Childhood Psychopathology Midterm

Why Study Child Psychopathology?

define normal and abnormal behavior

causes and correlates

predictions about outcomes

treatment and prevention

Historical Background

Ancient greeks- children as burden

pre-englightenment- harsh treatment, property, religious reaobs

17th and 18th century- 2/3 children died before age of 5

John Locke

children raised with thought and care

no harsh treatment

Jean Marc Intard

care and treatment of mental defectives

Victor of Aveyron

Leta Hollingworth

individuals with intellectual disabilities (imbeciles) from those with psychiatric disorders (lunatics)

Ben Rush

children incapable of adult like insanity (moral insanity)

Early Biological Attributions

psychological disorders are biological problems only

located causes in individual

dev of disorders could not be influenced by treatment or learning

return to custodial care and punishment

consequence= fear of contamination

• eugenics and segregation

1st Disorder Found to be Unique to Children

masturbatory insanity

Psychoanalytic Theory

Freud

disorders linked to childhood experiences

interaction of dev and situational processes

help in proper env and therapy

lack evidence but the experience and behavior is still used

Behaviorism

foundation for empirical study of how abnormal behavior dev

classical conditioning and Pavolv

Watson- studies on elimination of children’s fears and theory of emotions (Little Albert)

Evolution of Treatment

Psychodynamic= 1930 and 1950= children with disorders institutionalized

1945 and 1965= number of children in institutions decreased, number of children in foster care increased

1950 and 1960s= behavior therapy was used (operant conditioning and reinforcement)

behavior therapy keeps expanding and used today

Individuals with Disabilities Education Act of 1975 (IDEA)

free and appropriate public education

least restrictive env

assessed with culturally appropriate tests

parent and teachers involved

IEP

procedural safeguards (no mandate on medicine

United Nations General Assembly (2007)

new convention to protect the rights of people with disabilities

countries that ratify agree to enact laws and other measures to improve disability rights

Whats Different About Psychopathology in Children?

not clear whose problem it is (when adults seek services for children)

many child problems involve a failure to show expected dev progress

many problems are not abnormal

interventions often to promote further dev

Significance of Child Psychopathology…

public health problem

majority do not receive any treatment

• lack of access, stigma, lack of knowledge

demand for services double over next decade

4 Main Assumptions of Child Psychopathology

1. continuity between abnormal and normal behavior (exist on spectrum)

2. heterogeneity in expression (different symptoms), causal mechanisms (different causes)

3. health adaptation must consider strengths and weaknesses (understand typical behavior to understand atypical behavior)

4. sensitive to dev stage and tasks

Psychological Disorder

patterns of behavioral, cognitive, emotional, or physical symptoms associated with one of more of: distress, disability, or increase risk for furthering suffering

• Excludes circumstances where reactions are appropriate as defined by culture

• describes behavior not causes

Heterotypic Continuity

expression changes (what you see), mechanisms same (causes)

ex. Aggressive behavior- form changes (kids= bite, teens=verbal)

Homotypic Continuity

expression same, mechanisms change

ex. Separation anxiety (kids= feel increased danger, adults= have insecure attachment) (both=cry and beg)

Multi-finality

single risk or protective factor can result in multiple outcomes

ex. child maltreatment= eating disorder, mood disorder, conduct disorder

Equifinality

single dimensions of psychopathology can be influenced by multiple risk factors

ex. genetics, family factors, env stress= conduct problems

Risk Factor

precede a negative outcome (comes before)

increases chance of negative outcome

ex. acute stress and chronic poverty, parental mental illness, death of parent

Protective Factor

reduce chances of developing disorder

try to increase these

ex. postive role models, community resources, positive parenting

Resilience

ability to fight off or recover from misfortune

Associated with strong self confidence, coping skills, avoid risk situations

not categorical/fixed, varies

connected to personal triad (personal strengths, family unit, schools/communities

Sex Differences- General

reporting and referral biases or differences in expression of disorder

girls/boys express problems differently

Aggression- expressed more directly in boys (physical), more indirectly in girls (relational)

differences appear small in children under 3 but increase with age

Race and Ethnicity- General

race is socially constructed

minority children over represented in some disorders

• diagnostic assessment bias (African Americans have lower rates of autism)

when controlling for other effects- few differences in prevalence emerge in relation to race

barriers remain in access to care

minority children face multiple disadvantages (poverty, discrimination, racism)

Maltreatment

1 in 20 youth experience abuse and neglect

over 1 million verified cases every year

twice as likely to dev depression, 3 times as likely to dev anxiety

Adolescence and Mental Health

confluence of hormonal, cog, socio emotional

important transition period

increase in substance use, violence, accidental injury

mortality rates triple between late childhood and early adulthood bc of risk taking behavior

Macro

society, culture

Exosystem

media, services

Mesosystem

interaction of extended levels

Micro

family, peers

Etiology

study of the causes of childhood disorders

biological, psychological, env processes

always multiple causes

0-2 Years

Normal Achievements= eating, sleeping, attachment

Common Problems=temper, stubborness

Clinical Disorders= intellectual disability, feeding disorders

2-5 Years

Normal Achievements= language, tolieting, self care

Common Problems= arguing, demanding, attention, fears

Clinical Disorders= speech, maltreatment, anxiety

6-11 Years

Normal Achievements= academic skills, rule governed behavior

Common Problems= arguing, concentration, problems, embarrassment

Clinical Disorders= ADHD, school refusal, conduct problems

12-20 Years

Normal Achievements= romantic interest, personal identity, increased responsibility

Common Problems= arguing, bragging, anger outbursts, risk taking

Clinical Disorders= anorexia, substance abuse, del., depression

Adaptational failures

failure to master or progress in accomplishing dev milestones

differ from children their own age on some aspect of normal dev

failures may result from ongoing interaction between person and env

Sensitive Periods

windows of time when env influences on dev are enhanced

increasing differentiation proceeds in hierarchical order

Genetic Contributions

genome established at conception

genes have genetic info from each parent, 22 matched chromosomes and single pair of sex chromosomes

influences can be expressed early or later in life

expression is malleable and responsive to env

rarely is one gene the single cause of a disorder

What is a Gene?

Stretch of DNA, produces a protein

do not code for behavior

Effects of different envs may be dependent upon genes (gene- env interaction)

Behavioral Genetics

investigates possible connections between genes and observed behavior

• twin studies= role of genetic influence in disorders

Heritability

proportion of individual differences in a trait that can be accounted for by genes (0-100%)

Variation between people due to genetics

higher= greater genetic contributions

Molecular Genetics

assess association between variations in DNA sequences and variations in certain traits

identify specific genes for childhood disorders

how do gene mutations alter how genes function in brain dev?

Neurobiological Influences- General

fetal brain= all purpose cells, mature into complex neuron

• Initially lots of neurons that are the same, migrate and become more specalized

• 5th month of dev= most axons reached their general destination

Brain Dev is Ongoing

early childhood= selective pruning reduces the number of neural connections that shape brain functions

Throughout life we go through this

brain changes in response to en

the env can also change our brain

Hierarchical Process of Brain Maturation

Primitive areas (sensory and motor), 1st 3 years of life

Perceptual and instinctive centers affected by early childhood

prefrontal cortex and cerebellum do not dev many differential connections until 5-7 years

Restructuring occurs between 9-11 bc of pubertal dev

Plasticity Limitations

early events may be hard to change

• compromise more of CNS

proper prenatal care, nutrition, no alcohol, are important for reducing risks

Brain Stem

hindbrain= medulla, pons, cerebellum- provides regulation

Midbrain= movement and sensory input, reticular activating system

Diencephalon= thalamus and hypothalamus, behavior, emotion, relay systen

Forebrain

highly specialized functions

limbic system= emotions, learning, impulse control, hunger, sex, aggression

basal ganglia= regulates organizes and filters info related to cognition, motor function

Cortex

largest part of forebrain

plan, reason, create

left hemisphere (language), right hemisphere (social and creativity)

frontal lobe= thinking and reasoning (make sense of social relationships and customs)

Neurotransmitters

make connections between different parts of brain

• Serotonin, GABA, norepinephrine, dopamine

psychoactive drugs increase or decrease flow or NTs

drugs target NTs

Endocrine System

adrenal glands= produce epinephrine and cortisol (response to stress and alarms)

thyroid gland= thyroxine, eating disorders, depression

Pituitary gland= estrogen, testosterone, in many disorders

Hypothalamic Pituitary Adrenal Axis (HPA axis)

Hypothalamus= signals pituitary gland

Pituitary= signals adrenal

Adrenal= cortisol

helps us prepare for danger

negative feedback loop

extended stress exposure impacts system, less able to respond to stress

people have different thresholds

anxiety and mood disorders

Temperament

organization behavioral system that shapes how people approach env and how env respond

linked to adult personality

behavioral activity in novel situations- approach vs withdrawal

Dimensions of Temperament

Positive affect and approach= approach situations with positive emotions

fearful or inhibited= approach with fear, anxiety

negative affect or irritability= upset, distressed, mood disorders

Emotions

core element of psychological experience

feature of infant activity

cues to danger and safety

important for internal monitoring and guidance

provide motivation for action

primary form of communication in young children

Emotion Reactivity

individual differences in the threshold and intensity of emotional experience

Emotion Regulation

process that enhance, maintain, or inhibit emotional arousal

weak or absent control structures

control structures operate maladaptively, may be adaptive in some situations and maladaptive in others

child and caregiver relationship plays critical role

Functional Approach to Understanding Behavior (ABCs)

Antecedents= events that happen before behavior

Behavior= behavior were trying to understand

Consequences= events that come after behavior

Operant Learning and Behavior Shaping

Positive and negative reinforcement, punishment shapes onset, maintenance, and extinction of behavior

logic behind ABCs

positive reinforcement best way to increases behavior

Classical Conditioning

explains acquisition of problem behavior in terms of paired associations between previously neutral stimuli and unconditioned stimuli

ex. dog bite and fear of dogs

Cog and Social Learning

social learning considers overt behaviors and role of possible cog mediations

Observational learning

social cog relates to how children process, store, and apply info

role of emotional arousal and relational context

Attachment

process of establishing emotional bond

begins early on (6-12 months), crucial, provide infant with secure and consistent base

Mutual responsiveness

helps to regulate emotions and behavior

Internal Working Model of Relationships

influenced by initial caregiver and is carried into later relationships

Attachment Types

secure

Avoidance

resistent

disorganized

uses strange situation to classify

Family and Peer Context

importance of family system= complex relationships, reciprocal influences among family subsystems (child behavior may influence parenting style)

peers become bigger influences beginning in elementary school

• early adolescence= highly sensitive

Family Systems Theory

understanding behavior of certain family member cannot be done in isolation from other family members

how family deals with atypical stress is important to childs dev.

• disrupts care and basic needs

Neighborhood and Cultural Factors

Neighborhood factors can be predictors of psychopathology

• poverty, resources, quality of schools

• cultural shifts in expectations of childs behavior and norms

• racism and violence very influential on mental health of minority childrne

Influences of technology on dev

• empathy and social skills

People Skeptical About Research..

experts disagree, media oversimplified

treatments harmful to some

things are complicated, no clear answer

confirmation bias

When Science is Ignored

need scientific evidence

Pseudoscience based on anecdotes, ignores scientific methods

scientists play by rules (admit when wrong and open to change)

Facilitated Communication

for autism

not valid, caused lots of harm, but still used

facilitator is the one to respond (not the child)

parents accused of SA

Incident Rates

percent of new cases, over a specified period of time (ex. 1 year)

Prevalence Rates

all cases (new or past), observed during a specified period of time

usually lifetime prevalence (birth- age 18)

examine proportion of children with a disorder

Correlates

associated at particular point in time

no clear proof that one causes the other

Sleeper/ delayed effects

risk not apparent until later in dev.

complicates study

Moderating Variable

influence direction or strength of relationship between 2 variables

categorical (sex) or continuous (age)

risk factors have different associations for depression for boys v girls

Mediating Variable

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

explains relationship

Randomized Control Trials

gold standard

random assignment to treatment and control conditions to evaluate treatments

Treatment Efficacy

does treatment work under well controlled conditions (internal validity)

use randomized control trials

bigger effect in lab

Treatment Effectiveness

does treatment work in real world (external validity)

Internal Validity

extent to which particular variables account for the findings

threats= maturation, effects of testing, subject selection biases, regression to mean

External Validity

degree to which findings can be generalized to other people, times, settings, etc

threats= sample representation, setting cohort effects, subject reactivity to participation, time that measurements are made

Standardization

specifies a set of standards/ norms for a method of measurement

assured its used consistently across occasions

compare case to normal pop distribution

Reliability

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

internal consistency= all parts of method of measurement contribute in meaningful way to info

inter rater- various observers agree on what they see

test retest= results obtained from a measure are stable over time

Validity

extent to which the method actually measures the construct of interest

Face Validity

extent to which it appears to assess the construct of interest

content validity

Construct Validity

does score on measure behave as predicted by theory or by past research

Convergent Validity

Reflects correlation between measures that are expected to be related

constructs validity

Discriminant Validity

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

construct validity

Criterion Related Validity

how well measure predicts some other real world criterion

at same time= concurrent

in future= predictive

Reporting Methods

structured and unstructured interviews

self reports= info about ones own behavior, feelings, thoughts

informant report= someone who knows child well provide info

Strengths= easy to give, low cost, good reliability/validity

Weaknesses= biases (social desirability), over/under endorsing experiences, need verbal/ reading ability (problem for young children)

Psychophysiological Methods

relationship between physiological processes and behavior

often measure autonomic NS activity

• heart rate, blood pressure, respiration

limitations= high level of inferences/ susceptibility to extraneous influences

EEG and event related potentials used

fMRI

Activity in functioning areas of brain, finer grained

Diffusion Tensor Imagaing

images showing connections between brain regions (white matter tracks)

Position Emission Tomography (PET)

assesses cerebral glucose metabolism

MRI

finer grained structures

CT

reveals coarse grain structure

Observational Methods

from unstructured to highly structured

strengths= cost effective, allow for focused attention, useful for studying infrequent behavior, allow for more control of situation (internal validity)

limitations= representativeness of measure, generalizability, depends on coding schemes, Hawthorn effect (people act differently when being watched)

Recruitment

where does sample come from?

consider issues of comorbidity

• high rate from clinic referred sample

• random selection is rare

• child studies often use samples of convenience