Child and Adolescent Psychopathology

Theoretical and Clinical Implications

Cecilia A. Essau, Cecilia A. Essau

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781135447038
• Edition: 1
• Topic: Medicina
• Subtopic: Psichiatria e salute mentale

How do biological and environmental factors influence the development of childhood and adolescent disorders?

There has been a substantial increase of interest in research into child and adolescent psychopathology. In this book, Cecilia Essau brings together contributions from the UK, the US and Canada to provide a comprehensive summary of the information available on the subject.

Beginning with an introduction to general issues related to child and adolescent psychopathology, including theoretical models of normal and abnormal development, each chapter goes on to address the issues associated with specific disorders, such as:

• oppositional defiant disorder and conduct disorder

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• attention-deficit/hyperactivity disorder

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• eating disorders

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• substance use disorders

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• somatoform disorders.

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The contributors present a thorough overview of each disorder, including discussion of definition and classification, epidemiology, risk factors, comorbidity, course, outcome and prevention.

Child & Adolescent Psychopathology will be welcomed by all mental health professionals seeking a reliable source of scientifically and clinically relevant information on the nature and treatment of child and adolescent disorders.

1

Normal and Abnormal Development

What the Child Clinician should know

Michael C. Lambert

Human development is a complex process and no single theory covers this complexity. Thus, while I will address some of the major theories of development, it is important to note that such theoretical models will cover only selected portions of the developmental process. First I will discuss psychoanalytic theories then cognitive theory followed by ecological theory and behavioral and social cognitive theories. Finally, I discuss the developmental psychopathology perspective, which I view as being most critical to many clinicians who treat children with behavioral and emotional difficulties. I do have another word of caution, which is that space limitations do not permit the discussion of all major theories of development. I have therefore chosen to focus only on some of those I view as being the more dominant theories pertaining to diagnosis and treatment of children.

Psychoanalytic Theories

Sigmund Freud is often referred to as the father of psychoanalytic theory. Although his theories are often thought to be more related to clinical work, they do have developmental implications. I will return to these implications near the end of my discussion of Freudian theories. Briefly described, much of Freud’s theories emerged out of his work as a neurologist, where he discovered that certain psychological problems were masked in the form of neurological symptomatology. Such psychological problems, he believed, were products of experience and especially conflicts emerging in earlier life.

Freud presented two models, the topographical and structural models, which he viewed as being essential to his explanation of human behavior. The topographical model referred to the fact that virtually no experiences of the organism are lost but rest in various levels of the organism’s consciousness. The conscious, according to Freud, holds current experiences of which the organism is aware. The preconscious holds material that is easily retrieved and brought to consciousness. The unconscious holds primitive material that is not easily retrievable and may emerge in dream content or that of hallucinations.

The structural model refers to the makeup of the personality, where three structures are present, the id, the ego, and the superego. Freud thought that the id was virtually unconscious and he also believed it had little contact with reality. In fact, Freud noted that the id uses primary process thought, which he viewed as being illogical and irrational. Freud further believed that as children age and as they are exposed to reality, they develop a structure that is more reality focused, which he called the ego. This structure he often referred to as the executive structure, as it constantly makes decisions within the context of reality. He therefore noted that the ego uses secondary process thought that is more logical and which also functions within the context of reality. The moral structure of the personality, Freud labeled as the superego, to which many commonly refer as being our conscience. The relationship between these three structures determines the individual’s functioning, where the ego mediates between the other two structures, and where imbalance might lead to psychopathology.

Freud’s theory might be considered to be dated by some. Understanding it is important not only because many clinicians continue to use it as a guiding paradigm to understanding, assessing, and treating psychopathology, but also because Freud was one of the earliest theorists to formally write about his theories of human development and also to indict faulty development as the root cause of psychological problems. To explain this process, he indicated that there were five developmental stages that he labeled the oral, anal, phallic, latency, and genital stages. The oral stage, he believed, occurred at birth through the first year and a half of life where the infant seeks gratification through, and explores the world with, the mouth. The anal stage occurs between ages 18 and 36 months, where the anus becomes the place of focus and pleasure. The phallic phase emerges and remains between ages 3 and 6, where the genitals are discovered and are sources of pleasure. Although not discussed in detail here, Freud addressed the Oedipus complex as critical in this phase, where the child desires the opposite sex parent while fearing that the same sex parent might punish the child for such impulses. Freud believed that the conflicts at this phase are resolved by the child’s identification with the same sex parent. This stage is followed by latency, which emerges at age 6 and continues through puberty, where all sexual impulses are repressed and are replaced with interest in mastering social and intellectual development. The final stage, the genital stage, occurs at the time of puberty, where the sexual impulses of the child reemerge, but are focused outside the family.

It should be noted that Freud believed that developmental problems could occur if the individual does not successfully master the challenges emerging at each phase. More specifically, he believed that parts of the libido would be left at these phases, a process he labeled as fixation. Under stress, the organism would therefore return to these points of fixation and exhibit symptoms that are typical of such phases. For example, an individual who experienced difficulty during the oral phase might become needy under stress or someone who is fixated at the anal stage might become obstinate. Freud also noted that to maintain its integrity, the ego develops certain defenses. Such defenses, he believed, were often dependent on the stage of development where the individual might be fixated. Therefore he labeled some defenses as being more primitive than others. An example of a primitive defense is that of denial, whereas a higher order defense might be rationalization.

It should be noted that Freud’s theories have experienced numerous criticisms and these theories have been modified by psychoanalysts to address such criticisms. Criticisms include the difficulty in testing a theory that attempts to explain just about every aspect of human behavior but in so doing explains little. The theories are believed to be culturally biased and also possess gender bias. Despite these and other criticisms, the theory must be credited for emphasizing that early experiences are important contributors to the development of the organism.

Although others (e.g., Jung) modified Freud’s theory, one important variant of this modification is that of Erik Erikson. While Erikson acknowledged Freud’s contributions, he was concerned that Freud only partially covered the stages of human development and focused entirely on psychosexual development. According to Erickson, Freud’s theory missed other aspects of development. Erickson therefore proposed eight stages of what he labeled as psychosocial development, trust versus mistrust, autonomy versus shame and doubt, initiative versus guilt, identity versus identity confusion, intimacy versus isolation, generativity versus stagnation, and integrity versus despair. Trust versus mistrust emerges in the first year of life where trust emerges from physical comfort and a sense of security. Autonomy versus shame and doubt occurs during ages 1 to 3 where upon mastering the challenges associated with trust the organism exerts its own autonomy. Initiative versus guilt emerges in the preschool years, where the child must begin coping with the social challenges in the society. Industry versus inferiority emerges in the elementary school years where the child is required to master intellectual skills. Identity versus identity confusion emerges in adolescence, where an important task for adolescents is defining who they are. In early adulthood the challenge of intimacy versus isolation emerges, where the adult must form healthy and intimate relationships. Generativity versus stagnation emerges in middle adulthood where the adult must begin assisting the younger generation in leading useful lives. Integrity versus despair constitutes the final stage occurring in late adulthood where in evaluating one’s life, one has a sense of satisfaction or despair.

It should be noted that as the case with other psychoanalytic theories Erikson’s theory is criticized. One criticism that is levied against Erikson’s theory, as well as many existing theories, is that it is culturally biased. That is, it is possible that the development of individuals in other cultures does not necessarily follow the stages Erikson purports. One of its strengths, however, rests in its emphasis on the effects that changes in childhood and adulthood have on the developmental functioning of the individual. For example, both Freud’s and Erikson’s theories underscore the need to successfully address the challenges inherent at each stage. Furthermore they underscore that lack of success in such domains can have serious consequences and thus lead to abnormal development of the organism.

Cognitive Theory

The distinct field of cognitive development dates back to the early 1950s. Thus, prior to the 1950s, few specialists on cognitive development existed. As a related area, learning theory goes back to the beginning of the field of psychology and was conceptualized primarily in terms of behavioral principles (Feldman, 2003). While Piaget is credited with work on numerous areas regarding the development of reasoning in childhood, including space, time, morality, causality, and necessity, he is most regarded for being the major contributor to understanding cognitive development (Feldman, 2003). Partly as an antidote to what he considered as an unhealthy focus on individual differences among children, Piaget was interested in developing universal principles of human behavior and not individual differences (Berlin, 1992; Feldman, 2003). Piaget also viewed human development as being fundamentally continuous and that it proceeds according to an invariant sequence (Berlin, 1992; Feldman, 2003). Thus, while he did present stages of cognitive development, he pointed out the need to explain the mechanisms under which stagelike changes occur, and thus account for the transformation from one stage to the next (Berlin, 1992). Piaget’s theories were both structural and functional, which he believed were closely associated. That is, he believed that there is no structure without function and no function without structure (Berlin, 1992). He also believed in constructivism, where the development of cognition emerges from the interaction of a knowing subject and reality. That is, the action of the subject on the object. Piaget saw development as the differentiation and integration of increasingly abstract structures (Berlin, 1992).

Piaget indicated that children actively construct their own cognitive world and that two processes engineer the children’s construction of their world. These processes are organization and adaptation (Santrock, 2001). That is, to make sense of the world, children use their developing cognitive ability to organize it. Furthermore, he believed that continued refinement is a product of cognitive development. That is, the child goes through the process of assimilation when new information is incorporated into existing knowledge and accommodation occurs when the child is able to adjust to new information. Piaget also used the term equilibration to explain the process of children’s shift from one stage of thought to the next. This process occurs when children experience cognitive dissonance in their attempt to understand their world. In resolving this conflict, Piaget noted that the child achieves equilibrium (Berlin, 1992; Santrock, 2001).

In order to understand the process of cognitive development, Piaget presented four stages of development, which he noted were gradual and continuous. First is sensorimotor intelligence, which lasts from birth through to the eighteenth month of life. The infant at this stage begins coordinating sensation and action by using reflexive behaviors (Santrock, 2001). Circular reaction is evident at this stage, where the child tries to replicate a chance event that resulted in pleasurable outcomes. Thus, repetition plays a major role at this phase where the infant increasingly refines the process of exploring objects. Also important at this phase of development is the acquisition of object permanence, where the child now acknowledges that objects out of sight continue to exist. In other words, the infant develops the capability of thinking about an object that is not present in the line of sight (Santrock, 2001).

At approximately ages 2 to 7 representational also known as preoperational thought emerges. Children at this stage are able to fantasize and in many cases ascribe characteristics of life to inanimate objects. Cognition becomes representational where the use of language emerges and where objects are represented by spoken word, drawings, and images. Children are, however, egocentric in their thought and are thus unable to take the perspectives of others. Also important at this phase is that the child develops the ability to conserve. Here the child can understand that quantity does not change despite changes in shape (Berlin, 1992). Piaget cautioned that although the child can represent parts of the world, the child lacks the ability to perform operations.

The concrete operational phase occurs approximately between the ages of 7 and 11. Achieving this developmental phase allows the child to perform logical operations that are one-way or reversible. At this phase the child also begins to understand the rules of mathematics including addition, multiplication and subtraction. More specifically, if the problems can be solved using concrete examples, the child is able to understand and apply the operation. Problems such as algebra, which require more abstract thought, present a problem that the child at the concrete operational phase is unable to solve (Berlin, 1992).

The formal operations phase is the final phase of cognitive development Piaget postulated. This phase emerges between the ages of 11 and 15 and involves propositional thought where the adolescent can think hypothetically and thus solve hypothetical problems. Because adolescents are able to think in more abstract forms, they also have the ability to contemplate the future and are also able to theorize using abstract thought. Thus, adolescents are also able to think about their own thoughts. Because of their ability to think in abstract terms, adolescents sometimes use this ability to hypothesize regarding ideal situations. Thus, many adolescents are described as being idealistic in their thinking (Santrock, 2001).

Reflecting on Piaget’s contributions, he remains a dominant figure in the field of children’s cognitive development. He also provided a framework for the observation and study of children. Despite these accomplishments, contemporary research has challenged the accuracy of the ages at which children achieve the different phases of cognitive development. For example, it is now believed that children achieve some cognitive competencies at earlier ages than Piaget presented while some adolescents might not achieve formal operational thought as early as once thought (Flavell et al., 1993; Santrock, 2001).

Ecological Systems Theory

Ecological theory is credited to Urie Bronfenbrenner. While recognizing the effects of biological factors on development, ecological theory emphasizes the effects of environmental influences (Santrock, 2001). According to Bronfenbrenner (1992) the ecology of human development is the scientific study of progressive, mutual accommodation, throughout the life course, between the active growing human being, and the changing properties of the immediate settings in which the developing person lives. This process is affected by the relations between these settings and the larger context in which the settings are embedded. Bronfenbrenner (1992) further highlighted the interaction of the person and the environment in which the person exists. Thus, he noted that the person context phenomenon indicates that the person’s characteristics and those of the environment are taken into account jointly. For example, he indicated that children growing up in similar environmental contexts often develop differently. These differences he viewed as a function of partic...