Children exhibit a wide array of problem behaviors, some that are relatively common and others that are quite rare. Many of these behaviors are marked by either a lack of control or excessive internalizing of troublesome issues. THE DEVELOPMENTAL APPROACH TO PSYCHOPATHOLOGY Developmental psychopathology involves the study of the origins, changes, and continuities in maladaptive behavior over the life span. The four basic principles of developmental psychopathology are: (1) the role of development must be considered in interpreting the symptoms and in seeking to understand its origins and course; (2) psychopathology must be viewed in relation both to the child's normal development and to the developmental tasks for children of his/her age; (3) the earliest precursors of disordered behavior must be studied; and (4) there are multiple pathways to both normal and abnormal behavior. There is great variability in response to biological and environmental risk factors, including permanent developmental delays, sleeper effects that are exhibited later, resilience, and including enhanced adaptability due to the stress. The child's resilience is greatest in the presence of three main protective factors: positive individual attributes, a supportive family environment, and supportive extrafamilial people or groups. WHAT IS ABNORMAL? Most researchers and clinicians think that psychopathology is best thought of as problems in living. The Medical Model The medical model's view of problems as pathological may obscure the role of social judgments that depend on cultural and individual values. Abnormality as Deviation from the Average or Ideal The statistical model views as abnormal any behaviors or feelings that differ from the average. Abnormality may also be defined as a deviation from the ideal. The Social Judgment of Child Psychopathology Children are usually referred to mental health professionals by their parents or other adults, and factors other than the child's behavior may influence the referring adult's judgment about the child. Three kinds of factors that may influence the adult's perceptions are the child characteristics, characteristics of the referring adult, and characteristics of the child's environment. Continuity over Time Whether a particular behavior is viewed as normal depends on the child's age and the likelihood that it will continue over time. Some problems, such as bedwetting, decline with age; others, such as nightmares, increase until adolescence and then decline. However, some childhood disorders, such as autism, are associated with later adult dysfunction. Continuity in some problem behaviors can be maintained by cumulative continuity, the selection of environments that support maladaptive behavior, or by interactional continuity, the evocation of negative responses from others that create and maintain dysfunctional interactions. CLASSIFYING CHILD PSYCHOPATHOLOGY The Diagnostic Approach Two major ways of assessing and classifying developmental psychopathology are the diagnostic approach and the empirical method. Diagnoses are based on descriptions of clusters of behaviors and disturbing thoughts or feelings that are classified into various diagnostic categories. A diagnosis must convey information about the etiology and course of a disorder to be useful. The most widely used diagnostic classification system is the American Psychiatric Association's DSM-IV. Although this system has been revised several times, it still has problems of reliability and validity. Diagnostic reliability is crucial to a classification system. The Empirical Approach The empirical approach involves having adults familiar with the child rate a large number of problem behaviors and then use statistical techniques to determine which disorders are related to one another. Undercontrolled disorders, such as conduct and attention deficit/hyperactivity disorders, are the most frequently reported of all psychological problems of childhood and have considerable impact on the child's social environment. Overcontrolled disorders, such as childhood depression, have a greater effect on children, who bottle up their feelings and concerns. Children with pervasive developmental disorders like autism are characterized by gross deficits and extreme disturbances. SOME PSYCHOLOGICAL DISORDERS THAT AFFECT CHILDREN Conduct Disorders Children with either socialized or unsocialized conduct disorders repeatedly violate the rights of others or age-appropriate societal norms. Children that violate the law are termed delinquent and run the risk of being charged with either status or criminal offenses. Young offenders commit a sizable percentage of major offenses, and they are also often the victims of violent crime. Juvenile crime rose significantly in the 1980s but declined somewhat in the early 1990s. Although among young people substance abuse, one kind of conduct disorder, also declined in the 1980s, it began an upswing in the 1990s. The evidence suggests that European American youths are more likely than Hispanic or African American adolescents to use legal and illegal drugs, although the data may not include youths who are absent from school or dropouts. Personal factors, such as anxiety and depression, are significant causes of drug abuse, and the common pathway starts with legal drugs like alcohol and tobacco. Behavioral techniques, including reinforcement of appropriate behavior and the time out method, are among the most successful treatments for conduct disorders. Prevention programs that involve both family and school show early promise. Attention Deficit/Hyperactivity Disorder Attention deficit/hyperactivity disorder, often not diagnosed until children enter the structured environment of school, is characterized by overactivity, impulsivity, poor attention, and difficulties with rule-governed behavior. Although the inappropriate activity of hyperactive children diminishes with age, some problems may persist, resulting in poor academic performance. Although biological explanations for this disorder, such as minimal brain damage, have received little empirical support, some genetic component may be involved. Environmental explanations, such as dysfunctional parent-child interaction patterns, have received some research support. At present, it appears that hyperactivity may have multiple causes. It is often treated by psychostimulant medication, behavior therapy, or a combination of the two. Depression in Childhood Depression in childhood may be characterized by depressed mood, changes in cognitive functioning such as inability to concentrate, behavioral signs such as irritability and crankiness, and such physical problems as loss of appetite and weight loss. Depression in children is hard to diagnose because children may not be able or willing to talk about feelings of overwhelming sadness until they have reached a certain level of cognitive maturity. Diagnoses of depression increase dramatically in adolescence, as does the rate of suicidal thinking and actual suicide attempts. A number of causes of depression have been hypothesized. Biological theories emphasize genetic and biochemical causes. Social and psychological theories suggest maternal depression and parental conflict. Cognitive theories suggest that feelings of personal inadequacy, or learned helplessness, may lead to depression. Antidepressant drugs are generally more successful at treating adults than children. Cognitive behavior therapy is one of the most effective treatments for childhood depression. Training in cognitive and problem-solving skills is a promising method of preventing depression. Autistic Disorder The most widely recognized pervasive developmental disorder is autistic disorder, which is characterized by a lack of interest in other people, various language abnormalities, such as echolalia, and an intense desire to preserve sameness in the environment. Obsessive self-stimulation may be seen as an effort to control sensory stimulation. Psychologists and others continue to debate the intelligence of autistic children. Some children sometimes exhibit specific talents in mathematics or the ability to repeat television commercials verbatim, but they score in the retarded range on IQ tests. The cause of infantile autism is thought to have a biological basis. Treatment, which has included medication and operant behavior therapy, has met with limited success. Although treatment allows the children to develop many skills they would not otherwise acquire, their range of abilities remains quite limited. TREATING AND PREVENTING CHILD PSYCHOPATHOLOGY Five approaches to the treatment of developmental psychopathologies are commonly tried. Psychoactive Medication Psychoactive medications result in short-term benefits but have some side effects. Controversy about this form of treatment centers on the use of a drug when there is no firm evidence to indicate the existence of underlying biological disorder. Play Therapy Play therapy is often used with children because of their limited ability to express themselves verbally. The therapist attempts to gain insight into the child's concerns by interpreting the child's play. Behavior Therapy Behavior therapy is a collection of different treatment techniques derived from the principles of social learning and operant conditioning. The goal is to teach the child new ways of behaving by changing the environmental contingencies. Family Therapy Family therapy views the child as part of a system and assumes that the child's behavior is an indication that something is wrong in the family system. Thus, the therapist meets with all members of the family and works on modifying family relationships and interactions. Community Psychology and Prevention Community psychology works to prevent disorders at the community level through primary prevention - providing interventions aimed at changing social conditions, secondary prevention - identifying and providing services for at-risk groups, and tertiary prevention - treating families who have already been identified as having problems.