Goddard established one of the largest training schools for the mentally disabled (i.e. extremely low IQ) but did much to harm the attitudes towards these people. There were several obstacles that prevented child psychopathology to become a unique discipline.
Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 1
Goddard established one of the largest training schools for the mentally disabled (i.e. extremely low IQ) but did much to harm the attitudes towards these people. There were several obstacles that prevented child psychopathology to become a unique discipline:
Developmental psychopathology defines a system on human development as holistic (i.e. the whole child needs to be looked at) and hierarchical (i.e. moving toward increasing complexity). Recently, emphasis has been placed on finding protective and risk factors for the development of maladaptive behaviours in children.
To diagnose a child, information is necessary from several sources (e.g. school, home environment, sport team) to get a holistic image of this child. A case formulation refers to a hypothesis about why problem behaviour exists and how it is maintained. This formulation should be based on the longevity of problems (1), consistency of problematic behaviour across situational contexts (2) and family history (3).
To understand whether a behavioural pattern is normal or abnormal, it is essential to have an understanding of the range of behaviours normal at a certain age. Comparing behaviour to normal expectations can be done by using the four d’s, namely deviance, dysfunction, distress and danger.
Clinical decisions are often based on measures of the intensity (1), duration (2) and frequency (3) of the behaviour relative to the norm. The developmental stage of a child needs to be taken into account.
Stage of development and age | Task or limitations |
Birth to 1 year | Trust vs. mistrust. |
Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 2Multifinality should be understood in terms of protective and risk factors. Similar stressors can lead to different results as a result of protective or risk factors.
In longitudinal studies, people are followed and measured for a long period of time (e.g. 15+ years). These studies provide useful results but are very costly and often have a lot of attrition. In accelerated longitudinal studies researchers study several age groups at the same time and follow these groups for the next few years. This is faster than a longitudinal study but protects against cohort effects of cross-sectional studies.
Cross-sectional research refers to studies looking at different age groups at the same time and measuring these groups at one point in time. This does not provide information regarding developmental pathways and there may be cohort effects.
There are risk and protective factors across several areas of concern:
The level of influence are individual (1), family (2), peer (3), school (4), community (5) and other (6). There are several common risk factors and protective factors that influence behaviour problems and school failure.
Environmental context | Risk factor | Protective factor |
Community | Poverty, ineffective school policies. | Adequate social norms, effective school policies. |
School | Poor quality schools. | High quality schools. |
Peers | Negative peer influence or role models. | Positive peer influence or role models. |
Family | A low SES, history of parent psychopathology, marital conflict and harsh or punitive rearing. | Positive parent-child relationship. |
Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 3The purpose of diagnosis is to classify the problem within the context of other known behavioural clusters or disorders for the purposes of being able to draw on clinical knowledge regarding potential aetiology, course and treatment alternatives. The purpose of assessment is to diagnose the nature of the problem to ensure that the most appropriate treatment can be selected.
There are three questions that need to be answered by the clinician after the assessment:
The diagnostic method can be used to predict what types of measures might be selected. Classifying child disorders can be done by using the categorical classification system or the empirical/dimensional classification system.
The diagnostic and statistical manual of mental disorders (DSM) and international classification of diseases (ICD) rely on the medical model (i.e. disorder is absent or present).
CATEGORICAL CLASSIFICATION (e.g. DSM) | |||
Bases of classification | Conceptualization of disorders | Strengths | Weaknesses |
Observation (1), matching symptom criteria (2), medical model and diagnostic categories (3) and structured and semi-structured interviews (4). | Present or absent (1), qualitative and distinct entities of homogeneous features (2), mutually exclusive distinct boundaries (3). | Widespread usage (1), tested using clinical trials (2), comprehensive documentation of disorder features (3). | Subjectivity (1), dichotomous (2), mutually exclusive and comorbid disorders (3) and reliability and validity issues (4). |
DIMENSIONAL CLASSIFICATION (e.g. BASC) | |||
Multirater scales (1), factor analysis (2), dimensions/levels/degrees (3), multirater rating scales (4). | Continuum or degree of disorder (1), adaptive to maladaptive range (2), empirically based normative benchmarks (3), multirater format (4), focus on syndromes of co-occurring problems (5), quantitative and continuous (6), two broad-band behavioural dimension (7) and externalizing and internalizing (8). | ||
Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 4Intellectual disabilities are not an actual medical condition. It is a label used to designate children with subnormal intellectual functioning (i.e. IQ < 70). The DSM-5 (1), AAIDD (2) and the educational system (3) are used for classification of intellectual disability. To be diagnosed with ID in any of the three systems, a low IQ (1), deficits in adaptive functioning (2) and age of onset prior to 18 years of age (3) must be present.
Global developmental delay refers to a diagnosis which indicates that a child is not meeting developmental expectations in some areas of intellectual development. This diagnosis is only given to children under the age of 5 and can be seen as a temporary category.
A developmental delay refers to a delay of 35% or more in one of five developmental areas (i.e. cognitive; motor; speech and language; social/emotional; adaptive functioning) or 25% in two or more. This definition of developmental delay is used by the educational system. It is a temporary category and requires further validation of definite disability in an area of functioning.
Children who lack stimulation or have been deprived of adequate opportunity to develop their cognitive skills may score very low on IQ tests. This makes it essential to assess whether deficits are the results of lack of opportunities or limitations in capacity. Adaptive functioning may be influenced by factors other than intellectual ability (e.g. comorbid conditions; deprivation).
Degree of severity | Conceptual | Social | Practical |
Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 5Attention-deficit/hyperactivity disorder (ADHD) consists of several subtypes:
Children younger than 17 years need six symptoms to receive a diagnosis whereas children older than 17 years only need five symptoms. Intellectual disability (1), communication disorders (2), autism spectrum disorders (3), attention-deficit/hyperactivity disorder (4), specific learning disorder (5) and motor disorders (6) are included in the neurodevelopmental disorder section of the DSM-5.
There are several symptoms for the inattentive presentation:
To be diagnosed with this subtype, a child must show six out of nine symptoms (1), the symptoms are pervasive across two or more settings (2), they interfere with performance (3) and they have been evident prior to 12 years of age (4). The disorder is classified as mild, moderate or severe depending on the number of symptoms and the impairment.
Children with the inattentive presentation are often undiagnosed and misunderstood. These children may be characterized by a sluggish information processing style (i.e. slow to process information) and there may be problems with focused or selective attention. They are unable to filter essential from non-essential details. The lack of attention to detail results from information overload and the inability to selectively limit the focus of attention. The inattention is often misinterpreted as a lack of motivation. They have a poor performance on tests because of their poor attention and their poor concept of time and time management.
There are several symptoms for the hyperactive-impulsive presentation:
There are also several impulsivity symptoms:
Children with the hyperactive-impulsive presentation experience academic problems because of their impulsive nature. They emphasize speed over accuracy and approach tasks incorrectly because they do not wait for all the instructions. They are at social risk because their inability to wait for their turn can make them unpopular. Children with ADHD often have poor social skills and have difficulties making and maintaining friendships. They often gravitate towards other rule-breaking children and this can lead to other behavioural problems.
Children with the combined presentation must meet criteria for both the hyperactive-impulsive
.....read more Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 6Learning disability often refers to an intellectual disability. A specific learning disability or specific learning disorder often refers to dyslexia. Diagnosis was based on the discrepancy between an individual’s intellectual functioning and one’s academic functioning. However, it was not sure how this should be applied (1), critique that it favours older children and people with higher IQ (2) and concerns that this model is failure based (3).
Another method of diagnosing is response to intervention (RTI) which refers to a tiered system of interventions that can be applied and failure to respond is a criteria for SLD. However, this does not take IQ into account. According to the DSM-5, a specific learning disorder occurs when there are academic skills that are substantially and quantifiable below those expected for somebody’s chronological age. When a sensory deficit is present, the learning disorder must be in excess of what would be expected given that deficit.
Prevalence rates of SLD are 2% to 10% although this varies widely due to definitional issues. Children with learning disabilities have more social difficulties. Social skills deficits can represent an SLD though social deficits can occur without an academic deficit. Social skills deficits may also emerge prior to SLD and persist into adulthood. Children with a SLD are more often neglected or rejected by peers.
Social competence can be undermined in three ways:
Social competence refers to a trait that determines the probability of completing a social task in an acceptable way. Social skills refer to the behaviours that are exhibited in social situations that produce socially acceptable outcomes. People with SLD typically have low self-esteem and a poor self-concept.
There are five specific learning disabilities:
Dyslexia is the most prevalent specific learning disability. In dyslexia, the reading problems are not caused by general cognitive limitations or other environmental factors
.....read more Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 7One-year prevalence of anxiety disorders in childhood and adolescence are 13%. Anxiety disorders regard chronic worry about current or future events and have common behavioural (e.g. escape and avoidance), cognitive (e.g. negative appraisal) and physiological (e.g. involuntary arousal; increased heart rate) symptoms.
There are six forms of anxiety that can exist in children:
Separation anxiety disorder, selective mutism and specific phobias are the earliest-occurring anxiety disorders. GAD typically has an onset from 8 to 10 years of age. Social anxiety and panic disorder mainly occur in adolescence.
Disorder | SEPARATION ANXIETY DISORDER |
Clinical description | These children experience developmentally inappropriate intense feelings of distress upon separation of the caregiver lasting for at least four weeks. The disorder manifests itself before 18 years of age and 6 is early onset. School refusal is common with this disorder. |
Symptoms | At least three of the following for at least four weeks:
|
Prevalence and course | The prevalence is 4% in general populations but up to 10% in clinical populations. It is more frequent in females than in males and is comorbid with GAD, depression and somatic complaints. It may be a precursor for increased risk for disorders in adulthood (e.g. depression; anxiety disorders) and agoraphobia and panic attacks for females in adulthood. |
Aetiology | A lot of children with SAD have mothers with a history of anxiety disorders. Overprotectiveness and reinforcement of the child’s avoidance behaviours can maintain SAD. This can be the result of maternal depression and family dysfunction. |
Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 9Autism spectrum disorder refers to disorders that meet criteria in two broad symptom categories:
- Deficits in social communication and social interaction
There must be deficits in social-emotional reciprocity (1), non-verbal communication (2) and the development and maintenance of relationships (3).
- Restricted repetitive patterns of behaviour
There must be two of four symptoms present (i.e. motor movements; rituals; fixated interests; hyper/hypo response to sensory information).
75% of the people diagnosed with autism also have an intellectual disability. However, this may be different in the DSM-5. The onset of ASD is during early development, around 2 years of age. Symptoms may not manifest until later in people with mild versions of the disorder or manifest earlier in people with more severe variants of the disorder.
The prevalence of autism is 1% and 4 times more males than females are diagnosed. The prevalence rate of ASD has been increasing but it is unclear whether this is due to an actual increase or differences in diagnostics. It is likely that the increase is due to better methodology and improved awareness.
Asperger’s syndrome may be a less severe type of autism though it may also be a separate category due to differences in language development. These children tend to have more verbal rituals and ask odd questions. The group with high-functioning autism (HFA) demonstrates more atypical speech patterns (e.g. echolalia, noun reversal, atypical gestures). It is difficult to differentiate high-functioning autism and Asperger’s syndrome solely on the basis of diagnosis.
Children with autism have difficulties with theory of mind. However, children with mild autism are able to solve these problems while children with more severe autism cannot.
Symptom category Examples
Qualitative and persistent impairment in social interaction and communication across three broad areas (three symptoms). • Social reciprocity: sharing, social referencing, initiating, maintaining interaction.
• Non-verbal communication: lack of eye contact, gestures, facial expression.
• Maintaining and developing social interactions: deficits in adapting behaviour to context, imaginary play, engaging with peers
Restricted, repetitive patterns of behaviour or activities (2 symptoms). • Repetitive speech, non-functional activities, echolalia.
• Need for sameness: rituals.
• Preoccupation and fixedness on topics or parts of objects or themes.
• Hyper- or hypo-responsiveness to sensory stimuli.
Referential looking refers to shifting the gaze between the caregiver and the object of interest. This occurs around six to nine months of age and is followed by the active use of gestures to engage adults in reciprocal interaction. Children with autism may find comfort in hyper-focusing on a repetitive, non-functional task when their senses are overwhelmed.
It was first believed that autism was caused by a cold and non-nurturing way of raising the child (i.e. refrigerator mother). However, this is not the case. There is a strong genetic component of autism. In the case of twins, the chance is 1/3 that the other twin has autism as well. If this twin does not have
Patterson (2016). Coercion theory: The study of change.” – Article summaryAnti-social boys are less responsive to social reinforcement. Punishment only has short-term suppressive effects on behaviour. Punishment only seems effective in combination with positive reinforcement.
Coercion refers to a process during which aversive events are used to control the behaviour of another person (i.e. control behaviour using threats). A social action must be experienced by others as aversive and be used contingently to be part of the coercive process. An aversive event may serve any of the three functions:
These sequences are not pathological by themselves. A lot of the aversive events (e.g. attack) are positively reinforced by the victim (e.g. give up bicycle; cry). This leads to an increase in the probability of future effects on the victim. Peers and siblings may be important sources of positive reinforcement, especially for hitting.
Overlearned activities require very little active cognitive processing making it possible to do something else at the same time (e.g. driving and talking). Coercion may be overlearned. The effects of reinforcement and punishment contingencies found in family interaction sequences may be automatic, meaning that they are not mediated by thought or expectancies. Family therapy is very difficult because the coercion process is automatic.
In one intervention, it may be useful to provide clearly stated directives in neutral effect and follow-up with positive reinforcement for cooperation and small negative sanctions (e.g. time out) for non-compliance. This brings the overlearned aspects of coercion in the open.
The contingency theory states that everybody changes their behaviour in an effort to match the changes in contingencies one experiences in their social environment. Contingencies may operate outside of family members’ awareness or intention. This means that they may result in increasing reliance on aversive behaviour as a means of influence and control and lead to extended conflict which escalate in intensity.
When one member of a family engages in coercive behaviour, negative reciprocity is more likely (e.g. when the mother engages in aversive behaviour, the child is more likely to also respond negatively). This leads to a sequence that leads to increased coercion:
The presence of negative affect increases the risk. Longer chains of aversive events are more likely to escalate in
.....read more Matson, Beighley, Williams, & May (2014). Conducting diagnostic screening and assessment.” – Article summaryTo provide care to people with autism spectrum disorder (ASD), it is imperative to screen for this disorder and to adequately diagnose it. Early evaluation can be useful. Diagnosis is best accomplished with standardized tests, developmental history and a clinical interview. The prevalence of ASD is 110 per 10.000.
Early intensive treatments appear to have the best outcomes. This emphasizes the need for early screening and diagnosis. Early diagnosis is affected by reluctance to express concern by parents (1), failure to be provided prompt assessment and diagnosis (2) and a failure of parents or professionals to detect signs of ASD (3). While ASD is believed to exist at birth, there are no biological markers and assessment and diagnosis thus relies on standardized tests and behavioural observation.
Parent observations are useful for early detection, especially speech regression (1), loss of motor skills (2), poor visual tracking (3) and a lack of joint attention (4). Factors that helped differentiate children with ASD from children with no or another developmental disorder were less looking at others (1), failure to respond to their name (2), less eye contact (3) and fewer positive facial expressions (4).
People with ASD are so heterogeneous that it is unlikely that there will be one gold standard for a test. To assess ASD, three things need to be taken into account.
It is essential to have a structured observation and attempts to elicit core symptoms. Historical data on developmental milestones, socialization and communication also need to be collected. Parents may over or underreport symptoms, as reflected by the lack of correlation between the clinician and the parent reports. In this case, another caregiver may need to be used (e.g. grandparents).
Early diagnosis increases parental stress and this could negatively impact the child with respect to behaviour problems and treatment outcomes. Using the DSM-5 criteria for ASD lead to a decrease in the prevalence. The DSM-5 may have higher specificity compared to the DSM-4 but a lower sensitivity. This means that mainly females will be missed according to the new criteria.
ASD is characterized by deficits in social skills (1), verbal and non-verbal communication problems (2) and repetitive behaviours or interests (3). Social skills deficits involve problems understanding and responding to social information. This includes problems with social imitation (1), joint attention (2), orienting to social stimuli (3), face perception (4), emotional perception and expression (5) and symbolic play (6). Communication deficits are characterized by delayed and problematic language development. This includes echolalia (1), abnormal prosody (2) and pronoun reversal (3). Repetitive behaviours or interests refer to invariant motor movements and insistence on routines and circumscribed interests. It includes stereotyped movements (1), toe walking (2),, finger flapping (3) and
.....read more Neil, Moum, & Sturmey (2014). Comorbidity among children and youth with autism spectrum disorder.” – Article summary A psychiatric disorder refers to a significant dysfunction in an individual’s cognitions, emotions or behaviours that reflects a disturbance in the psychological, biological or developmental processes underlying mental functioning.
Comorbidity refers to two or more forms of psychopathology within the same person. For some, a second diagnosis requires symptom presentation without assumptions of causality (i.e. disorder one causes disorder two). For others, a second diagnosis requires the dysfunction to be significant enough to require treatment in addition to the primary condition.
There are several difficulties in assessing comorbidity in people with ASD:
Diagnostic overshadowing refers to not recognizing a second disorder because the problems are attributed to the first disorder. Intellectual disability is common in ASD. There are several benefits of having accurate and early recognition of comorbidity:
Comorbid disorders may cause impairment in learning, which makes the treatment of ASD more problematic. There are few standardized assessment tools to assess psychiatric symptoms among individuals with ASD. Tools developed to assess typically developing children cannot always be used because the validity has not been established for individuals with ASD.
It is not clear whether challenging behaviour is an atypical symptom of a comorbid psychiatric disorder. The severity of either ID or ASD may alter or mask the mental health symptomology presentation. It is imperative to study the relationship between individual and environmental factors that influence development of psychiatric disorders in children an youth with ASD. This may have a significant impact on a person with ASD’s vulnerability or resilience to developing particular disorders. Individual factors may include genetics (1), cognitive profile (2), diagnosis (3), Asperger’s syndrome (4), PDD-NOS (5) and self-management skills for coping with stress and aversive events (6). Environmental factors may include community placement and parenting style.
Problems arising from ADHD appear similar to core symptoms of ASD (e.g. impairments in social interactions; poor communication restricted and stereotyped interests). There are several common comorbid issues between ASD and ADHD:
Jessurun, Shearer, & Weggeman (2016). A universal model of giftedness – an adaptation of the Munich model.” – Article summary In the Munich Model of Giftedness (MMG), giftedness refers to a multi-factorized ability construct within a network of non-cognitive (e.g. motivation; interests) and social moderators which are related to the giftedness factors (i.e. predictors) and the exceptional performance areas (i.e. criterion variables).
Giftedness typically refers to the presence of a talent desired in the culture and the expression thereof. It does not necessarily mean an IQ of 130 or higher.
Intelligence typically refers to a computational capacity to procss a certain kind of information. This entails the ability to solve a problem in a particular cultural setting. This means that what is seen as intelligent depends on the culture. Intelligences are thus potentialities and not things that can be counted. Something can be seen as an intelligence when there is localization of the functions in a brain area (1), evolutionary relevance (2) and a set of symbols (e.g. letters) (3).
There are eight type of intelligences:
Everything a person does can be described as making use of one or more of these eight intelligences. Creativity and perseverance to a task differentiate intelligence and high-giftedness.
In the universal model of giftedness (UMG), there are three non-cognitive personality characteristics:
Renzulli (1978). What makes giftedness? Reexamining a definition.” – Article summary People have always been interested in giftedness although the areas of performance in which one might be recognized as gifted are determined by the needs and values of the culture. There is no consensus with regards to what giftedness is. The restrictiveness of definitions of giftedness can be expressed in two ways:
Giftedness is typically seen as multifaceted. Subjectivity of measurement is a problem in assessing giftedness as not every aspect of human life can be put into performance scales (e.g. art). One definition of giftedness is that gifted children are those who by virtue of outstanding abilities are capable of high performance. Children capable of high performance include those who have one or more of the following:
However, this definition does not include non-intellective (e.g. motivational) factors. Moreover, the high performance aspects are not separate (e.g. productive thinking may apply to a specific academic aptitude). Lastly, the categories are typically treated as mutually exclusive while this is not the case.
Gifted people typically possess a set of three interlocking clusters of traits:
The interaction among these clusters makes someone gifted. People have to score above average on each of the clusters but not necessarily in the superior range. None of the separate clusters is more important.
Persistence in the accomplishment of ends (1), integration toward goals (2), self-confidence (3) and freedom from inferiority feelings (4) are four personality factors that predict achievement among individuals with high intellect.
Giftedness consists of an interaction among the three clusters. Gifted children are those possessing or capable of developing this set of traits and applying them
.....read more Subotnik, Olszewski, & Worrell (2011). Rethinking giftedness and gifted education: A proposed direction forward based on psychological science.” – Article summaryThere are five views on giftedness:
However, giftedness may be a developmental process that is domain specific and malleable. The path to outstanding performance begins with potential but giftedness must be developed and sustained by way of training and interventions in domain-specific skills (1), the acquisition of psychological and social skills to pursue difficult new paths (2) and the individual’s conscious decision to engage fully in a domain (3).
The process of talent development consists of talent identification and talent promotion. There are several essential points when it comes to giftedness:
Giftedness does not manifest itself in the same way in children and adults. Giftedness refers to the manifestation of performance that is clearly at the upper end of the distribution in a talent domain even relative to other high-functioning individuals in that domain. In the beginning of giftedness, potential is key. Later, achievement becomes a measure of giftedness and lastly, excellence is what makes somebody gifted. Psychosocial variables play an essential role in the manifestation of giftedness at every developmental stage. These psychosocial variables are changeable and need to be cultivated.
Giftedness reflects the values of society (1), is typically manifested in actual outcomes (2), is domain-specific (3), is the result of the interaction between factors (e.g. biological and psychological) (4) and is relative to the extraordinary (5).
Ability is necessary but not sufficient for giftedness (1), interest and commitment to a domain are essential in becoming gifted (2), development of talent requires a substantial investment of time (3), the percentage of eminent adults is smaller than gifted children in every domain (4), developmental periods in which potential and eminence are recognized differ across domains (5), transitions across stages are largely a function of developed psychosocial skills (6) and the emergence of new domains allows for new opportunities to develop talent and eminence (7).
There are several beliefs which makes policy makers not too fond of gifted education:
Van Nieuwenhuijzen & Vriens (2012). (Social) Cognitive skills and social information processing in children with mild to borderline intellectual disabilities. – Article summaryChildren with mild to borderline intellectual disabilities (MBID) have problems with adaptive functioning in social situations and in peer relations. They are rejected more often and have problems building social relations. They show more aggressive behaviour, partially because of the lack of adequate social skills. Comorbidity is also common in MBID. Youth with MBID is overrepresented in the criminal justice system.
To show socially adaptive behaviour, complex social skills are needed. Adaptive social behaviour depends on social information processing (SIP). This refers to the way social information is encoded (1), behaviour of others is interpreted (2), own emotions are regulated (3), responses to the problem situation are generated, selected and enacted (4). Youth with MBID typically encode more negative information (1), have less assertive but more submissive problem solving skills (2) and have more aggressive problem solving skills (3).
Cognitive limitations may explain differences in SIP. Selective attention (1), working memory (2) and inhibition (3) may be the most important skills for SIP. Social cognitive skills such as perspective taking (1), emotion recognition (2), interpretation of emotional facial expressions (3) and the understanding and interpretation of social situations in general (4) are important conditions to be able to process social information adequately. Intent attribution depends on the interpretation of emotional facial expression.
People with MBID may be at higher risk for inadequate interpretation of others intentions and have inadequate SIP as a result of their problems with recognizing emotions.
There are several conclusions:
Working memory (1), emotion recognition (2) and interpretation (3) have unique contributions to social information processing. Working memory (1), perspective taking (2) and emotion recognition (3) have unique contributions to variance in encoding cues.
Cognitive skills predict social information processing in children with MBID, especially emotion recognition and interpretation skills. Emotion recognition and working memory skills help children to encode information more thoroughly.
Cline (2000). Multilingualism and dyslexia: Challenges for research and practice.” – Article summaryDyslexia refers to a language problem relating to the analysis of words in print. Identification of dyslexia often makes use of an exclusion criterion (e.g. IQ-achievement discrepancy) rather than several criteria. However, this exclusion criterion does not fit dyslexia properly as IQ tests in English are not reliable for a bilingual child whose language proficiency in English is still developing (e.g. immigrant children). The gap between indigenous and immigrant children decrease when immigrant children have been in the country for longer. This may lead children who are bilingual to not be identified as having a specific learning disorder (e.g. dyslexia).
IQ is likely to be underestimated in bilingual children while avoidance of IQ-tests will lead to under-identification. It may thus be useful to use a definition of dyslexia which does not make use of exclusionary criteria. Dyslexia is evident when fluent and accurate word reading and/or spelling develops very incompletely or with great difficulty. The problem is severe and persistent despite appropriate learning opportunities.
Differences in the orthography of a language influences the development of dyslexia. It is important to look at bilingualism in broad terms to properly detangle the effects of bilingual development on the development of dyslexia and vice versa. There are three dimensions to describe people’s associations with a language:
Only looking at monolingual and bilingual children may use overinclusive categories and may neglect the emotional importance and developmental impact of affiliation and inheritance factors. Literacy practices in school may contradict expectations brought from other experiences for some children. Contextual factors in bilingualism may play an important role in the outcome of a child with dyslexia. When a parent helps a child in learning, the parent needs to adjust one’s help to the preferences of the child to have the best outcomes.
| Social circumstances | Motive for learning second language | Investment in learning second language |
Elite bilingual | Parents work in high-status occupation away from home country. | Cultural enrichment. |
Stevens et al. (2003). Parent, teacher and self-reported problem behavior in the Netherlands (2003).” – Article summaryStructural adversity and rejection by the host country may cause stress and negatively influence psychological adaptation. Adolescents are at particular risk because they have to function in different cultural contexts (e.g. family; peers; institutions; ethnic community). Turkish adolescent immigrants show more internalizing and externalizing problems compared to Dutch natives. However, there is no consensus regarding the impact of migration on psychological development. Results may vary due to methodological difficulties. For example, parents, teachers and adolescents report different levels of behavioural and emotional problems. Next, there may also be differences between specific migrant groups regarding their culture (1), socio-economic status (2), level of education (3), migration history (4), position in the host country (5) and reception in the host country (6).
Moroccans may have to cross a wider cultural gap when migrating to the Netherlands than Turks due to the lower levels of literacy (1), education (2) and later development of democracy and industrialization (3).
Moroccan parents report less internalizing and externalizing problems than Turkish parents but more internalizing problems than Dutch parents. Teachers report more externalizing problems for the Moroccan children than for the Dutch and Turkish children. Moroccan adolescents report less internalizing problems than Turkish adolescents and less externalizing problems than both Turkish and Dutch adolescents.
Boys had higher externalizing problems (1), aggressive behaviour (2), delinquent behaviour (3) and attention problems (4). Girls had more somatic complaints. 12- 18 year olds had higher withdrawn and somatic complaint scores but lower aggressive behaviour than 4- 11 year old children. Young Moroccan children scored lower on delinquent behaviour compared to Dutch natives whereas adolescents scored higher. Gender differences in somatic complaints were less marked at a younger age.
Moroccan adolescents scored higher on delinquent behaviour and externalizing problems than Turkish adolescents whereas the opposite pattern occurred for young Moroccan and Turkish children. Differences between young Turkish and Moroccan immigrant children were greater than between adolescents.
Dutch adolescents had more self-reported somatic complaints (1), thought problems (2), attention problems (3), delinquent behaviour (4), aggressive behaviour (5), externalizing problems (6) and total problems (7) than Moroccan adolescents.
DISCUSSION
Moroccan parents reported similar levels of problems compared to Dutch parents. Teachers reported more externalizing problems for Moroccan children than for Dutch children. Moroccan adolescents reported less problems than Dutch adolescents. Moroccan parents reported less emotional and behavioural problems than Turkish parents. Similar patterns were present for the teacher and self-report between Moroccan and Turkish immigrants. Differences between Moroccans and Turks were most striking for children aged 4-11 years.
The found results may be explained by true differences in children’s behaviour (1), perceptual biases (2), social desirability (3), differences in parents’, adolescents’ and teachers’ thresholds to report child problem behaviours (4) and methodological limitations (5). Culture may influence expectancies and beliefs regarding children and this may influence the distress felt concerning particular kinds of child behaviour.
Van de Vijver & Phalet (2004). Assessment in multicultural groups: The role of acculturation.” – Article summaryAcculturation refers to phenomena which result when groups of individuals having different cultures come into continuous first-hand contact with subsequent changes in the original cultural patterns of either or both groups.
Gordon’s unidimensional acculturation model states that acculturation is a process of change in the direction of the mainstream culture. The outcome is adaptation to the mainstream culture. Unidimensional models are controversial as migrants more often desire to have a bicultural identity due to the increasing magnitude of migration and a change in the view of migrants (i.e. more accepting climate).
Berry’s bidimensional acculturation model states that the degree of acculturation depends on the degree of adaptation and the degree of cultural maintenance. This leads to several strategies:
It is important to take acculturation into account with assessment as it is necessary to know whether the person is part of the population on which an instrument has been tested and whether the instrument can measure the intended construct with that person (e.g. may not be possible due to implicit assumptions of the instrument about general knowledge). Acculturation can be a moderator of test performance.
A culture refers to a largely shared, unchanging and internalised sets of beliefs, values and practices which are transmitted across generations and which constrain human behaviour in context. Individuals differ in their level and strategy of acculturation. To measure acculturation, it may be useful to measure maintenance and adaptation dimensions (1), contact, change and identity aspects (2), domain specificity (3) and psychological and sociocultural outcomes (4).
Acculturation measures allow for different combinations of positive or negative attitudes towards adaptation (i.e. adjusting to the host culture) and maintenance (i.e. holding on to the original culture). There are three question formats to measure this:
The two- and four-question format appear to be most successful in discriminating between strategies. Hutnik proposed four identity strategies:
Van Gelderen et al. (2004). Linguistic knowledge, processing speed, and metacognitive knowledge in first- and second-language reading comprehension: A componential analysis.” – Article summaryLower order processes refer to the level of letter and word recognition. Higher order processes refer to the comprehension of the content of text. Efficient word recognition processes are necessary but not sufficient for the successful execution of reading tasks. It allows the reader to allocate optimal attention to the interpretation of meanings communicated in the text but are not sufficient because text comprehension comprises other components as well (e.g. general knowledge).
It is possible that reading comprehension in the second language (i.e. L2) is the application of higher order reading strategies of the first language on the second language. It is also possible that linguistic knowledge of the second language is important for a satisfactory level of text comprehension. Next, it is also possible that the efficient or automized processing of linguistic information is important for successful reading comprehension in the second language. This would thus mean that efficient lower order processing is important for attaining a level of reading skill in the second language with that already attained in the first language. However, it is not clear whether and how reading skills are transferred from the first to the second language.
Metacognitive skills in reading refer to the ability to use strategies to regulate the reading process. These skills are believed to be learned in the first language and transferred to second language reading. It is not clear whether first and second language reading depends on the same skills. The threshold hypothesis states that a threshold level need to be passed before second language readers can apply strategies for text comprehension (e.g. knowledge of vocabulary and grammar). There is no conclusive evidence for this hypothesis.
The speed of lower order processing (i.e. automaticity) may be important for second language reading. This would mean that more than linguistic knowledge is needed for the development of automatic word recognition. When lower order reading processes are inefficient, they will occupy working memory capacity which inhibits controlled, meaning-oriented processes. When it is automatic, working memory capacity can be fully devoted to text comprehension.
Reading comprehension in the first language is predictive of reading comprehension in the second language. It seems as if word recognition speed of the second language does not contribute to second language reading comprehension, though this result is correlational. Both first and second language reading comprehension are explained by combined skill components. However, for the first language only metacognitive knowledge is important whereas vocabulary knowledge and metacognitive knowledge is important for reading comprehension in the second language. Speed components do not contribute significantly to the reading comprehension of either language (i.e. processing speed). It seems as if higher order processing speed is important for reading comprehension of the first language. Processing efficiency on word and syntactic level are important for language two text comprehension. Word recognition speed is not an important factor for normal first language readers.
De Smetd & Gilmore (2011). Defective number module or impaired access. Numerical magnitude processing in first graders with mathematical difficulties.” – Article summaryChildren with mathematical difficulties have particular impairments in understanding and processing numerical magnitudes. The defective number module hypothesis states that a highly specific deficit of an innate capacity to understand and represent quantities leads to difficulties in learning number and arithmetic. The access deficit hypothesis states that mathematical difficulties originate from impairments in accessing numerical meaning (i.e. their quantity) from symbols rather than from difficulties in processing numerosity.
Infants and young children are able to understand and manipulate numerical magnitude information by means of non-symbolic representations (e.g. discriminate between large sets of dots). Non-symbolic representations are characterized by a distance effect. This holds that the numerical difference (i.e. distance) between two sets that need to be compared is small, performance is slower and less accurate than when the distance is large (e.g. comparing 7 to 442 is easier than comparing 23 to 22). This effect may occur due to overlapping internal representations of numerical magnitudes. A magnitude that is closer to another has a larger representational overlap and this makes it more difficult to compare. The size of the distance effect is an indicator for the preciseness of representations of numerical magnitudes and this effect decreases over development.
Mathematics development requires children to map symbolic representations (e.g. Arabic numerals) onto pre-existing non-symbolic representations of magnitudes. Children’s representations of magnitude (i.e. number line estimation task) is predictive of their learning of answers to novel mathematics problems. Representations of magnitude are impaired in children with mathematical difficulties.
In the symbolic comparison task, children indicate the numerically larger of two simultaneously presented numbers. In the non-symbolic comparison task, the same happens but with dots rather than Arabic numerals. The symbolic approximate addition task refers to a task where, through a short story, an approximation between two numbers is made to assess which number is larger. In the non-symbolic approximate addition task, the same happens but with dots rather than numerals.
Children with mathematical difficulties have impairments in the ability to access numerical magnitude information from symbolic representations. However, they are not compared on the non-symbolic task. This provides evidence for the access deficit hypothesis. It appears as if the access to representations of magnitude from symbolic numbers is impaired rather than the representation of magnitude by itself.
Children with severe mathematical difficulties score lower on tests of symbolic representation but not on tests of non-symbolic representations. Children with mild forms of mathematical difficulties have a similar but less severe performance pattern. Children with severe mathematical difficulties perform more poorly and develop at a slower rate than their typically achieving peers. Children with mild forms of mathematical difficulties perform more poorly but developed at the same rate as their typically achieving peers.
Children who have difficulties in accessing numerical meaning from symbols are at risk of developing more immature counting strategies and may acquire more arithmetic facts without meaning. This makes it more difficult to retrieve it from long-term memory. Schools should provide opportunities where children learn to connect symbols and the quantities
.....read more Landerl, Fussenegger, Moll, & Willburger (2009). Dyslexia and dyscalculia: Two learning disorders with different cognitive profiles.” – Article summaryDyslexia refers to a specific deficit in the acquisition of reading. Dyscalculia refers to a specific deficit in the acquisition of arithmetic skills. The prevalence rates for these disorders are four to seven percent and are often comorbid.
The common deficit account states that in the case of comorbid dyscalculia and dyslexia, it may be caused by phonological-verbal deficits. Dyscalculia without reading difficulties may be related to a different cognitive profile. Reading difficulties seem to aggravate rather than cause math difficulties.
The domain-specific cognitive deficit account states that dyscalculia and dyslexia have two separable cognitive profiles. This means that a phonological deficit would underlie dyslexia whereas a deficit in the cognitive representation of numerosity underlies dyscalculia.
There are three subcomponents of phonological processing that are typically deficient in people with dyslexia:
It is unlikely that phonological awareness itself is relevant for arithmetic development as the sub-lexical phonology is not necessary for arithmetic. Phonological short-term and working memory may impact the development of number fact knowledge because it may be involved in holding and manipulating information when doing mental arithmetic. Deficits in lexical access could explain dyscalculia because it is needed to store and retrieve orthographic information.
A slow naming speed is characteristic for people with dyslexia whereas a slow naming speed for small quantities is characteristic for people with dyscalculia. Young children tend to overrepresent the spatial distance of small numbers resulting in a logarithmic function. During development and with experience, this number line becomes linear. Children with dyscalculia may have difficulties in developing this number line.
The number module refers to an innate capacity specialized for recognizing and mentally manipulating numerosity. A failure to develop this basic capacity would negatively impact the developmental trajectory of numerical and later arithmetic understanding. This is believed to be the cause of dyscalculia. Dyscalculic children may have difficulty in accessing number magnitude from symbols rather than in processing numerosity itself. However, this is not clear.
Children with dyslexia show deficits in phonological processing but age-adequate performance in tasks tapping into the number module. Children with dyscalculia showed deficits in basic numerical processing but not in the tasks assessing phonological awareness and RAN. The problems of the comorbid dyslexia and dyscalculia children are mainly additive from two separate underlying cognitive deficits.
Children with dyslexia have deficits in phoneme deletion and RAN. This is not influenced by children’s arithmetic skills. Their performance on numerical processing is comparable to children with typical development with the exception of the most difficult tasks, though these problems do not seem to result from deficiencies in the basic cognitive representation of numerosity.
.....read more Norton & Wolf (2012). Rapid automized naming (RAN) and reading fluency: Implications for understanding and treatment of reading disabilities.” – Article summaryThere is a dedicated brain area for acquiring oral language but not for written language (i.e. reading). The reading circuit consists of neural systems that support every level of language and includes visual and orthographic processes, working memory, attention, motor movements and higher-level comprehension and cognition. Each component works smoothly with accuracy and speed as reading develops automaticity (i.e. making reading more automatic).
Fluency (i.e. fluent comprehension) refers to a manner of reading in which all sublexical units, words and connected text and all the perceptual, linguistic and cognitive processes involved in each level are processed accurately and automatically so that sufficient time and resources can be allocated to comprehension and deeper thought. This means that reading needs to be both accurate and automatic.
Rapid automatized naming (RAN) refers to a mini-circuit of the later-developing reading circuitry. RAN tasks include naming a series of familiar items as quickly as possible and this requires the reading circuit and can thus be used to assess reading fluency. RAN tasks depend on automaticity within and across each individual component in the naming circuit. It is a universal process that predict the young child’s later ability to connect and automize whole sequences of letters and words with their linguistic information regardless of writing system. RAN may be predictive of later reading because it includes the ability to automate both the individual linguistic and perceptual components and the connections among them in visually presented serial tasks. RAN latencies are related to how automized the naming process is.
Reading difficulties can be developmental (e.g. dyslexia) and acquired (e.g. alexia). The core deficit in alexia includes a disconnection between the visual and verbal processes in the brain.
Phonological awareness refers to the explicit ability to identify and manipulate the sound units that comprise words. Deficits in phonological awareness is a core deficit in dyslexia. Reading development depends on the explicit awareness of the sounds of the language and young readers need to learn to match the phonemes of speech with the graphemes that represent them in print. However, a deficit in phonological awareness is not the sole cause of dyslexia and children with intact phonological awareness may be identified less often as having dyslexia. They will also be less likely to benefit from instruction focused on improving phonological awareness.
The double deficits hypothesis (DDH) states that children can be characterized in subgroups according on their performances on each set of processes (e.g. phonological awareness; RAN).RAN deficits indicate weakness in underlying fluency-related processes. Children with a double deficit (i.e. phonological awareness and RAN) are the most impaired readers. There should be a multidimensional approach to dyslexia and reading difficulties as there is not one underlying cause.
A task can be characterized as a RAN task if it involves timed naming of familiar stimuli presented repeatedly in random order. The time taken to name items is believed to be key. The tasks typically involve naming of
.....read more Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 1Goddard established one of the largest training schools for the mentally disabled (i.e. extremely low IQ) but did much to harm the attitudes towards these people. There were several obstacles that prevented child psychopathology to become a unique discipline:
Developmental psychopathology defines a system on human development as holistic (i.e. the whole child needs to be looked at) and hierarchical (i.e. moving toward increasing complexity). Recently, emphasis has been placed on finding protective and risk factors for the development of maladaptive behaviours in children.
To diagnose a child, information is necessary from several sources (e.g. school, home environment, sport team) to get a holistic image of this child. A case formulation refers to a hypothesis about why problem behaviour exists and how it is maintained. This formulation should be based on the longevity of problems (1), consistency of problematic behaviour across situational contexts (2) and family history (3).
To understand whether a behavioural pattern is normal or abnormal, it is essential to have an understanding of the range of behaviours normal at a certain age. Comparing behaviour to normal expectations can be done by using the four d’s, namely deviance, dysfunction, distress and danger.
Clinical decisions are often based on measures of the intensity (1), duration (2) and frequency (3) of the behaviour relative to the norm. The developmental stage of a child needs to be taken into account.
Stage of development and age | Task or limitations |
Birth to 1 year | Trust vs. mistrust. |
Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 2Multifinality should be understood in terms of protective and risk factors. Similar stressors can lead to different results as a result of protective or risk factors.
In longitudinal studies, people are followed and measured for a long period of time (e.g. 15+ years). These studies provide useful results but are very costly and often have a lot of attrition. In accelerated longitudinal studies researchers study several age groups at the same time and follow these groups for the next few years. This is faster than a longitudinal study but protects against cohort effects of cross-sectional studies.
Cross-sectional research refers to studies looking at different age groups at the same time and measuring these groups at one point in time. This does not provide information regarding developmental pathways and there may be cohort effects.
There are risk and protective factors across several areas of concern:
The level of influence are individual (1), family (2), peer (3), school (4), community (5) and other (6). There are several common risk factors and protective factors that influence behaviour problems and school failure.
Environmental context | Risk factor | Protective factor |
Community | Poverty, ineffective school policies. | Adequate social norms, effective school policies. |
School | Poor quality schools. | High quality schools. |
Peers | Negative peer influence or role models. | Positive peer influence or role models. |
Family | A low SES, history of parent psychopathology, marital conflict and harsh or punitive rearing. | Positive parent-child relationship. |
Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 3The purpose of diagnosis is to classify the problem within the context of other known behavioural clusters or disorders for the purposes of being able to draw on clinical knowledge regarding potential aetiology, course and treatment alternatives. The purpose of assessment is to diagnose the nature of the problem to ensure that the most appropriate treatment can be selected.
There are three questions that need to be answered by the clinician after the assessment:
The diagnostic method can be used to predict what types of measures might be selected. Classifying child disorders can be done by using the categorical classification system or the empirical/dimensional classification system.
The diagnostic and statistical manual of mental disorders (DSM) and international classification of diseases (ICD) rely on the medical model (i.e. disorder is absent or present).
CATEGORICAL CLASSIFICATION (e.g. DSM) | |||
Bases of classification | Conceptualization of disorders | Strengths | Weaknesses |
Observation (1), matching symptom criteria (2), medical model and diagnostic categories (3) and structured and semi-structured interviews (4). | Present or absent (1), qualitative and distinct entities of homogeneous features (2), mutually exclusive distinct boundaries (3). | Widespread usage (1), tested using clinical trials (2), comprehensive documentation of disorder features (3). | Subjectivity (1), dichotomous (2), mutually exclusive and comorbid disorders (3) and reliability and validity issues (4). |
DIMENSIONAL CLASSIFICATION (e.g. BASC) | |||
Multirater scales (1), factor analysis (2), dimensions/levels/degrees (3), multirater rating scales (4). | Continuum or degree of disorder (1), adaptive to maladaptive range (2), empirically based normative benchmarks (3), multirater format (4), focus on syndromes of co-occurring problems (5), quantitative and continuous (6), two broad-band behavioural dimension (7) and externalizing and internalizing (8). | ||
Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 4Intellectual disabilities are not an actual medical condition. It is a label used to designate children with subnormal intellectual functioning (i.e. IQ < 70). The DSM-5 (1), AAIDD (2) and the educational system (3) are used for classification of intellectual disability. To be diagnosed with ID in any of the three systems, a low IQ (1), deficits in adaptive functioning (2) and age of onset prior to 18 years of age (3) must be present.
Global developmental delay refers to a diagnosis which indicates that a child is not meeting developmental expectations in some areas of intellectual development. This diagnosis is only given to children under the age of 5 and can be seen as a temporary category.
A developmental delay refers to a delay of 35% or more in one of five developmental areas (i.e. cognitive; motor; speech and language; social/emotional; adaptive functioning) or 25% in two or more. This definition of developmental delay is used by the educational system. It is a temporary category and requires further validation of definite disability in an area of functioning.
Children who lack stimulation or have been deprived of adequate opportunity to develop their cognitive skills may score very low on IQ tests. This makes it essential to assess whether deficits are the results of lack of opportunities or limitations in capacity. Adaptive functioning may be influenced by factors other than intellectual ability (e.g. comorbid conditions; deprivation).
Degree of severity | Conceptual | Social | Practical |
Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 5Attention-deficit/hyperactivity disorder (ADHD) consists of several subtypes:
Children younger than 17 years need six symptoms to receive a diagnosis whereas children older than 17 years only need five symptoms. Intellectual disability (1), communication disorders (2), autism spectrum disorders (3), attention-deficit/hyperactivity disorder (4), specific learning disorder (5) and motor disorders (6) are included in the neurodevelopmental disorder section of the DSM-5.
There are several symptoms for the inattentive presentation:
To be diagnosed with this subtype, a child must show six out of nine symptoms (1), the symptoms are pervasive across two or more settings (2), they interfere with performance (3) and they have been evident prior to 12 years of age (4). The disorder is classified as mild, moderate or severe depending on the number of symptoms and the impairment.
Children with the inattentive presentation are often undiagnosed and misunderstood. These children may be characterized by a sluggish information processing style (i.e. slow to process information) and there may be problems with focused or selective attention. They are unable to filter essential from non-essential details. The lack of attention to detail results from information overload and the inability to selectively limit the focus of attention. The inattention is often misinterpreted as a lack of motivation. They have a poor performance on tests because of their poor attention and their poor concept of time and time management.
There are several symptoms for the hyperactive-impulsive presentation:
There are also several impulsivity symptoms:
Children with the hyperactive-impulsive presentation experience academic problems because of their impulsive nature. They emphasize speed over accuracy and approach tasks incorrectly because they do not wait for all the instructions. They are at social risk because their inability to wait for their turn can make them unpopular. Children with ADHD often have poor social skills and have difficulties making and maintaining friendships. They often gravitate towards other rule-breaking children and this can lead to other behavioural problems.
Children with the combined presentation must meet criteria for both the hyperactive-impulsive
.....read more Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 6Learning disability often refers to an intellectual disability. A specific learning disability or specific learning disorder often refers to dyslexia. Diagnosis was based on the discrepancy between an individual’s intellectual functioning and one’s academic functioning. However, it was not sure how this should be applied (1), critique that it favours older children and people with higher IQ (2) and concerns that this model is failure based (3).
Another method of diagnosing is response to intervention (RTI) which refers to a tiered system of interventions that can be applied and failure to respond is a criteria for SLD. However, this does not take IQ into account. According to the DSM-5, a specific learning disorder occurs when there are academic skills that are substantially and quantifiable below those expected for somebody’s chronological age. When a sensory deficit is present, the learning disorder must be in excess of what would be expected given that deficit.
Prevalence rates of SLD are 2% to 10% although this varies widely due to definitional issues. Children with learning disabilities have more social difficulties. Social skills deficits can represent an SLD though social deficits can occur without an academic deficit. Social skills deficits may also emerge prior to SLD and persist into adulthood. Children with a SLD are more often neglected or rejected by peers.
Social competence can be undermined in three ways:
Social competence refers to a trait that determines the probability of completing a social task in an acceptable way. Social skills refer to the behaviours that are exhibited in social situations that produce socially acceptable outcomes. People with SLD typically have low self-esteem and a poor self-concept.
There are five specific learning disabilities:
Dyslexia is the most prevalent specific learning disability. In dyslexia, the reading problems are not caused by general cognitive limitations or other environmental factors
.....read more Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 7One-year prevalence of anxiety disorders in childhood and adolescence are 13%. Anxiety disorders regard chronic worry about current or future events and have common behavioural (e.g. escape and avoidance), cognitive (e.g. negative appraisal) and physiological (e.g. involuntary arousal; increased heart rate) symptoms.
There are six forms of anxiety that can exist in children:
Separation anxiety disorder, selective mutism and specific phobias are the earliest-occurring anxiety disorders. GAD typically has an onset from 8 to 10 years of age. Social anxiety and panic disorder mainly occur in adolescence.
Disorder | SEPARATION ANXIETY DISORDER |
Clinical description | These children experience developmentally inappropriate intense feelings of distress upon separation of the caregiver lasting for at least four weeks. The disorder manifests itself before 18 years of age and 6 is early onset. School refusal is common with this disorder. |
Symptoms | At least three of the following for at least four weeks:
|
Prevalence and course | The prevalence is 4% in general populations but up to 10% in clinical populations. It is more frequent in females than in males and is comorbid with GAD, depression and somatic complaints. It may be a precursor for increased risk for disorders in adulthood (e.g. depression; anxiety disorders) and agoraphobia and panic attacks for females in adulthood. |
Aetiology | A lot of children with SAD have mothers with a history of anxiety disorders. Overprotectiveness and reinforcement of the child’s avoidance behaviours can maintain SAD. This can be the result of maternal depression and family dysfunction. |
Child and adolescent psychopathology by Wilmhurst (second edition) – Summary chapter 9Autism spectrum disorder refers to disorders that meet criteria in two broad symptom categories:
- Deficits in social communication and social interaction
There must be deficits in social-emotional reciprocity (1), non-verbal communication (2) and the development and maintenance of relationships (3).
- Restricted repetitive patterns of behaviour
There must be two of four symptoms present (i.e. motor movements; rituals; fixated interests; hyper/hypo response to sensory information).
75% of the people diagnosed with autism also have an intellectual disability. However, this may be different in the DSM-5. The onset of ASD is during early development, around 2 years of age. Symptoms may not manifest until later in people with mild versions of the disorder or manifest earlier in people with more severe variants of the disorder.
The prevalence of autism is 1% and 4 times more males than females are diagnosed. The prevalence rate of ASD has been increasing but it is unclear whether this is due to an actual increase or differences in diagnostics. It is likely that the increase is due to better methodology and improved awareness.
Asperger’s syndrome may be a less severe type of autism though it may also be a separate category due to differences in language development. These children tend to have more verbal rituals and ask odd questions. The group with high-functioning autism (HFA) demonstrates more atypical speech patterns (e.g. echolalia, noun reversal, atypical gestures). It is difficult to differentiate high-functioning autism and Asperger’s syndrome solely on the basis of diagnosis.
Children with autism have difficulties with theory of mind. However, children with mild autism are able to solve these problems while children with more severe autism cannot.
Symptom category Examples
Qualitative and persistent impairment in social interaction and communication across three broad areas (three symptoms). • Social reciprocity: sharing, social referencing, initiating, maintaining interaction.
• Non-verbal communication: lack of eye contact, gestures, facial expression.
• Maintaining and developing social interactions: deficits in adapting behaviour to context, imaginary play, engaging with peers
Restricted, repetitive patterns of behaviour or activities (2 symptoms). • Repetitive speech, non-functional activities, echolalia.
• Need for sameness: rituals.
• Preoccupation and fixedness on topics or parts of objects or themes.
• Hyper- or hypo-responsiveness to sensory stimuli.
Referential looking refers to shifting the gaze between the caregiver and the object of interest. This occurs around six to nine months of age and is followed by the active use of gestures to engage adults in reciprocal interaction. Children with autism may find comfort in hyper-focusing on a repetitive, non-functional task when their senses are overwhelmed.
It was first believed that autism was caused by a cold and non-nurturing way of raising the child (i.e. refrigerator mother). However, this is not the case. There is a strong genetic component of autism. In the case of twins, the chance is 1/3 that the other twin has autism as well. If this twin does not have
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