1. Child psychopathology
Factors that complicate the study of child psychopathology
Many adults with a mental disorder first developed psychopathology as children. Thus, interest in the
study of child psychopathology has increased dramatically. However, issues concerning the definition
and of psychopathology in children continue to be debated. Only in recent decades have child-
focused models of depressive disorders emerged for example.
Even in studies conducted with children, much of the knowledge is based on findings obtained at a
single point in a child’s development and in a single context. Such findings provide still photographs
of moving targets and fail to capture the dynamic changes over time. The study is further
complicated by the fact that many childhood problems are not narrow in scope or expression, and
most forms of psychopathology in children are known to overlap and/or coexist with other disorders.
Moreover, distinct boundaries between many commonly occurring childhood behaviours and those
problems that come to be labelled as ‘disorders’ are not easily drawn. Most forms of
psychopathology differ in degree from normative behaviour, rather than in kind (i.e. distinctions
between normal and abnormal behaviour are typically quantitative, rather than qualitative).
Furthermore, judgements of deviancy often depend as much on other child characteristics, the
situational appropriateness of the behaviour, the social and cultural context in which judgements are
made, and the characteristics and decision rules of adults who make these judgements as they do on
any specific child’s behaviours.
Most forms of child psychopathology are etiologically heterogeneous and can’t be attributed to a
single unitary cause. Genetic influences can no longer be assumed to be static in their effects, as the
functional impact of polymorphisms is further moderated by an array of regulatory processes known
as “epigenetic effects”, some of which unfold in response to environment conditions.
Numerous risk markers for child psychopathology have been identified, including genetic influences,
temperament, insecure child-parent attachments, social-cognitive deficits, deficits in social learning,
emotion regulation and dysregulation, effortful control on related constructs, neuropsychological
and/or neurobiological dysfunction, maladaptive patterns of parenting and maltreatment, parental
psychopathology, parental discord, limited family resources and other poverty-related life stressors,
institutional deprivation, and a host of other factors. However, these factors can’t be understood in
isolation.
The designation of a specific factor as a cause or an outcome of child psychopathology usually
reflects; (1) the point in an ongoing developmental process at which the child is observed, and (2) the
perspective of the observer.
It is also worth noting that there may be issues related to the stigma of mental illness with particular
relevance to children. Stigma appears to play a role in decreasing the likelihood that services are
sought for children with a mental disorder, particularly in minority groups and cultures.
Current approaches view the roots of developmental and psychological disturbances in children as
the result of complex interactions during the development between the biology of brain maturation
and the multidimensional nature of experience.
Significance of child psychopathology
The growing attention to children’s mental health problems and competencies arises from a number
of sources. First, many young people experience significant mental health problems that interfere
with normal development and functioning. Second, a significant proportion do not grow out of their
,child-hood difficulties, although the ways in which these are expressed change in dynamic ways over
time. Third, recent social changes and conditions may place children at increasing risk for the
development of disorders, and also for the development of more severe problems at younger ages.
Fourth, for a majority that experience mental health problems, these problems go untreated. Fifth, a
majority with mental health problems who go unidentified and unassisted often end up in the
criminal justice or mental health systems as young adults. Finally, a significant number of children in
America experience maltreatment, and chronic maltreatment during childhood is associated with
psychopathology in children and later in adults.
Epidemiological considerations
Prevalence
Current best estimates are that 20-40% of all children worldwide have a clinically diagnosable
disorder, and many more children exhibit specific symptoms or subclinical problems. The most
consistent general conclusions to be drawn from studies are that prevalence rates are generally high,
but rates may vary with the nature of the disorder; the age, sex, SES, and ethnicity of the children;
the criteria used to define the problem both concurrently and over time, the method used to gather
information, the informants, sampling methods, and a host of other factors.
Age differences
Some studies have reported interactions among age, number or type of problems, sex, clinical status,
and source of information.
Socioeconomic status
Although most children treated for mental health problems are from the middle class, mental health
problems are overrepresented among the very poor. Lower-SES children have been reported to
display more psychopathology and other problems. However, although the relationship between SES
and child psychopathology are significant, the effects are small. Knowledge of processes is needed to
inform our understanding of disorders and to developed preventative efforts that target the
appropriate mechanisms.
Low SES is often characterised by low maternal education, low level of employment, single-parent
status, parental psychopathology, limited resources, and both chronic and acute negative life events,
in addition to low income. The effects of physical abuse on internalising disorders may be
independent of SES, whereas the effects of physical abuse on externalising disorders may be
dependent on SES.
Sex differences
Psychopathology in girls has historically received far less research attention than psychopathology in
boys. There are important differences in the prevalence, expression, accompanying disorders, under-
lying processes, outcomes, and developmental course of psychopathology in boys vs. girls. ADHD,
autism, childhood conduct and opposition disorders, and learning and communication disorders are
all more common in boys, whereas the opposite is true for most anxiety disorders, depression, and
eating disorders.
Boys exhibit higher levels of externalising symptoms throughout childhood and early adolescence,
whereas girls and boys are comparable in terms of internalising symptoms in early childhood, with
girls’ levels of these symptoms increasing more rapidly during adolescence.
The “gender paradox of comorbidities” refers to the fact that although the prevalence of disruptive
behaviour is lower in females, the risk of comorbid conditions such as anxiety is higher in females.
,However, the relations between gender and comorbidity are likely to vary with the disorders, the
age, the source of referral, and other factors.
Rural versus urban differences
Rates of child behaviour disorders are higher in urban than in rural areas, though differences are
small. For the most part, these differences were associated with economic and cultural differences
between sites, and not with urbanisation per se. Further complicating this issue is the possibility that
the effects of urbanicity on psychopathology likely vary depending on disorder.
Ethnicity and culture
Ethnicity – ethnic representation and the study of ethnic-related issues more generally have received
less attention in studies of child psychopathology. Though externalising problems have been
reported more frequently among African American children, this finding is probably an artifact
related to SES.
Culture – the values, beliefs and practices that characterise a particular ethnocultural group
contribute to the development and expression of childhood distress and dysfunction, which in turn
are organised into categories through cultural processes that further influence their development
and expression. Culture also structures the way in which people and institutions react to a child’s
problems. The form, frequency and predictive significance of different forms of child
psychopathology vary across cultures, and cultural attitudes influence diagnostic and referral
practices.
The expression of, and tolerance for, many child behavioural and emotional disturbances are related
to social and cultural values. In this regard, it is important that the results on child psychopathology
not be generalised from one culture to another. The rates of expression of some disorders, especially
those with a strong neurobiological basis, may be less susceptible to cultural influences than others.
Even so, social and cultural beliefs and values are likely to influence the meaning given to these, the
ways in which they are responded to, their forms of expression, their outcomes, and responses to
intervention.
An important distinction to be made with respect to cross-cultural comparisons is whether there are
substantive differences in the rates of a disorder, or differences in the raters’ perceptions of these
problems. Cross-cultural research on child psychopathology would suggest that the expression and
experience of mental disorders in children is not universal.
Key concepts in child psychopathology
Several recurrent and overlapping issues in the study of child psychopathology are (1) difficulties in
conceptualising psychopathology and normality; (2) the need to consider healthy functioning and
adjustment; (3) questions concerning developmental continuities and discontinuities; (4) the concept
of developmental pathways; (5) the notions of risk and resilience; (6) the identification of protective
and vulnerability factors; and (7) the role of contextual influences.
Psychopathology versus normality
Childhood disorders have most commonly been conceptualised in terms of deviances involving
break-downs in adaptive functioning, statistical deviation, unexpected distress/disability, and/or
biological impairment. An overarching concept of mental disorder has been proposed as “harmful
dysfunction”. In this context, a child’s condition is viewed as a disorder only if (1) it causes harm or
deprivation of benefit to the child, as judged by social norms; and (2) it results from the failure of
some internal mechanism to perform its natural function. This view focuses attention on evolved
, adaptations or internal functional mechanisms. However, this does not specify how decisions are
made.
Clear distinctions do not necessarily need to exist for categorical distinctions to have utility. E.g.,
there is no joint at which one can carve day from night, although distinguishing the two is incredibly
useful to humans in going about their social discourse and engagements. Thus, despite the lack of
boundaries between what is normal/abnormal, categorical distinctions are still useful as long as they
adequately predict which children will be most likely to benefit from access to special education,
treatment or disability status.
Healthy functioning
The study of child psychopathology requires attention to adaptive developmental processes for
several reasons. First, judgements of deviancy require knowledge of normative developmental
functioning, both with respect to a child’s performance relative to same-age peers and with respect
to the child’s own baseline of development. Second, maladaptation and adaptation often represent
two sides of the same coin, in that dysfunction in a particular domain of development is usually
accompanied by a failure to meet developmental tasks and expectation in the same domain.
Third, in addition to the specific problems that lead to referral and diagnosis, disturbed children are
likely to show impairments in other areas of adaptive functioning. Fourth, most children with specific
disorders are known to cope effectively in some areas of their lives. Fifth, children move between
pathological and nonpathological forms of functioning over the course of their development. Sixth,
many child behaviours that are not classifiable as deviant at a particular point in time may
nevertheless represent less extreme expressions/compensations of an already existing disorder or
early expressions of a later progression to deviant extremes as development continues. Finally, not
theory of childhood disorder is complete if it can’t be linked with a theory of how the underlying
normal abilities develop and what factors go awry to produce the disordered state.
Developmental continuities and discontinuities
Some childhood disorders are typically chronic conditions that will persist throughout childhood and
into adulthood. Other disorders occur during childhood and only rarely manifest themselves in
adults. However, most disorders are expressed in both childhood and adulthood and exhibit varying
degrees of continuity over time.
Some examples of direct relationships between early and later difficulties include (1) the
development of a disorder during infancy or childhood, which then persists over time; (2)
experiences that altar an infant’s or child’s physical status, which in turn influences later functioning;
and (3) the acquisition of early patterns of responding that may be adaptive in light of a child’s
current developmental level and circumstances. but may result in later psychopathology.
Some examples of indirect associations between child and adult psychopathology may involve early
predispositions that eventually interact with environmental experiences, the combination of which
leads to dysfunction. Other examples include (1) experiences that contribute to an altered sense of
self-esteem, or that create a negative cognitive set, which then leads to later difficulties; and (2)
experiences providing various opportunities or obstacles that then lead to the selection of particular
environmental conditions, and by doing to guide a child’s course of development.
Although research supports the notion of continuity of disorders, it does not support the continuity
of identical symptoms over time. Continuity over time for patterns of behaviour rather than for
specific symptoms is the norm.
Developmental pathways
