Focusing the APA Ethics Code to Include Development: Applications to Abuse

Abstract

Extant ethics codes in psychological work generally are not sufficiently developmentally oriented. Here, we examine the American Psychological Association ethics code for its developmental sensitivity, find it lacking in this regard, and make recommendations. Our approach was to place children and youth at the forefront in forming developmentally-targeted principles, meta-principles, values, and rights. To further this aim, we consulted the one ethics code in the field that is developmentally-attuned, the ethics code of the American Academy of Child and Adolescent Psychiatry. We used a revised set of ethical principles for psychological work and developed a set of meta-principles. The five APA ethics code principles are: (a) beneficence and nonmaleficence; (b) fidelity and responsibility; (c) integrity; (d) justice; and (e) respect for people’s rights and dignity. The set of ethical principles taken from Young (Revising the American Psychological Association ethics code, Springer International Publishing, 2017) includes: (a) life preservation, (b) caring beneficence/nonmaleficence, (c) relational integrity, (d) respect for the dignity and rights of persons and peoples, and (e) promoting and acting from justice in society. The major meta-principles proposed here include: (a) functioning from responsibility, (b) promoting personhood, and (c) promoting participation. In addition, we added meta-principles for working from appropriate (d) theory and (e) meta-theory (Neo-Maslovian and a combined relationism-empiricism, respectively). Secondary meta-principles in the text refer to (a) systems, (b) the person as unique, (c) the vulnerabilities of people, (d) autonomy, and (e) morality.

Introduction

Working with children and youth is ethically challenging and the extant mental health ethics codes are not sufficiently sensitive to the special ethical demands required to work with them. For example, a fully-informed and functioning ethics code will refer extensively to the abuse or maltreatment of children and youth. There are close to 700,000 victims of child abuse each year (US Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, 2022) and psychologists are likely to come into contact with these cases and have a legal duty to report. There are also situations with children that may involve harm, yet might not meet the threshold of reporting. Bullying, which is a common occurrence among youth, can have devastating effects, but might not be considered serious harm in the same way as suicide (Graham, 2016). Other issues that are relevant when working with children and youth, and require modifications related to them in ethical codes, concern confidentiality and informed consent. Also, children and youth need to have their voices heard in all situations that deal with them psychologically, such as in custody and access disputes, consent for treatment and research, and any situation in which the law is involved.

The ethics code of the American Psychological Association (APA, American Psychological Association, 2017a) is a comprehensive document based on five ethical principles and 89 standards. The APA ethics code principles are considered aspirational, intended to guide the behavior of psychologists toward the highest ideals of the profession. The code includes multiple standards, which are not aspirational but obligatory for psychologists. For example, there are standards that deal with competence, record keeping, fees, assessment, and therapy. Each of these standards contains further specific information and guidance on topics within the larger standard. For example, under the Assessment standard, there are guidelines related to informed consent in assessment and explaining assessment results. The five APA ethics code principles are: (a) beneficence and nonmaleficence; (b) fidelity and responsibility; (c) integrity; (d) justice; and (e) respect for people’s rights and dignity. The APA ethics code is currently in revision (American Psychological Association, Ethics Code Task Force, 2020).

Young (2017) reworked these ethical principles by comparing them to those of the Canadian Psychological Association (CPA, 2017) and giving it a theoretical underpinning by relating them to the five levels of his Neo-Maslovian model. But he did not explicitly relate his revised list of ethical principles and the multiple other suggestions toward revising the APA ethics code in terms of developmental considerations in ethics. The five reworked ethical principles proposed by Young (2017) referred to: 1. life preservation; 2. caring beneficence/nonmaleficence; 3. relational integrity; 4. respect for the dignity and rights of persons and peoples; and 5. promoting and acting from justice in society. Young added five supplementary principles, referred to as: 1. adopting a system perspective (ethics as system); 2. adopting a scientific perspective (ethics as science/science as ethics); 3. adopting a legal and governing authority perspective (ethics and laws); 4. abiding by ethical standards in mental health testing and evaluation (ethics and assessment procedures); and 5. screening and detecting symptom under overreporting (ethics in symptom/performance validity).Young listed five sub-principles for each principle. For example, for 2. caring beneficence/nonmaleficence, they are: (1) maximize benefit, (2) minimize/correct harm, (3) risk/benefit ratio, (4) caring, and (5) harms.

Although Young (2017) did not address the lack of a developmental perspective in the APA ethics code in his monograph, Young and Kenny (2022) started to work on developmental ethics in this regard. They noted that working with children and youth experiencing psychopathology leads to situations that are ethically challenging and complex, thus requiring careful professional consideration. They examined the major areas in working with children in these regards. Because of children’s legal status as minors, there are many ethical considerations that emerge in working with them that are not factors to consider with adults.

Developmental Considerations in Ethics

Ethics is a dynamic, evolving area, and psychologists need to be aware of recent developments in the field and their competence in addressing ethical issues (e.g., Drogin, 2019). This is illustrated by reference to the standard ethics code that govern practice in the field, such as those for psychologists (APA, 2017a) and psychiatrists (American Medical Association, AMA, 2017). Typically, they give short shrift to particular issues related to children and rarely address how their principles and standards might apply differentially to children and other vulnerable populations.

A search of the terms “child,” “development,” and related words in the APA ethics code yielded almost no entries, and nothing of import to dealing ethically with children. The word “child/children” appears once in the APA code, in relation to providing therapy to couples and families. Specifically, the standard suggests making it clear at the outset who is the client and the relationship the psychologist will have with each person. The term “development” appears three times, all in the preamble, and not in the context of relating to children or youth. Rather, the word development was used in the context as a verb, specifically in “development” of policy or assessments. Although the ethics code of the AMA (2017) hardly refers to children and youth, Young and Kenny (2022) consulted the ethics code of the American Academy of Child and Adolescent Psychiatry (AACAP, American Academy of Child & Adolescent Psychiatry, 2014). Here, children and youth are better served ethically, but still in a very limited way compared to what this article is suggesting.

The use of the term “developmental perspective” within the first principle of the AACAP (2014) code of ethics demonstrates the importance it places on this concept. Similar to other codes, the next two principles are beneficence and nonmaleficence. The following Principles IV and V refer to Autonomy and are similar in nature to the APA Principle E. The AACAP Principle IV refers to Autonomy (i.e., assent and consent, confidentiality; which are embedded in the APA principle E). Principle V refers to Fidelity, which is also in the code’s Principle VI on Third Party Influence. Principle VII in the AACAP code refers to Scholarship and Research, while Principle VIII refers to Justice, Principle IX to professional rewards (e.g., financial), and Principle X to Legal Considerations.

There is much overlap in the AACAP ethics code with the APA ethics code, but a notable difference is that topics that are covered in the standards of the APA ethics code are placed as principles in the child psychiatric one. Also, the AACAP code highlights research and law as separate areas of principled ethics, which are noteworthy additions. (See Table 1 for a comparison of the principles of the two ethics codes).

Table 1.

Comparison of APA and AACAP Ethical Principles

American Psychological Association APA (2017)	American Academy of Child and Adolescent Psychiatry AACAP (2014)
A. Beneficence and Non-Maleficence	I. Developmental Perspective
B. Fidelity and Responsibility	II. Promoting the Welfare of Children and Adolescents (Beneficence)
C. Integrity	III. Minimizing Harmful Effects (Non-maleficence)
D. Justice Principle	IV. Assent and Consent (Autonomy)
E. Respect for People’s Rights and Dignity	V. Confidentiality (Autonomy/ Fidelity)
	VI. Third Party Influence (Fidelity)
	VII. Research Activities
	VIII. Advocacy and Equity (Justice)
	IX. Professional Rewards
	X. Legal Considerations

Adapted from the APA (2017a) and the AACAP (2014)

Although both the APA and AACP ethical codes are reasonably comprehensive, there are some glaring omissions. Young (2017, 2020) has advocated for a principle on science focus, which would include evidence-based practices, treatment, and assessments. The draft of the revised APA ethics code (APA, Ethics Code Task Force, 2020) does refer to the Principle of scientific mindedness, which is a noteworthy addition and is consistent with Young’s recommendation. Young (2017, 2020) has also proposed a principle on Life Preservation in his revised principles for an ethics code for psychologists. This principle would include areas such as dealing with suicidality, duty to warn and protect, and prohibition of involvement with torture. The APA has always been clear in its role about psychologists’ role in torture (strictly prohibited). But Young (2017) placed all these critical aspects in life preservation under one principle, highlighting the cohesion and importance of these issues.

Ethics in psychology provide guidance in two important areas of professional work. The first is in providing obligatory rules and guidelines that psychologists must adhere to in interactions with patients, patients’ family members, research participants, colleagues, etc. Secondly, ethics codes provide awareness of how to handle ethical conflicts between, for example, one’s ethical codes and their relevant state or federal laws. When conflicts seem unavoidable, various ethical decision making models provide assistance and steps to help manage the conflicts (e.g., Pope et al., 2021; Young, 2017).

Our own approach to these conflicts is that psychologists’ duty to their own moral codes is equally important as their laws and applicable ethics codes. Perhaps the best example of this is the torture imbroglio that plagued the APA for years (Pope, 2016) and remains not fully resolved. To be fully moral and use applicable ethics codes as useful tools in addressing moral dilemmas, psychologists need guidance beyond the particular principles in their ethics codes. Here, we suggest that a solution to help resolve complex moral dilemmas, ethical codes should adopt meta-principles and not only principles.

Meta-Principles in Ethics

In this sense, we propose three major superordinate ethical principles or meta-principles to extant mental health ethics codes, one of which was included in Young (2017). These three principles add to two more that are conceptual, as presented in Young (2017). First, the various principles in the APA and other ethics codes all relate to Responsibility, and the term should not be relegated to part of one principle or even become a separate principle (Young, 2017). In Young (2017), the meta-principle was referred to as Re-Responsibilities. Acting from a stance of adopting a responsible ethical role in all undertakings as the psychologist conducts work will facilitate navigating tricky issues over codes, laws, and personal morality.

Second, an overarching principle in mental health ethics is that our patients, research participants, and other contactees are characterized by their personhood, the development of which is a fundamental human right (Young, 2019). Keeping in mind that our ultimate ethical priority is to optimize our patients and other contactees in terms of their personhood development also will help us deal with difficult ethical situations. Third, children need to have their voice respected, and treated as equals even if they are younger, vulnerable, and perhaps manifesting psychopathology, as will be discussed here. Children should not be shunted aside, objectified, etc., but need to be listened to and validated, especially when decisions taken by adults, psychologists, or authorities involve them and their status (Young & Kenny, 2022). The overarching ethical principle here concerns Participation.

Young and Kenny (2022) also referred to these meta-principles in ethics beyond Re-Responsibilities. They referred to them as (a) Promoting Participation and (b) Promoting Personhood. Other proposed relevant meta-principles are more conceptual – there should be a theoretical basis for the select few ethical principles, as well as an appropriate world view (Young, 2017). Specifically, Young (2017) proposed two broader ethical meta-principles – (d) Theory organizing the principles (Neo-Maslovian), and (e) Integrated world view (integrating positivism and relationism).

Further, Young (2017) had suggested a superordinate standard dealing with Autonomy that covers informed consent, confidentiality, and anonymity, and we take a similar approach in grouping together these topics under one rubric as we proceed. Young and Kenny (2022) similarly referred to the principle of Autonomy. Here, then, we refer to not only five meta-principles in ethics but also five secondary ones, which include Autonomy. Given this new concept of five secondary meta-principles, we refer to the five major meta-principles as primary. Thus, here, we have created an inclusive model of five primary and five secondary meta-principles in ethics. Next, we elaborate these principles and indicate for each one what it means for development, giving the example of child maltreatment/ abuse, where applicable.

Primary Meta-principles

1. Theoretical Source, per Young (2017). The theoretical model that informed Young (2017) in his elaboration of five revised ethical principles is Neo-Maslovian. Young’s Neo-Maslovian model extends Maslow’s five levels of hierarchical needs by including Eriksonian concepts, in particular. He noted that Maslow had referred to the five levels as reflecting a developmental progression as much as a motivational one. Young examined the contents of each of the five levels in the theoretical model and noted a correspondence across the five revised levels in the model and the five revised ethical principles of the APA ethics code. For example, the Maslovian reference to most basic physiological needs in the first level of the model corresponds to Young’s principle of Life Preservation.

   Therefore, here, we re-emphasize that the Neo-Maslovian model is explicitly developmental, and not just about hierarchical needs, as per Maslow and in Young (2017). That is, a proper understanding of the five revised ethical principles in Young (2017) indicates the need not only to understand their correspondence with a model that is developmental but also to adopt a developmental sensitivity in examining and applying them.

2. Epistemological World View, per Young (2017) (Integrated positivism and relativism). Young described the opposition between two major world views that pertain to psychology, the traditional positivistic, empirical one and the more dialectical, relational one (Overton, 2013). He advocated for an integrated epistemological approach in these regards. In this sense, here, we maintain that we construct the person from our world view, but cannot do so without considering empirical and factual realities. This means that we need to especially consider the context. The person/ entity with whom we are working with (the contactee) cannot be considered as a separate person/ entity, nor can we. Also, we have to understand and accommodate our own biases, which are constructed. Also, in working with contactees, we have to be evidence-indicated (supported, based), or working from reliable and valid data, methods, and models/ theories in developing our targeted approaches to the issues at hand for the contactee, and these need to understand the constructed world of the person. Developmentally in these regards, there is no room for error, as with traumatized/ abused children and youth. They have a very subjective construction of the world based on their objective negative experiences, and different realities have to be constructed with them (while changing their objective situation, as through child abuse treatment agencies).

3. Re-Responsibilities. Lévinas’s (1981) philosophy is based on Responsibility, but Young (2017) expanded the concept to Re-Responsibilities, given the numerous responsibilities that we have and the constant need to rededicate them in each nanosecond of our lives. This applies most clearly to children, for whom we have the responsibility of total care at every second, and even one momentary lapse can be dangerous. For example, the failure to recognize and report child abuse may lead to a continued dangerous, perhaps even fatal, situation for youth. As psychologists, Responsibility refers to adhering to all the five (revised) ethical principles of the APA ethics code. Responsibility is inherent in all of them, the reason why Young removed the term the one time it was included in the five principles of the code. In terms of relating to contactees, this refers to being supremely present in the moment, observing and communicating with perspicacious fullness as conditioned by our training and professional standing. Developmentally, the concept Re-Responsibilities applies as much to psychologists and child and youth workers of all professions as parents and caregivers of all kinds.

4. Participation applies to excluded/ devalued individuals/ groups, races, etc., but also to children/ youth. The principle is emphasized in work with children; they should not be objectified, given little voice, etc. Rather, they should have their voices heard, treated with respect and dignity, e.g., in child and family service investigations, and given the fullest agency that their context allows and the one in which we are working with them. The same applies to each contactee for the psychologist, and not only the child or youth. We have the ethical obligation to fully encourage their participation in all contexts, for example, in work with couples, in assessment, or in clinical therapy sessions. Just as the dictum has it that communication should be two-way, so should professional contact with children, youth, and indeed any contactee. For example, when making a report of abuse, it would be wise to be honest with the child and let them know about the process. This allows them to participate in the reporting actively.

5. Personhood is explicitly developmental as described in Young (2019) and Young and Kenny (2022). Here, we add that each person has an inalienable right to fully develop and grow to their maximum potential, contribute to society, and have society protect that inalienable right at all levels, including developmentally. Society needs to optimize opportunities for all persons and peoples in this regard, including in providing universal access to schooling and education for children and youth, while freeing them from poverty and from discriminating, persecuting, and harming environments. Psychologists play a large role in these regards, bootstrapping vulnerable and psychopathological children to better integration and to developing toward an optimal personhood trajectory in their circumstances, while working to change those circumstances for the better to the degree possible.

Secondary Meta-Principles

Secondary meta-principles are principles of broader scope than meta-principles. They apply ethically by giving ground to them. They inform their ethics. Five secondary-meta principles follow:

1. Systems. Individuals, families, and groups live in complex systems that need to be understood for their functioning and influence. This applies especially to children and youth, but also to each contactee. Only by perceiving the whole range of contexts acting on the contactee can their relational standing to them, as well as their constraints and influences on them, be fully understood, which is a necessary precondition in working with them. Children are part of a family system, community, society, and culture, all of which influence their development. To the contrary, decontextualizing individuals exposes them to harm in working with them. Psychologists are aware of the whole system in which the person inhabits, and this is especially required when working with children and youth. Moreover, adding the element of trauma, abuse, and maltreatment magnifies the need for understanding the caregiving and related system of the child as well as the system of supports available to help the child.

2. Uniqueness. Each person is unique and cannot be characterized by the average person with which they are associated, for example, their age group, sex, other family members/ siblings, their classmates/ work colleagues, and their culture, race, or society. No matter their origins and circumstance, and if applicable, how they have been marginalized, suppressed, etc., they have special characteristics that have to be encouraged and cultivated. They should never be seen from the viewpoint of the norm but as independent individuals with their proper personalities/ identities, values, and preferences. Children and youth, in particular, should have their uniqueness fostered, their constructed identities encouraged, their self-esteem, respected for whom they consider what they are, and also where they aim, etc., while respecting the individual and group differences in their familial, cultural and related bonds. Denying individuality exposes contactees to harm in working with them. At the same time, psychologists will work with individuals (children/ youth) who have maladaptive cognitions, constructions, identities, etc., in these regards, e.g., in cases of trauma, abuse, and maltreatment. Here, the psychologist will promote more adaptive replacements in these regards, while respecting the individual and group (e.g., cultural) differences involved.

3. Vulnerabilities. Every individual has some degree of vulnerabilities, stress, and difficult challenges that need acknowledgement and accommodation or help, whether from family/ friend, school/ society, or health or helping professional. This is especially true for those with psychiatric conditions and disabilities/ impairments, injuries and illnesses, and homelessness and poverty, but it applies to certain groupings demographically and in society, such as the inequitable status to varying degrees of certain minorities and races, sexual identities, women, the elderly, etc. By definition, children and youth are especially vulnerable, and merit concern and care. Not protecting them violates our moral contract with them, including in working with them. Psychologists are keenly aware of the vulnerabilities of children and youth, especially in cases of trauma, abuse, maltreatment, etc. In such cases, they serve as professional aids in addressing and rectifying the situation with other professionals and institutions. They require special education, training, and competence to do so effectively.

4. Autonomy (Informed Consent, Confidentiality, Privacy, Anonymity (in Young (2017) and Young and Kenny (2022)). Individuals and entities enter into relationships with health and mental health workers expecting their privacy protected, except in instances in which they give fully informed, noncoerced, and voluntary consent for sharing personal (health) information. They deserve to have their anonymity protected, for example, when volunteering to participate in research. These standards of practice can be summarized as respecting the autonomy of contactees. They should be responsible for their decisions, viewed as responsible agents making them, and have their decisions respected and carried out in the circumstances in which they apply, for example, in relation to the treating professional. Young (2017) had argued that this collection of rights be considered as a meta-standard, because they cropped up often in the standards of the APA and CPA ethics codes. Here, we argue that they constitute a separate secondary ethical principle, thereby informing equally all standards deriving from them. Autonomy needs to be taken into consideration with children and youth, for example, in obtaining assent to participation in treatment or research, with the parent/guardian supplying the consent. The autonomy developing in children is fragile and requires care in scaffolding it toward effective decision-making. Anything that diminishes their sense of agency and autonomy can have negative repercussions on their development. Psychologists take special care in promoting and protecting the autonomy of children and youth, and even more so in very vulnerable children and youth who have experienced trauma, abuse, or maltreatment. Already, their sense of agency might have been excessively stifled, silenced, and undermined. The psychologist fosters new beginnings along these lines, which requires extreme developmental sensitivity.

5. Morality. In the end, ethics is a moral stance, and one personally taken. Ethics codes and principles serve as guidelines even when they are considered obligatory in practice. The highest roads taken morally should dictate ethical professional practice, and every decision taken in this regard needs to be justified not only in terms of ethics codes and principles but also in terms of personal ethics and morality. There are sufficient examples where the latter have and should outweigh the former. That said, the health professional realizes that decisions taken that go against the jurisdictional ethics code of the practitioner could lead to disciplinary action. The psychologist understands that the disciplinary committee involved in any complaint that derives has ultimate authority in consequent deliberations. Appeals can refer to personal ethics and morality but cannot override them if the committee so decides. Personal vs. professional ethics/ morality could be quite different in cases with children and youth, for example, in attempting to protect them when laws are inconsistent, not up to date with current psychological knowledge, etc. The professional might take a stance that is costly personally but ethically and morally necessary and satisfying.

Ethics

Developmental Considerations

Children undergo constant developmental changes that affect them socially, emotionally, behaviorally, and cognitively. They manifest great individual differences in this regard (Young, 2022a), ranging from those who have often debilitating developmental delays to those who are gifted and talented. Epidemiological research indicates that 17% of children will be diagnosed with an impairing central nervous system, brain, or neurodevelopmental abnormality (Zablotsky et al., 2019). A recent meta-analysis found alarming rates of mental illness among children globally. Worldwide, there was a 13.4% prevalence rate of mental disorders (6.5% anxiety, 2.6% depression, 3.4% ADHD, and 5.7% for disruptive disorders) (Polanczyk et al., 2015).

Many children experience multiple risk factors that put them at a higher likelihood of developing mental conditions. These can include child abuse and neglect, parental conflict, parental substance abuse, and exposure to war and trauma. These risks impact the child’s neurodevelopment and may affect crucial factors in children’s development, including executive function, emotional regulation, inhibition, and self-control (Young, 2022b). Moreover, children might experience changes in their cognitive schemas as a result of these experiences, which impact their self-esteem and self-competence. Some of these events might also affect their locus of control and increase feelings of fear. From an ethical standpoint, psychologists need awareness of these potential vulnerabilities of children, as well as the potential supportive factors in their lives. In some cases, such as parent abuse, parents can be both a source of support and harm.

The AACAP (2014) ethics code goes to great lengths to specify the ethics involved in engaging in professional relationships with children and their families/ guardians (herein referred to as families). The AACAP code notes that, legally, children are dependent minors with developmental immaturities and potential conflicts between their aspirations and those of their families. Mental health workers will need to communicate with families and possibly advocate for the children, notwithstanding their obligations to all involved. The worker might have to deal with agencies or other referral sources, as well, whose agendas might differ greatly from that of the families. Once engaged, the worker will have to determine the presenting problem in an assessment and arrive at a diagnosis, if called for. Given their minor status, children cannot give legally binding consent, but typically assent to assessments, treatments, and other recommendations. Children do have rights and interests. Workers should be aware of their multiple roles and potential conflicts of interest, for example, testifying in court as an expert witness having treated the child beforehand. The AACAP code continues by providing the specific developmental principle in child ethics. Workers need to be “aware of” and “strive to optimize” children’s development, including in their relationships with others, agencies, schools, etc.

There are several other overarching documents that provide guidance for psychologists’ behavior when working with children. The United Nations Convention on the Rights of the Child (Convention on the Rights of the Child, 1989) clearly states that children have inherent dignity and equal and inalienable rights without discrimination. It is clear in its’ prose that children are entitled to special care, safeguard considerations, and, perhaps most importantly, protection. The best interests of the child should be paramount and they should be involved in proceedings about them. This is an important freedom given to them—freedom of expression. The Nuremberg code (U.S. Government Printing Office, 1949) should also be considered by psychologists in their work with children, particularly as research participants. It includes 10 principles that primarily relate to experimentation. This code is clear in the obligation of obtaining voluntary consent of all participants in experiments and that experiments should avoid physical and mental injury to participants. The code also addressed the rights of children and calls for balancing the degree of risk with the intended benefits of the research. Continuing this train of thought, we add that the three major overarching meta-principles that are inherent in ethics codes referred to above (responsibility, personhood, participation) suggest other fundamental rights that professionals need to respect in dealing with children. They should serve as guides in engaging with them.

First, workers in the field need to engage with children from a meta-principle of responsibility that surpasses the obligations of any applicable ethics code due to the dynamic nature of ethics, the changing applicable laws to a case at hand, and the possible conflicts between ethic and law. Relative to the theme of the article, ethics codes should not be viewed as cookbooks for ethical conduct by workers but as reflective documents toward ethical conduct involving children. Having an ethic of responsibility places the contactee at the apex of concern rather than treating them only in ways that avoid disciplinary action. Children and youth, in particular, need a proactive ethical stance of engaging them with Re-Responsibility.

Second, mental health workers need to engage with children with an awareness of and toward an optimization of their rights toward the development of full personhood (within their developmental and other (e.g., situational, biological) constraints. Psychologists need to adopt a biopsychosocial understanding of a child’s life course; and how to right its trajectory when it goes awry and to protect them from further negative psychological impacts, e.g., from abuse or adverse events, that might have taken place.

Third, psychologists need to function from an ethical stance that children’s participation in processes and decisions that affect them constitute a fundamental child right. They should have the right to describe their narratives of events that have transpired that have adversely affected them, everything else being equal, e.g., in legal proceedings involving their present and future. They should be respected with appropriate interview techniques in eliciting these narratives and they should be treated as an end rather than as a means to an end. That is, they should not be objectified, and their voices should be heard and respected within the limits of the applicable law at hand.

Beneficence/ Nonmaleficence

Beneficence/ Maleficence is a primary principle in most ethics codes, including those for psychologists and psychiatrists. According to AACAP, beneficence concerns optimizing children’s welfare, functioning, and development. Mental health workers, including psychologists, should adopt this perspective in any judgments and actions related to children, prioritizing them over any pressures from family or society. These judgements and attitudes should be scientifically informed without excluding personal professional experience. Psychologists should be cognizant of children’s significant relationships. Psychologists act on behalf of the child and their families or agencies and other institutions that might be involved, e.g., educational and court systems. Psychologists need to define from the outset their roles and limitations. They need to indicate when their advice is scientifically different from the positions held by the child or family while considering their views.

AACAP continued with describing the mental health worker’s obligation to avoid harm when working with children. The psychologist should avoid actions that can have detrimental effects on the child’s development. The psychologist should strive to reduce harmful actions by others. There should not be any exploitation of the child’s or family’s vulnerabilities, for example, for personal gain, or have any dealings with children and their families outside of the professional relationship. The psychologist must ensure that any pre-existing relationship does not adversely impact evaluation and care of the child. Sexual contact (with the child or any family member) is forbidden and often illegal, and many boundaries need to be evaluated as actions with the child and family proceed.

When dealing with children with psychopathology, we uphold that the ethic of beneficence becomes even more salient, given children’s increased vulnerability. Psychologists should assess any developmental issues/mental conditions and determine their impact on the child’s welfare, functioning, and development. Non-maleficence also becomes particularly relevant when working with children with psychopathology. They are often vulnerable given their conditions and dependence on others. One way in which this can be demonstrated is the informed consent process. Psychologists should be sure to address the child’s psychopathology and its potential impact on assessment and treatment. For example, the child with depression may not be as engaged in the assessment process due to lack of attention and low motivation. In addition, one must consider assessments and evidenced based treatments for the child with these conditions that are appropriate for them.

For the three meta-principles under discussion (concerning responsibility, personhood, participation) acting from an ethic of beneficence/ nonmaleficence in cases of childhood psychopathology, first, requires enhanced vigilance of one’s professional responsibilities. The difficulty in optimizing children’s development of personhood in these cases will become more salient. Assuring children’s participation in decisions that affect them will require more effort. These complications should not be used to circumvent these principled stances, but should lead to a search for and implementation of adaptive solutions.

Autonomy and Life Preservation

Autonomy refers to having meaningful voice or choice that is not impeded by others and is essential in obtaining informed consent (Greig et al., 2013). The topics of maintaining privacy and anonymity are closed related. However, there are times privacy and confidentiality must be broken, particularly in cases of child abuse.

Life Preservation is concerned with preserving life, as is the case when dealing with suicidal ideation/intent and the potential threat of harm to others. In cases of child abuse and neglect and suicidality, psychologists must reflect on the ethical codes and consider the severity of these harms, prior to breaching confidentiality. These limits of confidentiality should be explained clearly, in language the child can understand at the outset of treatment.

There are three primary situations in which a mental health professional would be required to breach confidentiality with a minor client. These include: (1) suspicion or knowledge of child abuse or neglect, (2) potential for serious self-harm (e.g., suicide, non-suicidal self-injury (McManus et al., 2021; North et al., 2021) and (3) potential threat of serious harm to others by the minor (e.g., homicide). These situations also typically appear in law as exceptions to confidentiality. In other words, psychologists would be required to break confidentiality in these situations in order to protect the child (abuse and suicide) and others (homicide). Psychologists also have to balance the right of the child to privacy with the potential demands from parents/ caregivers for information about the treatment. Legally, parents are entitled to information because the child is a minor, but revealing the contents of sessions to them in their entirety will leave the child feeling betrayed and distrusting of the psychologist.

This article emphasizes the meta-principles of responsibility and promoting personhood and participation (Young, 2017, 2019), which are quite applicable to mental health work with children and those with psychopathology. The obligation to give autonomy and preserve life intertwines in cases of threatened suicide or other harm, which are magnified in cases of trauma, abuse, and maltreatment. This would be especially true for those with consequent psychopathology. The psychologist should remain cognizant of these obligations and attuned to the child or youth who expresses serious effects of abuse and the like. Even the so-called resilient child or youth could bear psychological scars that will lead to later long term consequences in this regard.

Developmental Ethics in the Five Principles

Young (2017) redescribed the APA’s five ethical principles (see Table 2 for the principles). Table 2 adds a column on the obligations of health workers dealing with children and youth. The latter are phrased in terms of the three major superordinate ethical meta-principles espoused in the present work as critical to health work ethics codes: (i) responsibility; (ii) personhood promotion; and (iii) participation promotion.

Table 2.

Five universal ethical principles considered developmentally

Principle	Explanation	Developmental Application
1. Life Preservation	Universal conventions, government laws, and ethical codes insist that people continually act to protect the physical integrity of children and youth, and all others, for example, as it applies to torture and related abuses, genocide, homicide, and suicide. People continually act to protect children from the dangers of trauma, abuse, and negligence. People continually act to preserve the sanctity of life, its survival, for children and youth, and all others. *	Health workers have a special obligation in all these regards, and behave with responsibility in every facet related to life preservation as currently defined. With respect to children and youth, this means that they adopt the goal of facilitating their development toward full personhood to the degree possible, for example, in helping them using scientifically-supported practices to deal with and rehabilitate from torture, trauma, abuse, and negligence. Also, to the degree possible, health workers promote the agency, voice, and participation of children and youth in all decisions affecting them in relation to life preservation and its consequences when gone awry, within the limits of context, culture, and demographics, such as age, developmental level, etc
2. Caring Beneficence/ Nonmaleficence	Universal conventions, government laws, and ethical codes insist that people continually act to safeguard the welfare of all peoples and persons, including the most the vulnerable, children and youth being among them. The most vulnerable include not only children and youth, but also women who are discriminated against/ abused, the disabled/ differently enabled, those with mental difficulties and disorders, and so on. People continually aim to do no harm, or minimize it	Health workers have a special obligation in all these regards, and behave with responsibility in every facet related to caring/ beneficence/ nonmaleficence, as currently defined. With respect to children and youth, this means that they adopt the goal of facilitating their development toward full personhood to the degree possible, for example, in providing scientifically-based health services. Also, to the degree possible, they promote the agency, voice, and participation of children and youth in all decisions affecting them concerning their care/ beneficence/ non-maleficence within the limits of context, culture, and demographics, such as age, developmental level, etc
3. Relational Integrity	Universal conventions, government laws, and ethical codes insist that people continually strive to build positive relationships with children and youth, as well as all others, and behave with openness, honesty, fairness, trust facilitation, rapport encouragement, a genuine presence, and mutual respect in a two-way interaction or dialogue. They emphasize the humanity of the other	Health workers have a special obligation in all these regards, and behave with responsibility in every facet related to relational integrity, as currently defined. With respect to children and youth, this means that they adopt the goal of facilitating their development toward full personhood to the degree possible, for example, in encouraging relational and professional support from multiple sources towards the development of their full humanity. Also, to the degree possible, they promote the agency, voice, and participation of children and youth in all decisions affecting them concerning relational integrity and the development of their full humanity within the limits of context, culture, and demographics, such as age, developmental level, etc
4. Respect for the Dignity and Rights of Persons and Peoples	Universal conventions, government laws, and ethical codes insist that people continuously respect the inherent self-worth of every child and youth, every individual, and all groupings of people. They respect the fundamental individual and collective rights of all peoples related to their dignity and sense of self-worth. People deeply respect the autonomy and self-determination of all individuals or groupings and rights of individuals and peoples to: non-discrimination, fairness, equity, justice in this regard, and personal and collective (e.g., cultural/minority status) identity. People respect rights to voluntary informed consent, privacy, confidentiality, anonymity, etc	Universal conventions, government laws, and ethical codes insist that people continuously respect the inherent self-worth of every child and youth, every individual, and all groupings of people. They respect the fundamental individual and collective rights of all peoples related to their dignity and sense of self-worth. People deeply respect the autonomy and self-determination of all individuals or groupings and rights of individuals and peoples to: non-discrimination, fairness, equity, justice in this regard, and personal and collective (e.g., cultural/minority status) identity. People respect rights to voluntary informed consent, privacy, confidentiality, anonymity, etc Health workers have a special obligation in all these regards, and behave with responsibility in every facet related to respect for the dignity and rights of persons and peoples, as currently defined. With respect to children and youth, this means that they adopt the goal of facilitating their development toward full personhood to the degree possible, for example, in encouraging full societal, institutional, and professional support from multiple sources towards the development of their full dignity and self-worth and that of their home group, such as culture and race. Also, to the degree possible, they promote the agency, voice, and participation of children and youth in all decisions affecting them concerning dignity and self-worth, for example, in obtaining voluntary informed consent from caregivers and voluntary informed assent from the children and youth, within the limits of context, culture, and demographics, such as age, developmental level, etc
5. Promoting and Acting from Justice in Society	Universal conventions, government laws, and ethical codes insist that people continuously ensure that other parties dealing with children and youth, and persons/ peoples generally, do so in an equitable and just manner. They are constant in their monitoring of any deviations of societal infringement and abuse of the basic tenets of equality and justice for all, and act accordingly, but always taking the highroad and never descending into violence. The growth of children and youth, and persons and peoples generally, per the present principles and values is the best strategy for promoting universal human rights as described in this document	Health workers have a special obligation in all these regards, and behave with responsibility in every facet related to promoting and acting from justice in society, as currently defined. With respect to children and youth, this means that they adopt the goal of facilitating their development toward full personhood to the degree possible, for example, in encouraging full societal, institutional, and professional support from multiple sources towards equity, justice, and universal human rights for them and that of their home group, such as culture and race. Also, to the degree possible, they promote the agency, voice, and participation of children and youth in all decisions affecting them concerning equity, justice, and universal human rights, for example, within the limits of context, culture, and demographics, such as age, developmental level, etc. All children and youth, as well as all persons and peoples, should be able to live in and develop toward full equity, justice, and universal human rights, as per United Nations pronouncements, for example, https://www.ohchr.org/en/udhr/documents/udhr_translations/eng.pdf, and https://www.unicef.ca/en/policy-advocacy-for-children/about-the-convention-on-the-rights-of-the-child

This list of universal ethics was elaborated by the author based on a compare/ contrast format with other ethical codes and their values. It applies universally to all health work, e.g., medical, psychological, social work, child and youth work, child and youth protection services, school counselling/ guidance

The first two columns are adopted from Young (2022a); the third is original to this article. Reprinted by permission from Springer International Publishing, Causality and neo-stages in development: Toward unifying psychology, G. Young, Copyright 2022 [Table 14.3, pp. 429]

^*It is impossible to cover every contingency that the general principles cover, or ones they do not, nor explicate every possible interpretation. The principles have leeway in interpretation and application. For example, (a) the first one was not meant to address the issue of prolife; (b) the second one is not describing the nature of care in its universality (e.g., does not exclude capital punishment); (c) the third one cannot explicitly define how to create the relationships advocated for; (d) the fourth one purposely does not mention nations and national rights, migration and forced immigration/ asylum issues; and (e) the fifth one does not specify the definition of justice that should be used

Discussion

This article has advocated for considering explicitly in applicable mental health ethics codes the developmental needs and priorities of children and youth, who constitute a vulnerable population meriting general and specific ethical approaches. Moreover, we couched these issues in the context of a revised approach to the principles in the 2017 APA ethics code (APA, 2017a). Moreover, we added meta-principles to these revised principles, and examined all the suggested principles, primary and secondary, in terms of the ethical needs in dealing with children and youth, including those who have experienced abuse, trauma, and maltreatment. We have been very specific about the principles and their applications developmentally. Next, we offer a more narrative description of the ethical needs of children.

General Considerations

1. Children and youth deserve to be treated within the scope of the highest ethical and moral principles. Adults who raise and interact with children should behave with the utmost respect and responsibility, care, safeguards, and assistance, and the fostering of their dignity and self-worth, well-being, and growth. They shall not be victims of discrimination, prejudice, hate, or abuse and neglect of any kind. Child maltreatment has long lasting effects on youth, including contributing to deficits in social, emotional and behavioral functioning (Spatz-Widom, 2014; Young, 2022b). Given that these experiences can severely disrupt their developmental path and cause long lasting deleterious outcomes, it is imperative that youth be protected and nurtured during their childhood.

2. Their special vulnerable status both physically and psychologically should be recognized whenever adults engage with them; their vulnerability is accentuated by their age, cognitive level, and dependent status (Schweiger, 2019). This vulnerability often leaves them without a voice or excluded from decision making. Psychologists should strive to include youth in decisions that affect them. Inquiring about issues of abuse and neglect is essential to assist youth, but should be done in a culturally sensitive, non aversive, trauma informed manner (Mathews et al., 2022).

3. Their legal status as minors should not detract from giving them agency, autonomy, and voice, and having them participate in decisions that affect them, for example, if the context allows, by listening to their expressed needs and desires. Manneheim et al. (2019) found that most psychologists in their study would not disclose information to parents without youths’ consent or at least informing the youth. There is strong evidence for an age-related gradient, with psychologists viewing protecting the confidentiality of adolescents as an ethical imperative, compared to younger clients. Despite their status as minors, they should have an active role in consenting to research as participants, thus increasing their power and autonomy and creating egalitarian relationships with researchers (Alves et al., 2022; Marinkovic Chavez et al., 2022).

4. Each child and youth should be recognized for their unique personhood, their individual needs and desires, their special interests and talents, and their particular potential and paths in growth, without denying their familial, racial, and cultural membership and other contextual and group-related factors. Psychologists should recognize barriers to youths’ development, including systemic racism, poverty, and socioeconomic disadvantage (Berkman et al., 2022).

5. Children and youth experience risk factors, influences, impacts, and adversities on their growth trajectories. The adults who care for them, who guide them, who educate them, or who offer advice and treatment to the caregivers need to understand how these factors affect them, and strive to mitigate the negative effects behaviorally, emotionally, socially, and cognitively that might eventuate from them. The Centers for Disease Control and Prevention (2019) estimate that more than half of adults report experiencing at least one adverse childhood experience that affects their development. Psychologists play a critical role in ameliorating the effects of these traumas and can work closely with caregivers to assist in youths’ treatment.

6. Children and youth require sensitive, warm, contingent, and efficacious care. They shall not be neglected, abused, and so on. They require firm limit setting and appropriate discipline to guide them. Corporal punishment has been shown to be ineffective in the long term in disciplining children and is associated with negative effects for youth. There is ample evidence to support the relationship between corporal punishment (e.g., spanking) and poor developmental outcomes, including higher levels of aggressive behavior, lower moral internalization, weaker parent child bonds, more mental health problems, and delinquency (Gershoff & Grogan-Kaylor, 2016; Gershoff et al., 2017). The American Academy of Pediatrics (AAP) also recommends that parents and other caregivers should not use corporal punishment either in anger or as a punishment for misbehavior, based on evidence that links this form of discipline to negative outcomes for youth (Sege et al., 2018).

7. The adult who has responsibility for them, e.g., parent, teacher, guidance counsellor, psychologist, shall act in their best interests and help them develop positively. They shall not expose them to harm; they should be treated with respect toward fostering their optimal development. They will relate to them genuinely and with integrity, being aware of the impact of their behavior on the child or youth. The best interest of the youth, sound judgement, empirical evidence, and the likelihood of the outcomes, as opposed to one’s own values, should be considered in treating youth (Birchley, 2021; Thomson & Molloy, 2001).

8. Children and youth are embedded members of familial, racial, and cultural groupings that deserve the utmost respect and dignity for the children and youth to thrive. Buffering, buttressing, and bootstrapping their community together constitute an excellent way to help children and youth grow. All children, youth and their families, races, and cultures should be treated equitably and have equitable rights in order for the children and youth and their holding communities to grow optimally. Kung and Johansson (2022) warn that practitioners must reflect on their hidden biases, and be aware of diverse cultures, racism, oppression, and micro- and macroaggressions in their practice. They must avoid cultural ignorance and biases that will disrupt the therapeutic alliance and possibly impose harmful treatments on youth.

9. Children and youth require their needs are taken care of, from the basic life protection, nourishment, healthy lifestyle, freedom from persecution and poverty, safety, and so on, to their social and leisure life, and to their educational, extra-curricular, and training regimes in which they participate. Their bodies are their own and should be free from exploitation. Their minds are their own and should be free to engage in exploration and education. There is an epidemic of exploitation, including labor and sexual, of youth globally (Chisolm-Straker & Stoklosa, 2017). Youth who are exploited endure disrupted development, which can have a lasting impact.

10. Children and youth have an inherent curiosity, motivation, sense of discovery, and will to learn that should be cultivated, instilled, and refined. They are our future. Youth have the capacity to contribute to their community and psychologists should serve as allies to them, providing resources and professional effort toward helping them realize their own self-righting capacities, understand their ability to learn, and engage in activities that bring them passion (Lewis, 2019).

Specific Considerations

• 11.Mental health professionals are aware of the developing brain and behavior of children and youth, offering services that are developmentally appropriate for the age of the child or youth. Psychologists should consider the developmental level of a child, and not just age, when selecting treatment strategies (Field & Ghoston, 2020). Having a fundamental understanding of neuroscience and the developing brain are critical when working with youth.
• 12.They are aware of the complex familial and cultural contexts in which children and youth live, adopting a systems approach. Conrad and Brumbaugh (2021) advocate for a systems approach when working with and diagnosing youth that reflects an understanding of their intersecting identities and the social context of functional impairment. When conducting research, psychologists need to consider children's physical, mental, and emotional vulnerabilities, along with their interdependence with family members (Dubois et al., 2022).
• 13.They are aware of developmentally, linguistically, and culturally appropriate assessment techniques and tests. They use instruments with reliability, validity, and developmental sensitivity normed on the cultural group to which the child belongs. As the American Psychological Association (2017b) warns, psychologists should possess an awareness of youths’ intersecting identities (e.g. racial, ethnic, sexuality identity) and begin treatment with accurate assessment of available, accessible and appropriate services for the youth. Psychologists should remember that some psychometric tests have little meaning outside the culture in which the concepts have their meaning and may not represent the culture of the child who is being assessed (Thomson & Molloy, 2001).
• 14.They are aware of the developmental contents of the diagnostic manuals, know how to take a developmental approach to diagnostics, and are aware of the low bar set for some diagnostic disorders and the inherent dangers that represents. The difficulties associated with diagnostic bracket creep for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5, American Psychiatric Association, 2013) has been described in depth (e.g., Young, 2013), and psychologists need to take heed.
• 15.They use developmentally and culturally appropriate intervention and treatment procedures and techniques, ones that are evidence-supported or indicated, and considered reliable and valid for children and youth. There is a need for psychologists to adopt a developmental perspective in clinical work by considering age-at-onset of conditions and changes over time, while recognizing the impact of developmental periods on symptoms when interpreting clinical symptoms (Thapar & Riglin, 2020). Data driven approaches to treatment of serious childhood conditions, such as child maltreatment, are needed to ensure children receive appropriate intervention (Fluke et al., 2021).

Recommendations

Finally, we make a series of recommendations related to developmental ethics. First, extant mental health work ethics codes should seriously consider reworking them to make them more developmentally informed. Second, the present revisions of ethical principles could serve as a common framework for mental health ethics codes across disciplines. While we have focused on psychologists, this work could be applied to other mental health workers. Third, the concept of superordinate ethical meta-principles can help rework extant ethical codes, including at the developmental level. In the end, ethics is what the profession and the practitioner makes of it, and revising ethics codes in the way described here will help awareness of ethics generally, and also specifically for children and youth, while raising the liklihood of ethical work in dealing with all contactees, including those children and youth who have been traumatized, abused, and maltreated.

Data Availability and Sharing Statement

Data sharing not applicable to this article, as no datasets were generated or analyzed during the current study.

Declarations

Ethics Approval Statement and Informed Consent

N/A

Conflict of Interest

The authors declare that they have no conflict of interest.