example first year essay · 2018-01-29 · hallucinations is not exclusive to schizophrenia which...

Example First Year

Essay The following essay was based on the following topic and requirements: Topic: Treating Schizophrenia: The role of psychological therapies This essay should include: (i) a brief overview of the symptoms and diagnosis of schizophrenia (approx 200-300 words) (ii) a brief description of the current pharmacological (drug) approach to the treatment of schizophrenia (approximately 200- 300words) (iii) the key body of work in your essay should then discuss the role of psychological therapies in managing schizophrenia (approximately 700-900 words) (iv) a final conclusion summarising the essay (approximately 200-300 words) Three starting references were provided and students were asked to find a further 5 – 8 related references. The word limit was 2000 words.

Running head: TREATING SCHIZOPHRENIA

1

Treating Schizophrenia: The Role of Psychological Therapies

Rhubarb A. Jueves

Griffith University

Student Number: 23092929

Course: 1009PSY

Tutor: Domingo Pear

Tutorial time: Tuesday; 2-4pm

Due Date: 21st November, 2013

Date Submitted: 21st November 2013

Word Count: 1520

Check the marking criteria or speak to your tutor regarding what is included in your word count

TREATING SCHIZOPHRENIA

2

Abstract

Schizophrenia is a disabling and complex disorder often presenting during adolescence and early

adulthood and is distinguished by three broad categories of symptoms; positive symptoms,

negative symptoms, and cognitive impairment. Treatment of schizophrenia involves the use of

antipsychotic medications that block abnormal dopamine pathways. Despite improvements in

pharmacological treatments, many of the symptoms prove difficult to manage. Psychological

therapies such as cognitive behaviour therapy (CBT) have improved outcomes in the treatment

of affective disorders which led to the specific use of CBT for psychosis (CBTp). Variability of

results range from a number of factors including the type of CBT used, to the way therapy is

delivered. Research indicates that a multifaceted approach is necessary for achieving better

outcomes. .

This is a very good abstract. The language is clear, the sentences short and sharp and it provides an excellent outline of the essay.


3

Treating Schizophrenia: The Role of Psychological Therapies

Schizophrenia is a complex and debilitating disorder affecting approximately one percent

of the population (Tarrier & Wykes, 2004). Symptoms of schizophrenia emerge during

adolescence and early adulthood and mostly persist throughout life. The high economic, social

and psychological costs of schizophrenia place it among the top ten causes of long-term

disability in the world today. Research has led to both pharmacological and psychological

advances in the treatment and management of schizophrenia allowing many diagnosed with the

disorder to live a more rewarding and meaningful life within their community (Mueser &

McGurk, 2004).

Schizophrenia is distinguished by three broad categories of symptoms; psychotic

(positive) symptoms involving false beliefs, false perceptions and/or bizarre behaviours; negative

symptoms, where basic emotional and behavioural processes are diminished or absent; and

cognitive impairment, relating to attention and concentration, learning and memory, abstract

thinking and problem solving, and psychomotor speed (Mueser & McGurk, 2004). For a

diagnosis of schizophrenia to be made two or more of the following symptoms must be present

for the duration of one month. The Diagnostic and Statistical Manual of Mental Disorders,

Fourth Edition, Text Revision (DSM-IV-TR) lists diagnostic symptoms as; delusions,

hallucinations, disorganised speech - such as incoherence, frequent derailment, grossly

disorganised or catatonic behaviour, (American Psychological Association [APA], 2000, p. 640),

alogia - an inability to generate spontaneous speech (Matsumoto, 2009, p.29), avolition - an

inability or lack of desire to engage in motivated activities (Matsumoto, 2009, p. 73), and

affective flattening (APA, 2000, p. 640). However, psychosis involving delusions and

hallucinations is not exclusive to schizophrenia which makes diagnosis very difficult. Criteria

gical costs of schizophrenia place it among the

he world today. Research has led to both pharm

he treatment and management of schizophreni

ve a more rewarding and meaningful life within their community (Mueser &

4)

e

m

ia

A statement about the purpose of the essay would have been good here. Perhaps something like “This paper will provide a review of the current treatment approaches to schizophrenia drawing from both pharmacological and psychological treatment studies.”

guished by three broa

false beliefs, false perceptions and/or bizarre behaviours; ne

nal and behavioural processes are diminished or absent; and

to attention and concentration, learning and memory, abstra

and psychomotor speed (Mueser & McGurk, 2004). For a

e made two or more of the following symptoms must be pre

The Diagnostic and Statistical Manual of Mental Disorders

ad

This is an excellent description of the symptoms. The student understands the concept of diagnosis and is using the current diagnostic nomenclature from DSM IV TR


4

based on duration, dysfunction, associated substance use, bizarreness of delusions, and the

presence of depression or mania are used to distinguish between the different categories of

psychotic disorders (van Os & Kapur, 2009).

Clinical management after a diagnosis of schizophrenia begins with a pharmacological

approach of antipsychotic drugs which block dopamine transmission. First generation

antipsychotics, discovered in the 1950’s such as haloperidol and chlorpromazine are effective in

the treatment of psychotic symptoms but frequently cause side-effects such as muscle stiffness,

tremors, and the neurological syndrome tardive dyskinesia which causes involuntary movements

in the body’s extremities. Evidence suggests that second–generation or atypical antipsychotic

drugs such as clozapine and aripiprazole are more clinically effective and have a better effect on

cognitive functioning then first-generation drugs. Although the side-effects of second-generation

antipsychotics have a more favourable profile they still have some potentially life threatening

drawbacks such as a dramatic lowering of the white blood-cell count (Mueser & McGurk, 2004),

weight gain, increased triglycerides, and high cholesterol (van Os & Kapur, 2009). However,

despite the effectiveness of anti-psychotic pharmacotherapy, a substantial number of patients

experience medication-resistant positive schizophrenia (Lindenmayer, 2000).

Research evidence supports the effectiveness of adjunct psychological therapies such as

cognitive behaviour therapy (CBT) in the treatment of both negative and positive symptoms in

drug refractory schizophrenia (Sensky et al., 2000). While other medications such as

antidepressants and mood stabilisers are frequently used in the management of schizophrenia

there is limited evidence to the benefits of polypharmacy (Mueser & McGurk, 2004). The need

for a more effective treatment of schizophrenia has led to the use of psychological interventions

such as CBT, which has been used to treat affective disorders over the last 30 years. Cognitive

are used to distinguish betw

apur, 2009).

r a diagnosis of schizophrenia begins with a pharmacological

which block dopamine transmission. First generation

1950’s such as halop

oms but frequently c

w The student could have provided some examples of what symptoms are reduced e.g. positive symptoms such as hallucinations and delusions

ause side effects suc s usc e s ess,

nesia which causes involuntary movements

ond–generation or atypical antipsychotic

nically effective and have a better effect on

peridol and chlorpro

ause side-effects suuchchccchhhhchcchhh aaaaasssss mumumumumuscscscscsclelelelele ssssstititititiffffffffffnenenenenessssssssss,,,,,

o

uccchhchccchch aass mumuscsclele sstitiffffnenessss

Again … how are they clinically effective?

Os & Kapur, 20

substantial num

mayer, 2000).

0

mb

This is a nice summary and provides a good reason for looking for better ways of managing schizophrenia. A linking sentence could have been used here.

ment of both negative and positive s

000). While other medications such

ntly used in the management of sch

s

a

h

It is appropriate to use et al. after this first author in this instance (even though this is the first reference to this source) as there are more than 6 authors.


5

behavioural techniques in psychosis were first used by Aaron T. Beck in 1952. CBT is based on

the general principles Beck developed for treating depression and has since been adapted for the

treatment of schizophrenia. Beck’s early theory was built on behavioural theories and the

assumption that early life experiences and social environment contributed to the forming of

schemas about the self, other people and the world, which led to distortions in cognition and

negative ways of thinking. Beck believed that by evaluating their accuracy, inaccurate negative

emotional reactions resulting from thought distortion could be reduced or extinguished (Tai &

Turkington, 2009). Although Beck started this work in 1952, which was the first evidence of the

use of psychotherapy for the treatment of delusions, his main work was with depression and

anxiety. This was a shift away from the institutional and biological dominance in psychiatric

thinking generally and schizophrenia specifically (Tarrier & Wykes, 2004).

In the 1980’s the consistent findings on family environment prompted family

interventions to be used. These interventions were strongly behavioural and were developed to

assist in reducing relapses and to facilitate the reduction of stress to family members. The key

elements of effective family interventions include; emotional support, crisis intervention, and

training and education on dealing with the illness. Early intervention proved pivotal to better

outcomes (Dixon et al., 2010). The need to address social skills which are known to be deficient

in schizophrenia led to the development of social skills training (SST). SST incorporated three

elements of social competence and interactions such as receiving skills (social perception),

processing skills (social cognition) and how the individual responds (behavioural responding or

expression). SST targeted such elements through modelling, goal setting, positive reinforcement,

role playing, community-based homework assignments, and corrective feedback. Research

indicates that SST has a moderate to average effect on negative symptoms in schizophrenia

q p y y

the general principles Beck developed for treating depression an

Beck’s early theory was built on be

assumption that early life experiences and social environment c

BBB

i h l lif

Not entirely correct but small errors of fact are not fatal in a first year essay.

ent of delusions, his main work was

m the institutional and biological dom

thinking generally and schizophrenia specifically (

In the 1980’s the consistent findings on fam

mme

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When you use a term it is often good to provide an example so that your reader (or marker) is clear what you mean (and your marker knows that you know what it means).

p y

ompted family

e strongly behavioural and were developed to

uction of stress to family members. The key

; emotional support, crisis intervention, and

E l i t ti d i t l t b tt

g

(Tarrier & Wykes, 2

mily environment pro

2Expand – how early? With whom?


6

(Kurtz & Mueser, 2008). Schizophrenia has a major impact on education and vocational

development, which led to the need for a supported employment program. Evidence suggests

that employment plays a critical part in the process of recovery, improvement of social skills,

and economic functioning. Supported employment combined with training in skills development

is an empirically validated approach to vocational rehabilitation based on a “place and train”

philosophy (Mueser & McGurk, 2004). A number of recent concepts that expand the range of

CBT strategies for use in schizophrenia are; mindfulness training - training of the mind to

disengage from unhelpful thinking, meta-cognitive approaches - based on changing the way in

which thoughts are experienced and regulated, and compassionate mind training – where

emphasis is placed on increasing awareness of negative internal hostile signals, as useful

adjuncts in CBT for psychosis (Tai et al., 2009).

As the benefits of CBT were expanded to other affective disorders it became the

treatment of choice for non-psychotic conditions. This led to the development of specialised

CBT treatments for the management of psychosis in schizophrenia. CBT was not considered as a

stand-alone therapy but an addition to already established management practices. Random

control trials, specifically in the United Kingdom Mental Health Services, have shown CBT to be

effective in the treatment of positive psychotic symptoms. The research also indicates that the

specific use of cognitive behaviour therapy for psychosis (CBTp) must be evaluated on

individual needs and effectiveness. One size does not fit all and must be considered carefully in

acute psychotic phases of the disorder as compared to its use in the chronic phases (Tarrier &

Wykes, 2004). An example of this is the effect of CBTp on hopelessness studies which indicate

that this type of therapy may not be beneficial and perhaps even detrimental on this particular

symptom (Wykes, Steel, Everitt, & Tarrier, 2008). Most studies concentrate on the chronic phase

c on increasing awareness of negati e in

T

enefits of CBT were expanded to other aff

oice for non-psychotic conditions. This led

for the management of psychosis in schiz

apy but an addition to already established

ecifically in the United Kingdom Mental H

treatment of positive psychotic symptoms.

e gativve

fffiiit fff CCBTBT ddd ddd t thhh

This is clearly demonstrating that the student has read and understood the importance of evaluating treatments within the context of clinical trials: the science of psychological treatment is key here.


7

of schizophrenia as maintenance medication does not always control the symptoms of

hallucinations and delusions (Tarrier & Wykes, 2004). A study conducted by Zimmermann,

Favrod, Trieu, and Pomini (2005), showed that CBTp had a better effect on the acute psychotic

phase of the disorder then on stabilized chronic psychotic symptoms.

Variability of results may be influenced by a number of variables such as; the type of

CBT used, the timing of the intervention, family involvement in learning CBT techniques,

individualisation of therapy, the level of therapist competence, patient therapist relationship, and

the way in which the outcome was assessed. However, all studies do indicate the usefulness of

all types of CBT in a variety of settings, interactions, and symptoms targeted (Tarrier & Wykes,

2004). To this end a cognitive therapy scale has been developed to measure the therapist skills in

offering CBTp. A cognitive therapy scale for psychosis CTS-PSY and the cognitive therapy for

psychosis: adherence scale, have been developed to standardise outcomes from these therapies.

The need for such scales is to quantify essential nonspecific interpersonal relationships,

adherence to treatment procedures, and individual treatments, with further scale modification

required as more specific CBTp is developed. This gives a background upon which individual

therapists can empirically measure outcomes for themselves and their clients. For evidence based

psychological treatments to be recognised within mental health services, quality evaluation

methods of precise and accurate assessment of treatment benefits must be maintained (Tarrier &

Wykes, 2004).

As can be seen from the ongoing research, a multifaceted approach is required in the

management of schizophrenia, as no individual treatment, whether it be pharmacological,

psychological or social, can control all of the symptoms. While the use of antipsychotic drugs

may dampen the symptoms of psychosis, psychological therapy holds out hope of improved

required as more specific CBTp is devel

therapists can empirically measure outco

recognise

e assessm

r

ttte

This is good, an area for improvement would once again have been to include some examples of the terms to once again demonstrate that you the student, know what you are talking about.


8

outcomes and should be viewed as a range of therapies in the management of this complex

disorder. Variability of results indicate that individualisation of adjunct therapy may be the

cornerstone of improved outcomes in the future treatment and management of schizophrenia. g

A nice conclusion. Clear, short and well written.


9

References

American Psychological Association. (2000). Diagnostic and statistical manual of mental

disorders (4th ed., text rev.). Arlington, VA: American Psychological Association.

Dixon, L. B., Dickerson, F., Bellack, A. S., Bennett, M., Dickenson, D., Goldbery, R.

W., ... Kreyenbuhl, J. (2009). The 2009 schizophrenia PORT psychosocial treatment

recommendations and summary statements. Schizophrenia Bulletin, 36, 48-70.

http://dx.doi.org/10.1093/schbul/sbp115

Kurtz, M. M., & Mueser, K. T. (2008). A meta-analysis of controlled research on

social skills training for schizophrenia. Journal of Consulting and Clinical Psychology,

76, 491-504. http://dx.doi.org/10.1037/0022-006X.76.3.491

Lindenmayer, J. P. (2000). Treatment refractory schizophrenia. Psychiatric Quarterly, 71, 373-

384. http://dx.doi.org.libraryproxy.griffith.edu.au/10.1023/A:1004640408501

Matsumoto, D. (Ed.). (2009). The Cambridge dictionary of psychology. New York,

USA: Cambridge University Press.

Mueser, K. T., & McGurk, S. R. (2004). Schizophrenia. The Lancet, 363, 2063-2072.

Sensky, T., Turkington, D., Kingdon, D., Scott, J. I., Scott, J., Siddle, R., ... Barnes, T.

R. E. (2000). A randomized controlled trial of cognitive-behavioral therapy for

persistent symptoms in schizophrenia resistant to medication. Arch Gen

Psychiatry, 57, 165-169. http://dx.doi.org/10.1001/jamapsychiatry.2013.786.

Tai, S., & Turkington, D. (2009). The evolution of cognitive behaviour therapy for

schizophrenia: Current practice and recent developments. Schizophrenia

Bulletin, 35, 865-873. http://dx.doi.org/10.1093/schbul/sbp080

y , ( ) p p y

mmendations and summary statements. Schizophrenia Bulletin, 36, 48-70.

//dx.doi.org/10.1093/schbul/sbp115

M., & Mueser, K. T. (2008). A meta-analysis of controllle

For references with eight or more authors, list the first six authors, then insert three ‘full stops’ then add the last author’s name.


10

Tarrier, N., & Wykes, T. (2004). Is there evidence that cognitive behaviour therapy is an

effective treatment for schizophrenia? A cautious or cautionary tale?

Behaviour Research and Therapy, 42, 1377-1401. http://dx.doi.org/

10.1016/j.brat.2004.06.020

van Os, J., & Kapur, S. (2009). Schizophrenia. The Lancet, 374, 635-645.

Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2008). Cognitive behaviour therapy

for schizophrenia: Effect sizes, clinical models, and methodological rigor.

Schizophrenia Bulletin, 34, 523-537. http://dx.doi.org/ 10.1093/schbul/sbm114

Zimmermann, G., Favrod, J., Trieu, V. H., & Pomini, V. (2005). The effect of

cognitive behavioural treatment of the positive symptoms of schizophrenia

spectrum disorders: A meta-analysis. Schizophrenia Research, 77, 1-9. http://dx.doi.org/

10.1016/j.schres.2005.02.018

A good reference list, the student has demonstrated that these have been read by using them within the body of the essay to support an argument or point.

1

Case-Scenario of Anne and Jude: A Practical Approach to Child-Care Placement

Rhubarb A. Jueves

Griffith University

Student Number: s8765432

Course Code: 3011PSY

Tutor: Domingo Pear

Tutorial time: Monday; 8 – 10am

Due Date: 6th May 2010

Date Submitted: 6th May 2010

Word Count: 2587 words

s8765432

3011PSY

NOTE: This a third year level essay, intended as a guide as your studies progress.

Remember: Running head: CHILD-CARE PLACEMENT (should be included)

2


The decision to consign one’s child into a child-care (CC) facility is often a difficult and

complicated stage affecting many parents (Gonzalez & Eyer, 1997). Simply put, whether CC is

“good” or “bad” for a child’s overall development is often confounded by a host of conflicting

literature (Brooks-Gunn, Han, & Waldfogel, 2002). When taken together such literature presents

an array of interacting factors which may further complicate the decision making process

(Peterson & Seligman, 2004). Therefore, the aim of this essay is to assess the particular

challenges inherent in provided scenario (see Appendix) and suggest strategies for optimising the

CC experience and developmental outcome of the child. Deliberation will be made in regards to

Bronfenbrenner’s ecological systems theory of development (EST; Bronfenbrenner, 1994) and

modern literature. In order to minimise ambivalence, several assumptions will be made in

reference to the scenario: The child will be subsequently referred to as Jude; Anne and Jude are

currently residing in the United States; both are of African American ethnicity and are

categorised as low socioeconomic status (SES); high-quality CC is available in Anne’s area

thereby eliminating the need to discuss the effects of low-quality CC in general; Anne is

considering seeking full-time (over 30 hours per week) employment. The precise details of

Anne’s working arrangements, relationship status or other potentially influential factors will not

be assumed; no other assumptions regarding Anne or Jude’s biological or environmentally

shaped characteristics will be made. All literature referred to will pertain to the United States

unless otherwise stated.

Urie Bronfenbrenner (1917-2005) is credited with establishing a complete theory of

lifespan development due to its emphasis on diversity, completeness and contextual influences

(Berk, 2010). EST portrays human development as evolving through bi-directional interactions


The decision to consign one’s child into a child-care (CC)

omplicated stage affecting many parents (Gonzalez & Eyer, 199

)

97

Remember: Abbreviated title: CHILD-CARE PLACEMENT (should be included)

3

between the biological organism and the ecological environment, that is, the actual environments

in which human beings live their lives (Bronfenbrenner, 1994). The ecological environment is

represented as a set of interrelated rings including the microsystem, mesosystem, exosystem,

macrosystem and chronosystem from the innermost level to the outermost respectively

(Bronfenbrenner, 1994).

The microsystem contains face to face activities and interpersonal relations in immediate

settings (Bronfenbrenner, 1994). Bronfenbrenner (1994) referred to these interactions as

proximal processes and considered them to be more influential than the environmental contexts

in which they transpire. The mesosystem contains linkages between two or more microsystems

containing the person, for example in relation to the child: The link between CC and the family

(Bronfenbrenner, 1994). The exosystem is comprised of linkages between two or more settings

in which at least one setting does not contain the developing person, for example in relation to

the child: The home setting and the mother’s workplace (Bronfenbrenner, 1994). The

macrosystem can be viewed as a particular culture’s blueprint for society and contains: Beliefs,

material resources and laws (Bronfenbrenner, 1994). The chronosystem is the time in which

development takes place including chronological development across the lifespan but also across

historical time (Bronfenbrenner, 1994). Bronfenbrenner (1974) maintained that development

should be examined within its ecological context, with the results of research directly influencing

public policy. Due to the impracticability for Anne to alter Jude’s macrosystem, and the

chronosystem simply being Jude’s current age at the present historical time, neither the

macrosystem nor chronosystem will be discussed subsequently.

Over the last 25 years the early experiences of young children have undergone a

considerable transformation (National Institute of Child Health and Human Development Early

system from the innermost level to the outermost respectively

contains face to face activities and interpersonal relations in immediatell ll tii ii ii didi t

Remember: NO spaces between paragraphs (as is demonstrated in this essay)

) referred to these interactions as

uential than the environ

ges between two or mor

d h li k b d h f il

n

r

Remember: The year is needed again here as the first citation for this source (in this paragraph) was formatted within brackets.

4

Child Care Research Network [NICHD ECCRN], 2006). The percentage of children that receive

regular CC prior to formal schooling has now escalated from below 25% to above 80%; with a

substantial portion of the later experiencing CC within their first two years of life (West, Denton,

& Germino-Hausken, 2000). The increasing utilisation of CC can in part be attributed to a rise

in numbers of working mothers in modern westernised society (Berk, 2010). Currently, over

60% of mothers with a child below age two are employed (Berk, 2010). Berk suggests that even

though the use of CC for infants and toddlers has become common practise, many parents are

unsure of the quality and standards of CC experiences.

An abundance of literature has examined the links between the quality of CC and the

cognitive, behavioural, language and socioemotional outcomes of children’s development

(Brooks-Gunn et al., 2002; Field 1991; Geoffroy et al., 2007; NICHD ECCRN, 2006; Vermeer,

van Ijzendoorn, De Kruif, Fukkink, & Tavecchio, 2008). Typically early research highlighted

poor carer ratios, large group size, inadequate carer training; and the associated negative

outcomes in children’s immediate well-being (Belsky, 1990). In spite such findings, the NICHD

ECCRN (2006) cautions that the validity of early research may be questionable due to a lack of

control for confounds such as selection bias. The NICHD ECCRN (2006) suggests that

differences in family genetics, education and income influence the home environment and CC

decisions, which in turn are associated with CC outcomes. Consistent with this idea,

Bronfenbrenner’s (1994) notion that an individual’s genotype (genetic constitution), phenotype

(observable constitution) and microsystem structures are all influential in children’s

development, may indicate that the benefit or harm of CC is already partially determined before

enrolment.

5

To address this issue Brooks-Gunn et al. (2002) conducted a longitudinal study in which

they examined the association between CC placement due to maternal employment within the

first 12 months and cognitive outcomes of children as measured within the first three years of a

child’s life. The researchers predicted that certain subgroups of the population would be

particularly at risk for poorer outcomes and that any effects may be mediated by the type of

home environment experiences. Using data from NICHD ECCRN (1999; 2000) the researchers

measured the quality of the home environment with the Home Observation of the Measurement

of the Environment Scale (HOME); and cognitive development with the Bracken School

Readiness Scale. They found that negative effects observed in children with working mothers

were pronounced in instances where mothers worked more than 30 hours per week. Moreover,

children with mothers rated as low on maternal sensitivity by the NICHD ECCRN (2006) were

categorised as being susceptible to negative outcomes. In support of this, Bradley and Vandell

(2007) noted that in instances where longer working hours were associated with low maternal

sensitivity, a reduction in positive engagement between mother and child was also observed.

In light of previous research (Bradley & Vandell, 2007; Brooks-Gunn et al., 2002) on

subgroup susceptibility, Bronfenbrenner’s (1994) emphasis on context and bi-directional

proximal processes within the microsystem seems particularly relevant. Bronfenbrenner’s view

of the ecological environment as an ever-changing and unique structure may be beneficial in

accounting for subgroup susceptibilities to maternal employment. Papero (2005) endorses this

viewpoint contending that one of the factors which substantially impacts on proximal processes

between mother and child is maternal depression. Depressed mothers typically view their

parenting style negatively; doubt their ability to have a positive impact on their child’s

6

development; and are reluctant to challenge their child’s opposition (Radke-Yarrow, Cummings,

Kuczynski, & Chapman, 1985).

Although it could be argued that depression is a complex and multi-faceted phenomenon,

Papero (2005) suggests that regardless of causal diagnosis, a mother’s ability to maintain

sensitive and responsive parenting is the most crucial aspect of a child’s development and is

compromised by all forms of depressive symptomology. In contrast to this, Field (1991) claims

that the cause of maternal depression should not be discounted, and suggests that mothers under

financial strain may desire to work, and as a result become depressed while waiting for CC

openings. Moreover, financial pressure is often associated with maternal depression in instances

where mothers feel forced into employment due to desire to provide full-time maternal care

(Papero, 2005). Anne’s previous decision to leave work and provide full-time primary care for

Jude indicates that she may believe full-time maternal care is important for Jude’s development.

Therefore, Anne’s belief and financial position may place her at risk for maternal depression. In

addition, upon securing employment, excess stress resulting from working and parenting could

limit Anne’s ability to provide sensitive care (NICHD ECCRN, 2006). Consequently, it may be

reasonable to assume that Anne could benefit from regular medical examinations.

Bronfenbrenner and Morris (1998) maintain that multiple unstable characteristics of

connected systems, such as maternal depression, low income, and irregular childcare can have a

synergistic effect by reinforcing each other and producing cumulative effects that are likely to

jeopardise a child’s development. In such instances developmental benefits of regular CC may

be observed, and in which case may be explained via the compensatory/protective hypothesis

(Geoffroy et al., 2007). Geoffroy et al. (2007) elucidates that CC may act as a protective factor

by compensating for limited resources in the home environment, particularly in low SES

, p p

hers feel forced into employment due to desire

05). Anne’s previous decision to leave work

tes that she may believe full time maternal care is important for Jude’s development

e

a

i i f d ’ d l

Remember: Even though the first occurrence of this citation was within the narrative, the year must always be included in ALL bracketed citations.

7

families. Consistent with this, Lamb and Ahnert (2006) assert that children from low SES

families are frequently enrolled in community-based CC which has superior carer-child ratios

and smaller group sizes than the majority of CC centres attended by children from middle SES

families. In this way, the opportunity to attend community-based CC afforded by Anne’s low

SES status may inadvertently provide a positive impact on Jude’s development. Perhaps this

may be interpreted as evidence that high quality CC can counter the reinforcing properties of

synergestic effects proposed by Bronfenbrenner and Morris (1998).

Burchinal et al. (2000) conducted a longitudinal study which examined the relationship

between the quality of CC and the associated cognitive, language and communication

development in children aged between 6 and 36 months. The researchers were particularly

interested in children deemed to be vulnerable in relation to ethnicity, CC quantity and SES. For

this reason they restricted recruitment to African American children attending at least 30 hours

per week of community based CC in low SES environments. Developmental assessments were

made using Bayley Scales of Infant Development (cognitive), Sequenced Inventory of

Communication Development (language) and Communication and Symbolic Behaviour Scales

(communication skills). The researchers found that when controlling for selection bias and

family characteristics, higher quality CC was associated with increased cognitive, language and

communication skills over time. In addition they determined that the quality of CC in infancy

tended to be poor on average, and improve linearly towards the pre-school years. Therefore, in

an effort to optimise Jude’s CC experience, it may be beneficial for Anne to utilise the three

months before Jude’s possible enrolment to compare and contrast the particular age-specific care

provided by CC centres in her area. Moreover, it may be beneficial to determine the specific

evidence that high quality CC can counter the reinforcing properties of

oposed by Bronfenbrenner and Morris (1998

l. (2000) conducted a longitudinal study wh

f CC d th i t d iti l d i ti

8

hi

Consider: Writing ‘and colleagues’ instead of ‘et al’ in a sentence. It makes the sentence more coherent. Write as you would speak.

8

characteristics of CC which contribute to its quality and hence, its developmental outcomes

(NICHD ECCRN, 2006).

The NICHD ECCRN (2006) insists that when making predictions for a child’s

development that multiple characteristics of CC experience must be considered. The NICHD

ECCRN examined developmental outcomes at ages 15, 24, 36 and 54 months in over 1300

children that had received prior regular CC. They observed that higher quality CC (as

operationalised by cognitive and language stimulation as well as responsive and sensitive

caregiving) was associated with almost all cognitive, language, preacademic and socioemotional

developmental outcomes. In addition, they noted that children in high-quality CC were

frequently rated by caregivers as displaying more prosocial behaviours. In consideration of the

NICHD ECCRN’s stance on the importance of CC quality, Anne’s search for optimal CC may

be enhanced by comparing and contrasting the characteristics of CC quality as operationalised by

the NICHD ECCRN. In this way she may be able to refine her choices by eliminating those CC

centres that are indicative of providing lower quality experiences in regards to the operational

dimensions.

Anne’s choice of a CC centre may have direct implications for Jude according to

Bronfenbrenner’s (1994) notion of the means by which ecological environments change.

Bronfenbrenner reasons that whenever individuals add or change roles in their environment an

ecological transition results: That is, a change in the breadth of one’s microsystem.

Consequently, Anne’s decision to expand Jude’s microsystem with the addition of a new

structure (CC) would also inadvertently create an additional mesosystem (CC to family). In this

way, the caregiver-parent relationship would become an important dimension of the ecology of

children within CC (Bronfenbrenner, 1979). Consistent with this notion, Shpancer (2006)

9

indicates that CC outcomes are influenced by caregiver-parent relationships, which in turn are

dependent on caregivers’ perceptions of parents.

Shpancer (2006) suggests that caregivers’ negative evaluations of parents may stem from

their attitude towards working mothers. In support of this, Galinsky (1990) reported that 24% of

caregivers participating in the National Child Care Staffing Study had negative attitudes towards

maternal employment. Moreover, Galinsky advised that mothers are often unfavourably

perceived due to their general lack of desire for extensive communication with the caregiver.

This may partially explain Kontos and Dunn’s (1989) findings that mothers displaying a limited

knowledge of CC services and a reluctance to interact, or request advice were valued less by

caregivers. In consideration of previous research (Galinsky, 1990; Shpancer, 2006) on

perceptions of caregivers, Anne’s status as a working mother may attract negative evaluations

from CC staff. In attempting to counter such evaluations and ensure a beneficial mesosystem for

Jude, Anne may have to display enthusiasm for communication and be available for interaction

with caregivers (Kontos & Dunn, 1989).

Berk (2010) suggests that the ability to maintain developmentally favourable

mesosystems is partially dependant on the degree to which an individual’s exosystem is

conducive. Berk contends that adequate leave for parents with sick children and flexible

working schedules can enhance children’s development. In support of this, results of the data

analysis conducted by the NICHD ECCRN (2006) were directed towards the need for specific

policy changes including: Extended welfare benefits, flexible working schedules and paid

parental leave at any time within the first five years following child birth. Although directly

changing exosystem policy may be an impractical objective for Anne; the work conducted by the

NICHD ECCRN indicates that it may be beneficial for Anne to examine prospective workplace

10

policies, specifically in regards to employer flexibility. In this way Anne may be able to

negotiate a position within a company that is considerate of her status as a mother.

Subsequently, extra flexibility in the workplace may assist Anne in retaining her position, which

according to Brooks-Gunn et al. (2002) can impact positively on child development by ensuring

adequate resources in the home environment. Another method for increasing home resources is

highlighted by Brooks-Gunn (2004), who suggests that low SES families may have access to

community or home based interventions; which provide health services, social support and

parental education aimed at enhancing children’s development. In particular Anne could

consider applying for the Early Head Start program, which ensures high-quality CC for children

from low SES families (NICHD ECCRN, 2006).

Overall, CC is a complex multidimensional phenomenon (Vandell, 2004).

Developmental outcomes tend to be determined not only through multiple dimensions but also

through the subtle and dynamic interactions of their underlying components (Shpancer, 2006).

In light of this, it could be argued that the multiple systems incorporated within EST placed it in

a unique position for analysing developmental outcomes specific to Anne and Jude’s situation.

However, the multiple systems which comprise EST are often considered to be its greatest

strength and its greatest downfall (Ungar, 2002). More specifically, EST has been criticised for

neglecting to explain why connections exist and why situations occur (Ungar, 2002).

Nevertheless, Bronfenbrenner (1994) asserts that the principal goal of EST is not to validate

hypotheses or obtain answers. Bronfenbrenner maintains that the primary scientific aim of EST

is to provide a theoretical framework that when applied, will lead to advances in discovery of the

processes, and circumstances that shape the course of human development. Therefore, the main

11

benefits of EST may be its suitability as a complementary theory to other developmental

theories, or its usefulness in highlighting areas of importance for future developmental research.

By using an EST framework, modern research has been utilised to highlight Anne and

Jude’s probable challenges and formulate strategies for optimising Jude’s CC experience and

developmental outcomes. It was determined that Anne’s ethnicity, low SES, and intention to

work for 30 hours or more per week placed Jude at risk for poor developmental outcomes. This

highlighted the importance of protecting Jude from negative outcomes by providing high-quality

CC as measured by cognitive and language stimulation, and sensitive and responsive caregiving.

In addition, strategies that Anne could employ to improve the parent-caregiver relationship and

to secure flexible employment were discussed. In this way a practical or problem-solving

approach has been implemented. As a result any ambivalence regarding whether or not CC

placement is best for Anne and Jude has been reduced, and alternatively, the issue of how Anne

and Jude can make the best of CC has been presented.

12

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d hild ’ i ti l

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Remember: The addition of ‘doi’ reference, if journal articles are obtained online. This complies with APA 6.

/1131183

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Include the issue number (non-italicised, in brackets after the volume number) only when the journal is paginated by issue (i.e. each new issue starts at page 1).

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Appendix

1) Anne is the parent of a 9-month-old child. When her child was born, she decided to give up

work to become a full-time parent and primary caregiver. Due to financial difficulties, however,

she is now considering going back to work in 3 months time and placing her child in a day-care

nursery. Discuss the pros and cons of doing this with reference to developmental research and

theories.

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