In a book on psychological theories of child and adolescent development, why are we including an (albeit brief) consideration of a perspective on children's behaviour, which is arguably not a theory, not developmental in nature and not based in the psychological tradition? We consider it essen- tial that this approach be addressed, given the real impact a medical per- spective has on the lives of many children whose behaviour is considered to be problematic in some way. Both undergraduate and postgraduate stu- dents may be introduced to a medical diagnostic approach to children's behavioural and emotional problems, and indeed clinical psychology
course accreditation may require that students learn psychiatric diagnosis.
However, in our experience, the specific issue of how such an approach accords (or otherwise) with psychological theories of child development (and indeed, with the scientist-practitioner model frequently espoused by professional psychology courses - see Chapter 12) is rarely addressed.
Students and beginning practitioners (and perhaps many not-so-beginning practitioners!) are left to try and make sense of the professional dilemmas this can cause. For example, a psychologist working in a hospital setting in Australia may conceptualize a child-client's difficult behaviour in terms of scientifically well-established principles of learning theory. S/he would devise an intervention accordingly, considering issues such as antecedents and reinforcers. However, the official hospital records may not reflect this theoretical orientation at all, but require the psychologist to record the case in terms of a medical (psychiatric) diagnosis, which may be irrelevant to how the case was actually conceptualized and managed.
The pervasiveness of the medical model in industrialized societies may also cause behaviours to become seen as problematic. Imagine, for example, an overstretched mother struggling to cope with many demands including a lively toddler; if she sees a TV programme about ADHD it will not be sur- prising if she decides that her child must have this condition and so visits her doctor to request psychostimulant medication. There is, indeed, evi- dence that parents frequently present their children (and even themselves) as suffering from ADHD (Searight and McLaren, 1998). ADHD illus- trates the application of medical diagnoses to children's (and adults') behaviour, as laid out in various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association
(APA, 1994) - another example of Pepper's (1942) 'formism' metaphor.
When this manual was drawn up, it was done so as a descriptive taxo- nomic system, which was explicitly claimed to be atheoretical, to enable it to be used by practitioners favouring different theoretical orientations.
However, it is not possible to devise an explanatory system devoid of underlying theoretical assumptions. Those underlying the DSM project include viewing mental disorder as a subset of medical disorder, with each illness defined by certain behavioural criteria that are endowed with bio- logical significance, removing them from any broader contextual consider- ations. Butler claims that 'despite the cool neutrality of its language, the diagnostic project was intended from its inception to lead to a progressive exclusion of non-biologically focused systems of explanation (psycho- logical, psychosocial, psychoanalytic) from authoritative psychiatric discourse' (Butler, 1999: 21). Butler and others have argued that successive changes to DSM classifications, rather than being driven by scientific evidence, as claimed, have been heavily influenced by sociocultural factors - the modi- fication and eventual removal of homosexuality as a mental disorder, in the face of the gay liberation movement, being a prime example.
To return to the example of ADHD, this provides perhaps the best illus- tration of the current trend to view children's problematic behaviours through a medical lens. ADHD is often 'uncritically accepted as a neuro- biological condition' (Reid and Maag, 1997: 13), with children's problem- atic behaviours in the areas of attention, impulsivity and high activity levels attracting a medical label and a drug-based solution (usually methylphenidate). In fact, three-quarters of children diagnosed with ADHD are seen solely by general medical practitioners, without any psychological evaluation occurring (Searight and McLaren, 1998). The wide acceptance of this medical perspective has sidelined the expertise of other professionals, including child psychologists, whose very area of expertise is children's behaviour (Atkinson and Shute, 1999). Furthermore, the increased demands that industrialized countries place upon children for educational achievement, together with declining education and mental health budgets, increase the pressure for children's behaviour problems to be treated medically (Searight and McLaren, 1998). Consequently, chil- dren are more likely to receive drugs than a careful assessment and inter- vention in terms of the contextual factors maintaining the behaviours or for consideration to be given to the role of broader public policy and fund- ing issues (Prosser et a/., 2002); see also Box 2.2.
Even ADHD policy documents in which psychologists have played a leading role use the medical term 'diagnosis' rather than the psychological term 'assessment', and may grant precedence to the medical profession in assessment and intervention (Atkinson and Shute, 1999). In fact, some psychologists argue strongly that it is vital for psychologists to be excellent diagnosticians. On the other hand, expert psychological evidence has been ruled inadmissible in court with regard to behaviours codified within the DSM since such behaviours are judged as within the domain of medicine (Australian Psychological Society, 1998). This is part of a general pattern that has been identified in western societies of 'medicalization' of non- disease states, with relief sought for discomforts and distress that would have been tolerated in the past (Searight and McLaren, 1998). For example, it can be questioned whether it is really appropriate for as many as 12 per cent of boys in the USA to be taking methylphenidate for ADHD (Searight and McLaren, 1998). If indeed the very intention of the DSM project was to sideline alternative theoretical perspectives on mental and behavioural problems, it has succeeded very well, with those raising voices in protest such as Butler (1999), Pilgrim (2000a; 2000b) and critical psychologists (Bendle, 2001) being in a minority to date.
Thus it can be seen that a document that purports to be atheoretical in fact has underlying theoretical assumptions and has been claimed to further certain professional interests to the detriment of others, even those with genuine expertise in the area at hand. It can therefore be difficult in practice for the alternative perspectives on child development
Box 2.2 ADHD: the social context of biological explanations
The labelling phenomenon represents a powerful social force in the United States which supports and maintains the perspective of ADHD being a neurobiological condition. ADHD is a potent and desirable label of forgiveness because it attributes troubling behaviour to physiological forms (i.e. neurobiological) outside an individual's control. ... the ADHD label legitimizes parents' concerns that children do, in fact, manifest problems and that those problems are recognized, common, and socially palatable.
Problem behaviour now can be portrayed as an inability to respond appropriately to an underlying disorder, rather than unwillingness, lack of motivation, or poor parenting. ... the ADHD label allows parents to 'externalize the disorder' thereby separating the 'good' child from the 'bad' behaviour ... a diagnosis of ADHD may be the most powerful route for parents to secure services for children.
(Reid and Maag, 1997: 15)
considered in this book to be brought to bear effectively to address children's behaviour problems, in accord with melioristic values as noted previously.
Conclusions
Biological influences on child development theorizing have been apparent ever since the discipline emerged. With the advent of new technologies for studying genes and brain function, biological approaches to development are gaining further credence, as is a tendency to conceptualize children's behaviour problems from a medical perspective.
While it is generally accepted that genes and the environment interact to produce developmental change, controversies continue about the relative role of each and how far development can be modified by environmental change. A major attraction of evolutionary and other biological approaches to behavioural development may be that they provide psychology with a yearned-for basis in the physical sciences (Miller, 1999). Miller notes that such approaches sideline cultural issues. Culture is seen as an aspect of the environment that contributes to a greater or lesser degree in psychological processes, but not as a qualitative determinant of the patterning of those processes. She presents a theoretical argument for why culture must be viewed as an integral part of theorizing in psychology. We take up this theme in Chapters 7 and 9. Other aspects of biological approaches we
discuss or revisit elsewhere include Pavlov's research on conditioned reflexes (see Chapter 6), the current tendency to view neurological ex- planations as superior to cognitive or behavioural ones (see Chapter 7), the attempt to develop a systems theory of development that is biologically valid (see Chapter 11) and the notion that evolutionary theory has the potential to play an integrative role in developmental theorizing (see Chapter 11).
sum of its colours:
beginnings of organicism
Introduction
Organicism, as described by Pepper (1942), draws heavily upon the image of the growing organism whose development is significantly shaped by mutual influence and the patterning of its parts. What is important is not the 'uniqueness' of the individual child but rather the universal features of children. Theories in this tradition emphasize internal regulation and organization, and the ability of the organism to organize and reorganize itself at different levels.
A number of different features underpinning development have been commented upon by organismic theorists. First, it has been noted that children generally share some common features in relation to behaviours and capabilities; for example, children crawl before they walk. Second, there is some commonality in the timing of the emergence of behaviours and abilities; for example, most children will start to crawl at around the same time. Third, while deviations from the general path of development may occur, such deviations tend to be short-lived. Fourth, new abilities and capabilities of quite a different nature emerge out of early behaviours;
thus walking is a very different activity from crawling.
The organismic tradition has drawn heavily upon biological writings including evolutionary theory (see Chapters 2 and 11). Human develop- ment is conceptualized in terms of the interaction involving genetic maturation and experience. Development unfolds according to a purpose or design - a teleological view. As part of this unfolding, development is frequently conceptualized discontinuously, in terms of stages. The human organism is understood to be relatively active in terms of seeking out and responding to a more or less passive environment. Generally, organismic theories espouse that the organism is different from the sum of its parts, and the structural arrangement of the parts is quite significant.
The nature of organismic thinking is better understood in the light of some historically influential ideas. We will outline these before considering the views of a number of early organismic theorists.