PSYC 3615 � SEPT 8/08

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					                                PSYC 3615 – SEPT 8/08


1              Introduction to Abnormal Child Psychology
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Key Considerations:
Children do NOT typically refer themselves for treatment - implications
The “timing” of normal childhood development is variable.
There is a range of normal behavior which is not always easily defined.
Goal of treatment with adults is often to eliminate distress – with kids, we also need to
boost their skills and develop their self-image.
Key Questions:
   1. What is normal vs abnormal behavior for a child of this age and gender?
   2. What causes this behavior to occur?
   3. What will the long-term outcome of this child’s specific problem?
   4. How can we help?

I.     Historical Views and Breakthroughs
       A.      Early Treatment of Children
                   Considered servants of the state (Greece)
                   Disabled to be abandoned, put to death (Rome & Greece)
                   Religious views – aberrant behavior result of demon possession,
                      sin
                   17th and 18th centuries children were subjected to harsh, often
                      abusive treatment; any means acceptable in order to
                      educate/discipline a child
                   Severely disabled kept in cages or cellars
                   Animal rights came before child rights due to monetary value of
                      livestock
                   Concern for welfare of children with mental and behavioral
                      disturbances rose with increasing medical advances
       B.      The Emergence of Social Conscience
                   John Locke, 17th century philosopher & physician, advanced the
                      belief that children should be raised with thought and care, and he
                      saw the importance of providing them with opportunities for
                      education
                   “Victor” of Aveyron; Jean-Marc Itard undertook one of the first
                      documented efforts to work with a special needs child around the
                      turn of the 19th century, an undertaking that launched a new era of
                      a helping orientation towards children
       C.      Psychiatric Disorder and Mental Retardation
                   Distinction between those with mental retardation vs psychiatric
                      disorders began with universal education of children in Europe &
                      North America in latter half of 19th century; these children unable
                      to handle demands of school
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           Children with normal cognitive abilities but disturbing behavior
            were said to be suffering from “moral insanity”
         Advances in medicine, physiology, and neurology led to a
            replacement of the moral insanity view by the organic disease
            model
         Increased concern for moral education, compulsory education &
            improved health practices
D.   Early Biological Attributions
         Early attempts at biological explanations for abnormal behavior
            were very biased in favor of locating the cause of the problem
            within the individual; neglected the person’s environment
         limited to most visibly “different” disorders such as psychoses or
            severe mental retardation; societal ignorance & avoidance of those
            with mental illness
         The view of mental disorders as being “diseases” meant that they
            were progressive and irreversible, and resistant to treatment or
            learning
         Blamed for social ills, crime & thus segregated in institutions
            and/or sterilized to prevent procreation of the insane
E.   Early Psychological Attributions
         Psychological influences did not emerge until the early 1900s,
            corresponding with the formulation of a taxonomy of illnesses
            (diagnostic categorization system)
         Psychoanalytic theory linked mental disorders to interplay between
            innate drives and childhood experiences; for the first time the
            course of mental disorders was not viewed as inevitable – interest
            in treatment began to arise
         Freud was first to linking mental disorders to childhood and to
            focus on multiple rather than single causes
         Anna Freud – developmental stages of symptoms – i.e., different
            expression than in adults or children of a different age
         Currently psychoanalytic theories are out of vogue in favour of
            descriptive nosologies; however, developmental differences have
            been lost in these current classification systems
         Development of evidence-based treatments began with rise of
            behaviorism in the early 1900’s (Pavlov & his dogs; John Watson
            & Little Albert studies)
F.   Evolving Forms of Treatment
         Until late 1940s, most children with intellectual or mental
            disorders were still nstitutionalized
         Rene Spitz (1940’s) revealed that infants raised in institutions with
            little physical contact or stimulation developed severe physical &
            emotional problems (failure to thrive); in the next 20-year period
            there was a rapid decline in institutionalization and an increase in
            foster family and group home placements
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                  in the 1950s and 1960s behavior therapy emerged as a systematic
                   approach to treatment of childhood disorders such as mental
                   retardation or psychoses, where psychoanalysis of internal motives
                   & drives was deemed ineffective or inappropriate; most behavioral
                   work took place in institutions or classrooms, where it was easier
                   to “control” the environment; remains a prominent form of
                   treatment
      G.    Progressive Legislation
                In countries such as the U.S. and Canada, many laws have been
                   enacted in the past few decades to protect the rights of special
                   needs children and provide them with appropriate public education
II.   What is Abnormal Behavior in Children and Adolescents?
      A.    Defining Psychological Disorders
                Determining the boundaries between what is normal and abnormal
                   is an arbitrary process – compulsive vs organized vs disorganized;
                   getting 2 psychiatrists to agree!
                Psychological disorders have traditionally been defined as patterns
                   of behavioral, cognitive, emotional, or physical symptoms, which
                   are associated with distress and/or disability and/or increased risk
                   for further suffering or harm
                Due to children’s dependency on others, many childhood problems
                   are better depicted in terms of relationships, rather than problems
                   contained within the individual e.g., ADD often not first identified
                   as problematic by child or even parents; most often in classroom
                   setting
                Labels describe behavior, not people; children have many other
                   strengths that should not be overshadowed by global descriptor
                   e.g., “Autistic child” vs “Child with autism”
                Problems may be the result of children’s attempts to adapt to
                   abnormal or unusual circumstances (e.g., hoarding of food)
      B.    Competence
                Need to consider children’s competence (the ability to successfully
                   adapt to his/her environment – success varies across culture &
                   ethnicity
                Need to know what is developmentally normal and also what is
                   culturally “normal” e.g., conduct & case of “adolescent rebellion”
      C.    Developmental Pathways
                Refers to the sequence and timing of particular behaviors, as well
                   as the possible relationships between behaviors over time
                Two examples of developmental pathways: (SEE FIG 1.1)
                   a.      Multifinality- similar early experiences lead to different
                           outcomes (e.g., abuse could lead to eating disorder, conduct
                           disorder or no psychopathology)
                   b.      Equifinality- different early experiences lead to a similar
                           outcome (conduct disorder could stem from genetic pattern,
                           family characteristics or environmental factors)
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                    With respect to abnormal child psychology, the following must be
                     kept in mind:
                     a.      There are many contributors to disordered outcomes in
                             each child
                     b.      Contributors vary among children who have the disorder
                     c.      Children express features of their disturbances in different
                             ways
                     d.      Pathways leading to particular disorders are numerous and
                             interactive
III.   Risk and Resilience
       A.     Risk
                  Risk factors are variables that precede and increase the probability
                     of a negative outcome
                  May be an acute, stressful situation or chronic adversity
                  Known risk factors include perinatal stress, community violence,
                     parental divorce or family breakup, chronic poverty, care-giving
                     deficits, parental psychopathology, death of a parent, community
                     disasters, homelessness
       B.     Resilience
                  Resilience factors are variables that increase one’s ability to avoid
                     negative outcomes, despite being at risk for psychopathology
                  Examples include strong intellectual intelligence, emotional
                     intelligence, coping skills and self-confidence
                  Connected to a “protective triad” of resources and health-
                     promoting events, involving strengths of the child, the family, and
                     the school/community (SEE FIG 1.2)
                  Resilience is not a universal, fixed attribute - it varies according to
                     the type of stress, its context, and similar factors – a person may be
                     “resilient” in one situation, but not another
                  The concept of resilience suggests that there is no one pathway
                     leading to a particular outcome; there are situational and personal
                     protective and vulnerability factors which must be considered as
                     well
IV.    The Significance of Mental Health Problems Among Children and Youth
       A.     Mental Health Issues in Children and Adolescents
                  About 1 in 5 (20%) of children have a significant mental health
                     problem, with at least half of these meeting the criteria for a
                     specific psychological disorder (this statistic is worded
                     ambiguously in the text!; many more have emerging problems
                     that place them at-risk for the later development of a psychological
                     disorder.
                  Of those children who require mental health services, 75% do not
                     receive it; lack of funding for services in an on-going issue
                  By the year 2020, the demand for children’s mental health services
                     is expected to double, and the number of professionals in this area
                     is not expected to increase at the required rate
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     B.    The Changing Picture of Children’s Mental Health
               In the past, children with various mental health and educational
                  needs were too often described in global terms, such as
                  “maladjusted”
               Today, researchers are better able to distinguish among the various
                  disorders, which has given rise to increased and earlier recognition
                  of problems
               Today, the problems of younger children and teens are also better
                  acknowledged
               In the past, lack of resources and the low priority given to
                  children’s mental health issues meant that children did not receive
                  appropriate services in a timely manner. Today, this situation is
                  reportedly changing, with greater attention paid to empirically
                  supported prevention and treatment programs.
               Mental health problems remain unevenly distributed; those from
                  disadvantaged families and neighborhoods, those from
                  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
                  health problems
V.   What Affects Rates and Expression of Mental Disorders? A Look at Key
     Factors
     A.    Poverty and Socioeconomic Disadvantage
               About 1 in 6 children in North America live in poverty
               Poverty is associated with greater rates of learning disabilities,
                  poor school achievement, conduct problems, violence, chronic
                  illness, hyperactivity, and emotional disorders
               Poverty has a significant, but indirect, effect on children’s
                  adjustment, likely due to its association with other negative
                  influences and stressors such as increased family violence and poor
                  nutrition
     B.    Sex Differences
               Sex differences appear negligible in children under the age of 3,
                  but increase with age (SEE FIG 1.3)
               Boys demonstrate greater difficulties than girls in early/middle
                  childhood; they are diagnosed significantly more often with the
                  following disorders – hyperactivity, autism, disruptive behavior
                  disorders, learning and communication disorders; boys have more
                  “externalizing” problems
               girls’ problems increase during adolescence and they are more
                  often diagnosed with the internalizing problems of anxiety,
                  depression and eating disorders
     B.    Ethnicity
               Minority children in the U.S. are overrepresented in rates of some
                  disorders such as substance abuse, delinquency and teen suicide
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            but there are few differences once the effects of SES and other
            confounding variables are controlled for.
           Significant barriers remain in access, quality and outcomes of care
            for minority children, and many groups remain marginalized.
           Research into 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 racial groups
C.   Culture
          The values, beliefs, and practices that characterize an cultural
             group influence the meaning given to behaviors, the ways in which
             they are responded to, their forms of expression, and their
             outcomes e.g., shyness
          Some underlying processes may be similar across diverse cultures
             and less susceptible to cultural influences (e.g., those with strong
             neurobiological bases such as autism)
D.   Child Maltreatment and Non-Accidental Trauma
          There are over 1 million substantiated reports of maltreatment in
             the U.S. each year (over 60,000 in Canada); it is estimated that
             more than one-third of 10- to 16-year-olds experience physical
             and/or sexual abuse in their families, communities and schools
          Many additional reports of “accidental” injuries to children may be
             the result of unreported neglect/abuse by parents or siblings
          The adverse effects of maltreatment are particularly devastating
             with regard to adjustment at school, with peers, and in future
             relationships
E.   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, violence,
             accidental injuries, and mental health problems make adolescence
             a particularly vulnerable period
F.   Lifespan Implications
          Unfortunately, about 20% of children (those with the most chronic
             and serious disorders) will experience significant difficulties
             throughout their lives – school drop-out, social problems,
             psychiatric disorders
          When provided with circumstances and opportunities that promote
             healthy adaptation and competence, children can often overcome
             major impediments

				
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