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Developmental Disorders – Content
1. Introduction 2
2. Anxiety and Related Disorders 23
3. Mood Disorders 41
4. Conduct Problems 61
5. Language and Learning Disabilities 78
6. Intellectual Disability 88
7. Eating Disorders 101
8. Attention-Deficit Hyperactivity Disorder 112
9. Autism Spectrum Disorder 125
10. Schizophrenia 135
11. Maladaptive Aging 140
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1. Introduction
(Chapters 1, 2, 3, 5)
What is Abnormal?
Abnormality is usually defined in terms of how a person is acting or what a person is saying relative
to a number of norms – or the degree to which a person deviates from the average and adaptation is
interfered with. Behavior is inextricably linked with the larger world in which it is embedded and it is
classified according to the following types of norms:
1. Developmental norms: Typical rates of growth, sequences of growth, and forms of physical skills,
language, cognition, emotion, and social behavior compared to deviations from them.
a. Developmental delay
b. Developmental regression or deterioration
c. Extremely high or low frequency of behavior
d. Extremely high or low intensity of behavior
e. Behavioral difficulty persisting over time
f. Behavior inappropriate to the situation
g. Abrupt changes in behavior
h. Several problem behaviors
i. Behavior qualitatively different from normal
2. Cultural norms: Expectations, judgements, and beliefs about the behavior of youth are defined
by cultural norms, and culture, ethnicity, and race need to be taken into account when assessing
various aspects of abnormality.
3. Gender norms: Gender stereotypes play a role in judgements about normality in boys and girls.
4. Situational norms: Judgments of deviance and normality also take into account what is expected
in specific settings or social situations.
5. Role of adults: The identification and labeling of a problem is more likely to occur when others
become concerned, so that the characteristics of parents, teachers, or family physicians matter.
6. Changing views of abnormality: Judgments about abnormality are not set in stone, but change
with time (e.g., homosexuality).
How Common are Psychological Problems?
The prevalence of psychological disorders depends on several factors, most importantly how a
disorder is defined and the criteria set for identification. Considering the disparity in classification,
prevalence rates usually differ across studies. Generally, the global incidence rate lies at
approximately 50%: Every second person will suffer from a mental disorder at least once during their
lifetime. Additionally, there is a prevalence of 15-20% for developmental disorders, with 10% having
a mild and 10% having a serious form at a given point in time.
Some people have been concerned that societal changes have increased the risk of disorders for
young people. However, there is mixed evidence for such secular trends: Some studies indicate
increases, others decreases. Whether or not problems are increasing, young people do have need for
appropriate treatment for their mental health problems, which still largely go unrecognized in
schools, primary health facilities, and other settings. Early disturbance can interfere with subsequent
developmental processes, so early intervention is crucial.
How are Developmental Lebel and Disorder Related?
There is a relationship between specific problems and the age at which they usually first appear. This
is because chronological age is correlated with developmental level, which makes some disorders
more likely than others. Information about developmental level and disorder is helpful in several
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ways: Determining its causes, severity and outcomes, facilitating early treatment, or even preventing
the disorder completely.
How are Gender and Disorder Related?
Males have consistently been found to be affected more frequently than females. However, this
differences also depend on the specific disorder:
Higher for males Higher for females
Autism Spectrum Disorder Anxiety and Fears
Oppositional Disorder Depression
Drug Abuse Eating Disorders
Intellectual Disability
ADHD
Conduct Disorder
Language Disorder
Reading ability
Some gender differences are also related to age. Males are particularly vulnerable to
neurodevelopmental disorders that occur early in life, whereas females are more vulnerable to
emotional problems and eating disorders that more commonly are seen at adolescence.
Furthermore, gender differences exist in developmental change for externalizing and internalizing
problems and problems may be expressed differently according to gender.
Although there probably are real gender differences, to some extent they may be the result of
methodological issues, such as a bias for studying males and a difference in reporting of symptoms.
True differences might be due to underlying biological causes, but are also influenced by
psychosocial factors, including differential exposure to harmful and protective experiences.
Developmental Psychopathology Perspective
The developmental psychopathology perspective integrates the understanding of normal
developmental processes with those of child and adolescent psychopathology. It is a systems
framework for understanding disordered behavior in relation to normal development and combines
various approaches around a core of developmental knowledge, issues, and questions. It is the study
of developmental processes that contribute to, or protect against, psychopathology.
Concept of Development
Although many different definitions of development have been proposed, there is some consensus
on the essence of development. Development refers to change over the lifespan that results from
ongoing transactions of an individual with biological, psychological, and sociocultural variables.
Although quantitative change in development is important, qualitative change is more salient. Early
development of the biological, motor, physical, cognitive, emotional, and social systems follows a
general course and development proceeds in a coherent pattern, so that current functioning is
connected to both past and future functioning. Lastly, the change that comes with development is
not inevitably positive.
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Pathways of Development
The developmental psychopathology perspective assumes that abnormal behavior emerges gradually
as the child and environment influences transact. Development is characterized as involving
progressive adaptations or maladaptations to changing circumstances. An exemplary way of
depicting development is to describe pathways of adaptation and maladaptation:
Path 1: Stable Adaptation Few environmental adversities; few behavior problems; good self-worth
Path 2: Stable Maladaptation Chronic environmental adversities
Path 3: Reversal of Maladaptation Important life change creates new opportunity
Path 4: Decline of Adaptation Environmental or biological shifts bring adversity
Path 5: Temporal Maladaptation Can reflect transient experimental risk taking
The transactional and probabilistic nature of development is recognized in the principles of
equifinality and multifinality. Equifinality refers to the fact that diverse factors can be associated with
the same outcome, while multifinality refers to the fact than an experience may function differently
depending on a host of other influences that may lead to different outcomes.
Because of the complex effects various life factors can have, risks, vulnerability and resilience are
especially important. Risks are variables that precede and increase the chance of psychological
impairments. The term vulnerability is often applied to a subset of risk factors that resides in youth’s
tendency to respond maladaptively to life circumstances. Vulnerability may be inborn or acquired,
and although somewhat enduring can be modified.
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Resilience is defined by relatively positive outcomes in the face of significantly adverse or traumatic
experiences. It can also be defined as the absence of psychopathology or adaptation beyond what
would be expected in situations that overcome many individuals, and in terms of competence
regarding the developmental tasks applied to young people.
Personal attributed, family characteristics, and support from outside the family are sources of
protective factors that foster resilience. Resilience is viewed as residing within the individual and can
be regarded as the opposite of vulnerability. At the resilience end of the continuum, more stress is
required for disorder to occur. With vulnerability, even low stress can result in mild disorder, and
severity of disorder increases as stress level rises.
Another issue of the different pathways of development relates to the continuity and change of
disorder over time. Both continuity and discontinuity have been observed, so that we cannot simply
assume that young people grow out of psychopathology.
The expression of a problem may change in form with development (= heterotypic continuity) or it
may be relatively stable over time (= homotypic continuity). Some disorders are also more likely to
cease as children age, such as sleep or eating problems. In general, continuity of problems varies
depending of the length of time being examined, the kinds of psychopathology or symptoms, and
other variables.
Normal Development and Problematic Outcomes
The areas of attachment, temperament, emotion, and social cognitive processing are good examples
to illustrate how normal developmental processes and less-than-optimal outcomes go hand in hand,
and how development involves the overlap and interdependence of the biological, social, emotional,
and cognitive domains of functioning.
Attachment, as proposed by Bowlby, is part of the ongoing transactions between a child and its
primary caregivers. It helps shape developmental pathways to adaptive or less adaptive outcomes
and is the basis for later relationships, because the child’s attachment experiences result in internal
representations about others’ availability and responsiveness.
Attachment theory distinguishes between secure and insecure attachment, with insecure
attachment being divided into three subtypes: avoidant attachment, resistant attachment, and
disorganized attachment. Secure attachment has been associated with adaptive behavior in
childhood and adolescence. In contrast, insecure attachment is linked to maladaptive behaviors.
Temperament is viewed as individual differences in behavioral style that are thought to develop into
later personality through environmental interaction. The final outcome depends on goodness-of-fit,
or how the child’s behavioral tendencies fit with parental characteristics and other environmental
circumstances. But early temperament is also moderately stable over time and predict later
temperament and adult personality.
Most descriptions of temperament include aspects of positive/negative emotion, approach/
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avoidance behaviors, activity level, sociability, attention, or self-regulation. Sanson’s 3 dimensions of
temperament are most widely recognized:
Negative reactivity (related to many types of Refers to emotional volatility and irritability;
problems) sometimes called negative emotionality, anger,
or distress proneness; a basic component of
most definitions of temperament and an aspect
of difficult temperament in most research
Inhibition (related to worry and anxiety) Describe the child’s response to new persons or
situations; also referred to as approach
withdrawal, social withdrawal, or sociability
Self-regulation (related to low levels of acting- Refers to processes that facilitate or hinder
out behaviors, good social competence, and reactivity; includes effortful control of
academic adjustment) attention, emotion, and behavior
There are two perspective of temperament and psychopathology. One considers problem behavior
as an extreme of normal temperament, while the other views temperament as a risk or protective
factor, depending on the specific temperamental tendency and circumstance.
It has also been proposed that difficult temperament is associated with increased sensitivity to the
environment regardless of the quality of the environment. According to the differential susceptibility
hypothesis, reactive children should not only be more affected by adversities but also by
advantageous environments.
Human emotion is evident early in life and entwined with social development. Three elements of
emotion are widely recognized: (1) Private feelings, (2) automatic nervous system arousal and bodily
reactions, and (3) overt behavioral expressions. Emotions serve several general functions: They
important for communication, are involved in the development of empathy, motivate and guide
individual cognition and motivation, and they also play a critical role in psychological maladjustment.
The understanding of emotion is important to child competence and adjustment. Children who
showed low levels of emotion knowledge tended to have social problems and withdrawal two years
later.
Emotional regulation involves learning to initiate, maintain, and modulate the feelings, biological
responses and expressions of emotions – it can be viewed as an aspect of effortful control, which is
crucial to adaptive and competent development. High levels of negative emotions combined with
poor regulatory skills are associated with both low social competence and behavioral problems.
Social cognitive processing has to do with thinking about the social world. It focuses on how
individuals take in, understand, and interpret social situations, and how behavior is then affected.
Especially important is the assumption that interpretation of the social situation plays a major role in
maladaptive behavior: Specific beliefs and attributions about the world and the self appear to
operate I depression, anxiety, and negative peer relationships, among other difficulties.
General Developmental Framework
A general developmental framework views normal and abnormal development from different, but
interacting, contexts. This includes biological, individual, family, social, and cultural contexts. An
example of such a framework is the ecological transactional model, which will be discussed in detail
later.
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Biological and Environmental Contexts of Psychopathology
Brain and Nervous System
The nervous system begins to develop shortly after conception.
The brain is made up of numerous types of cells, including
neurons, which are specialized to chemically transmit impulses
within the nervous system and to and from other body parts.
With development and experiences, neurons become more
interconnected and functional – but the time of their
maturation depends on the specific brain area.
All neurons consist of a cell body, dendrites, and an axon, and
communication between neurons occurs across synapses.
Neurotransmitters (e.g., dopamine, serotonin, norepinephrine,
glutamate, and GABA) are released into the synaptic gap and
taken up by receptors on the dendrites of the receiving neuron,
which generates an electrical impulse that causes another
neurotransmitter release at its end.
The development of the brain results from both intrinsic biological programming and experience and
pruning takes place both before and after birth to shape the brain by eliminated unneeded cells and
connections.
The nervous system can be divided into two specific structures: The central nervous system (brain
and spinal cord) and the peripheral nervous system. The latter consists of the somatic system, which
involves sensory organs and muscles and is engaged in sensing and voluntary movement, and the
autonomic system, which involves the sympathetic and parasympathetic system. The entire nervous
system communicates within itself and with the endocrine system.
The brain itself has three major interconnected
divisions: The hindbrain (including the pons, medulla,
and cerebellum), the midbrain (connecting the
hindbrain and upper regions), and the forebrain
(consisting of two cerebral hemispheres and the
cortex).
The hind- and midbrain are sometimes referred to as
the brain stem, which plays a role in more basic
functioning, such as heart regulation, breathing,
movement, or sleep. The cerebral hemispheres are
connected to each other by the corpus callosum and
consist of four loves. They are involved in a wide
range of activities, such as sensory processing, motor
control, and higher mental functioning.
The subcortical structures of the thalamus and the
hypothalamus are involved in processing and relaying
information between the cerebral hemispheres and
other parts of the central nervous system, and in
regulating basic urges, respectively. The limbic system
includes the hippocampus and amygdala, and it plays
a central role in memory and emotion.
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Nervous System and Risk for Disordered Functioning
The nervous system is a major aspect of the constitutional factors that influence psychological
functioning and behavior. Impaired functioning can result from inheritance, early-occurring
abnormalities, or even prenatal, perinatal, and postnatal harm.
Numerous prenatal influences can put the developing child at risk, including poor maternal diet and
health and maternal stress. The developing fetus is vulnerable to so-called teratogens, or harmful
substances, which encompass certain drugs (e.g., alcohol, tobacco), radiation, environmental
contaminants, and maternal diseases. Teratogens interfere with brain cell formation and migration,
as well as other developmental processes. Central to the outcome is the amount of exposure and the
timing of the exposure to the substance. Generally, specific structures and systems are most
sensitive to harm when they are rapidly developing.
Fetal Alcohol Syndrome (FAS) is an example of the adverse consequences of prenatal exposure. It
lies at the most severe end of a spectrum of alcohol related disorders and is characterized by
abnormal brain development, retarded growth, birth defects, facial abnormalities, and neurological
and psychological signs.
Perinatal risk factors include excessive medication given to the mother, unusual delivery, and lack of
oxygen. Preterm delivery and low birthweight are associated with death and a variety of
developmental problems. But developmental outcome depends on the interplay of biological and
psychosocial factors.
Postnatal effects on the nervous system can result from malnutrition, accident, illness, or exposure
to chemical. When brain damage occurs in youth, a major concern is the degree to which the
resulting problems can be remediated, which is closely connected to plasticity of the brain to
recover. The young, immature nervous system is relatively adept at restoring itself or transferring
functions to undamaged brain areas. But sometimes, damage to the immature brain might also set
up a cascade of negative effects on future brain development.
The timing, extent, severity, and region of damage, as well as the kind and amount of environmental
support and therapy provided, are among the factors that influence recuperation.
Genetic Context
Genetic contributions to behavioral development operate in complex ways. The study of genetic
influences on individual differences in behavior is called behavior genetics. It seeks to establish the
extent of genetic influence on attributes, discover the genes involved, understand how the genes
operate, and reveal the paths from genes to characteristics. We need to keep in mind that genes act
indirectly and in complex ways to guide the biochemistry of cells, and that the path from someone’s
genotype to their observable characteristics, or phenotype, is thus also indirect and intricate.
One of the most basic principles in genetics is that of single-gene inheritance. Here, a gene can be
either dominant – its transmission by either parent leads to the display of traits associated with it –
or recessive – only its transmission by both parents results in associated traits. In general, the effects
of single genes are quite predictable, and often result in individuals either having or not having the
relevant phenotype.
But multiple-gene inheritance are often more important, especially in the context of complex human
characteristics and psychological disorders. Referred to as quantitative trait loci (QTL), these genes
are inherited like others, but each has relatively small influence that combines to create a larger
effect. Quantitative genetic methods allow the assessment of heritability, or the degree to which
genetic influence accounts for variance in behavior in a certain population.
Heritability for psychological disorders or dimensions rarely exceeds 50% - thus, substantial variation
in attributes has a basis in other biological factors, the environment, or some interplay of genes with
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these other influences. This contribution of environmental influences is assessed in the context of
shared and nonshared environmental influences, with the letter often having greater influence on
psychological and behavioral outcomes.
Molecular genetics seeks to discover the genes associated with a disorder, the biochemicals coded
by the genes, and how these biochemicals are involved in behavior. In research with humans, the
methods of linkage analysis (i.e., revealing the location of a defective gene) and association analysis
(i.e., testing whether a particular form of a gene is associated with a trait or disorder) are central.
Genome-wide linkage and association analyses enable researchers to scan across the genomes of
individuals or large portions of the genome.
Gene-environment interaction refers to differential sensitivity to experience due to difference in
genotype, while gene-environment (GE) correlation refers to genetic differences in exposure to
environments.
Type of GE correlation Example
Passive: A family's environment is influenced by The child who has a genetic propensity for a
the genetic predisposition of the parents. The high activity level also experiences a high-
child experiences this environment and also activity family environment.
shares the genetic predisposition of the
parents. This mechanism occurs at birth and is
“passive” in the sense that the child has
relatively little active input.
Reactive: A child evokes reactions from other Others react to the child's gene-based high
people on the basis of her or his genetic activity level.
predisposition, so that the child's genetic
propensities are linked to environmental
experiences.
Active: A child, particularly as he or she grows The child with a genetic propensity for high
older, selects or creates environments on the activity level engages
basis of his or her genetic predisposition. in activities requiring high activity rather than
restrained, quiet activities
such as reading.
Learning and Cognition
Learning and cognition are inextricably intertwined with development. The abilities to learn and think
not only become more advanced over time, but also facilitate other kinds of development as the
child transacts with the environment.
Our understanding of learning is heavily based on behavioral tradition and its concepts of classical
conditioning (e.g., Pavlov and Watson) and operant conditioning (e.g., Thorndikes’ Law of Effect and
Skinner). The table below displays some fundamental operant conditioning processes.
Term Definition Example
Positive reinforcement A stimulus is presented contingent on Praise following good behavior
a response, increasing the frequency increases the likelihood of good
of that response. behavior.
Negative reinforcement A stimulus is withdrawn contingent on Removal of a mother's demands
a response, increasing the frequency following a child's tantrum
of that response. increases the likelihood of
tantrums
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Extinction A weakening of a learned response is Parents ignore bad behavior, and
produced when the reinforcement it decreases.
that followed it no longer occurs.
Punishment A response is followed by either an A parent scolds a child for hitting,
unpleasant stimulus or the removal of and the child stops hitting; food is
a pleasant stimulus, thereby removed from the table after a
decreasing the frequency of the child spits, and the spitting stops.
response.
Generalization A response is made to a new stimulus A child has a stern uncle with a
that is different from, but similar to, mustache and develops fear of all
the stimulus present during learning. men with mustaches.
Discrimination A stimulus comes to signal that a An adult’s smile indicates that a
certain response is likely to be child’s request is likely to be
followed by a particular consequence. granted.
Shaping A desired behavior that is not in the A mute child is taught to talk by
child’s repertoire is taught by initially reinforcing any sound,
rewarding responses that are then a sound somewhat like a
increasingly similar to the desired word, and so on.
response.
A wide range of behaviors can be acquired or removed by observing others perform them, which is
known observational learning. Children are more likely to display the responses of a model if they
observe that model being reinforced for their behavior and are less likely to display them if they
observe the model being punished.
Various approaches also focus on cognition and how individuals mentally process information and
think about the world. Individuals perceive their experiences, construct concepts or schemas that
represent experience, store information in memory, and employ their understanding to think about
and act in the world.
The cognitive-behavioral perspective incorporates cognition, emotion, behavior, and social factors
and assumes that behaviors are learned and maintained by the interaction of internal cognitions and
emotions with external environmental events. Cognitive factors influence an individual’s attention,
perception, and behavior. It is assumed that maladaptive cognitions are related to maladaptive
behavior.
An attempt to distinguish the complex cognitive functions that contribute to the development,
maintenance, and treatment of psychopathology involves the following aspects: Cognitive structures
(= schemas for representing information in memory), cognitive content (= the actual content of the
cognitive structures in memory), and cognitive processes (= how people perceive and interpret
experience). The combination of these three aspects interacting with actual events results in
cognitive products. There is a further distinction between cognitive deficiencies and distortions.
Cognitive deficiencies refer to an absence of thinking, while cognitive distortions are inaccurate
thought processes that are dysfunctional.
Cognitive-behavioral therapy aims, through behavior-based procedures and structured sessions, to
modify maladaptive cognitive structures, deficiencies, and distortions.
