Child Mental and Behavioral Disorders Exam One

Typical Milestones for ages 0-3 months

• Respond to smiles with smiles

• Use crying and facial expressions to communicate hunger, fear, discomfort

• Enjoy “peak-a-boo”

Typical Milestones for around 6 months

• Recognize familiar faces

• Communicate happiness with laughter and squeals

• Express annoyance and anger with screams

• Babbling

Typical Milestones for around 12 months

• Respond to another’s distress by showing distress or crying

• Show affection to familiar adults and children

• Show mild to severe anxiety at separation from parent

• Show apprehension about strangers

Typical Milestones for Toddlerhood

• Realizing they are a person separate of others (independence and defiance)

• Noticing others, combined with language skills

  • use and repeat words and short phrases

  • follow simple instructions (put the block in the box)

  • Increasingly enthusiastic about socializing with other children

  • normal: disagreements, trouble sharing, defensiveness over possessions

• Wider range of social emotions w/ quick shifts

  • increased fearfulness

Typical Milestones for Preschool ages (3)

• Enjoy playing with peers

  • Play spontaneously with 2-3 children in a group

  • Can cooperate and take turns (sometimes)

  • Assign roles in pretend play (house)

• Sometimes cannot distinguish fantasy and reality

• Express more emotion towards others

  • Affection to parents

  • Talk about feelings

  • Try to make others laugh

Signs of Problems in Preschool ages (3)

• Excessive clinging or crying when separated from parents

• Socially disengaged; ignores other children and adults

• No fantasy themes in play

• Resist age-appropriate adaptive behavior (dressing, sleeping, using the toilet)

• Show little control when angry or upset

Typical Milestones for ages 4-5

• Continued interest in peer relationships

  • Want to please friends and be like friends

  • Agreeable to rules

• Sophisticated play

  • Increase in creativity in pretend play

  • Imaginary objects

  • Better able to distinguish reality from fantasy

• Increased independence and solo play

• More advanced/flexible social behaviors

  • Try to bargain with parents and peers

  • Sometimes demanding, sometimes eagerly cooperative

• Interested in gender differences; gender socialization has already starter

• View self as a whole person involving body, mind, and feelings

Signs of Problems in ages 4-5

• Extreme social behaviors

  • extremely fearful or timid behavior

  • protests to separation from parents, aloof to people’s communication

  • extremely aggressive behavior

  • little interest in playing with other children

• High distractibility

• Challenges with play

• Intense or limited range of emotions

  • unhappy, angry, or sad much of the time

Typical Physical Milestones for ages 6-12 (Childhood)

• Slowed physical development compared to younger ages

• Continued development of muscle coordination

  • musical instruments, sports

• Growth spurt in later stages of middle childhood, which indicates impending onset of puberty

• At times, difficulty balancing high energy activities and quiet activities

Typical Social-Emotional Milestones for ages 6-12 (Childhood)

• More complex peer relationships

  • “Best friends” and “enemies”

    • mostly same sex and live nearby

  • Age dynamics come into play

    • Nurturing and domineering with younger kids

    • Follow and idolize older children

  • Competitive, argumentative, hierarchical

    • Peer judges to resolve disputes

    • Bossy and love to win, lead, be first

• Greater interest in relationships with adults

  • Try to please adults

  • Tattle to attract adult attention

• Think more independently

  • Test independence (defiance)

  • Begin to see the point of view of others more clearly

• Improved emotional regulation abilities

  • Fewer angry outbursts, greater frustration tolerance and delay of gratification

  • Feelings hurt easily, especially when failure is involved

  • Mood swings

  • fear shifts from monsters/dark to school/social relationships/disasters

• Self-conscious

  • Define self in terms of their appearance, possessions, and activities

  • spotlight effect emerges - thinking everyone notices changes

Typical Physical Milestones for Adolescents

• most rapid growth since infancy

  • changes in sleep needs/circadian rhythms

• Development of secondary sex characteristics

• Increasing awareness of appearance, peer comparison

Typical Cognitive Milestones for Adolescents

• Abstract, hypothetical thinking; metacognition

• Increasingly complex moral reasoning and future orientation

• Brain still developing - related to judgement/emotion

Typical Emotional Milestones for Adolescents

• Complex emotional experiences

• Developing emotion regulation

• Sensitivity to social evaluation

Typical Social Milestones for Adolescents

• Peer relationships become central

  • Friendship = first equal-power, opt-in relationship

  • Learn to start, maintain, and end relationships

  • Giving and getting support, negotiating disagreements

  • Peer acceptance and evaluation is critical

  • Social media, digital communication – the social world is infinite

• Romantic relationships emerge

  • Developing skills in communication, trust, boundaries – in an emotionally intense relationship

  • Learning about sex, consent, and intimacy

• Still exploring – and want to be autonomous

• Developmental Task of adolescence = becoming increasingly autonomous while still remaining connected to others

Psychopathology

the scientific study of mental disorders, including their symptoms, causes, development, diagnosis, and treatment

Developmental Psychopathology

the study of how psychological disorders and maladaptive patterns of behavior develop and change across a person’s lifespan

“Four Distinguishing Features of Child/Adolescent Mental Health
Concerns”

1. When adults seek services for children, it often is not clear
whose “concern” it is.
2. Many child and adolescent behaviors of concern involve failure
to show expected developmental progress.
3. Many behaviors of concern shown by children and youths are
not entirely atypical.
4. Interventions for children and adolescents often are intended to
promote further development, rather than merely to restore a
previous level of functioning

John Locke

• Humane treatment

• more to learn from children than adults

• children are blank slates shaped by their surroundings

• children should be raised with care

• influenced the expansion of universal education across Europe

Jean Marc-Itard

• one of the first documented efforts to treat a child with evident mental and behavioral differences

• spent years trying to help Victor of Avignon (feral child) with developmental milestones

Historical Biological Explanations for Mental Illness

• “Disease” model – removing blame from
  the person…But also led to some
  concerning perceptions

  • Fears about contagion (in the same way
    many medical diseases are)

  • Mental health symptoms as “progressive”
    and “irreversible” → Loss of hope

  • Focus on the most visible disorders
    (psychosis, intellectual disability)

  • Blaming those with the most severe
    symptoms for crimes, social ills

• Slippery slope towards segregation and eugenics - preventing people with undesirable characteristics from having children

Leta Hollingworth

• not the children’s fault that they have intellectual or psychological symptoms

• “Moral Insanity” - they have disturbed emotions even if they can reason

• Advances in medical science → medical model → more humane treatment

imbeciles (1800s)

individuals with intellectual disabilities

lunatics (1800s)

those with psychaitric disorders

Dorothea Dix (1840-80s)

• Advocated for more humane treatment of mentally ill children

• Established 32 humane mental hospitals (children could be treated at these)

Sigmund Frued’s Psychoanalytic theory

• linked mental disorders to childhood experiences

  • the course of symptoms not viewed as inevitable - multiple causes and outcomes

  • children are more sympathetic

John Watson’s Behaviorism

• laid foundation for studying conditioning

• Little Albert study showed emotions like fear could be learned through classical conditioning

How have the forms of treatment changed from the 1940s to the 1960s

• Until late 1940s: most children with intellectual ot mental disorders were institutionalized

• 1945-1965: children in institutions decreased, children in foster families and group homes increased

• 1950s-1960s: behavior therapy was the systematic approach to treatment

  • similar principles to the dominant forms of therapy for children today

Urie Bronfenbrenner’s Ecological Systems Theory (1977)

• acknowledges that we cannot separate children from the levels of their environment

• things that happen within the child are important, and so are the things that happen around the child

Statistical Deviation

• Defines abnormality as any thought, behavior, or emotion that is rare or statistically uncommon in a population

• Characteristics are often mapped on a bell curve (normal distribution), where traits falling far from the average (usually two standard deviations away) are labeled abnormal

• Limitations: It treats positive rarities (like an exceptionally high IQ or rare artistic genius) the same as negative ones. It also relies on arbitrary cutoffs

Norm Violation

• Defines disorders as behaviors that break unwritten social rules, cultural expectations, or moral standards of a specific society

• Actions are judged based on the social or cultural context in which they happen; what is unacceptable in public during peacetime might change in other settings

• Limitations: Social norms change across time and cultures, risking cultural bias or the misdiagnosis of harmless non-conformity or unique cultural practices as mental illness

Personal Distress

• Defines abnormality based on the individual experiencing subjective emotional pain, suffering, or anguish

• If a person feels intense anxiety, depression, or fear that compromises their well-being, it points toward a psychological issue

• Limitations: Not all disorders involve personal distress. For example, individuals with antisocial personality disorder or manic phases in bipolar disorder may feel fine while causing harm to others. Conversely, normal life events like grief also cause intense distress without being a disorder

Psychological Disorder

• pattern of behavioral, cognitive, emotional, or physical symptoms shown by an individual associated with one or more of the following:

  • Person shows a degree of distress

  • Behavior causes impairment in at least one important area of functioning

  • The distress and/or behavior increase the risk of further suffering or harm

  • AND: excludes situations in which the
    reaction is expected and appropriate
    based on one’s context and/or culture

Challenges with modern diagnoses

• Imperfect system, blurry cutoffs and definitions

• Patient disagrees, or does not feel affirmed by the diagnosis

• Stigma carried with some diagnoses – among people and among providers

Multifinality

similar early experiences lead to different (multiple) outcomes

Equifinality

different early experiences lead to a similar (equal) outcome

Risk factors

• variables that precede a negative outcome and increase the chances that the outcome will occur

  • acute, stressful situations

  • chronic adversity

Resilience

• the ability to avoid negative outcomes despite being at risk for psychopathology
  

  • associated with strong self-confidence, coping skills,
    ability to avoid risk situations, ability to fight off or
    recover from misfortune

  • not a fixed attribute (“you’re so resilient!”) – a process of
    adaptation that the child has been forced to do in their
    given circumstances

Protective Triad

strengths of the child, the family, and the community

T/F treatment is disproportionately given to older white children/adolescents

True

Children who experience what are disproportionately affected?

• SES disadvantaged backgrounds and neighborhoods

• chronic stress associated with oppression

• abuse and neglect

• inadequate childcare

• low birthweight due to smoking, diet, alcohol, or drug use

• born to parents with mental illness or substance use disorder

Poverty is associated with greater risks of

• learning impairments and academic problems,

• conduct problems,

• chronic illness,

• hyperactivity,

• and emotional disorders

Sex/Gender differences in developmental trajectories

• negligible under age 3

• boys externalize more in early and middle childhood

• girls internalize more in adolescence

Is racism or race a risk factor

racism

Global Mental Health

• a growing field aiming to improve mental well-being and achieve equity in mental health care for all people worldwide

  • Addressing treatment gaps, providing and evaluating
    services in the communities across the world

Etiology

The study of the causes of disorders

• Considers how biological, psychological, and environmental processes interact to produce outcomes over time

• Multiple, interactive causes—rather than one-dimensional models help in understanding the complexity of disorders

Assumptions made by developmental psychopathology

1. Atypical development is multiply determined

2. Child and environment are interdependent (transactional view)

3. Atypical development involved continuities and discontinuities

• No single theory is sufficient to explain disorders

• Different theoretical orientations emphasize different etiological factors

• Integrative approach: each theory contributes important insights - “pieces of the puzzle”

The biological perspective views what as the underlying cause of psychological disorders?

The Brain

• shows neural plasticity

• experience plays a critical role in brain development

What do the hypothalamus and thalamus help regulate?

behavior and emotion

What does the endocrine system help regulate?

hormones

• seem to be related to eating disorders (thyroid) and anxiety and mood disorders

Gene-Environment Interaction

• Any trait a child has results from an interaction of environmental and genetic factors

  • Very few specific genetic causes have been isolated or identified as the underlying cause of psychopathology

  • Genetic contributions to psychological disorders come from many genes that each make relatively small contributions

  • Expression of genetic influences is malleable and responsive to social environment

  • Genes influence how we respond to environment and the environment shapes the expression of genes

    • Children and their environments are interdependent and interact dynamically (the “transactional” view).

What are some functions of emotional experiences?

• Alert us to danger, keep us safe

• Are important for internal monitoring and guidance (give us information about our reactions to things)

• Tell us what needs our attention and what can be ignored

• Provide motivation for action

• Affect quality of social interactions and relationships

Emotional reactiivty

Individual differences in the threshold and intensity of emotional experience. Trait-like.

Emotional regulation

Enhancing, maintaing, or inhibiting emotional arousal

Temperament

An organized style of behavior that appears early in development and shapes an individual’s approach to his or her environment (and vice versa)

Three Primary Dimensions of Temperament

1. Positive affect and approach → “easy child”

2. Fearful or inhibited → “slow to warm up”

3. Negative affect or irritability → “difficult child”

• Correlated with adult personality styles

• can be related to developing symptoms

Operant Conditioning

Learning occurs based on four principles

1. Positive reinforcement: add good stimulus, increase target respsonse

2. Negative reinforcement: remove bad stimulus, increase target response

3. Extinction: remove reward, decrease target response

4. Punishment: negative consequence, decrease target resposonse

Classical Conditioning

• Explains the development of abnormal behavior on the basis on paired associations between previously neutral stimuli and unconditioned stimuli

  • Any neutral event can become a conditioned stimulus if it is paired enough times with an event that already elicits a certain response

  • Although classical conditioning may be one explanation for. some adjustment problems in children, we often don’t know what the original association was

  • Often classical & operant conditioning work hand in hand

Albert Bandura (1977)

• Behavior may be learned not only directly (classical & operant conditioning) but also indirectly through observational or vicarious learning

  • Social cognition: how children think about themselves and others, resulting in the formation of mental representations of themselves, their relationships, and their social world

  • More emphasis on cognitive processes than overt behavior

Parent-child coercive cycle

a repeating behavioral loop where negative interactions between a caregiver and a child inadvertently reinforce and escalate aggressive, defiant, or aversive behaviors

1. The Request: A parent or authority figure gives a standard command or sets a limit (e.g., asking a child to clean up toys).

2. The Pushback: The child responds with non-compliance, whining, ignoring, or a defiant "no".

3. The Escalation: The parent reacts with increased frustration, yelling, or harsh scolding.

4. The Escalating Counter-Response: Instead of complying, the child ramps up their negative behavior—such as screaming, crying louder, or throwing a full tantrum.

5. The Reinforcement (The Trap): To stop the immediate stress or public disturbance, the parent eventually gives in, withdraws the demand, or offers a reward just to achieve peace.

Scientific Approach

• Organized approach to improving common sense and casual observations

  • Theories backed by empirical evidence

  • Controlled studies

  • Findings checked and repeated

• Multistage process

  • Develop a hypothesis (based on previous research)

  • Identify sample, select measurement methods, develop research design and procedures

  • Gather data

  • Analyze data

  • Interpret results

What are the 7 Questions we can ask and answer through research?

1. What are distributions of childhood disorders?
2. What are the correlates, risks, and causes of “abnormal”
child behavior?
3. What factors influence the strength of the relationship
between a predictor and child outcome?
4. What factors explain how/why a variable is related to a
child outcome?
5. What are the long-term outcomes for children who
experience difficulties?
6. How effective are our methods for treating/preventing
childhood problems?
7. How can we get existing effective treatments to more
children?

Epidemiology

the study of what is upon people

Epidemiological research

Incidence, prevalence, and co-occurrence of disorders in clinic-referred and community staples

Incidence rates

The extent to which new cases of a disorder appear over a specified time period

Prevalence rates

All cases, whether new or previously existing, that are observed during a specified time period

Co-occurance

multiple disorders are present in the same child

Correlates

Variables associated at a particular point in time with no clear evidence that one precedes the other

Causes

• Factors directly or indirectly influence behaviors

• Very difficult to study causes of psychopathology

Longitudinal research

repeated measures over time within the same child

Moderator

Influences the strength or direction of the relationship of variables of interest

• explain when / under what conditions a predictor variable is related to an outcome variable

Mediator

Describes the process, mechanism, or means through which a variable produces a particular outcome

• explain how / why a predictor variable is related to an outcome

• usually time-ordered

Randomized controlled trials (RCTs)

children with a particular problem are randomly assigned to various treatments and control conditions

Treatment efficacy

how well a treatment can produce changes under well-controlled conditions (lab)

Treatment effectiveness

how well the treatment can be shown to work in clinical practice not just in well-controlled laboratory conditions (irl)

Implementation science

evaluates interventions based on how well they translate to actually implementing them (or delivering them in real systems)

• emerging area of study

• more concerned with systems, policies, and processes than with specific treatment approaches

RE-AIM Framework

• Reach: how well the program reaches target audience, especially lower resource groups

• Effectiveness: overall success of the program and key outcomes

• Adoption: rate of participation in the program

• Implementation: how similar is the program or intervention being delivered

• Maintenance: what is required to continue to deliver the intervention, is it sustainable

Standardization

specify a set of standards/norms for a method of measurement that is used consistently

Reliability

consistency or repeatability of results obtained using a specific method of measurement

Internal Consistency

Whether all parts of a method of measurement contribute in a meaningful way to information obtained

• asking same question over and over again

Interrater reliability

Various observers agree on what they see

Test-retest reliability

Results obtained from a measure are stable over time

Validity

how much are we actually measuring what we want to measure

Face Validity

the extent to which it appears to assess the construct of interest

Construct Validity

whether scores on a measure behave as predicted

Convergent Validity

correlation between measures that are expected to be related

Discriminant Validity

correlation between measures that are not expected to be related to one another

Criterion-related Valdiity

how well a measure predicts behavior in specific settings
• at the same time (concurrent validity)
• in the future (predictive validity)

Internal Validity

does the variable we are studying account for the findings, or is a third variable driving these associations?

• Threats to internal validity → maturation, effects of testing, subject selection biases, third variables

External Validity

do the findings from this experiment generalize to other people, settings, times, measures, characteristics, etc?

• Threats to external validity → individual characteristics of participants, setting, and time that measurements are made

True Experiements

• Experimental research

• researchers have maximum control over the independent variable, subjects are randomly assigned, and possible sources of bias are controlled

• Random assignment of participants to treatment conditions, control for participant characteristics that affect outcome

Correlational studies

• examine relationships among variables; causality cannot be determined

• non-experimental

natural experiments

comparisons between conditions that already exist

Case studies

Intensive, usually anecdotal, observations and analysis of an individual child
• Rich sources of descriptive information, but often viewed as unscientific and flawed

PRO/CON of cross-sectional studied

• PRO: efficient and less susceptible to attrition and practice effects

• CON: evidence about individual change is not available

PRO/CON of longitudianl studies

• PRO: Track differences in developmental paths, identify individual developmental trends

• CON: Funding over time, problems with practice effects as well as aging and cohort effects

Retrospective Designs

Ask people to recall things from the past

• Highly susceptible to recall bias and distortion

Prospective design

Sample is followed longitudinally over time

• Time consuming and susceptible to sample attrition (dropout)

Assessment

A collaborative process of systematic problem-solving strategies to understand children and their family and school environments

• Flexible, ongoing hypothesis testing that
  assesses:

• Child’s emotional, behavioral, and cognitive
  functioning

• The role of environmental factors

• Nature, causes, and likely outcomes of the
  problem

Clinical description

Summarizes the child’s unique behaviors, thoughts, and feelings that make up a given psychological disorder

Diagnosis

Analyzing information and assigning a formal diagnosis