Child Psychopathology Power Point 2 - PowerPoint PPT Presentation

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Child Psychopathology Power Point 2

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Title: 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.
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