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Chapter 12

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Chapter 12 Emotions and Mental Health in Childhood Emotions and disorders - Disorders of emotional life in childhood/adolescence are states when they are no longer able to cope - Concerned with extremes of emotions: intense and long-lasting states of anxiety, depression or of anger - The Case of Peter (child acting out at school as well as at home) - Classifying childhood disorders o Mental health workers have developed classification systems for clusters of disordered behaviour o Main system is that of psychiatric diagnosis, usually by means of an interview o Diagnoses are descriptions of patterns of behaviour o For children reaching these criteria, family and school relationships have often become extremely strained and the childs symptoms may have made normal life impossible o Main scheme used to diagnose psychiatric problems of adults and children in North America: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision(DSM-IV-TR) or International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Both based on a medical model and focus on individuals rather than their contexts o There is a continuum, (NOT: Having a disorder or not having one). Method of assessment typically involves checklists of symptoms or behaviour patterns and sometimes questionnaires o In middle childhood, two kinds of emotional disorder become important: externalizing disorders defined by anger, hostility, aggression, stealing, and lying. Internalizing disorders include anxiety and depression with tendencies to withdraw. - How are emotions involved in childrens disorders o Two principal emotion-based externalizing disorders of childhood are called oppositional defiant disorder and conduct disorder Oppositional defiant disorder (DSM-IV-TR): Over a 6 month period, a child frequently displays four or more of the following behaviours that lead to an impairment of social or school life(Loses temper, argues with adults, defies or refuses adult requests or rules, deliberately does things that will annoy other people, blames others for own mistakes, is touchy or easily annoyed by others, is angry and resentful, is spiteful or vindictive) Criteria for conduct disorder are similar but more seriously antisocial behaviour such as truanting before age 13, stealing, fire-setting, sexual assault, physical fights, physical cruelty to people or animals, and use of weapons Chapter 12 Emotions and Mental Health in Childhood o Two main types of internalizing disorders: anxiety and depression. Anxiety disorders are fears that are abnormal in intensity, duration and how they are elicited (excessive or unrealistic anxiety or worry, with marked tension for at least six months across a range of areas: future events, incompetence, self-consciousness, and concerns about previous performance). There is also separation anxiety with main attachment figures. Depressive episodes: child feels either very low in mood or has no interest in anything for at least 2 weeks. Must also have 4 other symptoms (weight changes, sleep disturbance, fatigue, feelings of worthlessness, inability concentrate and recurrent thoughts of death or suicide) - What is disordered? Hypotheses about relationship between emotion and disorder o Predominance of one emotion system Tomkins (1962): one emotion becomes prominent (e.g. little girl being separated from her parents when taken into hospital. Event elicits great fear and sadness. Subsequent events that have any similarity to the initial eliciting circumstances then trigger the same emotions, magnifying and amplifying them. Sees a man with white coat = doctor = Gets scared again) Dodge and Coie (1987): aggressive and non-aggressive children read vignettes about one child bumping into another or one child refusing to let another child play. Are they being deliberately mean? Aggressive children were more likely to say that the perpetrator was being intentionally hostile. Depressed children are more likely to make attributions for negative events that are stable (it will always be like this), internal (it is my fault) and global (all situations will be like this). In terms of temperament, boys are more likely than girls: think aggression enhances self-esteem In externalizing disorders: children found value gaining control over another child (social goal of assertion) more than cooperation (social goal of affiliation) and to value aggressive solutions more positively than their non-aggressive counterparts o Inappropriate emotional responses Children with a disorder react to events with deviant emotional responses (laughing when someone is distressed, crying when nothing happened, being angry when someone is friendly) Emotional responses are unsettling and people find it hard to make sense of them. o Dysregulation Emotions are not properly regulated and inappropriate to the social contextChapter 12 Emotions and Mental Health in Childhood Rothbart, Ellis and Posner (2004) think of regulation of emotions as a dimension of temperament, based on effort to direct attention Eisenberg (2005) relate dysregulation to lack of effortful control so children with externalizing disorders (not internalizing) are impulsive and low in effortful regulation of their emotions. Prevalence of disorders in childhood - Psychiatric epidemiology: study of how many people show a particular disorder in the population, statistically relating disorder to factors in peoples lives - Prevalence is proportion of a population suffering from some disorder over a particular time period - Incidence is the number of new onsets of a particular disorder in a given time - First major study in childrens psychiatric epidemiology was by Rutter, Tizard and Whitmore (1970): Isle of Wight - Epidemiological methods were a breakthrough in understanding origins of disorder and have helped plan services for children. Psychological instruments assessing presence of disorder have been developed for use with parents, teachers and children. - Diagnoses differ according to whether informant is a parent, a teacher or a c
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