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Interventions for Existing Diagnosable Problems in Children Aged 1.5 to 5 Years

Module description

Applying evidence-based psychological therapies to children, young people and their families requires fundamental academic knowledge and clinical skills together with a reflective approach to practice. This module delivers the Department of Health’s Improving Access to Psychological Therapies national curriculum of specific knowledge and skills you will need in order to practice effectively as a 0-5 Therapist. You will explore how session-by-session measurement and routine outcome monitoring are fundamental components of effective practice.

This module will introduce you to behavioural interventions for existing common diagnosable problems in children between the ages of 18 to 60 months (i.e. 1.5 to 5 years). The module should also consider the application of some of these interventions for younger infants (i.e. ten months and over) presenting with early regulatory difficulties (e.g. persistent crying/colic). You will complete all lectures and skills workshops in conduct problems, regulatory difficulties and social and emotional difficulties, to develop skills in all areas.  However, clinical caseload will focus on two of these areas only, one of which must be conduct problems.  Problems in these areas being experienced by younger children (i.e. less than 18 months of age) should be addressed using learning from PYCM035).

Workshops in the module will include learning related to the following areas:

• The evidence base for the effective assessment, formulation and management of behavioural problems in children aged 1.5 to 5 years, using both individual and group approaches. This will cover the main presentations of pre-school behavioural problems for this age group, including proactive and reactive aggression and loss of temper, defiance and non-compliance, destructiveness and deliberate provocation of peers and adults, disobedience and argumentativeness, persistent irritation, annoyance, anger and/or vindictiveness. These difficulties should be enduring and disruptive beyond the normative expectations of age appropriate development. The workshops will also cover the diagnostic classification of behavioural problems including Oppositional Defiant Disorder and Conduct Disorder and common comorbid conditions such as ADHD, callous-unemotional traits, learning disabilities, emotional dysregulation;
• The evidence base for the effective assessment, formulation and management of self-regulation (sleep-wake cycles, persistent crying/colic, feeding patterns, toileting) problems. This section, while focusing primarily on children aged 1.5 to 5 years, will also address early supportive intervention and guidance for persistent crying/colic during the first year. The module will include the key principles and tools required for adequate assessment of these difficulties, and practical experience of using guided self-help, psycho-education, reassurance/support and direct face-to-face behavioural management with parents or in groups;
• The evidence base for the effective assessment, formulation and management of social and emotional difficulties in children aged 1.5 to 5 years of age. This includes the specific and varied presentation of signs and symptoms of early emotional, internalising and anxiety difficulties across infants, toddlers and preschool children, including separation anxiety, panic, phobias, generalised anxiety manifesting in social anxiety, distress, need for safety figures. The curriculum will take account of the inter-relationship between early emotional difficulties and other early childhood difficulties including attachment and behavioural problems.

Module aims - intentions of the module

The module aims for you to:

• Obtain a critical knowledge and understanding of the existing diagnosable problems in the 0-5 age group.  This will cover three areas as follows:
  • Conduct problems (e.g. including the main presentations of pre-school behaviour problems for children aged 1.5-5 years).
  • Regulatory difficulties (e.g. sleep, persistent crying, feeding and toileting difficulties).
  • Social and emotional difficulties (e.g. general anxiety, specific fears, separation anxiety, and stressor related adjustment).
• Develop critical knowledge and understanding of evidence-based interventions for existing diagnosable problems in this age group.
• Develop practical skills and competencies of interventions with parents for existing diagnosable problems in infants and young children in this age group.
• Develop critical knowledge of the theoretical and research literature underpinning behavioural, regulatory, social and emotional difficulties.

The module further aims for you to have a critical understanding of:

• The principles of key underpinning theories including social learning theory (SLT), behavioural theory and operant conditioning, parenting and family functioning, attachment, and parent-child relationships, human ecology and child development.
• Cognitive and behavioural principles.
• Systemic factors influencing parenting and behavioural difficulties in children, for example, family structure and interaction, peers, early years setting, and community risk and resilience factors.
• The factors affecting and impact of parent-child relationships, interaction, and attachment.
• The importance of establishing routines (e.g., sleep   hygiene, toileting).
• Cognitive and behavioural principles, including ABC (antecedent-behaviour-consequence)/functional analysis, ignoring, shaping, reward. Principles of learning and graded extinction.
• How to successfully engage parents and preschool children.
• The importance of multidisciplinary working.
• The influence of the key care settings and practitioners including day care, children’s centres and the value of using multi-informant reports and observations.
• The advantages and risks involved in early identification and intervention, the use of personalised models of care, stepped approaches to care that are led by individual and family need, the interconnection between early childhood and parental emotional disorders 
• The interrelationship and influence of significant emotional problems across developmental domains including neurological and brain development, cognitive appraisal and processing, social and peer relationships, language and communication, physiological and motor skills. 
• The typical development of sleep, feeding and toileting from birth to age 5 years, and the expectable range of deviation in pattern and timing of these among typically developing children.  The typical developmental course of infant crying, with particular emphasis on early-evening crying in the first year.
• The prevalence and types of regulatory problems commonly occurring among children aged 5 years and under.
• Aetiological factors in regulatory difficulties among young children, including physical/medical contributory factors or conditions that may need investigation prior to a behavioural or psychological intervention Social and cultural factors related to norms and practices for sleep, feeding, crying/soothing and toileting; contextual factors (e.g., family chaos, conflict) and co-occurring conditions (e.g., neurodevelopmental problems, chronic physical health conditions)
• The consequences of poor sleep and eating for children’s health and wellbeing.
• The impact of regulatory problems and persistent crying on parents/carers, associated risks (e.g., depression, non-accidental injury, maltreatment).
• The evidence regarding the effective treatment of sleeping, feeding and toileting problems in young children at different ages.
• Potential adverse consequences of parental pressure to encourage children’s eating and excessive restrictive practices aimed at limiting it.
• The importance of multidisciplinary working in cases with severe feeding problems and complex medical conditions, or where physical impairments may contribute to feeding or toileting difficulties.
• The aetiology, phenomenology, prevalence, diagnostic classifications and epidemiological characteristics of emotional, internalising and anxiety problems in infants, toddlers and pre-school children including developmentally sensitive diagnostic-specific as well as more diffuse presentations.
• The influence of heritable, intrinsic, life events and environmental factors on the vulnerability to and development of early emotional, internalising and anxiety problems.
• The clinical research literature on emotional, internalising and anxiety problems including predictors, moderators and mediators of treatment
• The range of child-focussed, parent-directed and self-directed evidence- based intervention methods, techniques and manualised programmes that are effective for young children experiencing emotional, internalising and anxiety difficulties including cognitive-behavioural and parent-child interaction methods.
• Comparison of outcomes resulting from self-directed, parent-directed, parent-child, family and child-only interventions.
• The influence and impact of concurrent intervention for parental anxiety and mood disorder on childhood emotional difficulties.
• The practical supports for running successful group interventions such as crèche facilities, refreshments, materials, relating to each member in a positive manner, agree group rules and confidentiality, managing group members including dominant and withdrawn ones, manage sessions content, time and tasks successfully so that time boundaries are maintained, to plan and enact role plays to illustrate key PT content, methods and techniques using a number of group participants, knowing when to share accurate information and knowledge in a helpful and constructive way alongside guiding and facilitating group members to reflect on and generate effective solutions, to draw out core principles seen in a vignette, allowing parents to speak first and give their views, relating content to parents’ own predicaments, following up parents who do not attend or engage with groups and/or individual approaches and to develop appropriate strategies for re-engaging parents and/or offering appropriate alternatives.

Intended Learning Outcomes (ILOs)

ILO: Module-specific skills

On successfully completing the module you will be able to...

• 1. Synthesise theory and practice in planning, delivering and reflecting on parent support therapy (PST) for children, young people and families
• 2. Apply the core competencies in PST for children, young people and families
• 3. Identify how you meet the relevant specific competency standards in PST for children, young people and families
• 4. Evaluate the use of routine outcome monitoring in PST practice

ILO: Discipline-specific skills

On successfully completing the module you will be able to...

• 5. Address systematically complex therapy practice problems that may be framed within unpredictable contexts, thinking critically, creatively, and independently
• 6. Critique the wider ethical and professional issues encountered within psychological therapy practice

ILO: Personal and key skills

On successfully completing the module you will be able to...

• 7. Appraise your personal strengths and weaknesses in training and experience, and reflect upon the implications for your further training needs
• 8. Function independently and reflectively as a learner and practitioner

Syllabus plan

This module is taught through weekly whole day workshops and half-day small group tutorials in terms two and three. Topics derived from the Incredible Years Parent Training Programme will form the core content of the workshops. There will be plenty of opportunities for skills practice and discussion of clinical issues through simulation and problem-based learning.

Learning activities and teaching methods (given in hours of study time)

Details of learning activities and teaching methods

Formative assessment

Summative assessment (% of credit)

Details of summative assessment

Details of re-assessment (where required by referral or deferral)

Re-assessment notes

Two assessments are required for this module. In all cases re-assessment will be the same as the original assessment. Where you have been referred/deferred for any form of assessment detailed above you will have the opportunity to resubmit within the period specified above from the date that feedback was provided.

If you pass re-assessments taken as a result of deferral, your re-assessment will be treated as it would be if it were your first attempt at the assessment and the overall module mark will not be capped.

If you pass re-assessments taken as a result of referral (i.e. following initial failure in the assessment), the overall module mark will be capped at 50%.

If you fail re-assessments taken as a result of referral (i.e. following initial failure in the assessment), you will be failed in the module and as a consequence you will be failed in the programme and your registration as a student of the University will be terminated.

Indicative learning resources - Basic reading

• Child IAPT National curriculum (2012). London: Department of Health
• Scott, S and Dadds, M (2009) When parent training doesn’t work: Theory-driven clinical strategies. Journal of Child Psychology and Psychiatry 50, 1441-1450
• Webster-Stratton, C. (2008). Collaborating with Parents to Reduce Children's Behavior Problems: A book for Therapists Using the Incredible Years Programs. Seattle: IY Press.

Indicative learning resources - Web based and electronic resources

• ELE page: http://vle.exeter.ac.uk/course/view.php?id=7173 (All resources will be made available on ELE. This includes additional material covered in the tutorials, the required readings, information about assessment and additional material (e.g., videos).)
• NICE (2013). Antisocial behaviour and conduct disorders in children and young people: recognition and management, CG158 https://www.nice.org.uk/guidance/cg158
• NICE (2006). Parent-training/education programmes in the management of children with conduct disorders, TA102 https://www.nice.org.uk/guidance/ta102
• NICE (2010). Nocturnal enuresis - The management of bedwetting in children and young people, CG111
• https://www.nice.org.uk/guidance/cg111
• Constipation (NICE, 2010). Constipation in children and young people, QS62. https://www.nice.org.uk/guidance/qs62
• NICE (2008). Maternal and child nutrition, PH11. https://www.nice.org.uk/guidance/ph11

Indicative learning resources - Other resources

• DVD/audio competency clips from IAPT and University of Exeter teaching team.

Key words search

Supervision, young people, children, improving access to psychological therapies, IAPT, cognitive behaviour therapy, parenting, competency assessment, 0-5s