CHILD PSYCHOPATHOLOGY

Psychopathology
The study of abnormal thoughts, behaviors, and feelings. Psycho refers to mind.
Derives from the Greek Psyche for soul.

Pathology refers to disease.

Child Psychopathology
The term encompasses problems such as mental retardation, conduct disorder, autism & dysfunctional moods & emotions, including depression & eating disorders & many more.

Three Case Descriptions

Following are given case report of two children & an adolescent whose behavior concerns their parent & teachers. All of these children were referred to a mental health outpatient clinic for evaluation. The question in each case were: Is this childs adjustment normal or disordered? If disordered, what diagnosis should be given? If any type of mental health treatment required? If so, what is prognosis for this child? Will the child probably improve dramatically, stay the same, or will the condition worsen?

1. 2. 3. 4.

Case Report # 1
Bio Data Name Charyle Age 9 year old

Presenting Complaints Bossy, issues loud orders to playmates, steal others lunch & money, take younger children's possessions by threatening them & beat them up, denied when confronted with evidence. In her home she tore apart sofa. Family History Her mother is ill-groomed & belligerent alcoholic, whose boyfriend live with them. He is unemployed because of alcoholism & police have been called to their home than once because of noisy fights.

Personality History Chreyle is large, athletically built 9 years old girl with curly red hair & lots of freckles. Premorbid Personality Aggressive behavior, no social contact or circle, no sharing & cannot perform routine work Diagnosis This child might have the symptoms of ADHD. Prognosis This child has more chances of recovery, if sufficient care is also provided with medication Treatment Medication, intensive behavioral treatment & both

Case # 2
Bio Data Name Bobby Age 5 years old Presenting Complaints Delayed language & social development, isolated, lack of affectionate nature, hardly speaks a word of a normal conversation. Don't responds to his parent smile, or return hugs when they attempt to hold or cuddle him. Family History His parents love him & worried about him. Personal History According to her mother, her pregnancy & delivery were normal & that Bobby was a good baby, hardly ever cried.

Premorbid Personality Slow development, isolated, no social contact with other. Diagnosis Bobby failure to develop speech, strange preoccupation & profound social unresponsivity are highly unusual & suggestive of infantile autism. He may also have mental retardation. Prognosis The long-term outcome for autism is variable. It is difficult to determine during the first visit of a child what his future ability will be. It is however clear that this is a life long disorder that will leave its impact one way or another on the individual's life. The most important prognostic factor is the I.Q. ability of the child. Also, the degree of social interaction impairment and lack of appropriate communication early on correlates with the severity of the outcome. Early intervention that includes behavioral modification and speech therapy may also change the outcome positively. The most accurate predictor of outcome, however, is the progression over a period of about 1 year from early diagnosis. Those with few autistic features may do remarkably well.

Case # 3
Bio Data Name Steve Age 17 years old Sex male Presenting Complaints Stopped studying & rarely attend school. His grades have dropped from average to failing. Even he doesn't touch his guitar. He seems to have no interests & no hope; he only sits alone in front of the TV set for hours of time. Family History Steve has led his usually mild-mannered parents to despair & uncharacteristic out-bursts of rage about his behaviour. His parents have found drugs & a handgun in his room.. Family friends console them with descriptions to similar problems with their teenaged sons, but Steves parents continue to worry & fight with him, warning him repeatedly that he will never amount to anything if he does not try. Personal History Steve was formerly an average to good student, he virtually stopped studying & rarely attend school. His two closest friends are very heavy drug users & his parents also found drug & handgun in his room.

Premorbid Personality He was Diagnosis It is unclear that whether 17-years old Steve school problems, disengament, & alcohol & drug misuse are transitory & typical for his age group or whether they represent psychopathology. A persistent loss of motivation & ability to enjoy usual activities, school failure, & family conflict combined with drug use could indicate depression, & a ready access to gun possibly could increase the lethality of a suicide attempt. Prognosis In the vast majority of cases, the prognosis for depression is good. Of course, this is true only when someone is in treatment for depression. Untreated depression usually doesn't go away by itself, and often gets worse with time. And remember, untreated depression can be terminal, since it is the leading cause, by far, of suicide. Depression is a very serious illness which demands treatment--but those who take the difficult step of getting treated for it, will usually recover.

To sum up my whole topic

The term PSYCHOPATHOLOGY literally means illness of mind but mental heath authorities recognize that there are many different sources & types of psychological disorder. Not only thinking & other cognitive process be disrupted, but so can entire patterns of behavior such as aggression & self-control. All three children require closer diagnostic scrutiny, but at first glance each appears to represent major psychopathology requiring expert attention. Criteria of behavioral normality in addition to age norms must be considered.

History of child psychopathology

concerned about childrens spiritual salvat on and physical survival. villages fools

Neglect and abandonment

Neglect Abandonment In the past European babies were seriously neglected or abandoned In the 18th century paris, laws prohibited transporting babies.

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charitable institutions In Dubli, between 1775 and 1800 10, 272 infants were admitted to foundling homes but only 45 survived Late 1700, less than about one third of infants born survived the first year of life

Harsh discipline
Disobedience children were thought to be possessed by demons Concern about conformity and salvation. Childrens comfort and happiness were less important.

Developmental psychologist
Bosky & Cassidy, 1994 Parents distorts the normal socialization process Andersson 1992 Social changes occurring simultaneously causing of societal problems are not clear.

Rise of modern attitudes towards children In the 18th century children were increasingly valued for their innocence.

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John lock (1632-1704) tabula rasa

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Jean Jacques Rousseau (17121778) Children have a natural tendency towards healthy growth both in body and spirit.

Industrialization and child welfare

Growth of industry also threatened the health of multitudes of impoverished child workers. According to 1870 U.S census One out of every eight children were employed By 1900 approximately 1,750,00 children one out of six were gainfully employed

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60% were agricultural workers 40% in industry over half were children of immigrant families. Childrens welfare was not seriously considered No concern for their mental health.

Elitism and Exploitation.

One force opposed to social reform as social Darwinism a corruption of Darwin's theory of evolution. Many people of wealth and privilege drew an erroneous parallel between evolutionist Charles Darwin's principle of the survival of the fittest and their own social advantages, which they attributed to their innate biological superiority. In contrast, they viewed the poor, uneducated, and ill as genetically unfit and unworthy of decent treatment even if they are defenseless children

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This inhumanness was rationalized by the assertion that it was better for them to die young that to grow up with unfit and the socially dangerous. Today, we realize that all groups of humans are genetically highly similar and that no social class or geographic, national, racial, and ethnic group is generally or genetically inferior and superior to any other.

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Group differences in rates of psychopathology, intellectual and social achievement, crime and other characteristics are largely attributable to sociocultural factors, primarily wealth and access to educational and employment opportunities. Every human group contains extraordinarily achievement, given favorable circumstances

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This nurturing view of children paved the way for contemporary compensatory educational programs such as head start, community mental heath and drugs prevention services for children, and child protection practices

Child Study & Assessment of Child Psychopathology

Advent of compulsory public education in 1800s In 1900 century minister of education employed Binet & Simon to identify children who have lack of intellectual abilities. Institution for retarded were viewed as dead end placement Stanford-Binet intelligence test in 1916 Darwins theory of evaluation led early psychiatrists that deviance could be related to heredity flaws

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Francis Galtons also emphasis on the heridity base of intellectual & personality characteristics Victorians belief that certain type environmental events & personal practices could bring on madness Adolescent Masturbatory Insanity Brain irritability & deviant behavior In 1900s medication Alchole Steve

Improve Protection of Children

In1900 century , few social institution protected children Social reforms was beginning in early 1900s century Schools Poor people migrated toward cities Political also produce social reforms for poor people that they don't become violent

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Clergymen educated middle class women reforms set up settlement houses & formed social clubs to help the poor 1st American branch for the protection of children formed in 1874 Children were placed in large, impersonal, & inadequate institutions that stunted in emotionally & accept them to highly contagious diseases such as tuberculoses Later it was recognized that they need affectionate care in healthy environment

Improvement Protection of children

As late as 19th century, Just Few institutions were established for protection of children Result is, many orphans were abandoned However, social reforms was beginning.

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During the early 1900s, Reforms Schools were established to attempt to teach and rehabilitate young offenders. Settlement house and social clubs: Clergymen and educated middle class women reformers set up Settlement house and social clubs to help the poor.

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Because, Poverty and starvation forced citizens and immigrant to search for work in teeming city slums.

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Affectionate Environment: Many children were placed in large, impersonal, and inadequate institutions that stunted them emotionally and then they suffer with contagious diseases such as TB. Only later, it was recognized that children need affectionate care in a healthful, stimulating, home-like setting in order to thrive.

Treatment service for Children:

Better health service provided to children and families by American school system of the 1800s and 1900s. At Public School Systems: Hired visiting teachers in order to provide a wide range of services to children with special problems that interfered with their academic achievement.

Children's clinics.
In 1896, Lightner Witmer established the first true psychological clinic at the university of Pennsylvania. He established his clinic for the treatment child's educational problems

Juvenile Justice Systems

(a new view arose for the fate of Juvenile who had committed crimes)

Imprisonment with adults criminals no longer seemed appropriate for children Juvenile's Court: The public-spirited womens club of Chicago helped to organize the first Juvenile Court. The courts charges included: protecting children to rehabilitating and punishing them for their illegal behavior.

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It soon became apparent that many of the young delinquent were also seriously emotionally disturbed, so In 1909 the psychiatrist William Healy was chosen to head of a new Juvenile Psychopathic Institute for the treatment of children under the jurisdiction of the Juvenile Court.

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William Healy with the help of psychologist study the origins of delinquency and attempted to rehabilitate individuals juvenile offenders.

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Their treatment method was flexible and include: >Psychoanalytic techniques >Residential placement >Consultation with judges and police officers >Advise to parents >Short-tern child counseling

Reforms of the 1960s

The growth of federally supported community mental health service (in the social reforms of the 1960s), offered help to more children and families than ever before. Although the need was always greater than the services available, many community mental health service were exemplary and included programs aimed at prevention as well as treatment.

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However in the 1970, the economic and, more importantly, the political climate turned against the generous provision of treatment services to the poorest families.

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Treatment and educational services for children and families were severely curtailed. Government funding has been drastically cut or eliminated for impoverished women and their infants, child well fair, family nutrition and health, impressive federal; compensatory education programs such as Head Start. There is some evidence that such social welfare programs decrease the costs of other health, legal, and criminal justice service

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Ultimately, such severe reductions in educational and health services to children may well lead to increase in other social problems such as family break up, crime, violence, riots, drug use, and outbreaks of disease.

Criteria of normality
1. 2. 3. 4. Age appropriateness Preschool years Elementary school years Adolescence

Age Appropriateness
These illustrate that certain problem behavior are more socially acceptable and much more frequent at some age then at others. The clinician or therapist must familiar with the behavior of a child of particular age in order to determine weather the particular reaction of child are normal or not.

Problem behavior at various age

2 year or below 3_5 year Over activity, inattentiveness, specific fears, demanding attention constantly.

Over sensitivity, lying, negativism, refusal to do things when asked, over activity. 6_10 years Over activity, specific fears, lying, school achievement problems, jealously, excessive reserve, over sensitivity.

11_14 years 15_18 years

Over sensitivity, jealously, school problems, excessive reserve, moodiness, School achievement problems, skipping school, cheating on exams, depression, drinking, smoking, drug misuse, shoplifting, early sexual activity, and other miner law violations.

Age and behavior

Preschool years Elementary school years Adolescence

Ideal or optimal adjustment

The modal suggest that a behavior reaction would be considered pathological if it presented a health or adjustment problem to the child, family, or associates. The model is even more demanding and includes as pathological any factors that interfere with actualization of potentialities

intensity
A particular reaction could be relatively common but still could constitutes disordered behavior because of its severity. Behavior that is so intense as to do major damage to oneself, to other people, or to property certainly qualifies as deviant.

Duration
If the behaviors persist however and become more or less permanent aspect of the Childs life then the clinical problem might be indicated. The DSM IV TR is the official manual present standers for the judging whether a particular problem has lasted long enough to be classified as a genuine disorder.

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a brief problem might be highly pathological if it is highly intense, bizarre, dangerous, and appears as a part of a syndrome in which it is accompanied by a characteristics set of other disordered . The related group of problems is important that is only a single problem behavior is sufficient for the psychiatrist diagnosis.

Sex typed behavior

The expectations are communicated to children directly as they are thought to act appropriately for their gender and through the actions of adults as model of socially approved behavior.

Effect of Rater Familiarity

The observer degree of familiarity with the child and opportunities to observe the child over an extended time period affect the likelihood that the observer will accurately identify the childs behavior as normal or deviant.

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Teachers Expectations School and cultural mismatches Culturally appropriate schooling

 Cultural and temporal differences in definitions of disorder

Prevalence of serious behavior disorder

Impossible to provide definitive answer how many children have serious mental health problems Training of the person making the assessment e.g. teachers, professionals, parents, or the child themselves

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Important to distinguish terms Incidence Prevalence Epidemiological studies are not comparable Necessary it have some idea of the frequency various type of disorder in order to plan for needed treatment services Childrenss problem prevalence rates vary with the assessors training, experience and familiarity with the child

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The demands of managing difficult children may also lead teachers to be oversensitive to deviance and to overestimate its prevalence According to a study 10% of the children were judged to need short-term mental health services, mostly for excessive shyness, anxiety and chronic nervous habits And 4% needed long term mental health services largely because of their antisocial and aggressive behavior

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Approximately one-third of the children were thought to be high-risk because they had experienced ill health or injury very early in life, their families were very poor and troubled by chronic discord, divorce or parental mental illness Two-third of the high risk children developed problems, but one-third were resilient children who developed into competent, responsible adults

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Presidents Committee on Mental Health offered an estimate of 15% Institute of Medicine of the National Academy of Science decided 12% Institute of Medicine report that the prevalence may exceed 20%

Prevalence of academic achievement problems

It is easier to estimate the number of children with academic problems than adjustment disorders Children with school achievement problems can be easily identify with the help of standardized achievement test

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Children with serious academic underachievement problems had nine time as much contact with police, mental health, and other social service agencies as did children with no academic problems Werner and Smith (1999)

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Cultural differences, poverty and language problems contribute to childrens school difficulties

Age and gender differences in psychopathology

During childhood boys are identified with psychological problems more than girls Specially with antisocial aggression (1% girls to 12% boys) With ADHD (1% girl 10% boys) According to APA 1994 boys also clearly outnumber girls in prevalence of mental retardation (2 to 1) and infantile autism and childhood psychosis (3 to 1)

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Sexes may differ more in the type of problem than in the number of problems they experience. Boys have more trouble in controlling their impulses and aggression Girls are more likely to suffer from disorders of over control (phobias, social withdrawal Boys exhibit more easily detected problems with under control (antisocial aggression, ADHD)

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In industrialized Western countries about twice as many women as men are treated for depression, especially in the higher cost private treatment services. Considering all type of mental disorders women and men are approximately equally likely to the community mental health centers and outpatient psychiatric services.

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Overall, the sexes seem to be equivalent in number of psychological problems.

Predicting Future Development

Life would be much simpler but less interesting if we could accurately predict a childs future. The research data indicate that success in long-term prediction depends largely on what one is attempting to predict.

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Three consideration in attempting to predict childrens long-range adjustment outcomes
Developmental status Of the child Changes in the childs environment

Accuracy in measuring the childs behavioral characteristics

Developmental changes impair prediction

Development brings new challenges, opportunities and hazards. Developmentally significant events include learning to speak, entering kindergarten and first grade, adapting to junior high school, graduating from high school, and other such milestones Prediction is difficult because change is the essence of development

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As developmental psychopathologists have observed. Some degree of prediction is possible (Cicchetti et alm., 1995) Fortunate children who are cognitively and socially advanced can be expected to continue their superior adjustment in later years.

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Direction of development for virtually all children is from less to more advanced--physically, intellectually, socially and emotionally

General vs. Specific Traits

General----intellectual capacity. Ego development, self-control and general psychological maturity and moral development (better pr on one hand and symptoms or discrete problem behaviors (useless for prediction) on the other hand Presence or absence of specific problems may not aid prediction, especially if the problems are minor

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More difficult to predict long-term outcomes if the environment changes drastically than if life continues as usual Such as parental divorce, and the dissolution of the family

Environmental change disrupt prediction

It is more difficult to predict longterm outcomes if the environment changes drastically than if life continues as usual. like, parental divorce and the dissolution of the family, serious illness of a family member of the child, Financial emergencies, or a move to a very different social and geographical setting

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Even common place events can prove upsetting Parental conflict and divorce could stimulate children's aggression, school problems and other types of adjustment difficulties

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Young children in particular may be upset by changes in their routine or surroundings and their behavior may deteriorate following major disruptions in family life.

Measurement accuracy aids prediction

It discus that prediction only when helpful when it base on accurate measures.e.g we make prediction only when we have research on issue deeply.

Problem persist
It describe the problem persist as when we see that people with good health and with good status then there is more chance to wrong perception which influence the perception

Prediction is more accurate

It state that the prediction which made for short time is more accurate than those which are made for long time or for long term.

Group data do not predict individual out come

From this statement we find out that when we collect data from group it has only average information or problems it dose not focus on individual problems or issues.

Continuity and discontinuity in disordered behavior

in which person Continuity and discontinuity in disordered behavior literature suggest that two possibilities. Continuity hypothesis Growth hypothesis In continuity hypothesis adjustment status is relatively stable. In growth hypothesis children have extra ordinary capacity to overcome their problems.

Persistent characteristics
Persistent problems that change over time. The persistence of antisocial behavior. Underachievement Mental retardation

 Highly disturbed psychotic children continued to b very deviant and developmentally delayed throughout their lives. The researchers suggest that even relatively mild aggression tendencies may indicate continuing adjustment problems. Antisocial behavior intimidates others bringing the youth short term benefits, but long term adjustment perils

Underachievement:
Children does academic work quality is significantly below their capacity as measured by their IQ scores are likely to continue to b underachievers as they grow older Nearly all of those who became deviant in adolescence had earlier academic difficulties or social adjustment problems by the age of 10 years.

Mental retardation:
Mental retardation may or may not persist depending upon is severity. When they become adults, mildly retarded childrens may appear to improve and score within the dull normal range rather than the retarded range on intelligence tests

 In contrasts childrens with severe retardation (IQ scores below 50) rarely improve significantly and many require continuing supervision in sheltered workshops and institutions many of low scoring group can acquire basic eating, toileting and self-care skills and can learn simple, repetitive jobs , but few can live independently.

Less persistent characteristics:

Many childhood problems either diminish or disappear over time .for example in most cases childrens shyness and social withdrawal neither persist nor precede other types of adjustment difficulties, If it would chronic than it may turn toward the nail biting, mild food finickiest hair twirling etc