Developmental Psychopathology

Developmental Psychopathology Overview

What Makes Development Abnormal?

  • Criteria to Define Abnormal Behavior:

    • Statistical Deviance: Is the behavior statistically rare or more common?

    • Maladaptiveness: Does the behavior interfere with daily activities, relationships, or performance at school/work?

    • Personal Distress: Is the behavior personally upsetting to the individual?

DSM Diagnostic Criteria

  • DSM (Diagnostic and Statistical Manual of Mental Disorders):

    • Defines features and symptoms for numerous psychological disorders.

    • Variability in psychological disorders, often requiring a range of symptoms for a minimum duration.

    • For example, the Major Depressive Disorder requires at least five of the following symptoms, one of which must be either depressed mood or loss of interest/pleasure, for a minimum duration of two weeks.

Developmental Psychopathology

  • Definition:

    • Study of the origins and course of maladaptive behavior.

    • Investigates how disorders develop and express as individuals grow.

  • Philosophical Approach:

    • Some critics argue against the DSM-5 medical/disease model, suggesting psychopathology should be viewed as a developmental process rather than strictly a disease.

  • Neurodevelopmental Disorders:

    • Emphasizes the development aspect of psychological conditions.

Developmental Issues in Psychopathology

  • Key Issues:

    • Nature-Nurture: Examines the influence of genetic and environmental factors.

    • Continuity-Discontinuity: Looks at whether disorders persist over time or not.

    • Universality-Context Specific: Investigates whether psychopathological issues are consistent across cultures or specific to certain contexts.

  • Diathesis–Stress Model:

    • Proposes that psychopathology arises from the interaction over time of a predisposition or vulnerability to psychological disorders and stress-inducing events.

    • Example - Depression:

    • Depression often emerges from the interplay between genetic predispositions (diathesis) and environmental stressors.

    • The relationship between stress and psychological disorder is reciprocal.

Autism Spectrum Disorder (ASD)

  • Definition:

    • A disorder usually identified in infancy characterized by:

    • Abnormal social and communication development.

    • Restricted interests and repetitive behaviors.

  • Key Features in DSM-5:

    • Social and Communication Deficits:

    • Difficulty forming social relationships and responding to social cues.

    • Restricted Interests and Repetitive Behaviors:

    • Obsession with particular objects and ideas, resistance to change.

    • Often seek sameness and repetition.

Epidemiology and Diagnosis of ASD

  • Prevalence:

    • 1 in 54 (which is approximately 2%) of 8-year-olds in the United States diagnosed with ASD.

  • Reasons for Increased Rates:

    • Greater awareness among parents and healthcare professionals.

    • Broader definitions of autism spectrum in diagnostic criteria, now including conditions like Asperger's syndrome.

    • Increased diagnosis rates due to improved healthcare practices.

Characteristics of ASD in Infants

  • Typical Behaviors:

    • Lack of normal interest in social stimuli.

    • Failure to respond to someone calling their name.

    • Preference for nonhuman objects over human interaction.

    • Lack of eye contact.

  • Comorbidities and Gender Prevalence:

    • ASD often coexists with other disorders.

    • More frequently diagnosed in males than females.

Neurobiological Aspects of ASD

  • Brain Functioning Issues:

    • Abnormal brain growth patterns and connectivity.

    • Deficits in mirror neuron systems, which are vital for social interaction and empathy.

    • Impairments in executive function often seen in individuals with ASD.

  • Suspected Causes:

    • Genetic factors play a major role.

    • Environmental triggers (like prenatal exposure to infections, chemicals) may interact with genetic predispositions.

Developmental Outcomes and Treatments for ASD

  • Outcomes:

    • A small minority may outgrow symptoms.

    • Positive developmental outcomes are more likely for individuals with an IQ above 70.

  • Interventions:

    • Intensive and highly structured behavioral and educational programs (e.g., Applied Behavioral Analysis - ABA).

    • Early identification and intervention are critical for better outcomes.

Depression in Infancy

  • DSM-5 Criteria:

    • Major depressive disorder diagnosed in children but not typically in infants.

  • Risk Factors for Depressive Symptoms in Infants:

    • Abuse or neglect.

    • Lack of a secure attachment relationship.

Externalizing and Internalizing Problems in Youth

  • Externalizing Problems:

    • Manifest as lack of self-control, acting out behaviors that disturb others.

    • Such behaviors may include aggression and disobedience, creating disruptive situations.

  • Internalizing Problems:

    • Characterized by negative emotions being bottled up or internalized instead of expressed outwardly.

    • Common internalizing disorders include anxiety, phobias, severe shyness, withdrawal, and depression.

Attention Deficit Hyperactivity Disorder (ADHD)

  • Symptoms:

    • Inattention: Easily distracted, misses details, and forgets things.

    • Hyperactivity and Impulsivity: Symptoms include restlessness, fidgetiness, and difficulty waiting or taking turns.

  • Developmental Course:

    • Symptoms of hyperactivity/impulsivity may present in infancy, while inattention issues frequently persist across the lifespan.

  • Suspected Causes:

    • Likely rooted in differences in brain chemistry, particularly in the frontal lobes.

    • Interaction between genetic predispositions and environmental factors.

  • Treatment Approaches:

    • Medication, which when combined with behavioral treatment, can significantly improve functioning over the short term.

Depression in Childhood

  • Prevalence:

    • Generally rarer than in adolescents and adults.

  • Symptoms:

    • Manifest as sadness, irritability, and lack of interest in previously enjoyed activities.

  • Treatment Options:

    • Cognitive-behavioral therapy (CBT), Parent-Child Interaction Therapy, and medication.

The Adolescent Developmental Stage

  • Characteristics of Adolescence:

    • Increased propensity for risk-taking behaviors and susceptibility to various psychological disorders.

    • Common issues include substance abuse and delinquent behaviors, often linked to sensation-seeking tendencies and immature self-regulation.

Eating Disorders in Adolescents

  • Prevalence:

    • 5% of females aged 13 to 21 exhibit one of three specific eating disorders.

  • Types of Eating Disorders:

    • Anorexia Nervosa:

    • Characterized by restricted caloric intake leading to significantly low body weight, persistent fear of gaining weight, and distorted body image.

    • Affects less than 1% of the population; prevalence is highest in non-Latino white females with competitive/perfectionistic tendencies.

    • Bulimia Nervosa:

    • Involves binge and purge behavior patterns, with a sense of loss of control during binging, occurring at least twice weekly over a three-month span.

    • Predominantly affects females (90% cases); prevalence at 1-2% among women.

    • Binge Eating Disorder (BED):

    • Newly classified in the 2013 DSM.

    • Characterized by binge eating without subsequent purging.

    • Often associated with diminished activity in the prefrontal cortex.

Depression and Suicidal Behavior in Adolescence

  • Challenges of Adolescence:

    • Increased likelihood of depressive symptoms due to stronger genetic influences and accumulation of stress in girls, who tend to utilize ruminative coping strategies.

  • Suicidal Behavior Statistics:

    • Suicide: Second leading cause of death for 15 to 24-year-olds.

    • 12% of male high school students and 19% of female high school students reported suicidal thoughts within the past year.

    • Males demonstrate a higher likelihood of completing suicide, often as a result of diathesis-stress interactions.

Depression in Adulthood

  • Onset Age:

    • Average onset of major depression occurs in the early 20s.

  • Prevalence in Elderly:

    • Major depressive disorder affects 1 to 2% of the elderly population, while 15-25% exhibit depressive symptoms.

  • Gender and Ethnic Differences:

    • Women are twice as likely to be diagnosed with depression compared to men, and variations exist across ethnic groups.

Stress and Disorder in Early Adulthood

  • Link Between Early Stress and Patterns of Psychopathology:

    • Early stressful experiences can be correlated with the emergence of adult psychopathological conditions.

  • Stress Levels Across Life:

    • Stress peaks during early adulthood and tends to decline with age.

    • This variation helps explain changes in the prevalence of psychological disorders across the life span.

Depression in the Elderly

  • Diagnosis Challenges:

    • Older adults may not receive a proper diagnosis due to misconceptions about depressive symptoms being a natural part of aging.

    • Mental health professionals might also misdiagnose depressive symptoms in this demographic.

  • Benefits of Treatment:

    • Depressed elderly patients who seek psychotherapy often show significant positive outcomes.

    • The most successful approaches typically involve a combination of pharmacological treatment and psychotherapy.

Aging and Neurocognitive Disorder

  • Definition of Dementia:

    • Described as a progressive deterioration of neural functioning associated with cognitive decline and not an inherent aspect of normal aging.

    • Recognized in DSM-V as Neurocognitive Disorder.

Alzheimer’s Disease

  • Description:

    • A progressive and irreversible brain disorder leading to gradual cognitive decline and deterioration of brain function.

  • Prevalence:

    • Affects 10% of individuals aged 65 and older, with varying rates by age group: approximately 3% from 65-74, 17% from 75-84, and 32% from 85 and over.

  • Biological Aspects:

    • Characterized by a deficiency in acetylcholine which is linked to memory functions.

    • Presence of beta-amyloid plaques and neurofibrillary tangles (tau) observed in neurodegeneration.

    • Mitochondrial dysfunction is an early indicator of the disease process.

  • Genetic Factors:

    • Gene ApoE (apolipoprotein E) implicated, specifically the ApoE4 allele correlating with higher risk, while ApoE2 allele provides protective effects.

    • Differences in these alleles and their methylation variations have been noted in lipid and cholesterol processes in the blood.

  • Treatment Considerations:

    • While pharmaceutical treatments can slow the disease, no known interventions can stop or reverse dementia or Alzheimer's disease.