Introduction

• Developmental psychopathology is the study of the origins and course of disordered behavior. It includes the study of disturbed children, the developmental roots of adult disorders, and the patterns that disorders follow after they emerge.
• It also stresses the major themes of this book: importance of developmental contexts, interaction of genes and environment, role of past development in current developmental outcomes, and orderliness of development despite changes in a person over time.
• Studying psychopathology from a developmental perspective has enriched our understanding of emotional and behavioral disorders in several ways:
1. It has encouraged us to explore both the origins of abnormal behavior and the ways in which abnormal behavior changes over time.
2. It has focused attention on children who seem to be on a path to developing some disorder yet somehow manage not to develop it.
3. It encourages us to explore how disorders may have their roots in the ways individual resolve (or fail to resolve) the major developmental issues all people face.

• A major goal of developmental approaches to psychopathology is to understand why some children who are at risk for developing an emotional or behavioral disorder go on to develop it (what are the risk factors?), while others at similar risk do not (what are the protective factors?).
• Risk Factors and Protective Factors
1. Determining factors that place people at risk for developing an emotional or behavior disorder is a central task of developmental researchers. A risk factor is any factor that increases the likelihood of negative developmental outcome. May be genetic, familiar, socioeconomic, cultural, or developmental. See Table 15.1 for a summary of risks.
2. The notion of risk is a statistical rather than a causal concept. It applies to groups of people, not to particular individuals.
3. Individual risk factors have limited predictive power, but the presence of multiple risk factors increases that predictive power dramatically.
4. Different combinations of risk factors can lead to the same disorder.
5. Whether risk factors lead to serious emotional or behavior problems is also influenced by the presence of protective factors-factors that promote or maintain healthy development.
• Assessing Normal and Abnormal
1. In developmental psychopathology, normal and abnormal behavior must be considered together. Disorders often have their roots in the ways people handle the normal developmental issues we all face.
2. Some problem behaviors are quite common at certain ages, while others are not (e.g., hallucinations) and may predict later pathology. An example is poor peer relations, not pathological by itself, but the link between peer problems and later maladjustment is understandable.
• Change and Stability over Time
1. Although some childhood disorders show rather simple continuity with adult disorders, many do not. Some childhood problems typically disappear with time, while others evolve into quite different forms in later years.
2. There are, however, meaningful links between childhood problems and adult psychopathology.

• Various models of psychopathology, or frameworks for explaining why things happen, have been proposed over the years. They focus on the etiology of psychological disorders (conditions that produce them).
• Most researchers believe that psychological disorders often involve a complex interplay of biology and environment. Researchers differ, however, in where they place their major emphasis--that is, in which factors they consider the primary determinants of a disorder.
• Biological Perspectives
1. The Traditional Medical Model
• According to this model, psychological disorders are mental illnesses to be diagnosed and cured, in much the same way as physical diseases. Psychological disturbance is assumed to be linked to an underlying structural or physiological malfunction.
• Certain mental disorders do fit the medical model (e.g., early childhood autism).
2. Modern Neurological and Physiological Models
• Chemical imbalances in the neurotransmitters in the brain have been found to be associated with various disorders but should probably not yet be viewed as causes of the disorders but as correlates or markers of a disorder.
3. Genetic Models
• Researchers who take a genetic perspective assume that some individuals inherit a predisposition to develop certain disorders.
• Most of these predispositions must be polygenic, rather than being based on one defective gene.
• The diathesis/stress model demonstrates the contributions of both heredity and environment to the development of psychological disorders. We all have some degree of biological vulnerability and everyone encounters stress. For those with high vulnerability, little stress is needed to develop the disorder and vice versa.
• Environmental Perspectives
1. Sociological Models
• Sociological models of psychopathology stress the social context surrounding children who develop a disorder.
• Depression and attentional problems have been explored via these models.
2. Behavioral Models
• Behavioral models focus on specific rewards, punishments, modeled behaviors, and cognitive strategies that might contribute to disturbed behavior. They are based on the assumptions that disruptive responses persist because they are reinforced and that restructuring the environment can change the behavior.
• Early behavioral models assumed that the symptoms are the disorder; more recent versions take internal cognitive processes into account.
• Psychodynamic Models
  Psychodynamic models have evolved from Freud's psychoanalytic theory. They assume that disturbed behavior results from underlying thoughts and feelings produced by life experiences and that merely treating the behavioral symptoms of a problem is not enough.
  
• Family Models
1. Family models hold that an individual's disturbed symptoms are a reflection of disturbance in the larger family system.
2. Although one person may be labeled as the problem, signs of the family system's disturbance can usually be found in any member of the family.
• The Developmental Perspective
1. The developmental perspective draws upon and integrates all of the models of psychopathology discussed so far. It assumes that a variety of biological and environmental factors influence abnormal as well as normal development.
2. This approach has been useful for uncovering the variety of factors that may contribute to a particular disorder and also for explaining patterns of change and continuity in the course of emotional problems (e.g., schizophrenia, juvenile depression).

• For most childhood disorders, both biological and environmental causes have been proposed. Autism is the one childhood disorder about which developmentalists are in agreement that biological factors are largely to blame. The other disorders discussed below are open to a number of explanations.
• Early Childhood Autism
1. The core features of autism are a powerful insistence on preserving sameness in the environment, extreme social isolation, and severe speech deficits. Autism afflicts only 4 children in 10,000.
2. Autism is classified as a pervasive developmental disorder because it is so severe. Its symptoms are always apparent by the age of 3 but severity varies.
3. Autistic children appear physically normal. There is general agreement that it has a biological basis, but it is not clear exactly what it is.
4. Evidence of biological factors: autistic children have extremely atypical behavior, their siblings are usually normal, parents are usually no different from typical parents, continue to have profound language and cognitive deficits even after years of treatment, statistical relationship to certain biological problems, and many will develop signs of brain pathology as they get older.
5. Structured therapy programs can often improve autistic children's functioning, but the long-term outlook for them is not very positive.
• Conduct Disorders
1. A conduct disorder is a persistent pattern of behavior that violates the basic rights of others or age-appropriate social norms.
2. There are several types of conduct disorders, distinguished by whether or not the child is aggressive and whether or not he or she can form normal bonds of affection.
3. It is one of the most frequent diagnoses given to children who are referred to mental-health centers, especially males.
4. When aggression and anti-social behavior begin early, they are very stable across childhood years and predict problems in adulthood. These disorders are referred to as life-course persistent conduct disorders. In contrast, adolescence limited conduct disorders are those that first appear in adolescence and those who fit this generally do not go on to have chronic problems.
5. Several biological causes for conduct disorders have been suggested (e.g., testosterone levels), and studies have found a link between conduct disorders and a number of environmental factors (e.g., poverty, conflict, abuse).
6. Treatment is often difficult, especially if the disorder is allowed to persist into adolescence. Early intervention and prevention are key ingredients. Programs must last at least 2 years, provide high quality day care or preschool, provide emotional support for parents, address the family's broader context via educational and vocational counseling.
• Attention Deficit/Hyperactivity Disorder
1. Children diagnosed with attention deficit/hyperactivity disorder (AD/HD) are a heterogeneous group, with the common thread being attention-related difficulties.
2. It is quite common (3 - 5 % of all children), with the incidence being higher for males.
3. It is often quite difficult to distinguish AD/HD children from those with conduct disorders. As many as half the children fitting the diagnosis of AD/HD also fit that of conduct disorders, a situation referred to as co-morbidity.
4. Causes of AD/HD
   To date, there is no biological marker that reliably distinguishes hyperactive from nonhyperactive children, and there may be environmental factors that contribute to hyperactivity. Recent research has implicated family and other environmental factors as contributors to AD/HD, especially parental criticism and overstimulation.
   
5. Treatment and Prognosis
• AD/HD is often treated with stimulants, which (due to a paradoxical drug effect) may increase a child's ability to concentrate but seem to have short-lived effectiveness. Some argue that it offsets a biochemical deficiency in the brains of children with AD/HD.
• Stimulants may not produce a paradoxical effect, as these children do not slow down with stimulants. Also, just because children's performance improves with stimulants does not suggest a biological need for them. And, there is reason to doubt the long-term effectiveness of stimulants.
• Behavioral therapy can be effective for AD/HD sufferers and have been successful in the classroom. This type of therapy with medication works better than medication alone.
• Many continue to have problems through adolescence, even if they have been treated for years with stimulants.
• It is important to evaluate the drugs' long-term effects on the body.
• Anxiety Disorders
1. Anxiety disorders are less common than conduct disorders or AD/HD (up to 8 %). Anxiety disorders include generalized anxiety disorder (very general and pervasive worries and fears) and separation anxiety disorder (excessive anxiety precipitated by separation from someone to whom the child is emotionally attached).
2. Anxiety disorders are more likely than conduct disorders or AD/HD to show spontaneous remission, and they usually do not predict serious problems in adulthood.
3. No reason to believe that these disorders in children are caused by biological factors.
4. Family factors seem the most likely source of anxiety disorders.
5. They are generally quite responsive to treatment with either behavioral or psychodynamic therapies. Focusing on the parents' anxiety also seems useful in treating school anxiety.
• Depression
1. It is now recognized that children suffer from depression. Often show such problems through somatic complaints, irritable mood, and social withdrawal rather than motor slowing and obvious despondency. It is difficult to diagnose because it co-occurs with other problems such as anxiety disorders or AD/HD.
2. It may be distinct from adult onset depression. It is most strongly associated with a history of psychosocial adversity, including stress, anxious attachment, and physical or sexual abuse.
• Anorexia Nervosa
1. Anorexia nervosa is a serious eating disorder characterized by extreme reduction in food intake, major weight loss (25 % of original weight), and a distorted body image. Some anorectics go on eating binges, but then induce vomiting to avoid gaining weight--a practice called bulimia. This self-abuse can cause serious side effects, even death.
2. Anorexia nervosa is primarily a disorder of middle-class adolescent girls and young women (with perfectionistic tendencies).
3. Biological theories include the possibility of a dysfunctional hypothalamus-not much evidence to support this.
4. Psychological theories have emphasized early sexual abuse or overinvolved, overentangled families. Demand for compliance in return for nurturance. By adolescence, girls with this problem exert control over their bodies, over how much they eat.
5. Why do adolescent girls focus on food to assert her autonomy? Part of the answer is cultural.
6. It is difficult to treat because of the girl's entrenched belief that she is not too thin and perhaps should become even thinner. Behavioral and family therapies have had some success.
• Comorbidity
1. Comorbidity is the rule for childhood psychological problems. For example, anorexia overlaps greatly with depression. Depression overlaps with each of the others.
2. May have several causes: 1) limited ways in which children manifest problems (e.g., difficulty concentrating) and 2) childhood problems may not represent distinct syndromes at all.

• Each of the disorders discussed in this chapter underscores some of the processes of development and sheds light on normal development:
1. Autism marks a profound deviation from normal development and underscores the interrelationships among various areas of development.
2. Conduct disorders show notable stability over time, but their ultimate outcomes are not totally predictable; they predict a wide range of adult problems.
3. Attention deficit/hyperactivity disorder highlights the transformations that can occur over the course of development.
4. Anxiety disorders demonstrate what can happen when normal developmental issues are not successfully negotiated.
5. Anorexia nervosa demonstrates a delayed attempt to establish autonomy--an issue usually addressed initially in toddlerhood; it also illustrates the complexity of developmental pathways.
6. Other disorders illustrate the complex interaction of risk factors and protective factors in the development of psychopathology, both biologically based and environmental ones. For all disorders, the total developmental context must be considered.