Introduction to the Exceptional Child

1. Introduction to the Exceptional Child Carolyn R. Fallahi, Ph. D. Some of these slides taken from Mash & Wolfe’s Instructor’s manual.

2. Historical views of child psychopathology • The emergence of Social Conscience • Historical views of the behaviorally disturbed child. • John Locke (17th C) • Jean-Marc Itard (19thC) • Itard & “wild child” Victor.

3. Historical views • Psychiatric disorders & mental retardation • Late 19th C, there was a distinction made between individuals with MR (“imbeciles”) and those with psychiatric disorders (“lunatics”). • “Moral insanity”. • Advances in medical science led to the replacement of moral insanity view by the organic disease model (medical model). • Syphilis & the advancement of the medical model.

4. Historical views • Early biological attributions • Early attempts at biological explanations for abnormal behavior were biased in favor of locating the cause of the problem within the individual. • The view of mental disorders as “diseases” led to eugenics and segregation.

5. Historical views • Early Psychological Attributions • Psychological influences did not emerge until the early 1900s. • Psychoanalytic theory linked mental disorders to childhood experiences – for the first time mental disorders were not viewed as inevitable. • Behaviorism laid foundation for studying conditioning and elimination of children’s fears.

6. Historical views • Evolving Forms of Treatment • Until the late 1940’s, most children with intellectual or mental disorders were institutionalized. • From 1945-1965, number of children in institutions decreased while number of children in foster families and group homes increased. • In 1950’s and 1960’s, behavior therapy was the systematic approach to treatment.

7. How do we determine what is normal or abnormal? • Determining normal versus abnormal is an arbitrary process. • Traditionally – defined as a pattern of behavioral, cognitive, or physical symptoms, that is associated with one or more of: • Distress • Disability • Increased risk for further suffering or harm

8. Defining psychological disorders • Many childhood problems best depicted in terms of relations. • Labels describe behavior; not the child. • Problems may be the result of the children’s attempts to adapt to abnormal or unusual circumstances.

9. Competence • Must consider not only the degree of maladaptive behavior, but also the children’s competence (the ability to adapt in the environment and achieve normal developmental milestones). • Knowledge of developmental tasks is fundamental for determining if there are impairments in developmental progress. • How would you know if your baby wasn’t developing properly? We bring our newborns in for “well-baby” visits. If they are showing “failure to thrive”… we would see…..?????

10. Developmental Pathways • Refers to sequence and timing of behaviors, and the relationship between them over time. • Two types of developmental pathways: • Multifinality: similar early experiences lead to different outcomes. • Equifinality: different early experiences lead to a similar outcome.

11. Developmental pathways • With abnormal psychology, must keep in mind: • There are many contributors to disordered outcomes in each child. • Contributors vary among children who have the disorder. • Children express features of their disturbance in different ways. • Pathways leading to particular disorders are numerous and interactive.

12. Risk and Resilience • Risk: • Risk factors are variables that precede a negative outcome and increase the chances that the outcome will occur. • Typically involve acute, stressful situations, as well as chronic adversity. • Known risk factors include: community violence and disasters, divorce/family break-up, chronic poverty, homelessness, parental inadequacies, parental psychopathology, perinatal stress.

13. Significance of children’s mental health problems • 1 in 5 children has a significant mental health problem. • 10-20% meet the criteria for a specific psychological disorder. • 75% of children who require mental health services do not receive them. • By 2020, the demand for children’s mental health services is expected to double. • We are doing a better job at distinguishing among disorders and recognizing them earlier. • Problems of younger children and teens are better acknowledged.

14. Significance • Today there is greater attention paid to empirically supported prevention and treatment programs. • Mental health problems remain unevenly distributed; those from disadvantaged neighborhoods and families, abusive/neglectful families, those receiving inadequate care, those born with very low birth weight, and those born to parents with criminal or severe psychiatric histories often have more mental problems.

15. What affects rates and expression of mental disorders? • Poverty and SES Disadvantage • About 1 in 6 children in North America live in poverty. • Poverty is associated with greater rates of learning impairments and academic problems, conduct problems, chronic illness, hyperactivity, and emotional disorders. • Sex Differences • Sex differences appear negligible in children under age 3, but increase with age. • Boys demonstrate greater difficulties than girls in early/middle childhood; girls’ problems increase during adolescence.

16. Rates & Expressions • Ethnicity • Minority children in the U.S. are over-represented in rates of some disorders. • Once other effects (SES, gender, age, referral status) are controlled for, very few differences emerge in relation to race or ethnicity. • Minority children face multiple disadvantages, including marginalization and poverty, suggesting that these factors may contribute to the prevalence of behavior problems in some populations. • Research in child psychopathology has generally been insensitive to possible differences in prevalence, age of onset, developmental course, and risk factors related to ethnicity, and the considerable heterogeneity that exists within specific groups.

17. Rates & Expression • Culture • The values, beliefs, and practices that characterize an ethnocultural group contribute to the development and expression of children’s disorders. • Some underlying processes may be similar across diverse cultures and less susceptible to cultural influences (e.g., those with strong neurobiological bases. • Still, social & cultural beliefs and values likely influence meaning given to behaviors, the ways in which they are responded to, their forms of expression, and their outcomes.

18. Rates & Expression • Child maltreatment & non-accidental trauma • There are over 1 million verified reports of maltreatment in the U.S per year. • Estimated that more than 1/3 or 10- to 16- year olds experience physical and/or sexual abuse. • Adverse effects of maltreatment are practically devastating with regard to adjustment at school, with peers, and in future relationships.

19. Rates & Expression • Special Issues concerning adolescents • Early- to mid-adolescence is an especially important transitional period for healthy versus problematic adjustment. • Issues such as substance abuse, sexual behavior, accidental injuries, and mental health problems make adolescence a very vulnerable period.

20. Rates & expression • Lifespan implications • About 20% of children have significant difficulties throughout their life. • When provided with circumstances & opportunities that promote health adaptation and competence, children can overcome major impediments.