Article summary by Developmental systems and psychopathology by Sameroff - 2000

Introduction

A contrast in psychopathology is always that the phenomena are classified as much as possible in a categorical system, while they are very dynamic. Another area of ​​tension is the contrast between studying serious mental disorders versus mental health. When we focus on mental health, we always find extremes on every behavioral scale that resembles pathology, and when we focus on pathology, we find that there are also areas that resemble mental health. If we look at psychopathology from a developmental perspective, it may be that a disorder suddenly becomes nothing more than an adaptive process of an individual for an environmental experience. A final contradiction is found in the interaction between nature and nurture, because when we study the environment we learn more about the individual, but when we study the individual, we learn more about the environment.

Important subjects

First of all, it is good to look at how we actually define pathology. An important topic from the development perspective is the continuity versus the discontinuity of development. Here one can look at differences between individuals, but also differences within an individual. Furthermore, it is difficult to precisely understand how the process of development in individuals can be understood. Should we look at stable traits of the individual independent of the context or should we look at traits that are stable in the context, independent of the individual? Or should we look at the functioning of certain traits in an environment? It is also difficult to understand what exactly the context is. Is it a passive collection of experiences that influence the potential of the individual in collaboration with their genes or does experience change when it comes into contact with individual developmental processes?

In the past, individuals were often not seen as integrated systems of biological, psychological and social functioning, but more divided into biological and behavioral parts. However, this results in three problematic principles that often do not match the reality of psychopathology. First of all, the same underlying cause should cause the same disorder in all individuals (children and adults). Secondly, all symptoms at different ages should have the same underlying cause, and third, all child disorders should lead to the same disorder in adulthood. All these three principles are therefore not applicable to psychopathology. First, the same biological problem can lead to very different behaviors in both children and adults. Secondly, the same symptoms can best arise from very different underlying processes and thirdly, there is little evidence for continuity from child disorders to adulthood disorders.

Developmental psychopathology

Developmental psychopathology arose from the realization that a developmental perspective could contribute much to our ability to understand, treat and prevent psychopathology. The perspectives of developmental psychologists are often about the same phenomena as the perspectives of psychopathology, but the concepts are often approached differently. If these perspectives could be combined, it would therefore provide a broader view of psychopathology.

The only question is whether this model can also apply well to individuals who do not stay on the expected development line. Some individuals seem to face a very good future, while eventually ending up with various psychopathological disorders, while others are very vulnerable and display disturbed behavior in childhood, but simply function well in adulthood. Results that arise from research in the laboratory are not always equally applicable to reality. Scientific knowledge also often does not directly influence behavior, just as genes and atoms do not directly influence human behavior.

So there are still many problems that need to be solved before we can really understand psychopathology. The best model for understanding psychopathology should be one that responds to human behavior in all its complexity.

Studies on high-risk groups

Studies into groups with a high risk factor were the first attempt to transfer anything from the development perspective to the study of child psychopathology. The intention was to have a new perspective, which looked at the entire life course of an individual. Mednick assumed that you can only really say something about underlying factors when you have studied someone before the disorder developed. Because not everyone could be studied, there had to be some sort of selection to be studied. A sample had to be found of people who already had a higher risk of a certain disorder than others.

In the schizophrenia study, a group was then selected whose parents or one of the parents had schizophrenia. The aim of the research was to discover early markers that could eventually lead to schizophrenia. Birth complications, certain motor patterns, attention processes and eye movement patterns were examined.

Three hypotheses were created in advance:

• Deviant behavior in children could be traced to variables that can be associated with the diagnosis of the parents (schizophrenia in this case).
• Deviant behavior in children could also be linked to traits associated with mental disorders in general, such as the severity and long-term nature of a disorder.
• Deviant behavior in children can be linked to the social circumstances in which the child finds itself (excluding the psychopathology of the parents).

Little evidence was found for the first hypothesis. However, the second hypothesis was confirmed fairly strongly. So a mental disorder in general has significant consequences for the behavior of the children. Some evidence was also found for the third hypothesis, namely when looking at the social class in which children grow up.

Despite the fact that there were useful results from the research into high-risk groups, it remained difficult to translate this into reality. Research continues to be needed into the role of environmental experiences, and further research is needed into the development of both children with normal behavior and abnormal behavior.

Psychopathology

There are two basic questions that must be answered before child psychopathology can be understood. What does it mean if you display disturbed behavior and are these children different in type or status? In terms of intelligence, you can distinguish between two types of children with low intelligence. One group is distinguished by a low score on an intelligence test and these children are often considered mentally retarded. This diagnosis is then purely a consequence of the normal distribution and does not depend on the individuals themselves. The second group is also a group that scores low on intelligence tests, yet they differ significantly from the previous group. Their entire biological basis is different, as are the processes in which they develop and the treatments they need to improve their status. Are the children we are concerned about now purely at the lower end of the normal distribution or are they really different from the rest of the population?

Illness is generally associated with personal suffering. And even though this is often the case with adults with a disorder, this is often not the case with children. In children it is often that the environment suffers from the behavior of the child and that it therefore comes into clinical practice. The child often does not belong and that is striking. This does not mean that the children themselves do not experience any negative consequences, but this is usually the result of abuse or neglect. In these cases, the responsibility for the diagnosis is placed with the parents and not with the children. With problems with children you are often confronted with not only individual problems, but with conflicts that the child has with the context and the context with the child.

Individual development

One of the biggest problems for psychology in general and in particular for developmental psychopathology is the use of well-operationalized definitions. These definitions should divide the world into categories that are easy to grasp and that approach behavior so that they are similar to the person's behavior. According to Werner, it is necessary that a thorough evaluation takes place of the factors that influence the development of patterns as well as the different paths through which the same development outcomes can be achieved. It is important to map out the processes that play a role in normal development, because disruptions in these factors can contribute to the development of deviant behavior or the adaptability of an individual.

Characteristics

An adjustment pattern is very difficult to measure, since the individual changes when the environment changes and vice versa. A simpler alternative is to look at the characteristics of a child, because they are easier to classify on the basis of a diagnostic interview or a behavioral questionnaire. First of all, a distinction is made between mentally retarded and mentally disturbed children. In addition, it is examined whether the child acted out of wrong passions or passions or out of a wrong moral sense.

Depression

The question is whether a depressive disorder in children takes the same form as a depressive disorder in adults, or whether high scores on depression mainly differ in quality or quantity from low scores on depression and a new problem is that there is a high correlation between symptoms of depression. depression and symptoms of other disorders. There are three levels of depression that all have different levels of depression, namely depressive mood, depressive syndrome and depressive disorders.

It is almost never the case that children with depression have no other problems. Often emotional problems occur at the same time as behavioral problems. This is a fascinating fact, since it should already be rare for someone to have one disorder, let alone two. For depression, however, comorbidity is the rule rather than the exception. Anxiety disorders are most common in depression and this can be explained by the fact that it is both disorders that belong to the internal processes of people. Yet depression is also common with external disorders, such as conduct disorder, ODD, ADHD and alcohol and drug problems. This comorbidity becomes higher the more severe the depression. A possible explanation for this is that children with depression are more exposed to other risk factors and that this leads to additional negative outcomes.

Conduct disorder

Problems that express themselves externally often have much more influence on the child's environment than problems that are internal. Crimes are often committed by teenagers and young adults, but are not easy to grasp in the categories of mental disorders. Adults with antisocial behavior often have a history of antisocial behavior in childhood, but by no means all children who exhibit antisocial behavior also show this in adulthood. Boys who show purely aggressive behavior are much less likely to show criminal behavior later than boys who are aggressive and hyperactive. These boys are also much more likely to have school problems, relationship problems and problems in conflict management.

With conduct disorder, a distinction is made between three development paths:

• Authority conflicts (stubborn behavior, detachment and authority avoidance).
• Secret behavior (destruction, theft).
• Open behavior (aggression, fighting and violence).

The worse the disorder is, the more likely it is that someone will develop on more than one of the three paths. So the worse a disorder, the more chance there is of comorbidity, but also the more chance there is of multiple forms of the disorder.

Individual development as an adjustment system

Underlying factors do not exist independently of development processes. Children are therefore integrated individuals and not a collection of characteristics. The worse the problems, the more likely it is that more than one area of ​​behavior is involved. Looking at patterns of adaptation this will not give a simple catalog of behavior, but it can lead to a better understanding of how children develop and how they deal with the positive or negative consequences of this development. In this way, every change in the child's life and how it relates to the whole can be taken into account.

As an environment becomes more organized, adaptation problems will decrease and as experiences become more chaotic, adaptation problems will occur more often. The development perspective provides an identification of factors that influence a child's ability to organize and adapt to experiences.

Environment

Research has shown that if the only risk factor for a child is psychopathology of the mother, the child would do well in life. However, if a child has a mother who, in addition to a psychopathological disorder, is also poor, poorly educated, lives without social support and is stressed, the child has a less positive future.

These factors give a poor prognosis for the future of children, even if the mother does not have a psychopathological disorder. Social environment is a greater risk factor than any mental disorder. It is also likely that it is mainly about the quantity (so the quantity) of factors that are present than the quality (ie how bad something is).

However, the majority of children who grow up in low social classes or certain ethnic groups do not develop a disorder. They just get a job, have successful social relationships and raise a new generation of children. These results have meant that attention is no longer focused solely on risk factors, but also on protective factors. However, the distinction between risk and protection factors is by no means always clear, but often a risk factor is the exact opposite of a protection factor. Families in which there were many protective factors had better outcomes than families with many risk factors.

Risk factors

The risk factors for depression, conduct disorder, substance abuse and even schizophrenia all seem the same. Poor environmental factors that influence a certain outcome also influence the other outcomes. This result does not help much further in the investigation of specific risk factors in specific disorders.

Control systems in development

A theory that wants to integrate our knowledge of pathology and our knowledge of development must explain how an individual and the environment interact with each other. Next, we must look at how good or bad adaptation patterns arise from this and how these adaptations have an effect on the future.

At the molecular level we have discovered that despite the fact that every cell has the same genotype, every cell manifests itself differently and has a different history. Also at the level of behavioral genetics we have learned that every family member has his or her own unique environment.

Environment types

Just as there is a biological organization (genotype) that regulates the physical appearance of someone, there is also a social organization that regulates the way in which someone fits in with their environment. This organization is created by family and cultural patterns and is often called environtype (as a counterpart to genotype). The behavior of a child therefore arises from an interaction between the genotype and the environtype. The genotype is the most important from conception to birth. The period from birth to adulthood is mainly characterized by influences of the environtype. Individual factors certainly play a role in this period, but it is mainly the environtype that influences the way in which a child can adapt to all kinds of situations.

Most disorders arise from an active search for a good adaptation to the environment of an individual. The positive diet and the negative influences that the individual experiences will give color to this adaptation. No human outcome is created without a contribution made by experience.