Development During Middle Childhood The Years From Six to Twelve (1984) / Chapter Skim
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9 The Status of Research Related to Psychopathology
9 The Status of Research Related to Psychopathology
Pages 370-397
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From page 370... ...
Aside from the broad impact of mental health problems and the sharp rise in referrals from the preschool to the elementary school period, what is distinctive about the psychopathology of middle childhood? Unlike major adult disorders, such as schizophrenia and manic-depressive conditions, most disorders of middle childhood involve exaggerations of behavior that nearly all children show in some degree.
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From page 371... ...
Thereafter, ~ consider research needs in terms of the prospects for blending clinical and developmental approaches; the methodological and theoretical challenges and contributions of the developmental study of psychopathology; the effects of buffers, prevention, and intervention on the development of disorders; and the training needed to advance developmental research on psychopathology. IMPLICATIONS OF RECENT RESEARCH: DISPELLING MYTHS Although there has long been a vast literature on behavior disorders of childhood, little of it was firmly grounded in programmatic research.
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From page 372... ...
treating most behavior disorders, yet the research of the 1970s and 1980s has helped combat certain influential myths. This is an essential step in creating a sounder basis for unclerstanding and treating childhood disorders.
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From page 373... ...
and SED (specific learning disability; e.g., Ochroch, 1981~. Under the assumption that an attention deficit is a core problem in hyperactivity, the official psychiatric nosology eventually adopted the diagnostic category of attention deficit disorder with hyperactivity (American Psychiatric Association, 19801.
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From page 374... ...
Wender and Wender have argued that hyperactive children have a specific deficiency in the functioning of the neurotransmitter dopamine and that the efficacy of stimulant drugs indicates that they compensate for this de ~. tlclency.
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From page 375... ...
This casts doubt on the assumption that behavioral responses to stimulant medication substantiate neurotransmitter deficits unique to hyperactive children. Furthermore, follow-up studies show that medication alone does little to improve the long-term social or academic functioning of hyperactive children (e.g., Gittelman, 1982~.
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From page 376... ...
Such research is needed to produce the measures, constructs, and basic data for a positive science able to generate valid theories as well as to dispel myths. Although research on hyperactivity is a key example, some instructive parallels are evident in recent research on a strikingly different disorder: infantile autism, which begins much earlier but typically remains a permanent handicap.
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From page 377... ...
Mednick's research began with a cohort of Danish children who had schizophrenic mothers and a demographically matched comparison group whose families were free of mental disorders. Denmark was chosen because it has public health services that can aid in the identification and longitudinal study of groups at risk, plus centralized case registers of mental disorders.
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From page 378... ...
A fundamental contrast was drawn between the traditional emphasis on inferences about underlying variables such as psychodynamic constructs, disease entities, and personality and the behavioral emphasis on observable behaviors and the environmental contingencies supporting them (Mash and Terdal, 19811. The behavioral assessment method par excellence is the structured recording of behaviors as they occur in natural settings.
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From page 379... ...
The limitations of direct observations under natural conditions and the lack of perfect agreement among various assessment methods have led be' havior modifiers to advocate multimethod behavioral assessment (Nay, 19791. For assessments of children the multiple methods include interviews, standardized tests, checklists and log books completed by parents and teachers, observations in natural and clinical settings, and simulation of problem .
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From page 380... ...
Because it is assumed that a specific disease underlies each symptom pattern, the nosological approach puts great emphasis on identifying each disorder in a present versus absent fashion. The dominant version of the nosological approach to behavior disorders is the Amerian Psychiatric Association's Diagnostic and Statistics Manual of Mental Disorders (the "DSM"~.
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From page 381... ...
2. The nosological syndromes require yes-or-no judgments of the presence or absence of each relevant attribute, whereas multivariate syndromes generally utilize quantitative gradations in the assessment of each attribute.
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From page 382... ...
Although categorical nosologies need not necessarily imply organic causes for all disorders, the DAM- conveys a heavy presumption in favor of organic etiologies by repeatedly referring to disorders as illnesses (American Psychiatric Association, 1980~. While organic determinants may eventually be found for some disorders, rigid adherence to a disease mode} may prematurely impose conceptual categories on children who are not well served by the concept of a specific illness.
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From page 383... ...
The Multivariate-Descuptive Paradigm The lack of satisfactory diagnostic schemes for children's disorders is what initially prompted researchers to apply multivariate methods to the derivation of syndromes. The multivariate syndromes represent a conceptual level roughly analogous to nosological syndromes in the sense that both purport to represent groupings of attributes that tend to co-occur.
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From page 384... ...
The detection of the "cruel" syndrome among girls may seem surprising, because hurtful behavior toward animals and people is stereotyped in our culture as being more masculine than feminine. Yet empirically derived syndromes reflect the covariation among reported behaviors rather than just their prevalence rates.
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From page 385... ...
After considering research needs, ~ will consider the need for training people to do developmental research on psychopathology. Developmental Perspectives Research on psychopathology typically stems from concern for a particular disorder or a particular type of treatment.
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From page 386... ...
386 DEVELOPMENT DURING MIDDLE CHILDHOOD 3. Assessing the course and outcome of disorders requires longitudinal comparisons with children manifesting other disorders and no clisorders, so that variance unique to a particular disorder can be distinguished from variance associated with psychopathology in general and variance associated To answer these clinical-developmental questions, we need more than just a general knowledge of developmental and clinical phenomena.
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From page 387... ...
Normative Epidemiological Research Developmental research seeks to identify the mechanisms and sequences of development that characterize children in general. Yet developmental studies seldom obtain normative data on representative samples using pro' cedures that are widely replicable.
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From page 388... ...
Without such a data base, developmental research on psychopathology tends to be random and noncumulative, unable to relate the findings of one study to those of other studies or to individual children. Periodic repetitions of normative-epidemiological studies at intervals of approximately 10 years would make it possible to reshape the normative data base according to advances in assessment methodology.
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From page 389... ...
Because teachers are well situated to observe behavior problems related to educational development, standardized teachers' assessments of the behavior of representative samples of their pupils can provide a data base on which to build subsequent studies of specific relationships between psychopathology and educational development, as illustrated by the research cited earlier on precursors of schizophrenia (John et al., 1982~. Efforts to form such a data base suggest that teachers apply such terms as hyperactivity too broadly to provide much discriminative validity (Edelbrock and Achenbach, 1984~.
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From page 390... ...
Under the banners of social competence and the invulnerable child, positive adaptive characteristics have won considerable fanfare in recent years. Despite the popularity of competence as a theoretical construct, how' ever, much remains to be teamed about the specific strengths that enable some children to deal constructively with major risk factors that would debilitate other children.
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From page 391... ...
, for example, massive efforts at changing behaviors have met with little success. Where the specific causes of behavior disorders are unknown, the call for prevention hardly seems more likely to be answered with success.
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From page 392... ...
Although controlled evaluations of the outcome of interventions for child psychopathology are difficult, expensive, and lengthy, such evaluations should be mandatory for all efforts at prevention and therapeutic intervention. Training for Developmental Research on Psychopathology Developmental research on psychopathology requires skills and interests spanning two areas that have differed in training programs, occupational roles, reward systems, and consumer audiences.
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From page 393... ...
The study of psychopathology in middle childhood requires a blending of research on developmental processes and sequences with clinically oriented research on individual differences. Recent research has helped dispell influential myths about the origins and nature of certain disorders, such as hyperactivity and autism.
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From page 394... ...
Edelbrock, C., and Achenbach, T.M. 1980 A typology of child behavior profile patterns: Distribution and correlates for disturbed children aged 6-16.
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From page 395... ...
1981 Behavioral Assessment of Childhood Disorders. New York: Guilford Press.
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From page 396... ...
.E. 1979 Diagnostic Reliability of Childhood and Adolescent Behavior Disorders.
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From page 397... ...
., Ogar, D., and Schultz, S 1980 Behavioral responses to artificial food colors.
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