Child and Adolescent Psychopathology1.pdf
Child and Adolescent Psychopathology1.pdf Psyc 5020
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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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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-esteemnot 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 ADHDnot 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