Download 16 DEVELOPMENTAL PSYCHOPATHOLOGY LEARNING

16
DEVELOPMENTAL PSYCHOPATHOLOGY
LEARNING OBJECTIVES
After students have read and studied the material in this chapter, they should be able to answer the
following questions:
1. What criteria are used to define and diagnose psychological disorders? How is the DSM-IV
used in this process?
2. What is the perspective of the field of developmental psychopathology? What disorders are
studied by developmental psychopathologists?
3. What are the characteristics, suspected causes, treatment, and prognosis for individuals with
infantile autism?
4. In what ways to infants exhibit depression-like conditions? How is depression in infants similar
to, or different from, depression in adults?
5. What is the difference between undercontrolled and overcontrolled disorders? What are the
symptoms, suspected causes, treatment, and long-term prognosis for children with attentiondeficit hyperactivity disorder?
6. How is depression during childhood similar to, or different from, depression during adulthood?
7. How do interactions of nature and nurture contribute to psychological disorders? Do childhood
problems persist into adolescence and adulthood? Explain.
8. What psychological problems are more prevalent during adolescence than other periods of the
life span? What are the characteristics hypothesized causes and treatment of eating disorders?
9. What is the course of depression and suicidal behavior from adolescence through adulthood?
10. What are the physiological characteristics and psychological symptoms of Alzheimer’s
disease?
151
Chapter 16
CHAPTER OUTLINE
I.
What makes development abnormal?
A. Criteria for diagnosing psychological disorders
1. Three criteria for diagnosis
a. statistical deviance: Does the person's behavior fall outside the normal
range of behavior?
b. maladaptiveness: Does the person's behavior interfere with personal and
social adaptation or pose a danger to self or others?
c. personal distress: Does the behavior cause personal anguish or
discomfort?
B. DSM-IV diagnostic criteria
1. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)-- fourth
edition of book used by professionals to diagnosis psychology disorders
a. DSM-IV characteristics of depression (technically called major depressive
disorder)
i. depressed mood (e.g., sad)
ii. greatly decreased interest/pleasure in activities (e.g., quit
participating)
iii. significant change in weight (e.g., weight loss)
iv. change in sleep patterns (e.g., insomnia)
v. psychomotor change (e.g., sluggish)
vi. loss of energy (e.g., fatigue)
vii. feeling of worthlessness or guilt
viii. decreased ability to concentrate (e.g., often off task)
ix. recurrent thoughts of death (e.g., suicide)
2. Considering social norms
3. Considering age norms
4. Specific diagnostic criteria
B. Developmental psychopathology-- study of origins and course of maladaptive behavior
1. Psychopathology as development, not disease
a. better to conceptualize of problems as disorders not diseases
i. not defect within person but product of complex interaction
between aspects of individual and environment
ii. many differential paths for developmental disorders to take
2. Considering social norms and age norms
a. social norms-- expectations about how to behavior in particular situation
b. definition and incidence of abnormal behavior culturally bound
c. age norms-- societal expectations about appropriate behavior for one’s
age
i. this issue critical for life span developmental perspective
d. must understand normal before defining as “abnormal”
3. Developmental issues
a. concerned with nature-nurture issue (origin) of maladaptive behaviors
b. concerned with continuity-discontinuity (progression) of maladaptive
Chapter 16
152
behaviors
4. The diathesis/stress model
a. diathesis-- predisposition or vulnerability (genetic, cognitive, personality)
i. genetic vulnerability could involve imbalance of neurotransmitter
b. stress-- environmental pressure (biological, experiential)
c. key is combination of these factors
i. extreme stress and high vulnerability (severe disorder)
ii. extreme stress and high resiliency (mild disorder)
iii. low stress and high vulnerability (mild disorder)
iv. low stress and high resiliency (no disorder)
II.
The infant
A. Autism
1. Identified by Leo Kanner as disorder with three core symptoms
a. impaired social interactions
b. deviant communication development
c. repetitive, stereotypic behavior
2. Type of pervasive developmental disorder-- severe early life and associated with
gross abnormalities
a. often fail to show attachment behavior
3. DSM-IV definition
a. deviant social development
i. respond poorly to social cues
ii. fail to form normal social relationships
iii. less to no eye contact
iv. aversive reaction to physical contact
v. if attachments forms often disorganized/disordered
b. deviant language and communication skills
i. many mute-- do not speak
ii. speak in monotone
iii. reverse pronouns (e.g., “I” for “you”)
iv. echolalia--parrot (repeat) back what someone else says
c. repetitive, stereotyped behavior
i. obsessive need for sameness (great distress when environment
changed)
ii. rock back and forth, flap hands, and/or spin repeatedly and
without purpose (may be seeking stimulation)
iii. clearly deviant (not just delayed)
iv. some show savant syndrome-- exceptional skill in specific areas
(e.g., mathematical calculation) despite extreme cognitive
limitations in most other areas
d. autistic vary greatly in level of impact
4. Suspected causes
a. cognitive impairments
i. lack theory of mind-- understanding of mental states (e.g., feelings,
153
Chapter 16
beliefs) their impact on behavior
ii. autistics with good verbal skills do not appear to lack this ability
iii. deficiency in executive functions-- planning and organizing
ability
associated with prefrontal lobe of brain
b. early “refrigerator parent” theory (cold mechanical, unresponsive) now
rejected
c. possibly a neurological disorder
i. possible damage to cerebellum
ii. possible high levels of neurotransmitters serotonin, and/or
norepinephrine
iii. damage to brain stem during prenatal development (possibly due
to effect of drug)
d. possible genetic contributor
i. HOXA1 gene (impacts brain stem)
ii. come autistics do not have HOXA1 gene
5. Developmental outcomes
a. long tem prognosis usually poor
b. drugs can be used to treat some symptoms
c. intensive behavioral and educational training beginning early in life
i. some studies have shown dramatic improvement
B. Depression
1. Behavioral and somatic symptoms-- bodily related symptoms like loss of
appetite and disruption of sleep
2. Infants of depressed mothers at risk
3. Failure to thrive-- neglected, abused or otherwise stressed infants that fail to
grow
III.
The child
A. Two general categories of developmental problems
1. Undercontrolled (externalizing) disorders (acting out)
a. aggression, disobedience, disruptive, hyperactive
b. more common in boys
2. Overcontrolled (internalizing) disorders (inner distress
a. worry, phobias, severe shyness, depression
b. more common in girls
B. Attention-deficit hyperactivity disorder (ADHD)
1. DSM-IV criteria
a. inattention (distractible, does not complete activity)
b. impulsivity (act before thinking, cannot inhibit an urge)
c. hyperactivity (fidgeting, restless)
d. some believe that it is overdiagnosed
e. some children have inattentive problems but not
impulsivity/hyperactivity
f. some children have impulsivity/hyperactivity but not inattentiveness
Chapter 16
154
g. some children with ADHD have conduct disorders and behave
aggressively
h. comorbidity -- when an individual simultaneously displays symptoms
from two or more conditions (e.g., ADHD and learning disabled)
i. comorbidity make diagnosis more difficult
2. Developmental course
a. some symptoms may be present in infancy/early childhood
b. preschool years mainly involve activity levels
c. inattentiveness becomes more pronounced in school age children
d. symptoms may remain into adulthood
3. Suspected causes
a. neurological abnormalities (although no consistent brain damage no
problems with neurotransmitters have been identified)
b. deficiency in executive functioning (those allowing for planning)
c. highly intrusive parenting style may be contributor
d. food additives and sugar likely play little role in ADHD
4. Treatment
a. often treated with stimulant drugs (e.g., Ritalin)
i. somehow stimulants sometimes lead to better focus
ii. some concern about side effects of medications
b. many argue that stimulants are overprescribed and not that effective
c. others argue that more children could benefit from use of medication
d. behavioral treatments focusing on parenting training and child training
has
proven effective
C. Depression
1. Chronic feelings of worthlessness, hopelessness, self-blame
2. Masked depression-- depression expressed in atypical symptoms like aggression
3. Depression rare in childhood and more common in adolescence
4. Suicide attempts in children rare but do occur
5. Multiple types of therapies
a. cognitive-behavioral-- focus on changing thinking
b. antidepressant medication (e.g., Prozac) that selectively inhibit serotonin
reuptake can be somewhat effective
D. Nature, nurture, and childhood disorders
1. Simplistic to just blame parents
2. Genetic factors and disturbances in family relations
3. Unfavorable home environments not necessarily cause of problems
4. Child’s disorder could be cause not effect of poor parenting
5. Family conflict and ineffective parenting can contribute
E. Do childhood problems persist?
1. Is a tendency for problems to persist beyond childhood
a. pattern of development varies by disorder
i. anxiety more discontinuity
ii. depression more continuity
155
Chapter 16
2. Protective factors (processes that keep child from becoming maladjusted in face
of risk) are critical and include…
a. personal competence (intellectual and social skills)
b. strong social support (stable family with at least one quality caregiver)
3. Continuity more likely if problems are severe
IV.
The adolescent
A. Is adolescence really a period of storm and stress?
1. Hall viewed adolescence of emotional time of “storm and stress”
2. Most adolescents actually well adjusted and do not experience a lot of “storm
and stress”
3. Is time of heightened vulnerability to some disorders
4. Mistake to over and underestimate levels of psychopathology in the teen years
5. Risk comes in several areas…
a. delinquent behavior
b. overuse of drugs
B. Eating disorders
1. Anorexia nervosa-- “nervous loss of appetite”
a. refusal to maintain body weight
b. significant loss of weight resulting in weight 85% or less of expected
weight
c. female cession of menstrual cycle
d. often begins as diet during or shortly after puberty
e. more often diagnosed in females
2. Bulimia nervosa-- “binge/purge syndrome”
a. recurrent binge eating of mass quantities of food
b. may purge (rid self of food) using self-vomiting, diuretics, and/or
laxatives
c. accompanied by depression and anxiety
d. weight range varies from overweight to underweight
e. some sex and cultural variation in incidence (e.g., less common in African
American females)
3. Suspected causes
a. social pressures and values
i. media presentations of thin women
b. genetic predisposition
i. may be due to defect in gene regulating appetite control
c. disturbed family relationships
d. negative internal working models of self
e. may involve overprotective parents who do not allow for the expression
of negative emotions
d. pileup of stressors (e.g., relationship issues, school, changing body in
puberty) that is the trigger
4. Treatment
a. behavior modification to alter eating
Chapter 16
156
b. family therapy to build healthier child-parent relationships
c. drug therapy often to treat symptoms of depression
C. Depression and suicidal behavior
1. More vulnerable to depression than in childhood
2. Increase in both thoughts and attempts
a. males more successful during attempts
b. females more general and unsuccessful attempts
3. Peak suicide rate in older age
a. don’t hear about it as much because rate of attempt so high in adolescents
and it is thought to be an problem of adolescence
4. Most likely process of diathesis/stress
a. history of troubled relationships
5. Professional intervention important and can be effective
V.
The adult
A. Greatest quantity of life stresses take place in early adulthood
1. Incidence of psychological disorders varies by age
a. some decrease in incidence of certain disorders (e.g., alcohol abuse,
depression, mod disorders, schizophrenia, and anxiety disorders) as
we get older
b. cognitive impairments tend to increase in frequency with age
B. Depression
1. Age and sex differences
a, suicide rates highest among the elderly with depression
b. elderly adults become less vulnerable to stress
c. may be difficult to diagnose in older adults (both overdiagnosed
and underdiagnosed)
d. symptoms of depression similar across age groups
e. women more likely to be diagnosed with depression
2. Treatment
a. many adults receive no treatment services for depression
b. elderly most likely to go undiagnosed
c. psychoactive drugs (antidepressants) and psychotherapy often used for
treatment
C. Aging and dementia
1. Dementia-- term for senility (progressive deterioration of neural functioning and
associated traits (memory, thinking, personality changes)
a. not a single disorder
b. not a normal part of aging
2. Alzheimer's disease (Dementia of Alzheimer’s Type (DAT))-- most common
form of dementia
a. progressive loss
b. related brain changes
i. senile plaques-- masses of dying neural material with toxic protein
call beta amyloid
157
Chapter 16
ii. the plaque injures/kills neurons
iii. neurofibrillary tangles-- twisted strands of neural material
c. Alzheimer’s symptoms
i. first, mild cognitive impairment in memory recall
ii. progresses to learning and remembering
iii. progresses to inability to care for self and loss of verbal abilities
iv. progresses to death
d. cause may involve gene or combination of genes
i. early-onset form (prior to age 60) more linked to genetic factors
ii. presence of ApoE gene linked to increased risk of cognitive
impairment and Alzheimer’s in older age
e. family history not predictive in cases diagnosed after age 70
f. environmental risk factors include head injury in at younger age and diet
g. treatments include…
i. drugs to improve memory (e.g., Cognex)
ii. anti-inflammatory drugs (e.g., ibuprofen, estrogen)
iii. anti-oxidants (e.g., vitamin E and C)
iv. vaccine that prevents buildup of beta-amyloid
2. Other causes of cognitive impairment
a. vascular dementia (multi-infarct dementia)-- series of continuing strokes
i. unpredictable pattern of development
ii. often related to smoking, diet high in fat
b. other forms of dementia include Parkinson’s disease and Huntington’s
disease
c. reversible dementia-- treatable condition characterized by loss of memory,
confusion, disorientation, and hallucinations
d. delirium-- reversible condition developing rapidly over course of a day
that can be caused by drug overdoes, illness, pain, malnutrition
e. depressed individuals sometimes misdiagnosed with dementia
f. vital to accurately diagnose and differentiate between reversible and
irreversibility types of dementia
Chapter 16
158