The terms classification, assessment and diagnosis are used to describe the process of description and grouping. Classification (or taxonomy) stands for creating large categories or dimensions of behavioural disorders. It is a system for describing phenomena. These systems are mostly for clinical or scientific purposes. A diagnosis is when a category or classification is considered applicable to an individual. Assessment refers to evaluating (young) people to facilitate classification and diagnosis and to make treatment plans.
Classification systems try to systematically describe a phenomenon. For example, biologists have classification systems for organisms, such as cold and warm-blooded animals. There are also systems for classifying psychological problems. These systems describe categories or dimensions of problem behaviour, emotions and / or cognitions.
A category is a discrete grouping, for example anxiety disorders, to which an individual belongs or does not belong. A dimension , on the other hand, is a continuous property that can occur in various sizes. For example, there are different degrees to which a child is anxious.
The categories or dimensions in a classification system must be clearly defined: the criteria must be explicitly named. In addition, a distinction must be made between the different categories. It must also be proven that a category or dimension actually exists, meaning that the characteristics used to describe a category or dimension must regularly occur together.
Classification systems must be reliable and valid. There are two types of reliability:
Validity refers to the extent to which a diagnosis provides us with more information than we initially had (before defining the category). Diagnoses must provide information about the origin, development and treatment of disorders. Another aspect of validity is the extent to which a description of a disorder is accurate.
The clinical utility of a classification system is assessed on the basis of the completeness and usability of the system in a practical scenario.
In the US, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is used most as a classification system. The International Classification of Diseases (ICD) is an alternative system that is also widely used. The Diagnostic Classification (DC) has been developed to classify the mental disorders of children between the ages of zero and three years old.
The DSM is a clinically derived classification system , based on the consensus of researchers that certain characteristics go together. Experts' committees propose concepts of disorders and choose diagnostic criteria.
In addition, the DSM is categorical : a child does or does not meet the criteria for a diagnosis. It is therefore assumed that there is a clear substantive difference between normal and abnormal behaviour and not a degree of difference. Categorical approaches therefore assume that a distinction can be made between qualitatively different types of disorders.
There have been several revisions of the DSM. The most recent revision is the DSM-IV. The DSM-IV contains information about a large number of disorders. These disorders are divided into different groups of related disorders. Every disorder has a description and a diagnostic criterion. In addition, information has been added about prevalence, the likely course of the disorder, cultural, age and gender-oriented information and any common characteristics (e.g. low self-confidence).
Initially, the classification of abnormal only focused on adult disorders and there was no comprehensive classification system for childhood and adolescent disorders. For some disorders the same criteria apply for children and adults and sometimes there are specific criteria for children.
Grouping of disorders
The disorders are grouped in the DSM-IV. Disorders within a group are seen as related by similar symptoms, cognitive processes, risk factors and the response to treatment, but different in the behaviour that’s showing.
Approach from the DSM
One of the aspects that is important when we talk about the approach to classification of the DSM is comorbidity. Of comorbidity (co-occurrence) occurs when a child meets the criteria of more than one disorder. This phenomenon causes some scientists to question the DSM as a classification system. Do these children really have multiple disorders or are there other explanations? There are several possible explanations for the occurrence of comorbidity:
Difficulties
The DSM has been improved several times over the years. For example, empirical data has been used in a more consistent way and structured diagnostic rules have been drawn up. Yet there are still difficult issues:
The empirical approach is an alternative to the clinical approach of, for example, the DSM. This approach uses statistical techniques to identify coherent behavioural patterns. A parent or other respondent provides information about the presence or absence of certain behaviour in the child. Three coded numbers are used for this: 0 = the behaviour does not occur with the child, 1 = the behaviour occurs to some extent with the child, 2 = the behaviour clearly occurs with the child. This information is obtained for a large number of young people. Factor analysis identifies groups of items that often occur together. This leads to factors (also called clusters). The term syndrome describes behaviours that often occur together.
The core of the empirical approach is therefore not formed by clinical consensus (the opinion of professionals), but by statistical information. With the empirical approach, evidence has been found for two general clusters of behaviours (broadband syndromes): (1) internalizing (anxious, withdrawn, depressed, shy and physical complaints) and (2) externalizing (aggressive behaviour and breaking the rules). Among other things, the Achenbach instruments are used to measure these two syndromes , such as the Child Behaviour Checklist (CBCL) for parents and the Teacher's Report Form (TRF) for teachers of children from 6 to 18 years and the Youth Self Report (YSR) for 11 to 18-year olds. These instruments can be scored so that they correspond to categories from the DSM.
In addition, there are eight empirical, less common syndromes found (narrowband syndromes):
The DSM versus the empirical classification system
There are several differences between the DSM and the empirical classification system:
Reliability and validity of the empirical approach
The test-retest reliability for the empirical approach is very high (0.8 to 0.9). The inter-assessor reliability is also reasonably good if two informants assess the behaviour of a child in the same situation. However, the inter-assessor reliability is much lower if the child is observed in two different situations. This does not have to be the result of the empirical approach but may be the result of differences in behaviour at different times, in different situations and in the presence of different people.
Various studies have demonstrated the validity of the empirical classification system. The same two general syndromes have been found in studies that use different measuring instruments, different types of informants and different samples. Studies from different cultures always show two similar syndromes, although there are probably cultural factors that contribute to the way a problem is expressed. Differences between children with high scores on different syndromes also say something about the validity of the empirical approach. The comparison between children that externalise and internalise shows that these children differ in the expression and regulation of emotion. Finally, syndromes discovered through the empirical approach can predict outcomes, such as future problems, and receiving psychological help. This fact supports the validity of the empirical and dimensional approach.
The purpose of classification is to facilitate the treatment of psychological problems. It is intended as a clinical and scientific venture but can also be considered as a social process. The diagnostic label places the child in a subgroup of individuals, which has implications for how he / she is approached by others. If the influence is negative, this may partly be due to the stigma associated with mental disorders. Stigmatisation refers to stereotypes, prejudices and discrimination that are associated with a socially devalued group. It is important to be aware that classification is meant for categorizing disorders instead of people. So it's better to say that James is dealing with aggressive issues rather than that James is an aggressive person.
Diagnosing someone with a mental disorder can have several negative consequences:
However, labels do not always lead to negative expectations. Labels can provide an explanation for the problem behaviour of the child. This creates more understanding of his / her behaviour, which reduces negative responses and adjusts expectations and more appropriate.
Finally, there is some fear that diagnosing leads to a minimization of attention to the child's interpersonal and social context. Traditional diagnostic categories ignore the fact that the child is never the sole "owner" of the problems, but that at least one other person has the problem: the person who identifies or reports the problem. The way in which a child is described says just as much about both the descriptive person and the child's behaviour.
However, categorization is part of our thought pattern and contributes to an increase in knowledge. Not categorizing is neither desirable nor possible. It is therefore important to improve classification systems and to pay attention to social factors inherent in the use of categories, the social status that a label entails and the influence of labels on the child and family.
Assessment
Because behavioural disorders often consist of multiple components and are the result of multiple factors, it is important to perform a comprehensive assessment. Information must be obtained from different informants, as problems can vary per context or in the presence of different people. Informers can also each view behaviour in a different way. For example, a depressed mother will be less capable with dealing and / or tolerating excited behaviour than a stable father might be.
It is desirable to use evidence-based assessments : procedures based on empirical evidence and theories that support validity. If a treatment is taking place, the assessment must be continued to evaluate the effects of the treatment.
The general clinical interview
The most commonly used assessment method is the general clinical interview, in which information about a child is obtained in all areas of executive functioning. Most clinicians gather information about the nature of the problem, current circumstances, feelings, perceptions, attempts to solve the problem and expectations regarding treatment. This information can also be used to make a treatment plan. The general clinical interview is unstructured: there are no specific questions that the clinician must ask, no predetermined set-up and no clear-cut way of coding information. This does make it difficult to assess its reliability and validity.
The structured diagnostic interview
Structured diagnostic interviews are designed to increase the reliability of interviews. They are also used to make a diagnosis based on a certain classification system (for example the DSM), for research or as a screening instrument. Structured diagnostic interviews consist of fixed questions. There are rules for how the interview is conducted and coded.
Questionnaires and self-reporting
With queries or questionnaires , numbers are assigned to the child's behaviour based on the seriousness of these behaviours. There are general checklists and checklists for more specific problems. If several informants fill in the questionnaire, a good picture can be created of the situational aspects of problem behaviour. Differences in perceptions of two informants can provide important information to situational or interpersonal context of behaviour.
Also, self-reporting is a way to get more information about the functioning of a child. In this case, the child assesses his or her own behaviour. Parents can also be asked to fill in a questionnaire about themselves, to find out if they have similar problems. In addition, this information can be obtained about the feelings, attitudes and beliefs of the adult with regard to the child. This can provide information about the social environment and factors that can influence problem behaviour, but is often harder to do regarding the mental functioning of children.
Behavioural observation
Structured behavioural observations are an important aspect of the assessment process. With this the behaviour of the child is systematically observed. Behavioural observations are often done in the natural environment of the child. Sometimes the clinical or laboratory setting is adjusted to approach a natural environment. Observations can be made of discrete behaviours of the child, interactions between the child and peers (or parents) or complex interaction systems between family members.
The first step in a behavioural observation is to determine and define the behaviours that are to be observed. Observers are trained to use the system. The reliability, validity and clinical usability of observation systems are influenced by various factors, such as the complexity of an observation system and changes in the use of the system by an observer (observer drift) . Reactivity poses a challenge to the usability of an observation. This is the change in someone's behaviour if he or she knows that they are being observed. Good training, supervising the way an observer acts and using observers who are already in the situation (for example, a teacher) are ways to counteract the influence of these factors.
Projection material
Previously, projective tests were very popular. These tests are rarely used today because their reliability and validity are questioned. Projective tests are derived from the psychoanalytical idea that projection is used as a defence mechanism: one way the ego deals with unacceptable impulses is by projecting them on an external object. Children receive an unclear stimulus, which the child must interpret. For example, a child is asked at the Rorschach test what he / she sees in ten different ink stains. Children can also be asked to make a drawing themselves or to come up with a story for a picture.
Assessment of intellectual functioning
The evaluation of intellectual and academic functioning is an important aspect of almost all clinical assessments. Intellectual functioning is a central characteristic of disorders such as intellectual disability and learning disabilities but can also contribute to and be influenced by various behavioural problems. Compared to other assessment instruments, tests of intellectual functioning have better normative data and better reliability and validity.
Intelligence tests
The most commonly used assessment method for assessing intellectual functioning are tests of general intelligence, such as the Stanford-Binet and the Wechsler Intelligence Scale for Children (WISC). The outcome of an intelligence test is an intelligence score (IQ). The average IQ is 100 and an individual score reflects how far an individual scores above or below the average person of his or her age. There has been much criticism of the use of intelligence tests. Critics, for example, argue that the use of IQ scores has ensured that intelligence is seen as fixed characteristics rather than as a complex and subtle concept. In addition, it is claimed that intelligence tests are culturally biased.
Development scales
The intellectual functioning of very young children cannot be measured with an intelligence test. One can make use of development tests that give a developmental index instead of an intelligence score. Intelligence tests are mainly focused on language and abstract reasoning, while development tests mainly focus on sensory, motor and social skills. An example of this is the Bayley Scales of Infant and Toddler Development.
Power and performance tests
Power and performance tests are used to look at the performance of a child in a specific area. With this type of testing, for example, you can look separately at arithmetic skills and language skills.
General physical assessment
An assessment of general physical functioning can provide information that is valuable in gaining insight into disturbed behaviour. For example, it can reveal genetic problems that can be treated through adaptations to the environment. For example, phenylketonuria (PKU) is a genetic disorder that is influenced by the diet. In addition, certain conditions can directly (for example, urinary tract infection that impedes toilet training) and indirectly (for example, a sick child who is overprotected by their parents) influence their functioning. An atypical or delayed physical development may also indicate developmental disorders.
Psychophysiological assessment
Psychophysiological tests are often used when parents or clinicians are concerned about the alertness level of a child. These tests can, for example, look at the functioning of the muscles, heart rate and breathing. Measurements of electrical activity in the autonomic nervous system, such as skin conduction, or in the central nervous system, such as an EEG, are often aspects of psychophysiological assessments.
Assessment of the functioning of the nervous system
Assessments of the functioning of the nervous system can provide information about the aetiology of the disorder and can provide insight into the mechanisms by which a treatment, in particular medication, has an effect.
Neurological tests measure the functioning of the nervous system. In an EEG or ERP, electrodes are attached to the head to measure the brain activity of a child when performing a task. Through EEG and ERP, more is now known about the functioning of the brain in children with ADHD, autism, language and learning disabilities, among other things.
These days, brain imaging is also often used to gain insight into the structure and functioning of the brain. There are different forms of brain imaging:
Neuropsychological assessments are made to assess characteristics such as attention, memory, learning and verbal skills. Based on an individual's performance on such tests, conclusions are drawn about brain functioning. A neuropsychological evaluation has different functions:
Neuro-psychological evaluation of children is called paediatric neuropsychology . This is a whole different field of research.
Intervention stands for both the prevention and treatment of psychological problems. Prevention refers to the prevention of psychological problems in individuals who are at increased risk of developing these psychological problems. Of treatment occurs when individuals (or symptoms) are a disorder programs to reduce (or eliminate) symptoms. This is possible with medication and therapy, for example.
Various intervention strategies can be used to help children and families. Primary forces are present in the youth, families, communities and cultures. In this summary, interventions from the most universally applicable prevalence (top) to the most specific ones (bottom) are:
A series of possible settings is described below in which the interventions can be carried out. From top to bottom, the first mentioned are the least restrictive intervention institutions, and the bottom ones the most restrictive.
In the book, there is a diagram of a circle. The interventions in the upper half of the circle are organized as follows: the most universally applicable ones are on the far left. The further you go to the right, the more the interventions shift to treatments for specific target groups. In the lower half of the circle there are various possible settings in which interventions can be offered. The inner circles indicate that the child's strengths are supported by the family and the community, which are influenced by cultural and ethnic differences. The different intervention strategies are considered to be complementary.
Interventions are based on programs that are proven to be effective, and make a difference in evidence-based interventions and evidence-supported interventions.
Caplan's model has served as a general framework for thinking about prevention. In this model, a distinction is made between primary, secondary and tertiary prevention:
The 'Institute of Medicine' makes a distinction between universal, selective and indicated prevention strategies:
Individual and group psychotherapy
With individual psychotherapy, only the psychologist and the child talk to each other. The advantage of group therapy is that it offers opportunities for social experiences. In addition, group therapy can be experienced as less threatening and a child sees that children other than him or herself also have similar problems.
Play therapy
Play is often used by psychologists for communicating with young children because it puts children at ease and is a familiar way for them to interact with adults. It is also possible to use game as a form of therapy.
Family therapy and parent training
Involving family members in the treatment process is consistent with the idea that a clinical problem exists in a social context. A commonly used form of therapy is parent training, where parents are taught effective parenting skills. This can reduce problem behaviour of the child.
Pharmacological treatment
A pharmacological treatment uses medication. Psychotropic or psychoactive medication influences mood and thoughts. Psychotropic drugs exert influence via neurotransmitters. They can influence the production, storage, secretion, activation, reuptake and receptors of neurotransmitters. The choice to use medication is determined by various factors, such as the nature of the problem, possible side effects, and racial / ethnic factors.
When is behaviour abnormal? - Chapter 1You can use many varying terms to describe abnormal behaviour. Consider, for example, ‘mental disorder’, ‘psychological disorder’, ‘psychopathology’ of ‘developmental disorder’. This is thus why guidelines have been developed to help identify abnormality. What does abnormal behaviour actually mean?
Abnormal behaviour occurs when the actions of a significant person deviate from the normal standard of behaviour. According to this definition, a child with a far above average IQ is thus also considered abnormal. So, abnormal doesn’t immediately mean ‘bad’. Psychopathology research involves abnormal behaviours that are harmful to the individual. The APA (American Psychiatric Association) defines a disorder as a ‘clinically significant pattern in an individual’ (psychological and behavioural). This pattern causes frustration, disruptions, an increased risk of harm or danger to one’s wellbeing. Psychopathology interferes with the adaptation to the environment and impedes the individual from completing developmental tasks. A disorder can be seen as an internal problem or as a person's response to circumstances. The final explanation tend to be more obvious to recognise.
Age can be considered as an index for the level of development and is important in assessing behaviour. Assessments of behaviour depend on developmental norms , which say something about the growth of motor skills, language, cognition and socio-emotional behaviour. These standards serve as a benchmark when looking at the (abnormal) development of a child. There are different ways to regard behaviour as deviating from the norms:
There is culture when groups of people are organized in specific ways, live in a specific environment and share specific beliefs, norms, values and customs. Cultural norms influence the expectations, assessments and ideas regarding the behaviour of young people. What is very normal in one culture can be very strange in another culture. As a result, disorders can be culturally specific.
Ethnicity is about shared values, beliefs and customs in an area. Race , on the other hand,
.....read more What does developmental psychopathology include? - Chapter 2Kuhn, among others, has shown us that science is not entirely objective. To study phenomena, scientists all take a perspective from which they view it. If a perspective is shared by researchers, this is called a paradigm. It is a kind of cognitive frame of reference that includes assumptions and concepts. The advantage of such a (subjective) perspective is that it provides guidelines for the way in which a problem is approached, investigated and interpreted. A disadvantage is that researchers can limit themselves by assuming this perspective and are confined within the boundaries of it. They can limit themselves in the type of research questions or in the interpretation of research results. Despite these disadvantages, it is still smart to take a perspective.
Theories and models
A theory is a formal, integrated set of principles that explains a phenomenon (or multiple phenomena). Scientific theories are supported by evidence. In addition, they offer formal assumptions that can be tested, which can lead to an increase in knowledge. A model provides a description of what is being studied. Models that show that many factors lead to psychopathology are especially interesting for psychology. Interactional models assume that several variables together lead to an outcome. An example of this is the vulnerability stress model. This model is based on multiple vulnerability factors and stress factors that together cause psychopathology. Vulnerability (diathesis) is often regarded as a biological factor and stress as an environmental factor. The biological vulnerability of a child to anxiety (meaning you’re more likely to get anxiety than others), for example, can lead to psychological problems in interaction with the stress of a divorce.
Transactional models are used to investigate both normal and abnormal behaviour. These models assume that the development is the result of continuous, reciprocal transactions between the individual and the environment. The individual is seen as an active being formed by past experiences. The environmental context includes variables that are close to (proximal) or far (distal) away from the person.
Transactional models fall under the system models. System models assume different levels of functioning. The development is the result of interactions between the different levels. Changes at one level affect the other levels. An example of this is the biopsychosocial model, which integrates brain functioning, genes and behaviour with aspects of the social environment. Another example is the ecological model, which states that the individual and the environment influence each other.
What influence do genes and environment have on behaviour? - Chapter 3The early development of the brain and nervous system is largely determined by biological factors, but the influence that experience has is also fairly large. The nervous system begins to develop shortly after conception, as the neural plate (a group of cells) thickens, folds in and forms the neural tube. The cells start to migrate to fixed locations. The brain contains millions of multifunctional cells, glial cells , and neurons . Neurons carry messages within the nervous system and to and from other body parts. The extensions of these neurons, called nerves, get a layer of myelin, a white substance that promotes the efficiency of communication in the brain. An excess of neurons and connections is produced both before and after birth to ensure the flexibility of the brain. Some parts of the brain develop faster than others. For example, the development of brain parts for vision and hearing is faster than the development of the frontal brain area, which is involved in complex thinking.
There are many developments in the brain during adolescence. In this way the connections between brain areas increase. Also, the amount of grey matter in the frontal brain area decreases, while the white matter shows an increase, which is a reflection of constant myelination. These changes have implications for psychological and behavioural functioning.
The development of the brain depends on the interaction between biological predisposition and experiences (activity-dependent processes). There is pruning occurring both before and after birth, which means unnecessary cells and connections between cells are broken down. This process is probably the cause of the decline in grey matter in adolescence.
Structure
The brain and backbone together form the central nervous system . The peripheral nervous system is formed by the nerves outside the central nervous system, which carry signals to and from the central nervous system. The peripheral nervous system has two subsystems:
The entire nervous system
.....read more What kind of research is involved in this field of psychology? - Chapter 4The general purpose of science is to describe and explain phenomena. Scientific knowledge comes from a systematic formulation of a problem, observation and data collection and interpretation of research results. Theoretical assumptions and concepts are used to choose variables, procedures and research goals. Often hypotheses are tested that are derived from theories. Testing hypotheses is valuable because knowledge is then obtained in a systematic manner. When finished, a study does not prove that a hypothesis is true or false but it does offer evidence in favour or against the hypothesis. If a hypothesis is not supported, this can lead to an adjustment of the underlying theory.
Research participants
Researchers often try to make statements about their entire population of interest. Because it is not possible to examine everyone in a population, a representative sample is used. Representativeness can be achieved through random selection: every person from the population has an equal chance of being selected. Sometimes certain groups of people are systematically excluded from selection. But even though it’s handy, trying to get a true random sample is not always feasible because it is impossible to draw a random sample of, for example, all children with intellectual disabilities. However, there are ways to approach representativeness. The extent to which this is successful influences the interpretation of the research findings.
Research into psychological disorders often uses clinical populations: participants from, for example, hospitals or institutions. Such clinical populations are usually not representative of the entire population because they exclude children who, for example, cannot be treated due to financial circumstances. Clinical populations can also offer an overrepresentation of young people with more severe symptoms or with symptoms that affect the environment. In this case there is a selection bias.
Measurements
A researcher must make an operational definition of the behaviour or concept that is being studied, so that it becomes clear which observable behaviour or concept is involved in the research. For example, aggression can be operationalized as the frequency with which children threaten their peers.
Validity
A measurement must be valid. Validity refers to the accuracy of the measurement: the extent to which a measurement is an accurate indicator of the behaviour being studied. A distinction can be made between internal validity and external validity. Internal validity refers to the degree to which the statement/hypothesis is correct. Depending on the research design and research methods used, there are various
.....read more How can disorders be classified? - Chapter 5The terms classification, assessment and diagnosis are used to describe the process of description and grouping. Classification (or taxonomy) stands for creating large categories or dimensions of behavioural disorders. It is a system for describing phenomena. These systems are mostly for clinical or scientific purposes. A diagnosis is when a category or classification is considered applicable to an individual. Assessment refers to evaluating (young) people to facilitate classification and diagnosis and to make treatment plans.
Classification systems try to systematically describe a phenomenon. For example, biologists have classification systems for organisms, such as cold and warm-blooded animals. There are also systems for classifying psychological problems. These systems describe categories or dimensions of problem behaviour, emotions and / or cognitions.
A category is a discrete grouping, for example anxiety disorders, to which an individual belongs or does not belong. A dimension , on the other hand, is a continuous property that can occur in various sizes. For example, there are different degrees to which a child is anxious.
The categories or dimensions in a classification system must be clearly defined: the criteria must be explicitly named. In addition, a distinction must be made between the different categories. It must also be proven that a category or dimension actually exists, meaning that the characteristics used to describe a category or dimension must regularly occur together.
Classification systems must be reliable and valid. There are two types of reliability:
Validity refers to the extent to which a diagnosis provides us with more information
.....read more What are the anxiety disorders and what are their characteristics? - Chapter 6There is a difference between anxiety and fear. Anxiety is an emotion that is focused on the future. This emotion is characterized by the feeling that someone has no control over possible negative events. The events also seem to be unpredictable for the person in question. If someone is confronted with potentially dangerous events, there is immediately a lot of attention for the dreaded (or for the emotions that accompany it).
Stress is a response to an existing threat. It is characterized by an alarm response. stress and fear are considered a complex pattern of three types of responses to perceived threat:
Anxiety is a cognitive component of stress and is difficult to control. Worries are thoughts about possible negative consequences that are difficult to control.
It is difficult for clinicians to determine whether the anxiety of a child or adolescent is normal and temporary, or atypical and persistent. Anxiety is part of normal development, as a result of which children develop certain competencies and become more autonomous, for example. For example, children learn how to cope with the dark, while adolescents learn how to cope with dating fears.
Age differences, gender differences and cultural differences
Both the number and the intensity of fears decrease with age. Concern becomes prominent around the age of 7 and becomes more complex and varied as development progresses. Certain fears appear to be more common at certain ages, such as the fear of strangers between 6 and 9 months after birth and social anxiety and fear of failure in adolescence. Changes in the content of fears and worries are probably a reflection of cognitive, social and emotional development.
Anxiety disorders are more common among girls than among boys. This gender difference also becomes larger with older children. It is suggested that the intensity of anxiety in girls is also higher. However, research findings regarding gender differences should be interpreted with caution because they may be (partly) the result of gender-specific
.....read more What are the mood disorders and what are their characteristics? - Chapter 7An important aspect of internalizing disorders are mood problems. Children and adolescents who have an unusually sad or euphoric mood, which are extreme or persistent and interfere with functioning, can be diagnosed with a depressed or manic mood disorder. Nowadays there is increasing attention for mood disorders, for various reasons:
It is difficult to distinguish between different sub-categories of mood disorders, because many people meet the criteria of more than one disorder.
For many years the orthodox psychoanalytic perspective has been dominant. According to this perspective, depression was the result of the functioning of the superego and adult ego. For example, because the superego punishes the ego, a certain type of depression occurs. Because the superego in children is not yet fully developed, depression could not occur in them. That is why this subject received little attention.
A second important perspective contributed to the controversy regarding the existence of childhood depression. The concept of masked depression meant that child depression did exist, but that the sad mood and other characteristics of depression were often not present in children. There might have been an underlying depression, but this was masked by other problems (depressive equivalents), such as hyperactivity or delinquency. The idea of a masked depression was problematic because there were no clear guidelines for deciding whether or not a particular symptom was a sign of depression.
This perspective was nevertheless important, because it was at least recognized that depression could also be a major and common problem in children. Moreover, the central idea of masked depression is still really relevant in the terms that depression can exist in children and that this can be expressed in age-related forms that differ from depression in an adult.
The idea that depression and expression are expressed differently in children and adults has contributed to the evolution of a developmental psychopathology perspective. Initially, this perspective stated that behaviours that led to the diagnosis of depression were only temporary developmental phenomena that were common among
.....read more When is something a behavioural problem and how do they affect people? - Chapter 8While anxiety and depression arise from internalizing problems, behavioural disorders are often the result of externalizing them. The term ‘behavioural problems’ refers to the general group of disruptive and antisocial behavioural problems. The terms behavioural disorder and disruptive behavioural disorder are used to refer to specific diagnostic groups. The term delinquency is mainly used in the legal system and refers to young people who exhibit antisocial behaviour or other behavioural problems. It refers to a minor who is caught performing an index crime (an act that is illegal for both adults and minors, such as theft) or a status crime (an act that is only illegal for minors, such as alcohol consumption).
Classification and description
Disruptive behaviour occurs at different moments in the development. Children of preschool age will beat, kick or bite other children. In the primary school period there is talk of bullying and various forms of aggression, which can definitely also be physical. In adolescence, young people display risky behaviour and / or use illegal drugs. The table below provides an overview of the types of behavioural problems that adults often describe as problematic and the DSM disorders associated with them.
Development period | Problem behaviours | Related DSM disorder |
Early childhood | Disobedience Oppositional behaviour Temper tantrums | Oppositional Defiant Disorder (ODD) |
Middle childhood | Open or covert antisocial behaviour Relational aggression | Oppositional Defiant Disorder (ODD) Conduct disorder (CD) |
Adolescence | Delinquency Drug use Risky sexual behaviour | Conduct disorder (CD) Disruptive Impulse Control |
The DSM category Disruptive Impulse control and Conduct disorders include, among other things, the diagnosis of ODD and CD, as well as, among others, kleptomania and antisocial personality disorder. The latter diagnosis applies to people who show a persistent pattern of aggressive and antisocial behaviour after the age of 18. This pattern must be present from the age of 15. In addition, there must have been a conduct disorder (CD) before the age of 15 .
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What characterizes ADHD disorder? - Chapter 9ADHD is defined in many different ways. In the 1950s, the emphasis was on the hyperactivity characteristic of the disorder. Various terms were used at the time, such as hyperkinetic syndrome and hyperactive child syndrome . Over time, attention for hyperactivity and concentration problems decreased. In the DSM-III it was recognized that attention deficit disorder (ADD) could occur with and without hyperactivity. Attention Deficit Hyperactivity Disorder (ADHD) was not included in the revised version of the DSM-III . This disorder is also recognized by dimensional classification systems.
Research suggested that ADHD consists of two components: inattention and hyperactivity-impulsivity. There is a lot of cross-cultural evidence for the validity of these factors. Although both components have unique genetic influences, they are interrelated as a result of shared genetic influences.
DSM classification
The DSM states that the two factors (inattention and hyperactivity-impulsivity) together form three subtypes of ADHD:
The diagnostic criteria state that there must be symptoms of inattention and hyperactivity-impulsivity, respectively. the diagnostic criteria state that some symptoms must be present before the age of 12 and for at least six months. Because all symptoms occur to some extent in normally developing children and may vary with the level of development, the diagnosis is only made if the symptoms are excessive and occur in at least two different settings (for example at home and at school). The symptoms must also interfere with the social and academic functioning of the child.
Inattention
Adults see different signs of inattention in children with ADHD. An apparently special aspect of the disorder is the situational attention of children: the child can concentrate well if he or she is interested or motivated, while it has concentration problems when performing a boring, strenuous or repeated task. Research shows that children and adolescents with ADHD do indeed have more concentration problems than children with learning disabilities or normally developing children. Specific deficits have been identified, including a lack of selective attention: the ability to focus on relevant stimuli and not be distracted by irrelevant stimuli. Children with ADHD are more easily distracted if the task is boring
.....read more What disorders are there with regard to language and learning? - Chapter 10From around 1800 on, there has been attention on language-related problems. During this time, a medical orientation was developed, with specific limitations associated with brain abnormalities. For example, Wernicke discovered brain abnormalities in patients who did not understand language well, but who had no language or cognitive impairment – which you might know because there is a brain area named after him. From 1920 on, there was also a psychological orientation. During this period, more emphasis was placed on gaining insight into the characteristics of people with language and learning difficulties and treating them. In 1963, Krik introduced the term 'learning disabilities'. This is considered a milestone in the emergence of the concept of learning disabilities. For example, teachers were no longer accused of causing such problems.
Definition
According to the 'Individuals with Disabilities Education Act (IDEA)', the definition of a learning disability is as follows: “a learning disability is a disorder in one or more psychological processes involved in the understanding or use of (spoken or written) language. The disorder can affect listening, thinking, speaking, reading, writing, spelling or math. This does exclude children who have learning difficulties due to visual problems, hearing problems, a motor impairment, an intellectual disability, emotional problems or a cultural-economic disadvantage. There are no specific criteria for identifying disabilities. So there are different ways to identify learning disabilities. Differences in definitions have led to different prevalence estimates, incomparable research groups and different criteria for determining whether children are eligible for special education.
Discrepancy between the IQ and performance level
There are two common ways to discover learning disabilities. First of all, we can look at the difference between someone's intellectual capacity (IQ) and specific performance level. It is assumed that if there is a specific disorder, the performance on general assets (IQ) is higher than the performance on tests that relate to the specific disability. Often a difference of two or more standard deviations between the scores on the intelligence test and the specific test is considered significant.
Below average performance
Another way to diagnose a disorder is to see if a child performs at least one academic area lower than the average classmate. A problem with this method is that a large discrepancy in younger children is
.....read more When does someone have an intellectual disability? - Chapter 11An intellectual disability (ID, formerly also called mental retardation) is characterized by limitations in both intellectual functioning and adaptive behaviour. This is expressed in conceptual, social and practical skills. ID occurs before the eighteenth year of life. There are three diagnostic criteria:
According to the American Association on Intellectual and Developmental Disabilities (AAIDD) model, the way in which ID is expressed depends on how it works on the five dimensions;
Intellectual limitations are not seen as an absolute trait, because sufficient support can lead to an improvement in functioning.
Initially, the AAIDD made a distinction between four levels of ID: light, moderate, serious and profound. The AAIDD, however, no longer uses this approach because it would not be appropriate for making decisions about the care of individuals with ID. Instead of the ID level, an assessment must be made for each individual of the level of support he or she needs. This approach recognizes that the need for support may be different in different areas of functioning and may change over time. In addition, it emphasizes the perspective in which an ID is seen as dynamically related to the social environment rather than as static quality of the individual.
The DSM approach
The DSM approach to diagnosis has many similarities with the AAIDD approach. A diagnosis requires both intellectual and adaptive limitations, and the disorder must occur during the development phase. The IQ score is usually around 70. The criteria also state that there must be deficits in at least one area of adaptive behaviour.
The DSM in 2013 still classified individuals on the basis of the intelligence level: light (IQ 50-70), moderate (IQ 35-50), severe (IQ 20-40) and profound (IQ <20). About 85% of the cases were only lightly mentally limited. In the past, a light and moderate ID in
.....read more What are the most important characteristics of autism and schizophrenia? - Chapter 12In the past, no distinction was made between schizophrenia and pervasive disorders, such as autism. Nowadays we do differentiate between them. Schizophrenia is rare among children, often develops in adolescence and increases in adulthood. Autism and Asperger's syndrome are non-psychotic disorders that arise at a young age.
The DSM-V contains the Pervasive Developmental Disorders (PDD) category. This category includes:
Rett's disorder is now viewed differently and will not be further discussed for this reason. Criticism, such as whether Autistic Disorder and Asperger's syndrome would not be a single disorder, was common. In the DSM-V, the above-mentioned disorders are no longer considered separate. They now coincide in the Autism Spectrum Disorder (ASD). Two domains with primary symptoms can be distinguished in ASD: Firstly, persistent limitations in social communication and interaction, and secondly, restrictive, repetitive behavioural patterns.
What is Autistic disorder (autism)?
Kanner described autism as a disorder characterized by communication problems, atypical cognitive skills and behavioural problems such as obsessiveness, repetitive behaviour and unimaginative play. However, Kanner saw social inability as the biggest problem.
Primary characteristics
Social interaction
Already before the age of 1, autistic children show subtle differences from normally developing babies. They respond less to visual stimuli, respond less when someone calls their name and often don't like to be touched. They do not follow people with their eyes, avoid eye contact, appear to have an ‘empty’ or unseeing eye and respond little to others with emotional expression and positive emotions. Particularly striking is that autistic children exhibit deficits in joint attention, where the child and parent or caregiver focus attention on the same object or situation, thereby sharing an experience. Joint attention is facilitated by certain gestures, such as pointing, and eye contact. Another component of an atypical social interaction is abnormal processing of social stimuli, particularly the face. Children with autism have difficulty recognizing and remembering faces (and associated expressions of emotion). They also process faces in other ways than normal developing children. All in all, delayed or atypical social behaviours seem to occur at a young age in at least five areas of social behaviour: attention to social stimuli, joint attention, emotion, imitation and facial processing. Although the symptoms may change
.....read more Which disorders have a strong influence on physical functions? - Chapter 13Paediatric psychology is concerned with the investigation of (psychological) problems leading to disruption of physical function and health.
Problems with toilet training and learning sleeping and eating habits are common. Both the ability of the child to master these skills and the skills of parents to guide the child in this are important for the well-being of the child and parents. Sometimes parents seek help if they are unable to learn certain habits.
Potty training
The usual order in which children get toilet training is as follows: control of the intestines at night, control of the intestines during the day, control of the bladder during the day and control of the bladder at night. Although there is considerable variation in the age at which children become toilet-trained, they are often toilet-trained between the ages of 1.5 and 3. Parents disagree about when or at what age it is good to start toilet training. This decision often depends on cultural values, attitudes and daily circumstances, such as requirements for childcare and the presence of other siblings.
There are various factors that contribute to good toilet training. First of all, it is important that parents are able to determine when the child is ready for development. In addition, the parents must be able to properly assess when the child needs to go to the toilet. Thirdly, they must prepare well for toilet training, for example by having the child wear clothing that can be easily taken off. Finally, it is effective to positively reinforce the child.
Enuresis refers to a lack of control over the bladder, during the day and / or at night, that cannot be explained by a physical disorder. Often the diagnosis can only be made after the age of 5. The diagnostic criteria also state that there must be a certain frequency of the control deficiency and this frequency varies with the age of the child. It must be done at least twice a week and for three months or there must be a clinically significant disruption of daily functioning.
A distinction is made between urinating in bed and urinating during the day and between primary and secondary enuresis. Enuresis is called primary, if the child has never been toilet trained, and secondary if the child has been toilet trained. About 85% of the cases belong
.....read more What is the connection between psychology and (physical) health? - Chapter 14Physical disorders that are influenced by psychological factors have been called psychosomatic disorders in the past . In DSM-II this term had been replaced by psychophysiological disorders and in DSM-III this term had again been changed to psychological factors that influence physical conditions. In the DSM-IV this was transformed into psychological factors that influence medical conditions . Now in the DSM-V there is a new chapter called somatic symptoms and related disorders. This includes the psychological factors category that affect other medical conditions. These adjustments are the result of the discussion about the relationship between body (soma) and mind (psyche). During the 20th century, the interest in the effects of psychological processes on the body has resulted in the development of psychosomatic medicine. It became clear that many physical complaints are influenced by psychological factors. Researchers started with psychogenesis: the identification of the psychological cause of physical disorders. More attention is now being paid to multicausality: the idea that biological, social and psychological factors contribute to health. This perspective is holistic and assumes continuous interactions between influences. Pediatric psychology is the field that focuses on these processes in children and adolescents.
In asthma there is a hypersensitivity of the airways to different stimuli. The airways become chronically inflamed and narrower. This causes breathing problems. Serious attacks (status asthmaticus) can be life threatening. The breathing problems and the danger of serious attacks can lead to anxiety for the patient and his family members.
About 10% of children suffer from asthma. The disorder is extra common in children who are poor, live in an urban area and / or belong to a minority group. A bright spot is that asthma can be temporary.
Research shows that genetic factors influence the risk of asthma. In addition, other factors most likely play a role. People who have asthma may be exposed to factors that influence the chance of an asthmatic attack. These influences are considered as triggers or irritants instead of as direct causes of asthma. Every individual has different triggers and over time triggers can change for the same individual. Repeated respiratory infections can play a role in the development of asthma and viral respiratory infections can lead to an asthmatic attack or worsen its severity. An allergy can also increase the chance of an attack. For example, some children are allergic to dust and get an asthmatic attack more quickly when
.....read more What issues are currently affecting young people? - Chapter 15In recent decades, dramatic changes have taken place in families in the US due to an increased number of divorces, families with one parent and families with stepparents.
Working mothers and childcare
Nowadays, with women having more and more jobs outside of the household, children are more often cared for by others than the mother, such as by relatives or at a day-care centre. The effect of this differs based on the quality of care, the amount of care and certain family characteristics. High quality care is positively related to the cognitive, social and language development of children who go to a day-care centre from an early age. The research findings regarding the effects of the amount of care are inconsistent. In general, the amount of care seems to be negatively related to the child's development. With regard to the interaction between childcare and family characteristics, it appears that children from low-income families benefit from care at a day-care. This means that care by others can serve as a protective factor for children from families with a low socio-economic status. It is also important that a good relationship between parents and child remains.
From the age of 9 to 12, an increasing number of children will start taking care of themselves. The effects of self-care depend on the amount of time self-care, the level of development of the child, family factors, neighbourhood characteristics and social support. Participation in after-school programs often has a positive effect on the social and academic behaviour of children.
Adoption
The number of adoptions has risen sharply in recent decades. Adopted children have relatively more issues with psychological problems. This is especially the case if children have were adopted at an older age or because they have been exposed to negative conditions such as poor prenatal care, drug addiction or care in an orphanage.
A study has made a distinction between two types of peers: peers from the past (peers or brothers or sisters from the institution from which the child was adopted) and current peers (peers in the current situation). The following conclusions can be drawn from this study:
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