Clinical Child and Adolescent Studies: Concepts, Theories and Challenges
Chapter 1: Introduction
Introduction:
Prof-ed is short for a professional in education and refers to university trained professionals serving the
education, learning, development and health of children and adolescents, as well as functionally impaired
persons who depend on prof-eds’ help beyond adolescence.
Prof-eds’ sensitivity to social values:
The prof-ed seeks opportunities to optimize the development and health of clients. Clients are children and
older persons who in a community are considered to function cognitively and emotionally as if they were
children. Health is used as a super standard and defined as a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity. However, the notions of health and optimizing health
need to be substantiated in specific communities. This substantiation may vary between cultures or
communities, depending on social norms.
Norms and their abidance (=naleving) may come about using their power of tradition and social rules
as to who is allowed to reinforce particular traditions. Prof-eds tend to warrant some space for traditions as a
source for substantiating what health is. For example, a prof-ed may support the practice of Afro-Caribbean
mothers to put soap on the infant’s foot against the influence of bad spirits. Prof-eds don’t oppose the
practices, not because they favour them, but because they are aware that the prof-ed’s acceptance of such
traditional interventions may be conducive to the clients’ acceptance of more modern, evidence-based
interventions.
Next to the force of traditions and religion, prof-eds tend to use communities of consensus as a source
of substantiation of the definition of health. Whereas traditions refer to rules that evolved in the past,
consensus refers to rules or agreements that have a more recent status, emerging in the present that allows to
see the actual engagement and discussion of persons and groups involved. There are three different consensus
strategies:
1. Community is directly involved in defining what is a proper intervention or what is desired behaviour.
In this approach the social network is invited to meet and talk about what to do to optimize the
education of the client to achieve better social adjustment or healthier behaviour
2. Prof-ed uses legislation combined with a notion of what are common measures of health optimization
in their community as indicators of consensus. An example of a common measure in NL is that children
under 10 years old are not left alone at home and shouldn’t have to look after themselves.
3. The scientific community is used as a referent to consensus. An influential example is the DSM
A cultural-historical approach to educational challenges:
Vygotsky suggests that challenges met by prof-eds should always be defined and approached from the
perspective that society isn’t capable or willing to invest in finding ways to equip functionally impaired persons
with the tools needed for conquering or compensating for the functional impairment. Other scholars think this
is a nonsensical approach to always blame the environment. According to Vygotsky, children and adults who
are incapable of understanding and regulating a functional impairment and its consequences can’t be held
responsible for it. Vygotsky voices a call to take up the challenges and help and continue to seek ways to
alleviate the plight of clients in needs. Prof-eds analyse what type of support tools their clients need, whether
these are available or need to be developed, and how they can be put to use most effectively. Hence, prof-eds
not just use instruments available, they also develop and validate instruments for diagnostics, interventions,
and models of implementation.
The use of interpersonal relationships and tools is central to the way scholars in the cultural-historical
approach explain normative developmental processes as well as developmental psychopathology. They also
use these tools for preventing and remedying. Prof-eds primarily use interpersonal relationships and non-
invasive tools to optimize well-being and development. However, if something is wrong with the physiological
or neurological functioning, they will seek to address this with interventions that try to induce a form of social
or socialized regulation of the physical or biological challenges and the physiological consequences.
,Iatrogenic effects:
What clinicians do, may sometimes be detrimental to clients’ health and well-being. Such negative
consequences of pedagogical, clinical acting are referred to as iatrogenic effects. These are likely to occur when
prof-eds wilfully or unconsciously contribute to a client’s suboptimal functioning or problematic well-being.
Many incidences reported to and evaluated by the inspectorate of the Dutch youth care are about youth care
and foster care institutions that don’t succeed in providing a caring, warm and stimulating setting in which the
clients feel safe and secure, and in which prof-eds collaborate to warrant positive development.
When client come to a prof-ed they are in a diagnostic process which specifies the nature, seriousness
and intensity of the problems that trouble the client and its social environment. The outcome is a label which is
important for justifying particular treatments or support and warrant financial compensation for the costs
involved. The extra facilities and tools are meant to improve a client’s opportunities for social participation or
development. However, these good intentions are not always realized. Sometimes the label and associated
treatments are without much thought brought together and the process starts. However, it would be
preferable to have a close look at particular dysfunctional processes of the individual and what causes them.
Reactive pathogenic effects:
Labelling may also lead to referral to a special school and as such set children apart, with the consequence of a
higher risk of evading, bullying or rejecting a labelled child. Also, labels may make children’s characteristics
more salient, which may make adults feel ashamed and take measure that are meant to shelter the children
from other people’s negativity. These effects are reactive pathogenic effects which are negative effects that are
due to reactions by others to a clinical treatment or diagnoses and labels that are the consequence.
Facilitative pathogenic effects:
Facilitative pathogenic effects are directly related to diagnostics and treatments that are flawed, invalid or
ineffective. When diagnostics are invalid or incorrect this is likely to result in the prescription of an unsuitable
intervention, a delay of the start of support, or an adequate intervention.
Contagion effects:
Contagion effects refer to the interpersonal transmittance of particular characteristics. These characteristics
can be either positive or negative, but the notion of contagion is predominantly used when negatively valued
characteristics are at stake. Contagion effects increase when children or adolescents characterized by either
externalizing or internalizing problems are brought together for their treatment and live together. Such
treatments may have short term positive effects, but in the long run lead to more problems because the peers
spread and reinforce the negative characteristics amongst each other.
Restriction of learning opportunities:
Restriction of learning opportunities is at stake when children either on instigation of or with the approval of a
prof-ed are restrained from partaking in activities that are important for children’s development and well-
being. After registration and intake in schools for physically or mentally handicapped children, these schools
have to make sure that they define for each student a perspective of development. A committee of experts
evaluates each perspective as well as a road map on how the school and possibly other institutions will make
sure the developmental perspective is realized. During this task, three groups may be distinguished:
1. Students who have a well-planned, analysed and formulated developmental perspective and plan as
to how it will be achieved
2. Students for whom no developmental perspective or plan has been formulated. These students are
approached as a group that just needs a shelter environment and simple activities to do, but have little
possibilities to develop competencies that would allow them to fulfil a socially valued task.
3. Students who have a perspective and plan certified by a committee, but for whom the realization of
the plan hast to be postponed time and again, because they are waiting for or take part in an
intervention.
Both in the second and third group students’ opportunities for learning are restricted.
, Prof-eds at work: opportunities, restraints and responsibilities
Jantzen contends that in the educational field, professionals prefer to play safe and take up less responsibility
when the request for help becomes more complicated. How to make sure that prof eds can effectively handle
complicated professional challenges? Educational institutions make the judicial aspect of their functioning
salient and manageable by developing and using protocols. Protocols are systems of rules that explain the
correct conduct and procedures to be followed in particular situations. They specify what quality criteria have
to be met and what professional efforts are warranted in specified educationally challenging situations. They
also specify how professionals are supposed to act in order to avoid liability claims against either the
professional or institution represented.
Delegated authority and anticipation of approval:
Delegation of responsibility ends for most children in the Netherlands when they reach the age of 18 years.
Exceptions are made for severely handicapped persons and for criminals. They do have the right of self-
determination and personal integrity, but the basic notion is that persons are closely engaged when it comes to
decisions about perspective for their own development and treatments or interventions needed for realizing
these perspectives. This same legislature specifies the restrictions of this right to self-determination with
respect to persons of whom is evident or likely that they are insufficiently capable of evaluating the quality of a
perspective for development or to oversee and weight the risks involved in efforts to realize it.
Chapter 2: Classical theories
What are psychodynamic theories?:
Psychodynamic theories state that all human behaviour is rooted in biological drives or needs. Freud used
sexual drives as the common reference point in most of his attempts to develop a theory of human
development. Central was his distinction of erogenous zones or bodily regions of pleasure like the mouth, anus,
penis or clitoris/vagina. Each zone plays a central role in structuring a child’s development defining the oral,
anal and phallic stage. In the oral stage the mouth is the domain of pleasure, e.g. breastfeeding. The anal stage
is characterized by a fascination for playing with poop and confrontations with educators who try to avoid this
and who push towards child’s control of the bowel function. The phallic stage is when children start to touch
their own private parts, and when the Oedipus (for boys) and Elektra (for girls) complex needs to be resolved.
After that, children enter the latent stage which is a time of relative tranquillity and in this stage the big divide
of sexes takes place, so boys prefer to play with boys and girls prefer to play with girls. When puberty arrives
children enter the genital stage. Freud stated that someone’s personality consists of three components:
1. Id = collection of innate drives and needs. Society wants children to control their id.
2. Ego = thinking processes, monitoring, planning and regulation of behaviours for drive control of the id.
It is a navigation pane with two navigation strategies:
Displacement = process of loosening drive accomplishment or need satisfaction from its
original target to a new, socially more acceptable and accessible target.
*e.g. breast pacifier chewing gum
Sublimation = comparable process to displacement but it changes not just the target but also
the process. So if a person has a strong drive he/she delays its satisfaction by using it to
develop competence and activity space allowing to maintain some of the exciting/positive
qualities of the urge but manifesting it in socially acceptable activities.
* e.g. strong drive for sexual engagement conduct research and writing about the
development of human sexual behaviour
3. Superego = collection of social norms, rules and customs, acquired and personalized into a person’s
conscience
Repression is another important mechanism and is the consequence of the working of the ego and superego to
make sure that information or sensations that are unacceptable to the ego become or remain unconscious or
subliminal. Repression is hardly susceptible to self-regulation or personal steering. The superego initially helps
the ego to repress manifestations and fantasies and eventually succeeds to move all memories of it beyond the
ego.
Findings:
Psychodynamic clinicians seek to find the source of pathology in the first three stages, so in early childhood.
