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Samenvatting Disorders of childhood: development and psychopathology Mindtap
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Samenvatting Developmental Pyschopathology - Hoorcolleges, Boek en Artikelen
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Gehele samenvatting Ontwikkelingspsychologie en Psychopathologie (P_BOWPPSY) - Psychologie periode 6 (thema 5-8)
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Test Bank for Disorders of Childhood: Development and Psychopathology, 3rd Edition by Parritz, 9781337098113, Covering Chapters 1-14 | Includes Rationales
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Chapter 1: introduction- Developmental psychopathology Intense, frequent, and persistent maladaptive patterns of
emotion, cognition, and behavior considered within the context of normal development,
resulting in the current and potential impairment of infants, children, and adolescents.
1.1 Defining disorders of infancy, childhood and adolescence
One of the first steps leading to accurate and useful conceptualizations of psychopathology is to
recognize the many connections between typical and atypical development. Most contemporary
theorists, researchers, and clinicians emphasize that a useful model of typical development requires a
dynamic appreciation of children’s strengths and weaknesses as they experience salient, age-related
challenges. A model like this takes into account the complexities of individual, familial, ethnic,
cultural, and societal beliefs about desirable and undesirable outcomes for children and adolescents.
Against this multilayered background of typical child development, we are then able to identify
children whose distress and dysfunction are exceptional.
1.2 What is normal?
Note that we primarily use the terms typical and atypical when referring to development and patterns
of adaptation and maladaptation. Common descriptions of normality and psychopathology often focus
on:
1. Statistical deviance the infrequency of certain emotions, cognitions, and/or behaviors. A
child who displays too much or too little of any age-expected behavior might have a disorder.
2. Sociocultural norms the beliefs and expectations of certain groups about what kinds of
emotions, cognitions, and/or behaviors are undesirable or unacceptable. Children who fail to
conform to age-related, gender-specific, or culture-relevant expectations might be viewed as
challenging, struggling, or disordered. There is a significant potential for disparity among
various sociocultural groups and norms.
3. Mental health perspectives theoretical or clinically based notions of distress and
dysfunction. A child’s psychological well-being is the key to consideration. mentally healthy
children and adolescents enjoy a positive quality of life; function well at home, in school, and
in their communities; and are free of disabling symptoms of psychopathology.
1.3 The role of values
Closer examination of these definitions reveals that each one raises questions about the role of values
in conceptualizations of mental health and psychopathology. A key value judgment involves
distinctions between adaptation and maladaptation and personal or group standards of adequate or
average adaptation, or optimal adaptation (Offer, 1999). Adequate adaptation has to do with what is
considered okay, acceptable, or good enough. Optimal adaptation has to do with what is excellent,
superior, or “the best of what is possible.” Our understanding of children’s psychological disorders is
informed continuously by our understanding of children’s usual development. When we think about
what happens in children’s lives, we need to remember not only the range and variety of hoped-for
outcomes, but also the basic, bottom-line components of “what every child must have to grow, learn,
and flourish.”:
The need for ongoing nurturing relationships
The need for physical protection, safety, and regulation
The need for experiences tailored to individual differences
The need for developmentally appropriate experiences
The need for limit setting, structure, and expectations
The need for stable, supportive communities and cultural continuity
Neither adequate nor optimal adaptation guarantees smooth sailing throughout development.
Challenges are inevitable, and struggles themselves are not evidence of disorder. Indeed, challenges
and struggles are viewed by most developmental psychologists as forces of growth. In this view, it is
the overcoming of challenge that furnishes the social, emotional, and intellectual skills that produce all
forms of growth, both healthy and unhealthy.”
, - 1-3d The impact of values on definitions of disorder
Other important judgments involving values are tied to specific definitions of disorder. With statistical
deviance definitions, it sometimes makes sense to examine both extremes of the continuum (e.g., too
much intense emotion as well as too little) because we have made a judgment that there is a desirable
middle course related to the characteristic in question. At other times, it makes sense to focus only on
the “bad” end of the continuum and ignore the “good” end (e.g., too little empathy, but not too much
empathy; too little intelligence, but not too much intelligence). In these specific cases, judgments are
made that some types of extreme characteristics are to be accepted or even prized.
With sociocultural definitions, value judgments are the very basis of definitions of disorder. Whether
casual use of mind-altering substances is tolerated or condemned by a particular sociocultural group
influences conceptualization of pathological addiction. Whether independence or connectedness is
more valued influences conceptualizations of pathological dependency.
With mental health definitions, the values of psychologists, psychiatrists, and clinical social workers
are embedded in both scientific and lay community decision making.
1.4 Definitions of psychopathology and developmental psychopathology
- Psychopathology refers to intense, frequent, and/or persistent maladaptive patterns of
emotion, cognition, and behavior.
- Developmental psychopathology extends this description to emphasize that these
maladaptive patterns occur in the context of typical development and result in the current and
potential impairment of infants, children, and adolescents.
- 1.4a Rates of disorders in infancy, childhood and adolescence
If definitions of disorder are problematic, estimates of rates of disorder are even more so. The
multipart task of estimating rates of disorder includes:
1. Identifying children with clinically significant distress and dysfunction, whether or not they
are in treatment (and most of them are not).
2. Calculating levels of general (e.g., anxiety disorders) and specific (e.g., generalized anxiety,
separation anxiety disorder, phobia) psychopathologies and the impairments associated with
various disorders.
3. Tracking changing trends in the identification and diagnosis of specific categories of disorder,
such as autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), and
depression.
Personal, clinical, and public policy implications must be considered when collecting these data.
- Developmental epidemiology Frequencies and patterns of distributions of disorders in
infants, children, and adolescents.
- Prevalence all current cases of a type (or types) of disorder.
- Incidence new cases of a type (or types) of disorder in a given time period.
- 1.4b Allocation of resources, availability and accessibility of care
One continuing difficulty involves access to care.
- Barriers to care Factors that impede access to mental health services, including structural
barriers such as lack of provider availability, inconveniently located services, transportation
difficulties, inability to pay, inadequate insurance coverage, or both; individual barriers such
as denial of problems or lack of trust in the system; and sociocultural barriers such as the
stigma of psychopathology or mental illness.
Tolan and Dodge (2005, pp. 607–608) propose a four-part model for a comprehensive system that
“simultaneously promotes mental health within normal developmental settings, provides aid for
emerging mental health issues for children, targets high-risk youth with prevention, and provides
effective treatment for disorders:
1. Children and their families should be able to access appropriate and effective mental health
services directly.
2. Child mental health should be a major component of healthy development promotion and
attention in primary care settings such as schools, pediatric care, community programs, and
other systems central to child development.
, 3. Efforts should emphasize preventive care for high-risk children and families.
4. More attention must be paid to cultural context and cultural competence.
1.5 The globalization of children’s mental health
Discussions of mental health and mental illness involving resource allocation and public policy
increasingly emphasize global perspectives that require careful thinking about Western models of
development, disorder and intervention, as well as the vastly different experiences of children who live
in resource-rich versus resource-poor countries. Patel, Flisher, Nikapota, and Malhotra (2007)
and Omigbodun (2008) identify rapid social change, urbanization and urban poverty, and inadequate
health and educational services as key factors that increase children’s vulnerability to psychopathology
in resource-poor countries in Eastern and Central Europe, Africa, Asia, Latin America, and the Pacific
region. In these countries, awareness of mental illness issues and promotion of mental health are
limited by allocation of scarce resources to urgent medical needs, a lack of formal mental health
policies and programs, and too few mental health professionals. The costs of impairment and lost
potential are enormous. We must also emphasize that, across the globe, millions of children are
struggling in the face of unimaginable trauma, including exposure to disease and death, armed
conflict, abandonment and homelessness, and dislocation. These terrible situations require increased
awareness, advocacy, and a responsibility to provide interventions to ensure children’s safety and
well-being. Interventions include both prevention efforts and treatment for those with various
disorders. To facilitate the success of interventions, mental health professionals must consider how to
implement treatments in countries where the health and welfare systems work differently (or are
nonexistent), as well as how to provide treatment to children who are difficult to reach. Treatments
must take into account local and culture-based approaches and community caretaking and service
models. Holistic approaches with achievable goals, embedded in health, social, and educational
networks, have been proposed. These multicomponent treatments focus on children and adolescents,
on families, and on communities and systems. Finally, the development and implementation of
globally useful interventions require recognition of the current disconnect between where research
takes place and where the need is greatest, as well as a commitment to do better on behalf of the
world’s children.
1.6 The stigma of mental illness
- Stigmatization Negative attitudes (such as blaming or overconcern with dangerousness),
emotions (such as shame, fear, or pity), and behaviors (such as ridicule or isolation) related to
psychopathology and mental illness.
A final issue concerns the continued and painfully unnecessary stigmatization of individuals with
psychopathology.
Mukolo, Heflinger, and Wallston (2010) identify:
1. Several dimensions of stigma, including negative stereotypes, devaluation, and discrimination.
2. Two targets of stigma, the individual and the family.
3. Two contexts of stigma, the general public and the self/individual. Both Mukolo et al.
(2010) and Heflinger and Hinshaw (2010) urge researchers to continue to investigate the
multiple ways that stigma complicates the experiences of children with mental disorders and
their families.
Ignorance and intolerance have long been identified as critical issues for those struggling with mental
illness. Much of the available research focuses on adults’ limited and inaccurate knowledge of and
negative attitudes toward other adults with mental illness. In study after study, the data suggest that
most adults tend to think primarily in terms of serious psychopathology (such as schizophrenia and
bipolar disorder), believe that individuals are responsible for their disorders, and overestimate the
likelihood of aggression and violence in adults with mental illness; stigmatization, in terms of ridicule,
avoidance, and rejection, is rampant. Adults also exhibit distorted beliefs and harmful attitudes toward
children who are struggling with mental illness, as well as toward their families. Adults both trivialize
the reality of children’s distress and dysfunction by suggesting that children are overdiagnosed,
overmedicated, and poorly parented, and exaggerate the extent to which these same children are
unpredictable, dangerous, and deviant. How do children and adolescents compare to their adult
, counterparts? Sadly, their beliefs and attitudes are all too similar. Surveys of children’s labels for those
dealing with mental illness—including crazy, nuts, retarded, psycho, and lunatic—reveal their
aversion. Although children display increasing knowledge about the causes of mental illness as they
age, their attitudes reflect ongoing stigmatization related to views of those struggling with mental
illnesses as violent, unpredictable, blameworthy, and beyond hope. Stigma is often associated with
exclusion, and evidence suggests that adolescents worry about the perceived social and personal risks
of friendships with peers with mental health problems. It is not surprising, then, to find that many
children and adolescents with disorders “self-stigmatize”; that is, they internalize these negative
beliefs and attitudes and exhibit low levels of self-esteem and self-efficacy. Given that children are
exposed to multiple sources of information and attitudes, including parents, peers, and the media, how
can stigmatization be prevented or minimized? Many types of programs, from those designed for
individual classrooms to those intended as national demonstration projects, have shown improvements
in knowledge and attitudes. Successful programs share several emphases. They must begin early;
target multiple dimensions of knowledge and attitudes; be developmentally appropriate; and include
individuals, families, and communities. Children can learn lies or they can learn facts; they can display
ugly attitudes or they can display compassion. The choices are theirs, and ours.
Chapter 2: Models of child development, psychopathology and treatment
2.1 The role of theory in developmental psychopathology
- 2.1a Dimensional and categorical models
Dimensional models of psychopathology Models that emphasize the ways in which typical
feelings, thoughts, and behaviors gradually become more serious problems, which then may intensify
and become clinically diagnosable disorders. There are no sharp distinctions between adjustment and
maladjustment. Dimensional models are referred to as continuous or quantitative.
Categorical models of psychopathology Models that emphasize discrete and qualitative
differences in individual patterns of emotion, cognition, and behavior. There is a clear distinction
between what is normal and what is not. Categorical models are sometimes referred to as
discontinuous or qualitative.
- 2.2a Historical and current conceptualizations
Physiological models Models of psychopathology that emphasize biological processes, such as
genes and neurological systems, as being at the core of human experience; physiological models
explain the development of psychopathology, its course, and its treatment in terms of biological
factors. There is a physiological basis for all psychological processes and events.
With respect to brain development, we need to consider how children’s brains adapt to their
environments over time in ways that are similar to all other children, as well as in ways that are
idiosyncratically distinct. We must appreciate both how specific brain regions are associated with
particular types of activity (e.g., emotion, memory) and how interactions and connectivity among
brain regions contributes to overall brain function. We must appreciate both how specific brain regions
are associated with particular types of activity (e.g., emotion, memory) and how interactions and
connectivity among brain regions contributes to overall brain function (Johnson et al., 2015). In fact,
recent work suggests that important information about psychopathology is less likely to come from
investigations of “the dysfunction of one specific brain region” and more likely to come from studies
of the ways in which “these regions are anatomically and functionally connected”.
Connectome The diagram of the brain’s neural connections. This makes use of graph theory,
diffusion imaging, and quantitative analysis to map the anatomical and functional features of complex
brain networks. Explanations of the connectome focus on macroscopic connectivity (e.g., between
brain regions), and include descriptions of nodes, hubs, and modules. Nodes are understood in the
context of numbers of connections, distances between them (i.e., the path length of connections),
centrality, and clustering. Hubs are nodes with extensive connections to other nodes. Modules are
groups of nodes with strong interconnections. With greater connectivity within and across brain
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