Within your chosen topic area, – Health Psychology In Action: Children and the development, (chapter 3 by Tony Cassidy) – discuss the ways in which developmental psychology can inform practice.
Psychology is a cumulative scientific study of the mind based on empirically driven theories that link experience, behaviour and the brain. Health psychology, despite being a relatively new branch of applied psychology, is following that exact path. It is the study of the psychological processes of health, illness and healthcare systems (Cassidy 2006). While the breadth of the discipline is far reaching, its core goal is the use psychological theories and interventions to prevent damaging behaviour.
Perhaps the mind begins as a blank slate and we start of as perfect idiots. At the other extreme, it could be like a Swiss-army knife, a collection of innately structured neural modules – or perhaps it starts off undifferentiated and becomes modular. Is it our cultural learning or meta-representation that shapes our behaviour? (Wexler 2006) There is no shortage of one-line theories of human nature. However, when it comes to children there is very little room for error. There is overwhelming evidence documenting the effect of early childhood experiences with their long term health and associated behaviours. For example, stress in early life can inhibit neurogenesis in later adulthood (Tucker 2002; Karten et al 2005), but to what extent does such developmental theory actually inform real life practice? Or in other words, are the current initiatives used by health psychologists working in the way theories predict? There isn’t room for an exhaustive search here and so this piece will focus on a few practical examples.
More than 400 million adults worldwide are obese according to the World Health Organization (2004) and children from many difference socio-cultural backgrounds are at risk (Cassidy 2006). There are a barrage of studies contemplating how our surroundings are responsible for the growing obesity problem (Brownell 2004). These papers all point towards two key issues:
(a) The easy availability of foods that are high in fat.
(b) Poor opportunities for exercise.
While it is intuitively obvious why people become obese, the relationship between weight and behaviour is still highly complex and health psychology has attempted to identify some of the reasons behind the obesity epidemic. For example, a large body of evidence suggests that the family environment is the major source of influence over childhood eating behaviour (Rivett 2008).
Psychologists have attempted to influence children’s food choices through the application of social learning theory in programmes such as The Food Dudes Program (Tucker 2002). The researchers developed a video of four older children who appeared to gain super powers for eating fruit and vegetables. The basic premiss being that a child is more likely to imitate the behaviour of a person they admire and is consistent with a behaviouralist approach because there are rewards for behaviours which are desirable.
Similar programs have borrowed from Gratton et al (2007) and have used the Theory of Planned Behaviour (TPB) as a framework to promote children’s fruit and vegetable consumption. TPB posits that behavioural intentions are the proximal determinants of actual behaviour, with the perception of control being an important co-determinant of behaviour (Gratton et al 2007). The programme simply took two groups of children and showed one group ways in which they could make time in the day to eat five-a-day and another group on how they could overcome motivational barriers to achieving this goal. Both interventions were found to be successful. Similar programmes encouraging children to take exercise also exist (Cassidy 2006).
Despite some success stories, the effects have been disappointing in the long-term with such programmes (Brownell 2004). Surrounded by a social construct implying that being overweight is normal and acceptable, psychologists are presented with a constant struggle. However, by improving children’s own understanding of illness, this can promote healthy actions by groups and in tandem with a new TPB framework, help improve future lifestyle choices (Williams & Binnie 2002).
The focus of preventive intervention is also a key area of theoretical implementation in health psychology. This fits with a biopsychosocial model where biological, psychological and social factors are implicated in both health and illness. Prevention cannot focus on only a single factor. For example, drug misuse in adolescence, both legal and illegal, is an issue across the developed world which can be tied into other more serious health concerns (Cassidy 2006).
Three aspects of family background have been found to predict risk of drug use: parental involvement in crime, poor relationships with parents and unsupportive child-parent interactions (Mazanov & Byrne 2008). Interventions have sought to use social inoculation theory developed by McGuire in the 1960s – the basic ideology being that decisions are made in the context of social pressure. More recent work has attempted to model what makes an adolescent successfully quit smoking and found that past behaviour explained more than four times the variance of other factors (Mazanov & Byrne 2008). On the other hand, family environment is evidently a key area of theoretical and subsequent practical intervention. Recent research has proposed that family therapy is currently undergoing radical change, but this change seems to be driven by more contextual factors as opposed to new theoretical advances. (Rivett 2008)
However, any interventions are often clouded by the prevalence of problematic behaviour patterns including impulsivity and rebelliousness making behaviour difficult to predict:
‘The 14 year old has a very simple decision to make. When he sees a light out of the corner of his eye, he is supposed to ignore it.’ (Powell 2006, p. 865)
This is an extremely easy task and even 8 year olds can do it correctly half of the time, but it requires suppressing a natural impulse – not the strong point of most teenagers. In this simple test the teenager performs as well as adults do, but inside his head, a lot more cognitive effort is required, as shown by recent functional magnetic resonance imaging studies (Powell 2006). Are outdated theories keeping up with new physiological knowledge or should health care be expanded amongst the young – moving away from traditional approaches and into the community? (Williams et al 2002)
Health psychology is a new and exciting discipline and is constantly surprising both the academics and applied psychological communities. From enhanced wound healing after an emotional disclosure intervention (Weinman et al 2008) to simply using a distraction intervention to ease the pain of pre-school children undergoing injections (Dahlquist et al 2002), there is a constant stream of new theories and interventions. However, no one theory is going to answer and treat all our health problems and there is always an inherent danger when generalizing to large populations. There is a tendency for fragmentation within modern applied psychology that inevitably results from the growth and development of individual areas.
Brownell, D. K. (2004) Food Fight, London: McGraw-Hill
Cassidy, T. (2006). Health Psychology: children and development. In Wood et al. (eds) Developmental Psychology in Action. Blackwell Publishing. p. 101-135
Dahlquist, M. L., Pendley, S. J., Landthrip, S. D., Jones, L. C., & Steuber, P. C. (2002) Distraction intervention for preschoolers undergoing intramuscular injections and subcutaneous port access. Health Psychology, 21 (1), 94-99
Gratton, L., Povey, R., & Carter, D. (2007). Promoting children’s fruit and vegetable consumption: Interventions using the Theory of Planned Behaviour as a framework. British Journal of Health Psychology, 12, 639-650
Karten, J. G. Y., Olariu, A., & Cameron, A. (2005). Stress in early life inhibits neurogenesis in adulthood. Trends in Neuroscience, 28 (4), 171-172
Powell, K. (2006). How does the teenage brain work? Nature, 442 (24), 865-867
Rivett, M. (2008). Towards a metamorphosis: current developments in the theory and practice of family therapy. Child and Adolescent Mental Health, 13 (3), 102-106
Tucker, M. C. (2002). Expanding pediatric psychology beyond hospital walls to meet the health care needs of ethnic minority children. Journal of Pediatric Psychology, 27 (4), 315-323
Weinman, J., Ebrecht, M., Suzanne, S., Walburn, J., & Dyson, M. (2008). Enhanced wound healing after emotional disclosure intervention. British Journal of Health Psychology, 13, 95-102
Williams, M. J., & Binnie, M. L. (2002). Children’s concepts of illness: An intervention to improve knowledge. British Journal of Health Psychology, 7, 129-147