Developmental Psychopathology

Developmental psychopathology does not refer to an either/or condition; in other words, individual's exist on a continuum, and there is no clear-cut point at which someone's functioning or behavior suddenly shifts from "normal" to "deviant." To determine what is maladaptive, one must first examine what is adaptive, or "normal." However, even then what is "normal" for one age or environmental situation may not be adaptive at a different age or environmental situation. Achenbach (1990) stated: “To improve our understanding of maladaptive behavior, it is helpful to view it in relation to normal sequences and achievements for particular ages. When this is done, it is evident that many behavioral/emotional problems for which professional help is sought are not qualitatively different from those that most individuals display to some degree at some time in their lives. Instead, many problems for which help is sought are quantitative variations on characteristics that may normally be evident at other developmental periods, in less intense degree, in fewer situations, or in ways that do not impair developmental progress. A fundamental challenge, then, is to distinguish those developmental variations that are within the normal range, from those that are more ominous, either because they disrupt development or because they reflect pathological proccesses that bode ill for the future.” Achenbach continued: "A developomental approach to understanding psychopathology...focuses on connections between development and its deviations. This approach counteracts the tendency to view behavioral/emotional disorders as encapsulated entities existing in all-or-none fashion unrelated to the individual’s developmental level."
Thus, the study of developmental psychopathology studies what could be considered normal or average development for particular ages and conditions, as well as what behaviors or conditions develop begin to appear to be maladaptive develomentally.



This is a short clip of an adolescent who had committed over 100 felonies. The interview with mother might provide evidence related to the development of this adolescent's behavior. It is also interesting to note how this behavior is being viewed by the media and pop culture.

What does develop?

See DSM-IV TR for a full list of pathologies.


What are the mechanisms of development?

Developmental psychopathology is principally concerned with psychological, emotional, or social development. Multiple factors can impact an individual's psychological development including a person's social relationships, the richness of the environment, and the quality of attachments experienced during development.

The presence of:
  • teratogens (For example, the mother's use of alcohol during pregnancy)
  • malnutrition (For example, low levels of B6 or sertonin that is influenced by diet)
  • and early childhood abuse or neglect can all lead to maladaptive psychological development.
Schore (2002) reported that stress systems located in the developing right brain have a dominant effect early in human development; this system is closely connected to vital functions which are necessary for the survival of the organism. Acute stress, or brief activations of this system early in development, tend to result in short-term and reversible impacts upon the individual. However, cumulative stressors, particularly chronic and unpredictable stressors, result in long term “autonomic reactivity” as well as neuronal structural changes. These structural changes often include neuronal atrophy which might lead to permanent damage of structures and neuron loss. Schore also reports that relational traumas have been shown to have greater developmental impacts than other traumas, such as inanimate or non-human etiological sources.

Schore (2002) suggested that the limbic system is closely related to attachment development, and that the majority of this network is formed in the first 15 months of life. The limbic system is closely associated with emotions, but this system has more recently been shown to be fundamental in organizing new learning. This association between learning and emotion suggests that to acquire or learn new schemas will likely necessitate accessing connected affect. Additionally, as early traumatic events will likely disrupt limbic development, it becomes apparent why persons with early attachment traumas tend to develop dysfunctions that last for their lifetime.

Van der Kolk argued that trauma disorders are related to a dysfunction of the right brain, which is responsible for inhibitory controls over automatic responses (1994). Van der kolk also demonstrated dysfunction in the orbitofrontal system in the right frontal lobe, which controls instinctive processes through cognitive processes. Because these areas of the brain are largely responsible for controlling automatic or instinctual responses and emotive responses, traumatized individuals often display poor emotion regulation. Additionally, learning or reprocessing of new or healthier information is compromised by the repeated activation and interference of intense emotional states related to past traumas (van der Kolk, 2006).

Issues of diversity

Greenleaf and Williams (2009) suggested that oppression within a society has "caustic effects on wellness and development." Stress related to oppression impacts psychological and physical health, eventually leading to potential physiological changes in the brian. These changes can contribute to mental illness, substance abuse, or suicide, as well as related immunological deficiencies. Dohrenwend (2000) reported that adversity related to ethnic or racial prejudice and discrimination leads to increased stress among these groups, in turn contributing to higher rates of depression, anxiety, and other psychological problems.
Ivy and Zalaquett (2011) discussed how poverty and social injustice contribute to diminished psychological functioning; in some cases there may be diminished activity in the prefrontal cortex area associated with experiencing empathy, increased vulnerability of brain areas associated with addiction, and how stress can contribute to attention issues, learning disabilities, impulsivity, and aggression. These authors stated "Stressful events can curtail normal brain development in newborns and youngsters and negatively affect brain neurogenesis and plasticity in adults and older adults. Thus, these social justice issues are detrimental to the psychological, physical, and social well-being of individuals. Poverty provides a clear illustration of the detrimental effects of unjust conditions." (p. 107).

Methodology

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Suls and Rothman (2004) suggest the BioPsychoSocial (BPS) model is the model of choice for health psychology, a discipline with a focus on prevention fitting well with counseling pscyhology's focus on prevention. Additionally, their research suggests that the BPS model is becoming more accepted in the field of physical medicine as there is an increasing recognition in the advantages of focusing upon the cause of medical problems rather than focusing on them after they occur. Ivey and Zalaquett (2011) report advances in neuroimaging techniques such as PET scans and fMRIs are being utilized to demontsrate differences in brain structures within individuals who exhibit developmental psychopathology; additionally, these techniques demonstrate interventions such as cognitive and interpersonal therapies also produce measurable structural changes as a result of treatment.

History of topic

Achenbach (1991) described the development of early personality disorders as being rooted in the medical model, focusing on pathology and from an either/or perspective; the individual is abnormal or not. Achenbach advocated for a developmental model of personality developement, and states that in his approach the developmental theory is more akin to a meta-paradigm, an encompassing paradigm within which more specific theories of personality development can be nested. Thus, he argued that all personality theories would likely be developmental in nature and ascribe to specifc characteristics.

Current issues in the topic area

There continues to be debate related to the degree to which either nature or nurture contribute to developmental psychopathology. Ferguson (2010) conducted a meta analysis of personality stability and reported that evidence supported a biological model, suggesting traits are stable across a lifetime; however, this author suggested that this stability occurs in early adulthood and did not examine the key developmental years associated with childhood.

One of the biggest issues is the current diagnosis and treatment of childhood mental illness.This next segment will highlight some of these views as well as alternative treatment methods to disorders in both children and adults. The following is a clip about two young girls diagnosed with schizophrenia and being treated with medication.


Several authors have released interesting works about the current medical model of psychiatry and the use of medication for treating mental illness. Irving Kirsch in The Emperor's New Drug reviews scientific literature on anti-depressants and reveals that there is virtually no scientific evidence that anti-depressants make people less depressed. In An Anatomy of an Epidemic, Robert Whitaker tackles all of the psychiatric medications, their history, and what outcome studies have shown. Both books highlight a growing trend in the belief that mental illness is either created or exacerbated by our current methods of treatment.









Thomas Szasz has been actively speaking out against the psychiatric treatment of individuals for many years. Here is a short clip about his take on the treatment of a common childhood disorder of ADHD.








This last video, while making some interesting claims is not shown to be "fact," but simply to show that there are many in the medical community and other fields who believe that alternative forms of treatment, such as nutrition may, in fact, be the best way of dealing with mental illnesses.



The following chart is found in an article by Raymond J. Pataracchia outlining some of the examples of deficiencies found in those with pathologies.

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Relevant developmental outcomes / implications

Cicchetti (2003) provided evidence that maltreated children exhibited significantly altered levels of cortisol activity, directly related to the pattern of maltreatment/abuse. Ciccheti stressed that these patterns are not irreversible, that “changes in the internal and external environment may lead to improvements in the individuals in the ability of the individual to grapple with developmental challenges.” (Cicchetti, 2003: p.353). Thus, although historical factors canalize and constrain the adaptive processes to some degree, neural plasticity may be possible throughout the life course as a result of adaptive neural and psychological self-organization (p. 353). Ivey and Zalaquett (2011) also cite neuroplasticity, and stress that counseling and intervention efforts can help to re-structure the brain to function more adaptively. Additionally, these researchers stressed the importance of societal justice in alleviating the conditions that contribute to high rates of developmental psychopathology, particularly within oppressed groups.
Burt (2009) conducted a meta analysis of 490 studies concerning the development of childhood psychopathic disorders. Burt concluded that environmental inflcuences were significant contributors (50% contribution or larger) to anxiety, depression, oppositional defiant disorder, and conduct disorder, but not attention-defecit/hyperactivity disorder.

Strengths and weaknesses of current knowledge and methodology

Strengths:
  • There is and increasing ability to examine genetic factors contributing to the development of psychopathology.
  • The bio-psycho-social model is encompassing and offers a flexible framework within which to study development as well as maladaptive development.
  • Recognition that pathologcial development is on a continuem, rather than either-or; additional recgonition of the dangers inherent in labeling or pathologizing individuals.
  • Increasing recognition of the environmental context in relationship to determining what is deviant or normal; this is especially important in that researchers are recognizing historical tendencies to over-pathologize oppressed groups. There is more recognition that what may appear to be pathology could be viewed as normal or adaptive within a context of oppression; recognitionas well of the role the dominat culture plays in instilling the conditions contributing to conditions of oppression and related distress.

Weaknesses:
  • Flexibility also creates questions related to what is and is not pathological.
  • The bio-psycho-social model has been criticized as being rooted too firmly in the medical model.
  • Over use of medication may be exacerbating the problem.

References:
Achenbach, T. M. (1990). Conceptualization of developmental psychopathology. In M. Lewis & S. M. Miller (Eds.), Handbook of developmental
psychopathology (pp 3-14). New York, NY: Plenum Press.

Burt, S. A. (2009). Rethinking environmental contributions to child and adolescent psychopathology: A meta-analysis of shared environmental influences. Psychological Bulletin, 135, 608-637.

Cicchetti, D. (2003) Neuroendocrine functioning in maltreated children. In Cicchetti D. & Walker, E. Eds. Neurodevelopmental Mechanisms In Psychopathology, 345-365 Cambridge University Press, Cambridge, UK.

Dohrenwend, B. P. (2000). The role of adversity and stress in psychopathology: Some evidence and its implications for theory and research. Journal of Health and Social Behavior, 41, 1-19.

Ferguson, C. J. (2010). A meta-analysis of normal and disordered personality across the life span. Journal of Personality and Social Psychology, 98, 659-667.

Greenleaf, A.T., & Williams, J.M. (2009). Supporting social justice advocacy: A paradigm shift towards an ecological perspective. Journal for Social Action in Counseling and Psychology, 2, 1-14.

Ivey, A.E., & Zalaquett, C.P. (2011). Neuroscience and counseling: Central issue for social justice leaders. Journal for Social action in Counseling and Psychology, 3, 103-116.

Pataracchia, R.J. (2008). Orthomolecular Treatment For Schizophrenia: A Review (Part Two). Journal of Orthomolecular Medicine. 23(2).

Shore A. (2002) Dysregulation of the Right Brain: A Fundamental Mechanism of Traumatic Attatchment and the Psychopathogenesis of Posttraumatic Stress Disorder. Australian and New Zealand Journal of Psychiatry, 36, 9-30.

Suls, J., & Rothman, A. (2004). Evolution of the biopsychosocial model: Prospects and challenges for health psychology. Health Psychology, 23, 119-125.

van der Kolk, B. A., (1994) The Body Keeps The Score: Memory & the Evolving Psychobiology of Post Traumatic Stress. Harvard Review of Psychiatry, 1(5), 253-265.
van der Kolk B. A. (2006) Clinical Implications of Neuroscience Research in PTSD. Annals of the New York Academy of Sciences, June, 1-17.