KC

Abnormal Child Psychology – Lecture 8 Notes

Lecture 8 Notes – Abnormal Child Psychology (PSY 338)

Psychodynamic perspective

  • Mutism is a symptom of an unconscious conflict and can be resolved through play which focuses on these conflicts.
  • Provides the child with a developmentally appropriate way of communicating their feelings about these conflicts.
  • Play and a supportive environment facilitate this work with the child.
  • Lyndsay and the therapist will explore her situations and resolve issues.

Therapy Session 1

  • Themes include hostility and aggression.
  • Lyndsay used her teddy bear Simon to kick puppets.
  • Therapist allows Lyndsay to be successful beating up the puppets with Simon.
  • Led to displays of confidence and happiness.
  • Lyndsay held the ball they were playing with and refused to throw it back to the therapist.
  • When she threw it, she aimed at a doll on the floor.

Therapy Sessions 2–5

  • Same theme: aggression and dominance using Simon.
  • Lyndsay used Simon to pull the finger puppets off the therapist’s fingers and kicked them around the room.
  • Simon won each altercation.
  • Lyndsay molded a family out of clay: big blue piece = her father; the smallest piece = her; an even smaller piece attached to Simon representing herself.
  • Lyndsay threw the clay pieces around and used Simon to hold a toy sword, chopping up the biggest pieces of clay.

Therapy Sessions 5–10 – Emerging changes

  • Themes of aggression, hostility, and smallness began to change as therapy progressed.
  • Clay was used to make plates and pretend food; she fed Simon and the therapist.
  • She put Simon aside and pretended to eat something.
  • She expressed a desire for her mother to come into the end of the session to see her creations.
  • She remains nonverbal in session, gesturing and playing rather than speaking.
  • Around this time she made progress in school and at home.
  • She spoke to a teacher and asked a friend if they wanted some of her snack.

Psychoanalytic analysis of treatment

  • Why is Lyndsay doing better?
    • Hostility and aggression lead to a sense of winning/agency when successful in play.
    • A self-concept of being small and vulnerable is challenged by aggressive victories, altering self-perception.
    • Aggression leads to social interaction within the therapeutic context.
    • Progressive opportunities for communication emerge through play as conflicts are expressed nonverbally.

Factors contributing to effectiveness

  • Therapeutic relationship
  • Diagnostic opportunities
  • Breaking down defense mechanisms
  • Facilitating articulation
  • Therapeutic release
  • Anticipatory preparation

View: Family systems in psychopathology

  • Psychopathology is viewed as a result of variables in the family system.
  • Family = network of connected individuals who influence and partially direct one another’s behavior.
  • Goals:
    • Improve patterns of communication.
    • Symptom reduction in the identified patient.
    • Identify roles within the family.
  • Example: Structural Family Therapy
    • Focus on boundaries, hierarchies, subsystems.
    • Family treatments aim to reorganize the family structure to reduce pathology.

Family systems – key concepts

  • Family system: what each member brings into the family impacts the unit; the unit impacts each member.
  • The family is a social system that includes:
    • Characteristics
    • Roles
    • Communication patterns (can be pathological)
    • Rules
    • Hierarchy
    • Subsystems
  • Interactions are transactional.

Roles in dysfunctional families

  • Satir discusses these roles in the context of children with addiction.
  • Common explanations:
    • Parent may not be healed from a trauma.
    • A family that meets its own needs rather than the children’s needs is dysfunctional.
    • Child is assigned a role by reinforcement in the environment (conditioning) based on what they are praised for and rejected for.
    • They develop an adapted self, which can conflict with their authentic self.
  • The six most common roles are noted but not listed in these slides.

Working with the parents – parenting styles

  • Authoritative vs. Authoritarian (two ends of a spectrum)
  • Four coercive practices (often discussed with authoritarian practices):
    • Unqualified power assertion
    • Arbitrary discipline
    • Psychological control
    • Severe punishment
  • Hostile verbal criticism
  • Permissive
  • Neglectful

Maltreatment (overview)

  • Definitions and frameworks for understanding maltreatment.
  • Four types of maltreatment: neglect, physical abuse, sexual abuse, psychological abuse.
  • Children who experience maltreatment are diagnosed based on the signs and symptoms they display.

Maltreatment statistics and economic impact

  • Facts:

    • Approx. 3.5 imes 10^6 youths referred to child protective services annually for suspected maltreatment.
    • Approx. 6.75 imes 10^5 of these cases are substantiated.
    • 1ackslash 100 children and adolescents are abused or neglected each year.
    • The $1\%$ estimate does not include unreported cases.
      (US Department of Health and Human Services, 2019)

  • Economic impact (lifetime costs per victim):

    • [2.10\times 10^5, 8.31\times 10^5]
    • Average annual national cost of child maltreatment in the U.S.: 4.28\times 10^{11} dollars per year.
    • Direct costs plus indirect costs.

What is maltreatment? (definition and types)

  • First definition (Child Abuse Prevention and Treatment Act, 1974): physical or mental injury, sexual abuse, exploitation, negligent treatment, or maltreatment of a child under 18 by a person responsible for welfare under circumstances harming or threatening health/welfare.
  • Four types: neglect, physical abuse, sexual abuse, psychological abuse.
  • Children diagnosed based on signs and symptoms.

Role of parents and caregivers

  • Children depend on parents/caregivers for protection, nurturance, and direction.
  • Attachment biology: humans are predisposed to form attachments with caregivers and seek them in times of stress.
  • Absence of caregivers is traumatic and impairs coping.

Child neglect (DSM-5)

  • Definition: an action by a parent or caregiver that deprives a child of basic age-appropriate needs and results or has reasonable potential to result in physical or psychological harm.
  • Subtypes:
    • Abandonment
    • Lack of appropriate supervision
    • Failure to attend to necessary emotional/psychological needs
    • Failure to provide necessary education, medical care, nourishment, shelter, and/or clothing
  • Most common form of maltreatment: approx. 75\% of reported cases.

Socio-emotional deprivation (S-E deprivation)

  • Definition: extreme absence of emotional attention/responsiveness from primary caregiver.
  • Effects: severe global psychosocial and cognitive dysfunction; deviant developmental trajectories of brain maturation.
  • Global scope: roughly 15\times 10^6 infants and young children worldwide have lost both parents.

Socio-emotional deprivation in infancy – institutional care

  • Institutional care path is often pathogenic due to:
    • High child-to-caregiver ratios
    • War/disease/instability in caregiver networks
    • High caregiver turnover (50–100 caregivers in first 18 months)
    • Long periods of isolation or poor stimulation
  • Some centers may provide adequate physical care and cognitive stimulation; others are abusive or deplorable.

DSM-5 disorders related to deprivation

  • Reactive Attachment Disorder (RAD)
  • Disinhibited Social Engagement Disorder (DSED)
  • Mostly seen in orphanages, foster care, group homes; rarer with severe neglect at home.

Reactive Attachment Disorder (RAD)

  • Pathogenic care background; common in international adoptees who spent first 12–24 months in low-quality orphanages.
  • Also seen after extreme neglect or multiple foster homes in early life.
  • Key feature: lack of attachment to a single caregiver early in life.
  • Not the same as insecure or disorganized attachment (attachment can be present but not optimal).

RAD – DSM-5 highlights

  • Rare and almost exclusively in young children subjected to extreme deprivation.
  • Disturbed or developmentally inappropriate attachment behaviors.
  • Do not seek or respond to comfort when distressed.
  • Emotionally withdrawn; negative affect toward caregivers (seldom smiles, hugs, or kisses).
  • Present as sad, anxious, or irritable.
  • Should not be diagnosed before 9 months old.
  • Bucharest Early Intervention Project (BEIP): adoptees before 24 months did not develop RAD; about one-third of children remaining in orphanages developed RAD.

Socio-emotional deprivation – historical context

  • Anna Freud and Hampstead War Nursery (World War II): early work on maternal deprivation effects.
  • René Spitz and Katherine Wolf (1946): observational study of infants in U.S. orphanages; compared to infants in prison nurseries; orphanage infants were less playful, less responsive, did not seek contact comfort, and had poorer growth and developmental outcomes.

Post-WW II – John Bowlby’s research

  • Bowlby (1951) reviewed deprivation outcomes for children in postwar Europe.
  • Concluded that a warm, intimate, continuous relationship with a primary caregiver is essential for physical, cognitive, and social–emotional development.

Romanian orphanages and policy (Ceauşescu era)

  • 1966 policy to increase birth rate led to mass orphanage growth; high throughput of children into state care.
  • Policies included incentives for large families and penalties for contraception/abortion.
  • Result: ~170,000 children in orphanages; widespread deprivation.

Issues in Romanian orphanages

  • Under-nourishment; high staff-to-child ratios; long crib confinement; little social interaction with staff; no foster care system.
  • International assistance sought; BEIP implemented.

Bucharest Early Intervention Project (BEIP)

  • Design: find foster parents in the U.S./UK; random assignment among Romanian infants.
  • Groups (three arms):
    1) 68 children raised in Romanian orphanages
    2) 68 children initially raised in orphanages but placed in foster homes before age 24 months
    3) 72 Romanian children raised by biological families (controls)
  • Comprehensive assessments at multiple time points: 9, 18, 30, 42 months; 8, 12, 16, 21 years.
  • Domains assessed: physical development, attachment, social functioning, cognitive development, brain development.

BEIP findings – development and attachment

  • Bailey Scale of Infant Development (baseline): institutionalized vs. community differences observed (scores shown on charts).
  • IQ outcomes: at 30, 42, and 54 months, children placed in foster care had significantly higher IQs than those in institutions; improvement was greater if placed by age 2; significant even if placed after age 12.
  • Percent securely attached (BEIP): higher in foster/adoptive/biologically raised groups than in stayed-in-institution group; data show improved security with remove-from-institution placement.

Disinhibited Social Engagement Disorder (DSED)

  • BEIP research found 31.8% of previously institutionalized children showed DSED features.
  • DSED signs were not consistently associated with care quality; secure infants could also show DSED; DSED associated with attention and social inhibition difficulties later.

DSED – characteristics and causes

  • Symptoms: developmentally inappropriate, overly familiar behavior with strangers; approaching unfamiliar adults; not checking back with caregivers for safety; may sit on laps or hold hands with strangers.
  • Onset around early infancy; wariness of strangers typically develops by 6–7 months, but children with DSED do not show the typical stranger wariness.
  • Causes: lack of social inhibition; high caregiver turnover (6–24 months); late infancy/early childhood is a sensitive period for social inhibition; stranger danger is not learned in these contexts.

DSED – treatment considerations

  • Prevention is best: infants adopted into nurturing homes within the first 6 months are less likely to develop DSED.
  • Treatment approaches emphasize play and creative expression to foster attachments and bonding with caregivers.
  • Therapeutic approaches include play therapy and creative arts therapy; nonverbal approaches are effective for young children.
  • Rationale: these therapies provide sensory experiences and joint activities that promote caregiver–child bonding when verbal communication is limited.

Trauma, socio-emotional deprivation, and physical health effects

  • Sociomotional deprivation can affect physical development (illustrative case examples shown on slides).
  • Physical abuse: nonaccidental physical injury; injuries range from minor to severe or death; reasonable and non-bodily-harm-causing physical discipline is not considered abuse under the harm standard; endangerment standard is used in legal contexts.
  • Psychological abuse: repeated acts or omissions by caregivers that cause or could cause serious behavioral, cognitive, emotional, or mental disorders. Five broad types:
    • Spurning
    • Terrorizing
    • Isolating
    • Exploiting
    • Denying emotional responsiveness/neglect
  • Childhood Emotional Neglect (CEN): caregivers fail to respond adequately to emotional needs; common even when physical care is provided.

Poly-victimization

  • Definition: experiencing multiple victimizations (sexual abuse, physical abuse, bullying, family violence exposure) across different domains, not just repeating the same type.
  • Typically occurs during transitions when children are most vulnerable.
  • Associated with a cluster of adverse life circumstances (e.g., domestic violence, chaotic families, violent neighborhoods, mental health problems).

Maltreatment chronicity and peer relations

  • Chronically maltreated children are more likely to be rejected by peers.
  • Maltreatment chronicity is associated with higher levels of aggressive behavior as reported by peers, teachers, and the children themselves.
  • Social withdrawal is associated with peer rejection but does not mediate the maltreatment–peer rejection relationship.
  • Effects observed in both girls and boys.

Cognitive and emotional effects of maltreatment

  • Deleterious effects on cognitive functioning.
  • Effects on memory and executive functions: verbal episodic memory, working memory, attention, and executive function performance can be impaired.
  • Young maltreated children have difficulties recognizing and discriminating facial expressions of emotions.
  • Severe early life stress is linked to emotion regulation difficulties, which increases risk for later psychopathology.

Maltreatment and aggression research findings

  • Studies show maltreated children exhibit higher aggression and peer rejection relative to non-maltreated peers; effects are observed across genders.
  • Representative study (Masten et al., 2008): recognition of facial emotions among maltreated children with high PTSD rates.

Trauma and PTSD – real-world example

  • Chowchilla bus hijacking (July 15, 1976): 26 kids and the driver abducted; held for 16 hours; all survived but many developed PTSD.
  • PTSD can emerge as a consequence of traumatic events, including kidnappings and other life-threatening experiences.

PTSD – general manifestations and outcomes

  • PTSD may involve fears of further trauma, hallucinations, and omen formation (anticipatory beliefs about danger).
  • Time-skew: distorted recall of event sequences.
  • Posttraumatic play, reenactment, and personality changes may occur as trauma expressions.

PTSD – PTSD in children

  • PTSD criteria overview (DSM-5; applicable to adults, adolescents, and children over 6): A–E criteria (short summaries below). For children 6 years and younger, refer to the DSM-5 section for children 6 and younger.

  • Criterion A (traumatic exposure): direct experience, witnessing the event as it occurred to others, learning that a close family member or friend experienced the event (must be violent or accidental if the death is involved), or exposure to aversive details (e.g., first responders repeatedly exposed to remains). Note: Media exposure alone does not count unless work-related.

  • Criterion B (intrusion symptoms): recurrent memories, distressing dreams, dissociative reactions (e.g., flashbacks), intense distress at cues, marked physiological reactions. In children, trauma-related play may express themes of the event.

  • Criterion C (avoidance): persistent avoidance of distressing memories, thoughts, feelings, or external reminders related to the event.

  • Criterion D (negative alterations in cognitions and mood): inability to remember aspects of the event; persistent negative beliefs; distorted blame; persistent negative emotional state; diminished interest; detachment; inability to experience positive emotions.

  • Criterion E (alterations in arousal): irritable behavior, reckless or self-destructive behavior, hypervigilance, exaggerated startle, concentration problems, sleep disturbance.

  • Criterion F–H: duration > 1 month (F); clinically significant distress or impairment (G); not attributable to substances or another medical condition (H).

  • Specifiers:

    • With dissociative symptoms: depersonalization or derealization in response to the trauma.
    • With delayed expression: full criteria not met until at least 6 months after the event.

  • Source: American Psychiatric Association. (2022).

Notes on DSM-5 criteria for children

  • Criterion A4 (exposure) does not apply to general media exposure unless work-related.
  • Intrusion symptoms in children may present as play reenactment or other age-appropriate expressions.
  • Distinctions between child age groups are important for accurate diagnosis and treatment planning.

Connections to foundational principles and real-world relevance

  • Psychodynamic therapy emphasizes the role of unconscious conflicts and symbolic expression (play) in childhood psychopathology and recovery.
  • Family systems theory highlights how family structure, roles, and communication influence child outcomes and the development/amelioration of symptoms.
  • Maltreatment research links early deprivation and caregiver instability to long-term cognitive, emotional, and social outcomes, justifying early intervention and foster care programs.
  • DSED and RAD illustrate how early caregiving environments shape attachment styles and later behavior, with implications for prevention and early placement in nurturing homes.
  • PTSD diagnostic frameworks guide recognition of trauma effects in children and the use of developmentally appropriate assessment and intervention strategies (including play and nonverbal therapies).

Key equations and numerical references

  • Population and cost statistics:
    • Referrals to child protective services: 3.5\times 10^6 per year.
    • Substantiated cases: 6.75\times 10^5 per year.
    • Prevalence estimate: 1\% = 0.01 of children and adolescents abused/neglected annually.
    • Lifetime cost per victim: [2.10\times 10^5, 8.31\times 10^5].
    • National economic cost: 4.28\times 10^{11} USD per year.
  • BEIP sample sizes: group sizes include n=68 (institution), n=68 (foster), n=72 (raised by biological families).
  • DSED prevalence in BEIP: 31.8\% of previously institutionalized children.
  • BEIP assessment timepoints: 9, 18, 30, 42 months; 8, 12, 16, 21 years.
  • BEIP secure attachments: approximate group differences (illustrated percentages: up to ~70% in some foster/biological groups vs lower in institution-only groups).

Summary takeaways

  • Early attachment experiences and the caregiver–child relationship critically shape long-term cognitive, emotional, and social development.
  • Psychodynamic play-based approaches can reveal and work through unconscious conflicts in children who are nonverbal or have restricted verbal expression.
  • Structural family dynamics and caregiver behavior patterns (authoritative vs. authoritarian, coercive practices) influence child outcomes and the likelihood of maltreatment.
  • Maltreatment has widespread and lasting effects on mental health, cognition, emotion regulation, and social functioning, with economic and societal costs.
  • In severe deprivation, specialized longitudinal studies (e.g., BEIP) demonstrate that earlier placement into nurturing environments improves attachment security and developmental trajectories, though effects can vary by timing and context.
  • PTSD in children manifests with developmentally specific expressions (including trauma reenactment and posttraumatic play) and requires DSM-5 criteria-based assessment with attention to age-related differences and specifiers.