CHAPTER 16 DEVELOPMENTAL PSYCHOPATHOLOGY

1. CHAPTER 16DEVELOPMENTAL PSYCHOPATHOLOGY

2. Learning Objectives • What criteria are used to define and diagnose psychological disorders? • What is the perspective of the field of developmental psychopathology? • What sorts of questions or issues do developmental psychopathologists study? • How does the diathesis-stress model explain the causes of psychopathology?

3. What Makes Development Abnormal? • Mental health professionals use three criteria to differentiate between normal and abnormal behavior • Statistical deviance • Does the person’s behavior fall outside the normal range of behavior? • Maladaptiveness • Does the person’s behavior interfere with adaptation or pose a danger to self or others? • Personal distress • Does the behavior cause personal anguish or discomfort?

4. What Makes Development Abnormal?DSM Diagnostic Criteria • Professionals who diagnose and treat psychological disorders use the criteria of the Diagnostic and Statistical Manual of Mental Disorders (1994) • DSM-IV-TR published in 2000 • DSM-V to be published in 2013

5. What Makes Development Abnormal?DSM Diagnostic Criteria • According to the DSM-IV-TR diagnostic criteria for major depressive disorder, an individual must experience at least 5 of the following symptoms, including one of the first two, persistently within a 2-week period • Depressed mood (or irritable mood in children and adolescents) nearly every day • Greatly decreased interest or pleasure in all, or almost all, usual activities most of the day • Significant weight loss when not dieting or weight gain (or for children, failure to achieve expected weight gains)

6. What Makes Development Abnormal?DSM Diagnostic Criteria • The DSM-IV-TR diagnostic criteria for major depressive disorder (continued) 4. Insomnia or sleeping too much 5. Psychomotor agitation or sluggishness/slowing of behavior observable by other people 6. Fatigue and loss of energy 7. Feelings of worthlessness or extreme guilt 8. Decreased ability to think or concentrate or indecisiveness 9. Recurring thoughts of death, recurring suicidal ideas, or a suicide attempt or specific plan to commit suicide

7. What Makes Development Abnormal?DSM Diagnostic Criteria • The DSM-IV-TR diagnostic criteria manual calls for distinguishing major depressive disorder from other disorders and requires that the symptoms cause significant distress or impaired functioning and are not due to the direct effects of a substance (an abused drug or a medication) or a general medical condition • Symptoms should not be described as reactions to bereavement • To qualify as major depressive disorder, grief reactions would need to persist for more than 2 months after a death and involve serious symptomatology

8. What Makes Development Abnormal?Developmental Psychopathology • Sroufe and Rutter (1984) define developmental psychopathology as the study of the origins and course of maladaptive behavior • Evaluate abnormal development in relation to normal development and study the two in tandem

9. Caption: Developmental pathways leading to normal and abnormal outcomes

10. What Makes Development Abnormal?Developmental Psychopathology • March (2009) believes that psychological disorders should be viewed as lifespan neurodevelopmental disorders • This perspective requires looking at normal and abnormal pathways of brain development and their implications for functioning and intervening early with individuals who are at risk for various disorders to put them on healthier developmental trajectories

11. What Makes Development Abnormal?Developmental Psychopathology • Developmental psychopathologists regard behaviors as abnormal or normal according to their social and developmental contexts • Social norms are expectations about how to behave in a particular social context • Age norms are societal expectations about what behavior is appropriate or normal at various ages

12. What Makes Development Abnormal?Developmental Psychopathology • Two major developmental issues are relevant to understanding the pathways to adaptive or maladaptive functioning • Nature and nurture • Continuity and discontinuity

13. What Makes Development Abnormal?Developmental Psychopathology • Understanding the developmental pathways of psychopathology in light of the nature-nurture issue involves asking questions such as • How do biological, psychological, and social factors interact over time to give rise to psychological disorders? • What are the important risk factors for psychological disorders, and what are the protective factors that keep some individuals who are at risk from developing disorders?

14. What Makes Development Abnormal?Developmental Psychopathology • Understanding the developmental pathways of psychopathology in light of the continuity-discontinuity issue involves asking questions such as • Are most childhood problems passing phases that have no bearing on adjustment in adulthood, or does poor functioning in childhood predict poor functioning later in life? • How do expressions of psychopathology change as the developmental status of the individual changes?

15. What Makes Development Abnormal?Developmental Psychopathology • Developmental psychopathologists have proposed a diathesis-stress model to explain how nature and nurture contribute to psychopathology • Suggests that psychopathology results from the interaction over time of a predisposition or vulnerability to psychological disorder and the experience of stressful events • The predisposition or vulnerability is called a diathesis, which can involve a particular genetic makeup, physiology, set of cognitions, personality, or a combination of these

16. Caption: The diathesis-stress model

17. Learning Objectives • What are the characteristics, suspected causes, treatment, and prognosis for individuals with autism and its related syndromes? • In what ways do infants exhibit depression-like conditions? • How is depression in infants similar to, or different from, depression in adults?

18. The Infant – Autism • Autism is a serious disorder that begins in infancy and is characterized by • Abnormal social development • Difficulty forming normal social relationships, responding appropriately to social cues, and sharing social experiences with others • Impaired language and communication • May be mute or may have language but be unable to communicate • May use flat, robotic tone, reverse pronouns, and engage in echolalia, parroting of another’s speech • Repetitive behavior • Engage in stereotyped behaviors (rocking) or rituals • Highly distressed when the physical environment is altered

19. The Infant – Autism • Autism is one of the autism spectrum disorders • Labeled in the DSM-IV as “pervasive developmental disorders” • Asperger syndrome is another of the autism spectrum disorders • Characterized by normal or above-average intelligence and good verbal skills • The individual desires to establish social relationships but has seriously deficient social-cognitive and social-communication skills • Affected children are sometimes called “little professors” because they talk at length about topics that interest them

20. The Infant – Autism • In 2006 the autism spectrum disorders affected almost 9 of 1,000 8-year-olds • According to 2005 data, autism (in the narrow sense) affected about 20 of 10,000 children • There are 4 or 5 affected boys for every girl • Researchers believe that the increase in rates of autistic spectrum disorders is a result of increased awareness of autism, broader definitions of it to include the entire autistic spectrum (including mild cases), and better recognition and diagnosis of cases that might previously have been diagnosed as language impairments, learning disabilities, or even odd personalities

21. The Infant – Autism • Autistic children display autistic characteristics before age 3 and likely were autistic from birth • Early screening and diagnosis enables early treatment and improved developmental outcomes • The longer autistic infants are undiagnosed and therefore are not learning about the social world, the more severe their social and communicative problems become

22. The Infant – Autism • Autistic infants fail to display normal infant behaviors such as • Orientation to human voices • Babbling • First words • Preference for human over nonhuman stimuli • Eye contact • Visual focus on faces in a scene (autistic babies tend to focus on objects in the background) • Joint attention (a key precursor of theory-of-mind skills) • Reciprocity or taking turns (as in mutual smiling and peek-a-boo games)

23. The Infant – Autism • Suspected causes of autism include the following • Genes related to neural communication appear to have been copied incorrectly • “Copy number variations” • Environmental contributors • A virus or chemical could interact with a genetic predisposition to autism • Epigenetic influences that turn genes that guide brain development on or off could be involved • Prenatal exposure to teratogens can contribute to ASDs • Maternal bleeding or pregnancy complications could be involved

24. The Infant – Autism • Suspected causes of autism include the following conditions (continued) • Early brain overgrowth • Neurons in the frontal cortex and/or the amygdala proliferate wildly during the early sensitive period for brain development in infancy and do not become properly interconnected with other areas of the brain so that they can integrate brain signals from these other areas

25. The Infant – Autism • Suspected causes of autism include the following conditions (continued) • Malfunctioning of the mirror neuron systems • Mirror neuron systems allow us to make sense of other people’s feelings and thoughts by reacting to them as though they were feelings and thoughts we have experienced ourselves - Malfunctioning of mirror neuron systems located in a number of brain areas could account for the deficits individuals with autism show in imitation, theory-of-mind skills, empathy, and language

26. The Infant – Autism • The autism spectrum disorders involve multiple cognitive impairments • Autistic individuals have difficulty with certain executive functions • Higher-level control functions based in the prefrontal cortex of the brain that allow us to plan, change flexibly from one course of action to another, and inhibit actions • This may explain the repetitive behaviors • The tendency to focus on details is accompanied by difficulty integrating pieces of information to get “the big picture” or overall meaning

27. The Infant – Autism • Previously, the long-term outcome for individuals with ASDs has been poor, especially if autism is accompanied by intellectual disability • Most individuals with autism improve in functioning, but they are usually autistic for life • Positive outcomes are most likely among those who have IQ scores above 70 and reasonably good communication skills by age 5

28. The Infant – Autism • The most effective approach to treating autism is intensive and highly structured behavioral and educational programming, beginning as early as possible, continuing throughout childhood, and involving the family - The goal is to make the most of the plasticity of the young brain during its sensitive period for development

29. The Infant – Depression • Infants can exhibit some of the behavioral symptoms and somatic (bodily) symptoms of depression • Depressive symptoms are most likely to be observed in infants who lack a secure attachment relationship or who experience a disruption of an all-important attachment • Infants who display a disorganized pattern of attachment are especially likely to show symptoms of depression

30. The Infant – Depression • Infants whose mother or father are depressed are at risk for depression • They use an interaction style that resembles that of their caregivers • They vocalize little, look sad, and show developmental delays • Infants who are abused, neglected, separated from attachment figures, or raised in a stressful, unaffectionate manner may develop failure to thrive • A life-threatening disorder in which infants fail to grow normally, lose weight, become seriously underweight for their age, and often are developmentally delayed

31. Learning Objectives • What are the symptoms, suspected causes, treatment, and long-term prognosis for children with ADHD? • How is depression during childhood similar to, or different from, depression during adulthood? • How do interactions of nature and nurture contribute to psychological disorders? Do childhood problems persist into adolescence and adulthood?

33. The Child – Externalizing and Internalizing Problems • Two broad categories are used to refer to whether a child’s behavior is out of control or overly controlled • Externalizing problems • Internalizing problems • When children have externalizing problems, they act out in ways that disturb other people and violate social expectations • When children have internalizing problems, negative emotions are internalized or bottled up rather than externalized or expressed

34. The Child – Externalizing and Internalizing Problems • Externalizing behaviors decrease from age 4 to age 18 • Internalizing difficulties increase during this time • Externalizing problems are typically more common among boys • Internalizing problems are more prevalent among girls, across cultures • Children from low socioeconomic homes show more externalizing and internalizing problems than higher SES children do, partly because their environments are more stressful

35. The Child – Externalizing and Internalizing Problems • It is helpful to view developmental disorders from a family systems perspective and to consider how emerging problems affect and are affected by family interactions • Problems are located not in an individual family member but in a whole family • From a family systems perspective, parents both influence and are influenced by their children, and the family also functions in a larger environment that influences it

36. The Child – Externalizing and Internalizing Problems • As the diathesis-stress model suggests, disorders often arise from the toxic interaction of a genetic vulnerability and stressful experiences • Abnormal development, like normal development, is the product of both nature and nurture and of a history of complex transactions between person and environment in which each influences the other

37. The Child – Externalizing and Internalizing Problems • The research of Caspi and colleagues (1996) suggests that there is continuity in susceptibility to problems over the years and that early problems tend to have significance for later development • Children who had externalizing problems (such as aggression) as young children and were described as irritable, impulsive, and rough were more likely than inhibited, overcontrolled children, or well-adjusted children to be diagnosed as having antisocial personality disorder and to have records of criminal behavior as young adults • Internalizers – inhibited children who were extremely shy, anxious, and upsettable at age 3 – were more likely than other children to be diagnosed as depressed as young adults

38. The Child – Externalizing and Internalizing Problems • The research of Caspi and colleagues (1996) suggested that there is continuity in susceptibility to problems over the years and suggested that early problems tend to have significance for later development • Children who had externalizing problems were more likely to be diagnosed as having antisocial personality disorder and to have records of criminal behavior as young adults • Internalizers – inhibited children – were more likely than other children to be diagnosed as depressed as young adults • However, the study also revealed discontinuity • The relationship between early behavioral problems and later psychology pathology was weak – most children with temperaments that put them at risk did not have diagnosable problems as adults

39. The Child – Depression • Children as young as age 3 can meet the same criteria for major depressive disorder that are used to diagnose adults • An estimated 2% of children have diagnosable depressive disorders • Depression may coexist with other distinct diagnoses such as conduct disorder, attention deficit hyperactivity disorder, and anxiety disorder • The co-occurrence of two or more psychiatric conditions in the same individual is called comorbidity • Comorbidity is very common throughout the lifespan

40. The Child – Depression • Depression in children may manifest with behavioral and somatic symptoms of depression such as losing interest in activities, or eating poorly • They are prone to be anxious • As early as age 3, children who are depressed may express excessive shame or guilt (for example, saying that they are bad) • Some depressed children act out themes of death and suicide in their play • Depressed children are sad or irritable and show the same lack of interest in usually enjoyable activities that depressed adults do • Children as young as age 2 or 3 are capable of attempting suicide

41. The Child – Depression • The carryover of depression problems from childhood to adulthood is not as strong as carryover from adolescence to adulthood • However, research has shown that 5- and 6-year-olds who report many depression symptoms are more likely than their peers as adolescents to be depressed, to think suicidal thoughts, to struggle academically, and to be perceived as in need of mental health services • It is estimated that half of children and adolescents diagnosed as having major depressive disorder have recurrences in adulthood

42. The Child – Depression • Most depressed children respond well to psychotherapy • Cognitive behavioral therapy attempts to identify and change distorted thinking and the maladaptive emotions and behavior that stem from it • The category of antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) may be used to correct for low levels of the neurotransmitter serotonin in the brains of depressed individuals • However, SSRIs do not appear to be as effective with children as with adults • Some research suggested that SSRIs may increase the risk of suicidal thoughts and behavior among child and adolescent users, causing the U.S. government to issue a warning to that effect in 2004

43. Learning Objectives • Are psychological problems more prevalent during adolescence than other periods of the lifespan? • What are the characteristics, suspected causes, and treatment of eating disorders such as anorexia nervosa? • What is the course of depression and suicidal behavior during adolescence? • What factors influence depression during adulthood?

44. The Adolescent – Storm and Stress? • Adolescence is a period of risk-taking, of problem behaviors such as substance abuse and delinquency, and of heightened vulnerability to some forms of psychological disorder • Among adolescents, there is a 20% rate of diagnosable psychological disorder at a given time • Most adolescents cope with the challenges of teenage life remarkably well and maintain the level of adjustment they had when they entered adolescence • However, for a minority of adolescents, a buildup of stressors can precipitate serious psychopathology

45. The Adolescent – Eating Disorders • Anorexia nervosa (“nervous loss of appetite”) has been defined as a refusal to maintain a weight that is at least 85% of the expected weight for the person’s height and age • Anorexic individuals are also characterized by a strong fear of becoming overweight, a distorted body image (a tendency to view themselves as fat even when they are emaciated), and, if they are females, an absence of regular menstrual cycles

46. The Adolescent – Eating Disorders • Another eating disorder is bulimia nervosa (the so-called binge-purge syndrome), which involves recurrent episodes of consuming huge quantities of food followed by purging activities such as self-induced vomiting, use of laxatives, or rigid dieting and fasting

47. The Adolescent – Eating Disorders • Approximately 3 in every 1,000 adolescent girls experience anorexia • There are about 11 female victims for every 1 male victim • Anorexia is evident at all socioeconomic levels and in all racial and ethnic groups

48. The Adolescent – Eating Disorders • Both nature and nurture contribute to eating disorders • On the nurture side, cultural factors are influential, especially the Westernized ideal of thinness as the standard of physical attractiveness • On the nature side, researchers believe that genes serve as a diathesis, predisposing certain individuals to develop eating disorders • Genes may contribute to low levels of the neurotransmitter serotonin, which is involved in both appetite and mood and has been linked to both eating disorders and mood disorders

49. The Adolescent – Eating Disorders • Both nature and nurture contribute to eating disorders • On the nature side (continued) • The neurotransmitter dopamine has also been implicated, as it is involved in the brain’s reward system, and some evidence suggests that eating disorders, like alcohol and drug addiction, involve compulsive behavior that is reinforcing • Genes also may contribute to a personality profile that puts certain individuals at risk • Females with anorexia tend to be highly anxious and obsessive perfectionists

50. The Adolescent – Eating Disorders • The interaction of nature and nurture • However, anorexia may not emerge unless a genetically predisposed girl living in a weight-conscious culture experiences stressful events • Genes and environment interact to produce a disorder