Models, Principles, and Practice

Barriers to mental health care

structural (waiting lists, location), perceptions about mental health difficulties, perceptions about mental health services, money

How many children/adolescents who need mental health interventions actually receive them

fewer than half

psychopathology

intense, frequent, and/or persistent maladaptive patterns of emotion, cognition, and bx

For children, intervention is called for if we see:

- Deviation from age-appropriate norms

- Exaggeration or diminishment of normal dev expressions

- Interference in normal dev progress

- Failure to master age-salient dev tasks and/or failure to dev a specific function/regulatory mechanism

Child maltreatment

increases likelihood of immediate, short-term and long-term negative dev outcomes

Psychoanalytic perspective

(Freud) Linked mental dxs to childhood experiences and that mental dxs can be helped w proper environ or therapy

Psychodynamic perspective

Mental representations of self, other, and relationships (Unconscious cognitive, affective, and motivational processes)

Behavioral perspective

Normal and abnormal bxs are gradually acquired via processes of learning, focus on indv's observable bx w/in specific environ

(Classical conditioning, operant conditioning, observational learning, reinforcement)

Cognitive perspective

Focus on components and processes of the mind and mental dev, consider content and dev level of children's thinking (Neoconstructivist approach)

neoconstructivist approach

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

Humanistic perspective

Emphasizes personally meaningful experiences, Innate motivations for healthy growth, and Child's purposeful creation of self

Carl Rogers

Humanistic approach - believed the patient is the expert on themselves

Family Systems perspective

Seek to understand personality and psychopathology of a child w/in the dynamics of the family, considers the shared environ and non-shared environ that family members experience

Socio-cultural perspective

Emphasize importance of social context, inc gender, race, ethnicity, and SES (Culture is not only the background for dev but major influence on dev itself)

birth cohort

indvs born in a particular historical period that share experiences/events (Ex. COVID, baby boomers)

Bronfenbrenner's Ecological Framework

Micro, Meso, Exo, Macro, Chrono

Diathesis-Stress Model

Diathesis - physiological vulnerabilities such as genetic abnormalities, structural pathologies, and biochemical disturbances

Stress - physiological or environmental

Two in combo: result in dev of a dx

Empiricism

theory of knowledge emphasizing role of experience, especially based on perceptual observations by 5 senses (Importance of objectivity observable evidence)

Pavlov's research on classical conditioning

Unconditioned response => conditioning => conditioned response

Watson and Little Albert

convinced he could create and eliminate fear.

The Study: aversive noise paired with white rabbit - conditioned fear response, conditioned him to be scared of the rabbit by playing the loud noise when the rabbit was present. Then, eliminated the fears my taking away the aversive noise.

resilience

adaptation (or competence) despite adversity

(reflects combined contributions or protective factors from indv, family, and social levels)

protective factors

indv, family, and social cx-istics that are associated w/ positive adaptation

narrative fallacy

create a story or explanation for any event, even when the story or explanation has no basis in fact

availability heuristic

tendency to make judgements about probability of events based on a bx that easily comes to mind (ex: risk of shark attack if you go swimming)

Representativeness heuristic

judge the probability of an event based on a mental prototype or stereotype

anchoring effect

tendency to give excessive value to the first piece of info and not modify judgement w/ additional info

confirmation bias

tendency to look for, intercept, and remember info that is consistent w/ one's beliefs

Gene-environment correlations

passive, evocative, and active

Passive correlations

parents provide environ that is correlated with the child's genotype

Evocative correlations

child receives responses from environ that are influenced by their genotype (ex: teacher goes out of way to focus on child with ADHD)

Active correlations

child seeks environ that's related to their genotype

(ex: Kid with hyperactivity does extreme sports)

Risk alleles

variants of genes that are significantly associated with increased risk of disease but may not lead to disease in isolation

Genome-Wide Association Studies (GWAS)

seek to identify relationships btwn genetic variants and dxs

Polygenic models

emphasize that dx may be associated with many risk alleles

Copy-number variations

parts of chromosome duplicated/missing, can lead to a wide variety of dysfunction (ex: down syndrome, prader willi syndrome)

Epigenetics

study of how environ factors influence gene expression

(Causes gene x environment interactions)

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 positive and negative experiences

(plasticity is greatest during sensitive (critical) periods in brain development), can be experience expectant or

experience dependent

synaptic pruning

occurs at diff times in diff areas of the brain, not fully completed until adolescence (pruning helps make neural pathways that are used frequently more efficient)

How do NTs make biochemical connections?

Neurons more sensitive to particular NT cluster together and form brain circuits

Categorical models

emphasize diff btwn distinct patterns of emotion, cognition, and bx that are w/in normal range and those that define clinical dxs

Dimensional Models

emphasize gradual transition from normal range of feelings, thoughts and bxs to clinically significant problems - the classification model we use today

RDoC framework: Research Domain Criteria

Framework adopted by the NIMH, aim is for researchers to understand the nature of mental health and illness in terms of varying degrees of dysfunction in fundamental psych/bio systems

RDoC Goals

heterogeneity, comorbidity (don't want comorbidity), spectrum of functioning, dimensional conceptualizations

Sleep-Wake Disorders

Insomnia - difficulties falling/staying asleep

Disorders of arousal - e.g. sleep terrors/sleepwakling

Nightmare dx

These dxs can result from indv variations in arousal and attention, combined w/ parental factors

temperament

biologically based differences in:

- Reactivity/responsiveness - easily startled or quiet/shy

- Regulation - what does infant do in response

- Surgency - interact w/ environment

- Negative affectivity - prone to anger

- Effortful control - ability to regulate stimulations and their response

- Society and culture

Temperament and psychopathology

Irritability, conflict, coercive relationships => can shape temperament into problems later

Harlow: Monkey and Mothers

one "mother" was made from wire, the other from cloth.

Monkeys spent 17-18 hrs per day with cloth mother even though wire mother was the one with food - monkey chose comfort over nutrition

attachment

bond btwn infant and caregiver based on needs, security, etc. (for biological parents, this can start before birth)

types of attachment

Secure - least at risk for psychopathology

Anxious-Avoidant

Anxious-ambivalent

Disorganized - most at risk for psychopathology

Strange Situation

measured security of attachment in 1-2 year olds

8 stages, each about 3 min, various scenarios of interactions btwn mother, infant, and stranger

Strange Situation attachment style results

Secure attachment 70% - distressed when separated from mother, avoidant of stranger

Ambivalent 15% - showed intense distress when mother left, fear of stranger, approached but rejected contact with mother when she returned

avoidant 15% - no interest when mother leaves, play with stranger, do not notice when mother returns

Bucharest Study

Even in extreme cases of deprivation, there is sufficient plasticity for attachments to form once stable caring caregiving is provided, earlier intro of such results leads to a more secure attachment

Reactive attachment disorder (RAD)

Usually in presence of severe neglect, common in foster care (20-40% develop RAD)

Disinhibited social engagement disorder (DSED)

exhibiting overly familiar behavior with strangers, lacking caution around unfamiliar adults, and a failure to check back with caregivers.

CARE (child-adult relationship enhancement)

Goals of CARE:

- Helpful child-adult develop/better relationships

- Foundational attachment skills

- manage/improve bxs

- Increase compliance

What do you need to diagnose Intellectual developmental dxs?

Need IQ and adaptive functioning!

Intellectual developmental dx (IDD)

Deficit in intellectual and adaptive functioning

(Adaptive = mastering daily skills); If IQ is lower than 85, struggle w/o support

Causes of IDD

Genetic: Down Syndrome, PKU, Fragile X

Prenatal: FAS, Disease, chemicals, poor nutrition, anoxia during birth

Environ: malnutrition, abuse, neglect, social deprivation

IDD environmental risk factors

In utero: exposure to teratogens (infection, alcohol, drugs, toxins)

Injury during birth

Traumatic brain injury

Severe and chronic social deprivation

Toxins

Down Syndrome

caused by trisomy of chromosome 21, Offspring receives 3 chromosomes from each parents (instead of 1), Most common identified cause of IDD

Down Syndrome Sxs

Mild-moderate IDD, Flattened facial features (epicanthic folds under eyes), Excess flexibility, Congenital heart defect, Will develop Alzheimer's

Flat profile: same skill level and functioning across the board (Vocab smaller given expected age - Difficulty switching attention, Inhibiting impulses, verbal memory)

Token economy

accumulate points, get reward => Helps connect bx to consequence through reinforcement

Brain differences in those with Down Syndrome

Lower synaptic density, less myelination, atypical neuronal migration

Williams Syndrome

More differential levels of skills (uneven profile - DS has flat profile) - Decreased myelination, slower processing

Vineland Adaptive Behavior Scales

- Assess adaptive functioning in 4 broad domains: communication, daily living skills, socialization, and motor skills

- Provides raw, ranked, percentile and age equivalent scores

- Semi-structured interview format w/ caregivers

Fragile X Syndrome Sxs

Primarily affects males

Women who carry fragile X

Learning disabilities

Hyperactivity

Short attention spans

Gaze avoidance

Perspective speech

Physical cx-istics: large ears, testicles, and head circumferences

Learnings Disorders (LDs)

LDs are neurobiologically based, core cognitive processes, bx/psychosocial factors, environ --Learning and achievement gaps btwn typical children and those with LDs widen over time

Have difficulty with saccades (eye tracking)

Dyslexia

difficulty w/ phonemic awareness and processing, Indv letter decoding difficulty, affects 5-17% of gen pop

(Dyslexia has multifinality in psychopathology for kids)

Dysgraphia

LD that affects writing skills (difficulty with grammar, spelling, spacing and words, organizing thoughts and expressing them in writing), affects 7-15% of school-aged children

Dyscalculia

difficulties with math-related concepts, memorizing math-related facts, organizing numbers, understanding how problems are organized on the page, affects 3-6% of gen pop

Lexicon

one's known vocab

Orthography

appearance of letters in words

Phonology

smallest unit of sound in a language

How do we learn how to read?

Decoding = Learn phonological skills, Sound out words, Map the word meaning

Early readers

Break down language in phonemic parts and then combine them into bigger words

Interventions: teach sounding out (letter to sound)

Fluent readers

Move directly from the way the word looks to the sound

To get there, need word decoding (if decoding skills do not appear, you cannot become a fluent reader or sound out new words)

comorbidities with dyslexia

ADHD

Sensory difficulties, motor/balance difficulties

Dev lang dx

Dyscalculia

Three theoretical perspectives

- Domain-specific/additive account - diff diagnoses have diff etiologies

- Common deficit account - diff diagnosis stem from single factors like auditory processing

- Domain general account - processes like working memory underlie multiple diagnoses

Main types of experiments (discussed in class)

cohort - longitudinal study that samples a cohort (a group of people who share a defining characteristic)

longitudinal - data is collected from the same indvs repeatedly over an extended period

quasi experimental - cause-and-effect relationships, used when random assignment cannot

correlational - relationships btwn two + variables w/o the researcher controlling/manipulating any of them