Abnormal Child and Adolescent Psychology

Category: Education

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Written from a developmental perspective, Abnormal Child and Adolescent Psychology is organized around five prominent and recurring themes: the course of normal development proceeds in an orderly and predictable direction; maladaptive behaviors represent deviations from the normal path; maladaptive behavior is represented by a continuum of severity (symptoms, syndromes, disorders) based on the degree to which behaviors deviate from the norm; individual, interpersonal, contextual and cultural factors interact in a reciprocal way to influence normal development and abnormal deviations; theoretical input from diverse perspectives can guide our understanding of underlying processes that precipitate and maintain behaviors and the different developmental pathways that might result. The revision will be divided into five sections, all integrating the DSM-5, and will include a new chapter on child maltreatment and self-injurious behavior.


Presentation Transcript

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ABNORMAL CHILD AND ADOLESCENT PSYCHOLOGY Written from a developmental perspective Abnormal Child and Adolescent Psychology is organized around fve prominent and recurring themes: the course of normal development proceeds in an orderly and predictable direction maladaptive behaviors represent deviations from the normal path maladaptive behavior is represented by a continuum of severity symptoms syndromes disorders based on the degree to which behaviors deviate from the norm individual interpersonal contextual and cultural factors interact in a reciprocal way to infuence normal development and abnormal deviations theoretical input from diverse perspectives can guide our understanding of underlying processes that precipitate and maintain behaviors and the diferent developmental pathways that might result. Tis revised edition is divided into fve sections all integrating the DSM-5 and will include a new chapter on child maltreatment and self-injurious behavior. Linda Wilmshurst PhD ABPP is in private practice and teaches graduate students online at Capella University. She has previously taught in graduate programs and practiced internation- ally. Linda is a Diplomate in Clinical Psychology American Board of Professional Psychology and is a licensed clinical and school psychologist in Florida.

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Second edition published 2017 by Routledge 711 Tird Avenue New York NY 10017 and by Routledge 2 Park Square Milton Park Abingdon Oxon OX14 4RN Routledge is an imprint of the Taylor  Francis Group an informa business © 2017 Taylor  Francis Te right of Linda Wilmshurst to be identifed as author of this work has been asserted by her in accordance with sections 77 and 78 of the Copyright Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic mechanical or other means now known or hereafter invented including photocopying and recording or in any information storage or retrieval system without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for identifcation and explanation without intent to infringe. First edition published by Routledge 2008 Library of Congress Cataloging-in-Publication Data A catalog record for this book has been requested ISBN: 978-1-138-96051-0 hbk ISBN: 978-1-138-96050-3 pbk ISBN: 978-1-315-66027-1 ebk Typeset in Minion Pro by Apex CoVantage LLC Visit the Taylor Francis Web site at http://www.taylorandfrancis.com and the Routledge Web site at http://www.routledge.com Cover art by Rachel Wilmshurst www.rachelwilmshurst.com

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v List of Figures vii List of Tables ix Preface xi Part I: Te Foundations of Abnormal Child and Adolescent Psychology 1 Abnormal Child Psychology: Past Present and Future 3 2 Understanding Abnormal Development: Teoretical Perspectives 27 3 Understanding Abnormal Development: Risks Protective Factors and Culturally Diverse Y outh 67 4 Developmental Considerations in Research and Practice: Ethical Issues and Research Methods 113 5 Issues in Diagnosis Assessment and Treatment 155 Part II: Emotional Behavioral and Learning Difculties in Children and Y outh: Teir Nature and Teir Course Section I: Neurodevelopmental Disorders: An Introduction 197 6 Intellectual Disability Intellectual Developmental Disorder IDD 203 7 Autism Spectrum Disorder ASD 241 8 Specifc Learning Disabilities SLD 269 9 Attention Defcit Hyperactivity Disorder ADHD 315 Contents

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vi • Contents Section II: Internalizing Disorders 357 10 Anxiety Disorders and Obsessive Compulsive and Related Disorders 369 11 Te Mood Disorders: Depression Bipolar Disorder Suicide and Non-suicidal Self-Injury and Suicide Prevention 415 Section III: Externalizing Problems and Disorders: An Introduction 463 12 Behavioral Problems and Disruptive Disorders 469 Section IV: Problems With Onset in Later Childhood or Adolescence 505 13 Eating and Feeding Disorders 507 14 Substance-Related Disorders 541 Section V: Stress Trauma-Related Disorders and Child Maltreatment: An Introduction 575 15 Stress Trauma-Related Disorders and Child Maltreatment 577 References 617 Index 679

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vii 1.1 Bronfenbrenner’s Ecological Model 14 1.2 Te K-3 Paradigm 23 2.1 Parts of the Brain 38 2.2 Te K-3 Paradigm 59 3.1 Te Cycle of Poverty 73 4.1 Number of Problem Behaviors Noted by Single Moms 132 5.1 Normal Distribution Standard Scores and T-Scores 166 5.2 Frequency of Assessment Methods Used by Practicing School Psychologists Shapiro  Heick 2004 184 8.1 Percentage Distribution of Children Ages 3–21 Served Under the Individuals With Disabilities Education Act IDEA Part B by Disability Type School Y ear 2012–2013 287 8.2 Neural Systems Involved in Reading 291 9.1 Barkley’s Model 1997 of the Four Executive Functions and How Tese Relate to Behavioral Inhibition 339 10.A.1 Te Tri partite Model of Anxiety and Depression 362 10.A.2 Temp erament: Efortful Control and Emotionality/Neuroticism 363 11.1 Variations of Bipolar Disorder 442 12.1 Te Ability to Develop Behavioral Self-Control and to Increase Emotion Regulation Infuences Behavior and Development in Many Areas 472 12.2 Illustration of Results from Study of Aggression Emotion Regulation and Self-Control Rydell Berlin  Bohlin 2001 477 12.3 Te Cycle of Maternal Depression Rejection and Child Aggression 479 12.4 Four Quadrants of Aggressive Behaviors Frick et al. 1993 484 13.1 Te Anorexic Cycle: Restricting Subtype 521 13.2 Te Bulimic Cycle: Binge/Purge Type 523 13.3 Subtypes of Anorexia Nervosa and Bulimia Nervosa 525 Figures

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ix 1.1 Developmental Tasks Competencies and Limitations at Each Stage 18 1.2 Stages of Development and Ecological Infuences 21 1.3 Six Teoretical Views of Childhood Depression 22 1.4 Developmental Stages Ecological Infuences and Teoretical Perspectives: An Integrated Model 23 2.1 Infa nt and Child Temperament Characteristics Tomas  Chess 1977 41 2.2 Reward and Punishment Paradigm 43 2.3 Classroom Observation for Robby B 45 2.4 Classical Conditioning 47 2.5 Parenting Style 58 3.1 A Contextual Look at Common Risk and Protective Factors for Behavior Problems and School Failure 70 3.2 DSM-5: Examples of Cultural Concepts of Distress APA 2013 84 3.3 Who Are the Y outh in Juvenile Detention JD 87 4.1 Ethical Principles and Codes of Ethical Conduct 117 4.2 Sample Experimental Design 127 4.3 Research Methods: A Comparative Look 131 4.4 Frequency Table for Number of Behaviors Reported by Single Parents 132 4.5 Experimental Design: Te Study of Development Over Time 144 4.6 Comparison of Quantitative and Qualitative Methods 146 5.1 Common Structured/Semi-Structured Interviews and Behavior and Self-Rating Scales 158 5.2 Common Exceptional Categories and Criteria According to IDEA 2004 173 5.3 Observational Recording Methods: Applications Advantages and Disadvantages 180 5.4 Frequency of Assessment Methods Used by Practicing School Psychologists Shapiro  Heick 2004 184 5.5 A Sample of Personality Assessment Instruments 185 6.1 Severity Levels and Adaptive Domains 212 6.2 Assessment Instruments for Intelligence and Adaptive Behaviors 213 7.1 Examples of Symptoms and Severity Levels for ASD 245 7.2 Some Assessment Instruments for ASD 252 8.1 Perspectives on Learning Disabilities: Te Early Y ears 273 8.2 Specifc Types of Learning Disabilities 288 9.1 A Historical Look at ADHD 318 9.2 ADHD Comorbidity and Related Problems 328 Tables

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x • Tables 9.3 ADHD: A Comprehensive Look at Domains of Assessment 341 10.1 Historical Evolution of Anxiety Disorders and the DSM 374 10.2 Cumulative Risk and Precipitating Event Models of Anxiety Disorders and Developmental Pathways 376 10.3 Common Assessment Instruments for Anxiety Disorders 378 10.4 Classical Conditioning 388 11.1 Characteristics Associated With Depression in Children and Adolescents 428 11.2 Risk and Protective Factors for Depression and Suicide in Children and Adolescents 429 11.3 Common Assessment Instruments for Evaluation of Depression in Children and Adolescents 437 11.4 Type s of Bipolar Disorder 441 12.A.1 A Sample of Behaviors Considered to Be Externalizing or Disruptive Behavior Disorders by Diferent Classifcation Sources 464 12.1 Specifc Risk Factors Identifed for Conduct Problems and Aggression 495 12.2 Proactive and Reactive Aggression as Two Distinct Pathways Brendgen et al. 2001 496 13.1 Body Image Concerns and Dieting Among High School Students 512 13.2 Prevalence of Unhealthy Dieting Practices for Weight Loss Among High School Students 513 13.3 Risks and Protective Factors: Research Findings Concerning Factors Related to Adolescent Body Dissatisfaction BD 514 13.4 Dife rences Between Anorexia Nervosa AN and Bulimia Nervosa BN 527 13.5 Domain-Specifc Assessments for Eating Disorders 531 14.1 Categories of Substances and Symptoms of Substance Intoxication 544 14.2 Drug Usage and Symptoms of Intoxication 547 14.3 Tren ds in 30-Day Prevalence of Use of Various Drugs for 2014 Grades 8 10 and 12 combined 1993 2000 2007 2014 548 14.4 Monitoring the Future: A Comparison of Annual Prevalence Rates for Substance Use in Adolescent Eighth Tenth and Twelfh graders in 2005 2010 and 2014 549 14.5 Y outh Risk Behavior Survey YRBS Report of Alcohol and Marijuana Use by High School Students for 2014 by Gender Ethnicity and Grade 551 14.6 Y outh Risk Behavior Survey YRBS Report of Percentages of Other Substances Inhalants Prescription Medications Ecstasy and Hallucinogenic Drugs Used by High School Students for 2014 by Gender Ethnicity and Grade 553 14.7 Substance Use Disorders SUD and Comorbid Associations in Y outh From Community Clinical and Juvenile Justice Populations 561

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xi Preface How to Use the Book: Format for Optimum Learning Te book has several features that can help in understanding remembering and applying the key concepts presented. Overall Temes and Learning Objectives Te book is organized around fve recurrent themes that provide the foundation for under - standing abnormal child psychology from a developmental perspective: 1. Normal development typically follows an orderly and predictable path 2. Maladaptive behaviors represent deviations from the normal path 3. Maladaptive behavior is represented by a continuum of severity 4. Individual interpersonal contextual and cultural factors infuence deviations in development 5. Mental health practitioners can draw on a multiplicity of theoretical perspectives to assist in understanding maladaptive behaviors. Te fve themes are consistently applied to each chapter on childhood disorders and provide an organizational framework for approaching variations in child behaviors over the course of development. As a result learning is facilitated in a format that is predictable consistent and meaningful. Learning how the fve themes apply to diferent disorders provides a framework for learning built on analysis synthesis and integration of information from three essential bodies of knowledge. Within this context the overall learning objective is to increase stu- dents’ appreciation of the complex nature of child and adolescent behaviors and to empha- size the need to integrate information from three essential sources. Te K-3 Paradigm is a helpful heuristic learning tool for reinforcing the three cornerstones of information that are required to understand the nature of maladaptive behavior: 1. Knowledge of developmental expectations 2. Knowledge of sources of infuence child characteristics and environmental characteristics 3. Knowledge of theoretical models and perspectives. Pedagogical Features Chapter Outlines and Previews: Each chapter is introduced by a Chapter Preview that pro- vides an overview of the material to be covered the rationale for inclusion and essential

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xii • Preface highlights. Te outlines provide the organizational format and the previews set the stage for assimilating the information to be presented. Call Out Boxes: Another important learning tool is the use of call out boxes. Tese boxes are inserted throughout the chapters and draw attention to information for several reasons. Tere will be recurrent call out boxes specifcally designed to reinforce key concepts Important Distinction or Consider Tis. Other boxes will be designed to fag information for later recall Memory Bank highlight research fndings Science Talks and reinforce information previ - ously addressed Recall and Rewind. Where applicable call out boxes will also address the developmental nature of disorders that may set them apart from adult variations Development in Focus. Other call out boxes will be given unique headings designed to capture the main idea or create increased interest. Case Studies: Te use of case studies Case in Point is a strategic efort to bring the concepts to life in several important ways. Embodied within the case scenarios readers will obtain vivid images depicting a variety of symptom presentations for the diferent disorders discussed. Te multiple case studies located at the beginning of each chapter are essential tools for introducing the disorders on several levels. In these introductory scenarios characters illustrate how disor- ders appear at diferent stages of development and diferent levels of severity of symptoms and how symptoms may be expressed within diferent environmental contexts. Use of Tables and Figures: Integrating information across diferent sources and perspectives can be a very difcult task especially for students new to the feld of abnormal child psychology. Terefore whenever possible complex comparisons are made in tabular form. Information can be available “at a glance” through the use of numerous tables and fgures developed to illustrate complex information in graphic form. Fonts Highlights and Glossary of New Terms: Te use of bold face and italic font styles are also an important feature to set the text apart and reinforce the learning process. Key concepts are emphasized through the use of bold and italic fonts. Each new term introduced will be displayed in a consistent font and subsequently included in the Glossary of New Terms at the end of the chapter. New terms will be added to the Glossary in the order that they appear in the chapter to facilitate recall for terms that were clustered together in the main text. Summary and Review: A synopsis of the main ideas and themes follows the presentation of the main chapter text. Students will have an opportunity to review what they have read in capsular form to provide an overview of the information and a glimpse of the bigger picture. Components that Challenge Critical Tinking Increase Self-Monitoring and Improve Student Evaluations Tought-provoking questions Consolidate and Communicate have been developed to chal- lenge students to process information at a deeper level and to relate the new material to previ- ously learned information. Many of these questions can provide excellent material for classroom discussions homework assignments or projects for extra credit. In addition a set of Multiple Choice Review Questions and Answers provides an opportunity for students to test their com- prehension and recall of important details presented in the chapter and can help students pre- pare for classroom tests and quizzes. Important Resources for Instructors An Instructor’s Manual is available as a resource to instructors to assist in course develop- ment and organization. Te manual contains an overview of topics covered in each chapter

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Preface • xiii suggestions for class demonstrations and activities and discussion topics to enhance critical thinking. In addition each chapter contains a list of relevant internet sites movies and media references that can be integrated into the classroom experience to engage students in the learn- ing process and provide a catalyst for discussion group work and individual assignments. A comprehensive set of PowerPoint Presentation Slides has been developed to closely follow each chapter outlining relevant themes highlighting key points and introducing new terms found in the Glossary of New Terms. Copies of charts tables and fgures found in the text are also provided as needed. Important Information for Students Te author has drawn upon her experience of teaching courses in abnormal child psychology from a developmental perspective to provide answers to questions that students ofen generate about issues trends and controversies. Many of these questions and answers appear in the call out boxes that draw attention to Important Distinctions between concepts and probe areas for critical thinking Consider Tis. Material in the text is presented in a way that conforms to an important and proven approach to enhancing learning efectiveness and recall for textbook information the SQ3R Method Martin 1985. Te SQ3R method is named for the fve steps involved in the learning process: survey question read recite and review. Each chapter begins with a survey preview designed to help organize how the information will be received or encoded. Next headings provide higher order organizers that can be turned into a question by the reader. Students who read the material trying to answer the question they have formulated will have a deeper understanding of the content. Recall is also enhanced when students recite what they have read prior to going on to the next section. Call out boxes that feature Recall and Rewind provide opportunities to recite and consolidate information. Finally the chapter closes with a survey review intended to enhance the integration and retention of information in the chapter. Overview of the Book: How the Book Is Organized Te book is divided into two major parts: Part I: Te Foundations of Abnormal Child and Adolescent Psychology Part II: Emotional Behavioral and Learning Difculties in Children and Y outh: Teir Nature and Teir Course Part I: Te Foundations of Abnormal Child and Adolescent Psychology Te major goal of Part I will be to introduce readers to the study of abnormal child psychology from a developmental perspective as a unique feld of study with its own history and issues. Tis introductory section contains fve chapters that present information concerning the historical background conceptual development current trends and contemporary issues in the feld of abnormal child psychology. Te fve chapters in Part I include the following. In Chapter 1 historical information about the origins of clinical child psychology is discussed along with roadblocks that delayed recognition of clinical child psychology as a unique feld of study. Important roadblocks included the initial denial that children could have “emotional prob- lems ” only to be followed by an equally fallacious mindset that children were miniature adults and as such had the same disorders requiring the same treatment as adults. In this chapter fve

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xiv • Preface consistent themes are introduced that will be addressed throughout the book. Tese themes are the cornerstone of understanding child psychopathology. Te frst three themes relate to: • Understanding normal development as predictable and orderly • Recognition of maladaptive behavior as a deviation from the normal pathway • Understanding the continuum of maladaptive behavior ranging from mild developmental deviations to more severe disturbances mild moderate severe. Te fourth theme speaks to the contextual infuences that shape development for better or worse: • Interactions between child characteristics temperament genetics and environmental characteristics family peers school community culture that infuence predispose pre - cipitate and maintain the maladaptive behaviors. Ultimately the ffh theme addresses: • Teoretical models that assist clinicians to interpret and understand maladaptive behavior from a number of diferent perspectives. Te focus of Chapter 2 concerns several issues that are pertinent to clinical decision making regarding children and youth. Some of the topics discussed include distinguishing normal from abnormal behavior and the diferences between adult and child psychopathology. Five theoreti- cal models are introduced and discussed as they apply to understanding child psychopathology including biological behavioral cognitive psychodynamic/attachment and family systems/par - enting style. Ultimately an overarching ecological/transactional framework will be discussed as it pertains to integrating information from all perspectives into a bio-psycho-social framework. Each model is built on a diferent set of assumptions about human behavior. Relevant theoreti- cal models will be revisited in Chapters 6 through 15 as they pertain to unique perspectives in understanding the various disorders discussed. Chapter 3 provides an in-depth discussion of the many risks and protective factors that can shape the course of development. Te chapter follows Bronfenbrenner’s ecological model which is discussed within a transactional framework ongoing and reciprocal infuences. Following a general discussion of risks and protective factors the chapter focuses on resilience and how it can also be viewed within a transactional ecological framework. Finally the chapter focuses on the unique challenges facing children and adolescents from ethnic minority populations African American Latino/Hispanic Americans Asian American/Pacifc Islanders and Amer - ican Indians. Cultural competence in the assessment and treatment of minority youth is also addressed. In Chapter 4 the focus is on the unique ethical challenges that children and adolescents pose for professionals in their research and practice assessment treatment and issues of conf- dentiality. A comparative look at diferent ethical codes American Counseling Association or ACA American Psychological Association or APA American School Counselors Association or ASCA and National Association of School Psychologists or NASP provides a broad over - view of the many ethical similarities recognized among these disciplines. Tis chapter contains information regarding research methods and designs that are particularly well-suited to a devel- opmental psychopathology focus epidemiological research longitudinal cross sectional and

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Preface • xv accelerated longitudinal designs and provides ongoing cumulative and case-based information to assist in the development of critical thinking skills. In Chapter 5 issues in diagnosis assessment and treatment are discussed. Controversial issues include: • Te use of the dimensional versus categorical classifcation systems with children and youth • Te reliability of various informants in rating children’s problems • Te complex nature of comorbidity among childhood disorders • Te need for increased attention to treatments that are empirically supported. Part II: Emotional Behavioral and Learning Difculties in Children and Y outh: Teir Nature and Teir Course Part II presents the most prevalent problems of behavioral emotional and learning difculties facing children and youth today. Problem areas have been grouped to emphasize comorbid fea- tures while at the same time providing the necessary proximity to highlight diferential diag- nosis. Te focus is on presenting the most relevant and empirically based evidence available concerning disorders that practitioners are most likely to encounter in their work with children and adolescents on a daily basis. As a result these chapters provide more in-depth and compre- hensive coverage of commonly occurring abnormal child behaviors than can be found in other texts that sample a wider variety of problems. Chapters are contained within fve sections. Each section will contain a cluster of disorders that have similar features and allow for a cohesive discussion of how these disorders present in developmental populations. Tis organizational framework will support discussions of such topics as comorbidity multifnality and equifnality. Each of the sections will begin with a brief introduction explaining the rationale for why the disorders are clustered into their current for - mat and present relevant statistical information on comorbidity rates for the disorders discussed within that section. Each chapter will begin with a multiple case illustration designed to introduce the topic in a way that will enhance understanding on various levels including: • Te range in severity of the problem normal behavior mild developmental variation moderate and severe manifestations • Developmental presentations how the behavior may appear at diferent developmental ages and in diferent contexts • How behaviors relate to each of the fve themes as outlined in the beginning of this chapter. Within this context the most severe level will be discussed relative to DSM-5 APA 2013 cri- teria. Each chapter is presented in a predictable format that provides information about each disorder as it relates to: • Description and associated features • Prevalence • Developmental issues and trends

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xvi • Preface • Etiology and theoretical perspectives biological model and any other theoretical perspec- tives of importance • Risks and protective factors • Assessment a review of the most reliable assessment instruments available • Trea tment/intervention and prevention empirically supported treatments. In addition where applicable information concerning relevant historical trends in conceptual - izing the disorder e.g. learning disabilities ADHD and any other pertinent issues and con- troversies will also be addressed. Discussions of child disorders include references to both the clinical and educational systems of classifcation to provide students with an excellent grasp of the similarities and diferences between systems in preparation for future work with children in a wide variety of clinical and/or school settings. Section I: Neurodevelopmental Disorders: An Introduction Introduction to Neurodevelopmental Disorders. Te introduction includes a discussion of the rationale behind the DSM-5 decision to cluster disorders in this category and the chal- lenge facing those involved in the revision process regarding which disorders to include in the category and which disorders to exclude. Ultimately six disorders were included based on their shared features representing a wide range of neurodevelopmental impairments including intellectual disability autism spectrum disorders motor disorders communica- tion disorders learning disorders and attention defcit hyperactivity disorder. Four chapters will be devoted to a discussion of the neurodevelopmental disorders that are most likely to be of interest to psychologists and mental health professionals working with children and adolescents. In Chapter 6 the focus will be on intellectual disability or intellectual developmental disor - der formerly mental retardation. Te chapter will discuss changes in the conceptualization of the disorder across time and current emphasis on defnitions that emphasize the impor - tance of environmental contexts and the levels of support available in conceptual social and practical adaptive domains. Te chapter will also discuss the newly added category of global developmental delay as a temporary diagnosis for those under fve who are awaiting further assessment. Chapter 7 will discuss the controversial decision to replace the category of pervasive devel- opmental disorders PDD in the DSM-5 with that of autism spectrum disorders ASD. Te category of ASD now includes disorders that were previously found under PDD including Asperger’ s disorder which has been redesignated as ASD. Te DSM-5 has also reduced the num- ber of criteria for the disorder from three to two broad categories combining impairments in social relatedness and communication into one category. In Chapter 8 the focus will be on specifc learning disorders or specifc learning disabilities. In addition to the three diferent types of learning disorders recognized by the DSM-5 reading written expression and mathematics the chapter will also discuss nonverbal learning disabili- ties and dyspraxia or developmental coordination disorder. Attention defcit hyperactivity disorder ADHD will be the topic for Chapter 9 which will review the criteria needed to diagnose the three diferent variations of the disorder: predomi- nantly inattentive predominantly hyperactive-impulsive and combined. Changes in the DSM-5 have recognized the longevity of the disorder and provide fewer criteria for the diagnosis of ADHD in individuals 17 years of age and older.

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Preface • xvii Section II: Internalizing Disorders Introduction to Internalizing Disorders. As an introduction to the next two chapters internal- izing disorders are discussed from a historical perspective that addresses the concept of negative afectivity and the similarities among problems that share internalizing features. Characteristically internalizing behaviors are “overcontrolled” behaviors that are ofen covert and difcult to assess. Depression and anxiety are the two most common internalizing disorders experienced by chil- dren and youth. Te introduction also discusses changes in the DSM-5 including the decision to place separation anxiety disorder and selective mutism in the chapter on anxiety disorders and to remove obsessive compulsive disorder and the stress disorders from the chapter on anxiety. Te chapter on depression bipolar disorders and suicide also includes a section on non-suicidal self- injury NSSI because recent research has increasingly linked NSSI to increased risk for suicide. In Chapter 10 anxiety problems and disorders that most likely have onset in early childhood are discussed. Tese anxious behaviors range from normal worries to fears and phobias and from general problems generalized anxiety disorder to specifc concerns separation anxiety disorder. Early onset anxieties include fears and phobias separation anxiety and generalized anxiety disorder while social phobia and panic disorder usually have later onset. Although the DSM has moved obsessive compulsive disorders to its own category for our purposes it will be grouped within this chapter. Chapter 11 begins with a historical look at depression and how it was once thought that children were incapable of being depressed. Other topics in this chapter include the nature of symptoms of depression across the developmental spectrum symptom presentation relative to symptoms manifest by adult populations major depression and suicide risk and how to distin- guish bipolar disorder from attention defcit disorder. A signifcant portion of this chapter delves into the controversy and multitude of methods and subtyping that are currently employed to measure describe and conceptualize the disorders in children and youth. Although the DSM-5 has separated bipolar from depression the two disorders will be discussed within this chapter on mood disorders. Te chapter will also include a discussion of NSSI. Section III: Externalizing Disorders: An Introduction Introduction to Externalizing Disorders. Externalizing behaviors or “undercontrolled” behav- iors are characteristically overt disturbing to others and more readily observable than internaliz- ing disorders. Te introductory section provides an overview of the various methods that can be used to classify externalizing behaviors dimensional classifcation disruptive behavior disorders DSM categorical system and emotional disturbance educational classifcation system: IDEA 2004. In addition this section also highlights the many diferent types of behaviors that have been included in rating scales designed to measure externalizing behaviors in children and youth. In Chapter 12 a developmental perspective of aggression will serve as introduction to an increasing array of aggressive behaviors: problems of conduct oppositional defant disorder ODD and conduct disorder CD. Controversy regarding whether ODD and CD are variants degrees of severity of the same disorder will be addressed as will topics concerning gender diferences in aggressive response. Section IV: Problems With Onset in Later Childhood or Adolescence Introduction to Later Onset Disorders. Te introduction begins with a discussion regarding the impact of the transition to adolescence and how the role of peers and family environment

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xviii • Preface infuence changes at this time. Important DSM-5 changes to the newly developed category of “feeding and eating disorders” will be introduced as well as changes to conceptualizing sub- stance related disorders. Chapter 13 will address distinctions between disordered eating and eating disorders. Results of national surveys concerning unhealthy dieting and body dissatisfaction among youth will be discussed in relation to age gender and ethnic variations. Te major eating/feeding disorders with onset in early childhood will be discussed as will the two major forms of eating disorders: anorexia nervosa and bulimia nervosa. Te role of family dynamics and peer infuence on high- risk behaviors will also be addressed. In Chapter 14 substance-related disorders will be discussed using data from national surveys that have tracked usage rates for youth from grades 8 through 12 for substances such as tobacco alcohol and marijuana and recent increases in the use of prescription drugs such as OxyContin. Controversy regarding the gateway phenomenon starter drugs that lead to more serious drug usage will be addressed. Sections on substance use and substance abuse will include informa- tion concerning DSM criteria and particular challenges that youth pose in the area of treatment. Section V: Stress Trauma-Related Disorders and Child Maltreatment: An Introduction Introduction to Maltreatment Stress and Trauma. Te fnal chapter will discuss two topics that ofen can co-occur maltreatment and trauma. Te introduction will provide a brief over - view of the diferent types of maltreatment that exist and the outcomes that can result. Tere will also be a discussion of the decision made by those involved in the revision of the DSM-5 to remove the trauma disorders from the anxiety disorder category and place them within a separate chapter on stress and trauma disorders. Te introduction will briefy discuss rationale behind changes to the DSM-5 criteria for post-traumatic stress disorder for very young children under 5 and revisions in criteria for the attachment disorders. Chapter 15 will discuss the diferent defnitions of child maltreatment and specifc types of trauma that may result. Child maltreatment can include physical sexual emotional/psycho- logical abuse and neglect. Other forms of maltreatment can include multiple maltreatment and polyvictimization. Te discussion will also include research fndings regarding outcomes based on the various forms of maltreatment. Diferent types of trauma and the disorders that might result will also be discussed including attachment disorders and acute and post-traumatic stress disorders PTSD. Te prevalence rates for PTSD and diferent developmental symptom presentations will also be addressed.

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1 Foundations of Abnormal Psychology Understanding abnormal child behavior from a developmental perspective requires an appre- ciation of the science of child psychopathology as it exists today and a recognition of how the discipline has evolved over time. In some ways it is ironic that developmental psychopathology will always be considered one of the youngest disciplines relative to other psychological felds of study with its birth dating back only some 30 years ago 1984. Yet in many ways the sci- ence is also blessed with the intensity and energy of youth that has resulted in an explosion of research and theory in the area unsurpassed by many of the most mature of disciplines. It is the author’s frm belief that without an appreciation of the evolutionary nature of progress in the feld and the contexts of development one cannot hope to understand the complex nature of developmental psychopathology. With this goal in mind rather than rush- ing on to the problems themselves this text probably more than any other begins by focus- ing on the essential core upon which the discipline has been built. Within the spirit of a truly developmental perspective the study of child psychopathology unfolds from its past to the present and with an eye to the future. In this section important concepts will be introduced that will be re-addressed and rein- forced throughout the text. Laying the foundation for future discussions the foundations prepare readers with vital information integrating sources from history theory risk and resilience cultural diversity ethical issues research methods and issues in diagnosis assess- ment and treatment. Once students have an appreciation for the breadth and depth of the discipline they will be able to approach developmental problems with a more focused and intense understanding. Part I Te Foundations of Abnormal Child and Adolescent Psychology

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3 1 Abnormal Child Psychology Past Present and Future Chapter 1 At-a-Glance A Brief History of the Origins of Clinical Child Psychology Child Advocacy and Clinical Child Psychology: Four Historical Phases 1 Recognition of Childhood as a Distinct Period of Development 2 Industrialization and the Social Reform Movements Early 20th Century 3 Building Structures in Support of Social Reform 4 Regression in Social Welfare 1970s On Child Psychopathology as a Unique Discipline: Barriers and Roadblocks 1 Nature/Nurture Debate 2 Te Disease Model of Pathology 3 Te Shif in Emphasis From Treatment to Identifcation 4 Adult Versus Child Perspective Clinical Child Psychology: Focus on Development Developmental Psychopathology: Te Merging of Two Disciplines Te Increasing Role of Developmental Contexts Trends in Conceptualizing Developmental Change and Maladaptive Infuences Contemporary Viewpoints Regarding Developmental Change Understanding Maladaptive Behaviors From a Developmental Perspective Looking Ahead: Applying a Developmental Framework to Understanding Aggressive Behaviors Te Five Recurrent Temes Teme 1: Normal Development Typically Proceeds Along an Orderly and Predictable Path Teme 2: Maladaptive Behaviors Represent Deviations From the Normal Path Teme 3: Maladaptive Behavior Is Represented by a Continuum of Severity Teme 4: Individual Interpersonal Contextual and Cultural Factors Infuence Deviations in Development

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4 • Foundations of Abnormal Psychology Teme 5: Clinical Psychologists Can Draw on a Multiplicity of Teoretical Perspec- tives to Assist in Understanding Maladaptive Behaviors Te K3 Paradigm Overall Learning Objective CHAPTER PREVIEW Tis chapter will provide an introduction to abnormal child psychology and focus on relevant information in the following areas: 1. A Brief History of the Origins of Clinical Child Psychology Te development of abnormal child psychology as a unique area of study has not been with- out growing pains. Te developmental pathway was riddled with roadblocks that delayed recognition of abnormal child psychology or clinical child psychology as a unique feld of study. Initially there was a denial that children could have “emotional problems” later on progress was derailed by the equally fallacious mindset that children were miniature adults and as such had “adult” disorders requiring the same “adult” treatment. A look at how our understanding has evolved over time will provide a deeper appreciation of some of the more contemporary issues and concerns. 2. Understanding Maladaptive Behavior: Five Recurrent Temes Te fve themes emphasize the importance of conceptualizing maladaptive behavior as an ofshoot of normal development and provide the foundation to understanding abnormal behavior from a developmental perspective: • Normal development typically follows a predictable and orderly path. • Maladaptive behaviors veer of the normal path. • Maladaptive behavior is represented by a continuum of severity based on the degree to which behaviors deviate from the normal path. • Individual interpersonal contextual and cultural factors infuence deviations in development. • Tere are a number of theoretical models that can serve as a framework to assist in under - standing how the behavior developed precipitating factors and how it is maintained maintaining factors. Ultimately the fve themes converge in the K-3 Paradigm a heuristic learning tool that empha- sizes three pivotal areas of knowledge fundamental to understanding abnormal child behavior from a developmental perspective: a. Knowledge concerning normal development and developmental expectations b. Knowledge of the sources of infuence child characteristics and environmental characteristics c. Knowledge of theoretical models. A Brief History of the Origins of Clinical Child Psychology Tere are several important milestones evident in the development and recognition of clin- ical child psychology as a unique feld of study. One such milestone was the founding of the

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Past Present and Future • 5 Journal of Clinical Child Psychology JCCP in 1972 by Gertrude J. Williams who was the initial editor. Williams had previously been associated with the Child Guidance Clinic at Washing- ton University in St. Louis. Over the course of the next 18 years JCCP evolved from being a forum for “refective comments” by concerned child advocates to a peer-reviewed journal that focused on publishing “research reviews articles on child advocacy as well as on training and on professional practice in clinical child psychology” Routh Patton  Sanflippo 1991 p. 3. In their review of articles published by JCCP between 1972 and 1989 Routh and colleagues 1991 noted that the percentage of research articles published increased to over 90 relative to articles devoted to advocacy issues which fell to less than 2. Te authors suggest that these changes likely refect the increased recognition and emphasis on clinical child psychology courses being ofered in undergraduate and graduate psychology programs in major universities across the United States resulting in prolifc academic research initiatives in the area of clinical child psychology. Child Advocacy and Clinical Child Psychology: Four Historical Phases In her review of the historical roots of the child advocacy movement Culbertson 1991 traces the changing conceptualizations of childhood through four historical phases that par - allel changes in underlying economic conditions social beliefs and the prevailing political cli- mate. Te four phases include: recognition of childhood as a specifc period of development the impact of increased industrialization and social reform formal organizations established to support social reform and a period of regression that began in the 1970s resulting from chil- dren living in dire economic conditions. It is Culbertson’s belief that this changing perspective on childhood parallels similar changes evident in the felds of developmental and clinical child psychology. Research in areas of child development and clinical child psychology contributed signifcantly to the growing body of knowledge about the nature of children’s emotional and cognitive capacities and served to inform those involved in the social reform movement and shape the nature of their involvement. 1 Recognition of Childhood as a Distinct Period of Development In Europe prior to the 15th century children as young as 5 and 6 years of age were considered to be miniature adults Culbertson 1991. Over the course of the next 200 years beginning with the Renaissance educators and scholars of the 15th century the role of children began to be viewed as being diferent from adults although this was primarily reserved for children from the upper classes because poorer families relied on children to occupy the workforce. Te nature of childhood and the role of parenting went through several transitions from an emphasis on the responsibility of parents to educate and fll their child’s mental slate with knowledge 17th- century English philosopher John Locke to a belief that childhood was a period of innocence that should be lef alone to unfold naturally 18th-century French philosopher Jean-Jacques Rousseau. In the United States at the end of the 18th century children as young as 5 and 6 years of age could still be found working alongside their parents as part of the family economy farms shops as apprentices or if orphaned following their master’s orders. It wasn’t until the 19th century that values and beliefs about individual rights ushered in an era of sentimentality toward childhood as slavery fell out of favor and humanitarian sensibilities increased. However even at this time youth 12 to 18 years of age were not considered as part of childhood. By the mid-19th century Americans began to follow parenting practices suggested some two centuries earlier by

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6 • Foundations of Abnormal Psychology John Locke as they assumed greater responsibility for instructing and socializing their children. By the late 19th century there was a paradigm shif from seeing the child as primitive and unredeemed the early American Calvinist child to the child as innocent and cherubic expression of God’s kingdom the Victorian child. Te innocent child had emerged earlier in the 18th century but had fewer immediate social and legislative consequences. It was the change in the values to which children contributed from the economic realm to the emotional realm that made the great diference in the late 19th century. Fass 2003 p. 966 2 Industrialization and the Social Reform Movements Early 20th Century With the advent of increased industrialization the need to rely on children as a primary source of the workforce was reduced. At the same time humanitarian concerns about children in the workforce were gaining increased momentum with the formation of such organizations as the National Child Labor Committee in 1904. With a focus on children’s rights and improved access to health care and education child protection and compulsory education became a reality and ushered in the creation of institutions hospitals schools clinics for the provision of child ser - vices Culbertson 1991. With the shif in focus from child labor to child rights beliefs in child innocence and vulner - ability resulted in an increased emphasis on adult responsibility in areas of education shelter and protection. With a view to the child as the promise for a better future the discipline of psy- chology began to take on a prominent role in examining emotional and cognitive child develop- ment. Mandates for compulsory education for children who previously had very little exposure to formal learning was a cause for concern and resulted in a new wave of interest that focused on the challenge of teaching children who experienced signifcant difculties in learning. In the West many new immigrant families were faced with adjusting to the economic loss resulting from abolishing child labor mandatory education and increased focus on the importance of play on child development and learning Fass 2003. At this time an American psychologist Lightner Witmer returned to the United States hav- ing recently received his PhD from the University of Leipzig. Witmer immediately set out to address the learning problems experienced by many of the children by establishing the frst psychology clinic to treat children with learning disabilities. Auspicious Beginnings Witmer established the frst child psychology clinic in 1896 and immediately began to expand the clinic’s horizons the following year by ofering a summer institute in child psychology. Within the next 10 years over 450 children were seen at the clinic. In 1907 Witmer established a residential school for children who were mentally retarded and launched the frst psychological journal the Psychological Clinic. Witmer’s methods involved individual diagnostic assessment followed by prescriptions for remedial tutoring. However despite his popularity with the public schools Witmer lost the support of his colleagues because he refused to join the widely popular movement to adopt T erman ’ s revision of the Stanford–Binet

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Past Present and Future • 7 tests of intelligence. In addition Witmer did not subscribe to Freud’s theories on behavior disor - ders further setting him apart from the majority in the feld. Te following year 1908 Henry Goddard opened the frst clinical internship training program at the Vineland Training Pro- gram for individuals with mental retardation. Henry Goddard and Martin Kallikak Although Henry Goddard was the founding father of the Vineland Training Program for the mentally retarded his frm beliefs in genetic versus environmental “infuence” and negative attitudes about mental retardation did more harm than good. In his fctional portrayal of Martin Kallikak Goddard traced the lives of Martin’s ofspring from unions with two very diferent women. While his union with a barmaid produced children who were characterized as being feeble-minded prone to alcoholism and in trouble with the law his ofspring from the union with a “good girl” all became upstanding citizens. In 1909 G. Stanley Hall president of the newly formed American Psychological Association APA arranged for Freud to lecture at Clark University in Massachusetts. William Healey an English-born psychiatrist shared America’s enthusiasm for Freud’s theories something that set him even further apart from Witmer whose popularity continued to wane Nietzel Bernstein  Milich 1994. In that same year Healey opened the frst child guidance clinic in Chicago called the Juvenile Psychopathic Institute. Freud’s theories infuenced the tone for this clinic which was established to prevent and treat child mental illness. In only 8 years’ time child clinics had more than quadrupled from 9 to 42 and could be found in a variety of settings including juve- nile institutions courts hospitals schools and universities. Horn 1984 describes the typical child guidance clinic at this time as ofering a multidisciplinary team approach psychiatrist psychologist and social worker to the study and treatment of the “maladjusted child. ” Read All About It An editorial written in the New Y ork Times 1926 heralded the arrival of the child guid- ance clinics at a time when “modern life” had tended to “weaken parental authority and destroy the infuence of the home” New Y ork Times 1926. Horn also suggests that during this time period there was a shif in focus from emphasizing delinquency as a prime concern to concentrating on the causes of deviant behaviors emanating from problems at school or at home. Child guidance clinics commonly dealt with one of three categories of problems: socially unacceptable behavior e.g. tantrums lying fghting person - ality reactions e.g. reclusiveness nervousness and problems of habit formation e.g. eating and sleeping difculties. Clinic treatment involved a “three step process of study diagnosis and therapy” and either used direct treatment or “manipulation” of the environment according to Horn 1984. Te underlying philosophy of the time was that the source of children’s problems could be found in the parents and the family Horn 1984 p. 27.

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8 • Foundations of Abnormal Psychology 3 Building Structures in Support of Social Reform In 1948 54 child guidance clinics came together to form the American Association of Psychiat- ric Clinics for Children AAPCC. A paradigm shif also occurred during this time as the role of the child guidance clinic changed from the identifcation of problem children to training and treatment a movement that sparked debate over standards professional roles and status among proponents of psychiatry psychology and social work Horn 1989. A similar shif was noted in the child advocacy movement as the United Nations Declaration on the Rights of the Child 1959 and the White House Conference on Children and Y outh 1960 placed emphasis on the underlying infrastructure necessary to support the movement. Between the early 1950s and late 1970s increased emphasis was being placed on grounding advocacy issues within the context of “sound child development knowledge” Joint Commis - sion on Mental Health of Children 1970 p. 9. Te contribution of research eforts in clinical child psychology in establishing the conceptual bases of child advocacy issues had clearly been recognized. 4 Regression in Social Welfare 1970s On It has been suggested that the 1970s ushered in a fourth wave in the evolution of child advocacy Shore 1987 a regression caused by the increasing rate of children living in poverty in the United States. Te issue of child poverty and its relationship to child risk factors will be dis- cussed at length in Chapter 3. Child Psychopathology as a Unique Discipline: Barriers and Roadblocks Despite increased recognition of the importance of clinics designed to assist children and the growing popularity of child guidance clinics early in the 20th century the feld of clinical child psychology or child psychopathology encountered many difculties that delayed consideration of child psychopathology as a unique discipline. Child psychopathology was not conceptualized as a unique discipline until the 1970s due to four important obstacles: 1. Te nature/nurture debate 2. Te introduction of the disease model of pathology 3. Te shif in emphasis from treatment to identifcation the testing movement 4. Te conceptualization of child problems as similar to adult problems. 1 Nature/Nurture Debate Te nature/nurture debate stalled the progress in considering child psychopathology as a unique discipline because energy was diverted into endless arguments and debate concerning whether genetic or environmental infuences were primary on child development adaptation and change—an argument that had no apparent resolution. Te debate had its onset in the 17th century when John Locke an English philosopher championed the environmental side of the debate by arguing for the importance of parental nurturing in child-rearing. According to Locke young children begin as a blank slate tabula rasa and the role of the parent is to become actively engaged in flling the slate by nurturing development. In the 18th century the French philosopher Jean-Jacques Rousseau openly opposed Locke’s environmental stance by arguing that the young child was like a fower that would unfold over time without interference.

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Past Present and Future • 9 Rousseau saw the parent’s role as passive and argued for a laissez-faire attitude suggesting that parents were best to leave the child alone and let nature take its course. Is It Genetics or Environment Inquiring Minds Want to Know Although most psychologists today appreciate the interaction between genes and the environment the debate is by no means conclusive. More recent studies suggest that the picture is far more complex than initially thought. Researchers are fnding evidence that the impact of environment and heredity on cer - tain traits changes with age. Furthermore our own genetic predispositions may not only infuence how we respond to the environment but predict how others respond to us and infuence the experiences we choose Azar 1997. 2 Te Disease Model of Pathology Te 20th century ushered in two opposing perspectives on abnormal functioning: the somato - genic perspective abnormality results from physical causes and the psychogenic perspective illness due to mental or psychological causes. Although the somatogenic perspective dates as far back as Hippocrates’s beliefs in the four humors a renewed interest in linking abnormal functioning to physical or biological causes resulted when Kraepelin 1856–1926 published a textbook in 1883 wherein he argued that physical ailments such as fatigue can cause mental dysfunction. Later Kraepelin devised a diagnostic system that identifed a number of syndromes and linked the symptoms to their physical cause Kihlstron 2002. At the end of the 18th century Cliford Beers a rising businessman and graduate of Y ale Uni- versity attempted suicide due to his despair and fear of sufering a mental collapse. He chroni- cled the course of his mental illness in his autobiography A Mind Tat Found Itself. His recovery became walking proof of the ability to “cure” mental illness however his testimony also exposed the abusive conditions existing in psychiatric hospitals at the time. In 1909 Beers established the National Committee for Mental Hygiene in an efort to enlighten society about the disease of mental illness and rally support for treatment and prevention Levine  Levine 1992. At this time a German neurologist Richard von Kraf-Ebing 1840–1902 discovered that syphilis caused general paresis a disorder that produced both physical paralysis and mental delu- sions of grandeur problems. Te rise of the somatogenic perspective or the disease model of mental illness brought with it the hope of a “cure” but it also ushered in stigma and fear of potentially “catching” transmitted from a carrier or inheriting the illness. For the next half century the unfortunate consequence was that out of fear and misunderstanding many individ - uals with mental disorders were institutionalized and overcrowding ofen leading to deplorable conditions. 3 Te Shif in Emphasis From Treatment to Identifcation During the early part of the 20th century with the advent of IQ testing many individuals were diagnosed with mental retardation and placed in residential training schools with the intent of curing their mental retardation. Although there had been growing concern with conditions in institutions that housed the mentally ill it wasn’t until the mid-1960s that attention turned toward the increasing numbers of individuals being identifed and placed in state hospitals and training schools for the mentally retarded. At this time Burton Blatt a university professor from

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10 • Foundations of Abnormal Psychology Boston University and Fred Kaplan a friend and photographer released their exposé of the deplorable conditions they uncovered when they visited four large state schools in the north- eastern United States Taylor 2006. A Picture Is Worth a Tousand Words Blatt and Kaplan 1966 published their photographic essay of the deplorable conditions that existed in the back wards of state institutions for the mentally retarded. Teir book Christmas in Purgatory: A Photographic Essay on Mental Retardation revealed graphic illustrations of the overcrowded conditions of the residents many of whom were either naked or scantily clad. Te following year a version of the story “Te Tragedy and Hope of Retarded Children” describing conditions of these “human warehouses” was pub - lished in Look magazine Blatt  Mangel 1967. Te failure of the training schools to “cure” mental retardation resulted in conditions of over - crowding such as those exposed by Blatt. Widespread trends toward deinstitutionalization also were formative in trends to move students back into their own communities when special edu- cation classes were initiated in 1975 with the passing of Public Law 94-142 then called the Edu- cation of All Handicapped Children Act EHA Wilmshurst  Brue 2005. As a result training schools initially erected as primarily educational institutions shifed their role to that of cus- todial living centers for the severely mentally retarded Biasini Grupe Jufman  Bray 1999. Past Roadblocks and Ghosts Revisited Overcrowding in residential training centers resulted from an emphasis on identifca - tion and placement spawned largely from the intelligence testing movement. However with the advent of special education emphasis on the use of intelligence tests for iden- tifcation and placement became even more pronounced as countless numbers of chil- dren were tested to determine whether they qualifed for special education services. Te tendency to equate assessment a process of evaluation with testing administer- ing a test such as an IQ test had its beginnings in 1910 when Goddard translated the Binet-Simon allowing for many children to be tested for “feeblemindedness. ” However some 60 years later the testing movement was called into question by the famous Cal- ifornia case of Larry P v. Riles 1972. Te California court ruled that the use of stan- dardized IQ tests on Black children for the purposes of placement in special education programs for the educable mentally retarded EMR was unconstitutional unless prior approval was obtained by the court. On a more recent note . . . school psychologists currently spend about two-thirds of their time performing intellectual assessments or other placement procedures for the purposes of identifcation and placement of children in special education programs which has led some to refer to them as “gatekeepers for special education” Reschly  Wilson 1995. Models of in-school consultation and response to intervention RTI have been proposed as alternative assessment methods to reduce the volume of intelli- gence tests given for placement decisions.

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Past Present and Future • 11 4 Adult Versus Child Perspective With the advent of child labor laws and child protection issues children were no longer con- sidered “little adults” as they had been in the 19th century. However the clinicians who treated children did so following training procedures that had been based primarily on work with adult patients. Terefore the need to develop methods more suited to developmental populations was not considered necessary at this time because childhood psychopathology was considered to share the same features as adult psychopathology and treated using adult methods Peterson  Roberts 1991. Furthermore according to Horn 1984 the child guidance clinics in the 1920s and ’30s held two opposing views of parents: those who blamed parents for the child’s prob- lems and those who believed that a stable family environment was essential to positive mental health. Te majority of emphasis in the 1930s was frmly entrenched in linking child problems to adult problems maternal overprotection was thought to cause overly submissive children while maternal rejection was thought to promote overly aggressive children. Freud’s Child While Freudian theories emphasized the importance of childhood in infuencing per - sonality development psychoanalytic theorists held the viewpoint that children were not capable of experiencing major depression. Tey reasoned that young children did not have the capability of this experience because they did not yet have a well-developed and internalized superego a necessary precursor to major depression Clarizio 1994. Tese theorists adhered to these beliefs despite Spitz’s 1946 observations of depression in institutionalized infants and early descriptions of depression depicted in child case studies Bleuler 1934. Currently there is increasing emphasis on understanding the unique variants of child and adolescent psychopathology that exist at diferent developmental levels. Tere was a growing level of discontent with the Diagnostic and Statistical Manual of Mental Disorders DSM for several reasons including 1 the majority of criteria for disorders of anxiety mood disorders and disorders of substance use and abuse disorders have been based on feld trials that have been conducted primarily with adult populations and 2 the categorical nature of DSM diag- nosis. In particular there is increasing concern about the lack of diagnostic criteria for infants and toddlers despite a greater understanding of psychopathology in younger children Boris et al. 1998 Scheeringa  Zeanah 2001. Tis concern has been addressed somewhat by the most recent revision of the DSM-5 APA 2013 which has attempted initial steps to integrate a dimensional approach to diagnosis and attempts to cluster disorders “according to what has been termed internalizing and externalizing factors” that “represents an empirically supported framework” p. 13. In addition the DSM-5 has also attempted to organize the disorders in the manual based on developmental and life span considerations beginning with disorders that usually have onset earlier in life neurodevelopmental disorders and concluding with disorders that have later onset neurocognitive disorders personality disorders. Clinical Child Psychology: Focus on Development Te terms abnormal child psychology clinical child psychology and child psychopathology can be used interchangeably as is evident in the wide variety of journal titles available. Tere has

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12 • Foundations of Abnormal Psychology been enormous growth in empirical research concerning child and adolescent psychopathology since the 1970s and a large number of journals have emerged exclusively devoted to research about child and adolescent clinical concerns Journal of Clinical Child Psychology Journal of Abnormal Child Psychology Journal of the American Academy of Child and Adolescent Psychia - try Journal of Child Psychology and Psychiatry etc.. In what now seems like a very logical pro- gression groundbreaking events occurred in the mid-1980s when clinical child concerns were conceptualized within a developmental framework giving rise to the feld of developmental psychopathology Sroufe  Rutter 1984 an ofshoot of developmental psychology complete with its own journal Development and Psychopathology. Developmental Psychopathology: Te Merging of Two Disciplines In their groundbreaking article on the “Domain of Developmental Psychopathology ” Sroufe and Rutter 1984 discuss the complexities evident in developmental psychopathology which was at that stage of an “emergent” discipline. Te discipline the authors suggest should be closely “wed - ded” to the “methods theories and perspectives of developmental psychology ” while regarding “pathology” as “developmental deviations. ” Within this context the authors defne developmen - tal psychopathology as “the study of the origins and course of individual patterns of behavioral maladaptations” p. 18. Developmental Psychopathology Versus Clinical Child Psychology Sroufe and Rutter 1984 distinguish developmental psychopathology from clini- cal child psychology which they depict as more static in nature. Te developmental psychopathologist’s emphasis is on the origins and nature of disordered behaviors and how behavior patterns change over the course of development “its varying man- ifestations precursors and sequelae and its relation to nondisordered patterns of behavior” p. 18. Te Increasing Role of Developmental Contexts Within the framework of developmental psychopathology atypical child behavior is concep- tualized as a deviation from normal development. Since its inception there has been extensive research devoted to many variations on the theme including how to incorporate developmental psychopathology as an overarching approach and how to successfully integrate other theoreti- cal models into a comprehensive understanding of the underlying processes that precipitate and maintain maladaptive behaviors Wilmshurst 2015. With an eye on prevention increased emphasis has been placed on determining processes that can inhibit or escalate the development of maladaptive behaviors. Research eforts have focused on uncovering risk factors that place children in jeopardy for the development of mal- adaptive behaviors and identifying protective factors that can bufer children from harm. At its core developmental psychopathology focuses on human development as a holistic process that is both interactive and dynamic. Te “total child” incorporates and is the sum total of multiple levels of biological social and psychological processes that act and react in a movement that is hierarchical transactional and increasingly complex Cicchetti  Toth 1998 Cicchetti  White 1988 Wenar  Kerig 2000.

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Past Present and Future • 13 Important Distinction Initially parent–child interactions were thought to be a one-way system of communi - cation with the onus placed on a parent’s ability to infuence child behaviors Parent→ Child. Later the concept of bidirectional infuence Bell 1968 recognized that child behaviors are equally as likely to infuence parenting behaviors Parent → Child Child → Parent. Te transactional model Samerof  Chandler 1975 incorporates infu- ences in development as an ongoing process of bidirectional reciprocal interactions between the child and the environment such that changes in either can afect each other in a reciprocal way. Viewing abnormal child behavior from a developmental perspective several recurrent themes provide the foundation for understanding the nature of psychopathology in children. Te frst theme acknowledges that understanding deviation from the norm requires at the onset A thorough understanding of normal development and normal expectations Teme 1. Within this model normal development becomes the yardstick that provides the measure of the severity of pathology because: Te degree to which behavior deviates from the norm defnes the degree of maladaptive behavior Teme 2. Te next theme is a natural progression from the frst two themes and emphasizes the impor - tance of recognizing that Maladaptive behavior exists on a continuum of severity Teme 3. Terefore the feld of developmental psychopathology has emphasized three of the fve themes that provide the foundation for this text on abnormal behavior from a developmental perspec- tive. Viewing behaviors along a developmental continuum provides continuity because normal and abnormal behaviors stem from the same developmental principles. It is through our under - standing of normal behavior its stages and underlying processes that a greater appreciation is achieved in understanding how and why abnormal behaviors have developed Sroufe 1990. Trends in Conceptualizing Developmental Change and Maladaptive Infuences Bronfenbrenner’ s 1979 1989 ecological model is a sociocultural framework that can increase our understanding of how child characteristics and environmental characteristics interact at various levels of infuence. Graphically the model is portrayed as a series of concentric circles with the child occupying the central core. Te ecological or sociocultural model is depicted in Figure 1.1. Within this sociocultural model individual characteristics genotype intelligence tempera- ment personality interact with environmental characteristics that exist in the immediate envi- ronment family school peers the prevailing social and economic climate socioeconomic status extended family neighborhood safety and culture laws and values policy customs. Infuences from the immediate environment or what Bronfenbrenner calls the microsystem can be acute or chronic such as ongoing family confict or the painful loss of a family mem- ber. Infuences of the exosystem such as available health services employment opportunities or neighborhood safety can have a signifcant impact on the growing child for better or worse as is evident in the diferent trajectories found for children who are raised in secure homes versus those raised in a more chaotic environment. Finally subtle infuences exerted by factors in the

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14 • Foundations of Abnormal Psychology macrosystem can have a profound impact on children as policy changes may alter future oppor - tunities for growth or cultural expectations may result in parent and child conficts as new ways clash with the old. To fully appreciate and understand a child’s mental status it is necessary to not only consider the child but also the role of contextual variables that serve to predispose precipitate and maintain the disordered behavior. Tis interaction is another important and recurrent theme: individual interpersonal con- textual and cultural factors infuence deviations in development Teme 4 . Macrosystem Exosystem Microsystem Individual Child Figure 1.1 Bronfenbrenner’s Ecological Model Individual child: Child characteristics biological genetic temperament IQ Microsystem: Immediate family school peers community neighborhood Exosystem: Extended family social and economic conditions Macrosystem: Culture values and laws. Compatibility and Goodness of Fit A major factor that can contribute to whether infuences exert a positive or negative impact is the degree to which communication exists between diferent members in a child’s environment. If the members are not compatible e.g. mother and father do not communicate efectively such as in giving the child contradictory messages then the nature of infuence is not cohesive. Bronfenbrenner refers to the communication or inter - action between systems as the mesosystem. Good communication and sharing similar goals would predict a healthy exchange and more opportunities for success compared to a mismatch. For example if there is a communication breakdown between home and school two immediate environmental infuences microsystems then the opportuni- ties for successful progress are likely to be seriously compromised. However if the home and school support a similar agenda e.g. compliance with rules respect for authority motivation to do well then the likelihood of success would be predicted to increase.

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Past Present and Future • 15 Contemporary Viewpoints Regarding Developmental Change Although Bronfenbrenner’s ecological model provides an excellent beginning for understand - ing multiple levels of infuence it is important to consider that dual nature of infuences that can determine patterns of action and reaction. For instance an infant who resists his mother’s attempts to pick him up may set the stage for the mother being less likely to attempt to hold the infant in the future. Similarly if a mother continually ignores her child’s pleas for attention the child may withdraw or act up in an attempt to get any form of attention possible. It is within this developing repertoire of responses that the bidirectional nature of infuences Bell 1968 or what Bandura 1985 called reciprocal determinism can be very helpful in understanding the action → reaction paradigm that can result in a wide range of diferent developmental outcomes. Never Underestimate the Power of Environmental Infuences Research studies suggest that economically stressed parents of children living in poverty tend to discipline these children more harshly and inconsistently while ignoring their chil- dren’s dependency needs Dodge Pettit  Bates 1994 McLeod  Shanahan 1993. Fur- thermore prolonged and persistent poverty is signifcantly more detrimental to the child’s social-emotional functioning than transitory fnancial hardship Duncan Brooks-Gunn  Klebanov 1994. However parenting behavior can also serve to bufer children from the efects of poverty Cowen Wyman Work  Parker 1990. For example studies have iden- tifed stress-resilient children who respond more favorably to parents who were more sup- portive less harsh and more developmentally appropriate and consistent in their discipline. As theorists’ understanding of child development increased more intricate and advanced models were constructed to capture the complex nature of developmental change. Although Bandura’s 1985 model emphasized reciprocal infuences Samerof wanted to capture the ongoing and interactive process of infuence and change that occurs as the child continually adapts to his environment and the environment changes as a result. Samerof’s transactional model Samerof  Chandler 1975 applied to developmental psychopathology has provided an increased understanding of the underlying dynamics evident in the development of a given disorder and the diferent trajectories that can result. By tracing specifc pathways researchers have begun to unravel the infuences that can place children at risk for developing disorders and the protective factors that mitigate risk. Trough the use of an ecological transactional model Cicchetti and Toth 1998 provide a comprehensive look at the nature and development of depressive disorders in children and youth that would not have been possible without con- sideration of the diverse and multiple infuences that interact to produce depressive outcomes. Understanding Maladaptive Behaviors From a Developmental Perspective Looking Ahead: Applying a Developmental Framework to Understanding Aggressive Behaviors One of the most researched areas of problem behaviors in children concerns the development of aggressive behaviors. Tere are several reasons for research emphasis in this area including studies devoted to understanding “what is normal” and what is considered a “serious devia- tion from the normal path” e.g. acts of aggression that violate the rights of others or indicate serious rule violations. Aggressive behaviors can be a threat to the safety of others therefore it is important to know what is “normal” child behavior and what can signal cause for alarm.

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16 • Foundations of Abnormal Psychology Research has demonstrated that “early starters” Aguilar Sroufe Egeland  Carlson 2000 or those who demonstrate an increasing pattern of aggression in the frst 3 years of life are at greatest risk for continuing to evidence a stable and escalating pattern of aggressive behavior patterns throughout their life span. Terefore the concept of aggressive behaviors provides an excellent starting point for looking at how problem behaviors are conceptualized and what con- stitutes behaviors that cross the line into the area of clinically signifcant variations from normal patterns. Te following case study is an example of the types of case presentations that will serve to introduce each of the disorders presented in this text. Te cases illustrate various levels of severity and how symptoms can manifest at diferent developmental levels. Case in Point: Variations in Aggression Jerry is easily upset and displays his low tolerance for frustration by throwing his base- ball bat into the feld when he fails to connect with the ball. When reprimanded by the coach Jerry throws himself on the ground and begins kicking his feet. Jerry typically has problems coping with being emotionally upset and he ofen responds with an intense negative reaction. When asked to remove himself from the playing feld Jerry argues with the coach and refuses to budge. Sara is angry with Julie. Instead of dealing with her anger directly Sara waits until that evening and calls all of their mutual friends saying nasty things about Julie until she rounds up a circle of friends who agree to completely isolate Julie and not talk to her in the morning. Te next day Julie arrives at her locker to fnd grafti scribbled in marker across the front and is faced with rejection from her friends for no apparent reason. Sara has been successful in obtaining sweet revenge. Although George was somewhat oppositional when younger now his behaviors have escalated out of control. He has been caught stealing CDs from the local music store and he has been truant from school on four occasions in the past month. Rule violations have been a problem at home as well. Not only has he stayed out all night on several occasions but has been suspected of stealing money from his mother’s purse. In the scenarios just presented Jerry Sara and George all display various levels of aggressive behavior. Viewing these scenarios from a developmental perspective there are several questions that immediately come to mind that can assist in determining the degree of severity of the problem behaviors. Referring back to the fve recurrent themes and the K-3 Paradigm it becomes essential to frst consider what is considered to be “normal” within the context of aggressive behaviors. However it is not possible to determine what is normal for the children noted in the case study unless we have an idea of where they are developmentally. Terefore the frst obvious question is: How old are the children in the scenario Jerry is 8 years of age. For his age level he has signifcant problems with emotion regulation and he demonstrates temper tantrums that are more typical of a 2- or 3-year-old. He is oppositional and defant refusing to comply with the coach’ s requests. Based on the frequency with which these behaviors are demonstrated and the degree to which the behaviors are exhibited in the home envi- ronment a diagnosis of oppositional defant disorder ODD is possible. Te diagnostic criteria for ODD according to the DSM-5 APA 2013 will be addressed in Chapter 12. Sara is 11 years of age an age at which retaliatory getting even types of aggression are com- mon. Her behavior although not condoned does represent a somewhat typical and negative

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Past Present and Future • 17 behavior pattern that may be evident in females of middle school age. Sara is displaying rela - tional aggression a predominantly female form of aggression that is directed toward a victim’s social relationships with the goal of destroying social ties. George is also 11 years of age however the behaviors that he is engaging in seem to have far more serious consequences. George displays many of the symptoms of conduct disorder evident in behaviors that are either serious rule violations or that defy the rights of others. Te diagnostic criteria for conduct disorder will be addressed in Chapter 12. George’s behaviors are more consistent with the covert hidden and non-destructive variety which is less severe than the overt and destructive type that involves such infractions as property destruction and intentional cruelty to others or animals. From a developmental perspective there are empirical guidelines that provide benchmarks for providing answers to questions about: • What is normal • What is a normal variation • What is a serious deviation from the norm We know from longitudinal studies of aggressive behaviors that normally overt acts of aggres - sion peak in the second year and diminish with age as children become more socialized Trem- blay et al. 1999. However not all children follow this preferred path. For some children like George overt aggression is a stable pattern of behavior that can persist through middle school and adolescence Aguilar et al. 2000. While very young children primarily engage in acts of instrumental aggression I shove you away so I can get a toy Sara’s aggressive behavior is more appropriately labeled as interpersonal aggression or hostile aggression because her intent is to infict distress on another person. At 11 years of age typical aggressive patterns are more likely to have a “get even and retaliatory” quality to them and are more likely to be verbal name-calling derogatory remarks than phys- ical. Sara’s covert and verbally aggressive behaviors relational aggression are more typical of females at this developmental stage. Although the case study scenario presents a snapshot in time there are several clues that hint at the more serious nature of George’s aggressive behav- ior. In order to determine the severity of George’s behaviors we would need more information about the contexts and history of these behaviors. However to rule out a situational reaction it would be important to determine if there have been any recent traumatic changes in the family e.g. parents’ separation or school/social environments such as being a victim of bullying. If so then these conditions might be seen as a precipitating factor for George’s aggression or acting-out behaviors. However if aggressive behaviors have been maintained for a much longer duration e.g. George has always been difcult to manage and he has a history of noncompliant and defant responses at home then our evaluation of these behaviors takes on a diferent level of severity. Tese scenarios reinforce the importance of the fve underlying themes that are fundamental to understanding maladaptive behaviors from a developmental perspective. Next we will take a closer look at each of these fve themes. Te Five Recurrent Temes Te book will stress fve consistent themes that can guide the reader and provide a framework for understanding the nature and the development of maladaptive behaviors thoughts and feelings.

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18 • Foundations of Abnormal Psychology Table 1.1 Developmental Tasks Competencies and Limitations at Each Stage Age/Stage of Development Task/Limitations Infancy Birth to 1 year Trust vs. Mistrust Erickson Secure vs. Insecure Attachment Bowlby Diferentiation Self and Others Reciprocal Socialization Development of Object Permanence Piaget: Objects exist when out of sight First Steps First Word Toddler 1 to 2½ years Autonomy vs. Shame and Doubt Erikson Increased Independence Self Assertion and Pride Beginnings of Self Awareness Social Imitation and Beginnings of Empathy Beginnings of Self Control Delayed Imitation and Symbolic Tought Language Increases to 100 Words Increased Motor Skills and Exploration Preschool 2½ to 6 years Initiative vs. Guilt Erickson Inability to Decenter Piaget: Logic bound to perception problems with appearance/reality Egocentric emotional and physical perspective one emotion at a time Increased Emotion Regulation under-regulation vs. over-regulation Increased Need for Rules and Structure Can Identify Feelings: Guilt and Conscience Are Evident Emergent Anxieties Phobias Fears School Age 6 to 11 years Industry vs. Inferiority Sense of Competence Mastery and Efcacy Concrete Operations Piaget: no longer limited by appearance but limited by inability to think in the abstract Can Experience “Blends” of Emotions love/hate Self Concept and Moral Conscience Realistic Fears injury failure and Irrational Fears mice nightmares Teen years 12+ years Identity vs. Role Difusion Erickson Abstract Reasoning Piaget Emotional Blends in Self and Others ambiguity Return of Egocentricity Piaget/Elkind: imaginary audience and personal fable Self Concept Relative to Peer Acceptance and Competence Teme 1: Normal Development Typically Proceeds Along an Orderly and Predictable Path Development is cumulative and progressive with age- and stage-related expectations for cogni- tive afective and behavioral outcomes. At each of the ages and developmental stages there are tasks to be mastered and goals to be fulflled. Development is a process of qualitative change that provides the background for understanding both the limitations that compromise children’s understanding behaviors and feelings at various stages and the capacities or milestones they are expected to achieve. From our knowledge of developmental expectations we can assume that unless Sara repeatedly and intensively engages in aggression her behavior is likely to refect normal developmental progression. Familiarity with normal developmental expectations provides an important backdrop for clinical decision making and evaluation of deviations from the norm. Predominant tasks to be mastered as well as expected stage-based competencies and limitations are presented in Table 1.1.

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Past Present and Future • 19 Development in Focus Although the selection of specifc ages to defne the beginning or ending of stages can be somewhat arbitrary this text will use the following stage divisions: Infancy birth to 1 year Toddler 1 to 2.5 years Preschool 2.5 to 6 years School Age 6 to 11 years Teen or Y outh 12+ years. Teme 2: Maladaptive Behaviors Represent Deviations From the Normal Path Although there is a grand plan for developmental progression and a predictable pattern of stages there are normal variations or individual diferences in the rate at which these changes take place. Some children develop more quickly than others and some children meet devel- opmental goals at a much slower pace than the norm. For example in Chapter 6 much of our understanding of intellectual disability comes from an appreciation of how cognitive limitations might impact on the rate of learning and the particular challenges that children with these lim- itations might face in mastering developmental tasks. Behaviorally some children lag in social and/or emotional skill development and these delays may result in poor peer relations with outcomes of peer rejection or neglect. In our earlier case scenario Julie’s rejection by her peers may predispose her toward greater social difculties in the future Kagan  Snidman 1999. In addition to variations in the rate or pace of mastering developmental tasks developmental deviations may also be evident in the degree to which certain patterns of behaviors thoughts or feelings veer of the normal path or in the course of these abnormal developmental trajectories or pathways. Te Tree of Life Bowlby 1973 used a branching tree to explain the concept of developmental pathways. In this model the trunk of the tree represents normal development and the branches represent diferent pathways that individuals might take in their growth and develop - ment. Although this model maintains a positive perspective in that positive choices are always possible Bowlby does maintain that the choices are constrained by previous choices. Analogous to a highway with a series of detours the further of the normal path one devi- ates the more difcult it becomes to return to the main road. Te concept of pathways is also important because it helps to illustrate two other very important principles of development. Te frst principle is the concept of equifnality which simply stated is the idea that two people can arrive at the same destination using very diferent roads. Te second principle is the concept of multifnality or the fact that two people can have very similar risk factors yet have very dif- ferent outcomes or you can start on the same road but end up in very diferent destinations. Important Distinction Te principles of equifnality and multifnality represent diferent mechanisms for explaining how infuences impact outcomes. Te principle of equifnality explains

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20 • Foundations of Abnormal Psychology how similar symptoms e.g. depression can develop from diferent sources maternal depression peer rejection etc.. Multifnality points to the diferent outcomes that can result even if individuals face similar circumstances. For example two siblings growing up in the same household with a depressed mother may exhibit diferent outcomes one may have conduct problems another may be depressed or they may demonstrate few atypical symptoms due to protective factors. Teme 3: Maladaptive Behavior Is Represented by a Continuum of Severity Behaviors can diverge from the normal path in mild symptoms moderate syndromes or severe disorders digressions. Te extent to which the behavior is deviant requires an understanding of normal expectations. Negativity and power struggles can be anticipated at the toddler stage and again in adolescence however severe and persistent noncompliance and defance across the devel- opmental spectrum is not a normal deviation. In the Case in Point if Jerry’ s aggressive defant and noncompliant behaviors have longevity and are intense then we are more concerned about the degree of pathology. Based on the information provided further investigation would certainly be warranted to determine whether Jerry met DSM criteria for oppositional defant disorder. Teme 4: Individual Interpersonal Contextual and Cultural Factors Infuence Deviations in Development In order to understand the underlying processes that shape the extent and nature of maladaptive behavior it is essential to look at the role of ecological or sociocultural infuences internal and external in precipitating and maintaining the behavior patterns. Although the fourth theme is not unique to child psychology it is important to understand the degree to which children by their nature are embedded in their contexts. Initially young children are totally dependent on their caregivers. However even in the initial stages a subtle exchange of mutual responses between caregiver and child begins to chart the course of devel- opment as a reciprocal pattern of interchanges unfolds each infuencing the other. Recall and Rewind Bronfenbrenner 1989 conceptualized developmental infuences as a series of concen- tric circles with the child at the inner core. Child characteristics and environmental characteristics interact to produce change adaptation to change and further changes. It is well established that individual factors such as having a difcult temperament Rutter 1990 can place a child at risk for later behavior problems. In charting the course of develop- mental pathways and trajectories we have learned that difcult beginnings can set the stage for insecure attachments Sroufe Egeland  Kreutzer 1990 maternal rejection and poor outcomes socially emotionally academically and behaviorally Cassidy  Mohr 2001 Lyons-Ruth  Jacobvitz 1999 Main  Hesse 1990. Furthermore theories such as coercion theory Patterson Reid  Dishion 1992 have taught us the importance of linking reciprocal behaviors to family contexts and the interaction of parent and child response patterns that continually recycle nega- tive outcomes. Developmental stages Teme 1 and sociocultural infuences Teme 4 provide an initial foundation for understanding adaptive and maladaptive behaviors. Te relationship between these two themes can be viewed in Table 1.2.

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Past Present and Future • 21 Table 1.2 Stages of Development and Ecological Infuences Inner Circle: Child Child as Individual Internal Infuences Immediate Circle: Family Peers Child in Relationship Reciprocal Infuences Outer Circle Neighborhood Community Government External Infuences Outermost Circle Culture of Origin Minority Status External Infuences Biological Makeup Family and School Context Social and Economic Cultural Context Developmental Stages: All Levels: Infancy Toddler Preschool School Age T een Years Family infuence continues through all stages Peer infuences increase with stages Social and economic issues infuence all levels of development Culture infuences all levels of development Increased opportunity for clashes between culture and peer groups as stages increase Memory Bank Coercion theory developed by Patterson 1982 provides some insight into the poten- tial causes of aggressive and antisocial behavior in children. Te theory suggests that aggressive behaviors are learned through reinforcing events in the social environment. Patterson hypothesized that aggressive behavior develops in children when parents use coercion as the primary mode for controlling their children. Teme 5: Clinical Psychologists Can Draw on a Multiplicity of Teoretical Perspectives to Assist in Understanding Maladaptive Behaviors Teoretical input from diverse perspectives psychodynamic biological behavioral cognitive family systems parenting/attachment sociocultural can provide increased insight and under - standing of the nature of maladaptive behaviors and the diferent pathways that might be involved. Te following exercise will assist in demonstrating the variations in interpretation that might exist among clinicians concerning a young patient who presents with symptoms of depression. Te viewpoints presented in Table 1.3 represent a hypothetical view of depression across the spectrum of theoretical viewpoints. Each viewpoint presents a template for understanding the underlying dynamics inherent in the disorder. Each set of questions seeks to obtain answers based on a set of theoretical assumptions. From a biological approach family history of depres - sion is signifcant because research has demonstrated that children of depressed mothers are at higher risk for a number of disorders including depression Hammen Burge  Stansbury 1990 Peterson Maier  Seligman 1993. A behaviorist would likely target environmental factors that might be reinforcing and maintaining the depressed behaviors. For example depression may be positively reinforced by increased attention from family members or negatively reinforced by a reduction in chores. It may be that the depressed person’s behaviors are serving to drive others away and isolation becomes a self-fulflling prophecy Lewinsohn Clarke Hops  Andrews 1990. Depression may also represent mourning of a symbolic loss or anger turned inward according to psychodynamic theories Bemporad 1992 or stem from insecure attachment to the caregiver. A cognitive therapist would be interested in how the child is cognitively inter- preting the behavior of others. Perhaps the child is overgeneralizing and considering every slight as a major rejection Dykman Horowitz Abramson  Usher 1991 Seligman  Peterson 1986. A cognitive therapist might want to know if feelings of helplessness are perpetuating the

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22 • Foundations of Abnormal Psychology Table 1.3 Six Theoretical Views of Childhood Depression Teory Child Characteristics Environmental Characteristics Biomedical Model: Focus on: brain and body Genetic Traits Neurotransmitter Function Chemical Imbalance Temperament/Behavioral Inhibition wary/shy Familial history of depression Behavioral Model: Focus on learned behaviors Depressed behavior is reinforced by attention or depressed behaviors serve to drive others away and further alienate Maternal depression caregiver reinforces depressed behaviors peer rejection negative coercive cycles Cognitive Model: Focus on thoughts and beliefs Negative thought patterns and attributions cognitive triad: helpless hopeless and worthless learned helplessness Maternal depression and modeling of negative parental interactions peers reinforce negative thinking in teasing and bullying behaviors Family Systems Parenting Style: Focus on family dynamics Parenting patterns: authoritarian authoritative permissive Child adopts the role of the “depressed” child Lack of parental support nurturance Detouring: family focus on child depression to avoid family problems Authoritarian parenting style: high on control low on warmth Psychodynamic/Attachment: Focus on underlying subconscious conficts Focus on secure/insecure/ ambivalent attachment Depression as anger turned inward or symbolic loss Subconscious confict Insecure attachment low self- esteem and poor coping ability Parent cold and rejecting Maternal depression Parental rejection inability to soothe Sociocultural: Focus on social networks and social conditions Poor school relations Neighborhood safety Poverty family stress lack of community belonging sense of hopelessness and despair. A family systems therapist would want to know how family relationships were impacting on the depression e.g. Do these relationships serve to alleviate or increase feelings of inadequacy and low self-esteem Are there boundaries and alliances that serve to efectively lock the child out of the family support system. A sociocultural perspective might look beyond the child’s immediate environment to determine factors evident in child’s cultural background neighborhood or peer associations that might be causing or maintaining the child’s sense of depression Altmann  Gotlib 1988 Patterson  Capaldi 1990. Although the preceding tables and discussion present hypothetical examples concerning the possible infuence of theoretical perspectives on symptom presentation and interpretation there is an increasing appreciation of the need to integrate information from multiple sources and across theoretical perspectives. Recent research has increased our awareness of the complexity of childhood disorders Kazdin 1997 Kazdin  Kagan 1994 and as a result emphasis has shifed from single-factor to multiple-factor and interactive explanations for childhood disorders Cic- chetti  T oth 1998. As a result contemporary clinicians ofen draw on several theoretical frame- works in an efort to assess the many factors that may serve to predispose initiate and maintain disordered behaviors with the ultimate goal of targeting these areas for therapeutic interventions. Te K-3 Paradigm Ultimately our understanding of maladaptive behavior in children and adolescence requires the ability to converge the fve themes into an overall working paradigm. When theories are

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Past Present and Future • 23 integrated with ecological infuences and developmental levels behaviors are understood within a rich contextual presentation. Te ultimate goal in understanding patterns of abnormal child behaviors is the ability to bridge theoretical assumptions with developmental contexts and then consider whether this behavior is appropriate or deviant based on the child’s development level. Tis integrated model can be seen in Table 1.4. Table 1.4 Developmental Stages Ecological Infuences and Theoretical Perspectives: An Integrated Model Inner Circle: Child Child as Individual Internal Infuences Immediate Circle: Family Peers Child in Relationship Reciprocal Infuences Outer Circle: Neighborhood Community Government External Infuences Outermost Circle: Culture of Origin Minority Status External Infuences Biological makeup Family and school context Social and economic Cultural context Developmental Stages: All levels: Infancy Toddler Preschool School age Teen years Family infuence continues through all stages Peer infuences increase with stages Social and economic issues infuence all levels of development Culture infuences all levels of development Increased opportunity for clashes between culture and peer groups as stages increase Child-Centered Teories: Biomedical Physical Development Behavioral Cognitive Psychodynamic Personality Relationship Teories: Behavioral Cognitive Family systems Attachment/parenting Contextual Teories: Sociocultural Family systems Teories: Sociocultural Knowledge of Theories Knowledge of Development Knowledge of Contexts Knowledge of Theories Knowledge of Development Knowledge of Contexts Figure 1.2 The K-3 Paradigm

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24 • Foundations of Abnormal Psychology Overall Learning Objective Using the K-3 Paradigm readers will gain an increased appreciation of the complex nature of child and adolescent behaviors and the degree to which these behaviors are maladaptive based on their understanding of the need to integrate information from three key information sources: 1. Knowledge of developmental expectations 2. Knowledge of sources of infuence 3. Knowledge of theoretical models. CHAPTER SUMMARY AND REVIEW Historical Background and Organizational Temes 1. Te ref orm movement ushered in an era of child protection as child labor laws were insti- tuted and mandatory education became a reality. 2. With the advent of the Stanford–Binet Intelligence test and the new infux of children in the schools psychologists were preoccupied with intellectual assessments for identi- fcation purposes. As a result unfortunately many identifed as mentally retarded were institutionalized. 3. In 1909 the frst child guidance clinic was established. Twenty years later there was a shif from focusing on the treatment of delinquent youth to identifcation of parents as the problem cause. By 1948 54 child guidance clinics came together to form an association however this movement also coincided with a controversial shif in the role of the centers. Rather than focus on the identifcation of children’s problems the child guidance clinics would become centers for training and research. 4. Initially it was thought that children were too young to experience emotions such as depression. Later the fallacy was that children experienced the same emotions as adults and required the same treatment. Both beliefs deterred recognition of clinical child psy - chology as a unique feld of study. 5. In 1984 developmental psychopathology emerged as an integrated approach to consider- ing maladaptive behaviors within the context of developmental expectations and norms. T oday there is increasing recognition that maladaptive behavior is a byproduct of ongoing interactions between multiple ecological infuences child family peers school commu - nity culture. 6. Te book stresses fve pivotal themes to understanding maladaptive behaviors: a. Normal development is orderly and predictable. b. Maladaptive behaviors are deviations from the normal path. c. Te degree of deviation determines the severity along a continuum. d. Developmental change is infuenced by child and environmental characteristics fam- ily peers community economics culture. e. Tere are a number of theoretical perspectives that can help explain maladaptive behavior. 7. Understanding abnormal child behavior requires integrating knowledge from three piv- otal areas K-3 Paradigm: a. Knowledge of normal expectations b. Knowledge of sources of infuence c. Knowledge of theoretical models.

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Past Present and Future • 25 Consolidate and Communicate 1. In their article on the domain of developmental psychology Sroufe and Rutter 1984 dis- cuss how the feld of developmental psychopathology difers from the felds of abnormal child psychology and clinical child psychology. Te authors suggest several points of dis- tinction including an emphasis on disordered versus nondisordered behavior diferential diagnosis versus origins and time course and degree of severity versus diagnosis. Discuss how the position in this article supports or does not support the fve themes of this text. 2. Describe some of the possible diferences that might be evident at the individual and immediate levels of environment infuence for Joey a preschooler compared to Sara who is in grade 4. Incorporate how diferent developmental tasks would be evident at both levels and what types of interactions might take place between infuences at various levels. In your discussion demonstrate how an increased rate of interest imposed by the govern- ment might impact both of these children at all levels of their world. 3. Six dif erent theoretical frameworks were introduced in this chapter psychodynamic/attach - ment biological behaviorist cognitive sociocultural and family systems/parenting style . Explain how each of these theoretical models might explain aggressive behaviors demon- strated by each of the three children referred to in the Case in Point Jerry George and Sara. Chapter Review Questions 1. Te precipitating incident that opened the doors for children to attend schools at the end of t he 19th century was: a. Te introduction of the Stanford–Binet b. Te establishment of the child guidance clinics c. Te ref orm movement d. Witmer’s establishment of learning centers 2. Te arrival of the Stanford–Binet ushered in a new era for psychologists marked by: a. Greater recognition of the role of psychology in treating child disorders b. Increased intelligence testing for primarily placement issues c. Use of intelligence testing to secure children placements in private schools for the gifed d. Greater understanding of the “maladjusted” child 3. In the child guidance clinics there was a shif in emphasis in the late 1920s and early 1930s from treating children for delinquent behaviors to: a. Using clinics for research and training b. Using the clinics basically for child care facilities c. Blaming the parents for the child’s problems d. Developing new testing materials 4. Which of the following was NOT a roadblock to clinical child psychology being recog- nized as a separate discipline a. Children were seen as miniature adults b. Te nature/nurture controversy c. Denial that children could have “emotional” problems d. Establishment of clinical child journals 5. Which of the following is NOT one of the fve essential themes a. Development proceeds in a unique and unpredictable direction b. Maladaptive behaviors represent deviations from the normal path

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26 • Foundations of Abnormal Psychology c. Adaptive and maladaptive behavior are infuenced by child and environmental characteristics d. Teoretical perspectives enhance our understanding of maladaptive behaviors 6. In Bronfenbrenner’s ecological model which of the following does NOT apply a. Family infuences are in the immediate environment b. Te innermost circle represents child characteristics c. Cultural infuences are not represented d. Peer infuences are in immediate environment 7. Te fol lowing theorists Bowlby Bandura Samerof/Chandler and Cicchetti/Toth all developed models for understanding the relationship between child and environmental characteristics. Which one statement most closely applies to all theories a. Children infuence their environments b. Environments and communities infuence children c. Te environmental impact of culture infuences the child d. Children infuence their environment and the environment infuences children 8. Goddard established one of the most prominent training schools for the retarded. In his fctional book called the Kallikak Family 1912 Goddard portrays the mentally retarded as: a. Having the ability to rise up in the face of overwhelming odds b. Persevering and slow but able to make gains with great efort c. Loving in a paternal sense d. Feeble-minded and doomed Glossary of New Terms somatogenic perspective psychogenic perspective developmental psychopathology risk factors protective factors bidirectional infuence transactional model ecological model microsystem exosystem macrosystem mesosystem reciprocal determinism transactional model ecological transactional model relational aggression instrumental aggression interpersonal aggression/hostile aggression developmental trajectories or pathways equifnality multifnality coercion theory Answers to Multiple Choice Questions: 1. c 2. b 3. a 4. d 5. a 6. c 7. d 8. d.

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27 2 Understanding Abnormal Development Teoretical Perspectives Chapter 2 At-a-Glance Child Psychopathology and Adult Psychopathology Determining Normal From Abnormal Behavior Shared Competencies and Skills: Determining Normal From Abnormal Behavior Te Four D’s: Concepts of Abnormality Deviance and Cultural Diversity Competencies and Skills Unique to Issues of Child Treatment Trends in Conceptualizing Developmental Change: Teories and Contexts Te Impact of Teoretical Perspectives Biological Teories How the Brain Can Predict Abnormal Behavior Brain Anatomy Brain Development: Neurons and Biochemical Activity Brain Development: Structures Genetics and Heritability Te Role of Temperament Biological Approach: A Summation Behavioral Teories Operant Conditioning Classical Conditioning Modeling or Observational Learning Cognitive Teories Piaget’s Stages of Cognitive Development Social Cognitive Teories Cognitive Behavioral Teories

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