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4 Chapter 1 Introduction
Cultural norms influence developmental expectations.
Human Services, 2000, p. 123) states that “mentally healthy
children and adolescents enjoy a positive quality of life;
function well at home, in school, and in their communities;
and are free of disabling symptoms of psychopathology.”
Using this criterion, children who have a negative quality
of life, who function poorly, or who exhibit certain kinds of
symptoms might have a disorder. The Centers for Disease
Control and Prevention (CDC, 2021) add: “Mental health
is not simply the absence of a mental disorder. Children
who don’t have a mental disorder might differ in how
well they are doing, and children who have the same
diagnosed mental disorder might differ in their strengths
and weaknesses in how they are developing and coping, and
in their quality of life. Mental health as a continuum and
the identification of specific mental disorders are both
ways to understand how well children are doing.” Again,
we think of Emma. From this mental health perspective,
what matters most is how Emma’s fears and anxieties make
the transition to kindergarten distressing and whether she
is able to participate comfortably in various academic and
social tasks.
The Role of Values
Closer examination of these definitions reveals that
each one raises questions about the role of values in
conceptualizations of mental health and psychopathology
(Hindley & Whitaker, 2017; Wakefield, 2002). Box 1.1
provides an example of a values-informed set of children’s
needs for psychological well-being. A key value judgment
involves distinctions between adaptation and maladaptation
Digital Vision/Getty Images
and personal or group standards of adequate or average
adaptation or optimal adaptation (Offer, 1999). Adequate
adaptation has to do with what is considered okay,
acceptable, or good enough. Optimal adaptation has to
do with what is excellent, superior, or “the best of what is
possible.” The following cases illustrate poor adaptation,
adequate adaptation, and optimal adaptation.
Poor Adaptation
The Case of Dylan
Dylan is an eight-year-old boy who lives with his mother
and two older siblings in an aff luent suburb. He is currently
struggling in a variety of ways and in multiple contexts.
He is having trouble with the increasingly demanding
Box 1.1 The Child in Context
The Irreducible Needs of Children
Our understanding of children’s psychological disorders is
informed continuously by our understanding of children’s
usual development. When we think about what happens in
children’s lives, we need to remember not only the range and
variety of hoped-for outcomes, but also the basic, bottom-
line components of “what every child must have to grow,
learn, and flourish.” Two prominent children’s advocates,
T. Berry Brazelton and Stanley Greenspan, have described
these essential needs (Brazelton & Greenspan, 2000). They
include:
● The need for ongoing nurturing relationships
● The need for physical protection, safety, and regulation
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● The need for experiences tailored to individual
differences
● The need for developmentally appropriate experiences
● The need for limit setting, structure, and expectations
● The need for stable, supportive communities and cultural
continuity
In our descriptions and discussions of children’s disorders,
we will refer repeatedly to prevention and intervention strategies
that are based on these needs. Satisfaction of these needs—
from birth through adulthood—is an index of our concern,
compassion, and commitment to children’s well-being.
The Role of Values 5
academics in his private school and is usually ignored by
his classmates. At home, Dylan is angry and withdrawn.
Dylan’s mother had a history of depression before
having children. After years of healthy functioning, she
became depressed following Dylan’s birth, a problem that
she has struggled with throughout his early childhood.
Dylan was described as a “difficult” baby, who cried
frequently and slept poorly. As a toddler, he had frequent
temper tantrums that often involved biting and scratching.
In fact, Dylan’s parents were asked to withdraw him from
his preschool because of his poor emotional and behavioral
regulation. When these issues with Dylan escalated, so
did his mother’s depression as well as conflict between his
parents, who disagreed on what should be done to manage
Dylan’s behavior.
Dylan’s father died just before the start of kindergarten.
Following the unexpected loss, Dylan’s anxiety, always
present but overshadowed by his behavior problems,
became much more severe. Over the next two years,
both his first- and second-grade teachers provided Dylan
with extra support and encouragement but with little
positive effect. At the beginning of third grade, the school
counselor suggested to Dylan’s mother that they consult
with a child psychologist. Although Dylan’s mother
wanted to comply with the referral, she felt overwhelmed
by the challenges of single parenting and her depression
and never arranged for Dylan to meet with a therapist.
As his classmates became more focused on developing
friendships and enjoying academic experiences, Dylan felt
increasingly isolated, lonely, and unhappy.
Adequate Adaptation
The Case of Benjamin
Benjamin is a six-year-old boy who is currently in his
third foster home. Benjamin was severely neglected early
in his life and was removed from his biological mother’s
home when he was nine months old by the county’s child
protection services. After two brief foster placements,
Benjamin has been in a stable and nurturing foster home
for two years.
Although his teachers have no concerns about his
basic academic skills, they note that Benjamin does have
difficulty paying attention and that he is frequently
impulsive. Benjamin has several friends that he likes
to play with, but he is seldom sought out as a playmate
by other children. His feelings are hurt easily, and he
sometimes misinterprets the intentions of others, feeling
that they are out to get him. Consequently, he is quicker
than other children to resort to name-calling or shoving
when he is upset.
Benjamin is more comfortable and relaxed at home with
his foster parents, but he asks often if he will have to move
away from them. While being as reassuring as possible, his
foster parents have acknowledged that they do not know how
long Benjamin will be with them. He clearly worries about
leaving his current home, and although his psychotherapist
attempts to provide support for his concerns, Benjamin is
adamant that he does not want to talk about any possible
relocation.
Optimal Adaptation
The Case of Sofia
Sofia is a six-year-old girl who, like Dylan and Benjamin,
suffered an early loss. Sofia’s mother was a single parent
who died in an automobile accident when Sofia was two.
Following her mother’s death, Sofia went to live with her
maternal grandparents. Although distraught at the loss
of their daughter, they dedicated themselves to caring for
Sofia to the best of their ability.
In addition to her grandparents, Sofia is involved with
and supported by her many relatives who live nearby and
include her in their lives. Sofia’s teachers describe her as
bright and enthusiastic in the classroom. She is excited
about learning to read and seems to have a special aptitude
for math. Sofia is well liked by both the girls and the boys
in her class, and she is often invited to play dates and
birthday parties.
At home, Sofia enjoys hearing stories about her mother
and thinking of how loving and proud her mother
would be. There are times, of course, when Sofia and her
grandparents cry together about Sofia’s mother. And, as
Sofia gets older, she may become more aware of her absent
biological father and seek to learn more about him. But
Sofia and her grandparents are able to take comfort in
each other and in the warm and secure home that they
have created together.
Even with the traumatic beginnings of their childhoods,
both Benjamin and Sofia are moving in a positive develop-
mental direction, in contrast with Dylan. Still, Benjamin’s
adequate adaptation is different from Sofia’s optimal adapt-
ation in the degree to which each successfully manages past
traumas and current challenges, the quality of caregiving
and friendship, and the potential for growth in coming
years. Neither adequate nor optimal adaptation guarantees
smooth sailing throughout development. Challenges are
inevitable, and struggles themselves are not evidence of
disorders. Indeed, challenges and struggles are viewed by
most developmental psychologists as forces of growth.
Sameroff (1993), in fact, suggests that “all life is characterized
by disturbance that is overcome, and that only through
disturbance can we advance and grow. . . . In this view,
it is the overcoming of challenge that furnishes the social,
emotional, and intellectual skills that produce all forms of
growth, both healthy and unhealthy” (p. 3).
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6 Chapter 1 Introduction
The Impact of Values on Definitions
of Disorder
Other important judgments involving values are tied to
specific definitions of disorders. With statistical deviance
definitions, it sometimes makes sense to examine both
extremes of the continuum (e.g., too much intense
emotion as well as too little) because we have made a
judgment that there is a desirable middle course related
to the characteristic in question. At other times, it makes
sense to focus only on the “bad” end of the continuum
and ignore the “good” end (e.g., too little empathy, but
not too much empathy; too little intelligence, but not too
much intelligence). In these specific cases, judgments are
made that some types of extreme characteristics are to be
accepted or even prized.
With sociocultural definitions, value judgments are the
very basis of definitions of disorders. Whether casual use
of mind-altering substances is tolerated or condemned by a
particular sociocultural group influences conceptualizations
of pathological addiction. Whether independence or
connectedness is more valued influences conceptualizations
of pathological dependency.
With mental health definitions, the values of psychologists,
psychiatrists, and clinical social workers are embedded in both
scientific and lay community decision making. Returning
to the Surgeon General’s and the CDC’s descriptions of
psychological well-being, clinicians must evaluate whether
a young person’s life is characterized by a positive quality,
adequate functioning, and few symptoms. Whether these
particular benchmarks represent the least we can do for
children and adolescents or the best we can hope for is yet
another value judgment. Indeed, recent discussions of models
of mental health have emphasized the difference between the
absence of mental illness and the presence of flourishing. To
enhance individuals’ opportunities for flourishing, clinicians,
parents, and others concerned about children’s health and wellbeing advocate for increased resources for programs that focus
on the promotion of mental health across the lifespan as well
as for programs that focus on the prevention and treatment of
mental illness.
Definitions of Psychopathology and Developmental Psychopathology
In this textbook, we will work within the framework
provided by the following definitions of disorder. The term
psychopathology refers to intense, frequent, and/or persistent
maladaptive patterns of emotion, cognition, and behavior.
Developmental psychopathology extends this description
to emphasize that these maladaptive patterns occur in the
context of typical development and result in the current and
potential impairment of infants, children, and adolescents.
Rates of Disorders in Infancy, Childhood, and Adolescence
If definitions of disorders are problematic, estimates of rates of
disorders are even more so. The multi-part task of estimating
rates of disorders includes (1) identifying children with
clinically significant distress and dysfunction, whether or not
they are in treatment (and most of them are not); (2) calculating
levels of general categories of disorders (e.g., anxiety disorders
or neurodevelopmental disorders) and within-category type of
disorder (e.g., generalized anxiety, separation anxiety disorder,
phobia) and their associated impairments; and (3) tracking
changing trends in the identification and diagnosis of specific
disorders, such as autism spectrum disorder, attention deficit
hyperactivity disorder (ADHD), and/or depression. Personal,
clinical, and public policy implications must be considered
when collecting these data. For instance, specific diagnoses
may or may not qualify for insurance coverage. Increases or
decreases in the diagnosis of certain disorders may also have an
impact on the staffing of special education programs in schools.
Frequencies and patterns of disorders in infants,
children, and adolescents can be estimated with varied
methodologies. These frequencies and patterns are the focus
of the field of developmental epidemiology (McLaughlin,
2014). Prevalence and incidence rates are both measures
of the frequency of psychopathology. Prevalence refers
to the proportion of a population with a disorder (i.e.,
all current cases of the disorder); incidence refers to the
rate at which new cases arise (i.e., all new cases in a given
time period). Random sampling of a general population is
one option for estimating prevalence (e.g., using surveys,
phone questionnaires, and/or detailed psychopathology
screening instruments). For example, the investigators in
the Great Smoky Mountains Study interviewed over 1,400
participants multiple times between 9 and 30 years of age
(Costello et al., 2016). Sampling in schools, using teachers’
assessments, or in children’s primary care clinics are other
options for data gathering. Researchers may also examine
population statistics for disorders or treatments within
communities or countries or collect data in many different
countries for comparisons. One example of this type of
research strategy is a large-scale school-based investigation
that compared rates of disorders in four geographic areas
within the United States (Colorado, Florida, Ohio, and
South Carolina), noting important similarities across
geographic sites (Danielson et al., 2021).
Whatever the method, there can be no doubt that
many children struggle with distress and dysfunction.
Data summarized by the Centers for Disease Control and
Prevention (CDC) estimate that between 13% and 16% of
school-aged children in the United States meet the diagnostic
criteria for a psychological disorder (Merikangas et al., 2009;
Zablotsky & Terlizzi, 2020). These rates are comparable to
those reported in a large-scale meta-analytic review of the
prevalence of disorders in children and adolescents from
27 countries and every world region (Polanczyk et al., 2015)
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Allocation of Resources, Availability, and Accessibility ofCare 7
and to rates described in a study of 6- to 12-year-old children
from eight European countries (Italy, France, Germany, the
Netherlands, Lithuania, Bulgaria, Romania, and Turkey
(Husky et al., 2018).
In addition to estimates of overall rates of disorders, we
also need to know whether rates of disorders are increasing.
Are children and adolescents more likely to develop disorders
than in past decades? Are we in the midst of a youth mental
health crisis? In October 2021, the American Academy of
Pediatrics, the American Academy of Child and Adolescent
Psychiatry, and the Children’s Hospital Association declared
a national emergency in child and adolescent mental
health. These groups focused on worsening mental health,
with disproportionate impact on children and families in
communities of color, and tied the immediate crisis to the
COVID-19 pandemic and the painful struggles related to
racial and social justice. The groups’ recommendations for
responding to the crisis are summarized in Box 1.2.
Examination of distribution trends (within and across
countries) reveals increases in many different types of
disorders, including autism spectrum disorders and ADHD,
depression and anxiety, conduct disorders, and suicidality.
These increases will be discussed in more detail in upcoming
chapters, but it is important to emphasize here that these are
real and meaningful changes in rates of disorders (Collishaw,
2015; Cybulski et al., 2021). Figures 1.1a and 1.1b illustrate
these trends. There are, of course, many hypotheses about
these higher frequencies of disorders. Explanations include
increased help-seeking by children, parents, and others; more
screening and better recognition of disorders; and changes
related to individual vulnerability, family life, and widespread
sociocultural change and challenge (Collishaw, 2015;
Cybulski et al., 2021). Each of these contributors to increased
rates of disorders will also be explored in upcoming chapters.
Allocation of Resources,
Availability, and Accessibility
ofCare
Although it is always the case that children’s distress and
dysfunction deserve our attention, our compassion, and our
best clinical responses, a number of critical issues demand
renewed and innovative efforts. Even with abundant researchbased knowledge about ways to promote children’s health
and well-being that has been available for years, parents,
schools, communities, and policy makers have struggled to
allocate scarce emotional, social, and financial resources.
One continuing difficulty involves access to care. Multiple
investigations suggest that fewer than half of children and
adolescents who need mental health interventions receive
them (e.g., childstats.gov, America’s Children: Key National
Indicators of Well-Being, 2021).
Box 1.2 The Child in Context
Recommended Responses to a National Emergency in Child and Adolescent Mental Health
This list is a summary of the recommendations provided as
part of a joint declaration of a national emergency in youth
mental health by the American Academy of Pediatrics, the
American Academy of Child and Adolescent Psychiatry, and
the Children’s Hospital Association.
● Increase federal funding dedicated to ensuring all families
and children, from infancy through adolescence, can access
evidence-based mental health screening, diagnosis, and
treatment to appropriately address their mental health
needs, with a particular emphasis on the needs of underresourced populations.
● Address regulatory challenges and improve access to
technology to assure continued availability of telemedicine
to provide mental health care to all populations.
● Increase the implementation and sustainable funding of
effective models of school-based mental health care.
● Accelerate the adoption of effective and financially
sustainable models of integrated mental health care in
primary care pediatrics.
● Strengthen emerging efforts to reduce the risk of suicide in
children and adolescents through prevention programs in
schools, primary care, and community settings.
● Address the ongoing challenges of acute care needs of
children and adolescents, including the shortage of beds
and emergency room boarding by expanding access to stepdown programs from inpatient units, short-stay stabilization
units, and community-based response teams.
● Fully fund comprehensive community-based systems of
care that connect families in need of behavioral health
services and supports for their child with evidence-based
interventions in their home, community, or school.
● Promote and pay for trauma-informed care services that
support family health and resilience.
● Accelerate strategies to address longstanding workforce
challenges in child mental health, including innovative
training programs, loan repayment, and intensified efforts
to recruit underrepresented populations into mental health
professions; address the challenges to well-being faced by
health professionals.
● Advance policies that ensure compliance with and
enforcement of mental health parity laws.
From: AAP News. (2021, October 19). AAP, AACAP, CHA declare national
emergency in children’s mental health.
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
8 Chapter 1 Introduction
Annual rate per 10,000 person-years at risk
6 to 9 10 to 12
Anxiety: girls
Anxiety: boys
Figure 1.1a Incidence rates for anxiety, depression, and eating disorders by sex
and age group, 2003–2018
300
250
200
150
100
50
0
2004 2006 2008 2010 2012 2014 2016 2018
350
300
250
200
150
100
50
0
2004 2006 2008 2010 2012 2014 2016 2018
Depression: girls
300
250
200
150
100
50
0
2004 2006 2008 2010 2012 2014 2016 2018
350
300
250
200
150
100
50
0
2004 2006 2008 2010 2012 2014 2016 2018
Depression: boys
30
25
20
15
10
5
0
2004 2006 2008 2010 2012 2014 2016 2018
Source: Cybulski et al. (2021). Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the
UK, 2003–2018.
According to information from the CDC, children aged
12–17 years were more likely to have received mental health
care than children aged 5–11 years (Zablotsky & Terlizzi,
2020). White children were more likely than Hispanic or
Eating disorders: girls
30
25
20
15
10
5
0
2004 2006 2008 2010 2012 2014 2016 2018
13 to 16
non-Hispanic Black children to have received any mental
health treatment. Boys were somewhat more likely to have
received treatment than girls. Children and adolescents in
rural locations were more likely to receive medication as
Eating disorders: boys
17 to 19
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Allocation of Resources, Availability, and Accessibility ofCare 9
1 to 5
6 to 9
Annual rate per 10,000 person-years at risk
ADHD: girls
ADHD: boys
Figure 1.1b Incidence rates for ADHD and autism by sex and age group, 2003–2018
60
50
40
30
20
10
0
2004 2006 2008 2010 2012 2014 2016 2018
60
50
40
30
20
10
0
2004 2006 2008 2010 2012 2014 2016 2018
Autism: girls
60
50
40
30
20
10
0
2004 2006 2008 2010 2012 2014 2016 2018
60
50
40
30
20
10
0
2004 2006 2008 2010 2012 2014 2016 2018
Autism: boys
10 to 12
Source: Cybulski et al. (2021). Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the
UK, 2003 –2018.
treatment compared to children and adolescents in urban
locations. Figures 1.2a and 1.2b illustrate some of these
differences.
In addition to the lack of everyday availability of mental
health treatments (such as routine therapy or medication),
emergency mental health care is also difficult to access.
Emergency mental health care (e.g., access to a hospital
emergency department with a pediatric mental health care
policy or access to emergency pediatric inpatient treatment)
varies a lot by region, by state, and by urban versus rural
location. The majority of children in the United States do
not have access to such emergency care (Cree et al., 2021;
Whitney & Peterson, 2019). For those who require care
over long periods of time, there are few mental health care
policies and practices in place for youth needing to move
from child-centered care to adult-centered care (Appleton
et al., 2021; Whitney & Peterson, 2019).
Barriers to care are widespread, persistent, and have
been extensively summarized (Owens et al., 2002; Radez
et al., 2021; Stiffman et al., 2010). Barriers related to the
structure and funding of the mental health care system
13 to 16 17 to 19
include limited or poorly-conceived mental health
policies, lack of provider availability, long waiting lists,
lack of service coordination, inconveniently located
services, transportation difficulties, and the inability
to pay and/or inadequate insurance coverage (Ronis
et al., 2017). Barriers related to perceptions about mental
health difficulties include the inability to acknowledge
a disorder, denial of problem severity, and beliefs that
difficulties will resolve over time or will improve without
formal treatment. Barriers related to perceptions about
mental health services involve a lack of trust in the system,
previous negative experiences, and the stigma related to
seeking help.
Barriers may be greater or more difficult to manage for
various groups, or there may be additional barriers that
require attention. Clinicians, researchers, and children’s
advocates identify particular obstacles for Black families
compared to White families, for Asian American families
and Hispanic families, and for families who have recently
immigrated to the United States (Georgiades et al., 2018;
Planey et al., 2018). There may be language barriers or
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10 Chapter 1 Introduction
20
Percent
Hispanic Non-Hispanic White Non-Hispanic Black
16
Percent
Boys Girls
Figure 1.2a Frquency of treatments by
sex/gender
Percentage of male and female youth aged 5–17
years who received any mental health treatment,
took medication for their mental health, or received
counseling or therapy from a mental health
professional in the last 12 months.
14.8
12
8
4
0
health treatment
Source: Zablotsky & Terlizzi (2020). Mental health treatment among
children aged 5–17 years: United States, 2019. NCHS Data Brief, no. 381.
12.4
Any mental
9.8
7.0
Took
medication
10.3
9.7
Received
counseling
or therapy
Figure 1.2b Frequency of treatments by
race/ethnicity
Percentage of youth aged 5–17 years who received
any mental health treatment, took medication for their
mental health, or received counseling or therapy from
a mental health professional in the last 12 months, by
race and Hispanic origin.
17.7
16
12
9.2
8
4
0
Any mental
health treatment
Source: Zablotski & Terlizzi (2020). Mental health treatment among
children aged 5–17 years: United States, 2019. NCHS Data Brief, no. 381.
8.7
11.4
5.6
4.7
Took
medication
12.4
7.6
Received
counseling
or therapy
6.9
cultural barriers related to stigma, differences related
to perceptions of disorders, or concerns about cultureaffirming services. Other youth and their families,
including LGBTQ+ youth and their families, may
encounter difficulties in finding options that prioritize
gender-affirming health care (Town et al., 2021).
The ignorance and intolerance that contribute to the
painfully unnecessary stigmatization of individuals with
psychopathology must be confronted in and of itself but also
addressed as a barrier to care (Heary et al., 2017; Kaushik
et al., 2016; Mukolo, et al., 2010). For parents concerned
about their children’s distress or dysfunction, there is
almost always shame, fear, and/or blame. For children
and adolescents, experiences of secrecy and rejection are
commonplace. Lack of respect and lack of access to care
(again) are often the results of personal, familial, social, and
institutional stigmas.
With respect to the stigma, there are some important
signs of progress. There are many accounts of greater
openness to self-disclosure and more parental openness
about their family experiences (Collishaw, 2015). There are
also effective programs that reduce stigma. Honest, Open,
Proud, for example, is an intervention that decreases stigma
stress and improves functioning in adolescents with serious
mental illnesses (Muflinger et al., 2018).
Increasing availability and access to mental
health care requires significant and ongoing efforts.
Recommendations for integrated mental and physical
health care in clinic settings and increased access to
health care in schools and community centers offer more
options for children and families (Fehr et al., 2020;
Planey et al., 2019; Ronis et al., 2017). Identifying new
and effective treatment delivery models are a priority for
the field. These types of recommendations have been
made for decades and are especially critical as clinicians
respond to unprecedented needs for care and treatment
(refer again to Box 1.2).
-/AFP/Getty Images
Far too many children experience displacement, hardship, and
loss; the negative impact on physical and psychological wellbeing is enormous.
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The Globalization of Children’s Mental Health 11
The Globalization of Children’s
Mental Health
Discussions of mental health and mental illness involving
resource allocation and public policy increasingly emphasize
global perspectives that require careful thinking about
Western models of development, disorders, and intervention
as well as the vastly different experiences of children who
live in resource-rich versus resource-poor countries. Rapid
social change, urbanization and urban poverty, and
inadequate health and educational services are key factors
that increase children’s vulnerability to psychopathology
in resource-poor countries in Eastern and Central Europe,
Africa, Asia, Central and South America, and the Pacific
region (Patel, 2012; Weine et al., 2020). In these countries,
where most of the children in the world live, awareness of
mental illness issues and the promotion of mental health
are limited by allocation of scarce resources to urgent
medical needs, a lack of formal mental health policies and
programs, and too few mental health professionals. The
costs of impairment and lost potential are enormous.
We must also emphasize that, across the globe, millions
of children are struggling in the face of unimaginable
trauma, including exposure to disease and death, armed
conflict, abandonment and homelessness, and dislocation
(Vostanis, 2012; Weine et al., 2020). These terrible
situations require increased awareness, advocacy, and a
responsibility to provide interventions to ensure children’s
basic safety and well-being. Interventions include both
prevention efforts and treatment for those with various
disorders. To facilitate the success of interventions, mental
health professionals must consider how to implement
treatments in countries where the health and welfare
systems work differently (or are nonexistent) as well as
how to provide treatment to children who are difficult
to reach. Treatments must take into account local and
culture-based approaches and community caretaking
and service models (Atilola, 2015). Holistic approaches
with achievable goals, embedded in health, social, and
educational networks, have been proposed. For instance,
dependence on highly-skilled mental health professionals
might usefully shift to more support and services provided
by community health workers, teachers, and peers (for
adolescents) (Galagi & Brooks, 2020). These multicomponent treatments focus on children and adolescents,
on families, and on communities and systems (Weine
et al., 2020; Wuermli, Tubbs, Petersen, & Aber, 2015).
Finally, the development and implementation of globally
useful interventions require recognition of the current
disconnect between where research takes place and where
the need is greatest as well as a commitment to do better
on behalf of the world’s children.
Key Terms
Statistical deviance (3)
Sociocultural norms (3)
Mental health definitions (3)
Psychopathology (6)
Chapter Summary
●
Disorders in children and adolescents may be defined or
identified in various ways. Statistical deviance refers to the
relative frequency or infrequency of a specific emotion,
cognition, or behavior in comparison to a sample group.
Sociocultural norms refer to the beliefs and expectations of
certain groups about what kinds of emotions, cognitions,
and/or behaviors are undesirable or unacceptable. Mental
health definitions refer to mental health professionals’
descriptions of youth illness and well-being.
●
Defining and identifying disorders depends on value
judgments. The role of values is observed in definitions
that focus on statistical deviance, sociocultural norms,
and mental health perspectives. Values also influence our
Developmental psychopathology (6)
Developmental epidemiology (6)
Prevalence (6)
Incidence (6)
Barriers to care (9)
Stigmatization (10)
understanding of poor adaptation, adequate adaptation,
and optimal adaptation.
●
Developmental psychopathology refers to intense, frequent,
and/or persistent maladaptive patterns of emotion,
cognition, and behavior considered within the context
of typical development and resulting in the current and
potential impairment of infants, children, and adolescents.
●
Estimating rates of disorders in children and adolescents
involves (1) identifying children who experience distress
and dysfunction; (2) calculating levels of general
categories of disorders and specific subtypes of disorders;
and (3) tracking changing trends in various rates of
disorders.
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12 Chapter 1 Introduction
●
Developmental epidemiology is focused on the frequencies
and patterns of disorders in children and adolescents.
Prevalence refers to all current cases of a set of disorders.
Incidence refers to the number of new cases in a given
time period. Although specific study results vary, many
estimates suggest that significant numbers of children
and adolescents struggle with disorders that are associated
with serious impairment.
●
Allocation of resources and the availability of and access
to care are critical issues. Many children experiencing
distress and dysfunction are not identified or diagnosed.
Many children who are diagnosed are not able to access
mental health services.
●
Barriers to care include the structure and funding of the
mental health care system, negative perceptions about
mental health and mental illness, a nd negative perceptions
about mental health treatments. Stigmatization is another
barrier to care.
●
The globalization of children’s mental health involves
the recognition of children’s experiences of distress,
dysfunction, and unmet needs around the globe.
Children in resource-poor locations (e.g., in low- and
middle-income countries) are at higher risk for poor
adaptation and poor outcomes.
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Models of Child Development,
Psychopathology, and Treatment
Chapter Outline
2
The Case of Max
The Case of Aisha
The Role of Theory in Developmental
Psychopathology 14
Dimensional and Categorical Models
Physiological Models 15
Historical and Current Conceptualizations
Box 2.1 Emerging Science: Behavior Genetics, Epigenetics,
and Developmental Psychopathology
Thinking about Max
Thinking about Aisha
Psychodynamic Models 24
Historical and Current Conceptualizations
Thinking about Max
Thinking about Aisha
Behavioral and Cognitive Models 25
Historical and Current Conceptualizations
Learning Objectives
1. Explain the differences between dimensional models
of psychopathology and categorical models of
psychopathology.
2. Summarize the key assumptions and contributions of each
model of development, disorder, and treatment.
3. Outline the research and clinical issues related to behavior
genetics and epigenetics.
Thinking about Max
Thinking about Aisha
Humanistic and Positive Psychology Models 26
Historical and Current Conceptualizations
Thinking about Max
Thinking about Aisha
Family Models 27
Historical and Current Conceptualizations
Beyond Family Relationships: The Role of Peers
Thinking about Max
Thinking about Aisha
Sociocultural Models 29
Historical and Current Conceptualizations
Thinking about Max
Thinking about Aisha
Box 2.2 Risk and Resilience: COVID-19: Bio-Psycho-Social
Perspectives on a Pandemic
4. Compare and contrast the benefits of various models in
explanations of the cases of Max and Aisha.
5. Integrate at least two models of development, disorder, and
treatment to better understand the cases of Max and Aisha.
6. Explain the ways in which poverty impacts children’s
adaptation and maladaptation across models of
development, disorder, and treatment.
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
13