Child Psychopathology Power Point 2

1
Attachment

• Attachment- the bond of love that develops
  between the caretaker and child in the first year
  of life
• Infants are programmed for attachment
• 1) Prefer the human voice (2 weeks,
  conditioned in the womb)
• 2) Prefer the mothers voice (4 weeks)
• 3) Eye contact is established (2nd
  month)
• 4) The human face is distinguished
  from other stimuli and the percept people is
  fused with the affect pleasure.
• 5) The infant responds with a social
  smile (3rd and 4th month)

2
Attachment

• 6) Indiscriminate responsiveness gives way to
  selectivity as preference for the mothering one
  (6th- 9th month)-
• Attachment has occurred!
• Some emotions now manifest themselves.
• A) Separation anxiety- The child is now
  bonded enough to fear the caretaker leaving, and
  yet the lack of complete object constancy makes
  it feel as if they leave forever.
• B) Stranger anxiety- The child now feels
  anxiety with people who they are not familiar.
• C) Hostility- An attached child after a
  period of separation will often ignore the
  caregiver and often become angry and touchy for
  the next few days or even weeks.

3
Caregiving

• Human beings have the longest period of
  helplessness infancy of any species. Thus
  attachment takes place in the caregiving
  situation the kind of care infants receive
  influences, to a significant degree, the kind of
  attachment they form.
• Caregiving is made up of
• Comforting- meeting the babies deficit
  needs for food, warmth, etc.
• and
• Stimulation- a parent is a source of interesting
  and delightful visual and auditory stimuli and a
  mediator of stimulation (introduces the child to
  mobiles, rattles, etc.)

4
Attachment

• Attachment the need to maintain proximity,
  distress upon separation, joy at reunion, grief
  at loss, and security seeking is important for
• Secure-insecure attachment
• Socialization- this is the first communion
  relationship. Mother and child engage in a
  dance as they interact in harmony. It sets the
  tone for a childs friendships , sexual
  partnership, and relationship to God.
• Exploration - The securely attached infant can
  venture out from a secure base
• Parental bonding- e.g. Fathers felt closer ,
  played more, read more, and were generally more
  involved with their child when they held their
  baby at birth.

5
Initiative

• Attachment is central to the first year of life,
  and initiative is central to the second year of
  life.
• The terrible twos will be terrible if the
  parent does not realize that the battle for
  autonomy begins at fifteen months. In fact, we
  now see that the roots of initiative lie in
  infancy.
• The old image of the infant as being a passive
  creature just waiting for its needs to be
  satisfied, has given way to evidence that as soon
  as there are periods of awareness, the baby
  begins to explore their environment.
• In the first month the baby
• a) has searching eyes
• b) receptive ears
• c) manifests exploratory
  behavior characterized by orientation,
  concentration, perseverance, gratification and
  annoyance
• d) the learning response-
  when in a new learning situation the babies
  brain wave changes

6
Initiative

• Infants not only want to explore the environment,
  but want to actively control it.
• e.g. At about 20 weeks babies will try to
  gain contact with the mother by lifting their
  arms in greeting, clinging to the mother, and
  following her around.
• Initiative has important consequences for
• Self-definition- discovering what one can do
  helps define the self
• Self-worth- children who succeed at what
  they do begin to feel valuable
• By middle childhood a global sense of self-worth
  emerges in three areas of competence
• academic
• physical
• social

7
Self-Control

• Factors involved include
• Socialization- Children need to move from
  being motivated by fear and being regarded as
  love-worthy to being motivated to control the
  self because of internalized social standards.
• Cognitive variables- thinking serves to
  delay and guide an individual
• When a child stops to think it
  delays immediate action.
• The content of thought itself may
  serve to guide behavior into socially acceptable
  channels.

8
Self-Control

• Emotion Regulation- The ability to monitor,
  evaluate, and modify ones emotional reactions in
  order to accomplish ones goals. This includes
  the ability to inhibit, intensify, or maintain
  emotional reactions. This enables a person to
  manage their own behavior (self-management) and
  be more in charge of their own destiny.
• Parental Discipline- Four parenting styles are
  1) Authoritarian
• 2) Permissive
• 3) Authoritative
• 4) Neglectful
• (See Handout)

9
Parenting Styles (Baumrind, 2005)

• Authoritarian
• Enforce rigid rules and demand strict obedience
  to authority children are obedient and
  self-controlled

10

• Permissive
• Give little guidance, allow too much freedom, or
  dont require child to take responsibility
  children tend to be dependent and immature and
  frequently misbehave

11

• Authoritative
• Supply firm and consistent guidance combined
  with love and affection children tend to be
  competent, self-controlled, independent, and
  assertive

12
Logical and Natural Consequences Method of
Discipline

• Natural Consequences Effects that naturally
  follow a particular behavior intrinsic effects
• Principle Children learn best by experiencing
  the natural consequences of their own behavior
  and value choices.
• Logical Consequences If natural consequences are
  too dangerous or long in coming, logical
  consequences can teach responsibility (see
  handout)

13
Moral Development

• Four Approaches to Moral Development
• Psychoanalytic- the superego is largely formed
  by
• Anacilitic identification (leaning
  on)- The child depends on and adopts values as
  they identify with their parents
• Defensive identification- The child is
  afraid of the same sex parent and feels they
  cannot compete. They are frightened by this
  parent and decide that if you cant beat them,
  them, join them. This identification helps to
  resolve the Oedipal conflict and in the process
  of identifying the child internalizes the
  parents values. (research suggests respect and
  love more important for identification).

14
Moral Development

• Social learning approach
• The child models the behavior of an
  admired person, especially behaviors they have
  seen the model get reinforced for.
• Virtues approach
• The child must
• know the good,
• do the good,
• and
• love or value the good
• Aristoles Wisdom - When one loves
  the good, then doing the good is its own
  reward. The person has a permanent source of of
  reinforcement.

15
Moral Development

• Cognitive Developmental approach
• As children develop they go through a
• universal
• hierarchically ordered
• invariant sequence of
• qualitatively different stages of
• moral reasoning
• (See the handout)

16
The Ego and Anxiety

• The egos highest function is to bridle and
  express the id. Freud said, Such decisions make
  up the whole essence of worldly wisdom.
• The egos task is gigantic. It is a poor
  creature owing service to three masters and
  consequently menaced by three dangers (Freud).
  The ego mediates between the id, superego, and
  external reality.
• The ego is the seat of anxiety. Three sources of
  anxiety are
• realistic (objective)
  anxiety- caused by a danger or threat from
  external reality
• neurotic anxiety- threat from
  a previously punished id impulse
• moral anxiety- threat from
  the superego (the anxiety of guilt- the anxiety
  of moral purposes broken or left unfulfilled)

17
Ego Defense Mechanisms

• Repression- unconsciously pushing
  anxiety-provoking material out of consciousness
  e.g. maintain sanity
• Suppression- consciously pushing away
  anxiety-provoking stimuli.
• Denial- mind denies the reality of or defends
  itself from thinking about anxiety-provoking
  situations.
• e.g. the first lies of children.
• Displacement- to redirect an impulse away from
  the person or force that prompts it to a safer
  object
• e.g. - man mad at boss, abuses wife
• - barnyard psychology
• Compensation- strengthening oneself in an area of
  weakness (called overcompensation when it is
  maladaptive) e.g. weightlifting

18
Ego Defense Mechanisms

• Reaction-formation- to transform an unacceptable
  impulse or feeling into its opposite
• e.g. - girl now hates the guy she loved
• - primary mechanism of conversion
• Rationalization- to give a less threatening
  explanation or motive for a behavior, thought, or
  feeling
• e.g. professor who reads four science fiction
  novels in two weeks
• Projection- to attribute our thoughts and
  feelings to another person
• e.g. origin of paranoia
• a) I hate others becomes others hate me.
• b) I want to hurt others becomes others want
  to hurt me.
• e.g. origin of not being able to accept love
• Repressed, I dont like me becomes others
  dont like me. (See Defensive Functioning Scale
  p. 42)

19
Aspects of Sexuality

• Anatomical gender Other Variables
• (sex) Sex drive
  
• Brain-formation gender Cathexis
• 
  Onset of puberty
• Gender identity Onset of arousal
• (Sexual)
• Gender role behavior
• (Sex)
• Sexual orientation

20
Aspects of Sexuality

• Anatomical gender- gender as indicated by
  genitalia
• Brain-formation gender- physiological structure
  of the brain as influenced by sex hormones
• Gender identity- identification and feeling of
  comfort with gender
• Gender role behavior- gender typed roles and
  behavior
• Sexual orientation- object of sexual desire

21
Aspects of Sexuality

• For Male Healthy / Vulnerable
• Anatomical gender M MF
• (sex)
• Brain-formation gender MF FM
• (androgen in utero)
• Gender identity M FM
• (Sexual)
• Gender role behavior A F or M
  (extreme) (Sex)
  MF
• Sexual orientation M-M
• M-F M-M
  or F
• 
  (M) (asexual)

22
Aggression

• Aggression- behavior that has injury or
  destruction as its goal, and anger as its
  accompanying affect.
• Developmental Picture
• Infancy- by six months anger can be
  differentiated from general stress (i.e. Baby
  cries and has body movements such as kicking,
  flailing of limbs, and arching of back)
• Preschool Period- the child moves from
  explosive, undirected outbursts to directed
  attacks, and from physical violence to symbolic
  expression of aggression. The infant cannot be
  angry at anyone because the independent existence
  of others has not been grasped (i.e. object
  performance is not complete). While the toddler
  can aggress intentionally, the ideas that the
  attack may hurt does not register until about 3
  years of age.

23
Aggression

• Middle Childhood
• The expression of aggression becomes
  progressively more intentional, retaliatory, and
  symbolic.
• The child can distinguish intentional from
  accidental provocations and respond less
  aggressively when it is not intentional (the
  attribution process is so crucial in the
  expression and targeting of anger).
• The child can now feel guilty about their
  outbursts.
• On the other hand, their increased time
  perspective enables them to hold a grudge and
  have more delayed and sustained aggression.

24
Aggression

• Adolescence
• Infantile modes of aggression, such as stamping
  feet, throwing objects, and crying may appear.
• Verbal expression of aggression predominates
  (i.e. sarcasm, name-calling, swearing,
  ridiculing, and humiliating) and sulking
  frequently follows an outburst.
• The situations triggering anger are similar to
  those of middle childhood unfair treatment,
  encroachment on rights, removal of privileges,
  being treated as a child, and failure to
  achieve a goal.

25
Aggression (Dynamics and Management)

• Anger and aggression can be adaptive and lead to
  health.
• How? What function might they serve?
• - It might help a child mobilize energy to
  remove obstacles or enlist help.
• Frustration-aggression hypothesis the
  frustration of being blocked in the pursuit of a
  goal produced aggression.
• a) Sometimes a person will direct their anger
  to the person or thing they believe is most
  responsible for blocking them. (e.g. beat up
  teacher)
• b) Sometimes the above is too dangerous or
  costly so they displace aggression onto a less
  threatening person or thing.
• (e.g. this is the source of abuse, barnyard
  psychology)
• c) People can sometimes direct the energy they
  derive from frustration and the resulting anger
  to a target that is helpful.
• (e.g. get mad at the ball and see it all
  the way to your bat)

26
Aggression (Dynamics and Management)

• Helping Children Control Anger and Aggression
• 1) Find the sources of frustration and
  eradicate them or help children cope with them
  (e.g. unfairness in the system).
• 2) Help a child redirect their anger-energy in a
  manner and to a target that is beneficial. There
  is some evidence that the more aggressive child
  is more pro-social when the aggression is
  redirected.
• 3) Model self-control and good anger management.

27
Peer Relations- Socio-metric Status

• Sociability- interest in the larger world of
  peers
• Socio-metric status- the way that a child is
  perceived by his peers
• Four types of children emerge from socio-metric
  studies
• Accepted children tend to be resourceful,
  intelligent, emotionally stable, dependable,
  cooperative, and sensitive.
• Rejected children tend to be aggressive,
  distractible, socially inept, alienated and
  unhappy.
• Neglected children (who tend to be neither liked
  nor disliked) tend to be anxious and lacking in
  social skills.
• Controversial children tend to be perceived both
  positively and negatively are often
  troublemakers or class clowns, yet have
  interpersonal skills and charisma that attracts
  others.

28
Determinants of Sociability

• Social perspective-taking- seeing a situation as
  others see it.
• Social problem-solving- which is concerned with
  conflict resolution. This includes
• 1) encoding and accurately interpreting social
  cues,
• 2) generating problem-solving strategies,
• 3) evaluating their effectiveness,
• 4) and enacting them.
• Empathy awareness of the feelings of others and
  a vicarious response to those feelings.
• - At home a child needs to be love-worthy. With
  peers a child needs to be respect-worthy and
  socio-ability is one of the many competencies a
  child must show.

29
The Adolescent Group

• Functions the group serves- These groups may
• 1) serve as a bridge to the future
• 2) provide a sense of
  belonging
• 3) help adolescents master
  uncertainty by prescribing behavior (e.g.
  clothes, music, language, etc.)
• 4) provocation and protection in
  changing from same-sex to heterosexual
  relationships (implications for youth groups)
• 5) support individuals in their
  opposition to their parents

30
The Adolescent Group

• In middle childhood and especially in adolescence
  there is a narrow group-centeredness which is the
  counterpart of the childs ego-centrism.
• The group may diminish
• 1) perspective
• 2) flexibility of thinking
• 3) the evaluation of individuals in terms of
  personal worth
• 4) social commitment that transcends group
  interests.
• How much does the group impact core values?
• Some findings suggest that groups tend to
  influence lifestyle choices more than deeper
  values and beliefs (i.e. hard work, kindness,
  believing in God).

31
The Adolescent Group

• Why is the adolescent turning to the group when
  their new powers of reason give them the feeling
  they can answer most any problem in existence?
• Are the possibilities opened up by reason
  actually frightening? Is it possible that some
  adolescents cling to the safe answers offered by
  the group, for the same reasons that many cling
  to science, philosophy, religion, etc.

32
Work

• Work is requiredness the necessity to complete
  tasks regardless of whether they are
  intrinsically interesting and whether one feels
  like it.
• After unfettered initiative, socialization begins
  with its intrusive no, wait, good boy and
  good girl.
• School is the childs first
• 1) work
• 2) encounter with a superordinate
• organization which regulates his/her daily life
• 3) experience with other children he/she has
  not chosen to be with
• 4) encounter with an adult upon whom he/she has
  no special claim
• 5) time he/she faces significant restrictions
  on need satisfaction
• 6) time the childs skills and products will be
  evaluated and compared with their peers

33
Work

• Vocational choice and identity in adolescence
• There are two important elements.
• 1) doing the job
• 2) relating to others- In fact, more
  jobs are lost for interpersonal reasons then for
  lack of skill and inadequate preparation.
• Intrapersonal factors are important in choosing a
  career and/or major.
• 1) abilities, skills, and talents (What you
  can do.)
• 2) values, interests (What you like, even
  love to do.)
• What you are good at and have a passion for.

34
Work

• In adolescence identity (Who am I?) is related
  to the question, What can I do that will be
  fulfilling?
• There are two inherent dangers.
• premature occupational choice- e.g. without
  adequate information the young person concludes
  they are meant to be a VIP executive, brain
  surgeon etc.
• role diffusion- uncertainty and confusion which
  usually results in little action

35
Diagnosis and Classification

• Introduce Multiaxial Classification

36
Classification and Diagnosis
37
Multiaxial Clasification

• Axis I - Acute condition for which a diagnosis is
  usually sought.
• Axis II - Mental Retardation and Personality
  Disorders
• Axis III - General Medical Conditions
• Axis IV - Psychosocial and Environmental
  Problems
• Axis V - Global Assessment of Functioning Scale
  (GAF Scale)

38
A sample diagnosis

• Janie, 24, is frequently depressed, for two or
  three weeks at a time, and she often thinks of
  ending it all as a way out of her problems. Even
  when she is not depressed, she cannot seem to
  maintain a relationship. Whenever she dates a
  new man, although he seems nice at first, she
  soon discovers that he has been using her, and
  she breaks it off, usually in a screaming tirade.

39
More on Janie

• She is in good health, generally, although she
  has asthma that developed at age 14. She is
  currently unemployed, having lost her third job
  since college six months ago. She lives alone,
  as her roommate asked her to leave when she could
  not keep up with her share of the rent.
• She tells you that the five psychologists she has
  seen in the past six months give her a GAF score
  of 70, and you find the same result.

40
DSM-IV diagnosis

• Axis I Major Depression
• Unemployment (V code)
• Axis II Borderline Personality Disorder
• Axis III Asthma
• Axis IV Work problem
• Housing problem
• Relationship problem
• Axis V GAF score of 70

41
The DSM from a Developmental Perspective

• 1) It assumes (wrongly at times) the diagnostic
  criteria are essentially identical across
  development. For example, young children with
  separation anxiety disorder worry excessively
  about separation and have nightmares, whereas
  older children , primarily have physical
  complaints , and are reluctant to go to school.
  (also ADHD go from motor to attention sym.)
• 2) Two fundamental criteria for diagnosing
  clinical disorders, namely, subjective distress
  and impairment of functioning are not always
  appropriate for children. Anna Freud points out
  that children quite often do not feel disturbed
  but are treated because they disturb others. In
  addition, they are very inconsistent in their
  functioning. Anna Freud proposed that only one
  criterion could help determine psychopathology in
  a child whether it interferes with the childs
  capacity to move forward in development.

42
The DSM from a Developmental Perspective

• 3) Many of the family and interpersonal problems
  that play a significant role in childhood
  psychopathology are listed as V codes and do not
  become the focus of treatment.
• 4) The DSM approach has not coped well with the
  comorbidity problem that frequently arises in
  studies of childhood psychopathology.

43
Multivariate Statistical Approach

• Placing a child in a category is an all or none
  approach that does not give one the whole
  picture.
• Factor analysis has been used to define the
  crucial variables that help us understand and
  diagnose childhood disturbance.
• The Child Behavior Checklist (CBCL) has items
  such as argues a lot, complains of loneliness,
  does not eat well,
• There are two wide-band factors-
• Internalizing which includes
• 1)Withdrawn 2)Somatic Complaints
  3)Anxious/Depressed
• Externalizing which includes
• 1)Delinquent behavior 2)Aggressive
  behavior
• Plus three more variables Social
  problems
• 
  Thought problems
• 
  Attention problems
• 
  

44
Continuity

• The three deviations with the greatest continuity
  from childhood to adulthood are aggressive
  behavior, the psychotic disorders, and severe
  mental retardation.
• Aggressive behavior after 6 years of age is
  predictive of juvenile delinquency.
• Aggressive behavior in adolescence, in turn, is
  predictive of a number of acting out behaviors in
  every area of adult life. (e.g. criminality,
  excessive drinking, etc.)

45
Continuity

• Pervasive developmental disorders, and psychoses,
  which include autism and schizophrenia have a
  poor prognosis. However , from one quarter to
  one third of children with these disorders make
  an adequate adult adjustment.
• Schizophrenia is an interesting example of
  continuity of disturbance, but discontinuity of
  behavior. In adults, schizophrenia is
  characterized by emotional withdrawal, anxiety,
  and thought disturbance in the form of delusions
  and hallucinations, while few of these
  characteristics are found in children , who will
  be diagnosed with schizophrenia in adulthood.
  The at-risk child evidences both acting-out and
  withdrawal behaviors, and is characterized as
  unstable, irritable, aggressive, resistant to
  authority, reclusive, friendless, and given to
  daydreaming.

46
Discontinuity

• Discontinuity is a function of development
  itself. Aside from the early psychoses and severe
  mental retardation, problem behavior in children
  before six years of age , tends not to be a good
  prognosticator of future disorders.
• In general, internalizing symptoms, such as
  moderate anxiety, tend to be less stable across
  development, than are externalizing symptoms.
• Internalizing symptoms also tend to be highly
  responsive to treatment, further indicating that
  their course is not rigid or fixed. However,
  clinically significant levels of anxiety and
  withdrawal do predict later patterns of
  internalizing disorders.

47
Discontinuity

• The data suggests that disturbed children can
  outgrow their psychopathology and normal
  children can grow into disturbances as adults.
• Since children without behavior problems in
  childhood , who go on to develop conduct
  disorders were more likely to associate with
  delinquent peers in adolescence, we might
  conclude that this negative result is accounted
  for by mediating factors within and external to
  the child.

48
Resilience

• In a study by Werner and Smith (1992) one third
  of the high-risk children became competent,
  confident, caring adults.
• The authors were able to isolate three clusters
  of protective factors that help account for this
  resilience.
• 1)at least average intelligence and personal
  attributes that elicited positive responses
• 2)affectionate ties with parent substitutes who
  encouraged trust, autonomy, and initiative
• 3)and external support systems, such as church,
  youth groups, or school

49
Resilience

• The authors were able to rate the relative weight
  of protective factors.
• Rearing conditions were more important than
  prenatal or perinatal complications.
• Intrapersonal qualities of competence,
  self-esteem, self-efficacy, and temperamental
  disposition were more important than
  interpersonal variables of parental competence,
  and sources of support.
• Intrapersonal qualities enabled the participants
  to take advantage of opportunities for growth.

50
Resilience

• Resilient children were often said to be
  invulnerable. Recent findings suggest that
  resilient children often pay in other ways as
  adults.
• Although resilient people adapt to society well,
  they often have significant trouble with anxiety
  and depression. In one study 85 of the resilient
  adults exhibited symptoms in these areas. In
  another study, many resilient adults had stress
  related health problems, such as migraines and
  backaches.
• Resilient people often end up caring for
  nonresilient people.