Chapter 12(1).docx

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Chapter 12 Emotions and Mental Health in Childhood
Disorders of emotional life in kids and adolescence are states in which young kids are no longer able successfully to cope, or in
which they’re getting into serious trouble.
Classifying Childhood Disorders
Mental health workers developed classification systems for clusters of disordered behaviour
o Main system is that of psychiatric diagnosis interview
Diagnoses are descriptions of patterns of behaviour
o To make diagnosis criteria are used by which behaviour, experiences, and/or emotions are judged
o Importance of diagnosis is that someone who fulfills defined criteria for defined period is usually impaired in functioning
study of this is psychopathology
Main scheme used to diagnose psychiatric problems of adults and kids in North America is the Diagnostic and Statistical Manual of
Mental Disorders 4th Edition (DSM-IV-TR)
o Another used one is the International Classification of Diseases 10th Revision, Clinical Modification (ICD-10-CM) which
includes psychiatric disorders
Another way of conceptualizing emotional disorders, preferred by psychologists, is to accept there are no sharp distinctions
between having and not having disorder there is continuum
Assessment: involves checklists of symptoms or behaviour patterns and sometimes questionnaires, which someone completes for
child. At older ages, kids complete themselves
o Checklists and questionnaires provide continuous measures
o In middle childhood, two kinds of emotional disorder are important externalizing disorders defined by anger, hostiligy,
aggression, stealing and lying. Internalizing disorders, which include anxiety and depression
o In adolescence, disorders can continue and other disorders can occur
How Are Emotions Involved in Kid’s Disorders?
2 principle emotion-based externalizing disorders of kids are called oppositional defiant disorder and conduct disorder
Criteria for defiant disorder is that over 6 month period, child displays 4+ of following behaviours that lead to impairment of
school life
o Loses temper, argues with adults, defies or refuses requests or rules, deliberately does things that will annoy others,
blames others for own mistakes, touchy or easily annoyed, angry and resentful, spiteful and vindictive
Criteria for conduct disorder are similar, but include more serious antisocial behavior like truanting (missing school) before 13,
stealing, firesetting, sexual assault, and weapon use.
For internalizing disorders, 2 main types are anxiety and depression
o Anxiety disorders are fears that are abnormal in intensity, duration and how they’re elicited. Disabling syndrome is
overanxious disorder, in which there is excessive or unrealistic anxiety or worry for at least 6 months.
Separation anxiety is defined as excessive anxiety for at least 2 weeks about separation from main attachment
figures; worry about harm befalling them, refusal to attend school
o Major depressive episode is kids feels very low in mood or has no interest in anything for at least 2 weeks. Kid needs to
be diagnosed, must have 4 other symptom like weight changes, sleep disturbance, fatigue feelings of worthlessness,
inability to concentrate and recurrent thoughts of death or suicide
Emotions central to how define certain types of disorder in childhood
Not included in diagnostic criteria are understandings of how different levels of emotional experience relate to one another
What is Disordered?
Predominance of One Emotion System
Most common view of disorders of emotion in childhood, Tomkins argued, 1 emotion becomes prominent dominates other
possible experiences, so depressed people experience more sadness than other emotions, or experiences sadness more
Dodge and Coie studied aggressive and non-aggressive kids reading vignettes or videotapes in which something negative
happened one kid bumpbed into another or kid refused to let another play asked to say whether perpetrator was being
deliberately mean
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o Aggressive kids more likely to say that perpetrator was being intentionally hostile
o Meta analysis shown that bias of appraisal is substantial and frequently found among aggressive kids
o Another appraisal pattern is depressogenic attribution style depressed kids more likely to make attributions for
negative events that are stable (will always be this way), internal (it’s my fault), and global (all situations will be like this)
Another version of emotional predominance is in terms of kids’ goals
o In temperament, boys more likely to think that aggression enhances self-esteem and may contribute to gender
differences
o In externalizing disorders, predominance of goals seems to be exaggerated, so kids with externalizing disorders have
been found to value gaining control over another more than cooperation and value aggressive solutions more positively
Inappropriate Emotional Responses
Another view about what becomes disordered is that kids with disorders react to events with deviant emotional responses
laughing when someone distressed, crying when nothing happened
Emotional responses are unsettling and other people find it hard to make sense of them
Dysregulation
Emotions are not properly regulated inappropriate to social context
Cole induced negative moods in preschoolers some kids were inexpensive, some were modulated, and others were expressive
o Both inexpressive kids and expressive kids had more externalizing symptoms, both as preschoolers and at follow up in
first year at school
Shields and Ciccetti proposed that emotion dysregulation underlies both bullying and being victimized by bullies among kids who
have been physically or sexually abused
Rothbart, Ellis, and Ponswer think of regulation of emotions as dimension of temperament based on effort to direct attention and
relates to processes of regulation
Eisenberg relate dysregulation to lack of effortful control, so that kids with externalizing disorders, but not internalizing disorders,
are impulsive, and low in effortful regulation of emotions
Prevalence of Disorders in Kids
Psychiatric epidemiology: study of how many show particular disorder in population, statistically relating disorder to factors in
people’s lives
o Prevalence is proportion of population suffering from some disorder over particular time period
o Incidence is number of new onsets of particular disorder
Rutter, Tizard and Whitmore first major study in kids psychiatric epidmoiology Isle of Wight study
o Parents of 10 YO kids living on Isle of Wight, had kids screened by asking parents and teachers to complete
questionnaires about behaviours. Kids who had many problems were interviewed to see whether psychiatric diagnosis
was to be made
o Many estimates of prevalence of psychiatric disorders among kids in West societies have been made subsequently
o Though figures differ widely due to methods used, and whether degree of handicap that disorder imposes is taken into
account, a review of published studies yielded median rates of psychiatric disorder in kids as 8% for preschoolers, 12% of
preadolescents and 15% for adolescents
Epidemiological methods were breakthrough in understanding origins of disorder, and developed for use with parents, teachers
and kids
Diagnoses differ, however, according to whether informant is parent, teacher or kids
o Ids more closely in touch with fears and anxieties than parents, and report more
o Parents more in touch with externalizing behaviours than kids, and report more
o Reliability of kids as respondents increases with age
Externalizing Disorders
Younger kids show more externalizing behaviours such as aggressive behaviour, screaming, than internal behaviours like sadness,
anxiety and withdrawal
Achenback surveyed parents of 2500 kids between 4-16 YO, drawn from different parts of US
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o Each completed questionnaire about 1 kid, and kids in community sample were matched with group of kids receiving
treatment in clinics
o Questionnaire had 215 items of behavior, and parents scored frequency with which child showed each one
Same patterns seen using measures of psychiatric disorder based on criteria based on DSM-IV
Oppositional defiant disorder most common in early childhood, but conduct disorder becomes more common later
o Reflects increased opportunity for seriously antisocial behaviour as they grow older
o Bongers showed, aggression, property violations and opposition gradually decrease from age 4 to 8, whereas status
violations increase with age.
Boys sho more externalizing disorders of all kinds than girls throughout childhood and different levels of aggression evident by age
of 2
Goodenough reported angry outbursts in kids decline sharply in second year
o For girls, decline sharper than for boys angry outbursts continue to decline as kids progresses
o Different rates of aggressive behaviour in males and females found in many cultures, and show greater prevalence than
girls
Graham estimated 3:1 ratio of boys to girls in prevalence of conduct disorder
Anxiety Disorders
Prevalence of anxiety increases with age during childhood
Richman found 9-fold increase in maternal reports of kids’ worrying from 3-8 YO
Between middle childhood and adolescence the prevalence of diagnosable anxiety disorders remains constant or drops a bit with
age
Forms of anxiety disorders take change with age
Separation anxiety more common in early childhood, but overanxious disorders more common in adolescence
Girls more likely than boys to show single symptoms of anxiety and show anxiety disorders
o Not uncommon for kids to show 2 different types of anxiety disorder
Often anxiety occurs with depression
o Anderson found that 17% of preadolescents with anxiety disorder were also depressed; by adolescence Kashani and
Orvaschel found that figure risen to 69%
Depressive Disorders
Both normal low mood and depression become more common as kids get older
Larson used experience sampling to ask preadolescents and adolescents to rate moods through day
o Adolescents’ emotions no more variable than younger kids’ but adolescents found to have generally lower mood
For diagnosable depressiong, rates of depressive disorders increase dramatically in adolescence
Boys and girls about equally likely to suffer from depression
Cyranowsky showed females become almost twice as likely as males to be depressed, but not case for boys, whose level of
reported symptoms remains constant from earlier childhood through adolescence
Reasons for girls’ and boys’ differences in rates of disorder aren’t fully understood, but socialization is likely to play role
Stress-Diathesis Hypothesis
Stress diathesis hypothesis is general idea about how differences in outcomes can occur
Stress is something that occurs in environment being orphaned
Diathesis: predisposition or vulnerability, to disorder that is inherent in kids, perhaps genetic. Perhaps, surprisingly, neither
stresses on own nor vulnerability in own causes disorder but in combination, stress occurring to child with diathesis can cause
disorder interaction affect
Environmental stresses could provoke disorders
Risks
One of big contributions to understanding families has come from study of how they’re unhappy and how they cause distress to
all members, and cause psychiatric symptoms in some
Risks in environment are stresses that increase likelihood that kid develops disorder not rigid causes
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