Child development theory is a demanding and competitive area driven by a need understand the exact nature of the developing child. Traditional medical models of understanding and intervention are in stark contrast to more recent psychological models initiating the debate over which model is of most value and how best to meet the developing needs of your child.
The journey from birth, through infancy and onto adulthood is by no means a smooth one and can be challenged by many factors. Two such examples are that of Down’s syndrome and autism.
Medical Models of Intervention in Child Development
History shows a medical model of understanding and intervention has held dominance in the past. This approach views difficulties experienced by a child to be that of ‘disease’ and should be treated in the same respect.
A clear route of investigation, diagnosis, treatment to cure is employed by fully trained medical professionals with little or no reference to social interactions or circumstance. Moreover, intervention is entirely focussed on the child and treatment given to that child.
Psychological Models of Intervention
The more recent development of a psychological model of intervention is concerned with psychosocial factors such as relationships with parents and siblings and environmental factors such as the circumstances the child is living in.
Intervention follows a more explorative route taking time over assessments and aiming to achieve a favourable ‘outcome’ rather than a ‘cure’. The psychological model is also particularly concerned with intellectual development which is a topical starting point for this debate.
Intellectual Development in Children
The definition of intellectual impairment depends very much upon which approach is used. The medical model approach views this as intelligence that is measured by standardised methods, i.e. IQ tests. Intelligence is assessed and when scores are lower than a certain level or where a diagnosis has been made regarding lower than what is considered ‘normal’ intelligence, intervention is usually activated.
A psychological model defines intellectual ability as what is different from the majority. Overall the level of intelligence that has been labelled ‘normal’ is of crucial significance and is used as a baseline.
Children’s intelligence is generally not measured by standardised means but often children are grouped into categories with others of similar ability. They are then labelled with a term which is considered appropriate by society at that particular time.
Differences in ability such as this has created several explanations. Three in particular were identified by Zigler and Balla (1982);
1) deficit in that a process is missing and clear brain dysfunction is present,
2) delay in that a child’s development is delayed and,
3) difference where a child is operating in different ways to others.
Both the delay and difference models refer to children who have no brain dysfunction but do have some form of intellectual impairment. All three models have recently been applied to the development of children with Down’s syndrome and autism.
Down’s syndrome is a genetic chromosomal disorder which can be detected prenatally, however identification often occurs shortly after birth where abnormalities can be tested for.
Children who have Down’s syndrome take longer to process visual information than others and also process tactile information differently. A common intervention method at the present time in the UK is that of Portage.
This is a medical model of intervention that focuses solely on the child and uses standardised methods of treatment. Designed in the US, Portage is a method involving a key worker who, using a developmental checklist, works with the child and the carer to set developmental targets over a set period time, including when to work on a particular skill and how to go about it.
This process is repeated with each visit with the aim to encourage development to the standard of a ‘normal’ child on which the checklists are based upon.
The Portage method has been praised by parents and carers, however it is difficult to pinpoint whether it actually has any long term benefits for the child.
This kind of intervention follows a traditional route where a difficulty is identified and a treatment is employed.
Other factors such as parenting and social interaction are not considered and not incorporated into the intervention programme. These points highlight the areas in which a medical model of intervention such as Portage may not consider, and areas in which many researchers feel are too significant to ignore.
The criticism of the Portage method is the basis in which the developmental checklists, in which this method relies on, are created. They are centred on the developmental stages and milestones of a ‘normal’ child and may not be the most effective way of improving the development of a child with Down’s syndrome.
Down's Syndrome Information
Some researchers claim children with Down’s syndrome follow the same path of development as non-Downs syndrome children but their development is delayed (Dunst and Trivette 1990). Whereas others disagree, and believe a delay model cannot explain the many differences in which these children display (Morss, 1985).
Which model is applied to conditions such as Down's syndrome determines which model of intervention is favoured. Despite disagreements amongst researchers on this issue it is becoming increasingly apparent that a psychological model of intervention may be a more effective method to improve development in such children.
Many researchers such as Wishart (1990) are pushing for an intervention model which is designed specifically to the child and that is in line with the understanding of conditions like Down’s syndrome and how they develop. In particular this involves recognising that such children are developing in different ways rather than having just delayed development.
These more recent opinions are also reflected in other conditions. One such example is that of autism.
Autism was originally identified by Kanner in 1943 as being a condition of innate causes where children display an inability to relate to or hold relationships with others. It is condition often undetected until early infancy when a child’s behaviour becomes a concern when it does not fit with the ‘norm’.
Autism causes impairments in social, communicative and imaginative functioning and research suggests it has biological origins. This has lead to a medical model of intervention where similarly to Down's syndrome, intervention is based around a standardised education programme which uses the ‘normal’ development route as a base.
Autism is now recognised as a lifelong condition where behaviour and skills can be improved but autistic behaviours will be present throughout life.
Causes of Autism
The causes of Autism are under great debate centred on the key questions of whether it is a condition caused by environmental factors or by factors from within the child. Consequently, which approach is taken towards the cause will greatly influence the method of intervention undertaken.
Further to Kanner’s early claims, research has suggested Autism is not caused by innate factors but autistic behaviours are in fact symptoms of delayed personality development. Significantly, Kanner himself altered his view in later years and highlighted environmental factors, education and parenting as equally influential in the causes of autism.
Bettelheim (1967) was strongly against innate causes and believed if parenting was erratic and a child was not cared for correctly in infancy they would not develop a mature personality due to a lack of social interactions and begin to show autistic behaviours. Further, he favoured a psychological model of intervention.
Support for a psychological method of intervention can also be seen in the techniques of Niko and Elizabeth Tinbergen in the 1970’s. They suggested an emotional and motivational imbalance in a child may be the cause for autistic behaviour (Chance, 1985). They believed that this in turn causes autistic children to find strong emotions overwhelming, causing them to become withdrawn, often from people and surroundings they are familiar with. They suggested a technique called ‘holding therapy’ designed to strengthen the mother-child bond.
Is Autism Genetic?
Morton (1989) suggests autism has a genetic basis. Studies conducted have suggested abnormal brain functioning may be a significant factor.
For example, links have been found between autism, infantile spasms and epilepsy pointing at brain stem and temporal lobe dysfunction. Furthermore, neurochemical studies have shown a difference in the brain functioning of autism suffers in comparison with non autism sufferers.
Variable expressivity has been suggested as a possible factor in autism where a parent or a sibling of an autistic child may have a cognitive impairment, providing further support for a genetic basis.
Early intervention in autism is often centred around management of the behavioural and communication difficulties experienced. Programmes based on operant conditioning are common and are often employed through special schools and education programmes designed for children with conditions such as autism.
Examples such as Down’s syndrome and autism serve as illustrators to the current theory, research and methods that are in place.
The current debate centres on whether these conditions are due to a delay in development or a complete difference in the way development proceeds. More recent research appears to be pointing towards a difference model rather than a delay model, certainly in the cases of autism and Downs syndrome which has strong implications for intervention.
Overall it can be said that modern research is providing increasing evidence, adding to this debate all the time. Embracing social factors such as parenting and social interactions alongside the child’s personal difficulties may provide a more efficient and positive intervention method which can only be improved upon in time as research grows.
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Bettelheim, B. (1967). Empty fortress. Simon and Schuster.
Chance, M. R. A. (1985). " Autistic" Children: New Hope for a Cure By Niko Tinbergen and Elizabeth A. Tinbergen (review). Perspectives in Biology and Medicine, 28(4), 636-638.
Dunst, C. J., & Trivette, C. M. (1990). Assessment of social support in early intervention programs.
Faulkner, D and Lewis, V. (1995) ‘Psychological Intervention: Down’s Syndrome and Autism’ in Bancroft, D and Carr, V. (1995) ‘Influencing Children’s Development’, Oxford, The Open University/Blackwell
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous child,2(3), 217-250.
Morss, J. R. (1985). Early cognitive development: Difference or delay. Current approaches to Down's syndrome, 242-259.
Morton, J. (1989). The origins of autism. New Scientist, 124, 44-47.
Wishart, J. G., & Duffy, L. (1990). Instability of performance on cognitive tests in infants and young children with Down's syndrome. British Journal of Educational Psychology, 60(1), 10-22.
Zigler, E., & Balla, D. (1982). Motivational and personality factors in the performance of the retarded. Mental retardation: The developmental-difference controversy, 9-26.
© 2014 Fiona Guy
Fiona Guy (author) from UK on February 14, 2015:
It certainly is a challenging area and everybody wants the best for their child. The parents role is really very important and such a responsibility for any individual. Thank you Stewart for reading and sharing your thoughts!
Stewart Guy on February 13, 2015:
This is an excellent hub, voted up; and a very challenging area for the medical profession as well as for parents of a child or children with either Downs Syndrome or Autism. Let us all hope that further research can answer some of the questions on the best way to help the children who have these conditions and the parents to better understand that they play a crucial role in a child's development from the day the are born!
Fiona Guy (author) from UK on December 08, 2014:
Thank you DDE! I totally agree, those early years for learning and development are so very important for children and I do wish more parents would take that on board!
Devika Primić from Dubrovnik, Croatia on December 08, 2014:
incredible! Child development is crucial and very important for all parents to pay attention to. A useful hub and I voted up!