Chapter 1, introduction:
Defining disorders of infancy, childhood and adolescence:
One of the first steps leading to accurate and useful conceptualizations of psychopathology is to
recognize the many connections between typical and atypical development. To provide some context
for decision making it may be helpful to review some of the many approaches to the field of child
development itself.
Most contemporary theorists, researchers, and clinicians emphasize that a useful model of typical
development requires a dynamic appreciation of children’s strengths and weaknesses as they
experience salient, age-related challenges. A dynamic model like this takes into account the
complexities of individual familial, ethnic, cultural, and societal beliefs about desirable and
undesirable outcomes for children and adolescents.
What is normal?
Common descriptions of normality and psychopathology often focus on (1) statistical deviance (the
infrequency of certain emotions, cognitions and/or behaviours), (2) sociocultural norms (the beliefs
and expectations – in a given time or place or of a group of people – about what kinds of emotions,
cognitions, and/or behaviours are problematic, undesirable or unacceptable); and (3) mental health
definitions (theoretical of clinically based notions of distress and dysfunction).
Statistical deviance
From a statistical deviance perspective, a child who displays too much of any age-expected behaviours
or too little of any age-expected behaviour might have a disorder.
Sociocultural norms
From a sociocultural norm perspective, children who fail to conform to age-related, gender-specific, or
culture-relevant expectations might be viewed as challenging, struggling or disordered.
Mental Health Definitions
From a mental health perspective, a child’s psychological well-being is the key consideration.
The role of values
A key value judgment involves distinctions between adaptation and maladaptation and personal or
group standards of adequate or average adaptation or optimal adaptation.
• Adequate adaptation: has to do with what is considered okay, acceptable or good enough
• Optimal adaptation: has to do with what is excellent, superior, or the best of what is possible
Challenges and struggles are viewed by most developmental psychologists as forces of growth.
The impact of values on definitions of disorder
• With statistical deviance definitions, it sometimes makes sense to examine both extremes of
the continuum, because we have made a judgment that there is a desirable middle course
related to the characteristics in question.
• With sociocultural definitions, value judgments are the very basis of definitions in disorders.
• With mental health definitions, the values of psychologists, psychiatrists, and clinical social
workers are embedded in both scientific and lay community decision making.
Definitions of psychopathology and developmental psychopathology
• Psychopathology: refers to intense, frequent, and/or persistent maladaptive patterns of
emotion, cognition and behaviour
, • Developmental psychopathology: extends this description to emphasize that these
maladaptive patterns occur in the context of typical development and result in the current and
potential impairment of infants, children and adolescents
Rates of disorders in Infancy, Childhood and adolescence
The multi-part task of estimating rates of disorders include:
1) Identifying children with clinically significant distress and dysfunction, whether or not they
are in treatment
2) Calculating levels of general categories of disorders, and within-category type disorder and
their associated impairments
3) Tracking changing trends in the identification and diagnosis of specific disorders
Personal, clinical and public policy implications must be considered when collecting these data.
Frequencies and patterns of disorders in infants, children, and adolescents can be estimated with varied
methodologies. These frequencies and patterns are the focus of the field of developmental
epidemiology. Prevalence and incidence rates are both measures of the frequency of psychopathology.
• Prevalence: refers to the proportion of a population with a disorder
• Incidence: refers to the rate at which new cases arise
Allocation of resources, availability and accessibility of care
One continuing difficulty involves access to care. In addition to the lack of everyday availability of
mental health treatments, emergency mental health care is also difficult to access.
Barriers to care are widespread, persistent, and have been extensively summarized.
• Barriers related to structure and funding of the mental health care system include limited or
poorly-conceived mental health policies, lack of provider availability, long waiting lists, lack
of service coordination, inconveniently located services, transportation difficulties, and the
inability to pay and/or inadequate insurance coverage.
• Barriers related to perception about mental health difficulties include the inability to
acknowledge a disorder, denial of problem severity, and beliefs that difficulties will resolve
over time or will improve without formal treatment
• Barriers related to perceptions about mental health services involve a lack of trust in the
system, previous negative experiences, and the stigma related to seeking help
The ignorance and intolerance that contribute to the painfully unnecessary stigmatization of
individuals with psychopathology must be confronted in and of itself but also address as a barrier to
care
The globalization of Children’s Mental health
Discussions of mental health and mental illness involving resource allocation and public policy
increasingly emphasize global perspectives that require careful thinking about Western models of
development, disorders, and intervention as well as the vastly different experiences of children who
live in resource-rich versus resource-poor countries.
We must emphasize that millions of children are struggling in the face of unimaginable trauma,
including exposure to disease and death, armed conflict, abandonment and homelessness, and
dislocation.
To facilitate the success of interventions, mental health professionals must consider how to implement
treatments in countries where the health and welfare systems work differently as well as how to
provide treatment to children who are difficult to reach.
,Finally, the development and implementation of globally useful interventions require recognition of
the current disconnect between where research takes place and where the need is greatest as well as a
commitment to do better on behalf of the world’s children.
Chapter summary:
• Disorders in children may be defined or identified in various ways (statistical deviance,
sociocultural norms & mental health definitions)
• Defining and identifying disorders depends on value judgements
• Developmental psychopathology refers to intense, frequent and/or persistent maladaptive
patterns of emotion, cognition, and behaviour considered within the context of typical
development and resulting in the current and potential impairment of infants, children and
adolescents
• Estimating rates of disorders in children and adolescents involves (1) identifying children who
experience distress and dysfunction; (2) calculating levels of general categories of disorders
and specific subtypes of disorders; (3) and tracking changing trends in various rates of
disorders
• Developmental epidemiology is focused on the frequencies and patterns of disorders in
children and adolescents. Prevalence refers to all current cases of a set of disorders. Incidence
refers to the number of new cases in a given time period.
• Allocation of resources and the availability of and access to care are critical issues. Many
children experiencing distress and dysfunction are not identified or diagnosed.
• Barriers to care include the structure and funding of the mental health care system, negative
perceptions about mental health and illness, and negative perceptions about mental health
treatments. Stigmatization is another barrier
• The globalization of children’s mental health involves the recognition of children’s
experiences of distress, dysfunction, and unmet needs around the globe (children in resource-
poor locations are at higher risks).
Chapter 2, Models of Child Development, Psychopathology and Treatment:
The role of Theory in Developmental Psychopathology
Dimensional and categorical models
Dimensional models of psychopathology emphasize the ways in which typical feelings, thoughts, and
behaviours gradually become more serious problems, which then may intensify and become clinically
diagnosable disorders. There is no sharp distinction between adjustment and maladjustment.
Dimensional models also are referred to as continuous and or quantitative.
Categorical models of psychopathology emphasize discrete and qualitative differences in individual
patterns of emotion, cognition and behaviour. There are clear distinctions between what is normal and
what is not. Categorical models are sometimes referred to as discontinuous or qualitative.
Physiological models
Historical and current conceptualizations
Physiological models propose that there is a physiological (a genetic, structural, biological, and/or
chemical) basis for all psychological processes and events. Early physiological models focused on
genes, brain structure and function, and how prior development influenced, directed and constrained
later development.
, Brain structure and function
Advances in neuroscience have led to detailed descriptions and remarkable images of development,
organization, and reorganization. Neuroscientists provide evidence of prolonged and hierarchical brain
development with earlier developing regions influencing the neurobiology of later-developing regions.
These advances include the study of gray matter (processes and functions) and white matter
(connectivity within and between regions).
Connectome: the diagram of the brain’s neural connections focuses on macroscopic connectivity
(between brain regions).
Brain growth and development in environmental context
The Human brain develops over a very lengthy timeline and allows for collaboration between child
and parent in the co-construction of the human brain. In addition, protracted brain development
support the adaptation of children embedded in specific environments.
Sensitive (critical) periods in brain development are spans of time when environments have especially
powerful and enduring impacts. While brain development is mostly similar for typically developing
children, differences have also been observed. We must understand that there is diversity between and
within groups of typically developing children.
Neural plasticity illustrates several physiological processes related to brain development, organization
and reorganization. In cases where the developing brain is affected by early adversity, plasticity allows
for better outcomes following positive and enriched environmental experiences. As important as
plasticity is across development, a balance between plasticity and stability is critical.
Brain-body-behaviour process
All physiological systems (brain, cardiovascular, immune, metabolic, and neuroendocrine systems)
interact with one another, adapting to the environments in which the child develops.
Defining disorders of infancy, childhood and adolescence:
One of the first steps leading to accurate and useful conceptualizations of psychopathology is to
recognize the many connections between typical and atypical development. To provide some context
for decision making it may be helpful to review some of the many approaches to the field of child
development itself.
Most contemporary theorists, researchers, and clinicians emphasize that a useful model of typical
development requires a dynamic appreciation of children’s strengths and weaknesses as they
experience salient, age-related challenges. A dynamic model like this takes into account the
complexities of individual familial, ethnic, cultural, and societal beliefs about desirable and
undesirable outcomes for children and adolescents.
What is normal?
Common descriptions of normality and psychopathology often focus on (1) statistical deviance (the
infrequency of certain emotions, cognitions and/or behaviours), (2) sociocultural norms (the beliefs
and expectations – in a given time or place or of a group of people – about what kinds of emotions,
cognitions, and/or behaviours are problematic, undesirable or unacceptable); and (3) mental health
definitions (theoretical of clinically based notions of distress and dysfunction).
Statistical deviance
From a statistical deviance perspective, a child who displays too much of any age-expected behaviours
or too little of any age-expected behaviour might have a disorder.
Sociocultural norms
From a sociocultural norm perspective, children who fail to conform to age-related, gender-specific, or
culture-relevant expectations might be viewed as challenging, struggling or disordered.
Mental Health Definitions
From a mental health perspective, a child’s psychological well-being is the key consideration.
The role of values
A key value judgment involves distinctions between adaptation and maladaptation and personal or
group standards of adequate or average adaptation or optimal adaptation.
• Adequate adaptation: has to do with what is considered okay, acceptable or good enough
• Optimal adaptation: has to do with what is excellent, superior, or the best of what is possible
Challenges and struggles are viewed by most developmental psychologists as forces of growth.
The impact of values on definitions of disorder
• With statistical deviance definitions, it sometimes makes sense to examine both extremes of
the continuum, because we have made a judgment that there is a desirable middle course
related to the characteristics in question.
• With sociocultural definitions, value judgments are the very basis of definitions in disorders.
• With mental health definitions, the values of psychologists, psychiatrists, and clinical social
workers are embedded in both scientific and lay community decision making.
Definitions of psychopathology and developmental psychopathology
• Psychopathology: refers to intense, frequent, and/or persistent maladaptive patterns of
emotion, cognition and behaviour
, • Developmental psychopathology: extends this description to emphasize that these
maladaptive patterns occur in the context of typical development and result in the current and
potential impairment of infants, children and adolescents
Rates of disorders in Infancy, Childhood and adolescence
The multi-part task of estimating rates of disorders include:
1) Identifying children with clinically significant distress and dysfunction, whether or not they
are in treatment
2) Calculating levels of general categories of disorders, and within-category type disorder and
their associated impairments
3) Tracking changing trends in the identification and diagnosis of specific disorders
Personal, clinical and public policy implications must be considered when collecting these data.
Frequencies and patterns of disorders in infants, children, and adolescents can be estimated with varied
methodologies. These frequencies and patterns are the focus of the field of developmental
epidemiology. Prevalence and incidence rates are both measures of the frequency of psychopathology.
• Prevalence: refers to the proportion of a population with a disorder
• Incidence: refers to the rate at which new cases arise
Allocation of resources, availability and accessibility of care
One continuing difficulty involves access to care. In addition to the lack of everyday availability of
mental health treatments, emergency mental health care is also difficult to access.
Barriers to care are widespread, persistent, and have been extensively summarized.
• Barriers related to structure and funding of the mental health care system include limited or
poorly-conceived mental health policies, lack of provider availability, long waiting lists, lack
of service coordination, inconveniently located services, transportation difficulties, and the
inability to pay and/or inadequate insurance coverage.
• Barriers related to perception about mental health difficulties include the inability to
acknowledge a disorder, denial of problem severity, and beliefs that difficulties will resolve
over time or will improve without formal treatment
• Barriers related to perceptions about mental health services involve a lack of trust in the
system, previous negative experiences, and the stigma related to seeking help
The ignorance and intolerance that contribute to the painfully unnecessary stigmatization of
individuals with psychopathology must be confronted in and of itself but also address as a barrier to
care
The globalization of Children’s Mental health
Discussions of mental health and mental illness involving resource allocation and public policy
increasingly emphasize global perspectives that require careful thinking about Western models of
development, disorders, and intervention as well as the vastly different experiences of children who
live in resource-rich versus resource-poor countries.
We must emphasize that millions of children are struggling in the face of unimaginable trauma,
including exposure to disease and death, armed conflict, abandonment and homelessness, and
dislocation.
To facilitate the success of interventions, mental health professionals must consider how to implement
treatments in countries where the health and welfare systems work differently as well as how to
provide treatment to children who are difficult to reach.
,Finally, the development and implementation of globally useful interventions require recognition of
the current disconnect between where research takes place and where the need is greatest as well as a
commitment to do better on behalf of the world’s children.
Chapter summary:
• Disorders in children may be defined or identified in various ways (statistical deviance,
sociocultural norms & mental health definitions)
• Defining and identifying disorders depends on value judgements
• Developmental psychopathology refers to intense, frequent and/or persistent maladaptive
patterns of emotion, cognition, and behaviour considered within the context of typical
development and resulting in the current and potential impairment of infants, children and
adolescents
• Estimating rates of disorders in children and adolescents involves (1) identifying children who
experience distress and dysfunction; (2) calculating levels of general categories of disorders
and specific subtypes of disorders; (3) and tracking changing trends in various rates of
disorders
• Developmental epidemiology is focused on the frequencies and patterns of disorders in
children and adolescents. Prevalence refers to all current cases of a set of disorders. Incidence
refers to the number of new cases in a given time period.
• Allocation of resources and the availability of and access to care are critical issues. Many
children experiencing distress and dysfunction are not identified or diagnosed.
• Barriers to care include the structure and funding of the mental health care system, negative
perceptions about mental health and illness, and negative perceptions about mental health
treatments. Stigmatization is another barrier
• The globalization of children’s mental health involves the recognition of children’s
experiences of distress, dysfunction, and unmet needs around the globe (children in resource-
poor locations are at higher risks).
Chapter 2, Models of Child Development, Psychopathology and Treatment:
The role of Theory in Developmental Psychopathology
Dimensional and categorical models
Dimensional models of psychopathology emphasize the ways in which typical feelings, thoughts, and
behaviours gradually become more serious problems, which then may intensify and become clinically
diagnosable disorders. There is no sharp distinction between adjustment and maladjustment.
Dimensional models also are referred to as continuous and or quantitative.
Categorical models of psychopathology emphasize discrete and qualitative differences in individual
patterns of emotion, cognition and behaviour. There are clear distinctions between what is normal and
what is not. Categorical models are sometimes referred to as discontinuous or qualitative.
Physiological models
Historical and current conceptualizations
Physiological models propose that there is a physiological (a genetic, structural, biological, and/or
chemical) basis for all psychological processes and events. Early physiological models focused on
genes, brain structure and function, and how prior development influenced, directed and constrained
later development.
, Brain structure and function
Advances in neuroscience have led to detailed descriptions and remarkable images of development,
organization, and reorganization. Neuroscientists provide evidence of prolonged and hierarchical brain
development with earlier developing regions influencing the neurobiology of later-developing regions.
These advances include the study of gray matter (processes and functions) and white matter
(connectivity within and between regions).
Connectome: the diagram of the brain’s neural connections focuses on macroscopic connectivity
(between brain regions).
Brain growth and development in environmental context
The Human brain develops over a very lengthy timeline and allows for collaboration between child
and parent in the co-construction of the human brain. In addition, protracted brain development
support the adaptation of children embedded in specific environments.
Sensitive (critical) periods in brain development are spans of time when environments have especially
powerful and enduring impacts. While brain development is mostly similar for typically developing
children, differences have also been observed. We must understand that there is diversity between and
within groups of typically developing children.
Neural plasticity illustrates several physiological processes related to brain development, organization
and reorganization. In cases where the developing brain is affected by early adversity, plasticity allows
for better outcomes following positive and enriched environmental experiences. As important as
plasticity is across development, a balance between plasticity and stability is critical.
Brain-body-behaviour process
All physiological systems (brain, cardiovascular, immune, metabolic, and neuroendocrine systems)
interact with one another, adapting to the environments in which the child develops.
