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 / 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