Literatuuroverzicht DPP

Week 36 & 37

Chapter 1: Introduction

• Developmental psychopathology: understanding children’s disorders when we think about those disorders within the context of typical development
• Common descriptions of normality and psychopathology focus on
  
  • Statistical deviance: the infrequency of certain emotions, cognitions and/or behaviors (low and high number cutoffs, compared to peers)
  • Sociocultural norms: the beliefs and expectations of certain groups about what kinds of emotions, cognitions and/or behavior
  • Mental health perspectives: theoretical or clinically based notions of distress and dysfunction (a child’s psychological well-being is the key consideration)
• The role of values
  
  • Adequate or average adaptation (what is considered okay, or good enough) Optimal adaptation (what is excellent, superior, ‘the best of what is possible’) Poor adaptation
  • With sociocultural definitions, value judgements are the very basis of definitions of disorder. Whether causal use of mind-altering substances is tolerated or condemned by a particular sociocultural group influences conceptualizations of pathological addiction.
• Definitions of psychopathology and developmental psychpathology
  
  • Psychpathology: intense, frequent, and/or persistent maladaptive patterns of emotion, cogntion, and behavior.
  • Developmental psychopathology: extends this description to emphasize that these maladaptive patterns occur in the context of typical development and result in the current and potential impairment of infants, children and adolescents.
  • Developmental epidemiology: the frequencies and patterns of distrubition of disorders in infants, children and adolescents
  • Prevalence: the proportion of a population with a disorder
  • Incidence: the rate at which new cases arise
  • Barriers to care
  • stigmatization

Chapter 2 Models of Child Development Psychopathology, and Treatment

• theoretical models of development, psychopathology, and treatment help organize clinical observations, direct research efforts, and design treatment programs.
• Dimensional models of psychopathology emphasize the gradual transition from the typical range of feelings, thoughts and behaviors to cliniclly significant problems.
  
  • Referred to as continuous or quantitative
  • No sharp distinctions between adjustment and maladjustment
• Categorical models of psychopathology emphasize differences between distinct patterns of emotion, cognition and behavior that are within the typical range and those define clinical disorders.
  
  • Referred to as discontinuous or qualitative
  • Clear distinctions between what is normal and what is not
• Physiological models emphasize the roles of genetics, biological factors (such as brain structure and function), and chemical processes. Increasingly complex models that highlight the combined effects of genes and environments are the focus of much contemporary research, including studies of behvior genetics and epigenetics.
  
  • Connectome: the diagram of the brain’s neural connections
    
    • Nodes: are understood in the context of numbers of connections, distances between them, centrality, and clustering
    • Hubs: are nodes with extensive connections to other nodes
    • Modules: are groups of nodes with strong interconnections
    • Sensitive (or critical) periods:
      
      • Experience-dependent brain development: brain reacting to environmental feedback
  • Neural plasticity: illustrates several physiological processes related to brain development, organization, and reorganization.
  • Genetics play a critical role in physiological models.
    
    • Genotype: the genetic makeup of an individual
    • Phenotype: the observable characteristics of an individual
    • Our undestanding of genetics is ever expanding (i.e. genes and heritability): behavior genetics (the study of the joint effects of genes and environment), molecular genetics, genome-wide association studies.
      
      • One of the most important shifts in thinking about genetics involve moving beyond early views on nature vs. nurture to current complex descriptions of gene-by-environment effects and gene-by-environment interactions.
    • Epigenetics: the study of how environmental factors influence gene expressivity, focussed rather on the activity of the gene than the presence of it.
    • Risk alleles: a limited set of alleles that impair general processes across many disorders
      
      • Common variants: risk alleles shared by individuals with and without disorders
      • Rare variants: risk alleles both inherited and de novo (newly appearing)
    • Polygenic models: emphasize the likelihood that many genes have small effects and attempt to account for multiple types of genetic variations and processes that result in genetic burdens that influence the development of both mild and severe forms of disorders
    • Diathesis-stress model: there are inborn or acquired vulnerabilities to disorders that may lead to psychological distress and dysfunction; structural damage or chemical imbalance do not by itself lead to disorder
      
      • Example of gene-by-environment effects or interactions
• Psychological models, such as the psychodynamic, cognitive-behavioral, humanistic, and family models, emphasize intrapersonal and interpersonal factors in the development, course and treatment of psychopathology.
  
  • Contemporary psychodynamic approaches continue to emphasize (1) unconscious cognitieve, affective, and motivational processes; (2) mental representations of self, other, and relationships; (3) the meaningfulness of individual (i. e. subjective) experiences; and (4) a developmental perspective focused ont he origins of typical and atypical personality in early childhood and the constantly changing psychological challenges faced by children as they age.
  • Behavioral models (Skinner, Bandura, Mischel) have an outward instead of inward orientation, focusing on the individuals observable behavior within a specific environment. Behavioral models are based on core concepts of learning theories, including classical conditioning, operant conditioning, observational learning, with reinforcement as critical component of all those learning processes.
  • Cognitive models (Piaget, Vygotsky) focus on the components and processes of the mind and mental development, like information-processing and interactionist models.
    
    • Neoconstructivist approach emphasizes evolutionary contexts, experience-expectant learning and both qualitative and quantative change across development.
  • Humanistic models emphasize personally meaningfull experiences, innate motivations of healthy growth, and the child’s purposeful creation of self. Within the humanistic framework, psychopathology is usually linked to interference with or suppression of the child’s natural tendencies to develop an integrated (or whole) sense of self, with valued abilities and talents.
    
    •  Humanistic models are related to positive psychology
      
      • The broaden-and-build theory of positive emotions explores the ways in which positive experiences lay the groundwork for the development of well-being and resilience across the lifespan. Positive youth development in adolescence, involving identifying opportunities for initiative and engagement, is one application of this model.
  • Family models propose that the best way to understand the personality and psychopathology of particular children is to understand the dynamics of their particular families.
    
    • Shared environment: the aspects of family life and function that are shared by all children in the family (nurture).
    • Nonshared environment: the aspects of family life and function that are specific and distinct for each child
• Sociocultural models emphasize the importance of the social context, including gender, race, ethnicity, and socioeconomic status, in the development course, and treatment of psychopathology.
  
  • Kind of behavior settings, components of ecological models, include homes, classrooms, and neighborhood playgrounds.
  • A birth cohort includes individuals born in a particular historical period who share key experiences and events.

Chapter 3 Risk and resilience

• Developmental psychopathology focuses on the developmental context within the maladaptive patterns of emotion, cognition, and behavior occur.
  • Types of adaptational failures have often been viewed as either delay (e.g. the child acquires languare more slowly than other children), fixation (e.g. the child continues to suck her thumb long after other children have stopped), or deviance (e.g. the child behaves strangely, unlike other children). Understanding children’s disorder as delay, fixation or deviance highlights the difficulties of a particular child at a particular point in time, providing us with one way of thinking about the connection between typical and atypical development.
  • Another way of thinking about the connection between typical and atypical development is to examine the notion of process.
• The study of developmental pathways highlights patterns of adjustment and maladjustment over time.
  
  • With a developmental perspective, we need to account for ways in which adaptation (or maladaptation) at an earlier point in time connects to adaption (or maladaptation) at a later point in time. First, development is cumulative; it builds upon itelf. Second, developmental pathways are probabilistic, not deterministic.
  • Broad pathways include large-scale, goal-directed patterns of feelings, thought and behaviors across multiple domains, e.g. achieving social competence. Narrow pathways involve more specific goals, e.g. mastering a musical instrument.
  • Parents have significant impact on pathways: Initiating trajectories by selecting environments and activities, supporting trajectories by providing attention and encouragement to children, mediating trajectories by actively helping children with unexpected challenges of stressful circumstances.
  • Children react to parent-initiated pathways, control their own degree of engagement and effort on a particular pathway, and initiate their own pathways.
• Equifinality refers to developmental pathways in which differing circumstances lead tot he same diagnosis, whereas multifinality refers to developmental pathways in which similar beginnings lead to different outcomes.
• The developmental pathways model emphasizes the ongoing possibility of change over time.
  
  • 1. Change is possible at many times
  • 2. Change is constrained or enabled by previous adaptations
  • Detours are events or junctures that redirect pathways (like new school), roadblocks are events or repsonses that shut down or slow down postive trajectories (like restricted acces to high education), off-ramps are places where children exit a positive trajectory
• Coherence in development reflects the logical links between early developmental variables and later outcomes. Continuity is found in understanding the relationship between outcomes and the variables that lead to stability or change.
• Competence, from a developmental perspective, reflects effective functioning in relation to relevant developmental tasks and issues; evaluations of competence are embedded in the environment within which development is occurring.
  
  • Domains of competence or areas of comfort; children’s developmental pathways cannot be described as altogether good or altogether bad: academic achievement, behavorial competence, social competence, romantic competence, job competence
  • Other models of competence are less focused on domains in which children display effective behavior and more focused on characteristicss that contribute to competence in a variety of circumstances. The core competencies model is focused on five markers: a positive sense of self, self-control, decision-making skills,  moral system of belief, social connections.
• Risk is defined as increased vulnerability to disorder, whereas risk factors are the individual, family, and social characteristics that are associated with this increased vulnerability.
  
  • Risk factors increase vulnerability in two ways: non-specific risks whihc involves increased vulnerability to any or many kinds of disorders & specific risk, which involves increased vulnerability to one particular disorder. There are factors that are both somethwat specific and somewhat nonspecific.
  • Individual risk factors are child focussed and include things like genetics and physiological processes, gender and temperament or personality.
  • Family risk factors are those associated with the child’s immediate caretaking environment and include parent characteristics such as the presence of psychopathology or harsh, punitive styles of parenting, as well as family characteristics such as chronic conflict between parents, lack of supervision or unusual discord among siblings.
  • Social risk factors include those associated with the child’s larger environment, including peers and schools, neighborhood and socioeconomic niche, and racial, ethnic and cultural characteristics.
  • The total number of risk factors that children experience is even more important than the particular type of risk factors.
  • Understanding the role of timing of risk factors is also important.
• Resilience is defined as adaptation (or competence) despite adversity, and protective factors are the individual, family, and social characteristics that are associated with this positive adaptation.
  
  • Resilience is a process, a capacity that develops over time. Thus some children display certain types of resilience but not others or resilience that builds up over a period of years.
  • The social-ecological perspective on resilience asserts that ‘the more a child is exposed to adversity, the more the child’s resilience depends on the quality of the environment (rather than individual qualities)’.
  • Rutter suggests that protective factors influence children’s outcomes by (1) reducing the impact of risk, (2) reducing the negative chain reactions that follow exposure to risk, (3) serving to establish or maintain self-esteem and self-efficacy, and/or (4) opening up opportunities for improvement or growth.
• The study of child maltreatment illustrates the varied effects and range of outcomes associated with developmental risk factors.
• Cross-sectional research involves the collection of data from comparison groups at a single point in time. Longitudinal approaches involve the ongoing collection of data from the same individual or group of participants over time.
• The cumulative or spreading effects (both positive and negative) of ongoing developmental processes, across domains, are represented in developmental cascade models.
• Gene-by-environment interactions represent the expression of genetics in the context of life circumstances. This model is commonly used to consider children’s vulnerability to particular risk factors experienced in typical and atypical development.
• The purpose of translational research is to facilitate the application of basic research to clinical practice, and to inform research with findings and insights drawn from applied practice.

Chapter 4: Classification, Assessment and Diagnosis, and Intervention

• Diagnostic classification systems group individuals with similar patterns of disorder. Effective classification systems help organize symptom patterns into meaningful groups, facilitate commmuncation among professionals, and inform research and treatment efforts.
• The most commonly used categorical (clinical) classification system with adults and children is the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5, in its current incarnation). This type of classification identifies types of disorders and then specifies the defining symptoms of disorders.
  
  • A good classification system enhances clinical utility; it helps clarify thinking about the expression and emergence of particular disorders, as well as about prognosis and treatment decisions.
  • In the newest version, DSM-5, the arrangement of categories reflects a more developmental perspective.
• Dimensional (empirical) classification systems have been an especially useful way to consider the development of psychopathology. This approach is based on statistical techniques that identify key dimensions of children’s functioning and dysfunction, with the assumption that all children can be meaningfully described along these dimensions.
• The two usefeul and well-researched clinical dimensions are the externalizing dimension, with undercontrolled behaviors such as oppositional or agressive behaviors; and the internalizing dimension, with overcontrolled behaviors such as anxiety and depression.
• The integration of developmental perspectives with classification systems is an ongoing concern in the field of developmental psychopathology. A number of efforts emphasize the integration of information about typcial development, age-salient challenges and expectations, and developmentally informed assessment and diagnosis.
• Comorbidity is the cooccurrence of two or more disorders in one individual. Systematic comorbidities reflect the fact that certain disorders are likely to occur together often (e.g. ADHD and oppositional defiant disorder).
  
  • Heterogenity within categories or groups of disorders involves the ways in which children with the same disorder or diagnosis display idiosyncratic sets of difficulties or symptoms.
• Psychological assessment involves the systematic collection of relevant information in order to differentiate everyday problems from psychopathology and to diagnose disorders accurately.
• Assessment methods, including interviews, standardized tests, projective measures (based on the assumption that, given an ambiguous stimulus, individuals’ responses will reflect the projection of unconscious motivations, concerns, and conflicts), and observation, all contribute to a diagnosis; differential diagnosis is making a decision about which of several diagnoses best describes an individual.
  
  • Diagnostic efficiency: the degree to which clinicians maximize diagnostic hits and minimize diagnostic misses
• Research on psychotherapy generally focuses on either outcome or process. Outcome research has to do with whether, at the end of treatment, children and adolescents have improved relative to thier pre-treatment status and compared to others who have not received treatment. Process research has to do with the specific mechanisms and common factors that account for therapeutic change.
• Interventions can vary in their focus (child, parent, or school) and timing (primary, secondary, or tertiary), depending in part on whether they are designed to prevent or treat psychopathology.
  
  • Primary prevention: reducing or eliminating risks, as well as reducing the incidence disorder in children
    
    • Universal preventive measures: provided for entire populations
    • Selective preventive measures: provided for groups at above-average risk
    • Indicated preventive measures: provided for groups with specific risk factors that include more extensive interventions
  • Secondary prevention: interventions that are implemented following the early signs of distress and dysfunction, before the disorder is clearly established in the child
  • Tertiary prevention: responding to already present and clinically significant disorders

Chapter 5: Disorders of early childhood

• There is widespread acceptance of the need to identify and respond to young children’s distress and dysfunction.
• Recent research in areas such as physiological development, temperament, and attachment is contributing tot he emerging field of infant mental health.
• Temperament is best understood as basic dispositons in the domains of activity, affectivity, attention, and self-regulation, and is reliably related to later personality.
  
  • Reactivity involves the infant’s excitability and responsiveness.
  • Regulation involves what the infant does to control his or her reactivity.
  • Both reactivity and regulation are influenced by physiological factors.
  • Several temperament traits: surgency (i. e. sociability and positive emotionality), negative affectivity (i. e. predispositions to epxerience fear/anger) and effortful control (i.e. infants attempts to regulate stimulation and response)
  • There is also a place for nurture in almost all temperament models, with warmth and positive and negative control as important dimensions of parenting
  • Goodness of fit: interplay between infant temperament and parenting
  • Differential sensitivity: the hypothesis that some individuals are more susceptible than others to both negative and positive environmental conditions
  • Given connectons between temperament and perosnality, we expect to see evidence of temperamental consistency across a variety of situations and stability across time: temperament traits are consistenly displayed and progressively more stable over development, with moderate stability by preschool and increasing over childhood
• The development of a secure attachment relationship between infant and caregiver is the critical task in the first year of life.
  
  • Attachment relationships reflect the degree to which infants exprience safety, comfort and affection
  • Sense of self: compromises the earliest set of cognitions and emotions focused on the infant as a separate being
  • Understanding of others and the world includes early beliefs about unfamiliar adults and children, along with new situations in which infants so often find themselves
  • Protection and survival are linked to several defining features of caregivers: (1) providing a safe haven, a person to whom the infant can turn to for comfort and support, (2) allowing for proximity maintenance, for an infant who seeks closeness and resists separation, (3) establishing a secure base, a person whose presence serves as a source of security from which a child ventures out to explore the world and to which he or she can reliably return
• Secure attachment relationships are the result of consistent, appropriate responsiveness by the caregiver to the infant’s physical, emotional and social needs.
• Resistant attachment (or anxious/ambivalent attachment) relationships stem from inconsistent caregiving behavior.
• Avoidant attachment (or anxious/avoidant attachment) relationships result from ineffective or inappropriate caregiving (like intrusive, excessively controlling care).
• Disorganized attachment relationships occur when the caregiver is associated with frightening or malicious events. They involve a distinctive pattern of both approach and avoidance in infants.
• Early attachment relationships affect neurological and personality developoment and provide models for future relationships.
• Feeding disorders represent an impairment of efficient and effective feeding – an especially salient developmental task in infancy and early childhood. The sleep disorders most common in early development are those that involve significant difficulties falling or staying asleep. Other common problems are night terrors and nightmare disorder.
  
  • Pica: feeding disorder; ingestion of nonfood substances such as paint, pebbler or dirt
  • Rumination: feeding disorder; the repeated regurgitation of food
  • Avoidant/restrictive food intake disorder: feeding disturbances related to not eating enough for typical growth and development
• The assessment of both feeding and sleeping disorders requires careful consideration of general health and developmental history, as well as current behavioral and relationship patterns.
• DSM-5 describes two kinds of attachment disorders: reactive attachment disorder (RAD) and disinhibited engagement disorder (DSED).
  
  • RAD involves an absence of attachment behaviors, failure to seek comfort when distressed, reduced social and emotional reciprocity, reduced positive emotion, increased negative emotion, and poor emotion. It’s rare in the overall population and almost always diagnosed in children with very adverse experiences, such as institutionalization or chronic maltreatment.
  • DSED involves a lack of wariness, an inappropriate approach to strangers, and a lack of physical and social boundaries.
  • Compared to RAD focus on atypical attachment behaviors, DSED is focused on atypical social behaviors. For children with RAD, improvement occur when they are placed in better caregiving environments. Symptoms of DSED are more persistent.
• Severely adverse circumstances, such as institutionalizaton or chronic maltreatment, contribute to the development of disorders of attachment.
• Prevention strategies range from universal measures for the general population, selective measures for groups at above-average risk, and indicated measures for groups with specific risk factors that require more extensive help.
• There are several treatments for disorders of attachment, with a focus on providing children with a sensitive caregiving environment.

Week 38

Chapter 11: Anxiety Disorders, Obsessive-Compulsive Disorder, and Somatic Symptom Disorders

• Although some fears and worries are a typical and expected part of childhood, when they consistently interfere with healthy development, an anxiety disorder may be present.
• Emotional regulation (ER), the ability to modulate and organize emotions, follows a developomental course that must be considered when determining whether typical anxiety crosses over to pathological anxiety.
• Anxiety disorders represent the maladaptive experience of anxiety in terms of intensity, duration, and pervasiveness. They are also characterized by inhibition and withdrawal, exaggerated and unrealistic fears and worries, and overcontrol. Anxiety disorders are among the most frequently diagnosed disorders in children, adolescents and adults.
  
  • Fears are defined as anxieties elicited in the presence of a specific stimulus. Worries are defined as anxieties about possible future events.
  • In addition to the primary symptoms of anxiety, many children and adolescents exhibit anxiety sensitivity, involving hypervigilance and attention to bodily sensations, a tendency to focus on weak or infrequent sensations, and a disposition to react to somatic sensations with distorted cognitions.
• Some of these disorders, such as generalized anxiety disorder (GAD), represent an anxious reaction to a wide array of stimuli, whereas others, such as seperation anxiety disorders (SAD) and specific fobias, are rooted in more specifie anxiety-producing situations.
  
  • Phobic disorders involve excessive and exaggerated fears of particular objects or situations, and avoidant behaviors
    
    • Related to specific phobias are social phobia (e.g. fear of scrutiny or evalution by others) and agoraphobia (i.e. intense anxiety in places where individuals feel insecure, trapped, or not in control).
  • Somewhat unpredictable panic attacks are the primary component of panic disorder.
• In some anxiety disorders, including obsessive-compulsive disorder (OCD) and conversion disorder, the behaviors used to block the direct experience of anxiety (i.e. avoidance) are the primary symptoms.
  
  • Obsessions: persistent and intense intrusions of unwanted thought or images
  • Compulsions: persistent and intense impulses to perform a specific behavior
• Somatic symptom disorders involve the experience of physical symptoms that appear related to the moderation of emotions, especially anxiety. Anxiety sensitivity is often exhibited.
  
  • Somatization refers to a variety of processes in which aspects of psychological distress manifest themselves in physical symptoms.
  • Conversion disorder (functional neurological symptom disorder) is characterized by unexplained deficits in voluntary motor or sensory function that cannot be adeaquately accounted for by known pathophysiological mechanisms; psychological factors are clearly associated with the emergence of symptoms.
• Homotypic continuity: the stability of specific diagnosis over time
  heterotypic continuity: if specific anxiety diagnoses change over time, likely related to developmental challenges, maladaptive anxious emotion is the core feature that contributes to heterotypic continuity
• Genetic and other physiological risk factors are clearly linked to the development of anxiety disorders. Research suggests that anxiety and mood disorders result from closely related risk factors.
  
  • The complex psychological construct of affectivity is the basis of the tripartite model of anxiety and depression. The model’s three core concepts are as follows: (1) anxiety and depression share a common causal factor of negative affectivity; (2) along with negative affectivity, low levels of positive affectivity are associated with depression (3) along with negative affectivity, high levels of physiological arousal are associated with anxiety
• Parenting behaviors that may potentially contribute to the development of anxiety disorders include an anxious style of parenting, such as overinvolvement and overprotection, as well as the modelling of anxious and avoidant behavior.
• One of the assessment challenges with regard to anxiety disorders is the fact that agreement between parent’s and children’s reports of anxiety symptoms is relatively low.
• Comprehensive assessment, including clinical interview, self-report measures, and clinical observations, are used to differentiate typical from pathological levels of anxiety and discriminate among anxiety disorders.
• A variety of psychological interventions (cognitive-behavorial therapy in particular), often in combination with pharmological approaches, have proven effective in the treatment of anxiety disorders.
  
  • 6 main components of CBT:
    
    • Psychoeducation involves providing children and their families with information about typical anxiety and the emergence and maintenance of pathological anxiety, as well as about theoretical and practical aspects of CBT
    • Somatic management involves targeting the distressing physiological symptoms and is usually focused on relaxtion and breathing techniques. In addition, children and adolescents learn how to predict and tolerate the anxiety that accompanies challening and stressful events
    • Cognitive restructuring has to do with the identification and modification of negative thought that elicit and prolong anxiety. Thinking about emotions and emotional biases also may be important and is the focus of treatment efforts in some instances.
    • Problem solving is a step-by-step, active, behaviorally oriented approach for coping.
    • Exposure to stimuli and situations that are associated with anxiety is systematic and controlled, with in vivo (real life) practice preferred.
    • Relapse intervention involves laying the groundwork for the maintenance and generalizaton of improvements.
  • Positive child treatment outcomes often include spillover effects, improvement in parent functioning, parent-child relationships, and family functioning, in addition to improvement in child and adolescent functioning.
  • Four classic behavorial treatments for fears:
    
    • Modeling treatments are based on the impact of observational learning (symbolic modeling, live modeling, participant modeling)
    • Systematic desensitization involves teaching an anxious child how to relax and how to maintain relaxation when exposed to the feared stimulus
    • Exposure involves rewarding a child for desired behavior
    • Self-talk is a cognitive technique focused on providing positive self-statements.

Chapter 12: Depressive Disorders, Bipolar Disorders, and Suicidality

• Depression in childhood occurs frequently, can have long-term consequences, and is generally underrecognized and undertreated.
• The transition from childhood to adolescence is marked by the development of a coherent psychological identity  that includes a sense of competence and self-esteem. These are among the core domains adversely affected by child and adolescent depression.
  
  • A coherent sense of self and a positive identity become critical for ongoing healthy adjustment in the transition form late childhood to adolescence.
  • Domains of competence are areas of challenge and resolution that have an impact on the ways in which children perceive themselves.
    
    • Areas of comfort are the domains in which adolescents express relative satisfaction with themselves and their accomplishments.
• Major depressive disorder in childhood and adolescence is characterized by sadness and loss of pleasure and is accompanied by cognitive, behavorial, and somatic symptoms.
• Persistent depressive disorder is a long-standing disturbance of mood and places the child or teen at significantly greater risk for developing major depression.
• Disruptive mood dysregulation disorder is a new type of depressive disorder included in DSM-5. It features developmentally atypical and severe temper tantrums and chronic negative mood and irritability.
  
  • The presence of other comorbid disorders is a frequent phenomenon. Double depression is a name for the combination of major depressive disorder with persistent depressive disorder.
• In younger children, depression often manifests itself in a depressed appearance, somatic complaints, anxiety symptoms, and externalizing behaviors. In teens, hopelessness, substance abuse, suicidality, and other serious symptoms are more common.
• Before adolescence, the rate of depressive disorders is generally the same for boys and girls. However, beginning in adolescence, the rate of depression is much greater for girls.
• Bipolar disorders are severe forms of mood disorder involving alternating periods of depression and mania. In adolescence, bipolar disorders generally present as they do in adulthood.
  
  • Hypomania involves unusual and dysregulated emotions, thoughts, and behaviors similar to mania, although there are no psychotic symptoms and the degree of impairment is less severe.
  • Bipolar I disorder is diagnosed when an individual displays both major depressive episodes and at least one episode of mania.
  • Bipolar II disorder is diagnosed when an individual displays both  major depressive episodes and hypomanic episodes.
  • Cyclothymia is diagnosed when the individual presents a combination of hypomanic episodes and depressive symptoms that do not meet the criteria for major depressive disorder.
  • Episodic nature of mania, in contrast to the chronic display of irratibility in disruptive mood dysregulation disorder
• There is significant developmental continuity of depressive disorders occurring in childhood, through adolescence, and into adulthood.
• Researchers are considering a range of genetic, neurological, life stress, and parenting risk in the development of depression.
  
  • Kindling model: suggests that over time, the increasingly sensitive neurological response system requires lower thresholds of stimulation to trigger a new episode (physiological consequences of social stress)
  • Four domains of child facotrs in which atypical processes increase the risk of depression: (1) physiological regulation (2) emotion differentiation and regulation (3) the attachment relationship (emotional security) (4) the emergence of self and self-awareness
  • Rumination is a relatively stable maladaptive coping strategy that involves repeated focus on problems or symptoms and causes and consequences of those problems and symptoms; it appears to prolong episodes of depression
  • Both specific negative life events and chronic hassles have been associated with depression in children, especially in the early years.
  • Two physiological risk factors receiving special attention are:
    
    • reward hypersensitivity: the biobehavioral system that regulates motivation and goal-seeking behaviors is hypothesized to be hyperreactive to goal- and reward-relevant cues. Enthusiastic, excited, and often agitated pursuit of reawards is part of the hypomanic or manic symptom pattern. Failure to achieve goals or rewards leads to depressive symptoms.
    • social/circadian rhythm disruption: disruptions in daily social rhythms  lead to disruptions in circadian rythms such as sleep patterns, which in turn lead to mood symptoms.
    • An integrated reward/circadian rhythm dysregulation model to account for the emergence and course of bipolar disorder is proposed
• Genetic impact on the development of depressive disorders increases as children get older, most likely due to gene-by-environment interaction effects.
• Parent depression is an especially important and researched risk factor for the development of depression in childhood.
  
  • Three pathwyas of parental impact on child and adolescent depressive disorders have been described:
    
    • Parent depression affects parent-child relationships and interactions and leads to child psychopathology.
    • Parent depression affects family relationships and interactions and causes family disruptions, which lead to child psychopathology.
    • Parent depression affects relationships with romantic partners, and this leads to child psychopathology.
  • Overall, many of these risk factors are consistent with a reinforcement model of depression, in wich parents offer fewer rewards and more punishments to their children. This model is sometimes viewed as more consistent with the maintenance of depression in children rather than the emergence of depression.
• Many children and adolescents with major depression have other psychopathologies as well, especially dysthymia and anxiety disorders.
• Recent research suggests that the combination of cognitive-behavorial therapy and medication is generally the most effective intervention approach in the treatment of more severe mood disorders in childhood and adolescence.
  
  • Interpersonal therapies (i.e. relationship focussed approaches) appear also useful.
• Although still rare, adolescent suicide attempts and completions have steadily increased in recent decades.
• Although adolescent girls are more likely to experience suicidal ideation and to attempt suicide, boys far outnumber girls in terms of completed suicides.
  
  • Suicidal ideation involves a varity of cognitions from fleeting thought that life is not worth living to very concrete well-thought out plans for killing oneself
  • Parasuicide inclusdes many behaviors, from less dangerous gestures to serious but unsuccesful suicide attemps.
  • Nonsuicidal self-injury (NSSI) or self-harm overlaps with many kinds of parasuicide but can also be considered a distinct phenomon
  • Suicidality is the construct that includes suicidal ideation, parasuicide, and suicide
  • Interpersonal-psychological theory of suicidality: proposes two general categories of risk: dysregulated impulse control and intense psychological pain
• In addition to mood disorders, substance abuse is a significant risk factor for suicide among youth.

Week 39

Chapter 7: Autism Spectrum Disorder

• Autism Spectre Disorder (ASD) is a broad term that is used in a variety of contexts, reflecting compromised development in social functioning and communication, as well as restricted, repetitive behaviors and fixated interests.
• Social cognition refers to the many ways that people think about themselves and their social worlds. Children with ASD display atypical social cognition.
  
  • Joint attention: the capacity to coordinate one’s visual attention with the attention of another person
• Theory of Mind (ToM) refers to the ability to understand that others have their own mental state or perspective; it is an example of an important psychological process that is compromised in the development of autism spectrum disorder.
• Affective social competence – the coordination of emotional perception, experience, and communication – is another developmental achievement that is compromised in children with ASD.
• Although children with autism spectrum disorder are a heterogenous group, all display quantative and qualitative deficits in social and communication adaptation, as well as repetitive, restricted behaviors and fixated interests.
• Although the core symptoms of autism spectrum disorder are generally evident between two and four years of age, there are a number of developmental pathways that children exhibit.
• The core symptoms of autism spectrum disorder generally present lifelong challenges and compromised social functioning.
• A variety of physiological factors, including genetics, brain structure and function, and brain chemistry, are all being actively researched in an effort to identify causes of autism spectrum disorder.
  
  • The growth dysregulation hypothesis proposes that the normally well-controlled process of brain growth and organization goes awry, leading to the clinical symptoms of autism
  • The over-pruning hypothesis describes ‘overly agressive synaptic pruning in the sensory and/or motor regions.
  • Dysfunctions in the mirror neuron system may help explain the deficits in social cognition
• Child factors reflecting differences in the perception and processing of socially salient information are another set of factors that are being investigated in order to better explicate the etiology and course of autism spectrum disorder.
  
  • Children and adults are sometimes described as having mindblindness, and the vast majority of them fail even simple ToM (also refferred to as mentalizing) tests.
  • The central coherence hypothesis is based on the idea that most individuals attempt to perceive and construct meaning from information that is part of an environmental whole. Information makes sense, or is coherent, because it is part of something larger than itself. Children and adolescents with autism are at a disadvantage because they process information piecemeal, in a more fragmented fashion.
  • Executive functioning involves a variety of processes, including planning, memory, impulse control, and control of attention.
  • Baron-Cohen takes a different approach to atypical cognitive functioning and describes the empathizing-systemizing (E-S) theory, which includes below-average empathy (indexed by poor performance on ToM tasks) and above-average systemizing.
  • In contrast to explanations focused on cognitive deficits and differences, social motivation – or social brain – theories of autism emphasize important socioemotional deficits related to social attention, social engagement and social rewards.
  • A recent developmental model of autism provides an example of how multiple factors might together explain the emergence and course of autism spectrum disorder. In the two-hit model of autism, the first hit involves genetic and neurodevelopmental disruptions that lead to a vulnerable brain-behavior system and poor early childhood outcomes. The second hit comes during adolescence, when physiological changes are coupled with social challenges.
• The broad array of symptoms and varied degree of compromised functioning necessitates multiple asessment and intervention strategies. The most succesful interventions are those that are delivered early and intensively across a variety of domains of functioning.
  
  • Applied behavior analysis is an intensive behavorial approach, with high levels of control and direciton of the child and his or her environment. Begins as early as possible and involves more than 40 hours per week for two or more years. Focus is on decreasing negative behaviors  and then increasing language and peer interaction. The introduction of new behaviors must take into account the positive, enjoyable aspects of prosocial actions.

Chapter 9: Attention Deficit/Hyperactivity Disorder

• Attention deficit/hyperactivity disorder (ADHD) is characterized by a combination of the symptoms of impulsivity, restlesness, and inattentiveness.
• Self-regulation, effortful control, and executive functioning skills are important developmental milestones that are compromised by ADHD.
  
  • Self-regulation (or self-control), involving one’s own control of emotion, cognition, and behavior, refers to actions taken to achieve future goals despite conflicting desires in the present.
    
    • One model proposes a dual-influence framework that identifies a set of processes that underlie impulsive, immediate gratification and another set of processes that underlie more intentional pursuit of longer-term goals.
  • Effortful control is an espcially important mechanism of self-regulation.
  • Executive function (EF) includes those cognitive processes that underlie goal-directed behavior and are orchestrated by activity within the prefrontral cortex.
    
    • With respect to basic forms, 3 components have been identified:
      
      • Inhibition involves delay (i.e. withholding a dominant or habitual response), conflict (i.e. making a response that is incompatible with the preponent repsonse), or termination (of a response already initiated or executed).
      • Working memory involves maintaining and manipulating information over relatively brief periods of time and is the component that is most closely related to intelligence.
      • Shifting involves attentional control and/or conscious changes in mental states, rule sets or tasks.
      • Diamon and Lee describe 4 EF qualities that underlie success: creativity, flexibility, self-control and discipline.
      • Parental influences on EF include scaffolding (i.e. actions that help children engage with a challenging acitivity), stimulation (i. e. providing enriched experiences), and control (i.e. supportive, positive control vs harsh, negative control). Family socioeconomic status (SES) also has an impact on children’s EF, with low ES associated with poorer performance on EF tasks.
• The diagnosis of ADHD reflects compromised functioning in the domains of inattention, hyperactivity/impulsivity, or both.
  
  • Using the two-factor model of ADHD, descriptions of children as having predominantly hyperactive/impulsive difficulties, predominantly inattentive difficulties, solely inattentive difficulties, or combined difficulties reflect ‘a convenient cllinical shorthand’ and index their current presentations rather than any empirically valid distinctions related to etiology, functioning or response to treatment.
• Boys receive diagnoses of ADHD four to five times more often than do girls.
• In general, ADHD is an exceptionally stable diagnosis over time.
• Rates of co-occurring internalizing and externalizing disorders increase for children with ADHD over time.
• Diagnoses most commonly occurring along with ADHD include oppositional defiant disorder, mood and anxiety disorders, and learning problems.
• Genetic and neurological factors are central to the development of ADHD, whereas psychosocial factors play an important role in the maintenance and exacerbation of the disorder.
  
  • A polygenic model of ADHD is proposed, taking into account both rare and common genetic variants affecting a wide range of brain functions.
• Extensive research into the cognitive deficits that tend to characterize ADHD points, in particular, to weaknesses in effortful control.
  
  • Decision making that is both deficient and impulsive.
  • Recent EF work has focused on the distinction between hot and cold EF, and emphasizes that hot EF decision making is particularly problematic.
  • Sluggish cognitive tempo includes varied combinations of drowsiness, daydreaming, lethargy and slowed thinking and is associated with higher levels of anxiety, depression, withdrawn behavior, and lower levels of academic and social competence.
• Because the core symptoms of ADHD (e.g. distractibility and impulsivity) are present in many children, variable, and continuous with typical behavior, it is especially important that assessment include multiple data sources from multiple settings.
• The majority of children treated with stimulant medication show significant improvement. Although medication is especially helpful in the short-term, psychological interventions such as behavorial parent training, and environmental interventions, such as classroom adaptations, are important for sustained improvement in functioning.
  
  • Among the most effective school-based interventions involve behavior contingency management in the classroom. These interventions include reward programs, point systems, and time-outs for inappropriate behavior. They are designed to target multiple difficulties, including academic, behavorial and social functioning.

Week 40

Chapter 13: Eating disorders

• Adolescence is a time of increased risk for all types of eating disorders.
• Weight gain in adolescence is generally accompanied by an increase in body fat for girls and a decrease in body fat for boys. Attitudes of body dissatisfaction increase during adolescence for both boys and girls.
• Core eating disorder symptoms include disturbed eating behaviors, body dissatisfaction and negative body perceptions, and compensatory behaviors in order to lose weight or prevent weight gain.
• Key symptoms of anorexia nervosa include a fear of being fat and extreme behaviors leading to weight loss. Binge eating and compensatory behaviors to prevent weight loss characterize bulimia nervosa, whereas binge eating disorder does not include the compensatory behaviors.
  
  • Avoidant/restrictive food intake disorder is a residual category for eating disorders with atypical, mixed, or below-threshold presentations
• The prevalence of eating disorders has increased in recent decades.
• Depressive disorders, anxiety disorders, substance abuse, and nonsuicidal self-injury commonly occur along with eating disorders.
• The peak onset of eating disorders is early adolescence for anorexia and late adolescence for bulimia. Compared to anorexia or bulimia, binge eating disorder has a later onset.
• The biopsychosocial model of eating disorders emphasizes the interaction of genetic, physiological, personality, and family factors in the development and maintenance of eating disorders.
• Negative emotionality and emotional dysregulation are personality characteristics with particular salience for eating disorders.
• Negative life events increase the risk for eating disorders and also may precipitate the onset of an eating disorder.
• Once established, many forms of eating disorders are relatively resistant to treatment. Severe and life-threatening forms often require hospital-based programs for medical stabilization.
• Current treatment trends include the use of family-based treatments for older children and adolescents, and the use of cognitive-behavioral therapy for young adults.
  
  • The Maudsley model of family therapy, in which parents have a central role in treatment, is a ‘highly practical approach, which initially focuses exclusively on problems related to improving eating and promoting weight gain’. The last part focuses on the typical developmental challenges of adolescence that may have an impact on continued progress.
• An important component of all treatment models is a focus on healthy attitudes toward food and eating, as well as improved coping skills.

Chapter 14 Substance-Related Disorders and Transition to Adult Disorders

• Adolescent brain development is characterized by continuing growth, increased risk taking, and evolving self-regulation.      
  • Incentive motivation is observed when adolescents seek out experiences in pursuit of reward or positive reinforcement.
• Substance use and abuse in adolescence carries particular risk for the still developing adolescent brain.
• Substance abuse is defined as excessive use of or dependence on an addictive substance. Addiction is defined as a chronic disorder characterized by compulsive drug seeking and abuse.
  
  • Experimental substance use involves trying a drug once or a few times, often related to curiosity or peer influence
  • Social substance use occrus during social events with one or more peers
  • Tolerance occurs when the central nervous system gradually becomes less responsive to stimulation by particular drugs.
  • Physical dependence involves susceptibality to withdrawal symptoms; it occurs only in combination with tolerance.
  • Withdrawal symptoms are noxious physical and psychological effects caused by reduction or cessation of substance intake.
• Alcohol use and abuse by adolescents is of particular concern because of its relatively high incidence and its specific detrimental effects on adolescent brain development.
• Other substances abused by adolescents include marijuania, inhalants, cocaine, methamphetamine, hallucinogens, and prescription drugs.
• For most classes of drugs, developmental trajectories involve a progression from exposure to experimentation, to regular use, and potentially, abuse and dependence.
  
  • There are two periods of highest vulnerability: during early adolescence and during the transition to young adulthood.
  • Brown et al describe the following trajecotry groups: abstainers/light drinkers (with stable low use or nonuse), stable moderate drinkers (with stable or moderate use and limited heavy use), fling drinkers (with timelimited periods of heavy use), decreasers (early onset, but declining use), chronic heavy drinkers (early onset and stable heavy drinking), late-onset heavy drinkers (late onset, rapid escalation, heavy use).
  • For pathways of marijuana 3 adolescent trajectories of nonescalating use have been identified: low users, medium users and high users. One trajectory of escalating use has been described: escalating users.
• In general, early substance abues predicts later use and a range of negative phyiscal and psychological outcomes.
• The gateway hypothesis is a stage theory of drug involvement that propose that the use of drugs such as alcohol or marijuana act as a gateway to the use of harder drugs such as cocaine, heroin, or metamphetamines. The common liability to addiction model assumes there is a nonspecific propensity to use drugs. Developmental cascase models emphasize that early maladjustment in a particular domain leads to later maladjustment in multiple domains.
• Genetic studies indicate that a strong heritable vulnerability exists for substance abuse problems.
  
  • Physiological factors
    Going beyond the hedonic view that emphasizes the pleasure associated with drug use and the need to avoid withdrawal symptoms, the incentive-sensitization theory is a multistage explanation of addiction. First, various substances alter brain organization and fucntion. Second, these altered brain systems affect behavior in situations involving motivation and reward. The dopamine system that usually signals that certain stimuli will lead to positive reinforcement becomes hypersensitized to drugs and drug stimuli; this is referred to as incentive salience. At this stage, drug cues are increasingly difficult to ignore, and craving may become a more important factor in continued drug use than pleasurable effects. To understand craving as an essential aspect of drug use, researchers must adress both physiological and psychological factors.
• Conduct problems and depression occuring in childhood are both significant risk factors for the development of substance abuse during adolescence.
  
  • The connections between externalizing disorders and substance use and abuse raise the issue of self-medication.
  • Integrating physiological and cognitive factors, the cognitive-deficits model of addiction is based on the idea that repeat, chronic drug use results in abnormalities in the prefrontal cortex, impairing judgment, decision making, and impulse control.
• Parental expectations and practices are a powerful influence on wheter adolescents abuse  substances during adolescence.
• Peer attitudes supporting substance use, especially as teens enter high school, lead to an increase in substance abuse.
  
  • Cohort effects related to generational forgetting of the potential harm associated with particular drugs also seem related to increases and declines in substance use.
• Assessment of, and treatment for, comorbid pscyhopathologies is particularly important when treating substance abuse in adolescence.
• Relapse prevention is an important aspect of an effective substance abuse treatment program.
  
  • Universal preventions often promote healthy lifestyle. One example is emphasizing safe or sensible drinking with some adult supervision.
  • Working with adolescent beliefs is core to the cognitive model of psychotherapy. Beliefs about self, beliefs about life experiences and sustance related beliefs are all important.
  • Motivational interviewing is a brief intervention incorporating aspects of motivational pscyholgoy, client-centered therapy, and stages-of-change theory.
  • The variables most associated with relapse are negative emotion, comorbid psychpathology, peer pressure and withdrawal symptoms.
• In the study of major psychopathology, an emerging focus has been on the early detection of those at risk for psychosis, the mechanisms responsible for the onset of psychotic symptoms and the implications of these findings for early intervention.
  
  • The prodrome is the period of time before the first episode of psychosis. Along with declines in functioning, there are increases in presychotic symptoms such as unusual ideas, suspiciousness and atypical perceptual experiences.
• The consolidation of identity and personality characteristics is key developmental tasks of adolescence making the study of personality disorders important to the field of developmental psychopathology.   
  
  • Dimensional models describe 2 core components of personality: one concerned with the self, including identity, esteem and regulation and the other concerned with relationships, including capacities for connection, empathy and intimacy.
  • 3 pattern clusters: internalizing cluster, externalizing cluster, borderline-dysregulated cluster
  • Among the DSM-5 categorical syndromes are antisocial personality disorder, avoidant personality disorder, borderline personality disorder, obsessive compulsive personality disorder, narcissistic personality disorder and schizotypal personality disorder.

Week 41

Chapter 10: Oppositional Defiant Disorder and Conduct Disorder

• Important developmental tasks across emotional, cognitive, and behavioral domains are critical to the formation of typical self-regulatory and prosocial skills.
  • Prosocial behaviors: are behaviors that benefit others 
    • As children age, their prosocial repertoires expand in a variety of ways, involving achievements related to self-control and rule-based behavior.
    • The development of conscience is the key child factor underlying prosocial behavior. The construct of conscience includes both moral emotions (guilt, discomfort following transgressions) and moral conduct (behavior compatible with rules and standards).
    • Other research on prosociality emphasize the parent-child mutually responsive orientation (MRO). With MRO, parents and children become responsive to each other, smoothing the way for succesful parental socialization efforts.
• The social context for the development of self-regulatory and prosocial skills is anchored in the parent–child relationship, especially in early development, and then widens over time to include peer and other social relationships. This broadening social context can serve as either a protective or risk factor in relation to the development of disruptive behavior problems.
  
  • Four extreme status groups of children, based on peer nominations:
    
    • Popular children were those who received lots of positive responses and few negative ones
    • Rejected children received many negative responses and few positives
    • Neglected children received few positive or negative responses
    • Controversial children had both positive and negative responses
• Bullying is characterized by negative actions intended to cause harm, that are repeated over time, and that involve a power differential between bully and victim.
• Oppositional defiant disorder (ODD) is characterized by a sustained pattern of negativistic, hostile, and defiant behavior. Irritability and impaired social cognition are also common symptoms of ODD.
  
  • The disorders is differentiated from the more severe conduct disorder, which involves the violation of social norms and rules as well as the rights of others.
  • Four dimensions that underlie ODD: agressions, noncompliance, temper loss, low concern for others
• Although most children diagnosed with ODD do not go on to develop more severe forms of the disorder, ODD does significantly increase the risk for later conduct disorder.
• The presence of ADHD along with ODD is associated with a more negative prognosis.
• Conduct disorder (CD) is differentiated from ODD by the severity of the externalizing behaviors and the degree of impairment associated with the disorder.
• Conduct disorders are further differentiated by patterns of externalizing behaviors and whether the onset of the disorder occurs during childhood or adolescence.
• Callous–unemotional characteristics, such as lack of empathy or remorse, shallow emotions and a lack of concern about performance, are associated with greater continuity of problems throughout development.
• Adolescence onset of conduct disorder is significantly more common than childhood onset.
  
  • Child-onset and adolescent-onset conduct disorder do not only differ in their timing, but also in their symptom patterns, severity and outcomes. Moffit’s theory of CD describes a life-course persistent (LCP) trajectory, similar to child-onset CE; and an adolesence limited (AL) trajectory.
• A number of etiological risk factors may contribute to the development of ODD and CD, including characteristics of the child (such as temperament), quality of parenting, genetics, and environmental factors.
  
  • Most common child factors: deficits in the processing of negative emotional stimuli & differences in sensitivity to reward and punishment
    
    • Deficits in social information processing & impaired social cognition: less acurate and more hostile/agressive interpretations of everyday social information
    • Early puberty and premature autonomy
  • Peer contagion: like coercion and deviancy training are two processes that underly deteriorating pathways
• The etiological complexity of ODD and the overlap with normal range negative behavior in childhood makes assessment and diagnosis of ODD challenging.
• Because externalizing symptoms are usually identified more easily and earlier by observers, early diagnosis and intervention efforts are especially relevant for both ODD and CD.
  
  • Agression involves behaviors that are carried out with an immediate goal of causing harm to another.
  • Instrumental agression is agression that is premediated or planned.
  • Reactive agression is agression that occurs in response to provocation.
  • Overt agression (also called direct agression) involves harmful physical behaviors or overt behaviors such as name-calling. Overt agression is more often associated with low levels of prosocial behaviors, emotional dysregulation, externalizing problems, and poor peer relationships.
  • Covert agression (also indirect agression) may include the externalizing behaviors observed in CD, such as property damage or theft; it may also involve behaviors that harm the target by rejection or exclusion (relational agression) or alternative strategies (such as manipulation) employed when the costs of overt agression are high. Covert agressions is associated with higher levels of prosocial behavior and internalizing problems.
  • A threepart, developmentally informed conceptualization of psychopathy: disinhibition, boldness (capacity to remain calm in stressful situations, high self-assurance, social efficacy) and meanness (deficient empathy, disdain for others).
• Differential diagnosis often focuses on the commonalities and distinctions among ODD, CD, and ADHD. In addition, both ODD and CD may be comorbid with either anxiety or depression.
  
  • A model of externalizing disorders in which only those children who are diagnosed with both ODD and ADHD go on to develop conduct disorders, with ADHD often preceding ODD as a specific risk factor. In this model, there are 3 deviant pathways: the overt pathway (with minor agression leading to more serious agression that tends to be unconcealed or secretive), the covert pathway (with minor misbehavior leading to more serious delinquent acts that tend to be more concealed or secretive), authority conflict pathway (with stubborn relationship oriented behaviors leading to more serious disobedience and hostility).
  • The coercion model (also called Oregon model) by Patterson is a developmental model that provides a framework for understanding the emergence, maintenance and treatment of ODD. The primary focus is on social interaction learning and patterns of parental characteristics that lead to negative parent-child interactions by these characteristics: (1) inconsistent discipline (2) irritable, explosive discipline (3) inflexible, rigid discipline (4) low supervision and involvement.
• Intervention approaches that are intensive, comprehensive, multimodal, and implemented early have been shown to be most effective.
  
  • Parent management training (PMT) involves decreasing coercive interactions, increasing positive parenting and increasing compliant behavior and prosociality.
  • Parent-Child interaction therapy (PCIT) recognizes that the parent-child relationship provides a powerful context for understanding and changing behavioral patterns in young children
  • The benefits of multidomain interventions are that achievements in specific domains can mitigate risks in others.
  • Overall, there are 9 characteristics associated with effective prevention efforts: a comprehensive approach, a theory-driven model, a well-trained staff, varied methods, sufficient intervention intensity, opportunity’s for positive relationships, appropriate timing, sociocultural relevance, and outcome evaluation.

Chapter 8: Maltreatment and Trauma- and Stressor-Related Disorders

• Stress occurs when the demands on the individual to adjust to the environment exceed available coping resources. Allostasis refers to the natural process of maintaining physiological and psychological stability in response to environmental demands. Allostatic load refers to the cumulative physiological and psychological wear and tear caused by ongoing (and sometimes maladaptive) allostatic processes.
  • Exposure to prenatal and postnatal stress has programming effects on the developing brain and HPA axis, these involve changes in gene function (epigenetics).
  • Adversity gets under the skin: early adversity appears to alter the magnitude of the stress response (usually in the direction of hyperreactivity, but also sometimes hyporeactivity) and the poor regulation of that response. The experience of stress in early development is buffered by responsive caregiving.
  • Early adversity is often discussed in tandem with toxic stress.
  • Positive stress responses include brief, mild-to-moderate responses, usually with a supportive caregiver (like everyday frustration or first day of school)
  • Tolerable stress responses involve atypical stressors (like serious ilness, frequent interparental conflict, natural disaster)
  • Toxic stress responses are the result of strong, frequent, or prolonged activation of the body’s stress response systems in the absence of the buffering protection of a supportive, adult relationship.
• Coping involves the child’s active attempts to respond to stress and adversity.
  
  • Distinction between automatic processes (like biases to attend to threatening information) and controlled processes (purposeful shifting of attention observed in distraction)
  • Distinction between antecedent regulation (i.e. coping that anticipates a psychologically demanding event), response-focused regulation (i.e. coping that follows the psychologically demanding event)
• Child maltreatment, including physical, sexual, and emotional abuse, as well as neglect, is a significant risk factor for immediate, short-term, and long-term negative developmental outcomes.
  
  • Sexual abuse involves sexual contact or attempted sexual contact between an adult and a child
  • Physical abuse refers to injuries that are inflicted by nonaccidental means
  • Neglect involves failure to provide minimum standards of care that leasd to harm or endangerment.
  • Emotional (or psychological) abuse refers to ongoing and extreme disregard or thwarting of basic emotional needs.
• Acute stress disorder involves the development of multiple psychologically based symptoms that last up to one month following exposure to a traumatic event. Posttraumatic stress disorder (PTSD) involves significant, specific symptoms that develop after a traumatic experience and last longer than one month.
  
  • Recent studies of children and adolescent who experience multiple and complex interpersonal trauma suggest that a new diagnostic category can be included in upcoming editions of DSM: developmental trauma disorder, a disorder involving both exposure and adaptation to chronic trauma, with exposure often occurring in the context of a child’s caregiving environment.
  • Several distinct PTSD pathways have been described: resilient (i.e. stress-resistant pathway), response and recovery pathway, delayed breakdown pathway, chronic dysfunction (i.e. breakdown without recovery) pathway
• Maltreatment, and other forms of trauma, has both short- and long-term negative effects on neurological, psychological, and social development.
  
  • Poly-victimization, the experience of high levels of many types of victimization, is a particularly distressing outcome. There are 4 pathways to becoming a poly-victim:
    
    • Living in a dangerous community
    • Living in a dangerous family
    • Having a chaotic, multiproblem family environment
    • Having emotional problems that increase risky behaviors and compromise adaptation (related to temperament)
• A parent’s own response to trauma has a significant effect on his or her child’s symptom development, severity, and outcome.
• Resilience and recovery following trauma is related to health-promoting child, family, and sociocultural factors.
  
  • One issue that remains unresolved is whether exposure to stress and adversity involves inoculation (early exposure to stress allows children and adolescents to develop and practice a variety of coping responses and may provide one kind of protective effect) versus sensitization (early exposure lead to physiological and psychological changes that likely increase risk) effects
• Posttraumatic growth refers to positive changes following trauma.
• Multiple etiological factors, including genetic, physiological, individual, family, and environmental factors, interact in complex ways and lead to pathological responses to stress and trauma.
  
  • Parents can influence the development of PTSD, for example via:
    
    • Shotgun effect: involves trauma that is so overwhelming that it produces anxiety symptoms in all family members. In other words, parents as well as children struggle to deal with the aftermaths of awful experiences such as the loss of a home in a fire or flood
    • Lack of protective shield effect: involves parents who, for varied reasons, cannot provide the comfort, support, and security necessary for recovery
    • Toxic family effect: has to do with the ways in which parent responses to trauma actually elicit and maintain anxiety symptoms in children
  • Parents also contribute to children’s risk or resilience via socialization of coping:
    
    • Amplification-effects model: suggests that there are stronger risk effects for maladaptive coping suggestions and stronger protective effects for adaptive coping suggestions.
    • Differential effects model: suggests that socialization of coping has different but equally significant effect of risk for psychopathology in the context of high versus mild stress
• Although a variety of treatment approaches are effective in treating symptoms related to maltreatment, trauma, and stress, prevention programs targeting at-risk families are especially important to the reduction of child maltreatment.

Week 42

Chapter 6

• Individual patterns of intellectual development are relatively stable by 4 or 5 years old.
  • Fluid intelligence: i.e. the ability to reason and solve problems in new situations
  • Crystallized intelligence: i.e. the skills and knowledge acquired through education and experience
  • Practical intelligence
  • Creativity
  • Cognitive development: general age-related trends
  • Intellectual development: individual differences across children at all ages
  • The genetic effects on intelligence increase with age, as children select and evoke experiences in line with their genetic predispositions and as these experiences in turn stimulate their cognitive development
  • Flynn effect: the gradual increase in IQ scores over many decades. Researchers suggest that the industrial revolution combined with a need for more advanced skills led to higher levels of intelligence in many countires. In addition, better nutrition, schooling and health continues to contribute.
• Intellectual developmental disorders (also knows as  intellectual disability) involve significant deficits in intellectual functioning and adaptive functioning.
• The classification levels of mild, moderate, severe, and profound intellectual developmental disorder describe the degree of compromise in intellectual and adaptive functioning present in an individual diagnosed with intellectual developmental disorder.
  
  • The AAID views intellectual development disorder that involves significant limitations, both in intellectual functioning and in adaptive behavior leading to impaired conceptual, social, and practical skills. Each area of dysfunction includes a corresponding description of the support necessary for maximizing the individual’s well-being: intermittent, limited, extensive or pervasive support.
  • Zigler (holistic approach) described two groups of children with intellectual development disorder: individuals with mild forms of intellectual disability, reflecting the low end of normal distribution of intelligence in the general population (often called familial intellectual developmental disorder) & individuals with more severe forms of intellectual disability, usually the result of pathological processes such as genetic disorders.
• Adaptive behavior refers to the ability to master age-appropriate tasks of daily living.
• An alternative classification approach focuses on the relation between genetic causes (genotype) and specific behaviors and symptoms (phenotype). Examples of this approach include Down syndrome, Williams syndrome, and fragile X syndrome.
  
  • The construct of behavorial phenotypes emphasizes the likelihood that a child will display a particular pattern of difficulties given a particular genetic etiology.
  • Down Syndrome is caused by an extra chromosome (trisomy 21)
  • William syndrome is caused by a microdeletion in chromosome 7
  • Fragile X syndrome, caused by atypical gene expression on the FMR1 gene, is the most common type of inherited intellectual development disorder in boys.
    
    • Single gene disorder, epigenetic disorder
  • With respect to genetic factors, there is evidence for a strong heritable component.
• In addition to careful consideration of all relevant medical and developmental background information, standardized assessment of both intellectual and adaptive functioning is critical to the valid and reliable diagnosis of intellectual developmental disorder.
  
  • DSM-5 describes three domains of specific learning disorder: reading, written expression, and mathematics. Specific learning disorders involving reading include difficulties related to word recognition, reading fluency, and reading comprehension.
  • Recent models of assessment emphasize the large-scale screenings and instruction implementation should be provided to all students.
• In contrast to most forms of psychopathology, the focus of treatment for intellectual developmental disorder is not the condition itself. Rather, the focus of intervention is the maximization of the individual’s potential functioning.
  
  • In the US, special educations and remediation efforts are often based on individualized education plans (EIPs) designed for students with learning disorders.

Week 43

Chapter 10

Zie de overview aan het eind van het hoofdstuk zelf, die is volledig!