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Developmental Psychopathology > Week 11 > Flashcards

Week 11 Flashcards

1
Q

Early childhood dev problems

A

Sleeping problems, toileting problems, ASD, learning
disorders

Starting kinder, school

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2
Q

Middle childhood dev problems

A

CD, ADHD, anxiety, somatic complaints

School success, peer relationships

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3
Q

Adolescence dev problems

A

Depression, eating disorders, OCD, schizophrenia

Transition to secondary school, peers, body image

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4
Q

Early adulthood

A

Depression, anxiety, substance use, personality disorders

Tertiary study, employment, intimate relationships,
parenting

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5
Q

Middle adulthood

A

Depression, anxiety, post-natal depression

Parenting, financial stressors, separation/divorce, care of
own parents, loss of parents

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6
Q

Older adults

A

Depression, dementia

Retirement, health declines, loss of partner

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7
Q

Conceptualising and validating child interventions

Historically:

A

One treatment fits all approach – “uniformity myth”

Practitioner (rigid) adherence to one theoretical viewpoint

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8
Q

Conceptualising and validating child interventions

More recently

A

Recognition of therapist effects

Recognition of comorbidity

Empirically supported treatments

Evidence-Based Practice

Important to consider equifinality

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9
Q

Challenges of efficacy studies:

A

Parent willingness to allow child to be part of trial

( many don’t want their kids in there. Might for payment or free child therapy)

Exclusion criteria in RCTs limits participants to those without comorbidities

Treatment fidelity in trials not necessarily carried over to
practise
- we tightly control what we do in an RCT, real therapy often less controled.

Research samples often do not have as severe symptomatology as clinical samples

Problems with dissemination to “real world” clinics

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10
Q

Evaluation of interventions for
children and adolescents
(Weis, 2014)
Despite challenges

A

Evaluations of efficacy: meta-analyses consistently show
moderate to large effect sizes

Efficacy of therapy for children similar to efficacy of therapy for adults

As with adult therapy outcomes, can not conclude that one type of therapy is best overall.

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11
Q

Conclusions from meta-analyses of efficacy studies:

A

Behavioural therapies tend to yield greater effect sizes

  • behaviourists are more likely to apply beh therapies to problems with a beh underpinning
  • beh ther lends itself well to rigorous RCTs

Treatments tend to work better for adolescents compared to children

Treatment equally efficacious for internalising and externalising disorders

Children show global and specific improvements
- If you target a specific behavioural issue or symptom within treatment, they tend to show improvements in that but also in other areas.

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12
Q

Effectiveness studies

A

Effect sizes much lower than efficacy studies.

Most therapy not delivered under same conditions as
efficacy studies

High therapist workloads

Lack of training in empirically supported interventions

Complexity and diversity in most clinics

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13
Q

Knowledge of normal development is essential

A

To distinguish normal from pathological behaviour
Understanding of developmental context, e.g., current
psychosocial tasks
Cognitive and emotional development is taken into account

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14
Q

dev transitions vs transactional processes

A

Consideration of developmental transitions

e. g., to primary school
- kids are in a context, interacting with other people. The other people are influenced by others. All complex and connected.

Consideration of transactional processes
Suggests importance of others, e.g., parents, peers

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15
Q

Developmental Psychopathology Approach:

Implications for intervention

A

Link intervention planning to understanding of pathogenic
processes
(Shirk et al., 2011, cited in Kerig, et al., 2012)

Case formulation: Clinician’s theoretical formulation of the
developmental issues underlying the child’s problem

Match the formulation of the pathological process to the most relevant change process

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16
Q

Case Formulation – “5Ps”

A

Presenting problem

Predisposing factors - historical, biological factors

Precipitating factors - why me, now? current triggers

Perpetuating factors - things that maintain the problem

Protective factors - things that help protect against risk

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17
Q

Interventions with Children:
Cross-cultural Considerations
(Kerig, et al., 2012

A

Cultural differences in pathology
e.g., due to hostility and prejudice associated with racism

Cultural differences in treatment
e.g., involvement of families, involvement of therapist from own cultural group

Cultural differences in knowledge (clinician being culturally competent)

Culturally responsive treatments - Modified to create a better fit with the individual

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18
Q

Common factors in therapy

A

Unconditional positive regard: acceptance
Congruence: genuineness

Empathy: attempt to understand the world from the client’s perspective

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19
Q

Working with children and families
(from: AusParenting Program, Parenting Research Centre)
General principles

A

Take a strength based approach

Recognise family strengths

Normalise challenges and experience
- others have experienced this, others are now

Model problem-focused approach
- helping people to help themselves. What have you tried to do before? have you thought of trying something else?

Developmental perspective
- teachers do this normally, so they need to convey to first time parents what’s normal or abnormal in kids.

Acceptance of diversity
- Respect values, beliefs, traditions

20
Q

Psychodynamic Approach:
Classic Psychoanalysis
(Kerig et al., 2012)

A

Conceptual model:

Freud’s psychosexual stages
Psychopathology originates in the psychosexual stages, in which the child who is unable to master psychosexual anxieties defends against them

Therapeutic process:
Undoing of defense mechanisms that inhibit self-awareness and emotional growth

21
Q

Ego Psychology

Kerig et al., 2012

A

Conceptual model:
Erikson’s psychosocial stages

Behavioural and emotional problems arise when child is
struggling with conflicts, e.g., struggling with identity
confusion in adolescents

Therapeutic process:
Assist child to gain mastery over conflicts

22
Q

Objects Relations Theory

(Kerig et al., 2012

A

Conceptual model:

Disruptions in interpersonal relations lead to psychopathology, e.g., parenting that leads to disruptions in development of autonomous self - provide people with choices

Therapeutic process:
Therapeutic relationship is essential

Supplying a corrective emotional experience aimed at helping development return to its natural course

23
Q

Psychoanalytic Approach:

Psychodynamic Developmental Therapy Approach (PDTA)

A

Conceptual model:
Failures in early attachment relationships deprive child of the social experiences that lead to positive, undistorted view of self and relationships
(Fonagey & Target, 2009, cited in Kerig, et al., 2012)

Therapeutic process:
Supplying a corrective experience
aimed at helping development of more complete and accurate representations of the self and other

24
Q

Psychoanalytic Approach

Empirical support

A

Limited research conducted compared to CBT interventions

Success for PDTA for depression, anxiety, phobias, PTSD,
ODD, CD, ADHD
(Fonagey & Target, 2009, cited in Kerig, et al., 2012)
APS (2018)

Level II evidence for psychodynamic therapy for inpatients
with mixed CD and emotional problems (12-19 years)

Level II evidence for bulimia (14-18 years)

25
Q

Humanistic Approach

Kerig et al., 2012

A

Conceptual model:

Based on the work of Carl Rogers
Unconditional positive regard associated with adjustment
Conditions of worth associated with maladjustment in children

Therapeutic process:
Unconditional positive regard in therapy can undo the damage of conditional love

26
Q

Humanistic Approach

Empirical support

A

Strong support for warmth, support, acceptance for promoting child outcomes in therapy
(Shirk & Burwell, cited in Kerig et al., 2012)

Meta-analyses suggest similar effect sizes for play therapies generally, and humanistic therapy effect sizes tend to be larger compared to non-humanistic play therapies (Kerig et al.,2012)

27
Q

Behaviour Therapies

A

Conceptual model:

  • Focus on changing current behaviours
  • Application of general principles of behaviour change
  • Incorporates empirical approach in intervention, e.g.,ABAB designs (baseline, intervention, b, i)

Developmental Dimension:

  • Behaviour therapy has been criticised for being ahistorical, i.e, ignoring the past
  • More recently do incorporate developmental considerations
  • Cognitive capacity of the child
  • Developmental tasks
  • Developmental context, e.g., role of peers in adolescence
28
Q

Behaviour Therapies
(Kerig et al., 2012)
Therapeutic process:

A

Therapeutic process:

Classical Conditioning, e.g., systematic desensitisation for phobia
Operant Conditioning, i.e., contingency management (beh reinforcement e.g. star charts)

Observational Learning, i.e., modelling

Family context:
e.g., Parent Management Training (Patterson, 1982)

29
Q

Behaviour Therapies

Empirical support:

A

APS (2018)
Level I evidence for ADHD (6-18 years)
Level I evidence for Sleep Disorders (0-5 years)
Level I evidence for Enuresis (3-16 years)
Level I evidence for “Family Intervention” for CD and ADHD

“Family Interventions”: Incorporate Parent Training based on Behavioural principles

30
Q

Cognitive Therapies

A

Conceptual model:
Behavioural and emotional problems result from dysfunctional and maladaptive beliefs

Like behavioural approach, focus on specific observable behaviours, and systematically monitor change
Often incorporate behavioural elements (CBT)

e.g., practising new skills in real world environments, reinforcement for completion of homework/practise tasks

Therapeutic process:
Target the dysfunctional and maladaptive beliefs that guide
behaviour
e.g., Cognitive therapy for Anxiety Disorder
Coping Cat, Coping Koala, FRIENDs

31
Q

Cognitive-Behavioural Therapies

A

Empirical support:
APS (2018)

Level I evidence for CBT for PTSD, SAD, CD, OCD, in children and adolescents; depression (12-18 years)

Level II evidence for CBT for depression (7-12 years), GAD (7-17 years), specific phobia (7-17 years).

Using treatment manuals:
Creativity and flexibility important
Consideration of developmental level
Consideration of individual differences
Consideration of culture
32
Q

Family Systems Approach

A

Conceptual model:
Psychopathology of an individual serves a function in the family system
Therapeutic process:
Facilitate change in the family systems

33
Q

Family Systems Approach

Empirical support for focus on families

A

APS (2018)

Level II evidence for Multisystemic Family Focused therapy (MST) for adolescents (11 to 18 years of age) with externalising behaviour problems

Level I evidence for Multidimensional Family Therapy (MDFT) for substance use in adolescents (11 to 18 years of age)

MDFT includes components drawing from cognitive and behavioural perspective

34
Q

Prevention

A

Preventative efforts can be conceptualised along a continuum

  1. Primary prevention:
    Universally delivered to reduce risk
  2. Secondary prevention:
    Early identification of problems: “early intervention”
    At-risk groups identified
  3. Tertiary prevention:
    Intervention to prevent problems from worsening
    Boundary between tertiary prevention and “intervention” is not a clear one, particularly for childhood problems
35
Q

From Resilience Research to

Intervention and Prevention

A

Identify protective factors
-> Design program

Reciprocal relationship between research and theory

  • Theoretical resilience research
  • Program development
  • Program evaluation
  • Testing of theoretical models
36
Q

Assets and protective factors

A

Across many studies and different methodologies:
high degree of consistency in the factors that predicted
good outcomes in children at risk

Individual
Family
Community
Cultural and societal characteristics

37
Q

Child characteristics

A

Social and adaptable temperament in infancy
Good cognitive abilities and problem-solving skills
Effective emotional and behavioural regulation strategies
Positive view of self self-confidence; high self-esteem, self-efficacy
Positive outlook on life (hopefulness)
Hope, faith, sense of meaning in life, religious affiliation
Characteristic valued by society and self talents, sense of humour, attractiveness to others

38
Q

Family characteristics

A

Stable and supportive home environment
Low level of parental conflict
Close relationship to responsive caregiver
Authoritative parenting style

Positive sibling relationship
Supportive connections with extended family
arents involved in child’s education

Parents individual qualities (as for child)
Socioeconomic advantages
Post-secondary education of parent
Hope, faith or religious affiliations

39
Q

Community characteristics

A

High neighbourhood quality
Safe neighbourhood
Low level of community violence
Affordable housing
Access to recreational centres
Clean air and water
Effective schools
Well-trained and well-compensated teachers
After-school programs
School recreational resources (sports, music, art)
Employment opportunities for parents and teens
Good public health care
Access to emergency services (police, fire, medical)
Connections to caring adult mentors and pro-social peers

40
Q

Cultural and societal characteristics

A

Protective child polices
- child labour, child health and welfare
Value and resources directed toward education
Prevention and protection from oppression or political violence
Low acceptance of physical violence

41
Q

Child focus:

What might resilience programs include?

A 
Individual
Family
Community
Cultural and Societal
What would the programs developed and/or 
delivered by psychologists focus on?
What would a good program “look” like?
Types of components, activities, broader initiatives
How delivered?
42
Q

Individual characteristics

A

Social and adaptable temperament in infancy
Good cognitive abilities and problem-solving skills
Effective emotional and behavioural regulation strategies

Positive view of self
self-confidence; high self-esteem, self-efficacy

Positive outlook on life (hopefulness)
Faith and sense of meaning in life

Characteristic valued by society and self
talents, sense of humour, attractiveness to others

43
Q

Family characteristics

A

Stable and supportive home environment

Low level of parental conflict
Close relationship to responsive caregiver
Authoritative parenting style
Positive sibling relationships
Supportive connections with extended family

Parents involved in child’s education
Parents individual qualities (as for child)
Socioeconomic advantages
Post-secondary education of parent
Faith or religious affiliations
44
Q

Community characteristics

A 
High neighbourhood quality
Safe neighbourhood
Low level of community violence
Affordable housing
Access to recreational centres

Clean air and water
Effective schools
Well-trained and well-compensated teachers
After-school programs
School recreational resources (sports, music, art)

Employment opportunities for parents and teens
Good public health care
Access to emergency services (police, fire, medical)
Connections to caring adult mentors and pro-social peers

45
Q

Cultural and societal characteristics

A

Protective child polices

child labour, child health and welfare

Value and resources directed toward education

Prevention and protection from oppression or political violence
Low acceptance of physical violence

46
Q

Older adult focus:

What might resilience programs include?

A

Individual
Family

Community
Cultural and Societal

What would the programs developed and/or delivered by
psychologists focus on?
What would a good program “look” like?
Types of components, activities, broader initiatives
How delivered?

Developmental Psychopathology (10 decks)

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