Welcome to Abnormal Child Psychology

1. Welcome to Abnormal Child Psychology Jill M. Norvilitis, Ph.D.

2. Issues that research in this field addresses • What constitutes normal/abnormal behavior for kids of different ages and both genders. • Identifying causes and correlates of abnormal child behavior • Making predictions about long term outcomes • Developing and evaluating methods for treatment and prevention

3. Unique to disorders of childhood • Often not clear whose problem it is • Problems often involve failure to show expected developmental progress • Many problems are not entirely abnormal • Interventions are often intended to promote further development

4. Developmental Psychopathology • Multiply influenced—psychological, sociocultural, biological • Patterns of behavior, emotions, cognitions that are abnormal, disruptive, distressing • Either to person or to others around the person

5. Defining Psychological Disorders • Person shows some degree of distress • Behavior indicates some degree of disability • Distress or disability increases risk of further suffering or harm

6. Keys to Remember • Importance of relationships • Labels and stigma • Competence • Frequency/intensity of problems • Multifinality • Equifinality • Accurate views of what is normal

7. Risk Factors • Characteristics, events, or processes that increase risk for the development of psych problems • Categories • Some risk factors are more predictive of problems than others • Vulnerability varies • Risk accumulates • Some connection between risk factors and specific disorders • Number of risk factors is important

8. Resiliency/Protective Factors • Characteristics, events, or processes that protect an individual from the dev of psychological problems • Personal attributes—intelligences, self-confidence, etc • Family strengths • Support from outside the family

9. How common are problems? • Epidemiology • Prevalence—total # of cases at a given time • Incidence--# of new cases in a given period • Between 1/8 and 1/5 have clinical problem that impairs functioning • 10-20% meet diagnostic criteria • 10% of those with problems receive tx • Youngest ¼ of population receives 1/9 tx dollars

10. Theories and Causes • Theory—systematic set of statements designed to help organize, analyze, explain, and predict • Purpose… • A good theory should • Account for the majority of existing research data • Give relevant explanations/logical reasons • Be able to be tested for accuracy • Predict new events, incorporate new info • Be parsimonious • Be logically consistent

11. Etiology • Underlying assumptions • Behavior is multiply determined • Child and environment are interdependent—this dynamic interaction is called a transaction • Abnormal development involves continuity and discontinuity • Adaptational failure—failure to master or progress in accomplishing developmental milestones • Developmental psychopathology is a macroparadigm that draws on multiple perspectives

12. Freud • Deterministic • Mental processes are often unconscious • Conflict model—id/ego/superego • Stages • Oral • Anal • Phallic • Latency • Genital • Advantages to this theory • Helped establish field of psychology • Emphasized importance of childhood

13. Updates to Psychoanalytic Theory • Object relations theory—importance of relationship with caregiver is key. • Melanie Klein—healthy relationships as infants lead to healthy relationships as adults • Attachment theory—Bowlby 1969, Ainsworth, 1978 • Secure, ambivalent, avoidant, disorganized

14. Biological Model • Hippocrates—somatogenesis • Late 1800s, bio causes for everything • Varies by genetic and constitutional factors, neuroanatomy, rates of maturation • Neural plasticity—malleability • It is rare to find a disorder that is completely bio in origin • Diathesis-stress model

15. Genetic Contributions • ADHD—multiple genes, Huntington’s Chorea—single gene • Heritability—proportion of variation in a given trait that is genetic/inherited • Concordance rates—MZ, DZ, adoption

16. Neurobiological Contributions • Brain structure & function • Many locations, particularly frontal lobes • Damage to brain pre or post-natally • Accident • Illness • Malnutrition • Toxic substances • Neurotransmitters • Implicated in many disorders • Not as well understood in kids

17. Psychological Factors • Emotional influences • Reactivity—differences in threshold and intensity of expression of emotion & regulation • Temperament • Easy—positive affect and approach • Difficult—negative affect or irritability • Slow to warm—fearful or inhibited

18. Behavioral Theories • The connection with developmental psychopath really began with Watson • Operant conditioning • Some disorders are more linked to behavioral contingencies than others. For example, phobias, enuresis, oppositional problems • We will talk about this theory more when we discuss tx • Social learning theory

19. Cognitive Behavioral Theories • Observable behavior can be influenced by mental processes • Particularly useful as a theory for depression (but others as well) • Automatic thoughts—immediate, unquestioned thoughts when faced with a new or recurrent situation • Cognitive distortions-help develop and maintain symptoms

20. Family Systems Theory • The child is only the identified • Child’s problems are a reflection of family problems or problems in marital relationship • Families want to maintain homeostasis • Family structures and alliances are often disrupted • Communication is also often disrupted • Can be enmeshed or disengaged

21. Bronfenbrenner’s Ecological Systems Theory • There are many systems and settings to be considered when trying to understand the etiology of problems • Macrosystem—beliefs and values of the culture • Exosystem-social structures • Mesosystem-interconnections between various community systems • Microsystem-child’s immediate environment • Ontogenic development—the child’s own internal development and adaptation

22. Ethics in Working with Children and Families • Competence—can’t just deem yourself competent • Multiple relationships—also known as dual relationships • Informed consent and assent—must inform about the kind of therapy or assessment • Also—must clarify who is the client and what role each person plays

23. Confidentiality and Limits to Confidentiality • Suicide, homicide, and abuse of a dependent person • Tarasoff—duty to warn • Involuntary commitment • Children’s legal rights in treatment decisions • Children can’t be forced to participate, but can be forced to sit there

24. Research Ethics • IRBs • Non-harmful procedures • Incentives • Deception • Anonymity • Mutual responsibilities • Jeopardy • Informed consent and assent • Confidentiality • Informing participants of results

25. Research in Abnormal Child Psychology • Time frame of the study • Cross-sectional—possible cohort effects • Longitudinal designs—time consuming, expensive, drop outs, historical factors • Accelerated longitudinal designs aka sequential designs • Where do we get participants—schools, clinics, hospitals, community, laboratory

26. Just a Bit on Freud Himself • Born 5/6/1856 in Freiburg, Moravia (now Pribor, Czech) to a 40 yo wool merchant father on his 2nd marriage—remote and authoritarian. • Mother—Amalie—more nurturing • Had 2 older ½ brothers, but had nephew 1 yr older • 1859 moved to Leipzig for economic reasons • 1860—to Vienna where Freud stayed until 1938 when Nazis came • Had brother Julius—one year younger, died in 1858 • Sister Anna • Age 17—moved by curiosity about human concerns • Became physician in his 20s • Trained as a neurologist under Charcot and then under Breuer. • With Breur treated Anna O in 1895, began to develop own ideas after that

27. Dora • Dora began to suffer from a hysterical cough and loss of voice • Threatened to kill herself • Freud found multiple sexual conflicts • Dora’s father was having an affair with Frau K, whom Dora had adored • Dora envied both of the lovers and felt betrayed by both • Frau K’s husband was attracted to Dora and Herr K made advances to Dora • Dora’s father didn’t believe her, but Dora was also attracted to Herr K and had fantasized marrying him but Dora learned he’d been having an affair with the governess and she was mad. • But Dora quit tx abruptly

28. Dora’s Outcome • Freud had had high hopes for the tx. Wrote it up in only 3 wks • Book was written as a follow up to Freud’s dream book. Not intended to convey every treatment utterance. • In April 1902, 15 mos after termination, Dora reappeared. She had improved. Had visited Ks—got Frau K to admit affair and Herr K to admit advances. • In Oct. 1901—1 yr after beginning therapy, Dora lost her voice again after she bumped into Herr K on the street. He stopped and was run over by a carriage. He survived and her voice got better. • Later Dora married and Freud wrote that she was “reclaimed by the realities of life”

29. The Real Dora • Ida Bauer, born 1882 in Vienna of Bohemian Jewish ancestry • Dora's father, Philip Bauer, was a wealthy textile manufacturer. • Dora's brother, Otto Bauer, became a leading figure in the Austrian Social Democratic Party, a Marxist theorist who specialized in the question of nationality and nationalism. • Dora married in 1903 at the age of twenty-one. • She continued to suffer from a variety of psychosomatic ailments throughout her life. • One of her few satisfactions, a later analyst reported, was that she knew herself to be the subject of one of Freud's most famous case histories.

30. Hysteria • Originally “wandering uterus”—therefore only women • Multiple somatic complaints without any obvious medical cause • Overtime took on connotation of exaggerated or overly dramatic • Take overpowering anxiety and convert it into sx (conversion hysteria)

31. Assessment • Developmental considerations: age, gender, cultures • Many purposes of assessment • Determine levels of problematic emotions and behaviors • Determine range of problematic emotions and behaviors • Help identify any appropriate diagnoses • Identify strengths and competencies • Evaluate efficacy of treatment by assessing before, during, and after tx • Determine etiological factors of problem • Identify children at risk for dev problems in the future • Establish prognosis and tx planning

32. Effective Assessment (Prevatt, 1999) • Prereferral used—may be able to intervene before an assessment • Ecologically based assessment • Multimodal • Emphasis on family/school environment • Avoidance of label/pathology based approach • Emphasis on why things occur • Outcome-based • Adherence to legal and ethical guidelines • Uses tests with good psychometric properties—reliable, valid, adequate normative data, cost effective • Intervention focused • Strengths and weaknesses • Learning-based strategies, school, family and community strategies • ? need for consultations

33. Must choose between depth and breadth in assessment • Should be multimethod—using several types of techniques and should use multiple informants

34. The most common technique Unstructured, semi-structured, structured Rapport Weaknesses of unstructured interviews—not very reliable, may go off on tangents as they come up Structured and semi-structured are more reliable. May be used in combination. Should cover Parent and child History of current difficulties Child’s educational hx Home environment Expectations for child Child’s strengths and competencies Parent only Details of pregnancy and birth Developmental hx Medical hx Family characteristics and hx Child’s interpersonal skills Child only Job hx and goals Sexual involvements Friendships Illicit substances Interviews

35. Behavioral Assessment • Behavioral observation • structured or unstructured • look for antecedents and consequences • most often done in schools • A-Antecedent, B-Behavior, C-Consequences • Functional assessment • evaluation of actual behaviors and child’s ability to perform these • Self-monitoring • allows child to keep track of a specific behavior by recording its occurrence • Concern with all of these techniques: reactivity

36. Checklists and Rating Scales • Not very expensive, widely used • Most take 5-15 minutes • Broad measures: CBCL, TRF, YSR • Specific measures: CDI, Conners, STAI-kiddie • Concern—parents’ pathology may increase ratings of kids’ problems. Kids may downplay problems. • When looking at CBCL, TRF, YSR • Those in similar roles (parent-parent) corr about .6, adults in different roles (parent-teacher) corr about .3, children with adults corr about .2 • All corrs are higher for externalizing. • Why?

37. Personality Assessment • Ask about functioning without asking about specific behaviors • Personality inventories—MMPI-A • Projective measures • Ambiguous stimuli onto which individuals project ideas and feelings. • Many types-Rorschach, TAT/CAT/RAT, DAP.

38. Intellectual and Educational Assessment • Intelligence tests • Most commonly employed assessment device beyond interviews • WISC-IV—10 mandatory, 5 supplementary scales. • Stanford-Binet • Both M= 100 sd=15 or 16. • Criticisms • Cultural loading and school based quality of some tests • Focus on speed of responses to detriment of methodical kids • View of IQ as rigid and inflexible • Using IQ tests makes IQ real and not a construct. • Educational tests—Woodcock-Johnson, WIAT, WRAT

39. Neuropsychological Testing • Primary purpose • Find the implications of brain-related deficits and lesions • Much more specific than broader measures • Areas • Perceptual/sensory • Motor functions • Verbal functions/language/communication • Attention/learning/processing • Non-verbal functions

40. Strengths and Weaknesses of Testing • Strengths of standardized testing • Many tests—finding a good one in your area shouldn’t be hard • Identifies strengths and weaknesses from a variety of perspectives • Weaknesses of testing • Assumes that everyone is motivated and honest • Some techniques may be biased

41. Classification and Diagnosis • In dx, we use either categories or dimensions • Keys to a classification system • Must be clearly defined • Groups or dimensions must exist (go together regularly) • Reliable—get same dx across observers • Valid—provide us with useful info, not overlap with other dx • Clinical utility

42. Clinically Derived Systems • From a consensus of clinicians about which sx usually go together • DSM-American (ICD-10-other countries) • Grew out of Kraepelin’s initial classification in 1883 • 1952-DSM-I had 2 categories for children-Adjustment reaction and childhood schizophrenia • Adultomorphism • 1968—DSM-II—new section “Behavior Disorders of Child and Adolescence” • 1980—DSM-III—multiaxial • Now DSM-IV-TR • 5 axes • I—Clinical disorders • II—Developmental disorders, personality disorders • III-General medical conditions • IV—Psychosocial stressors • V-Global assessment of functioning 0-100

43. Strengths and Weaknesses of the DSM • Reliability—test-retests is fair for dx such as ADHD, CD, ODD--.51. to .64 • Inter-rater is better for some than others—autism .85, ODD .55 • Strengths—common diagnostic language • Wide acceptance and use • Multiaxial • Weaknesses—usually used for classification (not for understanding or tx) • Medical model • Reliability for kids and adolescents behind adults • Very complex • Labeling • Self-fulfilling prophecies

44. Empirically-based Taxonomies • Collect info in a standardized manner from a large N of kids • Analyze data through statistical means • Explore associations between sx • Develop scales based on these behavioral items • CBCL by Thomas Achenbach

45. Therapeutic Interventions • Settings for interventions • Inpatient settings • Residential tx facilities • Group homes/therapeutic foster care homes • Day hospitals • Outpt settings • School based mental health services

46. Involvement in Treatment • Flisher et al 1997—at least 17% of kids and adolescents with severe psychopathology never receive tx • Goodman et al 1997—compared with those who do not receive services, those who do… • Experienced higher levels of psychopathology • Showed lower levels of competence • More likely to have comorbid disorders • More likely to be non-Hispanic Caucasians • Less likely to be prepubertal girls • Tended to have parents who were • More educated • More dissatisfied with their family functioning • Less involved in monitoring children’s behavior • More likely to have received tx themselves

47. Who drops out? • High SES less likely to drop out • Attrition is lower when the whole family is involved • Most parent factors are not significant • Congruence between parental expectations and treatment recommendations is related to lower attrition • More coercive referral sources are more likely to drop out

48. Does therapy work? • Consumer Reports surveys say pts are satisfied, but does it work? • Outcome studies—waitlist controls, no treatment controls, attention-placebo control, standard tx/routine care control • Casey and Berman 1985—first large scale meta-analysis • Tx outcome for those 12 and younger—64 studies—single ES for each study • Mean ES .71 -across studies the avg treated child functioned better after tx than 76% of control kids • Most tx (other than dynamic) were more effective than no tx • Behavioral somewhat better than non-behavioral • Worked whether play or no-play and parents and kids vs kids only • Tx is somewhat more effective for specific problems than for social adjustment problems • Tx effective across observers • Other meta-analyses have found very similar things

49. The Next Step in Efficacy • Goal now is to establish empirically supported tx for specific problems • Two categories • Well-established tx • Probably efficacious tx (new tx that appears effective from 1 or 2 high-quality studies) • Problem—clinic vs. research tx—generally clinic is less effective

50. One technique to discuss across tx Problem: young kids are less verbal, so play tx uses play to concretize communications 2 primary perspectives Dynamic—kids can’t do verbal free association Now dynamic people view play as a mode of expression Client-Centered Axline—basic principles of CCT—unconditional + regard, accurate empathy, genuiness Non-directive Not a great deal of support for play therapy as a stand-alone technique Typical play therapy room contents: Tactile materials Drawing materials Dolls and dollhouses Hand puppets Nerf balls Blocks Communication facilitators Play Therapy