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Jan 8 2013 Psy341 Psychopathology of childhood.docx

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University of Toronto St. George
Ross Hetherington

Jan 8 2013 Psy341 Psychopathology of childhood (Lecture 1) Historical influences, child maltreatment, and developmental psychopathology Developmental psychopathology 1. Historical issues: treatment of children o Infanticide common in Western society from antiquity. How to recognize the newborn that is worth Rearing o Soranus wanted to look at muscle tone. Would pick the child up, father would decease it, that would mean the child would be accepted o Most early stages also practices child sacrifices, 200-400 BC, sacrifices by their parents, if GOD grants them a wish such as, food etc o Mainly by the rich in these early societies o When bridge was built, ch8ild would be build in as sacrifices o Lloyd deMause and psychohistory (The history of Childhood, 1974)  Evolution of parent-child relationships are an independent source of social change  It is the vehicle of transmission of all cultural traits  Important, places a great deal on child rearing, how we treat children over the years  Child-rearing vehicle for transmission of all other cultural traits  Considered a fringe character for political thought o 1654: Massachusetts stubborn child act o 1750: odds: 3:1 against child surviving past age 5  Reasons why people have so many children  Health care, maltreatment, o Up to 100thears ago, children was considered a possession of the father o Late 19 C: Society for the prevention of cruelty to children (youtube film)  Prevention of cruelty to animals, because to humans, no such prevention existed  Journey to protect children began – to prevent and protect o Convention on the rights of the child 1989 o The 3 P‟s:  Protection: abuse and neglect, exploitation, harmful substances  Provision: education, health care, basic economic welfare  Participation: freedom of thought, conscience, and religion voice in matters that affect that child  Adopted unanimously in General Assembly  Not yet ratified by U.S or Somalia – concerned with things such as united unions, convention would undermine authority etc. cannot get the ratification of this convention pass because of these concerns o Section 43 of Canada‟s Criminal Code provides a legal defense for use of physical punishment by parents  Upheld by Supreme Court in 2004, but imposed new limitations  Cannot be administered to children with disability, under the age of 2, etc  Continuous problem o Child abuse a continuing problem o Documented incidence of maltreatment: 10/1000 per year in U.S  That is reported and discovered  What kind of crazy maltreatment can go on for years, what is not reported? We don‟t know, undiscovered  It is a significant underestimate 2. Historical figures o Neglect: emotional, educational: 78.3% o Physical abuse: 10.8% o Sexual abuse: 7.6% o Psychological maltreatment: 7.6% o Medical neglect: 2.4% o Other: 9.6% o Jean Marc Itard (1734-1838)  French physician: interested in mute autism  “Wild Boy of Averyron”  Because he was mute, limited language ability  Victor mat have lived on own for seven years: initially mute made gradual progress  Pioneered behavior modification for severely impaired children  Scars: physical abuse  Uta Frith: problems with autism  Sequin: pupil of Itard  Developed treatment method for the intellectually disabled o Johann Pestalozzi (1746- 18267)  Swiss clergyman, educatory, author  Implemented ideas of Rousseau  Children should learn through activity and things, and not words  Help children develop innate powers of observation and perception  Believed in the innate power of children  Opened a number of schools in Switzerland 1830 o Lightner Witmer (1856-1956)  Established first child psychology clinic in the USA  Aim to study children with learning or behavior problems  Assist children struggling in school  Founder of „clinical psychology‟ o The Binet-Simon Scale (1905)  Binet: lawyer and psychologist  Simon: physician, Binet‟s RA  Education reform in France: screening for special education  Genesis of the modern IQ test, concept of mental age  Binet wished to remediate impoverished experience o Stanley Hall (1844-1924)  Studied childhood and adolescents systematically with questionnaires  He thought sex should be segregated for more effective education o Freud (1856-1939)  Psychosexual development  Unconscious, psychoanalysis  Idea of unconscious, successfully treated middle class people  Varies across time o Henry Goddard (1856-1957)  Translated Binet intelligence tests  Studied mental retardation  Proposed a scale of mental retardation based on IQ  51-70% : Moron  26-50%- imbecile  0- 25% - Idiot  Morons, according to Goddard, were unfit for society and should be removed from society either through institutionalization, sterilization, or both o Arnold Gesell:  Pediatrician and psychologist  Maturation: intrinsic unfolding of development independent of environmental influences  Has it own timetable, idea of marathon  3. Developmental psychopathology  Developmental psychopathology: an approach to studying disorders of childhood emphasizes the importance of developmental processes and tasks, context. Uses normative approach  Dante Cicchetti (1984): The emergence of developmental psychopathology. Child development General developmental psychology + Traditional academic psychology + Clinical psychology, psychiatry (& neurology)  Macroparadigm, abnormal with normal  Synthetic, cross-disciplinary  Joins cognitive science, neuroscience and genetics with more traditional disciplines (developmental and clinical)  Clinical (assessment, intervention) and theoretical/research concerns  Biopsychosocial: cross-disciplinary macroparadigm for understanding behavior and outcomes  Age period: Infancy to preschool o Task: attachment to caregivers, language, differentiation of self from environment, self- control and compliance  Age period: middle childhood o Task: school adjustment (attendance, appropriate conduct), academic achievement (learning to read), getting along with peers, rule-government conduct  Age period: adolescence o Task: successful transition to secondary schooling, academic achievement (learning skills needed for higher education or work), involvement in extracurricular activities, forming close friendships within and across gender, forming a cohesive sense of self-identity  SLIDES PAGE 11, TABLE 4. Frequency of psychological disorders o Psychological disorder: a pattern of behavioural, cognitive, emotional or physical symptoms shown by an individual. Associated with one or more of: 1. Distress (fear, sadness) 2. Disability or impairment in some area of function 3. Distress and disability increase risk of further suffering o Incidence rate: the number of new cases of a particular condition that appear within a specified period of time o Prevalence rate: all cases of a particular condition whether new or previously diagnosed that are observed within a specified period of time o Epidemiology: a hybrid science with psychological, sociological, demographic, and medical aspects that deals with the study of diseases, their distribution in populations and their impact o Graph: 1 in 4 or 5 youth will meet criteria for a mental disorder with severe impairments  Cumulative lifetime percentages of DSM-IV disorders: anxiety highest, behavior, mood then substance o Most consistent demographic association with parental education o Risk is greatest across all disorders among those whose parents were not college graduates o Considerations in the etiology of psychological disorders o Etiology: the study of the causes of diseases o Developmental pathways: sequences and timing of particular behaviours and relations among behaviours over time  Multifinality  Equfinality  Many contributors to disorders outcomes and variability in expression of disorders o Etiology of psychological disorders  Early maltreatment can lead to different negative outcomes  A -> environment -> (genotype) -> disorders  B -> genotype -> (environment) -> disorders o Risk factor: a variable that precedes a negative outcome and increases the change the outcome will occur  Acute stressors or chronic adversity (perinatal stress, death of parents, chronic poverty, parental psychopathology) o Proactive factor: a variable that increases the ability to avoid negative outcomes despite being at risk for psychopathology. Increases resilience  Individual strengths (good intellectual function, high self-esteem)  Positive family infleunces (close relationship, socioeconomic advantage)  Schools and community support (connections to social organizations, effective schools) o Resilience: ability to avoid risk situations, recover from misfortunes, sustain competence o In general direct causal pathways are very rare, usually consists of interaction of factors 5. Assessing disordered behavior o Competence: ability to adapt to the environment o Norm: number, range, or level that is representative of a group and may be used as a basis for comparison for individual cases. Behavior pattern typical of a group o Relying on norms, what we‟re observe and expect in a child, - their background, sex o Different kinds of norms o Socio-cultural norms: quite flexible, vary from society to society. Sets expectations  Differ among societies  Situational within a society  Gender differences in expectation o Developmental age norms  Typical rates at which skills, knowledge, and social-emotional behavior develop: developmental tasks  Age-appropriateness o Other factors that can influence behavior judgments: frequency, intensity, duration, qualitative differences, attitudes and expectations Added notes; Historical figures: American behaviorists  Importance on Thorndyke o Developed a sophisticated theory of learning o Law of effect: behavior is shaped by its consequences  John Watson o Influenced by classical conditioning of Pavlov o „father of behaviorism‟ o Little Albert experiments  Ethical issues  Albert likely cognitively impaired o Ended career working in advertising  B.F Skinner (1874-1949) o Operant conditioning o Applied behavioral theories to education  Teaching machine  Albert Bandura (1925-) o Social learning theory o Bobo the doll experiment o “learning would be exceedingly labourious, not to mention…” Developmental psychopathology  Paradigm: collective set of attitudes, assumptions, values, procedures, and techniques that form the generally accepted perspective of a particular discipline or group of investigators o Developmental: common general course of development o Biologic/ genetic: physiological view: malfunctioning biological system o Psychodynamic: specific cause for all behaviours – deterministic stage theory o Behavioural/ social learning: classical conditioning: operant conditioning: observational learning; cognitive behavioural approaches o Psychoeducational: arises from perspective of working with children o Family systems: family unit „organism‟ for study o Medical: behaviours symptomatic of diseases with specific etiologies Jan 15 2013 Psy341 Psychopathology of childhood (Lecture 2) Classification and assessment 1. Classification  Categorical approaches oCategorical vs dimensional classification o Categorical classification: assumes every diagnosis has a clear underlying cause and each disorder is fundamentally different (DSM-IV-IR) o Dimensional classification: assumes a number of different traits or dimensions of behavior all exist that children or adults posses to varying degrees (CBCI) oCategorical classification: o Classification: the process of categorizing things or events into mutually exclusive categories. Emphasis on description and grouping for scientific study o Diagnosis: the identification of a disease, disorder, or syndrome. Classification and categorization are central concerns. Emphasis on grouping for clinical purposes o Assessment: the process of evaluating the phenomenon: to be classified or diagnosed. Assessment is meaningful to the extent that it leads to effective intervention oCriteria for evaluation of systems: 1. Categories must be clearly defined 2. Defining features must occur together regularly 3. System must be reliable a. Inter-rater reliability b. Test-retest reliability 4. System must be value 5. System must have clinical utility  Covering everything that covers. Would not be useful if every patient comes in with every presentation. Must be a system that allows us to give reasonable and valid evaluation to cases that we see  DSM-IV-IR/ DSM-V oClinically derived classification system o International classification of Diseases (ICD-10)  Maintained by world health organization  Manual of major illnesses with universal numeric codes  Added mental disorders in 1948  DSM-IV-TR uses ICD-9 codes o DSM (1952) response to inadequacies of early ICD classifications o DSM-II (1968) neglected children and adolescents o DSM-III (1980)  Has included more categories on children  Clinical descriptions replaced with specific criteria  More child categories  Multiaxial system o DSM-III-R (1987)  Recognized subsets within diagnostic classifications  We see anxiety, ADHD, numbers of categories with sub-categories – multiaxial o DSM-IV (1994)  Greater focus on empirical validation and field trials  Neurosis disappears from psychiatry, remains alive. One dimension o the Big five personality factors o DSM-IV-TR (2000)  Updated text to include information and findings about prevalence and associated features  Most test of DSM-IV are not revised  Multiaxial system: Axes of DSM-IV-TR  Axis I: Clinical disorders, other conditions that may be a focus of clinical attention  Axis II: personality disorders, mental retardation  Axis IV: psychosocial and environmental problems  Axis V: Global assessment of functioning (GAF) o Rutter’s recommendations for DSM-V (required reading) 1. Remove grouping of disorders with onset specific to childhood.  Specify age variations for all disorders. 2. Add a grouping for known disorders that require further validity testing. 3. Major reduction in the number of diagnoses. 4. Use a combined categorical and dimensional approach. 5. Exclude the criterion of impairment. o DSM-V  Multiaxial system is gone. Most text not revised  Embrace cross-cutting issues: developmental; age-related; cultural  Gender Identity Disorder now Gender Dysphoric Disorder: less stigmatizing  Diagnoses involving children:  New condition: Disruptive Mood Disorder with Dysregulation  Attempt to resolve paediatric bipolar disorder controversial  Asperger syndrome merged into new autism spectrum disorder  Revision could result in exclusion of some previously diagnosed  Changes:  3 sections: 1. Introduction and use of the manual 2. Categorical disorders grouped by similarities 3. Conditions that require further research. Cultural considerations o Criticisms of DSM approach
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