how students communicate using this technology. There are both concerns on how to address these virtual communications and on how appropriate it is to access them. Concerns on where the line can be drawn on where intervention methods end and invasion of privacy begin are raised by students, parents, administrators, and faculty. Addressing these behaviours becomes even more complicated when considering the current methods of treatment for problematic behaviours, and implementation of these strategies can become complex, if not impossible, within the use of technology.

To incorporate topics in a school, utilise lesson plans for students and staff because the teachers need to ensure the content is connected to other meaningful topics covered in the class/school.

Racial Disproportionality in Special Education

Disproportionality refers to a group’s under or overrepresentation in comparison to other groups within a certain context. In the field of school psychology, disproportionality of minority students in special education is a concern. Special Education Disproportionality has been defined as the relationship between one’s membership to a specific group and the probability of being placed in a specific disability category. Systemic prejudice is believed by some to be one of the root causes of the mischaracterisation of minority children as being disabled or problematic.

“Research on disproportionality in the U.S. context has posited two overlapping types of rationales: those who believed disproportionate representation is linked to poverty and health outcomes versus those who believed in the systemwide racist practices that contributed to over-representation of minority students.”

The United States Congress recently received an annual report on the implementation of IDEA which stated that proportionally Native Americans (14.09%) and African Americans (12.61%) were the two most highly represented racial groups within the realm of special education. In particular, African American males have been overidentified as having emotional disturbances and intellectual disabilities. They account for 21% of the special education population with emotional disturbances and 12% with learning disabilities. American Indian and Alaska Native students are also overrepresented in special education. They are shown to be 1.53 times more likely to receive services for various learning disabilities and 2.89 more likely to obtain services targeting developmental delays than all other Non-Native American student groups combined.] Overall, Hispanic students are often overidentified for special education in general; however, it is common for them to be under-identified for Autism Spectrum Disorder and speech and language impairments in comparison to White students.

Minority populations often have an increased susceptibility to economic, social and cultural disadvantages that can affect academic achievement. According to the US Department of Education, “Black children were three times as likely to live in poor families as white children in 2015. 12 percent of white and Asian children lived in poor families, compared with 36 percent of black children, 30 percent of Hispanic children, 33 percent of American Indian children, and 19 percent of others.” There may be other alternative explanations for behaviour and academic performance as well. For example, Black children are twice as likely as Whites to experience heightened levels of lead in the blood due to prolonged lead exposure. Lead poisoning can be known to affect a child’s behaviour by increasing their levels of irritability, hyperactivity, and inattentiveness even in less severe cases.

Cultural Biases

Some school psychologists realise the need to understand and accept their own cultural beliefs and values in order to understand the impact it may have when delivering services to clients and families. For example, these school psychologists ensure that students who are minorities, including African Americans, Hispanics, Asians, and Native Americans are being equally represented at the system level, in the classroom, and receiving a fair education.

For staff, it is important to look at one’s own culture while seeing the value in diversity. It is also vital to learn how to adapt to diversity and integrate a comprehensive way to understand cultural knowledge. Staff members should keep the terms race, privilege, implicit bias, micro aggression, and cultural relevance in mind when thinking about social justice.

Services

Behaviour Interventions

School psychologists are involved in the implementation of academic, behavioural, and social/emotional interventions within a school across a continuum of supports. These systems and policies should convey clear behaviour expectations and promote consistency among educators. Continuous reinforcement of positive behaviours can yield extremely positive results. Schoolwide positive behaviour supports A systematic approach that proactively promotes constructive behaviours in a school can yield positive outcomes. These programs are designed to improve and support students’ social, behavioural, and learning outcomes by promoting a positive school climate and providing targeted training to students and educators within a school. Data should be collected consistently to assess implementation effectiveness, screen and monitor student behaviour, and develop or modify action plans.

Academic Interventions

Academic interventions can be conceptualised as a set of procedures and strategies designed to improve student performance with the intent of closing the gap between how a student is currently performing and the expectations of how they should be performing. Short term and long term interventions used within a problem-solving model must be evidence-based. This means the intervention strategies must have been evaluated by research that utilised rigorous data analysis and peer review procedures to determine the effectiveness. Implementing evidence-based interventions for behaviour and academic concerns requires significant training, skill development, and supervised practice. Linking assessment and intervention is critical for determining that the correct intervention has been chosen. School psychologists have been specifically trained to ensure that interventions are implemented with integrity to maximise positive outcomes for children in a school setting.

Systems-Level Services

Leaders in the field of school psychology recognise the practical challenges that school psychologists face when striving for systems-level change and have highlighted a more manageable domain within a systems-level approach – the classroom. Overall, it makes sense for school psychologists to devote considerable effort to monitoring and improving school and classroom-based performance for all children and youth because it has been shown to be an effective preventive approach.

Universal Screening

School psychologists play an important role in supporting youth mental wellness, but identifying youth who are in distress can be challenging. Some schools have implemented universal mental health screening programs to help school psychologists find and help struggling youth. For instance, schools in King County, Washington are using the Check Yourself digital screening tool designed by Seattle Children’s Hospital to measure, understand, and nurture individual students’ well-being. Check Yourself collects information about lifestyle, behaviour, and social determinants of health to identify at-risk youth so that school psychologists can intervene and direct youth to the services they need. Mental health screening provides school psychologists with valuable insights so that interventions are better fitted to student needs.

Crisis Intervention

Crisis intervention is an integral part of school psychology. School administrators view school psychologists as the school’s crisis intervention “experts”. Crisis events can significantly affect a student’s ability to learn and function effectively. Many school crisis response models suggest that a quick return to normal rituals and routines can be helpful in coping with crises. The primary goal of crisis interventions is to help crisis-exposed students return to their basic abilities of problem-solving so the student can return to their pre-crisis level of functioning.

Consultation

Consultation is done through a problem solving method that will help the consultee function more independently without the intensive support of a school psychologist.

Social Justice

The three major elements that comprise social justice include equity, fairness, and respect. The concept of social justice includes all individuals having equal access to opportunities and resources. A major component behind social justice is the idea of being culturally aware and sensitive. American Psychological Association (APA) and the National Association of School Psychologists (NASP) both have ethical principles and codes of conduct that present aspirational elements of social justice that school psychologists may abide by. Although ethical principles exist, there is federal legislation that acts accordingly to social justice. For example, the Elementary and Secondary Education Act of 1965 (ESEA) and the Individuals with Disabilities Education Improvement Act of 2004 (IDEA) address issues such as poverty and disability to promote the concept of social justice in schools.

Schools are becoming increasingly diverse with growing awareness of these differences. Cultural diversity factors that can be addressed through social justice practice include race/ethnicity, gender, socioeconomic status (SES), religion, and sexual orientation. With the various elements that can impact a student’s education and become a source of discrimination, there is a greater call for the practice of social justice in schools. School psychologists that consider the framework of social justice know that injustices that low SES students face can sometimes be different when compared to high SES students.

Advocacy

A major role of school psychologists involves advocating and speaking up for individuals as needed. Advocacy can be done at district, regional, state, or national level. School psychologists advocate for students, parents, and caregivers.

Consultation and collaboration are key components of school psychology and advocacy. There may be times when school personnel may not agree with the school psychologist. Differing opinions can be problematic because a school psychologist advocates for what is in the best interest of the student. School psychologists and staff members can help facilitate awareness through courageous conversations.

Multicultural Competence

School psychologists offer many types of services in order to be multiculturally competent. Multicultural competence extends to race, ethnicity, social class, gender, religion, sexual orientation, disability, age, and geographic region. Because the field of school psychology serves such a diverse range of students, maintaining representation for minority groups continues to be a priority. Despite such importance, history has seen an underrepresentation of culturally and linguistically diverse (CLD) school psychologists. which may appear alarming given that the diversity of our youth continues to increase exponentially. Thus, current professionals in the field have prioritised the acquisition of CLD school psychologists. School psychologists are trained to use their skills, knowledge, and professional practices in promoting diversity and advocating for services for all students, families, teachers, and schools. School psychologists may also work with teachers and educators to provide an integrated multicultural education classroom and curriculum that allows more students to be represented in learning. Efforts to increase multicultural perspectives among school psychologists have been on the rise to account for the increased diversity within schools. Such efforts include establishing opportunities for individuals representative of minority groups to become school psychologists and implementing a diverse array of CLD training programmes within the field.

Education

In order to become a school psychologist, one must first learn about school psychology by successfully completing a graduate-level training programme. A B.A. or B.S. is not sufficient.

United States

School psychology training programs are housed in university schools of education or departments of psychology. School psychology programmes require courses, practica, and internships.

Degree Requirements

Specific degree requirements vary across training programmes. School psychology training programs offer masters-level (M.A., M.S., M.Ed.), specialist-level degrees (Ed.S., Psy.S., SSP, CAGS), and doctoral-level degrees (Ph.D., Psy.D. or Ed.D.) degrees. Regardless of degree title, a supervised internship is the defining feature of graduate-level training that leads to certification to practice as a school psychologist.

Specialist-level training typically requires 3-4 years of graduate training including a 9-month (1200 hour) internship in a school setting.

Doctoral-level training programs typically require 5-7 years of graduate training. Requirements typically include more coursework in core psychology and professional psychology, more advanced statistics coursework, involvement in research endeavours, a doctoral dissertation, and a one-year (1500+ hour) internship (which may be in a school or other settings such as clinics or hospitals).

In the past, a master’s degree was considered the standard for practice in schools. As of 2017, the specialist-level degree is considered the entry-level degree in school psychology. Masters-level degrees in school psychology may lead to obtaining related credentials (such as Educational Diagnostician, School Psychological Examiner, School Psychometrist) in one or two states.

International

In the UK, the similar practice and study of School Psychology is more often termed Educational Psychology and requires a doctorate (in Educational Psychology) which then enables individuals to register and subsequently practice as a licensed educational psychologist.

Employment in the United States

In the United States, job prospects in school psychology are excellent. Across all disciplines of psychology, the abundance of opportunities is considered among the best for both specialist and doctoral level practitioners. They mostly work in schools. Other settings include clinics, hospitals, correctional facilities, universities, and independent practice.

Demographic Information

According to the NASP Research Committee, 74% of school psychologists are female with an average age of 46. In 2004-2005, average earnings for school practitioners ranged from $56,262 for those with a 180-day annual contract to $68,764 for school psychologists with a 220-day contract. In 2009-2010, average earnings for school practitioners ranged from $64,168 for those with a 180-day annual contract to $71,320 for school psychologists with a 200-day contract. For university faculty in school psychology, the salary estimate is $77,801.

Based on surveys performed by NASP in 2009-2010, it is shown that 90.7% of school psychologists are white, while minority races make up the remaining 9.3%. Of this remaining percentage, the next largest populations represented in school psychology, are African-Americans and Hispanics, at 3% and 3.4% respectively.

Shortages in the Field

There is a lack of trained school psychologists within the field. While jobs are available across the country, there are just not enough people to fill them.

Due to the low supply and high demand of school psychologists, being a school psychologist is very demanding. School psychologists may feel under pressure to supply adequate mental health and intervention services to the students in their care. Burnout is a risk of being a school psychologist.

Bilingual School Psychologists

Approximately 21% of school-age children ages 5-7 speak a language other than English. For this reason, there is an enormous demand for bilingual school psychologists in the United States. The National Association of School Psychologists (NASP) does not currently offer bilingual certification in the field. However, there are a number of professional training opportunities that bilingual LSSPs/School Psychologists can attend in order to prepare to adequately administer assessments. In addition, there are 7 NASP-Approved school psychology programs that offer a bilingual specialisation:

  • Brooklyn College-City University of New York- Specialist Level.
  • Gallaudet University- Specialist Level.
  • Queens College-City University of New York- Specialist Level.
  • San Diego State University- Specialist Level.
  • Texas State University- Specialist Level.
  • University of Colorado Denver- Doctoral Level.
  • Fordham University- Lincoln Centre – Doctoral Level.

New York and Illinois are the only two states that offer a bilingual credential for school psychologists.

International School Psychology

The role of a school psychologist in the United States and Canada may differ considerably from the role of a school psychologist elsewhere. Especially in the United States, the role of school psychologist has been closely linked to public law for education of students with disabilities. In most other nations, this is not the case. Despite this difference, many of the basic functions of a school psychologist, such as consultation, intervention, and assessment are shared by most school psychologists worldwide.

It is difficult to estimate the number of school psychologists worldwide. Recent surveys indicate there may be around 76,000 to 87,000 school psychologists practicing in 48 countries, including 32,300 in the United States and 3,500 in Canada. Following the United States, Turkey has the next largest estimated number of school psychologists (11,327), followed by Spain (3,600), and then both Canada and Japan (3,500 each).

Credentialing

In order to work as a school psychologist, one must first meet the state requirements. In most states (excluding Texas and Hawaii), a state education agency credentials school psychologists for practice in the schools.

The Nationally Certified School Psychologist (NCSP) credential offered by the National Association of School Psychologists (NASP). The NCSP credential is an example of a non-practice credential as holding the NCSP does not make one eligible to provide services without first meeting the state requirements to work as a school psychologist.

State psychology boards (which may go by different names in each state) also offer credentials for school psychologists in some states. For example, Texas offers the LSSP credential which permits licensees to deliver school psychological services within public and private schools.

Subspecialisations

  • Paediatric School Psychology.
  • Systems Level Consultation.
  • School Based Mental Health.
  • Behavioural School Psychology.

Professional Organisations in the United States

  • National Association of School Psychologists.
  • American Psychological Association.

Journals

  • Psychology in the Schools.
  • School Psychology Quarterly.
  • School Psychology Review.
  • School Psychology Forum: Research in Practice.
  • School Psychology International.
  • Canadian Journal of School Psychology.
  • International Journal of School & Educational Psychology.
  • Journal of Psychoeducational Assessment.

What is Child Psychoanalysis?

Introduction

Child psychoanalysis is a sub-field of psychoanalysis which was founded by Anna Freud.

Freud used the work of her father Sigmund Freud with certain modifications directed towards the needs of children. Since its inception, child psychoanalysis has grown into a well-known therapeutic technique for children and adolescents.

Brief History

For many years, the work of Sigmund Freud was considered revolutionary in his creation of psychotherapy, or talk therapy, and his theories regarding childhood experiences affecting a person later in life. His legacy was continued by his daughter Anna Freud in her pursuit of psychotherapy and her fathers theories as applied to children and adolescents.

In 1941, Anna help found the Hampstead Nursery in London and there she treated children for several years until it was shut down in 1945. Anna, with the help of Kate Friedlaender, soon opened the Hampstead Child Therapy Course and Clinic to continue her work and to continue sheltering homeless children. Anna was the director of the clinic from 1952 until her death in 1982. The clinic was renamed the Anna Freud Centre following her death as a memorial for the care and support she provided to hundreds of children over the decades.

Much of Anna’s published papers and books reference her work at the Hampstead Nursery and Clinic. Some of her more famous books are “The Ego and Defense Mechanisms”, which explored what defence mechanisms are and how they are used by adolescents, and “Normality and Pathology in Childhood” (1965), which directly summarizes her work at the Hampstead Clinic and other facilities. In fact, it was her work at the Nursery and the Clinic which allowed Anna to perfect her techniques and establish a therapy specifically designed for improving child and adolescent mental health.

Techniques

Anna’s first task in developing a successful therapy for children was to take Sigmund’s original theory regarding the psycho-social stages of development and create a timeline by which to grade normal growth and development. Using this line, a therapist would be able to observe a child and know whether they were progressing as other children or not. If a certain aspect of development lagged, such as personal hygiene or eating habits, the therapist could then assume that some trauma had occurred and could then address it directly through therapy.

Once a child was in therapy, techniques had to continue to change. Foremost, Anna knew that she could not expect to create situations of transference with the children as her father had done with his adult patients. The parents of a child in psychotherapy are typically still very active in their lives. Even when children were being housed at the Clinic, Anna encouraged mothers to visit frequently to ensure a stable attachment was formed between parent and child. In fact, one of the most important features of child psychotherapy is the active role parents play in their child’s therapy, knowing exactly what the therapist is doing, and their lives outside of therapy by helping the child implement the techniques taught by the therapist. So, to avoid becoming a replacement parent and avoid having the child view her as an authoritative adult, Anna did her best to take on the role of a caring and understanding adult figure. To this day, child psychotherapists aim to be viewed by the patient as a person analogous to a teacher.

The goal of any psychotherapist is for the patient to find comfort in their stable presence and eventually have no issue with speaking whatever comes to their mind. With children, this involves a high frequency of visits with the child, possibly even daily sessions. Anna also saw child’s play as their way of adapting to reality and confronting problems they faced in their real lives. For this reason, therapy sessions are intended to suspend the rules of reality and allow the child to play and speak whatever they want. This play allows therapists to see where the child’s traumas lie and help the child overcome these traumas. However, Anna also realised that children’s play does not reveal some unconscious revelation. Children, unlike adults, have not yet repressed events or learned how to cover up their true emotions. Often, in therapy what a child says is what a child means. This differed greatly from the original practices of psychotherapy that often had to decode meaning out of the patient’s words.

Newest Developments

In recent years there has been a shift in analytic technique for severely disturbed or traumatised children from a conflict- and insight-oriented approach to a focused, mentalisation-oriented therapy. Furthermore, the importance of parent work in the context of child psychoanalysis has been emphasized. Short-term psychoanalytic therapy which combines focus oriented techniques in the psychoanalytic work with the child with focused parent work has been shown to be effective especially in children with anxiety disorders and depressive comorbidity.

What is Child and Adolescent Psychiatry?

Introduction

Child and adolescent psychiatry (or paediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families.

It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the paediatric population.

Brief History

When psychiatrists and paediatricians first began to recognise and discuss childhood psychiatric disorders in the 19th century, they were largely influenced by literary works of the Victorian era. Authors like the Brontë sisters, George Eliot, and Charles Dickens, introduced new ways of thinking about the child mind and the potential influence early childhood experiences could have on child development and the subsequent adult mind. When the Journal of Psychological Medicine and Mental Pathology, the first psychiatric journal in English, was published in 1848, child psychiatry didn’t exist as its own field yet. However, some of the earliest works on the possibility of nervous disorders and “insanity” in children were published in the Journal and several medical writers directly referenced works such as Jane Eyre (1847), Wuthering Heights (1847), Dombey and Son (1848), and David Copperfield (1850), to illustrate this new conceptualisation of the child mind. Until that time, it was generally accepted that children were free from nervous disorders and the “passions” that affected the adult mind.

As early as 1899, the term “child psychiatry” (in French) was used as a subtitle in Manheimer’s monograph Les Troubles Mentaux de l’Enfance. However, the Swiss psychiatrist Moritz Tramer (1882-1963) was probably the first to define the parameters of child psychiatry in terms of diagnosis, treatment, and prognosis within the discipline of medicine, in 1933. In 1934, Tramer founded the Zeitschrift für Kinderpsychiatrie (Journal of Child Psychiatry), which later became Acta Paedopsychiatria. The first academic child psychiatry department in the world was founded in 1930 by Leo Kanner (1894-1981), an Austrian émigré and medical graduate of the University of Berlin, under the direction of Adolf Meyer at the Johns Hopkins Hospital in Baltimore. Kanner was the very first physician to be identified as a child psychiatrist in the US and his textbook, Child Psychiatry (1935), is credited with introducing both the specialty and the term to the anglophone academic community. In 1936, Kanner established the first formal elective course in child psychiatry at the Johns Hopkins Hospital. In 1944 he provided the first clinical description of early infantile autism, otherwise known as Kanner Syndrome.

Maria Montessori together with It:Giuseppe Ferruccio Montesano and Clodomiro Bonfigli, two distinguished child psychiatrists, created in 1901 in Italy the “Lega Nazionale per la Protezione del Fanciullo” (National League for the Protection of Children). She gradually developed her own pedagogic method, initially based on the “intuition that the question of the ‘mentally deficient’ was more pedagogic than medical”. In 1909, Jane Addams and her female colleagues established the Juvenile Psychopathic Institute (JPI) in Chicago, later renamed as the Institute for Juvenile Research (IJR), the world’s first child guidance clinic. Neurologist William Healy, M.D., its first director, was charged with not only studying the delinquent’s biological aspects of brain functioning and IQ, but also the delinquent’s social factors, attitudes, and motivations, thus it was the birthplace of American child psychiatry.

From its establishment in February 1923, the Maudsley Hospital, a South London-based postgraduate teaching and research psychiatric hospital, contained a small children’s department. Similar overall early developments took place in many other countries during the late 1920s and 1930s. In the United States, child and adolescent psychiatry was established as a recognised medical speciality in 1953 with the founding of the American Academy of Child Psychiatry, but was not established as a legitimate, board-certifiable medical speciality until 1959.

The use of medication in the treatment of children also began in the 1930s, when Charles Bradley opened a neuropsychiatric unit and was the first to use amphetamine for brain-damaged and hyperactive children. But it was not until the 1960s that the first NIH grant to study paediatric psychopharmacology was awarded. It went to one of Kanner’s students, Leon Eisenberg, the second director of the division.

The discipline has relatively flourished since the 1980s, in large part, because of contributions made in the 1970s, even if the outcomes for patients have been disappointing at times. It was a decade during which child psychiatry witnessed a major evolution as a result of the work carried out by, Eva Frommer, Douglas Haldane, Michael Rutter, Robin Skynner and Sula Wolff, among others. The first comprehensive population survey of 9- to 11-year-olds, carried out in London and the Isle of Wight, which appeared in 1970, addressed questions that have continued to be of importance for child psychiatry; for example, rates of psychiatric disorders, the role of intellectual development and physical impairment, and specific concern for potential social influences on children’s adjustment. This work was influential, especially since the investigators demonstrated specific continuities of psychopathology over time, and the influence of social and contextual factors in children’s mental health, in their subsequent re-evaluation of the original cohort of children. These studies described the prevalence of ADHD (relatively low as compared to the US), identified the onset and prevalence of depression in mid-adolescence and the frequent co-morbidity with conduct disorder, and explored the relationship between various mental disorders and scholastic achievement.

It was paralleled similarly by work on the epidemiology of autism that was to enormously increase the number of children diagnosed with autism in future years. Although attention had been given in the 1960s and ’70s to the classification of childhood psychiatric disorders, and some issues had then been delineated, such as the distinction between neurotic and conduct disorders, the nomenclature did not parallel the growing clinical knowledge. It was claimed that this situation was altered in the late 1970s with the development of the DSM-III system of classification, although research has shown that this system of classification has problems of validity and reliability. Since then, the DSM-IV and DSM-IVR have altered some of the parsing of psychiatric disorders into “childhood” and “adult” disorders, on the basis that while many psychiatric disorders are not diagnosed until adulthood, they may present in childhood or adolescence (DSM-IV). The American Psychiatric Association’s DSM is now on its fifth edition (DSM-5).

People in the field are sometimes referred to as “neurodevelopmentalists”. As of 2005 there was debate in the field as to whether “neurodevelopmentalist” should be made a new speciality.

In terms of patient outcomes, there is evidence that, in the United Kingdom at least on the 70th anniversary of the NHS, mental health remains a medical “Cinderella” (low priority) and the more so Child and Adolescent Health services which have been through repeated reorganisations and underinvestment all of which leads to disruption and loss of adequate provision.

“Modern neuroscience, genetics, epigenetics, and public health research has presented the tantalizing possibility that it can now be said with relative certainty that much (certainly not all) is understood about why some children struggle and others soar. Although it is an oversimplification, it can now be suggested that it is possible to understand how environmental factors, both negative and positive, influence the genome or epigenome, which in turn influence the structure and function of the brain and thus human thoughts, actions, and behaviors.”

Classification of Disorders

Not an exhaustive list:

  • Developmental disorders:
    • Autism spectrum disorder.
    • Learning disorders.
  • Disorders of attention and behaviour:
    • Attention deficit hyperactivity disorder.
    • Oppositional defiant disorder.
    • Conduct disorder.
  • Psychotic disorders:
    • Childhood schizophrenia.
  • Mood disorders:
    • Major depressive disorder.
    • Bipolar disorder.
    • Persistent Depressive Disorder.
    • Disruptive Mood Dysregulation Disorder.
  • Anxiety disorders:
    • Panic disorder.
    • Phobias.
  • Eating disorders:
    • Anorexia nervosa.
    • Bulimia nervosa.
  • Gender identity disorder:
    • Gender identity disorder in children.

Disorders are often comorbid. For example, an adolescent can be diagnosed with both major depressive disorder and generalised anxiety disorder. The incidence of psychiatric comorbidities during adolescence may vary by race, ethnicity and socioeconomic status, among other variables.

Clinical Practice

Assessment

The psychiatric assessment of a child or adolescent starts with obtaining a psychiatric history by interviewing the young person and their parents or caregivers. The assessment includes a detailed exploration of the current concerns about the child’s emotional or behavioural problems, the child’s physical health and development, history of parental care (including possible abuse and neglect), family relationships and history of parental mental illness. It is regarded as desirable to obtain information from multiple sources (for example both parents, or a parent and a grandparent) as informants may give widely differing accounts of the child’s problems. Collateral information is usually obtained from the child’s school with regards to academic performance, peer relationships, and behaviour in the school environment.

Psychiatric assessment always includes a mental state examination of the child or adolescent which consists of a careful behavioural observation and a first-hand account of the young person’s subjective experiences. The assessment also includes an observation of the interactions within the family, especially the interactions between the child and his/her parents.

The assessment may be supplemented by the use of behaviour or symptom rating scales such as the Achenbach Child Behaviour Checklist or CBCL, the Behavioural Assessment System for Children or BASC, Connors Rating Scales (used for diagnosis of ADHD), Millon Adolescent Clinical Inventory or MACI, and the Strengths and Difficulties Questionnaire or SDQ. These instruments bring a degree of objectivity and consistency to the clinical assessment. More specialised psychometric testing may be carried out by a psychologist, for example using the Wechsler Intelligence Scale for Children, to detect intellectual impairment or other cognitive problems which may be contributing to the child’s difficulties.

Diagnosis and Formulation

The child and adolescent psychiatrist makes a diagnosis based on the pattern of behaviour and emotional symptoms, using a standardized set of diagnostic criteria such as the Diagnostic and Statistical Manual (DSM-IV-TR) or the International Classification of Diseases (ICD-10). While the DSM system is widely used, it may not adequately take into account social, cultural and contextual factors and it has been suggested that an individualized clinical formulation may be more useful. A case formulation is standard practice for child and adolescent psychiatrists and can be defined as a process of integrating and summarising all the relevant factors implicated in the development of the patient’s problem, including biological, psychological, social and cultural perspectives (the “biopsychosocial model”). The applicability of DSM diagnoses have also been questioned with regard to the assessment of very young children: it is argued that very young children are developing too rapidly to be adequately described by a fixed diagnosis, and furthermore that a diagnosis unhelpfully locates the problem within the child when the parent-child relationship is a more appropriate focus of assessment.

The child and adolescent psychiatrist then designs a treatment plan which considers all the components and discusses these recommendations with the child or adolescent and family.

Treatment

Treatment will usually involve one or more of the following elements: behaviour therapy, cognitive behaviour therapy (CBT), problem-solving therapies, psychodynamic therapy, parent training programmes, family therapy, and/or the use of medication. The intervention can also include consultation with paediatricians, primary care physicians or professionals from schools, juvenile courts, social agencies or other community organisations.

In a review of existing meta-analyses and disorders on the four most frequent childhood and adolescent psychiatric disorders (anxiety disorder, depression, ADHD, conduct disorder), only for ADHD was the use of medication (stimulants) considered to be the most efficacious treatment option available. For the remaining three disorders, psychotherapy is recommended as the most effective treatment of choice. A combination of psychological and pharmacological treatments is an important option in ADHD and depressive disorders. Treatments for ADHD and anxiety disorders produce higher effect-sizes than do interventions for depressive and conduct disorders.

Training

In the United States, Child and adolescent psychiatric training requires 4 years of medical school, at least 4 years of approved residency training in medicine, neurology, and general psychiatry with adults, and 2 years of additional specialised training in psychiatric work with children, adolescents, and their families in an accredited residency in child and adolescent psychiatry. Child and adolescent sub-speciality training is similar in other Western countries (such as the UK, New Zealand, and Australia), in that trainees must generally demonstrate competency in general adult psychiatry prior to commencing sub-speciality training.

Certification and Continuing Education

In the US, having completed the child and adolescent psychiatry residency, the child and adolescent psychiatrist is eligible to take the additional certification examination in the subspecialty of child and adolescent psychiatry from the American Board of Psychiatry and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP). Although the ABPN and AOBNP examinations are not required for practice, they are a further assurance that the child and adolescent psychiatrist with these certifications can be expected to diagnose and treat all psychiatric conditions in patients of any age competently. Training requirements are listed on the web site of The American Academy of Child & Adolescent Psychiatry.

Shortage of Child and Adolescent Psychiatrists in the United States

The demand for child and adolescent psychiatrists continues to far outstrip the supply worldwide. There is also a severe maldistribution of child and adolescent psychiatrists, especially in rural and poor, urban areas where access is significantly reduced. As of 2016, there are 7991 child and adolescent psychiatrists in the United States. A report by the US Bureau of Health Professions (2000) projected a need by the year 2020 for 12,624 child and adolescent psychiatrists, but a supply of only 8,312. In its 1998 report, the Centre for Mental Health Services estimated that 9-13% of 9- to 17-year-olds had serious emotional disturbances, and 5-9% had extreme functional impairments. In 1999, however, the Surgeon General reported that “there is a dearth of child psychiatrists.” Only 20% of emotionally disturbed children and adolescents received any mental health treatment, a small percentage of which was performed by child and adolescent psychiatrists. Furthermore, the US Bureau of Health Professions projects that the demand for child and adolescent psychiatry services will increase by 100% between 1995 and 2020.

Cross-Cultural Considerations

Steady growth in migration of immigrants to higher-income regions and countries has contributed to the growth and interest in cross-cultural psychiatry. Families of immigrants whose child has a psychiatric illness must come to understand the disorder while navigating an unfamiliar health care system.

Criticisms

Subjective Diagnoses

One criticism against psychiatry is that psychiatric diagnoses lack complete “objectivity,” particularly when compared with diagnoses in other medical specialties. However, for several major psychiatric disorders interrater reliability, which shows the degree to which psychiatrists agree on the diagnosis, is generally similar to those in other medical specialties. In 2013, Allen Frances said that “psychiatric diagnosis still relies exclusively on fallible subjective judgements rather than objective biological tests.”

Traditional deficit and disease models of child psychiatry have been criticised as rooted in the medical model which conceptualises adjustment problems in terms of disease states. It is said by these critics that these normative models explicitly characterise problematic behaviour as representing a disorder within the child or young person and these commentators assert that the role of environmental influences on behaviour has become increasingly neglected, leading to a decrease in the popularity of, for example, family therapy. There are criticisms of the medical model approach from within and without the psychiatric profession: it is said to neglect the role of environmental, family, and cultural influences, to discount the psychological meaning of behaviour and symptoms, to promote a view of the “patient” as dependent and needing to be cured or cared for and therefore undermines a sense of personal responsibility for conduct and behaviour, to promote a normative conception based on adaptation to the norms of society (the ill person must adapt to society), and to be based on the shaky foundations of reliance on a classificatory system that has been shown to have problems of validity and reliability.

Prescription of Psychotropic Medications

Since the late 1990s, use of psychiatric medication has become increasingly common for children and adolescents. In 2004 the US Food and Drug Administration (FDA) issued the Black Box Warning on antidepressant prescriptions to alert patients of a research link between use of medication and apparent increased risk of suicidal thoughts, hostility, and agitation in paediatric patients. The most common diagnoses for which children receive psychiatric medication are ADHD, ODD, and conduct disorder.

Some research suggests that children and adolescents are sometimes given antipsychotic drugs as a first-line treatment for mental health problems or behavioural issues other than a psychotic disorder. In the United States, the usage of these drugs in young people has greatly increased since 2000, especially among children from low-income families. More research is needed to specifically assess the efficacy and tolerability of antipsychotic medications in paediatric populations. Because of the risk of metabolic syndrome and cardiovascular events with long-term antipsychotic use, use in paediatric populations is highly scrutinized and recommended in combination with psychotherapy and effective parent-training interventions.

Electroconvulsive Therapy

In 1947, child neuropsychiatrist Lauretta Bender published a study on 98 children aged between four and eleven years old who had been treated in the previous five years with intensive courses of electroconvulsive therapy (ECT). These children received ECT daily for a typical course of approximately twenty treatments. This formed part of an experimental trend amongst a cadre of psychiatrists to explore the therapeutic impact of intensive regimes of ECT, which is also known as either regressive ECT or annihilation therapy. In the 1950s Bender abandoned ECT as a therapeutic practice for the treatment of children. In the same decade the results of her published work on the use of ECT in children was discredited after a study showing that the condition of the children so treated had either not improved or deteriorated. Commenting on his experience as part of Bender’s therapeutic program, Ted Chabasinski said that, “It really made a mess of me … I went from being a shy kid who read a lot to a terrified kid who cried all the time.” Following his treatment, he spent ten years as an inmate of Rockland State Hospital, a psychiatric facility now known as the Rockland Psychiatric Centre.

On This Day … 14 April

People (Deaths)

  • 2010 – Alice Miller, Polish-French psychologist and author (b. 1923).

Alice Miller

Alice Miller, born as Alicija Englard (12 January 1923 to 14 April 2010), was a Polish-Swiss psychologist, psychoanalyst and philosopher of Jewish origin, who is noted for her books on parental child abuse, translated into several languages. She was also a noted public intellectual.

Her book The Drama of the Gifted Child caused a sensation and became an international bestseller upon the English publication in 1981. Her views on the consequences of child abuse became highly influential. In her books she departed from psychoanalysis, charging it with being similar to the poisonous pedagogies.

Life

Miller was born in Piotrków Trybunalski, Poland into a Jewish family. She was the oldest daughter of Gutta and Meylech Englard and had a sister, Irena, who was five years younger. From 1931 to 1933 the family lived in Berlin, where nine-year-old Alicija learned the German language. Due to the National Socialists’ seizure of power in Germany in 1933 the family turned back to Piotrków Trybunalski. As a young woman, Miller managed to escape the Jewish Ghetto in Piotrków Trybunalski, where all Jewish inhabitants were interned since October 1939, and survived World War II in Warsaw under the assumed name of Alicja Rostowska. While she was able to smuggle her mother and sister out, in 1941, her father died in the ghetto.

She retained her assumed name Alice Rostovska when she moved to Switzerland in 1946, where she had won a scholarship to the University of Basel.

In 1949 she married Swiss sociologist Andreas Miller, originally a Polish Catholic, with whom she had moved from Poland to Switzerland as students. They divorced in 1973. They had two children, Martin (born 1950) and Julika (born 1956). Shortly after his mother’s death Martin Miller stated in an interview with Der Spiegel that he had been beaten by his authoritarian father during his childhood – in the presence of his mother. Miller first stated that his mother intervened, but later that she did not intervene. These events happened decades before Alice Miller’s awakening about the dangers of such childrearing methods. Martin also mentioned that his mother was unable to talk with him, despite numerous lengthy conversations, about her wartime experiences, as she was severely burdened by them.

In 1953 Miller gained her doctorate in philosophy, psychology and sociology. Between 1953 and 1960, Miller studied psychoanalysis and practiced it between 1960 and 1980 in Zürich.

In 1980, after having worked as a psychoanalyst and an analyst trainer for 20 years, Miller “stopped practicing and teaching psychoanalysis in order to explore childhood systematically.” She became critical of both Sigmund Freud and Carl Jung. Her first three books originated from research she took upon herself as a response to what she felt were major blind spots in her field. However, by the time her fourth book was published, she no longer believed that psychoanalysis was viable in any respect.

In 1985 Miller wrote about the research from her time as a psychoanalyst: “For twenty years I observed people denying their childhood traumas, idealising their parents and resisting the truth about their childhood by any means.” In 1985 she left Switzerland and moved to Saint-Rémy-de-Provence in Southern France.

In 1986, she was awarded the Janusz Korczak Literary Award for her book Thou Shalt Not Be Aware: Society’s Betrayal of the Child.

In April 1987 Miller announced in an interview with the German magazine Psychologie Heute (Psychology Today) her rejection of psychoanalysis. The following year she cancelled her memberships in both the Swiss Psychoanalytic Society and the International Psychoanalytic Association, because she felt that psychoanalytic theory and practice made it impossible for former victims of child abuse to recognise the violations inflicted on them and to resolve the consequences of the abuse, as they “remained in the old tradition of blaming the child and protecting the parents”.

One of Miller’s last books, Bilder meines Lebens (“Pictures of My Life”), was published in 2006. It is an informal autobiography in which the writer explores her emotional process from painful childhood, through the development of her theories and later insights, told via the display and discussion of 66 of her original paintings, painted in the years 1973-2005.

Between 2005 and her death in 2010, she answered hundreds of readers’ letters on her website, where there are also published articles, flyers and interviews in three languages. Days before her death Alice Miller wrote: “These letters will stay as an important witness also after my death under my copyright”.

Miller died on 14 April 2010, at the age of 87, at her home in Saint-Rémy-de-Provence by suicide after severe illness and diagnosis of advanced stage of pancreatic cancer.

Work

Miller extended the trauma model to include all forms of child abuse, including those that were commonly accepted (such as spanking), which she called poisonous pedagogy, a non-literal translation of Katharina Rutschky’s Schwarze Pädagogik (black or dark pedagogy/imprinting).

Drawing upon the work of psychohistory, Miller analysed writers Virginia Woolf, Franz Kafka and others to find links between their childhood traumas and the course and outcome of their lives.

The introduction of Miller’s first book, The Drama of the Gifted Child, first published in 1979, contains a line that summarises her core views:

Experience has taught us that we have only one enduring weapon in our struggle against mental illness: the emotional discovery and emotional acceptance of the truth in the individual and unique history of our childhood.

In the 1990s, Miller strongly supported a new method developed by Konrad Stettbacher, who himself was later charged with incidents of sexual abuse. Miller came to know about Stettbacher and his method from a book by Mariella Mehr titled Steinzeit (Stone Age). Having been strongly impressed by the book, Miller contacted Mehr in order to get the name of the therapist. From that time forward, Miller refused to make therapist or method recommendations. In open letters, Miller explained her decision and how she originally became Stettbacher’s disciple, but in the end she distanced herself from him and his regressive therapies.

In her writings, Miller is careful to clarify that by “abuse” she does not only mean physical violence or sexual abuse, she is also concerned with psychological abuse perpetrated by one or both parents on their child; this is difficult to identify and deal with because the abused person is likely to conceal it from themselves and may not be aware of it until some event, or the onset of depression, requires it to be treated. Miller blamed psychologically abusive parents for the majority of neuroses and psychoses. She maintained that all instances of mental illness, addiction, crime and cultism were ultimately caused by suppressed rage and pain as a result of subconscious childhood trauma that was not resolved emotionally, assisted by a helper, which she came to term an “enlightened witness.” In all cultures, “sparing the parents is our supreme law,” wrote Miller. Even psychiatrists, psychoanalysts and clinical psychologists were unconsciously afraid to blame parents for the mental disorders of their clients, she contended. According to Miller, mental health professionals were also creatures of the poisonous pedagogy internalised in their own childhood. This explained why the Commandment “Honour thy parents” was one of the main targets in Miller’s school of psychology.

Miller called electroconvulsive therapy “a campaign against the act of remembering”. In her book Abbruch der Schweigemauer (The Demolition of Silence), she also criticised psychotherapists’ advice to clients to forgive their abusive parents, arguing that this could only hinder recovery through remembering and feeling childhood pain. It was her contention that the majority of therapists fear this truth and that they work under the influence of interpretations culled from both Western and Oriental religions, which preach forgiveness by the once-mistreated child. She believed that forgiveness did not resolve hatred, but covered it in a dangerous way in the grown adult: displacement on scapegoats, as she discussed in her psycho-biographies of Adolf Hitler and Jürgen Bartsch, both of whom she described as having suffered severe parental abuse.

A common denominator in Miller’s writings is her explanation of why human beings prefer not to know about their own victimisation during childhood: to avoid unbearable pain. She believed that the unconscious command of the individual, not to be aware of how he or she was treated in childhood, led to displacement: the irresistible drive to repeat abusive parenting in the next generation of children or direct unconsciously the unresolved trauma against others (war, terrorism, delinquency), or against him or herself (eating disorders, drug addiction, depression).

The Roots of Violence

According to Alice Miller, worldwide violence has its roots in the fact that children are beaten all over the world, especially during their first years of life, when their brains become structured. She said that the damage caused by this practice is devastating, but unfortunately hardly noticed by society. She argued that as children are forbidden to defend themselves against the violence inflicted on them, they must suppress the natural reactions like rage and fear, and they discharge these strong emotions later as adults against their own children or whole peoples: “child abuse like beating and humiliating not only produces unhappy and confused children, not only destructive teenagers and abusive parents, but thus also a confused, irrationally functioning society”. Miller stated that only through becoming aware of this dynamic can we break the chain of violence.

Book: Avoiding Anxiety in Autistic Children: A Guide for Autistic Wellbeing

Book Title:

Avoiding Anxiety in Autistic Children: A Guide for Autistic Wellbeing.

Author(s): Luke Beardon.

Year: 2020.

Edition: First (1st)

Publisher: Sheldon Press.

Type(s): Paperback and Kindle.

Synopsis:

One of the biggest challenges for the parent of any autistic child is how best to support and guide them through the situations in life which might cause them greater stress, anxiety and worry than if they were neurotypical.

Dr Luke Beardon has put together an optimistic, upbeat and readable guide that will be essential reading for any parent to an autistic child, whether they are of preschool age or teenagers. Emphasising that autism is not behaviour, but at the same time acknowledging that there are risks of increased anxiety specific to autism, this practical book gives insight into the nature of the anxiety experienced by autistic people, as well as covering every likely situation in which your child might feel anxious or worried. It will help you to prepare your child for school, to monitor their anxiety around school, and also to be informed about the educational choices available to your child. It will give you support to help make breaktimes less stressful for them and how to help them navigate things like eating at school and out of the house.

Educationally, this book will take you and your child right up to the point of taking exams and leaving school; socially and emotionally it will cover all the challenges from bullying, friendships, relationships, puberty and sex education. It will give suggestions for alternatives in the scenarios that might cause anxiety or confusion in your child; it will also give a full understanding of your child’s sensory responses and such behaviours as masking, or echopraxia.

As the parent of an autistic child, you may find their path to adulthood different to the one you had expected to take, but as this book makes clear, autism should be celebrated and affirmed. Avoiding Anxiety in Autistic Children helps you to do just that, with practical strategies that will help happiness, not anxiety, remain the over-riding emotion that colours your child’s memories of their early years.

Book: A Straight-talking Introduction to Children’s Mental Health Problems

Book Title:

A Straight-talking Introduction to Children’s Mental Health Problems (Straight Talking Introductions).

Author(s): Sami Timimi (Author), Richard Bentall (Editor), and Pete Sanders (Editor).

Year: 2009.

Edition: First (1st).

Publisher: PCCS Books.

Type(s): Paperback and Kindle.

Synopsis:

Rates of diagnosis of psychiatric disorders such as ADHD, and the subsequent prescription of psychiatric drugs in children, have increased alarmingly over recent years. Yet diagnoses are supported by very little scientific evidence and the effectiveness and safety of drugs for children is highly questionable. Unlike medications, psychotherapeutic or ‘talking therapies’ with children, adolescents and their families have established themselves as both safe and effective. Here, Sami Timimi arms you with some of the information you’ll need to make informed choices about a child’s diagnosis and treatment. He provides an honest account of the dangers of medicating children or adolescents and discusses alternative therapies. He also describes practical advice on things parents can try themselves, common pitfalls to avoid, and how to find the professionals you need.

Book: A Practical Guide to Mental Health Problems in Children with Autistic Spectrum Disorder

Book Title:

A Practical Guide to Mental Health Problems in Children with Autistic Spectrum Disorder: It’s Not Just Their Autism!.

Author(s): Alvina Ali, Michelle O’Reilly, and Khalid Karim.

Year: 2013.

Edition: First (1st).

Publisher: Jessica Kingsley Publishers.

Type(s): Paperback and Kindle.

Synopsis:

Exploring the relationship between ASD and mental health difficulties, this book offers practical guidance to help parents and professionals recognise and handle co-morbid conditions, and dispels the myth that they are just a part of autism. The authors cover a wide range of common mental health problems experienced by children with ASD, including Obsessive Compulsive Disorder (OCD), anxiety, ADHD, eating disorders, psychosis, stress, tics and depression, and illustrate these issues with case studies. They also provide vital advice in an accessible format and suggest strategies to ease the difficulties which arise from these co-morbid conditions. This book is essential reading for professionals working with children on the autism spectrum and is an accessible and practical resource for parents and carers.

Book: Listen Mama

Book Title:

Listen Mama.

Author(s): MSP Williams.

Year: 2021.

Edition: First (1st).

Publisher: Bowker.

Type(s): Paperback and Kindle.

Synopsis:

Through a series of letters at times heart-breaking, poetic, and unexpectedly humorous, come explore this true teen and young adult journey of a lost soul searching for the love of his mentally ill mother. While facing seemingly insurmountable odds, Manny ultimately becomes her caretaker and guardian while also parenting his four younger siblings in 1990’s Houston, Texas.

Witness his transformation in this coming-of-age story of a forgotten and disfigured black child, born into spirit-crushing poverty, and thrust into adult life all too soon. Manny’s teen years are spent battling the silent and treacherous enemy of mental illness in his mother’s erratic and terrifying behavior. Years of bullying and abuse finally take their toll, and Manny soon finds himself at war with his own demons of depression, anxiety, and suicide attempts as he struggles to find his place in the world, and the true meaning of unconditional love.

Experience this inspirational story of loss, faith, love, and redemption that is guaranteed to bring forth both tears and laughter, heartache and happiness, as it captures your imagination, ignites your soul, and soon has you racing from page to page, breathlessly waiting to discover what happens.

Book: Gut and Psychology Syndrome

Book Title:

Gut and Psychology Syndrome: Natural Treatment for Autism, Dyspraxia, A.D.D., Dyslexia, A.D.H.D., Depression, Schizophrenia.

Author(s): Natasha Campbell-McBride.

Year: 2010.

Edition: First (1st), Revised and Enlarged Edition.

Publisher: Medinform Publishing.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Dr. Natasha Campbell-McBride set up The Cambridge Nutrition Clinic in 1998. As a parent of a child diagnosed with learning disabilities, she is acutely aware of the difficulties facing other parents like her, and she has devoted much of her time to helping these families. She realised that nutrition played a critical role in helping children and adults to overcome their disabilities, and has pioneered the use of probiotics in this field. Her willingness to share her knowledge has resulted in her contributing to many publications, as well as presenting at numerous seminars and conferences on the subjects of learning disabilities and digestive disorders. Her book Gut and Psychology Syndrome captures her experience and knowledge, incorporating her most recent work. She believes that the link between learning disabilities, the food and drink that we take, and the condition of our digestive system is absolute, and the results of her work have supported her position on this subject. In her clinic, parents discuss all aspects of their child’s condition, confident in the knowledge that they are not only talking to a professional but to a parent who has lived their experience. Her deep understanding of the challenges they face puts her advice in a class of its own.

Book: Right from the Start – A Practical Guide for Helping Young Children with Autism

Book Title:

Right from the Start – A Practical Guide for Helping Young Children with Autism.

Author(s): Karin Donahue and Kate Crassons.

Year: 2019.

Edition: First (1st), Illustrated Edition.

Publisher: Rowman & Littlefield Publishers.

Type(s): Hardcover and Kindle.

Synopsis:

Right from the Start: A Practical Guide for Helping Young Children with Autism asserts that autistic children can be successful when parents and teachers understand key principles of autism and have the tools to help these children expand their social and emotional skills. This book explains the importance of self-regulation, the ability to moderate our feelings and reactions. In prioritising this essential skill, Right from the Start is an indispensable resource for parents, professionals, and educators. It describes practical strategies to help children manage their emotions and behaviour, learn social and play skills, and cope with challenging sensory experiences. With these techniques, we can lay a positive foundation that enables autistic children to be confident and successful in any environment.