child psychopathology and Treatment

Developmental Psychopathology

Childhood disorders are better understood when considered within the context of normal development

Statistical deviance

The infrequency of certain emotions, cognitions, and/or behaviors

Sociocultural norms

 The beliefs and expectations of certain groups about what kinds of emotions, cognitions, and/or behaviors are undesirable or unacceptable

Mental health definitions

Theoretical or clinically-based notions of distress and dysfunction

Adequate adaptation

what is considered acceptable

Optimal adaptation

what is excellent or superior

The Irreducible Needs of Children:

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

Developmental Epidemiology

The field that studies frequencies and patterns of disorders in infants, children, and adolescents

Barriers to care include

Structural (e.g., long waiting lists, inconveniently located services, inability to pay)

Perceptions about mental health difficulties (e.g., denial, belief that problems will resolve on their own over time)

Perceptions about mental health services (e.g., lack of trust in the system, previous negative experience)

The Stigma

For parents: Almost always shame, fear, and/or blame

For children: Experiences of secrecy and rejection are commonplace

Adults think that children are over-diagnosed, overmedicated, and poorly parented

Children hold similar beliefs and attitudes to adults

Ignorance and intolerance are critical, ongoing issues for those struggling with mental illness

• Treatment get insurance and out-pocket

• Barrier not enough session, some people share to insurance don’t use cause stigma

Gilal cell 5 main function

1) glue and hold the neuron in place 

2) from myelin sheath

3) people nourishment for the cell

4) remove waste protect

5) protect neuron form harmful substance 

Identifying

children with clinically significant distress and dysfunction, regardless of treatment

Calculating 

levels of general and specific psychopathologies and their impairments

Tracking

changing trends in the identification and diagnosis of specific categories of disorders

Developmental Epidemiology

The field that studies frequencies and patterns of disorders in infants, children, and adolescents

Prevalence

refers to all current cases of a set of disorders

Incidence

refers to new cases in a given time period

Models of Child Development, Psychopathology, and Treatment

Theoretical models of development, psychopathology, and treatment help to organize clinical observations, research, and treatment programs.

•Although various models of psychopathology are presented individually, they are not mutually exclusive.

•These models often provide complementary perspectives on complex clinical phenomena.

Dimensional models of psychopathology

Emphasize the gradual transition from the normal range of feelings, thoughts, and behaviors to clinically significant problems

Categorical models of psychopathology

Emphasize differences between distinct patterns of emotion, cognition, and behavior that are within the normal range and those that define clinical disorders

Physiological models

propose that there is a physiological basis for all psychological processes:

-Structural

-Biological

-Chemical

human connectome

the diagram of the brain’s connections – maps the anatomical and functional features of complex brain networks.

Neural plasticity

The development and modification of neural circuits

–Occurs due to both positive and negative experiences

–There exists lifelong potential for new, improved, and recovered function

–A balance between plasticity and stability is critical

Genotype

Genetic make-up

Phenotype

Observable characteristics

Behavior Genetics

The study of the joint effects of genes and environment

Epigenetics

The study of how environmental factors influence gene expressivity

Risk alleles 

impair general processes across many disorders

–These include common variants, rare variants, and many combinations of variants

Polygenic models

emphasize that many genes have small effects that influence the development of both mild and severe forms of disorder

Diathesis-stress model

Diatheses: Physiological vulnerabilities such as genetic abnormalities, structural pathologies, and biochemical disturbances

-Stress: Physiological or environmental

Diatheses

Physiological vulnerabilities such as genetic abnormalities, structural pathologies, and biochemical disturbances

-Stress

Physiological or environmental

Psychodynamic

models emphasize:

-Unconscious cognitive, affective, and motivational processes

-Mental representations of self, other, and relationships

-A developmental perspective

Behavioral Models

Both normal and abnormal behaviors are gradually acquired via processes of learning

•Classical conditioning, operant conditioning,  observational learning are processes of learning

Reinforcement

is key to all of these learning processes

-Focuses on the individual’s observable behavior within a specific environment

-Environmental variables have powerful effects on the development of personality and psychopathology

Cognitive Models

Focus on the components and processes of the mind and mental development

-Consider the content and developmental level of children’s thinking

neoconstructivist approach

emphasizes evolutionary contexts, experience-expectant learning, and both qualitative and quantitative change across development

Humanistic Models

-Emphasize:

•Personally meaningful experiences

•Innate motivations for healthy growth

•The child’s purposeful creation of a self

-Related to discussions of self, wellness, and positive psychology

Family Models

-A way to understand the personality and psychopathology of a child within the dynamics of the family

-Considers the shared environment and nonshared environment that family members experience

-Assessment and treatment addresses the child within the family unit

-In addition, peer relationships provide opportunities for companionship, intimacy, and acceptance

Sociocultural models 

emphasize the importance of the social context, including gender, race, ethnicity, and socioeconomic status

-Culture is not only the background for development, but a major influence on development itself

-Components of ecological models include homes, classrooms, and neighborhoods

-Birth cohort: individuals born in a particular historical period share key experiences and events 

Multiculturalism

•Culture shapes how clients understand their problems

•Questions to assess client understanding:

oWhat do you call your problem (illness, distress)?

oWhat do you think your problem does to you?

oWhat do you think the natural cause of your problem is?

oHow do you think this problem should be treated?

oWho else (e.g., family, religious leaders) do you turn to for help?

Cultural Competence

•The acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society

•Three main components:

oAwareness

oKnowledge

oSkill

Knowledge of Diverse Cultures

Can gain knowledge by

o Reading, especially regarding history

o Direct experiences

o Relationships with people of various cultures

o Asking client to explain cultural meaning (to a limited

extent)

o Remember that there are exceptions to cultural trends

– heterogeneity

Cultural competence has 2 dimensions

generic and specific

Cultural sensitivity is foundation

what are the values and norms of this specific client?

•Ex: using CBT need to challenge cognitions/beliefs? How to challenge beliefs in culturally sensitive way?

•Ex: Mr. Lee- “survivors of great catastrophe surely will have good luck later on,”

•Ethnic match between therapist and client- how important is it?

•Can use CA with different types of therapeutic modalities

Sue (2020) 

Micro-interventions

○Everyday anti-bias actions taken by targets, parents, significant others, allies, and well-intentioned bystanders to counteract, challenge, diminish, or neutralize individual (microaggressions) and the institutional/societal (macroaggressions) expressions of prejudice, bigotry and discrimination

Interacting Cultural Variables

•Multiple cultural factors can combine to create a unique culture for a particular individual

oTwo people of the same ethnicity can differ on many other variables, and can have very different life experiences as a result

Categorical classification

assumes there are groups of individuals with relatively similar patterns of disorder

•The best known classification system is the Diagnostic and Statistical Manual (DSM)

•The newest version is the DSM-5

´Classification

is a system for describing important categories, groups, or dimensions of disorder.

Diagnosis

is the method of assigning individual children to specific classification categories.

´Effective classification systems:

-Organize symptom patterns into meaningful groups

-Facilitate communication among professionals

-Inform research and treatment efforts

Reliability

Whether different clinicians classify children into the same categories

Interrater reliability

Two or more clinical psychologists come to the same conclusion.

Cross-time reliability

A child is similarly classified by the same clinician over time.

Validity

Whether the classification gives us true-to-life, meaningful information

Internal validity

About etiology or core patterns

External validity

About the implications of the disorder

Dimensional Classification

-Identifies key dimensions of functioning & dysfunction

Assumes that all children can be meaningfully described along these dimensions

Emphasizes differences in degree (or quantity) of a dimension

´Two clinically useful and well researched dimensions:

Externalizing dimension,Internalizing dimension

Externalizing dimension

Characterized by undercontrolled behaviors such as oppositional or aggressive behaviors

Internalizing dimension

Characterized by overcontrolled behaviors such as anxiety or social isolation

Developmental Contributions to Classification Systems:

•One system is the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood published by the Zero to Three Association

•Classification systems can be improved by emphasizing:

Developmental pathways

´Two real-life concerns that all classification systems must contend with:

Heterogeneity and Comorbidity

´Assessment

Systematic collection of relevant information used to evaluate clinically significant psychopathology

Differential diagnosis

Making a decision about which of several diagnoses best describes an individual

Diagnostic efficiency

The degree to which clinicians maximize diagnostic hits and minimize diagnostic misses

Interviews

Allow parents and children to explain their concerns and to tell their stories

Standardized tests

Assessments compared to data gathered from large samples

Projective measures

Given an ambiguous stimulus, individuals responses may reflect aspects of personality and individual concerns

Physiological measures

Are not used routinely due to cost, feasibility, and usefulness

Observation

Viewing a child’s behaviors and context

Essential Qualities of Assessment Techniques

´All assessment techniques (including interviews) should have adequate:

oValidity—measures what it claims to measure

oReliability—yields consistent, repeatable results

oClinical utility—benefits the clinician and ultimately the client

Validity

measures what it claims to measure

Reliability

yields consistent, repeatable results

Clinical utility

benefits the clinician and ultimately the client

Cultural Components

´Appreciating the cultural context

oKnowledge of the client’s culture, as well as the interviewer’s own culture

oFor behavior described or exhibited during interview

´Acknowledging cultural differences

oWise to discuss cultural differences rather than ignore

oSensitive inquiry about a client’s cultural experiences can be helpful

´Individuals with Disabilities Education Improvement Act (IDEA)

•Passed in 2004

•The categories for special education are more broad than the diagnoses found in the DSM

0-5 Manual

´Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (2021)

´Follows same multiaxial system of DSM 

´Birth to 5 years of age

´Provides specific criteria for diagnoses by focusing on developmental appropriateness for each classification              

Infant assessments

´Bayley Scales of Infant and Toddler Development (4^th ed.)- assesses cognitive, language, motor and social/emotional development

´Observations and interviews with caregivers

´Ages 1 -42 months

´Clinical Disorders

´´Neurodevelopmental disorders

´´Ex: Autism Spectrum disorder

´Sensory processing disorders

Sensory over/under responsivity disorder

´Anxiety disorders

 Separation anxiety disorder 

´Mood disorders

´Ex: Depressive disorder of early childhood

´II. Obsessive compulsive and related disorders

´Ex: Obsessive compulsive disorder

Sleep disorders

 Sleep onset disorder

´Crying disorder

´Ex: Excessive crying disorder

Trauma stress and deprivation disorders

´Ex: Post traumatic stress disorder

´VII. Relationship disorders 

Janssens et al. (2009)

´Fifty-four percentage of the preterm infants fulfilled one or more DC 0–3 diagnoses.

´Premature infants had significantly more diagnoses than full-term infants on axis I, axis III and axis V of the DC:

Temperament consists of basic dispositions focused on two dimensions:

Reactivity and Regulation

Developmental tasks and challenges

Developmental tasks and challenges related to

physiological functioning, temperament, and

attachment:

• Physiological Functioning:

• Bio-behavioral shifts that signal interpersonal and intrapersonal

changes

• Changes in the sleep-wake system

Reactivity

The infant’s excitability and responsiveness

Regulation

The infant’s control of his or her reactivity

Thomas and Chess

Structure of Temperament

▪Easy: 40%

▪Difficult: 10%

▪Slow-to-warm-up: 15%

▪Unclassified: 35%

Rothbart

Structure of Temperament

▪Reactivity: quickness

and intensity of

▪emotional arousal

▪attention

▪motor activity

▪Self-regulation:

strategies that modify

reactivity

Surgency

sociability and positive emotionality

Negative affectivity

predispositions to experience fear, frustration, or anger

Effortful control

regulation of stimulation and response

Goodness of fit

the interplay between infant temperament and parenting

Differential sensitivity

some individuals may be more susceptible to both risk-promoting and development-enhancing environmental conditions

Genetic influences

Responsible for about half

of individual differences

▪Vary with trait and age of individuals studied

Environmental influences

▪Nutrition

▪Quality of caregiving

▪Cultural variations

▪Gender stereotyping

▪Role of siblings

Emotional Self-Regulation

▪Adjusting one’s own state

of emotional intensity

▪Requires effortful control

▪Improves over first year, with

brain development

▪Caregivers

▪contribute to child’s self-regulation style

▪teach socially approved ways of expressing feelings