Child Psychopathology - Chapter 1 Notes

Historical Views and Breakthroughs

  • Ancient Greek and Roman societies:

    • Individuals with physical or mental disorders were seen as economic burdens and social embarrassments.
    • They faced scorn, abandonment, or were put to death.

  • Before the 18th century:

    • Children were subjected to harsh treatment and largely ignored.
    • Massachusetts's Stubborn Child Act (1654): Allowed parents to kill their "stubborn" son.

  • Mid-1800s:

    • Specific laws permitted children with severe developmental disorders to be kept in cages and cellars.
    • Mental illness was often seen as possession by the devil or supernatural forces.

The Emergence of Social Conscience

  • John Locke (1632–1704):

    • Believed in individual rights.
    • Tabula Rasa: Children are born as "blank slates," and their experiences shape who they become.
    • Children should be raised with thought and care instead of indifference and harsh treatment.

  • Jean Marc Itard (nineteenth century):

    • Focused on the care, treatment, and training of children with severe developmental delays.
    • Victor (The Wild Boy of Aveyron): A feral child found around age 9.

  • Leta Hollingworth (1886-1939):

    • Distinguished between individuals with mental retardation ("imbeciles") and those with psychiatric disorders ("lunatics").
    • Pioneered work with "gifted" children.
    • Showed that IQ was not just genetic but environmental.
    • Children with normal cognitive abilities but disturbing behavior suffer from "moral insanity."

  • Benjamin Rush (1745-1813):

    • Children were deemed incapable of true adult-like insanity.
    • Children with typical cognitive abilities but disturbing behavior are experiencing moral insanity (emotional disturbance in personality or character).

  • Dorothea Dix (1802-1887):

    • Established humane mental hospitals for youth and adults instead of caging, chaining, or locking them in cellars.

  • Organic disease model:

    • Emphasized more humane forms of treatment and replaced the moral insanity view of psychological disorders.

  • The emerging view was that children needed "moral" (i.e., emotional) guidance and support.

Early Biological Attributions

  • Late nineteenth century (late 1800s):

    • Mental disorders were viewed as biological problems.
    • The prevailing bias was that the individual was at fault for deviant or abnormal behavior.
    • Masturbatory insanity: The 1st mental illness ascribed to children.

  • Clifford Beers (1909):

    • Sought to prevent psychopathology by raising the standards of care and disseminating reliable information.

  • Late 1800s and early 1900s:

    • Society reverted to a belief that disorders could not be influenced by treatment or learning.
    • There was a return to custodial care and punishment of behaviors.
    • Sterilization of the weak (eugenics) or institutionalization
    • Led by views of genetics from Theory of Evolution (interestingly, not led by Darwin or Wallace but by others who expanded views of evolution like Herbert Spencer and Francis Galton)
    • Herbert Spencer: Coined the term "survival of the fittest."
    • Henry Goddard and “Kallikak” family (1912): "Heredity of feeblemindedness."
    • Galton’s work on IQ and inheritance: Galton was Darwin’s cousin.

Early Psychological Attributions

  • The recognition of psychological influences emerged early in the twentieth century.

  • Such recognition allowed researchers to organize and categorize ways of differentiating among various psychological issues.

  • Two major theoretical paradigms:

    • Psychoanalytic theory
    • Behaviorism

Psychoanalytic Theory

  • Sigmund Freud: Individuals have inborn drives and predispositions that strongly affect their development.

    • Experiences play a necessary role in psychopathology.
    • Children and adults could be helped if provided with the proper environment, therapy, or both.
    • First person to directly link childhood experiences to the development of psychiatric disorders in adulthood

  • Anna Freud: Children’s symptoms were related more to developmental stages than were those of adults.

  • Psychoanalytic theory’s approach to child psychopathology has had less influence on recent clinical practice and teaching.

Behaviorism

  • Evidence-based treatments for children, youths, and families can be traced to the rise of behaviorism in the early 1900s.

  • Ivan Pavlov’s research on classical conditioning

  • John Watson: Studies on the development of children’s fears and the theory of emotions

    • Famous study with Little Albert

  • Mary Cover Jones (“mother of behavior therapy”)

    • Famous study: Little Peter

Ecological and Cognitive Theories

  • Piaget and Vygotsky studies on how children’s brains developed in relationship to their environment

    • Piaget: Stages of cognitive development
    • Vygotsky: The sociocultural environment and adult instruction

  • Urie Bronfenbrenner: The Ecological Systems Theory

  • Focus is shifting from individual responsibility to focusing on understanding the developmental and systemic considerations.

Evolving Forms of Treatment

  • 1930 to 1950: psychodynamic approaches prevailed.

    • Most children with intellectual or mental disorders were institutionalized.

  • Late 1940s: Spitz’ studies pointed out the harmful impact of institutional life (anaclitic depression).

  • 1945 to 1965: institutionalization decreased.

  • By the 1960s: behavior therapy emerged as a systematic approach to treatment of child and family disorders.

  • Behavior therapy is currently a prominent form of therapy.

Progressive Legislation

  • Attitudes have advanced in the humane and egalitarian treatment of children.

  • Individuals with Disabilities Education Act (IDEA) Requires:

    • Free and appropriate public education for children with special needs in the least restrictive environment
    • Each child must be assessed with culturally appropriate tests
    • An individualized education program (IEP) for each child

What Is Psychopathology in Children and Adolescents?

  • A psychological disorder traditionally has been defined as a pattern of behavioral, cognitive, emotional, or physical symptoms shown by:

    • Distress
    • Disability
    • Increased risk for further suffering or harm

  • Understanding particular impairments should be balanced with recognizing individual and situational circumstances.

  • Labels Describe Behavior, Not People

    • Stigmatization is a challenge.
      • Separate the child from the disorder.
      • Problems may be the result of children’s attempts to adapt to atypical or unusual circumstances.
    • According to DSM-5-TR guidelines:
      • The primary purpose of using terms is to help describe and organize complex features of behavior patterns.

Competence

  • The ability to successfully adapt in the environment

    • Successful adaptation is influenced by culture and ethnicity.

    • Children and families in underrepresented ethnic groups

      • Must cope with multiple forms of racism, prejudice, discrimination, oppression, and segregation
      • All of which significantly influence a child’s adaptation and development

    • Developmental tasks: areas include knowledge, conduct, and the self-domain

Examples of Developmental Tasks

  • Infancy to preschool

    • Attachment to caregivers
    • Language
    • Differentiation of self from environment

  • Middle childhood

    • Self-control and compliance
    • School adjustment
    • Academic achievement
    • Getting along with peers
    • Rule-governed conduct

  • Adolescence

    • Successful transition to secondary schooling
    • Academic achievement
    • Involvement in extracurricular activities
    • Forming close friendships within and across gender
    • Forming a cohesive sense of self-identity

Developmental Pathways

  • The sequence and timing of particular behaviors as well as the relationships between behaviors over time

  • Two types of developmental pathways:

    • Multifinality: various outcomes may stem from similar beginnings
    • Equifinality: similar outcomes stem from different early experiences and developmental pathways

Risk and Resilience

  • Risk Factors

    • Risk factor: a variable that precedes a negative outcome of interest
    • Known risk factors that increase children’s vulnerability to psychopathology
      • Chronic poverty/socioeconomic marginalization
      • Interactions with oppressive systems
      • Serious caregiving deficits
      • Parental mental illness
      • Divorce, homelessness, and racism

  • Resilience

    • Protective factor: a personal or situational variables that mitigate a child developing a disorder
    • Resilience may vary over time and across situations.
    • Resilience is seen in children across cultures.
    • Positive cognitive schemas about self, coping skills, and abilities to avoid risky situations may be considered resilient.

  • Characteristics of Those Who Show Resilience

    • “Protective Triad” of resources:

      • Strengths of the child
      • Strengths of the family
      • Strengths of the school/community

The Significance of Behavioral Health Concerns among Children and Adolescents

  • Globally, one in seven 10- to 19-year-olds experiences a mental disorder (perhaps 1 in 5 in the US)

  • One-fourth of the population (youth) have very few treatment options.

  • The demand for mental health services is expected to double over the next decade.

  • A better ability to distinguish among disorders has led to increased and earlier recognition of problems.

    • Fortunately: increased awareness of younger children’s and teens’ unique mental health issues
    • Unfortunately: limited and fragmented resources

What Affects Rates and Expression of Psychopathology? A Look at Some Key Factors

  • Poverty and Socioeconomic Disadvantage

    • One in five children in the United States and one in eight in Canada live in poverty.

    • Native American/First Nations, Latino, and Black children are at greatest risk.

    • Children from poor and disadvantaged families are more likely to be diagnosed with

      • Conduct disorders, chronic illness, and school issues
      • Emotional disorders and cognitive/learning challenges

  • Sex and Gender Differences

    • Members of the LGBTQIA+ community face multiple challenges that can affect their health and well-being.
      • Biases against other sexual identities
    • Children of various genders can express their mental health concerns in different ways.
    • Gender is not binary, and many of our youth identify along the spectrum in a fluid manner.
    • Sex differences in behavioral concerns increase with age.

  • Externalizing and Internalizing Problems

    • Externalizing problems

      • Higher in boys than girls in preschool and early elementary years and rates converge by age 18
      • Exhibited as acting-out behaviors

    • Internalizing Problems

      • Similar rates in early childhood but higher rates among girls over time
      • Include anxiety, depression, somatic symptoms, and withdrawn behavior

  • Race and Ethnicity

    • Most cultural anthropologists see race as a socially constructed concept, not biological.
    • However, significant barriers remain in access to, and quality and outcomes of, care for children from underrepresented racial and ethnic groups.
    • The majority culture has often neglected to incorporate respect for or understanding of the histories, traditions, beliefs, languages, and value systems of culturally diverse groups.
    • Marginalization results in a sense of alienation, loss of social cohesion, and rejection of the norms of the larger society.

  • Cultural Issues

    • Values, beliefs, and practices that characterize a particular ethnocultural group contribute to development and expression of children’s disorders
      • Affect how people/institutions react to children’s problems
      • Affect how problems are expressed
      • Children express their problems differently across cultures
    • It is important that research on child psychopathology not be generalized from one culture to another unless there is support for doing so.

  • Child Maltreatment and Non-Accidental Trauma

    • At least one in seven children has experienced child abuse or neglect in 2020 in the United States. (some estimate 1 in 3)
    • More than one-third of 10- to 16-year-olds experience physical and/or sexual assaults.
    • Adverse childhood experiences (ACEs) are associated with chronic health problems, substance use challenges, and mental illness.
    • ACEs negatively impact individuals in areas such as education, job opportunities, and earning potential.

  • Risk Issues Concerning Adolescents

    • Early- to mid-adolescence is an important transitional period for healthy adjustment.

    • Issues during adolescence

      • Substance use, risky sexual behavior, violence, accidental injuries, and mental health problems

    • Special needs and problems of adolescents are receiving greater attention.

  • Lifespan Implications

    • Impact is most severe when problems go untreated for extended periods of time.

    • About 20% of children with the most chronic and serious disorders face life- long difficulties.

      • Are least likely to finish school
      • Are most likely to have social problems and psychiatric disorders

    • Lifelong consequences associated with child psychopathology are costly.