CHAPTER 1:

DEVELOPMENTAL

PSYCHOPATHOLOGY

AKHILA RAO
ASSISTANT PROFESSOR, CMRU
CONTENTS

Nature
Models
Causative Factors
DSM-IV and V
ICD-10
Classification of childhood disorders
Physical abuse and neglect
Social maltreatment
Sexual abuse
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DEFINITION OF DEVELOPMENTAL PSYCHOPATHOLOGY

The scientific study of the origins and progression of psychological disorders is

related to the typical processes of human growth and maturation. Central to this field
is the belief that studying departures from developmental norms will enhance
understanding of those norms, which will, in turn, enhance the conceptualization and
treatment of mental illness.

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NATURE OF DEVELOPMENTAL PSYCHOPATHOLOGY

Longitudinal research has consistently demonstrated that most adult disorders have

roots in childhood difficulties, and most childhood disorders have sequelae that

persist to adult life.

It is now clear, for example, that the burden of psychiatric disorders begins early in

development.
Developmental neuroscience is beginning to map the delays and perturbations in

brain development characteristic of specific childhood disorders (Shaw et al., 2010);

to clarify the effects of stress exposure at different stages in the life course (Lupien et

al., 2009); and to highlight how both the pre-and postnatal environments affect

epigenetic programming, with the potential for pervasive influences on the

developing brain (Kofink et al., 2013).

Developmental findings reveal a complex mix of continuities and discontinuities, and

evidence of both homotypic prediction—the persistence or recurrence of the same

disorder in different developmental periods—and apparently heterotypic transitions,

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where earlier and later vulnerabilities differ in form.
NATURE OF DEVELOPMENTAL PSYCHOPATHOLOGY

Early emotional and behavioral difficulties also foreshadow a broad spectrum of

problems in adult social functioning; poor physical health and health-related

behaviors; poor economic circumstances (Goodman et al., 2011); and, in some

instances at least, an increased risk of early death (Jokela et al., 2009).

Identifying the processes that underlie these differing pathways is central to the

developmental psychopathology approach (Sroufe & Rutter, 1984).

Many ideas, and many people, played critical roles in the emergence of

developmental psychopathology as a key perspective on both developmental

processes and the causes and course of psychopathology. Some of the noteworthy

mentions are listed below:

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NATURE OF DEVELOPMENTAL PSYCHOPATHOLOGY

Risk research:
Longitudinal studies were set up to examine the emergence of schizophrenia in the

offspring of mothers with a schizophrenic disorder.

It soon became clear, however, that many of the children who did not develop

schizophrenia did show other forms of psychopathology, and that the risks for such

psychopathology also derived from other forms of mental illness in parents .

Epidemiological studies provided an extension in their demonstration that many of

the risks were found in families exhibiting discord, disruption and disharmony but

where the parents had no diagnosable mental illness (Rutter & Quinton, 1984).
Given the same risk experience, some children succumb with disorder whereas

others seem to escape largely undamaged.

If risk processes are to be understood adequately, investigations need to include

detailed longitudinal studies of risk populations, as well as large-scale

epidemiological studies. 6
NATURE OF DEVELOPMENTAL PSYCHOPATHOLOGY

Selective attachments:
Early studies had made clear both the importance of selective attachments and the

phases of early development that were involved in their establishment (Bowlby,

1969).
Patterns of attachment relationships differed in the degree of security provided and

that these individual differences mattered for later development moved

developmental thinking into an individual differences perspective.

The approach behavior of attachment in the toddler age period was viewed as (and

empirically found to be) a precursor of later independence (rather than dependence),

if the attachment relationships were secure (Sroufe, 1983; Sroufe, Fox, & Pancake,

1983).

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NATURE OF DEVELOPMENTAL PSYCHOPATHOLOGY

Cognitive processing of experiences:

Findings in the fields of both antisocial behavior and depression showed the

importance of individual differences in the attributions that people make to the

experiences and personal interactions that they encounter.

The findings pointed to the need to move away from a sharp dichotomy between risk

factors based on environmental hazards and risk factors involved with personal

attributes.
A more dynamic appreciation of how the two worked together was required.

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NATURE OF DEVELOPMENTAL PSYCHOPATHOLOGY

Life-span development:
The importance of this field of inquiry derived from the important changes in

functioning that take place in adult life; the powerful impact of key experiences in

adult life; the finding that people varied in the life trajectories they took, and that it

was misleading to see development as a single universal progression that varied

only in its timing.

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MODELS OF DEVELOPMENTAL PSYCHOPATHOLOGY

Models of development always represent world views about human nature and

environments that create a human life course.

Models of abnormal development also reflect these different world views.
Two views of human nature have predominated in our theories of development.
First, the human psyche is acted on by its surrounding environment—both its

biological and external physical and social environments.

In the second view, the human organism acts on and in a bidirectional fashion and

interacts with the biological, physical, and social environments.

The reactive view has generated a dichotomy of two major theoretical paradigms:

biological determinism and social determinism.

The active view, in contrast, has generated what has recently come to be known as

the relational developmental systems perspective (Lerner,2006).

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MODELS OF DEVELOPMENTAL PSYCHOPATHOLOGY

In both the biological-motivational and social-determinism paradigms, the causes of

behavior or action are forces that act on the organism, causing it to behave.
These may be internal biological features of the species, including species-specific

action patterns.
In all cases, within this worldview, the organism is acted on and the causes of its

action (including its development) are external to it.

Thus, for example, the major determinant of sex-role behavior is thought to be

biological, that is, determined by sex and in this case by the effects of hormones. (e.g.,

parental praising or punishing of specific sex-role-appropriate actions, such as

playing with particular toys.

Alternatively, sex-role behavior can be determined externally by the shaping of the

effect of the social environment, either the differential rewards of conspecifics

(Fagot, 1973).
Examples of determinism by the social world include giving the child a male or
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female name or specific toys to play with.
MODELS OF DEVELOPMENTAL PSYCHOPATHOLOGY

In all such external control paradigms, we need not infer a self or consciousness and

with it a will, intention, or plans.

In contrast with this passive or reactive view is the relational developmental systems

perspective based on the world view that the organism is inherently active, acting on,

and being acted on the biological, physical, and social environment in a bidirectional

fashion (Lewis, 2010; Lewis & Rosenblum, 1974).

Within this perspective, the organism has a self and consciousness and as such has

desires and plans.

These desires and goals are constructed, as are most of the actions enabling the

organism to behave adaptively.

This view does not necessitate discarding either biological imperatives or social

control as potential determinants of behavior, because, from this relational

perspective, humans are both biological and social creatures, and both must impact

behavior. 12
MODELS OF DEVELOPMENTAL PSYCHOPATHOLOGY

These two world views are present in all psychological inquiry.

The reactive organism mechanistic model receives support in the case of the

biological study of action (e.g., T cells tracing foreign proteins that have entered the

body).
Relational developmental systems views are supported by theories of the mind.
It should not go unnoticed that with the growth of cognitive science, the idea of

constructing mental representations, in particular of the self (that do not correspond

in any one-to-one fashion with the “real” world) and with its plans and intentions, had

become more acceptable to psychology proper by the 1980s but is still somewhat

lacking in the study of developmental psychopathology (Gardner, 1985).

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CAUSATIVE FACTORS OF DEVELOPMENTAL

PSYCHOPATHOLOGY

Prenatal Perinatal Postnatal Socio-cultural factors

Inborn errors of metabolism -

Prematurity Infections Low SES

Phenylketonuria (PKU)

Chromosomal abnormalities -

Intra-uterine growth

Down's Syndrome; Fragile X

Malnutrition Lack of stimulating environment
retardation
Syndrome

Complications of pregnancy Birth injuries Lead poisoning Poor pre and ante natal care

Maternal infections during

Head injuries Exposure to health hazards
pregnancy - Syphilis, Rubella, AIDS

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DIAGNOSIS-DSM IV

DSM-IV

Disorder Class: Pervasive Developmental Disorders

Severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or

when stereotyped behavior, interests, and activities are present but are not met for a specific pervasive developmental disorder.

Autistic Disorder, Asperger's Disorder, Rett's Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not

Otherwise Specified (PDD-NOS), Disorders Usually Diagnosed in Infancy, Childhood, and Adolescence

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DIAGNOSIS-DSM 5

DSM-5

Disorder Class: Neurodevelopmental Disorders

Intellectual Disabilities (317-319)

Communication Disorders (315-307)

Autism Spectrum Disorder (299)

Attention-Deficit/Hyperactivity Disorder (314)

Specific Learning Disorder (315)

Motor Disorders (315-307)

Other Neurodevelopmental Disorders (315)

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DIAGNOSIS- ICD 10

ICD-10

Disorder class: Mental Retardation (F70-F79)

Disorder class: Disorders of psychological development ((F80-F89)

The disorders included in this block have in common: (a) onset invariably during infancy or childhood; (b) impairment or delay in

development of functions that are strongly related to biological maturation of the central nervous system; and (c) a steady course

without remissions and relapses.

F80: Specific developmental disorders of speech and language [Specific speech articulation disorder, Expressive language disorder,

Receptive language disorder, Acquired aphasia with epilepsy [Landau-Kleffner], Other developmental disorders of speech and

language, Developmental disorder of speech and language, unspecified]

F81: Specific developmental disorders of scholastic skills [Specific reading disorder, Specific spelling disorder, Specific disorder of

arithmetical skills, Mixed disorder of scholastic skills, Other developmental disorders of scholastic skills, Developmental disorder of

scholastic skills, unspecified]

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DIAGNOSIS- ICD 10

ICD-10

Disorder class: Behavioural and Emotional Disorders with Onset Usually Occuring in Childhood and Adolescence (F90-F98)

F90: Hyperkinetic Disorders

F91: Conduct Disorders

F92: Mixed disorders of conduct and emotions

F93: Emotional disorders with specific onset to childhood

F94: Disorders of social functioning with onset specific to childhood and adolescence

F95: Tic disorders

F98: Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence

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DIFFERENCE BETWEEN DEVELOPMENTAL

DISORDERS AND MENTAL ILLNESS

Developmental Disorders Mental Illness

A well-known example of
Mental illnesses include mood

developmental disorders is
disorders such as depression and

Autism. anxiety disorders and psychotic

In the case of pervasive

disorders such as schizophrenia.
developmental disorders,
A mental illness does not directly

individuals with the disorder do

impact cognitive abilities but

not have the cognitive ability to

instead changes an individual’s

have or understand certain

perceptions and thought

thoughts. processes.
A developmental disorder may be
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an obstacle to learning.
DIFFERENCE BETWEEN DEVELOPMENTAL

DISORDERS AND MENTAL ILLNESS

Developmental Disorders Mental Illness

Developmental disorders are

Mental illnesses can affect people

diagnosed when a patient is

of any age.
younger than 18 years of age. While children can suffer from

Developmental disorders are

mental illnesses, these conditions

lifelong disabilities. can just as easily begin during

adulthood.
Mental illnesses may not be

lifelong. Some are chronic while

others are temporary or recur in

episodes, but are not omnipresent. 20

CHARACTERISTICS OF NEURODEVELOPMENTAL DISORDERS

Neurodevelopmental disorders are a group of conditions with onset in the

developmental period.
The disorders typically manifest early in development, often before the child enters

grade school, and are characterized by developmental deficits that produce

impairments of personal, social, academic, or occupational functioning.

The range of developmental deficits varies from very specific limitations of learning

or control of executive functions to global impairments of social skills or intelligence.

The neurodevelopmental disorders frequently co-occur; for example, individuals

with autism spectrum disorder often have intellectual disabilities, and many children

with attention-deficit/hyperactivity disorder (ADHD) also have a specific learning

disorder.

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CHARACTERISTICS OF NEURODEVELOPMENTAL DISORDERS

For some disorders, the clinical presentation included symptoms of the excess as

well as deficits and delays in achieving expected milestones.

For example, autism spectrum disorder is diagnosed only when the characteristic

deficits of social communication are accompanied by excessively repetitive

behaviors, restricted interests, and insistence on sameness.

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CLASSIFICATION OF CHILDHOOD DISORDERS

Intellectual Disabilities
Learning Disorders
Motor Skills Disorder
Communication Disorders
Autism Spectrum Disorder
Attention-Deficit/Hyperactivity Disorder
Conduct Disorder
Oppositional Defiant Disorder
Feeding and Eating Disorders of Infancy or Early Childhood
Tic Disorders
Elimination Disorders
Separation Anxiety Disorder
Selective Mutism
Reactive Attachment Disorder 23
ABUSE AND NEGLECT

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PHYSICAL ABUSE

Physical abuse is usually intra-familial and may occur alone or in conjunction with

sexual abuse, neglect, or emotional abuse.

The physical consequences of abuse include scarring, disfigurement, neurological

damage, visual or auditory impairment, and failure of growth. While the majority of

these effects attenuate with time, most persist into adulthood.

The short-term psychological consequences include negative self-evaluative beliefs;

problems with the development of linguistic and cognitive competencies, problems

with affect regulation, and associated excesses of internalizing and externalizing

behavior problems and relationship difficulties.

Negative self-evaluative beliefs include low self-esteem and low self-efficacy.
Cognitive and language deficits include developmental delays in the emergence of

abilities and language usage; poor academic attainment; and lower levels of

symbolic play.
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PHYSICAL ABUSE

Affect-regulation difficulties find expression in externalizing behavior problems such

as uncontrolled anger and aggression. Affect-regulation problems also find

expression in internalizing behavior problems such as depression, anxiety, overly

compliant behavior in the face of authority, and self-harm.

Relationship difficulties, probably associated with the development of victim-abuser

internal working models of caregiver relationships, are first evident in the abused

children’s anxious-avoidant or disorganized attachment to their primary caregivers.

The long-term effect of physical abuse is that individuals abused as children have a

higher risk of externalizing and internalizing behavior problems during adolescence

and adulthood.
Externalizing behavior problems include teenage delinquency, aggression, domestic
violence, child abuse, and substance abuse.
Internalizing behavior problems include self-injury, suicide, anxiety, depression, and

somatization. 26
PHYSICAL ABUSE

Long-term adjustment difficulties in making and maintaining intimate relationships

are also a possible outcome for individuals abused as children.

Child risk factors for physical abuse:
Young, premature, developmental delay, frequent illnesses, difficult

temperament, and aggression

Parental factors for physical abuse:
Psychological problems, alcohol and substance abuse, from aggressive family,

inaccurate expectations of a child, poor child empathy skills, etc.

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SEXUAL ABUSE

Child sexual abuse (CSA) refers to the use of a child for sexual gratification.
Sexual abuse actions may vary in intrusiveness (from viewing or exposure to

penetration) and frequency (from a single episode to frequent and chronic abuse).
A distinction is made between intra-familial sexual abuse, the most common form of

which is father-daughter incest, and extra-familial sexual abuse, where the abuser

resides outside the family home.

Behavior problems shown by children who have experienced CSA typically include

sexualized behavior, excessive internalizing or externalizing behavior problems, and

school-based attainment problems.

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SOCIAL MALTREATMENT

(https://www.who.int/news-room/fact-sheets/detail/child-maltreatment)

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Thank you