Midterm 1 Flashcards
What is Unique about Understanding and
Treating Psychopathology in Youth?
- Some disorders are only diagnosed with childhood onset
Ex: Autism, ADHD - Indicators of a significant emotional or behavioral problem may be different
Ex: children may not have the same cognitive capacity of adults to express their depressive feelings - Presentation over time might change
Ex: A child that’s depressed may just present a lot of irritability - Developmental differences may lead to differences in efficacy in treatment
Ex: Cognitive therapy & Medication - Who advocates for youth? -> Decision-makers in course of care and treatment for a child is not usually the child
Why is cognitive therapy not always effective for children?
Children may not respond well with therapies that are purely based on cognitive functions that focus on sharing cognitive experiences (sharing thoughts and feelings) since they may struggle to understand and vocalize their thoughts and feelings
What are the indicators of abnormal behaviour?
- Norm Violation
- Statistical Rarity
- Personal Discomfort
- Maladaptive Behaviour
- Deviation from an Ideal
Describe the “norm violation” indicator of abnormal behaviour
- Norm violation indicates abnormality when one deviates from the “norm”
- Norms are culturally bound -> dependent on what our reference group is and to whom we are comparing people
- Dependent on reference groups and sub-groups within that reference group (ex: reference group = women in Canada and sub-group = women in Canada who attended university)
Describe the “statistical rarity” indicator of abnormal behaviour
- Represent base rates or how frequent/likely we are to see a certain behaviour or diagnosis
- Statistical rarity looks at the tails of a distribution (2% or 0.1%)
Ex: someone with an IQ of 145 is abnormal because you’re unlikely to have it (0.1% in distribution)
Ex: Sheldon’s high IQ (from the Big Bang Theory) is a statistical rarity
Ex: Eating insects in Canada or North America is a statistical rarity
Are DSM disorders a statistical rarity?
- DSM disorders in general are not that rare
- Lifetime prevalence of meeting criteria for any disorder by age 75 is = ~ 12 - 47.4% (almost 1 in 2 people)
- However, abnormal levels of impairment (significant impairment) or higher levels of anxiety would be deemed more statistically rare
TRUE or FALSE: Prevalence rates are always consistent
FALSE
* Prevalence rates may not be consistent across different samples and sources in part due to:
- Different sampling procedures
- Different sample sizes and variability
- Different populations (who is your reference group?)
- Changes in population over time (ex: mental health base rates change over time)
Describe the “deviation from an ideal” indicator of abnormal behaviour
- Ideal self VS actual self
- Parents often have very high expectations for their children (they have an ideal of how their child should be -> if their child doesn’t meet expectations, this would be a deviation from an ideal with which the parents would consider their child as abnormal) -> example of deviation from an ideal as imposed on someone
How is abnormal behaviour defined?
Defined as a pattern of symptoms associated with:
- distress
- disability
- increased risk for further suffering or harm
- Distress and disability can be lumped together as impairment
With regards to abnormal behaviour, what can “disability” and “risk” be defined by?
Adaptational failure (of failure to meet benchmarks) with typical behaviour as a benchmark
Describe the “personal discomfort” indicator of abnormal behaviour
- People have different thresholds of personal discomfort
- Someone may feel constantly burdened and bothered by their disorder, others may see the benefits in it
- Abnormality is determined by going above that threshold and leading to lots of personal discomfort
Concerning developmental benchmarks, what are the normal achievements for a child between the ages of 0-2?
- Eating
- Sleeping
- Attachment
Concerning developmental benchmarks, what are the normal achievements for a child between the ages of 2-5?
- Language
- Toileting
- Self-care skills
- Self-control
- Peer relationships
Concerning developmental benchmarks, what are the normal achievements for a child between the ages of 6-11?
- Academic skills and rules
- Rule-governed games
- Simple responsibilities
Concerning developmental benchmarks, what are the normal achievements for a child between the ages of 12-20?
- Romantic relations
- Personal identity
- Separation from family (may be more culturally-embedded)
- Increased responsibilities
Concerning developmental benchmarks, what are common behaviour problems for a child between the ages of 0-2?
- Stubbornness
- Temper
- Toileting difficulties
Concerning developmental benchmarks, what are common behaviour problems for a child between the ages of 2-5?
- Arguing
- Demanding attention
- Disobedience
- Fears
- Overactivity
- Resisting bedtime
Concerning developmental benchmarks, what are common behaviour problems for a child between the ages of 6-11?
- Arguing
- Inability to concentrate
- Self-consciousness
- Showing off
Concerning developmental benchmarks, what are common behaviour problems for a child between the ages of 12-20?
- Arguing
- Bragging
Concerning developmental benchmarks, what are clinical disorders common for a child between the ages of 0-2?
- Intellectual disability
- Feeding disorders
- Autism spectrum disorder
Concerning developmental benchmarks, what are clinical disorders common for a child between the ages of 2-5?
- Speech and Language disorders
- Problems stemming from child abuse and neglect
- Some anxiety disorders (ex: phobias)
Concerning developmental benchmarks, what are clinical disorders common for a child between the ages of 6-11?
- ADHD
- Learning disorders
- School refusal behaviour
- Conduct problems
Concerning developmental benchmarks, what are clinical disorders common for a child between the ages of 12-20?
- Anorexia
- Bulimia
- Delinquency
- Suicide attempts
- Drug and alcohol abuse (substance abuse)
- Schizophrenia
- Depression
What is the Denver Dev Screening Test (DDST) and what does it evaluate?
A screening test that can be used to assess if developmental benchmarks are being met at the appropriate age according to a percentile range indicating abnormal development through statistical rarity
How could failure to meet developmental benchmarks be an indicator of the onset of pathology?
- If a child fails to meet the normal achievements for their age range, that could be a predictor of the development of the clinical disorders related to that age range
- Ex: Failing to meet eating and sleeping achievements can be early indicators of intellectual disability or autism spectrum disorder
What’s the developmental psychopathology framework?
- Broad approach to disorders of youth -> thinking about a lots of factors (ex: developmental processes and tasks) that may lead to disorders in youth
- Stresses importance of developmental processes and
tasks - To understand maladaptive behavior, one must view it in relation to what is considered normative within whatever our particular reference group is
How can we describe the prevalence for child psychopathology?
- The prevalence is broad
- Numerous studies from different places and using different samples come to different prevalence rates
- However, often the fact that someone meets criteria for a disorder is considered more of a norm than abnormal
What are lifespan implications of child psychopathology?
- Impact on someone’s life course outcome is most severe when problems go untreated for extended periods of time
- About 20% of children with the most chronic and serious disorders face life-long difficulties and on average have worse life course outcomes
- Lifelong consequences associated with child psychopathology are costly (for individuals and to healthcare systems)
What are common problems with mental health services?
- Inadequate services (shortage of healthcare and mental healthcare workers in Quebec, often our systems aren’t set up to help individuals effectively)
- 1st point of contact often medical doctor (may not have the mental health knowledge to help out individuals)
- Racial/ethnic disparities in mental health service access
- Lower levels of utilization due to unique barriers (barriers related to geography and finances)
- Are your practitioners sensitive to cultural differences or nuances?
- Is the treatment that you’re getting tailored or adapted to your ethnic or cultural background?
What are gender differences in psychopathology?
- Social and Biological differences
- Certain criteria aren’t well suited for particular genders (ex: women with ADHD often go undiagnosed)
- Differences in timing
(Males show higher rates of disorders in childhood (ex: ADHD, early conduct problems) VS Females show higher rates of disorders in adolescence (ex: depression, eating disorder)) - Differences in form
(disorders may look different in the different genders -> men tend to show higher levels of externalizing behaviours VS women tend to show higher levels of internalizing behaviours)
What are SES differences in psychopathology?
- Poverty and socioeconomic (SES) disadvantage
- Yearly snapshots may underestimate the # of youth who live in poverty
- The ways we assess poverty may underestimate the percentage of children that experience poverty
- Poverty linked with higher rates of MANY disorders
What are racial/ethnic differences in psychopathology?
- Disparities NOT all attributable to SES
differences - More noticeable in treatment settings
- Differential treatment: certain racial groups (ex: black children) may be more likely to be diagnosed with conduct disorders
- Black youth more likely to be diagnosed with disruptive behavior
disorders & psychosis & less likely to be diagnosed with mood and substance use disorders (ex: school 2 prison pipeline) - Shows bias in diagnostic practices (how do mental health practitioners and clinicians interpret behaviours? -> over-diagnosis of certain groups of people -> implicit bias in diagnostic practices)
- Racism = large driver of health disparities
- These groups show lots of resilience and positive outcomes
What’s a large stressor that could lead to the onset of disorders in LGBTQ people?
- Victimization
- They’re more likely to be victimized by their peers and family members
- The vast majority of them experience verbal abuse (81%)
- Almost half (38%) threatened with physical attacks
- Higher rates of mental health problems stemming from this discrimination and maltreatment
- However, lots of resilience in these populations
What are cultural differences in psychopathology?
- Meaning of behaviors varies
- Ex: Social anxiety (fear of evaluation by others) VS Taijin kyofusho (incapacitating fear of offending or harming others through one’s social awkwardness) -> Taijin has to do with cultural norms in Japan around group harmony, not sticking out from the group
- Expression of symptoms varies
- Racial/ethnic minority group members often reports physical symptoms when there is underlying mental health problem (ex: “I have a tummy ache)
What are models of etiology & maintenance of disorder used in child psychopathology?
◼Diathesis-stress model
◼Developmental pathways (multifinality and equifinality)
Describe the General Diathesis-Stress Model
- Diathesis:
underlying vulnerability or tendency toward disorder (could be * biological, contextual, or experience-based) - Vulnerability can be changed throughout your lifespan (ex: due to the loss of a loved one)
- Diathesis is subject to change but its more stable because it has a biological component
- Stress:
situation or challenge that calls on resources (typically thought of as external, negative events) - The underlying vulnerability interacts with stressors and could lead to the onset of some type of disorder
- Different people have different levels of vulnerability (determines where you start in the race)
- The stressors keep pushing us toward the onset of a disorder
- People that have more vulnerability have a higher likelihood of developing a disorder
- Applied to many disorders
What’s the difference between Diathesis Stress Model and Differential Susceptibility
- Differential susceptibility: some children are more susceptible to the effects of their environments, both good and bad
- There may be vulnerability factors but there are also protective factors (these may reduce vulnerability and risk)
- Diathesis-stress: some children are more susceptible to the negative effects of a problematic environment
What are the strengths of the Diathesis-Stress Model?
- Organizes thinking about nature AND nurture behavior & that emotions are complicated
- Almost no disorders is caused by “just” genes or “just” stress
- Brain structure and function changes (neural plasticity) in response to environment
- Genes change in response to environment (behavioral epigenetics)
- This model isn’t prescriptive (not if x then y) -> interaction makes disorder more probable
(diathesis ≠ disorder & stress ≠ disorder) - Can have multiple interacting diatheses & stressors
What are developmental pathways?
- The sequence and timing of particular behaviors as well as the relationships between behaviors over time
- What kind of path do you get on and is that leading to an adaptive or maladaptive outcome?
What are the 2 common types of developmental pathways?
- Multifinality
- Equifinality
- They refer to the end points
What’s multifinality?
- Multi -> multiple outcomes
- A same stressor may lead to a wide variety of outcomes
- Ex: Early childhood maltreatment is a common stressor that can lead to a variety of disorders (conduct disorder, mood disorder, eating disorder, normal adjustment (aka resilience))
What’s equifinality?
- Different stressors might lead to a similar outcome
- Ex: experiences of SA, car accident and gun violence can all lead to PTSD
What’s the scientific approach and why is crucial when assessing child psychopathology?
- An organized way of investigating claims, without relying on common sense and casual observations, that requires that a claim be based on theories backed up by data from well-designed studies that test alternative explanations and that observations be checked and repeated before conclusions are drawn
- Parents and professionals who work with children tend to interpret and relate information according to their own belief systems and experiences
Explain the reasons why people are skeptical about research in abnormal child psychology
- Experts on childhood problems frequently disagree
- Research in mainstream media is often oversimplified, and the way that findings are presented can make them more or less believable
- Research findings in abnormal child psych often conflict with one another
- Research has led to different recommendations regarding how children with problems should be helped
- Even when scientific evidence is clear and produces a consensus, many parents and professionals may dismiss the findings because they have encountered an exception (usually from personal experience)
What’s a real-life example of scientific methods and evidence being ignored or dismissed concerning abnormal child psychology?
- Facilitated communication (FC)
- Procedure used to teach children with autism and other impairments how to communicate
- Controlled studies have consistently found that the child’s communication is being controlled by the facilitator
- Example of pseudoscience
Describe the research process
- Develop a hypothesis (research question) based on observation, theory, and previous findings, and decide on general research approach
- Identify sample to be studied, select measurement methods, and develop research design and procedures
- Gather and analyze data and interpret results in relation to theory and previous findings
- Findings and interpretations from the study can then be used to generate future research questions and stimulate further research
What’s epidemiological research?
The study of the incidence, prevalence, and cooccurrence of childhood disorders and competencies in clinic-referred and community samples
What are incidence rates?
- The rate at which new cases of a disorder appear over a specified period of time
- Ex: the number of youths who develop a depressive disorder during the school year
- Estimates of incidence and prevalence can be obtained over a short period, such as 6 months, or a much longer period
What are prevalence rates?
- The number of cases of a disorder, whether new or previously existing, that are observed during a specified period of time
- Ex: the number of teens with conduct disorder in the general population during 2012 and 2013
What’s the difference between lifetime prevalence estimates of mental disorders obtained prospectively and those obtained retrospectively?
Those obtained prospectively (studying the same sample of children over time and assessing them at periodic intervals) are double those found in retrospective studies (asking people to remember what occurred at an earlier time), which are subject to recall failure
Why is a case definition in abnormal child psychology complex?
- Children don’t refer themselves for treatment -> equating illness with seeking treatment can be misleading
- The factors that lead to referral sometimes have more to do with the child’s parents, teachers, or doctor than with the child’s behavior
- Children who are not referred to clinics for treatment should also have their problems studied
What are some explanations for why prevalence rates vary so widely in abnormal child psychology?
- Prospective vs retrospective studies
- Clinical cases vs community cases
- Whether cases are defined in terms of patterns of symptoms, impairment in functioning, or both
- Demographic and situational factors (ex: SES, parents’ marital status, age, gender, cultural background)
- Cultural variations in what constitutes abnormal behavior, how to identify such behavior, and what to do about it
What are the 3 variables of interest in abnormal child psychology?
- Correlates
- Risk or protective factors
- Causes of other variables
What are correlates (or correlated variables)?
Variables that are associated at a particular point in time with no clear proof that one precedes the other
What’s a risk factor?
- Variable that precedes an outcome of interest and increases the chances of a negative outcome
- Doesn’t necessarily mean that it’ll occur -> its occurrence depends on other factors
- Sometimes the effects of exposure to a risk factor during infancy or early childhood may not be visible until adolescence or adulthood (delayed or sleeper effects)
What’s a protective factor?
A positive variable that precedes an outcome of interest and decreases the chances that a negative outcome will occur
What’s the key difference between moderating and mediating variables?
Moderators have an independent effect on the existing relationship between 2 variables, whereas mediators account for some or all of the apparent relationship between 2 variables
What are moderator variables?
- A factor that influences the direction or strength of a relationship between variables
- The association between 2 variables depends on/differs as a function of moderating variables, such as the child’s age, sex, SES, or cultural background
- Ex: sex of the child moderates relationship between abuse and internalizing problems
What are mediator variables?
- The process, mechanism, or means through which a variable produces a specific outcome
- Mediators describe what happens at the psychological or neurobiological level to explain how one variable results from another
- Ex: type of discipline used by mothers on days they’re feeling distressed mediates the relationship between maternal distress and child behavior problems
What are randomized controlled trials (RCTs)?
- Design used to evaluate treatment outcomes in which children with a particular problem are randomly assigned to various treatment and control conditions
- Numerous studies evaluate treatment outcomes using RCTs
- Findings from controlled research studies indicate that children who receive treatment are generally better off than children who don’t
What’s treatment efficacy?
- Degree to which a treatment can produce changes under well-controlled conditions that depart from those typically used in clinical practice
- In efficacy research, careful control is exercised over the selection of cases, therapists, and delivery and monitoring of treatment
What’s treatment effectiveness?
- Degree to which a treatment can be shown to work in actual clinical practice, as opposed to under controlled laboratory conditions
- In research on effectiveness, treatment is evaluated in clinical settings, clients are usually referred rather than selected, and therapists provide services without many of the rigorous controls used in research
Fill in the blank: The benefits of treatment for children with problems have generally been found to be lower in ______ than in _______
- The benefits of treatment for children with problems have generally been found to be lower in clinical practice settings (effectiveness trials) than in controlled research settings (efficacy trials)
- A high priority for intervention research is on developing and testing interventions in settings where clinical services for youths are typically provided and finding ways to strengthen the bridge between research, public policy, and clinical practice
What’s standardization?
- Process by which a set of standards or norms is specified for a measurement procedure so that it can be used consistently across different assessments
- These standards and norms relate to the procedures that must be followed during administration, scoring, and evaluation of findings
- Without standardization, it’s nearly impossible to replicate the info obtained using a method of measurement
- Results are likely to be unique to the situation in which they are obtained and will not apply to other situations (ex: the test scores of an 8-year-old boy from a low-SES background should be compared with the scores of other children like him, not with the scores of a 16-year-old girl from an upper-SES background)
What’s reliability?
- The extent to which the result of an experiment is consistent or repeatable
- 3 types: internal consistency, interrater reliability, test-retest reliability
What’s internal consistency?
- Type of reliability
- Whether all parts of a method of measurement contribute in a meaningful way to the information obtained
What’s interrater reliability?
- Type of reliability
- Info must not depend on a single observer or clinician -> various people must agree on what they see (consensus)
What’s test-retest reliability?
- Tests or interviews repeated within a short time interval should yield similar results on both occasions
- The results need to be stable over time
What’s validity?
- The extent to which a measure actually assesses the dimension or construct that the researcher sets out to measure
- It’s not all or none but rather a matter of degree
- Can be assessed in many ways: face validity, construct validity, convergent validity, discriminant validity, criterion-related validity
What’s face validity?
- The extent to which the measure appears to assess the construct of interest
- Ex: a questionnaire that asks whether you get nervous before taking an exam would be a face-valid measure of test anxiety, whereas one that asks if you think you’re a parrot would not
What’s construct validity?
- Whether scores on a measure behave as predicted by theory or past research
- Ex: an intelligence test has construct validity if children who obtain high scores on the test also have better grades in school, understanding of concepts, and verbal reasoning than do children who obtain low scores on the test
- 2 components of construct validity: convergent validity and discriminant validity