Hoofdstuk 1 Introduction
Developmental psychopathology (ontwikkelingspsychologie) = Intense,
frequent, and persistent maladaptive patterns of emotion, cognition, and
behavior considered within the context of normal development, resulting
in the current and potential impairment of infants, children, and
adolescents. Infant, child, and adolescent psychopathology can be
understood only by placing descriptions of disorders against the
background of usual emotional, cognitive, and behavioral development.
Most children can and do face challenges!
Salient, Age-Related Issues of Development:
-Infancy. Major issue: Formation of an effective attachment. Additional
issues: Basic
state and arousal regulation, Development of reciprocity, Dyadic
regulation of
emotion.
-Toddler Period. Major issue: Guided self-regulation. Additional issues:
Increased
autonomy, Increased awareness of self and others, Awareness of
standards for
behavior, Self-conscious emotions.
-Preschool Period. Major issue: Self-regulation. Additional issues: Self-
reliance with
support (agency), Self-management, Expanding social world,
Internalization of rules
and values.
-School Years. Major issue: Competence. Additional issues: Personal
efficacy, Self-
integration, Competence with peers, Competence in school.
-Adolescence. Major issue: Individuation. Additional issues: Autonomy with
connectedness, Identity, Peer network competence, Coordinating school,
work, and
social life.
-Transition to Adulthood. Major issue: Emancipation. Additional issues:
Launching a
life course, Financial responsibility, Adult social competence, Coordinating
work,
training, career, and life.
,What is Normal?
Common descriptions of normality and psychopathology often focus on:
1. Statistical deviance (Statistische afwijking) (The infrequency of
certain emotion, cognitions and behaviors)
2. Sociocultural norms (Socio-culturele normen) (The beliefs and
expectations about what kinds of emotions, cognitions and
behaviors are problematic, undesirable or unacceptable)
3. Mental health definitions (Mentale gezondheidsperspectieven)
(theoretical or clinically based notions of distress and dysfunction)
From a statistical deviance perspective, a child who displays too much of
any age-expected behavior or too little of any age-expected behavior
might have a disorder. Children of a certain age above or below the
number cutoff would meet the criterion for 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.
Adequate adaptation has to do with what is considered okay, acceptable,
or good enough. Optimal adaptation has to do with what is excellent,
superior, or “the best of what is possible.”
Definitions 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.
Rates of Disorders in Infancy, Childhood and
Adolescence
If definitions of disorders are problematic, estimates of rates of disorders
are even more so. The multi-part task of estimating rates of disorders
includes:
, 1. Identifying children with clinically significant distress and
dysfunction, whether or not they are in treatment.
2. Calculating levels of general categories of disorders and within-
category type of disorder and their associated impairments
3. Tracking changing trends in the identification and diagnosis of
specific disorders.
Frequencies and patterns of disorders in infants, children and adolescents
can be estimated with varied methodologies. These frequencies and
patterns are the focus of the field of developmental epidemiology.
Prevalence and incidence rates are both measures of the frequency of
psychopathology. Prevalence (Prevalentie) refers to the proportion of a
population with a disorder. Incidence (Incidentie) refers to the rate at
which new cases arise.
Allocation of Resources, Availability, and Accessibility of Care
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. Daarbij: inadequate money for
prevention efforts is a public policy dilemma
The 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.
- Several dimensions of stigma, including negative stereotypes,
devaluation, and discrimination
- two targets of stigma, the individual and the family
- Two contexts of stigma, the general public and the self/individual.
They both urge researchers to continue to investigate the multiple
ways that stigma complicates the experiences of children with
mental disorders and their families.
,Hoofdstuk 2 Models of Child Development,
Psychopathology, and Treatment
The Role of Theory in Developmental Psychopathology
Models of development, psychopathology and treatment allow us to
organize our clinical observations of children and our research finding into
coherent, informative accounts.
Dimensional and Categorical Models
Dimensional models of psychopathology (Dimensionale modellen van
psychopathologie): Typical feelings, thoughts and behaviors become more
serious problems which then may intensify and become clinically
diagnosable.
- No sharp distinction between adjustment and maladjustment.
- Also referred to as continuous or quantitative.
Categorical models of psychopathology (Categorische modellen van
psychopathologie): Discrete and qualitative differences in individual
patterns of emotion, cognition and behavior.
- Clear distinction between what is normal and not.
- Also referred to as discontinuous or qualitative.
Physiological Models
Physiological models (Fysiologische modellen) propose that there is a
genetic, structural, biological and/or chemical basis for all psychological
processes and events.
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. These models suggest that there are inborn or acquired
vulnerabilities to disorders—including genetic abnormalities, structural
pathologies, and biochemical disturbances—that may lead to
psychological distress and dysfunction. Diagnose stellen vanuit DSM-idee
met fysieke basis (erfelijkheid, neurologische kenmerken). There is a
,physiological (genetic, structural, biological or chemical) bases for all
psychological processes and events.
- Historical conceptualizations focus on the way where genes, brain
structure, brain function and early critical periods influence, direct
and constrain (tegenhouden) development.
- Contemporary conceptualizations take into account behavior
genetics, gene-by-environment effects and the (re)organisation of
brain networking across development.
Sensitive (critical) periods in the brain have been identified; some are
domain/component dependent. We must understand that there are also
variations of brain structure within groups of typically developing children.
Neural plasticity: the brain’s ability to flexibly respond to physiological and
environmental challenges and insults.
- Both positive & negative experiences influence the brain's
connections.
- Balance between plasticity & stability is critical
Genes and Environments
Genetics play a critical role in physiological models. We need to think
about the many ways that the genetic make-up of an individual
(Genotype), influences the observable characteristics of an individual
(Phenotype).
Gene-by-environment interactions: The interactive effect between genetic
and environmental factors, including the influence of genes on
vulnerability to risk factors.
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, active correlations, and
evocative correlations.
1. Passive correlations : children are exposed to different environments
provided by their
genetically related parents.
○ Intelligent children > intelligent parents > more educational
opportunities.
2. Active correlations : children select/create their own environments as a
function of
, their genetic background.
○ Extraverted children seek other children on the playground.
3. Evocative correlations : children experience different
reactions/responses to their
genetically influenced emotions/behaviors.
o Highly anxious children may be shielded from even mildly stressful
situations.
Behavior genetics: study of the relationship between genetic variation and
psychological (personality, psychopathology) traits, symptoms and
disorders. Effects of genes & environment. Studies find:
- No traits are 100% heritable
- Environments matter
- Genetic impact is causes by many genes with small effects
(polygenic model)
- All traits show significant and substantial genetic influence
Epigenetics: the effect of experience/environment on the regulation of
gene expression. Focus on the activity of the gene (not the presence of
the gene). > Those can become biological embedded.
Risk alleles: Genetic variants that impair general processes.
Polygenic model: A etiological model of disorders based on the cumulative
and additive effect of multiple genes.
According to the physiological diathesis-stress model, atypical brain
structure, function or development does not by itself lead to disorder.
Rather diatheses such as neurological damage at birth or genetic risk for
disorder, in combination with additional stress, lead to the emergence of a
disorder. Diathesis-stress models call attention to the lack of a one-to-one
correspondence between the genotype and phenotype for most forms of
psychopathology, and they are an example of gene-by-environment-by-
time effects or interactions.
→ Basic: genetic profile and other biological factors interact with
environmental influences to produce individual differences. → updated
and extended → rooted in developmental and evolutionary theory,
differential susceptibility asserts that although it is true that some children
are differentially vulnerable to stressful environment, it is also true that
these same children differentially thrive with developmentally appropriate
and encouraging environments.
