Development and developmental problems in childhood
Lecture 1: introduction
Identifying behavioral problems
What do we mean by abnormal? No clear consensus but three broad criteria:
Statistical deviation: abnormal behavior based on relative infrequency in the
general population (e.g., suicidal thoughts in children; indication of mood disorder)
o Problem: context of behavior not considered (e.g., depression vs. grief)
Disability: abnormal behavior based on thoughts, feelings, actions that interfere
with social and/or academic functioning
o Problem: many psychological disorders do not show obvious impairments
(e.g., eating disorders)
Distress: abnormal behavior based on the degree of emotional distress
o Problem: subjective criterion (child needs to be able to verbalize feelings and
differentiate between different feelings to adequately describe situation),
some disorders do not necessarily lead to emotional distress (e.g., defiant
behavior)
Harmful dysfunction = combination of criteria = abnormal behavior: 1) reflects an
underlying dysfunction in a biological or psychological system, 2) causes disability
and 3) distress
DSM-V definition of a mental disorder: “A mental disorder is a syndrome
characterized by clinically significant disturbance in an individual’s cognition, emotion
regulation, or behavior that reflects a dysfunction in the psychological, biological, or
developmental processes underlying mental functioning. Mental disorders are usually
associated with significant distress or disability in social, occupational, or other
important activities.
An expectable or culturally approved response to a common stressor or loss, such as
the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g.,
political, religious, sexual) and conflicts that are primarily between the individual and
society are not mental disorders unless the deviance or conflict results from a
dysfunction in the individual, as described above.”
Definition focusses on a medical view, there is an underlying dysfunction as
cause.
Limitations when applying to children:
o Underlying causes cannot always be identified in children
o Many childhood disorders are relational; better understood in an interpersonal
context rather than only within the child
o Children’s behavior is best understood within their social-cultural surroundings
DSM-V diagnostic approach: diagnoses based on signs and symptoms
Sign: overt feature of a disorder
Symptom: subjective experience associated with a disorder
Diagnosis classification
o Categorical: “criteria A, B and C must be met” = mental disorders are divided
into mutually exclusive groups based on certain criteria. Categorical
classifications used in biology or medicine
o Prototypical: “5 or more symptoms must be present” = degree to which the
signs and symptoms present match the ideal picture (prototype) of the
disorder
, o Dimensional: disorders represent continuum of severity from mild to severe.
Dimensional approach as a new addition to the DSM classification, DSM-5
Cross-Cutting Symptom Measure as rating scale
Prevalence of childhood disorders
Prevalence = frequency of individuals within a population who have a medical or
psychological condition
o Point prevalence = a given point in time
o Lifetime prevalence = at any point in lifetime
Incidence = frequency of new cases in a time period (e.g., 1 year)
Comorbidity = two or more disorders are present in the same person
o Around 40% in children and adolescents
o 75% of children with depression also have anxiety
o 50% of children with ADHD also have conduct problems
Influencing factors:
o Age (prevalence of disorders differs for children vs. adolescents)
o Gender (during childhood prevalence higher in boys; during adolescence
prevalence higher for girls, differences in type of disorder)
o Socioeconomic status (e.g., access to health care, more mental disorders in
parents with lower SES)
o Race, ethnicity (e.g., confounded with SES, cultural impact on development
and definitions of (ab)normal behavior)
Causes of childhood disorders
Developmental psychopathology = multidisciplinary approach to understand the
causes and emergence of child development and developmental disorders
Biological (e.g., genes, brain functioning, physical health)
Psychological (e.g., cognition, emotion, behavior)
Socio-cultural (e.g., social network, cultural background)
(Ab)normal development is probabilistic and transactional (factors at different
levels influence each other)
Abnormal development as deviation from normality (understanding normal
development to better understand developmental disorders and vice versa)
Developmental pathways as course of trajectory of development
Developmental tasks as challenges during development (Erikson)
Stage Developmental tasks
Infants Attachment to caregivers
and Basic motor skills (sitting, standing, jumping, walking)
toddlers Acquiring basic speech and language skills
Achieving a sense of autonomy from parents
Younger Taking care of self and helping at home
children Obeying the rules at home, school, in public
Learning basic academic skills (reading, writing, spelling,
arithmetic)
Making and keeping friends
Older Greater independence outside the home (e.g., sports)
children mastering more advanced academic skills (creative writing,
science)
, Developing a personal identity or sense of self
Fostering close relationships with peers
Pathways characterized by change versus continuity
o Homotypic continuity: disorders persist unchanged across development
o Heterotypic continuity: symptoms of disorder change over time
Interindividual variability
Interactions between biological, psychological, social-cultural factors result in:
Equifinality: different developmental histories lead to similar outcomes (e.g.,
ADHD or aggression or maltreatment in childhood conduct problems in
adolescence)
Multifinality: similar experiences show different developmental outcomes (e.g.,
maltreatment in childhood depression or conduct problems or good adjustment
in adolescence)
Reasons for interindividual variability interaction of:
Risk factors (e.g., parental loss, maltreatment)
Protective factors (e.g., temperament, parent-child relationship, support systems)
Resilience (competence despite the presence of risk factors)
Diathesis-stress model, Caspi et al., 2003:
Psychopathology as interaction over time of vulnerability to
psychological disorder (diathesis, e.g., genetic makeup) and
experience of stressful events
Children exposed to maltreatment were at risk for adult
depression (main effect of maltreatment)
Childhood maltreatment (stressor) was predictive of adult
depression when certain genetic variation was present (s-allele
of 5-HHT-serotonin transporter gene; gene-environment
interaction)
Gene-environment correlation model, Scarr & McCartney, 1983:
Developmental course is based on biological foundation (genotype, genes) and
environment (experiences)
Genes “direct” experiences (experiences compatible to genotype), but
environmental opportunities are necessary for developmental course
Association/correlation between genes and environment:
o Passive correlation: parents provide enriching environment correlated to
genotype in both parents and child (e.g., parents with higher intellectual
abilities provide more intellectually stimulating environment)
o Evocative correlation: genotype evokes response in environment (e.g., smiley
babies receive more social attention)
o Active correlation: people seek out stimulating environments in relation to
genotypes (e.g., being engaged in sports)
Science and evidence-based practice
Principles of scientific thinking:
Falsifiability: hypothesis can be tested and proven wrong
Critical thinking: remaining skeptical and looking for plausible alternatives (e.g.,
placebo effects)
, Parsimony: looking for the simplest/most efficient explanation (e.g., unifying
diagnoses based on all symptoms vs. looking at symptoms separately)
Precision: being accurate and careful in the way conclusions are drawn (e.g.,
confirmation bias)
Reproducibility: using the same methods results in the same outcomes
Evidence-based practice in psychology = the integration of the best available
research with clinical expertise in the context of patient characteristics, culture and
preferences
Scientific research: according to the research literature, what methods work best
for specific problem?
Clinical expertise: according to own professional experience and judgement, what
is the best way to treat?
Patient characteristics: how might age, gender, social-cultural background or
family expectations and preferences for treatment affect the way of helping as a
professional?
Levels of evidence-based treatments
Well-established At least two, well-conducted experimental studies by
treatment independent researchers show the treatment is better than
placebo
Probably At least two, well-conducted experimental studies show the
efficacious treatment is better than waitlist (delayed treatment) control
treatment
Possibly At least one, well-conducted study shows the treatment is better
efficacious than waitlist (delayed treatment) or no treatment
treatment
Experimental At least one study, with methodological limitations, shows the
treatment treatment is helpful
Questionable The treatment has been tested and is inferior to waitlist (delayed
efficacy treatment) or no treatment
Lecture 2: internalizing problems (anxiety, depression)
Empirical classification in children: Internalizing vs. externalizing problems
Empirical classifications of mental disorders are based on symptoms or behavior
checklists (e.g., Child Behavior Checklist)
Achenbach (1966) identified 2 clusters of symptoms/broadband syndromes based
on factor analysis
Behavioral problems are considered dimensional rather than categorical, there is
no clear cut between typical and atypical; it is a degree/continuum
