Chapter 16

Developmental Psychopathology

Chapter 16: DEVELOPMENTAL PSYCHOPATHOLOGY

• Abnormality– Statistical deviance– Maladaptiveness

• Interferes with personal and social life

• Poses danger to self or others– Personal distress– DSM-5 diagnostic criteria (APA)

Developmental Aspects• Developmental psychopathology – study of origins

and course of maladaptive behavior

• Disorders and not disease (you have it or you don’t)– A pattern of maladaption, not defects

• Social and Age Norms

• Developmental issues– Nature/Nurture (origin of maladaptive behaviors)– Risk factors– Prediction

The Diathesis-Stress Model• Diathesis – predisposition or vulnerability

(genetic, cognitive, personality)• Stress – environmental pressure• Interaction of genes and environment• Example: Depression

– Genetic vulnerability– Environmental trigger(s)

• Not specific stressors for specific disorders• “Bad things have bad effects for some people

some of the time”

• Extreme stress and high vulnerability (severe disorder)

• Extreme stress and high resiliency (mild disorder)

• Low stress and high vulnerability (mild disorder)

• Low stress and high resiliency (no disorder)

Autism Spectrum Disorder

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Autism

• Begins in infancy: more boys• Several autistic spectrum disorders • Impaired social interaction, communication• Repetitive, stereotyped behaviors• 75% have intellectual disabilities: 10% have

savant syndrome• Severe cognitive impairment• Biologically based• Concordance: MZ=60%, DZ= 0%

Autism Spectrum Disorder

• Asperger syndrome– Normal or above-average intelligence– Good verbal skills– Clear desire to establish social relationships– Deficient social cognitive and social-communication skills

Autism Spectrum Disorder

• Is there an epidemic?– 1987: autism affected 4 or 5 of every 10,000 children– 2006: 1 in 110– Two years later: 1 in 88

Autism Spectrum Disorder

• Why are rates rising?– Increased awareness– Broader definition that includes the entire autistic

spectrum (including more mild cases)– Increased diagnosis– Variations in diagnostic practices

Mirror Neurons

Depression

• Infancy– Somatic symptoms– Depressive-like states– Related to poor attachment– “At risk” if mother depressed– “Failure to thrive” syndrome may occur

Childhood

• Externalizing problems– “Undercontrolled” disorders– Acting out– Aggressive, out of control

• Internalizing problems– “Overcontrolled” disorders– Inner distress, shyness– More girls

Figure 16.3

Attention-Deficit Hyperactivity Disorder

• DSM-5 Criteria: some combination of– Inattention subtype– Hyperactivity/Impulsivity subtype– Combined subtype– More boys; 3-5% of US kids – Comorbidity common

• Overactive behavior wanes with age• Attentional, adjustment problems remain

ADHD-Causes and Treatment

• Neurological: low Dopamine, Serotonin

– Underactivity in frontal lobes• Genetic predisposition; Environmental stress • 70% helped by stimulants

– Overprescription a problem• Most successful if combined with behavioral

treatment

Psychostimulants

• Ritalin• Concerta• Focalin• Adderall• Strattera• Cylert

Depression

• Childhood– Somatic symptoms– Psychotherapy, medication effective– Nature/Nurture question

• Adolescence– Often related to childhood symptoms

Adolescence• Storm and stress

– Only about 20%– Heightened vulnerability to psych disorders

• Alcohol and drugs are problems• Eating disorders

– Anorexia nervosa; more girls (10/1)– Bulemia nervosa; binge-eating– Binge eating disorder– Some genetic predisposition; stress also– Psychological treatment usually successful

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Adolescent Depression and Suicide

• 35% depressed; 7% diagnosable– Cognitive symptoms– Behavioral acting out– Genetic link– Environmental triggers

• Suicide 3rd leading cause of death– Males commit 3:1 compared to females– Females attempt 3:1 compared to males

Adulthood• Rates of disorder decrease after age 18• Depression

– Elderly less vulnerable to major depression– Concern with elderly

• Depression often related to health• 15% have some symptoms• 1-3% diagnosable• Difficult to diagnose

– More women (2:1)

Depression and Dementia• Many undiagnosed and untreated• Elderly can benefit, should NOT be excluded

from treatment• Dementia: deterioration of neural• Alzheimer’s Disease

– Leading cause of dementia– Progressive and irreversible

Causes of Alzheimer’s

• Senile plaques – masses of dying neural material with toxic protein called beta amyloid

• The plaque injures/kills neurons• Neurofibrillary tangles – twisted strands of

neural materialEarly-onset form (prior to age 60)-genetic linksLate-onset form (after age 70)-family history not

predictive

Figure 16.6

Aging and Dementia