PSYCHOPATHOLOGY OF

CHILDHOOD
 The Beginning

 Recognition of clinical child psychology as a

unique discipline has only emerged in the past
30 years.
 The need to protect children’s rights concerning
health and education, to provide protection
within the judicial system, and to free children
from working within the adult workforce.
The Beginning
The Beginning
The Beginning
The Beginning
The Beginning
 The Beginning

 Abnormal behavior in children continued

to be interpreted from the vantage point
of adults, and thus childhood
maladjustment was described in adult
terms and treated with adult treatment
methods.
 The Beginning

 The current trends are to refine our

understanding of how many characteristic
features of these child and adolescent disorders
differ from adult disorders.
 Since the 1970s, several journals have emerged
that are exclusively devoted to research about
child and adolescent clinical concerns.
 The Beginning

 In the mid-1980s, the domain of

developmental psychopathology emerged as
an offshoot of developmental psychology.
 Within this framework, atypical behavior is
conceptualized as deviating from the normal
developmental pathway.
 …Now
 Principles of developmental psychopathology define a system
that considers human development as holistic and hierarchical:
 Holistic: the interactive and dynamic concept of the total
child.
 Hierarchical: movement toward increasing complexity.
 Increased emphasis has been placed on determining processes
that can inhibit (protective factors) or escalate (risks) the
development of maladaptive behaviors.
 …Now

 Increased emphasis has been placed on

determining processes that can inhibit
(protective factors) or escalate (risks) the
development of maladaptive behaviors.
 …Now

 Conceptually, because normal and abnormal

behaviors stem from the same developmental
principles and are part of the same
continuum, increased emphasis is placed on
having knowledge of normal behavior (its
stages and underlying processes) as a
precursor to abnormal behaviors.
 Same Main Symptoms with Different
Diagnosis
 The Cases of Jason, Winnie, and Brian (fourth-grade – 9 years old):
 All the three children have been rated as demonstrating the
following behaviors (by teachers):
 Problems sustaining attention.
 Loses things necessary for school tasks.
 Easily distracted.
 Forgetful and restless.
 Don’t seem to listen.
 Don’t complete assignments.
 Demonstrate poor follow-through.
Same Main Symptoms with Different
Diagnosis
 Same Main Symptoms with Different
Diagnosis
 All three children scored within the average
range on the Otis-Lennon group intellectual
screening test given during the previous
third-grade school year (examples):
 Same Main Symptoms with Different
Diagnosis
 Is a diagnosis of attention-
deficit/hyperactivity disorder (ADHD) an
appropriate classification for Jason,Winnie, or
Brian? Why?
 Same Main Symptoms with Different
Diagnosis
 According to the DSM-5 all three children demonstrate
many symptoms associated with ADHD.
 In order for the psychologist to diagnose whether
the three children have ADHD or rule out the
possibility of ADHD in favor of a different diagnosis
(differential diagnosis); more information is required
from several key sources, including the home and
school environments.
 Same Main Symptoms with Different
Diagnosis
 Therefore, the psychologist schedules interviews
with all three parents to obtain additional
information.
 Differential diagnosis: there is more than one
possibility for the diagnosis. The psychologist must
differentiate between these to determine the
actual diagnosis and appropriate treatment plan.
 Same Main Symptoms with Different
Diagnosis
 Provisional Diagnosis: The psychologist is
not 100% sure of a diagnosis because
more information is needed. With a
provisional diagnosis, the psychologist
makes an educated guess about the most
likely diagnosis.
 The case of Brian
 The source: His mother.
 The assessment tool: interview.
 Complaint history: Always been this way.
 Description and indicators:
 Space cadet.
 Misplace things
 Gets distracted when trying to do his homework.
 Eats standing up and is always on the go.
 restless, active, and distracted (like his father).
 Bright boy (According to his mother and teacher).
 Everything seems to take his attention away from the task at hand.
 The case of Brian
 Case formulation: the psychologist develops a case
formulation which a hypothesis about why the
problem behavior exists and how it is being
maintained.
 The case formulation is based on information
obtained from the family history, consistency in
Brian’s behaviors across situational contexts (home
and school), and the longevity of the problem.
 The case of Brian

 The psychologist is now more confident in

suggesting that Brian does have ADHD
(provisional diagnosis).
 The case of Winnie
 The source: His mother (arrives at the interview out of
breath and very anxious to hear about her daughter).
 The assessment tool: interview.
 Complaint history: The stage of infancy.
 Description and indicators:
 Real worrier and very timid.
 As an infant; she was cautious, fearful, sensitive to noises and touch.
 Slow to warm up to others.
 Socially, Winnie has a few close friends.
 The case of Winnie
 Description and indicators:
 Homework is a painful process, as perfectionistic
tendencies get in the way of completing
assignments.
 Winnie keeps erasing her work.
 Winnie is often overwhelmed by tasks and appears
inattentive, distracted, and forgetful.
 The case of Winnie

 Provisional diagnosis is general anxiety

disorder (GAD), but the psychologist also
needs to rule out possible obsessive-
compulsive disorder (OCD).
 The Case of Jason
 The source: His foster mother with her social worker.
 The assessment tool: interview.
 Complaint history: This is Jason’s fourth foster
placement in the past 2 years. He has been in his
current foster placement for the past 6 months.
According to the social worker, he was a witness to
family violence from an early age.
 The Case of Jason
 Jason’s family was well known to Social Services, and
Jason has been in care several times in the past for
reported neglect and possible abuse.
 Shortly after Jason and his brother rejoined their parents 2
years ago, Jason’s father shot his mother and then himself,
while Jason and his younger brother slept in an adjoining
bedroom.
 Jason has been receiving play therapy for the past 2 years.
 The Case of Jason
 Description and indicators:
 Jason continues to have trouble sleeping and is often
agitated and restless.
 In relationships, his behavior vacillates between being
overly inhibited (shy and withdrawn) or disinhibited
(socially precocious).
 His ability to sustain his attention and concentration is
impaired, and he is often forgetful and appears
disorganized.
 The Case of Jason

 Provisional diagnosis is chronic

posttraumatic stress disorder (PTSD), but
an attachment disorder (reactive
attachment disorder [RAD] or disinhibited
social engagement disorder [DSED]) and
ADHD also need to be ruled out.
 Same Main Symptoms with Different
Diagnosis
 The process of DSM-5 differential diagnosis can be broken down
into six basic steps:
1. Ruling out malingering and factitious Disorder.
2. Ruling out a substance etiology.
3. Ruling out an etiological medical condition.
4. Determining the specific primary disorder(s).
5. Differentiating Adjustment Disorder from the residual Other
Specified and Unspecified conditions.
6. Establishing the boundary with no mental disorder.
 Ruling out malingering and factitious
Disorder
 Fake symptoms.
 Ruling out a substance etiology

 Certain drugs (both legal and illegal) can cause

the same symptoms as depression when
misused or used as prescribed.
 Ruling out an etiological medical
condition
 Psychologist will ask about previously diagnosed
conditions. They are particularly interested in
those that may have begun around the same
time. Lab tests may be ordered to screen for
conditions commonly associated with the
symptoms of specific disorder.
 Determining the specific primary
disorder
 Psychologist must differentiate the specific
disorder from related disorders or other
disorders which often coexist. This is done by
following the criteria established in the DSM-5.
 Differentiating Adjustment Disorder
from the residual Other Specified and
Unspecified conditions
 The psychologist must consider a diagnosis of
adjustment disorder.
 This is a condition in which the symptoms are
maladaptive -not typical- in response to the
psychological stressor.
 This means that the symptoms keep individual
from coping with the disorder.
 Differentiating Adjustment Disorder
from the residual Other Specified and
Unspecified conditions
 Some common examples of maladaptive
behavior include avoidance, passive
communication, anger, and substance use.
 If that category is not appropriate, they could
then consider placing the diagnosis into either
"other" or "unspecified" categories.
 Differentiating Adjustment Disorder
from the residual Other Specified and
Unspecified conditions
 Establishing the boundary with no
mental disorder

 Psychologists need to make a judgment

call. They need to determine whether the
individual is experiencing significant
impairment or distress in everyday life that
would qualify as a mental disorder.
 Related Disorders According to DSM-5
 Attention-Deficit/Hyperactivity Disorder (ADHD) (P.
59).
 Generalized Anxiety Disorder (GAD) (P.222).
 Obsessive-Compulsive Disorder (OCD) (P.237).
 Posttraumatic Stress Disorder (PTSD) (P. 271).
 Reactive Attachment Disorder (RAD) (P. 265).
.‫ اضطراب التعلّق التفاعلي‬
 Related Disorders According to DSM-5
 Disinhibited Social Engagement Disorder (DSED) (P.
268).
‫ أ و اضطراب جرأ ة المشارك ة‬،‫ اضطراب المشارك ة االجتماعي ة المتحل ل‬
.‫االجتماعيَّة‬
 Oppositional Defiant Disorder (ODD) (P. 426).
.‫ اضطراب التحدي المعارض‬
 Conduct Disorder (CD) (P. 469).
 Distinguishing Normal From Abnormal
Behavior
 One way of measuring how the behavior compares to
normal expectations is the use of “the four Ds” as a
guideline to evaluating the behavior:
 Deviance.
 Dysfunction.
 Distress.
 Danger.
 Deviance …
 Determining the degree that behaviors are deviant from the
norm can be assisted through the use of informal assessment
(interviews, observations, symptom rating scales) or more
formal psychometric test batteries (personality assessment).
 Intensity, duration, frequency, pervasive across situations,
and severity of the behavior in terms of (mild, moderate, or
severe). Comparing with population in specific age.
 Dysfunction …
 Once a disorder is identified, the relative impact of the
disorder on the individual’s functioning must be determined.
 Child clinicians may be interested in the degree of
dysfunction in such areas as school performance (academic
functioning) or social skills.
 Dysfunction (the extent of developing appropriate skills in
areas of self-control or social relationships).
 Distress …
 An area closely related to dysfunction is the degree of
distress the disorder causes. Children often have difficulty
articulating feelings and may provide little information to
assist the clinician in determining distress.
 Interviews with parents and teachers can provide
additional sources of information. Some disorders may
present little distress for the individual concerned but
prove very distressing to others.
 Danger …

 In order to determine whether a given

behavior places an individual at risk, two
broad areas are evaluated: risk for self-
harm and risk of harm to others (abuse,
neglect, suicide intent, and bullying).
 Normal and Abnormal Behaviors:
Developmental Considerations
 Evaluation of psychopathology from a developmental
perspective requires the:
 Integration of information about child characteristics
(biological and genetic) and environmental characteristics
(family, peers, school, neighborhood). Therefore,
 Requiring an understanding of the nature of cognitive,
social, emotional, and physical competencies, limitations,
and task expectations for each stage of development.
 The Impact of Theoretical
Perspectives
 The ability to distinguish normal from
abnormal behavior and to select
developmentally appropriate child
interventions can be guided by
information obtained from various
theoretical frameworks.
 The Impact of Theoretical
Perspectives
 Different theoretical perspectives can
provide the clinician with guidelines
concerning expectations for social,
emotional, cognitive, physical, and
behavioral outcomes.
 The Impact of Theoretical
Perspectives
 In addition, a therapist’s theoretical
assumptions will also influence how the
disorder is conceptualized and guide the
course of the treatment focus.
Examples of Developmental Tasks,
Competencies, and Limitations
Examples of Developmental Tasks,
Competencies, and Limitations
Examples of Developmental Tasks,
Competencies, and Limitations
Examples of Developmental Tasks,
Competencies, and Limitations
Examples of Developmental Tasks,
Competencies, and Limitations
 Developmental Theories…

 Neurobiological Theories.
 Psychodynamic Theories and Theories of Attachment.
 Behavioral Theories (positive and negative reinforcement/
positive and negative punishment).
 Cognitive Theories.
 Social cognitive theories.
 Cognitive-behavioral theories.
 Theories of Parenting and Family Systems Theory.
 Developmental Theories…

 Parenting Styles:
 Authoritarian style (high on structure, low on
warmth) aggressive and uncooperative,
fearful of punishment, weak on initiative, self-
esteem, and peer competence.
 Developmental Theories…

 Parenting Styles:
 Permissive Style: (high on warmth, low on
structure) fail to develop a sense of
responsibility and self-control.
 Developmental Theories…

 Parenting Styles:
 Authoritative Style: (high on warmth and high
on structure) provide the optimum conditions
for growth, and as a result children often
demonstrate high degrees of self-reliance,
self-esteem, and self-controlled behaviors.
 Developmental Theories…

 Family Systems:
 Subsystems, boundaries, alignment, power.
Structural, hierarchal, communication,
interactions, rules, maintaining problems,
triangular relationships … etc.
 Influences and Developmental Change

 Ecological systems theory: (microsystem,

mesosystem, exosystem, macrosystem,
bioecological factor, chronosystem).