Developmental Psych

How to define normal (typical) versus abnormal (atypical)?

1. Normal as absence of disorders

2. Normal as statistical average

3. Normal as an ideal or desired state

4. Normal as successful ‘adaptation’

Normal as absence of disorders

• Normal: positive quality of life; function well in different contexts; free of disabling symptoms of psychopathology

• Abnormal: negative quality of life; function poorly; symptoms that form a recognizable pattern (syndrome) of psychopathology, fitting a clinical classification

• Mental health perspective (P&T)

Normal as statistical average

• Normal: behavior that occurs in the majority of the population

• Abnormal: behavior that occurs in a minority of the population

• Statistical deviance (P&T)

Normal as an ideal or desired state

• Normal: meeting social-cultural standards of healthy psychological development

  • Can be age-related, gender-specific, or culture-relevant expectations

• Abnormal: not meeting those standards

• Sociocultural norms (P&T)

Normal as successful ‘adaptation’

• Adaptation: ability of a person to adapt to his or her environment

• Normal: successful adaptation (adequate or optimal); one can deal effectively and flexibly with various possibilities and difficulties that arise in everyday life

• Abnormal: poor adaptation

Psychopathology

Refers to intense, frequent, and/or persistent maladaptive patterns of emotion, cognition, and behavior (P&T)

Developmental psychopathology

These maladaptive patterns occur in the context of typical development and result in the current and potential impairment of infants, children, and adolescents (P&T)

Developmental epidemiology 

Research into frequencies and patterns of disorders

Prevalence 

Proportion of a population with a disorder (number off current cases)

Incidence 

The rate at which new cases arise (all new cases in a given time period)

Stigma

• Is composed of stereotypes, prejudice and discrimination

• Multiple levels: public, personal and self-stigma (or internalized stigma)

• Can be harmful, and may prevent seeking help

Do we reach all children that need help?

Of children with problems, only 20% receives formal guidance and 35% support through informal services (teacher etc.), Zwaanswijk Others (2006)

Barriers to mental health care

• Perceptions of mental health and child welfare (e.g., lack of confidence in the system, previous negative experiences, stigma)

• Perceptions of psychological problems (e.g., denial, beliefs that difficulties resolve over time)

• Structural (e.g., long waiting lists, high personal cost)

Theoretical explanatory models

• Physiological models

• Psychodynamic models

• Behavioral and cognitive models

• Humanistic models

• Family or systemic models

• Sociocultural models

Physiological models

Physiological (i.e., genetic, structural, biological, or chemical) basis for psychological processes

• Brain development

  • Pruning: competitive loss of synapses – use it or lose it

    • Fewer, but stronger and faster pathways

    • Experience-dependent plasticity

• Interactions with environment

  • Diathesis (predisposition): physiological vulnerabilities (e.g., genetic)

  • Stress: physiological or environmental 

  • The interaction may lead to the development of a disorder

• Gene by environment effects and interactions

  • (1) All psychological traits are genetically influenced

  • (2) No traits are 100% heritable

  • (3) Genetic impact is caused by many genes with small effects

  • (4) Environment matters

Diathesis-stress model vs. Differential Susceptibility

Psychodynamic models

• Early psychodynamic models were scientifically dubious…

• Contemporary psychodynamic models:

  • Unconscious processes

    • Mental representations of self, other and relationships

  • Subjective experiences

    • Origins of (a)typical personality in early childhood (developmental challenges)

Behavioral and cognitive models

• Behavioral models: environment has powerful effects on development of personality and psychopathology

  • A(typical) behaviors are acquired via learning processes (e.g. reinforcement)

• Cognitive models: focus on processes of the mind and cognitive development (e.g. stages Piaget, Vygotsky)

• Cognitive behavioural therapy (CBT): manage problems by changing the way someone thinks and behaves

Humanistic models

• Emphasizes personally meaningful experiences, innate motivations for healthy growth, and the child’s purposeful creation of self (e.g. Maslow)

• Contrasts with psychodynamic models (conscious versus unconscious, positive versus negative human traits)

• Psychopathology: interference / suppression of these needs

Family or systemic models

• Understanding of personality and psychopathology of the child based on family dynamics

• Topics: family type, parenting styles, parent-child relationship, sibling relationship

• Shared and nonshared (unique) surroundings of siblings

• Diagnostics and therapy focus on the child within the family setting

Sociocultural models

• Culture is not only the background for development; rather, it is a major influence on development itself

• Examples: gender, ethnicity and socioeconomic status

• Settings of ecological models include home, classroom, neighborhood (embedded in meso, exo, macro and chrono* systems)

• *birth cohort (share key experiences and events)

Developmental psychopathology is not associated with a single point of view or model

Developmental pathways

• Adjustment and maladjustment are points or places along a lifelong map

• Some pathways are associated with psychopathology with high probability, others with low probability

  • Continuity and discontinuity refer to the overall group level of a characteristic or behavior

  • Stability and instability refer to the relative ordering of individuals compared to peers

  • Coherence: beginnings may be logically linked to outcomes if we carefully evaluate the variables that lead to stability as well as the variables that lead to change

  • Equifinality and multifinality: same initial conditions lead to various outcomes, and vice versa

Competence and incompetence

• Competence: effective functioning in important environments

• Similar constructs: arenas of comfort, spaces of relative calm

• All children, with and without disorders, display domains of competence and incompetence

Risk and protective factors

• Risk: increased vulnerability to disorder

• Risk factors: the individual, family, and social characteristics that are associated with this increased vulnerability

• Resilience: adaptation (or competence) despite adversity (better-than-expected functioning)

• Protective factors: the individual, family, and social characteristics that are associated with this positive adaption

Protective factors influence children’s outcomes by

• reducing the impact of risk

• reducing the negative chain reactions that follow exposure to risk

• serving to establish or maintain self-esteem and self-efficacy

• opening up opportunities for improvement or growth

Infant mental health consist of

1. Physiological functioning

2. Temperament

3. Attachment

Physiological functioning: 3 biobehavioral shifts in the first year

1. Rhythmic routines of feeding, dressing, comforting

2. Communicating feelings and intentions through gestures and vocalizations

3. Exploring the environment by crawling, walking etc.

Disturbances

• Pica: ingestion of nonfood substances, such as paint, pebbles or dirt

• Rumination: repeated regurgitation of food

• Avoidant/restrictive food intake disorder: limited appetites, severe selectivity of food, or fear of feeding

• Sleep-wake disorders: insomnia, disorders of arousal, nightmare disorder

Physiological functioning: Disturbances with food intake

When is it a problem and when a disorder?

• Disorder: inefficient and ineffective feeding pattern

  • No experience of hunger and relief from hunger*

  • Developmental delay in feeding routine due to neglect**

  • Aversive experiences with feeding (e.g., illness, force)

• Role of the caregiving environment

  • Increase in difficulties related to amounts of food, choices of food, and mealtime behaviour that are not solved

  • Worrying, frustration of the caregiver often increase the feeding problems

  • Feelings of personal incompetence and anger towards the child increase stress

• Possible treatments:

  • Empirically supported behavioural interventions and also attention for relational issues

Physiological functioning: Disturbances with sleeping

When is it a problem and when a disorder?

• Disorder: marked and persistent difficulties settling down and falling asleep, as well as maintaining sleep through the night, associated with impaired daily functioning

  • Insomnia: difficulties falling and staying asleep

  • Disorders of arousal: sleep terrors or sleepwalking

  • Nightmare disorder

• Problem:

  • 10-30% problems in families with typically developing young children

• Risk factors:

  • Child: individual differences in the ability to self-regulate and self-soothe

    • difficult temperament

    • medical condition

    • insecure attachment

  • Parents: reinforcing

    • maladaptive patterns

    • insensitive caregiving

    • anxiety/ depression

    • marital difficulties

Temperament (child)

There are individual differences in:

• Reactivity: Infant’s excitability and responsiveness

• Regulation: What the infant does to control its reactivity

Temperament traits / big five

• Surgency / extraversion: sociability and positive emotionality

• Negative affectivity / neuroticism: predispositions to experiences of fear and frustration/anger

• Effortful control / conscientiousness attempts to regulate stimulation and response

Well-adjusted: access to the full range of positive and negative emotions as well as mild, moderate and strong intensities of experience

Parenting dimension with large impact on temperament

• Warmth: connected to the child’s social and emotional needs

• Positive and negative control: connected to the child’s need for autonomy and self-regulation

→ Adding or reducing stress for the child?

If parents react to a stressed child with adding more stress without repairing this, it may result in toxic stress responses, with overactivation of the body’s stress response

Goodness of fit: match and mismatch

Interplay between infant temperament and parenting:

• easy-going baby with easy-going parents

• or fearful baby with strict parents

Two lessons:

1. In any infant-caregiver pair there are matches and mismatches; growth by ‘match-mismatch-repair’ cycles (shy children benefit from moderate challenges).

2. Extreme mismatches are problematic for children who are more susceptible due to their temperament (differential sensitivity)

Two central hypotheses of attachment theory

1. Individual differences in the quality of infant-caregiver relationships are largely the product of the history of interaction with the caregiver

2. Variations in attachment quality are the foundation for later individual differences in personality

Problem of continuity over time

Are these different reactions or is there continuity in behavior?

• What are (attachment) patterns of emotions, behavior and social interactions in context and over time?

Organisational perspective

• Development is characterised as changes in behavioral organisation (including emotion and cognition)

• Qualitative differences in behavioural organisation build on previous adjustments

Relations between early development and later outcomes are probabilistic and in continuous interaction with complex developmental processes and systems

• Stability/coherence over time vs. changes in support/expectations?

Developmental tasks at the end of first year of life

• Development of attachment relationship: experiences of safety, comfort and affection

• Development of a rudimentary sense of identity / self: earliest set of cognitions and emotions focused on the infant as a separate being

• Basic understanding of others and the world: early ideas about unfamiliar adults and children, along with new situations

4 attachment patterns: Based on behaviour of the child

Secure

1. Secure attachment

Insecure or anxious

• Organized:

2. Resistant / anxious / ambivalent attachment

3. Avoidant attachment

• Disorganized:

4. Disorganized / disoriented attachment

Secure attachment and caregiving history

• The caregiver often responds sensitively, consistently and appropriately to physical, emotional and social needs of the child

• More cooperative interactions between parent and child.

Regulation pattern of child

• Deeply rooted sense of safety and security

• Rudimentary cognitions and emotions, such as:

  • Self: "I am worthy of care.“; “I am lovable.”

  • Significant others: "I can trust that you will respond to me in appropriate ways."

  • World: "The world is safe and pleasant."

Resistant / ambivalent attachment and caregiving history

• The caregiver often responds inconsistently or unpredictable to the physical, emotional and social needs of the child

• Lower levels of psychological awareness in mothers and developmental lags in infants

Regulation pattern of child

• Basic sense of insecurity and uncertainty.

• Rudimentary cognitions and emotions, such as:

  • Self: "I do not know if I am worthy of care/ being loved.“

  • Significant others: "I cannot trust that you will respond to me in appropriate ways.“

  • World: "The world is sometimes pleasant and sometimes unpleasant."

Avoidant attachment and caregiving history

• The caregiver often responds with inadequate, intrusive or excessively controlling care to the physical, emotional and social needs of the child

• “Psychological unavailability” in caregivers.

Regulation pattern of child

• Basic sense of insecurity and unfriendliness

• Rudimentary cognitions and emotions, such as:

  • Self: "I'm not worthy of being loved."

  • Significant others: "I can trust that you usually do not respond."

  • World: "The world is unfriendly and not responsive."

Cultural differences in attachment patterns

Avoidance is more acceptable in "Western" countries than ambivalence

Situational variations / reactions to novelty (Ambivalent vs. Avoidant)

• Ambivalent: difficulty dealing with a novel, complex object; more hesitance; less flexibility; less effective in problem solving

• Avoidant: no problems in handling novel objects; close physical and emotional encounters with peers are very challenging

Patterns of behavior:

• Ambivalent: seeks help for smaller problems; asks for more nurturance as if they are younger than their actual age

• Avoidant: seeks help / contact when stress is over; often disobedient; others often respond instructive and controlling, not nurturant

Disorganised attachment and caregiving history

• The caregiver is perceived as frightening, frightened, or malicious

• A pattern in which both approach and avoidance is typical

Regulation pattern of child

• “Fright without solution": the caregiver is both a source of comfort and a source of anxiety.

Self, significant others, the world:

• "The temporary collapse (or absence) of attention-, emotion-, and behavioral strategies when experiencing stressful situations. “

• Prevalence: 15% non-clinical groups; 50-80% clinical groups

Disorganised attachment and later outcomes

Longitudinal data until the end of adolescence:

• More symptoms and more severe symptoms of psychopathology (e.a. self harm)

• Predicts dissociation or psychic collapse

• Predicts the development of a conduct disorder

• Predicts the development of a borderline personality disorder, sometimes in conjunction with avoidant attachment

Attachment and risk for development of (DSM) psychopathology

• Secure attachment pattern:

  • protective factor: in problematic situations a person has more resilience to deal with them

• Insecure-avoidant and insecure-ambivalent patterns:

  • higher risk for developing problems: not directly related to clinical disorders

• Insecure-disorganised pattern:

  • strong predictor of subsequent psychopathology

Attachment disorders

Reactive attachment disorder (RAD)

• lack of organised attachment behaviours, do not seek comfort when distressed and problems with emotion regulation (not easily soothed, excessively timid, hyper-sensitive)

Disinhibited social engagement disorder (DSED)

• little if any reticence with unfamiliar others, do not look back to the caregiver while wandering off, social superficiality and attention seeking, sometimes inappropriate physical contact

DSM-5: in Trauma- and Stressor related disorders (with PTSD)

Similarities and contrasts: RAD and DSED

Similarities:

• Social deprivation and neglect

Contrasts:

• RAD more responsive to enhanced quality of caregiving than DSED

• DSED more difficult to treat, "bottomless pit."

Risk factors for attachment disorders

Among other things:

• Inadequate, inattentive, inconsistent and intrusive care

• Psychopathology in parent

• In children: difficult temperament, genetic vulnerability and neurological difficulties

History of extreme insufficient care (DSM-5 C):

1. Social neglect or deprivation

2. Repeated changes of primary caregivers

3. Rearing in settings that limit forming selective attachments

Prevention / intervention for attachment disorders

Preventive support for at-risk children and families:

• Enhance positive parenting (STEEP, p. 83)

• Attachment and biobehavioural catchup (ABC) (p. 83)

• Placement in better caregiving environments (e.g., foster care; p. 81)

Interventions repairing unhealthy parent-child interactions:

• Home visits and parenting education/ support (p. 82)

• Infant-parent psychotherapy (p. 84)

→ Broad availability and easy accessibility of care

→ Growth towards more attachment security is possible

Historical perspective: Effects of the quality of the parents’ relationship on children

• St. Augustine (354-430): "Peace in society depends upon peace in the family."

• The family as an enclave; economic unit

  • Until about 100 years ago, violence against children and other family members was a private matter and was not or hardly considered criminal

  • Children were the property and responsibility of the father

Importance of adult intimacy for children

• Their parent’s relationship is the first model of adult intimacy

• From a very young age, children are acutely sensitive to the quality of the interaction of the adults around them.

• Not only overt hostility predicts distress in children, but also signs that parents are disengaged or withdrawn from each other.

Appraisal of conflict

Primary appraisal

• What is going on: good, bad or neutral?

Secondary appraisal

• IF BAD: why is there a conflict, have I done something wrong?

If the child’s behaviour does end the conflict, it will likely be repeated and reinforced → shaping models about attachment and intimacy

Learn how to handle stress within a family

• High satisfaction between intimate partners is related to secure parent-child relationship and positive interaction in families

• Secure relationship with mother + Many (unresolved) conflicts between partners = Emotional insecurity and stress for the child within the family

Dealing with conflicts between adults

• Healthy conflicts between caregivers: resolved successfully

  • Normal: conflicts take place in each family, these are instructive.

• Unbalanced conflicts: without a resolution

  • As a reaction, children often self-blame if the cause of parents’ behaviour is not identified resulting in:

    • pulling back, guilt, shame, fear, depressive symptoms.

    • a desire to intervene/mediate, angry, try to distract attention.

    • physiological responses (heart rate, blood pressure, skin reactions)

• Child does not become accustomed to conflicts between adults.

• Negativity between parents remains a stress factor

• For the outside world, a child can show indifference

Sensitisation hypothesis

• Desensitisation = becoming accustomed to conflicts/ arguments

• Sensitisation = becoming increasingly reactive to exposure

A history of conflict reduces the threshold for the child to react negatively and increases reactivity to the conflict:

• neuroendocrine system becomes increasingly vulnerable to stress

• flight-or-flight response is activated quickly

Siblings: better off with or without?

• More sensitivity to differential (parental) treatment and fairness

• Development of theory of mind at an earlier age

• Development of social competence through experiences of conflict and support to prepare for the complexities of an intimate relationship

What do they learn from siblings?

• Negotiation or competition for toys

• Playing together

• Sharing attention from parents

Differences between siblings and peers

Defining features of friendships with peers:

• voluntary

• reciprocity

• equal status

Consistent research results:

• A strong bond with a friend can make up for a weak sibling relationships. Not the other way around!

Effects on social and emotional development:

• Motivation for empathy

• Shared imaginative play

• Broader social network

• Expectations about social status: acceptance or rejection from others

Social standing between peers

Sociometric testing = four categories of social standing based on the question to name who they like and dislike within the group.

popular	rejected
controversial	neglected or socially isolated

Adolescents and intimate relationships

Early adolescence

• Clear distinction between intimate relationships and friendships.

• Understanding of intimacy becomes more sophisticated

• Often patterns repeat with siblings and friends:

  • Sroufe c.s.: strong continuity over 20 years (positive and neglected).

  • Conger c.s.: with supportive parents, also supportive and less hostile in interactions with romantic partners.

• Specific experiences can affect the trajectory (e.g., abuse).

Transitions during adulthood

• Cohabitation: Four groups of cohabiting couples

  • Precursor to marriage

  • Coresidential daters

  • Trial marriage

  • Substitute marriage

• Parenthood

  • Early age, or at later age?

  • Stressful or well-managed?

• Relationship satisfaction and family transitions

• Decline in positivity after early stages, less affective expressions between partners

• "Our brain is simply wired to take good things for granted." (B&K, p. 488)

• Related to transitions of children from one age period to the next

Relationship satisfaction and attachment

Security = balance between autonomy and intimacy

Factors that influence the quality of intimate relationships

Four negative patterns that predict divorce:

• criticism

• contempt

• defensiveness

• stonewalling

Intimacy in later life

• More older men remarry, women are 3x more likely to be living as a widow

• The more disruptions, the less financial security and more risk of hearth disease, esp. for women

• Not married in older adulthood does not mean without an intimate relationship

Specific life issues in later life

• Mixed blessing of retirement

• Widowhood

• Loss of health, skills, social relationships, social roles

• Relational problems/conflicts with children, partner, brothers/ sisters, others

• Increasingly aware of mortality/discuss meaning of life

Timing of issues?

• Early onset: arise earlier in life

• Late onset: arise in late adulthood

• Combination of early and late start

Autonomy in later life: how?

• Having a say in matters and being able to keep this up

• Active participation and contribution

• Freedom of choice and the possibility to shape your own individuality

• It is more than being autonomous, independent or in control

→ In later life, about 50% have psychological problems

Depression in later life

• First physical symptoms, vague complaints

• Subjective memory complaints

• Masked by 'smile‘

Often undetected by ascribing the complaints to other potential causes

Potential tips for good (mental) health in later life

• Check your blood pressure regularly

• Lead a physically and socially active life

• Invest in positive relationships (socioemotional selectivity theory):

  • Break up an unsatisfying relationship

  • Manage conflicts with more affection and less hostility compared to younger couples and strengthen positive feelings (including sexuality)

  • More time with close family members and friends

Pioneers in the autism research

• Term ‘autism’ used by Bleuler (1911) to describe symptoms of schyzofrenic patients

• Grunya Sukhareva (1925): the first psychiatrist to identify and pathologise autism.

• Leo Kanner (1943): Autism

• Hans Asperger (1944): Asperger’s Sydrome

Autism Spectrum Disorder in the DSM-5 is defined mainly by 2 domains

A. Deficits in social communication and social interaction, including:

• Social emotional reciprocity

• Nonverbal communication

• Relationships

B. Restricted, repetitive behaviour and interests (>2):

• Stereotypic or repetitive behaviour

• Insistence on sameness

• High restricted, fixated interest

• Hyper- or hypo responsiveness

New in DSM-5 (regarding autism)

• Sensory problems

  • Hyper- or hypo sensitivity

• Severity levels

  • Level 1-requiring support

  • Level 2-requiring substantial support

  • Level 3-requiring very substantial support

• PDDNOS / Asperger removed

• Symptoms must be present in early development but may not fully manifest until later/masked

Prevalence

• Prevalence 1-2%

• Around 70% normal intelligence

• Around 30% experience regression (loss of skills)

Females with Autism

• In general: 20% - 25% females

Explanations:

• Genes

• Symptoms

• Compensation

• Clinician bias

Savant skills (e.g. Calendric memory)

• 10% of autistic individuals

• Disharmonious IQ profile

Social subtypes (Lorna Wing)

• The aloof

• The passive

• The unusual (odd)

Medical characteristics of autism

• Epilepsia (± 25%)

• Insomnia and sleep problems (± 60%)

• Motor impairments (e.g. poor fine motor skills)

• Gastrointestinal symptoms (± 45%)

No empirical evidence of connection between vaccinations and mercury (kwik) → Fraudulent Lancet paper (1998)

Assessment of autism

• Current behaviour and Development

• Observation 

• Parent interview

• No biomarkers!

Treatment for autism

• There is no ‘cure’ for autism

• Focus on individual and environment

  • Customised care, Psychoeducation, Psycho/behavioural therapy, Fysio/speech therapy

• Medication

  • Directed at co-occurring problems (anxiety, hyperactivity, rigidity)

• Early intensive interventions (e.g. ABA)

  • Heated discussion, see recent NAR report

Neurodiversity

People experience and interact with the world around them in many different ways; there is no one "right" way of thinking, learning, and behaving, differences are not viewed as deficits

Medical Model → Social Model

What causes autism?

Short answers:

• We don’t know, there is no single cause

• We do know, it’s not the mothers fault and its not due to vaccination

Real answer:

• Genetics, neurobiology

• G x E (sensitivity to exposure)

• rGE (liability to exposure)

Heredity of autism

Concordance rate:

• Identical (Monozygotic) twins: 

  • 80% (100% shared genes, shared uteral environment)

• Fraternal (Dizygotic) twins: 

  • 31% (50% shared genes, shared uteral environment)

• Siblings: 

  • 20% (50% shared genes, no shared uteral environment)

Neurobiological explanations of autism

• Growth

  • Abnormal brain growth

  • Too much growth in early development

  • Larger head circumference 

• Chemistry

  • Neurotransmitters (transmit signal)

    • Serotonine

    • Oxytocine

    • Reward system

    • Excitation/inhibition balance

• Anatomy

  • No ‘characteristic’ brain structure found yet

  • Less neurons in lymbic system (amygdala, hippocampus) and

  • Cerebellum (movement, cognition)

  • Evidence: MRI, postmortem and animal studies

• Activity

  • EEG: Brain waves (oscillations) →  Some evidence for atypical activity during in specific regions during: perception faces, emotions, perspective taking

  • Need for studies on real-time interactions

Psychological explanations of autism

• Central Coherence

  • Natural tendency to see connection between stimuli

  • Weak central coherence: focus on detail

  • Strong central coherence: focus on whole

• Executive Functioning

  • Cognitive functions that regulate goal directed behaviour

  • e.g.: Mental flexibility, Planning, Working memory, Inhibition, Initiative

• Emotional competence

• Theory of Mind

  • ‘The ability to ascribe mental states to people and to explain and predict behaviour in terms of underlying mental states’

  • e.g.: Perspective taking, Empathy, Reciprocity

Double Empathy

Psychology vs. Criminology vs. Psychiatry

Typology of antisocial behaviour (Frick, 1993)

Normal course of antisocial behaviour (Bongers, 2004)

Normal course of delinquency 

Highest between 15 and 25

Adolescence-limited vs. Life-long persistent ASD (Moffit, 1993)

• Adolescence-limited: quite normative for the age period, spikes during teenage years and rapidly declines when people enter adulthood

• Life-long persistent: starts in pre-school age, stays at the same level throughout life

Disruptive, impulse-control, conduct disorder

Conditions involving impaired self-control of emotions and behaviours, SUCH THAT:

• these problems violate the rights of others, and/or

• bring the individual into significant conflict with authority figures

Disruptive behaviour disorders

• Oppositional Defiant Disorder (ODD)*

• Conduct Disorder (CD)*

• Antisocial Personality Disorder (ASPD)

• Intermittent Explosive Disorder (IED)

• Pyromania

• Kleptomania

Oppositional Defiant Disorder (ODD)

Conduct Disorder (CD)

Developmental cascade of ASB

Pyramide of ASB

Factors that affect the development of ASD

Genetic Vulnerability for ASD

• FOXP2 (speech, language, et al.)

Prenatal risk factors

Factors in inadequate parenting (Belsky, 1984)

Types of inadequate parenting 

Parent-child interaction & ASD