134 What is Child Psychopathology?
Child psychopathology is the manifestation of psychological disorders in childhood and adolescence; examples include Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Pervasive Developmental Disorders (Mash & Barkley, 2003).
Factors complicating the study of child psychopathology
Since modern views of mental illness began to emerge in the late 18th and early 19th centuries, there has been far less attention given to the study of child psychopathology than psychopathology in adults. An example of this is in 1812, when Benjamin Rush, the first American psychiatrist, suggested that children were less likely to suffer from mental illness because the immaturity of their developing brains would prevent them from retaining the mental events that caused insanity (Mash & Barkley, 2003). Fortunately, psychiatrists do not think this way. Recently interest in child psychopathology has increased. This is due to the growing realization that many childhood problems have lifelong consequences and costs both for children and for society, that most adult disorders are rooted in early childhood conditions and/or experiences, and that a better understanding of childhood disorders offers promise for developing effective intervention and prevention programs (Mash & Barkley, 2003). Another factor is that there are issues present concerning the conceptualization and definition of psychopathology in children continue to be debated. Also, there is the fact that in studies conducted with children, much of the knowledge gained is based on findings obtained at a single point in a child’s development and in a single context. A further complication is that childhood problems “do not come in neat packages” and that most forms of psychopathology in children are known to overlap and/or coexist with other disorders (Mash & Barkley, 2003, p. 4). As you come to learn about child psychopathology, you will see how much overlap really does occur and why this is such a complication. There is also a problem that distinct boundaries between many commonly occurring childhood difficulties and those problems that become labeled as disorders are not easily drawn. There is also a growing recognition that all current diagnostic categories of child psychopathology are heterogeneous with respect to etiology and outcome, and will need to be broken down into subtypes, as you will see with the disorders mentioned on this page. It has also become increasingly evident that most forms of child psychopathology cannot be attributed to a single unitary cause. Some disorders cannot be linked to a single gene or a single event in life. There is also the complication that numerous determinants of child psychopathology have been identified, including genetic influences, hypo- or hyper-reactive early infant dispositions, insecure child-parent attachments, difficult child behavior, social-cognitive deficits, deficits in social learning, emotion regulation, and/or impulse control and response inhibition (Mash & Barkley, 2003). The many causes and outcomes of child psychopathology operate in dynamic and interactive ways over time which makes it hard to disentangle them. To designate a specific favor as a cause or an outcome of child psychopathology usually reflects the point in an ongoing developmental process at which the child is observed and the perspective of the observer (Mash & Barkley, 2003).
Significance of child psychopathology
There has been and continues to be a great deal of misinformation and folklore concerning disorders of childhood (Mash & Barkley, 2003). Many of these unsubstantiated theories have existed in both the popular and scientific literature, one example is the misconception that over-stimulation in the classroom causes insanity. Many of the constructs used to describe the characteristics and conditions of psychopathology in children have been globally and/or poorly defined (Mash & Barkley, 2003).
The growing attention to children’s mental health problems and competencies arises from a number of sources. First, many young people experience significant mental health problems that interfere with normal development and functioning. In fact, as many as 1 in 5 children in the United States experiences some type of difficulty and 1 in 10 have a diagnosable disorder that causes some level of impairment (Mash & Barkley, 2003). Second, a significant proportion of children do not grow out of their childhood difficulties, although the ways in which these difficulties are expressed change in both form and severity over time. Third, recent social changes and conditions may place children at increasing risk for the development of disorders and also for the development of more severe problems at younger ages. Fourth, for a majority of children who experience mental health problems, these problems go unidentified. Only about 20% receive help, a statistic that has not changed for some time (Mash & Barkley, 2003). Fifth, a majority of children with mental health problems who go unidentified and unassisted often end up in the criminal justice or mental health system as young adults. They are at greater risk of dropping our of school and of not being fully functional members of society. Finally, a significant number of children in North America are being subjected to maltreatment and chronic maltreatment during childhood that is associated with psychopathology in children and later in adults. It has been estimated that each year as many as 2,000 infants and young children die from abuse or neglect at the hands of their parents or caregivers (Mash & Barkley, 2003).
Epidemiological considerations
Prevalence
The overall lifetime prevalence rates for childhood problems are estimated to be high and on the order of 14-22% of all children (Mash & Barkley, 2003). Rutter, Tizard and Whitmore (1970) found in the classic Isle of Wight Study that the overall rate of child psychiatric disorders to be 6-8% in 9 to 11 year old children (as cited in Mash & Barkley, 2003). Richman, Stevenson, and Graham (1975) found in the London Epidemiological Study that moderate to severe behavior problems for 7% of the population with an additional 15% of children having mild problems (as cited in Mash & Barkley, 2003). Boyle et al. (1987) and Offord et al. (1987) reported in the Ontario Child Health Study that 19% of boys and 17% of girls had one or more disorders (as cited in Mash & Barkley, 2003). Many other epidemiological studies have reported similar rates of prevalence.
Age differences
Some studies of nonclinical samples of children have found a general decline in overall problems with age, whereas similar studies of clinical samples have found an opposite trend. These and many other finding raise numerous questions concerning age differences in children’s problem behaviors. Answers to even a seemingly simple question such as “Do problem behaviors decrease (or increase) with age?” are complicated by a lack of uniform measures of behavior that can be used across a wide range of ages, qualitative changes in the expression of behavior with development, the interactions between age and sex of the child, the use of different informants, the specific problem behaviors of interest, the clinical status of the children being assessed, and the use of different diagnostic criteria for children of different ages (Mash & Barkley, 2003).
Socioeconomic Status
Although most children with mental health problems are from the middle class, mental health problems are overrepresented among the very poor. It is estimated that 20% or more of children in North America are poor, and that as many as 20% of children growing up in inner-city poverty are impaired to some degree in their social, behavioral, and academic functioning (Mash & Barkley, 2003).
Sex differences
Findings relating to sex differences and child psychopathology are complex, inconsistent, and frequently difficult to interpret, the cumulative findings from research strongly indicate that the effects of gender are critical to understanding the expression and course of most forms of childhood disorder (Mash & Barkley, 2003).