1 Introduction to Normal and Abnormal Behavior in Children and Adolescents

Introduction Research studies in abnormal child psychology seek to: Define normal and abnormal behavior for children of different ages, sexes, and ethnic and cultural backgrounds Identify the cases and correlates of abnormal behavior Make predictions about long-term outcomes Develop and evaluate methods for treatment and/or prevention

Features That Distinguish Child and Adolescent Disorders When adults seek services for children, it is not often clear who has what “problem” Many child and adolescent problems Involve a failure to show expected developmental progress Are not entirely abnormal Interventions are often intended to promote further development

Historical Views and Breakthroughs Ancient Greek/Roman view The disabled were a burden - scorned, abandoned, or put to death Before the 18th century Children were subjected to harsh treatment and largely ignored By end of 18th century Interest in abnormal child behavior surfaced

The Emergence of Social Conscience – Locke and Itard John Locke (17th century) Believed children should be raised with thought and care, not indifference and harsh treatment Jean-Marc Itard (19th century) Focused on the care, treatment, and training of “mental defectives”

The Emergence of Social Conscience – Hollingworth and Rush Leta Hollingworth Distinguished individuals with mental retardation (“imbeciles”) from those with psychiatric disorders (“lunatics”) Benjamin Rush Claimed that children were incapable of adult- like insanity Children with normal cognitive abilities but disturbing behavior suffer from “moral insanity”

Early Biological Attributes Late 19th century: mental illnesses were viewed as biological problems This was thwarted by the prevailing bias that the individual was at fault for deviant or abnormal behavior Clifford Beers’ efforts led to detection and intervention

Early Biological Attributes – Eugenics and Sterilization Early 20th century: society reverted to a belief that disorders could not be influenced by treatment or learning There was a return to custodial care and punishment of behaviors Mental disorders viewed as “diseases” led to fear of contamination Eugenics (sterilization) and segregation (institutionalization) were implemented

Early Psychological Attributes – Psychoanalytic Theory Linked mental disorders to childhood experiences and surroundings Focused on the interaction of developmental and situational processes Purported that mental disorders can be helped with proper environment or therapy Retains a role as a model for abnormal child psychology

Early Psychological Attributes – Behaviorism Laid the foundation for evidence-based treatments Key studies Pavlov’s research on classical conditioning Watson’s studies on the elimination of children’s fears and the theory of emotions Famous study: Little Albert

Evolving Forms of Treatment – Psychodynamic Approaches 1930 to 1950: psychodynamic approaches prevailed Most children with intellectual or mental disorders were institutionalized Late 1940s: Spitz’ studies pointed out the harmful impact of institutional life 1945 to1965: institutionalization decreased Placement in foster care and group homes increased

Evolving Forms of Treatment – Behavioral Approaches 1950s and early 1960s: behavior therapy emerged as a systematic approach to treatment of child and family disorders Behavior therapy is a prominent form of therapy

Progressive Legislation – IDEA IDEA (Individuals with Disabilities Education Act) requires: Free and appropriate public education for children with special needs in the least restrictive environment Each child must be assessed with culturally appropriate tests An individualized education program (IEP) for each child

Progressive Legislation – The UN United Nations General Assembly (2007) adopted a new convention to protect the rights of persons with disabilities The convention supports the attitude of considering persons with disabilities as individuals with human rights

What Is Abnormal Behavior in Children and Adolescents? Childhood disorders are accompanied by various layers of abnormal behavior or development Must also be sensitive to each child’s stage of development Disorders are commonly viewed as deviancies from normal Boundaries between normal and abnormal functioning are arbitrary

Defining Psychological Disorders Patterns of behavioral, cognitive, emotional, or physical symptoms linked with one or more of the following: Distress Disability Increased risk for further suffering or harm Culture and circumstances matter The characteristics describes behaviors, not causes

Labels Describe Behavior, Not People Stigmatization is a challenge Separate the child from the disorder Problems may be the result of children’s attempts to adapt to abnormal or unusual circumstances According to DSM-5 guidelines The primary purpose of using terms is to help describe and organize complex features of behavior patterns

Competence The ability to successfully adapt in the environment Successful adaptation is influenced by culture and ethnicity Abnormal child psychology considers: The degree of maladaptive behavior The extent to which normal developmental milestones are met Knowledge of developmental tasks provides important background information

Examples of Development Tasks Table 1.1 Examples of developmental tasks Source: From The Development of Competence in Favorable and Unfavorable Environments: Lessons from Research on Successful Children, by A. S. Masten and J. D. Coatsworth, 1998, American Psychologist, 53, 205–220. Copyright © 1998 by the American Psychological Association. APA is not responsible for the accuracy of this translation. Photo Credits (top to bottom): Flashon Studio/Shutterstock.com; Gelpi/Shutterstock.com; OLJ Studio/Shutterstock.com.

Developmental Pathways The sequence and timing of particular behaviors as well as the relationships between behaviors over time Two types of developmental pathways Multifinality - various outcomes may stem from similar beginnings Equifinality - similar outcomes stem from different early experiences and developmental pathways

Multifinality and Equifinality Figure 1.1 (a) Multifinality: Similar early experiences lead to different outcomes; (b) Equifinality: Different factors lead to a similar outcome Source: Cengage Learning 2012 Photo Credits: (a) © 2011 SW Productions/Jupiterimages Corporation; (b) © iStockphoto .com/Sarah Salmela.

Key Considerations in Developmental Pathways There are many contributors to disordered outcomes in each child Contributors vary among children who have the same disorder Children express features of their disturbances in different ways Pathways leading to particular disorders are numerous and interactive

Risk Factors and Protective Factors Risk factor: a variable that precedes a negative outcome of interest Examples: chronic poverty, care-giving deficits, parental mental illness, death of a parent, disasters, and family breakup Protective factor: a personal or situational variables that mitigates a child developing a disorder

Resilience The ability to fight off or recover from misfortune Associated with strong self-confidence, coping skills, avoiding risk situations Connected to a “protective triad” of resources: Strength of the child Strength of the family Strength of the school/community

Characteristics of Those Who Display Resilience Figure 1.2 Characteristics of children and adolescents who display resilience in the face of adversity Source: Based on Masten & Coatsworth, 1998 Photo Credits: (top to bottom) Odua Images/Shutterstock.com; Apollofoto/Shutterstock.com; iofoto/Shutterstock.com

The Significance of Mental Health Problems Among Children and Youth One in eight children has a mental health problem (North American studies) Many others are at risk for later development of a psychological disorder The majority of children needing mental health services do not receive them The demand for children’s mental health services is expected to double over the next decade

The Changing Picture of Children’s Mental Health A better ability to distinguish among disorders has led to increased and earlier recognition of problems There is a greater awareness of younger children’s and teens’ unique mental health issues Evidence-based prevention and treatment programs are more prominent

Prevalence of Mental Health Issues Mental health problems are more likely in children: From disadvantaged families From abusive or neglectful families Receiving inadequate child care Born with very low birth weight Whose parents have a mental illness or substance abuse problems

What Affects Rates and Expression of Mental Disorders? New pressures and social changes may place children at increased risk for development of disorder Environmental stressors may: Act as nonspecific stressors - bring about poor adaptation or the onset of a disorder Affect the extent to which a child’s problems are attenuated or exacerbated

Poverty One in five children in the U.S. and one in seven in Canada live in poverty Native American/First Nations and African American children are at greatest risk Poverty is associated with: Impairments in learning ability and school achievement, less education, low-paying jobs, inadequate health care, single-parent status, poor nutrition, and exposure to violence

Socioeconomic Disadvantages Associated with Poverty Poverty’s impact on children More conduct problems, chronic illness, school problems, emotional disorders, and cognitive/learning problems Poverty indirectly impacts children’s adjustment, which affects learning and mental health

Sex Differences Boys and girls express problems differently Certain disorders are more common in boys than girls, and vice versa Aggression is expressed more directly by boys; expressed more indirectly by girls Sex differences appear negligible in children under age three Disparities increase with age

Externalizing Problems Higher in boys than girls in preschool and early elementary years Exhibited as acting-out behaviors, e.g., aggression and delinquency Rates for boys and girls converge by age 18

Internalizing Problems Higher rates in girls Associated with: Anxiety, depression, or withdrawn behavior Somatic complaints Eating disorders Emotional disorders with peak age of onset in adolescence

Trajectories of Externalizing and Internalizing Problems Figure 1.3 Normative developmental trajectories of externalizing problems (left graph) and internalizing problems (right graph) from the Child Behavior Checklist. Ages are shown on the x axis. The y axis represents the raw scores (higher scores means more problems) Source: Adapted from the normative development of child and adolescent problem behavior., by Bongers, I. L., Koot, H. M., van der Ende, J., & Verhulst, F. C., 2003, Journal of Abnormal Psychology, 112, 179–192. Copyright © 2003 by the American Psychological Association. Reprinted with permission. APA is not responsible for the accuracy of this translation.

Sex Differences and Resilience Types of childrearing environments that predict resilience For boys: A male role model Structure and rules Encouragement of emotional expressiveness For girls: Households that combine risk taking and independence with support from female caregiver

What is Race? Most cultural anthropologists see race as a socially constructed concept, not a biological one Minority children in the U.S. are overrepresented in rates of some disorders Substance abuse, delinquency, and teen suicide

The Effects of Race and Ethnicity When controlling for other effects (SES, gender, age, referral status) Few differences emerge in relation to race or ethnicity Barriers remain in access to, and quality and outcomes of, care for minority children Minority children face multiple disadvantages, including poverty and marginalization

What is Culture? Values, beliefs, and practices that characterize a particular ethnocultural group Contribute to development and expression of children’s disorders Affect how people/institutions react to children’s problems Affect how problems are expressed

Culture and Diversity Important not to generalize research from one culture to another Social and cultural beliefs and values influence: The meaning given to behaviors The way in which behaviors are responded to The forms of expression and their outcomes

Child Maltreatment and Non-Accidental Trauma: Prevalence Nearly one million cases of child abuse and neglect occur in the U.S. each year Estimate: more than one-third of 10- to 16- year-olds experience physical and/or sexual assaults Acts of violence contribute to PTSD, major depressive disorder, or substance abuse/dependence

Child Maltreatment and Non-Accidental Trauma: Consequences Financial consequences of abuse and trauma: $124 billion per year in the U.S. More attention needs to be given to developing new ways to prevent and help those exposed to maltreatment and trauma

Special Issues Concerning Adolescents and Sexual Minority Youths Early- to mid-adolescence is an important transitional period for healthy adjustment Issues during adolescence Substance use, risky sexual behavior, violence, accidental injuries, and mental health problems Special needs and problems of adolescents are receiving greater attention

Special Issues: Lesbian, Gay, Bisexual, and Transgendered (LGBT) Youths LGBT youths in middle and high schools are more likely to be victimized by their peers and family members LGBT youths have higher rates of mental health problems

Lifespan Implications Impact is most severe when problems go untreated for extended periods of time About 20% of children with the most chronic and serious disorders: Are least likely to finish school Are most likely to have social problems and psychiatric disorders Lifelong consequences associated with child psychopathology are costly

Lifespan Implications – Solutions Children can overcome major obstacles When provided with circumstances and opportunities that promote healthy adaptation and competence Major initiatives for prevention and intervention have resulted from recognition of children’s mental health problems

Looking Ahead Children cannot advocate on their own behalf Viewing the whole child is the best strategy in understanding abnormal child and adolescent psychology Efforts to change policies and programs directed to- ward children and youths are gaining momentum