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Chapter 12

PSYC18--Chapter 12: Emotion Based Disorders of Childhood

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Simon Appolloni

PSYC18: CHAPTER 12—EMOTION-BASED DISORDERS IN CHILDHOOD Emotions and Mental Disorders Conceptualizing Childhood Disorders: Categories and Dimensions • Psychopathology is a term used for disorder in general. • Two types of systems used to assess and classify these disorders; the first involves psychiatric diagnosis (in which a child’s behaviors, experiences and emotions are evaluated by a trained clinician). In NorthAmerica, the Diagnostic and Statistical Manual of Mental Disorders is used to make a diagnosis, whereas the International Classification of Diseases is commonly used elsewhere. Classification are based on medical model which states that: 1) That problems are discrete and well-differentiated from normal functioning 2) There is a specific and recognized etiology (causation) and corresponding treatment for certain disorders, and 3) That the course of illness is similar across children who suffer from it • Research questions whether disorders are qualitatively distinct from one another and from normal functioning. • Aseparate way of conceptualizing emotion disorders is to view symptoms as varying on a dimension (e.g. the tendency to express anger as quantitative rather than qualitative). Information is usually gathered through psychometric assessment (checklists and questionnaires completed by clinicians, teachers, parents or their children). This method allows clusters of behaviors to overlap. • * See pg 295, figure 12.2 How is Emotion Involved in Children’s Mental Disorders? • Most-common emotion-based disorders of the childhood are described along two spectrums:  Internalizing: Characterized by disruptive behavior (“acting out” such as conduct disorder).  Externalizing: Characterized by depressed mood and anxiety (“acting in” such as separation anxiety disorder—fear that harm will befall their parents and they will lose them—and depressive disorder— characterized by marked shift in mood whereby children feel no interest in things for minimum 2 weeks). • Disturbance of emotion is central to the disorder. Other common psychopathologies of childhood (e.g. ADHD) are not emotional in their core symptoms. Other disorders, however, such as substance abuse and eating disorders, do not involve emotions in their core symptoms but underlying emotional issues may contribute to the occurrence of the disorder (e.g. an adolescent may start abusing substances due to feelings of discontent). However, no disturbance of emotions is needed for diagnosing these disorders. • Emotion-based disorders not necessarily discrete (e.g. a child can display both externalizing and internalizing tendencies). • Emotions are central to how we define types of childhood disorders (e.g. at one end of the continuum of emotional experience, expressions last for seconds, emotional episodes last minutes/hours, and depression/conduct disorder can drastically affect life over a long period of time, even a lifetime). Are Emotions Abnormal in Emotion-Based Disorders?—4 Theories 1) Predominance of One Emotion System • View that one particular emotion or family of emotions becomes prominent and dominates other possible experiences (e.g. depressed people experience more sadness than other emotions, or experience more sadness than other people). • According to this idea, disorders represent imbalance among emotions and become incongruent with the real world. • These emotion biases represent components of appraisal (e.g. aggressive children make biased appraisals of events, and these events make them angry). In one study, children were sown videotapes that portrayed a child bumping into another child or one refusing to let another play. Aggressive kids were more likely to say that the child who bumped into the child was being intentionally hostile while nonaggressive children said the event was an accident. Ameta- analysis suggests this type of appraisal is more common in aggressive children and predicts later behavior. • Equivalent to internalizing problems is the depressogeneic style of appraisal (depressogenic=tendency to cause depression). Children vulnerable to anxiety/depression show appraisal biases towards threat/misfortune. • Depressed people more likely to ruminate before and after negative events (replay negative veents/thoughts over and over again). Also, a person’s goals important in generating emotions are more problematic among individuals with emotion-based disorders (e.g. depressed people are guided by avoidance goals: they more likely to avoid negative situations/events compared to non-depressed people who are guided by approach goals: they often set goals for positive situations, events or things they would like to see happen). 2) Inappropriate Emotional Responses • Another view suggests that children react to events with atypical emotional responses (e.g. crying for no reason). • In this view, it is not that children show more of one emotion that another, but that certain emotions seem unusual. For instance, a child of 11 may be shy like a child of 2, this is inappropriate because most 11-year-olds grow out of this behavior. • Physiological mechanisms help explain the relationship between atypical emotions and disorders. For example, one study exposed youths to film clips intended to elicit feelings of anger, sadness, fear or happiness. Heart rate was measured during each clip and subsequently participants reported on their subjective experiences of emotion. People who exhibited externalizing symptoms showed a lack of coherence between cardiac indicators of emotional reactivity and their internal subjective states. Those with internalizing problems demonstrated coherence between heart rate and subjective reports of negative affect, however, negative emotions were elicited by clips not intended to provoke them. Also internalizing children showed an atypical positive emotionality pattern whereby feelings of happiness did not coincide with increased heart rate. Such findings suggest that emotional experiences have many components, and the relationship between components may be a factor in the inappropriateness of emotions in disorder. 3) Poor Emotional Regulation • Children with disorders are not capable of regulating their emotions adequately to meet situational demands. Suggests several and internal/external risk factors contribute to disorder by affecting the self-regulatory system, which is comprised of an integrated network of cognitive, executive, attentional and affective controls. • Internalizing children cannot inhibit self-blame and rumination. Children who develop externalizing problems find it hard to shift their their focus to anything positive when there are frustrated, and so they remain angry. • Children with developmental delays also have harder time regulating their behavior in response to frustration. They are more likely to vent than to use positive coping strategies. 4) Emotional Adaptation to Negative Environments • Suggests that psychological patterns that are viewed as disordered by society actually reflect strategic adaptations to negative environments that children have experiences. Suggests that children must adjust to achieve reproductive success (consistent with evolutionary framework). • Children reared in risky environments develop insecure attachments, opportunistic ways of interacting with others and rapid sexual development as ways of succeeding in risky contexts that they will likely encounter. For example, a child with angry outbursts/stealing problems may be (unconsciously) attempting to gain a survival and reproductive advantage over others who similarly competitive. Prevalence of Disorders in Childhood • Psychiatric epidemiology is the study of how many people show a particular disorder in the population. Prevalence is the proportion of the population suffering from some disorder over a particular time and incidence describes the number of new onsets of a particular disorder in a given time. • Population-based studies are very revelatory. Astudy involving a sample of kindergarten children found that one in five children met criteria for a disorder within the year prior to school entry, with boys showing more externalizing problems and girls more internalizing problems. *See pg 299, table 12.1. • By 9-10 years old, 1 in 5 North Carolina students met criteria for a disorder within the past 3 months. Gender differences in prevalence continued (externalizing disorders, substance abuse and depression increase with age whereas the internalizing problem of anxiety disorders decreases with age). *See pg 300, table 12.2 • At 13-18 years, it is suggested that nearly half of all children meet criteria for a diagnosis at some point in their lives. Estimate drops to 22% if threshold is set at a serious impairment. Gender differences remain persistent. • Behavioral disturbances in boys picked up earlier than emotional disturbances of females. Relationship between Risk Factors and Emotion-Based Disorders • Emotion-based disorders can only be understood through complex, systemic & dynamic framework. • Relationship between risks and outcomes is nondeterministic and nonspecific (presence of risk factor does not guarantee the development of disorder). Environment risks may contribute to disorder/disturbances. • Disorder development is also transactional in nature—children influence their outcomes (e.g. if child is oppositional, parents get frustrated and child is further disturbed). People, Contexts, and the Multilevel Experiment • Multilevel perspective suggests that children are influenced by multiple levels of their environments: macro- influences like cultures, neighborhoods and schools (called distal factors), those that are closer and more immediate to the child, such as their relationships with family members and friends (called proximal factors). *See pg 301, figure 12.3. Levels of organization within child also range from macro to micro—from a child’s overall personality and IQ to his/her neural circuitry, cells and synapses and genes. Distal/proximal risk factors influence all of these. • An implication of the multilevel perspective is to recognize the indirect effects that occur between various aspects of a child’s environment (e.g. neighborhood violence and disorganization increase negativity that parents show children and when parents show negativity, children are more likely to show deviant behavior). • Psychopathology can be thought of as maladaptive person-context interactions: the child is difficult for the environment and the environment is difficult for the child. • Sroufe suggests that initially child may be slightly deviant and if the child’s context cannot support this, the problematic behavior becomes more deviant over time. See pg 302, figure 12.4 (important). Risk and Resilience: The Combination of Risk and Protective Factors • When one environmental risk is present, others likely to present. • In a study of childhood adversities (experiencing abuse, poverty, mental health problems or substance abuse in parents), 87% of respondents who reported one adversity in childhood reported a second. When adversities in childhood
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