© cengage learning 2016 eric j. mash david a. wolfe introduction to normal and abnormal behavior in...
TRANSCRIPT
© Cengage Learning 2016 © Cengage Learning 2016
Eric J. MashDavid A. Wolfe
Introduction to Normal and Abnormal Behavior in
Children and Adolescents
1
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Introduction
• Research studies in abnormal child psychology seek to:– Define normal and abnormal behavior for
children of different ages, sexes, and ethnic and cultural backgrounds
– Identify the cases and correlates of abnormal behavior
– Make predictions about long-term outcomes
– Develop and evaluate methods for treatment and/or prevention
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Features That Distinguish Child and Adolescent Disorders
• When adults seek services for children, it is not often clear who has what “problem”
• Many child and adolescent problems– Involve a failure to show expected
developmental progress
– Are not entirely abnormal
• Interventions are often intended to promote further development
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Historical Views and Breakthroughs
• Ancient Greek/Roman view – The disabled were a burden - scorned,
abandoned, or put to death
• Before the 18th century – Children were subjected to harsh treatment
and largely ignored
• By end of 18th century – Interest in abnormal child behavior surfaced
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• John Locke (17th century)– Believed children should be raised with
thought and care, not indifference and harsh treatment
• Jean-Marc Itard (19th century)– Focused on the care, treatment, and training
of “mental defectives”
The Emergence of Social Conscience – Locke and Itard
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• Leta Hollingworth – Distinguished individuals with mental
retardation (“imbeciles”) from those with psychiatric disorders (“lunatics”)
• Benjamin Rush– Claimed that children were incapable of adult-
like insanity• Children with normal cognitive abilities but
disturbing behavior suffer from “moral insanity”
The Emergence of Social Conscience – Hollingworth and Rush
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Early Biological Attributes
• Late 19th century: mental illnesses were viewed as biological problems– This was thwarted by the prevailing bias that
the individual was at fault for deviant or abnormal behavior
• Clifford Beers’ efforts led to detection and intervention
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Early Biological Attributes – Eugenics and Sterilization
• Early 20th century: society reverted to a belief that disorders could not be influenced by treatment or learning– There was a return to custodial care and
punishment of behaviors
• Mental disorders viewed as “diseases” led to fear of contamination– Eugenics (sterilization) and segregation
(institutionalization) were implemented
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Early Psychological Attributes – Psychoanalytic Theory
• Linked mental disorders to childhood experiences and surroundings– Focused on the interaction of developmental
and situational processes
• Purported that mental disorders can be helped with proper environment or therapy
• Retains a role as a model for abnormal child psychology
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Early Psychological Attributes – Behaviorism
• Laid the foundation for evidence-based treatments
• Key studies– Pavlov’s research on classical conditioning
– Watson’s studies on the elimination of children’s fears and the theory of emotions
• Famous study: Little Albert
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• 1930 to 1950: psychodynamic approaches prevailed– Most children with intellectual or mental
disorders were institutionalized
• Late 1940s: Spitz’ studies pointed out the harmful impact of institutional life
• 1945 to1965: institutionalization decreased– Placement in foster care and group homes
increased
Evolving Forms of Treatment – Psychodynamic Approaches
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Evolving Forms of Treatment – Behavioral Approaches
• 1950s and early 1960s: behavior therapy emerged as a systematic approach to treatment of child and family disorders
• Behavior therapy is a prominent form of therapy
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• IDEA (Individuals with Disabilities Education Act) requires: – Free and appropriate public education for
children with special needs in the least restrictive environment
– Each child must be assessed with culturally appropriate tests
– An individualized education program (IEP) for each child
Progressive Legislation – IDEA
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• United Nations General Assembly (2007) adopted a new convention to protect the rights of persons with disabilities– The convention supports the attitude of
considering persons with disabilities as individuals with human rights
Progressive Legislation – The UN
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What Is Abnormal Behavior in Children and Adolescents?
• Childhood disorders are accompanied by various layers of abnormal behavior or development
• Must also be sensitive to each child’s stage of development
• Disorders are commonly viewed as deviancies from normal– Boundaries between normal and abnormal
functioning are arbitrary
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Defining Psychological Disorders
• Patterns of behavioral, cognitive, emotional, or physical symptoms linked with one or more of the following: – Distress
– Disability
– Increased risk for further suffering or harm
• Culture and circumstances matter
• The characteristics describes behaviors, not causes
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• Stigmatization is a challenge– Separate the child from the disorder
– Problems may be the result of children’s attempts to adapt to abnormal or unusual circumstances
• According to DSM-5 guidelines– The primary purpose of using terms is to help
describe and organize complex features of behavior patterns
Labels Describe Behavior, Not People
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• The ability to successfully adapt in the environment– Successful adaptation is influenced by culture
and ethnicity
• Abnormal child psychology considers:– The degree of maladaptive behavior
– The extent to which normal developmental milestones are met
• Knowledge of developmental tasks provides important background information
Competence
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Examples of Development Tasks
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• The sequence and timing of particular behaviors as well as the relationships between behaviors over time
• Two types of developmental pathways– Multifinality - various outcomes may stem
from similar beginnings
– Equifinality - similar outcomes stem from different early experiences and developmental pathways
Developmental Pathways
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Multifinality and Equifinality
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• There are many contributors to disordered outcomes in each child
• Contributors vary among children who have the same disorder
• Children express features of their disturbances in different ways
• Pathways leading to particular disorders are numerous and interactive
Key Considerations in Developmental Pathways
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• Risk factor: a variable that precedes a negative outcome of interest– Examples: chronic poverty, care-giving
deficits, parental mental illness, death of a parent, disasters, and family breakup
• Protective factor: a personal or situational variables that mitigates a child developing a disorder
Risk Factors and Protective Factors
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Resilience
• The ability to fight off or recover from misfortune– Associated with strong self-confidence,
coping skills, avoiding risk situations
– Connected to a “protective triad” of resources:• Strength of the child
• Strength of the family
• Strength of the school/community
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Characteristics of Those Who Display Resilience
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• One in eight children has a mental health problem (North American studies)– Many others are at risk for later development
of a psychological disorder
• The majority of children needing mental health services do not receive them
• The demand for children’s mental health services is expected to double over the next decade
The Significance of Mental Health Problems Among Children and Youth
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The Changing Picture of Children’s Mental Health
• A better ability to distinguish among disorders has led to increased and earlier recognition of problems
• There is a greater awareness of younger children’s and teens’ unique mental health issues
• Evidence-based prevention and treatment programs are more prominent
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• Mental health problems are more likely in children:– From disadvantaged families
– From abusive or neglectful families
– Receiving inadequate child care
– Born with very low birth weight
– Whose parents have a mental illness or substance abuse problems
Prevalence of Mental Health Issues
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• New pressures and social changes may place children at increased risk for development of disorder
• Environmental stressors may:– Act as nonspecific stressors - bring about
poor adaptation or the onset of a disorder
– Affect the extent to which a child’s problems are attenuated or exacerbated
What Affects Rates and Expression of Mental Disorders?
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• One in five children in the U.S. and one in seven in Canada live in poverty– Native American/First Nations and African
American children are at greatest risk
• Poverty is associated with:– Impairments in learning ability and school
achievement, less education, low-paying jobs, inadequate health care, single-parent status, poor nutrition, and exposure to violence
Poverty
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• Poverty’s impact on children– More conduct problems, chronic illness,
school problems, emotional disorders, and cognitive/learning problems
• Poverty indirectly impacts children’s adjustment, which affects learning and mental health
Socioeconomic Disadvantages Associated with Poverty
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• Boys and girls express problems differently
• Certain disorders are more common in boys than girls, and vice versa– Aggression is expressed more directly by
boys; expressed more indirectly by girls
• Sex differences appear negligible in children under age three– Disparities increase with age
Sex Differences
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Externalizing Problems
• Higher in boys than girls in preschool and early elementary years– Exhibited as acting-out behaviors, e.g.,
aggression and delinquency
• Rates for boys and girls converge by age 18
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Internalizing Problems
• Higher rates in girls
• Associated with: – Anxiety, depression, or withdrawn behavior
– Somatic complaints
– Eating disorders
– Emotional disorders with peak age of onset in adolescence
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Trajectories of Externalizing and Internalizing Problems
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• Types of childrearing environments that predict resilience– For boys:
• A male role model
• Structure and rules
• Encouragement of emotional expressiveness
– For girls:• Households that combine risk taking and
independence with support from female caregiver
Sex Differences and Resilience
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What is Race?
• Most cultural anthropologists see race as a socially constructed concept, not a biological one
• Minority children in the U.S. are overrepresented in rates of some disorders – Substance abuse, delinquency, and teen
suicide
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• When controlling for other effects (SES, gender, age, referral status)– Few differences emerge in relation to race or
ethnicity
• Barriers remain in access to, and quality and outcomes of, care for minority children– Minority children face multiple disadvantages,
including poverty and marginalization
The Effects of Race and Ethnicity
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• Values, beliefs, and practices that characterize a particular ethnocultural group– Contribute to development and expression of
children’s disorders
– Affect how people/institutions react to children’s problems
– Affect how problems are expressed
What is Culture?
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Culture and Diversity
• Important not to generalize research from one culture to another
• Social and cultural beliefs and values influence:–The meaning given to behaviors
–The way in which behaviors are responded to
–The forms of expression and their outcomes
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• Nearly one million cases of child abuse and neglect occur in the U.S. each year
• Estimate: more than one-third of 10- to 16-year-olds experience physical and/or sexual assaults
• Acts of violence contribute to PTSD, major depressive disorder, or substance abuse/dependence
Child Maltreatment and Non-Accidental Trauma: Prevalence
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Child Maltreatment and Non-Accidental Trauma: Consequences
• Financial consequences of abuse and trauma: $124 billion per year in the U.S.
• More attention needs to be given to developing new ways to prevent and help those exposed to maltreatment and trauma
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• Early- to mid-adolescence is an important transitional period for healthy adjustment
• Issues during adolescence– Substance use, risky sexual behavior,
violence, accidental injuries, and mental health problems
• Special needs and problems of adolescents are receiving greater attention
Special Issues Concerning Adolescents and Sexual Minority Youths
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Special Issues: Lesbian, Gay, Bisexual,and Transgendered (LGBT) Youths
• LGBT youths in middle and high schools are more likely to be victimized by their peers and family members
• LGBT youths have higher rates of mental health problems
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• Impact is most severe when problems go untreated for extended periods of time– About 20% of children with the most chronic
and serious disorders:• Are least likely to finish school
• Are most likely to have social problems and psychiatric disorders
• Lifelong consequences associated with child psychopathology are costly
Lifespan Implications
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Lifespan Implications – Solutions
• Children can overcome major obstacles– When provided with circumstances and
opportunities that promote healthy adaptation and competence
• Major initiatives for prevention and intervention have resulted from recognition of children’s mental health problems
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Looking Ahead
• Children cannot advocate on their own behalf
• Viewing the whole child is the best strategy in understanding abnormal child and adolescent psychology
• Efforts to change policies and programs directed to- ward children and youths are gaining momentum