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This chapter marks the passage from the left-hand section of the Arch, the section in which you discovered a potentially viable business, to the right-hand section, in which you execute that business (Figure 5.1). A plan describing how this business will be executed is the first step toward its realization.
At the end of the business assessment segment of the Entrepreneurial Arch, you now have a business model. It is specific. It articulates the offering, the firm’s actions that create the offering, and the specific customer that will purchase the offering. It also articulates the key collaborators in the creation and distribution of the offering to these customers. You also have a complete monetization model, which includes a value proposition for both your customers and your collaborators, in addition to a complete financial feasibility analysis. Despite its detail, a business model remains an architectural-level view of the business (Leung, 2007). It tells you what the business intends to do; it does not tell you how this will be done. The operational plan is the how. It is the building construction plan of attack. The business model plus the business’s strategy plus the business’s proposed tactics provide the operating plan for your business. The first step in operationalizing that business is to create an executable plan.
No other childhood disorder is as controversial as is Attention Deficit/Hyperactivity Disorder (ADHD). Some consider this condition an epidemic that is responsible for the underachievement at school and at work of a substantial segment of the population, whereas others regard it as a fabrication of the pharmaceutical industry. The “epidemic” is sometimes attributed to a mismatch between society’s demands for focused attention and what some see as the inherent tendency of many children, especially boys, to wander and explore.
The first published medical report of attention deficit with hyperactivity did not appear until the beginning of the twentieth century. However, a poem written by German physician Heinrich Hoffman in 1844 appears to have been part of the collective memory of several generations of members of the medical profession from that point on (Thome and Jacobs, 2004):
Successful businesses capture a significant share of the value their firms create. Clearly you must create value in the marketplace, but though a necessary criterion it is insufficient. What new entrepreneurs often fail to realize is that their business can fail while providing goods for an exceptionally attractive market if the business is not able to capture any of the value created.
Your organization’s ability to capture value is dictated by the relative robustness of your capabilities. In judging the outcome of any competitive sporting event, it is not enough to evaluate the talent of your team; rather, that talent must be evaluated in comparison with that of your opponent. No organization is an island. It takes an industry to serve a customer. You will need capabilities outside your firm to create and deliver your solution to your customer. Your capabilities relative to those in the ecosystem that you need to leverage will determine your organization’s share of that created value. David Teece, in his seminal paper, discussed the ability of firms to capture value from their intellectual property (Teece, 1986). The positioning for value capture (PVC) framework, Figure A1, broadens that work beyond intellectual assets to include the firm’s entire capability set.
There are two scientific reasons learning problems are considered mental health disorders. One reason is that learning disabilities probably share with many other forms of mental illness an underlying neurobiological basis. Another reason is that learning problems are linked with other forms of psychopathology such as attention deficit, depression and anxiety, and disruptive behavior disorders. When learning problems and other forms of psychopathology co-occur, the learning problems often exacerbate behavioral and emotional difficulties. At the same time, the behavioral and emotional difficulties make it harder for teachers to help with the learning problems.
This chapter begins with a short section on basic terminology. In the section that follows, several case examples from literary sources illustrate the interplay of learning and social/emotional problems. Diagnostic categories are then presented, followed by information about the prevalence. Cultural and gender issues are discussed as moderators of the prevalence rates. Possible causes are considered next, with emphasis on the neuropsychology that is thought to be at the root of learning disabilities. After a discussion of the family bases of learning disorder and peer factors, the final section of the chapter is devoted to treatment issues, with emphasis on the role of the psychologist. The assessment and remediation of academic skills per se are beyond the scope of this book. The reader is referred to textbooks oriented to the school-based professional, such as Learning Disabilities: Characteristics, Identification and Teaching Strategies (sixth edition, Bender, 2008).
More mental illness than mental health professionals can manage
Compared to progress in the treatment of psychopathology that has already appeared, the psychology profession has lagged in developing effective prevention strategies. Serious consideration of prevention strategies in their own right did not begin until the 1960s, and this early attempt failed to make a considerable impact (Duncan, 1994; Hage and Romano, 2010). In the past half-century, however, prevention has begun to be taken seriously. The term prevention science has emerged to reflect an empirical perspective. In the area of child psychopathology, prevention initiatives are particularly important, first of all, because children who experience mental illness are more likely than others to experience mental illness in adulthood (Pine et al., 2010). Furthermore, many of the psychological resources that protect against mental illness are developed in childhood, making this period especially critical (Serna et al., 2003). Lastly, experiencing mental illness as a child costs the individual the enjoyment of his or her childhood. This alone is enough reason to consider prevention initiatives against childhood psychopathology.
This chapter begins with definitional issues, focusing on the thorny distinction between prevention and treatment. The important differences between universal prevention programs, that is, those addressed at entire populations or communities, and indicated programs, that is, programs intended for individuals who already show some signs of psychological distress, are considered next. The subsequent section is devoted to reasons for involving the community in the basic design of interventions, not just their delivery. A history of preventive mental health in North America and Europe appears next. The subsequent section is devoted to methodological issues in the evaluation of prevention programs. Guidelines for the successful implementation of prevention programs appear next, followed by several examples of successful prevention programs.
The parable of the blind men and the elephant is well known. Each feels a different part of the elephant and describes that part as though it were the whole animal. One believes an elephant is like a snake as he feels its trunk, another a fan as he feels the elephant’s ear, still another a rope as he grasps the elephant’s tail, another feels the elephant’s side and believes the elephant is like a wall, the last man feels the elephant’s tusk and describes the elephant as a spear. Entrepreneurship is described in a very similar way. Some emphasize the business plan; others argue how the business plan is “dead” and it is now all about the business model; still others argue that it is all about financing or growth or passion. Like the blind men, they are all correct and simultaneously all wrong, as they each describe a piece and not the whole.
The Entrepreneurial Arch is the result of my quest to pull all these pieces into a unified description of entrepreneurship. That description has two parts: Business Discovery and Business Execution. Each of those parts has three components. Together the six components describe fundamental skills that every organization wishes it could enhance:
identifying emerging opportunities (and threats)
formulating innovative business solutions around those opportunities
assessing the feasibility of those proposed businesses
developing a practicable implementation plan from disparate and incomplete information
identifying, aligning and/or acquiring the necessary resources needed to power the plan forward, and
driving accelerated growth.
We call people with the above skill-set entrepreneurs.
Bipolar disorder or manic-depressive disorder is characterized by unpredictable mood swings, in which the individual shifts from depression to an elated, euphoric mood. Bipolar disorder is also known as bipolar depression. Few debates about child psychopathology are as contentious as the current controversy about the extent of this disorder among children. The moods of many children change frequently and their mood changes are not always predictable. Many people find it jarring when the reactions of others in their environments cannot be predicted. Irritable moods and the behaviors they provoke appear to be particularly disturbing to parents and teachers. The question is how bad it needs to be before it needs treating or is to be considered beyond what it developmentally typical.
Manic-depressive illness among adults is a severe disorder that has been recognized since ancient times, when melancholy and mania were described as sometimes constituting two phases of the same disease by the influential first-century Greek physician Aretaeus. Case studies of patients at La Salpêtrière Hospital (Paris) in the nineteenth century were presented in the psychiatry literature to illustrate this dual form of mood disorder. However, for a period at the beginning of the twentieth century, the distinction between unipolar and bipolar depression slipped from the nomenclature, to be resurrected from the 1960s on (Angst and Marneros, 2001). It is now considered a common and serious form of mental illness among adults. Bipolar disorder constitutes a strong risk factor for adult suicide (Bostwick and Pankratz, 2000).
The financial sources used to capitalize new companies can range from the straightforward (credit card debt) to complex investment agreements crafted between these companies and venture capitalists. As convoluted as the entrepreneurial company’s funding may become, it is critical the financing structure of the company be completely aligned with two things:
the company’s needs and
the founder’s desires.
Funding the initial financial needs of entrepreneurial companies is challenging as most of these nascent organizations have no collateral to leverage for a traditional bank loan. As a result, these companies must seek alternate forms of financing, which often include selling equity in the business. Selling company equity creates additional company owners whose desires must also be aligned with future funding decisions. The founders, however, are the ones that from the onset must make sure that the financing path they take the company down delivers both what the company needs and what is consistent with their personal vision for their new company. This appendix discusses the financing from the perspective of the financiers. Appendix C discusses the impact the various type of financing option will have on the founders.
The type of funding entrepreneurs can seek for their new venture, if they desire, must be consistent with the business that is being created. The investment potential framework (shown in Figure D.1), indicates the type of funding that could be attracted to the firm as it is currently designed. Of course, the simple fact that the firm is potentially equity investable (upper right-hand quadrant) does not mean that the founders desire that type of funding. It simply means they are creating the type of business that would be attractive to that type of investor. On the other hand, a firm that finds itself in one of the other three quadrants would not be attractive to equity investors even if the founders desired such investment. Few firms even have the potential to be equity investable. Indeed, in 1999, at the height of the VC investment bubble, only 6.3 percent of Inc. 500 companies had equity investments (Inc. Magazine, 1999). Today the percentage is less than half that level. This is despite the fact that the Inc. 500 represents the top privately held companies in the United States.
Depressed mood has been called the “common cold” of modern society because it is so common. Some scholars object vehemently to that expression because it implies that depression is a minor problem (Allen, Gilbert and Semadar, 2004). Many psychoanalysts, especially in the mid-twentieth century, argued that depression was a defense mechanism that was a vital component of normal psychological development. They maintained that this defense mechanism appears only after the child discovers that all of his or her wishes will not be gratified and, thus, would not occur among children. They were wrong.
This chapter is devoted to the reasons why depression constitutes a major threat to the well-being of a very substantial portion of the child and adolescent population. The chapter opens with the interesting issue of whether depression often underlies other disorders, such as aggression, belying their outward appearance. As with the other chapters devoted to specific disorders, the diagnostic criteria appear before a discussion of the prevalence rates for the population as a whole, boys and girls, children and adolescents. Causes (physiological, familial and societal) are considered next, followed by a description of typical patterns of impairment, emphasizing cognitive and interpersonal factors. The stability of child and adolescent depression is discussed next. The final section is devoted to the major treatment modalities used to help children and adolescents facing the challenge of major depression.
Terminology and stigmatization, intended and unintended
The title of this chapter, intellectual disability, is the new name for this disorder in DSM-5. It was known as mental retardation in DSM-IV. The change reflects contemporary usage by experts on intellectual disability, who consider the previous term, “mental retardation,” as highly stigmatizing. The term and its derivative “retard” have come to be used as pejorative, as is the case for the previous terms “feeble-minded,” “idiot,” “imbecile” and “moron,” which were used by psychologists and physicians without any intent to offend several decades ago (Schalock et al., 2007; Switzky and Greenspan, 2006). There is nothing inherently pejorative in the term “mental retardation,” which in itself signifies no more than that the individual’s intellectual development is delayed in comparison to the development of other people; this is indeed true for this segment of the population. Certainly, the professionals who used that term in their research and clinical writing intended no other meaning, including, for example, those who contributed articles to what was called until very recently the American Journal on Mental Retardation. However, as language evolved, the word “retard” came to be used pejoratively in daily speech. A recent survey of over 1,000 US youth ranging in age from 8 to 18 years revealed that 92 percent of respondents had heard the “r-word” used in a negative way. Only about a third of these respondents were fully aware of its meaning (Siperstein, Pociask and Collins, 2010). Although the same word seems not to be used as extensively as an epithet in the UK, BBC News Magazine reported in 2008 that other pejorative words are (Rohrer, 2008). Hopefully, the new term “intellectual disability” will not acquire a pejorative connotation over time, perhaps because of its grammatical structure and inherent meaning.
There is a substantial genetic basis for most of the childhood mental disorders described in this book, even though many psychologists may prefer to ignore this reality. Before considering the implications of genetic causation, however, the manner in which genetic causation may occur will first be discussed. As detailed herein, knowledge in this area is increasing rapidly. Direct examination of genetic material is becoming increasingly feasible.
Emergence of genetics in the nineteenth century
Human behavioral genetics, the scientific study of heritability in individual differences in human behavior, is thought to have begun with Charles Darwin’s cousin Sir Francis Galton (1822–1911) (Rushton, 1990), who provided the first evidence that individual differences in intelligence and behavior are heritable. Galton was also the first to promote the use of twins to disentangle the effects of genetic (or heritable) factors and environment on inter-individual differences in behavior.
The human body consists of approximately one trillion cells. Most human cells contain forty-six chromosomes. Each chromosome is a long, extremely thin DNA (deoxyribonucleic acid) molecule that consists of two parallel, intertwined chains of nucleotides in a double helix. One chain is inherited from each of the two biological parents. Four nucleotide varieties exist, differing in their nitrogenous base: adenine (A), guanine (G), thymine (T) and cytosine (C). Each chain is made up of hundreds of such nucleotides (i.e., gene sequences) and each gene has a designated place on every chromosome, called a locus.
Product development is a part of the overall business development process. The example listed below offers one view as to how the product development steps could overlay and synchronize with the business discovery, development, validation, and launch phases of the Entrepreneurial Arch.
Historically, the challenge of product development was that it was out of sync with the ideal business development de-risking. In a typical product development scheme (product concept → prototype → beta product → commercial product), no direct customer feedback was obtained until after the beta product had been created. This meant that, for many products, a significant investment was made before it was known whether the product would resonate with a customer. There were a couple of exceptions. One was software, where the development costs are low. The other exception was devices that create the same user experience as current products, albeit in a differentiated way (faster, cheaper, better). This classic product development schema created a disconnection between product development and business development, since the significant resources available for beta-product development are not generally available until the resource phase of the Entrepreneurial Arch. This meant that on the product development side entrepreneurs tended to leap from product concept to prototype development. In other words, entrepreneurs were leaping from the opportunity identification segment of the Arch to the resourcing segment, where financing was available. In turn, this leaping legitimately called into question the value of the business planning activities, since these plans were often being completed with little or no customer feedback. However, the real issue is not the value of assessing the feasibility of one’s business or of determining how to operationalize it before resourcing and launching it; rather it is the re-synchronizing of the business’s development processes with the product development process.
Undoubtedly, many cases of school refusal have been treated as simple truancy since the advent of compulsory public education in Western countries in the past two centuries. Even today, authorities in some parts of the United States and the UK sometimes launch campaigns to raise school attendance, often with the intent of enhancing the school achievement of members of underprivileged minority groups, without considering the many reasons for absence from school that are discussed in the small but growing professional literature on school refusal (Sheppard, 2011).
This brief chapter begins with a section on the nebulous status of school refusal in the literature on child and adolescent psychopathology. The subsequent sections are devoted to issues of prevalence, stability, possible causes and correlates, prevention and treatment.
Diagnostic criteria
School refusal and school phobia are not recognized diagnostic entities in DSM-5 or ICD-10, largely because of the heterogeneity of the problem and the reasons that lead to it. Persistent refusal to attend school because of anxiety about separation from parents is, however, listed in DSM-5 and ICD-10 as a possible symptom of separation anxiety disorder. The term “school phobia” is used less frequently than “school refusal” in current nomenclature because it implies that anxiety about the school is necessarily the core feature, which it can be but often is not. Last and Strauss (1990) suggest a distinction between school refusal caused by anxiety and school refusal that can be considered truancy.
When a child displays an atypical, maladaptive behavior, it is almost a reflex to ask what the parents did to cause it. The belief that parental upbringing is at the root of all positive and negative child outcomes is as old as history and deeply ingrained in religion, literature and people’s belief systems. As mentioned in Chapter 2, this unrestrained attribution of child psychopathology to faulty parenting went unchecked in much of the scientific literature until the 1960s and 1970s. From that time on, however, understanding of the substantial heritability of most psychological disorders increased, which is not to say that genetic factors were not emphasized in earlier eras or that some degree of environmental causation has been excluded (see Chapters 2 and 4). Although the scientific community now recognizes the complex multiple etiology of children’s mental disorders, it maintains its profound interest in parenting. Parents are responsible in all societies for the socialization of their children for successful functioning in society, guiding them from the totally dependent state in which they were born into an adult who can interact effectively with others and achieve prosocial goals (Baumrind, Larzelere and Owens, 2010). As such, they are the most appropriate sources of help and support for their children who experience problems in functioning successfully in society.
In the definition they propose of the psychological assessment of children, Ollendick and Hersen (1993) indicate what assessment should be and what it often but not always is: “an exploratory, hypothesis-testing process in which a range of developmentally sensitive and empirically validated procedures is used to understand a given child … and to formulate and evaluate specific intervention procedures” (p. 6). This image of assessment as the application of psychological science at the beginning of the helping process differs sharply from stereotypes and, to a considerable degree, from the routine testing that is a not uncommon vestige of earlier eras, as will be discussed later in this chapter. At its best, psychological assessment is the complete antithesis of the reading of tea leaves by fortune tellers. Children are not brought to psychologists to be “tested” like automobile batteries; they are brought so that the psychologist might engage with them and their parents in finding out what may explain the child’s problems and how the problems might best be alleviated. Tests may be part of the process but tests constitute only some of the data that are used to confirm or disconfirm hypotheses that emerge mostly from an informed understanding of the problem that has brought the child and family to seek help.
Elaborating on the steps involved in conducting psychological assessment in such a therapeutic way, Finn (2007) enumerates several essential components of the process. First of all, clients (i.e., in the case of the assessment of children, parents, teachers and, to the extent their development permits, children) must be helped to formulate the questions they would like to see answered during the assessment process. The goals of the assessment are then specified collaboratively. Finally, the assessment results, including the information on which the psychologist’s conclusions and recommendations are based, are discussed fully and empathically. Clients participate collaboratively in discussing what the results mean to them and in helping the psychologist make sense of them. Importantly, as noted by Johnston and Murray (2003), in hypothesis-based psychological assessment, the goal of the particular assessment should determine to a considerable degree the specific assessment measures that the psychologist uses.