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Child and Adolescent Psychopathology1.pdf

by: aiy0001

Child and Adolescent Psychopathology1.pdf Psyc 5020

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The first test will cover: Chapter 1: Mental Health Problems Worldwide Chapter 2: Theories & Causes Chapter 3: Research Chapter 4: Assessment, Diagnosis, & Treatment
Child and Adolescent Psychopathology
Dr. Brestan-Knight
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This 14 page Class Notes was uploaded by aiy0001 on Sunday August 21, 2016. The Class Notes belongs to Psyc 5020 at Auburn University taught by Dr. Brestan-Knight in Spring 2016. Since its upload, it has received 6 views. For similar materials see Child and Adolescent Psychopathology in Psychology (PSYC) at Auburn University.


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Date Created: 08/21/16
Child and Adolescent Psychopathology Chapter 1 Significance of Mental Health Problems Among Children  Serious shortage!  1 in 8 children have a mental health problem (in North America) and demand for services is expected to double over the next decade  *Fewer than 10% receive proper treatment (no one to help them or not the proper treatment) Based on history and location o Have to have insurance or at least money  Depends on where you live, but seeing a clinical psychologist is $130 an hour o If they are receiving treatment, it may not always be the best treatment o In luck if you go somewhere with an internship site The Changing Picture of Children’s Mental Health  With research, we have a better ability to distinguish among disorders o Increased and earlier recognition of problems  Diagnosis of Autism before the age of 3  Greater awareness of unique mental health issues of children  *Evidence based prevention and treatment programs are more prominent o Task Force: Evaluating intervention plans to treat children Prevalence of Mental Health Issues  Mental health problems are more likely in children… o From disadvantaged families o From abusive or neglectful families o Receiving inadequate child care o Born with very low birth weight o Whose parents have a mental illness or substance abuse problems Abnormal Behavior  3 out of 5 21 year olds lead the criteria for a diagnostic disorder  Affecting our development and functioning in some way  Must look beyond current symptoms and the developmental pathways and interacting events  Must be sensitive to the child’s stage of development! o What’s appropriate, what’s atypical at this age?  Children are even more tough to evaluate than adults o To get information from young children, you have to go to outside sources like teachers and parents  Childhood disorders are accompanied by various layers of abnormal behavior or development  Disorders are commonly viewed as deviancies from what is normal o However, boundaries between normal and abnormal are arbitrary Defining Psychological Disorders  Patterns of behavioral, cognitive, emotional, or physical symptoms linked with one or more of the following: distress (behavior problem), disability (difficulty getting along with peers) and increased risk for further suffering or harm (behavior problems often lead to more serious problems, such as juvenile delinquency)  Culture and circumstances matter o For examples, for a while eating disorders would only occur in certain parts of the world o Culture bound: Amuk disorder o Cultural differences in presentation  Characteristics describe behaviors, not always the causes Labeling People  Stigmatization is a challenge! o Separate the child from the disorder o Problems may be a result of a child’s attempt to adapt to abnormal or unusual circumstances  Wording is key: A child with Autism or a child with behavior problems  DSM-5 guidelines with using terms o The primary purpose of using terms is to help describe and organize complex features of behavior patterns Features that Distinguish Child & Adolescent Disorders  Not often clear who has what problem (the parent or the child) o Often the parent needs to learn some new skills  Times when the parent is the client, the co-therapist (parent going home to work with the child-far more effective!), consultant (where the parent is not a part of the problem as much, depending on the nature of the problem) Competence: The ability to successfully adapt to the environment and successful adaptation is influence by culture and ethnicity  Abnormal psychology considers the degree of maladaptive behavior and the extent to which normal developmental milestones are met  Looking for those positive things that the child brings to therapy o Knowledge of developmental tasks provides important background information Developmental Tasks  Infancy o Attachment to caregiver o Differentiation of self from their environment  Middle Childhood o Self control and compliance o School adjustment (such as attendance and appropriate conduct) o Academic achievement (such as learning to read and do math) o Getting along with peers (such as acceptance and making friends) o Rule-governed conduct (such as following the rules of society for moral behavior and prosocial contact  Adolescence o Successful transition to secondary schooling o Academic achievement (such as learning skills needed for higher education or work) o Involvement in extracurricular activities o Forming close relationships within and across gender o 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  Many contributors to disordered outcomes in each child, and these all vary among children who have the same disorder  Children express features of their disturbances in different ways  Pathways leading to particular disorders are numerous and interactive  2 types of developmental pathways  Multifinality: Various outcomes may stem from similar beginnings o Eating disorder, mood disorder, conduct disorder, or normal adjustment all could have stemmed from early childhood maltreatment  Equifinality: Similar outcomes stem from different early beginnings and developmental pathways o A genetic pattern, family problems, or environmental factors all could lead to a conduct disorder Risk Factors: A variable that precedes a negative outcome of interest  Increases the chance of a negative outcome  Chronic poverty, care giving deficits, parental mental illness, death of a parent, disasters, family breakup Protective Factors: Personal or situational variables that mitigates a child developing a disorders  Decreases the chances of a negative outcome  A family found a place to live after a natural disaster occurs Resilience: The ability to fight off or recover from misfortune  Associated with strong self-confidence, coping skills, avoiding risky situations  Connected to a protective triad of resources which are… o Strength of the child o Strength of the family o Strength of the school or community Gender Differences  Boys and girls express problems differently  Certain disorders are more common in boys than girls and vice versa o Aggression is more expressed in boys expressed more indirectly in girls  Resilience o Boys  Male role model  Structure and rules  Encouragement of emotional expressiveness o Girls  Households that combine risk taking and independence with support from female caregiver Chapter 2: Theories & Causes Jorge: Lots of determinants to look at when diagnosing the cause of his behavior  Children’s problems must be considered in relation to multiple levels of influence (i.e. individual, family, community and culture)  Possible causes: biological influences, emotional influences, behavioral and cognitive influences, family, cultural, and ethnic influences  There are so many determinants…where do we intervene? o English wasn’t his first language and was just thrown into the mix (far along in development) o Possible overlay between cultural background and inherent learning disability o Low self-esteemnot putting in a lot of effort o Parent’s not so much on the supportive side-chance of learning new techniques o Treatment plan: Thorough assessment-is a learning disability causing his anxiety or is his anxiety causing him to have learning problems? Theoretical Foundations  Child Abnormality involves: o The context of the child’s ongoing adaptation and development o Sorting out the causes of identified problems  Abnormal behavior studies require an understanding of development and individual events that can impact a child’s life  You must understand normal development before you can diagnosis what is abnormal!  Theory: A language of science that allows us to assemble and communicate existing knowledge effectively o Helps us to make educated guesses and predictions about behavior based on samples of knowledge  Etiology: The study of the causes of childhood disorders o Looking at how all these different factors (biological, psychological, and environmental) are interacting Developmental Psychopathology (smaller timeline)  Children and environments are interdependent-transactional view  More comprehensive assessments as the child gets older-more teachers as you go through school  Continuities and discontinuities in development o Continuity: Developmental changes are gradual and quantitative and predictive of future behaviors  Aggression o Discontinuity: Developmental changes are abrupt and qualitative and don’t predict future behaviors  Eating disorders, developmental delays (for whatever reason, the child loses all language abilities all of a sudden) o Sometimes there’s a combination of the two Integrative Approach  No single theory explains various disorders  Abnormal child behavior is best studied from multiple perspectives and of course, knowledge increases through research Adaptational Failure: Unsuccessful progress in developmental milestones (like Jorge) Organization of Development  Early patterns of adaptation evolve with structure over time  Sensitive Periods: Times where environmental influences on development are enhanced o If these don’t occur, the child might have difficulty in life later on o Current abilities or limitations are influenced by prior accomplishments (building on each other)  Development is a process of increasing differentiation and integration Psychological Perspectives  Emotional reactivity and regulation-in reaction to something that happened in the environment; very sensitive and irritableness o Ages range o Important how one communicates in their environment (can’t speak so uses their emotions such as tantrums) Temperament and Early Personality Styles  Temperament: An organized style of behavior that appears early in development o Shapes an individual’s approach to their environment and vice versa  Early infant temperament may be linked to psychopathology or risk conditions o Positive affect: Easy going o Fearful: Timid, not wanting to leave parent, introverted o Negative affect: Irritable babies, problems with emotional reactivity  Balancing emotional response with self control  Personality is pretty stable with age  Self-regulation: A balance between emotional reactivity and self- control o The best formula for healthy and normal adjustment Biological Influences  The brain is seen as the underlying cause of psychological disorders  Neural plasticity  Genetics o Rarely is one gene the single cause of a disorder Behavioral Influences  ABA o Explains behavior as a function of its antecedents and consequences o Operant learning principles (as well as PCIT)  Positive and negative reinforcement, extinction, punishment  Classical conditioning: Involves paired associations between previously neutral stimuli and unconditioned stimuli Cognitive Influences  Focus on how thought patterns develop over time  Social Learning and Cognition o Social Learning: Parents watching each other-helpful to have people at different skills o Social Cognition: How children think about themselves and others  Social skills training-hard to generalize Emotional Influences  Core elements of a human’s psychological experience  Central features of infant activity and regulation  Tells us what to pay attention to and what to ignore  Affects the quality of social interactions and relationships  Important for internal monitoring and guidance  Reactivity: Individual differences in the threshold and intensity of emotional experience  Regulation: Enhancing, maintaining, or inhibiting emotional arousal Family, Social, and Cultural Perspectives  Interested in proximal (immediate family) and distal (further removed) events  Shared and nonshared environments may produce behavioral similarities (or differences) o Shared: Environmental factors that produce similarities in developmental outcomes among siblings in the same family o Non-shared: Environmental factors that produce behavioral differences among siblings in the same family Bronfenbrenner’s Ecological Model  A child’s environment is a series of nested and interconnected structures with the child at the center Chapter 3: Research Scientific Approach  Requires that a claim be based on theories that are backed up by empirical evidence from well-designed studies before conclusions are drawn  Reasons for skepticism about research in abnormal child psychology o Experts disagree frequently o Studies appearing in mainstream media are oversimplified  “Baby Einstein” with classical music in child development o Findings often conflict with one another  Very challenging to explain why o Research has led to different treatments: some have been helpful and some have had no effect and some have even been harmful  Kids going to a jail yard and having an inmate give them a motivational speech  Need science and research to support work! Taking a slight detour can cost a lot of money and time  When Science is Ignored o Ineffective practices not based on scientific evidence may be used with potentially damaging effects  “Rebirthing” treatment that is frowned upon  Parent feeding their child at the age of 7 (reattachment)  Pseudoscience demonstrates benefits through anecdotes or testimonials  The difference between this and science is the quality of the evidence, how it was obtained, and how it was presented  Lots of time on research  The Research Process o 1. Developing a hypothesis on the basis of observation, theory, and previous findings  Clinician’s own experience and interest could come into play o 2. Identifying the sample to be studied, selecting measurement methods and developing research design and procedures o 3. Gathering and analyzing the data and interpreting the results  After, go back to the theory (step 1) Nature and Distribution of Childhood Disorders  Epidemiological research is the study of incidence, prevalence, and co-occurrence of behaviors o Incidence rate: The extent to which new cases of a disorder appear over a specific time period o Prevalence rate: All cases (new and existing) observed during a specified time period o Co-occurrence: 2 disorders occurring at once  Problems of one disorder are going against the problem of the other o Rates change over time due to more information of the disorder  A good example is Autism  Since we know early intervention is good, rates in seeking prevalence has gone up Correlates: Variables associated at a particular point in time o No clear proof that one preceded the other Interventions  Randomized Controlled Trails (RCT’s) o Children are randomly assigned to different treatment and control conditions  Treatment Efficacy o Whether a treatment can produce changes under well- controlled conditions (as in a lab)  Treatment Effectiveness o Whether the treatment can be shown to work in clinical practice  Can you take it from the university and into the real world?  Dissemination: Training people in other settings and then going out into the real world o Difference in cases with each approach o Following your trainees following their families they are working with Methods of Studying Behavior  Standardization: A set of standards or norms for measurement  Reliability: How consistent or repeatable an experiment is o Internal consistency: Measurement method remains the same (same kind of questions geared towards a child with behavior problems) o Interrater reliability: Agreement between observers o Test-retest reliability: Results between tests are stable over time  Sometimes you want change  Eyeberg Child Behavior Inventory (ECBI) o Given to parent at the beginning of each session-good way to track progress  Validity o Face: The extent to which a measure appears to assess the construct of interest o Construct: Whether scores on a measure appear as predicted o Convergent: Reflects the correlation between related measures o Discriminant: Degree of correlation between unrelated measures  Pet ownership and child behavior problems: no correlation o Criterion Related: How well a measure predicts behavior in specific settings  At the same time: Concurrent  In the future: Predictive  Methods of Measuring o Interviews o Questionnaires o Checklists and rating scales o Psychophysiological recordings o Brain imaging o Performance measures o Direct observations of behavior o Intellectual, academic, and neuropsychological tests  Observational Methods o Benefits of structured observations  Cost effective  Focusing our attention on just the parent and child (not the whole family or any other distractions)  Useful for studying infrequent behavior  Greater control over situation o Limitation of structured observations  Uncertain of whether the observations are representative of a sample behavior  May never see the tantrum in session (client acts a different way in a different setting)  Measuring Behavioral Change o Dyadic Parent-Child Interaction Coding System (DPICS)  Systematic coding of parent verbalizations during interaction with child as well as physical positives and negatives  Stop and go depending on the occurrences of problem behavior o Coding Situations  Low Demand: Child leading the play (child should pick up the toys by themselves)  Moderate Demand: Parent leading the play  High Demand: Child is required to put toys away- where we see the tantrum o Category Definitions  Parent Categories  Questions o On average, parents ask 19 questions  Commands  Negative Talk  Child categories  Compliance  Noncompliance  No opportunity to comply Comorbidity: 2 diseases occurring together at the same time Chapter 4: Assessment, Diagnosis, and Treatment Clinical Issues  Intake Assessment: Decision making process o Is this family appropriate for our clinic?  I.e. the child is suicidal-Don’t have a 24 hour service; need of inpatient treatment o Begin with Clinical Assessment  Tailor to problems that arise in the assessment  Flexible, ongoing hypothesis testing assesses: Looking for all possible reasons (emotional, biological, and cognitive) of why this behavior could be occurring  Identify maladaptive thoughts  Draw conclusions based on information provided o “Why did you think your dad wanted you here?”  If responses don’t match, it’s important to note  Interview multiple family members to get a better picture of the problem o Intellectual tests tend to last a whole day; for a child it’s broken up into 4 days o Prognosis and treatment plan (after 5 days usually comes a treatment plan)  Prognosis: The formulation of predictions about future behavior under specified conditions  Treatment o Goal is to strengthen the outcomes of the child’s functioning, family functioning, and societal importance o The most useful treatments are based on what we know about a particular disorder o Data is needed to show that interventions work  Idiographic Case Formulation o Obtaining a detailed understanding of the child or family (specific)  Nomothetic Formulation o Emphasizes general inferences that apply to the general population o Good to have a combination of these 2 formulations  Developmental Considerations o Ethnic minorities are at a greater risk for a misdiagnosis due to cultural background (saying a kid is Autistic when it’s actually not in their culture to look someone in the eye) o Cultural information is necessary to:  Establish relationship with child and family  Motivate family members to change  Obtain valid information as best you can  Arrive at an accurate diagnosis  Develop meaningful treatment recommendations o Bias on Gender  Males: ADHD, childhood conduct disorder, Autism, language disorder  Females: Anxiety disorders and depression (more common), sexual abuse, eating disorders  Tend to have inattentive type of ADHDnot as easy to pick out and thus, is never diagnosed  Both male and female  Adolescent conduct disorder (more and more females), childhood depression, feeding disorder, physical abuse and neglect  Must be aware of how disorders are displayed! o Bias on culture: Some cultural groups do not like lots of questions and want more time to build a report DSM (5 Edition): A rating for each category  1. Clinical disorders or conditions  2. Personality disorders and intellectual disabilities o Personality disorders are believed to develop in someone’s early 20’s  3. General medical conditions o Diabetes or cancer  4. Psychosocial or environmental problems o Trauma; physical abuse; parent-child conflict  5. Global assessment of functioning o Giving someone a grade for their life o Very subjective-guidelines of how to rate someone but often 2 psychologists might not have the same score  May need a diagnosis in order to receive insurance  Age 14: Child can consent to therapy  Criticisms o Fails to take everything into account as to why someone has some of these symptoms o Gives less attention to infancy/childhood disorders o Fails to capture the interrelationships of the child  Pros o Helps clinicians to summarize and order observations o Facilitates communication between other doctors o Helps parents by providing recognition and understanding their child’s problems o Research studies are on the same topic  Cons o Disagreement about the effectiveness of labels o Negative effects and stigmatization o Can negatively influence children’s views of themselves and their behavior o Parents may feel that their kid would use their disorder as a “crutch” to help them get by in school Parent and Teacher Problems  Have a hard time detecting anxiety and depression disorders o Rely on self-report Behavioral Assessment  Evaluates the child’s thoughts, feelings, and behaviors in specific settings  ABC: Antecedents, behaviors, consequences CBT  View psychological disturbances as the result of faulty thought patterns, learning, and environmental experiences  Focuses on identifying and changing maladaptive cognitions, teaching the child to use cognitive and behavioral coping strategies, and help the child learn self-regulation


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