Transcript Developmental, Cultural and Contextual Perspectives on Risk and

September 4, 2015
Holly Lem, Ph.D.
Administrative Details
 Problem with access/readings: Anne Blevins
[email protected]
 Teaching Team: James Chiarelli, Elise Naventi,
Molly Boynton
 Section: meeting today
 Powerpoints
 Readings/connection to class
 Any syllabus questions
“I love to discover potential in people who aren’t
thought to have any” (Oliver Sacks, 1986)
“ Narratives that cause us to pay attention
and also involve us emotionally are the stories
that move us to action” (Zaks, 2015)
Developmental Psychopathology
 A framework used to describe, explore and investigate
the complexities of a child’s experience with mental
health issues.
Case Study: 6th graders in Mrs. Flan’s class
Sam
Kate
Matt
Presenting Concerns
 Inattentiveness
 Restlessness
 Poor listening
 No follow through w/ directions/assignments
 Disorganized
 Social problems
Mel Levine’s Concept
 The Lumpers
vs. The Splitters
Chris: A Side Story
Important DP Concepts
 Equifinality: the presence of multiple pathways
lead to apparently similar outcomes (e.g., a child
who is acting aggressively)
 Multifinality: a given risk factor may lead to
multiple outcomes (e.g., a child who had
experienced physical/sexual abuse)
 Take home point: A vulnerability/risk
factor/diagnosis is not predestiny
Equifinality
Physical Abuse
Trauma
Aggressive
Behavior
Prenatal
Substance use
History is not Destiny:
Multifinality: “Jack”
“Broken
Trouble
Conduct
Home”
In School
Disorder
Multifinality
“Broken
Home”
Increased
School
Paternal
Challenges
Presence
Exceling
Reduction
In a School
In
Subject
Aggression
Counseling
4 D’s to Assess Psychopathology
(Comer, 2001)
1. Deviance: How far is the behavior from the
“norm”? What is expected behavior?
2. Dysfunction: How pervasive is the problem? How
many areas in their life is this impacting?
3. Distress: Child’s internal experience, hard to
capture
4. Danger: to self or others
The Bell Curve: Where is normal?
Assessing deviance: What is “normal?”
 Developmentally:
What does a typical ________ look like?
Can we decide what is “normative?”
 Psychologically:
Ab-normal? What is our “yardstick?”
Sarah: A side story
 “I am working with an adolescent girl who initially
presented with social anxiety and mild depression. Recently,
the girl has revealed a fascination and delight with fantasies
regarding live vivesection of animals and human beings. The
family is quite normal, with parents having some history of
anxiety difficulties. The thoughts are not intrusive or egodystonic for her. Due to social anxiety, she has spent a lot of
time on her computer and landed on some inappropriate (to
say the least) vivisectionist/torture type sites. We have
blocked some of her computer use. I have also had her read
articles on torture and write a paper on why such behavior
is unethical and simply wrong.”
Norm needs to be informed by 3
C’s
1. Culture/Ethnicity
2. Class/SES
3. ( and other) Contextual variables
Dysfunction:
2nd pillar of assessment
How much are their current symptoms affecting their
social, emotional, academic/occupational functioning?
 Frequency
 Duration
 Pervasiveness
Distress: 3rd pillar of assessment
How much distress is/are the presenting symptoms
causing the child?
 Tends to be difficult to evaluate, why?
 Ego-Dystonic vs. Ego Syntonic
 Sarah?
Danger:
th
4
pillar of assessment
Attention Deficit Hyperactivity
Disorder
1.
2.
3.
4.
5.
6.
7.
Difficulty sustaining attention
Doesn’t seem to listen
No follow through on tasks
Difficulty organizing
Often fidgets
Often leaves seat in classroom
Often talks excessively
Prevalence Rate
 Definition: The total number of cases
that appear of a specific disease within
a population at a given time (The American
Heritage Medical Dictionary, 2004)
Attention-Deficit/Hyperactivity Disorder
 Three subtypes: combined type, predominantly
inattentive, predominantly hyperactive/impulsive
 Prevalence rate: 3-7% in school age kids
 More frequent in males to females
2:1 to 9:1
Internalizing vs. Externalizing
 Externalizing: under-controlled, anti- social, outerdirected, male? e.g., ADHD, Oppositional Defiant
Disorder (ODD), Conduct Disorder (CD)
 Internalizing: “The secret illness” (Reynolds, 1992);
over-controlled, inner-directed, female? e.g., anxiety,
depression, phobias
Developmental Psychopathology
(Hinshaw, 2004)
1.
2.
3.
4.
5.
Interdisciplinary
Spectrum of “Normal”
Multiple Tools
Multiple Contexts
Temperament
Rosenhan’s Study (1973)
 “On Being Sane in Insane Places”
 8 Pseudopatients: hearing voices that went “thud, were
empty and hollow”
 Admitted to psych ward w/ dx of Schizophrenia
 Just being “normal”
 Behavior only interpreted through psychopathological
lens
 Stay averaged anywhere from 9 to 52 days
 Released with diagnosis of Schizophrenia in remission
2. Spectrum of “Normal”
3. Multiple Tools
School Records:
 Sam: variable grades depending on the subject; “a
mixed bag,” “quiet”, “inattentive”, “disinterested”,
“day dreams”, “doesn’t listen well,” “fidgety.”
 Kate: consistently had a hard time in class, “can’t
sit still”, “poor attention”, doesn’t seem to care
about her work.”
 Matt: fairly good student, only in 6th grade notable
changes.
 Differential Diagnosis: distinguishing between
diseases with similar characteristics by comparing
signs and symptoms (Merriam-Webster Medical
Dictionary, 2007)
Differential Diagnosis
1. Dysthymia (Persistent Depressive Disorder) is
characterized by a chronic state of depression
exhibited by a depressed mood for more days
than not for at least two years (at least one year
for children and adolescents).
2. Adjustment Disorder is a psychological response
to an identifiable (psychosocial) stressor resulting
in emotional and/or behavioral symptoms.
Symptoms show within 3 months of stressor
occurring.
4. Multiple Contexts
A Tale of Two Temperaments
Temperament defined:
 Overarching rubric that covers a group of related traits
 It is not singular, even though we talk about it as if it is
 Temperamental dimensions reflect behavioral
tendencies rather than specific behavioral acts
 Biological in origin
 Needs to be relevant to all infants
 Emphasis on individual differences
Temperament (1963)
 Temperament: classic study by Thomas and Chess
(1963)
 Temperament: “A child’s unique way of responding
to their environment”
 Longitudinal study on infant temperament
found 9 different dimensions of infant
temperament (motor activity, rhythmicity, novelty,
adaptability, sensitivity, energy level, mood,
distractibility, attention/persistence)
Temperament (1963)
 Thomas and Chess found 3 clusters of
characteristics that loosely described
temperament types
 “Easy Child”- agreeable, no intense reactions,
well-regulated, adaptable 40%
 “Difficult Child-very intense, frustration leads
to tantrums, withdraws from novel stimuli 10%
 “Slow to Warm Up”- low activity level,
withdraws from novelty, slow to adapt 15%
Temperament (1963)
 Of the kids who later developed behavioral problems, 70%
were classified as “difficult child” as infants.”
 “Goodness of fit” is key in thinking about temperament
and environment
 Kagan’s (1989)“high reactives” 20%
“low reactives” 40%
https://www.youtube.com/watch?v=CVJBzvaylH8
https://www.youtube.com/watch?v=URee25502aU
Elaine Aron (2002) “highly sensitive child” 20%
http://www.hsperson.com/test/highly-sensitive-child-test/
Elise’s Section





Rayna Edels
Xiaoke Kang
Lauren McDermott
Maritere Mix
Victoria Perrakis
Larsen 402






Elizabeth Ricketts
Emma Roose
Ana Maria Santos
Zachary Starr
Jessica Zausmer
Kathryn Zorniger
Molly’s Section Larsen G06
 Alicia Alvarez
 Shannon McCarthy
 Jaylan Elrahman
 Sarah Murphy
 Nicole Eslinger
 Carolyn Sparkes
 Joanna Audrey Florento
 Placido Gomez
 Erika Hillstead
 Wentong Jiang
 Kara Lawson
 Yelena Litvak
James’s Section Larsen 615







Sonia Alves
Erin Block
Briana Brukilacchio
Anna Feldman
Susan Johnson
Quan Le
Han Li






Amy Lipton
Donovan Livingston
Molly Lockwood
Jenna Mendes
Charlotte Wakeman
Angela Wang