Clinical Developmental & Health Psychology – Full course summary (UNIVERSITY OF AMSTERDAM)
Del Giudice (2016). The evolutionary future of psychopathology.” – Article summary
Developmental psychopathology focuses on the interplay of personal and environmental factors in the origin of mental disorders. This includes genotype-environment interactions and epigenetic encoding of life events (e.g. prenatal stress; abuse). Computational psychiatry uses mathematical models of cognitive and neural processes (e.g. decision making) to identify the mechanisms involved in mental disorders.
Evolutionary psychopathology focuses on biological models and concepts to understand the functions of the neural and psychological processes involved in mental disorders and how they have been shaped by selection during evolutionary history. It does not necessarily consider mental disorders as dysfunctions (e.g. it may reflect an adaptive process).
The two reasons for the evolution of vulnerability are trade-offs between competing traits or functions (1) and biological conflict of interest between individuals (2). Psychopathological conditions may arise from dysfunctional mechanisms or from functional mechanisms that produce maladaptive outcomes because the present environment is different from the one in which the mechanism was developed. It is also possible that psychopathological conditions may arise due to biologically adaptive but undesired behavioural strategies.
Traits associated with autism are associated with long-term sexual relationships and traits associated with psychosis are associated with short-term sexual relationships with multiple partners. This may indicate that there is a trade-off between the two and that they lie on the same continuum. A mood disorder may arise through a trade-off between pursuing rewards and avoiding punishment (e.g. depression).
Differential susceptibility states that individuals can be more or less sensitive to the effects of experience due to a combination of genetic and early developmental factors (i.e. people more susceptible to adverse conditions are also more responsive to safe, supportive conditions). This may have arisen because individual differences in plasticity may be an adaptive response to unpredictable fluctuations in the environment. It is possible that early adversity may not impair development but adaptively shape it.
The problems of the DSM are comorbidity between disorders (1) and heterogeneity within disorders (2). Externalising disorders refer to anti-social and rule-breaking behaviour. Internalizing disorders refer to anxiety, fear and distress. Life history theory refers to the way organisms allocate time and energy to the activities that comprise their life cycle. Life history strategies are suites of morphological, physiological and behavioural traits that implement life history allocations at the individual and species level. Life-history related traits covary along a fast-slow continuum (e.g. unpredictable environments are associated with early maturation and reproduction and vice versa). The fast-slow distinction can demonstrate that some mental disorders are adaptive responses to maladaptive environments.
Geeraerts et al. (2018). Individual differences in visual attention and self-regulation: A multimethod longitudinal study from infancy to toddlerhood.” – Article summary
Identifying reliable precursors of self-regulation early in development is important for early prevention of developmental problems. It appears as if longer fixation and less variation in fixation duration in infancy predicts better effortful control. Compliance in toddlerhood was not predicted by visual attention measures. Visual attentional measures in infancy may predict independent forms of self-regulation in toddlerhood.
Self-regulation refers to the ability to automatically or deliberately modulate affect, behaviour and cognition. Toddlerhood refers to a transitional phase during which the ability to inhibit dominant responses develops and external regulation is still required. Compliance refers to toddlers’ ability to display desirable behaviour in response to others. Effortful control refers to individuals’ ability to inhibit prepotent behaviours and perform less salient behaviours, detect errors and engage in planning. This is associated with compliance.
The development of self-regulation builds on simpler cognitive skills (e.g. visual attention). Visual attention refers to a set of cognitive operations by which the selection of relevant visual information and the exclusion of irrelevant visual information occurs. Attention processes consist of three neural networks which are closely related to self-regulation:
- Alerting network
This network is involved in achieving and maintaining attention. - Orienting network (most important during infancy)
This network is involved in selecting input. - Executive attention network (most important after 3 – 4 years)
This network is involved in executing control over the alerting and orienting network.
It is possible that a shorter orienting response reflects faster processing speed. However, this is challenged. The duration of a fixation is often conceptualized as an indicator of the time needed to process the visual information available at the point of fixation as the eye has many saccades to process a different area of the visual field (i.e. only small part of the retina has high acuity).
It is possible that longer fixations indicate better executive attention because of the enduring conflict between maintaining and disengaging attention. Less variation of fixation duration may indicate cognitive maturity. Diminished variation in fixation when watching dynamic stimuli in infancy relates to better concurrent cognitive control.
Disengagement of attention plays an important role in early state regulation. Attentional disengagement is an effective strategy for lowering negative affect in infancy. Prolonged disengagement is found in infants at risk for autism. Disengagement is unrelated to toddler effortful control or compliance.
Longer fixation duration and less variation in fixation duration predicts better effortful control but does not predict compliance.
Hunnius (2007). The early development of visual attention and its implications for social and cognitive development.” – Article summary
Looking behaviour forms the basis for cognitive and social development in the life of an infant. Looking is one of the most important methods of communicating for infants.
The preferential looking paradigm consists of presenting infants with two stimuli and checking whether infants discriminate between them by evaluating the looking duration. The visual habituation procedure consists of evaluating looking duration to an unfamiliar stimulus after habituation to another stimulus. It is based on the infant’s tendency to look at novel stimuli. These two methods, however, are not very precise.
Electro-oculography (EOG) measures the change in electrical potential caused by the rotation of the eye. It is a very precise method for measuring eye movements. However, it can be sensitive to artefacts (1) and requires electrodes to be attached to the subject’s face (2). Corneal-reflection photography measures the reflection of the front surface of the eyeball using infrared. This reflection changes when the subject moves fixation and this information is used to determine whether eye movement took place. It can determine the location of fixation but requires individual calibration.
Heart rate is associated with the cerebral cortex (i.e. higher level cognitive processes). This means that changes in heart rate occur in association with changes in attentional status and sensory and cognitive processing. Therefore, heart rate measures could be used to investigate attentional processes during visual tasks.
Marker tasks make use of behavioural tasks. It checks the performance on the same tasks at different ages and in different contexts to provide insight in the interrelations between developmental changes in observable behaviour and brain structure. However, it is difficult to generalize results as the results might be mediated by different neurological structures at different stages of development.
Electro-encephalography (EEG) can be used to measure event-related potentials regarding visual processing in infants. Functional magnetic resonance imaging (fMRI) and near infrared spectroscopy (NIRS) can be used to measure infant’s brain activity.
New-borns prefer looking at faces and spend more time looking at faces than at other stimuli. Overt orienting refers to shifting one’s gaze from one location to the other. Covert orientation refers to shifting attention without shifting gaze or body. Exogenously controlled shifts of attention refers to automatic shifts of attention (e.g. shift of attention due to salient stimulus; loud noise). Endogenously controlled shifts of attention refers to voluntary shifts of attention (e.g. voluntary shift of attention to location of interest). However, initiation of attention shifts includes both endogenous and exogenous components.
The visual grasp reflex (i.e. attention getting reflex) refers to automatic saccades as the result of the sudden onset of a stimulus in the peripheral visual field.
Overt orienting becomes more efficient during the first months of life. Infants start making one large eye movement rather than a series of small movements. However, adult-like performance in the visual field is not attained until the end of infancy.
Infants alternate intense inspections with short
.....read more Li, van Vught, & Colarelli (2018). Corrigendum: The evolutionary mismatch hypothesis: Implications for psychological science.” – Article summary
Psychological mechanisms are adaptations evolved to process environmental inputs, turning them into behavioural outputs that increase survival or reproductive prospects, on average. However, the environment in which these mechanisms evolved is different from the modern context. This is evolutionary mismatch.
Psychological adaptations refer to inherited, species-typical traits that develop reliably and have been retained by selection. It takes specific environmental cues as input and processes these inputs according to evolved decision rules. This leads to behaviour as output.
Mismatches can be classified along source (1), type (2), cause (3) and consequences (4). A mismatch occurs because of significant changes in input cues (i.e. intensity or quantity) (1) or the consequences of the mechanism’s output (2). A mismatch can be positive for the organism.
A forced mismatch occurs when a new environment is imposed on an organism. A hijacked mismatch occurs when novel stimuli are favoured by mechanisms over stimuli that the mechanism evolved to process (e.g. preferring candy over fruit). The mechanism is hijacked. D
There are different causes for mismatch:
- Changes in input
- Changes in input intensity
- Input replaced by novel or fake cues with similar attributes.
- Change in consequence of output
The different causes for the mismatches can lead to different consequences for individuals and for the reproductive fitness. The effect on individuals can be desirable or undesirable and the reproductive fitness can increase or decrease.
An understanding of a mechanism’s functional features along with relevant mismatched conditions can lead to predictions about mismatch consequences.
Diabetes, myopia and post-partum depression may be examples of mismatch. Prolonged media consumption contributes to the destabilization of long-term relationships and various types of self-dissatisfaction. The modern workplace is dissimilar to ancestral work (e.g. few nature exposure) and this can lead to a mismatch. The choice of leader (i.e. male, strong, tall) is not always effective in modern organizations. Another mismatch in modern organizations is the favouring of relatives in organizations.
Dovis, van der Oord, Wiers, & Prins (2012). Can motivation normalize working memory and task persistence in children with attention-deficit/hyperactivity disorder? The effects of money and computer-gaming.” – Article summary
Visuospatial working memory (WM) is the most impaired executive function in children with ADHD. Incentives improve the working memory performance of children with ADHD but does not normalize it. Children with ADHD showed a decrease in performance over time. The strongest incentives normalized the persistence of performance in children with ADHD. Executive and motivational deficits give rise to visuospatial working memory deficits in ADHD. The problems in task persistence result from motivational deficits.
Executive functions allow individuals to regulate their behaviour, thoughts and emotions. It allows for self-control. Children with ADHD show impairments in behavioural inhibition and working memory, especially visuospatial working memory. Visuospatial working memory refers to the ability to maintain and manipulate and reorganize visual-spatial information. An impairment of this leads to a child with ADHD having problems remembering what he was doing and what he has to do to reach the goal.
However, it is also possible that motivational deficits are a core problem in ADHD. This states that children with ADHD are less stimulated by reinforcement than typically developing children. This leads to the children being not motivated enough to function on a normal level. Deficits in executive functioning are believed to be the result of the abnormal reinforcement sensitivity.
The elevated reward threshold states that children with ADHD could reach optimal or normal performance but require much higher levels of reinforcement to reach this than for typically developing children.
The difference between ADHD children and typically developing children was smaller when incentives were used. Incentives improved the performance of children with ADHD. Children with ADHD showed lower performance in all conditions than the controls. For the children with ADHD, only strong incentives (e.g. money or gaming) can reduce the effects of time (i.e. playing for a long time) on task performance.
Children with ADHD showed a decrease in performance over time and strong incentives were unable to normalize their performance. However, strong incentives were able to normalize their persistence of performance. This means that the children with ADHD’s performance persisted longer over time with stronger incentives. The typically developing children did not show a drop in performance over time.
Children with ADHD required stronger incentives to reach a better performance and controls only needed feedback as an incentive to reach optimal performance. This provides evidence for the abnormal reinforcement sensitivity of children with ADHD. It is possible that the effects of reinforcement differ per executive function.
Franke et al. (2018). Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan.” – Article summary
ADHD is highly heritable and one of the most common neurodevelopmental disorders in childhood. ADHD is characterized by substantial comorbidity including substance abuse, depression and anxiety. It is a neurodevelopmental disorder that typically starts during childhood or early adolescence. It is defined by age-inappropriate levels of inattention and/or hyperactivity-impulsivity. This interferes with the normal development or functioning of a person.
ADHD often remains undiagnosed in girls. It is common in all countries and affects the productivity, life expectancy and quality of life. The clinical presentation of ADHD is very heterogeneous. It is necessary to have a lifespan perspective on ADHD as it often persists into adulthood and because the clinical picture often differs between patients. It is a highly dynamic disorder.
Patients often experience that the services provides are not aimed specifically at ADHD. This lack of support contributes to people with ADHD experiencing more severe problems with age.
Defiance (1), hostility (2) or failure to understand the task or instruction (3) are not reflected by the ADHD symptoms but these symptoms often accompany ADHD. It is not clear to what degree ADHD persists in adulthood but it is clear that it often appears to persist into adulthood.
The definition of impairment is difficult for ADHD as ADHD symptoms are continually distributed throughout the population. The disorder is thus defined by a high level of symptoms when they interfere with normal functioning. Young children with ADHD are more likely to show externalising symptoms (e.g. hyperactive-impulsive behaviour) and at a later age, it is more likely that inattention is the main problem rather than motor hyperactivity.
Persistence of more overt hyperactivity-impulsivity is seen at higher rates among those with the most severe comorbid problems related to ADHD (e.g. substance abuse). ADHD is more often diagnosed in young boys than girls. This is not the case for adults. It is possible that this is the case because young boys with ADHD often show more hyperactivity-impulsivity symptoms whereas young girls often show more inattentive symptoms. However, there are more ADHD symptoms in the male population although the difference between hyperactivity-impulsivity symptoms becomes equal by late adolescence. The expression of core ADHD symptoms is more similar across the sexes in an adult population. Comorbid problems (e.g. learning problems) also contribute to the difference in ADHD rates in young boys and girls.
There is a broader expression of symptoms commonly reported by adults with ADHD. This falls into three main categories:
- Age-adjusted expression of core ADHD symptoms
This includes internal restlessness, ceaseless unfocused mental activity and a difficulty focusing on conversations. - Behaviours reflecting problems with self-regulation
This includes problems with controlling impulses, regulating emotional responses, switching attention, initiating tasks and problem-solving. - Additional problems that are commonly seen in ADHD
This includes sleep problems and low self-esteem.
Secondary (i.e. acquired) ADHD refers to ADHD that is the result of brain injury at
.....read more “Hudson et al. (2019). Early childhood predictors of anxiety in early adolescence.” – Article summary
Preschool children are more likely to experience anxiety symptoms and disorders over time if the child was inhibited (1), there is a history of maternal anxiety disorders (2) and when the mothers displayed high levels of overinvolvement (3). There is an increased risk for anxiety symptoms and disorders for inhibited children when the involvement of the mother is high at age four but not if the involvement of the mother is not high at age four.
Anxiety disorders are very prevalent and negatively impact multiple domains of functioning. They have the earliest age of onset of all major mental health disorders. There are several predictive factors of anxiety for a child:
- Behaviourally inhibited temperament
This refers to reactions of withdrawal, wariness, avoidance and shyness in unfamiliar situations. ‘ - Maternal anxiety
Anxiety of the mother appears to significantly predict the child’s anxiety. - Parental overinvolvement
This can lead to reduced opportunities for exposure to novelty or potentially difficult situations, which reduces the child’s opportunities to determine accurate information about threat and coping. - Absence of a secure attachment
This is a non-specific risk for both internalizing and externalizing disorders. The child may develop an internal working model in which they view themselves as incapable, the world as unsafe and others as untrustworthy when the child is unable to reliably elicit caregiver attention.
Parental negativity might also be a predictive factor, although this has been very inconsistent in research. It appears as if infant attachment moderates the relationship between temperament and social anxiety in adolescents. Inhibited children with an insecure attachment have an increased risk for social anxiety.
The number of maternal lifetime anxiety disorders and maternal over-involvement predicted the presence of an anxiety diagnosis. Maternal negativity did not appear to predict anxiety at the follow-up.
Preschool children with inhibited temperament were at risk for anxiety symptoms in early adolescence when their mothers displayed high over-involvement. This pattern did not hold for inhibited children when their mothers did not display high over-involvement. Parenting appears to play a moderating role in the development of anxiety symptoms. The attachment of a child did not significantly predict anxiety symptoms or disorders over time. Behavioural inhibition appears to predict anxiety disorders.
Telman, van Steensel, Maric, & Bögels (2018). What are the odds of anxiety disorders running in families? A family study of anxiety disorders in mothers, fathers, and siblings of children with anxiety disorders.” – Article summary
Children with an anxiety disorder are two to three times more likely to have at least one parent with current and lifetime anxiety disorders. Children with anxiety disorders were more likely to have parents with anxiety disorders but not siblings with anxiety disorders. A child is more likely to have social anxiety disorder or generalized anxiety disorder if the mother has either of those two disorders.
It appears as if parental anxiety shapes the way for a parenting style which contributes to the development of anxiety disorders in children. Over-controlling behaviour which limits the autonomy of the child could be one of these parenting styles. This could maintain a child’s inhibition and anxiety. However, children’s anxious behaviour could also elicit overcontrolling in parents. Parents’ anxious behaviour could also promote and maintain child anxiety through modelling (e.g. catastrophizing).
Treatments for child anxiety disorders appear to be less effective when a parent has an anxiety disorder. The role of mothers appears to be greater than the role of fathers in the development of anxiety disorders.
Diagnostic specificity states that children of anxious parents are at a greater risk to develop the same anxiety disorder as their parents because parents model or communicate specific anxieties to their children. However, it is not clear whether this is the case.
Children with anxiety disorders were not more likely to have mothers with a lifetime anxiety disorder but were more likely to have mothers with a current anxiety disorder. Children with anxiety disorders are not more likely to have parents with a lifetime depressive disorder. There appears to be evidence for specificity of social anxiety disorder and general anxiety disorder. Children with social anxiety disorder were more likely to have fathers with lifetime anxiety disorders but children with specific phobia were less likely to have fathers with lifetime anxiety disorders.
It appears as if there is specificity for both SAD and GAD and familial risk for some child anxiety disorders. The child susceptibility hypothesis states that some children who are genetically susceptible for the development of an anxiety disorder because of an anxious temperament are more likely to be affected by the consequences of living in a family with parental anxiety disorders than siblings who are not genetically susceptible.
The specificity of social anxiety disorder could be explained by the lack of social skills of the parents which are then modelled to the children. It could also be explained by the fathers showing less challenging parenting behaviour which is a risk factor for the child developing social anxiety. This implies that the father’s role is different from the mother’s in the development of social anxiety disorder. It might be that the father shows less emotional warmth and more rejection to socially anxious children, which leads to a bi-directional relationship.
It is likely that the specificity of general anxiety disorder is not transmitted through modelling. It is possible that mothers transmit the
.....read more Bögels et al. (2014). Mindful parenting in mental health care: Effects on parental and child psychopathology, parental stress, parenting, coparenting and marital functioning.”
Training for parents to deal with the child’s externalizing mental disorder is less effective if the parent has a mental disorder. Parent training is also less effective if the parent suffers from marital problems. Marital problems have a negative effect on parenting and child behaviour problems.
Child problem behaviour could bias parental attention. This can also occur as a result of parent mental disorder. Biased parental attention toward negative child behaviours may be an unintended consequence of involvement in child mental health services (i.e. negative behaviours are the focus of the treatment).
Parents that are attentive toward all expressions of their child without prejudgement can respond more sensitively to their needs and the children will feel understood and contained. Self-nourishing attention may be important for parents suffering from mental disorders. Parents of children with mental disorders may find this difficult due to increased demands and stresses of raising a child with a mental disorder. This can lead to greater self-critique. Therefore, self-compassion and self-nourishment are important skills.
Mindfulness interventions teach participants to adopt a more accepting, non-judgemental and compassionate stance toward themselves. This may restore the balance between self-attention and attention for the child. Mindful parenting training aims to improve parenting by improving the quality of parental attention (1), increasing awareness of parental stress (2), reducing parental reactivity (3) and decreasing the intergenerational transmission of dysfunctional parenting (4). It aims to lead to a greater awareness of a child’s unique nature (1), a greater ability to be present and listen with full attention (2), recognizing and accepting things as they are in each moment (3) and recognizing one’s reactive impulses and learning to respond more appropriately (4).
Mechanisms of change refer to the processes or events that are responsible for the change. There are six potential mechanisms for change for mindfulness parenting.
- Reducing parental stress will reduce parental reactivity (i.e. fight, flight, freeze response).
- Reducing parental preoccupation which is the result of parental or child psychopathology.
- Improving parental executive functioning in impulsive parents.
- Breaking the cycle of intergenerational transmission of dysfunctional parenting.
- Increasing self-nourishing attention.
- Improving marital functioning and co-parenting.
Evidence was found for mechanism one, five and six. However, there is a need for more research for mechanism two, three and four.
Parent management training appears to be effective for reducing child behaviour problems but less effective for parents who suffer from a mental disorder, especially mental disorders related to executive functioning (e.g. ADHD). Mindful parenting, however, may be effective for both reducing the child behavioural problems and for parental mental disorders (e.g. less parental stress).
There were significant reductions in children’s internalizing and externalizing problems after a mindful parenting intervention. There were also reductions in parent’s internalizing and externalizing problems. Parental stress, overprotection and rejection decreased whereas autonomy encouragement increased. There was an increase in family integrity but a deterioration during a waitlist condition. Marital
.....read more Bögels, Lehtonen, & Restifo (2010). Mindful parenting in mental health care.” – Article summary
Mindful parenting refers to paying attention to your child and parenting in a particular way; intentionally, here and now and non-judgementally. Mindfulness-based cognitive therapy (MBCT) targets the patterns of thinking activated by dysphoria (i.e. the association between low mood and negative repetitive thinking). MBCT appears effective in doing this and reduces the likelihood of developing another depressive episode. Mindfulness-based approaches appear effective in the treatment of disorders where rumination plays a central role.
It is possible that attentional processes are the key mechanism underlying change in mindfulness. However, it is not clear how mindfulness affects attention. It has been shown to improve executive attention in general. Meditation experience is negatively associated with emotional interference (i.e. disengaging attention from emotional stimuli). The ability to disengage from unexpected and emotional stimuli and attention conflict monitoring improve as a result of meditation practice.
Mindfulness-based parenting interventions may exert their effects by targeting six domains:
- Parenting stress
This strongly affects parenting skills (e.g. parents become more rejecting under stress). This may be the case because parents may fall back in a fight/flight/freeze response when under stress. Besides that, parents with mental disorders or with children with mental disorders are more likely to be exposed to stress. Parental stress also negatively affects marital quality which, in turn, influences parenting. Mindfulness training may reduce parental stress and thus improve parenting skills. - Parental preoccupation
Negative, repetitive, preoccupied thinking (i.e. depression thinking) may take up a parent’s attention which leads to them having less attention to allocate to the child during interaction, which makes the interaction less synchronized. Parental preoccupation with negative thinking may also bias the attention of the parent on the child (e.g. focusing on the negative aspects). It is possible that mindfulness improves parenting by reducing parental preoccupation and negative bias. Mindfulness may lead the focus from the inner rumination to the child and be more non-judgemental. Parents’ preoccupied attention resulting from parents’ own mental disorder or child’s mental disorder may negatively affect parenting. Mindfulness parenting involves open and unbiased attention to the child which may improve parenting and child development. - Parental executive functioning (i.e. reduce parental reactivity)
Mindfulness may improve parenting through improving parental executive function and thus reducing parental reactivity. Parents of children with executive function disorders (e.g. ADHD) have poorer executive functioning themselves. Poorer executive function may lead to more impulsivity and impulsivity in the child may elicit more impulsivity in the parents. This leads to a vicious cycle of negative reactivity. Mindfulness could reduce impulsivity in parents and thus resolve this negative reactivity cycle. - Intergenerational transmission of parenting
Parents may repeat dysfunctional parenting patterns they have been exposed to as a child. These dysfunctional parenting patterns may be transmitted through cognitive schemas. These are activated by emotions during parenting (e.g. emotions that resemble past experience in parents’ childhood). Parents are more likely to activate these schemas under stress. This can be prevented by using mindfulness.
Boyer et al. (2016). Qualitative treatment-subgroup interactions in a randomized clinical trial of treatments for adolescents with ADHD: Exploring what cognitive-behavioural treatment works for whom.” – Article summary
Girls with ADHD appear to have less severe inattention, hyperactivity and impulsivity but greater intellectual impairments than boys with ADHD. Girls also tend to have more internalizing comorbid disorders than boys whilst boys with ADHD are at higher risk for externalizing psychiatric comorbidities than girls. The heterogeneity of ADHD increases the need for personalized treatment.
Plan my life (PML) is a treatment for ADHD which is focused on improving planning and planning-related skills. Solution-focused treatment (SFT) is a treatment focused on solutions and not necessarily focused on improving planning and planning-related skills. SFT is focused on finding solutions for chosen problems. Both treatments appear to be effective, although PML shows more reduction of parent-rated planning problems and higher treatment satisfaction of parents and therapists.
Qualitative treatment-subgroup interaction refers to the phenomenon where the optimal treatment for one subgroup differs from that for another subgroup. Quantitative treatment-subgroup interaction refers to the phenomenon where optimal treatment is the same in all subgroups but the size of the between-treatment difference differs across subgroups (e.g. effect is larger for males than for females). This implies that the patient characteristics defining the subgroup are moderators of treatment effect.
Having no or a single comorbid disorder (1), being older of age (2), having a mother with high parenting self-efficacy (3) or not having a particular gene (4) positively influence the effects of behavioural treatment on ADHD symptoms.
There appears to be no need for personalized treatment allocation for adolescents with ADHD symptoms in the treatment of ADHD symptoms. Adolescents with less ADHD symptoms should receive SFT over PML. On the other hand, greater treatment gains were obtained for adolescents with more severe ADHD symptoms who were assigned to the PML group.
There also appears to be no need for personalized treatment allocation for adolescents with ADHD symptoms when it comes to planning problems. Adolescents with more depressive symptoms at the start of treatment gained more from SFT than from PML with regard to planning problems. However, for adolescents with more anxiety symptoms and less depressive symptoms, there was more improvement on planning problems in PML than in SFT. There was no difference for adolescents with ADHD who scored low on both anxiety and depressive symptoms.
Only the results of the PML were upheld in the long-term. This implies that adolescents with more anxiety symptoms and less depressive symptoms should use PML rather than SFT, especially when it comes to planning problems. The more positive effects of PML for more severe cases of ADHD and more positive effects of SFT on less severe cases of ADHD did not remain in the long-term.
Anxiety in ADHD is associated with more negative affectivity and disruptive behaviour rather than fearfulness of phobic symptoms. This implies that some ADHD symptoms could be the result of anxiety or vice versa. Anxiety experienced by adolescents with ADHD may be attributed to poorer executive functions.
It
.....read more Daley et al. (2014). Behavioural interventions in attention-deficit/hyperactivity disorder: A meta-analysis of randomized controlled trials across multiple outcome domains.” – Article summary
Multimodal treatment approaches are recommended for the treatment of ADHD. The first-line intervention, especially for severe cases, is medication. However, medication has some limitations. Some patients report a partial or no response to the medication and the long-term effectiveness is unknown. Furthermore, it may not improve important aspects of functioning (e.g. academic achievement). Adverse effects are common and treatment compliance to medication can be low, especially in adolescence.
Another possible treatment for ADHD is behavioural intervention. The results of these behavioural interventions are contested, as most ratings are made by people close to the intervention (e.g. parents). This could inflate the efficacy of the intervention. The found effectiveness of the interventions could be due to biased unblinded raters (1), interventions increase parental tolerance for ADHD symptoms (2), the used blinded measurements were less valid than most proximal measurements (3) and the intervention effects did not generalize from the therapeutic setting to the daily-life setting (4).
There appears to be a significant effect for positive parenting for proximal measurements (i.e. not blinded). Negative parenting seemed to decrease for proximal measurements. There was a small increase in parental self-concept after treatment. There was no significant effect of treatment on parental mental well-being. There appeared to be no effect of treatment on the core symptoms of ADHD.
Behavioural interventions had positive effects on important aspects of child and parent functioning. Behavioural interventions improved parenting (i.e. increased positive parenting and decreased negative parenting). It also decreased children’s comorbid conduct problems. There appeared to be more positive parenting and a more appropriate use of this (e.g. praise).
There was an improved parenting self-concept. This has an empowering effect in the process of breaking negative parent-child interaction cycles. There were no beneficial effects of treatment on parental mental health. The most proximal measurements found that children with ADHD also improved on academic performance and social skills after treatment.
Cousijn, Luijten, & Feldstein (2018). Adolescent resilience to addiction: A social plasticity hypothesis.” – Article summary
The prevalence of substance use disorders is highest during adolescence. Many adolescents experience a natural resolution of their substance use by early adulthood without the need of any formal intervention.
Adolescence is characterized by an increase in risk taking and adolescence can be defined as the developmental period between the onset of puberty and the assumption of adult roles and responsibilities. Risk-taking might be adaptive as it may be crucial to adolescents’ successful maturation and movement towards independence. The adolescent brain undergoes rapid changes in how it processes affective and social information. This guides adolescents to choices mainly based on short-term outcomes.
Social attunement refers to a need to adapt and harmonize with the social environment. Adolescents’ capacity to learn from and adapt to their constantly changing social environment is thought to be supported by enhanced socioaffective processing and brain plasticity. This may be both a risk and a protective factor for substance use disorder. This is called the social plasticity hypothesis.
In adolescence, parent input remains important but peer input begins to take primacy. During this period, adolescents are more likely to be in a peer context in which substance use occurs. The proportion of substance-using friends is the best predictor as to whether someone will use substances. The perception of adolescents’ perception of peer substance use is related to their current substance use and their substance use progressions.
The rise in substance use after first experimentation is probably the result of exploration of new social groups, experimentation with new behaviours and reductions in parental monitoring. Most adolescents report a strong, positive effect of their substance use in the social domain. Substance use related accidents (e.g. falling while drunk) affect a large proportion of adolescents and young adults.
Complex cognitive functions (e.g. social cognition) develop throughout adolescence into adulthood. Adolescents primarily prefer short-term outcomes and affective context may drive decision making, especially in early to middle adolescence. The interplay between the changing social environment, heightened emotional arousal and enhanced reward sensitivity leads to more risk-taking and social interactions.
The executive network is involved in cold executive control (i.e. processing events of low emotional salience). It includes the frontoparietal brain areas (e.g. posterior parietal cortex; dorsolateral prefrontal cortex; inferior frontal gyrus; dorsal anterior cingulate cortex). The salience network is the hub for emotion regulation (1), salience attribution (2) and integration of affective information into decision making (3). It includes the ventral anterior cingulate cortex, anterior insula, orbitofrontal cortex and limbic areas (e.g. amygdala). Social cognitive functioning is driven by a network comprised of the medial prefrontal cortex and superior temporal brain areas.
The behavioural changes during adolescence result from widespread changes in structure, connectivity and function among these brain areas. Frontal brain regions involved in social cognition and control mature later than other regions. During adolescence, the functional connectivity during these areas is slowly being enhanced due to the continuation of white matter myelination.
.....read more “Kong et al. (2015). Re-training automatic actin tendencies to approach cigarettes among adolescent smokers: A pilot study.” – Article summary
Most smokers start during adolescence. Many adolescent smokers want to quit but the majority of them are unsuccessful. The dual process theory states that addiction may be related to an imbalance between the fast associative impulsive processes (1) and slower reflective processes (2).
The combination of strong impulsive and weak reflective processes result in susceptibility to cues triggering the addictive behaviour. This leads to difficulties in inhibiting the tendency to engage in the addictive behaviour. The implicit processes may be stronger among adolescents because impulse control processes have not been fully developed while emotional and reward-seeking processes are most active.
A treatment aimed to modify approach bias towards cigarettes did not modify this. However, it appeared to improve smoking cessation outcomes. Regardless of the type of treatment (i.e. CBM or CBT), there was an overall decrease of cigarettes smoked. Both treatments appeared to have reduced the approach bias toward substance use for people who already had an approach bias towards substance use. The change in approach bias is moderated by the strength of the approach bias prior to treatment (i.e. baseline). The stronger the approach bias prior to treatment, the greater the decrease in approach bias will be.
“Marsch & Borodovsky (2016). Technology-based interventions for preventing and treating substance use among youth.” – Article summary
Technology-based interventions are effective for preventing and treating substance use disorders. It is particularly suited for youth. They are relevant at any stage in the development of a substance-use disorder and they provide solutions to existing problems of traditional interventions.
Youth who use substances are at risk for sexually transmitted diseases (1), impaired cognitive functioning (2), major depressive episodes (3), poor educational attainment (4), involvement in the criminal justice system (5) and having a substance use disorder later in life (6).
Intervention strategies to prevent the development of a substance use disorder include universal prevention (1), selective prevention (2) and treatment (3). The goal of universal prevention is to prevent substance use initiation. Selective prevention involves identifying high-risk youth and intervening to stop problematic substance using behaviours that may escalate into a disorder. The goal of treatment is to intervene with individuals who meet the criteria for a disorder.
Problems with current treatments are that they are expensive (1), rarely tailored to adolescents (2) and are difficult to consistently access for patients (3). Technology-based treatment helps with these problems.
Technology-based universal intervention targets youth between 10 and 18 years old and consist of interactive, digital activities designed to increase drug-related knowledge and alter attitudes and normative beliefs around substance use. This is typically provided in three settings:
- Primary care setting
In a primary care setting, the computer-delivered brief intervention appeared to result in a lower cumulative proportion of cannabis use initiation compared to people who only read an educational brochure. - School setting
- CLIMATE
This intervention provides six lessons based on social influence research. This provides the adolescents with information about the prevalence and consequences of substance use and ways to avoid substance use. After this, roleplaying, group discussion and other activities take place. It is more effective than standard health class curricula. - HeadOn
This intervention is designed for youth between grades 6 and 8. It consists of interactive, simulated scenarios that require youth to engage in substance-related decision making. They can master 10 topics and receive a skill card for each topic, which they can use in a card game. This makes it very interactive. The treatment appears to be effective and is reported to be fun and interesting.
- CLIMATE
- Home setting
In a home setting, youth can engage with the intervention and their parents at the same time. These interventions offer parents the opportunity to reinforce new behaviours and beliefs to foster healthy relationships. It helps youth develop better self-efficacy and less substance use.
Technology-based selective prevention identify at-risk adolescents across a range of treatment settings and patient populations. It makes use of screening, brief intervention and referral to treatment. This is typically provided in two settings:
- Medical setting
- Primary care
In a primary care setting, patients typically fill in a questionnaire about their substance
- Primary care
“Bexkens et al. (2019). Peer-influence on risk-taking in male adolescent with mild to borderline intellectual disabilities and/or behavior disorder.” – Article summary
There is increased risk-taking in adolescence. Adolescent risk-taking may occur because of an imbalance in brain development with a protracted development of the cognitive control system relative to a high reactivity in the reward system. Real-life risk taking typically occurs when peers are present. Adolescents spend more time in the presence of peers and become more sensitive to the effects of peers.
Peer pressure enhances reactivity in the brain’s reward circuitry. This indicates an influence of the presence of peers on reward valence. The relationship between lower resistance to peer-influence and increased behavioural risk-taking is mediated by the right temporoparietal junction (TPJ). This is one of the core regions associated with social-cognitive processes (e.g. perspective taking). This indicates an important role of social-cognitive processes during peer influence on risk taking.
Factors related to the explanation of adolescent risk-taking are cognitive control processes (1), reactivity of the reward system (2), social cues (3) and social cognition (4).
There is increased risk taking in adolescents with mild-to-borderline intellectual disability. Mild-to-borderline intellectual disability consists of borderline intellectual functioning (i.e. IQ between 70 and 85) and mild intellectual disability (i.e. IQ between 50 and 85) and both consist of limitations in adaptive functioning. The prevalence of MBID is 10% and is heterogeneous and highly comorbid.
MBID is associated with cognitive control deficits. Adolescents with MBID struggle to make safe decisions under negative peer-pressure. There are social-cognitive deficits in MBID and this could make adolescents with MBID more vulnerable to peer-pressure because they are less able to read their peers’ intentions. Behavioural problems are associated to enhance risk-taking and it is linked to aberrant reward processing and cognitive control problems.
In the presence of peers, the presence of MBID is associated with increased risk taking and increased risk-taking propensity. This is not the case in the absence of peers. MBID but not BD is related to increased risk-taking propensity in the presence of peers. MBID was associated with lower behavioural consistency, especially in the presence of peers. This indicates that MBID and peer influence result in lower behavioural consistency.
Only having MBID (i.e. no BD) is related to increased safety estimates and MBID in general enhances safety estimates under peer pressure. Only having MBID is also associated with decreased uncertainty estimates and MBID in general decreases uncertainty estimates under peer pressure.
MBID is related to increased risk taking under peer pressure whereas BD is not associated with increased risk taking. This indicates that risk-taking may be the result of lower intellectual functioning rather than behavioural problems.
It is possible that adolescents with low resistance to peer-influence are distracted by the social implications of their decisions and, therefore, make more risky decisions. The MBID-only group is characterized by increased safety estimates and enhanced risk taking propensity. This both leads to increased risk taking behaviour.
Pro-social peers can successfully reduce externalizing behaviour. MBID-related increased real-life risk taking may be better
.....read more “Peltopuro et al. (2014). Borderline intellectual functioning: A systematic literature review.” – Article summary
People with borderline intellectual functioning (BIF) have a number of problems in life, including neurocognitive, social and mental health problems. They typically have lower-skilled jobs and earn less money.
People with borderline intellectual functioning (BIF) have an IQ test that is one to two standard deviations below average (i.e. 70 – 85). The adaptive behaviour of people falling in this group needs to be taken into account. People with BIF are typically not eligible to receive intellectual disability-related support.
When it comes to determining support (e.g. special education or not) it is often assumed that there is a discrepancy between performance in academic skills and the general level of intelligence.
//NEUROCOGNITIVE FUNCTIONING
--Academic and cognitive skills
Children with borderline intellectual functioning were outperformed by peers of the same age with average intelligence on measures of memory skills. There appears to be a deficit in memory functions in people with borderline intellectual functioning. Children with BIF show structural abnormalities in the phonological store. Furthermore, there appear to be developmental lags in their visuospatial and central executive subsystems. In short, the working memory functions of children with BIF seem to develop in line with their general intellectual abilities as they are experiencing a developmental lag and not a qualitative deviation from normal development.
Children with BIF showed poorer attention shifting (1), cognitive inhibition (2), problem solving (3), planning (4) and response inhibition (5) than controls. Processing speed in children with BIF appears to be slower. However, impulse control appears to be the same as the controls. Arithmetic skills for children with BIF were poorer than for the controls. There is no consensus regarding reading and writing skills.
Students with BIF used theories that were more immature than peers of average intelligence. They prefer to use intentional mechanisms as a relevant causal explanation (e.g. I want my child to have blue eyes so my child will have blue eyes). Furthermore, they used less advanced learning strategies than other children.
--Motor skills
About 40% of the children with BIF showed no motor problems while 43% showed definitive motor problems. This indicates that BIF is associated with motor problems. People with BIF showed better motor and memory functioning than people with mild intellectual disability. However, people with a specific learning disorder mostly outperformed the BIF group or had equal performance on measures. Executive functioning appeared to be poorer among the BIF group than the mild intellectual disability and specific learning disability group.
//SOCIAL BEHAVIOUR
--Social interaction
There is more solitary play and less group-play behaviour among children with borderline intellectual functioning compared to controls. Peers appear to have a great impact on behaviour as there was more positive interaction when children with BIF were paired with average-intelligence same-age children than when they were paired with other children with BIF.
Mothers of children with BIF exhibited less positive and less sensitive parenting than mothers of
.....read more “Seidenberg (2017). Language at the speed of sight.” – Article summary
Children whose experiences with early reading (e.g. preschool) are limited or of poor quality are at risk for reading failure. Dyslexia refers to reading that is impaired due to developmental neural and genetic anomalies that affect this skill, It focuses on reading impairments that are neurobiological and genetic rather than environmental.
The proximal causes are impairments in cognitive, perceptual or motor functions that affects components of reading. Dysfluencies in reading words can arise from several causes (e.g. slow recognition of letter combinations). Genetics can contribute to understanding reading disorders by specifying mechanisms that influence brain development in ways that underlie the proximal causes. Dyslexia is also associated with several types of anomalies in the structure and function of the neural systems for reading.
There are several common behaviours in children with dyslexia:
- Phonology
The impaired performance on phonemic tasks includes deletion (1), matching (2) and blending (3). - Reading aloud
The performance is often slow, dysfluent and error-prone. There is particular difficulty with irregularly pronounced words. - Processing speed
The performance is often slow when it comes to naming familiar digits, colours and objects. - Orthography
The limited knowledge of orthographic structure expresses itself in difficulty distinguishing valid from invalid letter strings (1), weak knowledge of word spellings (2), misspellings (3), misidentification (4) and dysfluency in generating spellings (5). - Working memory
There is a deficit on working memory tasks. - Language
There is a limit on vocabulary size and lexical quality (1), familiarity with a narrower range of sentence structures and expressions (2) and difficulty reading texts aloud with appropriate intonation (3).
It was important to distinguish reading difficulties that result from a general intellectual impairment from readings-specific ones. There is no consensus regarding the incidence of dyslexia due to arbitrary cut-off points for when someone can be considered to be dyslexic.
The genetic component of dyslexia is greater for higher-IQ children than for lower-IQ children. Higher IQ acts as a protective factor against falling into the dyslexic range. The behavioural characteristics of poor readers are very similar across a wide IQ range. The skills that pose difficulty for children with reading difficulty are not closely related to the skills that IQ tests measure.
All children face the same challenges in learning to read but dyslexics have more difficulty with the essential components. The accumulation of these deficits and their multiplicative effect on each other affect performance to the point where a child can be described as dyslexic.
It is not clear whether dyslexia is a valid developmental disorder since it entails the children who fall on the low end of a reading continuum. This does not necessarily mean that it is a disorder. How far an individual with dyslexia progresses with reading depends on the severity of impairment (1), timing and quality of intervention (2), protective factors (3) and the environment
.....read more “Doebel (2020). Rethinking executive function and its development.” – Article summary
Executive functions refer to the use of cognitive processes to engage, direct or coordinate other cognitive processes, typically in the service of goals. It is often believed to be a set of separable but related component processes involved in goal-directed thought and action (1), updating working memory (2), shifting between tasks (3) and inhibiting prepotent thoughts and responses (4). Deficits in executive function are linked to a range of clinical outcomes (e.g. ADHD).
The development of executive function is believed to consist of improvements in domain-general components that are thought to underlie self-regulatory and complex goal-directed behaviours. This, in turn, is improved due to prefrontal cortex development.
It is thought that executive function is reducible to one to three component processes that may become differentiated with age. Performance on measures of executive function improve dramatically in early childhood. Executive function may develop through neurocognitive mechanisms (e.g. active maintenance of abstract representation; inhibition).
It is believed that executive function is associated with a wide variety of things (e.g. theory of mind). Improvement in components of executive function is then believed to improve overall executive function, which is, in turn, believed to improve the particular object of interest (e.g. theory of mind). Improvements in executive function components are thus expected to lead to improvements in different but related domains that require executive function.
There are several problems with the view that executive function consists of a few components which are strongly related with other domains:
- Evidence that exercising supposed executive-function components improves executive function or abilities in other domains is limited.
- Standard lab measures of executive function do not consistently relate to questionnaire measures of self-regulation or many real-world outcomes of interest.
- It is difficult to draw conclusions from correlations between performance on lab measures of executive function and other outcomes.
- It is not certain that executive function consists of three components (i.e. the separable components identified in latent variable analyses may reflect common task demands).
Instead of viewing the development of executive function as the development of separable components, it should be viewed as the development of skills in using control in the service of specific goals. Specific goals activate mental content and children acquire this mental content with development in a specific sociocultural context. This shapes how they use control. According to this viewpoint, age-related improvement on measures of executive function may reflect the acquisition of knowledge, beliefs, values and more that shape how control is used in the service of particular goals. Executive functions most likely also consists of a basic capacity to maintain goal information.
Executive functions are always engaged in the service of a particular goal and these goals activate mental content that shapes how executive function is engaged and develops in relation to particular situations.
Different scores on executive function tasks related to self-regulation might have to do with the relevance of
.....read more “Michaelson & Munakata (2020). Same data set, different conclusions: Preschool delay of gratification predicts later behavioral outcomes in a preregistered study.” – Article summary
It is believed that the results of the marshmallow test predict important outcomes throughout the life span. However, this is not entirely certain.
Individuals vary in their ability to regulate behavioural, emotional and attentional impulses to achieve long-term goals. These individual differences show stability across the lifespan. This means that the marshmallow test may be predictive of later outcomes because the self-control remains stable throughout life. The marshmallow test may also be predictive because it captures social and situational factors. People are less willing to delay gratification with untrustworthy individuals or when delay is not normative or rational. A child’s ability to wait during the marshmallow test may thus be less important than the social and environmental circumstances influencing their willingness to wait.
Pre-schoolers who delayed gratification had significantly better academic achievement (1), fewer problem behaviours (2) and better social skills (3) in adolescence than those who did not delay gratification. Models that adjusted for pre-school levels of the adolescent outcome constructs continued to predict significantly less problem behaviour in adolescents. The relationships between delay of gratification and academic achievement and social skills were no longer present. This might have been due to a combination of concurrent associations (1) and correlations between repeated measures of the same outcome over time (2).
Social support (i.e. the social and environmental circumstances influencing willingness to wait) provide a more powerful explanation for the differences in the marshmallow test than self-control. The marshmallow test may be predictive because it reflects social factors. Children who grow up in supportive environments may be more willing to delay gratification because of greater trust that events will unfold as expected and because of norms around future-oriented decisions. Experiences with delaying gratification may turn in a greater willingness and ability to delay. Children in supportive environments may thus increasingly delay gratification to foster behavioural, social and academic success across development.
“Schneider & McGrew (2012). The Catell-Horn-Carroll Model of intelligence.” – Article summary
The Catell-Horn-Caroll (CHC) theory of cognitive abilities consists of a taxonomy of cognitive abilities and a set of theoretical explanations of how and why people differ in their various cognitive abilities. This model builds on previous theories of intelligence (e.g. Spearman’s ‘g’; Gf-gc theory; early factor analysis).
A useful classification system shapes how we view complex phenomena by illuminating consequential distinctions and obscuring trivial differences. A misspecified classification system orients us toward the irrelevant and distracts us from taking productive action. Classification systems need to be properly aligned with our purposes.
The Gf-Gc theory states that general intelligence can be split into two separate general intelligence factors, namely into fluid intelligence (i.e. Gf) and crystallized intelligence (i.e. Gc). This theory is able to describe the nature of both factors. Cattell believed that the differences in breadth and depth of knowledge are influenced are the joint function of two influences. Fluid intelligence, as low fluid intelligence limits the rate at which a person can acquire and retain new knowledge (1) and investment, the differences in time and effort spent on learning (2). According to Cattell, this explains the positive manifold (i.e. differences in fluid intelligence and investment). The positive manifold (i.e. ‘g’) results from the differential success of investment due to fluid intelligence.
After the Gf-Gc theory, it was expanded to include several broad ability factors (e.g. visual intelligence). Later, Carroll’s three-stratum model, which consisted of a reanalysis of factor-analytic studies of human cognitive abilities. This model was the first empirically-based taxonomy of human cognitive abilities. His three-tier model differentiated abilities as functions of breadth. The broadest level (i.e. stratum III) is a general intelligence factor. Next in breadth, there are eight broad abilities that represent basic constitutional and long-standing characteristics of individuals that can govern or influence a great variety of behaviours in a given domain. Stratum II consists of the abilities of fluid and crystallized intelligence as well as other broad factors (e.g. broad auditory perception). Stratum I consists of numerous narrow abilities subsumed by the stratum II abilities. Critique is that none of the datasets included the necessary breadth of variables to evaluate the general structure of his model.
The WJ-R was the first individually administered, nationally standardized, clinical cognitive and achievement battery to close the gap between psychometric theory and applied assessment practice. It was an implementation of the multifactor model of intelligence.
CHC theory is an umbrella term variations on a Gf-Gc theme. This recognition increased because of CHC research syntheses. It was believed that the speed domains of Gs and Gt might best be represented within the context of a hierarchically organized speed taxonomy with a g-speed factor at the top.
It appears as if cognitive abilities contribute to academic achievement in different proportions in different domains. These proportions change over the course of development. Intelligence tests should be more flexible as one battery of tests does not fit all.
.....read more “Brosschot, Verkuil, & Thayer (2017). Exposed to events that never happened: Generalized unsafety, the default stress response, and prolonged autonomic activity.” – Article summary
The generalized unsafety theory of stress (GUTS) states that the stress response is a default response and chronic stressors are caused by generalized unsafety, independent of stressors of their cognitive representation. There three prevalent conditions which are vulnerable to becoming compromised in terms of generalized unsafety and this has considerable health risks:
- Compromised bodies
This refers to conditions with reduced bodily capacity (e.g. obesity; older age). - Compromised social networks
This refers to conditions where one is not part of a cohesive social network (e.g. loneliness). - Compromised contexts
This refers to daily contexts which are neutral by themselves which then are seen as unsafe after association with stressors via context conditioning.
Chronic psychological stress responses are the crucial causal factor leading to disease. However, the precise causes of these responses are unclear. The reactivity hypothesis states that multiple intense responses during stressors are important. However, this theory (and other similar ones) neglects the duration of exposure that often outlasts the stressful events themselves.
Perseverative cognition refers to cognitive representation of stressors and this may be important in the perseverance of the stress response. Perseverative cognition causes prolonged physiological responses. Chronic responses, over time, lead to allostatic load (i.e. biological dysregulation).
It is possible that not the perseverative cognition but the generalized perception of unsafety is the crucial explanatory mechanism in the adverse effects of chronic stress.
The stress response is a default response of an organism and the organism automatically falls back on this response when no other information is available. Generalized perception of unsafety (GU) may cause the default response to remain activated because the brain fails to register situations of the modern society as safe. The generalized unsafety theory of stress states that not being able to inhibit the default stress response is not dependent on actual stressors or perseverative cognition. The generalized perception of unsafety is sufficient.
The stress response is mediated by subcortical areas in the brain (e.g. amygdala; limbic system). It is normally under continuous inhibition by the prefrontal cortex (i.e. ventromedial prefrontal cortex). The inhibition is decreased when safety is in doubt and the amygdala activity is enhanced. The stress response is not triggered but disinhibited. Inhibition of this response may be more cost-efficient than activation of the same response.
The default mode network refers to a network of brain areas which are activated when the brain perceives safety and is not involved in any particular task. This is not the same as the default response, which occurs when there is no information regarding safety available. This means that the default stress response is typically inhibited during the default mode network.
The brain will assess the surroundings to evaluate whether it is safe. However, if the safety of the surroundings cannot be guaranteed, then the stress response remains disinhibited. Safety signals are learned cues that predict the stress free periods. The stress
.....read more “Lindenberger (2014). Human cognitive aging: Corriger la fortune?” – Article summary
Human cognitive aging differs between individuals. It can be influenced by several factors (e.g. vascular conditions; chronic stress; experience-dependent cognitive plasticity). Living an intellectually challenging, physically active and socially engaged life may mitigate losses to cognition and consolidate gains.
The debilitating effects of old age occur at an increasingly later age. It is possible that the effects of old age reflect limitations in somatic maintenance, resulting in the build up of damage. Factors associated with vascular and metabolic risk (1), inflammation (2), stress (3) and deposition of iron and beta-amyloid (4) accelerate brain aging. However, continued neuroplasticity helps maintain the viability of neural structures and postpone the onset of cognitive decline.
Mechanisms related to maturation and the effects of cold age shape the course of cognitive development from conception to old age. In adulthood and old age, brains show increasing marks of aging but accumulate knowledge and continue to express potential for learning. There are experience-based cognitive abilities called crystallized abilities (e.g. vocabulary) and fluid abilities (e.g. reasoning) which are important in acquiring knowledge. The ages at which cognitive skills reach there peak are likely to reflect a balance among competing processes of knowledge accumulation and deterioration of the supporting neural infrastructure.
Senescence, the effects of old age, affect the neurochemistry and anatomy of the brain (e.g. neurotransmitters show age-related differences in concentration and receptor density). There is a pronounced decrease in dopaminergic neuromodulation. This plays a crucial role in cognitive functioning. Old age is associated with differences in smaller volumes of grey and white matter. Hippocampal shrinkage tends to increase with age and is exacerbated by vascular factors.
White matter hyperintensities (i.e. ischemic lesions; microbleeds; demyelination; expansion of perivascular spaces) tends to increase from middle to late adulthood and is associated with vascular risk and inflammation. The supply-demand mismatch model of adult cognitive plasticity states that the mismatch between functional supply and experienced environmental demands can be caused by primary changes in demand (1) or functional supply (2). Functional supply refers to structural constraints imposed by the brain on function and performance. It permits a given range of performance and functioning. Flexibility refers to the capacity to optimize the brain’s performance within this range. A prolonged mismatch pushes the system away from its current dynamic equilibrium. [CLINICAL DEVELOPMENTAL & HEALTH PSYCHOLOGY, YEAR 3]
The adult brain differs in the onset and degree of age-related volume losses. There are large individual differences in the lateral prefrontal cortex (1), prefrontal white matter (2) and the hippocampus (3). Rates of shrinkage are increased by risk factors (e.g. hypertension; metabolic syndrome; vascular risk). Individual differences in cognitive performance increase from early to late adulthood and old age. It appears as if volume losses in the frontal lobes are interdependent. Deficits in both prefrontal and hippocampal activation patterns contribute interactively to adult age differences in associative episodic memory.
Cognitive aging has a very general component (i.e. there is a general decline rather
.....read more “Wesarg et al. (2020). Identifying pathways from early adversity to psychopathology: A review on dysregulated HPA axis functioning” – Article summary
It is possible that early adversity could set in motion a detrimental developmental cascade. This includes changes in the hypothalamic-pituitary-adrenal (HPA) axis activity. This, in turn, influences self-regulation in childhood. Both patterns of high and low cortisol in the HPA axis are associated with impairments in executive function, which, in turn, is important for self-regulation.
Early adverse experiences are associated with problematic socio-emotional development. This may occur through alterations in neurobiological systems and impairments in self-regulation.
Children make great developments in self-regulation in the first years of life. Regulation success depends on the caregiver in infancy but afterwards, the child progresses to more internally-regulated behaviours. In toddlerhood, self-control, autonomy and compliance emerge as a function of increasing self-regulatory skills. Furthermore, the first years of life are characterized by maturational changes in the HPA axis. Both self-regulation and the HPA axis functioning can be disturbed by adversity.
Direct and contextual (i.e. indirect) adversities often co-occur. All forms of early adversity challenge the child’s coping resources, leading to chronic stress. The development of stress-response systems is affected by early adversity. Allostasis refers to the body’s ability to achieve stability through physiological changes in stress-mediating systems (e.g. secretion of inflammatory cytokines; changes in cortisol). This is adaptive in the short-term as they prepare an individual for a stressful event. However, prolonged exposure to stress (i.e. sustained allostatic state) leads to altered activity of stress mediators. This can eventually lead to allostatic overload, which is a major risk factor for pathology.
Activity of the HPA axis leads to cortisol increases when the organism is confronted with a stressor. Allostatic load could consist of heightened levels of cortisol. Chronic stress could also lead to a downregulation of the HPA axis to protect the body from damage caused by the toxic effects of stress hormones. It is believed that chronic stress initially elevates cortisol levels but this eventually becomes reduced compared to normal cortisol levels.
Caregivers provide a strong social regulator of HPA axis activity in the first years of life. Abuse refers to repeated exposures to threatening behaviours perpetrated toward the child. Neglect refers to lack of necessary care from the primary caregiver. There appears to be a pattern of hypoactive HPA axis activity in neglected children. Foster care may have a regulating influence on cortisol levels among children with maltreatment experiences. Foster children exhibited higher incidences of atypical cortisol patterns (i.e. both hypo- and hyperactive).
Hypoactivity of the HPA axis leads to low levels of cortisol in the morning. This, in turn, leads to flatter slopes of cortisol activity, which leads to a blunted pattern of HPA-axis activity. It is not clear whether abuse and neglect have differential effects on HPA axis activity. There is an association between maternal unresponsiveness and high cortisol levels in early childhood. It is possible that parental behaviour with the possibility of stress (e.g. maternal unresponsiveness) increases circulating levels of cortisol while neglect is severe
.....read more “Wylie, Ridderinkhof, Bashore, & van den Wildenberg (2010). The effect of Parkinson’s disease on the dynamics of on-line and proactive cognitive control during action selection.” – Article summary
Processing irrelevant visual information sometimes activates incorrect response impulses. The engagement of cognitive control to suppress these impulses and make proactive adjustments to reduce the future impact of incorrect impulses may rely on the integrity of frontal-basal ganglia circuitry. In Parkinson’s disease, motor symptom severity is associated with within-trial (i.e. on-line) control of response impulses. This implies that basal ganglia dysfunction produced by Parkinson’s disease has selective effects on cognitive control mechanisms engaged to resolve response conflict. The primary deficits are in the on-line suppression of incorrect responses occurring in the context of a relatively spared ability to adjust control proactively and minimize future conflict.
Inhibition of stimulus-driven response impulses can be beneficial to the speed and accuracy of emitted responses. However, activation of an unwanted response may also interfere with selection of a desired response or lead to response error. On-line control refers to mechanisms to suppress incorrect response activation. Proactive control refers to adjusting control mechanisms to better adapt to future response conflict.
Response interference tasks induce conflict between a response impulse that is driven automatically by an irrelevant feature of a stimulus display and a response that is selected deliberately by the processing of relevant stimulus features.
In the Simon task, people have to make a hand movement towards a spatial location as indicated by a coloured circle. The Simon effect refers to the detrimental influence on performance of non-corresponding trials relative to the facilitative influence of corresponding trials. Non-corresponding means that the spatial location of the trial (i.e. hemisphere wise) is incongruent with the preferred movement.
This is typically explained through dual-route processing models. These models state that the spatial location or the irrelevant dimension automatically and rapidly activates the corresponding response via a direct processing route. The relevant feature engages a deliberately processing route which utilizes a slower controlled processing mechanism to translate the feature in the correct response. On corresponding trials, the direct and the deliberate route converge. On non-corresponding trials, the direct and the deliberate route conflict, slowing reaction time and increasing error rate. The size of the Simon effect reflects the extra demands and time required to suppress the interference caused by the incorrect response activation in non-corresponding trials.
It is possible that interference control mechanisms can be adjusted proactively between trials. Control processes may be tightened by trials that follow conflict trials and vice versa. This means that the Simon effect reduces following trials with response conflict.
The basal ganglia is believed to contribute to the neural mechanisms involved in the focused selection and inhibition of action. To release motor pathways from inhibition, the output structures of the basal ganglia that correspond to a particular movement must be selectively inhibited by upstream basal ganglia projections.
The direct pathway of the basal ganglia provides inhibitory control over the output structures. The indirect pathway of the basal ganglia excites basal ganglia output structures, increasing inhibition. Thus, the
.....read more “Clinical Developmental & Health Psychology – Lecture 1 (UNIVERSITY OF AMSTERDAM)”
People with a mental disorder tend to have higher mortality and have lower reproductive success.
The paternal age effect refers to increased risk of a mental disorder when the father is older when he has the child. It is possible that females with mental disorders have higher reproductive success than males with a mental disorder because of females are not always fertile and thus have more of a choice of whether to reproduce.
The mental disorder paradox refers to mental disorders being common (1), having high heritability (2) and people with mental disorders having lower reproductive success but mental disorders not having been eliminated through natural selection. There are three general resolutions for this paradox:
- Ancestral neutrality
This states that mental disorders have a negative effect on reproductive success in modern times but this was not the case in ancestral times (e.g. schizophrenia was seen as divinity; anxiety served a purpose). - Balancing selection
This states that mental disorders have a negative effect on reproductive success but this is counterbalanced by positive effects (e.g. people with schizophrenia are more creative; people with autism have better systematic thinking). - Polygenic mutation-selection balance
This states that mental disorders are the result of unavoidable mutations in one of the many genes that underlie human behaviour. The mental disorders consist of a lot of genes meaning that the random variations cannot be selected out, which means that mental disorders cannot be filtered out through natural selection.
It is possible that people with a mental disorder themselves have lower reproductive success but family members with the genes but not with the disorder only have the positive effects (e.g. higher creativity). This could enhance their reproductive success (i.e. higher inclusive fitness), which keeps the genes of a mental disorder present in the population. However, this does not appear to be the case.
High comorbidity would be expected if a lot of genes underly mental disorders. As this is the case, this provides support for the polygenic mutation-selection balance hypothesis. Furthermore, it is possible that many genes for mental disorders are recessive as there is an association between inbreeding and mental disorders. The heritability of mental disorders could be explained in the polygenic mutation-selection balance because mutations can take a long time before they are eliminated.
Developmental psychopathology refers to the focus on the interplay of personal and environmental factors in the origin of mental disorders. This includes genotype-environment interactions, epigenetic encoding of life events and neurobiological factors. Computational psychiatry refers to mathematical models of cognitive and neural processes (e.g. decision making) to identify the mechanisms involved in mental disorders.
Evolutionary psychopathology uses biological models and concepts to understand the functions of the neural and psychological processes involved in mental disorders and how they have been shaped by selection processes. Evolutionary psychopathology does not necessarily regard mental disorders as dysfunctions. It is possible that behaviours
.....read more “Clinical Developmental & Health Psychology – Lecture 2 (UNIVERSITY OF AMSTERDAM)”
It is important to study infants as this might help predict outcomes later in life. Early development lays the foundation for later life (e.g. malnutrition in infancy can lead to obesity in later life). Early trauma has cascading effects. It is possible that cognitive processes can be predicted by using outcomes in infancy. Early intervention and prevention are more effective than later interventions.
Infants are extremely sensitive to learning. During infancy, there are fast-growth processes in both the body and the brain. Sleep and sleep quality are associated with good outcomes in infants. It is thus important for infants to learn how to sleep well and not learning this has cascading effects.
It is difficult to study infants because regular research methods do not work. However, there are several standardized tests to study infants (e.g. Bayley’s scales of infant development). The standardized tests have several disadvantages. The standardized tests are time-consuming (1), require much training (2) and are not very reliable (3). Using parent measures is not measuring the infant, which is a disadvantage.
There are two main methods of studying infants:
- Visual preference method
This method assumes that a longer looking time indicates a preference or an interest. Besides that, it is assumed that a longer looking time indicates that the infant is able to distinguish the stimulus of interest from other stimuli. This method can be used to examine what infants can perceive and what infants know. - Habituation-dishabituation method
This method presents an infant with repeated presentations of the same stimulus. A decrease in looking time is seen as habituation. It is believed that an increased looking time upon the presentation of a novel stimulus (i.e. dishabituation) is indicative of being able to distinguish the stimulus of interest from other stimulus and gives insight into the knowledge of infants.
Looking behaviour is used to study infants because it is available in infants early on (1), because saccades and looking behaviour is more under voluntary control than their arms and legs (2) and because visual acuity develops almost completely before three months of age (3).
A modern technique to study infants is the eye-tracking technique which uses a light to illuminate the eye (i.e. infrared light). A camera films the eye and an algorithm detects the corneal reflection and this determines eye gaze position. This data needs to be processed in fixations and saccades. Heart rate measures could also be used to study infants as a higher heart rate is associated with changes in attentional status.
The gaze patterns of adults depend on the instructions given to the participant. The eye-tracking technique can also be used to identify strategies when solving problems (e.g. children doing arithmetic problems).
There are different stages of attention development in infants:
- Alertness, wake-sleep cycles
- Spatial orienting (i.e. engagement, disengagement, shifting)
- Object attention
- Endogenous control
The looking
.....read more “Clinical Developmental & Health Psychology – Lecture 3 (UNIVERSITY OF AMSTERDAM)”
There are different types of responses to increased anxiety:
- Emotional response
This includes feeling anxious. - Cognitive response
This includes negative cognitions. - Behavioural reaction
This includes avoidance. - Physiological reaction
This includes trembling, sweating and more.
Anxiety disorder includes an overactivation of the amygdala and other bodily, cognitive and behavioural reactions in the absence of danger.
The older children get, the higher the probability that they develop an anxiety disorder. The prevalence of anxiety disorders in the general population is 0.5% - 5%. The prevalence of anxiety symptoms (i.e. above-average anxiety symptoms) is 5% to 10% in children and young people. Girls typically have increased levels of anxiety disorders in adolescence compared to boys.
There are three types of children who do not go to school:
- School refusal
This refers to a refusal or a reluctance to go to school. These children mostly stay at home and have severe emotional disturbance (i.e. anxiety). There is no anti-social behaviour and the parents make efforts to get the children to school. - School withdrawal
This refers to parent-motivated school absenteeism (e.g. children have to stay home from school to help in the household). - School truancy
This refers to school absenteeism to do something other than school (e.g. hang out in the mall)
There are several signs to recognize anxiety in children and adolescents in clinical practice and school:
- There will be unrealistic and excessive concern about past or future event and about their own performance.
- There will be a constant need for confirmation.
- There will be a lot of somatic complaints (e.g. stomach ache).
- There will be restlessness and alertness.
- There will be concentration problems.
- There will be avoidance behaviour.
- There will be a low(er) self-esteem.
- There will be a lot of fatigue.
- There will be problems after holiday, weekends and going away.
- There will be problems in saying farewell to parents.
- There will be a lot of blushing.
- There will be anxiety regarding negative opinions of others.
There is a lot of comorbidity in anxiety disorders with other anxiety disorders (1), depression (2), aggression (3) and school refusal (4).
There are several risk and protective factors for anxiety disorders:
- Genetics
The hereditary factor is between 45% of 68%. This could be both a risk and protective factor but the research is scarce and there is no consensus. - Temperament
The emotionality (1), neuroticism (2), behavioural inhibition (3) and score on the trait fear (4) influence the development and maintenance of anxiety disorders. However, these dimensions are very similar to each other. - Cognitive factors
This includes specific cognitive and attention characteristics (e.g. tendency to overestimate the risk of danger; believing I cannot do it). This is typically determined using self-report
“Clinical Developmental & Health Psychology – Lecture 4 (UNIVERSITY OF AMSTERDAM)”
ADHD is classified by two symptom clusters:
- Inattention
- Hyperactivity/impulsivity
Additional criteria for ADHD diagnoses is that the symptoms should be pervasive (i.e. symptoms should persist in more than one setting) (1), the symptoms should lead to impairment (2) and at least some of the symptoms should be present before the age of 12 (i.e. age of onset) (3).
There are three presentations of ADHD:
- Inattentive (30%)
There is mainly inattention and not necessarily hyperactivity. - Hyperactive/impulsive (5%)
There is mainly hyperactivity and impulsive actions rather than inattention. This is mostly seen in young children. - Combined (65%)
There is a combination of inattentive and hyperactive/impulsive symptoms.
There are several things to know about ADHD:
- There is substantial heterogeneity within ADHD.
- The differentiation between ADHD and other disorders is challenging as the presentation of ADHD symptoms can be caused by a lot of things (e.g. anxiety).
- The prevalence of ADHD appears to decrease from childhood to adulthood.
- There is a high comorbidity (i.e. 66%).
The prevalence of ADHD in children is 3% to 7%. In adults, the prevalence is 2.5%.
ADHD is a multifactorial disorder (i.e. there are multiple causes). There are several things that contribute to the causal factor of ADHD:
- Heritability
There is a high heritability in ADHD, meaning that there is a large genetic component. - Prenatal factors
The prenatal factors of the child influence the development of ADHD (e.g. maternal stress). - Interactions with environment (i.e. diathesis-stress model)
There are genetic vulnerabilities which can be triggered by the environment (i.e. gene-environment interaction).
The ADHD symptoms manifest themselves at different ages (e.g. ADHD in adolescence is associated with different symptoms than ADHD in childhood).
Childhood ADHD is a developmental risk factor for negative outcomes such as traffic incidents (1), substance abuse (2), aggression (3), delinquency (4), sexual risk-taking (5), gambling problems (6), financial risk-taking (7) and food-related risk-taking (8). Prevention and early intervention in childhood ADHD are very important.
There are children who grow out of ADHD when they reach adulthood but many do not. Of the children with ADHD, 20% - 45% meet the full criteria for ADHD as adults. About 25% to 48% of the children with ADHD have impairing symptoms as adults.
Children with ADHD have a delayed cortical development, especially the cortical thickness. The cortical regions are important for executive functions that are impaired in ADHD. This could explain some ADHD symptoms as the maturation of the cortex could alleviate ADHD symptoms.
The birthdate effect refers to the fact that ADHD is more often diagnosed in the youngest children in the class. This may be a wrong social comparison, as the children are compared to other children in the class. However, a younger child has a development that is a
.....read more “Clinical Developmental & Health Psychology – Lecture 5 (UNIVERSITY OF AMSTERDAM)”
Mindfulness refers to being deliberately aware of the present moment without judgement. Mindfulness is a relatively new intervention and was mostly rejected when it was first introduced.
Mindfulness-based stress reduction (MBSR) refers to an 8-week treatment employing mindfulness to reduce stress in participants. Mindfulness-based cognitive therapy (MBCT) refers to a mindfulness-based therapy aimed at participants with a mental disorder (e.g. depression). Mindfulness-based approaches appear to be effective in treatment of disorders where rumination plays a central role.
Mindfulness improves executive functioning and meditation experience is negatively associated with emotional interference (i.e. disengaging attention from emotional stimuli). The mindfulness-based approaches may be effective by targeting six areas:
- Reducing parenting stress
This affects parenting skill and mindfulness training may reduce parental stress and improve parenting skills. This, in turn, can also reduce parental reactivity. - Reducing parental preoccupation
Parents may be preoccupied with something and this biases and interferes with their attention. Mindfulness can reduce this and this may improve parenting. Parental preoccupation is typically the result of parent or child psychopathology. - Improving parental executive functioning (i.e. reduce parental reactivity)
The parental executive functioning may be improved through mindfulness and this may, in turn, reduce parental reactivity. Mindfulness may break the vicious cycle of negative reactivity. This may be especially effective in impulsive parents. - Breaking the cycle of intergenerational transmission of parenting
The parents may repeat dysfunctional parenting patterns and transmit these patterns through cognitive schemas. These schemas are likely to be activated under stress and mindfulness may reduce the occurrence of these schemas being used. - Improving self-nourishing attention
Mindfulness may improve parenting by improving self-nourishing attention. This may be particularly important for parents who suffer from mental disorders as they may not be able to provide positive attention to themselves due to growing up in an environment without positive attention. - Improving marital functioning and co-parenting
Mindfulness may improve this by improving marital conflict (1), marital satisfaction (2) and co-parenting (3).
- Reducing parenting stress
The vicious cycle of negative reactivity refers to poorer executive functioning leading to more impulsivity eliciting more impulsivity in the partner and this goes on and on.
In MBCT, there are typically 8 sessions with different topics:
- Automatic pilot
- Dealing with barriers
- Mindfulness of the breath
- Staying present
- Allowing and letting be
- Thoughts are not facts
- How I can best take care of myself
- Using what has been learned to deal with future moods
There are different mindfulness-based treatments for different disorders, for different developmental stages (e.g. menopause; adolescence) and different settings (e.g. company; school).
For neurodevelopmental disorders (e.g. ADHD), psychosis and bipolar disorder there is no consensus regarding the effectiveness of mindfulness-based interventions as more research is needed. For addictive disorders, neurocognitive disorders and PTSD there
.....read more “Clinical Developmental & Health Psychology – Lecture 6 (UNIVERSITY OF AMSTERDAM)”
Evidence-based treatment refers to the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. A practitioner can know what the best current evidence is by making use of guidelines. However, the guidelines only demonstrate what type of treatment is recommended for specific disorders but do not necessarily provide information about the efficacy.
The effectiveness of a treatment refers to the extent to which a treatment achieves its intended effect in the usual clinical setting. Efficacy refers to the extent to which a treatment has the ability to bring about its intended effect in ideal circumstances (e.g. randomized clinical trial).
For every treatment protocol, there should be information on efficacy. This information can be obtained by reviewing the literature (e.g. RCT; meta-analyses). It can also be found in databases following certain criteria (e.g. APA). For the Dutch database, there are several levels of efficacy:
- Well-reasoned
This entails that there is a clear description of the treatment which makes effectiveness plausible. - First indications of effectiveness
This entails that there are two studies using pre- to post measurements which yield positive results. - Good indications of effectiveness
This entails that there are two studies using reasonable designs or one study with strong evidence using a randomized controlled trial with follow-up. - Strong indications of effectiveness
This entails that there are two studies with strong evidence of effectiveness (e.g. RCT with follow-up).
Stimulant medication is the most used medication for ADHD. The short-lasting formula lasts for four hours and the long-lasting formula lasts for eight hours. Stimulant medication can be methylphenidate or dextroamphetamine. Atomoxetine is a different type of medication which reduces overactivity, impulsivity and inattention. It is supposed to improve associated behaviours (e.g. academic performance; social functioning).
Behavioural interventions are interventions aimed at changing behaviours. This is supposed to increase the desired behaviour and decrease the undesired behaviour. It consists of classic contingency management (1), behaviour therapy (2) and cognitive behaviour therapy (3).
A lot of the children with ADHD who have a combined treatment (i.e. behavioural treatment and pharmacological treatment) have normalized behaviour after 14 months. Medication appears to be highly effective but the doses can be lowered with behavioural treatment and the parents have a preference for behavioural therapy.
Medication has both advantages and disadvantages. Medication does not always improve aspects of functioning (e.g. academic achievement).
It appears as if people who can choose their own treatment have better outcome. Depending on age and symptom severity, behavioural intervention and medication are the recommended treatments.
The effect of medication and combined medication plus behavioural interventions had greater effects in the short term but the long-term effects of medication and behavioural intervention did not differ. The parents of a child with ADHD should always be informed about the potential advantages and disadvantages of ADHD medication.
.....read more “Clinical Developmental & Health Psychology – Lecture 7 (UNIVERSITY OF AMSTERDAM)”
In the past, addiction was seen as a choice and under full control of the addicted person. The addict was seen as a transgressor engaged in morally wrong behaviour. The inability to control the use of substances was seen as the core of addiction. There is physical and psychological dependence. In the past, the measurement of addiction consisted of measuring the withdrawal. Addiction is not the same as a lack of control.
Addiction refers to a brain disorder characterised by compulsive behaviour. It is the inability to control despite awareness of the serious negative consequences on daily life. The attempts to reduce or quit substance use fail. A simplified view of addiction is that there is an imbalance between approach-oriented motivational system and a regulatory control system in the brain.
Repeated use of a substance leads to a sensitized and conditioned response to cues associated with the substance. In the case of addiction, the behavioural control is compromised. The reinforcement learning network (1), the executive control network (2) and salience network (3) are involved in the development of addictive behaviours.
The salience network is the hub for emotion regulation (1), salience attribution (2) and integration of affective information into decision making (3). The reinforcement learning network is the hub for associative learning from both positive and negative behavioural outcomes. It is involved in the development of automatic and habitual behaviour. The executive control network is the main substrate for relatively cold executive functions (e.g. processing events of low emotional salience). It is involved in executive control (e.g. attention, working memory, inhibition).
The clinical symptoms of addiction include loss of control (1), social problems (2), pharmacological consequences (3) and high-risk use (4). The more symptoms a person has, the more severe the addiction is.
The environment plays an important role in the development of addiction as culture plays an important part in the development. Cannabis addiction appears to be real as 50% of the daily users develop an addiction. It is not clear whether behavioural addictions are also addictions. The harm of drug use is not equal to the severity of the addiction.
Adolescence marks the onset and escalation of drug use. At the age of 16, about 60% of the people use alcohol monthly. Binge drinking refers to drinking multiple glasses (e.g. >5) within 5 hours. This occurs relatively often among adolescents. It is associated with violence (1), risky behaviours (2), physical harm (3) and addiction (4). The proportion of substance-using friends is the best predictor as to whether a person will also use substances. Adolescents’ perception of peer substance use is related to their current substance use and substance use progressions.
There is an escalation of substance use in adolescence but also a de-escalation of substance use in late adolescence. This implies that adolescence is both a risk- and protective factor for the development of addiction.
Adolescent brain development is a key factor
.....read more “Clinical Developmental & Health Psychology – Lecture 8 (UNIVERSITY OF AMSTERDAM)”
The intervention spectrum includes promotion (1), prevention (2), treatment (3) and maintenance (4). It is used to determine what needs to be done as an intervention.
Intervention and prevention lead to positive health outcomes. However, there is not always an obvious distinction. Intervention is namely also a form of prevention (e.g. preventing the condition from getting worse). Besides that, there are also preventive interventions.
There are different types of prevention/intervention:
- Universal prevention
This is characterized by it targeting an entire population. There is no regard for individual risk factors. It is provided to everyone in the population (e.g. school). - Selective prevention
This targets subgroups of the general population. Typically, the subgroups determined at risk for substance abuse are included (e.g. children of substance abusing parents). The recruitment is based on risk profiles. - Indicated prevention
This includes identifying individuals who are experiencing early signs of substance abuse. There is no clinical diagnosis but risk factors are identified. It can consist of special programmes (e.g. substance abuse programme for high school students experiencing a number of problematic behaviour). - Treatment
This includes the treatment for people with a substance abuse disorder. It includes a diagnosis and the treatment can be group-based or individual.
Single-component interventions are delivered in one setting. It has one target and it is a stand-alone initiative. It can also focus on one component in a brief intervention (e.g. only focus on social norms). Multi-component interventions are delivered in more than one setting. It focuses on more components in brief interventions (e.g. social norms, money spent and protective behavioural strategies).
A multi-component programme often is a strategic framework with a theoretical basis for action. It consists of a programme of coordinated projects addressing the problem based on an integrative programme design where singular interventions run in combination with each other and are sequenced together over time. It includes identification (1), mobilization (2) and coordination (3) of appropriate agencies, stakeholders and local communities. There is an emphasis on modifying cultures, policies, structures and systems.
Interventions are based on theoretical frameworks. The target of interventions (e.g. communication; self-control) depends on the group that is targeted.
During adolescence, there is distancing from parents (1), intensifying of peer contacts (2) and experimentation with adult-like behaviour (3). After an anti-alcohol use campaign in the Netherlands, strict alcohol-specific parenting practices decreased alcohol use among adolescents. This is indicative of a social-cultural change regarding alcohol use. The parents appear to be important for adolescent alcohol use.
A combined intervention (i.e. aimed at both parents and the adolescents) appears to be most effective in battling substance use (e.g. alcohol) in adolescence. This effect is mediated by attitudes about alcohol (1), changes in rules about alcohol (2), self-control (3), and rules about alcohol (4). However, there are no changes in the adolescent attitude towards alcohol. Self-control appears to be the most important aspect of tackling
.....read more “Clinical Developmental & Health Psychology – Lecture 9 (UNIVERSITY OF AMSTERDAM)”
Dyslexia refers to an unexpected reading failure. A child with poor reading skills in a negative environment is to be expected but a child with poor reading skills in a favourable environment is unexpected. This could be indicative of dyslexia.
There are common behaviours of someone with dyslexia:
- Phonology
The impaired performance on phonemic tasks includes deletion (1), matching (2), and blending (3). - Reading aloud
The performance is often slow (1), dysfluent (2) and error-prone (3). There is particular difficulty with irregularly pronounced words. - Processing speed
The performance is often slow when it comes to naming familiar digits (1), colours (2) and objects (3). - Orthography
The limited knowledge of orthographic structure expresses itself in difficulty distinguishing valid from invalid letter strings (1), weak knowledge of word spellings (2), misspellings (3), misidentification (4) and dysfluency in generating spellings (5). - Working memory
There is a deficit in working memory tasks. - Language
There is a limited vocabulary size and lexical quality (1), familiarity with a narrower range of sentence structures and expressions (2) and difficulty reading texts aloud with appropriate intonation (3).
Reading is a highly complex skill and a skilled reader can read an isolated word in less than a second. It is a relatively newly acquired skill on the evolutionary timeline. Most people acquire speech naturally but they require explicit instruction for reading. Reading is how writing is turned into speech and speech is primary in reading.
During reading, people make quick saccades and the fixation point is very small. This means that a person processes a small area during reading. Every content word in reading is just quickly fixated on (i.e. 250ms). People use the context but cannot know the sentence by only using the context. People seldom go back during reading.
Beginning readers fixate on each content word briefly. However, compared to skilled readers, they fixate longer on each word and have more difficulty decoding the words. They also show more backtracking.
While learning to read, children have to go from the concept to the spoken sound to the written word and translate it back to the sound and then to the concept. Children have to learn how to go from orthography (i.e. spelling) to phonology (i.e. sound) to semantics (i.e. meaning) and vice versa. Learning to read is thus the integration between orthography and phonology.
Children have letter by letter decoding at first (e.g. b-a-t). Adults, on the other hand, have parallel activation of letters and word superiority effect. The words are read faster but all individual letters are still being read (just faster). People with dyslexia decode letter by letter longer and have problems in integrating which is central for reading. All children face the same difficulties in learning to read but dyslexics have more difficulty with the essential components. The accumulation of these deficits and their multiplicative effect
.....read more “Clinical Developmental & Health Psychology – Lecture 10 (UNIVERSITY OF AMSTERDAM)”
An intellectual disability refers to people with an IQ below 55. A mild intellectual disability refers to a people with an IQ between 55 and 70. A mild to borderline intellectual disability refers to people with an IQ between 70 and 85. However, they only qualify as borderline intellectual disability if they also show limited adaptive functioning.
Limited adaptive functioning refers to deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, it limits functioning in one or more activities of daily life (e.g. independent living).
Borderline intellectual functioning refers to slightly above the 70-75 IQ level with low normal functioning. There is, thus, a low level of adaptive functioning. With regard to adaptive functioning, there is a distinction between the conceptual domain (e.g. working memory), social domain (e.g. perspective taking) and practical domain (e.g. cooking). However, there is no clear consensus regarding the definition of adaptive functioning.
There are several characteristics of mild- to borderline intellectual disability:
- Academic and cognitive skills
- Memory
They have poorer memory skills (1), structural abnormalities in the phonological store (2), developmental lags in visuospatial and central executive subsystems (3). This is indicative of a working memory developing in line with their general intellectual abilities and not a qualitative deviation from development. - Attention
They have poorer attention shifting (1), cognitive inhibition (2), problem-solving (3), planning (4), response inhibition (5) and slower processing speed (6). Students with BIF tend to use more immature theories.
- Memory
- Motor skills
Mild- to borderline intellectual disability is associated with motor problems although not everyone has this. - Social behaviour
- Social interaction
There is more solitary play (1), less group-play behaviour (2) and peers have a greater impact on behaviour (e.g. more positive interaction when coupled with an average IQ peer) (3). - Parenting
There is less positive and less sensitive parenting. Parental understanding of problems of children with BIF may be inadequate. - Antisocial behaviour
There is more antisocial behaviour among boys but not among girls.
- Social interaction
- Mental health
Mental health problems are more common and they are less likely to receive treatment. When they do, they are more likely to receive medication. - Employment and marriage
Occupational prestige and income are lower (1), there is more unemployment among women compared to the general population (2) and adolescents have difficulty maintaining a job (3). The rate of marriage is lower at age 35 but not at age 50.
There is overrepresentation of limited adaptive functioning in forensic settings. Recidivism and multiple conducts occur more often among individuals with MBID.
Children with borderline intelligence are at risk for chronic educational failure (1), absence from school (2), repetition of grades (3) and dropout or expulsion from school (4). Suspension from school is one of
.....read more “Clinical Developmental & Health Psychology – Lecture 11 (UNIVERSITY OF AMSTERDAM)”
A school psychologist needs to take the environment into account when assessing the development of a child.
Action-oriented assessment refers to a theory about how assessment should be done. This should be as goal-oriented as possible. The problems of the child should be specifically assessed and which interventions are needed to help the child.
When assessing a child, the whole school environment needs to be taken into account. This requires taking into account a wide variety of factors. During the school years, there is physical (1), social-emotional (2) and cognitive development (3). This influences a child’s behaviour and responses to the social environment (e.g. bullying influences social-emotional development and this may influence learning).
There are several cognitive conditions for learning. This includes adaptation to different learning levels and providing social-emotional conditions for learning. These different factors also influence teacher demands.
The triangle of student success refers to a triangular relationship between students (1), parents and the school (3). These three factors together determine the success achievement of a child. The basic psychological needs theory (i.e. self-determination theory) states that competence (1), relatedness (2) and autonomy are basic psychological needs. The needs are interdependent. One compromised need leads to other compromised needs. These three needs influence the motivation of a child.
The involvement of the teacher influences the relatedness. The structure of a teacher influences the competence of the student. Autonomy support of the teacher influences autonomy. These three needs influence the motivation of the child.
There is a diversity in activities and levels of interventions. This can include prevention (1), identification (2), assessment (3), advice (4), intervention (5) and evaluation (6). The CHC model of intelligence is typically used for assessment.
There are three levels of intelligence:
- Intelligence A (i.e. genotype)
This refers to an inborn capacity to show intelligent behaviour. - Intelligence B (i.e. phenotype)
This refers to the cognitive capacities a person possesses at a specific moment. - Intelligence C (i.e. test score)
This refers to the result of an intelligence test.
Spearman proposed that there is a general intelligence factor (i.e. ‘g’). The Stanford-Binet test was the first test to measure a child’s mental age and predict school success. Guilford proposed that there were 120 components of intelligence. Later, Horn and Cattell came up with fluid and crystallized intelligence. After, Gardner proposed that there were multiple intelligence factors (e.g. being intelligence in one area but not in another one).
According to Ceci, intelligence originates from the interaction between cognitive, biological, metacognitive and environmental processes. This implies that intelligence cannot be assessed without context. Sternberg proposed that there are three types of intelligence:
- Analytical intelligence
This refers to capacities to solve abstract, well-known problems (i.e. comparing, evaluating, analysing). - Creative intelligence
This refers to the capacity to solve unknown problems (i.e. discovering, inventing, creating). - Practical intelligence
This refers
“Clinical Developmental & Health Psychology – Lecture 12 (UNIVERSITY OF AMSTERDAM)”
Self-regulation refers to the ability to flexibility activate, monitor, inhibit, persevere and adapt one’s behaviour, attention, emotions and cognitive strategies in response to direction from internal cues, environmental stimuli and feedback from others in an attempt to attain personally relevant goals. It is the same as executive functioning. All executive functions require the prefrontal cortex which keeps maturing up until adulthood.
Flexibility (i.e. an executive function) can be measured using the Wisconsin card sorting task. Monitoring is required to formulate an expected state (1), observe the actual state (2) and be sensitive to discrepancy (3). It appears as if young kids are not able to formulate an expected state. Inhibiting refers to suppressing behaviour or emotions. Reactive inhibition refers to inhibition in response to a stimulus (e.g. do not respond to a buzzing phone). Proactive inhibition refers to inhibition before a stimulus to prevent the need for reactive inhibition (e.g. muting phone). Perseverance is lower in young children compared to adults and this is especially the case in young girls (e.g. children not persevering in behaviour while that is the best option).
Improvement in components of executive functions is believed to improve overall executive function. Executive function is associated with a wide variety of things (e.g. theory of mind). It is possible that executive functions do not consist of several components which are strongly related with other domains because evidence is limited (1), lab tasks do not consistently correlate with real-life outcomes (2) and it is not clear of how many components executive functioning consists (3). However, the differences in outcomes on lab tasks and real-life outcomes may be due to differences in motivation. It is thus clear that motivation is important in executive functions. In order to determine whether self-regulation applies, it is thus important to establish what the goal is (e.g. alcohol use can be goal-directed if the goal is to mingle with the crowd).
Developmental differences in self-regulation originate in differences in capacity to self-regulate. However, the capacity to self-regulate will only be used when one is motivated to self-regulate. In other words, the willingness to use the capacity is moderated by the motivation to attain a goal. Thus, self-regulation is affected by the capacity to self-regulate and the motivation to attain goals. The capacity and motivation to self-regulate are influenced by the environment (e.g. not motivated; distraction). The environment may draw attention to goals and may enhance motivation to attain these goals.
Age-related improvement on measures of executive functioning may reflect the acquisition of knowledge (1), beliefs (2) and values (3) that shape how self-control is used in service of particular goals. It is thus also important to keep the environment in mind when assessing executive functions. It may be useful to provide children with experiences that make them value control more, which, in turn, improves their awareness of the need for control in critical moments.
The differentiation between hot and cold executive functions may be
.....read more “Clinical Developmental & Health Psychology – Lecture 13 (UNIVERSITY OF AMSTERDAM)”
Stressors refer to stimuli and context (e.g. losing a job). It is not the individual response to a stressor. There are positive stressors (1), tolerable stressors (2) and toxic stressors (3).
A positive stressor has the least impact on health (e.g. getting married). A stressor leads to change and can thus be positive. Toxic stressors are highly negative stressors (e.g. childhood adversity).
Childhood adversity refers to absence of nurturing stimulation or the presence of harmful stimulation. This is associated with maladaptive family functioning. This is highly predictive of mental disorders later in life and increases the need for early detection of childhood adversity. The effect of neglect can be measured using the still face experiment.
The stress system involves the amygdala, which signals the hypothalamus. This starts a cascade of hormonal reactions which is represented in the HPA axis. There is a fast and a slow stress response.
Chronic stress leads to a dysregulated HPA axis. The dysregulation can lead to a blunted cortisol response or a heightened cortisol response. Both are associated with impairments in executive functioning. A dysregulation of the HPA axis increases sensitivity to psychopathology and disease.
The 3-hit concept of vulnerability and resilience states that there are individual differences at the genetic level of the stress response. This influences the baseline stress response of a person. Thus, a negative genetic predisposition interacts with the early-life environment. The genetic predisposition is hit 1, the early life environment is hit 2 and hit 3 is the later life environment. Three negative hits would lead to negative health outcomes according to the model.
There are different methods to assess stress during different developmental periods.
HPA-axis dysregulations are apparent in stress-related psychiatric disorders. HPA-axis dysregulations appear to already be present during childhood adversity in children between the age of 0 and 5. There is a decrease in cortisol reactivity (1), increase in cortisol reactivity (2), decrease in baseline cortisol (3) and increase in baseline cortisol (4).
Childhood adversity could include maternal substance use during pregnancy (1), maternal mood and stress levels during pregnancy (2), maternal psychiatric and medication history (3), means of infant feeding (4), socio-economic status (5) and family structure and mother-infant attachment (6). These factors ideally should be studied in isolation, although this is often not possible.
Maternal care regulates the HPA-axis. The developmental theory of sensitive periods states that there are sensitive periods in which calibration of the HPA-axis is possible. In humans, HPA-axis regulation occurs due to breastfeeding (1), holding the child (2) and nurturing the child (3).
There are contextual adversities which are not as extreme as maltreatment but could still influence typical development (e.g. poverty). Parental behaviour mediates the effects of contextual adversity on child outcomes. There appears to be no connection between specific types of early adversity and HPA-axis hyper- or hypoactivity in early childhood.
It is
.....read more “Clinical Developmental & Health Psychology – Lecture 14 (UNIVERSITY OF AMSTERDAM)”
Pathological ageing refers to ageing that differs from its normal course (e.g. dementia). There are several symptoms of Parkinson’s disease.
- Tremor (i.e. resting tremor)
- Slowness of movement
This consists of two parts. Bradykinesia refers to slow movements and akinesia refers to the absence of movements. - Rigidity
This refers to the stiffness of muscles. - Walking and posture
This refers to walking with a stoop (i.e. walking hunched forward) and walking slower.
Other common features are micrographia (i.e. small handwriting) (1), difficulties doing two things at the same time (2) and an overactive bladder (3). Diagnosis is done by identifying 3 out of 4 major features. It most likely occurs after the age of 50. Medication includes dopamine medication (1), stem cell transplantation (2) and deep brain stimulation (3).
Parkinson’s disease is caused by a degenerating of dopaminergic neurons in the basal ganglia, specifically, in the substantia nigra.
The motor cortex is inhibited due to changes in the basal ganglia’s functioning as a result of a deficiency in the substantia nigra. The basal ganglia is highly interconnected with the motor circuit (1), associative circuit (2) and limbic circuit (3). There are deficiencies in all areas as a result of Parkinson’s disease.
The direct pathway of the basal ganglia provides inhibitory control over the output structures. The indirect pathway of the basal ganglia excites basal ganglia output structures. This means that the inhibition is increased (i.e. direct pathway decreases inhibition and indirect pathway increased inhibition).
Inhibitory action control refers to a facet of executive cognition that refers to the mechanism or set of processes engaged to suppress behaviours when such actions are reflex-like (1), impulsive (2), inappropriate (3), premature (4), incorrect (5) or no longer relevant (6).
This can be measured using the stop task. This task measures how fast someone can inhibit a voluntary action to a stop signal. It measures the stop-signal reaction time. The race model states that the winning process (i.e. response process or inhibition process) determines the behaviour. The response process has a U-shaped curve (i.e. slow at childhood, faster during adolescence and adulthood and slower at old age again). There is a less pronounced age development when it comes to the inhibition process.
People with Parkinson’s disease are not slower to respond. However, people with Parkinson’s disease are significantly slower when inhibiting the response.
The stop-change task includes a stop-change signal. This requires a person to reprogram their action when a stop-change signal occurs (e.g. press left instead of right). People with Parkinson’s disease are also significantly slower to change their response compared to healthy controls. The people with Parkinson’s disease show prolonged stopping latencies. It causes a deficit when changing actions.
The subthalamic nucleus, the global pallidus and the inferior frontal gyrus are active when healthy participants are inhibiting a response. The subthalamic nucleus (i.e. a nucleus
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