Child and Adolescent Psychopathology

Theodore P. Beauchaine, Stephen P. Hinshaw, Theodore P. Beauchaine, Stephen P. Hinshaw

• Publisher: Wiley
• Year: 2016
• ISBN:
  9781119169970
• Edition: 3
• Topic: Psychology
• Subtopic: Psychopathology
• Index: Psychology

A unique, multi-discipline, developmental approach to childhood psychopathology

Child and Adolescent Psychopathology is the only comprehensive text in the field to address genetic, neurobiological, and environmental factors within a developmental context. Based on cutting-edge research and aligned with the DSM-5, this book emphasizes how, when, and why disorders emerge among young people, and the ways in which symptom profiles change at different stages of development. This new third edition has been updated to include new chapters on OCD and trauma disorders consistent with DSM-5 classification, and includes new discussion on epigenetics and the neighborhood effects on the development of delinquency. Coverage includes extensive discussion of risk factors, from disturbed attachment relations and abuse/neglect, to head injury and teratogen exposure, followed by in-depth examination of behavior disorders and psychological disorders including Autism Spectrum, Schizophrenia Spectrum, and Eating Disorders.

Psychological disorders in children are increasingly being explored from a relational perspective, and continuous advances in neurobiology research are adding an additional dimension to our understanding of cause, effect, and appropriate intervention. This book provides detailed guidance toward all aspects of childhood psychopathology, with a multi-discipline approach and a unique developmental emphasis.

• Discover how psychopathology emerges throughout the stages of development
• Learn how both genetics and environmental factors influence risk and behaviors
• Understand the prevalence, risk factors, and progression of each disorder
• Gain deep insight from leading experts in neurobiology and developmental psychopathology

As the field of child psychology continues to evolve, behavioral and psychological disorders move beyond a list of symptoms to encompass the 'whole child'—biology, chemistry, environment, and culture are becoming increasingly relevant in understanding and treating these disorders, and must be considered from the earliest assessment stages. Child and Adolescent Psychopathology provides comprehensive information on childhood disorders from a developmental perspective.

PART I

THE DEVELOPMENTAL PSYCHOPATHOLOGY APPROACH TO UNDERSTANDING MENTAL ILLNESS

Chapter 1

Developmental Psychopathology as a Scientific Discipline: A 21st-Century Perspective

Stephen P. Hinshaw

Information continues to accumulate, at an increasingly rapid pace, about the complex processes and mechanisms underlying the genesis and maintenance of child and adolescent forms of mental disorder. Our major goal for this, the third edition of Child and Adolescent Psychopathology—in chapters written by international experts on the topics of interest—is to present current information, particularly surrounding core vulnerabilities and risk factors for major dimensions and categories of behavioral and emotional problems of youth. As in our prior editions (Beauchaine & Hinshaw, 2008, 2013), we emphasize psychobiological vulnerabilities in the active context of environmental forces that shape development. Framed somewhat differently, an important objective for each chapter is to delineate potential ontogenic processes in progressions to mental disorder, signifying mechanisms underlying individual development, with the realization that multiple vulnerabilities and risk factors interact and transact in case-specific yet ultimately predictable ways (Beauchaine & Hinshaw, 2016; Beauchaine & McNulty, 2013; Hinshaw, 2015). Parallel to the first two editions, we do not prioritize assessment or treatment-related information in this book, given that such coverage would necessitate a second or even third volume (e.g., Mash & Barkley, 2006, 2007).

Although the book's title focuses on children and adolescents, I note immediately that psychopathology, in many (if not most) cases, unfolds across the entire lifespan. Most so-called adult manifestations of mental disorder have origins, if not outright symptom presentations, prior to age 18. Moreover, even the earliest-appearing forms of behavioral and emotional disturbance typically portend escalating symptoms and impairments that can persist for decades (e.g., Kessler, Berglund, Demler, Jin, & Walters, 2005). Because resilience is also a possibility (Luthar, 2006), lifespan approaches to the topics of interest in this book are increasingly mandated for thorough understanding, carrying profound clinical as well as scientific implications. The child is the father of the man—and the mother of the woman—given that adults emerge from a cascading set of processes set in motion years before.

Before delving further, I immediately acknowledge the major debt that Ted Beauchaine and I owe to all of our contributors, as each is a major force in the scientific literature. We asked them to integrate state-of-the-art knowledge into the chapters that follow. Indeed, given the fast-escalating sophistication of mechanistic accounts of the development of psychopathology—which are now integrating genetic vulnerability and brain architecture in the presence of contextual forces across development, providing unprecedented levels of synthesis (Hinshaw, 2015)—no current compendium can afford to rest on the laurels of previous editions. The field's work is emerging at ever-more-detailed levels of analysis, with the promise of accounts that should, in the future, better inform evidence-based practice in the context of validated knowledge structures that can be applied to the clinical phenomena under consideration. In this initial chapter, I delineate the clinical and policy-related importance of the subject matter at hand, explicate core principles of developmental psychopathology (DP), and provide a general overview of the sequence of the chapters and their contents. In so doing I aim to set the stage for the cutting-edge advances and wisdom provided in the remainder of the volume.

RELEVANCE AND IMPORTANCE

The subject matter under consideration in this volume is at once clinically compelling and conceptually fascinating. Mental disorders yield substantial impairment, pain, and suffering for individuals, families, communities, and even cultures. The levels of personal and family tragedy involved are often devastating (Hinshaw, 2008a). At the same time, multifactorial vulnerabilities and risk factors—along with the complex, transactional developmental progressions that produce symptoms and impairments—challenge investigators from disciplines as diverse as neuroscience, genomics, public health, psychology, psychiatry, and public policy to emerge with new insights and syntheses. Overall, the clinical need is urgent and the scientific motivation compelling.

I begin with the concept of impairment. As elaborated in nearly every working guide to psychopathology (e.g., American Psychiatric Association, 2013; Wakefield, 1992), a designation of mental illness mandates, beyond behavior patterns or symptoms, that the individual in question display impairment or “harm” before a diagnosis is made. Clinically, then, attention must be paid to the often-excruciating pain and suffering attending to conditions as diverse as autism-spectrum disorders, various sequelae of maltreatment, severe attention deficits and impulsivity, interpersonal aggression, significant anxiety and mood disorders, thought disorders (including schizophrenia), eating-related conditions, self-destructive behavior patterns and personality configurations, and substance use disorders. Each is linked to setback and suffering, societal reverberations, and significant costs, the latter measurable in terms of huge expenditures borne by society, not related just to treatment per se but to the long-range outcomes of interpersonal, educational, and vocational failure that often attend to mental disorders (for an example of the huge costs linked to attention-deficit/hyperactivity disorder [ADHD], see Hinshaw & Scheffler, 2014).

Of course, impairment and harm—whether personal or experienced by others—are not sufficient for designating individuals as suffering from a mental disorder. In the view of Wakefield (1992), both harm (which involves a value-laden component) and dysfunction (a scientific construct) are required before mental illness should be diagnosed. Per Wakefield, dysfunction is “the failure of a mental mechanism to perform a natural function for which it was designed by evolution” (p. 373). Although mental health fields lack the objective markers and pathognomonic signs¹ as those found in medicine and neurology (see Chapter 2 [Beauchaine & Klein]), our aim for the accumulated work in the present volume is to propel knowledge of dysfunctional mechanisms related to child and adolescent psychopathology. At the same time, findings from each chapter remind us that the origins of mental health conditions are reciprocal, dynamic, multilevel, and fully linked with processes linked to environmental context.

Not every aspect of psychopathology is necessarily impairing. At the level of evolution, it cannot be the case that mental disorder is inevitably or inexorably linked to personal failure or reduced fecundity; otherwise, how would conditions such as severe thought and mood disorders have perpetuated across human history (for evolutionary psychological explanations of mental disorder, see Neese, 2005)? Partial genetic loadings or vulnerabilities in biological relatives may well carry adaptive advantage; at least some aspects of symptoms could yield inspiration or thriving. Still, clinical and population-level facts regarding impairment linked to mental illness are stark. Emotional and behavioral problems among children and adolescents are distressingly prevalent and often lead to serious impairments in such crucial life domains as academic achievement, interpersonal competencies, and independent living skills (for thorough accounts, see Mash & Barkley, 2014). These conditions incur intensive pain for individuals, families, and communities at large, delimiting life opportunities and triggering major burdens for caregivers, school districts, and health care systems. In short, far too many young lives are compromised by mental illness.

Moreover, child and adolescent conditions and mental-health-related issues are growing in impact. As just one harrowing example, recent data from the World Health Organization reveal that, worldwide, the number-one cause of death for girls aged 15–19 years is now suicide (World Health Organization, 2014). Rates of self-injury have escalated rapidly over the past decades, and conditions like autism and ADHD are undergoing huge increases in diagnosed prevalence (e.g., Visser et al., 2014). The age of onset of serious mood disorders appears to be dropping, signaling the importance of contextual “push” in unearthing vulnerability (Hinshaw, 2009). In both the developing and developed world, serious mental disorder in youth portends major life consequences and even tragedy (see, for example, Sawyer et al., 2002).

Moving beyond childhood and adolescence per se, each year the Global Burden of Disease findings convey that a number of mental health conditions (along with neurological and substance use disorders) are among the world's most impairing illnesses (Whiteford, Ferrari, Degenhardt, Feigin, & Vos, 2015). Indeed, the variable called “years lived with disability” is dominated by individuals with mental disorders in our current era, on par with and often surpassing so-called physical diseases. By t...