Understanding Child and Adolescent Behavior Abnormalities: Historical, Legislative, and Treatment Perspectives

1. 1 Introduction to Normal and Abnormal Behavior in Children and Adolescents

2. Introduction • Research studies in abnormal child psychology seek to: • Define normal and abnormal behavior for children of different ages, sexes, and ethnic and cultural backgrounds • Identify the cases and correlates of abnormal behavior • Make predictions about long-term outcomes • Develop and evaluate methods for treatment and/or prevention

3. Features That Distinguish Child and Adolescent Disorders • When adults seek services for children, it is not often clear who has what “problem” • Many child and adolescent problems • Involve a failure to show expected developmental progress • Are not entirely abnormal • Interventions are often intended to promote further development

4. Historical Views and Breakthroughs • Ancient Greek/Roman view • The disabled were a burden - scorned, abandoned, or put to death • Before the 18th century • Children were subjected to harsh treatment and largely ignored • By end of 18th century • Interest in abnormal child behavior surfaced

5. The Emergence of Social Conscience – Locke and Itard • John Locke (17th century) • Believed children should be raised with thought and care, not indifference and harsh treatment • Jean-Marc Itard (19th century) • Focused on the care, treatment, and training of “mental defectives”

6. The Emergence of Social Conscience – Hollingworth and Rush • Leta Hollingworth • Distinguished individuals with mental retardation (“imbeciles”) from those with psychiatric disorders (“lunatics”) • Benjamin Rush • Claimed that children were incapable of adult-like insanity • Children with normal cognitive abilities but disturbing behavior suffer from “moral insanity”

7. Early Biological Attributes • Late 19th century: mental illnesses were viewed as biological problems • This was thwarted by the prevailing bias that the individual was at fault for deviant or abnormal behavior • Clifford Beers’ efforts led to detection and intervention

8. Early Biological Attributes – Eugenics and Sterilization • Early 20th century: society reverted to a belief that disorders could not be influenced by treatment or learning • There was a return to custodial care and punishment of behaviors • Mental disorders viewed as “diseases” led to fear of contamination • Eugenics (sterilization) and segregation (institutionalization) were implemented

9. Early Psychological Attributes – Psychoanalytic Theory • Linked mental disorders to childhood experiences and surroundings • Focused on the interaction of developmental and situational processes • Purported that mental disorders can be helped with proper environment or therapy • Retains a role as a model for abnormal child psychology

10. Early Psychological Attributes – Behaviorism • Laid the foundation for evidence-based treatments • Key studies • Pavlov’s research on classical conditioning • Watson’s studies on the elimination of children’s fears and the theory of emotions • Famous study: Little Albert

11. Evolving Forms of Treatment – Psychodynamic Approaches • 1930 to 1950: psychodynamic approaches prevailed • Most children with intellectual or mental disorders were institutionalized • Late 1940s: Spitz’studies pointed out the harmful impact of institutional life • 1945 to1965: institutionalization decreased • Placement in foster care and group homes increased

12. Evolving Forms of Treatment – Behavioral Approaches • 1950s and early 1960s: behavior therapy emerged as a systematic approach to treatment of child and family disorders • Behavior therapy is a prominent form of therapy

13. Progressive Legislation – IDEA • IDEA (Individuals with Disabilities Education Act) requires: • Free and appropriate public education for children with special needs in the least restrictive environment • Each child must be assessed with culturally appropriate tests • An individualized education program (IEP) for each child

14. Progressive Legislation – The UN • United Nations General Assembly (2007) adopted a new convention to protect the rights of persons with disabilities • The convention supports the attitude of considering persons with disabilities as individuals with human rights

15. What Is Abnormal Behavior in Children and Adolescents? • Childhood disorders are accompanied by various layers of abnormal behavior or development • Must also be sensitive to each child’s stage of development • Disorders are commonly viewed as deviancies from normal • Boundaries between normal and abnormal functioning are arbitrary

16. Defining Psychological Disorders • Patterns of behavioral, cognitive, emotional, or physical symptoms linked with one or more of the following: • Distress • Disability • Increased risk for further suffering or harm • Culture and circumstances matter • The characteristics describes behaviors, not causes

17. Labels Describe Behavior, Not People • Stigmatization is a challenge • Separate the child from the disorder • Problems may be the result of children’s attempts to adapt to abnormal or unusual circumstances • According to DSM-5 guidelines • The primary purpose of using terms is to help describe and organize complex features of behavior patterns

18. Competence • The ability to successfully adapt in the environment • Successful adaptation is influenced by culture and ethnicity • Abnormal child psychology considers: • The degree of maladaptive behavior • The extent to which normal developmental milestones are met • Knowledge of developmental tasks provides important background information

19. Examples of Development Tasks

20. Developmental Pathways • The sequence and timing of particular behaviors as well as the relationships between behaviors over time • Two types of developmental pathways • Multifinality - various outcomes may stem from similar beginnings • Equifinality - similar outcomes stem from different early experiences and developmental pathways

21. Multifinality and Equifinality

22. Key Considerations in Developmental Pathways • There are many contributors to disordered outcomes in each child • Contributors vary among children who have the same disorder • Children express features of their disturbances in different ways • Pathways leading to particular disorders are numerous and interactive

23. Risk Factors and Protective Factors • Risk factor: a variable that precedes a negative outcome of interest • Examples: chronic poverty, care-giving deficits, parental mental illness, death of a parent, disasters, and family breakup • Protective factor: a personal or situational variables that mitigates a child developing a disorder

24. Resilience • The ability to fight off or recover from misfortune • Associated with strong self-confidence, coping skills, avoiding risk situations • Connected to a “protective triad” of resources: • Strength of the child • Strength of the family • Strength of the school/community

25. Characteristics of Those Who Display Resilience

26. The Significance of Mental Health Problems Among Children and Youth • One in eight children has a mental health problem (North American studies) • Many others are at risk for later development of a psychological disorder • The majority of children needing mental health services do not receive them • The demand for children’s mental health services is expected to double over the next decade

27. The Changing Picture of Children’s Mental Health • A better ability to distinguish among disorders has led to increased and earlier recognition of problems • There is a greater awareness of younger children’s and teens’ unique mental health issues • Evidence-based prevention and treatment programs are more prominent

28. Prevalence of Mental Health Issues • Mental health problems are more likely in children: • From disadvantaged families • From abusive or neglectful families • Receiving inadequate child care • Born with very low birth weight • Whose parents have a mental illness or substance abuse problems

29. What Affects Rates and Expression of Mental Disorders? • New pressures and social changes may place children at increased risk for development of disorder • Environmental stressors may: • Act as nonspecific stressors - bring about poor adaptation or the onset of a disorder • Affect the extent to which a child’s problems are attenuated or exacerbated

30. Poverty • One in five children in the U.S. and one in seven in Canada live in poverty • Native American/First Nations and African American children are at greatest risk • Poverty is associated with: • Impairments in learning ability and school achievement, less education, low-paying jobs, inadequate health care, single-parent status, poor nutrition, and exposure to violence

31. Socioeconomic Disadvantages Associated with Poverty • Poverty’s impact on children • More conduct problems, chronic illness, school problems, emotional disorders, and cognitive/learning problems • Poverty indirectly impacts children’s adjustment, which affects learning and mental health

32. Sex Differences • Boys and girls express problems differently • Certain disorders are more common in boys than girls, and vice versa • Aggression is expressed more directly by boys; expressed more indirectly by girls • Sex differences appear negligible in children under age three • Disparities increase with age

33. Externalizing Problems • Higher in boys than girls in preschool and early elementary years • Exhibited as acting-out behaviors, e.g., aggression and delinquency • Rates for boys and girls converge by age 18

34. Internalizing Problems • Higher rates in girls • Associated with: • Anxiety, depression, or withdrawn behavior • Somatic complaints • Eating disorders • Emotional disorders with peak age of onset in adolescence

35. Trajectories of Externalizing and Internalizing Problems

36. Sex Differences and Resilience • Types of childrearing environments that predict resilience • For boys: • A male role model • Structure and rules • Encouragement of emotional expressiveness • For girls: • Households that combine risk taking and independence with support from female caregiver

37. What is Race? • Most cultural anthropologists see race as a socially constructed concept, not a biological one • Minority children in the U.S. are overrepresented in rates of some disorders • Substance abuse, delinquency, and teen suicide

38. The Effects of Race and Ethnicity • When controlling for other effects (SES, gender, age, referral status) • Few differences emerge in relation to race or ethnicity • Barriers remain in access to, and quality and outcomes of, care for minority children • Minority children face multiple disadvantages, including poverty and marginalization

39. What is Culture? • Values, beliefs, and practices that characterize a particular ethnocultural group • Contribute to development and expression of children’s disorders • Affect how people/institutions react to children’s problems • Affect how problems are expressed

40. Culture and Diversity • Important not to generalize research from one culture to another • Social and cultural beliefs and values influence: • The meaning given to behaviors • The way in which behaviors are responded to • The forms of expression and their outcomes

41. Child Maltreatment and Non-Accidental Trauma: Prevalence • Nearly one million cases of child abuse and neglect occur in the U.S. each year • Estimate: more than one-third of 10- to 16-year-olds experience physical and/or sexual assaults • Acts of violence contribute to PTSD, major depressive disorder, or substance abuse/dependence

42. Child Maltreatment and Non-Accidental Trauma: Consequences • Financial consequences of abuse and trauma: $124 billion per year in the U.S. • More attention needs to be given to developing new ways to prevent and help those exposed to maltreatment and trauma

43. Special Issues Concerning Adolescents and Sexual Minority Youths • Early- to mid-adolescence is an important transitional period for healthy adjustment • Issues during adolescence • Substance use, risky sexual behavior, violence, accidental injuries, and mental health problems • Special needs and problems of adolescents are receiving greater attention

44. Special Issues: Lesbian, Gay, Bisexual,and Transgendered (LGBT) Youths • LGBT youths in middle and high schools are more likely to be victimized by their peers and family members • LGBT youths have higher rates of mental health problems

45. Lifespan Implications • Impact is most severe when problems go untreated for extended periods of time • About 20% of children with the most chronic and serious disorders: • Are least likely to finish school • Are most likely to have social problems and psychiatric disorders • Lifelong consequences associated with child psychopathology are costly

46. Lifespan Implications – Solutions • Children can overcome major obstacles • When provided with circumstances and opportunities that promote healthy adaptation and competence • Major initiatives for prevention and intervention have resulted from recognition of children’s mental health problems

47. Looking Ahead • Children cannot advocate on their own behalf • Viewing the whole child is the best strategy in understanding abnormal child and adolescent psychology • Efforts to change policies and programs directed to- ward children and youths are gaining momentum