SPPY 109

POSTGRADUATE COURSE
M.Sc. - Psychology

FIRST YEAR
SECOND SEMESTER

CORE PAPER - VIII

GUIDANCE AND COUNSELLING - I

INSTITUTE OF DISTANCE EDUCATION

UNIVERSITY OF MADRAS
M.Sc. Psychology CORE PAPER - VIII
FIRST YEAR - SECOND SEMESTER GUIDANCE AND COUNSELLING - I

WELCOME
Warm Greetings.

It is with a great pleasure to welcome you as a student of Institute of Distance

Education, University of Madras. It is a proud moment for the Institute of distance education
as you are entering into a cafeteria system of learning process as envisaged by the University
Grants Commission. Yes, we have framed and introduced Choice Based Credit
System(CBCS) in Semester pattern from the academic year 2018-19. You are free to
choose courses, as per the Regulations, to attain the target of total number of credits set
for each course and also each degree programme. What is a credit? To earn one credit in
a semester you have to spend 30 hours of learning process. Each course has a weightage
in terms of credits. Credits are assigned by taking into account of its level of subject content.
For instance, if one particular course or paper has 4 credits then you have to spend 120
hours of self-learning in a semester. You are advised to plan the strategy to devote hours of
self-study in the learning process. You will be assessed periodically by means of tests,
assignments and quizzes either in class room or laboratory or field work. In the case of PG
(UG), Continuous Internal Assessment for 20(25) percentage and End Semester University
Examination for 80 (75) percentage of the maximum score for a course / paper. The theory
paper in the end semester examination will bring out your various skills: namely basic
knowledge about subject, memory recall, application, analysis, comprehension and
descriptive writing. We will always have in mind while training you in conducting experiments,
analyzing the performance during laboratory work, and observing the outcomes to bring
out the truth from the experiment, and we measure these skills in the end semester
examination. You will be guided by well experienced faculty.

I invite you to join the CBCS in Semester System to gain rich knowledge leisurely at
your will and wish. Choose the right courses at right times so as to erect your flag of
success. We always encourage and enlighten to excel and empower. We are the cross
bearers to make you a torch bearer to have a bright future.

With best wishes from mind and heart,

DIRECTOR i/c

(i)
M.Sc. Psychology CORE PAPER - VIII
FIRST YEAR - SECOND SEMESTER GUIDANCE AND COUNSELLING - I

COURSE WRITERS

Dr. U. Vijayabanu, M.A., M.Phil, Ph.D, PGDBA

Guest Faculty
Department of Counselling Psychology
University of Madras
Chennai

EDITING & COORDINATION

Dr. S. THENMOZHI, M.A., Ph.D.,

Professor
Department of Psychology
Institute of Distance Education
University of Madras
Chennnai - 5.

Dr. S. Thenmozhi
Associate Professor
Department of Psychology
Institute of Distance Education
University of Madras
Chepauk Chennnai - 600 005.

© UNIVERSITY OF MADRAS, CHENNAI 600 005.

(ii)
 M.A. DEGREE COURSE

FIRST YEAR

SECOND SEMESTER

Core Paper - VIII

GUIDANCE AND COUNSELLING - I

SYLLABUS

Course Objective: To introduce the students to an introductory knowledge about the

theory, techniques and content of Guidance and Counselling

UNIT I

Nature and Scope Of Guidance: Concept and Definition of Guidance and Counseling,
Guidance and Life Goals, the Counselling Vocation, The Phases of the Counselling Process
(Assessment, Intervention, and Termination) , Characteristics of an Effective Counsellor,
Personal challenges as a Counsellor.

UNIT II

Stages of Human Development and Areas Of Guidance: Characteristics of Different Stages

of Development (Physical, Cognitive, Emotional, Social, and Moral), Problems of Childhood,
Problems of Adolescence, Problems of Adulthood and the Aged, The Concept of Adjustment
and Adjustment at Different Stages of Life

UNIT III

The Client-Counsellor Relationship: The Counsellor as a Role Model, The Counsellor’s

Needs Counsellor Objectivity/Subjectivity, Emotional Involvement, Counselor Limits in
Practice.

Basic Counselling Skills : Observation Skills, Questioning, Communication Skills (Listening,

Feedback, Non-Verbal), Making Notes and Reflections, The Counselling Interview History
Taking, Interviewing (Characteristics, Types, Techniques),Developing Case Histories:
Collecting, Documenting Information, Working with Other Professionals.

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UNIT IV

Ethics in Counselling: Need for Ethical Standards, Ethical Codes and Guidelines. Rights of
Clients: Dimensions of Confidentiality, Dual Relationships in Counselling Practices, The
Counsellor’s Ethical and Legal Responsibilities, Ethical Issues in the Assessment Process.

UNIT V

Counselling Special Groups: Characteristics and Needs of Special Groups, Socially and
Economically Disadvantaged, Destitutes and Orphans, Delinquents, Drop-outs, Aids
Patients, Drug Addicts and Alcoholics, Suicide, Abuse Counselling. Identifying Support
Networks, Referral Processes.

Reference

Smith, E.J. (2016) Theories of Counselling and Psychotherapy: An Integrative Approach,

2nd Edition, Singapore, Sage Publications.
 M.A. DEGREE COURSE

FIRST YEAR

SECOND SEMESTER

Core Paper - VIII

GUIDANCE AND COUNSELLING - I

SCHEME OF LESSONS

Sl.No. Title Page

1 Guidance: Concept and Needs 1

2 Counselling: Concepts and Needs 12

3 Characteristics of Counsellors 28

4 Problem in Childhood 37

5 Developmental Disorder 52

6 Pervasive Developmental Disorder 69

7 Anxiety and Fears 85

8 Disruptive Disorder 105

9 Adolescent Problems 118

10 Old Age: Emotional, Social And Physical Problems 168

11 Counselling Skills 179

12 Method of Collection Data 194

13 Ethical Principles of Counseling 209

14 Counselling Special Group 228

15 Counselling School Drop Outs, Aids Patients, Drug

Addicts And Alcoholics, Suicide 248

16 Abuse Counselling and Referral 276

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LESSON 1
GUIDANCE: CONCEPT AND NEEDS
INTRODUCTION

Every human being comes across challenges and stress that must be faced. Sometimes,
we feel the need for assistance and support to manage the problems and find solutions.
Traditionally, in India, such support was readily and easily available through the family, particularly
the joint or extended family, and the strong social network. Besides these, moral and emotional
support was also available from teachers, friends and spiritual/ religious mentors. In the present,
particularly urban, context there is an increasing speed in the pace of life, fragmentation of
family and socio religious support systems, and competitiveness. All such factors have led to a
greater need for assistance to help individuals cope with their problems. Consequently, the field
of guidance and counselling has evolved into a professional area.

We are social beings and, so in some way or other we need help and guidance of others.
Mother, father, grand parents, teachers and other elders, home, school and society guide
youngsters for successful living. Due to explosion of knowledge, industrialization and changes
in socio-economic set up the need of professional guidance is felt in the present day society. In
this unit you will be familiarized with concept, principles, need of guidance and implications of
areas of guidance on global context.

1.1 Objectives

After going through this unit you will be able to:

 Define the meaning of guidance

 Describe the need for guidance

 State the principles of guidance

 Explain different areas of guidance

Plan of the study

1.1 Objectives

1.2 Meaning and Principles of Guidance

1.2.1 Meaning of Guidance

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1.2.2 Guidance and Education : Guidance and Counseling

1.2.3 Principles of Guidance

1.3 Need and Importance of Guidance

1.4 Scope of Guidance: Guidance Services

1.5 Implications of Areas of Guidance in Global Context.

1.5.1 Personal

1.5.2 Educational

1.5.3 Vocational

1.5.4 A vocational

1.5.5 Social

1.5.6 Moral

1.5.7 Health

1.5.8 Leisure-time

1.6 Summary

1.7 Key terms

Check your Progress

Model questions

1.2 MEANING AND PRINCIPLES OF GUIDANCE

1.2.1 Meaning of Guidance

Literally guidance means to direct‘, to point out‘, to show the path‘. It is the assistance or
help rendered by a more experienced person to a less experiences person to solve certain
major problems of the individual (less experienced) i.e. educational, vocational, personal etc.
Guidance is a concept as well as a process. As a concept guidance is concerned with the
optimal development of the individual. As a process guidance helps the individual in self
understanding (understanding one‘s strengths, limitations, and other resources) and in self-
direction (ability to solve problems, make choices and decision on one‘s own).
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1.2.2 Guidance and Education; Guidance and Counselling, Guidance and

Education

The aim of education is to achieve the fullest possible realization of possibilities inherent
in the individual. Education fosters all aspects of an individual‘s personality. Guidance is an
integral part of education and helps in achieving the goals of education. Guidance is quite
essential for the development of individual which is the main objective of education. The Education
Commission (EC-1964-66) observes ¯Guidance should be regarded as an integral part of
education and not as a special, psychological or social service which is peripheral to educational
purposes. It is ¯meant for all students not just for those who deviate from the norm in one
direction or the other . Jone, A.J., pointing out the relationship between guidance and education
observes, All guidance is education but some aspects of education are not guidance. Their
objectives are the same the development of the individual but methods used in education are
by no means the same as those used in guidance.

Guidance and Counseling : The terms guidance‘ and counselling‘ have been loosely or
interchangeably used. Guidance is a term which is broader than counseling and it includes
counseling as one of its services. Butter makes a logical separation of the counseling process
i.e. (i) adjustive and (ii) distibutive phase. In the adjustive phase, the emphasis is on social,
personal and emotional problems of the individual, in the distributive phase the focus is upon
educational, vocational and occupational problems. The distributive phase‘ can be most aptly
described as guidance‘ while the adjustive‘ phase can be considered as description of
counselling‘.

1.2.3 Principles of Guidance: Guidance is based upon the following

principles.

(i) Holistic development of individual : Guidance needs to be provided in the context of

total development of personality.

(ii) Recognition of individual differences and dignity: Each individual is different from every
other individual. Each individual is the combination of characteristics which provides uniqueness
to each person. Similarly human beings have an immense potential. The dignity of the individual
is supreme.

(iii) Acceptance of individual needs: Guidance is based upon individual needs i.e. freedom,
respect, dignity.
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(iv) The individual needs a continuous guidance process from early childhood throughout
adulthood.

(v) Guidance involves using skills to communicate love, regard, respect for others.

1.3 NEED AND IMPORTANCE OF GUIDANCE

Guidance is needed wherever there are problems. The need and importance of guidance
are as follows.

Self understanding and self direction: Guidance helps in understanding one‘s strength,
limitations and other resources. Guidance helps individual to develop ability to solve problems
and take decisions.

Optimum development of individual

Solving different problem of the individual

Academic growth and development

Vocational maturity, vocational choices and vocational adjustments

Social personal adjustment

Better family life

Good citizenship

For conservation and proper utilization of human resources

For national development

Guidance is helpful not only for student and teacher in an educational institution but also
to the parents ,administrators, planners and community members.

1.4 DIFFERENT SCHOOL GUIDANCE SERVICES

The school is expected to provide more than just teaching and instruction. A school
guidance programme includes all those activities other than instructional which are carried out
to render assistance to pupils in their educational, vocational, personal development and
adjustment. The fundamental aim of guidance programme being the maximum development of
the child, all guidance programme must be geared toward attainment of the goal. Guidance
services can assist the pupils in knowing themselves-their potentialities and limitations, making
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appropriate choices in educational, vocational and other fields. Some of the important guidance
services are;

The orientation services

Student inventory services

Career Information services

Counseling services

Group guidance services

Placement services

Research and evaluation services

1.5 IMPLICATIONS OF AREAS OF GUIDANCE IN GLOBAL CONTEXT

The students life is getting complex day by day. Students in the twenty-first century have
facing many perplex and difficult situations i.e. to make wise curricular and other curricular
choices, to acquire basic study skills for optimum achievement, adjustment with peers etc. In its
beginning guidance was concentrated on problems relating to vocations. It was largely concerned
with getting jobs for young people. Now guidance has gone for beyond this. It is now concerned
with the entire individual in all aspects. The areas of guidance are very vast. The following are
some of the important areas of guidance.

1.5.1 Personal

Students face many personal problems related to themselves, their parents and family,
friends and teachers, etc. They often have memories related to home or family which creates
feeling of disappointment in them. If their parents are expecting too much of them it leaves
them with a feeling of incompetence and insecurity leading poor self-concept and self esteem.
The objectives of personal guidance are to help the individual in his/her physical, emotional,
social, rural and spiritual development. The aims and objectives of personal guidance are :

To assist the individual in understanding himself/herself.

To assist the individual involving the personal problems.

To assist the individual in taking independent decisions and judgement.

To assist the individual to view the world and the social environment in right
perspective.
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To assist the individual in making sound adjustments to different problems confronted

in life.

Personal guidance is necessary at all stages of life. At the elementary school stage
opportunities should be given to students 6 for their self expression. Personal guidance at this
stage deals with the problems related to feeling of insecurity, social acceptance, discipline etc.
At the secondary stage, the students have more intricate personal problems. During the
secondary stage adolescent students due to peculiar physical, emotional and social developments
undergo noticeable changes in their attitude and behaviour. Personal guidance at this stage
should therefore focus on personal and social adjustment. Personal guidance at the tertiary
stage aims at helping them view life in relation to reality. The scope of personal guidance at this
stage is very wider.

1.5.2 Educational Guidance

If one closely examines the problems of young pupils in schools and colleges, one would
exactly realize the need of educational guidance. Educational problems head the needs of
students‘ problems. So education is an important guidance area. Educational guidance is related
to every aspect of education school / colleges, the curriculum, the methods of instruction, other
curricular activities, disciplines etc. Educational guidance is the assistance given to the individual
(i) to understand his/her potentialities (ii) have a clear cut idea of the different educational
opportunities and their requirements (iii) to make wise choices as regards to school, colleges,
the course : curricular and extra curricular. Some of the aims and objectives of educational
guidance are:

To assist the pupil to understand him/herself i.e. to understand his/her potentialities,

strength and limitations.

To help the child make educational plans consist with his/her abilities, interests and
goals.

To enable the student to know detail about the subject and courses offered.

To assist the student in making satisfactory progress in various school/ college

subjects.

To help the child to adjust with the schools, its rules, regulations, social life connected
with it.

To help the child in developing good study habits.

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To help the child to participate in out of class educational activities in which he can
develop leadership and other social qualities.

At the elementary stage guidance programme must help the children to make good
beginning, to plan intelligently, to get the best out of their education and prepare them for
secondary schools. Educational guidance needs to be used in diagnosing difficulties, in identifying
the special needs of children. At the secondary stage educational guidance should help the
pupils to understand themselves better, to understand different aspects of the school, to select
appropriate courses to get information about different educational opportunities, to develop
good study habits. The students should be helped to be acquainted with the vocational
implications of various school subjects. Educational guidance at the tertiary stages must oriented
students about purpose and scope of higher studies and helps them to stimulate their studies.
Each college/ university must have a guidance unit with due provision of guidance services.

1.5.3 Vocational Guidance

You know that bread and butter aims is one of the main aims of education. Due to
advancement in science and technology and consequent charges in industry and occupations
have been emerged. There are thousands of specialized jobs/ occupations. In this context,
there is a great need for vocational guidance. Vocational guidance is a process of assisting the
individual to choose an occupation, prepare for it, enter upon it and progress in it. It is concerned
primarily with helping individuals make decisions and choices involved in planning a future and
building a career. The purpose behind assisting the youth to choose, prepare, enter and progress
in a vocation is the optimum growth of the individual. Some of the aims and objectives of
vocational guidance are:

Assisting pupil to discover his/her own abilities and skills to feet them into general
requirements of the occupation under consideration.

Helping the individual to develop an attitude towards work that will dignify whatever type
of occupation s/he may wish to enter.

Assisting the individual to think critically about various types of occupations and to learn
a technique for analyzing information about vocations.

Assisting pupils to secure relevant information about the facilities offered by various
educational institutions engaging in vocational training.
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At the elementary stage, although no formal guidance programmes are needed, the
orientation to vocation can be initiated at this stage. At this stage some qualities and skills which
have grater vocational significance viz. love and respect for manual work (ii) training in use of
hands (iii) spirit of cooperative work (iii) sharing (vi) appreciation for all works (vii) good
interpersonal relationship are to be developed.

At the secondary stage vocational guidance should help the students to know themselves,
to know the world of work, to develop employment readiness to develop decision making rules.
At the higher education stages it should be more formal one. The objectives of guidance at this
stage are to help the students to get information about different career, training facilities,
apprenticeship etc.

1.5.4 Avocational Guidance

The individual student spends only a small portion of his time i.e. 4 t0 6 hours per day in
school. The rest of the time needs to be effectively managed and utilized by the child for his/her
progress and development. Avocational guidance helps the child to judiciously utilize the leisure
time. The other co-curricular activities play an important role in all-round development of the
child .But many parents, teachers and children put secondary importance to these activities.
The students need to be properly guided for effective participation in varied types of avocational
pursuits so that they are able to shape their interpersonal behavior in desirable direction and
widen their outlook.

1.5.5 Social Guidance

We are social animals. But social relationships constitute a problem area for most of the
students. School/educational institution is a miniature society and pupil from different socio-
economic status, linguistic and socio-cultural background read there.Students some time may
face problems in adjustment and social relationship. It is very important that the students to be
helped in acquiring in feeling of security and being accepted by the group;in developing social
relationship and in becoming tolerant towards others. This is the task of social guidance. Formally
social guidance can be given by educational institutions whereas informal guidance may be
provided by Family, religious institutions, Media etc.
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1.5.6 Moral Guidance

Moral values occupy an important place in our life.Some times due to influence of diverse
factors students tell lies and indulge in undesirable practices. Moral guidance helps in bringing
these students in to proper track and help in their all round development.

1.5.7 Health Guidance: Health is regarded as the wealth.Total health i.e. preventive and
curative is the goal of health guidance.The health guidance may be a cooperative effort of
Principal, Doctors, Counsellor/psychologist, Teachers, Students and parents. For promoting
preventive care the conditions of school hostel, canteen needs to be checked. Similarly health
education through formal classes and information is essential in school education stages. In
the present day the concern of health guidance also pertains to guidance in HIV/AIDs.

1.5.8 Leisure – time guidance : Guidance for leisure is basically a part of personal guidance.
the individual should know how to utilize his/her leisure time fruitfully. leisure generally refers to
free time a person at his disposal. leisure in modern time is available to those who are technically
trained and efficient. But, unfortunately most of us do not know how to utilize the leisure time.
That is why guidance for leisure is necessary. Leisure can be fruitfully utilized for two purposes.
First of all Leisure provides us time for personal development. One can increase his efficiency
by utilising his leisure time. The second use of leisure is that it helps the individual to be more
productive by getting the necessary rest and recreation. Jones divides leisure time activities
into four groups.

1. Escape activities

2. General culture or appreciation activities.

3. Creative activities and

4. Service activities

It has also been suggested that individuals should spend their leisure time in social welfare
activities. For professional growth are must take active interest in the professional society of his
profession.

Thus it is quite evident that guidance for leisure is extremely important in modern society
because it helps the individual to attain efficiency and become a useful member of the society.
Therefore, it has been suggested that in the school curriculum there should be provision for
teaching about various leisure time activities so that children will able to know about them.
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1.6 Summary

Guidance is a concept as well as a process. Guidance is different from education and

counseling. Guidance is based upon the principles of holistic development of individual,
recognition of individual differences and dignity and acceptance of individual needs. Guidance
is needed wherever there are problems. Guidance helps in optimum development of individual,
Solving different problem of the individual, Academic growth and development, Vocational
maturity, vocational choices and vocational adjustments, Social personal adjustment., Better
family life, for conservation and proper utilization of human resources, and national development.
Guidance is helpful not only for student and teacher in an educational institution but also to the
parents, administrators, planners and community members. A school guidance programme
includes all those activities other than instructional which are carried out to render assistance to
pupils in their educational, vocational, personal development and adjustment. The areas of
guidance are very vast. Some of the important areas of guidance are personal, educational,
vocational, avocational, health, social etc.

1.7 Key terms

Guidance: It is the assistance or help rendered by a more experienced person to a less

experiences person to solve certain major problems of the individual

Vocational Guidance: Vocational guidance is a process of assisting the individual to choose

an occupation, prepare for it, enter upon it and progress in it

Check your progress

Fill in
a) Literally guidance means ______________

b) ________________is an integral part of education

c) _____________, the emphasis on social, personal and emotional problems of the

individual

d) _____________________is related to every aspect of education school / colleges,

and the curriculum

e) Guidance helps in_______________ development of individual

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Answers
a) to direct b) Guidance c) adjustive phase d) Educational guidance e) optimum

Model Questions
Q.1 Define guidance

Q.2 Explain the relation between guidance & counseling.

Q.3 State the relation between guidance & Education.

Q.4 Why do we need guidance?

Q.5 What should be the principles of guidance?

Q.1 What are the different guidance services?

Q.2 Differentiate between vocational & a vocational guidance.

Q.3 Explain the use of leisure time guidance.

Q.4 Write short notes on :

a) Objectives of educational guidance.

b) Need of vocational guidance.

c) Orientation services.

d) Personal guidance

REFERENCES
Agrawal,R(2006) Educational,Vocational Guidance and Counselling,New Delhi,Sipra
Publication

Bhatnagar,A& Gupta,N(1999).Guidance and Counselling:A theoretical Approach(Ed),New

Delhi,Vikash Publishing House

Jones, A.J.(19510.Principles of Guidance and Pupil Personnel work,New Y ork,MiGraw

Hill Kochhar, S.K., (1985): Educational and Vocational Guidance in Secondary
Schools,New Delhi,Strling Publisher

NCERT (2008).Introduction to Guidance,Module -1,DEPFE,New Delhi

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LESSON - 2
COUNSELLING : CONCEPTS AND NEEDS
Introduction

You may reflect that when you last experienced a problem, if you wereable to speak
about it with someone whom you trusted, you felt better. Theperson whom you confided in may
have suggested certain steps to handlethe problem, which you may not have thought of.
Sometimes the listeneris able to guide you to look inwards and find solutions. In this
manner,sharing one’s troubles with a trusted person can help the individual feelmore capable of
facing a situation. This is because seeking guidance fromothers enables a person to examine
the situation from various perspectivesand find appropriate solutions.

You may have seen or heard of people facing different types of challengingsituations. A
friend may be upset with her poor grades in examinations, ayouth may be disturbed because
his parents often quarrel with each other,another person may be having difficulty with friends,
some one else mayhave financial problems. Many students on the threshold of college maybe
confused about choices to be made for further studies and such otherissues. They are perhaps
in situations which they are unable to deal withby themselves. Here they would benefit from
professional guidance andcounselling. These are processes that help people when they feel
that theyare in a challenging situation and cannot find a way to cope with it.

2.1 Learning Objective

 by the end of this lesson you will be able to

 to define what is counselling

 to know various definitions of counselling

 difference between guidance and counselling

 process of counselling

Plan of the study

2.0 Introduction

2.1 Objective

2.2 What is counselling

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2.3 Difference between guidance and counselling

2.4 Process in counselling

2.4.1 Hypothetical model in process of counselling

2.4.2 Stages in counselling session

2.4.3 Categories in diagnosis

2.4.4 Some practical suggestions for termination

2.5 Summary

2.6 Key terms

Check your progress

Model questions

2.2 What is Counselling?

Counselling is an interactive learning process in which the counsellor(sometimes termed

therapist), helps the counsellees (be they individuals,families, groups or institutions) to understand
the cause(s) of difficultiesand guides them to sort out issues and reach decisions. The approachin
counselling is holistic, addressing social, cultural, economic andemotional issues. Counselling
can be sought at any time in life, althoughmany people reach out only in times of change or
crisis. The qualifiedprofessional counsellor speaks with the counsellee in a way to help thatperson
solve a problem or helps to create conditions that will cause theperson to understand and
improve life circumstances.

Counselling may be concerned with addressing and resolving specificproblems, making

decisions, coping with crisis, improving relationshipsand developing personal awareness. It
also involves working withfeelings, thoughts, perceptions and conflicts. The overall aim is to
provide counsellees with opportunities to work in positive ways so as to live withessence of well
being as individuals and as members of the larger society.

Counselling has been defined in different ways by different authors. Shertzer Stone (1976)
have defined counselling as a learning process in which individuals learn about themselves,
their interpersonal relationships and behaviours that advance their personal development. In
the same vein, Dustin and George (1973) define counselling as a learning process designed to
increase adaptive behaviour and to decrease maladaptive behaviour. On his part, Perez (1965)
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sees counselling as an interactive process conjoining the counsellee who needs assistance
and the counsellor who is trained and educated to give this assistance. Through his
communication of feelings of respect, tolerance,spontaneity and warmth, the counselor initiates,
facilities and maintains the interactive process.

The American Guidance Services Inc. defines Counselling as the process in which an
experienced and trained person assists a second person to:

 understand himself and his opportunities.

 make appropriate adjustments and decisions in the light of his understanding.

 accepts the responsibility for the choice, and

 follow a course of action in harmony with his choice.

Lewis (1970:10) describes counselling as a process by which a troubled person (the

client) is helped to feel and behave in a more personally satisfying manner through interaction
which an involved person (the counsellor) who provides information and reactions which simulate
the client to develop behaviours which enable him to deal more effectively with himself and his
environment.

Thompson and Poppen (1972) define counselling as a person to person relationship in

which one person helps another to resolve an area of conflict that has not been hitherto resolved

Carl Rogers, founder of client-centred psychotherapy, views counselling as the process

by which the stricture of the self is relaxed in the safety of the client’s relationship with the
therapist, and previously denied experiences are perceived and then integrated into an altered
self. Gustad (1953) provides one of the most comprehensive definitions of counselling indicating
not only its scope but also its functions. In his view, counselling is a learning oriented process,
carried on in a simple, one to one social environment, in which the counsellor, professionally
competent in relevant psychological skills and knowledge seeks to assist the client, by method
appropriate to the latter’s needs and within the context of the total personnel programme, to
learn how to put such understanding into effect in relation to more clearly perceived, realistically
defined goals to the end that the client may become a happier and more productive member of
the society. Acareful study of the available literature shows that professional opinion is not
unanimous about the differences between guidance and counselling. Some writers such as
Shertzer and Stone (1976) argue that distinctions between the terms frequently tend to be
 15

artificial, forced or contrived and theoretical rather than qualitative and practical in nature hence
the terms should be used interchangeably. However, other writers such as Rao (1981) argue
that although the two terms are in most respects similar and appear to be two sides of the same
coin, subtle differences exist between them. The following are some of the differences often
cited by guidance workers.

2.3 Difference between Guidance and Counselling:

1. Guidance is an umbrella term which over a total school programme of activities and
services aimed at assisting pupils to make and carry out satisfactory adjustment in life. On the
other hand, counselling is one part of guidance services (the other being appraisal, placement,
follow up, orientation, information, referral, etc). In the words of Shertzer and Stone, counselling
is subsumed by the general term Guidance, in that it is one service within guidance rather than
a synonym.

2. Guidance is recommended for all students on a regular basis while counselling is for
only those who are experiencing continuing or temporary problems that information alone will
not resolve. Thus, counselling has a therapeutic function.

3. Guidance attempts to modify behaviours and attitudes through the provision of accurate
and usable data. Emphasis is on cognitive or intellective functioning. On the other hand,
counselling attempts to change attitudes and behaviours by emphasising affective involvement.

4. Another distinction often made between guidance and counselling is that while Guidance
is primarily targeted at an individual or ‘classroom size’ group with a potential for self direction
but having a need for information, the focus of counseling, on the other hand, is primarily
individual attention targeted at non-incapacitating problems related to a need for self
understanding.

5. Guidance presupposes direction, and casts the client-counsellor relation as prescriptive

and instructional with the counsellor as an authority figure, teacher and expert and the client as
helpless, dependent, docile and passive whereas counseling views the client-counselor
relationship as a ‘partnership that works’ with the client actively involved and taking responsibility
for his actions and decisions.

6. Guidance could be given by anybody (principal, teacher, priest, parent, trained school
counselor or any other school personnel) at any setting (school, market place, church, mosque,
16

etc) using any medium of communication. (audio visual, television, radio, bill board, etc). whereas
counseling can only be given by a trained counselor in a school or clinical setting on a face to
face relationship.

However, despite the above differences, the general purpose of guidance and counselling
are the same, which is, to effect a change in behaviour which permits the client to achieve
realization and self direction and to live a more productive, happier and satisfying life.

Others regard counselling as an element of guidance. It is the later definition that persists
today. Guidance is a generic helping strategy that encompasses a range of activities, of which
counselling is one. Unlike counselling, the other activities are based on the helper’s knowledge,
skills and experience in a particular area.

2.4 Process of counselling

The Counselling process refers to the totality of activities involved in a counseling situation
in which the counsellor gives to the client and to thecounselling situation in such a way that the
client can discover his own powers and achieve his own self-determination. The counsellor’s
main focus in a counselling process is the growth of his clients, but the realisation of that growth
lies primarily in the counsellor’s intense involvement in what is presently happening within the
private world of his clients and with the relationship which he seeks to establish with his clients
and with the relationship which he seeks to establish with his clients. In other words, it is not the
counsellor who seeks to change the client. It is the counsellor’s role is to aid such change not by
taking over directions for the client but by enabling him to clarify goals and feelings to the point
where he can confidently assume self-direction.

2.4.1 Hypothetical model in Counselling Process

1. The person comes for help: He may come of his own accord or because someone else
has suggested he should. In certain cases, he may even have been told to come; if this is the
case the counsellor needs to be fully aware of the fact if he is to cope effectively with the initial
hostility which such pressure may have generated.

2. The counsellor attempts to relate to the client: The nature of this relationship is of
crucial importance and if it goes wrong there will be little hope of achieving anything very
constructive. The regard for him as a person of unquestionable value – he must convey, too,
that he is willing for him to reveal his own feelings in his own way or, in other words, he must
 17

communicate his desire to help but not to control. Such acceptance is indicated by word, gesture,
posture – by the total response of the counsellor to his client. This is, however, difficult to
accomplish unless the counsellor actually likes his client but, without it little growth will take
place. It I happens, however, and the client does begin to experience that he is unconditionally
liked and respected there is hope that he will then be able to face himself in the counsellor’s
presence without the fear which operates so strongly against the birth of insight.

3. The helping situation is defined: It is important to structure the counselling relationship

at the outset by exploring what kind of help may be possible, what period of time is available,
what sort of goals (however vague initially) can be established. This does much to rid the
counsellor of an aura of omniscience which the client may have ascribed to him. Structuring the
counselling relationship in the context described above is highly relevant to the client since it
communicates to the client that there is a shared task ahead and that this will involve work and
effort on both their parts.

4. The counsellor encourages his client to give free expression to his concerns: It is at this
stage that the counsellor’s ability to empathise with the client needs to be communicated if
further progress is to be made. Unless the client feels that he is being relieved he will quickly
lose confidence in the process and become reluctant to commit himself to it. At this juncture the
counsellor’s ability to reflect feeling accurately and to respond at the right level will be crucial.

5. The counsellor accepts, recognises and helps to clarify negative feelings in the client:
It is vital that the counsellor does not seek to evade his client’s expression of fear, anger,
depression, doubt or whatever it may be. Negative feelings need to be faced and vague
reassurance at this stage can be positively harmful; nor must they be cut short before they have
been fully expressed. Clearly, it is often painful to listen to a person denigrating himself or
spelling out in endured if authentic growth is to take place later. It is usually the case that only
when negative feelings have been fully explored can faint and hesitant expressions of positive
impulses be voiced.

6. The counselor accepts and recognises positive feelings. In other words the counsellor’s
behavior will indicate an understanding totally devoid of judgment. To call a person good can be
just as threatening as to call him bad for it leaves the counsellor in the position of power, able to
grant or to withhold approval at will.
18

7. Development of insight: With a lessening of fear and anxiety , insight should now be
developing and the counsellor, by his responses, will try to aid the growth of self-acceptance
which is the vital concomitant of awareness if behaviour change is to occur.

8. Establishing of new goals: With the development of more self-acceptance there will
come an increased clarification of needs which will lead to the tentative establishment of new
goals and objectives. It is possible at this point that the counsellor’s role may take on a more
directive or didactive flavour for the client may set up for himself goals which require for their
attainment certain forms of expertise or information which the counsellor possesses. Obvious
examples might be guidance in achieving more effective study skills or authoritative information
about an occupational area.

9. Growth of confidence and an ability to take decisions: At this point the client will be
initiating small but significant actions and will need the counsellor’s reinforcement and support.
The counselor will be alert now for the moment when counselling sessions should terminate.

It is perhaps worth remarking that with some clients’ stages 7, 8 and 9 may well be
reversed. For many insight does indeed lead to the establishment of new goals and the
development of new behaviours, but there are others for whom insight only follows in retrospect.
Such clients need to gain confidence by successfully adopting more appropriate forms of
behaviour before they can come to a clearer understanding of their overall needs.

10. No more need for help: Ending a counseling relationship is not always be easy and
the counsellor must beware of breaking off the process prematurely. Usually, however, the
client himself will take the initiative, thereby giving further proof of his desire to exercise his
new-found autonomy (Adapted from Newsome et al 1973).

While this model may have presented an idea of the process which can and does occur,
it is necessary to point out that in some cases the development may be very rapid while in
others each step forward will painfully drag especially if the client is not willing to “open-up”.

2.4.2 The Stages of a Counselling Session

The Counselling session could be divided into five stages. The first stage referred to as
referral takes place before actual contact with the counsellor, yet it is often considered an
integral part of the counselling process. The stages as shown in Figure 1 include referral,
diagnosis, treatment, termination and follow-up.
 19

Referral in the context of counselling process has a bi-modal ‘meaning. First, it refers to
the process by which a client is brought into contact with the counsellor. Referral of clients to a
counsellor could be from the family, from teachers, from medical doctors, from bosses, form
other helping agencies such as hospitals, churches, prisons remand homes or other counsellors.
It could also be self-referral in which the client ‘of his own accord seeks assistance from a
counsellor. These various sources of referral have implications for the counselling process
itself. Referral in the context described above is the first stage of counselling session. The
second context in which referral is used implies the sending away of a client to more appropriate
helpers whose expertise best suits the needs of the client. Referral in this context can take
place at any stage of a counseling session, but it would be most suitable after diagnosis.

The underlying assumption in referral is that a counsellor may not be the best available
counsellor for every client or every type of problem, and this may become apparent at any
stage of counselling for a particular client. Some counsellors have mixed feelings about referral.
They sometimes feel inadequate or ambivalent, experiencing both a sense of failure and relief
about referring their clients. It must be pointed out that referring client to a superior or a more
appropriate helper does not imply failure on the part of the counsellor. A good counsellor should
endeavor to refer his clients whenever it is necessary. The following are some of the
circumstances in which it is ethically responsible and appropriate for counsellors to make referral:
20

1. The client wishes to be referred.

2. The client needs longer-term work, an open-ended contract, or more frequent sessions
than the’ ‘counsellor can afford or, if the counselling demands of the client are not possible
‘within the constraints of the agency’s policy (if the counsellor is employed by any agency).

3. The counsellor feels overwhelmed, does not understand or has insufficient training or
experience to deal with the presenting problem.

4. The presenting problem is one for which others more appropriate or specialist agencies
exist. Similarly, at a later or action-planning stage of counselling it becomes apparent that the
client needs more specialist advice, information, longer-term counselling, or practical help.

5. The client persistently fails to respond to the counsellor‘s counselling efforts and may
be helped more effectively by someone else.

6. The client needs medical attention.

7. The client shows signs of severe mental illness and is not able to continue without
intensive care and support.

8. There is in the counsellor’s view a real risk or harm to the client or others.

9. The counsellor or the client are leaving the area to live somewhere else.

10. The counsellor experiences a very strong negative reaction to a client or there is a
clash of personalities.

11. When it is discovered that the counsellor and the client share a close relationship.

You and ‘your clients can experience a whole range of emotions about referral. While it
can bring a real sense of relief and hope, referral can also be disruptive and disappointing.
Clients can feel hurt, rejected and reluctant to start again with someone else, or feel that
counselling is not for them anyway. Those who have been passed on from one counsellor to
another may come to believe that their problem is too big for any counselor and that they are
beyond help. Other clients in similar situations feel powerless and become very angry. Referrals
in the early stage of the relationship are likely to be less emotionally fraught for both client and
counsellor.
 21

Whenever the possibility of referral arises, it is always appropriate that a decision about it
is made with the client, although the initial suggestion may come from the counsellor. The
process can be brief or take a number of weeks or longer, and the counsellor may wish to serve
as a ‘bridge’ and provide short-term supportive counselling. Facilitating any referral involves a
number of tasks to ensure as far as possible that clients feel generally positive about it.

These include:

 Checking that the agency or individual will be able to accept the referral.

 Helping clients explore and perhaps resolve any emotional blocks towards the agency
or referral.

 Working towards bringing clients’ perceptions of the problem close enough to that
of the referral agency for the referral to “work”.

 Explaining the nature of the help that might be offered and perhaps encouraging
the client to consider accepting the help.

 Helping clients if necessary to make their own approach or application.

 Reviewing what has been achieved with clients and exploring what still needs to be
achieved and how the referral agency may contribute to this.

 Anticipating and exploring ways of coping with possible differences and potential
difficulties in starting work with someone else.

 Letting clients know that referral doesn’t end your care and concern.

In order to increase the number of options and establish an efficient referral system the
counsellor needs to develop his own personal contacts and resources file, with people in a
variety of occupations-lawyers, osteopaths, psychiatrists, but particularly counsellors and
psychotherapists with different strengths and specializations. In addition to the nature of the
help offered by an agency or individual, it is useful for the counsellors resources file to contain
adequate information on each agency, e. g.

 Name of the contact person, telephone number and address; whether they offer a
24-hour service, drop-in or appointment system;

 Scale of fees charged, if any, or if financial assistance is available;

 Likely waiting time;

22

 how the referral can be made and by whom;

 whether they offer a telephone service;

 whether they send information or publications;

 theoretical orientation of counselors;

 training and supervision of counsellors;

 code of ethics to which counsellors subscribe;

 whether the agency offers individual and/ or group counselling.

b. Diagnosis: This stage which is often the first contact between the client and the counsellor,
is preoccupied with the attempt to clarify the nature and the associated causes of the client’s
problems. Thus, diagnosis embodies the attempt of the counsellor to establish rapport with the
client. This involves the establishment of mutual trust between them so that further progress
could be made. The establishment of rapport assists the so-called Intake-Interview to which a
number of questions are asked so as to encourage the client to talk about his problems.

During this stage, some counsellors use a range of assessment procedures and devices
which may involve lengthy intake interviews, case histories, psychological tests. Observations,
and diagnostic classifications systems (e. g. dsm – III).

Diagnostic procedures are employed in counselling sessions to obtain a full picture of the
clients’ problems. Whichever diagnostic method used, assessment of the client’s problem(s)
will typically be concerned with one or more of the following’ objectives.

a) Helping the client understand the nature of the client’s presenting’ problem and related
issues:

b) Identifying’ the factors that may be associated with the problem and the client’s
experience or behaviour.

c) Determining the client’s expectation and desired outcomes.

d) Collecting’ baseline data that can be compared with subsequent data to evaluate
progress.

e) Facilitating’ the client’s learning’ and motivation by sharing’ the counsellor‘s view of the
problem. This may in itself contribute to therapeutic hang through increasing’ self-awareness.
 23

f) Producing’ an initial assessment (formulation) which provides the counsellor with the
basis for, first, making’ a decision about whether to offer a counselling’ contract, to initiate
referral or to suggest that counselling’ would not be appropriate, and second to provide the
basis for ‘developing’ a therapeutic or counselling’ plan, including’ the length and pattern of
contract.

2.4.3 Categories in Diagnosis

Various kinds of information can be gathered or areas explored during assessment:

a) Presenting problem – including’ affective (emotions, feelings, mood), somatic (body-

related sensations), behavioural (what the client does or doesn’t do) and cognitive (thoughts,
beliefs, attitudes, values, images, fantasies, internal dialogue) elements.

b) Antecedents – factors that may have influenced or caused the presenting’ problem.

c) Consequences – factors which may be maintaining it, at least in part.

d) Previous attempts ‘to solve or cope with it.

e) Client resources and strengths.

f) The frequency, duration and severity of the problem, i. e. how long or how often the
problem occurs, when it first started and its effects.

c. Treatment: At this stage, a treatment plan is formulated and carried out, it is at this
stage that the counsellor draws upon his wide variety of skills and techniques and selects those
which in his judgement, would be of assistance to the client. Depending on his own theoretical
orientation, his conception of the problem and causes of his client’s problems, the counsellor
could select techniques from Psychoanalytic approach, the client centred approach, the rational
– emotive approach or from the Behavioural approach to tackle his client’s problems.

d. Termination (end): After a period of treatment, the counselling encounter is brought to

an end so that the client could try to exist on his own using his newly acquired skills. Termination
of counselling encounters usually takes two forms. It could be negative – that is usually by
default, with a client falling to turn up or leaving a message about not wanting to continue. A
more satisfactory form view. The counsellor may negotiate at the beginning of the session how
long counselling will last and even specify the ending date. More usually, however, the idea of
ending will be put forward by the counselor or his client when it is considered appropriate.
24

Peake et al (1998) suggest that counselors may find it helpful to reflect on three questions
about termination. This is concerned with explicitness, flexibility and the client’s needs.

i. How explicit is the issue of termination? The question is whether the counsellor should
make use of the fact that counselling will terminate or give way to the temptation to let it pass
without any mention, inwardly promising’ to deal with it when it happens. Knowing that ‘termination
is near’ can enhance motivation; it helps some clients to concentrate their efforts on making’ the
best use of the time available. Similarly, it can work against the procrastination and resistance
to change that can accompany a sense of counselling’ as open-ended and everlasting. The
loss, whether it is real or symbolic, embodied in ending’ the counselling’ relationship can be a
very potent force for positive change

a. If the counselor uses termination to try to stimulate change, the next question is when
to raise it. At the beginning, many may take and there may be at least some implicit understanding
that it will be a matter of so many sessions or so many weeks, months or years. After that,
unless there is an explicit time-limited contract, it would probably be premature to raise the
issue until counseling’ is firmly under-way and indeed some real sense of progress has been
achieved. Some counsellors find it useful to remind clients some time during each session ho w
many sessions have gone and how many remain.

ii. How rigid is the decision about ending’? There are several related questions here.
Should counselling’ finish on the agreed date. Or can it be allowed to continue if the client wants
it to do so? How flexible should a counselor be about termination and what are the ramifications?
What circumstances justify an extension? The answers to these questions depend on the nature
of the counselling goals and of the counsellor’s philosophy and theoretical model.

a. Some counsellors favour a staggered ending increasing the time ending, increasing
the time between sessions towards the end of a contract. This seems an especially useful way
to work towards ending with a client you have seen for a long time. Another option is to offer a
follow-up session some 3-6 months after the counselling has ended. This can help to consolidate
progress made.

iii. What are the needs of the client around ending? Many clients experience little if any
difficulty, seeing the end of counselling as an inevitable and natural event. This may be most
likely when the counselling is relatively short term, where there wasn’t a strong attachment, or
where the focus was on problem management. However, other clients find ending very difficult.
 25

They feel they won’t be able to cope without the counsellor, and ending may re-stimulate earlier
painful experiences of loss and separation. The counsellor needs to help these clients cope
with ending by talking through their existential or developmental needs, acknowledging their
achievements and resources, and deciding on particular strategies.

2.4.4 Some practical suggestions for terminations

The aims of spending some time on ending are to help clients to sustain any changes
they have made and to look forward to a new beginning. Bayne, Horton, Merry and Moyes
(1994) have provided practical suggestions for termination, which are represented in the following
questions:

1. How does the client feel about ending? The counselor needs to encourage clients to
talk about ending. Sometimes it is helpful to reassure clients that ending can produce feelings
of loss and that this is a normal and natural part of the process.

2. What has been achieved? The intention here is to consolidate learning by examining
what changes have occurred. Further changes may be anticipated and it may be appropriate to
review and celebrate the client’s strengths and achievements.

3. How has it been achieved? This question is concerned with the counsellor’s efforts in
helping’ his clients identify the ways in which the clients themselves have contributed to or are
responsible for what has been achieved and the positive aspects of their relationship with the
counselor. The client’s account of what has happened is the best predictor of whether changes
will last; if clients attribute responsibility for any gains to the counsellor then it may be difficult for
them to sustain and build on any useful changes beyond the ending (Peake et al., 1988)

4. What still needs to be achieved? This question is about identifying unmet goals, relative
weaknesses and aspects clients feel they still want to develop. Many counsellors believe that a
lot of learning and change go on not only between counseling sessions, but after counselling
has ended. It is useful here to examine your client’s available resources and support network
and other options for maintaining and developing the gains achieved in counselling.

5. What may happen in the future? The counsellor may wish to help clients look positively
towards the future, while not ignoring the possibility that problems or symptoms may return. It
may also be appropriate to anticipate stresses and ‘rough spots’, and ways of coping or trying
to cope with them. It can be helpful to identify indications of the need to start counselling again.
26

Typically people go in and out of counselling rather than having one continuous period. A good
ending makes it more likely that clients have positive feelings about this prospect rather than
feeling like a failure or seeing counselling as a waste of time.

6. What has happened in counselling? The attention here is to help clients evaluate their
experience of counselling. It may also provide the counsellor with valuable feedback on his
approach. The framework outlined above focuses on the client. The counsellor may also wish
to reflect on his own experience, to review what has been achieved and how, and to work
through his own reactions to an ending.

e. Follow-up: This refers to the attempt to reassess the clients condition after a period has
elapsed since the termination of the counselling relationship. Such reassessment could include
the use of psychological tests and other assessment tools. If conditions demand, the client
could be returned to any of the earlier stages of counselling. However, if the client is progressing
satisfactorily the counselling relationship is then permanently closed.

2.5 SUMMARY

The model of the counselling process includes:

a) The person comes for help

b) The counsellor attempts to relate to the client
c) The helping situation is defined.
d) The counsellor encourages his client to give free expression to his concerns.
e) The counsellor accepts, recognises and helps to clarify negative feelings in the client
f) The counsellor accepts and recognizes positive feelings.
g) Development of insight.
h) Establishment of new goals.
i) Growth of confidence and an ability to take decision and
j) No more need for help.

Key terms:

Counsellingis an interactive learning process in which the counsellor(sometimes termed

therapist), helps the counsellees (be they individuals, families, groups or institutions) to
understand the cause(s) of difficultiesand guides them to sort out issues and reach decisions.
 27

Referral: it refers to the process by which a client is brought into contact with the counsellor.

Check you Progress

a) Counselling is an ______________ process

b) Counselling as a learning process designed to ____________adaptive behaviour

and to ____________ maladaptive behaviour

c) ______________ is one part of guidance services

d) Stages of counselling process include ______, _________, __________,

__________ and follow-up.

Answers

a) interactive learning b) increase; decrease c) counselling d)referral, diagnosis, treatment,

termination

Model questions
Q.1 What is counseling

Q.2 State any two difference in guidance and counselling

Q.3 Explain counseling process

Q.4 Describe the major steps in counselling process

REFERENCES
Corey, G & Corey, M(1990). I never Knew I had a choice. Pacific Grove. C. A: Brooks
Cole.

Idowu A. I. (2014) Guidance and Counselling. An Overview; in Idowu A. I. (Ed) Guidance

and Counselling Education.

Jones, R. N. (1995) The theory & Practice of Counselling – Britain, Holt, Rinehart &
Winston Ltd.

Mearns, D & Thorne, B. (1998) Person-Centred Counselling in Action, Sage, London

Merry, T. & Lusty, B (1993) What is Person-Centred Therapy. Gale Publications, Loughton,
UK.
28

LESSON - 3
CHARATERISTICS OF COUNSELLORS
INTRODUCTION

The counsellor is a trained personnel who listens to student’s problems, conceptualises

them, clarifies issues and assists them to understand their potentials with a view to resolving
their educational, vocational and socioo personal problems.

According to Patterison (1967), the counsellor is concerned with and accepting a

responsibility for assisting all pupils and having as his major concern the developmental needs
and problems of youth. According to Denga (1983), the school counsellor is a staff member
with specialised skills who provides assistance to individual students and their parents in making
decisions that ensure an efficient and orderly progression of the student throughout the various
stages of their growth and development.

3.1 OBJECTIVES

At the end of this unit, you should be able to

 Mention attributes of a counsellor.

 Explain non-threatening, safe and non-possessive warmth of the counsellor towards

his or her client.

Plan of the study

3.0 Introduction

3.1 Objectives

3.2 Counsellor charateristics

3.3 personal qualities

3.4 professional qualities

3.5 Summary

3.6 Key terms

Check your progress

Model questions
 29

3.2 COUNSELLOR CHARATERISTICS

The counsellor whether in the school setting or non-school setting possesses a lot of
admirable qualities which help him to relate well with clients and people around him or who
work with him. These characteristics are those which have been found to increase the
effectiveness and overall success of the counsellor when they exist in him in sufficient numbers
and at adequate level of intensity. While no counsellor is expected to be endowed with all these
qualities at birth, these characteristics are such as could be acquired through training.

3.3 PERSONAL QUALITIES

The personal qualifications of the counsellor derives from his inherent qualities. Although,
not part of any official curriculum, there is the need for personal psychological growth of the
counsellor. He is the most important single factor in counselling. He needs to understand himself
psychologically in order to helping others. He needs to know how to control his biases and
defences so that they do not interfere with the progress of any person with whom he is working.

As a personal quality, the counsellor must have love for persons and interest in helping.
Since the focal point of the counsellor is man, it is beholden on the counsellor to not only have
the love of his clients but at the same time he should be interested in analysing issues, solving
problems and giving help. As a helping professional, the counsellor should de-emphasise
monetary reward. In other words, he falls within the rank of professionals that consider services
to humanity an integral aspect of living and a thing of joy rather than material reward.

The counsellor needs to be socially sensitive and flexible, imaginative, with good control
of both his intellectual activity and his emotions. To make success out of the counselling
relationship, the counsellor must be socially active. He interacts with a number of people, the
young and the old alike. In this way, he gets to know the needs of people at the different age
levels. In addition to this, he does not hold a view and stick dogmatically to it. He remains
flexible in the face of change so as to follow in the scheme of things. For example, he knows
when a particular theory or technique should be applied or is no longer working. A counsellor is
one that is imaginative. He has an open mind and is continually craving for improvement in his
relationship with others. He is abreast with changes that occur around him and so adapts
himself to such changes. Being imaginative has the advantage of invoking new knowledge
rather than being perpetually “fixed” to outdated knowledge.
30

In addition to the above, the counsellor must be one who is emotionally balanced and has
good control of his intellectual ability. The term emotional balance here implied that the counsellor
should not have unusual difficulty in maintaining satisfactory interpersonal relationships. He
should be able to express feelings and needs without creating serious difficulties for himself or
his clients. Because he needs to carry along the client with him, he cannot “act out” in aggressive
ways neither can he retreat from interpersonal contracts. Can you imagine what the reaction of
his client would be if the counsellor who has temper tantrums should slap him because he is
talking ‘rot’? of course the slap could ensure both a fight and a termination of the counselling
relationship. Added to this factor, is the fact that the counsellor must have good control of his
intellectual ability. As a counsellor, one meets with the dullard and the intelligent. If the counsellor
is cognitively weak and allows himself to be “dribbled” by his client, he then becomes a laughing
stock and most clients would begin to make caricature of him. Unfortunately, most people who
go in to read counselling today in our Nigerian Universities are drop-outs from other disciplines
who think that counselling is the “easy” way out. This is especially true when one remembers
the sandwich programme. This is unfortunate because they took the wrong way.

Empathic understanding is another quality which the counsellor necessarily has to possess.
In attempting to understand the client in his work, the counsellor should be able to imaginatively
transpose himself to the client’s position. He should be able to understand the client from his
internal frame of reference. In short, it is when the counsellor is sensing the feelings and personal
meanings which the counsellee is experiencing in each moment, when he can perceive that
from “inside”, as they seem to the client, and when he can successfully communicate something
of that understanding to the counsellee, would there exist the rapport for meaningful interaction.
In fact, Carl Rogers (1959) says:

Empathy is perceiving the internal frame of reference of another with accuracy, and the
emotional components and meanings which pertain thereto, as if one were the other person,
but without ever losing the “as if” condition. Thus it means to sense the hurt or pleasure of
another as he senses it, and to perceive the causes thereof as he perceives them; but without
ever losing the recognition that it is as if, I was hurt or pleased, etc. if this “as if” quality is lost,
then the state is one of identification.

According to Rogers, the counsellor should not only be able to understand his client but
should be able to communicate this understanding to the client so that he senses it. It
communicates to him that much value is placed on him as an individual and that the feelings
 31

and meanings which he attaches to his experiences are respected, worth attending to, and
understood. Thus, when a client senses that he counsellor feels his pains and pleasure, he
feels he is with him and therefore, ready to cooperate and explore his problems more.

As a personal quality, the person called the counsellor must have a good sense of humour
which helps build up confidence in the counsellee, thus making repertoire of social-emotional
skills that enable him to respond spontaneously and effectively to a wide range of human needs.
A counsellor should have a patient understanding of his clients, sometimes, clients come with
aggressive, at other times they become inarticulate. In either cases or in any way the client
comes, the counsellor should not be in a hurry. He should be a patient listener, he should clarify
meanings and attempt to assist the client in a very cool and calculating manner. Sometimes, a
client talks continuously without stopping. The counsellor should not be bored. He listens quietly,
sometimes nodding and putting in a word or two. In this way, he captures vividly the problems
of the client and then be in a better position to offer his assistance. According to Ipaye (1983),
“Patient understanding enables the counsellor to respond from the frame of reference of his
counsellee’s actual feelings and actual behaviour rather than mere generalities or vague
formulations.

A good communication ability has also been recognized as a personal quality of the
counsellor. To a very large extent, counselling depends on verbal encounter. The counsellor
should therefore, be able to communicate with his clients effectively. He should be audible
without necessary shouting, able to communicate his feelings without repression. Apart from
verbal communications, the counsellor should be able to interprete and communicate the non-
verbal messages of the clients to him.

Unconditional positive regard or non-possessive warmth is also a personal quality valuable

to the individual called the counsellor. The quality of unconditional positive regard simply means
“prizing the individual as a whole”. The counsellor, irrespective of his values, does not lay down
conditions for accepting a client in the counselling situation, sometimes, the client may come in
moody, smelly or happy. In whatever situation he comes, the counsellor does not reject him. At
all times therefore the counsellor communicates a feeling of total acceptance and liking for the
client. In short, the counsellor has to be nonjudgmental in accepting the client. According to
Achebe (1988(, “this level of acceptance gradually conditions the client to accept all of his own
experiences, making him more of a whole and congruent person able to function effectively”.
Thus, the client feels accepted, and, therefore will reduce all defense mechanism that would
inhibit effective rapport in the counselling session.
32

The counsellor must also possess the quality of genuineness or congruence. This implied
that at any point in time he is his real self. He does not fake situation, “not phoney and without
pretense or façade”. If for example, the client came in when the counsellor is tired, instead of
pretending to be helping, he should let the client know of his feelings, namely, that he is tired
and, therefore, an appointment could be made against another time. The client is likely to have
more trust in a counsellor that he finds to be genuine. Thus, the client must sense that the
helper is being genuine and not just faking a professional role or being polite. According to
Achebe (1988), “Rogers places such importance on this quality that he affirms that “the
unmotivated, poorly educated, resistant, chronically hospitalized individuals respond to those
who are first of all real, who react in a genuine human way as persons, who exhibit their
genuineness in the relationship.

3.4 PROFESSIONAL QUALITIES

Wrenn (1962) says “the counsellor must be professionally educated and not merely
“trained”. Like the minister or physician or any other educated professional, he must learn
specialised procedures and be responsible for their application in the light of a broad knowledge
of his field”.

The counsellor profession in Nigeria today is still grappling with some of the teething
problems expected of a new profession, one of which is legislating on the academic qualification
which a counselor should hold. For now people with the Bachelor’s Degree in Guidance and
Counselling, practice in the school. The third set are the stop-gap counselors usually called the
Teacher-counsellors. In fact, the counselling profession in Nigeria is one in which “dead woods”
from other fields infiltrate. According to Denga (1983), the Counselling Association of Nigeria
(CAN), the sole body charged with regulating the registration of counsellors, is still in the process
of doing this. However, “it might be safe to say that a Master’s Degree in Guidance and
Counselling is considered to be minimum requirement for holding a position as a trained school
counsellor”.

In addition to academic requirement of a Master’s Degree, the counselling profession

recognizes that as a social being, and can only be understood from different and varied
compartments of life. In recognition of this, counsellor educators insist that the counsellor should
be an “Encyclopedia”. In other words, he should be very knowledgeable in a wide range if
disciplines, some of which are:-
 33

(i) Psychology- This will help the counsellor to understand, predict and control human
behaviour. Thus, a study of psychology exposes the counsellor to principles of child-development
including intellectual as well as socio-emotional development. It will also expose him to the
dynamics of personality.

(ii) Appraisal Methods- This helps he counselor in the construction of tests which he uses
in appraising his clients’ interests, abilities and other potentials

(iii) Counselling Theory- This exposes him to various theoretical position so as to be able
to adapt them to suit his individual clients.

(iv) Vocational Development Theory – These expose the counsellor to the vocational
growth processes of his clients.

(v) Supervised Practicum- This relates all the theories learnt in the classroom setting to
the practical realities of students problems.

Others include ethical and professional responsibilities, occupational information, behaviour

modification techniques, group process and a host of others.

Another professional quality which the counselor has to possess is that he should be able
to keep information regarding the clients’ problem confidential. Thus, when clients come to the
counselling situation they disclose information especially their social-personal information at
times, Willy nilly. As part of the ethical requirements, the counsellor is under obligation not to
disclose such information to an unauthorised person unless professional colleagues such as
the psychologists, the psychiatrists and the medical doctors who might need the information for
the good and growth of the client. The counsellor can also reveal information divulged to him if
the client permits him to.

3.5 SUMMARY

The professional counsellor is an expert in his field and also has cultivated skills in helping
people understand their situation, clarify their values and make informed decision for which
they assume responsibility. He must have received training as a counsellor and must possess
certain skills and expertise that enables him to be effective. Moreover, it is also believed that the
counsellor’s personality is relevant to his effectiveness and that a key element in any counselling
relationship is the person of the counsellor.
34

Sofenwa (1977) described a counselor as “....a ready, patient and sympathetic listener.
His authority derives from his temperament, candour integrity, disposition and approachability.
The more versatile he is, the more interaction he/she has with the staff and students, and the
more diversified the point of contact, the more he will be respected and accepted by the students
and the easier it would be for him to reach them and win their confidence... he is frank and
truthful, and uses facts, skills and training to turn his client on himself.

The counselor should possess among others the following attributes:-

 A caring attitude and sincere interest in people

 Flexibility in thought and action

 Attractiveness, approachability and pleasantness

 A sense of humour

 Above average intelligence

 A good self-concept and self-acceptance

 Empathy, objectiveness, sincerity, broad-mindedness, friendliness and

cooperativeness.

Some conditions are identifiable for counsellor success, all of which are related to
counsellor’s personality. The first of these qualities is the ability to empathize accurately with
the person who is being counseled or interviewed. Empathy is the capability to “feel into” a
person. It is a very special type of understanding. Certainly it is a complex ability which is
difficult to define in few sentences. Empathy is the ability to feel with the client, the capacity to
take for the purposed of counselling, his stand point or client perspective about affairs. This
description makes empathy appear an intellectual exercise, but it is far more than this. It is a
type of momentary identification. Identification is emotional merging with another person, and
this is what empathy is. It can be illustrated quite simply by the phrase “get into the other man’s
shoes, and if they pinch then you feel the hurt”.

The second essential quality is one of spontaneity and genuineness. In the counselling
situation, spontaneity means the capacity to relate honestly to the client and reveal oneself as
one human being to another. This means that there should not be any false professional front,
for this can be easily detected by the intelligent client. When questioned about his or her beliefs
and values he must answer frankly, accepting the existence of other viewpoints. It means the
 35

counsellor should be able to reveal himself as a human being and not indulge in defensive
manoeuvres to maintain a position of false authority and security. In other words, the counselor
must be open to new evidences, be flexible when necessary, admit his errors and generally
function in a way which provides the client with a model of purpose and maturity. The authority
in counseling is constructive containing and not coercive. This is very close to Carl Roger’s
“structured permissive relationship.

Another quality is the counsellor’s capacity to show a non-threatening safe and non-
possessive warmth towards the client. This implies

 The ability to adapt realistically to both the client and the situation which led to the
counselling.

 The possession of intellectual ability, especially sufficient imagination and flexibility

of thinking to look for new solution to problems.

 The ability to communicate effectively.

The possession of sufficient sensitivity and skill to note the signal coming from the
client.

3.6 Key terms

counsellor is an expert in his field and also has cultivated skills in helping people
understand their situation, clarify their values and make informed decision for which they assume
responsibility.

Empathy is perceiving the internal frame of reference of another with accuracy, and the
emotional components and meanings.

Check your progress

a) The counsellor needs to be socially _________and _________

b) Counsellor should not have unusual difficulty in maintaining satisfactory

_______________

c) _____________is perceiving the internal frame of reference of another with accuracy

d) counsellor must have a good sense of ___________

36

Answers
a) sensitive; flexible b) interpersonal relationships c)Empathy d) humour

Model questions
Mention and explain 5 attributes of a counsellor

Explain some characteristics of an effective counselor.

REFERENCES
Achebe, C.C. (1988). “Person-centred Theory of Carl Rogers in Achebe (ed). Theories of
individual Counselling: Relevance to the Nigerian situation. Five college Black Studies
Press, Amberst Massachusetts.

Denga, D.I. (1982). Educational and Vocational Guidance in Nigeria Secondary School,
Savanna Press Ltd, Jos, Nigeria.

Denga, D.I (1983) The Counsellor in a Developing Nation: Problems and Prospects. Trinity
Press and Publishing Co. Calabar, Nigeria.

Ipaye, T. (1983) Guidance and Counselling Practices. University of Ife Press, Ile-Ife, Nigeria.

Omoegun, O. M. (2001). A Functional approach to practicum in guidance and counseling.

Ikorodu, Lagos; Bab Sheriff Ltd.

Peterson. P. (1981) Triad Counselling. In R. Cornisi (Ed) Innovative psychotherapies.

New York; Wiley. Pp. 840-855.
 37

LESSON - 4
PROBLEM IN CHILDHOOD
4.1 Introduction

During the childhood stage, children face various problem which may be due to genetic
influence, environmental causes, developmental delays etc. People with pervasive developmental
disorders experience problems with language, socialization and cognition. The word pervasive
means that these problems are not relatively minor (as on learning disabilities), but significantly
affect individuals throughout their lives. This lesson deals with autistic disorder, impairment in
social interactions and communication, restricted behavior, interests and activities. The
prevalence, causes, psychological, social and biological dimension also discussed in detail.
The lesson concludes with various psychosocial biological treatments.

4.2 Objectives

After reading this lesson, you will understand the following:

 Autistic disorder

 Impairment in social interactions

 Impairment in communication

 Restricted behavior, interest and activities

 Statistics

 Causes

 Psychological and social dimensions

 Biological dimension

 Psychosocial treatment

 Biological treatment

Plan of Study
4.1 Introduction

4.2 Objectives
38

4.3 Autistic Disorder

4.4 Impairment in Social Interactions

4.5 Impairment in Communication

4.6 Restricted Behavior, Interests and Activities

4.7 Statistics

4.8 Causes

4.9 Psychological and Social Dimensions

4.10 Biological Dimension

4.11 Psychosocial Treatment

4.12 Biological Treatment

4.13 Summary

4.14 Keywords

4.15 Check your Answers

4.14 Model Questions

4.3 Autistic Disorder

Autistic disorder or autism is a rare childhood disorder that is characterized by significant

impairment in social interactions and communication and by restricted patterns of behavior,
interest and activities. Individuals have a puzzling array of symptoms. Consider the following
case.

Clinical Description : Three major characteristics of autism as expressed in DSM-IV:

impairment in social interactions, impairment in communication and restricted behavior, interest
and activities.

4.4 Impairment in Social Interactions

One of the defining characteristics of people with autistic disorders is that they do not
develop the types of social relationships expected for their age (Waterhouse, Morris, Allen,
Dunn, Fein, Feinstein, Rapin& Wing 1994). Timmy and Amy never made any friends among
their peers and often limited their contact with adults to using them as tools; for example, taking
 39

the adult’s hand to reach for something they wanted. For many people with autism, the problems
they experience with social interactions may be more qualitative than quantitative. They may
have about the same rate of exposure to others as you or your friends, but the way they make
contact is unusual. Timmy, for instance, seemed to enjoy sitting on his mother’s lap, but he
always sat facing away from her rather than taking the face-to-face position that is typical of
most children. Although they do not make eye contact and smile at their mothers like children
without autism, they still recognize the difference between their mothers and strangers and
prefer to be near their mothers in stressful situations (Dissanayake&Corssley 1994;
Sigman&Ungere, 1984); for example, they will sit near their mothers rather than near strangers
after being left along for a short period of time. This research suggests that people with autism
are not totally unware of others, as we once thought; however, for some reason we do not yet
fully understand, they may not enjoy meaningful relationships with others or have thye ability to
develop them.

4.5 Impairment in Communication

People with autism nearly always have severe problems with communicating (Mundy,
Sigman& Kasari 1990).About 50% are like Timmy, never acquiring useful speech (Rutter,1978;
Volkmar, Klin, Siegel, Szatmari, et.at., 1994). In those with some speech, much of their
communication is unusual. Some repeat the speech of others , a pattern called echolalia we
referred to before as a sign of delayed speech development. If you say, “My name is Eileen,
what’s yours?” they will repeat allm or part of what you said: “Eileen, what’s yours?” And often,
not only are your words repeated, but so is your intonation. Some who can speak are unable or
unwilling to carry on conversations with others.

4.6 Restricted Behavior,Interest, and Activities

The more striking characteristics of autism include restricted pattern of behavior, interests,
and activities. Timmy appeared to like things to same; he became extremely upset if even a
small change was introduced(such as moving a living room chair a few inches). This intense
preference for the status quo has been called, maintenance of saneness. One parent related
that her some with autism liked one particular helicopter from a toy set and that she had contacted
the manufacturer and obtained more than 50 identical helicopters for her son. He would spend
hours lining them up, and his mother reported that he could immediately tell if even 1 of the 50
was removed.
40

Often, people with autism spend countless hours in stereotyped and ritualistic behavior,
making such stereotyped movements as spinning around in circles, waving their hand in front
of their eyes with their heads cocked to one side, or biting their hands. Amy spent hours watching
lint fall to the floor. The rituals are often complex. Some people must touch each door as they
walk down a hall; others touch each desk in a classroom. If they are interrupted or prevented
from completing the ritual, they may have a severe tantrum.

What must it be like to have autism? Is it an exquisite solitude, divorced from the stressors
of modern life? Or is it an oppressive state of anxiety, filled with the need to try constantly to
maintain sameness in a chaotic world? Such fundamental questions have led some researchers
to interview the few rare individuals who have both autism and good verbal abilities, hoping to
gain a better understanding of autism in order to aid those who have it.

One such firsthand account is an extensive interview with 27 years old man named Jim,
who was diagnosed with autism during his preschool years (Cesaroni & Gaber, 1991). Jim
showed all the typical characteristics, including stereotypic movements, resistance to change,
repetitive play and social impairments. Because of these unusual behaviors, a psychiatrist had
recommended that he be placed in an institution when he was about 9 years old. Despite these
obstacles, Jim acquired sufficient skills to complete high school, and at the time the interview
was published he was completing graduate studies in developmental psychology. During his
interview, Jim explained how he views the world and talked about his own behavior. In describing
his sensory impressions, he noted that his processing often gets mixed up. “Sometimes, the
channels get confused, as when sounds come through as color. Sometimes, I know that
something is coming in somewhere, but I can’t tell right away what sense it’s coming through”
(Ceasroni & Garber, 1991 p.305) He observed that not only do his senses sometimes becomes
switched (hearing sounds and interpreting them as seeing colors) but that sometimes they
overlap and become distracting. “I have caught myself turning off the car radio while trying to
read a road sign, or turning off the kitchen appliances son that I could taste something (Ceasroni
& Garber, 1991 p.304).

As he was growing up, Jim’s stereotyped behaviors included rocking back and forth,
twirling around and swinging his limbs from side to side. He continued to behave this way on a
limited basis even into adulthood. He has difficulty explaining why he does these things.

Stereotyped movements aren’t things. I decide to do for a reason; they’re things that
happen by themselves when I’m not paying attention to my body. If I’m not monitoring them
 41

because I’m worn out, distracted, overwhelmed, intensely focused on something else, or just
relaxed and off-guard, then stereotyped movements will occur. People who are close enough
for me to be relaxed and off-guard with can except to see me acting “weird”, while people who
only see me in “Public display” mode don’t see such behavior. (Ceasroni & Garber, 1991 p.309)

Social relationships seem to have given Jim the most trouble, and he reports putting in a
tremendous amount of effort to improve them. He felt that he had succeeded in establishing
meaningful relationship with others, but at great cost. For example, it wasn’t until he was 23 that
he allowed people to touch him.

Jim’s description of his disorder may illustrate what autism is like for most people or only
what is unique to him. However, to hear about such experience is enlightening and helps us
gain some insight into the disorder. Jim’s account makes us wonder whether the abnormal
sensory experiences are responsible for the disrupted social development, for instance. As we
gain access to more of these accounts, our understanding of autism should grow, allowing us to
offer great assistance to those this disorder.

4.7 Statistics

Autism is relatively rare, although exact estimate of its occurrence vary. Early research
placed the prevalence of this condition at approximately 2 to 5 per 10,000 people (Lotter, 1944).
Recent estimates, using contemporary definitions of autistic disorder, have lowered the rate to
about 2 per 10,000 people (Gillberg, 1984). Gender differences for autism vary depending on
the IQ level of the person affected. For people with IQs under 35, autism is more prevalent
among females; in the higher IQ range, it is more prevalent among males. We do not know the
reason for these differences (Volkmar, Szatmari & Sparrow 1993) Autistic disorder appears to
be a universal phenomenon, identified in every part of the world including Swedon (Gillberg,
1984), Japan (Sugiyama & Abe, 1989) Russia (Lebedinskaya & Nikolskaya, 1993), and China
(Chung, Luk & Lee, 1990). The Vast majority of people with autism develop the associated
symptoms before the age of 34 months (American Psychiatric Association, 1994).

There are people with autism along the continuum of IQ scores. Timmy showed all the
classic sign of autism but also seemed to have the cognitive delays characteristic of people with
mental retardation, as do three of every four people with autism. Almost half arein the severe to
profound range of mental retardation (IQ of 50 to 70), and the remaining people display abilities
in the borderline to average range (IQ grater that 70) (water house, wing & Fein 1989). IQ
42

measures are used to determine prognosis: the higher children score on IQ tests, the less likely
they are to need extensive support by family members or people in the helping profession.
Conversely, young children with autistic disorder who score on IQ tests, the less likely they are
to need extensive support by family members or people in the helping professing. Conversely,
young children with autistic disorder who score poorly on IQ tests are more likely to be
severelydelayed in acquiring communication skills and to need a great deal of educational and
social support as they grow older. Usually, language abilities and IQ scores are reliable predictors
of how children with autistic disorder will fare later in life. The better the languages skills and IQ
test performance, the better the prognosis.

Autistic disorder is considered atype of pervasive developmental disorder, of which there

are three other types: Asperser’s disorder, Retts’disorder, and childhood disintegrative disorder.
We are focusing on autistic disorder, on which the most research has been conducted. The
other three disorders are highlighted. People with pervasive developmental disorders all
experience problems with language, socialization, and cognition. The word pervasive means
that these problems are not relatively minor (as on learning disabilities), but significantly affect
individuals throughout their lives. There is general agreement children with a pervasive
developmental disorder can be identified fairly easily because of the delays in their daily
functioning. Picking Timmy out from his nondisabled peers didn’t require a great deal of diagnostic
sophistication. His lack of speech and his problems interacting with others were obvious by the
age of 3. What is not so easily agreed on, however, in how we should define specific subdivisions
of the general category of pervasive developmental disorders (Waterhouse, Wing, Sptizer &
Siegel, 1992)

More specialists agree that autism should remain a separate category. There is less
agreement, however, on whether Asperser’s disorder. Rett’s disorder, or childhood disintegration
disorder are distinctly different conditions. Some believe that they are at different points on an
autistic continuum, especially Asperser’s disorder . Others believe that there are important
differences and that the disorders should be side red separately in order to improve research
on each one (Rutter & Schopher, 1992).

4.8 Causes

Much research has been done on the causes of autism, but to date it has provided little
conclusive data. Autism is a puzzling condition, so we should not be surprised to find numerous
theories of why it develops. One generalization is that autistic disorder probably does not have
 43

a single cause (Rutter, 1978). Instead, there may be a number of biological contributions that
combine with psychological influences to result in the unusual behaviors of people with autism.
Because historical context is important to research, it is helpful to examine part as well as more
recent theories of autism. (In doing this, we are departing from our usual format of providing
biological dimensions first).

4.9 Psychological and Social Dimensions

Historically, autistic disorder was seen as the result of failed parenting (Bettelherim, 1947,
Ferster, 1941, Tinberg & Tinbergen & Tinbergen, 1972) Mothers and Fathers of Children with
autism were characterized as perfectionist, and aloof (kanner, 1949), with relatively high
socioeconomic status (Allen, DeMyer, Norton, Pontius, & Yang, 1971, Cox, Rutter, Newman &
Bartak 1975) and higher IQs than the general population (Kanner, 1943). Descriptions such as
these have inspired theories holding parents responsible for their children’s unusual behaviors.
These views were divesting to a generation of parents, who felt guilty and responsible for their
children’s problems. Imagine being accused of such coldness toward your own child as to
cause serious and permanent disabilities! More recent research contradicts these studies,
suggesting that on a variety of personality measures the parents of individuals with autism may
not differ substantially from parents of children without disabilities (Koegel, Schreimbman, O’Neil
& Burke, 1983; McAdoo & DeMyer.1978)

Other theories about the origins of autism were based on the unusual speech patterns of
some individuals – namely, their tendency to avoid first person pronouns such as I and me and
to use he and she instead. Foe example, if you ask a child with autism, “Do you want something
to drink?” he might say, “He wants something to drink” (Meaning “I want something to drink’).
This observation led some theorists to wonder whether autism involves a lack of self awareness
(Goldfarb, 1943; Mahler, 1952). Imagine, if you can, not understanding that you’re extensive is
distinct. There is no “you,” only “them”! such a debilitating view of the world was used to explain
the unusual way people with autism behaved. Theorists suggested that the withdrawal seen
among people with autistic disorder reflected a lack of awareness of their own existence.

However, later research has shown that some people with autistic disorder do seem to
have self awareness (Dawson &M.C.Keswick, 1984, Spicer& Ricks 1984), and hat it follows a
developmental progression. Just like children without a disability, those with cognitive abilities
below the level expected for a child of 18 to 24 months show little or no self-recognition, but
people with more advanced abilities do demonstrate self-awareness. Self-concept may be lacking
44

when people with autism also have cognitive disabilities or delays, and not because of autism in
itself. Both self-awareness and the affected persons; possible lack of attachment to other point
to the importance of studying disorders from a developmental perspective. Knowing more about
how people without autism change over time will help us better understand the people with this
disorder.

A mythology about people with autism is encouraged when the idiosyncrasies of the
disorder are highlighted. These perceptions are further by portrayals such as Dustin Hoffman’s
rain man-his character could for instance, instantaneously and accurately count hundreds of
toothpicks falling to the floor. This type of ability is just not typical with autism. It is important
always to separate myth from reality and to be aware that such portrayals do not accurately
represent the full range of manifestation of this very complex disorder.

It is also important to distinguish between problems that are a result of delays in

development and problems that are a result of autism. For example, we’ve seen that individuals
with autism do acquire some form of attachment to others, although the way it is expressed
may be different from the way of typical child would show it.

Another phenomenon that was once thought to be unique to autism is known as stimulus
over selectivity (Rosenblatt, bloom & Koegel, 1995). Some people with autism will respond to a
small number of sometimes irrelevant cues when they are learning. It would not be unusual for
a child with autism to learn to point to a picture of food to communicate hunger, then later to
stop pointing to the picture of food to communicate hunger, then later to stop pointing to the
picture if it is placed on the right side of the table rather than on of the left. In this case, the child
seems to over select the cue of position (left side versus right side) rather than focus on the
image in the picture, as if to the child with mental retardation did researchers realize that it was
common among children at an early stage of cognitive development and not an oddity unique
to autism (SC hover& Newsom, 1974).

The phenomenon of echolalia, repeating a word or phrase spoken by another person,

was once believed to be an unusual characteristic of this disorder. Subsequent work it
developmental psychopathology, however, has demonstrated that repeating the speech of others
is part of the normally developing language skills observed in most young children (I.K.Koegel,
1995; Prizant & Wetherby, 1989). Even a behavior as disturbing as the self-injurious behavior
sometimes seen in people with autism is observed in milder forms, such as head banging,
among typically developing infants (de Lissovoy, 1941). This type of research has helped workers
 45

isolate the fact from the myths about autism and clarify the role of development in the disorder.
Primarily, it appears that what clearly distinguish people with autism from others are social
deficiencies.

At present, few workers in the field of autism believe that psychological or social influences
play a major role in the development of this disorder. To the relief of many families, it is now
clear that poor parenting is not responsible for autism. Deficits in such skills as socialization and
communication appear to be biological in orgin. Biological theories about the orgins of autism,
examind next, have received much empirical support.

4.10 Biological Dimensions

A number of different medical conditions have been associated with autism, including
congenital rubella (German measles), hypsarhythmia, tuberous sclerosis, cytomegalovirus and
difficulties during pregnancy and labor. However , although a small percentage of mothers
exposed to the rubella virus children with autism, most often no autism is present. We still don’t
know why certain conditions result in autism sometimes but not always.

Genetic influence : It is now clear that autism has a genetic component (Smalley, 1991).
We know that families who have one child with autism have a 3% to 5% riskof having another
child with the disorder. When compared to the incidence rate of approximately 0.0002% to
0.0005% in the general population, this rate is evidence of a genetic component in the disorder.
(Falconer, 1945)

Twin studies have been conducted to assess genetic influences on autistic disorder,
although autism is so rare that finding enough people for valid research is extremely difficult.
Susan Folstein and Micheal Rutter (1977) studied 11 people with autism who had fraternal (or
dizygotic) twins. They found a concordance rate of 34% for the monozygotic twins: I 4 of the 11
twin pairs, both twins had autism. Folstein and Rutter also examined the twin for the presence
of other developmental and cognitive problems and found that the concordance rate increased
to 82% for the monozygotic group and to 10% for the dizygotic group. In other words, when
they looked at developmental disorders in general, they found hat, if one of the monozygotic
twins had autism, the other twin was highly likely to have autism or some other cognitive or
developmental problems. This study and others (Herault, Petit, et al.1989) are important because
they strongly suggest that autism is inherited. As with so many of the disorders we have examined,
the exact nature of the genetic influence on autism is not yet clear to researchers. Current
thinking suggests to autosomal recessive inheritance. (Smalley, 1991)
46

Neurobiological influences. Evidence that autism is associated with some form of organic
(brain) damage comes most obviously from the prevalence of data showing that three of every
four people with autism also have some level of mental retardation. In addition, it has been
estimated the between 30% and 75% of these people display some neurological abnormality
such as clumsiness and abnormal posture or gait (Tsai & Ghaziuddin, 1992). These observations
provide suggestive but only correlation al evidence that autism is physical in origin. With modern
brain-imaging and scanning technologies, a clearer picture is evolving of the possible neurological
dysfunctions in people with autism (B.S.Peterson, 1995). Researchers using computerized
axial tomography and magnetic resonance imaging technologies have found abnormalities of
the cerebellum, including reduced size, among people with autism.

Eric Courchene and hiscolleagues at the University of California at San Diego examined
the brain of a 21 year old man who had a diagnosis of autism but no other neurological disorders
and a diagnosis of autism but no other neurological disorders and a tested IQ score in the
average range (Courchesne, Hernigan, & Yeung Courchesne, 1987). He was selected as a
subject because he did not have the severe cognitive deficits seen in three quarters of people
with autism. Hence, the researchers could presume that he was free of any brain damage
associated with mental retardation but not necessarily with autism.

After obtaining the informed consent of this man and his parents, they conducted an
MRI scan of his brain. In the MRI scans of a person without autism on the left and of Courchesne’s
subject on the right, the most striking finding was that the cerebellum of the subject was
abnormally small compared with that of a person without autism. Although this kind of abnormality
has not been found in every study using brain imaging, it appears to be one of the more reliable
finding of brain involvement in autism to date (Courchesne, 1991), and may point out an important
subtype of people with autism.

The study of autism is a relatively young field and awaits an integrative theory. It is likely,
however, that further research will identify the biological mechanisms that may ultimately explain
the social aversion experienced by many people with the disorder. Also to be outlined are the
psychological deficits in socialization and communications as well as the characteristic unusual
behaviors.

Treatment

One generalization that can be made about autism is that there is no effective treatment.
We have not been successful is eliminating the social problems experienced bypeople with this
 47

disorder. Rather, like the approach to individuals with mental retardation, most efforts at treating
people with autism focus on enhancing their communication and daily living skills and on reducing
problem behaviors such as tantrums and self-injury (Durand, in press). Some of these approaches
are described next, including new work on early intervention for young children with autism.

4.11 Psychological Treatments

Early psychodynamic treatments were based on the belief that autism was the result of
improper parenting, and encouraged ego development (Bettelheim, 1947). Given our current
understanding about the nature of the disorder, we should not be surprised to learn that treatments
based solely on ego development have not had a positive impact on the lives of people with
autism (Kanner & Eisenberg, 1995). Greater success has been achieved with behavioral
approaches that focus on skill building and behavioral treatment of problem behaviors. This
approach is based on the early work of Charles First and IvorLoaves.

Although Fester’s view of the origins of autism is now generally discounted, he provided
a valuable perspective by showing that children with this disorder respond to simple behavioral
procedures (Ferster & DeMyer, 1941). Ferster used basic, single case experimental designs,
modeling his work after the pigeon and rat learning experiments of B.F.Skinner. He found that
he could teach children with autism very simple responses, such as putting coins is the proper
slot, by reinforcing them with food (Ferster, 1941).

Invar Lovaas at UCLA took Ferster’s findings further by demonstrating their clinical
importance. He reasoned that if people with autism responded to rein forcers and punishers in
the same way as everyone else, we should be able to use these techniques to help them
communicate with us, to help them become more social, and to help them with behavior problems.
Although the work of Ferster and Lovaas has been greatly refined over the past 30 years, the
basic premise-that people with autism can learn and that they can be taught some of the skills
they lack-remains central. There is a great deal of overlap between the treatment of autism and
the treatment of mental retardation. With that in mind, we highlight several treatment areas that
are particularly important of people with autism, including communication and socialization.

Communication: Problems with communication and languages are among the defining
characteristics of disorder. As we saw in Timmy’s case, people with autism often do not acquire
meaningfully speech; they tend to have either very limited speech; they tend to have either very
limited speech or unusual speech such as echolalia. Teaching people to speak in a useful way
48

is difficult. Think about how we teach language: It mostly involves imitation. Imagine how you
would teach a young girl to say the word Spaghetti. You could wait for several days until she
said a word that sounded something like “Spaghetti” (may be “confetti”), then reinforce her. You
could then spend several weeks trying to shape “confetti” in to something closer to “spaghetti”.
Or you could just prompt, “Say, “spaghetti.” Fortunately, most children can imitate and learn to
communicate very efficiently. But a child who has autism can’t or won’t imitate.

In the mid-1940s, Lovaas and his colleagues took a monumental first step toward
addressing the difficulty of getting children with autism to respond. They used the basic behavioral
procedures of shaping and discrimination training to reach these nonspeaking children to imitate
others verbally (Lovaas, Berberich, Perloff & Schaeffer, 1944). The first skill the researchers
taught them was to imitate other people’s speech . They began by reinforcing a child with food
and praise for making and sound while watching the teacher. After the child mastered that step,
they in forced the child only if she or he made a sound after the teacher made a request-such
as the phrase, “Say “ball” (a procedure known as discrimination training).

Once the child reliably made some sound after the teacher’s request, the teacher used
shaping to reinforce only approximately of the requested sound, such as the sound of the letter
“b”. Sometimes the teacher to help the child make the sound of “b”. Once the child responded
successfully, a second word was introduced-such as “mama”-and the procedure was repeated.
This continued until the child could correctly respond to multiple requests, demonist rating
imitation by copying the words or phrases made by the teacher. Once the children could imitate,
speech was easier, and progress was made in teaching some of them to use labels, plurals,
sentences, and other more complex forms of language (Lovaas, 1977). Despite the success of
some children in learning speech, other children do not respond to this training, and workers
sometimes use alternatives to vocal speech such as sign language and devices that have vocal
output and can literally “speak” for the child (Johnson, Baumgart, Helmstetter & Curry 1994).

Socialization

One of the most striking features of people with autism is their unusual reactions to
other people. One study compared rates of adolescent interaction among children with autism,
those with Down syndrome, and those developing normally; the adolescent with autism showed
significantly fewer interactions with their peers (Attwood, Frith, & Hermelin, 1988).Although
socialdeficits are among the more obvious problems experienced by people with autism, limited
progress has been achieved towards developing social skills. Behavioral procedures have
 49

increased behaviors such as playing with toys or with peers, although the quality of these
interactions appears to remain limited (Durand & Carr, 1998). In other words, behavioral clinicians
have not found a way of teaching people with autism the subtle social skills that are important
for interactions with peers-including how to intitiate and maintain social interactions that lead to
meaningful friendships.

Timing and settings for treatment: Lovaas and his colleagues at UCLA reported on their
early intervention efforts with very young children (Lovaas, 1987). They used intensive behavioral
treatment for communication and social skills problems for 40 hours or more per week, which
seemed to improve intellectual and educational functioning. Follow up suggests that these
improvements are long lasting (McEachin, smith & Lovaas, 1993). These studies crated
considerable interest as well as controversy. Some critics question the research on practical as
well as experimental grounds, claming that one on one therapy for 40 hours per week which
seemed to improve intellectual and educational functioning. Follow up suggests that these
improvements are long lasting (McEachin, Smith & Lovaas, 1993). These studies created
considerable interest as well as controversy. Some critics question the research on practical as
well as experimental grounds, claiming that one on one therapy for 40 hours per week was too
expensive and time consuming; they also criticized the studies for having no proper control
group. Nevertheless the results from this important study and a number of replications around
the world suggest that early intervention is promising for children with autism (Anderson, Avery,
DiPetro, Edwards & Christian, 1987; Fenske Zalenski, Krantz & Mcclannahan, 1985; Hoyson,
Jamieson & Strain, 1984; Rogers & DiLalla 1991; Rogers & Lewis 1989; Rogers, Lewis & Reis
1987)

Lovaas found that the children the children who improved most had been placed in
regular classrooms, and children who did not do well were placed in separate special classes.
As we will see in our discussion of mental retardation, children with even the most severe
disabilities are now being taught in regular classrooms. In addition, inclusion-helping children
fully participate in the social and academic life of their peers –applies not only toschool but to all
aspects of life. Many different models are being used to integrate people with autism in order to
normalize their experience (Durand, in press). For instance, community homes are being
recommended over separate residential settings, including special foster care programs (M.D.
Smith, 1992) and supported employment options are being tested hat would let individuals with
autism have regular jobs. The behavioral interventions discussed are essential to easing this
transition to fully integrated settings.
50

4.12 Biological Treatments

No one medical treatment has been found to cur autism. In fact, medical intervention has
had little success. A variety of pharmacological treatments have been tried, and some medical
treatments have been heralded as effective before research has validated them. Although
vitamins and dietary changes have been promoted as one approach to treating autism and
initial reports were very optimistic, research to date has found little support that they significantly
help children with autism (Holm & Varley, 1989).
Because autism may result from a variety of different deficits, it is unlikely that one drug
will work for everyone with this disorder. Much current work is focused on finding pharmacological
treatment for specific behaviors or symptoms.

Integrating Treatments

The treatment of choice for people with autism combines various approaches to the many
faces of this disorder. For children, most therapy consists of school education combined with
special psychological supports for problems with communication and socialization. Behavioral
approaches have been most clearly documented as benefiting children in this area.
Pharmacological treatments can help some of them on a temporary basis. Parents also need
support because of the great demands and stressors involved in living with and caring for such
children. As children with autism grow older, intervention focuses on efforts to integrate them
into the community, often with supported living arrangements and work settings. Because the
range of abilities of people with autism is so great, however, these efforts differ dramatically.
Some people are able to live in their own apartments with only minimal support from family
members. Others, with more severe forms of mental retardation, require more extensive efforts
to support them in their communities.

CHECK YOUR PROGRESS

FILL IN THE BLANKS
1. Three major characteristics of autism as expressed in DSM-IV,————————
——————,————————————————,—————————————
2.. Autistic disorder is a type of ——————————————
3. The three types of pervasive developmental disorder are———————————
———————— and ——————————————
4. People with autism spend countless hours in ———————————behavior.
Answers:
1. Social interactions, communication, Restricted behaviour 2. Developmental disorder
3. Asperser’s disorder, Retts’disorder, and childhood disintegrative disorder. 4. repitative
 51

4.13 Summary

Autistic disorder or autism is rare childhood disorder that is characterized by significant

impairment in social interactions and communication and by restricted patterns of behavior
interest and activities. One of the defining characteristics of people characteristics of people
with autistic disorders is that they do not develop the types of social relationships expected for
their age. People with autism nearly always have severe problems with communicating. The
more striking characteristics of autism include restricted pattern of behavior , interests and
activities. Often, people with autism spend countless hours in stereotyped and ritualistic hand in
front of their eyes with their heads cocked to one side, or biting their hands. Autistic disorder is
type of pervasive developmental disorder. Historically, autistic disorder was seen as a result of
failed parenting.

At present, few researches believe that psychological and social influences play a major
role in the development of his disorder. Autism has a genetic component, associated with some
from of organic damage. The treatment of choice genetic component, associated with some
from of organic damage. The treatment of choice for people with autism combines various
approaches to the many facets of his disorder.

KEY WORDS

Autistic Disorder or autism: rare childhood disorder that is characterized by significant

impairment in social interactions and communication and by restricted patterns of behavior ,
and interest and activities.

ECHOLALIA
Repeating a word or phrase spoken by another person.

Maintenance of sameness: intense preference for the status quo.

Tuberous sclerosis: Thinking of vessels.

Rubella: German measless.

Model Questions
1. Define the charateristics of autism

2. Explain the causes of autism

52

LESSON - 5
DEVELOPMENTAL DISORDER
INTRODUCTION

This lesson deals with speech disorders, language disorders, delayed speech, stuttering,
therapy for stuttering environmental manipulation, therapy for advanced stuttering, prevention
speech articulation problems.

OBJECTIVES

After learning this lesson you will understand the following;

 Speech disorders

 Language disorders

 Delayed speech

 Stuttering

 Therapy for stuttering

 Environmental manipulation

 Therapy for advanced stuttering

 Prevention

 Speech articulation Problems.

PLAN OF STUDY
5.1 Introduction

5.2 Objectives

5.3 Speech Disorders

5.4 Delayed Speech

5.5 Stuttering

5.6 Therapy for Stuttering

5.7 Environmental Manipulation

5.8 Theropy For Advanced stuttering

 53

5.9 Prevention

5.10 Speech Articulation Problems

5.11 Summary

5.12 Key words

5.13 Check your Answers

5.14 Model questions

5.3 SPEECH DISORDERS

Speech disorders include articulation difficulties, and stuttering or stammering. These

can occur in normal young children as a part of the developmental process. Yet, persistence of
these beyond the age of six to seven years needs to be seen as a problem. Both these respond
effectively to speech retraining. Stammering can occur in brief spells when the respond child
start to speak and usually disappears if ignored but can become a persistent pattern if the
adults respond to it with anxiety. However stammering which starts suddenly in an older child
under stressful conditions or after imitating someone can become persistent and create
psychological problems secondary to it. Stammering which starts suddenly in an older child
under stressful conditions or after imitating someone can become persistent and create
psychological problems secondary to it. Stammering occurs in 1 percent of the population and
mostly in boys. Speech and language problems are known to occur particularly in children who
are left handed and are forced to be come right handed. Stuttering is related to fully learning,
anxiety, and neurological dysfunction. Late one set of stammering may be indicative of deeper
conflicts.

Referral to a speech therapist, is helpful in removing the symptoms and helps the child
to return to normal social interaction,. Similarly voice disorders such as shrill or hoarse voice in
an adolescent can also be remedied. But like any of the other habit disorders these may be
remit in the course of time. Hence it is imperative that the child should undergo speech retraining
if the problems persist.

5.3.1 LANGUAGE DISORDERS

Language disorders include specific delay in language development, both expressions

and receptive, echolalia(repetition of the words and phrases spoken by other) autistic
communication and elective autism.
54

5.4 DELAYED SPEECH

Most children say their first words within a few months after their first birthday
and by eighteen to twenty four months they put together two and three word sentences. Individual
children vary widely in the age at which they speak and a few months delay rarely signals a
problem. But a prolonged delay may indicate an organic or psychological disorder. In some
cases, delayed speech in an early sign of autism. Deafness,mental, retardation, or another
specific form of brain damage.

Because speech is a child basic means of interacting with parents , teachers and peers,
delayed speech can have problems with articulation they do not enunciate clearly, or they go on
talking baby talk long after it is normally abandoned. Others have deficits in expressive language
that is. Problems with putting their thoughts into words either because their vocabularies are
limited or because they have difficulty formulating complete sentences. Both these patterns
can cause a child to be treated like a baby. The child may also become very frustrated when he
or she is not understood. But both patterns also tend to clear up by themselves during the grade
school years.

More serious and typically more long lasting are delays in receptive language, that is in
understanding the language of others. This type of disability can be disastrous for a child in a
school.

Surrounded by fast paced verbal messages that others are obviously understanding while
he or she is not the child may become overwhelmed with frustration, special education techniques
are usually necessary for children with receptive language deficits.

STUTTERINGS

Stuttering is the interruption of fluent speech through blocked prolonged or repeated

words syllabus or sounds, Hesitant speech is common in young children .Therefore as with so
many other child wood disorders it is often difficult to decide when stuttering is a serious problem.
Persistent stuttering occurs in about 1 percent of the population and in about four times as
many boys as girls. It is most likely to appear between the ages of two and seven (with peak
onset at around age five) and seldom appears after age eleven, Many children outgrow stuttering
as their as their motor skills and confidence increase. Even those who do not outgrow it completely
eventually tend to stutter less or only in stressful situations. About 40 percent of children are
estimated to overcome stuttering before they start school, and 80 percent of children are
 55

estimated to overcome stuttering before they start school, and 80 percent overcome it by late
adolescence(J.G.Sheehan&Martyn,1970)

Organic theories of stuttering are popular in some quarters. One organic theory, for
example holds that stuttering stems from a problem with the physical with the physical articulation
of sounds in the mouth and larynx(Angelo, 1975, kerr&cooper,1976) But many Psychologists
today think that stuttering psychogenic. Stuttering may be created unwittingly by parents who
become so alarmed at their children’s mild speech hesitations that they make the children
anxious about speaking. The children anxiety further disturbs their speech , which in turns
makes them more anxious, and so on, until a chronic problem has been created. Other theorists
emphasize factors other than parents over concern but almost all agree that anxiety is important
in creating, maintaining and aggravating stuttering.

5.6 THEROPY FOR STUTTERING

There are probably as many perspectives toward therapy for stuttering as toward its
causation. Some of our ideas have recently changed, while others have remained fairly constant
over time. AS you might expect, the ideas that have remained constant are generally those that
have proven to be effective. Those strategies that have changed and are still changing are
those that have been less effective or unsuccessful. In general the approach to treatment will
depend first and foremost on the age of the stutterer. different techniques are used for young
children who are just developing the problem. Than for adolescents and adults who have fluency
problems.(and often unsuccessful therapy) for years.

5.6.1 THEROPY FOR THE YOUND DEVELOPING STUTTERER

Therapeutic strategies for the preschool-age, developing stutter have been fairly constant
and have had high success rates. There are several approaches to therapeutic intervention for
early stuttering-environmental manipulation, direct work with the child, psychological therapy,
desensitization therapy, parent-child interaction therapy, fluency shaping behavioral therapy,
and parent and family counseling. The choice of approaches in individual cases depends on
the results of an assessment of the problem. Some of the strategies can be used in combination
with each other, and some may also be useful for more advanced stages of the problem in older
stutters . A critical variable in dealing with young children is always the family, as the family can
either reinforce or counteract the efforts of the speech language pathologist.
56

5.7 Environment Manipulation

Environment manipulation is a therapeutic which focuses on those variables operating in

the child’s environmental which are thought to be contributing to the maintenance of the stuttering.
Through both direct observation and parent and family conferences, the speech language
pathologist tries to identify these factors and to change the child’s environment so that their
function in maintaining stuttering is reduced or eliminated. Variables that can affect stuttering
include

1. General excitement level in the home

2. Fast-paced activity

3. Communicative stress

4. Competition for talking time

5. Social and emotional deprivation

6. Sibling rivalry

7. Excessive speech interruptions, and talking attempts aborted by family members

8. Standards and expectation that are unrealistically high or low

9. Inconsistent discipline

10. Too much or too little structure for acceptable child behavior

11. Lack of availability of parents

12. Excessive pressure to talk and to perform

13. Arguing and hostility among members of the family

14. Negative verbal interactions between the child and the family

15. Us of the child as a scapegoat or displacement of family problems on to thechild.

16. Clearly, the list could go on and on.

Each of these variables could be potent in maintaining stuttering. And each factor if
reversed,could help eliminate stuttering as problem. By helping became aware of these elements
and their effects on the child’s fluency, by helping each family became remember a high priority
for changing the child’s environment, the speech language pathologist may be able to reduce
or eliminate the stuttering. But to accomplish this, the family has to agree upon a goal-to eliminate
 57

the stuttering. The needs of each family member and their direct influences on the child’s
fluency have to be reconciled with the process of changing the family environment. Often this
process opens up totally new and unexpected problem areas that relate to the child’s speech.
It may also lead into interpersonal or psychological problems of the family. The speech language
pathologist should be prepared to deal with these problem areas or to refer the family for
appropriate intervention, such as family therapy, marital counseling, or psychological therapy.

5.7.1 Direct therapy

Direct therapy involves actively and regularly seeing the young developing stutterer for
therapy. Sometimes this means directly working on the speech symptoms of the child, but more
often it means seeing the child while working around the child and not directly on dissiliency
behavior. The theoretical assumption is that the child’s stuttering symptomatic of a more basic
underlying problem. usually of a psychological and interpersonal nature

5.7.2 Psychological therapy

Children who are thought to have psychological or emotional problems that affect stuttering
may be referred to play therapy or psychiatric therapy. These therapies assume that the diffluent
speech is a symptom of a deeper, underlying psychodynamic problem. In this therapy, very little
attention is given to the speech symptom per se. Rather, the focus is on the child’s psychological
coping and defense mechanism, personality development, anxieties, other feelings, and
interpersonal relationships. Advocates, of this approach believe that, through the theoretical
perspectives and clinical tactics of these therapies, psychological problems will be eliminated,
therapy getting rid of the symptoms of stuttering. These therapies, of course, are carried out by
trained specialists.

Some Children have been helped by these psychologically oriented therapies, but for the
most part, they have not been effective in reducing or eliminating stuttering behavior. However,
there might be some value to psychotherapy as an adjunct to other forms of speech thereby
(Bloodstain, 1975)

5.7.3 Desensitization therapy

Another form of direct work with the child but not directly on the child’s speech dissiliency
is desensitization therapy (developed by England, cited in Van Riper, 1954). The theory behind
this therapy is similar to the theory that underlines environmental manipulation. The Child’s
58

stuttering is a response to environmental actresses. However, a distinction is made between

unusual or unreasonable stress (the criterion for electing environmental manipulation) and the
expected or reasonable stress found in the typical family situation. Stuttering that is judged to
be a response to “normal stress” may be reduced by increasing the child’s tolerance for stress.
Desensitization therapy attempts to gradually increase the child’s stuttering that is judged to be
a response to “normal stress” may be reduced by increasing the child tolerance for stress. This
is usually done in individual activities – often play – that reduce dissiliency to its lowest level;
known as the basal level of dissiliency. Often stuttering can be completely eliminated during
these activities. The speech language pathologist keeps as many stress factors as possible
from operating. The desensitization sessions might involve eliminating talking altogether for a
while and interacting nonverbally, not asking direct questions, silent parallel play, avoiding stressful
content themes while taking, maintaining a low excitement level, maintaining a slow pace of
interaction, and so on. Very gradually, the speech-language pathologist reintroduces these
factors (usually identified by watching the child interacting with family members and by conferring
with parents) into the therapy session.

The professional closely monitors the child’s behavior for signs of emotional reactions
and tries to stop just short of precipitating speech dis-fluency. This may happen three or four
times in a session (introduction of stress followed by reduction). The speech-language pathologist
introduces more stress into each session without precipitating stuttering, with the goal of extending
the child’s tolerance for the process. In this way, the child’s is “desensitized” to these normal
stresses. Eventually, family members may be brought into the session to help the child generalize
the fluency to the homeenvironment, where these stresses probably occur naturally. The child
is gradually into the normal stress of the family. The family can learn this nurturing process and
became amenable to it and even to reducing some of the stress, when the end goals is helping
to change the child rather than changing something about themselves.

5.7.4 Parent-child verbal interaction therapy

Related to the tactics of desensitization is a therapy is a therapy based on parent child

verbal interactions (Shames &Engulf, 1976). The assumptions underlying this therapy is that
childhood disfluencies develop in the social context of verbal interactions with parents, with the
parents inadvertently reinforcing and maintaining the child’s dissiliency. After observing specific
and individual parent-child verbal interactions, the speech language pathologist can mirror-
image the process and do just the opposite of what the parent was observed to do following
 59

instances of dissiliency. When the child’s stuttering is reduced to 1% or less with the speech-
language pathologist, the parents are introduced into the therapy to learn the more productive
forms of verbal interaction with their child and to use them at home.

Fluency-shaping behavioral therapy: For many years, under the influence of the diagnostic
semantogenic theory of stuttering, direct work on the speech of young stutterers was avoided.
Experts thought the direct work on a young child’s early stuttering could result in awareness of
dissiliency by the child, in anxieties and guilt, and in a feeling of being different. There is logic to
this line of thought, especially if the focus on fluency, that is, on helping children learn to do
those things while talking that non stuttering child does.

Williams (1979) has developed a therapy that emphasizes “easy, normal” talking and
encourages children to attend to the smooth and easy behavior they are capable of performing.
The therapy developed by Ryan and Van Kruk (1974) gradually increase the length and
complexity (GILCU) of the child’s utterances. Webster(1980) developed a therapy that focused
on the gentle onset of an utterance. Curled and Perkins (1969) developed a rate control program;
while Perkins went on to developed a program for replacing stuttering with normal-sounding
“monitored” speech. Shames and Florence (1980) have developed a ‘slowed-down” speech
pattern keyed to continuous phonation between world and shaped to normal processes of
speaking behavior . The Ryan-Van Kirk and the Shames Florence therapies also organize a
system of reinforcement to facilitate generalization the child’s everyday environment (Ryan &
Van Kirk, 1974; Shames &Florance,1980).

5.7.5 Parent and family counseling

We have just seen that many aspects of the child’s environment cut to the core of the
family and its individual members Identifying and ultimate changing some family behavior patterns
might well require a close and caring counseling relationship for group as whole as well as for
its individual members .To meet the final goal, the needs of the fame as well as the child must
be considered.Parent and family counseling is designed to her family members to understand
how their behaviors and feelings interact with those of the stutterer and to recognize, accept,
and act on these feelings .

In some instances the speech language pathologist may feel that the speech of child is
within the boundaries of normal dissiliency, while the anxieties and concerns of parents persist.
In these instances, parent concern is a legitimate target for therapy intervention . This intervention
60

is not simply a matter of providing parents with information about normal development dissiliency.
The speech-language pathologistacknowledges and deals with the parent’s feelings. In these
circumstances the parent not the child, are the clients. The focus may start out on the child, but
the counseling situation often redefines the problems and issue in terms of the parents, their
history their interactions, feelings, and behaviors, with a much broader perspective than spend
and/or parenting. Therapy starts to focus on the parents as individuals.

Skills in interviewing and counseling, as well as knowledge of stuttering, child management,

and family dynamics, are prerequisites for this type of therapeutic intervention. Without these
skills, the speech-language pathologist might better serve the familyby a referral to someone
who has the proper training and skills. The combination of parent and family counseling with
environmental manipulation probably represents the highest rate of therapeutic success for the
problem and its early form and development.

5.8 Therapy for Advanced stuttering

Advanced stuttering can be much more complicated than early stuttering in its dynamics,
overt symptoms, hidden aspects, and thus the stutter, his family, and his listeners have had
more opportunity to develop negative reactions to the stuttering. Most advanced stutters evolve
a number of coping strategies in their attempts to survive the problem. The stutter’s speech is
typically characterized by muscular tension and forcing, fragmenting of utterances, and
superfluous motor activity, sometimes remote from the speech mechanism. He is painfully
aware of this speech and of reaction to it. He may be embarrassed or may feel inferior, guilty,
hostile, anxious, aggressive, or timid as he vacillates between approaching and avoiding talking.
Given the possibilities for such complex compounding of a problem that feeds on itself motoric
ally and emotionally, it is not surprising that the therapies for this problem have also vacillated
between the mysterious, the complex, and the simplistic.

Therapy for advanced stuttering ranges from tactics such as putting stones in the mouth,
oral surgery,, waving the hand rhythmically in the air, chewing one’s breath steam, superstitious
incantations, deliberate stuttering, and electric shock to psychotherapy, biofeedback, controlled
fluent stuttering, and sophisticated conditioning techniques. Even within each of these broad
therapeutic techniques, there have been numerous variations and combinations involving
counseling, desensitization, stuttering controls, and fluency-including producers. Space in a
single chapter does not permit a detailed discussion of these various therapies. Many are no
longer in use . We will discuss a few of these therapies is they may illustrate some specific
 61

issues and principles about therapy. As we have seen, variation in therapeutic practice are in
part of a function of how the problem has been definedand perceived theoretically. If stuttering
is seen as a symptom of anxiety, then therapy will deal with anxiety. If stuttering is seen as an
anticipatory struggle, then therapy deals with the stutter’s expectancies. If stuttering is seen as
being conditioned, then therapy deals with components of the conditioning model.

When we talk about therapeutic practice, we are including several components that are
critical management. These include:

1. Goals of Therapy

2. Tactics of therapy, including

a) Target behaviors

b) Style of therapy

c) Self-Management

d) Transfer and maintenance

3. Follow-up studies

5.8.1 General goals of therapy

The goals of each therapy program are a function of how the problem is perceived and
the goals should be reflected in the therapeutic tactics used. Generally the goals therapy focus
on:

1. Changing the way the stutter talks

2. Changing the way the stutter feels

3. Changing the way the stutter interacts with the environment

Within these broad categories, we find much polarization of thinking. For example the
past, some therapies assumed that stuttering was a chronic and permanent condition that
would be aggravated by any therapeutic attempt to reduce or eliminate it. Stuttering were
counseled to accept their problem. These therapies employed tactics of negative practice and
fluent stuttering(Van Riper.1954. Therapy work on stutters’ anxieties also a part of these
programs. Advanced felt that, by learning to control stuttering and do it voluntarily, stutters
would develop a sense of control over their behavior that would result in their not feeling helpless
and anxious.
62

Other therapies have as their primary goal the reduction of anxiety about speech. These
would include systematic desensitization (Brut tern& Shoemaker, 1967; Lanyon,1969)
psychotherapy (Barbara, 1954;glauber.1958,Travis, 1957), semantic based
therapy(Bloodstein,1975;johnson1933;Shames et al, 1969;W illiams,1957) and role
enactment(Sheehan,1975).

Some therapies were more prominently concerned with three significant theoretical
possibilities for relapse. One is that stutters use very small disfluencies that are barely
recognizable in therapy, but grow in magnitude and from the seeds for later relapse after therapy
ends. A second possibility is that post therapy speech monitoring is a non rewarding experience
and is eventually not continued by the stutterer. Third id inevitability of relapse if their is a heavy
genetic and therefore physiological basis for stuttering in given in a given person.

Many experts have proposed techniques to promote maintenance. Ryan and Van Kruk
(1974) encourage daily monitoring of stuttering, fading out home practice but continuing clinical
contact for evaluation and reinstruction. Ingham and Andrews(1973;ingam,1975) encourage
the stutter to continue practicing prolonged speech and to maintain clinical practice and
counseling. Webster (1980) encourages the initial over learning of the behaviors necessary for
fluent speech, towards the goal of making these behaviors automatic. However, they approach
that goal not through initial over learning, but through processes of generalization and systematic
scheduling of unmonitored speech as a formal part of therapy.

Different therapies have reported different maintenance and replace rates, ranging
from50% to over 90% maintenance, depending on the ages of clients, the tactics used initially
changing the stutter’s speech, and whether transfer and maintenance procedures were
employed. All therapies seem to have a significant drop-out rate. In a spite of these data and
the dropout rates, we are making significant increases in successful therapeutic out comes.
The prognosis for the problem of stuttering of stuttering has been undergoing a gradual change
from pessimism youtempered optimism.

5.9 Prevention

For many good reasons, there has been no work directly attacking the issue of prevention
of stuttering. Without, any conclusive evidence about the etiology of stuttering, it is difficult to
eliminate the causes . unlike the medical sciences, we cannot immunize children against attempt
to cause a child to stutter (eve if we knew how), because we are not certain that we could
 63

reverse the process. Furthermore, direct research on the prevention of a problem that may
have an environmental bee is extremely difficult to conduct. However, except for the gems tic
theory of stuttering, most theories imply a message of prevention.

5.10 Speech Articulation Problems

Problems with articulation refer to errors in the production of speech sounds or phonemes
(the smallest elements of language). Phonemicerrorsare evaluate din the context of development
norms; that is, the capacity to produce certain sounds varies as afunction of both age and
gender during the early years , articulatory proficiency about one year later.

The articulatory errors that young children make are not a random sample of possible
errors. The child’s earliest words consist of sounds that can be produced with ease. These
words almost always co0nsist of nasal consonants, labial (lip) sounds, and vowels (e.g.,”ma-
ma”,”dada”). The production of specific soundstends to occur in a developmental sequence
e.g./d/before/l/k/before/t/m/before/n/). This ordering may be due to several factors; the structure
of the speech apparatus, ease of sound production, and relative difficulty of sound discriminability.

5.10.1 Assessment

Deficiencies in articulation are the most common type of speech disorder among children.
Occasionally, preschool children are referred for articulation problems, but children with these
problems are not usually identified until they enter school. Prior to evaluating speech and
language, the speech pathologist usually requests the administration of an audio(hearing) test.
An interview with parents is also considered an essential part of the assessment procedure.
The parental interview focuses on the child’s developmental history with respect to
responsiveness to sounds and words as well as verbal expression. The parents are also asked
about the child’s early eating behavior and whether there were problem with sucking, swallowing,
or chewing.

The information provided by the parents and other professionals who have seen the child
often facilitates the assessment procedure in that the focus of diagnostic testing may be
sharpened . Generally, the speech pathologist’s assessment includes an inspection of the interior
of the mouth and an evaluation tongue movement, Since structural abnormalities of the mouth,
lips , and teeth as well as limitation of tongue movement interfere with normal articulation.
64

The evaluation of speech itself is conducted both formally and informally. During informal
assessment the pathologist attempts to engage the child in conversation about topics of interest
to the child. The child’s spontaneous speech is evaluated in terms of the standards for phoneme
usage. A record is kept of the occurrence of sound substitution, sound omission, and sound
distortions. Formal evaluation consists of the administration of standardized articulation
tests(Darley, Fay, Newman, Rees & Siegel, 1979). The goal of the speech pathologists is to
determine whether there is evidence for either articulatory immaturity or articulatory desaturation.
Articulatory immaturity refers to an articulatory speech pattern that is typical of children younger
than the client. Such patterns frequently occur in children who are mentally retarded or of
borderline intelligence. Articulatory desaturation refers to articulatory speech patterns that are
not typical at any developmental stage. These patterns are usually associated with structural
defects, motor problems, and neurological abnormalities.

5.10.2 Etiology

Articulation problems have been associated with a variety of etiological factors. Articulation
skills are highly correlated with mental age, suggesting that the factors. Articulation skills are
highly correlated with mental age, suggesting that the factors associated with slow rates of
intellectual development are also possible causes of problems with articulation. For example, a
high rate of problems with communication has been associated with Prematurity and neonatal
respiratorydistress(Enrich,Kimball&Hunter, 1973). Hearing deficits may also account for deficits
in articulation. There may be hearing loss that is confined to certain frequencies. If the impairment
is limited to the lower range of frequencies, speech pattern may be markedly affected; in such
cases, parents would not necessarily suspect a hearing loss because the child responds to
most environmental sounds that parents as stubborn or preoccupied because the child responds
to most environmental sounds that usually consists of a board range of frequencies. Sometimes
the child is described by the parents as stubborn or preoccupied because the child’s responses
to their directions are minimal. Children with hearing deficits rapidly become adept at learning
to lip read and respond to gesturecues, thus often causing a postponement of referral until the
articulatory speech problem is serve.

Articular problems may also be the product of leaning experiences. If child has a primary
speech model a person who has defects in articulation there may be an increased probability of
the child’s learning the same pattern through modeling . Likewise, if a child is strongly reinforced
forced for immature speech patterns may become strengthened. Fortunately, most children are
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exposed to a wide variety of speech models through urban living arrangement and exposure to
television.

5.10.3 Treatment

Historically, several approaches have been taken to treat articulatory problems remedially.
During the 1920s and 1930s, emphasis was given to the phonetic-placement method in which
child was taught the ‘correct’ position of the tongue and mouth for production of specific sounds.
Subsequent research, however, has shown that in different persons a specific sound may be
achieved with a variety of poisons. Since hearing is the primary sensory system for the acquisition
of speech during the preschool years , many pathologists have advocated the teaching of
auditory discrimination as fundamental to the correction of articulatory problems. Training auditory
discrimination, including self –discrimination, makes probable generalization outside of the
speech therapy sessions.

Most contemporary speech pathologists do not restrict themselves to any single approach
to therapy, although among the various options, auditory stimulation is still the principal component
or foundation of most therapeutic programs. The process of correcting misarticulated speech
sounds must focus on these related tasks: learning to identify the sounds and discriminate
among them, learning to produce the sounds in a variety of phonetic contexts and learning to
generalize the correct sound outside the therapy setting(Powers 1971). Auditory discrimination
training takes up a large proportion of the initial therapy sessions and less as the sound production
phase is undertaken. The pathologist introduces the sound in an interesting manner to ensure
that the child will pay attention. The sound is given a name to establish its identity; for example,
the/s/sound may be called the “snake sound”. To facilitate the child ‘s learning to discriminate
the stimulus sound from other sounds, the pathologist presents a series of sounds that includes
the stimulus sound and the child makes a particular response each time the stimulus sound
occurs.

Initially, sounds that are easily confused with the stimulus sound are not included in the
series; they are gradually included as the child becomes proficient in making the easier
discrimination. After the child is able to discriminate the stimulus sound from all other speech
sounds, the pathologist begins to introduce the sound as the initial sound in single words. This
series of discriminations is followed by training the child to discriminate the stimulus sound
when it appears in any position in the word. Training also includes the pathologist’s presenting
both the correct and incorrect versions of the sound and teaching the child to differentiate them.
66

Throughout this phase of discrimination training, the pathologist may use others sense modalities
to facilitate the learning process. With young school-aged children, for example, letters and
words may be presented visually in conjunction with the auditory stimuli.

Relatively little research has been done on the production phase of articulation training.
Webb and Siegen haler (1957), however, in a study comparing training methods, found that
verbal instructions on how to make the sound and auditory presentation of the sound followed
by evaluation of the child’s sound production was the most effective combination. Training in
sound production proceeds from the single sound through words, phrases and sentences to
spontaneous speech . Again, the child’s motivation and attention are best used by the careful
choice of stimuli including visual materials and by the reinforcement of successful productions.

Generalization outside of therapy is considered by the pathologist’s hope is that the

correct production of a word in the therapy sessions will be learned well enough to be reproduced
in other environments. To facilitate such transfer the pathologist may ask the child to perform
specific tasks at home or school, such a finding of objects that contain a specific stimulus
sound.

Speech therapy with children often involves the parents as well. Most pathologists agree
that the parents should be well informed about their child’s problem and about the steps that will
be taken to remedy it. In addition, parents are encouraged to be supportive and positive toward
the child. Pathologists disagree, however, on the extent to which parents should be directly
involved in the speech therapy itself. Some research studies suggest that trained parents can
be effective therapists for their own children, while other studies suggest that parental involvement
may be detrimental. Future research will likely begin to delineate those factors that will predict
which parents will be more effective than others.

Check Your Progress

Fill in the blanks:

1. _______________ include articulation difficulties, and stuttering or stammering.

2. _______________ is related to faulty learning, anxiety and neurological dysfunction.

3. Environmental manipulation is a therapeutic procedure which focuses on thought

to be contributing to the maintenance of the stuttering.

4. Desensitization therapy attempts to gradually increase the child’s tolerance for

____________.
 67

5. The combination represents the highest rate of therapeutic success for the problem
of stuttering.

5.11 SUMMARY

Speech disorders include articulation difficulties, and stuttering or stammering. Speech

and language problems are known to occur particularly in children who are left handed and are
forced to be come right handed. Language disorders include specific delay in language
development, both expressive and receptive, echolalia. Reconciliation with the family members
opens up totally new and unexpected problem areas that relate to the child speech. It may also
lead into interpersonal or psychological problems of the family. The speech Language pathologist
should be prepared to deal with the problem areas or to refer the family for appropriate
intervention, such as family therapy, marital counseling, or psychological therapy. Problems
with articulation refer to errors in the production of speech sounds or phonemes (the smallest
elements of a language). Deficiencies in articulation are the most common type of speech
sounds or phonemes (the smallest elements of a language). Deficiencies in articulation are the
most common type of speech disorder among children. Occasionally, preschool children are
referred for articulation problems, but children with these problems are not usually identified
until they enter school. Articulatory problems may also be the product of learning experiences.
Most contemporary speech pathologist do not restrict themselves to any single approach to
therapy, although among the various options, auditory stimulation is still the principal component
or foundation of most therapeutic programs.

5.15 Key Words

Speech : Child’s basic means of interacting with parents,

teachers and peers,

Receptive language : Understanding the language of others

Stuttering : interruption of fluent speech through blocked;

Prolonged or repeated words; syllables, or sounds.

Problems with articulation : errors in the production of speech sounds or

phonemes
68

Articulatory immaturity : articulatory speech pattern that is typical of children

younger than the client.

Articulatory dysmaturation : articulatory speech patterns that are not typical at

any developmental stage.

5.12 Check Your Answers

1. Speech disorders

2. Stuttering

3. Child’s environment

4. Stress

5. Parent and family counseling, environmental manipulation

5.14 Model Questions

1. Discuss about speech disorders

2. What is stuttering?

3. Discuss about the therapies for stuttering.

4. Explain environmental manipulation.

5. Why do you think advanced stuttering is more complicated than early stuttering?

6. What are the general goals of therapy?

7. What are speech articulation problem?

8. How will you assess the deficiencies in articulation?

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LESSON - 6
PERVASIVE DEVELOPMENTAL DISORDER
6.1 Introduction

People with pervasive developmental disorders experience problems with language,

socialization and cognition. The word pervasive means that these problems are not relatively
minor (as on learning disabilities), but significantly affect individuals throughout their lives. This
lesson deals with autistic disorder, impairment in social interactions and communication, restricted
behavior, interests and activities. The prevalence, causes, psychological, social and biological
dimension also discussed in detail. The lesson concludes with various psychosocial biological
treatments.

6.2 Objectives

After reading this lesson, you will understand the following:

 Autistic disorder

 Impairment in social interactions

 Impairment in communication

 Restricted behavior, interest and activities

 Statistics

 Causes

 Psychological and social dimensions

 Biological dimension

 Psychosocial treatment

 Biological treatment

Plan of Study
6.1 Introduction

6.2 Objectives

6.3 Autistic Disorder

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6.4 Impairment in Social Interactions

6.5 Impairment in Communication

6.6 Restricted Behavior, Interests and Activities

6.7 Statistics

6.8 Causes

6.9 Psychological and Social Dimensions

6.10 Biological Dimension

6.11 Psychosocial Treatment

6.12 Biological Treatment

6.13 Summary

6.14 Keywords

6.15 Check your Answers

6.16 Model Questions

6.3 Autistic Disorder

Autistic disorder or autism is a rare childhood disorder that is characterized by significant

impairment in social interactions and communication and by restricted patterns of behavior,
interest and activities. Individuals have a puzzling array of symptoms. Consider the following
case.

Clinical Description : Three major characteristics of autism as expressed in DSM-IV:

impairment in social interactions, impairment in communication and restricted behavior, interest
and activities.

6.4 Impairment in Social Interactions

One of the defining characteristics of people with autistic disorders is that they do not
develop the types of social relationships expected for their age (Waterhouse, Morris, Allen,
Dunn, Fein, Feinstein, Rapin& Wing 1996). Timmy and Amy never made any friends among
their peers and often limited their contact with adults to using them as tools; for example, taking
the adult’s hand to reach for something they wanted. For many people with autism, the problems
 71

they experience with social interactions may be more qualitative than quantitative. They may
have about the same rate of exposure to others as you or your friends, but the way they make
contact is unusual. Timmy, for instance, seemed to enjoy sitting on his mother’s lap, but he
always sat facing away from her rather than taking the face-to-face position that is typical of
most children. Although they do not make eye contact and smile at their mothers like children
without autism, they still recognize the difference between their mothers and strangers and
prefer to be near their mothers in stressful situations (Dissanayake&Corssley 1996;
Sigman&Ungere, 1984); for example, they will sit near their mothers rather than near strangers
after being left along for a short period of time. This research suggests that people with autism
are not totally unware of others, as we once thought; however, for some reason we do not yet
fully understand, they may not enjoy meaningful relationships with others or have thye ability to
develop them.

6.5 Impairment in Communication

People with autism nearly always have severe problems with communicating (Mundy,
Sigman& Kasari 1990).About 50% are like Timmy, never acquiring useful speech (Rutter,1978;
Volkmar, Klin, Siegel, Szatmari, et.at., 1994). In those with some speech, much of their
communication is unusual. Some repeat the speech of others , a pattern called echolalia we
referred to before as a sign of delayed speech development. If you say, “My name is Eileen,
what’s yours?” they will repeat allm or part of what you said: “Eileen, what’s yours?” And often,
not only are your words repeated, but so is your intonation. Some who can speak are unable or
unwilling to carry on conversations with others.

6.6 Restricted Behavior, Interest, and Activities

The more striking characteristics of autism include restricted pattern of behavior, interests,
and activities. Timmy appeared to like things to same; he became extremely upset if even a
small change was introduced(such as moving a living room chair a few inches). This intense
preference for the status quo has been called, maintenance of saneness. One parent related
that her some with autism liked one particular helicopter from a toy set and that she had contacted
the manufacturer and obtained more than 50 identical helicopters for her son. He would spend
hours lining them up, and his mother reported that he could immediately tell if even 1 of the 50
was removed.
72

Often, people with autism spend countless hours in stereotyped and ritualistic behavior,
making such stereotyped movements as spinning around in circles, waving their hand in front
of their eyes with their heads cocked to one side, or biting their hands. Amy spent hours watching
lint fall to the floor. The rituals are often complex. Some people must touch each door as they
walk down a hall; others touch each desk in a classroom. If they are interrupted or prevented
from completing the ritual, they may have a severe tantrum.

What must it be like to have autism? Is it an exquisite solitude, divorced from the stressors
of modern life? Or is it an oppressive state of anxiety, filled with the need to try constantly to
maintain sameness in a chaotic world? Such fundamental questions have led some researchers
to interview the few rare individuals who have both autism and good verbal abilities, hoping to
gain a better understanding of autism in order to aid those who have it.

One such firsthand account is an extensive interview with 27 years old man named Jim,
who was diagnosed with autism during his preschool years (Cesaroni & Gaber, 1991). Jim
showed all the typical characteristics, including stereotypic movements, resistance to change,
repetitive play and social impairments. Because of these unusual behaviors, a psychiatrist had
recommended that he be placed in an institution when he was about 9 years old. Despite these
obstacles, Jim acquired sufficient skills to complete high school, and at the time the interview
was published he was completing graduate studies in developmental psychology. During his
interview, Jim explained how he views the world and talked about his own behavior. In describing
his sensory impressions, he noted that his processing often gets mixed up. “Sometimes, the
channels get confused, as when sounds come through as color. Sometimes, I know that
something is coming in somewhere, but I can’t tell right away what sense it’s coming through”
(Ceasroni & Garber, 1991 p.305) He observed that not only do his senses sometimes becomes
switched (hearing sounds and interpreting them as seeing colors) but that sometimes they
overlap and become distracting. “I have caught myself turning off the car radio while trying to
read a road sign, or turning off the kitchen appliances son that I could taste something (Ceasroni
& Garber, 1991 p.306).

As he was growing up, Jim’s stereotyped behaviors included rocking back and forth,
twirling around and swinging his limbs from side to side. He continued to behave this way on a
limited basis even into adulthood. He has difficulty explaining why he does these things.

Stereotyped movements aren’t things. I decide to do for a reason; they’re things that
happen by themselves when I’m not paying attention to my body. If I’m not monitoring them
 73

because I’m worn out, distracted, overwhelmed, intensely focused on something else, or just
relaxed and off-guard, then stereotyped movements will occur. People who are close enough
for me to be relaxed and off-guard with can except to see me acting “weird”, while people who
only see me in “Public display” mode don’t see such behavior. (Ceasroni & Garber, 1991 p.309)

Social relationships seem to have given Jim the most trouble, and he reports putting in
a tremendous amount of effort to improve them. He felt that he had succeeded in establishing
meaningful relationship with others, but at great cost. For example, it wasn’t until he was 23 that
he allowed people to touch him.

Jim’s description of his disorder may illustrate what autism is like for most people or only
what is unique to him. However, to hear about such experience is enlightening and helps us
gain some insight into the disorder. Jim’s account makes us wonder whether the abnormal
sensory experiences are responsible for the disrupted social development, for instance. As we
gain access to more of these accounts, our understanding of autism should grow, allowing us to
offer great assistance to those this disorder.

6.7 Statistics

Autism is relatively rare, although exact estimate of its occurrence vary. Early research
placed the prevalence of this condition at approximately 2 to 5 per 10,000 people (Lotter, 1966).
Recent estimates, using contemporary definitions of autistic disorder, have lowered the rate to
about 2 per 10,000 people (Gillberg, 1984). Gender differences for autism vary depending on
the IQ level of the person affected. For people with IQs under 35, autism is more prevalent
among females; in the higher IQ range, it is more prevalent among males. We do not know the
reason for these differences (Volkmar, Szatmari & Sparrow 1993) Autistic disorder appears to
be a universal phenomenon, identified in every part of the world including Swedon (Gillberg,
1984), Japan (Sugiyama & Abe, 1989) Russia (Lebedinskaya & Nikolskaya, 1993), and China
(Chung, Luk & Lee, 1990). The Vast majority of people with autism develop the associated
symptoms before the age of 36 months (American Psychiatric Association, 1994).

There are people with autism along the continuum of IQ scores. Timmy showed all the
classic sign of autism but also seemed to have the cognitive delays characteristic of people with
mental retardation, as do three of every four people with autism. Almost half arein the severe to
profound range of mental retardation (IQ of 50 to 70), and the remaining people display abilities
in the borderline to average range (IQ grater that 70) (water house, wing & Fein 1989). IQ
74

measures are used to determine prognosis: the higher children score on IQ tests, the less likely
they are to need extensive support by family members or people in the helping profession.
Conversely, young children with autistic disorder who score on IQ tests, the less likely they are
to need extensive support by family members or people in the helping professing. Conversely,
young children with autistic disorder who score poorly on IQ tests are more likely to be
severelydelayed in acquiring communication skills and to need a great deal of educational and
social support as they grow older. Usually, language abilities and IQ scores are reliable predictors
of how children with autistic disorder will fare later in life. The better the languages skills and IQ
test performance, the better the prognosis.

Autistic disorder is considered atype of pervasive developmental disorder, of which there

are three other types: Asperser’s disorder, Retts’disorder, and childhood disintegrative disorder.
We are focusing on autistic disorder, on which the most research has been conducted. The
other three disorders are highlighted. People with pervasive developmental disorders all
experience problems with language, socialization, and cognition. The word pervasive means
that these problems are not relatively minor (as on learning disabilities), but significantly affect
individuals throughout their lives. There is general agreement children with a pervasive
developmental disorder can be identified fairly easily because of the delays in their daily
functioning. Picking Timmy out from his nondisabled peers didn’t require a great deal of diagnostic
sophistication. His lack of speech and his problems interacting with others were obvious by the
age of 3. What is not so easily agreed on, however, in how we should define specific subdivisions
of the general category of pervasive developmental disorders (Waterhouse, Wing, Sptizer &
Siegel, 1992)

More specialists agree that autism should remain a separate category. There is less
agreement, however, on whether Asperser’s disorder. Rett’s disorder, or childhood disintegration
disorder are distinctly different conditions. Some believe that they are at different points on an
autistic continuum, especially Asperser’s disorder . Others believe that there are important
differences and that the disorders should be side red separately in order to improve research
on each one (Rutter & Schopher, 1992).

6.8 Causes

Much research has been done on the causes of autism, but to date it has provided little
conclusive data. Autism is a puzzling condition, so we should not be surprised to find numerous
theories of why it develops. One generalization is that autistic disorder probably does not have
 75

a single cause (Rutter, 1978). Instead, there may be a number of biological contributions that
combine with psychological influences to result in the unusual behaviors of people with autism.
Because historical context is important to research, it is helpful to examine part as well as more
recent theories of autism. (In doing this, we are departing from our usual format of providing
biological dimensions first).

6.9 Psychological and Social Dimensions

Historically, autistic disorder was seen as the result of failed parenting (Bettelherim,
1967, Ferster, 1961, Tinberg & Tinbergen & Tinbergen, 1972) Mothers and Fathers of Children
with autism were characterized as perfectionist, and aloof (kanner, 1949), with relatively high
socioeconomic status (Allen, DeMyer, Norton, Pontius, & Yang, 1971, Cox, Rutter, Newman &
Bartak 1975) and higher IQs than the general population (Kanner, 1943). Descriptions such as
these have inspired theories holding parents responsible for their children’s unusual behaviors.
These views were divesting to a generation of parents, who felt guilty and responsible for their
children’s problems. Imagine being accused of such coldness toward your own child as to
cause serious and permanent disabilities! More recent research contradicts these studies,
suggesting that on a variety of personality measures the parents of individuals with autism may
not differ substantially from parents of children without disabilities (Koegel, Schreimbman, O’Neil
& Burke, 1983; McAdoo & DeMyer.1978)

Other theories about the origins of autism were based on the unusual speech patterns
of some individuals – namely, their tendency to avoid first person pronouns such as I and me
and to use he and she instead. Foe example, if you ask a child with autism, “Do you want
something to drink?” he might say, “He wants something to drink” (Meaning “I want something
to drink’). This observation led some theorists to wonder whether autism involves a lack of self
awareness (Goldfarb, 1963; Mahler, 1952). Imagine, if you can, not understanding that you’re
extensive is distinct. There is no “you,” only “them”! such a debilitating view of the world was
used to explain the unusual way people with autism behaved. Theorists suggested that the
withdrawal seen among people with autistic disorder reflected a lack of awareness of their own
existence.

However, later research has shown that some people with autistic disorder do seem to
have self awareness (Dawson &M.C.Keswick, 1984, Spicer& Ricks 1984), and hat it follows a
developmental progression. Just like children without a disability, those with cognitive abilities
below the level expected for a child of 18 to 24 months show little or no self-recognition, but
76

people with more advanced abilities do demonstrate self-awareness. Self-concept may be lacking
when people with autism also have cognitive disabilities or delays, and not because of autism in
itself. Both self-awareness and the affected persons; possible lack of attachment to other point
to the importance of studying disorders from a developmental perspective. Knowing more about
how people without autism change over time will help us better understand the people with this
disorder.

A mythology about people with autism is encouraged when the idiosyncrasies of the
disorder are highlighted. These perceptions are further by portrayals such as Dustin Hoffman’s
rain man-his character could for instance, instantaneously and accurately count hundreds of
toothpicks falling to the floor. This type of ability is just not typical with autism. It is important
always to separate myth from reality and to be aware that such portrayals do not accurately
represent the full range of manifestation of this very complex disorder.

It is also important to distinguish between problems that are a result of delays in

development and problems that are a result of autism. For example, we’ve seen that individuals
with autism do acquire some form of attachment to others, although the way it is expressed
may be different from the way of typical child would show it.

Another phenomenon that was once thought to be unique to autism is known as stimulus
over selectivity (Rosenblatt, bloom & Koegel, 1995). Some people with autism will respond to a
small number of sometimes irrelevant cues when they are learning. It would not be unusual for
a child with autism to learn to point to a picture of food to communicate hunger, then later to
stop pointing to the picture of food to communicate hunger, then later to stop pointing to the
picture if it is placed on the right side of the table rather than on of the left. In this case, the child
seems to over select the cue of position (left side versus right side) rather than focus on the
image in the picture, as if to the child with mental retardation did researchers realize that it was
common among children at an early stage of cognitive development and not an oddity unique
to autism (SC hover& Newsom, 1976).

The phenomenon of echolalia, repeating a word or phrase spoken by another person,

was once believed to be an unusual characteristic of this disorder. Subsequent work it
developmental psychopathology, however, has demonstrated that repeating the speech of others
is part of the normally developing language skills observed in most young children (I.K.Koegel,
1995; Prizant & Wetherby, 1989). Even a behavior as disturbing as the self-injurious behavior
sometimes seen in people with autism is observed in milder forms, such as head banging,
 77

among typically developing infants (de Lissovoy, 1961). This type of research has helped workers
isolate the fact from the myths about autism and clarify the role of development in the disorder.
Primarily, it appears that what clearly distinguish people with autism from others are social
deficiencies.

At present, few workers in the field of autism believe that psychological or social influences
play a major role in the development of this disorder. To the relief of many families, it is now
clear that poor parenting is not responsible for autism. Deficits in such skills as socialization and
communication appear to be biological in orgin. Biological theories about the orgins of autism,
examind next, have received much empirical support.

6.10 Biological Dimensions

A number of different medical conditions have been associated with autism, including
congenital rubella (German measles), hypsarhythmia, tuberous sclerosis, cytomegalovirus and
difficulties during pregnancy and labor. However , although a small percentage of mothers
exposed to the rubella virus children with autism, most often no autism is present. We still don’t
know why certain conditions result in autism sometimes but not always.

Genetic influence : It is now clear that autism has a genetic component (Smalley, 1991).
We know that families who have one child with autism have a 3% to 5% riskof having another
child with the disorder. When compared to the incidence rate of approximately 0.0002% to
0.0005% in the general population, this rate is evidence of a genetic component in the disorder.
(Falconer, 1965)

Twin studies have been conducted to assess genetic influences on autistic disorder,
although autism is so rare that finding enough people for valid research is extremely difficult.
Susan Folstein and Micheal Rutter (1977) studied 11 people with autism who had fraternal (or
dizygotic) twins. They found a concordance rate of 36% for the monozygotic twins: I 4 of the 11
twin pairs, both twins had autism. Folstein and Rutter also examined the twin for the presence
of other developmental and cognitive problems and found that the concordance rate increased
to 82% for the monozygotic group and to 10% for the dizygotic group. In other words, when
they looked at developmental disorders in general, they found hat, if one of the monozygotic
twins had autism, the other twin was highly likely to have autism or some other cognitive or
developmental problems. This study and others (Herault, Petit, et al.1989) are important because
they strongly suggest that autism is inherited. As with so many of the disorders we have examined,
78

the exact nature of the genetic influence on autism is not yet clear to researchers. Current
thinking suggests to autosomal recessive inheritance. (Smalley, 1991)

Neurobiological influences. Evidence that autism is associated with some form of organic
(brain) damage comes most obviously from the prevalence of data showing that three of every
four people with autism also have some level of mental retardation. In addition, it has been
estimated the between 30% and 75% of these people display some neurological abnormality
such as clumsiness and abnormal posture or gait (Tsai & Ghaziuddin, 1992). These observations
provide suggestive but only correlation al evidence that autism is physical in origin. With modern
brain-imaging and scanning technologies, a clearer picture is evolving of the possible neurological
dysfunctions in people with autism (B.S.Peterson, 1995). Researchers using computerized
axial tomography and magnetic resonance imaging technologies have found abnormalities of
the cerebellum, including reduced size, among people with autism.

Eric Courchene and hiscolleagues at the University of California at San Diego examined
the brain of a 21 year old man who had a diagnosis of autism but no other neurological disorders
and a diagnosis of autism but no other neurological disorders and a tested IQ score in the
average range (Courchesne, Hernigan, & Yeung Courchesne, 1987). He was selected as a
subject because he did not have the severe cognitive deficits seen in three quarters of people
with autism. Hence, the researchers could presume that he was free of any brain damage
associated with mental retardation but not necessarily with autism.

After obtaining the informed consent of this man and his parents, they conducted an
MRI scan of his brain. In the MRI scans of a person without autism on the left and of Courchesne’s
subject on the right, the most striking finding was that the cerebellum of the subject was
abnormally small compared with that of a person without autism. Although this kind of abnormality
has not been found in every study using brain imaging, it appears to be one of the more reliable
finding of brain involvement in autism to date (Courchesne, 1991), and may point out an important
subtype of people with autism.

The study of autism is a relatively young field and awaits an integrative theory. It is likely,
however, that further research will identify the biological mechanisms that may ultimately explain
the social aversion experienced by many people with the disorder. Also to be outlined are the
psychological deficits in socialization and communications as well as the characteristic unusual
behaviors.
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Treatment

One generalization that can be made about autism is that there is no effective treatment.
We have not been successful is eliminating the social problems experienced bypeople with this
disorder. Rather, like the approach to individuals with mental retardation, most efforts at treating
people with autism focus on enhancing their communication and daily living skills and on reducing
problem behaviors such as tantrums and self-injury (Durand, in press). Some of these approaches
are described next, including new work on early intervention for young children with autism.

6.11 Psychological Treatments

Early psychodynamic treatments were based on the belief that autism was the result of
improper parenting, and encouraged ego development (Bettelheim, 1967). Given our current
understanding about the nature of the disorder, we should not be surprised to learn that treatments
based solely on ego development have not had a positive impact on the lives of people with
autism (Kanner & Eisenberg, 1995). Greater success has been achieved with behavioral
approaches that focus on skill building and behavioral treatment of problem behaviors. This
approach is based on the early work of Charles First and IvorLoaves.

Although Fester’s view of the origins of autism is now generally discounted, he provided
a valuable perspective by showing that children with this disorder respond to simple behavioral
procedures (Ferster & DeMyer, 1961). Ferster used basic, single case experimental designs,
modeling his work after the pigeon and rat learning experiments of B.F.Skinner. He found that
he could teach children with autism very simple responses, such as putting coins is the proper
slot, by reinforcing them with food (Ferster, 1961).

Invar Lovaas at UCLA took Ferster’s findings further by demonstrating their clinical
importance. He reasoned that if people with autism responded to rein forcers and punishers in
the same way as everyone else, we should be able to use these techniques to help them
communicate with us, to help them become more social, and to help them with behavior problems.
Although the work of Ferster and Lovaas has been greatly refined over the past 30 years, the
basic premise-that people with autism can learn and that they can be taught some of the skills
they lack-remains central. There is a great deal of overlap between the treatment of autism and
the treatment of mental retardation. With that in mind, we highlight several treatment areas that
are particularly important of people with autism, including communication and socialization.
80

Communication: Problems with communication and languages are among the defining
characteristics of disorder. As we saw in Timmy’s case, people with autism often do not acquire
meaningfully speech; they tend to have either very limited speech; they tend to have either very
limited speech or unusual speech such as echolalia. Teaching people to speak in a useful way
is difficult. Think about how we teach language: It mostly involves imitation. Imagine how you
would teach a young girl to say the word Spaghetti. You could wait for several days until she
said a word that sounded something like “Spaghetti” (may be “confetti”), then reinforce her. You
could then spend several weeks trying to shape “confetti” in to something closer to “spaghetti”.
Or you could just prompt, “Say, “spaghetti.” Fortunately, most children can imitate and learn to
communicate very efficiently. But a child who has autism can’t or won’t imitate.

In the mid-1960s, Lovaas and his colleagues took a monumental first step toward
addressing the difficulty of getting children with autism to respond. They used the basic behavioral
procedures of shaping and discrimination training to reach these nonspeaking children to imitate
others verbally (Lovaas, Berberich, Perloff & Schaeffer, 1966). The first skill the researchers
taught them was to imitate other people’s speech . They began by reinforcing a child with food
and praise for making and sound while watching the teacher. After the child mastered that step,
they in forced the child only if she or he made a sound after the teacher made a request-such
as the phrase, “Say “ball” (a procedure known as discrimination training).

Once the child reliably made some sound after the teacher’s request, the teacher used
shaping to reinforce only approximately of the requested sound, such as the sound of the letter
“b”. Sometimes the teacher to help the child make the sound of “b”. Once the child responded
successfully, a second word was introduced-such as “mama”-and the procedure was repeated.
This continued until the child could correctly respond to multiple requests, demonist rating
imitation by copying the words or phrases made by the teacher. Once the children could imitate,
speech was easier, and progress was made in teaching some of them to use labels, plurals,
sentences, and other more complex forms of language (Lovaas, 1977). Despite the success of
some children in learning speech, other children do not respond to this training, and workers
sometimes use alternatives to vocal speech such as sign language and devices that have vocal
output and can literally “speak” for the child (Johnson, Baumgart, Helmstetter & Curry 1996).

Socialization

One of the most striking features of people with autism is their unusual reactions to
other people. One study compared rates of adolescent interaction among children with autism,
 81

those with Down syndrome, and those developing normally; the adolescent with autism showed
significantly fewer interactions with their peers (Attwood, Frith, & Hermelin, 1988).Although
socialdeficits are among the more obvious problems experienced by people with autism, limited
progress has been achieved towards developing social skills. Behavioral procedures have
increased behaviors such as playing with toys or with peers, although the quality of these
interactions appears to remain limited (Durand & Carr, 1998). In other words, behavioral clinicians
have not found a way of teaching people with autism the subtle social skills that are important
for interactions with peers-including how to intitiate and maintain social interactions that lead to
meaningful friendships.

Timing and settings for treatment: Lovaas and his colleagues at UCLA reported on their
early intervention efforts with very young children (Lovaas, 1987). They used intensive behavioral
treatment for communication and social skills problems for 40 hours or more per week, which
seemed to improve intellectual and educational functioning. Follow up suggests that these
improvements are long lasting (McEachin, smith & Lovaas, 1993). These studies crated
considerable interest as well as controversy. Some critics question the research on practical as
well as experimental grounds, claming that one on one therapy for 40 hours per week which
seemed to improve intellectual and educational functioning. Follow up suggests that these
improvements are long lasting (McEachin, Smith & Lovaas, 1993). These studies created
considerable interest as well as controversy. Some critics question the research on practical as
well as experimental grounds, claiming that one on one therapy for 40 hours per week was too
expensive and time consuming; they also criticized the studies for having no proper control
group. Nevertheless the results from this important study and a number of replications around
the world suggest that early intervention is promising for children with autism (Anderson, Avery,
DiPetro, Edwards & Christian, 1987; Fenske Zalenski, Krantz & Mcclannahan, 1985; Hoyson,
Jamieson & Strain, 1984; Rogers & DiLalla 1991; Rogers & Lewis 1989; Rogers, Lewis & Reis
1987)

Lovaas found that the children the children who improved most had been placed in
regular classrooms, and children who did not do well were placed in separate special classes.
As we will see in our discussion of mental retardation, children with even the most severe
disabilities are now being taught in regular classrooms. In addition, inclusion-helping children
fully participate in the social and academic life of their peers –applies not only toschool but to all
aspects of life. Many different models are being used to integrate people with autism in order to
normalize their experience (Durand, in press). For instance, community homes are being
82

recommended over separate residential settings, including special foster care programs (M.D.
Smith, 1992) and supported employment options are being tested hat would let individuals with
autism have regular jobs. The behavioral interventions discussed are essential to easing this
transition to fully integrated settings.

6.12 Biological Treatments

No one medical treatment has been found to cur autism. In fact, medical intervention has
had little success. A variety of pharmacological treatments have been tried, and some medical
treatments have been heralded as effective before research has validated them. Although
vitamins and dietary changes have been promoted as one approach to treating autism and
initial reports were very optimistic, research to date has found little support that they significantly
help children with autism (Holm & Varley, 1989).

Because autism may result from a variety of different deficits, it is unlikely that one drug
will work for everyone with this disorder. Much current work is focused on finding pharmacological
treatment for specific behaviors or symptoms.

Integrating Treatments

The treatment of choice for people with autism combines various approaches to the many
faces of this disorder. For children, most therapy consists of school education combined with
special psychological supports for problems with communication and socialization. Behavioral
approaches have been most clearly documented as benefiting children in this area.
Pharmacological treatments can help some of them on a temporary basis. Parents also need
support because of the great demands and stressors involved in living with and caring for such
children. As children with autism grow older, intervention focuses on efforts to integrate them
into the community, often with supported living arrangements and work settings. Because the
range of abilities of people with autism is so great, however, these efforts differ dramatically.
Some people are able to live in their own apartments with only minimal support from family
members. Others, with more severe forms of mental retardation, require more extensive efforts
to support them in their communities.
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CHECK YOUR PROGRESS

FILL IN THE BLANKS

1. Three major characteristics of autism as expressed in DSM-IV,————————

——————, ————————————————, —————————————

2. The intense preference for the status quo has been called, ————————,——
———————————————, ————————————————

3. Autistic disorder is a type of ——————————————

4. The three types of pervasive developmental disorder are ———————————

———————— and ——————————————

5. People with autism spend countless hours in ——————————— and ———

———————— behavior.

6.13 Summary

Autistic disorder or autism is rare childhood disorder that is characterized by significant

impairment in social interactions and communication and by restricted patterns of behavior
interest and activities. One of the defining characteristics of people characteristics of people
with autistic disorders is that they do not develop the types of social relationships expected for
their age. People with autism nearly always have severe problems with communicating. The
more striking characteristics of autism include restricted pattern of behavior , interests and
activities. Often, people with autism spend countless hours in stereotyped and ritualistic hand in
front of their eyes with their heads cocked to one side, or biting their hands. Autistic disorder is
type of pervasive developmental disorder. Historically, autistic disorder was seen as a result of
failed parenting.

At present, few researches believe that psychological and social influences play a major
role in the development of his disorder. Autism has a genetic component, associated with some
from of organic damage. The treatment of choice genetic component, associated with some
from of organic damage. The treatment of choice for people with autism combines various
approaches to the many facets of his disorder.

KEY WORDS:

Autistic Disorder or autism: rare childhood disorder that is characterized by significant

84

impairment in social interactions and communication and by restricted patterns of behavior ,

and interest and activities.

ECHOLALIA:

Repeating a word or phrase spoken by another person.

Maintenance of sameness: intense preference for the status quo.

Tuberous sclerosis: Thinking of vessels.

Rubella: German measless.

CHECK YOUR ANSWERS

1. Impairment in social interactions, impairment in communication and restricted
behavior, interests, and activities.

2. Maintenance of sameness.

3. Pervasive developmental disorder.

4. Asperger’s disorder, Rett’s disorder, childhood disintegrative disorder.

5. Stereotyped and ritualistic.

6.16 MODEL QUESTIONS

1. What do you mean by autistic disorder?

2. What are the major characteristic of autism as expressed in DSM-IV ? EXPLAIN.

3. What is a pervasive developmental disorders? Explain.

4. What are the psychological and social dimensions of autism?

5. What are the biological dimensions of autism?

6. Psychosocially how will you help an individual with autism?

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LESSON - 7
ANXIETY AND FEARS
7.1 Introduction

Fear and anxiety have been universal experiences of man at every age and stage of
development, yet, there is very little empirical evidence and clear understanding of childhood
anxieties and fears. Fear, anxiety and phobias are subjectively felt, with feelings of misery and
unhappiness and a heightened sense of uncertainty. Fear is a normal physiological reaction to
a genuine threat and disappears with the withdrawal of the threat. Anxiety is response to an
internal cue without obvious external threat. In phobia, the anxiety becomes attached to external
objects or situations which by themselves are not dangerous. This lesson deals with anxiety
and fears, characteristics of anxiety, school phobia, phobia, obsessive-compulsive disorder,
separation anxiety disorder, treatment, school refusal, development of school refusal among
children, assessment, interventions in school refusal, performance anxiety, temper tantrum,
depression, assessment, etiology.

7.2 Objectives

After learning this lesson, you will understand the following:

 Anxiety and fears

 Characteristics of anxiety

 School phobia

 Phobia

 Obsessive-compulsive disorder

 Separation anxiety disorder

 School refusal

 Development of school refusal among children

 Interventions in school refusal

 Performance anxiety

 Temper tantrum

 Depression
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Plan of Study
7.1 Introduction

7.2 Objectives

7.3 Characteristics of Anxiety

7.4 School Phobia

7.5 Obsessive-Compulsive Disorder

7.6 Separation Anxiety Disorder

7.7 School Refusal

7.8 Development of School Refusal Among Children

7.9 Interventions in School Refusal

7.10 Performance Anxiety

7.11 Temper Tantrum

7.12 Depression

7.13 Summary

7.14 Key Words

7.15 Check Your Progress

7.16 Model Questions

7.3 Characteristics of Anxiety in Childhood

1. Anxiety in children may be manifest or latent: When anxiety is not manifest, symptoms
such as hyperactivity, aggressive behavior, enuresis, encopresis, social withdrawal, stammering
and learning disabilities, may all arise out of latent anxiety. This construct is very helpful for the
clinician in understanding a child who presents different psychopathological complaints.

2. Anxiety may be a primary or secondary diagnosis : Sometimes anxiety produces the

symptoms, while at other times the symptom may, in turn, produce anxiety. Anxiety is common
in most of the psychopathological disorders, though less in aggressive conduct disorders and
more in internalizing disorders. Anxiety thus can be present in children with developmental
delays, organic brain dysfunction, neurotic and psychotic problems (Chess, 1973).
 87

3. Anxiety is age-related in the causes and consequences : Although experience of anxiety

or fears may be similar, the causes and consequences may be very different across ages.

4. The clinical and experimental evidence clearly demonstrates that the source of the
content of anxiety and fears changes with age and stabilizes around the age of six : In general,
the specific number of stimuli which give rise to fears also increases with age. This in turn may
be related to the ability to reason, abstract and generalize. Graziano, De Giovanni and Garcia
(1979) proposed that, in clinical practice, fears were to be defined as those with duration of over
two years or that had an intensity which was debilitating to the child’s lifestyle.

5. Anxiety as a state or a trait: Whether the child is anxious by nature when anxiety is
chronic condition, or whether a child is extremely anxious and the condition acute, is yet another
distinction to be made. This distinction should be understood in the context of developmental
stages, unlike in adults, where trait and state anxiety are clearly defined and understood. A
temperamental dimension of being anxious thus would be an equivalent of trait anxiety.

6. Anxiety and Depression: In children, depression like anxiety, is a nebulous concept

and may be manifest or latent, primary or secondary. In very young children, depression is
characterized by extreme withdrawal, particularly in the context of separation from the mother,
institutionalization and under stimulation. Spitz (1946) called it analytic depression. Bowbly
(1969) studied depression which follows separation from the caretaker in early years of childhood
and manifests by numbness, protest, despair and detachment. However, after early childhood,
depression manifests in older chidren with all adult aspects of depression, with disturbances in
affective, in cognitive, motivational, vegetative and psychomotor functions (Kovacs, 1977). The
only difference may be that dysphonic mood may not e the primary symptom, as it is in adults.
Achenbach (1977) reviewed studies using multivariate statistical techniques and suggested the
presence of symptoms of anxiety and depression in children and that the symptoms were
intermixed. Both anxiety and depression existed at the manifest level and were part of a general
inhibition (Internalizing) syndrome.

There are the two major theories of anxiety. In the psychoanalytic framework, conscious
anxiety is experienced by the person as a result of unconscious anxiety produced by conflict
between the ld, the Ego and the Superego. The social learning theory specifies respondent
conditioning, operant conditioning and the two factor theory of conditioning. Each of these
assumes that anxiety is learned. According to the respondent theory, any neutral stimulus that
happens to make an impact on the child at the time that a fear reaction occurs will subsequently
88

evoke a fear reaction. Operant theory postulates that the behavior that is rewarded tends to
occur again, while behavior that is not rewarded is extinguished. The two factor theory combines
the respondent theory and the operant theory and holds that anxiety occurs through fear reaction
and is unpleasant; consequently, avoidance of the fear –arousing reduces anxiety.

There are theories which explain childhood anxiety and fears, focusing on the stages of
cognitive and emotional development of the child. For example, fear of a snake will come after
the child’s cognitive ability makes him understand that snakes are dangerous. Separation from
the mother produces anxiety in a one year old, but not in a 12 year old, and this is related to the
phase of the educational development of the child. It is important that the clinician views the
cause of anxiety in a child from the perspective of the child in the context of interaction with his
environment. Furthermore, anxiety in children may be a product of several factors, and may not
be explained adequately by the simplistic explanations provided by some of the traditional
theories.

7.4 School Phobia

Many of the phobias seen in adults may also be present in children. The most interesting
and a typical phobia in children in school phobia wherein the child refuses to go to school.
School phobias are divided into two types: Type 1 and Type 2 (Kennedy, 1965). Type 1 occurs
in the younger group, has an acute and traumatic onset. It is attributed to separation anxiety
and generally occurs in a child who is functioning well in all other areas. IN the type II phobia.
Unlike Type I the onset is adolescence and is gradual. Disturbance is more pervasive and the
condition more resistant to treatment.

Hersov (1960a and b) in his study, of 50 cases of school refusal and 50 of truancy ,
reported that truants came from larger families, with inconsistent home discipline paternal
absence in infancy and in later childhood. They changed schools frequently their standard of
work was poor, and truancy was an indication of conduct disturbance. He found 74 per cent of
the school phobic’s to be timid and fearful when they were away from home, but willful and
dominating at home. The younger children had less experience in copying with parental absence
and tended to be overprotected. Mothers were over controlling and fathers, though good providers
were inadequate. Mothers were over controlling and fathers though good providers were
inadequate in nearly half the sample. Neorosis was also present in the families of school phobic’s
. Shapiro and jegede (1973) suggested a four dimensional approach to school phobia. The first
criterion is the age or the developmental stage, when a younger child, for example, has separation
 89

anxiety it is normal. The same in an older child is pathological. The second concerns the external
forces such as parental attitude to school, peer relations, punitive school system, and socio-
cultural values. The third is the child’s intra psychic organization, defenses and conflicts. The
fourth dimension is how the child perceives his anxiety. For example, a neurotic child does not
go to school because of anxiety, though he wants to go, whereas a truant avoids the school and
does not bother about it. Thus it is essential to identify whether school refusal is due to voluntary
withholding by the parents, due to separation anxiety, phobic manifestation, aspects of
depression, a psychotic disorder or personality disorder (Hersov, 1977). The management rests
on the identification of the causes. It is essential that the child is returned to school at the
earliest, as the longer the absence, the poorer is the prognosis.

Hersov (1960a and b), found that in his group of school phobic’s, 67 per cent had returned
to school in a year’s time. Recovery was not related to age, sex, and IQ duration of symptoms
or quality of relationships.

7.4.1 Phobias

Phobias in children are severe and unreasonable fears of specific persons, objects and
situations, which are very intense or which are milder but persist beyond two years. Miller,
Barrett and Hamper (1974) define phobia an anxiety which is:

 Attached to a specific non-threatening stimulus.

 Out of proportion to the demands of the situation

 Cannot be reasoned or explained away.

 Beyond voluntary control.

 Leads to avoidance of the feared situation.

 Persists over an extended period of t

 Un adaptive

 Not age or stage specific

Kessler (1972) suggests that phobias may develop in five different ways.First ,the parent’s
warning about something may create a fear about it.Second , some phobias may develop
through classical conditioning , in which a neutral object elicits fear by its association with a
feared object. Third ,it could be the child’s own imagination that gives rise to misunderstanding
.Fourth, a child might develop a phobic reaction by modeling the behavior of someone with the
90

child has positive identification. Finally, classical psychoanalysis views phobias as a defense
against the unconscious impulses striving for expression.Another reason could be family conflicts
or stressors.Hence, management has to be determine by the actual cause of phobia and
treatment consists of behavior theraphy , psycho dynamically oriented individual
therapy,familytheraphy or supportive measures .

7.5 Obsessive Compulsive Disorder

Obsessive-Compulsive Disorder is relatively rare in childhood.Judd(1965)reported a

prevalence rate of 1.2 per cent in child psychiatric population .Hollingsworth et al.(1970),in a
later study in the same setting , established it to be 0.2 per cent.Typically, the obsessive child is
above average in intelligence, and this disorder occurs more frequently in children of middle
socio-economic status.It must be remembered that some obsessive – compulsive rituals are
normal at certain ages,such as avoiding cracks on the road, touching lamp posts and
preoccupation with numbers of vehicles on the road. These are innocuous, non-intrusive and
are not distressing to the child or his family.

It is useful to distinguish whether the child yields to compulsion or resists it.Yielding to the
compulsion offers primary gratification. Based on extensive psychotherapeutic work with
obsessive children, Adams (1973) observed several defense mechanisms such as isolation of
affect, rituals, displacement and undoing, which could be used in psycho-dynamically oriented
theraphy.Adams considered the syndrome as one of cognitive pathology.

Several workers have commented on the higher incidence of psychological disorders in

the families (Judd, 1965; Hollingsworth et al .1970), where parents frequently showed obsessive
–compulsive neurosis themselves. Maritaldiscord,schizophrenia, depression and serious mental
illness among parents have also been reported .pollak (1979) suggested an association between
obsessive –compulsive, especially washing rituals, in their sample. The obsessions consisted
of religious thoughts, fears of harm and impersonal images. In rather traditional settings,
compulsive behavior may not strike the parents as pathological, because they merge in the
compulsive ritualistic background.

A relationship between obsessive –compulsive neuroses, LA Tourette’s syndrome and

conduct disorder has been reported and has led to the postulate of neurological basis of behavior
.Treatments have generally has psychodynamic, behavioral and , in more recent times
,pharmacological.
 91

7.6 Separation Anxiety Disorder

All the anxiety disorders described in this chapter may occur during childhood and there
is one additional anxiety disorder unique to children. Separation anxiety disorder is characterized
by a child’s unrealistic and persistent worry that something will happen to his parents or other
important people in his life or that something will happen to the child himself that will separate
him from his parents (for example, he will be lost, kidnapped, killed or hurt in an accident). The
child often refuses to go to school or even to leave home, not because he is afraid of school but
because he is afraid of separating from his loved ones. These fears can result in the child
refusing to sleep alone and may be characterized by nightmares involving possible separation
and by physical symptoms, distress and anxiety (Albano teal., 1996).

Of course, all young children experience separation anxiety to some extent, this fear
usually decreases as the child grows older. Therefore, a clinician must judge whether the
separation anxiety is greater than would be expected at that particular age (Ollendick&Huntzinger
1990). It is also important to differentiate separation anxiety from school phobia. In school
phobia, the fear is clearly focused on something specific to the school situation; the child can
leave the parents or other attachment figures to go somewhere other than school. In separation
anxiety, the act of separating from the parent or attachment figure provokes anxiety and fear.

Francis, Last and Strauss (1977) found that the prevalence of certain symptoms varies
as a function of age. For example, the prominent symptom among the youngest children was
worry that something would happen to their loved ones. Excessive distress upon being separated
was prominent in the middle age group of children and physical complains on school days
characterized separation anxiety in adolescents.

Treatment

Although the development of phobias is relatively complex, the treatment is fairly

straightforward. Almost everyone agrees that specific phobias require structured and consistent
exposure- based exercises. Nevertheless, most patients who expose themselves gradually to
what they fear must be under therapeutic supervision. Individuals who attempt to carry out the
exercises alone often attempt to do too much too soon and end up escaping the situation,
which may strengthen the phobia. In addition, if they fear having another unexpected panic
attack in this situation, it is helpful to direct therapy at panic attacks in the manner described for
panic disorder (Antony, Craske& Barlow, 1995; Craske, Antony & Barlow 1997). Finally, in cases
92

of blood-injury-injection phobia, where fainting is a real possibility, graduated exposure-based

exercises must be done in very specific ways. Individuals must tense various muscle groups
during exposure exercises to keep their blood pressure sufficiently high to complete the practice
(Ost& Sterner, (1977). New developments make it possible to treat many specific phobias,
including blood phobia, in a single day-long session (e.g., Ost, Ferebee&Furmark 1997). Basically
the therapist spends most of the day with the individual, working through exposure exercises
with the phobia object or situation. The patient then practices approaching the phobic situation
at home, checking in occasionally with the therapist. It is interesting that in these cases not only
does the phobia disappear, but the tendency, to experience the vasovagal response at the sight
of blood also lessens considerably.

7.7 School Refusal

Most children attend school on a regular basis. However, for some children school
attendance is emotionally interesting and they have difficulty attending to school, a problem
that can often result in prolonged absence from school. School phobia and school refusal are
terms used to describe children who have such a pattern of avoiding or refusing to attend
school. Though initially it used to be called as school phobia, in the current literature it is called
school refusal or school avoidance.

School refusal is defined as difficulty attending school associated with emotional distress,
especially anxiety and depression. School refusal is often characterized by abnormally high
anxiety concerning possible or actual separation from parents or other individuals to whom the
child is attached.

These children who experience significant difficulty in attending to school do so for various
reasons and exhibit a wide range of behaviors. In general, children who refuse to attend or
avoid school are in close contact with their parents or caregivers and are frequently anxious
and fearful. They may become upset or ill when forced to go to school.

School refusal is considered as a complex phenomenon with variable presentations.

However, three primary distinguishable clinical groups of school refuses have been identified.
These include: 1) Phobic school refuses; 2) Separation-anxious school refuses; and 3) anxious-
depressed school refuses. Other minor groups of school refuses include children who might be
characterized by other disorders.
 93

Last and Strauss examined 63 school refusing children and adolescent (aged 7-17 years)
referred to an outpatient anxiety disorders clinic. According to DSM-3 R criteria, the most common
primary diagnoses seen among these subjects included separation anxiety disorder (37%),
social phobia (39%) and simple phobia (22%). Less frequent diagnosis included panic disorder
and Post-Traumatic Stress Disorder (PTSD). They also found that many of these subjects had
multiple diagnoses. Reviews have indicated that school refusal occurs in approximately 5% of
all school age children, although the rates of school absenteeism are much higher in some
urban areas. Most studies suggest that school refusal tends to be equally common in boys and
girls. Not wanting to go to school is most common in children aged 5-7 and 11-14 years.

7.7.1 Distinction between Truancy and school refusal

Though truancy and school refusal may have a common behavioral symptom, children
with truancy are often differentiated from school refusal by the presence of antisocial or delinquent
behaviors, lack of anxiety about missingschool and the fact that they are not in contact with
parents or caregivers when they are avoiding school. Thus, when a child stays out of school
without the knowledge and agreement of parents it is called truancy. Children with truancy also
have behavioral problems such as stealing, lying, fighting and destructiveness. There may be
problems at home such as inconsistent disciplining, marital problems in parents, inadequate
supervision or defective temperamental/personality traits and learning difficulties. They will often
have friends who truant and who are involved in antisocial activities.

7.7.2 Classification of School refusal

Coolidge, Halin and Peck distinguished two types of school refusal: “neurotic” and
“characterological”. The neurotic group is consisted of younger children, mostly girls, with a
dramatic onset. The primary conflict of this group was seen as a “symbiotic tie” to the mother
(i.e. separation anxiety). The characterological group is described as more disturbed and
consisted of mainly older boys, with a graduate onset, with early history of school phobic
symptoms with spontaneous remission. Kennedy classified children with school refusal into
type 1 and type 2 school refusers. The type 1 is characterized by 1)the present illness is first
episode; 2) Monday onset, following an illness the previous Thursday or Friday; 3) acute onset;
4) lower grades most prevalent; 5) expressed concern about death; 6) mother’s physical health
in question, actually or the child thinks so; 7) good communication between parents; 7) mother
and father well adjusted in most areas; 9) father competitive with mother in household
management; and 10) parents achieve understanding of dynamics easily.
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The type 2 school refusal is characterized by 1) the present illness is the 2 nd, 3rd or 4th
episode; 2) Monday onset, following an illness the previous Thursday or Friday ; 3) acute onset;
4) lower grades most prevalent; 5) death theme not present; 6) mother’s health not an issue; 7)
poor communication between patients; 7) mother shows neurotic behavior, father a character
disorder; 9) father shows little interest in household or children and 10) parents very difficult to
work with.

When the child fulfills 7 of the above 10 characters he/she is classified as type 1 or type
2.

7.8 Development of School refusal among children

Almost all children display behavior to avoid going to school for academic or social reasons
at some point during their school career. This often happens for trivial reasons such as an
argument with a friend or the consequences of a missed homework assignment. A recent crisis
in the family (death, divorce, move etc) may cause a child to become, fearful/anxious. Some
children fear that something terrible will happen at home while they are at school. Children who
are struggling in school with academic or social problems may also develop school refusal.
Many children have social concerns and may have been teased or bullied at school or on the
way to school.

Children who have missed a lot of school due to illness or surgery may experience difficulty
returning to the classroom routines as well as academic and social demands. Some children
prefer to stay at home because they can watch TV, have parental attention and play rather than
work in school. Children who are transitioning may feel much stressed. All these factors may
lead to the development of school refusal/avoidance. Many children avoid or refuse school for
combination of reasons. When untreated it may result in academic deterioration, poor peer
relationships, school/legal conflicts, work/college avoidance and adult psychological or psychiatric
disorders may result. The potential long-term effects are serious for a child who has persistent
fears. These children may develop panic or anxiety disorders as adults. The child may develop
serious educational or social problems if away from school and friends for an extended period
of time. Refusal to go to school in the older child or adolescents is generally a more serious
illness and often requires more intensive treatment. Often, the child with school refusal may
complain of headache, sore throat, stomach ache shortly before it is time to leave for school.
The “illness” subsides after the child is allowed to stay at home and it reappears the next
morning before school. In some cases, the child may simply refuse to leave the house.
 95

Children with school refusal often display the following behaviors: clinging behavior;
excessive worries and fears about parents or about harm to themselves; shadowing the mother
or father around the house; difficulty going to sleep; frequent nightmares; exaggerated, unrealistic
fears of animals or burglars; fear of being alone in dark; and severe tantrums when forced to go
to school.

7.8.1 Family factors and school refusal

Problematic family functioning has been highlighted as contributing to school refusal in

children and adolescents.

Martin, Cabrol, Bouvard, Lepine and Mouren-Simeoni examined anxiety and depressive
disorders in the mothers of children with anxious school refusal and tested the existence of
differences in familiar aggregation between children suffering from school refusal related to
separation anxiety disorder and those suffering from phobic disorder based school refusal. The
findings indicated that relationships between specific anxiety disorders in children and their
parents revealed increased prevalence of simple phobia and simple and/or social phobia among
the fathers and mothers or phobic school refuses, and increased prevalence of panic disorder
and panic disorder and/or agoraphobia among the fathers and mothers of school refuter’s with
Separation Anxiety Disorder. Simple and/or social phobia in the father, simple phobia in the
mother, and age of the father were associated with the group of phobic school refuter’s. The
data indicated high prevalence of both anxiety and depressive disorders in fathers and mothers
of anxious school refuses. Significant differences were observed in familial aggregation
considering the subgroups of anxious school refused children.

7.8.2 Assessment

Since the problem of school refusal is a complex phenomenon with multiple antecedent
and consequence maintaining it, it is essential to have a structured comprehensive assessment
of various domains of the child and his/her environmental milieu. Such an assessment would
help in understanding the multiple issues involved in the school refusal. The assessment often
focuses on the child’s symptoms and behaviors and their duration, frequency and intensity. It is
also essential to assess the degree of proximity of the child to the caregiver. Assessment of
presence of specific stressors and their proximity with the onset of school refusal is essential.

It is essential to assess the patterns of family communication and interactions. Family

history of anxiety, alcoholism and mood disorders need to be explored. Family history of school
96

refusal also is helpful as it may correlate with separation anxiety disorder in certain situations
may correlate with phobic or anxious symptoms in the child.

These comprehensive assessments can be done using structured or semi structured

interviews and specific objective scales.

The following scales/schedules are often used in the assessment of children with school
refusal and associated mood disorders:

1. Schedule for Affective Disorders and Schizophrenia for school-age Children

(KSADS);

2. Diagnostic Interview for Children and Adolescents (DICA);

3. National Institute of Mental Health Diagnostic Interview Schedule for Children (DISC)

4. Anxiety Disorders Interview Schedule for Children (ADIS);

5. The Anxiety Rating Scale for Children;

6. Multidimensional Anxiety Scale for Children (MASC);

7. Children’s Manifest Anxiety Scale;

8. Interview Schedule for Anxiety Disorders;

9. Social Anxiety Scale for Children;

10. Child Behavior Check List;

7.9 Intervention in School refusal

It is important to get the child back to school, because the longer he/she is away the
harder it is likely to be. The goals of the intervention programs in the school refusal are essentially
1) to facilitate the child’s returning to normal functioning; 2) to make the child tolerate normal
separation from caregivers without distress or impairment of functioning; and 3) to make the
child attend school consistently without subjective experience of distress.

In a child with school refusal it is important to listen to the child and his/her anxieties in
refusing to go to school. It is also important, however, to be firm about getting the child to
school. In the initial stages of school refusal reassuring the child about the fear may help. In
some children, the child might become alright once he/she is in the class room and engaged in
the typical school activities. The longer the child is able to stall coming to school, the more
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difficult it will be to help him get over his anxieties. Often rewards may be added for the child
who stays in school. Slowly these reinforces could be faded away. The multidimensional treatment
programs have been found to be effective in the management of children with school refusal.
These programs often include one or more of the following strategies:

Cognitive behavior therapy (CBT) :Cognitive behavior therapy attempts to restructure the
child’s thoughts and behaviors into a more adoptive framework. Specific behavioral techniques
such as systematic desensitization, exposure and operant behavioral techniques have been
found to be effective. Identification of and recognition of anxiety and associated phenomena
are central to successful behavior change. Modeling, role playing, relaxation techniques as well
as reward systems for behavior change or frequently used as components of behavioral and
cognitive behavior therapies.

Family Therapy :Family therapeutic strategies in school refusal include the assessment
of family functioning and facilitating communication to change dysfunctional patterns of
communication and interactional patterns within the family as these maladaptive patterns may
serve to maintain the child feeling unable to separate from attachment figures. Further certain
maladaptive patterns within the family may cause the family to encourage the child in the sick
role. It is also essential to deal with the mental health/substance abuse issues of the parents
which might be influencing the child’s school refusal. Parents are often encouraged to assess
and find out the possible reasons for school refusal in the children. Parents should made aware
of the causes and possible ways of dealing with such causes. Parents should also encourage
the child to talk about his/her feelings and fears.

Changes in the environment : It is essential to identify the factors other than separation
anxiety which influence the child’s school refusal. If the child tends to avoid school due to issues
such as avoiding academic problems or refusing school due to anticipation of academic failure,
it is essential to deal with the school-related and other factors.

Psycho education : Psycho education with the family is important so that the family
members/care-givers learn how to reward the child for developmentally appropriate behaviors
and does not receive secondary gain from the symptoms of school refusal. Moreover, educating
the child regarding healthy ways to deal with the inevitable stresses that occur in family as well
as school plays a significant role in the management of school refusal. Teachers also play an
important role in the prevention and dealing with school refusal.
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Bernstein et al investigated the efficacy of 7weeks of imipramine versus placebo in

combination with cognitive behavioral therapy for the treatment of school-refusing adolescents
with co morbid anxiety and major depressive disorders using a randomized double blind trial
with 63 subjects entering the study and 47 completing . Outcome measures were weekly school
attendance rates based on percentage of hours attended and anxiety and depression rating
scales. Subjects underwent an 7-session CBT treatment program. The sessions were primarily
with adolescents and parent joined each session for90-15 minutes to participate in behavioral
contracti9ng and to informed about the weekly home –work assignment. In the first two-session,
the therapist:

1) Provided psycho educational information and rationale regarding the behavioral

conceptualization of school refusal and its treatment; 2) developed an individualized
gradual school reentry plan (based on fear and avoidance hierarchy) and 3) trained
the subject in the identification of negative thoughts surrounding school attendance
and replacement of these with more adaptive coping self-statements. Following
this, the subjects were allowed to complete the fear and avoidance hierarchies.
Behavioral contracting was used to increase compliance with the program. Over
the course of treatment, school attendance improved significantly for the imipramine
plus CBT group but not for the placebo group. School attendance of the imipramine
plus CBT group improved at a significantly faster between groups on attendance
after controlling for baseline attendance. Anxiety and depression rating scales
decreased significantly across treatment for both groups, with depression decreasing
at a significantly faster rate in the imipramine plus CBT group compared with the
placebo group. The authors concluded that imipramine plus CBTis significantly more
efficacious than placebo plus CBT in improving school attendance and decreasing
symptoms of depression in school refusing adolescents with co morbid anxiety and
depression.

As parents, we deal with many different issue with our children . Performance anxiety is
one such issue that is not discussed quite as often as some of the others.

7.10 Performance Anxiety

Performance anxiety can be defined as anxiety created by any variety of social settings
or situations. Performance anxiety in children can manifest itself during any number of
circumstances. One of the most common reasons for performance anxiety in the children is
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during tests taking days. Tests create high anxiety for some children, while not affecting others
at all. The very idea of having to sit in a desk and take a test within a certain amount of time can
cause tremendous inner panic in a child.

Another common cause of performance anxiety in children is strict classroom settings.

While, classroom rules are normal, some children feel great anxiety by strict limitations being
applied in the classroom. They may feel stifled or boxed in. Their creativity levels may drop to
an all time low. They might experience greater difficulty participating in classroom activities.

How are children affected by this?

In addition to some of the signs of performance anxiety live described above, there are
even more ways that kids can be affected by this. Some of these ways include:

 Their grades begins to slip, with no explanation or reason why.

 They may start to retreat within themselves and not hang around friends as much

 They become the class clown.

 They look for any excuse to miss school.

 They start skipping classes

Therapy: If you think your child is experiencing performance anxiety, there are always
you can help them out. Don’t wait for the teacher or school counselor to step into help. Start by
helping them by using the following tips:

 Became an active parent at school

 Create a special study time in the evening

 Reinforce positive, constructive to your child .

7.11 Temper Tantrums

A temper tantrum is a sudden, unplanned display of anger . It is not just an act to get
attention. During a temper tantrum, children often cry, yell, and swing their arms and legs.
Temper tantrums usually last 30 seconds to 2 minutes and are most intense at the start.

Sometimes temper tantrums last longer and are more severe. The child may hit, bite, and
pinch. These violent tantrums, in which children harm themselves or others, may be a sign of a
more serious problem.
100

Temper tantrums are most common in children ages 1 to 4 years. But anyone can have
a tantrum even a adult.

Is it normal for children to have temper tantrums?

Temper tantrums are common. Most children ages 1 to 4 have temper tantrums. Some
children have tantrums every day.

Why do children have temper tantrums?

A tantrum is a normal response when something blocks a young from gaining independence
or learning a skill. The child may not yet have the skills to express anger and frustration in other
ways. For example, a temper tantrum may happen when a child becomes frustrated while
trying to button a shirt or is told it’s time for bed when he or she wants to stay up.

Some children are more likely to have temper tantrums than other children. Things that
might make a tantrum more likely are:

 How tired a child is

 The child’s age

 The child’s level of stress

 Whether the child has other physical, mental or emotional problems.

Parent’s behavior also matters. A child may be more likely to have temper tantrums if
parents react too strongly to poor behavior or give in to the child’s demands.

Therapy :Ignoring the tantrums and helping a young child learn how to deal with anger
and frustration are often good ways to deal with tantrums. Pay attention to what starts the
tantrums. Knowing what triggers the tantrums can help you act before your child’s emotions get
past the point where he or she can’t control them.

If temper tantrums are still common after age 3, you may need to use a technique called
time out. A time out takes the child out of the situation and gives him or her time to calm down.
It also teaches the child that having temper tantrum is not an acceptable behavior. Time out
works best for children who understand why it is being used.
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Do children grow out of having temper tantrums?

Most children will grow out of having temper tantrums. With time, most children learn
healthy ways to handle the strong emotions that can lead to temper tantrums.

Children who still have tantrums after the age of 4 may need help learning to deal with
anger. If tantrum continues or start during the school years, they may be a sign of other issues,
such as learning problems or trouble getting along with other children.

7.12 Depression

Until the last decade, little attention had been given to depression in children. Spitz’s
(1945, 1946) classic studies describing the symptoms of hospitalized infants stimulated
considerable interest in mother-Infant separation as well as experimental research on the effects
of separating infant monkeys from their mothers. Spits observed that the hospitalized infants
were retarded in intellectual, social, and motor development and called this collection of symptoms
analytic depression. In addition, Spitz noted the following symptoms: apprehension, sadness,
immobility, listlessness, and apathy. He believed that these symptoms were similar to those
found in depressed adults.

Despite Spit’s early work, depression as a childhood psychological disorder was often
omitted in textbooks child psycho-pathology probably because many clinicians had serious
doubts that depression or other affective disorders existed in children prior to later adolescence.
Hersh (1977) suggested that our cultural mythology depicting childhood as a period without
concerns may be responsible for the relative lack of attention to depression during the last 30
years. During recent years, however, there has been an increasing acknowledgement that
depression can and does occur in children.

7.12.1 Assessment

Childhood depression is usually diagnosed by clinicians on the basis of information

obtained during the interviews with the child and parents. At a conference called Depression in
Childhood, sponsored by the National Institute of Mental Health in 1975, a subcommittee
proposed a set of clinical criteria for the diagnosis of depression in Children (Dweck, Gittleman-
Kelin, McKinney & Watson, 1977). Two essential clinical features were described: 1. Dysphoria
or reports of feeling sad and 2. Impairment in responding to experiences that were previously
rewarding. The impairment has to be apparent across settings and not confined to a specific
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area of functioning, and the clinical features have to be present for four weeks before the
diagnosis can be made. The subcommittee also described secondary features that may be
associated with the essential features; changes in self-esteem, guilt, personal and general
pessimism, and blaming others. The subcommittee recognized that research is needed to
determined the role of these features in children of different ages.

A number of clinicians (e.g. Glaser, 1967; Citron&McEwen, 1974) have maintained the
existence of masked depression; these clinicians believe that depression in children is “masked
“by symptoms which may include hyperactivity, aggressiveness, delinquency, and school failure.
In reviewing the literature on childhood depression, Kovacs and Beck (1977) asserted that
childhood depression is demonstrated by behavioral changes that are similar in type to those
manifested in adult depression. All of the studies agree that depressed children show some
type of negative cognitive change; most of the studies describe attitudinal-motivational changes
as well as disturbances in vegetative (such as sleep an appetite) and psychomotor (e.g. activity)
functions.

Most clinicians accept the DSM-3 R (1977) criteria for diagnosing depression in children
and adolescents as well as adults. DSM-3-R (1977) describes three depression disorders: major
depression, dysthymia, and adjustment disorder with depressed mood. Major depression refers
to a combination of severe symptoms including depressed mood and/or loss of pleasure in
virtually all activities and at least several other symptoms for a period of two weeks. Dysthymia
refers to a chronic disturbance of mood for most of the day for most days for at least two years
in adults and one year in children and adolescents. Adjustment disorder with depressed mood
refers to a maladaptive reaction for no longer than six months to an identifiable psychosocial
stressor with symptoms such as depressed mood, tearfulness, and feelings of hopelessness.

More recent research attention has focused on the development of behavior checklists
and rating scales that may be used for assessing and the development of norms for these
instruments in samples of normal school children . Kovacs and Beck (1977) administered the
short form of the Beck Depression Inventory 9Beck , 1972 ), originally developed for adult , to
a sample seventh and eight grade parochial schoolchildren. The items describe the following
symptoms: sadness, pessimism, sense of failure, dissatisfaction , guilt , self-dislike, self-harm,
social withdrawal, indecisiveness, self-image change , work difficulty, fatigability, and anorexia.
Based on adult norms , 33 percent of the students were classified as moderately to severely
depressed. This high incidence suggests that these depressive symptoms may reflect a normal
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development variation, namely, that adolescents typically check more depression items than do
adults . Another study (Kashmi &Simonds , 1979) found that only 1.9 percent of a sample of 7-
12 year olds met the DSM-III diagnostic criteria for affective disorders , while sadness was
reported by 17.4 percent of the children.

Self report scales are necessarily restricted by children’s reading skills; a minimum of
fourth through sixth grade reading levels is required by most self report scales. One of the most
frequently used self report scales is the children’s Depression inventory (CDI) (Kovacs, 1975)
that was modified from the Beck Depression Inventory for adults.

Interviews, scales, and biological measures of childhood depression permit acceptable

reliability of diagnosis (Romano & Nelson, 1977). Although both children and parents are adequate
reporters of children’s depression symptoms, and children report more internal symptoms and
fewer behavioral symptoms than their parents report.

Epidemiological studies indicate that between 2 and 7 parents of children show significant
symptoms of depression; this level increases substantially during adolescence. No gender
differences have been found for children , but beginning at puberty, more females report
depression symptoms . The clinical course of depression for children is similar to that for adults
, high rates of recovery and high rates of relapse (kovacs,1979). Major depression is linked to
a history of dysthymic disorder. Children and adolescents diagnosed with depression have an
increased risk for major depression as young adults; however, most cases of adult depression
are not preceded by childhood depression (Harrington, Fudge, Rutter, Pickles & Hill, 1990)

Depression is associated with suicidal ideation and suicide attempts , Suicide is rare for
children but increases sharply during adolescence . There is some concern that the rates for
both children and adolescents may be increasing .research findings indicate that individual and
family dysfunction exists to a high degree among adolescence suicide attempters; specific
associated factors include feelings of hopelessness, family conflict , and contagion (peers’
committing suicide) ( Spirito, Overholser & Fritz 1979). In clinical work suicidal talk is taken very
seriously. People who attempt suicide usually talk about it , although relatively few people who
talk about suicide usually talk about it, although relatively few people who talk about suicide
actually attempt it .
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Check your progress

Fill In
a) Anxiety can be ____________and ___________
b) In very young children,____________ is characterized by extreme withdrawal
c) symptoms of anxiety and depression in children are always ___________
d) Phobias in children are severe and unreasonable fears of specific _____________

Answers

a)state and trait b)depression c) intermixed d) persons, objects and situations

7.13 Summary

The present chapter dealt with children Anxiety and fears, Characteristics of anxiety,
School phobia, Phobia, Obsessive-compulsive disorder, Separation anxiety disorder, School
refusal, Development of school refusal among children, Interventions in school refusal,
Performance anxiety, Temper tantrum, Depression.

7.14 Key Terms

Anxiety: an uncomfortable feeling of nervousness or worry about something that is

happening or might happen in the future

Phobia:an extreme fear or dislike of a particular thing or situation, especially one that
cannot be reasonably explained

Obsessive Compulsive disorder: is a mental disorder in which people have unwanted

and repeated thoughts, feelings, ideas, sensations (obsessions), and behaviors that drive
them to do something over and over (compulsions)

Anxiety disorder: characterized by significant feelings of anxiety and fear. Anxiety is a

worry about future events, and fear is a reaction to current events.

Performance anxiety: extreme nervousness experienced before or during participation in

an activity taking place in front of an audience.

Model Questions

Define a) anxiety and fear b) phobias c) Anxiety disorder d) Performance anxiety e) OCD
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LESSON- 8
DISRUPTIVE DISORDER
8.1 Introduction

Disruptive Behavior Disorders involve consistent patterns of behaviors that “break the
rules.” This lesson deals with disruptive disorders. ODD and its treatment, conduct disorder and
intervention, somatic problems and intervention strategies, eating disorders prevention and
intervention in feeding problems.

8.2 Objectives

After reading this lesson, you will know about,

 ODD and its treatment

 Conduct disorder and intervention

 Somatic problems and intervention strategies

 Eating disorders prevention and intervention in feeding problems

Plan of Study
8.1 Introduction

8.2 Objectives

8.3 Oppositional Defiant Disorder

8.4 Conduct disorder and intervention

8.5 Summary

8.6 Key Words

8.7 Check Your Answers

8.8 Model Questions

8.3 Oppositional Defiant Disorder (OOD)

Children with Oppositional Defiant Disorder repeatedly engage in pattern of defiant,

disobedient, and hostile behavior toward authority figures. This behavior goes beyond acceptable
106

misbehavior for the given child’s age and the behavior has been continued for at least six
months.

Children with Oppositional Defiant Disorder tend to display the following symptoms:

 Persistent resistance towards taking direction from others

 Stubbornness or non compliant behavior

 An unwillingness to compromise

 Frequently arguing with, talking back to, or challenging of authority

 Irritably, resentfulness, or negativity

 Deliberate provocation of others which comes across as mean, spiteful, or rude

 Temper tantrums or out bursts

 Externalization of blame(it’s always someone else’s fault). Always blaming others

or denying responsibility

 Repeated testing of other people’s limits(ignoring orders, arguing with directions)

 Repeated trouble at school

 Few or no friends

The symptoms of oppositional Defiant Disorder are always evident at home. However,
ODD children will sometimes compartmentalize their bad behavior so that it does not occur in
other environments. Other children will display ODD symptoms across multiple environments
including school, home and while out the community.

Generally, ODD children are symptomatic when in the presence of adults or peers they
know well. They may not display obvious symptoms in front of strangers. This tendency to
reserve ODD behavior for family and friends (or home settings) can make diagnosing ODD
difficult. Symptoms may simply not be displayed when OD children are being interviewed by a
strange therapist.

According to the DSM, Oppositional Defiant Disorder is fairly common, occurring in between
2 and 16% of children and adolescents. ODD usually begins prior to age 8 and is only rarely
diagnosed after early adolescence has begun. Before puberty, males are more likely to develop
ODD; following puberty this disorder occurs at the same rate across genders.
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8.3.1 Diagnosis of Oppositional Defiant Disorder

Clinically diagnosable oppositional behavior must be distinguished from typical childhood

misbehavior(e.g., occasionally talking back or hitting a sibling). The DSM lists 8 diagnostic
criteria indicative of ODD. At least 4 of these behaviors must be present for at least 6 months in
order to diagnose a child with ODD.

1. Frequently loses his/her temper

2. Frequently argues

3. Frequently defies or refuses to comply with rules and requests

4. Frequently annoys people on purpose

5. Frequently blames other people for mistakes or poor behavior

6. Is frequently very sensitive to other’s comments, or is easily annoyed by others

7. Frequently angry or resentful

8. Frequently cruel or retaliate

Assessment of Oppositional Defiant Disorder takes place in much the same manner as
the process used to diagnose Conduct Disorder. The assessing clinical will typically conduct
interviews with the child, parents and family rating forms similar or identical to those used for
Conduct Disorder. To return to our section on Conduct Disorder, please

Conduct Disorder and Oppositional Defiant Disorder share features in common. For
instance , both conduct disorder and oppositional defiant children are highly irritable and have
poor social skills. However, children with ODD simply do not show the serious behavioral problems
that are present in Conduct Disorder(e.g., behaviors that violate the right of others such
destruction of property). Children who meet criteria for both Conduct Disorder and Oppositional
Defiant Disorder are the same time are diagnosed solely with Conduct Disorder as the diagnosis
of CD takes precedence over the diagnosis ODD (due to its greater severity).

8.3.2 Treatment of Oppositional defiant Disorder

Treatment for ODD is typically similar in design to therapy for treating Conduct Disorder.
As is the case with Conduct Disorder , treatment is typically designed to decrease or eliminate
as many current problem behaviors as possible(with a bias toward targeting and eliminating
behaviors in order of severity; more serious behaviors that have the potential to harm others or
108

cause more negative consequences are targeted first). Therapy also attempts to change affected
children’s long term developmental course toward a more positive outcome. There are several
different approaches to treating Oppositional Defiant Disorder. Close involvement of the entire
family ,and recruitment of parents as implements of the therapy is important for treatment
success.

Behavioral therapy in children with Oppositional Defiant Disorder is based on learning

theory. Behavioral therapists essentially set up conditions wherein children can “unlearn”
inappropriate behaviors and, in their place, learn new appropriate behaviors . After studying the
problematic interactions between ODD children and their parents and other authority figures,
behavioral therapists helps parents to draw up a behavioral contract that specifies in detail,
which negative behaviors are to be discouraged, and reward are also specified in detail, so that
the entire plan alternating children’s behavior is as explicit and transparent as possible . Parents
are taught to be consistent in their use of approved reinforcements (rewards) and ,as necessary,
punishment techniques . By learning to take better and more consistent control over the reward
landscape of their children’s environment, parents gain more control over how their children
behave .Over time , some rewarded behaviors became habitual, and (more usefully) been
reinforced by the environment itself (rather than by parent’s actions) such that children start that
children start engaging in those actions on their own. For example, parents may create conditions
which promote their children’s completion of homework, which in turn may result in their getting
better grades and experiencing a greater mastery of the subject matter being taught, which
causes them to want causes them to avoid homework less.

Behavior therapy for Oppositional Defiant and Conduct Disorders necessarily occurs within
the context of the family of the; techniques are taught to all family members, most especially to
parents. However, behavioral family therapy is commonly supplemented with individualized
therapy for the children themselves. Therapists work directly with disordered children in order
to teach them important skills and coping mechanisms(e.g., appropriately expressing feelings
such as anger, taking other’s perspectives, and appreciating the impact of their own behavior
on others). These two therapy strategies complement one another. The family therapy component
helps reinforce and maintain gains that occur in individual therapy. This sort of combination of
family and individual therapy work is currently thought to be the best way to approach therapy
for disobedient.

Both Conduct Disorder an ODD occur in the context of family and are heavily influenced
by the health of family interactions. Therapists working to treat these disorders may thus
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recommend material therapy or substance abuse treatment to parents and caregivers if they
believe such interventions will improve the overall health of family interactions.

Medications have not been proven effective in treating Oppositional Defiant Disorder, so
they are generally only used if a child has a co-morbid(co-occurring) disorder that responds to
medication, such as Major Depression or ADHD.

8.4 Conduct Disorder

Conduct Disorders are characterized by recurrent and persistent pattern of antisocial

behavior involving the violation of others basic rights and major societal norms or rules .Some
children manifest conduct disorder in terms of overt aggressive and hostile acts towards
others.(e.g., setting fire, destroying property), while others show a pattern of covert, deceitful
acts (e.g., stealing, lying ) without accompanying interpersonal aggression, and still others
shows a combine of these two patterns of antisocial behavior, These ‘externalizing’ behavior
problems are characterized by high rates of hyperactivity, aggression, impulsivity, defiance,
and noncompliance’. Conduct problems may co-occur with other disorders such as attention
deficit disorder, learning disabilities, language delays, and problems frequently come from families
who are experiencing considerable marital discord,depression and distress.

8.4.1 Prevalence

Conduct disorder are seen in approximately 5-8% of the general child population. Kazdin’s
review of prevalence indicated that the estimated rate of conduct disorders in children aged 4-
18 has ranged from 2% to 6%.Conduct disorders for youth under the age of 18 ranges from 6%
to 1% for males and from 2% to 8% for females.

8.4.2 Symptoms

The early –onset conduct disorder begins formally with the emergence of aggressive
and oppositional tendencies in the early preschool period ,progresses to aggressive (e.g. Fighting)
and non aggressive (e.g. lying and stealing ) symptoms of conduct disorder in middle childhood,
and then develops into the most serious symptoms by adolescence, including interpersonal
violence and property violation.
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8.4.3 Delinquent Behavior

Delinquent behavior and criminal behavior are grouped under sociopathic disorders.
Delinquency refers to behavior by the youths under 18 years of age which is not acceptable to
society ,which need some corrective measures or actions. Delinquency may range from truancy
and the use of illegal drugs to homicide and other serious criminal offenses. The actual incidence
of juvenile delinquency is difficult to determine ,since many delinquents acts are not reported.
In addition , the states differ somewhat in their definitions of delinquent behavior –particularly
regarding minor offences –so that what is considered delinquent behavior in Texas may not be
so considered in California or New York. Of the approximately two million young people who go
through juvenile courts each other in the United States, about half have done nothing that would
be considered a crime in the case of an adult . However ,many of these groups are returned to
the courts at a later time for committed serious offences. Delinquency has become a cause for
national concern not only in our own society but in most modern countries throughout the world.

Prevalence

Between 1868 and 1875,arrests of persons under 18 years of age for serious crimes
increased more than 100 percent –some four times faster than the increase in population for
this age group. In 1874,juveniles accounted for over 1 out of 3 arrests for robbery.1 out of 5
arrests for rape, 1 out of 10 arrests for murder . Although the great majority of “juvenile crime”
was committed by males, the rate of increase has risen sharply for females. In 1874 about 1
teenager out of every 15 in the nation arrested , and almost half of all serious crimes in United
State were committed by juvenile who are arrested each year have prior police records .Female
delinquents are commonly apprehended for drug usage, sexual offences ,runningaway from
home , and “incorrigibility”, but crimes against properly, such as stealing , have marked increased
among them . Male delinquents are commonly arrested for drug usage and crimes against
property; to a lesser extent, they are arrested for armed robbery , aggravated assault , and
other crimes against person. However, crimes of violence by juveniles are increasing in our
large metropolitan centers, contributing materially to the fact that in many areas the streets are
considered unsafe after dark. If current trends continue , the changes are estimated to be about
1 in 3 of a juvenile acquiring a police record by the time he is 18 (Polk, 1874).
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Casual factors

Various conditions singly and in combination, may be involved in the development of

delinquent behavior. There are three key variables (a) personality characteristics (b) family
patterns and interactions and (c) delinquent gangs.

(1) Personal pathology

(i) Brain damage and mental retardation hyperactive, impulsive, emotionally unstable-
cause delinquent behavior, low intelligence also a significant casus

(ii) Neuroses and psychoses -5% of delinquent behavior appears to be directly associated
with neurotic disorders and psychotic disorders.

(iii) psychopathic personality –a size number of habitual delinquents appear to share the
traits typically of the antisocial or psychopathic personality they are impulsive , defiant, resentful
,devoid of feeling of guilt, incapable of establishing and maintaining close interpersonal ties,
and unable to profit from experience.

(iv) drug abuse- A sizeable number of delinquent acts particularly theft, prostitution and
assault are directly are associated with drug problems.

(2) pathogen etic family patterns

(a) Broken homes : Delinquency appears to be much more common among youths coming
from homers broken by parental separation or divorce.

(b) parental rejection and faulty discipline : parental rejections ,physically punitive methods
of discipline are the main causes of the development of delinquent personality. The child finds
it to difficult to identify with punishing and rejecting parents and unable to use them as models
for his own development

(c)sociopathic parental models : in the view of bandura, alcoholism, brutality, antisocial

attitudes, failure to provide faith and affection, frequent unnecessary absences from home, and
other characteristics that made the father an inadequate and unacceptable model. Sociopathic
fathers and mothers may contribute in various ways delinquent behavior of children

(d) undesirable peer relationship: intheir study of delinquentshoney and gold found that
about two-thirds of delinquent acts were committed in association with one or two other persons
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(3) General socio –cultural factors

(a) alienation and rebellion: feeling of alienation and rebellion are common to many teen-
agers today from all socio economic levels. We find middle class youth who are uncommitted to
the values of their own values and sense of identify .thus he is likely to identify with and join
peer groups that engage in the use of illegal drugs or other behavior considered delinquent. In
some instances these alienated youths may, rebel leave home , and drift into groups in which
delinquent behavior is the way of life ,as in the case of runaway teen-age girls who become
affiliated with organized prosyiyuyion .the delinquent behavior also directly associated with
poverty, deprivation and discrimination

(b) the social rejects :young people who lack the motivation or ability to do well in school
an drop out and not having any training are not able to find job to make their livelihood . they
discover they are not needed ignore society . they arevictims of social progress they become
social rejects . with the academic handicap teen ages are at a serious disadvantages in the job
market . many of them may engage in delinquent behavior partly as a result of underlying
feelings of frustration confine and hopelessness.

(c)delinquent gang s are most prevalent in lower socioeconomic areas . most members
of delinquent gangs appear to feel inadequate and rejected by their larger society .gang
membership give them a sense of belonging and a means of gaining some measure of status
and approval

(d) unusual stresses and other factors : delinquent behavior may be precipitated by some
relatively minor events . in some instances ,traumatic experience in the life of a boy or girl
appear to act as precipitating events . in his study , Clarke found that events such as death of
parents ,disruption of family life of or discovery that they had been adopted act as precipitating
cause of delinquent behavior. Harrison also emphasized the iortance of stresses that under
mine a youth’s feeling of adequacy and worth as precipitating factors in some cases of aggressive
antisocial behavior.

Dealing with delinquency

If the have adequate facilities and personal juvenile institution and training schools can
be of great help to youths who need to be removed from aversive environments and given a
chance to learn about themselves and their world to further their education and develop needed
skills and to find purpose and meaning in their lives . in such settings the youths may have the
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opportunity to receive psychological counseling group therapy and guide group infractions .
behavior therapy and behavior modification technique have shown marked promise in the
rehabilitation of juvenile offenders who require institutionalized. Counseling with parents and
related sociotherapeutic measure are generally of vital important in the total rehabilitation
programmer.

8.4.4 Interventions

Historically, treatment for conduct disorders focused on intrapsychic approaches including

play therapy and individual psychotherapy with the children, which have met with less recent
acceptance in the absence of evidence for efficacy or promise. Current treatments essentially
focus on the social contexts in which children exhibit maladaptive behaviors (e.g. family, school
or with peers). Hence , behavioral treatment strategies utilize parents , teachers and peers as
therapeutic agents.

Essential , the behavioral interventions attempt to restructure the youth’s social environment
to shape and reinforce positive behaviors and limit antisocial behavior. In addition , the behavioral
formulation focuses on the internal cognitive set characteristics (beliefs and attitudes) of youth
who engage in antisocial behavior to produce lasting positive gains.

Response cost is found to be effective in dealing with maladaptive behaviors. In this

procedure, a response leads to the removal of some portion of accumulated reinforcement.
This technique has been used to suppress various conduct problems , either alone or in
combination with reinforcement , overcorrection , timeout and other procedures. Sometimes
this techi8nque is used in the context of token economy’.

Specific reinforcement schedules have been of use in dealing with a wide range of conduct
problems. These schedules which aim at the reduction of maladaptive behavior patterns are
called as Differential reinforcement schedules. The Differential Reinforcement of Others
Behavior(DRO)involves differentially reinforcing the child’s behaviors except one specific target
behavior . Thus , the target behavior is placed on the an extinction schedule while behavioral
alternatives are reinforced. Similarly, omission training involves reinforcing the child for failing
to emit the undesirable behavior during a specified time period . In the Differential Reinforcement
of Incompatible Behavior (DRI) the child’s behaviors which are physically incompatible with the
undesirable response are rein-excepted one specific target behavior. Thus , the target behavior
is placed on an extinction schedule while alternatives are reinforced. Similarly, omission training
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involves reinforcing the child for failing to emit the undesirable during behavior during a specified
time period . In the Differential Reinforcement of Incomplete Behavior (DRI) the child’s behaviors
which are physically incompatible with the undesirable response are reinforced. IN Differential
Reinforcement of Low Rate Behavior (DRL), the low rate of occurrence of target behavior is
reinforced. Thus , a wide range of conduct problems which are disruptive and inappropriate can
be successfully decreased or eliminated through DRO contingencies. These schedules procedure
durable and generalized response reduction without the application punishment procedures.

One of the most common and well researches intervention strategies for preadolescent
youth with conduct disorder is parent training in behavioral management skills . This programmer
involves the following aspects:

1. Parent trainer’s help parents pinpoint , and then monitor , specific positive and
negative behaviors that they desired to change .

2. Emphasis on the positive reinforcement rather than on the punishment

3. Parents are encouraged to replace punishment with time-out for the younger children
or loss of privileges for the older ones .

4. Promotion of the principles of shaping

5. Emphasis on the positive communication by parents to motivate children strengthen

family reactions

6. Increase the probability of positive attention for child’s pro-social behaviors (e.g.
Cooperation, calm talking, appropriate play behavior, sharing ,complying with adult
requests, staying out of fights) and to assist parents in copying more effectively with
child’s antisocial, aggressive and noncompliant behavior.

The behavior training for parents can be administered in group or individual format. Such
training of parents also addresses parental discipline , family communication and affect, peer
associations, school issue , and other significant domains in the large context in which the
youth operates.

There also youth focused behavioral approaches that involve therapists working one on
one or in small groups with children .The youth focused approaches arise primarily out of the
social skills and cognitive-behavioral areas . Youth focused treatments for conduct disorder
include social skills training, problem solving training, self control training, anger management
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and combinations of these. Social skill training includes individual and group reinforcement,
shaping and prompting of specific interpersonal behaviors, positive group activities, friendship
skills, listening/ speaking skills and assertive behaviors. Other approaches have combined
interpersonal problem solving and self-instruction (self-talk) in an effort to alter the cognitive
bases assumed to underlie conduct problems.

Thus, the more promising behavioral interventions include social learning based
approaches to parent training and family intervention and child cognitive behavioral therapies
that include social skills interventions and interpersonal problem solving.

The future behavioral treatment strategies for conduct disorders need to focus on the
following aspects.

1. Using multiple participants, including parents, siblings, teachers, and peers.

2. Emphasis on the early intervention.

3. Focus on the preventive interventions.

4. Greater emphasis on the multimodal approaches to interventions.

Check Your Progress

Fill in the blanks.

1. Some children manifest ___________ in terms of overt aggressive hostile acts

others while others while show a pattern of covert , deceitful acts

2. Children with conduct problems frequently come from families who are experiencing
considerable __________ , ______________ , and _______________.

3. ______________ is found to be effective in dealing with maladaptive behaviors .

4. _________________ for conduct disorder include social skills training , problem

solving training , self control training , anger management and combinations of
these.

5. Anorexia expresses passive hostility in the older child . In a younger child, it is

mostly an _________________.
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8.5 Summary

Children with oppositional Defiant Disorder repeatedly engage in a pattern of defiant,

disobedient, and hostile behavior toward authority figures. This behavior goes beyond acceptable
misbehavior for the given child’s age and the behavior has been continued for at least six
months. Assessment and treatment of oppositional Defiant Disorder takes place in much the
same manner as the process used to diagnose and treat Conduct Disorder. Conduct Disorder
are characterized by recurrent and persistent pattern of antisocial behavior involving the violation
of other’s basic rights and major societal norms or rules. Some children manifest conduct disorder
in terms of overt aggressive and hostile acts towards others. (e.g. setting fire, destroying property),
while others show a pattern of covert, deceitful acts. Historically, treatment for conduct disorders
focused on intrapsychic approaches including play therapy and individual psychotherapy with
the children, which have met with less recent acceptance in the absence of evidence for efficacy
or promise.

There is an overwhelming likelihood that a child presenting failure to thrive will be suffering
from adverse psychosocial factors. Anorexia is not seen very often in Indian psychiatric practice,
and is even less frequently associated with bulimia. Anorexics, as rule, are treatment resistant
and often have to be treated in patient facilities because of their poor nutritional status, often
leading to fatal results. Childhood asthma is primarily due to an inborn vulnerability causing
hyperactive in the bronchi. Stomach-aches are common complaints with children with nonspecific
emotional disorders. Hysteria may manifest in numerous ways-amnesias, fugues, narcolepsy,
stupors, dissociative symptoms of different kinds, and conversion symptoms of sensory, motor
or somatic types. On occasions, psychotic or depressive episodes and mono symptomatic
hallucinations may be seen. Hysteria can thus mimic several neurological, psychosomatic and
psychological disorders. The major causes for eating disorders could be behavioral
mismanagement at home, neuron-motor dysfunction, mechanical obstruction, and genetic
abnormalities.

8.6 Key Words

Conduct Disorders : characterized by recurrent and persistent patent of

antisocial behavior involving the violation of others’
basic rights and major societal norms or rules.
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Differential Reinforcement differentially reinforcing the child’s behaviors except

one of Other Behavior (DRO) : specific
target behavior.

Omission training : reinforcing the child for failing to emit the undesirable
behavior during a specified period.

Extinction : When the response is not reinforced, the unwanted

behavior diminishes.

Time out : consists of a period of time when no positive

reinforcement
is provided.

8.7 Check Your Answers

1. Conduct disorder

2. Marital discord, depression and distress

3. Response cost

4. Youth focused treatments

5. Attention-seeking behavior

8.8 Model Questions

1. Explain ODD , diagnosis and its treatment.

2. How will you diagnose an individual as having ODD?

3. What are the common features of Conduct Disorder and Oppositional Defiant
Disorder?

4. Discus the conduct disorder and its treatment.

5. Explain parent training in behavioral management skills.

6. Illustrate the various psychosomatic disorders.

7. Explain hysteria.

8. How will you prevent and intervene feeding problems?

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LESSON - 9
ADOLESCENT PROBLEMS
9.1 Introduction

Adolescence is defined as a phase of life characterized by rapid physical growth &

development, social & psychological changes and maturity, sexual maturity, experimentation,
development of adult mental processes and a move from the earlier childhood socio economic
dependence towards relative independence. This lesson deals with puberty-the physical transition
from child to adult, growth spurt, sexual development, the psychological impact of adolescent
growth and development, causes and correlates of physical development, biological mechanisms,
environmental influences risks or challenges, sex education- need, aim, types, qualities of a
sex educator, examination fear, adolescent depression, aggression, adolescent stress, risks of
adolescent relationships, eating disorders-anorexia, bulimia, elimination disorders.

9.2 Objectives

After learning this lesson, you will understand the following:

 Puberty-the physical transition from child to adult

 Growth spurt

 Sexual development

 The psychological impact of adolescent growth and development

 Causes and correlates of physical development

 Biological mechanisms

 Environmental influences

 Risks or challenges

 Sex education-need, aim, types, qualities of a sex educator

 Examination fear

 Adolescent depression

 Aggression

 Adolescent stress
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 Risks of adolescent relationships

 Eating disorders-anorexia, bulimia

 Elimination disorders.

Plan of study
9.1 Introduction

9.2 Objectives

9.3 Puberty – The Physical Transition From Child to Adult

9.4 The Psychological Impact of Adolescent Growth and Development

9.5 Causes and Correlates of Physical Development

9.6 Risks or Challenges

9.7 Sex Education – Need, Aim, Types, Qualit6ies of a Sex Educator

9.8 Examination Fear

9.9 Adolescent Depression

9.10 Aggression

9.11 Adolescent Stress

9.12 Risks of Adolescent Relationships

9.13 Eating Disorder-Anorexia, Bulimia

9.14 Elimination Disorders

9.15 Summary

9.16 Key Words

9.17 Check Your Answers

9.18 Model Questions

9.3 Puberty – The Physical Transition from Child to Adult

The onset of adolescent is heralded by two significant changes in physical development,

First, children change dramatically in size and shape as they enter the adolescent growth spurt.
They also reach puberty (from the Latin word pubertal, meaning “to grow hairy”), the point in life
when an individual reaches sexual maturity and becomes capable of producing a child.
120

In this section we will first consider the dramatic physical changes that occurs during the
adolescent years as the child loses that “boyish” or “girlish” look and begins to resemble an
adult. And in considering the physical events of adolescence from the perspective of the teenager
who experiences them, we will disorder that these dramatic biological upheavals play a major
role in shaping a teenager’s self-concept, which in turn may affect the ways he or she relates to
other people later in life.

The Adolescent Growth Spurt

The term growth spurt describes the rapid acceleration in height and weight that marks
the beginning of adolescence. The timing of this event varies considerably from child to child.
Although girls may begin as early as age 7 ½ or as late as 12, they typically enter the growth
spurt by age 9 ½, reach a peak growth rate by age 12 and return to a slower rate of growth by
age 13-13 ½ (Tanner 1981). Boys lag behind girls by two to three years. They typically begin
their growth spurt by age 13, peak at age 14 and return to a more gradual rate of growth by age
16. Because girls mature much earlier than boys, it is not at all uncommon for the tallest two or
three students in a junior high school classroom to be females. In addition to growing taller and
heavier, the body assumes an adult like appearance during the adolescent growth spurt. Perhaps
the most noticeable changes are a widening of the hips for females and a broadening of the
shoulders for males. Facial features also assume adult proportions as the forehead protrudes,
the nose and jaw became more prominent and the lips enlarge. Gone forever is that soft-
featured, innocent look that we associated with childhood.

The adolescent growth spurt is not as uniform as overview might indicate. Body weight
begins to increase first, followed four to six months later by a rapid increase in height (Tanner
1990). The muscles are growing along with the rest of the body, although the period of greatest
muscular development does not occur until a year after the maximum acceleration in height.
And because this “muscle spurt” happens earlier for girls than for boys, there is a brief period
when the average girl has as much or more muscle than most of her male age mates.

9.4 Psychological Impact of Adolescent Growth and development

What do adolescents think about the dramatic physical changes they are experiencing?
For starters, they often become quite concerned about their appearance and may spend a
great deal of time worrying about what other people think of them (Berschied, Walster &
Bohrnstedt, 1973; Grief & Ulman 1982). In general, teenage girls hope to be attractive to members
 121

of the other sex and their self-concepts largely depend on how attractive they believe themselves
to be (Berschied et al., 1973). Changes that are congruent with cultural standards of the “feminine
ideal” are welcomed. Thus, when breasts appear early in the maturation process, girls tend to
feel better about their bodies, their peer relationships and even their prospects of succeeding at
a career (Brooks-Gunn & Warren 1988). Otherwise, adolescent females are very concerned
about being too tall or too fat and many well-proportioned young girls may compensate for
perceived physical inadequacies by slouching, wearing flats or trying an endless number of fad
diets.

As for their reactions to their first menstruation, most girls are rather ambivalent (Grief &
Ulman 1982). They are often a bit excited but may be somewhat confused as well, especially if
they mature very early or lack knowledge about what this event means. According to Diane
Ruble and Jeanne Brooks-Gunn (1982), few girls are traumatized by menarche, but at the
same time few express delight about becoming a woman.

Although adolescent males might have you believe otherwise, they too are very concerned
about their body images, particularly those characteristics that might reflect on their masculine
prowess (Berscheid et al., 1973). Thus, young teenage boys hope to be tall, muscular, handsome
and hairy; unlike teenage girls, they welcome their weight gains and are less likely to view
themselves as overweight (Duncan et al., 1985; Richards et al., 1990). Very little known about
boys’ reactions to their first ejaculation, although the responses of one small sample suggest
that teenage boys are somewhat more positive about their sign of manhood and happier to
“grow up” than girls are about their first menstruation (Gaddis & Book-Gunn 1985). As self-
conscious as adolescents are about their physical appearance, it may come as no surprise that
the timing of puberty can be very important to a teenager. Being either the first or the last to
experience own growth spurt, develop beats or sprout facial hair can have an immediate impact
on one’s self-concept. But does it have any long-term effects on an individual’s personality or
social relationships? We turn next to that question.

9.5 Causes and Correlates of Physical Development

9.5.1 Biological Mechanisms

Clearly, biological factors play a major role in the growth process. Although children do
not all grow at the same rate, we have seen that the sequencing of both physical maturation
and motor development is reasonably consistent form child to child. Apparently these regularly
122

maturational sequences that all humans share are species-specific attributes-products of our
common genetic heritage.

1.Effects of individuals genotypes

Aside from our common genetic ties to the human race, we have each inherited a unique
combination of genes that will affect our physical growth and development. For example, family
studies clearly indicates that stature is a heritable attribute: identical twins are much more
similar in stature than fraternal twins, whether the measurements are taken during the first year
of life, at 4 years of age or in early adulthood (Tanner, 1990; Wilson 1976). Rate of maturation
is also heritable: James Tanner (1990) reports that female identical twins who live together
reach menarche within 2-3 months of each other, whereas fraternal twin sisters are typically
about 9 months apart. Tanner concludes that this genetic control of growth rate “operates
throughout the whole process of growth, for skeletal maturity at all ages shows the same type
of family correlations as menarche. The age of eruption of the teeth is similarly controlled (by
one’s genotype)”.

Of course, knowing that genotype affects attributes such as stature and “rate of maturation”
is only part of the story. The next logical question is “How dose genotype influence growth?” To
be honest, we are not completely certain, although it appears that our genes regulate the
production of hormones, which in turn have a major effect on physical growth and development.

2. Hormonal influences- the endocrinology of growth

Hormones begins to influence development long before a child is born. A male fetus
assumes a male like appearance because (1) a gene on his Y chromosome triggers the
development of testes and (2) the testes then secrete a male hormone (testosterone) that is
necessary for the development of a male reproductive system. By the fourth prenatal month the
thyroid gland has formed and begins to produce thyroxin, a hormone that is essential if the
brain and nervous system are to develop properly. Babies born with a thyroid deficiency will
soon became mentally handicapped if this condition goes undiagnosed and untreated (Tanner
1990)

. Those who develop a thyroid deficiency later in childhood will not suffer brain damage,
because their brain growth spurt is over. However, they will begin to grow very slowly, a finding
that indicates that a certain level of thyroxin is necessary for normal growth and development.
 123

Perhaps the most critical of the endocrine (hormone-secreting) glands is the pituitary, a
“ master gland” located at the endocrine glands. For example, the thyroid gland secretes thyroxin
only if instr5ucted to do so by a pituitary hormone called thyroid-stimulating hormone or TSH. In
addition to regulating the endocrine system, the pituitary produces a growth hormone (GH) that
stimulates the rapid growth and development of body cells. Growth hormones is released in
small amounts several times a day. When parents tell their children that lot of sleep helps one
to grow big and strong, they are right –GH is normally secreted into the bloodstream about 60-
90 minutes after a child falls asleep (Tanner 1990). Although much remains to be learned about
how GH stimulates growth, we know it is essential for normal growth and development. Children
who lack this hormone do grow and they are usually well proportioned as adult; However, they
will stand only about 130cm tall-a little over 4 feet (Tanner 1990).

During infancy and childhood, physical growth seems to be regulated by thyroxin and the
pituitary growth hormone. This picture soon changes, however, for the approach of adolescence
is accompanied by subtle changes in the endocrine system. The process begins as the
hypothalamus (a part of the brain) instructs the pituitary to releases follicle-stimulating hormone
(FSH) and luteinizing hormone (LH), which in turn will activate the gonads (ovaries or tests). In
females, FSH causes the ovaries to produce estrogen, which, is an instrument in females in
sexual development. FSH and LH also work together to regulate the menstrual cycle. FSH
initiates the ripening of an ovum: LH causes the ovary to releases it and to produce
progesterone—a hormone that readies the uterus for implantation should the ripened ovum be
fertilized. If fertilization does not occur, LH levels decline, the uterus sheds its lining, FSH levels
increases and the cycle begins anew. In males, FSH causes the testes to produce sperm and
LH stimulates the production of testosterone—the hormone primarily responsible for male sexual
development.

Recent research (reviewed in Tanner 1990) has clarified the endocrinology of adolescence
far beyond what we knew only a few years ago. As estrogen in females and testosterone in
males reach critical concentrations, the hypothalamus instructs the pituitary to secrete more
growth hormone(GH). The increase in GH seems to be wholly responsible for the adolescent
growth spurt in females and primarily responsible for the growth spurt in males. As for sexual
maturation, the females hormones estrogen is what triggers the growth of a girl’s breasts,
uterus, vagina and public and auxiliary hair, as well as the widening of her hips. In males,
testosterone is responsible for growth of the penis and prostate, voice changes and the
development of facial and body hair. And although GH may be the primary contributor to the
124

male growth spurt, testosterone exerts its own independent effects on the growth of a boy’s
muscles, the broadening of his shoulders and the extension of his backbone. So it seems that
adolescent males experience larger growth spurts than adolescent females do simply because
testosterone promotes muscular and bone growth in ways that estrogen does not.

It was once believed that androgen, secreted by the adrenal glands, was what triggered
the female growth spurt and the development of a girl’s pubic and auxiliary hair. However,
recent research suggests that, If adrenal androgens affect growth at all, they play only a
secondary role to other hormones in promoting the development of muscles and bones (see
Tanner 1990).

Table – 9.3 Hormonal influences of growth and development

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What causes the pituitary to activate the endocrine glands, thereby precipitating the
dramatic physical changes of adolescence? No one say for sure. We know that skeletal maturity,
which seems to be genetically controlled, is an excellent predictor of when menarche will occur
(Tanner 1990). Yet any simple “genetic clock” theory that focuses on a singular precipitating
event or influence is likely to be oversimplified, for breast growth, testicular development and
many other pubertal events are not closely synchronized with skeletal age (or with each other).
So we have learned a great deal about how hormones affect human growth and development.
However, the events responsible for the timing and regulating of these hormonal influences
remain obscure.

9.5.2 Environmental Influences

At least four environmental influence are known to affect physical growth and development:
nutrition, illnesses, climate (including seasonal influences) and emotional stress.

1. Nutrition

Diet is perhaps the most potent environmental influence on human growth and
development. As you might expert, children who are inadequately nourished will grow very
slowly, if at all. The dramatic impact of malnutrition on physical development can be seen by
comparing the heights of children before and during wartime periods, when food is scarce. In
figure we see that the average heights of school children in Oslo, food Norway, increased
between 1920 and 1940—the period between the two World Wars. However, this secular trend
was clearly reversed during World War II, when it was not always possible to satisfy the children’s
nutritional needs.

The effect of malnutrition on growth: These graphs show the average heights of Oslo
school children aged 8-18 between 1920 and 1960. Notice the trend toward increasing height
(in all age groups) between 1920and 1940, the period between the two world wars. This secular
trend was dramatically reversed during World War II (the shaded section of the graphs) when
nutrition was often inadequate.

Problem of under nutrition: If under nutrition is neither prolonged nor especially severe,
children will usually recover from any growth deficits by growing much faster than normal once
their diet becomes adequate. James Tanner (1990) views this catch-up experienced short-term
growth deficits because of malnutrition or illness will grow trajectory. When growth catches up
with its preprogrammed course, it will then slow down follow the path dictated by heredity.
126

However, prolonged under nutrition has a more serious impact, especially during the first
five years of life. Brain growth may be seriously retarded and the child may remain small in
stature, never attaining his or her normal size (Barrett & Frank 1987; Tanner 1990). These
findings make sense when we recall that the first five years is a period when the brain will
normally grow in about 65% of its eventual adult weight and the body will grow to nearly two-
thirds of its adult height.

In many of the developing countries of Africa, Asia, and Latin America, as many as 85%
ofall children are severely undernourished, they are likely to suffer from either of two nutritional
diseases-marasmus and kwashiorkor-each of which has a slightly different cause.

Marasmus affects babies who get insufficient protein and too few calories, as can easily
occur if a mother is malnourished and does not have the resources to provide her child with a
nutritious commercial substitute for mother’s milk. A victim of marasmus becomes very frail and
wrinkled in appearance as growth stops and the body tissues begin to waste away. Even if
these children survive, they will remains small in stature and will often suffer impaired social
and intellectual development (Barrett & Frank 1987; WI nick 1976).

Kwashiorkor affects children who get enough calories but little if any protein. As the disease
Progresses, the child’s hair will thin, the face, legs and abdomen will swell with water and
severe skin lesions may develop. In many poor countries of the world, about the only high-
quantity source of protein readily available to children is mother’s milk. So breast-fed infants will
not ordinarily suffer from marasmus unless their mothers are severely malnourished; however
they may develop Kwashiorkor when they are weaned from the breast and thereby denied their
primary source of protein.

In western industrialized countries the preschool childhood who do experience protein/

calorie deficiencies are rarely so malnourished as to develop marasmus of kwashiorkor. However
, vitamin/mineral deficiencies affect large numbers of children from all social strata in these
relatively affluent societies (Lozoff, 1989). Particularly common among infants and toddlers are
iron (and zinc) deficiency that occur because rapids growth early in life requires more of these
minerals than a young child’s diet normally provides. Prolonged iron deficiency causes iron
deficiency anemia, which not only makes children irritable, inattentive and listless but also retards
their growth rates and is associated with poor performance on tests of motor and intellectual
development—deficiencies that often remain even after the anemia is corrected by supplementing
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the child’s diet (Lozoff 1989). Children suffering from vitamin/mineral deficiencies are also less
resistant to a variety of illnesses that can retard physical growth and development.

Although it is clear that severe and prolonged malnutrition early in life can have adverse
effects on physical growth and intellectual development, these deficits are not solely attributable
to biological insults. That malnutrition can cause young children to be lethargic, inattentive,
irritable and intolerant of stressful situations—a behavioral profile that places them at risk of
alienating their caregivers and thereby receiving little social or intellectual stimulation. This risk
is increased if caregivers are also malnourished and are themselves lethargic, inattentive and
prone to become irritable. In other words, many of the long-term effects of under nutrition may
be medicated by the un-stimulating environments in which malnourished children live and have
helped to create (Barrett & Frank 1987; Valenzuela 1990).

Nutritional supplements given to such children (and their parents) can make them more
receptive to social/intellectual stimulation (and perhaps make parents more inclined to provide
it ). Yet the results of several recent intervention studies suggest that dietary supplementation
alone is often not enough. Malnourished children are least likely to display long-term deficits in
physical growth and social/intellectual development when (1) their diets are supplemented and
(2) they receive more social and intellectual stimulation, either through high- quality day care
(Zeskind & Ramey 1981) or through a home-visitation program that teachers caregivers about
the importance of such stimulation while showing them how to provide it (Lozoff 1989; Super,
Herrera & Mora 1990).

Problems of over nutrition: Dietary excess (eating too much) is yet another form of
poor nutrition that can have several long-term consequences. The most immediate effect is
that the child may suffer obesity and face added risk of diabetes, high blood pressure and
heart, liver or kidney disease. Obese children may also find it difficult to make friends with age
mates, who are likely to tease them about their size and shape. Indeed, obese youngsters are
often among the least popular students in grade-school classrooms (Sigelman, Miller & Whitworth
1986; Staffieri 1967).

Although you may know (or even be) an exception to the rule, obese infants and toddlers
tend to be obese during the grade-school years (Shapiro et al., 1984) and obese school children
are more likely than their thinner peers to be obese as adolescents and adults (Kolkata 1986).
Heredity definitely contributes to these trends, for the body weights of adopted children correlate
more highly with the body weights of their biological kin than with those of their adoptive relatives
128

(Kolkata 1986; Stunkard, as cited in Okie 1990). Moreover, sluggish activity levels (which hinder
one from burning calories) and even a preference for sweets are moderately heritable attributes
(Mayer 1975; Milstein 1980). Yet a genetic predisposition toward obesity does not guarantee
that one will be obese; most obese people are overweight because they consume more calories
than they need (Kolkata 1986).

Overeating contributes to obesity in two ways: (1) by producing an excess of fat cells and
(2) by depositing fatty tissue within these cells, causing them to swell (Eichorn 1979). Fat cells
are most likely to be added during two periods: from the seventh prenatal month through age 2
and during the adolescent growth spurt. And once added, a fat cell remains in the body for life,
standing ready to soak up excess calories. So overeating at any age will increase one’s risk of
becoming and staying obese.

The eating patterns of many children are established very early in life (Birch 1990). Some
parents over feed infants because they almost always infer that fussy baby must be hungry.
Other parents use food to reinforce describe behaviors (for example, “Clean your room and you
can have some ice cream “) or they bribe their children to eat foods they do not want (for
example, “Eat your peas and I’ll take you swimming”) (Klesges et al., 1986; Olvera-Ezzell,
Power & Cousins 1990). Unfortunately, children may attach a special significance to eating that
extends far beyond its role in reducing hunger if they are encouraged to view food as a reward
or to think of eating as an activity that leads to positive outcomes.

In addition to eating more than their normal-weight peers, obese children tend to be less
active, Indeed, the amount of time children spend in the sedentary activity of watching television
is one of the best precitors of future obesity (Kolata 1986). TV viewing may also promote poor
eating habits. Not only do children tend to snack while watching TV, but the foods they see
advertised are mostly high calorie products containing lots of sugar or fat and few beneficial
nutrients (Stoneman & Brody 1981).

Crash diets for obese children are often counterproductive. Severe dietary restrictions
can interfere with the development of the brain, muscles and bones early in life and older
children on restrictive diets may feel mistreated, rejected and more willing to partake in binge
eating should the opportunity arise (Kolata 1986). Today many therapists favor a three-pronged
approach to treating childhood obesity: (1) convincing the child that obesity is harmful and that
he needs to burn more calories, (2) providing the child with explicit strategies that he can use to
alter his exercise and eating habits and (3) asking parents to put away the snack trays, serve
 129

fewer sweets and restrict eating to mealtimes without imposing strict limits on mealtimes calorie
intake. The idea is that an obese child won’t feel mistreated and ready to binge if he can eat all
he wants at mealtimes. And if he should eat no more (and ideally, a little less) than usual, his
weight should stabilize, thus allowing him to eventually outgrow his chubby physique as he
becomes taller.

2. Illness

Among children who are adequately nourished, common childhood illnesses such as
measles, chicken pox or even pneumonia have little if any effect on physical growth and
development. Major illnesses that keep a child in bed for weeks may temporarily retard growth;
but after recovering, the child will ordinarily show a growth spurt (catch up growth) that makes
up for the progress lost while he or she was sick (Tanner 1990).

Yet diseases are likely to permanently depress the growth of children who are moderately
to severely undernourished. A poor diet weakens the immune system, which means that childhood
diseases will strike an undernourished child sooner and will have a more devastating impact
(Tanner 1990). Not only does malnutrition increases one’s susceptibility to diseases contribute
to malnutrition by suppressing a child’s appetite and limiting the body’s ability to absorb and
utilize nutrients. In developing countries where gastrointestinal infections and upper respiratory
illnesses are common, young school-age children who have been relatively diseases-free are
already 1-2 inches taller and 3-5 pounds heavier on average than their more sickly peers (Martorell
1980; Roland, Cole & Whitehead 1977).

3.Climatic effects

Differences in the body builds of Caucasians, Africans and Asiatic are due in part to
climate. The taller, linear builds that characterize people of African ancestry permit rapid heat
loss-an adaptive characteristic in humid, tropical climates. The short limbs and stocky physique
that are typical of northern populations are also thought to be evolutionary adaptations—ones
that maximize the body’s ability to conserve heat in Arctic climates (Tanner 1990). Similarly,
Peruvian Indians who live at altitudes above 12,000 feet, where oxygen is scarce, large chests
and bigger lungs than Peruvians of European ancestry who live at high altitudes are already
developing the large chests and lung that characterize the native population (Gresham 1988).

There are also seasonal variation in the rate of growth. In temperate regions of Europe
and North America, children grow faster in spring and summer than in fall and winter (Marshall
130

1977; Tanner 1990)—although, interestingly, blind children do not. Perhaps seasonal variations
in the growth of sighted children are regulated in some unknown way by the growth of sighted
children are regulated in some unknown way by the amount (or intensity) of light striking the
eye (Tanner 1990).

4. Emotional stress and lack of affection

Otherwise healthy children who experience too much stress and too little affection are
likely to lag far behind their age mates in physical growth and motor development. This failure
to thrive syndrome may characterize as many as 6% of preschool children in the Unites States
and up to 5% of all patients admitted to pediatric hospitals (Lozoff 1989).

Perhaps the most intriguing research on the failure-to-thrive syndrome was reported by
Lytt Gardner (1972), who studied healthy, non-abused children who received adequate physical
care but little affection. One case involved twin—a boy and a girl—who grew normally for the
first four months. Soon thereafter the twins’ father lost his job; their mother became pregnant
with an unwanted baby and the father than moved out of the house. Focusing her resentment
on the boy twin, the mother became emotionally detached and unresponsive to his bids for
affection, although she did provide him with adequate nutrition and physical care. While his
sister continued to grow normally, the boy twin at 13months of age was about the size of an
average 7-month-old infant. In other words, his growth was severely retarded, a condition that
Garden called deprivation dwarfism.

Gardner believes that deprivation dwarfism is directly related to the emotional deprivation
that the child has experienced at home. He bases his conclusions on the behavior of many
deprivation dwarfs who were hospitalized for observation and treatment here is a typical case:

The 15-month-old child quickly responded to the attention she received from the hospital
staff, she gained weight and made up for lost growth; her emotional state improved strikingly.
Moreover, these changes were….unrelated to any changes in food intake. During her stay in
the hospital, she received the same standard nutrient dosage she had received at home. It
appears to have been the enrichment of her social environment, not of her diet, that was
responsible for the normalization of her growth (Gardner 1972 p. 17).

Gardner’s deprivation dwarfs (and most children who fail to thrive) are infants and toddlers
who have suffered severe emotional deprivation. Yet there is evidence that the older school-
age children who experience less severe emotional traumas may also grow more slowly than
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normal. In one study, for example, a group of orphans were given an enriched diet at the same
time they were placed under the care of a strict emotionally unresponsive teacher. These children
actually grew at a slower rate than second group who remained on the standard orphanage
fare (Widdowson, 1951). Apparently the emotional distress that the children experienced
interfered with normal growth , even though their diet had actually improved.

Check Your Progress – 1

Fill in the blanks.

1. The onset of adolescence is heralded by two significant changes in physical

development ___________________ and _________________ .

2. ___________________ play a major role in shaping a teenager’s self-concept,

which in turn may affect the ways he or she relates to other people later in life.

3. Psychoanalytic theorists have argued that the purpose of _____________ is to

avoid growing up and having to became independent of one’s parents by, remaining
childlike in appearance, and nurtured.

4. Bulimics are ________________ who may consume several times their normal
daily caloric intake in a single sitting and then purge themselves of this feast by
vomiting or taking laxatives.

5. Physical growth and development represent a complex interplay between

____________ and _______________ .

6. During infancy and childhood, physical growth seems to be regulated by

___________ and ___________________ .

7. When children are severely undernourished, they are likely to suffer from either of
two nutritional diseases- _________________ and _______________ .

9.6 Adolescent Challenges – Risk or Challenges?

Normative and non-normative shifts that young people are likely to encounter can turn
out to be either challenges or risks, depending on their psychosocial properties. In order to find
out what makes specific events or circumstances into a challenge or a risk we need to differentiate
between risk indicators and risk mechanisms (Ruder 1996a). Rather than simplistically assigning
certain events like family break-up as a risk, we should try to understand what mechanisms are
involved which turn these event into problematic contexts for some , whereas the same event
132

leave other adolescents unharmed or may even lead to personal growth.

Having briefly described the different functions of developmental challenge and risk, we
want to illustrate this with a few examples in relation to psychosocial functions in young people’s
lives.

Some Examples of Risk and challenge

Aspects from the Social environment

Cultural body imaged: Amongst others, Davies and Furnham (1986) have shown that the
average adolescence is not only sensitive to but also critical of their changing physical self.
Because of gender and sexual develop of young people are inevitable confronted perhaps for
the first time , with cultural standards of beauty in evaluating their own body image . Direct
influences may come, for instance via media images by the reactions of others. As we can
illustrate with someone quotes from a qualitative study by shucksmith and Hendry (1988).

You look in these magazines and you see all these super models, . You don’t see any
that are 22 stone . They’re all about seven stone (Girl age 15).

O God Where did all this fat come from? It never used to be there or I never noticed it I
used to be able to eat lots of sweets and the only thing that grew way may feet.(Girl age 15).

That is may lead to a non-normative shift is seen by the concerns about weight and
body shapes are frequently associated with dieting practices and sometimes byserious eating
disorder. In the Mayfly study (Balding1986) over half of the girl and 20 per cent of the boys had
tried to exert control over their weight. WhereasColeman and Hendry (1990) described how
young people may be especially vulnerable to teasing and exclusion if they are perceived by
peers as either over or per cent of the boys had tried to exert control over their weight. Fear of
such teasing can itself lead to feelings of self loathing and isolation (Shuck smith and Hendry
1988) and thus implies a clear risk for further development.

Realizing that you lack the physical attractiveness to make friends just by being good
looking can become a challenge leading to the development of alternative skills to gain peer
acceptance.Being helpful having listening skills, having a sense of humor or possessing
entertainment skills like playing an instrument or being good at highly regarded sports are all
accomplishments that can outweigh physical attractiveness (Hendry et al, 1993).
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9.6.1 FAMILY LIFE AND TRATIDITIONAL VALUES

Turning to family life, we have seen that adolescence is a time for renegotiating roles, if
done skillfully on both sides, this will lead to heightened autonomy and the development of
many necessary life skills like managing one own economy , personal hygiene, short and long
term planning and a continuing warm relationship with parents. Done in an unskilled way, this
can result in less effective solutions and may lead to further problems running away marrying or
becoming pregnant early, joining a religious cult, drug abuse or self harm and suicide attempts.

Another factor that can disturb parent adolescent relationship is the non-formative sights
that affect family life .Examples of this are economic hardship ,which can weaken the marital
bond and as a consequence,distort parental styles (Sibereisen etal) 1990)or in sudden value
changes in society after political unrest (kloep and Hendry 1997) or in some traditional south
European countries, media influence (Georgas 1991; Deliyannis Koulimtzi and Ziogou,1995)
who readily adapt to new western ways, find themselves in conflict with their parents and the
older generation over traditional values (pais 1995). In families with a supportive climate, parent
adolescent discussions can be an opportunity for numerous an additional issue can be disastrous.

Similarly a non-normative shift like parental divorce can have positive or negative
implications for a young person, depending how the separation is conducted. Research has
shown that children of a happy divorce are better adjusted than children of unhappy marriages
(Hetherington 1989). If there is conflict between the parents and particularly if adolescents are
involved in the conflicts. They are likely to suffer (kloep et al 1995). Further the young persons
coping style seems to make a difference, Avoidance of dealing with their parents divorce either
cognitively or behaviorally or even blaming them for the incident seems to be related with
poorer functioning. (Emery and Forehand 1996).

Protective factors identified in child resilience research in divorce

Individual factors Family factors Extra familiar support systems

Temperament (e.g
Active, cuddly,
Good –natured)
Gender(being female
Prior to adolescence
Warm supportive Supportive networks
Parents
\(e.g.grandparents,peers)
good parent-child Successful school experie
relations experiences
134

And male during

Adolescence
Age (being Younger) parental harmony
IQ
Self-Effigy
Social skills
Interpersonal awareness
Feelings of empathy
Internal locus of control
Humor
Attractiveness to others

Adapted from emery and forehand(1996)

On the other hand divorce can give youths the opportunity to assume a responsibility
role in the family, helping them to ‘grow up faster’.

Depending on the characteristics of the child available resources subsequent life

experience and especially interpersonal relationships. Children in the long run may be
survivors.Losers, or winners of their parents divorce or remarriage.

When young people leave their parents home many of them continue to live locally.
Often deriving help deriving help from an extended kin network(Harris 1993). It is those who do
not enjoy this family support who are at risk, for example o f becoming homeless. The pervasive
influence of unemployment has created a shifting population of homeless people who inhabit
the card board cities of many European towns. Voluntary organizations estimate that 200.000
young people experience homelessness each year in Great Britain alone(Killen 1992) .This last
example shows how a non-normative shift like the liberalization of ‘market forces’ has an
enormous impact on the life of young people –though varied for different adolescents.
 135

Factors influencing the experience of unemployment

Risks Challenges
Unsuccessful coping Successful coping
Low, guilt, self blame Self image Defensively high
Devalued ,low Aspirations High
Isolation Socialation Contact
With peers With peers
No freedom, Time use Structure, purpose
low structure self responsibility
Not ‘adult;
Frustrating Leisure ‘Appropriate, acceptable
Not useful Education Helpful, useful
Rejected, hostility Training Involvement
Schemes adapted from Hendry
(1987)

The omnipresent of multinational companies consumerism and the ascent of service

industries enable individuals to access the global marketplace to create and sustain a variety of
lifestyles-if they have available financial resources. As Buchner Et alk.(1995p.%70
concluded…apart from those winners of modernization who are able to integrate modern life
style features into their everyday lives, there are also quite a number of children who must be
regarded as losers of modernization . Such children do not have the necessary material or
personal resources at their disposal do not they have adequate support networks to liver modern
individualized lives. Rather they are at risk, both socio-economically (for example, new property)
and personally (for example deviant psychosomatic syndrome).

Not only age large sections of working class youth in affluent nations, but also the
majority of young people in former socialist countries find themselves so trapped, cash more
(1984) called this the ‘luxury gap’.

This situation constitutes a risk rather than a challenge foremost young people .There
are only a limited number of strategies at their disposal nor do they have adequate support
networks to live modern individualized lives . Rather they are not at risk, both socio economically
(for example , new poverty) and personally (for example ,deviant , psychosomatic, syndrome).
136

Not only large sections of working class young in affluent nations, but also they majority
of young people in former socialist countries find themselves so trapped; Cashmere(1984)
called this the luxury gap.

This situation constitutes at a risk rather than a challenge for most young people . There
are only a limited number of strategies at their disposal which may be approved of by adult
society. So, a small number make their way by succeeding in a sports-or arts career ,by obtaining
outstanding academic qualifications or as in the case of many poorer countries, by emigrating.
Other are left to adopt potentially damaging strategies. Turning to delinquency, rioting, drugs or
becoming totally apathetic.

9.6.2 Romance and sexuality

Young people awakening sexuality creates possibilities of both challenge and risk. If
first sexual experiences are positive one’s this can provide a basis for learning the new skills of
intimate relationship(such as respect,intuition,negation,and give and take conflict prevention
and resolution, developing a positive to ones own body and Specific sexual skills).These can
provide a firm foundation for future interpersonal understanding. Even the pain of ending a love
relationship can be an important learning experience for coping with loss or for helping to make
a future better choice. Yet having sex with the wrong even friendly relationships (Martin1996)
.Such as experience was summed up by a 15 year old young woman who said.

Then I went on holiday and I had sex with this guy and it was a total mistake and then I
came back and I wished I Hadn’t done it. There’s nothing special to it. There’s nothing to look
forward to..(shuck smith and Hendry 1998).

Hendry et al., (1991) have shown that power and intimacy are two dimensions around
which young people need guidance and help to understand the ways in which romantic sexual
relationships are negotiated .In particular the dangers of learning a masculine role which
separates sexual practices form emotional feelings cannot be overstated. For young men, the
threat of loss of precarious masculine identity makes them reluctant to engage emotionally with
sexual partners or to acknowledge their needs . The importance of assertiveness in young
women’s refusal of unwanted sexual advances has to be pointed out because rational models
of decision making can be affected by a number of interpersonal and social factors. Hendry et
al, found that amongst their sample of young women, being seen to carry condoms, to be
assertive about their own sexual needs or to be defined as sexually active would be interpreted
 137

as a loss of reputation as being respectable and make them vulnerable in other areas of their
lives. The creating and sustain of an acceptable sexual reputation will have a significant impact
on attitudes and believes in their social contexts and activities.9wight 1992)

All the foregoing relates to heterosexual activity.Kent-Baguley(1990) noted that not

surprisingly the majority of young lesbians and gays geel marginalized,isolated and unhappy at
school and are often feeling obliged to pretend to participate in queerbashing talk to avoid self
revelation gender orientation carries with it particular risks and challenges.

In this section we have looked at normative and non-normative shift in adolescence and
given some examples of influences from interpersonal relations, from primary groups like the
family and from wider society which turn transitional tasks into challenger or risks or normative
shifts into non-normative ones.

9.6.3 Behavioral Aspects

Such examples from the social environment lead us to problems adolescents might
build up for themselves by engaging in behaviors that might be a risk for their health or for their
psycho social development.

Defining Risk-Taking

At this stage, it is important to stress the distinction between problems from the social
environment and actions taken by adolescent (Behavioral Aspects) With regard to behavioral
aspects we mean activities which are normally referred to in the literature as adolescent risk –
taking? The concept of risk-taking is ill defined. It is part of the psychological makeup of youth-
a thrill seeking stage in the developmental transition-or a necessary step to the acquisition of
adult skills and self esteem? Or it is a consequences of a social or cultural urge by adults to
marginalize youth because in their transitions from controllable child to controlled adult they are
seen as trouble some and a threat to the stability of the community?

Before we even try answer such questions, we need a cleared such questions, we need
a clearer definition of what is meant by risk taking . Hendry and kloep (1996) offered the following
three categories of risk takingbehavior.

First there are thrill seekingbehaviors . These are exciting or sensation seeking behaviors
which arose and test the limits of one’s capacities. Such behaviors can be observed in children
as well as in adolescents and adults. Children, though lack resourcessuch money or non
138

supervised time to engage in these behaviors. Most adults, on the other hand, know their limits
reasonably well after years of experimentation and do not need to engage in so much risk
taking behavior , beyond meeting new challenges . What distinguishes adolescent thrill seeking
behavior is a combination of:

Frequency –they engage in these activities more often than adults to test themselves
and learn.

Resources- they have more access then children to money and time.

As a result, of limited experience, they lack judgment of their own capacities and the
extent of risk they are undertaking.

Next, there are audience-controlled risk-taking behaviors. In order to be accepted, too

find place in a peer group and to establish a social position, people have to demonstrate certain
qualities and abilities. Thus, it is obvious that most risky behaviors need an audience. This may
be the reason why adults do not engage so often in demonstrate risk-taking. They have symbolic
means of displaying their status in titles, expensive clothes or sports cars.

There is a special sub-category of audience controlled risk taking behavior that young
people engage, in with the intension of impressing or provoking other people. These other
people can be peers , parents or adult authority figures. Adults restrict many adolescent behaviors
and activities and defying norms is for may adolescent as step in the development of
independence. Eager to break adults dominance by refusing to obey their commands and
prohibitions .adolescents may not alwaysbe able to discriminate which rules were made too
suppress them and which were in their best interests. This can lead to risk taking behaviors ,
reinforced by adults negative reactions.

Third, there are risk taking behaviors which are irresponsible Behaviors. These are not
performed because of the risk they imply, but in spite of it, in order to achieve other desired
goals. Such irresponsible behaviors demonstrate the inability of individuals to see long term
consequence of if these are apparent, to be unwilling to abstain from them because of perceived
short term advantages. Examples of such behaviors are smoking and drinking. Abstaining from
exercise or engaging in unprotected sex. It is obvious that behaviors such as getting drunk or
falling to use condoms are not attractive because of the risks they imply. But are pursued for
other reasons that are temporarily more important that these consequences. As Arnett
 139

(1988)hassuggested. Cultures must accept a trade off in socialization between promoting

individualism and self- expression on the one hand and in promoting social order on the other.
Societies such as our pay the price for promoting individualism and achievement by having
higher rates of adolescent risk-taking in response to adult culture.

Types of risk-taking behaviors

Thrill-Seeking

Examples : Most alcohol and drug use, risky sports, some delinquent
Acts.

Adolescence Specific : partly

Prevention : Opportunities for less harmful thrilling behavior.

AUDIENCE CONTROLLED:
Examples : Vandalism, provocation, dangerous driving

Adolescence specific : Predominantly

Prevention : Self esteem enhancing measures, social skills

IRRESPONSIBLE

Examples : Unprotected sex, drunk driving, sunbathing Adolescence

specific- not at all

Prevention : information, self management training

9.6.4 Alcohol and other drugs

Hendry et al (1993) showed that five per cent of 13-14 year old scots and nearly 50 per
cent of 17-18 years old s were frequent drinkers (once a week of more often) and klep (1998)
found similar figures in Swedish rural youth (nine per cent of 13-14 years ole and 45 per cent of
17-18 year olds has been drunk at least once during at least once during the last four weeks) ,
Looking at drug use 15 per cent of young people in Stockholm percent of English youth (Coleman
1997) and 4 per cent of Swedish rural youth (klep 1998) admit that they have tried Marihuana at
least once. As Hurrelaman and losel (1990) have suggested, personal behaviors in adolescence
can contribute to morbidity and mortalitysmoking , drinking, using illegal drugs, precocious and
unprotected sexual activity, little involvement in sports and exercise, delinquent activities indicate
that the image of healthy adolescence is inaccurate. Gotten (1990) examined the aim with
140

drinking was principally to get out of it at the weekend and to lose control. Courtship or the
search for talent and sex were important possible outcome for both young man and women and
discourses of spontaneous and getting carried away were drawn on too excuse risky behaviors
. The search for a high and for magical transformations from the reality of the ordinary work a
day world was highly prized,.

Assessing patterns of illicit drug use among youth is notoriously, due to illegally and the
low number seeking treatment from drug agencies. Traditional assumptions derived from beliefs
that young people are manipulated by a range of factors-peer pressure, insecurity the desire to
be different and so on. More recently, researchers have suggested that this perspective is
overly simplistic and unhelpful in teasing out the dimensions of drug misuse (coggans et al
1993).Often this has been matched with explanations given by young drug users who do not
see themselves as weak or manipulated but rather actively involved and purposeful in their
assessment of the risks. Costs and benefits of particular substances. For some young people
the belonging to a leisure subculture may be important and may be compared to some adults
‘rationalization for use of alcohol.AS in may be far beyond the risks of drug usage itself.(e.g.
Christie and Brunn 1985)

The degree to which adolescents contact with alcohol and other drugs is a risk or
challenge depends on which functions they fulfill for the individual , to what degree the young
person is able to derive similar experiences by less harmful means and by the young persons
variety of skills around which they can make reasoned choices in leading a ‘balanced’ life.
Where alternative behaviors are not possible and drugs are perceived as the only means and
by the young life. Where alternative behaviors are not possible and drugs are perceived as the
only means as the only means of reaching desired gratification. They will be serious risk factor
especially when the adolescent lacks self control skills. Given the necessary self control and a
wid3e range of behavioral alternativeness (to create excitement in one friends) the possibilities
of over indulgence may be lessened. Then an occasional bottle of over indulgence may be
lessened. Then an occasional bottle of beer or wine for example is just another step in learning
sensible drinking and adding some pleasure to one life. Yet.

Among the young people we met, the non drinker is the deviant and talk about sensible
is drinking is openly reduced…(Young people) tend to dismiss any possible health risks because
they bounce back so quickly and without any apparent ill effects As Berndt (1998) suggested,
adolescents are influenced by their friends , over time mutual influence increases similarities .
 141

what is being suggested in this section is that both legal and illegal drugs are used by people
(and adults) as transformation. Additionally, for adolescence they can be symbolic, (e.g.looking
cool or grown up) .As with other behaviors the circumstances of learning of drink present young
people with a risk or challenge within cultures where adult drinking is approved.

9.6.5 Delinquent Behavior

Delinquent behavior is regarded by many as the most prominent from of adolescent risk-
taking (Farringdon 1995). The majority of those convicted for car theft , vandalism, shoplifting
theft and burglary are young men between 14 and 17 years. Yet the media picture of the
dangerous ,criminal teenager is exaggerated and may be a sign of perceived hostility by adults
towards adolescents (Davis 1990).Together with the fact that it is not many young men who
commit some crimes, but relatively few young men who commit many crimes(e.g Farrinton and
west ,1993), this begins to suggest that juvenile delinquency may be less of a problem than is
perceived by most adults.

To these views should be added a perspective that crime and delinquency in our society
are in some measure the cost of certain kinds of social development. It has been argued that
the predominant ethic of our society is acquisitiveness and desire for success. The values
underlying juvenile delinquency may be far less deviant than commonly assumed. A number of
theorists have emphasized the role of identity processes in determining delinquent behavior
(e.g Emler and Reicher 1995) .The desire to identify with a peer group requires adherence to
particular types can have different functions for different adolescents.For some it may be socially
controlled in helping them to attain status in the peer group or to enable them to challenge adult
society. For others it may be the thrill of sensation –seeking or a means of survival in a society
stressing individual achievement and gain.

9.6.6 SPORTS

One activity which is socially approved and can provide self control sensation-seeking
and peer approval, yet is seldom regarded as true risk-taking behavior, is sports participation.
Yet it is a useful example of how almost any activity can be viewed as a challenge or a risk,
depending on the psychosocial circumstances.

9.6.7 Adolescent Sexuality

Sexuality assumes far greater importance once children experience puberty and become
sexually mature. Now adolescents must incorporate concepts of themselves as sexual beings
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into they male of female self-identities. They must also figure out how to properly express their
sexuality. These tasks have never been easy. But they may now be more difficult that every
given the “new morality” that has emerged over the past several decades in Western societies.
What are the sexual values of today’s teenagers? What is normal sexual behavior during
adolescence? Let’s see what recent research can tell us.

Teenage sexual morality: Have today’s teenagers adopted a new morality that is
dramatically different from the standards that their parents and grandparents held? Intone sense
they have , for adolescents have become increasingly liberal in their thinking about sex throughout
this century-especially during the 1960s and 1970s.However it seems that sexual attitudes may
now be reverting ever so slightly in a conservative direction. Largelyas a result of the
AIDS problem (Carroll 1988).But even before the Spector of AIDS, it was clear that few teenagers
had completely abandoned the “old”(or traditional)Morality.

In his review of the literature on teenagers sexuality, Philip Dreyer (1982) noted three
major changes in teenagers sexual attitudes-changes that describe what the “New morality”
means to them.First most, adolescents now believe that sex with affection is acceptable. Thus
today’s youth are rejecting the maxim that premarital intercourse is always immoral, but they
still believe that causal or exploitative sex is wrong (even though they may themselves have
had such experiences)Still only a surprisingly small percentage of sexually active adolescents
in one national survey(6% of the males and 9% of the females) mentioned love as the reason
they first had intercourse, instead, nearly 75% of the girls and 80% of the boys attributed their
loss of virginity to strong social pressures to initiate sexual relations, while also citing curiosity
and sexual desire as important reasons for becoming sexually active.(Harris&Associates 1986)

A Second major change in teenage attitudes about six might be termed the decline of the
double standard the idea that many sexual practices viewed as appropriate for males (for
example, premarital sex,promiscuity) are less appropriate for females. The double standard
has not disappeared, for fathers often seem to condone(or at least, to not strongly discourage)
the sexual exploits of their sons(Brooks_Gunn&Furstenberg 1989), and college students of
recent times still believed that a woman who has many sexual partners is more immoral than an
equally promiscuous man(Robinson&Jadicka 1982).But western societies have been moving
for some time toward a single standard of sexual behavior for both males and females.

Finally, a third change in adolescents sexual attitude might be described as increased

ambiguous. Must one truly be in love or is mere liking enough to justify sexual intercourse? It is
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now up to the individual (s) to decide. Yet these decisions are tough because adolescents
receive mixed messages from many sources. On the one hand, they are often told by parents,
the clergy and advice columnist to value virginity and to avoid such consequences as pregnancy
and sexually transmitted diseases. On the other hand, adolescents are strongly encouraged to
be popular and attractive and the more than 9000 glamorous sexual innuendos and behavior
that they see annually on television (most of which occur between unmarried couples) may
convince them that sexual activity is one means to these ends (American Academy of Pediatrics
1986).Apparently the behavior of older siblings adds to the confusion, for younger brothers and
sisters of a sexually active sib tend to be even more sexually (Rodgers&Rowe,1988).One young
adolescent,lamenting the strong social pressures she faced to become sexually active, offered
this amusing definition of a virgin: “an awfully ugly third-grader”.(Gulotta,Adams&alexandar
1986,p.99).In years gone by the norms of appropriate behavior were much simpler: Sex was
fine if you were married (or perhaps engaged), but it should otherwise be avoided. This is not to
say that our parents and grandparents always resisted the temptations they faced; but they
probably had a lot less difficulty than today’s adolescents in deciding whether what they were
doing was acceptable or unacceptable.

SEXUAL BEHAVIOR:

Not only have sexual attitudes changed, also patterns of adolescent sexual behavior.
Today’s adolescents masturbate more(or at least report masturbating more)than those of past
eras(Dreier 1982) although many still feel guilty or uneasy about it (coals stokes 1985),And
although only a small minority of today’s 15 year olds have experienced sexual intercourse, we
see that premarital intercourse has become more common in recent years and that more than
half of all adolescents have had intercourse at least once before they leave high school. The
sexual behavior of females has changed more than that of males(see also widlandt&Boldsen
1989) .So the decline of the double standard is clearly not just a matter of changes in attitudes.
Indeed , college women today are about as likely as college men to have had sexual intercourse
(Darling , kallen & vandusen 1984)

Historical changes in the percentages of high Scholl and college students reporting
premarital intercourse
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Sources: “Sexuality drinking Adolescence “ By P.H..Dreyer , 1982 in B.B.Wolman(Ed.,)

Handbook of developmental Psychology, NewYork: Wiley; and American Teens Speak; sex,
,Myths, TV and Birth control.The planned parenthood Polly,ByL.Harris and Associates,1986,New
York: Planned parenthood federation Of America.

In sum, both the sexual attitudes and the sexual behaviors of adolescents have changed
dramatically in this century- so much so that sexual involvement is now part of the normal
adolescent search for an adult identify and emotional fulfillment (Dreyer 1982)Unfortunately
many sexually active adolescent couples fail to practice birth control (or do so sporadically)
Partly because they are often incredibly misinformed about reproductive issues. For example
only about one teenager in three can identify the phase of the menstrual cycle in which risk of
pregnancy is highest (Brooks-Gunn&Furstenberg 1989; Morrison 1985)

Of course, the consequence of a teenage pregnancy for the 1 girl in 9 who gives birth
before age 18 can be serious ones:an interrupted education low income and a difficult start for
both the new mother and her child .And compared to children of older mothers , children born to
teenagers show small but consistent cognitive decrements in the preschool and early grade
school years and markedly lower academic achievement thereafter ./Mean while the AIDS
epidemic continuous and although adolescence have become more cautions in their sexual
attitudes in response to this threat, they have shown few signs of having adopted safer sexual
practices .Is it any wonder, then, that many educators are now calling for stronger problems of
sex education and counseling in our schools? If teenage sexuality is here to stay, than there is
little hope of preventing its unwanted consequences unless both boys and girls begin to behave
in more sexually responsible ways.

9.7 NEED FOR SEX EDUCATION

As far as sex matters are concerned, parents and teachers feel justified in keeping their
child away from the realities of life. They believe that children are still not yet grown up enough
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to understand all the aspects related to sex. The reproductive process generally starts coming
into the syllabus of the student when the child is in the fifth standard. Teachers

Consider it as a taboo to teach about the reproductive process to the students as they feel
could cause embracement to the student and the teacher. Parents on the other and feel
authoritarian and maintain the aspects related to sex hidden from their children. This attitude
may ntoinjure the child when everything goes well with him but it leaves the child perplexed,
confused and at loss when he is confronted with a plethora of intriguing questions concerning
sex matters.

Thus, that leave a lot of unanswered queries to the boys and girls who are in the puberty
stages of development.They become curious and find different means to get answers for their
queries. They rush to the libraries and skim the encyclopedia to get every information pertaining
to sex. Some way watch blue films through the internet and also want to try out the act themselves
because of their curiosity. To add to their age, their body also takes a new form of male and
female when the primary sex characteristics and secondary sex characteristics develop. The
outcome of ignorance is all around. Children are seldom comfortable about their sexuality and
little girls worry about the onset of menstruation and feel guilty about such aspects. Their moral
development is shattered due to this feeling of guiltiness in boys, increase in the size of genital
organs are certain biological and physiological aspects that demands attention because major
psychological problems arise out of misconceptions about these sex matters.

A recent report says that venereal are spreading at an alarming rate especially among
those belonging to 15-30 age groups.Sex education program helps youngsters to conduct
themselves with dignity and restraint and promote emotional stability and sound character. It
makes them to adapt to a socially responsible behavior.Different forms of harassment like eve
teasing. Verbal passes, derogatory remarks, physicaltouching , rape etc. can be prevented if
proper knowledge of sex education is given to the students. The need of the hour is to identify
problems and face them with an open mind because unexplained queries always give rise to
behavior maladjustments.

What is Sex Education Program?

Sex education program covers a wide range of issues that affects the life of the growing
children and includes the biological aspects, psychological aspects, social factors and knowledge
pertaining to sexually transmitted diseases, (STD) and AIDS. It also covers topics like
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menstruation, the sexual act, contraception, consequences of a sexual involvement how to

prevent sexual abuse, attraction , gender, stereotypes, masturbation, sex and marriage.

9.7.2 AIMS OF SEX EDUCATION PROGRAM

Our Society is undergoing a tremendous change and our social norms and moral values
are facing tough competition from the western culture and influence. This Makes sex education
through right channels enables the growing children to conduct themselves with dignity, restrain
and responsibility. On the other hand it makes them more confident and highly clear in the
misconception concerning sex matters. For example nocturnal emissions highly clear in the
misconception concerning sex matters. For example, nocturnal emissions give rise to guilt
among adolescent boys because they consider it abnormal. Ignorance about menstruations
causes shock in females and they sometimes go to the extent of a rejecting womanhood. Sex
education is a scientific andthey way of inculcation moral values in the younger generation. Sex
education is a scientific and healthy way of including moral values in the younger generation.
Sex education is a scientific and healthy way of inculcating moral values in the younger
generation.Sex education aims at strengthening the moral values of youngster by making them
realize that sex means responsibility social responsibility and responsibility towards our own
self. Rise in the number of unwanted teenage pregnancies, sexual abuse, prostitution, rape
and the spread of STD and AIDS at an alarming rate reveals the need for sex education at
schools. Thus we should understand their problems with an open mind and discuss sex matters
with complete freedom.

Sex Education helps the youngsters at all leaves, of all age groups a confident and well
integrated personality. Sex education at a very junior level from the tender age of 4 years when
a child becomes aware of his environment and ventures out in a new world enables to feel
comfortable with their own sexuality, Later when the child attains puberty, he becomes free of
worries and anxieties connected to the physical, biological and psychological aspects that play
important role in the growing stages of maturity. A well informed adolescent learns t respect the
members belonging to the opposite sex symbol as depicted in pornographic literature or cheap
movies that distort the meaning of sex and sexuality, if he is in given sex education at home and
in school from the beginning of school years.

Sex education warns a person against vulnerable disease and makes him realize the
importance of controlling the uncontrollable desires. Most of the children becomes victims sexual
abuse of the ignorance and vulnerability . A good understanding of sexual abuse prevention
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where the different forms of touches can be explained to the child makes them mature enough
to handle this responsibility. Methods of contraceptives are introduced in the sex education
program by which students can safeguard themselves against sexually transmitted diseases.
Sex education removes all misconceptions and taboos related to sex, sexuality, and sex and
make the youngster accept it as a natural phenomenon.

9.7.3

Sex Education programmer can be organized by the teachers to the students according
to the different levels of education.Since teachers and parents cannot clarify al the queries
raised by the students pertaining to sex, experience resource persons who can walk, without
embarrassment and inhibitions can be called to impart the training program.Children have to
face the teacher san parents almost every day. So they might not ask any sensitivequestions to
them on account that attitude will be framed on them with this matter. The family background of
the students and the age group should be kept in mind while separating students in groups for
a sex education program. Also, the sex of the students should also be taken into consideration
and if needed separate classes should be arranged for boys that embarrassment and fear is
natural while listening to a sex education training program .Also care should be taken not to
pass any obscene comments or picture in the middle of the training program. In the last session
, open discussion should be encouraged by the sex educator to avoid embarrassment.

9.7.4 QUALITIES OF A SEX EDUCATOR

Sex education is a sensitive topic and one has to take precautions while taking to students
belonging to various age groups. ‘there is tendency for students to feel inhibited and embarrassed
which is natural. The sex educator should however posses certain qualities.

1. Excellent communication skills because he should be able to comprehend what

other are telling him.

2. In depth knowledge regarding problems, anxieties and fears that growing children
suffer from.

3. Ability to judge the mental levels of students. Teachers should refrain from passing
any judgment when a student comes out with any problem. Let him be frank and
free during discussions.
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4. They should converse in such a manner that students find it easy to understand
.For , this the teacher should come down to their level so that an effective two way
communication is possible.

5. Sex educator should be free of misconceptions or taboos attached to sex, only then
can they think of a positive outcome.

6. They should be confident while taking to the youngsters about conception, childbirth
masturbation or ejaculation.Any sign of embarrassment or uneasiness gets passed
on to the audience and this establishes the myth that sex is wrong or it is bad to talk
about sex related matters.

7. They should provide definite answers to every problem.

8. Sex education should be imparted keeping in minds the general age group, family
background and the areas of curiosity in which different age groups question parents
or teachers.

Types of sex education program

Sex education programs are different for different age groups and can be divided into two
parts:

1. Informal sex education program

2. Formal sex education Program

Informal sex education Program

Informal sex education program helps in familiarizing a small child with himself/herself,
his/her surroundings in a natural manner. It begins roughly when a small child starts responding
to its surroundings, music, and television, advertisements, and pictures in story books etc. The
child grows up without any botheration concerning the various changes that take place within
him from time to time. Informal sex education program should be bases on the age old theory
that the human brain comprises of two levels subconscious and conscious. The subconscious
level functions like a storehouse, where memories are locked from the moment the child is
born. These memories have profound impacton the child’s future live. If we care of what all is
being fed into that tiny brain then half the battle is won. The first lesson of our informal sex
education consists of;
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1. Introduce the child to the nature

2. Ensure healthy environment at home.

3. As far as possible , keep the child away from materialistic way of life.

4. Do not expose the child to unnecessary violence, obscenity and negative feelings
of hatred and fear.

5. As parents do not cajole each other or show any behavior that is uneasy for the
child.

The sensory development of the new born infant is surprisingly complete. All the senses
are functioning at birth and the perception of the young infant is also remarkably well organized.
Babies begin to perceive forms within the first three months. The development of attention
follows a U-shaped showing a good deal of attention in the early months, less late and finally
more again. Keeping these psychological aspects in their mind. Parents should take care that
along with personal care and attention, a child should be constantly exposed to positive
impressions. Unknowingly , child’s brain receives negative impression-when he is continuously
exposed to the world of horrifying things like war, tanks, pistols, guns through television programs,
movies and sometimes even toys. For proper mental development to take place, introduction of
the toddler to the world of animals, birds, plants, and trees, with the help of picture books is
essential. Take the children for an outing and let him feel freshness of the greenery around him.
Nature always has a shooting effect and makes the mind peaceful and relaxed.

At the age of 3-4 years almost all parents start preparing heir children for school interviews
and admission test. It is at this time that parents can provide specific information about the
physical features because a general observation of most parents is that children are curios
about their own body. A child readily learns the names of his body parts that form a part of the
syllabus for admission tests. A notable feature is that children are always keen to know the
names of genital organs and parents intentionally avoid answering such questions. It is here
that the parents downcast regarding sex related aspects that is passed on to the child and
persists throughout his life. Although it is difficult t begin with, but the child should be told the
actual names of all the body parts.

Slowly and steadily as the child mature mentally with age. She should be taught that other
people should touch her body as little as possible. This information is a must to prevent a
situation leading to sexual abuse of the child. Almost every school introduces a subject known
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as Environmental studies, Or EVS at the Junior level from kindergarten to classII. The main
objective is to develop children’s awareness of all the surroundings beginning with the child
own body. Informal sex education program comes to an end by the time a child reaches class
VI.

FORMAL SEX EDUCATION PROGRAM

Formal sex education program should start when children reach the age group of 8 years
with the onset of puberty. A general observation proves that the attitude towards each other by
the onset of puberty. Boys adopt a dominating attitude towards the fairer sex and show liking for
girls who are meek and docile. Girls start resenting boys and show a hostile attitude towards
them. This problem starts somewhere at the subconscious levels, both boys and girls actually
become aware of each other.

A teenager cannot grow up without an adults help and understanding attitude. The hormonal
changes bring about all the changes during puberty and adolescence which pay havoc with
their normal life style. Adolescents fail to handle natural changes like menstruation in girls and
ejaculation in boys. They demand definite answers but their queries are rejected or the entire
matter is hushed up. They are made to feel guilty unnecessarily and growing children feel the
stress and strain of these maturity years. Sometimes, they openly complain that they fail to
concentrate on studies because they all the time distracted or in a confused state of mind.
Growing children spend stressful days and nights in trying to find an answer to all those physical
and sexual desires they have. This phase requires a lot of guidance and correct information.
Definite answers concerning matters regarding sex require an open and friendly environment
at home. False and confused information regarding sex matters is passed on to them through
seniors in schools.

Before starting a formal sex education program, every educator should remember that
they would have to win over the confidence of the teenagers and make them understand that
the same feelingsand surging changes are universal and every human being has to pass through
this stage. They should focus on topics that are discussed below to bring awareness.

1.Role of Androgens: Androgens are hormones that are possessed by both males and
females, Androgens bring out the sex the urge to have sex. Older adults can suddenly become
as obsessed with sex if they are given artificial androgens.
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2.Sexual Relationship : Human sex is a strong relationship between a boy and girl or a
man and women . Stability in relationship should be established first before the act is carried out
because women are the one who are end up carrying the baby, before and after it is born. Also
it is safe to have sex with one partner commitment .I.e. Marriage.

3.Masturbation : Masturbation means stimulating genitals until climax or orgasm by the

individual itself. This is done to release the sexual tension that is present. Almost all boys
masturbate, a little or a lot and most girls do too. It isn’t adolescents that masturbate. Little
children do too, sometimes children who are barely able to walk. This has nothing to do with sex
but it is an outlet for other types of frustrations. Soon these children feel that masturbation is
good and sometimes it becomes a remedy for boredom too. But it isn’t something to feel miserably
guilty about as it is perfectly normal. Masturbation doesn’t weaken boys, but ejaculation (from
sex or from masturbation) makes the body tried which is temporary.

4. Sublimation: Sublimation is deliberately not giving a sexual release, through sex or

masturbation and trying to redirect sexual tension and energy into some other actively like
sports, music, art or writing. The idea is that the frustration would lead to more inspired work.

5. Acquired Immune Deficiency SYNDROME: AIDS is caused by a virus, HIV or Human

Immune Deficiency Virus. This Virus invades the cells in the immune system, the cells that fight
off infection. Once infected with HIV, it takes 8 – 9years for AIDS to develop. Once HIV has
destroyed the immune system, the body’s ability to fight infection decreases and it is easy to
pick up all sorts of diseases.

AIDS is always fatal and ends with death. There is so far/presently no cure for it. HIV is
spread from an infected person to an uninfected person by an exchange of body fluids, in
particular, infected blood and infected semen. Since the virus is fragile and cannot live long
outside the human body, HIV will not be infected from toilet seats, hugging, kissing, and shaking
hands, mosquito bites or from a swimming pool.

6. Body Fluids: Body fluids are things like blood, semen, vaginal secretions and saliva.
Blood is very likely to spread HIV because blood from transfusions or on used needles gets
through the skin and inside the person’s body. It doesn’t stay on the surface. Semen also get
through the skin of the vagina or the rectum in anal sex or the mouth or throat in some oral sex
because penetrative sex has a chance of causing tiny cuts and the semen gets into the body.
There is a chance that “French Kissing” could pass on HIV, if saliva from an infected person
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comes in contact with a cut in an uninfected person’s mouth. HIV doesn’t get passed on easily
as people think, because saliva that passes into the stomach without meeting a cut in the
mouth simply gets digested by the powerful acids in the stomach and this kills the virus!

Lesbians (gay women) also don’t tend to pass on HIV, since sex between women is
almost always non-penetrative: the virus doesn’t get forced through the skin. And there are also
times when male – female sex doesn’t pass on the HIV, if there is no cut in the vagina, rectum
or on the penis for the virus to enter. If it doesn’t get inside a human body under the skin, it is
likely to die fast.

7. Herpes: Herpes is a virus remains in the body and shows up from time to time as sores
with blisters on the mouth, genitals or anus, the same place every time. These sores are extremely
painful, because they are actually inflammations at the end of sensory nerves, the nerves that
pass on feelings. Herpessores also have a tendency to erupt when you are under stress. The
only way to avoid herpes is to avoid all sexual contact with an infected person while herpes
sores are there.

8. Cystitis: This is an inflammation of the bladder and women are the most likely to get it.
It is also known as the “honeymoon syndrome”, because many women get it the first time they
have sex. Cystitis is not usually caused by the man you have sex with: women can get Cystitis
even when their partner is using a condom. The bacteria are from the women’s own movements
during sex. The first symptom of Cystitis is that you find yourself needing to urinate again and
again and this causes pain inside the abdomen in the vaginal area and the pain feels a bit like
constant sexual friction. After a day or so the urine itself begins to show traces of blood. Cystitis
is easy to clear up with antibiotics and this must be done soon or the infection will move upwards
to the kidneys. If Cystitis comes again and again, the man should also be tested for signs for
the bacteria in the urine.

9. Trichomoniais: This symptoms are a yellowish – white smelly discharge from the vagina.
A man may have an inflammation of the penis and a women can have itching or swelling of the
external genitals. Trichomoniais has to be treated with antibiotics.

10. Candidiasis: The symptoms are a white lumpy discharge from the vagina and a feeling
of itchiness in the genital area. Candidiasis are very common and very simple to treat. Even if
only the women have the discharge, the man and the woman will both have to be treated.
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9. Chlamydia: There are no symptoms at all but men can have a burning feeling when
they urinate. The big danger for women in Chlamydia is that it can lead to pelvic inflammatory
disease, which can block the fallopian tubes, the tubes that bring the ovum or egg, from the
ovaries to the uterus. This could mean sterility or not being able to have a child. There is greater
chance of ectopic pregnancy, the fetus getting implanted in the fallopian tubes rather than in
the uterus. This would mean emergency surgery, since the fallopian tube will burst as the baby
grows. If Chlamydia is suspected, the patient will have to be tested and treated, along with
anyone he/she has had sex with.

12. Gonorrhea: The danger of gonorrhea are the same as for chlamydia that is all problems
of Pelvic inflammatory Diseases. Men can also get an infection of the prostate gland and both
can get infections of the joints, skins or the bloodstream.

9.8 Examination fear

March will be a dreaded season or a tension period for children and adolescents (more
for parents too) due to exam fear. Parents will sacrifice TV, outings, tours, sleep, etc. for the
sake of their children’s studies. In spite of it all, if they find that their children could not cope with
the situation and lose their concentration, they will often become frustrated, irritated and worried.
Also, parents would often complain that their children are studying well but not scoring well. At
this juncture, they need to encourage their children than blaming them and should go for analysis
of the cause to rectify / treat it.

Exams are not always easy going. Exams are conducted to honor our intellect. Here one
can aim for topper / achiever / champion to be proud of one or to make their parents proud.
Good learning, keeping everything in mind, recalling the things when there arises, a need,
perfection in doing things and seriousness in presentation will lead one always to the top.
Unwanted tension can precipitate exam fear.

Causes – are usually numerous, but the common causes are:

 Lack of memory or forgetfulness

 Fear of punishments from parents / teachers

 Bad past experiences

 Improper learning i.e. studying not in depth

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 Inattentive / distracted mind

 Lack of self – confidence / hopelessness/ inferiority complex

 Health problems

Symptoms: Some would just fear in succeeding / scoring high marks, some other would
fear and sweat and some others would sink and faint in addition. Some others get tremors,
nervousness; sometimes they find it difficult to control passing of urine and stool.

Likewise, exam fear can cause a variety of symptoms. The common symptoms are:

 Feeling blank or vagueness before exam

 Difficulty in concentrating and studying while preparing for exams

 Fear to appear for exams

 Getting tensed on seeing difficult questions

 Difficulty in expressing / presenting even for known answers due to fear or inferiority
complex

 Confusion and hopelessness

 Sweating and racing heart

 Dizziness due to sleepless study

 Tension and worries

9.9 ADOLESCENT DEPRESSION

Adolescent depression is a disorder that occurs during the teenage years and involves
persistent sadness, discouragement, loss of self-worth and loss of interest in usual activities.

Causes: Depression can be a temporary response to many situations and stresses.

 The normal process of maturing and the stress associated with it

 The influence of sex hormones

 Independence conflicts with parents

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It may also be reaction to a disturbing event, such as:

 The death of a friend or relative

 The breakup with a boyfriend or girlfriend

 Failure at school

Adolescents who have low self esteem are highly self critical and who feel little sense of
control over negative events are particularly at risk to become depressed when they experience
stressful events.

Adolescents girls are twice as likely as boys to experience depression:

Risk factors include:

 Child-abuse both physical and sexual

 Chronic illness

 Family history of depression

 Poor Social skills

 Stressful life events, particularly loss of a parent of death or divorce

 Unstable care giving

Depression is also associated with eating disorders, particularly bulimia.

Symptoms

 Acting out behavior (missing curfews, unusual defiance)

 Appetite changes(Usually a loss of appetite but sometimes an increase)

 Criminal behavior (Such as shoplifting)

 Depressed or irritable mood

 Difficulty concentrating

 Difficulty making decisions

 Episodes or memory loss

 Excessive sleeping or daytime sleepiness

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 Excessively irresponsible behavior pattern

 Excessive or inappropriate feelings of guilt

 Failing relations with family and friends

 Faltering school performance

 Fatigue

 Feelings of worthlessness, sadness or self-hatred

 Loss of interest in activities

 Persistent difficulty falling asleep or staying asleep

 Plans to commit suicide or actual suicide attempt

 Preoccupation with self

 Reduced pleasure in daily activities

 Substance abuse

 Temper(Agitation)

 Thoughts about suicide or obsessive fears or worries about death

 Weight change (Unintentional weight loss or gain )

If these symptoms last for at least 2 weeks and cause significant distress difficulty
functioning, get treatment

9.9 Aggression

Anger is an emotion that alerts us that we are feeling discontent resulting from what we
perceive t o be a mistreatment or opposion to ourselves. It usually shows itself in desire to fight
back at the cause of this feeling. Anger is the same whether a parent is feeling/expressing
anger or your adolescent is expressing it. Anger is not a bad emotion. It is a gauge that allows
us to understand what we are feeling. However there are reactions to anger that make anger
much more explosive.
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To understand angry behaviors, consider these three choices:

1. To understand angry behaviors, consider these three choices:

1. 1. Aggression : Anger is expressed overtly to hurt another, physically, emotionally or

psychologically

Common behaviors : hitting, kicking, yelling or screaming at others, harassing, threatening,

intimidating, slapping

If you choose an aggressive response to your angry feelings, you are really saying my
anger is not O.K. so I will make someone else responsible for the way

I am feeling Aggression is usually expressed when one fears their feelings and wants to
blame others for their suffering.

2. Passive Aggression : Anger is repressed by turning your feelings inward, towards

yourself and denying the feelings.

Common behaviors : revenge, depression, taking out your feelings on innocent people or
animals, making up rumors to get back at others, withdrawal

If your, choose a passive aggressive approach to your angry feelings, you are saying my
anger is not O.K. so I will deny it and don’t want to deal with it. I do not value my feelings.

3. Assertion : Anger is appropriately expressed in a direct, non-threatening way that

does not hurt yourself or someone else. You are acknowledging that you are feeling angry and
making the decision to deal with the situation in a suitable way.

Common behaviors : taking time out to cool down, identifying what you are angry about,
clarifying what you are really angry about, exercising, punching a pillow or yelling in private,
deep breathing. If you are really angry about, exercising, punching a pillow or yelling in private,
deep breathing. If you are an assertive person regarding your own anger, you are saying: my
anger is O.K. and is a natural emotion and expression of how I am feeling. I have a strong
sense of myself and can handle this in a positive way.
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9.11 Adolescent Stress

Adolescence is a time of high stress for teenagers and parents alike. Stress is the usual
result of any rapid change and rapid change is what adolescence is all about. As a parent you
watch your child cope with the stress and you hope. Grow stronger from the experience . Of
course watching these struggles without being able to do much to help can be stressful experience
in its own right although you may not be able to completely erase the sources of adolescent
stress nor would your really want to you can be a more supportive parent by understanding
where the stress is coming from.

9.11.1 SOURCES OF STRESS

Adolescent stresses come from within that is they can have a biological cause- as well
as from the various social spheres in which adolescents operates. The family, Scholl, peer
group and the society at large.

BIOLOGICAL STRESS

In general, the physical changes, of adolescences occur most rapidly from age 12 to 14
for girls and between 13 and 15 for boys.In addition to or perhaps because of their bodies rapid
change, adolescents tend to be extremely self –conscious and typically assume that everyone
is always starting at them,. Every pimple, every unwanted curve or lack of curves, can be a
source of misery and stress. Particularly for those who fit our culture narrow ideal of beauty. At
the same time, adolescents busier, than ever schedules-revolving around school, work and
socializing compete with an increase in their biological need for sleep. The result is that sleep
deprivation is another, often silent source of stress.

FAMILY STRESS; Even the most well adjusted adolescents face a major source of stress
in their relationships with their parents. That is because every adolescents must work through
theage –old struggle between the need to belong and to be taken care of and the need for
independence and freedom.

Psychologist Erik Erikson has pointed out that adolescents are driven by a need to
come to grips with their own individual identifies and part of this process involves understanding
their origins. Part of this task involves simply knowing their family history: where their parents
grew up ; how they met and soon. But the more difficult part of the task involves understanding
their parent as human beings, who grew up in a particular place and time and who were shaped
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by complex emotions and relationships. This sort of understanding is difficult to come by. It is
hard enough for a average teenager from a family with both parents living together. But when
parents live far apart or when one or both are unknown(due to abandonment or death) the task,
becomes even more stressful.

School stress : You don’t need me to tell you that academic pressures mount during
high school, particularly the last two years. And although many parents recognize that academic
struggles-to avoid failing an important course, for example-can be quite stressful, it may be the
most academically capable students who feel the greatest pressure, as they find themselves
competing for scare, high-prestige college spots.

Peer stress : Peer-group stress tends to be highest during the middle-school years, but
adolescents who do not find at least a minimal degree of acceptance at that time in their lives
are likely to suffer tined outlasting consequences: isolation, low self-esteem and stress. The
cigarettes, alcohol and drugs. For some teens, substance use provides temporary relief from
stress. However, in the long run the physical and psychological ups and downs end up increasing,
not decreasing, the level of stress they feel.

Societal stress : Adolescents don’t yet belong to the wider adult society; for example,
they cannot vote or buy alcohol legally and they are kept out of most well-paying jobs. At the
same time, many adolescents recognize that they are about to inherit all of society’s largest
problems-war, pollution, global warming, an uncertain economy-without any real economic or
political power with which to confront them: a recipe for stress.

9.11.2 Countering adolescent stress

Much as you might want to, you can’t wave a magic wand and make the sources of
adolescent stress disappear. But there are many things you can do to lower the impact of all of
these concerns on the adolescent you love:

Be a continued source of unconditional love : Adolescents, for all of their bravado and
bids for independence, need more than ever to know that they are loved simply for being who
they are period. How you communicate this love is a matter of personal style, but more parents
err on the side of being too subtle, rather than too gushy. A heartfelt “I love you!” every once in
a while can only do good-although you may want to be tactful about when and where you
deliver this message.
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Keep the faith : An adolescent batting stress on every front likes to hear a calm voice
from a trusted parent saying, “I know you’ll do the right thing and I know you’ll be fine”.

Set reasonable limits :you may not be able to exercise the same tight level of control
that you did when your child was, say, four, but you still have the right and the responsibility, to
ensure that your adolescent is safe. I also think that adolescents, while they often struggle
against parental limits, actually feel safer and less stressed knowing that there are limits. The
idea that everything is possible actually can be overwhelming-ever frightening.

Model healthy coping : although it was true before, it is doubly true now: Adolescents
learn from what you do, not what you say. If you want your adolescent to learn to cope with
stress, you need to engage in healthy coping behaviors yourself. That may mean practicing
yoga or meditation, reading a good book, indulging in a primal scream now and then or talking
with friends. It also mean forgoing the evening glass or two of alcohol to unwind or other short-
term fixes that end up increasing stress in the long run. I recommend two very healthy strategies
that can really help pull you and you’re adolescent through: honesty when it comes to talking
about your feelings and humor.

Relationship issues

Young people spend a great deal of time thinking about and being in romantic relationships
(Furman 2002), yet adults typically dismiss adolescent dating relationships as superficial. Young
people do not agree: half of all teens report having been in a dating relationship (Teenage
Research unlimited 2006). Although most adolescent relationships last for only a few weeks or
months, these early relationships play a pivotal role in the lives of adolescent and are important
to developing the capacity for long-term, committed relationships in adulthood.

9.12 Risks of Adolescent Romantic Relationships

While healthy romantic relationships have many potential benefits for youth, unhealthy
relationships pose risks that may have long-lasting impact. Youth are particularly Vulnerable to
becoming involved in relationships that include dating violence and risky sexual activity. In fact,
teens report dating abuse more often than any other age group (National Center for injury
Prevention and control 2006).

Abuse : Adolescent in dating relationships are at great risk for experiencing verbal,
emotional and physical abuse from their partners. A majority of teens (61 percent) who have
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been in relationships report that a partner has made them feel bad or embarrassed about
themselves. More than one fourth (27 percent) of dating teens said that they have a partner call
them names or put them down. Nearly one third (30 percent) of teens who have been in
relationships said that they been hit, slapped or pushed by a partner (Teenage Research Unlimited
2006). Dating violence is not limited to heterosexual youth. One study found that sexual minority
youth are more likely to have experienced dating violence that other students (Massachusetts
Department of Education 2003).

Involvement in abusive relationships can have lasting consequences for youth. Teens
that have experienced physical dating abuse are more likely to be involved in intimate partner
violence as adults (National Center for Injury Prevention and Control 2006).

STDs and Premature Pregnancy : Dating relationships also put teens at risk sexually
transmitted infections and pregnancy (Furman 2002). The strongest predictor for having sexual
intercourse in 7th through 12th grades is recent involvement in a romantic relationship (Bouchey&
Furman 2003). A significant minority of teens in romantic relationships report feeling pressured
to engage in sexual activity. One out of four teens report that having sex is excepted if you are
in a relationship and almost one-third of teen girls who had been in a relationship said that they
have been pressured to have sex or engage in sexual acts when they did not want to. Additionally,
nearly one-fourth of teen girls reported that they have gone further sexually in a relationship
than they wanted to (Teenage Research Unlimited 2006). Sexual activity can, of course, have
long-term consequences. Almost one-third of sexually active girls report having been pregnant
(Sullentrop & Flanigan 2006) and one out of two sexually active young people can expect to
become infected with an STD by age 25 (Center for Health and Healthcare in Schools 2004).

Acceptance of Unhealthy Relationship : Research suggests that some teens are

accepting of unhealthy relationships. Over one out of four youth say that it is okay for a significant
other to be “really jealous” at times (Teenage research unlimited 2006). One study found
significant tolerance for sexual coercion among young teens (ages 12-14). With 34% of boys
reporting that it was okay to pressure a girl to have sex if they had previously had sex (Albert,
Brown & Falnigan 2003).
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9.13 Eating disorders

9.13.1 Anorexia Nervosa

The primary diagnostic features of anorexia nervosa are weight loss to at least 20 percent
below height and weight standards an intense concern about being overweight that continues
during weight loss and a body image of “fat” that continues during weight loss. This disorder
usually has an onset during adolescence and affects females primarily.

The culture of the teenager, including fashion models and performers, strongly
emphasizes thinners and it should come as no surprise that more women think of themselves
as overweight than are in fact overweight (Power & Erickson 1986). The problem usually begins
with the girl’s becoming very concerned about her weight and appearance and deciding to diet.
The parents are usually initially supportive of the girl’s dieting. However, the adolescent becomes
unable to stop dieting and begins to starve herself. In addition to avoiding the ingestion of food,
the anorectic frequently indulges in excessive exercise; with increasing weight loss, she stops
having menstrual periods. There is a genuine risk of death by starvation with this disorder.
Anorectic adolescents are without concern for their health and deny that they have a problem.
They resist suggestions that they seek help and usually have to be forced by their parents to
get treatment. The disorder is usually manifested in a single episode, but it may become quite
active in preparing food for the family.

The etiology of anorexia has remained elusive. A number of clinicians are convinced
that the development of anorexia nervosa is indicative of pathological family relationships. Minchin
and his colleagues (1975) presented four characteristics of families that support the development
of anorexia. First , the family members are intrusive and do acknowledge each others individuality
and roles, second the family members are overprotective of the anorectic child. Third, the
families are rigid and reinforce the adolescent problem because they do not want anything to
change. Fourth, the families seem not to have learned to resolve conflict.

Although there is no question that family dynamics are involved with anorexia nervosa,
it is not clear whether family factors cause rather than maintain the problem or whether they are
effects. Some research findings suggest that there may be a physical redisposition toward
developing the disorder, although many biological correlates of anorexia, such as amenorrhea
are clearly effects rather than causes; experimental starvation research shows that even many
of the psychological correlates of anorexia, such as irritability, depression indecisiveness and
 163

obsession are also seen in starved non anorectic subjects. However, the normal starved subjects
did not show intense fear of food or ability to suppress hunger that is usually found for anorectic
patients.

Historically, anorexia nervosa has been reported as extremely difficult to treat(Bemis 1978)
Often by the time anorectics come to the attention of a professional, they are at considerable
physical risk. Perhaps a less severe criterion for weight loss should be considered. That is for
adolescents it may be advisable to initiate intervention when a weight loss of 9 t0 15 percent
below height and weight standards is obtained.

An apparent advancement in the treatment of anorexia nervosa has been made by the
application of behavior principles. The primary goal is to increase the anorectics motivation to
eat and thereby to reduce the life threatening condition. In Most instances, it is necessary for
the clinician to gain complete control of the client’s reinforces before adequate progress is
made. A typical procedure would include hospitalizing the client and depriving her of all privileges,
such as TV, use of the phone and visits, until weight gain in is progress. Some time it may be
possible to implement this treatment in the home. However anoretics are so motivated not to
eat that they try to manipulate their family and cheat to avoid eating. Cognitive therapy
interventions have also been specifically designed for anorectics to decrease the misconceptions
that they typically have (Garner 1986).Educational materials on starvation and its physical and
psychological effects are an important component of many programs. Therapy then focuses on
decreasing the faulty reasoning and erroneous beliefs about the body.

9.13.2 BULIMIA

The primary motivation in bulimia, to be thin, is the same as that in anorexia. However,
thinness is achieved by recurrent binges of eating followed by self induced vomiting or
purging(Using laxatives) Bulimia was originally described as a component or anorexia nervosa.
About of the anorectic patients in one study indicated that they sometimes engaged in binging
and vomiting (Casper, Ecker, Halmi, Goldberg&Davis 1980).

Bulimics tend to be older than anorectics, with an average age of onset at 19 years, Binge
eating is apparently a common behavior among college students, about 3 percent of a college
sample indicated that they had also induced vomiting after binging (Hawkins &Clement
1980).Another study (Johnson, Lewis, Lore, Lewis,&Stickeyt 1984) found that 4.9 per cent of
female high school populations met the DSM-III criteria fore diagnosis of bulimia. The behavioral
164

treatment of bulimia has included use of self-control reinforcement , contingency contracting

and systematic desensitization techniques to change the abnormal eating and vomiting purging
patterns. Some success has been demonstrated in case studies, but more empirical research
with larger samples is needed.(Wilson 1986).

CHECK YOUR PROGRESS:

Fill in the blanks.

1. Sex education programs can be divided into two parts—————————and —

——————

2. ————————————Always has a soothing effect and makes the mind

peaceful and relaxed.

3. ———————————Is a virus remains in the body and shows up from time to

time as sores with blisters on the month, genitals or anus,the same place every
time.

4. ——————————is an inflammation of the bladder and women are the most

likely to get it. It is also known as the honeymoon syndrome because many women
get in the first time they have sex.

5. Sleep deprivation is another, often silent source of ———————

9.15 SUMMARY

The onset of adolescents is heralded by two significant changes in physical development-

Growth spurt, sexual maturity. The term growth spurt describes the rapid acceleration in height
and weight that marks the beginning of adolescence. Maturation of the reproductive system
occurs at roughly the same time as the adolescent growth spurt and follows a predictable
sequence for members of each sex. Adolescents often become quite concerned about their
appearance and may spend a great deal of time worrying about what other people think of
them. Apparently the timing of puberty does have some meaningful social implications although
its impact varies somewhat between males and females.

The advantages of maturing early are greater for males than for females. Physical
growth and development represent a complex interplay between biological predisposition and
environmental influences, with biology assuming the more dominate role. Biological factors
play a major role in the growth process. Environmental influences are known to affect physical
 165

growth and development: nutrition, illnesses, climate (including seasonal influences) and
emotional stress.

Normative and non-normative shifts that young people are likely to encounter can turn
out to be either challenges or risks, depending on their psychosocial properties. Another factor
that can disturb parent-adolescent relationships is the non-normative shifts’ that affect family-
life. Turning to family life, we have seen that adolescence is a time for renegotiating roles, if
done skillfully on both sides: this will lead to heightened autonomy and the development of
many necessary life-skills like managing one’s own economy, personal hygiene, short and
long-term planning and a continuing warm relationship with parents.

Social environment lead us to problems adolescents might build up for themselves by

engaging in behaviors that might be a risk for their health or for their psycho social development
adolescents are influenced by their friends’ attitudes and behavior, but adolescents can also
influence their friends: over time mutual influence increases similarities.

Delinquent behavior is regarded by many as the most prominent form of adolescent

risk-taking. The majority of those convicted for car-theft, Vandalism, shoplifting, theft and burglary
are young men between 14 and 17 years. Sex education program helps youngsters to conduct
themselves with dignity and restraint and promote emotional stability and sound character. It
makes them to adapt to a socially responsible behavior. Exams are not always easy going.
Unwanted tension can precipitate exam fear. Adolescent depression is a disorder that occurs
during the teenage years and involves persistent sadness, discouragement, loss of self-worth
and loss of interest in usual activities. Anger is an emotion that alerts us that we are feeling
discontent resulting from what we perceive to be a mistreatment or opposition to ourselves. It
usually shows itself in a desire to fight back at the cause of this feeling. Adolescence is a time
of high stress for teenagers and parents alike. Stress is the usual result of any rapid change
and rapid change is what adolescence is all about. Adolescents often become quite concerned
about their appearance and go in for dieting. However, the adolescent becomes unable to stop
dieting and begins to starve herself which might lead to anorexia nervosa, bulimia.
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9.16 Key Words

Adolescent growth spurt : the rapid increase in physical growth that marks the
beginning of adolescence.

Puberty : the point at which a person reaches sexual maturity

and is physically capable of fathering or conceiving
a child.

Menarche : the first occurrence of menstruation.

Anorexia nervosa : nervous loss of appetite

Deprivation dwarfism : directly related to the emotional deprivation that the

child has experienced at home.

Informal sex education

program : Acquired Immune Deficiency Syndrome

Body fluids : things like blood, semen, vaginal secretions and

saliva

9.17 Check your Answers

I. 1. Growth spurt, sexual maturity.

2. Dramatic biological upheavals

3. Self-starvation

4. Binge eaters

5. Biological predispositions, environmental influences,

6. Thyroxin, pituitary growth hormone.

7. Marasmus, kwashiorkor

II. 1. ‘Luxury gap’

2. Power, intimacy

3. Adolescent risk-taking

4. Sports participation
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5. Sex education

6. Sex education program

III. 1. Informal sex education program, Formal sex education program

2. Nature

3. Herpes

4. Cystitis

5. stress

9.18 Model Questions

1. What is growth spurt?

2. When does a child mature? Discuss the sexual development in boys and girls.

3. What are the psychological impact, the sudden growth and development in
adolescent can have on the person?

4. Biology assumes a dominant role in the growth and development. Discuss.

5. What are the environmental influences on growth and development?

6. When children are undernourished, what are the nutritional diseases a child is likely
to suffer form?

7. What are the problems of over nutrition?

8. What can be the effects of too much stress and lack of attention on children?

9. Explain risk-taking behavior.

10. What is sex education? Discuss its aim, need, and its type.

11. What are the qualities of a sex educator?

12. What is examination fear? Discuss about its causes, symptoms.

13. Explain about adolescent depression.

14. Illustrate the adolescent aggression.

15. Explain about adolescent stress.

16. What are the risks involved in adolescent romantic relationships?

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LESSON - 10
OLD AGE: EMOTIONAL, SOCIAL AND PHYSICAL
PROBLEMS
10.0 INTRODUCTION

Old ages provide much needed comfort and wisdom to their families and communities,
but there are also times when they need assistance. The guidance center can help them with
certain needs. If a Old age is struggling to pay his or her rent, a worker at the guidance center
can point him or her to local non-profit groups that may offer utility vouchers

10.1 OBJECTIVES

After reading this unit the student will be able to:

Discuss the problems and issues of Old ages.

 State the facilities for the Old ages

 Describe the Signs and symptoms of depression in the elderly

 List the Causes and risk factors of depression in the elderly

 Describe Tips for helping a depressed elderly

 Suggest Ways to combat and prevent depression

 Identify Current Situation of the Health Issues of Old ages

Plan of the Study

10.0 Introduction

10.1 Objectives

10.3 Concept of Old ages

10.4 Problems and issues

10.5 Facilities for the Old ages

10.6 Signs and symptoms of depression in the elderly

10.7 Causes and risk factors of depression in the elderly

10.8 Tips for helping a depressed elderly

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10.9 Ways to combat and prevent depression

10.10 Counseling and therapy

10.11 Current Situation of the Health Issues of Old ages

10.12 Summary

10.13 Key terms

Check your progress

Model questions

10.2 CONCEPT OF OLD AGES

As we age, a great number of changes occur in our body. Such changes are the root
cause for various diseases. Heart disease is more commonly seen in Old ages. Most of the Old
ages do not even know that they are at the risk of heart disease. As we age, our general
activities get reduced. As the body needs have reduced, the cholesterol or the bad fat gets
deposited in various tissues and even in arteries blocking them or narrowing them resulting in
decreased blood flow to the heart. This situation finally leads to heart attack due to blockage of
blood supply to the heart. Old ages with diabetes are at increased risk for myocardial infarction.
Hence, it is essential to maintain appropriate sugar levels by regular usage of medications. To
avoid the risk of heart attack it is essential to follow certain practices. They include consuming
low fat or zero cholesterol foods, involving in some sort simple exercises regularly, quit habits
such as smoking and consumption of alcohol. It is essential to take a healthy nutritious diet rich
in fresh fruits and vegetable. Thus, by knowing the facts of heart disease in Old ages, they can
easily combat heart attack.

10.4 PROBLEMS AND ISSUES

Old ages who are living alone have been found abused, robbed, humiliated, and, in many
cities in India, they have been found murdered. The most important problem Old ages face
today is loss of independence. All other issues fall under this umbrella of inconvenience and
distress. Whether older persons have financial hardships, failing health or isolation

Deteriorating health, malnutrition, lack of shelter, fear, depression, senility, isolation,

boredom, non-productivity, and financial incapacity are the most common problems that Old
ages all over the world face today. These problems can be grouped into two categories that
170

relate to the physical and mental health and the financial capacity of the Old age. The rise in the
number of those who are non-productive‘ and who do not generate any hope‘ immediately
raises an economic problem. It is also a social problem: Who is going to provide support to
them and how? Apart from food and shelter, the old need care and medicines. They also crave
love and tender care. They would like to interact, be heard, be visible, and would like a bit of
space of their own and have a constructive and creative role to play in society. Among the old,
the problems of old women, single, divorced and widowed, are different from those of old men.

1. Physical and mental health

Stability of physical and mental health is a key concern that Old ages have to contend
with as they go through their twilight years. The human body is a system that wears out with
long and repetitive use; and quite easily, with neglect and abuse. Aging is a life-cycle stage
where the human capacity to think, act, relate, and learn starts to falter and deteriorate. Aging
breeds illnesses such as loss of memory, immobility, organ failure, and poor vision. These are
critical dysfunctions that could sideline a Old age to a lonely and miserable life. While a clean
and discreet lifestyle in his or her prime could reduce the susceptibility of a Old age to dreaded
post-retirement illnesses, the onset of any dysfunction is one unpredictable happening even if
the person might have had robust financial health.. 2. Financial capacity Possessing sustainable
financial capacity before, during, and after the inception of a senior status is both a basic problem
and an elusive dream for most people. This financial dilemma is common among Old ages who
are usually relegated to an abject position of economic inactivity. Lack or absence of financial
capacity creates a stressful life and invites the entry of problems other than physical and mental
health issues. For instance, domestic problems in an extended family system can aggravate
the problem of a financially-destitute Old age.

A financially secure Old age with the same illness, however, may have a longer life to live
because money can give quick and convenient access to life-giving remedies. Even with state-
of-mind dysfunctions like severe depression, boredom, nervous breakdown, and self-pity, financial
capacity can buy options to rejuvenate and refresh a financially-capable Old age, through travels,
elderly recreation, social renewal, and continuing education. A poor Old age in the same state
of mental degradation cannot afford to do the same; and more so, be back into the mainstream
of society.
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Ageing marginalized

An overwhelming number of people live in rural areas but migration from rural to urban
areas is substantial, which creates problems for the ageing at both ends. If children go to urban
areas leaving behind the aged in the rural areas, that creates one set of problems, and if the old
are taken along, it creates another set of problems. The growth of the urban population has
been haphazard, and there are acute shortages of housing and other facilities. The health care
system is woefully inadequate and there is hardly any specialised agency focusing on the old.
There are no programmes available to train people taking care of the aged. In other words, the
entire responsibility of taking care of the old continues to be with the traditional institution of the
family.

Ageing in urban areas

The entire responsibility of support and care of the ageing falls on the male children with
whom the ageing live. The composition of the family in urban areas is becoming nuclear and
smaller, as a result of which there are fewer people available in the house to provide care and
comfort to the ageing. Those who are available are torn apart by the stresses of urban living.
Women too in the urban areas are now working outside the family. They have fixed schedules
of work and have other pressures on them. Children are loaded with their studies, competitive
examinations and concerns for making their careers. The authority that the ageing exercised
on their children in the past as a result of greater experience has almost vanished, and the aged
are now told, You don‘t know‘. There are several reasons for this admonishment. First, the
children of the ageing are not in the same profession. Second, the quantum of information
which their children claim to have makes the ageing look almost primitive. Third, the whole
techno-economic situation has now completely changed, which leaves the ageing bewildered
and redundant. When paucity of accommodation, high cost of living, general stress and tensions
at all levels are added to these, the problems of the aged are extremely serious. In the past,
ageing was not a serious issue and societies did not give it priority. They dealt with it as a
natural phenomenon. Family members were responsible for the care and management of the
old. But now the situation is different. The size of the people in the ageing category is already
bulging and it is growing very fast. The problems posed by ageing are by no means accidental
and isolated. They have grown as a result of the development process itself. At family, community
and government levels the problems of the ageing get no or very low priority. It is taken for
granted that the problem will get solved on its own or that it is a problem of individual families,
with communities and governments having nothing to do with it. The family, where the ageing is
172

supposed to get care and comfort, is on the rocks and in any case shrinking. The members of
the family are spread around in pursuit of their careers. The old, on their part, are not getting
detached either. They think that they are going to live for ever and that in any case this is not the
time to quit. They are bored looking after grandchildren, listening to religious discourses and
devotional music, making rounds of holy places or just sitting before the small screen. They
seek companionship, appropriate creative and constructive roles. In India even systematic
thinking as to what should be the policy towards the ageing has not begun. At this stage the
country is caught up in the whirlpool of market forces and resultant consumerism. A shift from
consumption to conservation, from individual to community, is bound to take place, which will
be in keeping with the Indian ethos. It is possible to be modern with the emphasis on conservation
and focus on the community. Taking care of the aged means highlighting the importance of
conservation and humanitarianism. It will also strengthen the community, for the aged can be
best taken care of within the fold of the family, bound by filial rights, duties and obligations.
There is no institution that can replace the family but there is room to build into it the ideas of
equality, justice and freedom. All this will not happen automatically. The focus has to be human
development. That will provide new strength to the family and further support from the community.
Thus a combination of modern knowledge and intense feeling for those who are non-productive
can provide physical and emotional comfort to the old.

10.5 FACILITIES FOR THE OLD AGES

The facilities for the Seniors citizens like retirement homes, medical aid , free meals,
Indoor games and outdoor games transportation, nursing, healthy, environment ,domestic help
Books & magazines etc. to be provided by the government.

Old ages Discounts

Our governments are announcing many schemes every year for the Old ages. The Indian
Railways and Indian Airlines give some Old age discounts up to 30% but most of the Old ages
are not in a position to avail the available facilities. All the Public Sector banks give 0.5 %
interest to Old ages.

Old ages Retirement

The activities of Old ages increase after the retirement. All the market and government
related work has to be done by these elderly persons after retirement. There are no Old age
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jobs available for them., They have social problems &, housing problems. The government
should find some jobs for seniors citizens.. There are groups of aging Old ages. These seniors
have no activity to do whole day. These senior people find difficult to spend the whole day
honourably. They need elder care by their own family members. There are very few Retirement
homes. They need assisted living facilities. These old people have all type of problems after
retirement. They have family problems. Their children do not want to live with them.. They have
to travel long distance to collect their pension or pay the electricity, telephone, water bills. They
are living in the houses bought against home loans, and paying back the home loans out of
pension.

Old age’s medical insurance

Old ages have health problems. They are getting injuries every day due to uneven surface
of bad roads. No one is ready to help them .The Old ages health insurance required is not
affordable.

Mental Illnesses

Old ages are susceptible to a variety of mental illnesses. Depression is the most common
of these.

10.6 SIGNS AND SYMPTOMS OF DEPRESSION IN THE ELDERLY

Sadness

Fatigue

Abandoning or losing interest in hobbies or other pleasurable pastimes

Social withdrawal and isolation (reluctance to be with friends, engage in activities, or

leave home)

Weight loss; loss of appetite

Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime

sleepiness)
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Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)

Increased use of alcohol or other drugs

Fixation on death; suicidal thoughts or attempts

Unexplained or aggravated Loss of feeling of pleasure

aches and pains

Hopelessness Slowed movement

Helplessness Irritability

Anxiety and worries Lack of interest in personal care (skipping meals,

Memory problems forgetting medications, neglecting personal hygiene)

Lack of interest in activities you enjoyed doing

Sadness or unexplained crying spells, jumpiness or irritability

Loss of memory, inability to concentrate, confusion or disorientation

Thoughts of death or suicide

Change in appetite and sleep patterns

Persistent fatigue, lethargy, aches and other unexplainable physical problems

If a Old age is depressed, you can make a difference by offering emotional support.
Listen to your loved one with patience and compassion. Don‘t criticize feelings expressed, but
point out realities and offer hope. You can also help by seeing that your friend or family member
gets and accurate diagnosis and appropriate treatment. Help your loved one find a good doctor,
accompany him or her to appointments, and offer moral support.

Causes and risk factors that contribute to depression in the elderly:

Loneliness and isolation – Living alone; a dwindling social circle due to deaths or relocation;
decreased mobility due to illness or loss of driving privileges.

Reduced sense of purpose - Feelings of purposelessness or loss of identity due to

retirement or physical limitations on activities.
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Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage
to body image due to surgery or disease.

Medications – Many prescription medications can trigger or exacerbate depression.

Fears – Fear of death or dying; anxiety over financial problems or health issues.

Recent bereavement - The death of friends, family members, and pets; the loss of a
spouse or Helping a depressed friend or relative

10.7 TIPS FOR HELPING A DEPRESSED ELDERLY

Invite your loved one out. Depression is less likely when people‘s bodies and minds remain
active. Suggest activities to do together that your loved one used to enjoy: walks, an art class,
a trip to the museum or the movies—anything that provides mental or physical stimulation.

Schedule regular social activities. Group outings, visits from friends and family members,
or trips to the local senior or community center can help combat isolation and loneliness. Be
gently insistent if your plans are refused: depressed people often feel better when they‘re around
others.

Plan and prepare healthy meals. A poor diet can make depression worse, so make sure
your loved one is eating right, with plenty of fruit, vegetables, whole grains, and some protein at
every meal.

Encourage the person to follow through with treatment. Depression usually recurs when
treatment is stopped too soon, so help your loved one keep up with his or her treatment plan. If
it isn‘t helping, look into other medications and therapies.

Make sure all medications are taken as instructed. Remind the person to obey doctor’s
orders about the use of alcohol while on medication. Help them remember when to take their
dose.

Watch for suicide warning signs. Seek immediate professional help if you suspect that
your loved one is thinking about suicide.
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10.8 WAYS TO COMBAT AND PREVENT DEPRESSION

Getting out in to the world – Try not to stay cooped up at home all day.

Connecting to others – Limit the time you‘re alone.

Participating in activities you enjoy – Pursue whatever hobbies or pastimes bring or used
to bring you joy.

Volunteering your time – Helping others is one of the best ways to feel better about
yourself and regain perspective.

Taking care of a pet – Get a pet to keep you company.

Learning a new skill – Pick something that you‘ve always wanted to learn, or that sparks
your imagination and creativity.

Enjoying jokes and stories – Laughter provides a mood boost.

Maintaining a healthy diet – Avoid eating too much sugar and junk food. Choose healthy
foods that provide nourishment and energy, and take a daily multivitamin.

Exercising – Even if you‘re ill, frail, or disabled, there are many safe exercises you can do
to build your strength and boost your mood—even from a chair or wheelchair.

10.9 COUNSELING AND THERAPY

Studies have found that therapy works just as well as medication in relieving mild to
moderate depression. And unlike antidepressants, therapy also addresses the underlying causes
of the depression.

Supportive counseling includes religious and peer counseling. It can help ease loneliness
and the hopelessness of depression.

Psychotherapy helps people work through stressful life changes, heal from losses, and
process difficult emotions.

Cognitive behavioral therapy (CBT) helps people change negative thinking patterns, deal
with problems in healthy ways, and develop better coping skills.
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Support groups for depression, illness, or bereavement connect people with others who
are going through the same challenges. They are a safe place to share experiences, advice,
and encouragement.

10.10 CURRENT SITUATION OF THE HEALTH ISSUES OF OLD

AGES

Every Old age has to cope up with his health and associated problems by taking special
care by way of proper life style, exercises, regular walking without talking, yoga-pranayam,
proper diet and keeping busy physically and mentally by keeping in view the dictum -“Use it or
Lose it. ‘ Number of Old ages suffering from Hyper Tension, Heart Problems, Diabetes, Arthritis
etc is very large. Facilities to diagnose and treat old age ailments are very much limited and
treatments, whether surgical or by medicines are very very costly. With limited income and no
affordable health security schemes available to Old ages, most of the Old ages do not dare to
go for any treatment and leave everything to God‘s grace! Many are not able to travel
independently to Govt./Municipal hospitals, where they have to wait in long queues and treatment
mooted out to them is almost inhuman! Apart from ward boys, even well educated Doctors
taught to serve all with missionary zeal misbehave with elders and even insult them. They are
not available on their seats for a long time or remain busy chit-chatting! They along with all
medical and para medical staff in all Public & Private Hospitals should be given periodical
orientation course for treating Old ages in a proper way.

Check your pogress

Fill in
a) _____________, ____________, ________, ______, ________,
_______,________, ______, and _________ are the most common problems that
Old ages

b) __________ is the most common in old age.

c) Supportive counseling includes religious and ____________________

Answers
a Deteriorating health, malnutrition, lack of shelter, fear, depression, senility, isolation,
boredom, non-productivity, and financial incapacity.

b) Depression c) peer counseling

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10.11 Summary

The present time society needs to give Old ages, a life of dignity in their twilight years.
Urbanization, migration, industrialization, women entering in the labor force and many such
social changes has steadily chipped away the joint family system. The result is that Old ages
are now forced to face a life of despair and loneliness. There are very few mechanisms to look
into the problems of Old ages. We can solve social problem by the change in social reality and
application of knowledge. Because the root of this problem is lack of education, so we should
provide education to this particular social group. Educated Old age can deal with the problem in
a better way. And finally the family member of these people must understand that the old person
in their home is an asset not liability. The education and the mindset of family member can
reduce this problem form the society

10.12 Key Terms

old age: Individuals who are above 65 years of age.

Model questions
1. Discuss the problems and issues of Old ages.

2. State the facilities for the Old ages

3. Desribe the Signs and symptoms of depression in the elderly

4. List the Causes and risk factors of depression in the elderly

5. Describe Tips for helping a depressed elderly

6. Suggest Ways to combat and prevent depression

7. Identify Current Situation of the Health Issues of Old ages

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LESSON - 11
COUNSELLING SKILLS
11.0 Introduction

Helping another person in distress can be one of the most ennobling human activities.
For a better outcome client counselor relationship is very much imperative. Certain basic skills
are essential for a counselor in building up relationship with the client. Since counselling is a
conversation or dialogue between the counsellor and client, the counsellor needs certain
communication skills in order to facilitate change. Basic skills include listening, attending,
empathy, paraphrasing, summarizing etc. Also the counsellor in first place should understand
their own self in order to understand about others

11.1 Objective

By the end of this lesson you will be able to

 understand client-counselor relatiohsip

 counsellor as role model

 essential skills of counsellor

Plan of the study

11.0 Introduction

11.1 Objectives

11.2 Client- Counsellor relationship

11.3 Counsellors’ Characteristics and its impact on client relationship

11.4 Skills required to be a effective counsellor

11.5 Summary

11.6 Key terms

Check your progress

Model questions
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 11.2 Client- Counsellor relationship

In 1997, the American Counselling Association (ACA) adopted the following definition of
professional counselling: ‘The application of mental health, psychological, or human development
principles, through cognitive, affective, behavioural or systemic intervention strategies, that
address wellness, personal growth, or career development, as well as pathology’ (as cited in
Marini and Stebnicki 2009, p. 112). This definition establishes guidelines for the official ACA role
of counselling and seems to endorse a professional that works with the normal population as
well as with those with pathology. Counsellors help clients in reaching ‘their optimal level of
psychosocial functioning through resolving negative patterns, prevention, rehabilitation, and
improving quality of life’ (Hershenson and Power 1987, as cited in Marini and Stebnicki 2009, p.
112). Counsellors work in varied settings like schools, hospitals, corporate settings and so
forth, and their role also varies depending upon the setting in which they practice (Marini and
Stebnicki 2009).

Clients come to counsellor when they are troubled and the therapists, receive them with
warmth and understanding. Clients seek ease from their emotional pain, they want to recover
so they can face their future in a stronger frame of mind than when they took their first step over
our threshold.

Therapists, need to acknowledge that their clients are struggling. Equally it is important
make it clear that counsellors as therapists, are not going to go under themselves. A good role
model is someone who is always positive, calm, and confident in themselves. The personal
attributes of a counsellor affect not only the work with clients but also personal and professional
development (Rogers 19121). It has been suggested that the most important element in
counselling is the ‘personhood’ of the counsellor (Gibson and Mitchell 1999) and that the most
powerful impact on the client may be that of observing what the counsellor is or does. Wosket
(2002) observed that some aspects of the counsellor’s self unavoidably becomes accessible to
the client to a greater or lesser degree. Further Wosket (2002) states that counsellors’ Use of
self is evident in the way that they extend aspects of their personality with the intention of
influencing the client. Use of self involves the operationalisation [sic] of personal characteristics
so that they impact on the client in such a way as to become potentially significant determinants
of the therapeutic process. (p. 11, italics in original) It was important to explore the particular
aspects of self, both personal and professional, that counsellors brought to bear in their work
and to study the subsequent impact on their experiences.
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The therapist is a guide, helping clients to explore feelings in a safe environment. The
client may be psychologically lost. The therapist, on the contrary, needs to be quite clear about
where they are at in their own head. This is so important because clients’s traumatic experiences
can have an impact on them. This can be helpful - as it can help to develop a connection, client
can heighten own self-awareness and can help to be present and more effective.

Counsellor become an expert about ourselves and our own feelings, which is good
modelling for the client.

All the more reason then that as therapists, they need to care for themselves. Counsellors
in general are notorious for not looking after themselves.

To help self-protection, encourage clients to do interesting things for themselves. Reaffirm

the things which bring them enjoyment, or discover new things to enjoy. To be authentic,
counsellor need to do this thyself. They need to find a place to do the things and enjoy too and
make a commitment to do them.

As counsellor check your own self-care, it is important you feel at home with your inner
selves. Comfortable within your own skins. When you achieve this state you are more likely to
be more confident and resourceful. Clients are more likely to find therapy helpful and this in turn
does wonders for your self-esteem and self-belief.

Thinking clearly is important in this respect. Little fluffy clouds may come along, as therapists
can still be effective in what they do, big dark clouds which persist may indicate that perhaps
they need to take a rain check ourselves. It’s okay to take a break, after all therapist would
suggest that to their client wouldn’t they?

Counsellor job is to help their client’s recover, but they should not put at risk by doing so.
As therapists they need to be able to accept their own limitations as well as the issues client’s
face without ‘getting down’ about them.

11.3 Counsellors’ Characteristics and its impact on client

relationship 

Personality characteristics of the counsellor have an important bearing on therapeutic

outcomes (Garfield and Bergin 19812; Barnlund and Araki 1985). Wosket (2002) has suggested
a natural correlation between the personal characteristics of the counsellor and the way their
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style and approach develops.personal attributes such as being a good listener, being patient
and accepting; as contributing to their effectiveness as a counsellor.

Motivation

Sussman (1992) suggested that there are certain common motivations behind the pursuit
of the profession. These include desires to be idealized, to provide nurturance, to be in a dominant
position and to achieve intimacy.

Values

Packard believes that all individuals behave in accordance with a set of values, whether
these have been thought out and made explicit or not. Therefore, it is impossible for a counsellor
to maintain a position of neutrality (Packard 2009). Values have been defined as broad
preferences concerning appropriate courses of action that counsellors should take.

Personal/Cultural Values

In order to be able to relate to clients who hold different values and cultures from their
own, counsellors need to develop sensitivity to value differences, a very important issue in the
counselling process (Kelly and Strupp 1992). Counsellors had considered altruism and respect
for individuality as overarching values that defined their practice.

Professional Values

the values the counsellor believe were an essential part of the process of counselling.
confidentiality and being nonjudgmental were the most important professional values.
Nondirective behaviour, empathy and respecting the client were other important professional
values. Client autonomy was regarded as the central goal of counselling. Equality between the
client and counsellor had also been emphasized.

Biases

Counsellors are not without their ‘shadow’ side, which reflect their vulnerabilities and blind
spots. A research on counsellor bias revealed that they held against certain types of clients and
issues (Bhargava & Sriram, 20112). Rashmi (one of the participant in the research study) indicated
a bias against clients of high SES, and claimed that they tended to be ‘suspicious’ and preoccupied
with confidentiality. She had opinions regarding sharing information pertaining to therapeutic
modality:
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‘We usually don’t discuss such details with the clients. They don’t understand all these
therapies and all.’

This bias seems to be stemming from the traditional hierarchical doctor–patient relationship
in which doctors are seen to wield expert power (French and Raven 1959); and by behaving like
doctors, counsellors may be attempting to gain respect and public recognition for their work.
Allying themselves with a more powerful group may also be an attempt at defining professional
identity. Rashmi shared an anecdote about a gay client who came for counselling with problems
at work. The anecdote revealed how a counsellor’s unacknowledged bias could impact the
counselling process.

“ It was a very difficult case for me. It was transgender. Gay. It was a little away from my
regular normal cases. That was challenging. I worked with him and I heard that he is doing well
now. But his original problem has not been solved. He just wanted one session. He knows
about it for a long time…about his problem but he also doesn’t want to come out. He doesn’t
want to talk about it or about any other option. He wanted to live within his own limitations. Then
better for him. See I am very realistic. If he wants to be like this, let him be like this. When there
are no options for them, I tell them straight away. If at one needs to be radical then one has to
be.”

(Rashmi) The manner and tone of voice in which the client was refereed to—‘a gay’—
was seen as pejorative. The participant’s stance reflected that the client’s homosexuality was
inherently abnormal. Further, she conceptualized it as problematic and as a ‘limitation’. Besides,
she did not refer the client to another counsellor who may have been better equipped to help
him. Neither did the counsellor explore her role in influencing the outcome of this particular
encounter.

The above example is given to illustrate how subjectivity of the counsellor influences the
counselling process and as a counsellor they are not supposed to do. At the same time counsellor
should acknowledge that they do have certain bias.

11.4 Skills required to be a effective counsellor

1.Attending

Attending refers to the ways in which counsellors can be “with” their clients, both physically
and psychologically. Effective attending tells clients that you are with them and that they can
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share their world with you. Effective attending also puts you in a position to listen carefully to
what your clients are saying. The acronym SOLER can be used to help you to show your inner
attitudes and values of respect and genuineness towards a client (Egan.)

S: Squarely face your client. Adopt a bodily posture that indicates involvement with your
client. (A more angled position may be preferable for some clients - as long as you pay attention
to the client.) A desk between you and your client may, for instance, create a psychological
barrier between you.

O: Open posture. Ask yourself to what degree your posture communicates openness and
availability to the client. Crossed legs and crossed arms may be interpreted as diminished
involvement with the client or even unavailability or remoteness, while an open posture can be
a sign that you are open to the client and to what he or she has to say.

L: Lean toward the client (when appropriate) to show your involvement and interest. To
lean back from your client may convey the opposite message.

E: Eye contact with a client conveys the message that you are interested in what the
client has to say. If you catch yourself looking away frequently, ask yourself why you are reluctant
to get involved with this person or why you feel so uncomfortable in his or her presence. Be
aware of the fact that direct eye contact is not regarded as acceptable in all cultures.

R: Try to be relaxed or natural with the client. Don’t fidget nervously or engage in distracting
facial expressions. The client may begin to wonder what it is in himself or herself that makes
you so nervous! Being relaxed means that you are comfortable with using your body as a
vehicle of personal contact and expression and for putting the client at ease.

Effective attending puts counsellors in a position to listen carefully to what their clients are
saying or not saying.

2.Listening

“Most people do not listen with the intent to understand; they listen with the intent to reply.
They’re either speaking or preparing to speak.” - Steven R Covey

Yes, it’s true! When most people listen, they are filtering out what is being said and preparing
to respond with their own interpretations or agenda. Listening to understand, requires patience
and a certain set of skills, that when applied correctly, facilitate clear communication and deep
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understanding. Listed below are the most common forms of skill used in effective listening and
responding. Attending Being prepared to listen in an unhurried way. Making sure that your client
can see and feel that they have your undivided attention in the time you have together. This can
be demonstrated by appropriate use of eye contact*, and affirming verbals such as:

1. aha—exclamation of discovery or realization

2. uh huh—interjection signifying understanding

Listening refers to the ability of counsellors to capture and understand the messages
clients communicate as they tell their stories, whether those messages are transmitted verbally
or nonverbally.

Active listening involves the following four skills:

 Listening to and understanding the client’s verbal messages. When a client tells
you his or her story, it usually comprises a mixture of experiences (what happened
to him or her), behaviours (what the client did or failed to do), and affect (the feelings
or emotions associated with the experiences and behaviour). The counsellor has to
listen to the mix of experiences, behaviour and feelings the client uses to describe
his or her problem situation. Also “hear” what the client is not saying.

 Listening to and interpreting the client’s nonverbal messages. Counsellors should

learn how to listen to and read nonverbal messages such as bodily behaviour
(posture, body movement and gestures), facial expressions (smiles, frowns, raised
eyebrows, twisted lips), voice?related behaviour (tone, pitch, voice level, intensity,
inflection, spacing of words, emphases, pauses, silences and fluency), observable
physiological responses (quickened breathing, a temporary rash, blushing, paleness,
pupil dilation), general appearance (grooming and dress), and physical appearance
(fitness, height, weight, complexion). Counsellors need to learn how to “read” these
messages without distorting or over?interpreting them.

 Listening to and understanding the client in context. The counsellor should listen to
the whole person in the context of his or her social settings.

 Listening with empathy. Empathic listening involves attending, observing and listening
(“being with”) in such a way that the counsellor develops an understanding of the
client and his or her world. The counsellor should put his or her own concerns aside
to be fully “with” their clients.
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Active listening is unfortunately not an easy skill to acquire. Counsellors should be aware
of the following hindrances to effective listening (Egan, 1998):

 Inadequate listening: It is easy to be distracted from what other people are saying if
one allows oneself to get lost in one’s own thoughts or if one begins to think what
one intends to say in reply. Counsellors are also often distracted because they have
problems of their own, feel ill, or because they become distracted by social and
cultural differences between themselves and their clients. All these factors make it
difficult to listen to and understand their clients.

 Evaluative listening: Most people listen evaluatively to others. This means that they
are judging and labelling what the other person is saying as either right/wrong,
good/bad, acceptable/unacceptable, relevant/irrelevant etc. They then tend to
respond evaluatively as well.

 Filtered listening: We tend to listen to ourselves, other people and the world around
us through biased (often prejudiced) filters. Filtered listening distorts our
understanding of our clients.

 Labels as filters: Diagnostic labels can prevent you from really listening to your
client. If you see a client as “that women with Aids”, your ability to listen empathetically
to her problems will be severely distorted and diminished.

 Fact?centred rather than person?centred listening: Asking only informational or

factual questions won’t solve the client’s problems. Listen to the client’s whole context
and focus on themes and core messages.

 Rehearsing: If you mentally rehearse your answers, you are also not listening
attentively. Counsellors who listen carefully to the themes and core messages in a
client’s story always know how to respond. The response may not be a fluent,
eloquent or “practised” one, but it will at least be sincere and appropriate.

 Sympathetic listening: Although sympathy has it’s place in human transactions, the
“use” of sympathy is limited in the helping relationship because it can distort the
counsellor’s listening to the client’s story. To sympathise with someone is to become
that person’s “accomplice”. Sympathy conveys pity and even complicity, and pity
for the client can diminish the extent to which you can help the client.
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3. Basic empathy
 Basic empathy involves listening to clients, understanding them and their concerns
as best as we can, and communicating this understanding to them in such a way
that they might understand themselves more fully and act on their understanding
(Egan, 1998).

 To listen with empathy means that the counsellor must temporarily forget about his
or her own frame of reference and try to see the client’s world and the way the client
sees him or herself as though he or she were seeing it through the eyes of the
client.

 Empathy is thus the ability to recognise and acknowledge the feelings of another
person without experiencing those same emotions. It is an attempt to understand
the world of the client by temporarily “stepping into his or her shoes”.

 This understanding of the client’s world must then be shared with the client in either
a verbal or non-verbal way.

Some of the stumbling blocks to effective empathy are the following:

 Avoid distracting questions. Counsellors often ask questions to get more information
from the client in order to pursue their own agendas. They do this at the expense of
the client, i.e. they ignore the feelings that the client expressed about his or her
experiences.

 Avoid using clichés. Clichés are hollow, and they communicate the message to the
client that his or her problems are not serious. Avoid saying: “I know how you feel”
because you don’t.

 Empathy is not interpreting. The counsellor should respond to the client’s feelings
and should not distort the content of what the client is telling the counsellor.

 Although giving advice has its place in counselling, it should be used sparingly to
honour the value of self?responsibility.

 To merely repeat what the client has said is not empathy but parroting. Counsellors
who “parrot” what the client said, do not understand the client, are not “with” the
client, and show no respect for the client. Empathy should always add something to
the conversation.
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 Empathy is not the same as sympathy. To sympathise with a client is to show pity,
condolence and compassion - all well?intentioned traits but not very helpful in
counselling.

 Avoid confrontation and arguments with the client.

4.Probing/questioning

Probing involves statements and questions from the counsellor that enable clients to
explore more fully any relevant issue of their lives. Probes can take the form of statements,
questions, requests, single word or phrases and non-verbal prompts.

Probes or questions serve the following purposes:

 to encourage non-assertive or reluctant clients to tell their stories

 to help clients to remain focussed on relevant and important issues

 to help clients to identify experiences, behaviours and feelings that give a fuller
picture to their story, in other words, to fill in missing pieces of the picture

 to help clients to move forward in the helping process

 to help clients understand themselves and their problem situations more fully

Keep the following in mind when you use probes or questions:

 Use questions with caution.

 Don’t ask too many questions. They make clients feel “grilled”, and they often serve
as fillers when counsellors don’t know what else to do.

 Don’t ask a question if you don’t really want to know the answer!

 If you ask two questions in a row, it is probably one question too much.

 Although close-ended questions have there place, avoid asking too many close-
ended questions that begin with “does”, “did”, or “is”.

 Ask open-ended questions - that is, questions that require more than a simple yes
or no answer. Start sentences with: “how”, “tell me about”, or “what”. Open-ended
questions are non-threatening and they encourage description.
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5.Summarising

It is sometimes useful for the counsellor to summarise what was said in a session so as
to provide a focus to what was previously discussed, and so as to challenge the client to move
forward. Summaries are particularly helpful under the following circumstances:

 At the beginning of a new session. A summary of this point can give direction to
clients who do not know where to start; it can prevent clients from merely repeating
what they have already said, and it can pressure a client to move forwards.

 When a session seems to be going nowhere. In such circumstances, a summary

may help to focus the client.

 When a client gets stuck. In such a situation, a summary may help to move the
client forward so that he or she can investigate other parts of his or her story.

12. Integrating communication skills

Communication skills should be integrated in a natural way in the counselling process.

Skilled counsellors continually attend and listen, and use a mix of empathy and probes to help
the client to come to grips with their problems. Which communication skills will be used and
how they will be used depends on the client, the needs of the client and the problem situation.

11.5 Summary

It is essential that counsellors have certain basic skills of counselling The gist of the these
skills are given below:

Rapport building

Silence

The use of silence has two main functions:

1. It allows the client to tell their story and to feel heard and validated.

2. It allows the counsellor to gain a deeper understanding of the speaker’s issues, while
providing a useful space for the counsellor to consider appropriate responses to the client’s
story.
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Paraphrasing

This skill has three functions:

1. It lets the client know you are paying attention and ‘hearing’ them.

2. The client can be sure that you have listened and gives an opportunity to correct or add
information.

3. It gives the opportunity for the client to hear the power of their own words.

Example:

Client - “My father is very ill and I am worried. He lives a long way away and I will have to
get the train to see him. I really cannot afford the fare as I have very little money at the moment.”

Counsellor - “You are concerned about your father’s health. Traveling to see him is giving
you money worries as well.”

Be thoughtful that paraphrasing is rewording the client’s story in your own words. Avoid
repeating back what’s said word for word—that’s not paraphrasing. That’s parrot -phrasing!

Reflecting

Reflecting is a skill that can be used in conjunction with paraphrasing. This skill picks up
on the emotion shown by the client as they are telling their story.

Example: Client (clenching her fists) - “I don’t know why my father chose to live so far
away from me when he knew how ill he was going to become.”

Counsellor - “You seem angry at your father for moving so far away.”

Client - “I am. I now have to travel halfway across the country to see him. He is so selfish.”

In the above interaction, you can see how reflecting and paraphrasing work together.

Empathy

Focusing

Clarifying
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. Clarifying is a skill that uses a question to help the counsellor get a better understanding
of the client’s story.

Example:

Client - “Tom has always been selfish.”

Counsellor - “Who is Tom?”

Client - “Tom is my father’s name.”

Use of Questions

In counselling, questioning should be used with the skill of clarifying and understanding,
not to probe or interrogate the client. If questions are used, they should be open, not closed
questions.

Example:

Closed question - “Are you feeling sad today?”

Open question - “How are you feeling today?”

By using open questions, you allow the client to speak more about the issues, as opposed
to responding to a closed question with a yes or no answer. Summarising This skill is used
towards the end of the session and is effectively a longer paraphrase. It is a useful way for the
counsellor to reflect the key points of the session before bringing it to a respectful close.

Finally…

Listening to understand instead of listening to respond is the basis of forming a trusting,

mutually respectful relationship in which clients feel safe and secure enough to discuss difficult
issues. When this happens and the above skills are used properly, clients can see and embrace
the changes in their lives.

*Eye contact, In western cultures looking someone in the eye is seen as a sign of honesty,
integrity or that you have their undivided attention. In certain Asian cultures, it can be seen as a
sign of disrespect or rudeness. When using counselling skills always be culturally aware.
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11.6 Key terms

Rapport Building:Is advanced attending skills. It includes offering empathy; having a

welcoming and respectful manner; being a warm, genuine and real person in the relationship;
and most importantly, being non-judgmental toward you client.

Silence: Is perhaps the most underrated of all counselling skills. It can be used any time
during the session. However, it is very effective at the start of the session when the client is
talking about their issues or difficulties in life.

Paraphrasing

This skill is used by the counsellor to reflect back the key points of the client’s story.
Sometimes described as ‘holding up a mirror’ to the client so they can hear their words repeated
back to them.

Reflecting

Reflecting is a skill that can be used in conjunction with paraphrasing. This skill picks up
on the emotion shown by the client as they are telling their story.

Empathy

Sometimes referred to as ‘the frame of reference’, it is the client’s unique worldview. By

being empathic and emotionally ‘walking in the client’s shoes’, a counsellor understands both
the narrative and the felt emotion experienced by the client. This skill is sometimes referred to
as ‘listening to the music behind the words’.

Focusing

Is a useful skill if a client brings lots of issues to the session. By asking the client which
issue is most pressing, the counsellor and the client have a clear understanding of what is
being worked with.

Clarifying Sometimes clients give a lot of information all at once which makes perfect
sense to them but can be confusing for the counsellor to understand.

Listening to understand instead of listening to respond is the basis of forming a trusting,

mutually respectful relationship in which clients feel safe and secure enough to discuss difficult
issues.
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Check your progress

Fill in

a) Professional counselling is the application of mental health, psychological, and

__________

b) A good ___________ is someone who is always positive, calm, and confident in

themselves.

c) Personality characteristics of the counsellor have an important bearing on______

outcomes

d) Counsellors are not without their __________side

e) S stands for _________

Answers

a) human development principles b) role model c)therapeutic d) ‘shadow’ e) Squarely

face your client

Model questions
Q.1 What is counselling skills

Q.2. State some personal attribute of a counsellor

Q.3. What is attending?

Q.4. What is Listening skills?

Q.5. What is Summarizing?

Q.6. Parapharizing?

Q.7. Reflecting
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LESSON - 12
METHOD OF COLLECTION DATA
12.0 Introduction

The goal of assessment is to help counselors to develop an understanding of the client or

an individual. By using assessment, you will be able to gain understanding of the individual and
in turn foster individual‘s understanding himself or herself. In this sense, you will appreciate that
assessment processes and procedures are the means of obtaining comprehensive understanding
of students thereby fulfilling the goal of counseling. It is essential that, you need to be familiar
with the major tools and techniques of assessment, the purpose for which they are used and
how the information provided by these can be used in understanding the individual. Psychological
testing is one of the ways of assessment. The selection of any tool whether quantitative or
qualitative depends on the type of information the counselor is interested in gathering. In most
cases both are required to be used for holistic assessment

12.1 Objective

By the end of the lesson you will understand

 the importance of assessment

 the methods of assessment

Plan of the Study

12.0 Introduction

12.1 Objectives

12.2 Psychological tests

12.2.2 Case Study

12.2.3 Cumulative Record Card

12.2.4 Autobiography

12.2.5 Observation

12.2.6 Interviews

12.3 SUMMARY
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12.4 Key terms

Check your progress

Model questions

12.2 PSYCHOLOGICAL TESTS

Psychological tests are designed to assess the characteristics of people such as their
abilities, attitudes, motivations, interests, needs and values and so on. Psychological test can
be defined as a sample of an individual‘s, behaviour, obtaining under standard conditions and
scored according to a fixed set of rules that provide a numeric score (Anastasi, 2003). In a
standardized test, individual scores are compared with a norm or standard arrived at on the
basis of performance of sample of individuals of the same age or grade level from around the
country who took the same test when it was first developed. Good standardized tests are the
result of years of research. Tests may take many forms. Usually, they comprise of a series of
items / questions with well-defined correct answers such as in case of tests of intelligence or
achievement, while others such as personality inventories, do not have right or wrong answers,
but are designed to assess person‘s pre-dispositions, tendencies and preferences.

Tests can be used to compare the same individual on two or more traits and also compare
two or more individuals on the same trait. Such an assessment is usually quantitative. Although
most of the psychological tests provide relatively objective and quantifiable scores such as
tests of intelligence abilities / aptitudes.

A standard test has a manual which provides complete information of how the test was
developed, evidence of its consistency, accuracy and objectivity. It also consists of detailed
instructions for administering, scoring, interpreting the test, its uses and possible misuses. The
test manual thus, provides you the requisite information to allow you to make an informed
judgement as to whether the test is suitable for your use. Besides, the requirement to select the
appropriate psychological test, a counselor needs to develop various skills in test administration,
scoring, interpretation and communicating results to clients.

Psychological tests are classified into different types depending on their content and the
way they are administered. Tests vary in their content depending on the aspect of behaviour
that is assessed, for example, some tests are designed to assess abilities, others assess
motivation, personality characteristics etc. Psychological tests are also classified into individual
and group tests, verbal tests and non-verbal tests and performance tests.
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Psychological tests provide a score related to a particular area of the individual. This
score in itself does not tell everything about the individual. To enhance your understanding
about an individual / client, you will need to use other assessment techniques that provide
explanations of both the why and how of a particular situations or incident. This is the basis of
the qualitative assessment. The focus of qualitative enquiry is not on highlighting differences
among the individuals but on the uniqueness of individuals. Qualitative assessment helps to
understand an individual‘s behaviour in relation to the context and situation. Observation,
interviews, sociometry, case study, analysis of documents, informal talks, artifacts, rating scales,
checklists, self-descriptions etc. are all sources of data in qualitative.

12.2.2 Case Study

A case study is an in-depth, intensive and detailed study of an individual or the client. The
focus in case study is on factorscontributing to the development of particular personality patterns
and /or problems. The case study employs all possible tools and techniques that seem appropriate
to understand an individual (e.g., observation, interview, self-reports, teacher‘s ratings, checklist,
sociometry, document analysis, anti-biographics etc.). It gives detailed information regarding
different perspectives that can not be attained by any other methods. Case study is the most
comprehensive of all analytical techniques because it makes use of all other assessment
techniques. Case study as an assessment technique is used by counselors to provide a means
of integrating and summarizing all available information about the client in order to determine
what further steps should be taken to enhance his or her development. Remember that collection
of case study data is not simple stockpiling of information. Rather, the purpose of a case study
is to present the client as a fully functioning totality within his her environment. Therefore, a
case may be selected to understand the mechanism by which problems accrue or a case study
may attempt to achieve a better understanding of the problems of a child. For example, a case
study may be conducted on student who has a problem in reading or in arithmetic. We employ
case study method to study the whole individual (in her dynamic developmental process) so
that we may better understand his concerns, the reasons for his actions and behaviours and
plan the course of action, which is appropriate for him. Therefore we may say case study is a
synthesis and interpretation of information about the client and his/her relationships to his / her
environment. As counselors it would help you to understand the nature and cases of the client‘s
behaviour, personality trends and difficulties in adjustment. Then the question arises how to
conduct a good case study? You will now learn about the characteristics of a good case study,
types of information used, how a case study is organized and how to report a case study.
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Characteristics of a Good Case Study :

 A good case study is concerned with the individuals‘ past, present and future. The
data colleted from different sources, at different times through various tools and
techniques, should be analyzed synthesized and presented in a manner to present
a complete view of the individual/ clients life.

 A good case study is dynamic and longitudinal and not static and cross sectional.

 The focus of the case study may be the whole individual or a small part. The focus
of the study varies widely and depends on the age of the client, the purpose of
assessment, the working situation and the experience of the counselor.

Types of information used in a Case Study :

You have learnt that the aim of gathering information about a person is to develop a
holistic perspective, to be able to understand him / her and provide proper guidance and
counseling. The various kinds of information used in a case study are gathered from all reliable
sources. Cumulative records, observations, interviews, self reports, tests, peer appraisal data,
teaches perceptions, from parents, friends, relatives.

Organization of a Case Study :

The organization of case study depends on two major factors :

 The purpose for which the case study is being prepared. This depends upon the
heads of the client, counselor, parents, referral agency or purpose of study.

 The competencies and skill of the counselor/researcher in collecting, organizing

and using information.

Organization involves providing an outline or format and developing and executing a

logical plan such as to present the information in an integrated manner.
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An Outline for a Case Study Report :

An exemple of proforma for reporting a case study of a client is given below :

i) Identification of data : should consist of

Name of the Client :

Sex : Male / Female 179

Father‘s Name :

Mother‘s Name :

Father‘s occupation :

Date of Birth :

Class :

School :

Language used at home :

Present and permanent address :

ii) Referral Source

Personal history :

Date of assessment Duration :

Nature of problem Opinion of parents:

Onset and teachers :

Seriousness :

Frequency of occurrence of problem:

iii) Educational History and Record

Cumulative record card/ancetotal record :

Is there any change school with reason.

iv) Health background

v) Home and family background and neighbourhood

vi) Friends and acquaintance

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The steps in developing a case study are given below.

 Recognition and determination of the status of the problem to be investigated.

 Collection of data relating to the factors and circumstances associated with the
given problem.

 Diagnosis or identification of causal factors as a basis for remedial or developmental

treatment.

 Application of remedial or adjustment measures.

 Subsequent follow-up to determine the effectiveness of the treatment.

Caution in using Case Study

A counselor may guard against errors which creep in unknowingly.

 The case study should penetrate into the problems under study. It should not be
superficial.

 Parents should be contacted. Medical opinion should be sought. All those who come
into contact with the individual should be approached. The study not be one sided.

 All possible details should be gathered and not even the slightest detail should be
over looked.

12.2.3 Cumulative Record Card

Cumulative record cards, personal data cards and permanent data cards are some of the
synonyms to denote a record system which gives us a picture of the student from many different
sources. It is progressively developed and maintained over a longer period of time, and gives a
summarized ¯growth record indicating the direction and rate of development. It shifts the
emphasis from one-time or once a year performance in a few academic subjects to the full
development regarding all the important aspects of education and general, physical, social and
mental development over a longer period of time. Essentially meaningful and functionally
adequate information is collected from various sources, techniques, tests, interviews,
observations, case study and the like, is assembled in a summary form on a cumulative record
card, so that it may be used when the student needs our advice for the solution of some
educational or vocational problem. The cumulative record has been defined as ¯a method of
recording, filing and using information essential for the guidance of students. A cumulative
record and supplies information on points such as the following.
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a) Personal : (i) name, (ii) date of birth, (iii) place and evidence of birth, (iv) sex, (v) colour
(vi) residence

b) Home : (i) Names of parents, (ii) occupation of the parents, (iii) parents live or dead (iv)
economic status, (vI) number of siblings, older or younger, (vi) language spoken in the house.

c) Test Scores (i) general intelligence, (ii) achievement, (ii) other test scores, (iv) personality
traits.

d) School Attendance : (i) days present or absent each year, (ii) schools attend with data.

e) Health : record physical disabilities, vaccination record, diseases suffered from.

f) Miscellaneous : (i) vocational plans (ii)extra curricular activities,(iii) counselors note.

If we analyze the items recorded on a cumulative record card, we find that only such
items are included as are recorded in a case study. Data collected through non-standardized
techniques like check lists, questionnaires, autobiographies do not find a place in the record
card file. It must be remembered that recording and filing of information are not so important as
using the information.

Need and Importance of Cumulative Record :

The cumulative records about students provide useful information to teachers, counselors
and administrators. The need and importance of cumulative records in guidance are given
below :

Importance in Guidance :

The basic principle and assumptions of guidance take into consideration the individual
differences. Cumulative records reveal such individual differences and indicate the nature and
amount of professional assistance needed by individual students of various stages of their
development. It is useful in analyzing the future needs of the individual student and proper
educational and occupational guidance can be offered on the basis of his needs.

Importance in Teaching :

 The cumulative records of different students help the teacher in classifying students
in accordance with scholastic attitudes and mental abilities.
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 They are diagnostic tools to analyze a behaviour problem or an educational one.

For example, why is a student backward in the class? What steps can be taken to
remove his / her backwardness?

 Cumulative record indicate the students who had special help and adjust the teaching
accordingly.

Characteristics of a Good Cumulative Record :

The following are the characteristics of a good cumulative record.

1. Information gathered should be complete, comprehensive and adequate so that valid

inferences may be drawn.

2. Information recorded should be true and valid. Like other tools of measurement, a
cumulative record can be valid only when it measures what it intends to measure.

3. Information to be reliable should be collected by a number of teachers and then pooled.

 A cumulative record should be reevaluated from time-to-time.

 A cumulative record should be objective and free from personal opinions and
prejudices.

 It should be usable. A cumulative record may be card types, folder type or booklet
type.

Check your progress-I Q.1 Uses of socionetric techniques Q.2 Cautions in using case-
study. Q.3 Characteristics of a good cumulative Recordcaud.

12.2.4 Autobiography

You might have read a number of autobiographies of great personalities, some of the
common are ¯My Experiments with Truth by Mahatma Gandhi, autobiography of an unknown
Indian by Niral C. Choudhury. An autobiography is a description of an individual in his own
words. As a guidance technique for studying the individual, it gives a valuable information about
the individual‘s interests, abilities, personal history, hopes, ambitions, likes, dislikes, etc. In
guidance, structured autobiographic items are given to the individual and he is asked to write
them out. The autobiographical material is verified by various other means. Since feelings,
values and attitude can not be measured by any other technique, autobiography appears to be
the one technique for appraising these characteristics.
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12.2.5 Observation

Observation is the most direct method of learning about the development of children.
Since it requires focus on the child‘s behaviour, observation allows the counselor to know the
child as a unique individual, rather than as a member of a group. One of the most accurate
ways to learn about children is to observe them in their daily activities. It requires systematic
and rigorous observation, which involves far more than just being present and looking around.
To understand fully the complexities of many situations, direct participation and observation of
the student/client is considered one of the best approaches.

What to Observe :

Observation is often used by teachers to understand the cognitive, affective, and motor
development of children. What kind of individual actions are important for a counselor to observe
and record, what has to be observed would depend a lot on the problem faced by the client, no
exclusive list of indicators can be given.

How to Observe :

Systematic and objective observation requires preparation and training. Training includes
how to write descriptively, recording field notes, using method for validating observations.
Preparation for observation has mental, physical, intellectual and psychological dimensions.
The quality of information gathered from observation can be increased with training in the
observer‘s skills. The observer must know what to look for, how to record desired information
and how to explain the behaviour. The accuracy, validity and reliability of observations can be
improved through rigorous training and careful preparation. It is important to remember that the
purpose of observational data is to describe.

 the setting that was observed,

 the activities/behaviour that took place in the given setting,

 the people who performed the behaviour or participated in the activities, and

 the meaning of what was observed from the perspective of those observed.

As counselors you can make use of different sources for collection of observational data.
These sources could be documents (such as personal diaries, registers, or memos, etc.)
interviews, informal talks, physical settings (how space is used, lighting etc.), social settings
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(communication pattern, how decisions are taken etc.), non-verbal cues, or unobstructie indicators
(equipment in the laboratory, books used in the library, conditions of carpets etc.).

Variations in Observation :

Counsellors can make observations in a number of settings such as homes, schools,

classrooms, communities and organizations depending on the needs of the student. Variations
occur due to a number of factors associated with nature of counselors participation, extent of
involvement, duration of observation, duration and focus of observation (Patton, 1990) these
five factors can cause variations in an observation.

Nature of Participation :

Observation can be made by being part of clients setting i.e. full participant or it can be
made by observing from distance i.e. as a spectator. The extent to which the counselor or
observer participates in the setting /case being studied can also cause variations in observation.
A counselor can start as a spectator and gradually become a full participant or vice versa.

Portrayed of Observer Role :

The observations made can be overt i.e. purpose of making observation is not revealed
to the client or it can be covert i.e., clients know that observations are being made.

Duration of Observation :

Observations can vary from one hour to one year. However, all the observations should
last long enough to get the answers to client‘s problem.

Focus of Observation :

The focus of observation could be to gain holistic view of the client, therefore, all the
necessary aspects of the client have to be considered, or on the other hand, one single aspect
can be studied.

Methods of Recording Observation :

After having learned about what and how to observe, you now read to learn about the
technique to record observations i.e. field note taking.
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Field Note :

Field notes contain the description of what has been observed. They are descriptive,
should be dated, should contain basic information about when and where the observation took
place, who was present, what the physical setting was like, what activities took place, and what
social interactions occurred. It should permit the counselor, as observer, to experience the
activity observed while reading the observation and analyzing the data collected. There are a
number of ways for developing field notes. Anecdotes records and critical event records are
two examples of field notes.

Guidelines for Observation : There are a few rules to follow when making observations as
part of a qualitative enquiry.

 Be descriptive in taking field notes (anecdotal records, critical incidents).

 Gather information from different perspectives (client, peers, parents, and teachers
etc).

 Cross-validate and triangulate by using data from different sources; observation,

interview and documents, etc. and using more than one investigator.

 Present the views of the people, their experiences in their own words.

 Separate description from interpretation and judgement.

12.2.6 Interviews

The purpose of interviewing is to know what going on in a person‘s mind. You interview
people to find out from them those things you can‘t directly observe such as feelings, intentions
and thoughts. You can not observe things that happened in the past, or the meanings attached
to things or incidents going on around. To obtain information about these you have to ask
questions. This helps you to know another‘s perspective. In-depth, open-ended interviewing
aims to capture the clients‘ experiences and perspectives on their problem in their own terms.
Open-ended interviewing is based on the assumption that other‘s perspective is meaningful. It
is important to remember that skillful interviewing involves much more than asking questions.
Now, you will learn about the types of interviews content of interview, and guidelines on how to
question to conduct an interview with the client.
 205

Types of Interviews :

Informal Conversational Interview : It relies on spontaneous questioning which may take

place as part of the counsellor‘s participant-observation. Over the course of an informal talk,
the client may not even realize that she / he is being interviewed. In such interviews, the data
gathered would be on aspects that differ for each client depending on the issues that emerge
from the conservation. The major advantage is that the interview is highly individualized to the
client and produces information or insights that the counselor/ interviewer may not have
anticipated. This type of interview requires the counselor to be experienced in the content area
and strong in interpersonal skill.

Interview Guide Approach

It involves deciding before the interview, the issues that are to be explored with the client
i.e., identifies topics, but not actual wording of questions, thereby offering flexibility. These
identified issues are used to guide the interview and keep it on track and ensure that they are
covered. This kind of interview is focused and hence the data collected are more systematic
and comprehensive than informal conversational interview.

Standardized Open-ended Interview : This interview consists of set of questions arranged

in a sequence, which are asked to each client. It minimizes the variation in the questions passed
to the client at the same time provides scope to the client to give responses that are open-
ended. This reduces the possibility of biases that come from having different types of interviews
with different people. Data obtained from such interviews are systematic and thorough for each
client but it reduces flexibility and spontaneity because the questions are predetermined thus
leaving little scope for issues that may emerge during the course of the interview. The advantage
of these type of interview is that it is the most structured and efficient of the qualitative interviewing
techniques.

The Focus Group Interview : In the interview the counselor becomes a facilitator among
the interviewees in a group setting where they hear and react to one another‘s responses.
Focus groups can be used by counselors to assess the needs of a student group, obtain general
background information about a topic or diagnose the potential problems of a group of students.
In this type of interview the counsellor‘s role is of a moderator, directing the interaction and
inquiry in a manner that the purpose of interview is served. The common characteristic of all
qualitative approaches to interviewing is that the people being interviewed respond in their own
words and provide own personal perspectives.
206

Content of Interviews : Before an interview is conducted it is important to plan the type of

interview whether it will be the informal consersation, the interviewing guide approach, the
standardized open-ended interview or the focus group. Then it is important to know about the
different kinds of questions that could be asked while interview the client. The counselor must
decide what questions are to be asked, the sequence of questions, the details required, time of
the interview and how to word the actual questions. The different kinds of questions that could
be asked by the counselor are behaviour / experiential questions, opinion/ values questions,
feeling questions, knowledge questions, sensory questions, demographic questions.

How to Question : The way the question is worded is important. There are no fixed rules
of sequencing questions for an interview. Informal conversational interviews are flexible and,
therefore, fixed schedule is not required. However, standardized open-ended interviews must
have a sequence because of their structural formed. General Principle of Interview : The following
are the guidelines to make an interview successful.

 The counsellor should feel the need of interview and counseling.

 The counselor should have all relevant data about the client before he starts
counseling.

 A rapport should be established between the counselor and the counselee. It is a

sort of personal relationship of mental trust and respect based on the feelings of
confidence and security.

 Discussion should be restricted to issue at hand.

 When the counselee expresses himself he should be accepted. The counselor will
gain nothing by antagonizing or embarrassing the counselee.

 The counselee should be allowed to take the lead in making decisions.

 The interview should end with a constructive note.

 Interview is an art and a skill that is developed with practice.

12.3 SUMMARY

Qualitative assessment provides an in-depth understanding and a holistic perspective

about a client. The qualitative approach differs from a quantitative approach in its methodology
of studying people. In fact, they provide answer to different questions. Qualitative approach is
known to be descriptive, flexible, subjective, in-depth, interpretive and holistic in nature. The
 207

focus is on the uniqueness of an individual. One way to strengthen qualitative analysis is to use
triangulation i.e. use of several methods to study the same behaviour / phenomena. Observation
and open-ended interview are two important tools of qualitative inquiry. Systematic and objective
observation requires preparation and training. The observer must know what to look for, how to
record the obtain information and how to explain. Interviews help to obtain the client perspective.
Those are different approaches to collect qualitative data through open-ended interviewing.
Before conducting interview, it is important to decide the kind of questions to be asked, their
sequence, thinking and wording them. Sociometry is a technique for evaluating the social
acceptance of individual students and the social structure of a group i.e. how each individual in
a group is perceived. Case study is an in-depth, intensive and detailed study of each and every
pertinent aspect of an individual or phenomenon. Case study method is used for summarizing
and integrating assessment information. The information used in a case study gathered from
all reliable sources, cumulative records, observations, interview, task, peer appraisals, home
visit and teacher‘s perception etc. Ethical codes and standards have been developed for proper
use of psychological test. It is important for the counselors to adhere to the ethical norms while
using the tools.

12.4 Key terms

Psychological tests can be defined as a sample of an individual‘s, behaviour, obtaining

under standard conditions and scored according to a fixed set of rules that provide a numeric
score case study an in-depth investigation of a single individual, family, event, or other entity.
Multiple types of data (psychological, physiological, biographical, environmental) are assembled,

Observation: is the method of collecting data wherein participant’s behaviour is observed

and noted carefully

Interview: Method of obtaining information by asking questions to the partiipants

CHECK YOUR PROGRESS

Fill in

1. Psychological test can be defined as a____________, behaviour, obtaining under

standard conditions

2. Psychological tests are classified into different types depending on their ______

3. The focus of ___________is not on highlighting differences among the individuals

208

but on the uniqueness of individuals

4. A case study is an _____,________and detailed study of an individual or the client

5. __________ is the direct method of learning about the development of children.

Answers
1. sample of an individual‘s 2. content 3. qualitative enquiry 4. in-depth, intensive 5.
Observation

Model questions
1. What is a Psychological test?

2. What is Standard test?

3. List out the characteristics of a standard test.

REFERENCES
Stake, R.E., 1995. The Art of Case Study Research. Sage, London

Wragg, E.C., 1994. An Introduction to Classroom Observations. Routledge, London Manual

for Guidance Counsellor, NCERT, New Delhi

Anastasi, A. 2003. Psychological Testing (5th ed.), Mc. Millan, New York

Hood A.B. and Johnson, R.W., 1997. Assessment in Counselling (2nd ed.). American
Counselling Association, Alexandria, VA

Assessment and Appraisal in Guidance and Counselling – I, NCERT, New Delhi

Assessment and Appraisal in Guidance and Counselling – II, NCERT, New Delhi

Kochar, S.K. (1985). Educational Guidance and Counselling

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LESSON - 13
ETHICAL PRINCIPLES OF COUNSELLING
13.0 Introduction

The word ‘ethics’ comes from Greek language meaning ‘custom’ and is the branch of
axiology, which attempts to understand the nature of morality; to distinguish that which is ‘right’
from that which is ‘wrong’. The origin of ethics is related to the introduction of moral behaviour
in the early societies. The application of concepts such as ‘right’ and ‘wrong’ and the definition
of these concepts in different environments, induced the need for a formal approach to social
behaviour an attempt to create commonality and organization in a society. Similarly in counselling
certain ethical standard to be followed which we will discuss in this lesson.

13.1 Objectives

By the end of the lesson you will know

 the ethical principles of counselling

 ethical standards in assessment

 ethical codes and guidelines

Plan of the study

13.0 Introduction

13.1 Objetives

13.2 Ethics in Counselling

13.3 The ethical responsibilities of the counselling relationship

13.4 ETHICAL BASIS IN THE USE OF PSYCHOLOGICAL TESTS AND TOOLS

13.5 LEGAL AND ETHICAL CONSIDERATIONS IN COUNSELLING

13.6 Code of ethics according to ACA

13.7 Summary

13.8 Key terms

Check your progress

Model questions
210

13.2 Ethics in counselling

As societies evolve, the relationships between individuals become more complex and so
the etiquettes and codes of conduct. The development of business relationships has raised
many ethical dilemmas, ethical counselling being one of them. Counselling is not a regulated
profession in many countries therefore, the use of ethical standards is a method of guiding:

1. Quality of the services provided by the counsellors, quality of training provided to

counsellors and the duty of protecting the clients.

2. These standards provide conduct guidelines for professionals. It also serves the purpose
of structuring the counselling services, providing professional descriptions and service
boundaries.

According to Daniluk and Haverkamp (1993) “the main ethical framework referred to in
many discussions of therapy is one based on the concepts of autonomy, fidelity, justice,
beneficence, nonmaleficence and self-interest.” The need for professionalisation has created a
common link between ethical behaviour and legal conduct in the therapy fields. Legislation was
provided to primarily protect clients from misguidance and ultimately to provide guidelines for
the profession. However, as cited previously, in most countries ethical conduct in counselling is
not yet part of the legal framework— which outlines the importance of professional associations
in providing guidelines and codes of conduct for affiliated professionals. The very labeling of
counselling as a helping professional suggests that one has assumed the responsibilities of the
profession in providing for the clientele and serving the public. These responsibilities include
acceptable standards of performance or competence, an accepted code of personal conduct in
relationships with clients and the public and a commitment to contribute to the public well -
being that transcends monetary gain. A profession’s commitment to appropriate ethical and
legal standards is critical to the profession’s earning, maintaining and deserving the public’s
trust. Adhering to such guidelines is, therefore, the responsibility of all members of the profession
(Gibson & Mitchell, 2003). Counsellor will offer a non-judgmental professional service, free
from discrimination, honouring the individuality of the client. Counsellors respect the essential
humanity, worth and dignity of all people and this is reflected in their work. It is very important
that no value judgement should be passed at the client and the counsellor should be free from
bias, preference, opinion, favour, feelings of prejudice regarding the physical appearance,
gender,locality and status of the client. To be aware of one’s values, attitudes and beliefs and
not to impose these on the clients. Secondly, establish the helping relationship in order to
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maintain the integrity and empowerment of the client without offering advice. To assist the client
in taking the decision without advice is the most important goal of counselling. Counsellor own
opinion and suggestions have to be restrained and the client has to be capacitated to take the
decision for himself. They make clear to the clients the terms on which counselling is being
offered and establish clear agreements about the counselling process. The commitment is to
ongoing personal and professional development i.e., working for larger and more inclusive
goals than short-term individual goals (APA, 1990).

Some of the Ethical Principles of Counselling are discussed below:

1. Confidentiality and Privileged Communication:

Confidentiality plays a major role in defining the communication between a counsellor

and a client. Counsellors should respect the privacy of their clients and preserve the confidentiality
of information acquired in the course of their work. Trust is the backbone of therapy. There may
be many predominant issues in confidentiality.

(a) Consultation with supervisor may breach confidentiality except when serious physical
harm to themselves and others is involved.

(b) Record keeping information.

(c) Confidentiality of the information that the client has revealed identity to be kept a
secret.

(d) Inform the client about confidentiality. In distinguishing between confidentiality and
privileged communication, it is important to remember that confidentiality is primarily an ethical
concept whereas privileged communication is alegal concept. Confidentiality is defined as an
ethical responsibility and professional duty that demands that information learned in private
interaction with a client not be revealed to others. Professional ethical standards mandate this
behaviour except when the counsellor’s commitment to uphold client confidences must be set
aside due to special and compelling circumstances or legal mandate. Exceptions to confidentiality
and privileged communications are given by Remley and Herlihy, 2001.

2. Autonomy:

Counsellors should make every effort to foster self-determination and individual

responsibility on the part of clients. It’s a respect for the client right to be self governing. This
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principle emphasizes the clients’ commitment to participate in counselling, usually on a voluntary

basis, to seek informed consent, protect privacy, informing the client of any conflicts once they
become apparent. It prohibits the counsellor from manipulation of the client against their will
may be for socially beneficial ends. Clients are seen as ends in themselves not means to an
end.

3. Beneficence:

A commitment to promoting the clients well being. This principle means to act in the best
interest of your client. To provide service based on training/ experience. To continue updating
ones knowledge for professional development and to enhance the quality of services provided
to the client. Here, the obligation of the counsellor becomes important because the client may
have at that point of time diminished autonomy based an immaturity, distress, psychological
disturbance, emotional imbalance or nervous break down.

4. Non-maleficence:

A commitment to avoiding harm to the client. This principle is to avoid sexual, financial
and emotional or any form of exploitation. In India where there are no specified rules for same
sex therapistcounsellor this becomes pertinent. The counsellor should not to take any financial
favour, help or aid from the client for their own needs and not to exploit the weaker, dependent
and vulnerable position of the client. To cause no harm and to foster psychological and physical
wellbeing of the client.

5. Justice:

Counsellor needs to provide fair, impartial and adequate service to all clients. To provide
just and equal opportunity, disregarding their personal and social characteristics which might
give rise to discrimination/ oppression. Respect for human rights and dignity should actually
reflect in their work.

6. Self Respect:

Fostering the practitioners self-knowledge and care for self. Seeking counselling for
appropriate personal, professional support and development. To keep update on training, active
encouragement in life enhancing activities and relationships. Counsellors are strongly encouraged
to aspire for personal moral qualities like:
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1. Empathy: Feeling from another person’s perspective. ‘Standing in the client’s shoes’.

2. Sincerity: A personal commitment to consistency between what is professed and what

is done.

3. Integrity: Straight forwardness and commitment to being moral in dealing with others,
honesty and coherence.

4. Resilience: Strength to work for the client without getting stressed.

5. Respect: Showing appropriate esteem to others and their understanding of themselves.

6. Humility: The ability to assess accurately and acknowledge one’s own strengths and
weaknesses.

7. Competence: Using skills and knowledge to do what is required

8. Fairness: The consistent application of appropriate criteria to inform discussions and

actions.

9. Wisdom: Possession of sound judgment.

10. Courage: To act despite fears, risks and uncertainty.

11. Commitment: To keep up appointments and respect the individual.

12. Concern: To be all concerned and give adequate time/ attention to the client.

13.3 The ethical responsibilities of the counselling relationship:

(i) Client’s well-being: Counsellors should take all reasonable steps to ensure that the
client suffers neither physical nor psychological harm during counselling. They seek to promote
the clients control over his or her life, by respecting and supporting the client’s ability to make
choices and decisions. Counsellors are aware of their influential positions with respect to clients
and avoid exploiting the trust and dependency of clients in financial, sexual, emotional or any
other ways. They should also avoid fostering long term dependence unnecessarily (Mabe and
Rollin, 1986).
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(ii) Boundaries of the counselling relationship: Counsellors should be responsible for setting
and monitoring boundaries between the counselling relationship and any other kind of relationship
and making this explicit to the client. Secondly having more than one type of relationship may
lead to enmeshment of relationship boundaries, misuse of power and impaired professional
judgement, resulting in harming the client. When a dual relationship cannot be avoided,
counsellors should take appropriate steps to ensure that their judgement is not impaired and
their power is not being misused, such precautions may include seeking supervision. Thirdly,
engaging in any kind of sexual intimacy with clientsduring counselling is unethical. Finally
counsellors use discretion when accepting superiors or subordinates as clients.

(iii) Contracting: All information in any form given to clients before counselling commences
should reflect accurately the nature of the service on offer and the training, qualifications and
relevant experience of the counsellor. Counsellors are responsible for communicating the terms
on which counselling is being offered, including availability the degree of confidentiality offered,
provisions for safety and the counsellors expectations of clients regarding fees, cancelled
appointments and any other significant matters. Counsellors and their clients should work jointly
to define counselling aims, taking into account the abilities and circumstances of clients and
reviewing the counselling contract on an ongoing basis. Counsellors should communicate clearly
the extent of the confidentiality they are offering to their clients (Shilloto-Clarke, 1996).

(iv) Respecting diversity: Counsellors should be aware of their own values, attitudes,
beliefs and behaviours and how these apply in a diverse society and avoid imposing their
values on clients. They should not engage in unreasonable discrimination based on age, colour,
culture, ethnic group, gender, sexual preference, race, religion, disability, political orientation,
martial status, socio-economic status or any other aspect of human life.

(v) Financial relationships: It should be acceptable for counsellors to provide professional

services for little or no financial return. Counsellors exercise great discretion in giving and
receiving gifts and donations to or from clients during the course of counselling.

(vi) Relationships with former clients: Counsellors should always remain accountable for
their relationships withformer clients. They should exercise caution entering into any other type
of relationship with former clients.

(vii) Termination and referral: Counsellors should take steps not to abandon or neglect
clients at any stage of counselling. If counsellors feel unable to be of professional assistance to
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the client, they should either avoid entering or immediately terminate a counselling relationship
and suggest appropriate alternatives. If clients decline the suggested referral, counsellors are
not obligated to continue the relationship. Counsellors who terminate a counselling relationship
give advance and sufficient notice with adequate explanation to the client of impending
termination. Counsellors attempt to gain client agreement when possible. Following termination,
counsellors are required to assist their clients in making appropriate arrangements for a
continuation of counselling, when required by the client.

(viii) Research, training, publication and presentation: Data derived from a counselling
relationship can be used for research, training, presentation and publication only if the content
is disguised so that the individuals remain anonymous. Identification of a client in research,
training, publication or presentation is permissible only when the client has reviewed all the
material and has agreed, in writing, to its release.

(ix) Legal requirements: When responding to legal requirements to disclose confidential

information, counsellors should provide only essential information. Counsellors have a duty to
inform the court of potential harm to the client or the counselling relationship as a result of the
disclosure. Counsellors should seek legal advice if in doubt about their rights and obligations
regarding confidentiality.

The overall effect has been the recognition that this profession is maturing and facing
complex ethical challenges. It is for the counsellors to change the professional culture and
ethos from conformity to rules to ethical accountability and engagement. This will foster ethical
understanding and they will practice intrinsic ethics.

13.4 ETHICAL BASIS IN THE USE OF PSYCHOLOGICAL TESTS

AND TOOLS

Guidance like other professions has its own ethics, the core of which is respect for the
individual. Every counselee is equal in the eyes of the counselor. Further the action of the
counselor is governed by the belief that every individual possesses certain strengths. A good
counselor helps to facilitate the strengths of the individual and overcome his / her weaknesses.
Another important aspect of guidance ethics is that the counselor regards all information or
data about the individual as strictly confidential and never tries to misuse the data. The counselee
confides everything to the counselor, and it is the moral duty of the counselor to maintain
confidentiality. Besides, the counselor should never use the counseling session for the purpose
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of indoctrination or for the satisfaction of his own needs. He must always respect the freedom
and dignity of the counselee. It is also important for the counselors to adhere to the ethical
norms in the use of psychological test scores.

13.5 LEGAL AND ETHICAL CONSIDERATIONS IN COUNSELLING

Counselors like all professionals have ethical responsibilities and obligations. The principal
rule supporting ethical obligations is that the counselor must act with full recognition of the
importance of client‘s rights, the ethics of the profession. Counseling is not a value free or
neutral activity (Grant 1992). ¯It is a profession based on values, which are orienting beliefs
about what is good and how that good should be achieved . (Bergin 1985), the relationship of
moral standards and values, individual or cultural, in the life of that client. Professional bodies of
counselling have development ethical standards for which they have made available to the
practitioners. Professional organizations for practicing counselling and psychotherapy are :

American Psychological Association (APA)

British Association for Counselling (BAC) and

American Counselling Association (ACA)

Need for ethical codes: Ethical codes help professionalize and Protect an association
by government and promote stability within the profession. The need for ethical cods are:

To control internal disagreement.

To protect practitioners from the public

To protect client from incompetent counselors.

Especially in mal practice issues. Clients can also use codes to evaluate questionable
treatment from the counselors.

Ethical Issues

Ethical codes are not set in stone. They serve as principles upon which to guide practice.

There are two dimensions to ethical decision making:

o Principle ethics: Overt ethical obligations that must be addressed.

o Virtue ethics: Above and beyond the obligatory ethics and are idealistic.
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Ethical Issues:

Ethical codes and standards of practice for counselors have been formulated by the
American Counseling Association (ACA) and American Psychological Association (APA).

Ethical codes are guidelines for what counselors can and cannot do.

Each counselling situation is unique and sometimes the counselor must interpret the
code.

Ethical Issues that influence Clinical Practice

Client Welfare: Client needs come before counselor needs and the counselor needs to
act in the clients best interest.

Informed Consent Counselors need to inform clients as to the nature of counseling and
answer questions so that the client can make an informed decision.

Confidentiality: Clients must be able to feel safe within the therapeutic relationship for
counseling to be most effective. What the client says stays in the session unless the client is
threatening harm to self or others.

Ethical Issues that influence Clinical Practice

Dual Relationships: When a counselor has more than one relationship with a client (e.g.
The counselor is a friend and the counselor).

Sexual Relationships: Professional organizations strongly prohibit sexual relationships

with clients and in some states it is a criminal offense.

Privileged Communication

It is legal protection of the client which prevents a counselor from disclosing what was
said within the counseling sessions(s).

This right belongs to the client and not counselor.

Laws concerning privileged communication vary from state to state.

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When to break confidentiality

Tara off is Board of Regents of the University of California. A landmark case with the end
result being that counselors have a ¯duty to warn if a client threatens another person‘s life or
with significant bodily harm.

When a child under the age of 18 is being sexually abused.

If the counselor determines the client needs hospitalization.

If the information is involved in a court action.

Privileged Communication Doesn’t Apply

When a counselor is performing a court ordered evaluation.

When the client is suicidal.

When the client sues the counselor.

When the client uses a mental disorder as a legal defense.

When an underage child is being abused.

When a client discloses an intent to commit a crime or is dangerous to others.

When a client needs hospitalization.

Legal Issues and Managed Care

Counselors have the duty to appeal adverse decisions regarding their client‘s.

Counselors have a duty to disclose to clients regarding the limitations of managed care
and the limits of confidentiality under managed care.

Counselors have a duty to continue treatment and are not supposed to ¯abandon a client
just because the client does not have the financial means to pay for services.

Malpractice

When a counselor fails to provide reasonable care or skill that is generally provided by
other professionals and it results in injury to the client.
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Four conditions must exist:

o The counselor has duty to client.

o The duty of care was not met.

o The client was injured in the process.

o There was a close causal relationship between the counselor‘s failure to provide
reasonable care and the clients injury.

Suggestions on Avoiding Malpractice

Precounseling:

Make sure to cover all information counselling:

The financial costs of counselling.

Any special arrangements.

The competencies of the counselor.

Avoid dual relationships.

Clearly indicate if a treatment is experimental.

Identify limits to confidentiality.

Help the client make an informed choice.

Suggestions on Avoiding Malpractice (Continued) Ongoing Counseling:

Maintain confidentiality.

Seek consultation when necessary.

Maintain good client records.

Take proper action when a client poses a clear and imminent danger to themselves or
others.

Comply with the laws regarding child abuse and neglect.

Termination of Counselling:

Be sensitive to the client‘s feelings regarding termination.

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Initiate termination when the client is not benefiting from services.

Address the clients post-terminations concerns.

Evaluate the efficacy of the counseling services.

An Ethical-Legal Decision Making Mode:

Determine if an ethical-legal issue needs to be addressed.

Address contextual issues such as culture and personal bias.

Formulate an ethical-legal course of action.

Implement an action plan.

Counselor Competence
Counselors need to accurately represent their credentials and qualifications.

Counselors need to continue their education.

Counselors need to only provide services for which they are qualified.

Counselors need to keep up on current information of the field and especially in specialty
areas.

Counselors need to seek counselling when they have personal issues.

Ethical and Legal concerns: Major areas related to ethical and legal issues must focus
on the following major areas:

Informed consent

Confidentiality

Duty to warn/duty to protect

Pertinent Legal and Ethical issues:

Any appropriate course of action must be determined on a case by case basis.

Any policy requiring automatic dismissal or withdrawal of a student who expresses

disturbing behaviour is legally vulnerable.

The issue is often about assessing risk.

A significant risk constitutes a high probability of substantial harm not just a slightly
increased, or remote risk.
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13.6 Code of ethics according to ACA

The American Counseling Association (ACA) has a code of ethics, updated every 10

years, to help counselors navigate the challenging and sensitive aspects of their roles. Below
we have compiled a basic summary of the 2014 ACA code of ethics, so counselors must have
the foundational knowledge to work in the field confidently and ethically.

The Counseling Relationship (Section A)

The purpose of Section A is to provide ethical guidelines that focus on the counseling
relationship such as client welfare, informed consent, and managing multiple relationships.

Counselors must:

 Work hard to create and sustain a relationship with their clients based on trust.

 Obtain informed consent from clients entering a counseling relationship.

 Respect a client’s confidentiality and privacy.

 Explain to clients what the counseling relationship entails (which could include fees,
group work, and termination).

 Be cognizant of client’s culture, values, and beliefs.

Confidentiality and Privacy (Section B)

The purpose of Section B is to provide ethical guidelines that focus on the importance of
trust, boundaries, and confidential interactions.

Counselors must:

 Communicate the concept of confidentiality with their clients on an ongoing basis

and do so in a culturally sensitive way.

 Inform clients about the limitations of confidentiality regarding what situations

information must be disclosed (e.g., to protect clients or others from harm).

 Discuss if and how information may be shared with others.

 Understand legal and ethical issues involved in working with clients who cannot
provide informed consent (such as minors or clients with impairment).

 Maintain and store records in an approved way.

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 Professional Responsibility (Section C)

The purpose of Section C is to provide ethical guidelines that focus on respecting the
practice of counseling.

Counselors must:

 Adhere to the ACA Code of Ethics.

 Practice within one’s boundaries of competence.

 Participate in associations that help improve the profession.

 Practice counseling based on scientific foundations.

 Be mindful when advertising and talking with the media.

 Engage in self-care activities so they can work at their highest capacity.

 Relationships with Colleagues, Employees, and Employers (Section D)

The purpose of Section D is to provide ethical guidelines that focus on developing working
relationships with those within and outside of the counseling field.

Counselors must:

 Develop relationships with colleagues from other disciplines and be respectful of

those who have different theoretical approaches.

 Provide consultation services within areas of competence.

 Provide appropriate consultation referrals when requested or necessary.

Evaluation, Assessment, and Interpretation (Section E)

The purpose of Section E is to provide ethical guidelines that focus on how to ethically
use formal and informal assessments to guide treatment plans and intervention selection.

Counselors must:

 Understand the use of assessments as an important part of information gathering

and to assist in conducting clients’ treatment and evaluation.

 Use educational, mental health, forensic, and career assessments (among others)
on which they are trained and have had comprehensive supervised experience
administering and interpreting.
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 Diagnose clients and interpret assessments accurately and in a culturally sensitive

manner.

 Supervision, Training, and Teaching (Section F)

The purpose of Section F is to provide ethical guidelines that focus on how to develop
relationships with supervisees, students, and trainees in ways that support ethical boundaries
in a learning environment.

 Counseling supervisors must:

 Be trained in supervision methods and techniques before they offer supervision

services.

 Be responsible for monitoring supervisees’ clients’ welfare and supervisees’

performance and development through a variety of supervision modalities, such as
regular meetings and live supervision.

 Inform supervisees of their clients’ rights and inform clients with information regarding
the supervision process and its limitation on confidentiality.

 Be aware of and address the role of multiculturalism and diversity in the supervisory
relationship.

 Endorse supervisees that they deem qualified and sufficiently able to perform duties
in the areas of certification, licensure, employment, or completion of an academic
of training program.

Counselor educators must:

 Be knowledgeable regarding the ethical, legal, and everyday aspects of the

profession including how diversity impacts groups and individuals.

 Inform students of their ethical responsibilities and standards as professionals and

as students.

 Provide ongoing feedback, evaluation, and act as gatekeepers to the profession.

 Promote the use of techniques, procedures, and modalities that are grounded in
theory and have scientific foundations.

 Develop clear policies and provide direct assistance regarding field placement.
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Counseling students must:

 Be aware of their responsibility to follow the ACA Code of Ethics and applicable
laws.

 Understand the implications of taking a break from counseling others when impaired.

 Disclose their status as supervisees before beginning counseling others.

Research and Publication (Section G)

The purpose of Section G is to provide ethical guidelines that focus on how to ethically
conduct human subjects research and publish and/or present results.

Counselors must:

 Conduct research that is aligned with ethical principles, federal and state laws, host
institutional regulations, and scientific standards of governing research.

 Adhere to confidentiality in their research.

 Be responsible for participants’ welfare throughout the research process.

 Inform individuals of their rights as a research participant through informed consent.

 Plan, conduct, and report research accurately.

 Distance Counseling, Technology, and Social Media (Section H)

The purpose of Section H is to provide ethical guidelines that focus on how to ethically
use technology and social media within the field of counseling.

Counselors must:

 Be knowledgeable about the laws governing distance counseling and social media.

 Only utilize distance counseling after gaining competence through training and
supervised experience in this specialty area.

 Inform clients about the limits of confidentiality and potential Internet interruptions
due to the nature of technology.

 Understand the benefits and drawbacks related to distance counseling

 Utilize a professional presence if they choose to use social media platforms

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 Avoid disclosing confidential information through social media.

 Utilize informed consent to explain the boundaries of social media.

Resolving Ethical Issues

Counselors must:

 Behave in an ethical and legal manner and recognize when there is a conflict between
ethics codes and laws.

 Utilize and document an ethical decision-making process when faced with an ethical
dilemma.

 Hold other counselors to similar standards of professional conduct.

 Resolve ethical dilemmas with direct and open communication to all parties involved.

 Seek consultation when necessary.

13.7 Summary

Counselors play a key role in developing individuals and shaping communities. In their
role, counselors are often responsible for cultivating and maintaining relationships, monitoring
clients’ well-being, and working with different cultural values and confidential information.Ethics
codes provide professional standards for counselors with the purpose of protecting the dignity
and well-being of clients. The main reasons for the code of ethics include informing professional
counselors and counselors-in-training of their ethical guidelines, professional obligations, and
responsibilities to their clients. The five core professional values of the Counseling include:

1. Enhancing human development throughout the life span.

2. Honoring diversity and embracing a multicultural approach in support of the worth,

dignity, potential, and uniqueness of people within their social and cultural contexts.

3. Promoting social justice

4. Safeguarding the integrity of the counselor-client relationship.

5. Practicing in a competent and ethical manner.

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13.8 Key Terms

Autonomy: It’s a respect for the client right to be self governing

Beneficence: A commitment to promoting the clients well being

Non-maleficence: A commitment to avoiding harm to the client

Justice: Counsellor needs to provide fair, impartial and adequate service to all clients

Self Respect: Fostering the practitioners self-knowledge and care for self

Check your progress

Fill in
1. Counselling is a____________-professional service

2. Counsellors should respect the__________- of their clients

3. ___________principle means to act in the best interest of your client.

4. _____refers to Straight forwardness and commitment to being moral in dealing with

others

5. Counsellors should avoid imposing their___________ on their clients

Answers
1. non-judgmental 2. privacy3.Beneficence 4. Integrity 5.values

Model questions
1) Explain the different ethical issues to be taken into consideration in counselling.

Explain the importance of recording in counselling.

4. What is your opinion regarding considerations of legal & ethical issues in counselling
Justify your opinion.

REFERENCES
Amercian Psychological Association (1990). Ethical principles of psychologists (amended
June 2, 1989). American Psychologist, 45, 390-395.
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Daniluk, J.C. and Haverkamp, E.E. (1993). Ethical issues in counselling adult survivors of
child sexual abuse. In P. Jenkins (eds)., Counselling, Psychotherapy and Law,
London: Sage Publications.

Gibson, R.L. and Mitchell, M.H. (2003). Introduction to Counselling and Guidance, Delhi:
Pearson Education, Inc. IACP Code of Ethics. Irish Association of Counselling and
Psychotherapy. html.

Mabe, A.R. and Rollin, S.A. (1986). The role of a code of ethical standards in counselling.
Journal of Counselling and Development, 64, 294- 297.

Remley, T. and Herlihy, B. (2001). Ethical, Legal and Professional Issues in Counselling.
Upper Saddle River NJ: Prentice Hall.

Shilloto-Clarke, C. (1996). Ethical issues in counselling psychology. In R. Woolfe and W.

Dryden (eds.), Handbook of Counselling, (pp. 555- 580), London: Sage.

http/www.enhancehealing.com./articles/category. php

http/www.Vanessaemile.com.uk/pages/ethical.htm.
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LESSON - 14
COUNSELLING SPECIAL GROUP
14.0 Introduction

Groups are so much a part of everyday living that people tend to take them for granted.
All the things we learn about how to behave as human beings can beexperienced and tested in
group interaction. The individual’s psycho-social development can be attributed at least to a
series of group interactions and group memberships.

Groups are natural phenomena which occur wherever people are brought together
regularly. An individual chooses voluntarily to become a member of certain groups while he is
born into others. The individual would normally choose a group if he agrees with the values
such group support and the purpose the group I trying to achieve.

Several problems, whether vocational, educational or psycho-social can be talked through

effective use of group counselling. Problems that can be handled in groups includes:

- Problems relating to fear, anxiety, phobia

- Poor study habits, poor academic performances

- Inferiority/superiority complex

- Juvenile delinquencies, pilfering truancy

- Drug addiction/abuse, alcoholism, smoking

- Frustrations, depression, helplessness

- Choice of school subjects

- Vocational choice

- Peer group pressure

- Family problems, separation, misunderstanding and divorce

- Shyness, timidity, poor self-concept

- School rules and regulations.

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14.1 OBJECTIVES

At the end of this unit you should be able to

 Define group Counselling

 Define the characteristics of group

 Different special group counselling

Plan of the study

14.0 Introdcution

14.1 Objectives

14.2 GROUP GUIDANCE

14.3 GROUP COUNSELLING

14.4 Socially and Economically Disadvantaged, Destitutes and Orphans

14.5 Counselling for Orphans

14.6 Deliquents

14.7 Counseling for Delinquent

14.8 Summary

14.9 Key terms

Check your progress

Model questions

14.2 GROUP GUIDANCE

Group guidance refers to any part of a guidance programme that is conducted with more
than one client. Provision of information is basically the focus of group guidance activities.

This term is frequently used to refer to any part of guidance programme that is organised
with groups of students as distinct from that between an individual student and the counsellor.
The approach of group guidance is preventive and is mostly directly concerned with acquiring
information, gaining an orientation to new problems, planning and implementing student activities,
collecting data for occupational and educational decisions.
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Mahler (1977) defines group guidance as: a class or educational experience, mainly
involved with giving out information. In schools, it is usually oriented towards encouraging students
to know what the adults think the participants should know. Although the same topics discussed
in group guidance may also be discussed in group counselling, the major responsibility in
guidance remains with the teacher. In group counselling the focus is upon each member, not
the topic being discussed. Topics treated under group guidance include effective study habits,
preparing for and taking examinations, and obtaining and using vocational information. The
number of members here range between 20 to 30 persons and the setting is usually the
classroom. 154

Group guidance activities are an integral part of an effective school programme. Within a
well-articulated guidance programme, group guidance activities contribute directly to the goals
of students and the school implementing and supplementing the counselling and consulting
roles of the school counselor. The school guidance programme that contributes to each pupil’s
positive use of the school facilities. The programme is also directed towards helping teachers
and pupils to create a fertile environment in which children may feel and employ their development
of those skills, knowledge and attitudes that are the pivot of well-adjusted personality. Within
the context of the school guidance programme, group counselling captures the main essence
of the guidance and portends an active in future in primary school education. Its success depends
on the humility and caution with which the counselor adapts it to the needs of school children.

14.3 GROUP COUNSELLING

Group counselling is a process by which one counsellor is engaged in a relationship with

a number of counsellees. Most authorities cite six as the optimum number, with a range from
foul to twelve. Group counselling is usually concerned with developmental problems and
situational concerns of members. The focus is on attitudes and emotions, the choices and
values involved in interpersonal relationships. Members, by interacting with each other, establish
helping relationships that enables them to develop understanding, insight and the awareness
of self as a first step to effective functioning. According to Sherterz and Stone (1981), the
vehicle for achieving this goal in a group is that members discuss their personal emotional
concerns and other members provide feedback about their perceptions of these experiences.
Group counselling can be conducted for remedial, developmental and preventive purposes

Group counseling simply defined, is an interpersonal interaction among individual with

similar concerns in the presence of a facilitator who provides a suitable atmosphere for these
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individuals to explore with each other their feelings and attitudes about themselves or situations.
In group counseling normal children talk about the problems that bother them and try to help
each other learn to behave increasingly more effectively (Ohlsen, 1964). The inter-personal
interaction that goes on in the group enable the clients to learn to help others as well as obtain
help for themselves.

Gazda (1978) defines group counselling as a dynamic and interpersonal process focusing
on conscious though and behaviour and involving the therapy functions of permissiveness,
orientation to reality, catharsis and mutual trust, caring, understanding and support. The therapy
functions are created and nurtured in a small group through the sharing of personal concerns
with both one’s peers and the counsellor(s). Group counsellees are basically normal individual
with various concerns which are not debilitating to the extent that requires extensive personality
change. The group counselee may utilize the group interaction to increase understanding and
acceptance of values and goals and to learn and/or unlearn certain attitudes and behaviours.
He emphasized that group counseling is problem-centred and feeling-oriented. Reflection and
clarification of feelings and modification of attitudes are its cardinal points. Here major effort is
centred on helping members deal with their problems and experiences, and the emphasis is on
growth and adjustment rather than on cure of deficit behaviour.

14.4 Socially and Economically Disadvantaged, Destitutes and

Orphans

Elementary school-aged children who are homeless are confronted with a variety ofunique
challenges. Socially, children living in a homeless shelter are hindered in thedevelopment of
their social skills due to the shame of their homelessness and frequentfamily moves (Buckner,
Bassuk, Weinreb, & Brooks, 1999; Walsh & Buckley1994). Children who are homeless were
found to have less social support and copingbehaviors than children who were either never
homeless or previously homeless(Menke, 2000).

Emotionally, children who are homeless tend to experience more depression andanxiety
than children who are housed (Buckner et al., 1999). Approximately 47% ofchildren who were
homeless were found to have clinically significant internalizingproblems, such as depression
and anxiety, compared to only 21% of children whowere housed (Buckner et al.). Menke and
Wagner (1997) also found depression andanxiety were significantly higher in children who
were homeless compared tochildren who were never homeless. Other researchers (Homeless
Children, 1999)found that one fifth of children who were homeless had severe emotional
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difficultiesthat warranted clinical intervention, although these children seldom received

theinterventions. Many children who are homeless have experienced domestic
violence.Approximately 80% of mothers who were homeless compared to 66% of motherswho
were housed reported domestic violence (Buckner et al., 1999).Behaviorally, children who are
homeless tend to exhibit more externalizing problems,such as delinquent and aggressive
behavior, than the normative sample (Buckner etal., 1999). Increased behavioral problems of
children who were homeless comparedto children who were not homeless were identified as
early as preschool (Koblinsky,Gordon, & Anderson, 2000).

Academic achievement problems also have been reported for children who are homeless
(Masten et al., 1997). Rubin et al. (1996) found elementary school childrenwho were homeless
performed significantly more poorly on academic tests thanchildren who were not homeless.
Biggar (2002) found that a lifetime history ofhomelessness negatively predicted students’
academic performance as measured bygrade point average. Other research indicates children
who were homeless werediagnosed with learning disabilities at double the rate of children who
were nothomeless (Homeless Children, 1999).

14.5 Counselling for Orphans

Given the impact of homelessness on children, there are three reasons for providingschool-
based counseling to children who are homeless. First, as described above, theintense social,
emotional, behavioral, academic, and familial problems of childrenwho are homeless hinder
their ability to achieve success in school (Buckner &Bassuk, 1997). Second, parents who are
homeless have difficulty obtainingcounseling and psychological services due to limited energy.,
and resources (NationalLaw Center on Homelessness and Poverty, 1995; Torquati & Gamble,
2001). Third,the McKinney Act mandates that state and local education agencies remove
barriersto school success of children who are homeless (National Coalition for the
Homeless,2002). Therefore, it is incumbent upon school counselors to implement school-
basedmental health interventions to promote the academic, career, personal, and socialsuccess
of children who are homeless.

CASE DESCRIPTION OF A CHILD WHO IS HOMELESS

Regina (alias) was a 7-year-old girl resided with hermother and 10-year old brother in one
dormitory-like room at a homeless shelter. After several months in the shelter, Regina’s
mothermarried and her new stepfather moved into the room with the family. Regina’s
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motherreported a family history of homelessness and poverty, frequent moves, past

domesticviolence, and a lack of recent contact with the children’s biological father.

Regina was enrolled in the first grade in a general education at a school in the homeless
shelter where they resided. Her mother and theschool cumulative folder provided only a small
amount of useful family andacademic background information. Regina’s mother suggested her
daughter had noknown academic deficiencies but did have social and behavioral problems.
Her teachers reported Regina’s academic performance in the classroom was on gradelevel,
despite learning gaps in basic achievement skills (e.g., reading, writing, andmath).

According to her teachers and mother, Regina’s problem behaviors at home andschool
included excessive dependency and attention seeking from adults (e.g.,repeatedly asking, “Do
you love me?” and constantly approaching and interrupting);peer difficulties (e.g., making and
keeping friends); low frustration tolerance (e.g.,raising voice and talking out of turn); and stealing,
lying, and denying responsibilityfor her actions. In addition, her teachers reported a history of
somatic complaints,poor self-concept, impulsivity, depressed mood, distractibility,
oversensitivity,anxiety, and irritability. Regina’s strengths included being friendly, helpfulness,
anattractive appearance, and an active energy level.: The following counselling programs were
included to change her behaviour

Education/Prevention

For large-group classroom guidance, a weekly social skills training program entitled”Stop
and Think” (Knoff; 1999) was implemented in Regina’s class. The majorcomponents of the
“Stop and Think” model are (a) discussion of social skills, (b)modeling, (c) role playing, (d)
performance feedback, and (e) transfer of training viaapplication in an everyday environment
(Knoll). During weekly large-group guidancelessons, a part-time school psychology graduate
assistant presented the following”Stop and Think” steps (Knoff): (a) identify a problem and
verbalize “stop and think”;(b) activate decision making by asking, “What are my choices?”; (c)
evaluate optionsand ask, “Do I want to make a good choice or a bad choice?”; (d) select an
option andstate “just do it”; and (e) conduct a self-evaluation and encourage self by saying”good
job.” The teachers reviewed these steps on a daily basis with Regina and otherstudents in her
classroom.In addition, the school psychologist encouraged teachers to implement a
classroomwidebehavior management system that entailed a token economy using a
behaviormonitoring chart with written stars as a secondary reinforcer (Cooper, Herron, &Heward,
1987). If Regina tact her individualized behavior goals of being honestrather than lying, asking
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to borrow items rather than stealing, cooperating withteachers by raising her hand or waiting
her turn rather than interrupting, andcompleting her assigned tasks, then she was rewarded
with a star on her behaviormonitoring form at the end of each day. At the end of the week, if she
earned 5 stars,she received a primary reinforcer of a grab-bag toy or school supplies. In
addition,teachers were encouraged to give her frequent praise and to reward her with extrastars
for positive behavior.

Individual Student Planning

To assess Regina’s behavioral and emotional progress, the following three

assessmentinstruments were administered. These instruments were selected based on
prevalentuse in other studies of children who are homeless (Buckner et al., 1999) and based
onavailability, which was limited by the homeless shelter’s budget.The Child Behavior Checklist
Parent Report Form (CBCL-Parent Report), developedby Achenbach (1991), is a 113-item
scale through which parents rate their child’sbehavior. Results are described in two domains,
Internalizing Behavior andExternalizing Behavior, and nine subscales. The Child Anxiety Scale
(CAS), developed by Gillis (1980), is a 20 itemquestionnaire specifically designed to measure
anxiety in children ages 5 to 12 yearsold. The Joseph Pre-School and Primary Self-Concept
Screening Test (JPPSST),developed by Joseph (1979), is a 1 S-item test that measures the
self-concept ofchildren ages 3 to 9 years old. All the above tools were administered on her to
assess the level of problematic behaviour, anxiety and self-concept.

Responsive/Intervention Services

Based on Daniels (1992) and Walsh & Bucklev’s (1994) recommendations for
adevelopmental counseling approach with children who are homeless, the responsiveservice
intervention selected for Regina was play therapy, due to its proveneffectiveness with children
(Bratton & Ray, 2000; Ray, Bratton, Rhine, & Jones,2001). When play therapy was applied to
children who were homeless, Hunter (1993)reported that it empowered children to manage
family crises, resolve conflicts, makesense of their world, and develop strength for long-term
growth. Baggerly (2003)identified perspectives and procedures of child-centered play therapy
with childrenwho were homeless as well as their unique play themes of “eviction” and “I am
rich!”Because group work with children who are homeless was recommended (Daniels etal.,
1999; Davey and Neff; 2001; Nabors et al., 2001; Strawser et al., 2000), groupplay therapy was
implemented for the extra benefit of helping children assumeresponsibility in interpersonal
relationships (Landreth, 2002). Another female student in her class was also included in the
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play therapy. Basic child-centered play therapy principles of following the child’slead; avoiding
judgmental statements; creating a safe, accepting atmosphere;reflecting feelings; facilitating
decision making; enhancing self-esteem; and settingtherapeutic limits (Landreth, 2002) were
followed. . Sessions were in a private room withplay therapy tote-bag toys such as a doll family,
plastic dishes, handcuffs, toysoldiers, an inflatable plastic punching toy, Play-Doh, paper, and
crayons (Landreth). Parent counselling was also given. Her parents were with positive feedback
about her, such as, “Regina responds wellwhen limits are set in a friendly but firm way and
when she is given choices.” Inaddition, also encouraged the parents to use a more effective,
democratic parentingstyle of encouragement and problem solving within flexible limits rather
than anauthoritarian parenting style of harsh commands and corporal punishment
(Steinberg,Lamborn, Darling, Mounts, & Dornbusch, 1994). Unfortunately, Regina’s mother
andstepfather were distracted by meeting more basic needs and thus did not choose toimplement
a more positive approach to parenting at that time.

Program and System Support

Because teacher training in mental health prevention activities was suggested byNabors
et al. (2001), consultation to Regina’s teachers was also provided. Teachers were encouraged
to consistently implement the behavior management system for Reginaand provided them with
an alternative understanding of her behavior, such as, “She ismotivated by a desire to please
peers and adults.”

RESULTS

After implementation of these interventions during the 12 weeks that Reginaattended the
school and the family resided at the homeless shelter, she was considerably improved with her
behaviour. Internalising problems were reduced. Her anxiety level was also reduced. There
was a improvement in her self-concept. Intervention appeared to have contributed to Regina’s
personal and social development in a unique manner. Classroom guidance of social skills training
seemed to help increase Regina’s acceptance by peers and adults and thus made collaboration
for learning more likely. The classroom behavior management system appeared to help Regina
regulate her own behavior, be more attentive to schoolwork, and be less disruptive to other
children’s learning.

Responsive services of group play therapy seemed to help Regina identify and sort through
intense feelings, evaluate old and new social skills in light of immediate peer responses and
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therapeutic feedback, gain a sense of mastery over troubling experiences, and enhance her
self-concept.Regarding academic development, Regina’s improvement in personal and social
dimensions would likely reveal increases in her academic achievement. Regarding career
development, Regina’s career exploration was facilitated in group play therapy when she played
various occupations such as storekeeper, restaurant manager, and teacher. Play therapy
interventions of encouragement, esteem building, and facilitating responsibility during her career-
related play may have increased her self-concept related to having a successful career.

Recommendations

Based on this case study, the following four recommendations for improving interventions
for students who are homeless. First, school counselors should train teachers on behavior
management rationale, concepts, objectives, procedures, and record keeping. Second, school
counselors should help create a positive, democratic school environment by securing
administrators’ support and providing training to all staff on specific skills such as encouragement,
positive communication, active listening, and conflict resolution. Third, school counselors should
enhance community resources by offering training to homeless shelter staff and recruiting parent
mentors to guide and encourage parents who are homeless. Fourth, school counselors should
regularly meet with school psychologists, parents, and teachers to monitor the progress of
students who are homeless, adjust intervention strategies as needed, and reinforce positive
approaches.

Implications for school counsellors

First, school counselors can demonstrate the qualities of leadership, advocacy, and
collaboration to lead systemic change for students who are homeless by (a) informing teachers
about the intense needs of students who are homeless, (b) leading school staff and community
members in developing a systematic plan to meet those needs, and (c) collaborating with
homeless shelter staff; community leaders, and parents in leveraging resources. Second, school
counselors can promote academic achievement, career planning, and personal/social planning
of students who are homeless through the integrated components of the intervention program.
Finally, student competencies of knowledge, attitudes, and skills for academic development,
career development, and personal/social development should be maintained for students who
are homeless. Communicating these expectations to students, parents, and teachers will help
prevent a lower expectation for students who are homeless and will ensure appropriate effort
on everyone’s part. In so doing, students who are homeless will be encouraged to develop to
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their full potential in academics, career, and personal/social issues, thereby giving them the
needed skills to help break the cycle of homelessness.

14.6 Deliquents

“Life’s stage and we all play our roles” (William Shakespeare). There are many attributes
to everyone’s role playing a few ascribed and remain unaltered but the achieved ones,
accomplished by an individual, depends upon influences at home, neighborhood, friends, school
and wider society. In this context juvenile delinquency is defined as, a child with long and
problematic history and threat to public safety, laws has been framed in this regard for their
rehabilitation or punishment; increasing every year, with states spending huge amount of money,
manpower, professional services and amending and restructuring the laws. These delinquents
undergo pain, trauma, helplessness and the vulnerability to the existing situations. Also
environmental circumstances which overlap with individual demands lead to criminal behavior.
For the last three decades professionals from sociology, economics, criminal justice, and
psychology have been trying to establish a link between learning disabilities and juvenile
delinquency. Research consistently illustrates that poor academic achievement is a major factor
in crime and delinquency. (Winters 1993; Rutherford, Nelson, & Wolford, 1986). Among multiple
types of risk factors, learning disabilities are closely related to the likelihood of an adolescent
becoming involved in the juvenile justice system. Also Most of the research is related to learning
disabilities, emotional problem; broken homes, and psychological disorders, socio- economic
and biological factors.

Delinquents and their incapacitated problems which demand attention addressable; not
huge budgets, skilled professionals to exercise their rich minds, neither heavy handed policies
nor legal framework that waits for a pray, the problem can be solved by a need based and timely
approach where counseling as a tool can provide all the array of needs that have to be catered
in order to frame an effective and efficient timely intervention program at home or (and) at
school. “Pointing fingers is the simplest of all human tasks.But the same fingers joined together
and held out is a challenge by itself”.

14.7 Counseling for Delinquent

Multidimensional Perspective: Counseling involves the of identification, assessment and

evaluation of factors accountable for the development of an anti social personality, which fails
to conform to societal rules and norms, which drives to breach, to afflict, kill, without any mention
238

of; good or bad, right or wrong, the lacuna and paucity of reasoning and judgment, the destruction
of feelings of sympathy and empathy not merely for others but even for own family members
and the most conspicuous fact being to inflict pain to others for self gratification without any
consideration of guilt and audacity. Counseling as a tool can be very effectively used to not only
fathom the cognitive aspects surrounding the anti social aspects in a delinquent but also
understand the transcend from being a normal individual to escalating as an offender, finding
conformity to existing posit and the acme of all this; willing to stay in the present state without
aversion and resisting to terminate. Through guidance and counseling these facets surface
eventually with the help of various techniques; a skilled counselor who can plunge the world of
delinquents to find the unexploited fecund skills which can be manipulated, focused and attended
to obviate from worst occurrences, this multidimensional perspective of counseling include the
assistance to resolve the delinquents issues and restore normalcy and can be of great help to
policy framers and intervention program me designers. A holistic model as shown in figure
below, counselling

Identifying through counseling the circumstances leading and supporting to enter a different
world and mind set thereof, unambiguous desire to move in the direction and prepare for persisting
in the same state and acclaim, justify and defend the same [1], explain the various factors that
take closer and develop strong bond along with conformity to the values of this world, describe
the factors responsible for the situation and the effort at this point to avert them mostly goes in
vain. Point out the sensitive areas that can be manipulated and effectively help to avert the
 239

situation and help in designing intervention program . Reckon the state of the delinquent and
the factors and circumstances, at home or school which , conduce to perversity and this grotesque
nature of the delinquent necessitates to tap the critical areas and work on them so as to help
restore normalcy is the , chief purpose of counseling. When the intent of the problem becomes
clear then the solution also becomes visible. The internalized feelings, emotions and perturbations
visible in behavior are traced; the influential agents need to be examined and worked upon for
intervention program and policy making decisions. Counseling provides an insight of the
causatives and constituents to mitigate the problem of delinquency.

Stage I Ingenerating of a delinquent: factors that aid engender, persist and incubate:

Engendering factors

The cognitive paradigmatic shift of person suffering with problems at home, school,
neighbourhood, friends or personal learning or emotional disturbances constitute as the
escalators for commencement of digression; this phase of engendering comprise fault finding,
tracing the problems, assessing the weak areas, looking upon the child as problematic, labelling,
anxiety, and trying to improve the child in the direction of their weakness; all these factors are
focused on improving the negative traits and child is continuously under pressure with the
persisting feedback that they need to improve by parents, siblings, teachers and friends which
effects their self confidence, self respect and the outlook that they cannot overcome the problem
takes a stronghold in them and all the energy is diverted towards worrying about not being able
to do what all want them to do which clouds and blocks the other fecund areas with a sense of
worthlessness. As a result comparisons (with siblings, neighbours, friends and others), taunts
on their problems and rejection becomes a breeding ground for the emergence of a personality;
revolt, refuse, kinder jealousy, loose temper, annoyance, domination, hate people who speak
on their weakness, fight, argue, show lack of respect, and try to prove to be strong by pointing
others weaknesses verbally and nonverbally create fear in others and prove others wrong and
find fault with them, these traits satisfies their ego as it is a kind of revenge that they take on
those who are unlike him and at this critical juncture if he meets the like minded subjects then
it becomes nutrition for the growth of delinquency. As he has the support and conformity from
the group for all the acts and they find solace and satisfaction in the gregarious company; fact
someone is like them and for them. This pulls to stay, follow, and adhere, to stand for and
regard the group and any comment against him or the group results in revolt and violent action
and this becomes an achieved trait and germinates with occurrence of similar circumstances.
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Case Study (1): Jagan, In Hyderabad, Andhra Pradesh, India, Year 2001. Case study
conducted during

Bed internship. Jagan: twelve years old lived with his mother and step father after the
death of his father when he was five years old, his step father did not like him and wanted to get
rid of him and always insisted that he be sent to government hostel. But Jagan wanted to stay
with his mother but he mother was beaten up and tortured by the husband and Jagan was sent
to hostel but this child became emotionally disturbed and carved for mother but the hostel
authorities did not understand the problem and mocked at him, along with other boarders and
teachers failed to understand why the child was reluctant to read and beaten and abused. One
night he hit fellow boarder with stone causing serious injuries on his head for teasing him and
talking ill about his mother the child was admitted in juvenile jail for this act. After which the step
father never allowed Jagan’s mother to meet him.

Case Study (2): for Raman education is really frustrating especially when being labeled
as poor performer(s) by teachers, classmates or school. He thinks there is hardly anything to
gain from school and thus feel worthless .The teacher and school instead of mounding, charged
him for his impertinent behavior and finally expelled him. All these provide emotional heightened
sensation resulting in truancy. Once a child gets labeled, he starts thinking that this is what he
is and therefore begins to look for his counterparts. When this hostility to education reaches its
climax coupled with failure to live to the expected standards of society and passion for life ,his
innate urges him to outbreak all the norms , begins to choose and tread the path of delinquency.

Stage II Persisting circumstances

In this second phase if the problem is tackled realizing the needs of the disturbed students
the efforts become fruitful. But if badgering, with high and speedy expected recovery and if
pressing continue the case becomes worst. The individual now carries a tag of being different
from others wants to improve but fails to do so. This can be due to dearth of people who fail to
understand them and their wants? All the efforts are adjusted to bring desired changes and
expectations rise high at schools from teachers, and parents and siblings at home and the
child’s failure in coming up to their expectations causes agony in them and the full possibility of
losing patience mounds high and they scold, abuse, insist, and use coercive and deterrent
measures along with threatening of an ominous future in case of failure to improve. The fact of
helping rather becomes causing more damage to the child. Even the other acts and works of
the child look condemnable and the child is in a confused state and he further thinks strongly
 241

about being nugatory. The newly found friend circle draws him closer and he moves to it and all
the acts performed by them give pleasure, relief, solace, alternate to the trauma he is going and
a better off situation is voted to the worse off which he is passing through at school and home.
This new world discovered is not demanding, expecting results, not pointing out mistakes’, and
hammering about future life. Relief is found in watching movies, smoking, consuming alcohol,
drugs, prostitution (In case of females) to overcome the pain of worthlessness and to prove the
strength, dominated by robbing, teasing, insulting, fighting and arguing; derives pleasure, satisfies
the ego and revenge is taken on all those who look down on them. Any amount of counseling
from the family, school and others to leave the group in which they find comfort will be a vain
effort as long as the aim targets the group they belong; leaving the friends, staying away from
them and anything spoken against them further adds fuel to the problem. Everyone who does
this becomes a villain and his attachment becomes further stronger. This also irritates the
parents, teachers and others to lose patience and they become tired and start neglecting them
(how long? What can we do? It’s their fate? It’s enough. It’s your life.) As a result the persistence
of delinquency takes strong hold. There are cases where parents abandon children, send them
out of home and stop caring about them. The delinquent is at crossroads with an uncongenial,
stringent, objurgating and highly exceptional situation which perpetrate to turn of events as a
delinquent. “Changing todesired extent is accordant but twisting by obtruding; there is full
possibility of braking, do we really requirechange to this extent”?

Case study (1) continued……Jagan did not meet his parents (mother and step father).
He had a carving to meet his mother but she was not allowed to meet him by his step father. He
was an average child in studies but the teachers at the school did not take the efforts and pain
to find out his problem. He slowly crept into a gang of delinquents. This was more than a reason
for the step father to abandon him completely. The school authorities suspended him from the
school as the pressure from the parents community was mounting on the Head Mistress. The
subject was losing ground and slipped in to the world of delinquency. There was no choice left
but find comfort with the other fellow delinquents. All the doors closed; confused, deprived,
alone, carving for support, help, love, respect, and finding comfort without intended perching in
an anonymous tangled world of delinquency. The gap between expectations from the environment
and desires within the individual gets wider and steeper. “Help should be held out when needed,
if otherwise; does it really mean help when not needed”?

Case study (2): an unsympathetic teacher asks Raman, the student to solve the problem
on the board.
242

Raman is as good as any other student. Noticed that almost every time Raman stops
after half problem is solved, the teacher believes he does not concentrate and therefore always
humiliates Raman. This prevents him from gaining sympathetic friends and hence becomes an
object of ridicule in his class. All these provide emotional, heightened sensation resulting in
truancy making pathway to forbidden activities.

Stage III Incubating factors

The delinquent leads life of freedom on their own terms without those interferences,
nagging, expectations and controlling situations. It is pleasance that he gains as a boss of his
own life. He branches out further and finds extreme levels of self-complacency without thinking
about the pain inflicted to others. The self irrupts out like lava from the volcano; least bothered
about impact, damage and destruction all around. The normal act include robbery, theft, cheat,
fight, quarrels for the fulfillment of the needs like smoking, drugs, alcohol, conspicuous lifestyle
and gambling which become more intense as needs become uncontrolled habits which turns
towards murders, rape and smuggling. The concept of fear of the law is almost absent. The
single minded aim of life becomes self gratification and self satisfaction. The concept of God is
completely lost and in cases they blame God for making them so. They aim to avoid suffering,
keep away pain, going in and out the jails becomes normal. The concept of fear becomes
extinct. Negligence from parents, shunning from society and distances from previous relations
becomes an incubating ground and development in this direction exceeds without thought. This
struggle and suffering is the product of missing link in the early stages, a no turning back
situation. Some lucky ones who get required help and guidance and are willing to change are a
different case but most of them end up as vagabonds. Guilt is present but not shown outwardly,
regret for misdoings is there but not confessed and pain is definitely fathomed that hardly
emerges, it takes age to confess after all is lost. Tears flow but the timing is wrong and repentance
might come off late but unfruitful. The value of freedom is realized only from behind the bars. If
possible the billions of dollars spent, the professional help given, the rehabilitation work intensified,
if parents seriously realize, society understands and schools use effective tools and techniques
and laws are prepared for compulsory early intervention; situation might improve to a greater
extent.

Case study (1) continued: Jagan today is behind bars, hates his mother, father and siblings
and keeps a negative feeling for education system and teachers. Still regards his other offender
friends as helpful and respects them. No regrets from life but would like to have a loving and
caring mother in the other life if any.
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Case study (2) continued: Once a child who presents specific learning difficulties goes
undiagnosed and experiences repeated academic failures, he or she may avoid school effort in
general and enter a vicious cycle where specific learning difficulties causes abstinence from
school and abstinence of school aggravates learning difficulties (Wang, Blom- berg, & Spencer,
2005).

Potential targets for timely interventions

Every child is special and different and has talents and abilities. It is detached and deprived
circumstances that account for their deviant behavior. Family is the world of the infant and they
grow in it and shape up the way they are treated. The warmth, love, affection, attention, security,
concern, morals, values and the difference between good and bad, right and wrong are the
basic foundations laid by the family and remain till the end. In the absence of all these attributes
how wise it would be to expect normalcy in an individual’s life and behavior. Family is the prima
facie target for timely intervention programs me. Secondly the school is responsible for breeding
as well as curtailing delinquency. With trained teachers and counselors and psychologists the
problem can be uprooted with a network of parents at home, teachers and counselors at school
to understand the problem and work on it for a fecund lifestyle of the individual and society.

Conclusion and Suggestions

Strong families are the centre for peaceful and safe communities. Parents have a critical
role in teaching their children. Respect is all important, and this is missing in families that
behave dysfunctional (Home Office, 2003, p.8). Home is primary learning institute for a child,
the foundation is laid for the rest of life; morals, ethics, values, traditions, care, respect, love,
honor, sacrifice, safety, principles, aims, aspirations and living cordially with all. Punish (for
correction) if they are wrong which would be the best and desirable option because punishing
them for antisocial and criminal charges later would be better if we do the same in a light and
dignified manner at this early stage. When we exalt and individual with a reward should we not
punish for mistakes? This is the reason mistakes are taken for granted which branch and
flourish as crime.

Parenting is an encompassing and endless task that fosters caring for others opinions
and feelings. The parents play the role amongst the family which the child learns and passes on
to generations and society is formed and functions amicably. Any dearth should be filled by the
schools; teacher by teaching and correcting at right time and involving parents. Teachers have
244

more experience and knowledge and therefore should teach the qualities that foster coexisting
living and respect for others. These two foundation stones will give a strong base for a healthy
lifestyle and a potent and impregnable future, imbibed diligently and persistently in the child
and encourage them to practice, mould their minds with the instruments of self-reliance and
individualism and provide moral training rather being authoritative.

Developmental prevention is new frontier to crime prevention ((Farrringti” on & Tonry,

1995, p. 10) With the emergence of modernization, family break up, increase in divorce cases,
single parenting, weird lifestyles, materialization and commercialization, parents are in the race
to fulfill needs and the child is worst affected, neglected and lack of time to teach, talk, spend
with child effects. Parents becoming engrossed with their own problems and relationships so
much that they fail to exemplify and portray a healthy lifestyle, the result being the child
possessing; the qualities of being self exalted and problems like psychological, emotional,
disabilities, fear, frustration, aloofness and lack of understanding of self and others crop up.
The school adds to the not empathized by the teacher and peer groups. The teachers locate
the problem and try to help the child by supervising monitoring and preparing intervention
classes. But the case is so that they blame, abuse, discourage, label abuse and insult the child
for their deficiencies and complain the parents the same and the parents vent their anger and
frustration in the same direction. The result is a situation engulfed with pain, anger and
worthlessness coiling relations and lives.

The two major life directing and molding institutions fail to understand the child. This is
pessimistic situation and who now would help? Guidance and Counseling fathoms the problems
out and the reasons and causes from various sources and angles. If caretakers become gateway
to criminality and anti social shapers: the indispensable question logically thought and sensitively
investigated will be, “if criminal is punishedshouldn’t the postulated be made equally liable”?
The child is a plain paper if it is blotted isn’t the spoiler to be blamed? Has the law missed on
this? Is the system punishing right people and justice done? Testimony; during Counseling;
there are lot of men like me on death row-who felt to the same misguided emotion, but may not
have recovered as I have. Give them a chance to undo their wrongs, a lot of them want to fix the
mess and start but don’t know how” (5). “The spoilt is visible the spoiler isn’t”.

Precaution is always better then cure, spending billions of dollars on rehabilitation centers,
juvenile homes, prisons, officers, security system, skilled professionals, amending and
restructuring laws are worth as they show that we are indeed functioning and doing our jobs.
 245

But not solving the problems, are we really? Aren’t we punishing only the one who is visible and
caught and leaving the creator of culprit, the designer and the causative? Testimony: “he sees
it in the juvenile street gangs, who live in the fear of death and who propagate fear by inflicting
death to banish fear. And he sees it at its worst, as the result of violent emotions bursting into
the minds and erupting from the hands……” Ed McBain Quotes. We would fail in future attempts
to control, if seriously and sensitively do not consider the problem then we would produce more
such. “When the problem of administration and predisposition is solved, the problem of
delinquency mightnot arise. If we let the child grow in a healthy atmosphere for a productive,
meaningful and decent life wherethe values of trust, care, share and tolerance are taught and
practiced the society rests peacefully”

14.8 Summary

Groups are natural phenomena which occur wherever people are brought together
regularly. An individual chooses voluntarily to become a member of certain groups while he is
born into others.Group guidance refers to any part of a guidance programme that is conducted
with more than one client. Provision of information is basically the focus of group guidance
activities.Group guidance activities are an integral part of an effective school programme. Within
a well-articulated guidance programme, group guidance activities contribute directly to the goals
of students and the school implementing and supplementing the counselling and consulting
roles of the school counselor. Group counselling is a process by which one counsellor is engaged
in a relationship with a number of counsellees. Most authorities cite six as the optimum number,
with a range from foul to twelve. Group counselling is usually concerned with developmental
problems and situational concerns of members. Economically backward children face lot of
challenges and issues. The challenges they face are wide. Counselling helps them in overcoming
their beahvioural problems. Similarly Deliquents and their incapacitated problems which demand
attention addressable; not huge budgets, skilled professionals to exercise their rich minds,
neither heavy handed policies nor legal framework that waits for a pray, the problem can be
solved by a need based and timely approach where counseling as a tool can provide all the
array of needs that have to be catered in order to frame an effective and efficient timely
intervention program at home or (and) at school.
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14.9 Key words

Group guidance: Group guidance refers to any part of a guidance programme that is
conducted with more than one client

Group counselling: Group counselling is a form of therapy where people with similar
experiences/issues come together with a professional therapist.

Delinquents: young person who performs illegal or immoral acts

Check your Progress

Fill in

1. Guidance programme is conducted with___________

2. Group counselling is concerned with__________ and ___________ of members

3. Children who are homeless tend to experience_______ more than children who are
housed

4. _____________is a major factor in crime and delinquency.

5. Stage I in counselling delinquents is ______________

Answers

1. more than one client 2. developmental problems and situational concerns 3. depression
andanxiety 4. poor academic achievement 5. Engenerating of a delinquent

Model questions
1. What is group counselling?

2. What is group guidance?

3. Explain various strategies for counselling orphans.

4. Explain various steps in couselling delinquents.

Reference
Achenbach, T. M. (1991). Manual for the child behavior checklist/4-18 and 1991 Profile.
Burlington, V-F: University of Vermont Department of Psychiatry.
 247

American School Counselor Association. (2002). The ASCA National Model: A framework
for school counseling programs. Herndon, VA: ASCA Publications.

Baggerly, J. N. (2003). Play therapy with homeless children: Perspectives and procedures.
International Journal of Play Therapy, 12(2), 87-106

Chris Newrith, Cleve Meux & Pamela Taylor. “Personality Disorders and Serious Offending”
II edition 2006Publication, ‘Theory of Mind and Anti Social Behavior’

David Semple & Roger Smyth, Oxford Handbook of Psychiatry”, II Edition

Jennifer Baggerly “Applying the ASCA National Model to elementary school students who
are homeless: a case study”. Professional School Counseling.

FindArticles.com. 01 Jan. 2009.

http://findarticles.com/p/articles/mi_m0KOC/is_2_8/ai_n8680915
248

LESSON - 15
COUNSELLING SCHOOL DROP OUTS,
AIDS PATIENTS, DRUG ADDICTS AND
ALCOHOLICS, SUICIDE
15.0 Introduction

For most students entering high school is an exciting time. Oftentimes, students eagerly
anticipate that high school will be the best time of their lives. Ninth grade students entering high
school have the opportunity to make new friends, take courses with upperclassmen, and become
independent by making choices/decisions without parental consent. This represents a huge
shift in autonomy from the elementary and middle school times. Unfortunately, many students
are unprepared for the host challenges associated with transitioning to high school. Research
findings indicate that entering ninth grade can be one of the most emotionally difficult, most
academically challenging times in children’s lives (Reents, 2002). Students transitioning from
middle school to high school encounter developmental, social, and academic challenges. This
period is so turbulent that there is all possibility that they can become drop outs, get addicted to
alcohol, attempt suicide.

15.1 Objective

By the end of the lesson you will be able to

 know why students drop out from school

 understand the factors underlying substance abuse

 know various counselling techniques to handle school drop outs and substance
abuse.

Plan of the study

15.0 Introduction

15.1 Objective

15.2 School drop outs

15.2.1 Who Drops Out and Why

15.3 Effective Strategies

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15.4 Counselling for AIDS patient

15.5 Counselling for Alcohol addiction and substance abuse

15.5.1 The 4-Fold Prevention Program

15.6 Counselling for suicide

15.7 Summary

15.8 Key terms

Check your progress

Model questions

15.2 School drop outs

Developmentally, adolescence marks a significant shift in human development marked

by greater pubertal changes, development of larger social networks, involvement with social
cliques, and unfamiliar sexual and other social stressors (Cohen & Smerdon, 2009). Additionally,
during the transition, students begin to make important academic and social decisions that
eventually determine the likelihood of matriculating to college, going directly into the workforce,
or dropping out of high school (Cohen & Smerdon). Ninth-grade students exhibit higher rates of
failure in courses, decline in test scores, and experience behavioral problems more than students
in all other grade levels (Smith, 2006).Students who lack the academic preparedness for high
school often either repeat the ninth grade or drop out of high school. The National Center for
Education Statistics compiled data about high school dropout and completion rates in the United
States. Dropouts accounted for 8% of the 38 million non-institutionalized, civilian 16-to-24-
yearolds not enrolled in high school who have not earned a high school diploma or equivalency
credential and were living in the United States (Chapman, Laird, & KewalRamani, 2010).
Additionally, males are more likely than females to drop out of high school (Chapman et al.,
2010). The national dropout rates for Hispanics, Blacks, Whites, and American Indian/Alaska
and Natives are: 18.3%, 9.9%, 4.8%, and 14.6 % respectively. Consequently, the dropout rate
for students of color is considerably higher than for white students. Dropping out of high school
presents students with various challenges. All students and their parents are challenged to
consider the long-term consequences associated with dropping out; even though students might
lack the motivation to persevere through the academic rigors of high school.
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school counselors play an integral role in the overall development of student learning in
the areas of academic, career, and personal/social development. Moreover, school counselors
are encouraged to think in terms of the expected results of what 5 students should know and be
able to do as a result of implementing a standards-based comprehensive school counseling
program.

15.2.1 Who Drops Out and Why

Research findings suggest that too many students are leaving high school early. Somers,
Owens, and Piliawsky (2009) purport that dropping out is the most devastating consequence of
youths’ frustration with the demands of schooling and outside stressors. Subsequently, Tyler
and Loftstrom (2009) reported that, although researchers know about the characteristics of
students who leave school, they know less about the causal factors that lead to dropping out of
school early. Students of the twenty – first century have more demands and challenges to
endure than ever before. Blue and Cook (2004) noted that teenagers’ dropping out of high
school before completion have been a challenge for educators, parents, and 6 employers for at
least 30 years. Consequently, graduating from high school has remained problematic, even as
the nation’s general education level has increased (Dillow, 2003). Students are dealing with
circumstances that often place them at risk of dropping out of school. According to the National
Dropout Prevention Center (2011), there are numerous factors impeding learning, including
pregnancy, drug abuse, illness or disability, low self-esteem, and a dysfunctional home life.
According to Hupfeld (2007), researchers have correlated types of student characteristics with
students who drop out. For example, students who take on adult roles, such as parenting or
working a substantial number of hours, are more likely to drop out. Moreover, demographic
factors correlated with academic risk are also correlated with students who drop out. Hupfeld
identified several demographic factors associated with dropping out, including being from a
low-income family, being a minority, being a male, being from a single-parent family, having
learning or emotional disabilities, and having limited English ability. It appears that students
seem to drift toward dropping out as multiple challenges compound with each other, rather than
making a single decision based on a single event (Hupfeld, 2007). When one considers the
multiple factors students have to encounter, these events can be quite overwhelming for a 14 or
15 year old to handle. In a study conducted for Civic Enterprises (2006), students gave the
following personal reasons to dropping out: 32% said they had to get a job and make money,
26% had to become parents, and 22% had to care for a family member. These students are
charged with making decisions such as remaining in school or making other adult decisions at
an early age.
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Predictive Risk Factors

Unlike 30 years ago, school districts have a wealth of accessible student data information
identifying students at risk of dropping out of school. Allensworth and Easton (2005) purport
that some of the behaviors students’ exhibit as predictive of dropping out include academic
failure and disengagement. Another predictor is students who have repeated a grade in
elementary or middle school (Viadero, 2006). Gleason and Dynarski (2002) analyzed risk factors
for identifying students who will drop out of school. Risk factors were defined as student
characteristics or measures of past school performance thought to be associated with dropping
out. Within their study, Gleason and Dynarski suggested that dropping out was defined as not
being enrolled in school and not having earned a high school degree. According to a report by
Kennelly and Monrad (2007) for the National High School Center, early risk factors associated
with students dropping out of high school include failure to be promoted to the next grade level,
failure of core academic courses in secondary school, excessive absenteeism, and other signs
of disengagement.

Failure to be Promoted to the Next Grade Level

Being held back in the ninth grade is considered the biggest risk factor for dropping out
(Gleason & Dynarski, 2002). In a study conducted by Alexander, Entwistle, and Horsey (1997),
students who repeated a grade in elementary and middle school left school without a diploma.
Findings from a Philadelphia study showed students who failed to be promoted to the next
grade level attended less than 70 % of school, earned fewer than two credits, and if students
had one of these characteristics they had at least a 75 % probability of dropping out of school
(National High School Center, 2007). Finn (1989) indicated that performing poorly over school
one year may lead to temporary disappointment causing students to continue to perform poorly
over several years, leading to students becoming detached from school and internalizing the
notion that they are failures and leading them to drop out of high school. Moreover, Gleason
and Dynarsksi (2002) noted important indicators of poor academic performance have included
low grades, test scores, and placement on a non-academic track. Students who are retained
during ninth grade suffer emotionally if they cannot move forward with their peers. Failure to be
promoted to the next grade level fosters greater feelings of low self-worth. These students feel
as though they do not have the ability to meet the academic challenges of school. Neild and
Balfanz (2006) suggested one way schools can help students who have failed classes is through
an effective system of credit recovery. Credit recovery will provide students with the opportunity
to earn additional credits needed to be promoted to the next grade level. School counselors
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assist with the process of students gaining credit recovery by identifying students in need of
credit recovery and serve as the general point of contact for students to sign up for credit
recovery.

Failing Core Academic Courses

Students failing core academic courses have a greater chance of not graduating with
their cohorts. Allensworth and Easton (2005) identified indicators of failure for ninth graders.
Receiving more than one F per semester in core academic subjects together with failing to be
promoted to the 10th grade is 85 % accurate in determining who will not graduate on time.
Students who fail core academic courses typically have low academic achievement. Another
factor affecting the likelihood of students graduating is the number of credits earned. Kennelly
and Monrad (2007) noted that credit accumulation in the freshman year is highly predictive of
four-and six-year graduation outcomes. Neild and Balfanz (2006) noted that students who drop
out as ninth or 10th graders had the equivalent of fifth grade reading level scores. Furthermore,
Hupfeld (2007) reported that students who struggle academically by receiving low or failing
grades, scoring poorly on tests, repeating grades, and falling behind on credits required for
graduation are more likely to drop out. Therefore, it seems important for school counselors to
work together with school administrators to identify ways of assisting students with low reading
levels.

Excessive Absenteeism

Attendance during the first year of high school is directly related to high school completion
rates. According to Tyler and Loftstrom (2009), absenteeism and discipline are linked with a
higher probability of students dropping out of school. In a longitudinal study conducted by Gleason
and Dynarski (2002), the factors associated with the highest dropout rates were high absenteeism
and students being over age by two or more years. Since absenteeism is considered one of the
strongest predictors of course failure, which in turn is associated with dropping out. It is important
for schools to monitor attendance rates so they can intervene quickly (Kennelly & Monrad,
2007). Moreover, students often describe not being able to catch up, or gradually increasing
absences from school until they discover themselves no longer attending school (Hupfeld,
2007). Therefore, school counselors should implement preventive measures to monitor students’
attendance.
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Social Indicators

Students have many social, environmental, and contextual factors to encounter on a daily
basis. Sometimes, before students enter the building, they have faced environmental challenges
no child, at the tender age of 14 or 15, should have to encounter. In relation to dropping out of
high school, there are several red flags for schools to be aware of in order to prevent these
students from dropping out of school. Socioeconomic Status In general, students in low
socioeconomic neighborhoods are more likely to drop out of school than students in more
affluent neighborhoods (Blue & Cook, 2004). High school students from families within the
lowest 20% income range were six times as likely as those with families in the top 20% income
distribution to drop out of high school (Kaufman, Alt, & Chapman, 2004). Students with parents
who have limited resources must be encouraged to be resilient and fight through the challenges
and potential likelihood of dropping out. Moreover, family background greatly affects educational
outcomes and is commonly viewed as the most important predicator of school achievement.
Researchers examining family background have found family income, socioeconomic status,
and parents’ educational attainments are related to dropping out (Blue & Cook, 2004). Additionally,
students from lower socioeconomic families encounter numerous challenges. Social factors
experienced by students often lead to personal and psychological issues related to dropping
out. Therefore, school counselors should be mindful of the many social and psychological factors
including family characteristics students endure while trying to regularly attend school and achieve
required skills and information.

Students report a variety of reasons for dropping out of school; therefore, the solutions
are multidimensional.

15.3 Effective Strategies

that have the most positive impact on reducing school dropout. These strategies appear
to be independent, but actually work well together and frequently overlap. Although they can be
implemented as stand-alone strategies, positive outcomes will result when school districts or
other agencies develop program improvement plans that encompass most or all of these
strategies. These strategies have been successful at all school levels and in rural, suburban,
and urban settings.

The strategies are grouped into four general categories: Foundational strategies (school-
community perspective), early interventions, basic core strategies, and managing and improving
instruction.
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Foundational Strategies
Systemic Approach

School-Community Collaboration

Safe Learning Environments

Early Interventions
Family Engagement

Early Childhood Education

Early Literacy Development

Basic Core Strategies

Mentoring/Tutoring

Service-Learning

Alternative Schooling

Afterschool/Out-of-School Opportunities

Managing and Improving Instruction

Professional Development

Active Learning

Educational Technology

Individualized Instruction

Career and Technical Education (CTE)

Systemic Approach—

This strategy calls for a systemic approach and process for ongoing and continuous
improvement across all grade levels and among all stakeholders, through a shared and widely
communicated vision and focus, tightly focused goals and objectives, selection of targeted
researchbased strategies and interventions, ongoing monitoring and feedback, and data-based
decision making. It also requires the alignment of school policies, procedures, practices, and
organizational structures and continuous monitoring of effectiveness.
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School-Community Collaboration—This strategy focuses on the power of an engaged

and responsive community where everyone in the community is accountable for the quality of
education, resulting in a caring and collaborative environment where youth can thrive and achieve.
Critical elements of this type of collaboration rely on effective, ongoing, and multidimensional
communication so that dropout prevention is a communitywide and ongoing effort.

Learning Environments—Safe, orderly, nurturing, inclusive, and inviting learning

environments help students realize potential as individuals and as engaged members of society.
All students need to be safe, physically and emotionally; to be expected to achieve; to be
recognized and celebrated equitably for accomplishments; and to feel genuinely welcomed and
supported. A safe and orderly learning environment provides both physical and emotional security
as well as daily experiences, at all grade levels, that enhance positive social attitudes and
effective interpersonal skills. A comprehensive discipline plan and violence prevention plan
should include conflict resolution strategies and should deal with potential violence as well as
crisis management. A safe, nurturing, and responsive learning environment supports all students,
teachers, cultures, and subgroups; honors and supports diversity and social justice; treats
students equitably; and recognizes the need for feedback, innovation, and second chances.

Family Engagement—Research consistently finds that family engagement has a direct,

positive effect on youth’s achievement and is one of the most accurate predictors of a student’s
success in school. Critical elements of this type of collaboration rely on effective, ongoing, and
multi-dimensional, two-way communication as well as ongoing needs assessments and
responsive family supports and interventions.

Early Childhood Education—Birth-to-five interventions demonstrate that providing a child

additional enrichment can enhance brain development. The most effective way to reduce the
number of children who will ultimately drop out is to provide the best possible classroom instruction
from the beginning of school through the primary grades.

Early Literacy Development—Early literacy interventions to help low-achieving students

improve their reading and writing skills establish the necessary foundation for effective learning
in all subjects. Literacy development focus should continue P-12. Mentoring/Tutoring—Mentoring
is typically a one-to-one caring, supportive relationship between a mentor and a mentee that is
based on trust. Mentoring offers a significant support structure for high-risk students. Tutoring,
also typically a one-toone activity, focuses on academic support and is an effective practice
when addressing specific needs in collaboration with the student’s base teacher.
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Service-Learning—Service-learning connects meaningful community service experiences

with academic learning. This teaching/learning method promotes personal and social growth,
career development, and civic responsibility and can be a powerful vehicle for effective school
reform at all grade levels

Alternative Schooling—Alternative or non-traditional schooling and delivery model options

(e.g., alternative times and environments, blended learning, virtual learning, competencybased
credit opportunities) provide alternative avenues to credit earning and graduation, with programs
paying special attention to the student’s individual and social needs, career goals, and academic
requirements for obtaining a high school diploma and transitioning successfully to life beyond
graduation.

Afterschool/Out-of-School Opportunities—Many schools provide afterschool, before-

school, and/or summer academic/enhancement/enrichment opportunities (e.g., tutoring, credit
recovery, acceleration, homework support, etc.) that provide students with opportunities for
assistance and recovery as well as high-interest options for discovery and learning. These
opportunities often decrease information loss and can inspire interest in arenas otherwise
inaccessible. Such experiences are especially important for at-risk students because out-of-
school “gap time” is filled with constructive and engaging activities and/or needed academic
support.

Professional Development—Adults who work with youth at risk of dropping out need to
be provided ongoing professional learning opportunities, support, and feedback. The
professionnal learning should align with the agreed upon vision and focus for the school/agency,
the agreed upon instructional framework of high leverage research-based practices and
strategies, and the identified needs of the population served. The professional learning
opportunities provided should be frequently monitored to determine the fidelity of implementation
and need for additional support and feedback.

Active Learning—Active learning and student engagement strategies engage and involve
students in meaningful ways as partners in their own learning. These strategies include student
voice and choice; effective feedback, peer assessment, and goal setting; cooperative learning;
thinking critically, creatively, and reflectively; and micro-teaching, discussion, and two-way
communication. To be most effective, teachers must provide students with tools and strategies
to organize themselves and any new material; techniques to use while reading, writing, and
 257

doing math; and systematic steps to follow when working through a task or reflecting upon their
own learning.

Educational Technology—Instructional Technology can effectively support teaching and

learning while engaging students in meaningful, current, and authentic efforts; addressing multiple
intelligences; and adapting to students’ learning styles. Educational technology can effectively
be used in individualized instruction and can not only help prepare students for the workforce,
but can empower students who struggle with self-esteem. Effective use of technologies depends
upon the timely response to and application of the rapidly expanding choices and matches to
identified student needs.

Individualized Instruction— Learning experiences can be individualized, differentiated, or

personalized (combining paced and tailored learning with flexibility in content or theme to fit the
interests, preferences, and prior experiences of each learner). In an environment that is fully
personalized, the learning objectives and content as well as the method and pace may all vary
(so personalization encompasses differentiation and individualization). Career and Technical
Education (CTE)—Quality CTE programs and related career pathways and guidance programs
with P-20W orientation are essential for all students. Youth need workplace skills as well as
awareness and focus to increase not only the likelihood that they will be prepared for their
careers, but also that school will be relevant to what is next.

15.4 Counselling for AIDS patient

HIV and AIDS seem to be having less of an impact on the consciousness of everyone.
This is unfortunate, because despite considerable advancements in the treatment and care of
those who are infected, there remains no cure. We therefore need to continue our efforts to
raise awareness in order to prevent the virus from spreading further. It is important that we
continue not only to prevent transmission of the virus, but also ensure that those living with the
virus are supported and that the prejudice and discrimination still associated with HIV and AIDS
continue to be challenged.

What is HIV and AIDS?

HIV (Human Immunodeficiency Virus) is a virus that damages the immune system. Due
to improving therapies, being HIV positive does not automatically lead to AIDS (Acquired
Immunodeficiency Syndrome). Once AIDS develops it means that the body’s natural defences
258

are damaged and have been harmed by the HIV virus. AIDS relates to the stage when the
disease has become clinically significant. There is still no cure for HIV. However, over recent
years there have been considerable advances in treatment and care. This has resulted in people
who are HIV positive being able to live longer and healthier lives. In the case of HIV positive
children, many can now expect to live through childhood into adolescence and beyond.

How can HIV be transmitted?

The HIV virus is weak, and not easily spread. The virus can be transmitted through:

 blood and blood products;

 semen;

 vaginal and cervical secretions; or

 breast milk.

The most likely routes of transmission are through having unprotected penetrative sex
with an infected person or sharing needles or syringes with an infected person or from an
infected mother to baby either during pregnancy, birth or via breast milk.

There is no risk of spreading the HIV virus through social or work contact or through
sharing cups and eating utensils. No transmission has been found through contact with saliva,
tears, sweat, urine, faeces or vomit, unless they are bloody. This is because there is an insufficient
concentration of the virus in these body fluids.

Living with HIV

Living with HIV refers to those people who are either infected or affected by the virus.
There are many more people affected by the virus than infected. Those affected can include
partners, family and extended family as well as close friends and colleagues. With an increasing
number of infected women having children and infected parents living longer there will be an
increase in the number of children living in affected families. It is difficult to assess the number
of these children, but they are an important group and their needs are not always recognised. It
must be remembered that unfortunately there is often a powerful social stigma associated with
living with the HIV virus. This can mean that those living with the virus are reluctant to disclose
their status or the status of their relatives.
 259

It is important not to make assumptions about how anyone who is HIV positive became
infected. How they became infected is rarely relevant to providing any service.

Responsibilities

It is the responsibility of all of us to work towards challenging the stigma, prejudice and
discrimination still associated with HIV. By implementing these guidelines and making equal
opportunities an intrinsic part of our practice we will hopefully work towards a change in attitudes
and behaviour.

Health and Safety

 HIV and schools

As of September 2004, all the available research states that there has never been a case
of HIV being transmitted in a school. There is, therefore, virtually no risk of the virus being
transmitted through normal social contact and school activity. Existing hygiene and infection
control procedures will be sufficient to protect pupils and staff.

The risk to first-aiders

First-aiders are likely to be concerned about the possibility of having to deal with people
who may be HIV positive or have AIDS. To date there have been no recorded cases of infection
arising from the administration of first aid. Standard hygiene precautions are equally effective
against HIV infection.

In summary
 accidents involving spillages of blood should be dealt with using normal first aid
procedures (including wearing disposable gloves)

 normal cleaning methods using detergent and hot water are sufficient for most
spillages (the HIV virus even when present cannot survive outside the body for
even a short time and is destroyed by hot soapy water).

 soiled waste should be disposed of using normal waste disposal procedures.

260

Advice and guidance

If an incident occurs in an establishment where body fluids have been exchanged (for
example during playground or sportsfield injuries or biting incidents) the headteacher needs to
be told or a nominated colleague who can then assess the need for expert medical advice.

It is the responsibility of headteachers to ensure that good hygiene and infection control
procedures are followed in accordance with existing health and safety infection control policies
and procedures. For further information or advice please contact the Assistant Education Officer
responsible for Health and Safety

Confidentiality

Those who are living with HIV have a right to confidentiality. Unfortunately stigma, prejudice
and discrimination around HIV still exist. Fear of the reaction of individuals can lead to those
living with the virus avoiding disclosure of their status. Prejudice is in part caused by unfounded
fears regarding the risk of transmission of the virus. Services for Children and Young People
are committed to challenging these fears.

The following procedures regarding confidentiality will be applied:

 there is no obligation for anyone to disclose their HIV status. Some children may
not have been told that they have HIV, by their carers.

 a breach of confidentiality by an employee will be treated under disciplinary

procedures.

If HIV status is the subject of rumour or speculation schools need to ensure that this is
dealt with quickly. The spreading of such rumour or speculation will be treated as a breach of
confidentiality and advice must be sought from the Executive Director of Services for Children
and Young People.

Please note : In certain very limited circumstances, and only on the advice of an expert
medical practitioner who considers that the vital interests of another child or staff member have
been placed at significant risk, it may be necessary to inform the parents of that other child or
that staff member that they may have been exposed to a blood borne virus and the circumstances
of that exposure in order that they can seek urgent medical treatment.
 261

Record keeping

If the HIV status of a child is revealed by a parent/carer or by the child themselves the
following procedures will be applied:

 the HIV status will not be revealed to anyone without the prior written permission of
the parent/guardian/carer and/or child (where appropriate, which can be decided
on a case by case basis normally from the final year of primary school onwards),
subject to the following bullet point

 If express written permission is not given, disclosure must only be made if there is
an express legal requirement to disclose or there is a serious and significant risk of
harm if disclosure is not made and an expert medical practitioner has been consulted

 the decision to disclose the status will be the responsibility of the headteacher and
the Executive Director of Services for Children & Young People, after full consultation
with the parent/guardian/ carer and/or child, where appropriate

 disclosure will be based solely on the need for people to know in order to ensure
proper care of the affected persons.

 Any one receiving the information must be put on notice of its strictly confidential
nature and must be asked to maintain that confidentiality

 as far as possible, no record will be kept of HIV status. Any communications received
from external agencies will be kept in a secure place by the headteacher. No
communication will be issued without parental consent and/or the consent of the
child where appropriate (subject to the provisions of the second bullet point above)

 all this information must be destroyed three months after the young person leaves
the school, or other education provider.

Should a child or parent/carer make a disclosure to a teacher or other staff member they
should tell the headteacher and keep it confidential. If a parent/ carer or child wish to make such
a disclosure to another member of staff, the member of staff should advise them to speak
directly to the headteacher

Medication

If medication is to be administered within an educational setting, staff should receive

appropriate advice. Arrangements will have to be made to ensure safekeeping of any medicine,
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particularly in line with the need for confidentiality to be maintained. Further guidance may be
found in the guidance for the administration of medication in schools.

HIV and the Curriculum

Personal, Social & Health Education (PSHE), Citizenship and SRE (Sex Relationships
Education)

Educational schools need to develop PSHE and Citizenship programmes which involve
teaching about HIV and AIDS. The PSHE and Citizenship Framework is designed to support
the personal and social development of children and young people, in order that children and
young people:

 develop confidence and make the most of their abilities;

 prepare to play an active role as citizens;

 develop a healthy, safer lifestyle; and

 develop good relationships and respect the differences between people

It should include the following:

 factual up to date information about the transmission and effects of HIV including
the different ways the virus can be transmitted;

 focus on the development of knowledge, skills and attitudes;

 involvement, where appropriate, of people living with HIV - in line with the protocols
for the use of outside visitors;

 appropriate group work dealing with feelings and developing assertiveness skills;

 opportunities for young people to talk about their concerns and have their questions
answered both within school and other settings; and

 coverage of broad questions concerning HIV and AIDS, including sexuality, which
should be part of the school’s Sex and Relationships Education programme.

The school’s Sex and Relationships Education policy is the responsibility of the governing
body.
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Tackling discrimination

Balanced discussions about the implications of HIV and AIDS for society should take
place with older pupils. All pupils should be made aware of the incorrect information and myths
that have appeared in some parts of the media. Incorrect information and myths about the
origins of HIV and AIDS and the people that are affected by it should be clarified.

Training and Development

Services for Children and Young People recognises the importance of ongoing training
and development in relation to HIV in order to;

 allay any fears staff may have regarding the risk of transmission;

 create a sufficient level of awareness amongst staff to enable them to provide services
to young people living with HIV and AIDS; and

 provide a good level of support for people living with HIV and AIDS.

HIV and AIDS awareness training will be made available to schools and will be organised
by the Advisory Teacher for Sex and Relationships.

15.5 Counselling for Alcohol addiction and substance abuse

Education to prevent child and adolescent substance abuse has been the focus of avariety
of school-based programs and approaches through the last three decades(Kreft, 1998). In the
early days of prevention education, young people were shownwhat drugs looked like, with
warnings about what evil would befall them if thesedrugs were taken. In the 1980s, peers and
adults were portrayed as vicious culpritsexposing innocent children to drugs in the “just say no”
campaigns. The more recentfocus has been on concurrently teaching refusal skills and bolstering
self-esteem withthe belief that these will suffice to prevent experimentation with drugs. The
problemwith all of these prevention approaches is that there is no firm evidence that theywork
(Kreft, 1998; Lynam et al., 1999). Kids continue to use drugs, and at earlier andearlier ages.
The use of alcohol among teens has remained relatively stable in the pastfew years, with 51.3%
of high school seniors, 38.8% of 10th graders, and 24.6% of8th graders reporting some use in
the last 30 days. In addition, the use of cigarettesamong girls has risen sharply, and the use of
marijuana has more than doubled since1991 (St. Pierre, Mark, Kaltreider, & Aikin, 1997).
264

The professional school counselor is left to search out effective and provenprevention
programs for addressing substance-abuse issues in the schools. Researchhas suggested that
prevention programs that include an examination of relevant socialand environmental factors
may be more effective at preventing alcohol and drug usethan programs that focus primarily on
refusal skills.

15.5.1 The 4-Fold Prevention Program

4-Fold Prevention, designed to specifically focus on four primary areas of social support—
parents, schools, communities, and peers. This program enhances positive and
supportive relationships among children and influencing adults and peers by opening the lines
ofcommunication about attitudes and beliefs regarding alcohol and other drug use. The4-Fold
Prevention program is nested in recent and relevant research suggesting thatenhancing
relationships with positively influencing adults and peers during preadolescencesignificantly
impacts derisions to not use alcohol and drugs.

A lesson plan and a student workbook provided the structure of the program. The lesson
plan included group activities centered around discussions of family relationships, community
opportunities, positive peer relationships, feelings about school and drug information.

The program also contained outside-group activities in which the students interviewed
parents, school faculty, community members, and other peers about drug attitudes and beliefs.
In addition, students completed guided activities with their identified team, which consisted of a
family member, a school member, a community member, and a peer member. A student workbook
was provided to each participant and was used to help guide students through both the in-
group and outside-group activities.

Implications for School Counselors

School counselors are often the gatekeepers of substance-abuse prevention in schools.

Mainstream counselor duties such as group counseling and classroom guidance provide
counselors with opportunities to implement prevention programs. The 4-Fold Prevention program
holds promise as a new prevention approach for both classroom and small group settings. With
chemical experimentation and exposure to alcohol and drugs occurring at younger and younger
ages, the elementary school counselor is in a perfect position to begin implementing proactive
programs that provide students with a better foundation from which to make decisions about
alcohol and drug use.
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The 4-Fold Prevention program could serve as an effective prevention alternative for
school counselors.

Abbreviated Lesson Plans for 4-Fold Prevention Program

Purpose Procedure

LESSON 1 1. Give out student workbooks.

Gain an understanding of the
definition of “drug” and
successfully identify
substances that can about drugs.
be defined as “drugs.”
support team.
2. Define drugs/effects.
3. Discuss why people take drugs.
4. Discuss different attitudes
5. Identify members of social

LESSON 2

Gain an understanding of the 1. Share the names of social

definition of a support team members
“student friendly and positive qualities
school.” of team members.
2. Generate a list of the
characteristics of a “student
friendly” school.
3. Add to the list the names of
people who work at their school who
help to make it “student friendly.”

LESSON 3

1. Generate letters to the 1. Have small groups pick three

principal outlining ideas to make their
suggestions for a school more student friendly
student friendly school. and put them in one letter to the
principal.
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2. Gain an understanding
of the importance of
communicating
with parents about
LESSON 4
1. Identify opportunities
in the community
involvement in
“safe fun” activities.
2. Identify people in the
community who can be of help.
4.Generate a list of “safe”
and fun activities they can
be a part of in their communities.
LESSON 5
1. Discuss attitudes
about drugs
with a peer in class.
2. In small groups, prepare a
poster, skit, or research
presentation on some
aspect of substance
use as a final project.
2. Discuss the experience of working
with their school team member.
3. Discuss the importance of
drugs and alcohol. talking about drugs
and alcohol with parents
1. Discuss assigned activities
for with family member.
2. Have volunteers share family
drug use policy.
3. Have small groups do the scenes
for the class. After
each scene, the class determines
if the activity was
“safe” or “unsafe.”
1. Share the community activities
discussed with their
team member.
2. Have students work with a
partner in conducting
the friend interview.
3. In small groups, students
decide if their presentation
will be a skit, a poster, or a
lecture on some aspect of
drugs or alcohol.
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4. Make available to the groups

information fact sheets
as well as creative materials.
5. Have groups spend the
remainder of the time
preparing their projects.

LESSON 6
1. Work cooperatively 1. Ask students to introduce
to convey important any team members who
information about are attending the presentations
drugs and alcohol. to the class.
2. Synthesize 2. Have groups present their
experiences during final projects to the rest of
the 4-Fold Prevention the class.
program. 3. Thank students for
participating in the program,
and ask them to fill out the
evaluation form.
4. Remind students that they
will be completing a
post-test instrument
the following week.
5. Take up student journals.

Purpose Homework

LESSON 1
Gain an understanding of the
definition of “drug” and successfully
identify
substances that can “drugs.”
Gain an understanding of the definition
of “drug” and substances successfully identify
that can be defined as
be defined as “drugs.”
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LESSON 2
Gain an understanding of the 1. Interview school team
definition of a members about their attitudes
“student friendly about drugs and alcohol.
school.” 2. Have school team member
help generate ideas to make friendly.

LESSON 3
1. Generate letters to the
principal outlining
suggestions for a student
friendly school.
Complete the family member
interview and the family drug
use policy.

2. Gain an understanding
of the importance of
communicating
with parents about
drugs and alcohol.

LESSON 4.
1. Identify opportunities
in the community for
involvement in
“safe fun” activities.
2. Identify people in the
community who can be of help.
1. Interview community team
members about drug/alcohol
attitudes.
2. Generate list of community
activities with team member.

LESSON 5
1. Discuss attitudes Invite team member to pre
about drugs sentations for next week.
with a peer in class.
2. In small groups, prepare a
poster, skit, or research
presentation on some
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aspect of substance
use as a final project.

LESSON 6
1. Work cooperatively
to convey important
information about
drugs and alcohol.

2. Synthesize
experiences during
the 4-Fold Prevention
program.

15.6 Counselling for suicide

Suicidal ideation is a common medical term for thoughts about suicide. Thoughts may be
fleeting in nature, or they may persist and resolve into a formulated plan. Many people who
experience suicidal thoughts do not die by suicide, although they may exhibit suicidal behavior
or make suicide attempts. People who find themselves experiencing suicidal thoughts or
behaviors may find that they do so as a result of conditions such as depression, hopelessness,
severe anxiety, insomnia, or panic attacks. Not all people who are diagnosed with these or
other medical or mental health conditions will experience suicidal ideation, but some may.

All suicidal ideation and behavior should be taken seriously, and those who have suicidal
thoughts or know someone who is experiencing suicidal ideation should contact a crisis line as
soon as possible.

ASSESSING SUICIDE RISK AND BEHAVIOR

A person might have persistent thoughts of suicide and never attempt suicide, but a
person might also attempt suicide after only briefly experiencing suicidal ideation. Thus, it is
important that all threats of suicide and suicidal behavior be taken seriously.
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Get help immediately if you or someone you know does any of the following:

 Threatens to hurt or kill oneself.

 Attempts to access the means to kill oneself (weapons, medications, etc.)

 Talks or writes about one’s own death.

 Exhibits revenge-seeking behavior.

 Talks about feeling trapped in an unhappy situation and not seeing any way out.

 Feels no reason to live or has no purpose in life.

 Withdraws from friends, school, work, family, and all other important relationships.

 Engages in risky behavior without caution.

CAUSES OF SUICIDAL IDEATION AND BEHAVIOR

A person may have thoughts of suicide for no discernable reason, but often suicidal ideation
may occur as a symptom or result of a mental health condition or after one experiences a
challenging life event, such as a failed or failing relationship(s); grief; medical illness;
rejection; sexual abuse, emotional abuse, or physical abuse; or unemployment.

The risk of suicidal thoughts or behavior might also be increased by one’s family or personal
history. A family history of parasuicide (self-harm, attempts, or gestures with no intent to die) or
a personal history of previous suicide attempts, for example, may increase one’s risk for suicidal
ideation. Suicidal ideation and behavior can also occur as a side effect of various psychotropic
medications.

People diagnosed with schizophrenia have a higher rate of suicidal ideation during periods
of remission, and those diagnosed with serious medical illnesses such as AIDS or cancer are
more likely to experience suicidal ideation if they also have a psychiatric condition. Suicidal
ideation and behavior have been found to be most prevalent in people who are coping
with mood issues such as bipolar while also dealing with substance or alcohol abuse.

Psychological issues that might lead one to experience thoughts of suicide include, but
are not limited to:

 Eating and food issues

 Bipolar
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 Body image issues

 Dissociation

 Depression

 Panic

 Posttraumatic stress/trauma

 Schizophrenia

 Social anxiety

THERAPY FOR SUICIDAL IDEATION

Psychotherapy can often be beneficial for people who are experiencing chronic suicidal
ideation and behavior. However, when individuals are at risk of suicide it is essential that they
receive a higher level of care, such as hospitalization or intense in-patient or out-patient treatment.
Weekly psychotherapy is simply insufficient to protect those who are in crisis and adequately
address their risk. Once an individual is no longer in crisis, therapy to treat the underlying
causes of suicidal ideation or behavior is typically recommended.

The psychotherapy model considers hopelessness to be the strongest contributing factor

to suicidal ideation, and a large part of crisis intervention and post crisis counseling aims to
restore hope.

An individual who continues in therapy once the point of crisis has passed will likely
explore ways to resist urges to self-harm (if the person engaged in self-harming behavior),
address the factors that led to suicidal thoughts, and create a plan that includes coping strategies
and methods to address suicidal thoughts in the event that they recur.

MEDICAL TREATMENT FOR SUICIDAL IDEATION

When an individual seeks treatment for suicidal ideation, health care professionals will
likely attempt to diagnose and treat any medical or psychiatric conditions that may be present.
Because a variety of concerns may lead one to experience thoughts of suicide, diagnosing any
health concerns, physical or mental, is considered to be an important step in the treatment
process. Some individuals may obtain benefit from psychotropic medications, which might be
prescribed temporarily along with therapy.
272

In cases of severe suicidal ideation or behavior, or when an individual reaches a point of

crisis, hospitalization or intense in-patient or out-patient treatment may be necessary. Because
suicidal ideation may lead to deteriorating physical health or self-injury, medical treatment may
also be necessary for some individuals.

CONDITIONS ASSOCIATED WITH SUICIDAL IDEATION

The Diagnostic and Statistical Manual (DSM) lists many psychiatric conditions that may
lead to or result from suicidal ideation and behavior. Not all individuals with one or more of
these conditions will experience suicidal ideation or behavior, but having one or more of these
conditions has been shown to increase one’s risk of suicidal ideation.

 Adjustment disorder: A psychological response to identifiable stressor(s) that can

lead to significant behavioral or emotional symptoms.

 Anorexia nervosa: An eating disorder characterized by the inability to maintain a

healthy body weight and an extreme fear of gaining weight due to a distorted self-
image.

 Bipolar: A mood condition defined by one or more episodes of abnormally elevated
energy levels with or without one or more depressive episodes.

 Body dysmorphia: A psychological condition characterized by excessive concern

and preoccupation with a perceived defect in physical features.

 Borderline personality: A personality condition characterized by a prolonged

disturbance of personality function, defined by depth and variability of moods.

 Dissociative identity disorder: A psychological condition in which multiple and distinct

personalities are present.

 Gender dysphoria: The mental distress that occurs when one’s gender identity does
not align with the gender assigned at birth; in other words, gender dysphoria can be
described as distress experienced as a result of being in the wrong body.

 Major depressive disorder: A condition characterized by an all-encompassing low

mood with low self-esteem and social isolation.

 Panic: A form of anxiety characterized by severe and recurring panic attacks.

 Posttraumatic stress (PTSD): A condition that may develop after exposure to an

event that results in psychological trauma.
 273

 Schizophrenia: A serious mental health condition characterized by disintegrating
thought processes and perceptions of reality and diminishing emotional
responsiveness.

 Social anxiety: A form of anxiety in which social situations cause an individual to

experience significant fear and distress that may lead to an impaired ability to function.

Check your progress

Fill in
1. adolescence marks a significant shift in human development marked by greater
______________

2. 32% dropped out from school to get a ___________

3. _________in the same grade is considered the biggest risk factor for dropping out

4. ___________has a direct, positive effect on youth’s achievement

5. ___________is a virus that damages the immune system

6. Accidents involving spillages of blood should be dealt with using normal __________

Answers

1. pubertal changes 2.job and make money 3. . Being held back 4. family engagement 5.
Human Immunodeficiency Virus 6. first aid procedures

15.7 Summary

School going children when they enter into the adolescent age experiences physical,
cognitive and psychological changes. It is a period of stress and storm. Neither the family nor
the society helps them to handle the situation which results in deviant behaviour such as school
refusal, drop outs, substance abuse and suicidal ideation. Counselling and psychotherapy helps
these children to overcome the problem. There are various reasons like school environment,
acdemic failure, bullying etc for school drop outs. recreating new environment, helping them in
study skills and academic performance will help them. Sex education is imperative during
adolescence stage especially to understand about the HIV/AIDS. School curriculum should
include the HIV/AIDS education to identify the reasons that affect individuals immune system.
4 fold intervention program would help substance abusers to overcome substance abuse.
Psychotherapy can often be beneficial for people who are experiencing chronic suicidal ideation
274

and behavior. However, when individuals are at risk of suicide it is essential that they receive a
higher level of care, such as hospitalization or intense in-patient or out-patient treatment.

15.8 Key terms

School refusal: School refusal is the refusal to attend school due to emotional distress

School drop outs: a student who withdraws before completing a course of instruction. a
student who withdraws from high school

Substance abuse: Substance abuse refers to the harmful or hazardous use of

psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can
lead to dependence syndrome - a cluster of behavioural, cognitive, and physiological phenomena
that develop after repeated substance use and that typically include a strong desire to take the
drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a
higher priority given to drug use than to other activities and obligations, increased tolerance,
and sometimes a physical withdrawal state.

Suicidal ideation: Suicidal ideation, also known as suicidal thoughts, concerns thoughts
about or an unusual preoccupation with suicide. The range of suicidal ideation varies greatly
from fleeting thoughts, to extensive thoughts, to detailed planning, role playing (e.g., standing
on a chair with a noose), and incomplete attempts, which may be deliberately constructed to
not complete or to be discovered, or may be fully intended to result in death, but the individual
survives (e.g., in the case of a hanging in which the cord breaks).(ICD10)

Model question
1. Explain the causes for school drop outs.

2. Explain the counselling intervention for HIV patients.

3. Explain the steps in substance abuse counselling.

References
J. Kelly Coker “Four-fold prevention: strategies to prevent substance abuse among
elementary school-aged children”. Professional School Counseling. .

http://findarticles.com/p/articles/mi_m0KOC/is_1_5/ai_80306028
 275

Key research findings. (n.d.) American Foundation for Suicide Prevention. Retrieved from
https://www.afsp.org/understanding-suicide/key-research-findings

McIntosh, J. L., & Drapeau, C. W. (2014). U.S.A. suicide: 2011 official final data. American
Association of Suicidology. Retrieved from http://www.suicidology.org/Portals/14/
docs/Resources/FactSheets/2011OverallData.pdf

Statistics. (n.d.) Retrieved from http://www.nimh.nih.gov/statistics/index.shtml

Suicide facts. (n.d.) Suicide Awareness Voices of Education. Retrieved from http://
www.save.org/index.cfm?fuseaction=home.viewPage&page_id=705D5DF4-055B-
F1EC-3F66462866FCB4E6
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LESSON - 16
ABUSE COUNSELLING AND REFERRAL
16.0 Introduction

Child abuse has for a long time been recorded inliterature, art and science in many parts
of the world. Reports of infanticide, mutilation, abandonmentand other forms of violence against
children date back to ancient civilizations. The historicalrecord is also filled with reports of
unkempt, weak and malnourished children cast out by families tofend for themselves and of
children who have been sexually abused.The process of reporting abuse can be challenging,
traumatic, and at times,overwhelming. In order for school counselors to be effective helpers for
children, it isessential that they know how to recognize and prevent child abuse and neglect.

16.1 Objective

By the end of the lesson you will be able to understand

 the concept of abuse

 the preventive measures of child abuse

 counseling process of abuse

Plan of the study

16.0 Introduction

16.1 Objective

16.2 Child abuse

16.3 Abuse counselling

16.3.1 Referral

16.4 Summary

16.5 Key terms

Check your progress

Model questions
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16.2 Child abuse

The International Society for the Prevention of ChildAbuse and Neglect recently compared
definitions of abuse from 58 countries and found some commonalityin what was considered
abusive (7). In 1999, the WHO Consultation on Child Abuse Preventiondrafted the following
definition :

‘‘Child abuse or maltreatment constitutes all formsof physical and/or emotional ill-treatment,
sexual abuse, neglect or negligent treatment or commercialor other exploitation, resulting in
actual or potential harm to the child’s health, survival,development or dignity in the context of
arelationship of responsibility, trust or power.’’

Some definitions focus on the behaviours oractions of adults while others consider abuse
to take place if there is harm or the threat of harm to thechild. The distinction between behaviour
–regardless of the outcome – and impact or harm is apotentially confusing one if parental intent
formspart of the definition. Some experts consider asabused those children who have been
inadvertentlyharmed through the actions of a parent, whileothers require that harm to the child
be intended forthe act to be defined as abusive. Some of theliterature on child abuse explicitly
includes violenceagainst children in institutional or school settings.

Physical and sexual child abuse is extremely common in today’s society. Some statistics
show that in any given classroom, one to five children could be victims of sexual abuse alone
(Daignault & Hebert, 2009). Sexual abuse is defined as “involving a child in sexual activity that
the child does not fully comprehend, is unable to give informed consent to, is not developmentally
prepared for, or is enforced without the child’s consent” (Schonbucher, Maier, Mohler-Kuo,
Schnyder, & Landolt, 2014, p. 571). Additionally, of the 80% to 90% of sexual abuse cases that
are reported, the perpetrator is known to the victim and is often a member of the victim’s family
(Minard, 1993).

Over the past two decades reports of abuse and neglect have remained relatively constant.
Child Protective Services (CPS) received an estimated 3.195 million reports of child abuse or
neglect. Neglect was the most common form of abuse, detailing 52% of the reports while physical
abuse accounted for 26%, sexual abuse 7%, and emotional abuse 4% (Van der Kolk et al,
2001).There are many characteristics, trends, and risk factors that contribute to the profile of
perpetrators of child abuse. Statistics from Van der Kolk et al. (2001) affirm that parents constitute
for 81% of child abuse perpetrators while other relatives account for 10.6%; only 8.4% were not
278

related to the child. Women also accounted for a majority of abuse (65%) but males were more
likely to physically abuse (67% to 40%) and sexually abuse (89%) victims.

There were several risk factors identified in cases of child abuse. Coming from a single
family home made for a “greater risk of being harmed by physical abuse, emotional neglect,
educational neglect, and sexual abuse” (Van der Kolk et al., 2001, p. 4). A study in 1993 found
that 90% of all maltreatment occurs in families where the income is below the national median,
moreover “children in families below the poverty level are 13 to 17 times more likely to be
abused” (Van der Kolk et al., 2001, p. 4). The 2013 report from the DHHS also states that there
is “some research to support for caregiver poverty and low socioeconomic status (SES) as a
risk factor for abuse and neglect” (p.23)

Other than SES, data from other studies show additional characteristics of perpetrators.
A review from Becker (1994) found that “one of the most publicized characteristics of sex
offenders is a past history as a victim of abuse” (p.179). Becker noted that in a study conducted
by Johnson and Schrier (1985) that had a sample of male juvenile sex offenders, 19% had
been physically abused while 48% had been sexually abused.

There are many factors and demographics that profile who a child abuse perpetrator is.
Predominantly, most perpetrators know the victim and are related to the victim. Additionally,
those that are perpetrators generally come from a low socioeconomic household and some
may have previous history of abuse and neglect themselves (Becker, 1994). Because of these
riskfactors and the prevalence of child abuse in society, it is beneficial for individuals working
with children to be educated on the signs and symptoms of child abuse.

Signs and Symptoms

Physical signs. The most noticeable way of identifying child abuse is through observations
of physical signs on a child. Physical abuse is direct harm to a child’s body on one or more
occasions (Odhayani, Watson, & Watson, 2013). Many noticeable signs or symptoms include a
dirty body, nails or clothes, matted or thin hair, body odor, dental cavities, chronic infestation
(i.e. head lice), chronic rash, infected sores, or thin limbs (Lewin & Herron, 2007). It is important
to note that physical injuries can be external, such as lacerations or burns, while others could
be internal (i.e. bruised organs). It may also be common to see manifestations of enuresis (i.e.
involuntarily urinating oneself) or encopresis (i.e. involuntarily defecating oneself) (Odhayani,
Watson, & Watson, 2013). If a physical injury is noticed it is also critical to determine if the
 279

child’s explanation for the injury warrants the severity of that injury (Mayo Clinic, 2015). Also,
physical signs of sexual abuse can be apparent if it is noticed that a child is bleeding in the
genital area, there’s blood in the child’s underwear, or if a child has trouble walking or sitting and
complains of genital pain (Mayo Clinic, 2015).

Emotional and behavioral signs. Emotional and behavioral signs and symptoms also
can help indicate victims of child abuse. Many physical symptoms of abuse have the opportunity
to heal quickly, but psychological abuse can have a more long term effect with severe
consequences. According to Child Welfare Information Gateway (CWIG, 2013), the instant
emotional effects of abuse and neglect include “isolation, fear, or an inability to trust; this can
translate into lifelong psychological consequences including low self-esteem, depressions, and
relationship difficulties” (p. 4). Furthermore, abuse is a risk factor for borderline
personalitydisorder, depression, anxiety, and other psychiatric disorders (CWIG, 2013). Other
long term consequences include an increased chance of neglecting cigarettes, illicit drugs, and
alcohol (CWIG, 2013).

Shortly after abuse victims have a noticeably different personality from their normal behavior
and emotional state. Some of the changes in behaviors include; a) the loss of self confidence
and self-esteem, b) social withdrawal or loss of interest or enthusiasm in previously enjoyed
activities, c) avoidance of certain situations, d) desperately seeking affection, e) attempts to run
away, f) attempts at suicide, g) rebellious or defiant behavior, h) sexual behavior or knowledge
that’s inappropriate for the child’s age, and i) poor school attendance (Mayo Clinic, 2015).
Finally, Odhayini, Watson, and Watson (2013) include the refusal to eat and being afraid or
flinching while being touched.

Other research from Stirling and Amaya-Jackson (2008) focused on attachment issues in
the aftermath of child abuse. Their research notes that if a parent is abusive, “attachment for a
child can be confused and disorganized” and the child “no longer feels safe” (p. 670). Stirling
and Amaya-Jackson (2008) believe that symptoms attributed to abuse can be grouped into
three main behavioral categories:

1) Re-experiencing through intrusive thoughts, dreams, and “flashback” recollections;

2) Avoidance of reminders and numbing of responsiveness, including social withdrawal,

restricted range of affect, and constriction of play; and
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3) Physiological hyper arousal in the form of hyper vigilance and exaggerated startle
response, attention and concentration problems, and sleep disturbance (p.668).

When a child first experiences abuse the emotional response can be instant while others
lay dormant in various behaviors. Some children’s moods and emotions change from theirnormal
state while others revert to altered behavior or struggle with attachment and relationships. As a
result, some responses manifest in the school environment.

Academic signs. Researchers have found that abused children have poorer educational
outcomes when compared to peers and that many factors contribute to academic achievement
and failure among this population (Tanaka, Georgiades, Boyle, & MacMillan, 2015). The
percentage of young adults who failed to graduate high school was largest among the severely
physically abused group (16.3%) compared to 7.4% of those who were not physically abused
(Tanaka et al., 2015). Much like the physically abused group, those that reported exposure to
child sexual abuse had “fewer years of education and a higher percentage of those that failed
to graduate from high school than the group that reported no sexual abuse” (Tanaka et al.,
2015, p. 203).

Considering all above facts it is important for the school counselors to involve themselves
in abuse counselling

16.3 Abuse counselling

With such a high prevalence of abuse in children and adolescents, schools must be
prepared to deal with the effects of that abuse. School counselors are recognized as a credible
source with specialized skills to assist in these situations and help the victims who are in need
(Otto & Brown, 1982). Schools provide the greatest opportunity to reach the greatest number of
people in terms of child abuse, and therefore they are in the best position to develop preventative
programs on sexual abuse (Minard, 1993). Counselors should demonstrate an understanding
of child abuse problems, recognize and detect indicators of abuse, and provide strategies for
preventing and combating the cycle of child abuse (Brown, Brack, & Mullis, 2008).One way of
providing preventative resources to combat the cycle is by creating preventative programs that
address child abuse.

Research from Minard (1993) suggests that preventative programs should begin at the
kindergarten level because one in four victimizations occurs before the age of seven (p. 2). As
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a result, “the school counselor has not only the opportunity but a responsibility to these children
to initiate programs to identify abused children and provide help for both the children and their
families” (Otto & Brown, 1982, p. 101). Counselors ought to be working individually with students
and should also engage in classroom lessons to educate students about child abuse. Counselors
should also be involved with parents and encourage them to discuss the issue of physical and
sexual abuse (i.e. identifying signs, behaviors, etc.) with their children. Several competencies
in response to the type of services school counselors are expected to perform. Competencies
are met through direct and indirect services that when implemented will directly impact the
preventative and responsive services currently provided.

Direct services. direct services are “in-person interactions between school counselors
and students” (p. 83). competencies included under direct services are:

Develops materials and instructional strategies to meet student needs and school goals

Understands methods for helping students monitor and direct their own learning and
personal/social and career development

Provides responsive services

Demonstrates an ability to provide counseling for students during times of transition,

separation, heightened stress and critical change (ASCA, 2012)

In response to cases of child abuse and neglect, there are many ways school counselors
can perform direct services. One way to meet the requirements of direct services in regards to
child abuse victims is to provide individual counseling services. If considering individual
counseling, “school counselors would need to ascertain whether it is viable to provide individual
counseling in the school setting for issues related to emotional abuse, due to possible limitations
on resources and time” (Buser & Buser, 2013, p. 23). If resources and time permit, there are
several types of therapy that have shown to be effective in coping with child abuse.

Play Therapy. Play therapy is one of the most commonly used treatments with child
trauma populations. Play therapy has shown to be the most effective treatment for improving
social functioning in children with sexual abuse histories; it allows children to express themselves
in a developmentally appropriate way, making treatment more congruent and consistent with
the child’s natural manner of learning and engaging in the world (Misurell, Springer, Acosta,
Liotta, & Kranzler, 2014, p. 250).
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Significant research in play therapy was contributed by Carl Jung. Jung believed in symbolic
identification and archetypes, which are feelings associated with culturally specific images in
human behavior that may appear in dreams or fantasies (Green, 2008). With this idea in mind
Jung believed that through play, such as drawing and journaling, children could tell their stories
of abuse. Such drawings and journaling can then be interpreted by the counselor and will give
insight into the traumatic event and the residual effects.

One technique used in play therapy is the use of serial drawings. Drawings encourage
the expression of the child’s self-healing archetype through language depiction, which may
facilitateinner conflict resolution (Green, 2008, p. 109). The purpose of these drawings is to
amplify symbols that appear in the artwork. For example, a ten year old boy named Joe may
have frequent nightmares due to his abuse. The therapist then instructs Joe to draw an object
such as a tree. Joe draws a black hole in the middle of the tree; the therapist proceeds to ask
Joe how he would feel about being in that hole. Joe responds, “I would be happy because I’d be
with the owl in the tree and I would have a flashlight so the tree goblins wouldn’t hurt us” (Green,
2008, p. 109). The therapist or counselor could gain considerable insight into the trauma based
on this interpretation and symbolism.

Picture journaling and spontaneous drawing are other techniques in play therapy that
assist children in displaying their emotions. The symbols displayed in these techniques tell
therapists and counselors where children are by pointing to the area of the unconscious that is
most neglected (Green, 2008). Similar to serial drawings, these techniques permit children to
reflect on their developmental processes by combining journal writing, artistic creation, and a
safe environment (Green, 2008). Other studies suggest that play therapy may reduce fears,
anxiety, and depression in children (Scott et al., 2003). There are also new types of play therapy
that incorporate games to tell children’s stories.

Game-Based Cognitive Behavioral Therapy (GB-CBT). GB-CBT includes numerous

“modules” such as rapport building, emotional expression, and cognitive coping skills in sessions
to promote transparency and accurate information and storytelling. Sessions are generally 90
minutes in length and involve both parents and children. Games are structured, directive, goal-
oriented, and designed to promote skill acquisition through focus on specific skills (i.e. emotional
expression) (Misurell et al., 2014). An example for children could involve playing a game in
which they attempt to guess the feeling represented by a cartoon face (Misurell et al.2014).
This can help CSA victims express their own feelings through interpretations of other characters
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or objects feelings. A study by Misurell et al. (2014) demonstrated improvements in internalizing

symptoms and externalizing problem behavior and also found that children exhibited less sexually
inappropriate behavior. GB-CBT therefore is helpful in allowing children to express their feelings
and cope with trauma.

As previously mentioned completing therapy in a school setting is not practical and is not
the role of the school counselor. However, there are certainly pieces of play therapy and GB-
CBT that can be incorporated into weekly check-ins with students. School counselors can utilize
games or drawings during check-ins to build rapport and promote conversation about how
students are feeling. Other direct strategies may be more beneficial for providing support for a
larger audience.

Classroom lessons. An additional direct approach to combating child abuse is to lead

classroom lessons that focus on prevention strategies that will instruct children on how to identify
and also respond to abuse. In addition, incorporating child abuse education may help increase
children’s comfort in discussing sexual topics which may help reduce shame, stigma, and self-
blame for children who may have experienced abuse (Kenny, 2009). Child abuse education
lessons also increase student’s knowledge about sexual abuse; increases their self-protective
knowledge and skills; leads to earlier disclosure of abuse which prevents further abuse; and
increases positive feelings in children (Martyniuk & Dworkin, 2011).

While facilitating a lesson, it is important that school counselors are sensitive to student’s
maturity and emotional readiness when handling content regarding abuse and neglect (Tomback,
2010). One particular lesson for younger students aims at identifying “good touches” and “bad
touches” in addition to integrating information about healthy behaviors and personalresponsibility.
The “good touch/bad touch” lesson teaches students what good touches, bad touches, and
confusing touches are. They also learn how to identify grownups that can help, how to recognize
abusive relationships and how to say “no” (Mikton & Butchart, 2009). “Good touches” are touches
that feel warm and loving while “bad touches” are touches that are embarrassing or that can
hurt and leave bruises (Tomback, 2010). Once children learn about the types of touches, the
new knowledge is incorporated into a story that integrates the new terms. For example, you
may tell the students a story that involves animals that are being “touched” in certain ways; the
goal is for students to identify the actions and what they would do to help (Tomback, 2010).

For an effective lesson it is essential for counselors to include children as physically

active participants, to combine modeling and group discussion, and also perform multiple lessons
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over a long period of time (Martyniuk & Dworkin, 2011). Findings from studies have shown that
preventive lessons are effective at strengthening protective factors, they shorten duration of
abuse, and they increase knowledge of abuse which in turn helps reduce likelihood of abuse in
the future (Martyniuk & Dworkin, 2011; Mikton & Butchart, 2009). Lessons for older students
focus more so on healthy relationships and teen dating violence but the foundation of identifying
abuse starts at a younger age (Martyniuk & Dworkin, 2011). Working individually with students
and performing classroom lessons gives a direct approach to preventing and coping with child
abuse. But, it is important that preventing and coping with abuse is a collaborative effort that
includes teachers and parents.

Indirect services. In contrast to direct services, indirect services are “services provided
on behalf of students as a result of the school counselor’s interactions with others” competencies
included under indirect services are:

Understands how to make referrals to appropriate professionals when necessary;

Compiles referral resources to utilize with students, staff and families to effectively address
issues; and Partners with parents, teachers, administrators and education stakeholders for
student achievement and success (ASCA, 2012)

For school counselors there are many ways to provide indirect services for students. Two
approaches that will be further discussed is the role of collaboration with parents in addition to
the role of referring students to local mental health agencies.

Collaboration. In order for school counselors to adequately help and engage with students
that are victims of child abuse, it is necessary that they collaborate with their parents. Baker,
Robichaud, Dietrich, Wells, and Schreck (2009) state that collaboration “implies a process of
mutually seeking ways to understand and resolve challenges” (p. 201). Baker et al. (2009) goes
on to state that collaboration happens when consultants and consultees “engage in a process
of trying to identify possible solutions to problems that consultees are facing” (p. 201). This
happens through identifying the problem, identifying prospective solutions, implementing the
selected solution, evaluating the outcomes, and determining whether the implementation is
working or alternative prospective solutions need to be identified (Baker et al., 2009).

Parental involvement has a positive effect on children’s academic achievement and

personal/social well-being, so it is crucial that school counselors take the initiative to facilitate
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parental involvement in their school (Grubbs, 2013). School counselors can also teach parents
how to respond to their child’s abuse by promoting positive family interactions, teaching emotional
communication skills, and how to be supportive (Child Welfare Information Gateway,2013).
While educating parents, counselors must respect their knowledge and experience as well
because they are the experts on their child and the home situation (Sommers-Flanagan &
Bagley, 2011). With collaboration in mind, counselors and parents can work parallel with one
another to give children consistent help that will aid in coping with abuse.

16.3.1Referral. Generally school counselors are the initial mental health provider for
children (Paisley & McMahon, 2001). According to Lemberger, Morris, Clemens, and Smith
(2010), “Given the complex needs of students and school communities, it is unlikely that school
counselors alone can facilitate optimal interventions to all students and situations, at all times”
(p. 3). Ideally school counselors would like to provide acceptable help for all students, but time,
resources, and lack of expert knowledge may prevent long term individual therapy from
happening. When school counselors experience circumstances that hinder appropriate services,
a referral is a way to meet the needs of the child (Lemberger et al., 2010). Referring may
include informing parents of applicable resources or agencies that may best suit the family and
developing a list of community agencies and service providers for student referrals (ASCA,
2012; Lemberger et al., 2010). It is imperative that school counselors recognize the limitations
of their skills, abilities, and resources in order to best meet a student’s needs. Moreover, school
counselors must understand how and why referrals should be made as part of their requirement
to provide indirect services.

School counselors hold the ability to provide direct and indirect services for all students.
Direct services include individual therapy that focuses on the problem or trauma that is present.
A classroom lesson is another example of a direct service which can teach preventative skills
that will reach more students. In contrast, indirect services are those that work with outside
beings from the student. An important indirect provide parallel services for students while at
home and at school. If a school counselor feels that they cannot provide enough services for a
student, they have the ability to help families identify mental health agencies that can best meet
their child’s immediate needs.

School counselor’s roles and responsibilities are multifaceted; with the proper training
and implementation of services, school counselors can help students that are victims of child
abuse develop skills that will increase their academic and personal/social well being. As a
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leader in the school, school counselors have the platform to provide preventative and responsive
services to educate and assist all students in their school and community.School counselors
are tasked to manage the delicate balance of ethical responsibility and confidentiality when
working with students and their families. School counselors are also mandated reporters which
means that in situations of abuse they must report these actions to child protective services for
further investigation. School counselors work with students going through a variety of difficulties
on a daily basis. Therefore, school counselors ought to be prepared to handle these situations
in a calm and efficient manner. It is impossible to know how each individual will respond to a
crisis but with the proper preparation counselors can ensure that their responses will be
appropriate and helpful to their students.

16.4 Summary

Considering the importance of treating the abuse child, School counselors should be
proactive in their approach to preventing current and future child abuse. Preventative curriculum
such as classroom lessons should begin before age seven in order to identify abused children
and provide help. Lessons focused on the signs/symptoms of abuse and how to help strengthen
protective factors, shorten the duration of abuse, and increase knowledge of abuse which in
turn helps reduce the likelihood of future abusive situations (Martyniuk & Dworkin, 2011; Minard
1993).

Counselors should also be proactive in engaging parents and the community to increase
knowledge about child abuse. Parent involvement has positive effects on adolescent’s well-
being and school counselors can teach parents how to respond to abuse by promoting positive
family interactions and teaching emotional communication skills (Grubbs, 2013). To develop a
comprehensive school counseling program, school counselorsmust collaborate with parents
and community stakeholders and provide preventative education on child abuse to ensure that
more students are protected from this type of trauma.

16.5 Key terms

Child abuse: Child abuse or child maltreatment is physical, sexual, and/

or psychological maltreatment or neglect of a child or children, especially by a parent or other
caregiver.
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Sexual abuse is defined as “involving a child in sexual activity that the child does not fully
comprehend, is unable to give informed consent to, is not developmentally prepared for, or is
enforced without the child’s consent.

Physical abuse: Intentional use of physical force against the child that results in – or has
a high likelihood of resulting in – harm for the child’s health, survival, development or dignity.
This includes hitting, beating, kicking, shaking, biting, strangling, scalding, burning, poisoning
and suffocating. Much physical violence against children in the home is inflicted with the object
of punishing

Check your progress

Fill in
1. ___________is extremely common in today’s society.

2. 80% to 90% of sexual abuse cases that are reported, the perpetrator is __________

3. Children in families _______________are 13 to 17 times more likely to be abused

4. high prevalence of abuse was found in ___________

Answers
1. Physical and sexual child abuse 2.known to the victim 3. below the poverty level 4.
children and adolescents

Model questions
1. Define Abuse.

2. Difference between sexual abuse and physial abuse.

3. State various type of therapies to help abused child.

References
American School Counselor Association. (2012). ASCA national model: A framework for
school counseling programs, 3rd edition. Alexandria, VA: ASCA.

Child Help. (2012). Child abuse statistics and stats. Retrieved from https://
www.childhelp.org/child-abuse-statistics/.
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Dahir, C.A., & Stone, C.B. (2012). The transformational school counselor, 2nd edition.
Belmont, CA: Brooks/Cole Cengage Learning.

Mayo Clinic. (2015). Symptoms. Retrieved from www.mayoclinic.org/diseases- conditions/

child-abuse/basics/symptoms/con-20033789.

Van der Kolk, B.A., Hopper, J., & Crozier, J. (2001). Child abuse in America: Prevalence
and consequences. Journal of Aggression, Maltreatment, & Trauma, 1-20.
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MODEL QUESTION PAPER

Msc - PSYCHOLOGY
Semester - II
Guidance and Counselling

Section A (10x2=20)
Answer any ten questions
All questions carry equal marks
Each answer should not exceed 50 words

1. Guidance

2. Counselling

3. Common childhood problem

4. Eating disorder

5. Physical problems in old age

6. Stages in counselling

7. Basic counselling skills

8. Drop outs

9. Confidentiality

10. referral process.

11. Types of abuse

12. Delinquents

Section B (5x5=25)
Answer any 5 questions
All Questions carry equal marks
Each answer should not exceed 250 words

13. Differentiate between guidance and counselling.

14. Explain nature and scope of guidance.

15. Explain various types of guidance.

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16. Explain the Cognitive problems faced by old age people.

17. Explain the intervention for Drug addicts.

18. Importance communication skills for counsellor.

19. Explain ethical issues in assessment process

Section C (3x10=30)

Answer any 3

All Questions carry equal marks

Each answer should not exceed 1000 words

20. Explain various types of assessment.

21. Explain the problems faced by adolescents.

22. Explain basic counselling skills

23. Write in detail about ethical and legal responsibility of a counsellor.

24. Explain how you will counsell a abused child.