Lecture 1: Introduction
From Normal to Abnormal
Definitions
How to define normal (typical) vs abnormal (atypical)?
1. Normal as absence of disorders.
● Normal: positive quality of life; function well in different contexts; free of disabling symptoms of
psychopathology.
● Abnormal: negative quality of life; function poorly; symptoms that form a recognizable pattern
(syndrome) of psychopathology; fitting a clinical classification.
● Mental Health perspective (P&T).
2. Normal as statistical average.
● Normal: behaviour that occurs in the majority of the population.
● Abnormal: behaviour that occurs in a minority of the population.
● Statistical deviance (P&T).
3. Normal as an ideal or desired state.
● Normal: meeting social-cultural standards of healthy psychological development.
○ Can be age.related, gender-specific, or culture-relevant expectations.
● Abnormal: not meeting those standards.
● Sociocultural norms (P&T).
4. Normal as successful adaptation.
● Adaptation: ability of a person to adapt to his or her environment.
● Normal: successful adaptation (adequate or optimal); one can deal effectively and flexibly with
various possibilities and difficulties that arise in everyday life.
● Abnormal: poor adaptation.
Disclaimer:
● In some situations, there is clear distinction between normal and abnormal.
● Usually a large grey area: depending on the observer, instrument or situation.
● Knowledge of normal development is required.
Developmental Psychopathology
Psychopathology: refers to the intense, frequent, and/or persistent maladaptive patterns of emotion,
cognition and behaviour.
Developmental Psychopathology: these maladaptive patterns occur in the context of typical development
and result in the current and potential impairment of infants, children and adolescents.
Prevalence: the proportion of a population with a disorder (number of current cases).
Incidence: the rate at which new cases arise (all new cases in a given time period).
Kessler et al., (2005)
● Median age of onset is much earlier for anxiety (11yrs) and impulse-control (11yrs) disorders than for
substance use (20yrs) and mood (30yrs) disorders.
● ½ of all lifetime classes start by age 14 and ¾ by age 24.
, – in english-speaking countries.
Stigma & Barriers
They are composed of stereotypes, prejudice and discrimination. There are multiple levels: public, personal
and self-stigma (or internalised stigma). These can be harmful, and may prevent people from seeking help.
Stigma can be fueled by reification (naming and explaining are confused).
Do we reach all the children that need help?
● Of children with problems, only 20% received formal guidance, and 35% support through informal
services (teacher, etc), (Zwaanswijk et al., 2006).
Barriers to Mental Health Care
● Perceptions of mental health and child welfare (e.g. lack of confidence in the system, previous negative
experiences, stigma).
● Perceptions of psychological problems (e.g. denial, beliefs that difficulties resolve all the time).
● Structural (e.g. long waiting lists, high personal cost).
Implications:
● Negative impact is greatest when problems remain untreated for a long time.
● Approximately 20% of children with severe or chronic disorders…
○ Will experience lifelong difficulties.
○ Are less likely to finish school.
○ Have more social problems and psychiatric disorders.
● 80% of children with issues are treatable!
Theoretical Models
What is going on?
1. What is the etiology (cause), in terms of either biological, psychological and contextual processes?
2. Which multi-dimensional models are required to explain the causes and consequences of behaviour?
Theoretical Explanatory Models
They are often presented separately, but they are not mutually exclusive. They usually form complementary
perspectives and complex clinical patterns.
2 Types of Explanatory Models:
● Continuous models (Dimensional): gradual scale from normal to abnormal.
, ● Discontinuous models (Categorical): bounded and qualitative differences between normal and
abnormal development.
1. Physiological Models
Physiological (i.e. genetic, structural, biological or chemical) basis for psychological problems.
Brain Development:
● Pruning: competitive loss of synapses – use it or lose it.
● Fewer, but stronger and faster pathways.
● Experience-dependent plasticity.
Interactions with Environment:
● Diathesis (predisposition): physiological vulnerabilities (e.g. genetic, brain
injury).
● Stress: physiological or environmental. The interaction may lead to the
development of a disorder.
● Gene-By-Environment (G*E) Effects and Interactions
2. Psychodynamic Models
Early psychodynamic models were scientifically dubious…Sigmund Freud, Carl Jung…
Contemporary psychodynamic models focus on:
● Unconscious process.
● Mental representations of the self, other & relationships.
● Subjective experiences.
● Origins of (a)typical personality in early childhood (developmental challenges)
3. Behavioural & Cognitive Models
● Behavioural Models: environment has powerful effects on development of personality and
psychopathology.
○ (A)typical behaviours are acquired via learning processes (e.g. reinforcement).
● Cognitive Models: focus on processes of the mind and cognitive development (e.g. Piaget’s stages,
Vygotsky).
○ Cognitive Behavioural Therapy (CBT): manage problems by changing the way someone thinks
and behaves.
, 4. Humanistic Models
● Emphasises personally meaningful experiences, innate motivations for healthy growth, and the child’s
purposeful creation of self (e.g. Maslow).
● Contrasts with psychodynamic models (conscious vs unconscious, positive vs negative human
traits).
● Psychopathology: interference/suppression of these needs.
5. Family or Systemic Models
● Understanding of personality and psychopathology of the child based on family dynamics.
● Topics: family type, parenting styles, parent-child relationship, sibling relationship.
● Shared and Nonshared (unique).
● Diagnostics and therapy focus on the child within the family setting.
6. Sociocultural Models
● Culture is not only the background for development; rather it is the major influence on development
itself.
● Examples; gender, ethnicity and socioeconomic status.
● Settings of ecological models include home, classroom, neighbourhood (embedded in meso, eco,
macro and chrono* systems).
○ *birth cohort (share key experiences and events).
From Normal to Abnormal
Definitions
How to define normal (typical) vs abnormal (atypical)?
1. Normal as absence of disorders.
● Normal: positive quality of life; function well in different contexts; free of disabling symptoms of
psychopathology.
● Abnormal: negative quality of life; function poorly; symptoms that form a recognizable pattern
(syndrome) of psychopathology; fitting a clinical classification.
● Mental Health perspective (P&T).
2. Normal as statistical average.
● Normal: behaviour that occurs in the majority of the population.
● Abnormal: behaviour that occurs in a minority of the population.
● Statistical deviance (P&T).
3. Normal as an ideal or desired state.
● Normal: meeting social-cultural standards of healthy psychological development.
○ Can be age.related, gender-specific, or culture-relevant expectations.
● Abnormal: not meeting those standards.
● Sociocultural norms (P&T).
4. Normal as successful adaptation.
● Adaptation: ability of a person to adapt to his or her environment.
● Normal: successful adaptation (adequate or optimal); one can deal effectively and flexibly with
various possibilities and difficulties that arise in everyday life.
● Abnormal: poor adaptation.
Disclaimer:
● In some situations, there is clear distinction between normal and abnormal.
● Usually a large grey area: depending on the observer, instrument or situation.
● Knowledge of normal development is required.
Developmental Psychopathology
Psychopathology: refers to the intense, frequent, and/or persistent maladaptive patterns of emotion,
cognition and behaviour.
Developmental Psychopathology: these maladaptive patterns occur in the context of typical development
and result in the current and potential impairment of infants, children and adolescents.
Prevalence: the proportion of a population with a disorder (number of current cases).
Incidence: the rate at which new cases arise (all new cases in a given time period).
Kessler et al., (2005)
● Median age of onset is much earlier for anxiety (11yrs) and impulse-control (11yrs) disorders than for
substance use (20yrs) and mood (30yrs) disorders.
● ½ of all lifetime classes start by age 14 and ¾ by age 24.
, – in english-speaking countries.
Stigma & Barriers
They are composed of stereotypes, prejudice and discrimination. There are multiple levels: public, personal
and self-stigma (or internalised stigma). These can be harmful, and may prevent people from seeking help.
Stigma can be fueled by reification (naming and explaining are confused).
Do we reach all the children that need help?
● Of children with problems, only 20% received formal guidance, and 35% support through informal
services (teacher, etc), (Zwaanswijk et al., 2006).
Barriers to Mental Health Care
● Perceptions of mental health and child welfare (e.g. lack of confidence in the system, previous negative
experiences, stigma).
● Perceptions of psychological problems (e.g. denial, beliefs that difficulties resolve all the time).
● Structural (e.g. long waiting lists, high personal cost).
Implications:
● Negative impact is greatest when problems remain untreated for a long time.
● Approximately 20% of children with severe or chronic disorders…
○ Will experience lifelong difficulties.
○ Are less likely to finish school.
○ Have more social problems and psychiatric disorders.
● 80% of children with issues are treatable!
Theoretical Models
What is going on?
1. What is the etiology (cause), in terms of either biological, psychological and contextual processes?
2. Which multi-dimensional models are required to explain the causes and consequences of behaviour?
Theoretical Explanatory Models
They are often presented separately, but they are not mutually exclusive. They usually form complementary
perspectives and complex clinical patterns.
2 Types of Explanatory Models:
● Continuous models (Dimensional): gradual scale from normal to abnormal.
, ● Discontinuous models (Categorical): bounded and qualitative differences between normal and
abnormal development.
1. Physiological Models
Physiological (i.e. genetic, structural, biological or chemical) basis for psychological problems.
Brain Development:
● Pruning: competitive loss of synapses – use it or lose it.
● Fewer, but stronger and faster pathways.
● Experience-dependent plasticity.
Interactions with Environment:
● Diathesis (predisposition): physiological vulnerabilities (e.g. genetic, brain
injury).
● Stress: physiological or environmental. The interaction may lead to the
development of a disorder.
● Gene-By-Environment (G*E) Effects and Interactions
2. Psychodynamic Models
Early psychodynamic models were scientifically dubious…Sigmund Freud, Carl Jung…
Contemporary psychodynamic models focus on:
● Unconscious process.
● Mental representations of the self, other & relationships.
● Subjective experiences.
● Origins of (a)typical personality in early childhood (developmental challenges)
3. Behavioural & Cognitive Models
● Behavioural Models: environment has powerful effects on development of personality and
psychopathology.
○ (A)typical behaviours are acquired via learning processes (e.g. reinforcement).
● Cognitive Models: focus on processes of the mind and cognitive development (e.g. Piaget’s stages,
Vygotsky).
○ Cognitive Behavioural Therapy (CBT): manage problems by changing the way someone thinks
and behaves.
, 4. Humanistic Models
● Emphasises personally meaningful experiences, innate motivations for healthy growth, and the child’s
purposeful creation of self (e.g. Maslow).
● Contrasts with psychodynamic models (conscious vs unconscious, positive vs negative human
traits).
● Psychopathology: interference/suppression of these needs.
5. Family or Systemic Models
● Understanding of personality and psychopathology of the child based on family dynamics.
● Topics: family type, parenting styles, parent-child relationship, sibling relationship.
● Shared and Nonshared (unique).
● Diagnostics and therapy focus on the child within the family setting.
6. Sociocultural Models
● Culture is not only the background for development; rather it is the major influence on development
itself.
● Examples; gender, ethnicity and socioeconomic status.
● Settings of ecological models include home, classroom, neighbourhood (embedded in meso, eco,
macro and chrono* systems).
○ *birth cohort (share key experiences and events).
