What does developmental psychopathology include? - Chapter 2

What are paradigms?

Kuhn, 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 is developmental psychopathology?

The developmental psychopathology perspective integrates research into normal developmental processes with research into psychological disorders in young people. Central to developmental psychopathology is the origin and development of disturbed behaviour, and individual adaptation and competence. Developmental psychopathology is a framework for understanding disturbed behaviour in relation to normal development. It does not provide specific theoretical explanations but integrates different theories and approaches.

Development

The concept of development is hard to define. There is, however, some consensus among theoreticians about the essence of development:

• Development refers to changes over time, which are the result of the constant interactions between biological, psychological and socio-cultural variables.
• In development, qualitative changes, such as changes in the characteristics of social interactions, are more important than quantitative changes, such as the amount of social interactions.
• The early development of biological, motor, physical, cognitive and emotional systems follow a general course. Structures and functions become more differentiated and integrated within each system over time. In addition, there is an ever-increasing organization and complexity as interactions occur between the systems.
• The development follows a coherent pattern, with which the current functioning is linked to functioning in both the past and the future. The development of children is very flexible, but with time the amount of possibilities there still are to develop decreases.
• The development can have positive but also negative outcomes. Maladaptive behaviour can occur and physical health decreases with age.

The medical model

Many attempts have been made to explain the aetiology of abnormal development in a relatively simple way. An example of this is the medical model , which states that disorders are the result of biological factors in the person themselves. However, we now know that psychological or behavioural disorders never arise from just one single cause.

To study causal relationships, not only must the contributing factors be identified, but it must also be studied how causal factors work together and what the underlying processes are. A distinction must be made between direct and indirect causes. There is a direct effect if X immediately leads to Y (X → Y). With an indirect effect , X exerts a different influence on some other variable that leads to  Y (X -> …… -> Y). An example is the connection between alcohol abuse by parents and performance problems of children. There is an indirect effect in this case, because alcohol abuse leads to marital problems and parental difficulties. This in turn leads to performance problems in the child.

A mediator is a variable that causes an effect (Y) indirectly. Identifying mediators is crucial in understanding causal processes. In the example above, marital problems and parental difficulties are mediators.

The identification of moderators is also important in understanding causal processes. A moderator influences the direction (or strength) of the relationship between an independent variable (predictor) and a dependent variable (criterion). For example, culture can play a moderating role. Beating up your children has different effects on them in different cultures.

A distinction must also be made between necessary, sufficient and contributing causes. A necessary cause must be present for a disorder to manifest itself. A sufficient cause can (without the presence of other factors) be responsible for the occurrence of a disorder. In Down's syndrome, genetic abnormalities are both necessary and sufficient. In schizophrenia, on the other hand, brain abnormalities are necessary, but not sufficient, because there must also be specific environmental factors. Contributing (contributing) causes make a contribution, for which, to cause an actual problem, as specific limit or amount has to be present.

Adjustment

Developmental psychopathology assumes that abnormal behaviour develops gradually. The development is characterized as continuous adaptations or maladaptation to changing circumstances. The five developmental pathways in adolescence are:

1. Stable adaptation: little or no exposure to negative conditions. The adolescent has few behavioural problems and a positive self-image.
2. Stable maladaptation: exposure to chronic negative conditions. There is maladaptive behaviour, such as antisocial behaviour.
3. Reversal of maladaptation: major changes in life create new opportunities. This changes maladaptation into adaptation.
4. Decrease in adaptation: changes in biological or environmental factors cause a shift from adaptation to maladaptation.
5. Temporary maladaptation: there is a question of temporary maladaptation. This can be the result of experimental risk behaviour.

Equifinality and multifinality

The term equifinality occurs when several factors can lead to the same outcome. Kind of like an ‘all roads lead to Rome’, kind of thing. Children with different experiences can develop the same problems. Multi-finality means that one factor can lead to multiple outcomes. Children with the same experiences can develop different problems. An example of this is that child abuse can lead to various psychological problems, from aggressive disorders to social withdrawals.

Risk and vulnerability

Risk factors are variables that increase the risk of psychological disorders. Risk factors can exist at biological, cognitive, psychosocial and other levels. Examples of risk factors are below-average intelligence, poverty, etc.

There are five important aspects with regard to risk factors:

• A single risk factor can have an impact, but it is especially a combination of risk factors that has a lot of influence.
• Risk factors are often associated with each other.
• The intensity, duration and timing of a risk factor influences the outcome.
• Many risk factors have non-specific effects (multifinality).
• Other risk factors may be associated with the development of a disorder than with the maintenance of a disorder.
• A risk factor can increase the chance of future risks by increasing vulnerability to problems or by negatively influencing the environment.

Vulnerability refers to the tendency of children to react maladaptively to living conditions. Vulnerability can be congenital (for example due to genetic factors) or acquired (for example due to learned thought patterns). Although it is often persistent, vulnerability can be adjusted.

Risk factors can be incorporated into a transactional model that contains both individual factors and environmental factors. For example, stressors can lead to psychopathology through mediators. In addition, the relationship between stressors and mediators can be moderated by characteristics of the child or environment. Finally, this model recognizes the reciprocal influences between the components. This reflects the dynamic development processes.

Resilience

Of resilience occurs when there is a psychological positive result, while there is (or was) a negative or traumatic experience. Resilience refers to individual differences in the response to risks and in the ability to overcome negative circumstances. Resilience is often defined as the absence of psychopathology, or few symptoms, while this would not be expected under the circumstances. It can also be defined in terms of terms of competence related to development tasks. In this case, resilience exists when an individual is able to complete developmental tasks despite adverse circumstances.

Resilience can exist on three levels: personal factors, family factors and factors outside the family. These factors can be considered as protective factors : factors that resist the effect of risk factors. Examples of youth resilience are problem-solving skills, skills in self-regulation, a positive self-image, performance motivation, self-efficacy and control, coping strategies, a close and safe relationship with family members, supportive relationship with adults within society, friends or romantic relationships, and spirituality. Some of these factors are characteristics of the individual, such as problem-solving skills. In this sense, resilience can be seen as the opposite of vulnerability. The more resilience, the more stress is needed for the development of disorders.

How does the continuity of disorders work?

Some problems of young people remain stable, while others are only temporary. There are two types of continuity. With heterotypic continuity , the manifestation of some disorders changes over time. Depression manifests itself differently in childhood than in adolescence. With homotypic continuity, disorders are expressed by means of stable symptoms.

Factors that can sustain problems are:

• Genetic predisposition
• Continuity of environmental variables
• Effects of early experiences on the brain
• Mental representations of the social environment
• A chain of negative events or interactional behaviour patterns

Why is attachment important?

Attachment is a special social-emotional bond, for example between a child and his / her parents, that develops gradually and manifests itself after seven to nine months after birth. According to Bowlby, behaviours that are conductive to attachment, such as crying, smiling and eye contact of babies, are biologically determined to ensure that a child is cared for by an adult. These behaviours are components of an attachment system that protects against threat or anxiety and is conducive to exploring new situations. Bowlby considered the bond between a child and the parents as something fundamental to further development. He stated that attachment experiences of the child provide expectations or internal models about the availability and responsiveness of parents. This influences the ability of a child to regulate emotions and to deal with stress. In addition, it influences self-confidence.

During the time the child is an infant, the attachment is studied with Ainsworth's procedure, also known as The Strange-Strange Situation. In it, the mother, the child and a stranger sit in a room. The mother leaves the room several times and returns after a while. To see the type of attachment, you look at the way babies react differently to being left with a stranger and to the reunion with their mother. A distinction can be made between different bonding styles:

• Secure attachment : the baby is upset but calms down once the mother returns
• Insecure attachment : the baby is upset when the mother leaves and remains upset/angry when she returns. There are different types of insecure attachment;
  
  • Avoidant attachment style: the baby does not seem to get upset when the mother leaves and/or does not respond to her when she gets back.
  • Resistant bonding style: the baby is angry/fussy with the mother when she returns, seeming to be annoyed the she left in the first place.
  • Disorganized / disoriented attachment style : this style was discovered later than the other attachment styles. The baby does not have a consistent strategy to organize behaviour in stressful circumstances. The baby exhibits contradictory and atypical behaviour. This attachment style is more common in babies from families with many risk factors.

In late childhood and adolescence, the attachment system includes relationships with peers and romantic relationships. Some claim that early attachment experiences or troubles affect later relationships. The concepts of secure and insecure bonding are still relevant today. However, there is no consensus on the categories that are a good representation of the later attachment.

Bonding styles are related to behavioural patterns. For example, a secure attachment is related to adaptive behaviour, such as competence and positive interactions with peers. Insecure attachment, in particular disorganized attachment, on the other hand, is related to maladaptive behaviour, such as aggression and fear. However, the strength of the relationship between attachment style and later behaviour is moderate and is not found in every study. Moreover, the attachment style can change from safe to unsafe, or vice versa.

What are the concepts temperament and self-regulation?

Temperament refers to a biological predisposition. Chess and Thomas have discovered that there are reasonably stable individual differences in temperament in babies. They defined temperament in terms of nine dimensions of behavioural styles (including mood, response to stimuli, adaptation to change and regulation of body functions). They also identified three basic temperament styles: (1) easy, (2) difficult to initiate (slow-to-warm) and (3) difficult. A difficult temperament style is characterized by intense reactivity and a negative mood and is related to social and psychological problems.

Chess and Thomas state that the temperament of parents influences the reactions of the child, which influences the reactions of parents, and so on. It is a vicious cirlcle. According to them, temperament is malleable, and the final result depends on goodness-of-fit : how well the behavioural tendencies of the child match the characteristics of the parents. A good match can lead to a good adjustment.

Temperament is considered as individual differences in behavioural style, which develop into the child’s personality in interaction with the environment. With developments in research, changes have taken place in the dimensions or categories of temperament. According to Sanson, three dimensions of temperament are recognized worldwide, although the name may vary per study:

• Negative reactivity: irritability to behaviour that isn’t matched with theirs. This dimension is associated with various problems.
• Inhibition: the child's reaction to new people or situations. Does the child hold back or not? This dimension is associated with anxiety and concern.
• Self-regulation: Processes that facilitate or impede reactivity. Includes 'effortful control' of attention (for example, task persistence), emotion (for example, comforting yourself) and behaviour (for example, postponement of satisfaction). This dimension is associated with low externalizing behaviour, social competence and academic adaptation.

The outcome can vary due to interactions between the different dimensions.

Nigg has suggested two approaches to temperament and psychopathology. The first perspective regards problem behaviour as an extreme form of normal temperament. The second perspective regards temperament as a risk or protective factor, depending on the specific tendencies and circumstances.

What is the importance of emotions?

Emotional reactivity and regulation are elements of temperament. Three elements of emotion are recognized worldwide: (1) feelings such as sadness, happiness and anger, (2) nervous system reactions , such as a faster heartbeat and sweating, and (3) behavioural expressions, such as laughter, frowning and fleeing. Emotions can be considered as short or more general moods that vary in intensity and can be experienced as positive or negative.

Children express their emotions at a young age. Babies show basic emotions such as joy, sadness and fear. Between the age of 1 and 1.5, children learn 'social referencing', (using the expression of others to determine their own reaction - for example, when deciding to approach or avoid an object). Children of two years of age can already name and discuss basic emotions and can exercise some level of control over their emotion expression. Children learn to make connections between emotion and cognition between the ages of 2 and 5. Subsequently, further progress is made in understanding and regulating emotions.

Emotions have a biological basis, which interacts with environmental influences and which is formed by socialization and the cultural context. Proper care, open discussion of emotions and modelling of emotional behaviour all influence the formation of emotions. Emotions have different functions. They play a role in communication, empathy, cognition and behaviour. Emotions also play a role in psychological problems, such as depression.

Understanding emotions is important for the competence and adaptation of children. Emotional knowledge consists of (1) recognizing the emotional expressions of others and (2) knowing which emotions are experienced in specific circumstances. Emotion regulation also plays an important role in adaptation. Emotion regulation includes the ability to initiate, retain and modulate feelings, biological responses and expression of emotions. Education plays an important role in the development of emotion regulation. Children with little knowledge about emotions and poor emotion regulation have (later) more social and behavioural problems.

Social cognitive processing

Social-cognitive processing is about how people think about the social world. It focuses on the way in which individuals understand and interpret social situations and how behaviour is subsequently influenced. Although the emphasis in social information processing is on cognition, emotion also plays an important role. Cognition and emotion interact in different ways. A poor understanding of emotions causes social cues to be misinterpreted. From interpretation occurs when, among other things, consideration is given to the causes of events and the intentions of people. The wrong interpretation of behaviour sometimes plays a role in psychopathology. Aggressive children, for example, often mistakenly interpret other people's behaviour as hostile. The processing of the social context influences a lot of human functioning. For example, children's perception of how their parents interact with them is related to parents' influence on their children.