Developmental psychopathology is the
study of the origins and course of disordered behavior. It includes the
study of disturbed children, the developmental roots of adult disorders,
and the patterns that disorders follow after they emerge.
It also stresses the major themes of this
book: importance of developmental contexts, interaction of genes and environment,
role of past development in current developmental outcomes, and orderliness
of development despite changes in a person over time.
Studying psychopathology from a developmental
perspective has enriched our understanding of emotional and behavioral disorders
in several ways:
It has encouraged us to explore both the origins
of abnormal behavior and the ways in which abnormal behavior changes over
time.
It has focused attention on children who seem
to be on a path to developing some disorder yet somehow manage not to develop
it.
It encourages us to explore how disorders
may have their roots in the ways individual resolve (or fail to resolve)
the major developmental issues all people face.
A Closer Look at the Developmental Perspective
A major goal of developmental approaches to
psychopathology is to understand why some children who are at risk for developing
an emotional or behavioral disorder go on to develop it (what are the risk
factors?), while others at similar risk do not (what are the protective
factors?).
Risk Factors and Protective Factors
Determining factors that place people at risk
for developing an emotional or behavior disorder is a central task of developmental
researchers. A risk factor is any factor that increases the likelihood
of negative developmental outcome. May be genetic, familiar, socioeconomic,
cultural, or developmental. See Table 15.1 for a summary of risks.
The notion of risk is a statistical rather
than a causal concept. It applies to groups of people, not to particular
individuals.
Individual risk factors have limited predictive
power, but the presence of multiple risk factors increases that predictive
power dramatically.
Different combinations of risk factors can
lead to the same disorder.
Whether risk factors lead to serious emotional
or behavior problems is also influenced by the presence of protective
factors-factors that promote or maintain healthy development.
Assessing Normal and Abnormal
In developmental psychopathology, normal and
abnormal behavior must be considered together. Disorders often have their
roots in the ways people handle the normal developmental issues we all face.
Some problem behaviors are quite common at
certain ages, while others are not (e.g., hallucinations) and may predict
later pathology. An example is poor peer relations, not pathological by
itself, but the link between peer problems and later maladjustment is understandable.
Change and Stability over Time
Although some childhood disorders show rather
simple continuity with adult disorders, many do not. Some childhood problems
typically disappear with time, while others evolve into quite different
forms in later years.
There are, however, meaningful links between
childhood problems and adult psychopathology.
Explaining Psychopathology
Various models of psychopathology,
or frameworks for explaining why things happen, have been proposed over
the years. They focus on the etiology of psychological disorders
(conditions that produce them).
Most researchers believe that psychological
disorders often involve a complex interplay of biology and environment.
Researchers differ, however, in where they place their major emphasis--that
is, in which factors they consider the primary determinants of a disorder.
Biological Perspectives
The Traditional Medical Model
According to this model, psychological
disorders are mental illnesses to be diagnosed and cured, in much the
same way as physical diseases. Psychological disturbance is assumed
to be linked to an underlying structural or physiological malfunction.
Certain mental disorders do fit the medical
model (e.g., early childhood autism).
Modern Neurological and Physiological Models
Chemical imbalances in the neurotransmitters
in the brain have been found to be associated with various disorders
but should probably not yet be viewed as causes of the disorders but
as correlates or markers of a disorder.
Genetic Models
Researchers who take a genetic perspective
assume that some individuals inherit a predisposition to develop certain
disorders.
Most of these predispositions must be
polygenic, rather than being based on one defective gene.
The diathesis/stress model demonstrates
the contributions of both heredity and environment to the development
of psychological disorders. We all have some degree of biological vulnerability
and everyone encounters stress. For those with high vulnerability, little
stress is needed to develop the disorder and vice versa.
Environmental Perspectives
Sociological Models
Sociological models of psychopathology
stress the social context surrounding children who develop a disorder.
Depression and attentional problems have
been explored via these models.
Behavioral Models
Behavioral models focus on specific rewards,
punishments, modeled behaviors, and cognitive strategies that might
contribute to disturbed behavior. They are based on the assumptions
that disruptive responses persist because they are reinforced and that
restructuring the environment can change the behavior.
Early behavioral models assumed that the
symptoms are the disorder; more recent versions take internal cognitive
processes into account.
Psychodynamic Models Psychodynamic models have evolved from Freud's
psychoanalytic theory. They assume that disturbed behavior results from
underlying thoughts and feelings produced by life experiences and that
merely treating the behavioral symptoms of a problem is not enough.
Family Models
Family models hold that an individual's disturbed
symptoms are a reflection of disturbance in the larger family system.
Although one person may be labeled as the
problem, signs of the family system's disturbance can usually be found in
any member of the family.
The Developmental Perspective
The developmental perspective draws upon and
integrates all of the models of psychopathology discussed so far. It assumes
that a variety of biological and environmental factors influence abnormal
as well as normal development.
This approach has been useful for uncovering
the variety of factors that may contribute to a particular disorder and
also for explaining patterns of change and continuity in the course of emotional
problems (e.g., schizophrenia, juvenile depression).
Some Childhood Disorders
For most childhood disorders, both biological
and environmental causes have been proposed. Autism is the one childhood
disorder about which developmentalists are in agreement that biological
factors are largely to blame. The other disorders discussed below are open
to a number of explanations.
Early Childhood Autism
The core features of autism are a powerful
insistence on preserving sameness in the environment, extreme social isolation,
and severe speech deficits. Autism afflicts only 4 children in 10,000.
Autism is classified as a pervasive developmental
disorder because it is so severe. Its symptoms are always apparent by the
age of 3 but severity varies.
Autistic children appear physically normal.
There is general agreement that it has a biological basis, but it is not
clear exactly what it is.
Evidence of biological factors: autistic children
have extremely atypical behavior, their siblings are usually normal, parents
are usually no different from typical parents, continue to have profound
language and cognitive deficits even after years of treatment, statistical
relationship to certain biological problems, and many will develop signs
of brain pathology as they get older.
Structured therapy programs can often improve
autistic children's functioning, but the long-term outlook for them is not
very positive.
Conduct Disorders
A conduct disorder is a persistent
pattern of behavior that violates the basic rights of others or age-appropriate
social norms.
There are several types of conduct disorders,
distinguished by whether or not the child is aggressive and whether or not
he or she can form normal bonds of affection.
It is one of the most frequent diagnoses given
to children who are referred to mental-health centers, especially males.
When aggression and anti-social behavior begin
early, they are very stable across childhood years and predict problems
in adulthood. These disorders are referred to as life-course persistent
conduct disorders. In contrast, adolescence limited conduct disorders
are those that first appear in adolescence and those who fit this generally
do not go on to have chronic problems.
Several biological causes for conduct disorders
have been suggested (e.g., testosterone levels), and studies have found
a link between conduct disorders and a number of environmental factors (e.g.,
poverty, conflict, abuse).
Treatment is often difficult, especially if
the disorder is allowed to persist into adolescence. Early intervention
and prevention are key ingredients. Programs must last at least 2 years,
provide high quality day care or preschool, provide emotional support for
parents, address the family's broader context via educational and vocational
counseling.
Attention Deficit/Hyperactivity Disorder
Children diagnosed with attention deficit/hyperactivity
disorder (AD/HD) are a heterogeneous group, with the common thread
being attention-related difficulties.
It is quite common (3 - 5 % of all children),
with the incidence being higher for males.
It is often quite difficult to distinguish
AD/HD children from those with conduct disorders. As many as half the children
fitting the diagnosis of AD/HD also fit that of conduct disorders, a situation
referred to as co-morbidity.
Causes of AD/HD
To date, there is no biological marker that
reliably distinguishes hyperactive from nonhyperactive children, and there
may be environmental factors that contribute to hyperactivity. Recent research
has implicated family and other environmental factors as contributors to
AD/HD, especially parental criticism and overstimulation.
Treatment and Prognosis
AD/HD is often treated with stimulants,
which (due to a paradoxical drug effect) may increase a child's
ability to concentrate but seem to have short-lived effectiveness. Some
argue that it offsets a biochemical deficiency in the brains of children
with AD/HD.
Stimulants may not produce a paradoxical
effect, as these children do not slow down with stimulants. Also, just
because children's performance improves with stimulants does not suggest
a biological need for them. And, there is reason to doubt the long-term
effectiveness of stimulants.
Behavioral therapy can be effective for
AD/HD sufferers and have been successful in the classroom. This type
of therapy with medication works better than medication alone.
Many continue to have problems through
adolescence, even if they have been treated for years with stimulants.
It is important to evaluate the drugs'
long-term effects on the body.
Anxiety Disorders
Anxiety disorders are less common than
conduct disorders or AD/HD (up to 8 %). Anxiety disorders include generalized
anxiety disorder (very general and pervasive worries and fears) and
separation anxiety disorder (excessive anxiety precipitated by separation
from someone to whom the child is emotionally attached).
Anxiety disorders are more likely than conduct
disorders or AD/HD to show spontaneous remission, and they usually
do not predict serious problems in adulthood.
No reason to believe that these disorders
in children are caused by biological factors.
Family factors seem the most likely source
of anxiety disorders.
They are generally quite responsive to treatment
with either behavioral or psychodynamic therapies. Focusing on the parents'
anxiety also seems useful in treating school anxiety.
Depression
It is now recognized that children suffer
from depression. Often show such problems through somatic complaints, irritable
mood, and social withdrawal rather than motor slowing and obvious despondency.
It is difficult to diagnose because it co-occurs with other problems such
as anxiety disorders or AD/HD.
It may be distinct from adult onset depression.
It is most strongly associated with a history of psychosocial adversity,
including stress, anxious attachment, and physical or sexual abuse.
Anorexia Nervosa
Anorexia nervosa is a serious eating
disorder characterized by extreme reduction in food intake, major weight
loss (25 % of original weight), and a distorted body image. Some anorectics
go on eating binges, but then induce vomiting to avoid gaining weight--a
practice called bulimia. This self-abuse can cause serious side effects,
even death.
Anorexia nervosa is primarily a disorder of
middle-class adolescent girls and young women (with perfectionistic tendencies).
Biological theories include the possibility
of a dysfunctional hypothalamus-not much evidence to support this.
Psychological theories have emphasized early
sexual abuse or overinvolved, overentangled families. Demand for compliance
in return for nurturance. By adolescence, girls with this problem exert
control over their bodies, over how much they eat.
Why do adolescent girls focus on food to assert
her autonomy? Part of the answer is cultural.
It is difficult to treat because of the girl's
entrenched belief that she is not too thin and perhaps should become even
thinner. Behavioral and family therapies have had some success.
Comorbidity
Comorbidity is the rule for childhood psychological
problems. For example, anorexia overlaps greatly with depression. Depression
overlaps with each of the others.
May have several causes: 1) limited ways in
which children manifest problems (e.g., difficulty concentrating) and 2)
childhood problems may not represent distinct syndromes at all.
Childhood Disorders and Development
Each of the disorders discussed in this chapter
underscores some of the processes of development and sheds light on normal
development:
Autism marks a profound deviation from normal
development and underscores the interrelationships among various areas of
development.
Conduct disorders show notable stability over
time, but their ultimate outcomes are not totally predictable; they predict
a wide range of adult problems.
Attention deficit/hyperactivity disorder highlights
the transformations that can occur over the course of development.
Anxiety disorders demonstrate what can happen
when normal developmental issues are not successfully negotiated.
Anorexia nervosa demonstrates a delayed attempt
to establish autonomy--an issue usually addressed initially in toddlerhood;
it also illustrates the complexity of developmental pathways.
Other disorders illustrate the complex interaction
of risk factors and protective factors in the development of psychopathology,
both biologically based and environmental ones. For all disorders, the total
developmental context must be considered.
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