Chapter 2

Topic: Dimensional and Categorical Models

Notes:

Main idea: Dimensional and categorical models of psychopathology emphasize

different ways of defining and diagnosing disorders.

 Dimensional models:
 Emphasize gradual progression from typical to problematic feelings,
thoughts, and behaviors.
 No clear distinctions between adjustment and maladjustment.
 Also referred to as continuous or quantitative.
 Categorical models:
 Emphasize discrete and qualitative differences in patterns of emotion,
cognition, and behavior.
 Clear distinctions between normal and abnormal.
 Also referred to as discontinuous or qualitative.
 Differences between the models illustrated with the examples of Max and
Anna.
 Neuroscience has led to the mapping of brain structures and rich descriptions
of development, including the exuberant increase in brain connections,
dendritic pruning and synapse elimination, and differences in growth
trajectories in various regions.

Physiological Models:
Physiological models propose that psychological processes and events have a biological,
chemical, genetic, or structural basis. The historical conceptualizations of these models
focused on genes, brain structure, and function, and how they influence development.
Contemporary conceptualizations are more complex and take into account behavior
genetics, gene-by-environment effects, and brain networking across development. Brain
development considers how children's brains adapt to their environments over time in
similar or distinct ways. Specific brain regions are associated with particular types of
activity, and interactions and connectivity among brain regions contribute to overall brain
function. Research on the human connectome makes use of graph theory, diffusion
imaging, and quantitative analysis to map the anatomical and functional features of
complex brain networks. Advancements in neuroscience have led to the mapping of brain
structures over time and to rich descriptions of development. Some brain areas develop
under tight genetic control, while others are more influenced by the environment.
Sensitive periods in brain development have also been identified, and differences in brain
structure, function, and development are observed between typically and atypically
developing individuals.
 The text discusses neural plasticity, which refers to the brain's ability to develop and
modify neural circuits, allowing for new, improved, or recovered function. Both positive
and negative experiences can influence the wiring diagram of the brain, and ongoing
research explores the mechanisms underlying plasticity and stabilization. The balance
between plasticity and stability is critical, and our understanding of genetics, including
genes and heredity, influences our understanding of typical and atypical development.
Behavior genetics, which investigates the joint effects of genes and environments,
provides a framework for understanding many sources of genetic influence. Epigenetics,
the study of how environmental factors influence gene expressivity, can identify
mechanisms by which genes "listen" to the environment, with lifelong impacts on
developmental health. The understanding of physiological models influences what is
known about psychopathology. Certain disorders have a "maturational blueprint" that
relates to damage or dysfunction, while genetically informed models must account for
multiple genetic and nongenetic effects leading to psychological outcomes.

Notes on "Thinking about Max" and "Thinking about Anna":

 Physiological perspective on Max: focus on brain structure and function,

underarousal of key parts of the brain leading to inattentive and impulsive
behavior consistent with ADHD.
 First choice for intervention in Max's case is physiological treatment, such as a
trial of stimulant medication like Ritalin.
 Behaviorally influenced strategies would also be included in Max's
intervention in school and home settings.
 Physiological perspective on Anna: family history of clinical depression
suggests a genetic vulnerability to depression, Anna's symptoms may be a
result of low levels of the neurotransmitter serotonin or dysregulation of
multiple neurotransmitter systems.
 First step in Anna's intervention is a trial of antidepressant medication
designed to correct the biochemical imbalance.
 Treatment recommendations for Anna may also include suggestions for
structured social activities in school.

Psychodynamic models focus on the unconscious processes that influence

personality development, and how conflicts among structures of the mind impact it.
Psychodynamic models are rooted in the work of Sigmund Freud, Erik Erikson, Harry
Stack Sullivan, Margaret Mahler, Donald Winnicott, Robert Emde, and Daniel Stern.
Early psychodynamic models relied on a fixation-regression model of
psychopathology, suggesting that people who fail to work through developmental
issues become "stuck" in the past. Psychodynamic interventions use play and art to
bring repressed traumas and unconscious conflicts into therapeutic awareness.
Contemporary psychodynamic approaches continue to emphasize unconscious
cognitive, affective, and motivational processes, mental representations of self, other,
and relationships, and the meaningfulness of individual experiences. Recent
psychodynamic models take into account recent advances in neuroscience, but there
is still an emphasis on the importance of psychological contexts, such as
relationships, when explaining personality development and psychopathology.
Psychodynamic psychotherapy for children and adolescents also emphasizes the
important role of parents and family members. In considering the cases of Max and
Anna, a psychodynamic perspective would explore dynamic issues that could have
impacted their development, including family relationships and unconscious
conflicts. Treatment strategies may include exploring these issues through art,
games, and imaginative play, and involving the family in sessions.

Title: Behavioral and Cognitive Models: Historical and Current

Conceptualizations

 Behavioral models have an outward orientation, focusing on the individual's

observable behavior in a particular environment, whereas physiological and
psychodynamic models have an inward orientation.
 Environmental variables have powerful effects on the development of
personality and psychopathology in behavioral models.
 Major theorists like B.F. Skinner, Walter Mischel, and Albert Bandura have
described the effects of environmental variables in behavioral models.
 Behavioral models are based on core concepts of learning theories and share
a strong empirical foundation with them.
 Reinforcement is a critical component of all learning processes in behavioral
models.
 Psychopathology in the behavioral framework is understood as the result of
learning gone awry.
 Cognitive-behavioral and cognitive approaches emphasize the ways in which
children's thinking influences learning and the emergence of disorders.
 Contemporary revisions of Piagetian models focus on the dynamic interaction
of tasks, contexts, and emotional states that influence cognition, whereas
probabilistic models focus on innovative interpretations of children's thinking
and learning.
 An understanding of combinations of cognitive deficits is required to explain
disorders accurately.
 Max's and Anna's difficulties may be understood as a reflection of maladaptive
learning, cognitive deficits, or both in the behavioral and cognitive-behavioral
frameworks.

 The humanistic models of development and psychopathology emphasize the

importance of personally meaningful experiences, innate motivations, and the
 child's purposeful creation of self. Carl Rogers and Abraham Maslow are two
of the most prominent figures in this approach. Psychopathology is usually
linked to interference with or suppression of the child's natural tendencies to
develop an integrated sense of self. Intervention involves the discovery or
rediscovery of internal resources and the provision of external support for
self-organization, self-direction, and self-righting capacities.
 The humanistic models have been criticized for being overly optimistic about
the potential for happiness, creativity, and actualization, but they are related
to more recent discussions of the self, wellness, and positive psychology.
Positive subjective experience, positive individual traits, and positive
institutions are being emphasized to promote individual, family, social, and
community well-being. The broaden-and-build theory of positive emotions
explores the ways in which positive experiences lay the groundwork for the
development of well-being and resilience across the lifespan. Positive youth
development in adolescence, involving identifying opportunities for initiative
and engagement, is one application of this model.
 When thinking about Max, a humanistically oriented treatment would focus
on increasing his chances for pleasure and mastery in school. Therapeutic
work may include numerous opportunities for the creation of a valued sense
of self. With a strong belief in the self-righting tendencies of children, it is
expected that Max will be able to use these resources and experience more
rewarding personal, academic, and social outcomes.
 When thinking about Anna, psychotherapeutic challenges that require her to
take charge of planning, decision making, and her own happiness will be
balanced by clear expressions of support and encouragement that she actually
is capable, competent, and uniquely qualified for this responsibility. The
expectation is that individual positive experiences will lead to an upward spiral
of positive emotions and enhanced well-being.

 Title: Family Models - Historical and Current Conceptualizations

 Leo Tolstoy proposed that "happy families are all alike, but every unhappy
family is unhappy in its way" and portrayed the different ways in which misery
and dysfunction can be experienced and expressed within families. However,
different families also have varying ways of experiencing and expressing joy
and commitment, as they have different beliefs, dreams, and fears about
themselves and their children.
 Individual models of disorder focus on the "identified patient" and their
psychological characteristics, while family models propose that understanding
the dynamics of a particular family is the best way to comprehend the
personality and psychopathology of a child. Families are the first setting for
children's experiences, and their influence, particularly that of parents, is
powerful. Families can succeed or fail in meeting a variety of children's needs,
 including nurturing, socializing, promoting education, and providing financial
support.
 Various family characteristics require researchers and clinicians to alternate
between two perspectives on family life: "looking from the inside out and
from the outside in." These include family type, activities, rituals, narratives,
interparental warmth, sibling warmth, and conflict, family hierarchies, and
boundaries, and cohesive or disengaged relationships. Changes in family
relationships over time also need to be considered in understanding children's
development and adjustment in the context of particular family relationships.
 Family factors that impact development and psychopathology require
consideration of various intersections of individual and family processes. For
instance, how subsystems of the larger family system interact with one
another to influence child outcomes. The parent-child relationship, particularly
parental control, is often studied. Recent research emphasizes a more
interactional approach and describes several parenting profiles and
connections to adaptive and maladaptive outcomes.
 Shared environment, which is what is not explained by genes, and non-shared
environment are two important contributors to mental health outcomes such
as well-being or psychopathology. Shared environments are an essential
contributor to mental health outcomes, while non-shared environments
contribute to sibling dissimilarity.

The text discusses sociocultural models of development and psychopathology,

focusing on the ways in which social and cultural factors uniquely disadvantage
certain groups in society and increase vulnerability to disorders in these groups. The
impact of poverty on the physical and mental health of children and adolescents is
highlighted, as well as the paradigm shift in which cultural considerations have
moved from the periphery of inquiry to the core. The text also explores the different
ways in which culture influences adjustment and maladjustment, including cross-
cultural and within-culture variables. The concept of birth cohort is discussed, as well
as the influence of diverse family contexts on sibling experiences. Finally, the text
explores the possibility that transactions among multiple components of culture,
such as race, family makeup, socioeconomic status, and geographic location, can
have an impact on children's development.

Chapter 3
Title: The Framework of Developmental Psychopathology

 Developmental psychopathology is a conceptual approach that helps

understand the development of specific disorders, the progression of
disorders in children over time, and how to help these children.
 Developmental psychopathology is not tied to a single point of view; rather, it
incorporates a variety of assessment, prevention, and intervention techniques
 from other disciplines such as psychiatry, social work, education, and public
policy.
 Psychopathology in children is an adaptational failure characterized by the
deviation from age-appropriate norms, exaggeration or diminishment of
normal developmental expressions, interference in normal developmental
progress, failure to master age-salient developmental tasks, or failure to
develop a specific function or regulatory mechanism.
 Adaptational failures are categorized as delay, fixation, or deviance,
highlighting a particular child's difficulties at a specific point in time.
 Children's psychopathology unfolds over time as an ongoing activity, with
small problems leading to larger or different problems.
 Developmental psychopathologists make use of both photographs and videos
to capture the essence of children's psychopathology, as single photographs
may miss some details, while videos provide a more dynamic perspective.

 Title: Developmental Pathways, Stability, and Change

 The text explains the concept of developmental pathways, which refers to
different ways children can grow up and how early difficulties may lead to
adaptation or maladaptation in the future. The developmental pathways
perspective considers the cumulative nature of development and characterizes
pathways as probabilistic rather than deterministic. Pathways can be broad or
narrow, with recent work recognizing the role of parents in shaping children's
pathways.
 The equifinality and multifinality concepts refer to the similarities and
differences in individual pathways to a disordered outcome. Equifinality means
that different beginnings result in similar outcomes, while multifinality means
that similar beginnings result in different outcomes. Both these concepts are
concerned with the variables that influence children's developmental
pathways.
 The discussion of developmental pathways has emphasized stability and the
ways in which maladaptation continues over time and place. However,
developmental pathways also encompass change and transformation, and
change is possible at many points but constrained or enabled by previous
adaptations. The transitions and turning points of developmental pathways
are influenced by both intrinsic and extrinsic factors.

Title: Competence and Incompetence

 Competence reflects effective functioning in important environments.

 Well-being is not an all-or-nothing phenomenon.
  Most typically developing children are more competent in some areas than
others.
 Competence involves a child's skills and talents, beliefs about his or her
effectiveness, personality characteristics, and accomplishments.
 The study of competence takes into account sociocultural expectations, valued
outcomes, and environmental contexts that influence children's adjustment or
maladjustment.
 Carlos is a talented student in math and science, struggling to feel
comfortable with his family.
 Jasmine is an outstanding athlete, but she functions poorly in the school
setting due to her poor reading skills and difficulty comprehending complex
content.
 Children's developmental outcomes are not altogether competent or
altogether incompetent, but a combination of both.

The text discusses the concepts of risk and resilience in children's development and
functioning. Risk factors are defined as individual, family, and social characteristics
that increase vulnerability to disorder, while resilience is defined as adaptation
despite adversity. The early work on risk and resilience was focused on the
developmental outcomes of children of parents with schizophrenia. There are two
types of risk: nonspecific risk and specific risk. Poverty is an example of nonspecific
risk, while a genetic condition that interferes with the metabolism of phenylalanine is
an example of specific risk. Risk factors are not all-or-nothing events; they are
complex and dimensional. Risk factors can be individual, family, or social. Gender,
genetics, and temperament are individual risk factors, while family risk factors include
parental psychopathology, punitive styles of parenting, and chronic conflict between
parents. Social risk factors include neighborhood, socioeconomic status, and cultural
characteristics. Stressful or adverse life events such as divorce or parental
unemployment are also types of risk factors. The total number of risk factors that
children experience is more important than the particular type of risk factors.

The text discusses resilience and protective factors. Resilience is adaptation in the
face of adversity, and not simply doing well when all circumstances are favorable. It is
a process that develops over time and is embedded in particular contexts. There are
three types of resilient children: those with many risk factors who have good
outcomes, those who continue to display competence when experiencing stress, and
those who display good recoveries following stress or trauma. Children's resilience is
achieved by interacting with their families, social and community groups, and culture
to achieve individual and culturally relevant resilience. Protective factors are
individual, family, and social factors that help children in difficult situations.
Personality characteristics such as sunny dispositions, conscientiousness, and
agreeable behaviors are frequently noted individual factors. Having supportive,
emotionally available, and determined parents, family cohesion and warmth, and
positive relationships with siblings and friends are also protective factors. Children
who live in ethnic, cultural, and religious groups where their well-being is a
communal responsibility may have access to support and resources that other
children do not. Resilience rests on relationships.

The text discusses the research strategies in developmental psychopathology,

including cross-sectional and longitudinal approaches, complex hypotheses and
models, and research in real-world settings with practical applications. Cross-
sectional research involves data collection at a single point in time, with comparisons
made among groups of participants. Longitudinal research involves the ongoing
collection of data from the same group of participants over time, allowing for the
interpretation of data with respect to age and individual differences. Developmental
cascades, positive or negative, require longitudinal research. Researchers include
biological, psychological, and social variables in their studies. The text provides
examples of longitudinal methodologies and goals, such as Murphy's studies of
children's coping and the Great Smoky Mountains Study. The text also mentions that
research designs are becoming more complicated, with researchers now including
macrosystems such as culture in their studies. The text concludes by discussing the
complexity of research on child maltreatment, with investigators accounting for
multiple characteristics of that variable.

Disorders of early childhood

Developmental Tasks and Challenges Related to Physiological Functioning,
Temperament, and Attachment

Psychological functioning
 Infants' interaction with personal and material worlds promotes physical,
emotional, intellectual, and social development.
 Three biobehavioral shifts signal important intrapersonal and interpersonal
changes:
1. Occurs between two and three months of age
2. Occurs between seven and nine months of age
3. Occurs between 18 and 20 months of age
 Sleep-wake system undergoes dramatic change over the early months and
years of life.
 High-quality sleep is associated with emotion processing, cognitive
development, behavior regulation, adjustment, and well-being across the
lifespan.
 Parents play a key role in structuring and supporting infant and child sleep.
 Sociocultural factors influence the development of sleeping patterns, such as
beliefs about sleep and preferences for children sleeping together or apart
from parents.
Temperament
The text discusses the construct of temperament and its various dimensions, which
include reactivity and regulation. Reactivity refers to the infant’s excitability and
responsiveness, while regulation involves what the infant does to control his or her
reactivity. Both reactivity and regulation are influenced by physiological factors, such
as neurotransmitter functioning and brain connectivity. The text also describes
several temperament traits that reflect the combined influence of genetics,
physiology, and the maturation and increasing coordination of physiological and
psychological systems, including surgency, negative affectivity, and effortful control.

The influence of caregivers on infant temperament is also discussed, with an

emphasis on the important dimensions of warmth and positive and negative control.
Sensitive caregiving is associated with positive changes in infants’ stress-reactive
hormones, while less sensitive parenting is correlated with ongoing negative
affectivity. Caregivers also influence regulation, including the ways that infants
depend on active regulation by others and the ways that caregivers support infants’
own attempts at self-regulation.

Attachment

In infancy, there are different types of babies and caregivers, and each baby has its
own characteristics and needs. By the end of the first year, most infants, together
with their caregivers, have accomplished several key tasks and challenges, including
the development of an attachment relationship, a rudimentary sense of self, and a
basic understanding of others and the world.

Attachment relationships reflect the degree to which infants experience safety,

comfort, and affection, and it is the significant psychological achievement of late
infancy. The most critical advantage of attachment is to ensure the protection and
survival of the infant. Caregivers provide a safe haven, allow for proximity
maintenance, and establish a secure base, a person whose presence serves as a
source of security from which a child ventures out to explore the world and to which
he or she can reliably return.

Infants and toddlers share a variety of positive and negative experiences and
exchange relevant emotions, actions, and appraisals with their caregivers. They also
balance their wishes to explore with their ongoing concerns for maintaining
interpersonal connections.

Patterns of attachment can be broadly characterized as secure or insecure, and

individual differences emerge from particular caregiving and relationship histories
that become internalized early in development. Caregiver sensitivity, availability, and
responsiveness—or insensitivity, unavailability, or unpredictability—contribute to
infants’ and toddlers’ emotionally salient beliefs and expectations related to self,
significant others, and the world.

Patterns of secure attachment, in general, reflect caregiving histories in which the

caregiver responds sensitively, consistently, and appropriately to an infant’s physical,
emotional, and social needs. In contrast, patterns of insecure attachment develop
over time as a result of inconsistent, inadequate, or unavailable care, with such
caregiver inadequacies sometimes interacting with difficult infant characteristics
and/or environmental stressors. Patterns of infant insecurity are usually interpreted in
terms of resistant, avoidant, and disorganized attachments.

Temperament, Attachment, and Psychopathology

 Some infants and children exhibit temperament traits and attachment patterns
that can be roots of later child and adult psychopathology, instead of being
variations in personality.
 Risk factors are factors that increase the likelihood of a child developing or
experiencing psychopathology.
 Research has shown that difficult temperament in children, characterized by
underregulation or overregulation and high negative affectivity/low effortful
control, increases the risk of externalizing disorders.
 Temperamental exuberance is associated with positive social outcomes and
risk-taking behavior.
 Children with inhibited temperaments may have higher risk for developing
internalizing disorders, but lower risk for externalizing disorders, which could
be due to greater behavioral flexibility in challenging circumstances.
 Researchers have examined the role of caregivers' responses to their inhibited
children, and report that overinvolved, controlling, or intrusive parents may
lead to poorer outcomes.
 Insecure attachments are risk factors that can lead to both internalizing and
externalizing disorders, and can affect social skills and outcomes in childhood
and relationships in later life.
 Disorganized attachments are associated with a greater risk of externalizing
symptoms in boys compared to girls.

Disorders of Early Development

The article discusses the importance of early identification and treatment of atypical
patterns of feeding, sleeping, and attachment in young children to improve
immediate and long-term outcomes. It identifies two types of feeding disorders, pica
and rumination, that are dramatic but infrequently observed, and a more common
feeding disorder, avoidant/restrictive food intake disorder, which is related to not
eating enough for typical growth and development.
Avoidant/Restrictive Food Intake Disorder
 There are few categories of feeding disorders due to difficulty in determining
when feeding problems become disorders
 25-45% of typically developing children and up to 80% of developmentally
delayed children experience feeding problems
 Efforts to identify subtypes based on cause, course, and treatment, including
limited appetite, selectivity, and fear of feeding
 Avoidant/restrictive food intake disorder is one of the eating disorders
described in DSM-5
 Feeding involves integration of internal and relational processes; infant
characteristics that underlie this process include hunger and satiety, oral-
sensory and oral-motor functioning, developmental readiness, and past
feeding experiences
 Feeding difficulties may be the result of developmental delays, genetic
conditions, or abnormalities of oral anatomy
 Temperament differences, traumatic events, and parenting styles may also
contribute to the emergence of feeding disorders
 Ongoing feeding problems may have a negative impact on the caregiver,
causing distress and dysfunction, and may be associated with poor growth
and compromised development.

Sleep-Wake Disorders
 DSM-5 describes several sleep-wake disorders diagnosed in both adults and
children, including insomnia, disorders of arousal, and nightmare disorder.
Estimates of sleep problems in children are high and may be even higher for
atypically developing children.
 Sleep difficulties in children negatively affect their daytime emotions, moods,
attention, cognitive activities, and social relationships. Tired and distressed
children are also likely to have tired and distressed parents, leading to
negative impacts on parents' self-efficacy, marital satisfaction, and overall
family climate.
 Individual variations in the ability to self-regulate and self-soothe are
frequently mentioned as contributing to sleep difficulties, as well as the child
being diagnosed with a medical condition that makes sleep difficult or a
neurodevelopmental disorder. Parent factors such as problematic cognitions
related to setting limits, anxiety and/or depression, and marital difficulties also
increase the likelihood of sleep disorders.
 Sleep onset problems such as bedtime resistance and bedtime struggles
remain stable or increase in frequency or severity. Although many sleep
difficulties and disorders resolve over time, many persist. Night waking
problems tend to decrease over time.
  Sleep is the primary activity of the brain during infancy, and adequate, good-
quality sleep is essential for cognitive, emotional, and social development, as
well as overall well-being.

Disorders of Attachment
 Some young children have extreme attachment-related distress and
dysfunction that can be diagnosed as a clinically significant disorder.
 DSM-5 describes two categories of attachment disorders: reactive attachment
disorder (RAD) and disinhibited social engagement disorder (DSED).
 Children with DSED show a lack of wariness, inappropriate approach to
strangers, and lack of physical and social boundaries. They exhibit socially
superficial behavior, attention seeking, and inappropriate physical contact.
 Children with disorders of attachment may follow various developmental
pathways, including both resilience and psychopathology.
 Disordered attachment affects children's relationships and has negative effects
on their physiological, emotional, behavioral, and cognitive domains.
 Cognitive components of attachment and the development of internal models
and mental representations provide a theoretical basis for the association
between attachment disorders and cognitive difficulties.
 For children with RAD, improvements occur when they are placed in better
caregiving environments. For children with DSED, many difficulties persist
even in more favorable caregiving environments.
 Longer periods spent in institutions are associated with more persistent
difficulties for children with DSED.
 Depression appears more often in children with RAD, and impulsive disorders
appear more often in children with DSED.
 The etiology of disorders of attachment is based on what is known about the
development of insecure patterns in typical and at-risk children.

In summary, prevention strategies for disorders of attachment can be categorized as

universal, selective, and indicated measures. Universal measures are designed for the
general population, selective measures target groups at above-average risk, and
indicated measures are for groups with specific risk factors that require more
extensive help. Some prevention measures include early child education programs,
psychodynamic filial therapy, and the STEEP model. Prevention-oriented intervention
can also be provided to caregivers at high risk for maltreatment, such as the
Attachment and Biobehavioral Catch-up (ABC) program. Therapeutic approaches for
children already diagnosed with reactive attachment disorder or disinhibited social
engagement disorder include establishing a safe and stable caregiving environment
with a warm and consistent caregiver, with the goals of enhancing adaptive
behaviors and decreasing maladaptive behaviors. Attachment-based strategies can
be used to support therapy goals, and infant-parent psychotherapy based on
Fraiberg's work is a collaborative endeavor with a joint emphasis on what the parent
and the child each bring to the difficult relationship. The preferred goal for children
in orphanages is out-of-institution placement into adoptive families or foster homes,
but when family care is not possible, providing the best possible care should be the
focus of child welfare policies.

Autism Spectrum Disorder