Overview of Developmental Psychopathology and Psychological Growth in Children and Adolescents

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Overview of Developmental Psychopathology and Psychological Growth in Children and Adolescents

Abnormal Psychology · Chapter 21: Developmental Disorders Across the LifespanSection 21.1 · lesson 79 of 9716 min · free with a free account

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In this lesson

Judging a child's difficulty against development and context.

  • Describe the neurodevelopmental grouping, and lifelong difference vs decline
  • Use developmental expectation as the diagnostic pivot
  • Assess across settings and informants
  • Weigh over- and under-diagnosis, adversity, culture, and ethics

Transcript

Everything said in the video, section by section (2,103 words). Read along, or search it.

Developmental Disorders Across the Lifespan

Developmental Psychopathology

Chapter twenty-one covers developmental disorders across the lifespan. This first section lays the foundations of developmental psychopathology. We look at the neurodevelopmental grouping, and at why development itself is the baseline for judging a child's difficulty. We cover assessment across settings and informants, the debate over diagnosis rates, and the roles of adversity, culture, and ethics. Then two composite cases.

Before You Begin

2 Framing Statements

This material is educational. It is not a basis for diagnosing any child, including your own. Concerns about a child should go to a qualified professional, who can assess them properly, across settings and over time, in a way reading cannot. Two framing statements belong at the outset. Children are never described in this chapter in deficit-only terms. And nothing here implies that parents cause these conditions. That attribution has a long and damaging history, and the evidence does not support it.

The Neurodevelopmental Grouping

Lifelong Difference, Not Decline

The current American classification groups several conditions together as neurodevelopmental disorders. They include intellectual developmental disorder, communication disorders, autism spectrum disorder, ADHD, specific learning disorder, and motor disorders, including tic disorders. They share onset in the developmental period, and an effect on personal, social, academic, or occupational functioning. And, more consequentially, they co-occur with one another at high rates. Finding one is a reason to look for others, not a reason to stop looking. The last chapter covered acquired decline from a previous level. This chapter covers lifelong difference, present from early development. So there is no earlier baseline in the person. The comparison is with developmental expectation, what is typical for a child of this age, in this context.

Normative Development

The Baseline Is the Clinical Work

A clinician cannot judge a childhood presentation without knowing what is expected. That is not a preliminary to the clinical work. It is the clinical work. And the variation within normal is wide. Milestones are approximate expectations, not thresholds a child must meet. Children reach the same points by different routes and at different times. A child who is later than average at something is, in the great majority of cases, simply later than average. This course gives no ages as thresholds. In early childhood, concerns about sleep, feeding, tantrums, and late talking are common. What would be atypical is the absence of early social behaviors, or loss of skills already acquired. In middle childhood, concerns about school behavior and friendships are common. Atypical would be a sustained inability to form any peer relationship, or academic difficulty persisting despite good teaching. In adolescence, conflict and risk-taking are common. Atypical would be marked, sustained decline, and withdrawal from everything previously valued. So the concerns adults raise are mostly ordinary at every age. The referral itself tells you little, until it is set against expectation.

Early and Middle Childhood

Attachment, Peers, and School

Attachment is the organizing relational process of early childhood, the enduring bond that gives a child a base for exploration, and comfort under stress. Research describes patterns of attachment behavior, commonly labeled secure, avoidant, ambivalent, and disorganized. But attachment classification is not a diagnosis. It describes behavior with one caregiver in one situation. It is not a stable trait, it can differ across caregivers, and it does not predict any individual's outcome. Emotion regulation develops first through the caregiver relationship, which is why regulation difficulties in young children are relational as well as individual. In middle childhood, peer relationships become a context in their own right. Self-concept turns comparative, so academic difficulty starts to have emotional consequences. And school is a developmental context, not just a place where difficulties are noticed. A great deal of what is referred to services, starts in the fit between a child and that context.

Adolescence

Risk-Taking, Explained Developmentally

Adolescence brings physical maturation, a shift toward peers as the main reference group, identity development, and autonomy that is negotiated rather than granted. Conflict is a normative part of that negotiation. Two brain systems mature on different timetables. Reward-related and socioemotional systems become more responsive early in adolescence. Prefrontal control systems keep maturing into the early twenties. The gap is proposed to explain heightened sensitivity to reward and peers, alongside still-developing control. So risk-taking is normative and developmentally useful, not deviance. But the popular idea of an unfinished brain goes well beyond the evidence. Adolescents reason about risk roughly as well as adults, in calm conditions. The difference appears under emotional arousal, and with peers present. Maturation is gradual, so no age marks completion. And the idea is often used to dismiss young people's own views, which the evidence does not license. Adolescence is also a period of rising onset for depression, eating disorders, and psychotic conditions, because rapid reorganization brings vulnerability.

Continuity and Discontinuity

Some Difficulties Persist - Many Don't

Some childhood difficulties persist, and many do not. That finding constrains what can be said to a family, and it points in both directions. Homotypic continuity is persistence of the same difficulty over time, like an anxious young child who becomes an anxious adolescent. Heterotypic continuity is persistence of an underlying difficulty that changes its form. Early regulation difficulty may appear as oppositional behavior in middle childhood, and as something else again in adolescence. That is why an early presentation cannot simply be read forward. A difficulty now does not establish a difficulty later. And its absence now does not guarantee its absence later.

Figure 21.1.2

One Behavior Across Age

Here is the central claim of this section, in one picture. Take one behavior, intense distress at separation. In a toddler, it is expectable. In a seven-year-old, it is worth examining. In an adolescent, it is a marked departure from expectation. Nothing about the behavior itself has changed. Only the age. The same holds for talking to imaginary companions, which is ordinary at four and warrants attention at fourteen. Or intense conflict with parents, normative at fifteen and unusual at seven. So behavior must always be judged against developmental expectation and context. That is not a qualification attached to assessment. It is what assessment consists of.

In the Clinic

A Difficulty Is Not a Disorder

The distinction between a difficulty and a disorder turns on a few questions. Is it outside developmental expectation? Not is it difficult, but is it unusual for this age. How frequent and intense is it? Almost every clinical behavior occurs in typically developing children. Degree is what separates them. Does it persist? Most childhood difficulties resolve. And is it causing impairment, in learning, relationships, and wellbeing? And a fifth question worth asking explicitly. Whose problem is it? A behavior that distresses an adult, and costs the child nothing, is a different situation from one that is harming the child. Most childhood difficulties are transient. Difficulties are common and disorders much less so, so a clinician who reasons forward, from a difficulty to a probable disorder, will be wrong far more often than right.

Table 21.1.2

What Each Setting Tells You

A child is assessed within their family, school, peer, cultural, and socioeconomic contexts. A formulation that locates a difficulty inside the child, without examining those contexts, is incomplete. A difficulty at home only points toward the home context. Family stress, sleep, a relational pattern, or a demand specific to that setting. A difficulty at school only points toward the school. Instructional mismatch, an unrecognized learning difficulty, peer difficulty, or a poor fit with the classroom. A difficulty only in unstructured settings points toward social and peer factors, rather than attention or learning. A difficulty across all settings is consistent with a within-child condition. Even then, adversity and context must be considered first. The most common error in child assessment is hearing a single-setting report as a description of the child.

Informants

Disagreement Is Data

Children rarely refer themselves. The concern is almost always raised by an adult, and usually reflects that adult's distress, or an institution's demand. So the referral tells you about the adult and the setting as well as the child. A classroom of thirty has different requirements from a household of three, and neither is wrong. Ask why now. Usually something changed in the setting. Information from one informant is insufficient, and agreement between informants is only modest. Parents see home, history, and change over time, though their own stress affects their reports. Teachers see behavior under demand, with the huge advantage of comparison to many same-age peers. And only the child can report their inner experience, their worry, low mood, and fear. Internalizing difficulties are missed precisely when nobody asks the child. So do not resolve disagreement by picking an informant. The difference is data. Ask the child directly and separately, and ask everyone about the same specific situations.

Over- and Under-Diagnosis

Both Occur - in Different Populations

Both over-diagnosis and under-diagnosis occur, in different populations. Presenting only one is a common failure of balance. The case for over-diagnosis. Diagnostic rates for several conditions have risen substantially. Ordinary variation can be reframed as pathology, and diagnosis can be the only route to support. Narrow school expectations generate referrals. And the relative age effect, where the youngest children in a school year are diagnosed more often, shows developmental expectation is not always applied. The case for under-diagnosis. The rise is partly better recognition of conditions previously missed. Girls and women are diagnosed later and less often. Children in less advantaged families have poorer access to assessment. Adults are being identified who were missed throughout childhood. And children with internalizing difficulties are under-referred, because referral follows adult inconvenience. Both are probably true at once. The rise in rates is not, by itself, evidence for either position.

Adversity, Culture, Ethics

Before Locating It Inside the Child

Adversity must be considered before behavior is attributed to a within-child condition. It is referenced here at category level only, including abuse, neglect, loss, exposure to violence, and poverty. Presentations arising from adversity can closely resemble the conditions in this chapter. Inattention, restlessness, irritability, and peer difficulty are produced by both. Missing that leads to the wrong formulation, and the wrong intervention. Safeguarding is a professional responsibility, with recognition and reporting duties, covered in chapter twenty-five. What counts as a problem also varies across cultures. A child behaving as their community expects may be referred by an institution with different expectations. The difficulty then lies in the mismatch, not the child. Ethically, consent and assent are distinct. Legal consent usually comes from a parent, while the child's own assent, sought at their level, matters even where it is not legally required. And confidentiality with a minor has limits. State them at the outset, not after something has been disclosed. That clarity is what makes disclosure possible.

Prevention and Early Intervention

Before Difficulties Consolidate

Prevention and early intervention rest on developmental timing. Intervening before difficulties consolidate, and before cascades produce secondary consequences, works better than intervening afterward. Universal approaches address whole populations, through school programs, parenting support offered generally, and structural measures. Selective approaches address groups at elevated risk. Indicated approaches address children already showing early difficulty. And the familiar pattern recurs. Structural and skills-based approaches outperform information-only ones. The interventions that feel most obviously right are not necessarily the ones that work.

Case Vignette 1 (Composite)

Tomás: Developmentally Expectable

Now two composite cases, constructed for instruction. Tomás is four. His nursery referred him with concerns about tantrums and difficulty sharing. His development and speech are typical. He has friends, joins in, separates from his mother after a brief protest, and is manageable at home. Is it outside developmental expectation? No. Tantrums and difficulty sharing are near-universal at four. The frequency and intensity are within range, several months is not long, and there is no impairment. Then the fifth question. Whose problem is it? A new staff member had joined the nursery room, and the concern dated from then. The behavior had not changed. The tolerance and expectations of the setting had. The right response is not dismissal, which loses the relationship. It explains what is expectable at this age, acknowledges the behavior is genuinely hard to manage in a group, offers practical strategies, and leaves the door open. The nursery's concern was real, even though the child does not have a condition.

Case Vignette 2 (Composite)

Hana: A Cross-Setting Difference

Hana is nine. Her school referred her with a query about attention and disruptive behavior, for about a year, concentrated in literacy lessons, with little academic progress. The referral proposed ADHD, which is reasonable. Her parents reported no attention difficulty at home. She reads for long periods, and finishes lengthy craft projects. In unstructured settings, she manages her friendships well. And asked directly and separately, Hana said reading in class is hard, that other children notice, and that she would rather be told off than look stupid. So the difficulty is confined to one setting, and to one activity within it. That points toward an unrecognized reading difficulty, with the disruption serving to avoid a task that exposes it. The cross-setting requirement for ADHD is not met. Had the parents' report been dismissed, or the child not been asked, the assessment would have produced a diagnosis, a referral, and no help with reading. Establish the setting pattern before the formulation.

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About Overview of Developmental Psychopathology and Psychological Growth in Children and Adolescents

What are neurodevelopmental disorders?
Neurodevelopmental disorders are a DSM grouping of conditions with onset in the developmental period that affect personal, social, academic, or occupational functioning. They include intellectual developmental disorder, communication disorders, autism spectrum disorder, ADHD, specific learning disorder, and motor disorders such as tic disorders. They reflect lifelong difference rather than decline, so a child is compared with developmental expectations, and because they often co-occur, finding one is a reason to look for others.
Why does a child's age matter when judging whether behavior is a problem?
The same behavior can be typical at one age and unusual at another, so it must be judged against developmental expectations and context. Intense separation distress is expected in a toddler, worth examining at seven, and a marked departure from expectation in an adolescent. Clinicians also ask how frequent, intense, and persistent the behavior is, whether it causes impairment, and whose problem it really is.
What is the difference between homotypic and heterotypic continuity?
Homotypic continuity is persistence of the same difficulty over time, such as an anxious young child becoming an anxious adolescent. Heterotypic continuity is persistence of an underlying difficulty that changes its outward form, such as early regulation problems later appearing as oppositional behavior. Because difficulties can change form, and many childhood difficulties resolve, an early presentation cannot simply be read forward to predict later outcomes.
Why do child psychologists gather information from parents, teachers, and the child?
Each informant sees different things, and agreement between them is only modest. Parents see home life and change over time, teachers see behavior under demand compared with many same-age peers, and only the child can report inner experiences like worry or fear. Where a difficulty appears also guides formulation: problems in one setting point to that context, while problems across all settings fit a within-child condition.

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