Summary DP Long version All Chapters – Huyen Chau Nguyen
1 Introduction
1-1Defining Disorders of Infancy, Childhood, and Adolescence
One of the first steps leading to accurate and useful conceptualizations of psychopathology is to recognize
the many connections between typical and atypical development
A useful model of typical development requires a dynamic appreciation of children’s strengths and
weaknesses as they experience salient, age-related challenges. A model like this takes into account the
complexities of individual, familial, ethnic, cultural, and societal beliefs about desirable and undesirable
outcomes for children and adolescents. Against this multilayered background of typical child development,
we are then able to identify children whose distress and dysfunction are exceptional.
1-2What Is Normal?
Common descriptions of normality and psychopathology often focus on
(1) statistical deviance, the infrequency of certain emotions, cognitions, and/or
behaviors compared to a sample’s distribution;
(2) sociocultural norms, the beliefs and expectations of certain groups about what kinds of emotions,
cognitions, and/or behaviors are undesirable or unacceptable; and
(3) mental health perspectives, theoretical or clinically based notions of distress and dysfunction.
- From a statistical deviance perspective, a child who displays too much or too little of any age-expected
behavior (such as dependency or assertiveness) might have a disorder.
- From a sociocultural norm perspective, children who fail to conform to age-related, gender-specific, or
culture-relevant expectations might be viewed as challenging, struggling, or disordered.
- From a mental health perspective, a child’s psychological well-being is the key consideration.
1-3The Role of Values
Each definition raises questions about the role of values in conceptualizations of mental health and
psychopathology.
A key value judgment involves distinctions between adaptation and maladaptation and personal or group
standards of adequate or average adaptation, or optimal adaptation. Adequate adaptation has to do with
what is considered okay, acceptable, or good enough to meet the challenges an individual is facing. Optimal
adaptation has to do with what is excellent, superior, or “the best of what is possible.”
,Summary DP Long version All Chapters – Huyen Chau Nguyen
The essential/irreducible needs of children: ongoing nurturing relationships, physical protection/safety/
regulation, experiences tailored to individual differences, developmentally appropriate experiences
- The need for limit setting, structure, and expectations, stable, supportive communities and cultural
continuity
1-3abc Poor Adaptation, Adequate Adaptation, Optimal Adaptation
Neither adequate nor optimal adaptation guarantees smooth sailing throughout development. Challenges
are inevitable, and struggles themselves are not evidence of disorder. Challenges and struggles are viewed as
forces of growth. It is the overcoming of challenge that furnishes the social, emotional, and intellectual skills
that produce all forms of growth, both healthy and unhealthy.
1-3dThe Impact of Values on Definitions of Disorder
Other important judgments involving values are tied to specific definitions of disorder.
- With statistical deviance definitions, it sometimes makes sense to examine both extremes of the continuum
- With sociocultural definitions, value judgments are the very basis of definitions of disorder.
- With mental health definitions, the values of psychologists, psychiatrists, and clinical social workers are
embedded in both scientific and lay community decision making.
1-4Definitions of Psychopathology and Developmental Psychopathology
Psychopathology: intense, frequent, and/or persistent maladaptive patterns of emotion, cognition, and behavior
Developmental psychopathology extends this description to emphasize that these maladaptive patterns occur in
the context of typical development and result in the current and potential impairment of infants, children, and
adolescents.
1-4aRates of Disorders in Infancy, Childhood, and Adolescence
The multipart task of estimating rates of disorder includes
(1) identifying children with clinically significant distress and dysfunction, whether or not they are in
treatment (and most of them are not);
(2) calculating levels of general (e.g., anxiety disorders) and specific (e.g., generalized anxiety, separation
anxiety disorder, phobia) psychopathologies and the impairments associated with various disorders; and
(3) tracking changing trends in the identification and diagnosis of specific categories of disorder, such as
autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), and depression
Developmental epidemiology: Frequencies and patterns of distributions of disorders in infants, children,
and adolescents. Measures of the frequency of psychopathology:
- Prevalence: All current cases of a type (or types) of disorder – the proportion of a population with a disorder
- Incidence: New cases of a type (or types) of disorder in a given time period – the rate at which new cases arise
1-4bAllocation of Resources, Availability, and Accessibility of Care
Even with research-based knowledge about ways to promote children’s physical and mental well-being that
has been available for years, parents, schools, communities, and policy makers have struggled to allocate
often-scarce emotional, social, and financial resources. One continuing difficulty involves access to care.
Barriers to care: Factors that impede access to mental health services, including structural barriers such as
lack of provider availability, inconveniently located services, transportation difficulties, inability to pay,
inadequate insurance coverage, or both; individual barriers such as denial of problems or lack of trust in the
system; and sociocultural barriers such as the stigma of psychopathology or mental illness.
- Structural barriers: limited policy perspectives, disjointed systems, lack of provider availability, long waiting lists,
inconveniently located services, transportation difficulties, and inability to pay and/or inadequate insurance coverage.
- Barriers related to perceptions about mental health difficulties: the inability to acknowledge a disorder, denial of
problem severity, and beliefs that difficulties will resolve over time or will improve without formal treatment.
- Barriers related to perceptions: about mental health services involve a lack of trust in the system, previous negative
experiences, and the stigma related to seeking help.
,Summary DP Long version All Chapters – Huyen Chau Nguyen
Proposals lay the groundwork for resource allocation and policy implementation that will have long-standing
consequences for the well-being of countless children.
1-5The Globalization of Children’s Mental Health
Discussions of mental health and mental illness involving resource allocation and public policy increasingly
emphasize global perspectives that require careful thinking about Western models of development, disorder
and intervention, as well as the vastly different experiences of children who live in resource-rich versus
resource-poor countries.
They key factors that increase children’s vulnerability to psychopathology in resource-poor countries: identify
rapid social change, urbanization and urban poverty and inadequate health and educational services.
The development and implementation of globally useful interventions require recognition of the current
disconnect between where research takes place and where the need is greatest, as well as a commitment to
do better on behalf of the world’s children.
1-6The Stigma of Mental Illness
Stigmatization: Negative attitudes (such as blaming or overconcern with dangerousness), emotions (such as
shame, fear, or pity), and behaviors (such as ridicule or isolation) related to psychopathology and mental illness
- For parents concerned about their children’s distress or dysfunction, there is almost always shame, fear,
and/or blame. For children, experiences of secrecy and rejection are commonplace.
- Lack of respect and lack of access to care (again) are often the results of personal, familial, social, and
institutional stigmas.
- Self-stigmatize: internalize these negative beliefs and attitudes and exhibit low levels of self-esteem and
self-efficacy
You can identify:
(1) several dimensions of stigma, including negative stereotypes, devaluation, and discrimination;
(2) two targets of stigma, the individual and the family; and
(3) two contexts of stigma, the general public and the self/individual.
Prevent/minimalize stigmatization when you begin early: target multiple dimensions of knowledge and
attitudes; be developmentally appropriate; and include individuals, families, and communities.
, Summary DP Long version All Chapters – Huyen Chau Nguyen
2 Models of Child Development, Psychopathology, and Treatment
2-1The Role of Theory in Developmental Psychopathology
Models of development, psychopathology, and treatment allow us to organize our clinical observations of
children and our research findings into coherent, informative accounts.
2-1aDimensional and Categorical Models
Dimensional models of psychopathology emphasize the ways in which typical feelings, thoughts, and
behaviors gradually become more serious problems, which then may intensify and become clinically
diagnosable disorders.
- With dimensional models, there are no sharp distinctions between adjustment and maladjustment.
- Dimensional models also are referred to as continuous or quantitative.
Categorical models of psychopathology emphasize discrete and qualitative differences in individual patterns
of emotion, cognition, and behavior.
- With categorical models, there are clear distinctions between what is normal and what is not.
- Categorical models are sometimes referred to as discontinuous or qualitative.
2-2Physiological Models
2-2aHistorical and Current Conceptualizations
Physiological models: Models of psychopathology that emphasize biological processes, such as genes and
neurological systems, as being at the core of human experience; physiological models explain the
development of psychopathology, its course, and its treatment in terms of biological factors.
- They propose that there is a physiological (i.e., genetic, structural, biological, or chemical) basis for all
psychological processes and events.
Connectome: the diagram of the brain’s neural connections
- the connectome focus on macroscopic connectivity (e.g., between brain regions), and include descriptions
of nodes (the path length of connections/brain reagions), hubs (nodes with extensive connection to other
nodes), and modules (groups of nodes with strong connections)
Neural plasticity: The ability of the brain to flexibly respond to physiological and environmental challenges
and insults.
Genetics play a critical role in physiological models. There are many ways that the genetic makeup of an
individual, or genotype, influences the observable characteristics of an individual, or phenotype. It is
expanding and involves work in both behavior genetics and molecular genetics.
- Genotype: The genetic make-up of a cell, an organism, or an individual.
- Phenotype: The observable characteristics of an individual.
- Behavior genetics: The study of the joint effects of genes and environments.
- Molecular genetics: Studies of the effects of specific genes at the DNA level.
Gene-by-environment effects: Correlations between genes and environments that involve differential
exposure to environments or experiences. There are three types of gene-by-environment effects:
- passive correlations: when children are exposed to different environments provided by their genetically
related parents
- active correlations: when children select or create their own environment as a function of their genetic
background
- evocative correlations: when children experience different reactions or responses to their genetically
influenced emotions or behaviors
