In the past, no distinction was made between schizophrenia and pervasive disorders, such as autism. Nowadays we do differentiate between them. Schizophrenia is rare among children, often develops in adolescence and increases in adulthood. Autism and Asperger's syndrome are non-psychotic disorders that arise at a young age.
The DSM-V contains the Pervasive Developmental Disorders (PDD) category. This category includes:
Rett's disorder is now viewed differently and will not be further discussed for this reason. Criticism, such as whether Autistic Disorder and Asperger's syndrome would not be a single disorder, was common. In the DSM-V, the above-mentioned disorders are no longer considered separate. They now coincide in the Autism Spectrum Disorder (ASD). Two domains with primary symptoms can be distinguished in ASD: Firstly, persistent limitations in social communication and interaction, and secondly, restrictive, repetitive behavioural patterns.
What is Autistic disorder (autism)?
Kanner described autism as a disorder characterized by communication problems, atypical cognitive skills and behavioural problems such as obsessiveness, repetitive behaviour and unimaginative play. However, Kanner saw social inability as the biggest problem.
Primary characteristics
Social interaction
Already before the age of 1, autistic children show subtle differences from normally developing babies. They respond less to visual stimuli, respond less when someone calls their name and often don't like to be touched. They do not follow people with their eyes, avoid eye contact, appear to have an ‘empty’ or unseeing eye and respond little to others with emotional expression and positive emotions. Particularly striking is that autistic children exhibit deficits in joint attention, where the child and parent or caregiver focus attention on the same object or situation, thereby sharing an experience. Joint attention is facilitated by certain gestures, such as pointing, and eye contact. Another component of an atypical social interaction is abnormal processing of social stimuli, particularly the face. Children with autism have difficulty recognizing and remembering faces (and associated expressions of emotion). They also process faces in other ways than normal developing children. All in all, delayed or atypical social behaviours seem to occur at a young age in at least five areas of social behaviour: attention to social stimuli, joint attention, emotion, imitation and facial processing. Although the symptoms may change over time, many social deviations are persistent.
Communication
Children with autism have problems with non-verbal communication, such as gestures and facial expressions. In addition, 30% of the children do not learn to talk. Children who do acquire language show a delayed and abnormal language development. Echolalia and the reversal of pronouns are common among children with autism. Of echolalia occurs when an autistic child always repeats what another has just said. This also occurs for example with language disorders, schizophrenia and blindness. When reversing pronouns (pronoun reversal) for example, the child says 'I' or 'me' to others (instead of 'you') and calls himself 'he', 'she' or 'you'. Autistic children have difficulty with syntax, understanding and other structural forms of language. Particularly striking are the problems with pragmatics: the social use of language. Children with autism randomly jump from one topic to the other, do not communicate back and forth (or cannot start a conversation at all) and provide irrelevant details about topics. However, it should be noted that some children can function at a higher level and are more socially skilled.
Restrictive, repetitive and stereotyped behaviour and interests
A distinction can be made between two categories of restrictive, repetitive and stereotyped behaviour:
It is not clear why autistic children exhibit restrictive, repetitive and stereotyped behaviour. Possibly excessive arousal or anxiety plays a role, or such behaviour serves as self-stimulation. Research has shown that restrictive, repetitive and stereotyped behaviour can change over time.
Secondary characteristics
Sensory or perceptual limitations
Children with autism also have other problems and deficits. The senses are intact, but there are abnormal responses to stimuli. Both hyposensitivity and hypersensitivity to sensory stimuli are more common in children with autism. If a child is hypersensitive, he or she does not like stimuli, he or she is afraid of it or he or she avoids stimuli. However, hyposensitivity is more common. Here, for example, the child does not respond to sounds or runs into things.
Also, selectivity is common in autism: a child focuses on a select part of a stimulus, while other parts of it are ignored. This interferes with normal development and functioning. For example, ignoring specific aspects of a learning task can have a negative impact on task performance. Over selectivity can also have negative consequences in the social field. For example, an autistic child can pay a lot of attention to a toy that another child is holding, but not to the child's message (for example, "Shall we play together?" Versus "Go away, this is my toy").
Intelligence
Although children with autism can vary widely in intelligence, intellectual disabilities are common. Its prevalence is between 40% and 55%. Based on intelligence, a distinction is made between individuals who function at a higher and lower level. An IQ of 70 is used as the limit. A higher IQ is often accompanied by less severe symptoms and a greater chance of normal functioning.
Children with autism often exhibit an unbalanced cognitive development. They exhibit deficiencies in abstract thinking, language and social insight. On the other hand, they are relatively strong in memorizing things and visual-spatial skills. The non-verbal IQ is often higher than the verbal IQ.
A small proportion of autistic children have splinter skills : skills that are much better than would be expected based on their intelligence. Some children also have savant abilities: skills that are considerably better than those of normally developing children. For example, they can quickly calculate difficult sums in their heads or make very detailed drawings of something that they have only seen once. Although savant abilities are often associated with a higher IQ, they also occur in autistic children with an IQ of 55.
Adaptive behaviour
Autism is characterized by various problems in daily life. The self-help and daily living skills mainly depend on intelligence. Children with autism, however, have significant deficits in communication and social skills. These restrictions increase with age.
Social cognition: Theory of Mind
Research has shown that children with autism have a limitation in the theory of mind (ToM). The ToM is the ability to understand mental states with others and with themselves. It refers to the insight that people have mental states (such as intentions, beliefs, feelings and wishes) and that these mental states are related to their actions. ToM determines the interaction with others. Normally developing children have first-order capabilities around the age of 4: they understand the mental states of others somewhat. Around the age of 6 they acquire second-order capabilities: they can think about other people's thoughts about the thoughts of a third person. Because ToM is considered crucial for understanding the social world, it is claimed that the deficits of children with autism in ToM are at the root of many of the social and communication problems they have.
Aspects of ToM are measured with various tests. The Sally-Anne test measures whether a child understands that another person may have a false belief. The child is told during this test that Sally put a marble in a basket and then left the room. Anne then went inside, and she moved the marble to a box. The child is asked where Sally will look for the marble. To prove a ToM, the child must understand that Sally thinks the marble is still in the basket.
This first-order test can also be adapted to test the second-order power. In this case, Sally leaves the room, but peeks through a window and sees Anne move the marble to the box. The child then has to answer the following question: "Where does Anne think Sally will look for the marble?" The majority of children with autism fail both first and second order tests. It is still unclear what this explains.
For older children, or children who do well on the second-order test, more difficult tests have been developed, such as the faux pas test. The researcher reads a story in which person A makes a faux pas (accidentally saying something that may have a negative influence on person B). The child is asked to identify the faux pas. To be able to do this test correctly, the child must understand that person A and person B both have different knowledge and that the comment from person A influences the emotions of person B. Children with autism find this more difficult than other children.
Cognition: Central coherence
Normally developing children tend to use the context to link pieces of information together to form a whole. This is also called central coherence . Autistic people show shortages in this: they focus primarily on parts of stimuli and not on integrating information into a whole. Simply put, they see trees instead of a forest. Children with autism tend to process information in a more analytical, less global and integrative way than normally developing youngsters. This can lead to exceptionally good performance on one task and poor performance on the other task.
Cognition: Executive functions
Children with autism have deficits in executive functions. These deficits develop secondary, because autistic children of pre-school age do not yet differ from their peers. Kanner states that there is a lack of intersubjectivity in children with autism : an innate awareness that people have of each other, so that they are motivated to communicate with each other.
Physical characteristics
Autism is associated with minor physical anomalies (MPA) , such as a large forehead and low ears. This indicates genetic processes and disturbed prenatal development. Some autistic people have poor balance and limitations in gross motor skills. In addition, some exhibit unusual eating preferences and sleeping problems. Young people with autism sometimes exhibit maladaptive behaviour, such as aggression, withdrawn behaviour and auto-mutilation.
Comorbidity
Determining comorbidity in people with autism can be difficult due to communication problems. In addition, it is difficult to distinguish between some primary characteristics of autism and psychiatric disorders. Social phobia and OCD are examples of disorders that can resemble aspects of autism. The symptoms and disorders that are often associated with autism are anxiety, depression, hyperactivity and oppositional behaviour. The comorbidity of autism and anxiety may be the result of a hypersensitivity to stimuli. A social phobia could also arise if a child with autism is aware of his or her social deficits.
The pattern of comorbidity can depend on intelligence. For example, lower intelligence is related to irritability and hyperactivity, while higher intelligence is primarily associated with depression.
Epidemiology
The number of children with autism appears to have risen sharply in recent decades. There are a number of possible explanations for this increase:
Boys are more likely to suffer from autism than girls. An intellectual disability and more serious symptoms, on the other hand, are more common among girls. The gender difference may be partly explained by the fact that boys have a higher risk of genetic disorders associated with autism. In addition, it is claimed that there is a tendency for autism to systematize the world: a tendency that is more characteristic of the male brain.
No evidence was found for a connection between social class and autism. There is, however, some evidence that autism occurs more frequently among white children in the US and that prevalence increases faster for African American and Latin-American children.
Development process
Parents of children with autism often notice the first symptoms around the age of 2, but the diagnosis is often made a few years later, when there is a delay in language development and social problems. There are three patterns of onset of autism:
Research has shown that the development of autism can proceed in different ways. A study has identified six common pathways. With regard to social and communicative behaviour, children often improve over time. Children with the least severe symptoms often improve faster. Many people with autism show a decrease in the primary symptoms of autism and associated maladaptive behaviour. In general, people with intellectual disabilities and a lower family income improve less.
Despite some improvement, the symptoms persist in most people with autism until adulthood. About 15% of autistic children eventually become independent, have a good job and have a social life. The long-term outcomes are particularly poor if there is limited intelligence and limited communication skills at a young age.
Neurobiological abnormalities
The temporal-limbic system, the frontal lobes and the cerebellum belong to the "social brain" and are associated with autism. Research has shown that 5-10% of autistic children have a relatively large brain. They are born with a small to normal brain, but soon after birth there is an atypical growth spurt.
Evidence has also been found for abnormalities in brain volume. In the cerebrum there is an excessive amount of grey and white matter and in the cerebellum a lot of white matter. There are also deviations in the cell structure and organization of the temporal limbic system, the frontal lobes and the cerebellum, such as a reduced number of cells, fewer large cells, a high cell density, few dendritic branches and abnormal cell migration. In addition, research shows that there is less activity in different brain regions, particularly in the frontal lobes and the limbic system (especially the amygdala). The research findings regarding the role of neurotransmitters, such as serotonin and dopamine, are inconsistent.
Aetiology
Genetic influences
There is evidence for a genetic influence on autism. In addition, there appears to be a genetic predisposition to autism. Research has shown that identical twins have a 60% chance of having both autism, while this is only 4.5% for fraternal-twins. In 2-7% of the cases, brothers or sisters of an autistic child also have autism. In addition, other pervasive developmental disorders are more common in families with autistic individuals. Social, communicative and motor problems also occur in 20-30% of family members, who are not serious enough to meet the diagnostic criteria of an ASD. There may also be family members who exhibit other non-diagnosed symptoms of ASD, such as an increased serotonin level and neuroanatomical abnormalities. Fragile X syndrome and tuberculosis are genetic disorders that are associated with autism.
Prenatal and perinatal risk factors
There are several prenatal and perinatal factors associated with autism, such as an older age of the parents, medication use by the mother, bleeding of the mother, and troubles with the delivery.
Medical conditions and vaccines
In addition to fragile X syndrome and tuberculosis, there are other medical conditions that are associated with autism, such as hearing impairments, epilepsy and meningitis. The idea that autism is associated with vaccines is controversial but not proven.
Environment and social interaction
In many studies, the role of environmental and psychosocial factors in autism has been ignored. Dawson and Faja have developed a model that contains three components. This model states that genetic and environmental factors lead to brain abnormalities, which influence the interactions between the child and the environment. These interactions disrupt the input that is crucial for further brain development, leading to additional brain abnormalities and autism.
Asperger's syndrome is characterized by problems in social interaction and restrictive, repetitive and stereotyped behaviours. According to the DSM, children with Asperger's syndrome, on the other hand, have no delay in language development, cognitive development, adaptive behaviour (except in the social field) and curiosity about the environment.
Children with Asperger's syndrome have difficulty making friends. They show deficiencies in the use of non-verbal behaviour and are not very empathetic. They seem interested in others but are often lonely. In addition, they sometimes have obsessive and limited interests, for example in kitchen appliances or historical events. Young people with autism often have secondary problems, such as motor or behavioural problems.
Children are less likely to be diagnosed with Asperger's syndrome than with autism and the diagnosis is on average much later in life than with autism. Boys suffer from this syndrome more often than girls. The outcomes are fairly good, but the social problems are likely to persist over time.
It is doubtful that Asperger's syndrome is a qualitatively different disorder than autism. Research has shown that there are not very many significant differences between Asperger's syndrome and high-functioning autism, so that Asperger's syndrome can be considered as a variation on the autism spectrum. On the other hand, Asperger's syndrome differs qualitatively from autism in certain respects. For instance, Asperger's syndrome develops later in life than autism does. Children with Asperger's syndrome also have a higher verbal than performance IQ (instead of the other way around), they have more limited interests and they exhibit fewer motor symptoms than children with autism.
A person is not otherwise specified with pervasive disorder (PDD-NOS) if he or she exhibits symptoms that resemble the symptoms associated with autism and other pervasive developmental disorders but do not meet the diagnostic criteria of these disorders. The diagnostic criteria of PDD-NOS state that there must be a disrupted reciprocal social interaction. In addition, there must be a disturbed communication or stereotyped behaviour and interests. The prevalence of PDD-NOS is higher than that of other autism spectrum disorders. However, the diagnosis is less stable, which may be explained by the vagueness of the diagnostic criteria or a tendency of clinicians to use the diagnosis due to uncertainty.
What is Childhood Disintegrative Disorder?
The childhood disintegrative disorder (CDD) is diagnosed when a child develops normally until the age of 2, but then loses much of the acquired skills. The symptoms must be present before the age of 10. Autism also sometimes shows a decline in development, but the loss of skills occurs at a later age with CDD than with autism. The CDD diagnostic criteria state that there must be a significant loss of skills in at least two of the following areas: language, social skills, toilet training, game behaviour and motor skills. In addition, there must be abnormal behaviour in two of the following areas: social interaction, communication or restrictive, repetitive and stereotyped behaviour.
CDD often develops (gradually or abruptly) around the age of 3 or 4. The limitations are fairly stable over time. CDD is more common among boys than among girls. Compared with children with autism, mutism is more common among children with CDD. They also have fewer self-help skills and more often have an IQ below 40. These youngsters are among the lowest-functioning youngsters of children with pervasive developmental disorders.
Assessment
Because autism spectrum disorders (ASD) are characterized by problems in different areas, the assessment must be comprehensive. It is important to involve the parents in the assessment. It is also important to obtain a clear picture of the (medical) history of the child. Psychological and behavioural evaluations often include interviews, observations of the child and psychological tests. Tests are often used to assess intelligence, adaptive behaviour and language development. In addition, there are instruments for assessing autistic behaviour based on observation.
Evaluate autism-related behaviours and prevention
The universal prevention of autism includes good prenatal care and the improvement of environmental factors. However, early identification and treatment in particular are important for the prevention of autism. Identification could be through discussion with parents, observation and the use of 'screening tools'. Prevention programs for young children are often implemented at home or at school and use behavioural techniques. Programs often focus on language, social skills and imitation. This is conducive to the intelligence, language development and general development of children and can lead to a decrease in autistic symptoms.
Intervention
Pharmacological treatment
If children with ASD are prescribed medication, this is usually to reduce problem behaviour, such as aggression and auto mutilation. Antipsychotic medication that focuses on dopamine can be effective but has side effects such as motor problems. For this reason, atypical antipsychotic medication is used nowadays, which focuses on both dopamine and serotonin. These drugs have fewer side effects. Stimulants reduce the disruptive behaviour of children, but also have many side effects. Although many children receive ASD medication, it is unclear what the effects are (in the long term).
Behavioural intervention
A distinction can be made between two types of behavioural treatment:
Lovaas was the first to try to teach autistic children verbal communication. To achieve this goal, operant behavioural techniques such as modelling, and empowerment were used. Initially, the children benefited from the treatment, but failed to generalize the skills learned to other situations.
Functional analyses of maladaptive behaviour and Functional Communication Training are used to teach adaptive behaviour, among other things by learning the skills in a natural environment. This increases the chance of generalization.
The Central Response Treatment assumes that reinforcing central behaviour will have a positive influence on other behaviours. The general purpose of the intervention is to promote the independence of the child. The intervention takes place in natural settings. Motivation is considered as a key component in this treatment. It is assumed that improved motivation and behaviour have a positive influence on other behaviour. There is evidence for the effectiveness of the Central Response Treatment.
The Young Autism Project is an example of an intensive and long-term treatment method. Children of preschool age receive 40 hours a week (and three years of) skills taught by psychologists. Initially, it is often necessary to reduce maladaptive behaviour, to learn imitation and obedience, and to learn basic skills such as dressing oneself. Next attention is paid to the development of language and communication skills, interaction with peers and interactive play. In the final year the emphasis is on advanced communication and adaptation to school. Parents play an important role in the intervention. The research results show that the Young Autism Project is effective for some, but not all, children. For example, the treatment has positive effects on intelligence, language skills, social behaviour and adaptive functioning.
All in all, it can be concluded that intensive, early treatments can be very effective. Effective behavioural treatments are associated with carefully controlled learning situations. Use should also be made of techniques that promote the generalization and retention of the skills learned, such as educating parents as primary caregivers. The effects of different treatments differ per child.
Education
Treatment and Education of Autistic and related Communication Handicapped Children (TEACH) is a service research and training program for people with autistic spectrum disorders. The emphasis is on change at home, education and adapting to the community. TEACH works with individual programs and is applied in America and Europe.
The 'Individuals with Disabilities Education Act' (IDEA) also applies to children with ASD. The principles of least restrictive placement and inclusion have led to declining institutionalization and increasing educational opportunities for children with autism. The advantage of inclusion is that inclusion is that peers can model socially competent behaviour. There is evidence that some autistic children benefit from inclusion. On the other hand, it has been shown that children with autism have relatively fewer reciprocal friendships that are of poorer quality.
Primary symptoms
According to the DSM, the primary symptoms of schizophrenia are:
The first four characteristics are called positive symptoms . To be diagnosed with schizophrenia, someone must experience at least two of the above symptoms for a significant portion of the period being looked at (one month). These symptoms must last for at least six months. If the disorder develops in childhood or adolescence, the expected level of interpersonal, academic, or professional development should not be achieved.
Secondary symptoms
Schizophrenia is associated with various secondary characteristics, such as motor abnormalities (such as poor coordination), minor physical anomalies, limited communication skills, social problems (such as withdrawn behaviour) and emotional problems (such as anxiety). Many children with schizophrenia also score lower than average on intelligence tests. They have difficulty with tasks that require attention, memory and executive functions. There may also be social issues such as shyness, reclusive behaviour and isolation, and emotional issues such as depression, anxiety and a moody mood.
Epidemiology
Approximately 1% of the entire population suffers from schizophrenia. Schizophrenia develops more often at the end of adolescence rather than childhood. Few cases of schizophrenia diagnoses are known before the age of ten. Schizophrenia is most common in boys in childhood. However, this difference in sex has almost disappeared in adolescence. Among adults, the prevalence of schizophrenia is higher in lower socio-emotional classes.
Development process
Schizophrenia often develops gradually in childhood (insidious). Initially there are only non-psychotic symptoms, such as a delay in language skills and in cognitive, sensory and motor functions. There are also problems with peers, problems at school and socially withdrawn behaviour. Later the psychotic symptoms arise. Early hallucinations and delusions are simple and often deal with animals, toys and monsters. The content of delusions and hallucinations changes with the developmental level of the child.
When the disorder develops in adolescence, it is much less gradual. However, many children who are diagnosed with this disorder in adolescence have in the past suffered from attention problems, motor-perceptual problems and neurodevelopmental problems such as shyness, anxiety and aggression. This image is very similar to schizophrenia that develops in adulthood, where there is a lot of variation in the timing, severity and nature of early traits. The psychotic symptoms also resemble those of adults with schizophrenia. Hallucinations and delusions, for example, are more complex.
There is a lot of variation in the developmental course of schizophrenia. Some adolescents and adults with schizophrenia continue to experience difficulties throughout their lives, while others heal completely. Risk factors for poor outcomes are poor adaptation to living conditions before being diagnosed, a gradual and early onset, a long psychotic episode and severe symptoms.
Neurobiological abnormalities
The motor problems, coordination problems and minor physical anomalies of people with schizophrenia indicate neurobiological abnormalities. With regard to the brain structure, research shows that schizophrenia is associated with abnormal neurons, which are sometimes located at abnormal locations. Neurons have a high density and there are fewer synaptic processes and connections. The lateral ventricles are also larger in children, adolescents and adults with schizophrenia. The frontal and temporal limbic areas, on the other hand, are smaller than in normally developing individuals. In addition, it appears that the white matter in the frontal, parietal and occipital areas, especially in the right hemisphere, grows slower. This indicates poorer connections between brain regions.
With regard to brain activity, it appears that people with schizophrenia suffer from underactivity and overactivity in different areas of the brain when performing various tasks. Research has shown that the neurotransmitters dopamine, serotonin, GABA and glutamate are involved in schizophrenia.
Aetiology
Genetic factors
There is evidence for the influence of genetic factors on schizophrenia. There is approximately a 12% chance that children with a schizophrenic parent will also get schizophrenia themselves. There is a 59% chance that identical twins will both develop schizophrenia, while that is 14% for fraternal twins. Genetic vulnerability in families is also reflected in disorders similar to but less severe than schizophrenia and in cognitive processing deficits associated with schizophrenia. So it seems that a general vulnerability is inherited. It is probably a combination of several genes that together increase the risk of schizophrenia.
Prenatal and perinatal factors
Examples of prenatal risk factors for schizophrenia are poor nutrition, infections and problems during pregnancy. An emergency caesarean section can also be a risk factor for the development of schizophrenia. However, it is unclear what the direction of such relationships are. Perinatal problems may be due to genetic or prenatal factors.
Psychosocial factors
Psychosocial stress can also contribute to schizophrenia in young people. In adults, an increase in stress often precedes the first symptoms of schizophrenia. Stress can also contribute to the worsening of symptoms. Family characteristics are also related to the onset of schizophrenia.
Neuro-development model
The vulnerability stress model states that schizophrenia has various causes. According to the model, genetic (or prenatal) factors interact with environmental stress. Some people reach their limit and develop schizophrenia, while others show mild or no symptoms.
The neuro-development model of schizophrenia states that early brain development is what goes wrong. Early development is characterized by problems such as language problems, motor problems and problems in cognitive, social and psychological functioning. In most cases, the symptoms of schizophrenia are related to brain development in adolescence or young adulthood. All kinds of hormonal changes then take place, which make it possible to express the disorder. It is also possible that an excessive pruning process, whereby unnecessary connections between neurons are removed, is related to the development of symptoms. Biological factors lead to the development of schizophrenia in interaction with environmental factors.
Assessment
The following aspects are important in the assessment of a child or adolescent who is probably schizophrenic:
It is difficult to identify schizophrenia at a young age because the early non-psychotic symptoms are also characteristic of other disorders. Moreover, it is difficult to disassemble strange ideas and psychoses in young children. In addition, identifying a mental disorder can be difficult because the assessment is influenced by the child's language skills. Moreover, the classification of thinking patterns varies as abnormal with the level of development.
Prevention
Proper prenatal care, particularly for high-risk children, is important in the prevention of schizophrenia. In addition, early identification and treatment are associated with a better outcome. That is why it is very important to pay attention to early cognitive deficits, social problems and behavioural problems.
Intervention
Pharmacological treatment
In the pharmacological treatment of schizophrenia, antipsychotic or second-generation antipsychotic drugs are often used. These can reduce hallucinations, delusions, thinking problems and other symptoms, but are not effective for everyone. Second-generation antipsychotic drugs are used more often because they have less side effects. These side effects may have more impact on young people than on adults.
Psychosocial intervention
While pharmacological treatment focuses on reducing psychotic symptoms, psychosocial therapy focuses on broader goals. The most promising forms of treatment are:
When is behaviour abnormal? - Chapter 1You can use many varying terms to describe abnormal behaviour. Consider, for example, ‘mental disorder’, ‘psychological disorder’, ‘psychopathology’ of ‘developmental disorder’. This is thus why guidelines have been developed to help identify abnormality. What does abnormal behaviour actually mean?
Abnormal behaviour occurs when the actions of a significant person deviate from the normal standard of behaviour. According to this definition, a child with a far above average IQ is thus also considered abnormal. So, abnormal doesn’t immediately mean ‘bad’. Psychopathology research involves abnormal behaviours that are harmful to the individual. The APA (American Psychiatric Association) defines a disorder as a ‘clinically significant pattern in an individual’ (psychological and behavioural). This pattern causes frustration, disruptions, an increased risk of harm or danger to one’s wellbeing. Psychopathology interferes with the adaptation to the environment and impedes the individual from completing developmental tasks. A disorder can be seen as an internal problem or as a person's response to circumstances. The final explanation tend to be more obvious to recognise.
Age can be considered as an index for the level of development and is important in assessing behaviour. Assessments of behaviour depend on developmental norms , which say something about the growth of motor skills, language, cognition and socio-emotional behaviour. These standards serve as a benchmark when looking at the (abnormal) development of a child. There are different ways to regard behaviour as deviating from the norms:
There is culture when groups of people are organized in specific ways, live in a specific environment and share specific beliefs, norms, values and customs. Cultural norms influence the expectations, assessments and ideas regarding the behaviour of young people. What is very normal in one culture can be very strange in another culture. As a result, disorders can be culturally specific.
Ethnicity is about shared values, beliefs and customs in an area. Race , on the other hand,
.....read more What does developmental psychopathology include? - Chapter 2Kuhn, among others, has shown us that science is not entirely objective. To study phenomena, scientists all take a perspective from which they view it. If a perspective is shared by researchers, this is called a paradigm. It is a kind of cognitive frame of reference that includes assumptions and concepts. The advantage of such a (subjective) perspective is that it provides guidelines for the way in which a problem is approached, investigated and interpreted. A disadvantage is that researchers can limit themselves by assuming this perspective and are confined within the boundaries of it. They can limit themselves in the type of research questions or in the interpretation of research results. Despite these disadvantages, it is still smart to take a perspective.
Theories and models
A theory is a formal, integrated set of principles that explains a phenomenon (or multiple phenomena). Scientific theories are supported by evidence. In addition, they offer formal assumptions that can be tested, which can lead to an increase in knowledge. A model provides a description of what is being studied. Models that show that many factors lead to psychopathology are especially interesting for psychology. Interactional models assume that several variables together lead to an outcome. An example of this is the vulnerability stress model. This model is based on multiple vulnerability factors and stress factors that together cause psychopathology. Vulnerability (diathesis) is often regarded as a biological factor and stress as an environmental factor. The biological vulnerability of a child to anxiety (meaning you’re more likely to get anxiety than others), for example, can lead to psychological problems in interaction with the stress of a divorce.
Transactional models are used to investigate both normal and abnormal behaviour. These models assume that the development is the result of continuous, reciprocal transactions between the individual and the environment. The individual is seen as an active being formed by past experiences. The environmental context includes variables that are close to (proximal) or far (distal) away from the person.
Transactional models fall under the system models. System models assume different levels of functioning. The development is the result of interactions between the different levels. Changes at one level affect the other levels. An example of this is the biopsychosocial model, which integrates brain functioning, genes and behaviour with aspects of the social environment. Another example is the ecological model, which states that the individual and the environment influence each other.
What influence do genes and environment have on behaviour? - Chapter 3The early development of the brain and nervous system is largely determined by biological factors, but the influence that experience has is also fairly large. The nervous system begins to develop shortly after conception, as the neural plate (a group of cells) thickens, folds in and forms the neural tube. The cells start to migrate to fixed locations. The brain contains millions of multifunctional cells, glial cells , and neurons . Neurons carry messages within the nervous system and to and from other body parts. The extensions of these neurons, called nerves, get a layer of myelin, a white substance that promotes the efficiency of communication in the brain. An excess of neurons and connections is produced both before and after birth to ensure the flexibility of the brain. Some parts of the brain develop faster than others. For example, the development of brain parts for vision and hearing is faster than the development of the frontal brain area, which is involved in complex thinking.
There are many developments in the brain during adolescence. In this way the connections between brain areas increase. Also, the amount of grey matter in the frontal brain area decreases, while the white matter shows an increase, which is a reflection of constant myelination. These changes have implications for psychological and behavioural functioning.
The development of the brain depends on the interaction between biological predisposition and experiences (activity-dependent processes). There is pruning occurring both before and after birth, which means unnecessary cells and connections between cells are broken down. This process is probably the cause of the decline in grey matter in adolescence.
Structure
The brain and backbone together form the central nervous system . The peripheral nervous system is formed by the nerves outside the central nervous system, which carry signals to and from the central nervous system. The peripheral nervous system has two subsystems:
The entire nervous system
.....read more What kind of research is involved in this field of psychology? - Chapter 4The general purpose of science is to describe and explain phenomena. Scientific knowledge comes from a systematic formulation of a problem, observation and data collection and interpretation of research results. Theoretical assumptions and concepts are used to choose variables, procedures and research goals. Often hypotheses are tested that are derived from theories. Testing hypotheses is valuable because knowledge is then obtained in a systematic manner. When finished, a study does not prove that a hypothesis is true or false but it does offer evidence in favour or against the hypothesis. If a hypothesis is not supported, this can lead to an adjustment of the underlying theory.
Research participants
Researchers often try to make statements about their entire population of interest. Because it is not possible to examine everyone in a population, a representative sample is used. Representativeness can be achieved through random selection: every person from the population has an equal chance of being selected. Sometimes certain groups of people are systematically excluded from selection. But even though it’s handy, trying to get a true random sample is not always feasible because it is impossible to draw a random sample of, for example, all children with intellectual disabilities. However, there are ways to approach representativeness. The extent to which this is successful influences the interpretation of the research findings.
Research into psychological disorders often uses clinical populations: participants from, for example, hospitals or institutions. Such clinical populations are usually not representative of the entire population because they exclude children who, for example, cannot be treated due to financial circumstances. Clinical populations can also offer an overrepresentation of young people with more severe symptoms or with symptoms that affect the environment. In this case there is a selection bias.
Measurements
A researcher must make an operational definition of the behaviour or concept that is being studied, so that it becomes clear which observable behaviour or concept is involved in the research. For example, aggression can be operationalized as the frequency with which children threaten their peers.
Validity
A measurement must be valid. Validity refers to the accuracy of the measurement: the extent to which a measurement is an accurate indicator of the behaviour being studied. A distinction can be made between internal validity and external validity. Internal validity refers to the degree to which the statement/hypothesis is correct. Depending on the research design and research methods used, there are various
.....read more How can disorders be classified? - Chapter 5The terms classification, assessment and diagnosis are used to describe the process of description and grouping. Classification (or taxonomy) stands for creating large categories or dimensions of behavioural disorders. It is a system for describing phenomena. These systems are mostly for clinical or scientific purposes. A diagnosis is when a category or classification is considered applicable to an individual. Assessment refers to evaluating (young) people to facilitate classification and diagnosis and to make treatment plans.
Classification systems try to systematically describe a phenomenon. For example, biologists have classification systems for organisms, such as cold and warm-blooded animals. There are also systems for classifying psychological problems. These systems describe categories or dimensions of problem behaviour, emotions and / or cognitions.
A category is a discrete grouping, for example anxiety disorders, to which an individual belongs or does not belong. A dimension , on the other hand, is a continuous property that can occur in various sizes. For example, there are different degrees to which a child is anxious.
The categories or dimensions in a classification system must be clearly defined: the criteria must be explicitly named. In addition, a distinction must be made between the different categories. It must also be proven that a category or dimension actually exists, meaning that the characteristics used to describe a category or dimension must regularly occur together.
Classification systems must be reliable and valid. There are two types of reliability:
Validity refers to the extent to which a diagnosis provides us with more information
.....read more What are the anxiety disorders and what are their characteristics? - Chapter 6There is a difference between anxiety and fear. Anxiety is an emotion that is focused on the future. This emotion is characterized by the feeling that someone has no control over possible negative events. The events also seem to be unpredictable for the person in question. If someone is confronted with potentially dangerous events, there is immediately a lot of attention for the dreaded (or for the emotions that accompany it).
Stress is a response to an existing threat. It is characterized by an alarm response. stress and fear are considered a complex pattern of three types of responses to perceived threat:
Anxiety is a cognitive component of stress and is difficult to control. Worries are thoughts about possible negative consequences that are difficult to control.
It is difficult for clinicians to determine whether the anxiety of a child or adolescent is normal and temporary, or atypical and persistent. Anxiety is part of normal development, as a result of which children develop certain competencies and become more autonomous, for example. For example, children learn how to cope with the dark, while adolescents learn how to cope with dating fears.
Age differences, gender differences and cultural differences
Both the number and the intensity of fears decrease with age. Concern becomes prominent around the age of 7 and becomes more complex and varied as development progresses. Certain fears appear to be more common at certain ages, such as the fear of strangers between 6 and 9 months after birth and social anxiety and fear of failure in adolescence. Changes in the content of fears and worries are probably a reflection of cognitive, social and emotional development.
Anxiety disorders are more common among girls than among boys. This gender difference also becomes larger with older children. It is suggested that the intensity of anxiety in girls is also higher. However, research findings regarding gender differences should be interpreted with caution because they may be (partly) the result of gender-specific
.....read more What are the mood disorders and what are their characteristics? - Chapter 7An important aspect of internalizing disorders are mood problems. Children and adolescents who have an unusually sad or euphoric mood, which are extreme or persistent and interfere with functioning, can be diagnosed with a depressed or manic mood disorder. Nowadays there is increasing attention for mood disorders, for various reasons:
It is difficult to distinguish between different sub-categories of mood disorders, because many people meet the criteria of more than one disorder.
For many years the orthodox psychoanalytic perspective has been dominant. According to this perspective, depression was the result of the functioning of the superego and adult ego. For example, because the superego punishes the ego, a certain type of depression occurs. Because the superego in children is not yet fully developed, depression could not occur in them. That is why this subject received little attention.
A second important perspective contributed to the controversy regarding the existence of childhood depression. The concept of masked depression meant that child depression did exist, but that the sad mood and other characteristics of depression were often not present in children. There might have been an underlying depression, but this was masked by other problems (depressive equivalents), such as hyperactivity or delinquency. The idea of a masked depression was problematic because there were no clear guidelines for deciding whether or not a particular symptom was a sign of depression.
This perspective was nevertheless important, because it was at least recognized that depression could also be a major and common problem in children. Moreover, the central idea of masked depression is still really relevant in the terms that depression can exist in children and that this can be expressed in age-related forms that differ from depression in an adult.
The idea that depression and expression are expressed differently in children and adults has contributed to the evolution of a developmental psychopathology perspective. Initially, this perspective stated that behaviours that led to the diagnosis of depression were only temporary developmental phenomena that were common among
.....read more When is something a behavioural problem and how do they affect people? - Chapter 8While anxiety and depression arise from internalizing problems, behavioural disorders are often the result of externalizing them. The term ‘behavioural problems’ refers to the general group of disruptive and antisocial behavioural problems. The terms behavioural disorder and disruptive behavioural disorder are used to refer to specific diagnostic groups. The term delinquency is mainly used in the legal system and refers to young people who exhibit antisocial behaviour or other behavioural problems. It refers to a minor who is caught performing an index crime (an act that is illegal for both adults and minors, such as theft) or a status crime (an act that is only illegal for minors, such as alcohol consumption).
Classification and description
Disruptive behaviour occurs at different moments in the development. Children of preschool age will beat, kick or bite other children. In the primary school period there is talk of bullying and various forms of aggression, which can definitely also be physical. In adolescence, young people display risky behaviour and / or use illegal drugs. The table below provides an overview of the types of behavioural problems that adults often describe as problematic and the DSM disorders associated with them.
Development period | Problem behaviours | Related DSM disorder |
Early childhood | Disobedience Oppositional behaviour Temper tantrums | Oppositional Defiant Disorder (ODD) |
Middle childhood | Open or covert antisocial behaviour Relational aggression | Oppositional Defiant Disorder (ODD) Conduct disorder (CD) |
Adolescence | Delinquency Drug use Risky sexual behaviour | Conduct disorder (CD) Disruptive Impulse Control |
The DSM category Disruptive Impulse control and Conduct disorders include, among other things, the diagnosis of ODD and CD, as well as, among others, kleptomania and antisocial personality disorder. The latter diagnosis applies to people who show a persistent pattern of aggressive and antisocial behaviour after the age of 18. This pattern must be present from the age of 15. In addition, there must have been a conduct disorder (CD) before the age of 15 .
.....read more
What characterizes ADHD disorder? - Chapter 9ADHD is defined in many different ways. In the 1950s, the emphasis was on the hyperactivity characteristic of the disorder. Various terms were used at the time, such as hyperkinetic syndrome and hyperactive child syndrome . Over time, attention for hyperactivity and concentration problems decreased. In the DSM-III it was recognized that attention deficit disorder (ADD) could occur with and without hyperactivity. Attention Deficit Hyperactivity Disorder (ADHD) was not included in the revised version of the DSM-III . This disorder is also recognized by dimensional classification systems.
Research suggested that ADHD consists of two components: inattention and hyperactivity-impulsivity. There is a lot of cross-cultural evidence for the validity of these factors. Although both components have unique genetic influences, they are interrelated as a result of shared genetic influences.
DSM classification
The DSM states that the two factors (inattention and hyperactivity-impulsivity) together form three subtypes of ADHD:
The diagnostic criteria state that there must be symptoms of inattention and hyperactivity-impulsivity, respectively. the diagnostic criteria state that some symptoms must be present before the age of 12 and for at least six months. Because all symptoms occur to some extent in normally developing children and may vary with the level of development, the diagnosis is only made if the symptoms are excessive and occur in at least two different settings (for example at home and at school). The symptoms must also interfere with the social and academic functioning of the child.
Inattention
Adults see different signs of inattention in children with ADHD. An apparently special aspect of the disorder is the situational attention of children: the child can concentrate well if he or she is interested or motivated, while it has concentration problems when performing a boring, strenuous or repeated task. Research shows that children and adolescents with ADHD do indeed have more concentration problems than children with learning disabilities or normally developing children. Specific deficits have been identified, including a lack of selective attention: the ability to focus on relevant stimuli and not be distracted by irrelevant stimuli. Children with ADHD are more easily distracted if the task is boring
.....read more What disorders are there with regard to language and learning? - Chapter 10From around 1800 on, there has been attention on language-related problems. During this time, a medical orientation was developed, with specific limitations associated with brain abnormalities. For example, Wernicke discovered brain abnormalities in patients who did not understand language well, but who had no language or cognitive impairment – which you might know because there is a brain area named after him. From 1920 on, there was also a psychological orientation. During this period, more emphasis was placed on gaining insight into the characteristics of people with language and learning difficulties and treating them. In 1963, Krik introduced the term 'learning disabilities'. This is considered a milestone in the emergence of the concept of learning disabilities. For example, teachers were no longer accused of causing such problems.
Definition
According to the 'Individuals with Disabilities Education Act (IDEA)', the definition of a learning disability is as follows: “a learning disability is a disorder in one or more psychological processes involved in the understanding or use of (spoken or written) language. The disorder can affect listening, thinking, speaking, reading, writing, spelling or math. This does exclude children who have learning difficulties due to visual problems, hearing problems, a motor impairment, an intellectual disability, emotional problems or a cultural-economic disadvantage. There are no specific criteria for identifying disabilities. So there are different ways to identify learning disabilities. Differences in definitions have led to different prevalence estimates, incomparable research groups and different criteria for determining whether children are eligible for special education.
Discrepancy between the IQ and performance level
There are two common ways to discover learning disabilities. First of all, we can look at the difference between someone's intellectual capacity (IQ) and specific performance level. It is assumed that if there is a specific disorder, the performance on general assets (IQ) is higher than the performance on tests that relate to the specific disability. Often a difference of two or more standard deviations between the scores on the intelligence test and the specific test is considered significant.
Below average performance
Another way to diagnose a disorder is to see if a child performs at least one academic area lower than the average classmate. A problem with this method is that a large discrepancy in younger children is
.....read more When does someone have an intellectual disability? - Chapter 11An intellectual disability (ID, formerly also called mental retardation) is characterized by limitations in both intellectual functioning and adaptive behaviour. This is expressed in conceptual, social and practical skills. ID occurs before the eighteenth year of life. There are three diagnostic criteria:
According to the American Association on Intellectual and Developmental Disabilities (AAIDD) model, the way in which ID is expressed depends on how it works on the five dimensions;
Intellectual limitations are not seen as an absolute trait, because sufficient support can lead to an improvement in functioning.
Initially, the AAIDD made a distinction between four levels of ID: light, moderate, serious and profound. The AAIDD, however, no longer uses this approach because it would not be appropriate for making decisions about the care of individuals with ID. Instead of the ID level, an assessment must be made for each individual of the level of support he or she needs. This approach recognizes that the need for support may be different in different areas of functioning and may change over time. In addition, it emphasizes the perspective in which an ID is seen as dynamically related to the social environment rather than as static quality of the individual.
The DSM approach
The DSM approach to diagnosis has many similarities with the AAIDD approach. A diagnosis requires both intellectual and adaptive limitations, and the disorder must occur during the development phase. The IQ score is usually around 70. The criteria also state that there must be deficits in at least one area of adaptive behaviour.
The DSM in 2013 still classified individuals on the basis of the intelligence level: light (IQ 50-70), moderate (IQ 35-50), severe (IQ 20-40) and profound (IQ <20). About 85% of the cases were only lightly mentally limited. In the past, a light and moderate ID in
.....read more What are the most important characteristics of autism and schizophrenia? - Chapter 12In the past, no distinction was made between schizophrenia and pervasive disorders, such as autism. Nowadays we do differentiate between them. Schizophrenia is rare among children, often develops in adolescence and increases in adulthood. Autism and Asperger's syndrome are non-psychotic disorders that arise at a young age.
The DSM-V contains the Pervasive Developmental Disorders (PDD) category. This category includes:
Rett's disorder is now viewed differently and will not be further discussed for this reason. Criticism, such as whether Autistic Disorder and Asperger's syndrome would not be a single disorder, was common. In the DSM-V, the above-mentioned disorders are no longer considered separate. They now coincide in the Autism Spectrum Disorder (ASD). Two domains with primary symptoms can be distinguished in ASD: Firstly, persistent limitations in social communication and interaction, and secondly, restrictive, repetitive behavioural patterns.
What is Autistic disorder (autism)?
Kanner described autism as a disorder characterized by communication problems, atypical cognitive skills and behavioural problems such as obsessiveness, repetitive behaviour and unimaginative play. However, Kanner saw social inability as the biggest problem.
Primary characteristics
Social interaction
Already before the age of 1, autistic children show subtle differences from normally developing babies. They respond less to visual stimuli, respond less when someone calls their name and often don't like to be touched. They do not follow people with their eyes, avoid eye contact, appear to have an ‘empty’ or unseeing eye and respond little to others with emotional expression and positive emotions. Particularly striking is that autistic children exhibit deficits in joint attention, where the child and parent or caregiver focus attention on the same object or situation, thereby sharing an experience. Joint attention is facilitated by certain gestures, such as pointing, and eye contact. Another component of an atypical social interaction is abnormal processing of social stimuli, particularly the face. Children with autism have difficulty recognizing and remembering faces (and associated expressions of emotion). They also process faces in other ways than normal developing children. All in all, delayed or atypical social behaviours seem to occur at a young age in at least five areas of social behaviour: attention to social stimuli, joint attention, emotion, imitation and facial processing. Although the symptoms may change
.....read more Which disorders have a strong influence on physical functions? - Chapter 13Paediatric psychology is concerned with the investigation of (psychological) problems leading to disruption of physical function and health.
Problems with toilet training and learning sleeping and eating habits are common. Both the ability of the child to master these skills and the skills of parents to guide the child in this are important for the well-being of the child and parents. Sometimes parents seek help if they are unable to learn certain habits.
Potty training
The usual order in which children get toilet training is as follows: control of the intestines at night, control of the intestines during the day, control of the bladder during the day and control of the bladder at night. Although there is considerable variation in the age at which children become toilet-trained, they are often toilet-trained between the ages of 1.5 and 3. Parents disagree about when or at what age it is good to start toilet training. This decision often depends on cultural values, attitudes and daily circumstances, such as requirements for childcare and the presence of other siblings.
There are various factors that contribute to good toilet training. First of all, it is important that parents are able to determine when the child is ready for development. In addition, the parents must be able to properly assess when the child needs to go to the toilet. Thirdly, they must prepare well for toilet training, for example by having the child wear clothing that can be easily taken off. Finally, it is effective to positively reinforce the child.
Enuresis refers to a lack of control over the bladder, during the day and / or at night, that cannot be explained by a physical disorder. Often the diagnosis can only be made after the age of 5. The diagnostic criteria also state that there must be a certain frequency of the control deficiency and this frequency varies with the age of the child. It must be done at least twice a week and for three months or there must be a clinically significant disruption of daily functioning.
A distinction is made between urinating in bed and urinating during the day and between primary and secondary enuresis. Enuresis is called primary, if the child has never been toilet trained, and secondary if the child has been toilet trained. About 85% of the cases belong
.....read more What is the connection between psychology and (physical) health? - Chapter 14Physical disorders that are influenced by psychological factors have been called psychosomatic disorders in the past . In DSM-II this term had been replaced by psychophysiological disorders and in DSM-III this term had again been changed to psychological factors that influence physical conditions. In the DSM-IV this was transformed into psychological factors that influence medical conditions . Now in the DSM-V there is a new chapter called somatic symptoms and related disorders. This includes the psychological factors category that affect other medical conditions. These adjustments are the result of the discussion about the relationship between body (soma) and mind (psyche). During the 20th century, the interest in the effects of psychological processes on the body has resulted in the development of psychosomatic medicine. It became clear that many physical complaints are influenced by psychological factors. Researchers started with psychogenesis: the identification of the psychological cause of physical disorders. More attention is now being paid to multicausality: the idea that biological, social and psychological factors contribute to health. This perspective is holistic and assumes continuous interactions between influences. Pediatric psychology is the field that focuses on these processes in children and adolescents.
In asthma there is a hypersensitivity of the airways to different stimuli. The airways become chronically inflamed and narrower. This causes breathing problems. Serious attacks (status asthmaticus) can be life threatening. The breathing problems and the danger of serious attacks can lead to anxiety for the patient and his family members.
About 10% of children suffer from asthma. The disorder is extra common in children who are poor, live in an urban area and / or belong to a minority group. A bright spot is that asthma can be temporary.
Research shows that genetic factors influence the risk of asthma. In addition, other factors most likely play a role. People who have asthma may be exposed to factors that influence the chance of an asthmatic attack. These influences are considered as triggers or irritants instead of as direct causes of asthma. Every individual has different triggers and over time triggers can change for the same individual. Repeated respiratory infections can play a role in the development of asthma and viral respiratory infections can lead to an asthmatic attack or worsen its severity. An allergy can also increase the chance of an attack. For example, some children are allergic to dust and get an asthmatic attack more quickly when
.....read more What issues are currently affecting young people? - Chapter 15In recent decades, dramatic changes have taken place in families in the US due to an increased number of divorces, families with one parent and families with stepparents.
Working mothers and childcare
Nowadays, with women having more and more jobs outside of the household, children are more often cared for by others than the mother, such as by relatives or at a day-care centre. The effect of this differs based on the quality of care, the amount of care and certain family characteristics. High quality care is positively related to the cognitive, social and language development of children who go to a day-care centre from an early age. The research findings regarding the effects of the amount of care are inconsistent. In general, the amount of care seems to be negatively related to the child's development. With regard to the interaction between childcare and family characteristics, it appears that children from low-income families benefit from care at a day-care. This means that care by others can serve as a protective factor for children from families with a low socio-economic status. It is also important that a good relationship between parents and child remains.
From the age of 9 to 12, an increasing number of children will start taking care of themselves. The effects of self-care depend on the amount of time self-care, the level of development of the child, family factors, neighbourhood characteristics and social support. Participation in after-school programs often has a positive effect on the social and academic behaviour of children.
Adoption
The number of adoptions has risen sharply in recent decades. Adopted children have relatively more issues with psychological problems. This is especially the case if children have were adopted at an older age or because they have been exposed to negative conditions such as poor prenatal care, drug addiction or care in an orphanage.
A study has made a distinction between two types of peers: peers from the past (peers or brothers or sisters from the institution from which the child was adopted) and current peers (peers in the current situation). The following conclusions can be drawn from this study:
JoHo can really use your help! Check out the various student jobs here that match your studies, improve your competencies, strengthen your CV and contribute to a more tolerant world
JoHo kan jouw hulp goed gebruiken! Check hier de diverse studentenbanen die aansluiten bij je studie, je competenties verbeteren, je cv versterken en een bijdrage leveren aan een tolerantere wereld
There are several ways to navigate the large amount of summaries, study notes en practice exams on JoHo WorldSupporter.
Do you want to share your summaries with JoHo WorldSupporter and its visitors?
Field of study
Add new contribution