Transcript Issues in child psychopathology

Historical Views of Child
Psychopathology

The Emergence of Social Conscience
– Historically children often ignored or
subjected to harsh treatment
– John Locke (17thC)
– Jean-Marc Itard (19thC) – treat children with
kindness
Historical Views (cont.)

Early Psychological Attributions (for adults,
mostly)
– emerged in early 1900’s
– psychoanalytic theory
– behaviorism laid foundation for studying
conditioning and elimination of children’s fears
Historical Views of Child
Psychopathology

Child psychopathology generally ignored
– Insanity
– DSM
 1980 version of DSM included a child section
Reasons why ignored

Psychoanalytic theory

Behavior theory
Historical Views (cont.)

Evolving Forms of Treatment based in
historical context
– institutionalized
– foster families and group homes
– behavior therapy
Evidence for change in perspective
on children’s problems

Child-focused journals

Divisions of APA

Child abuse laws enacted

IDEA
Change in perspective (cont.)

Surgeon General’s report (2001)
– 1 in 10 has severe mental or behavior
problem
– Only 2 of 10 with problems get help
Surgeon General’s goals
1.
2.
3.
4.
Promote public awareness
Develop scientifically proven treatments
Improve assessment methods
Eliminate ethnic/SES disparities in
services
Surgeon General’s goals
5.
6.
7.
8.
Train frontline providers
Monitor access to mental health services
Improve infrastructure of services
Increase access to mental health
services
Reasons why child psychopathology
is now receiving more attention
Problems are common
 Lifelong consequences
 Predict adult disorders
 Few children receive necessary help
 Develop early intervention programs
 Legal mandates

Defining Psychological Disorders
Determining what is normal and abnormal
is an arbitrary process
 Traditionally defined as a pattern of
behavioral, cognitive, or physical
symptoms, that is associated with one or
more of:

– distress
– disability
– increased risk for further suffering or harm
Defining Psychological Disorders
(cont.)
Many childhood problems best depicted in
terms of relationships
 Labels describe behavior, not the child
 Problems may be the result of children’s
attempts to adapt to abnormal or unusual
circumstances
 Need to consider age/developmental level

Developmental Pathways
Refers to the sequence and timing of
behaviors, and the relationship between
them over time
 Two types of developmental pathways:

– multifinality: similar early experiences lead to
different outcomes
– equifinality: different early experiences lead
to a similar outcome
Developmental Pathways
(cont.)
Figure 1.1 (a) Multifinality: Similar early experiences lead to
different outcomes; (b) Equifinality: Different factors lead to a
Developmental Pathways (cont.)

With abnormal child psychology, must
keep in mind:
– there are many contributors to disordered
outcomes in each child
– contributors vary among children who have
the disorder
– children express features of their disturbances
in different ways
– pathways leading to particular disorders are
numerous and interactive
Issues unique to child
psychopathology

Referral process

Greist et al.: why do parents bring their
children in to clinics?
– Predicted mother’s ratings of their children
– Home observation for objective ratings
– Got ratings of mom’s mood/depression
Referral process cont.

Webster-stratton (1988)
– Questions of interest
– Method
– Results
– implications
Temperament & reciprocal
relationships

Innate biological factors which influence
behavior
– “easy” temperament
– “difficult” temperament
 Easiness to soothe
 Activity
 Sociability

Parent-child relationships are reciprocal
Reciprocal relationships

Pelham et al. (1997)
– Questions of interest
– Method
– Results
– implications
What Affects Rates and Expression
of Mental Disorders?

Poverty and Socioeconomic Disadvantage
– about 1 in 6 children in North America live in
poverty
– poverty is associated with greater rates of
learning impairments and academic problems,
conduct problems, chronic illness,
hyperactivity, and emotional disorders
Rates and Expression (cont.)

Sex Differences
– sex differences appear negligible in children
under age 3, but increase with age
– boys > girls in early/middle childhood; girls >
during adolescence
Figure 1.3
Figure 1.3 Normal developmental trajectories of Externalizing
problems (top graph) an Internalizing problems (bottom graph)
from the Child Behavior Checklist. Ages are shown on the x axis.
The y axis represents the raw scores (higher score means more
problems). Source: Bongers, Koot, van der Ende, & Verhulst,
Rates and Expression (cont.)

Ethnicity
– minority children over-represented
– once other effects (SES, gender, age, referral
status) are controlled for, very few differences
emerge in relation to race or ethnicity
– minority children face multiple disadvantages
Rates and Expression (cont.)
Ethnicity
–
(cont.)
Research has often ignored cultural factors
Rates and Expression (cont.)

Culture
– contributes to development and expression of
disorders
– some underlying processes are similar across
diverse cultures