Intro

Question 1

What is Unique about Understanding and Treating Psychopathology in Youth?

Answer 1

*Some disorders are only diagnosed with childhood onsetAutism, ADHD
*Indicators of a significant emotional or behavioral problem may be different
*Presentation over time might change
*Developmental differences may lead to differences in efficacy in treatmentCognitive therapyMedication
*Who advocates for youth?Who makes decisions about whether or not something should be treated and what that treatment should be

Question 2

Defining abnormal behaviour

Answer 2

1)Norm Violation
What is your reference group?Women’s mean age at birth of first childCanada – 27.6United States – 25.0Mexico – 20.8Nicaragua – 19.6India – 19.9Bangladesh – 18.1Kenya – 19
Eating insects… depends on country.

2)Statistical Rarity
Ex: IQ under 70 or over 130
Ex: being diagnosed with an anxiety disorder
85000 people from 17 countries (DSM-IV criteria)Lifetime prevalence of any disorder by age 75 = ~12 -47.4%
NOT statistically uncommon but significant impairment
Contrast to Sheldon, highly uncommon, no impairment
An aside about prevalence rates in this course (and in life)
*Prevalence rates may not be consistent across different samples and sources
*Different sampling procedures
*Different sample sizes and variability
*Different populations (who is your reference group?)
*Changes in population over time
In life & for class - know the general gist & don’t take the actual # super literally – is something very rare, uncommon, common, very common

3)Personal Discomfort

4)Maladaptive Behavior

5)Deviation from an Ideal
We in North America expect (or at least want) our kids to gain advanced academic skills from very young ages and often push our kids to develop these skills as early as possibleIdeal = kid being ‘ahead’ on developmental tasksIs the ideal realistic? Is it creating more problems
… destroying kids’ self-confidence, feeling guilty for relaxing, Baby einstein video watching associated with less language development…

Question 3

Abnormal behaviour continued

Answer 3

Defined as a pattern of symptoms associated with:
distress
disability
increased risk for further suffering or harm
“Disability” and “risk” can defined by adaptational failure:
w/ Typical behavior as a benchmark
Ex: some developmental benchmarks (milestones, normal achievements we expect at a certain age)
DDST: Denver Dev. Screening test

Normal Development as a Benchmark
Developmental psychopathology framework
Broad approach to disorders of youth
Stresses importance of developmental processes and tasks
To understand maladaptive behavior, one must view it in relation to what is considered normative

Question 4

The Scope of the Problem: Broad prevalence

Answer 4

Ontario Child Health Study Children (ages 4- to 11-years): 18%Adolescents (ages 12- to 17-years): 22%Great Smokey Mountains Study Cumulative prevalence of any DSM diagnosis by age 21 was 61.1%*Dunedin Birth Cohort Study35% with any disorder by age 15, 59% by age 18

Lifespan ImplicationsImpact is most severe when problems go untreated for extended periods of time.About 20% of children with the most chronic and serious disorders face life-long difficulties.*Lifelong consequences associated with child psychopathology are costly.If problems occur, we want to facilitate recovery

Inadequate services1st point of contact often medical doctorRacial/ethnic disparities in mental health service accessLower levels of utilization due to unique barriersFante-Coleman et al., 2020

Question 5

Who Develops Psychopathology? (Introduction to Epidemiology)

Answer 5

*Gender (social and biological)Differences in timingMales show higher rates of disorders in childhoodFemales show higher rates of disorders in adolescenceDifferences in form

LGBTQ+ YouthMore likely to be victimized by their peers and family members.81% experience verbal abuse38% threatened with physical attacks15% have been physically assaulted16% have been sexually assaultedHigher rates of mental health problems stemming from this discrimination and maltreatmentAgain, lots of resilience in these populations

*Poverty and socioeconomic (SES) disadvantage2017: 9% of Canadian children lived in povertyYearly snapshots may underestimate the # of youth who live in povertyPoverty linked with higher rates of MANY disorders

Racial/Ethnic disparities in mental healthComplex literatureMany health disparities exist (not universal)Canada not good at collecting/sharing racial health data obscures possible disparitiesDisparities NOT all attributable to SES differencesMore noticeable in treatment settingsBlack youth more likely to be diagnosed with disruptive behavior disorders & psychosis & less likely to be diagnosed with mood and substance use disorders^school 2 prison pipeline, Bias in diagnostic practices

Racial disparities exist in physical and mental health
Partly due to SES
Racism = large driver of health disparities
CDC Racism and Health article
Nonetheless, these groups show lots of resilience and + outcomes

CultureMeaning of behaviors variesExpression of symptoms variesSocial anxiety – fear of evaluation by othersTaijin kyofusho – incapacitating fear of offending or harming others through one’s social awkwardnessRacial/ethnic minority group members often reports physical sx when there is underlying MH problem“I’m having stomachaches” instead of “I’m feeling nervous & anxious”

Question 6

Models of Etiology & Maintenance of Disorder

Answer 6

Diathesis-stress model
The General Diathesis-Stress ModelDiathesisunderlying vulnerability or tendency toward disordercould be biological, contextual, or experience-basedStresssituation or challenge that calls on resourcestypically thought of as external, negative events
Some children are more susceptible to the negative effects of a problematic environment
Peer victimization example:
Jason is a 6-year-old boyHas difficulty controlling his anger - often lashes out and becomes physically and verbally aggressiveAt this school, some of the older kids often pick on the younger onesJason is harassed several times one month, and responds with physical aggression each timeAs a result, he is picked on even moreEventually, Jason becomes very anxious about going to school
Strengths of the Diathesis-Stress ModelOrganizes thinking about nature AND nurture behavior & emotions are complicatedalmost no disorders caused by “just” genes or “just” stressBrain changes (neural plasticity) in response to environmentGenes change in response to environment (behavioral epigenetics)
Simple foundation for complex theoriesdiathesis ≠disorder & stress ≠disorder interaction makes disorder more probable
can have multiple interacting diatheses & stressors

Developmental pathways
The sequence and timing of particular behaviors as well as the relationships between behaviors over time.2 common types:
Multifinality and equifinality
Multifinality: same cause leads to many different possible outcomes.
Ex: Early childhood maltreatment leads to eating disorder, mood disorder, conduct disorder, normal adjustment, etc. MultiFIN = multi outcomes
Equifinality: different causes/beginnings lead to same outcome.
Ex: genetic pattern, familial characteristics, environmental features all lead to conduct disorder.EquiFIN = equal outcome

Question 7

Summary

Answer 7

Abnormal behavior is that which is associated with distress, disability, and increases risk for future impairmentPsychopathology is very commonSome people are at greater risk for different types of psychopathology than are others*Diathesis-stress model is helpful way to think about risk factors and vulnerabilities and to make sense of different developmental trajectories