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Summary Everything you need to know for Developmental Psychopathology
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This is a summary of the developmental psychopathology lectures and literature. Everything is in English
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Developmentalpsychopathology
Samenvatting
Inhoud
Hc Fundamentals pt. 1 & 2.....................................................................................................................3
H1 introduction..................................................................................................................................8
H2 Models of child development, psychopathology, and treatment...............................................10
H3 principles and practices of developmental psychopathology......................................................16
H4 classification, assessment and diagnosis, and intervention.........................................................21
H5 disorders of early childhood........................................................................................................26
Hc Anxiety.............................................................................................................................................32
H11 Anxiety disorders, obsessive-compulsive disorder, and somatic symptom disorder................34
Hc Depression.......................................................................................................................................39
H12 Depressive disorders, bipolar disorders, and suicidality............................................................42
Hc Autism spectrum disorder...............................................................................................................48
H7 Autism Spectrum Disorder..........................................................................................................48
Hc Attention Deficit / Hyperactivity Disorder.......................................................................................53
H9 Attention Deficit/Hyperactivity Disorder.....................................................................................53
Hc eating disorders...............................................................................................................................57
H13 Eating Disorders........................................................................................................................58
Hc Substance use..................................................................................................................................60
H14 Substance-related disorders and transition to adult disorders.................................................60
Hc Disruptive behavior disorder...........................................................................................................65
H10 Oppositional Defiant Disorder and Conduct Disorder...............................................................68
Hc Trauma............................................................................................................................................72
H8 maltreatment and trauma- and stressor-related disorders.........................................................74
Hc Intellectual disabilities.....................................................................................................................79
H6 Intellectual developmental disorder and learning disorders.......................................................81
Hc dyslexia and dyscalculia...................................................................................................................86
Hc developmental language disorders.................................................................................................88
Wicks-Nelson & Israel – H10 Language and learning disabilities. Abnormal Child and Adolescent
Psychology........................................................................................................................................89
Begrippen.............................................................................................................................................93
1
,2
,Hc Fundamentals pt. 1 & 2
DPP is the study of normal development that has gone awry
It is this abnormal development that lead to psychopathological problems in
children and adolescents
Problem behaviors for both the youth and his/her environment
What is abnormal behavior?
- Not just atypical but can be also harmful
- Developmentally inappropriate
- Need to consider a variety of variables
o Age
o Situation / context
o Gender
o Culture
- Parents and professionals may differ in their views of a child and what is
considered inappropriate
- Society has changing views of abnormality
Abnormal development is multiply determined
- Must look beyond current symptoms
- Consider developmental pathways and interacting events
Children and environments are interdependent – transactional view
- Both children and the environment as active contributors to adaptive and
maladaptive behavior
Continuity = developmental changes are gradual and quantitative: predictive of
future behavior patterns
Discontinuity = developmental changes are abrupt and qualitative: not predictive
of future behavior patterns
Factors involved in judgements of abnormality:
- Developmental norms
- Cultural norms
- Gender norms
- Situational norms
- Role of adults
- Changing vies of abnormality
Some evidence that disorders have a particular age of onset
Sometimes onset is insidious
3
,Gender can impact:
- Timing (first occurrence)
- Severity
- Expression (expected behaviors)
However, concerns about gender bias exist
Historical influences
- Early expectations of psychopathology
o Adult-focused
o Demonology (possession)
o Somatogenesis (bodily imbalances)
o Strong focus on a single cause
- Nineteenth century
o Classification - Kraepelin
o Some childhood disorders identified
Mental retardation received attention
o Progress made on conceptualization of etiology
Sigmund Freud & psychoanalytic theory: his psychosexual theory of development
was one of the first developmental stage theories
Behaviorism: behavior is learned by interactions with the environment (skinner)
Social learning theory: learned behavior also comes from observations of one
environment (bandura)
Models:
- Interactional = variables interrelate to produce an outcome
- Transactional / systems = ongoing, reciprocal transactions of environment
and person. Environment variables can be close (proximal) or distant
(distal)
DPP studies the origins and developmental course of disordered behavior. But is
also studies adaption and success. It is the integration of various theories.
Causal factors:
- Direct cause = variable X leads straight to outcome
- Indirect = variable X influences other variables that in turn lead to
outcome
- Mediating factors = explain the relationship
between variables
- Moderating factors = presence or absence of
a factor influences the relationship between
variables
Pathways of development:
- Stable adaption = few environmental
adversities, few behavior problems, good
self-worth
- Stable maladaptation = chronic
environmental adversities
- Reversal of maladaptation = important life change creates new
opportunity
- Decline of adaption = environmental or biological shifts bring adversity
- Temporal maladaptation = can reflect transient experimental risk taking
4
,Continuity of DPP symptomology
- Homotypic continuity = stable expression of symptoms
- Heterotypic continuity = symptom expression change with development
- Cumulative continuity = child in an environment that perpetuates
maladaptive style
Multifinality = one problem leads to possible outcomes
Equifinality = possible beginnings lead to one outcome
Risk factors:
- Constitutional (genetic and health)
- Family
- Peers
- Emotional and interpersonal
- Intellectual and academic
- Ecological
- Non-normative life events
The more risks, the poorer the outcome
Timing of risk important
Risk for onset may differ from risk for persistence
Risk can accumulate over time
Some risk is tied to specific outcome
Resilience: positive outcome in the face of risk
Protective factors:
- Individual
- Family
- Extrafamilial
Can occur with one protective factor or may require more
Can occur in one domain or not another
Can be linked to neurobiology
Nervous system development
- Development begins shortly after conception
- Further development is an interaction of biological programming and (lack
of) exposure to stimuli
Nervous system structure
- Structure
o Central nervous system (CNS) – brain and spinal cord
o Peripheral nervous system – nerves outside the CNS. These nerves
send messages between CNS and other areas. It is made out of two
subsystems:
Somatic nervous system – sensory organs and muscles
Autonomic nervous system – arousal and emotions
Sympathetic – increase arousal
Parasympathetic – decrease arousal
Brain structure:
1. Hindbrain
a. Pons (relays information)
b. Medulla (regulates heart and lungs)
c. Cerebellum (movement and cognitive processes)
2. Midbrain
a. Connects hindbrain to higher structures
5
, b. Reticular activating system (waking and sleeping)
3. Forebrain
a. Two hemispheres (left & right) connected by corpus callosum
b. Cerebral cortex (sheet of neural tissue involved in memory,
attention, awareness)
c. Each hemisphere has 4 lobes
Nervous system: subcortical structures, these are located below cerebral
hemispheres and deep in the brain
- Thalamus – process and relay information between cerebral hemispheres
- Hypothalamus – basic urges
- Limbic system – emotion and memory
center
Neurotransmitters serve to inhibit or excite
neurons. Major neurotransmitters: serotonin,
dopamine, norepinephrine, glutamate, GABA
Behavioral genetics = the study of gene-
environment interactions
- Genotype = actual gene makeup
- Phenotype = expression of genetic
makeup
GxE (gene-environment interaction) refers to differential sensitivity to experience
due to differences in genotype
GE (gene-environment correlation) refers to genetic differences in exposure to
environments.
- Passive (parents transmit both genes and environment to their children)
- Reactive (child’s gene makeup and reactions from others)
- Active (child’s gene makeup and child’s selection of experiences)
Bronfenbrenner
- Microsystem
- Mesosystem
- Exosystem
- Macrosystem
Infant-caregiver attachment
Attachment = the process of establishing and maintaining an emotional bond
with parents or other significant individuals
- An ongoing process beginning between 6-12 months of age. Provides
infants with a secure, consistent base
- An internal working model of relationships comes from a child’s initial
crucial relationship. Carried forward into later relationships
6
,Effective parenting = the child’s needs and development are considered
Interactive, not unidirectional
Parenting styles:
Control high Control low
Acceptance high Authoritative Indulgent / permissive
Acceptance low Authoritarian neglectful
Research fundamentals:
- Hypothesis
- Selection of participants
o Representativeness
o Random selection
o Problems with clinic populations (selection bias)
- Measurement
o Direct observation
o Standardized tests
o Physiological test
o Clinician rating scales
o Self- reports
theory/previous
Research process: data collection, research,
data analysis, hypotheses/pre
interpretation of dictions, general
findings approach to
research
identifying the
sample,
selecting
measures,
research design
and procedures
Reliability = can you replicate it?
- Interrater reliability = do researcher find the same thing
- Test-retest reliability
Validity
- Internal
o Accuracy
o Rule out other explanations
- External
o Generalizability
Must find balance between internal and external validity
- Face validity = the extent to which a measure appears to assess the
construct of interest
- Construct validity = whether scores on a measure behave as predicted
- Convergent validity = reflects the correlation between related measures
7
, - Discriminant validity = the degree of correlation between unrelated
measures
- Criterion-related validity = how well a measure predicts behavior in
specific settings
o Concurrent validity = at the same time
o Predictive validity = in the future
Assessing problem behaviors
- Clinical assessment = information is obtained from different informants, in
a variety of settings, using various methods
H1 introduction
We need to understand developmental psychopathology so that we…
- May meaningfully describe the psychological disorders of infancy,
childhood and adolescence
- Can identify the numerous factors that increase vulnerability to
psychopathology
- Can design appropriate interventions for struggling children
- Can increase awareness and empathy for children who deserve to be
treated with dignity and respect
- Can provide the necessary support and resources to families, schools, and
communities
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.
We use the terms typical and atypical when referring to development and
patterns of adaption and maladaptation. Sometimes, however, we use the terms
normal and abnormal. Common descriptions of normality and psychopathology
often focus on:
- 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
- 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. Depending on the particular social and cultural settings, norms
will vary, but there will always be certain patterns of emotion, cognition,
and behavior that are considered evidence of psychopathology.
- Mental health perspective = theoretical or clinically based notions of
distress and dysfunction
A child’s psychological well-being is the key consideration. Children we
have a negative quality of life, who function poorly, or who exhibit certain
kinds of symptoms might have a disorder
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
8
, - The need for limit setting, structure, and expectations
- The need for stable, supportive communities and cultural continuity
The role of values
- Poor adaption
- Adequate or average adaption has to do with what is considered okay,
acceptable, or good enough
- Optimal adaption has to do with what is excellent, superior, or “the best of
what is possible”
Psychopathology = intense, frequent, and/or persistent maladaptive patterns of
emotion, cognition, and behavior.
Developmental psychopathology = extends the description of psychopathology
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.
If definitions of disorder are problematic, estimates of rates of disorder are even
more so. The multipart task of estimating rates of disorder includes:
- Identifying children with clinically significant distress and dysfunction,
whether or not they are in treatment (and most of them are not)
- Calculating levels of general (e.g. anxiety disorders) and specific
psychopathologies (e.g. separation anxiety disorder) and the impairments
associated with various disorders
- Tracking changing trends in the identification and diagnosis of specific
categories of disorder, such as autism spectrum disorder, ADHD, and
depressions
Developmental epidemiology = frequencies and patterns of distributions of
disorders in infants, children, and adolescents are the focus of the field.
Prevalence and incidence rates are both measures of the frequency of
psychopathology.
Prevalence = the proportion of a population with a disorder (i.e. all current cases
of the disorder)
Incidence = the rate at which new cases arise (i.e. all new cases in a given time
period)
Allocation of resources, availability, and accessibility of care
Barriers to care are widespread and have been extensively summarized
- Structural barriers include limited policy perspectives, disjointed systems,
lack of provider availability, long waiting lists, inconveniently located
services, transportation difficulties, and inability to pay and/or inadequate
insurance coverage.
- Barriers related to perceptions about mental health difficulties include the
inability to acknowledge a disorder, denial of problem severity, and beliefs
that difficulties will resolve over time or will improve without formal
treatment.
- Barriers related to perceptions about mental health services involve a lack
of trust in the system, previous negative experiences, and the stigma
related to seeking help.
Tolan and Dodge 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:
9
, - Children and their families should be able to access appropriate and
effective mental health services directly
- 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
- Efforts should emphasize preventive care for high-risk children and families
- More attention must be paid to cultural context and cultural competence
The globalization of children’s mental health
Rapid social change, urbanization, and urban poverty increase children’s
vulnerability to mental disorders in resource-poor nations. 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, 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 are
multicomponent approaches that focus on children, their families, and their
communities and systems, and are often embedded in existing health,
educational, or social networks.
A final issue concerns the continued and painfully unnecessary stigmatization (=
negative attitudes, emotions, and behaviors related to psychopathology and
mental illness) of individuals with psychopathology.
- Dimensions of stigma:
o Negative stereotypes
o Devaluation
o Discrimination
- Targets of stigma:
o Individual
o Family
- Contexts of stigma
o General public
o Self/individual
Understanding the development, course, and treatment of psychopathology in
infants, children, and adolescents represents only half the battle. Increasing our
tolerance and compassion for the diverse group of those who are diagnosed with
psychopathology and believing in the inherent worth of each struggling infant,
child, and adolescent make up the other, fare more difficult, half.
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? 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.
H2 Models of child development, psychopathology, and treatment
Models of development, psychopathology, and treatment allow us to organize our
clinical observations of children and our research findings into coherent,
informative accounts.
Historical models have contributed valuable ideas to our contemporary
understanding. Although these models are presented separately and are often
conceptualized as complete and comprehensive in and of themselves, they are
not mutually exclusive. It is more useful to think of these models as providing
10
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