Jami M. Furr, Shilpee Tiwari, Cynthia Suveg, and Philip C. Kendall
Maladaptive anxiety in youth occurs when the fear associated with a situation or object is disproportionate in the level and duration of distress experienced and to what is developmentally appropriate. This chapter provides an overview of how anxiety in youth is expressed with respect to cognition, physiological arousal, and emotion dysregulation. Next, this chapter reviews the specific symptoms and diagnostic criteria for each of the anxiety disorders that often onset during childhood. It also describes the epidemiology of, and risk factors associated with, anxiety in youth, and reviews the empirical literature on the assessment and treatment of anxiety in youth. Finally, this chapter highlights areas in need of further empirical attention.
Amanda L. Richdale
Parents of children with a developmental disability more commonly report sleep problems than parents of typically developing children. These sleep problems include difficulties getting their child to bed, and that their child takes a long time to fall asleep, wakes frequently, and/or wakes for long periods during the night. These reports are generally supported by objective findings. Sleep-disordered breathing is more common in children with specific developmental disorders such as Down syndrome and Prader-Willi syndrome, where craniofacial features associated with the disorder place them at high risk. Poor sleep in children with a developmental disability is generally associated with more severe daytime behavior difficulties, lower IQ, poorer adaptive behavior, compromised parent sleep, and increased parent stress, placing parents at risk for increased symptoms of anxiety and depression. Such sleep problems are likely to be multifactorial and are best viewed within a biopsychosocial context. Further research on the etiology, impact and intervention for sleep problems in children with a developmental disability is required.
Kelly C. Allison and David B. Sarwer
Body image disturbances are common among women in the general population. Less is known about their prevalence and impact during pregnancy. This chapter examines the history of body image theory and research. Next, we examine issues related to body image during pregnancy, such as pregravid weight, gestational weight gain, and the unique ways women think about the changes to their body during pregnancy. The role of physical activity, mood, and eating disorders in relation to peripartum body image disturbance is also discussed. Finally, assessment of body image disturbance and existing treatments are presented. Future research is needed to develop peripartum-specific body image assessment tools and to assess the impact of psychosocial interventions during and after pregnancy on body image dissatisfaction.
Challenges in the Assessment and Diagnosis of Eating Disorders in Childhood and Adolescence Given Current Diagnostic and Assessment Instruments
Jennifer L. Couturier and Sherry L. Blyderveen
The diagnosis and assessment of children and adolescents with eating disorders is fraught with challenges. This chapter reviews the problems inherent within the most widely used classification systems and assessment instruments currently available. The greatest challenge is that these systems and measures have typically been designed for adult populations, and thus, are often developmentally inappropriate for youth. It is recommended that future diagnostic criteria and assessment instruments be specifically designed at inception for youth, taking their developmental stages into account. Further, norm-referenced tests for different ages and genders are needed. Other essential elements of a multimethod assessment should be included in the assessment and diagnosis of youth with eating disorders, particularly collateral information, especially from parents, and both formal and informal observations. These elements are particularly important given the denial, minimization, shame, and guilt associated with eating disorders, which are perhaps even more prominent in children and adolescents.
Michael Kölch, Jörg M. Fegert, and Ulrike M.E. Schulze
In child and adolescent mental health care, the competing goals of protecting young people as a vulnerable population and their increasing legal autonomy constitute a specific ethical problem. Improving care, assessment, and treatment interventions requires research. Research that includes this vulnerable underage population has to be minimally burdensome and harmful and requires the informed consent of both children and parents. Therefore, adherence to evidence-based interventions and weighing the risks and benefits of interventions are of utmost importance in child and adolescent psychiatry. While access to mental health care can vary widely, it is crucial for at-risk populations such as children from families of low socioeconomic status, children of the mentally ill, and, in particular, children in youth welfare systems.
John E. Lochman, Caroline Boxmeyer, Nicole Powell, and Thomas J. Dishion
This chapter describes issues related to cognitive-behavioral group-based interventions for children with aggressive behavior problems. It describes beneficial aspects of group formats and notes the longer-term effects of the Coping Power program. It discusses potential problems in group-based interventions with aggressive children, including the potential for deviant peer effects and deviancy training. It then describes a study of Coping Power that randomly assigned schools to either group or individual formats for aggressive children. Results indicated significant reduction in behavioral problems for children in both conditions. However, teacher ratings indicated significantly stronger effects apparent by a 1-year follow-up for children in the individual sessions compared to the group format. The chapter discusses why these differences may have emerged and how group therapist behavior may be important in protecting against longer term follow-up deviant peer effects.
Filip De Fruyt and Barbara De Clercq
The personality disorders of the American Psychiatric Association would have antecedents in childhood and adolescence, but this has been a relatively weak area of investigation. This absence is the more remarkable given the abundant evidence that has accumulated over the years on the stability of psychopathology, the presence of prodromal signs of adult psychopathology in childhood, and the empirical support for temperament and personality traits in childhood and adolescence. This chapter begins with a review of personality disorder antecedents through the history of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders and follows with a discussion of the most recent evidence underscoring the importance of incorporating such a perspective for a better conceptual representation, assessment, and understanding of personality pathology across the life span.
Kathleen K. M. Deidrick and Elena Harlan Drewel
Children with chronic health conditions form a heterogeneous group at increased risk for cognitive and emotional difficulties that may lead to difficulties in academic and social environments. Rehabilitation psychologists are in a unique position to provide support to children with chronic health conditions due to their expertise in neuropsychology, mental health, and psychological aspects of illness and disability. However, research in pediatric rehabilitation psychology is limited by small sample sizes, cross-sectional research designs, and a lack of empirically supported interventions that are population and domain specific. In the future, research in these areas will provide a rich literature to guide work in pediatric rehabilitation psychology.
R. Robert Auger and Stephanie J. Crowley
Delayed sleep phase disorder (DSPD), common among adolescents, is characterized by an extreme “eveningness” circadian preference. Various etiologies have been proposed for this presumably multifactorial condition. As those afflicted frequently present during a time of transition to earlier school start times, sleep restriction can be profound, which may mediate described associated emotional and mental health difficulties, poor academic performance, and increased risk of unintentional injuries or death. A thorough assessment is required for accurate diagnosis and appropriate treatment. More studies are needed to establish evidence-based clinical guidelines for this young population, particularly as implementation of adult-based therapies are met with numerous barriers.
Thomas H. Ollendick and Stephen R. Shirk
This chapter on clinical interventions with children and adolescents has four primary goals: (1) to review early efforts to identify evidence-based psychosocial treatments for youth and their families; (2) to provide an overview of current evidentiary support for the treatment of the four most prevalent psychiatric disorders in youth: anxiety disorders, mood disorders, attentional disorders, and oppositional/conduct disorders; (3) to examine relational and developmental factors that qualify and potentially moderate these efficacious treatments; and (4) to speculate on the future of psychotherapy research and practice with youth. Our review indicates that several evidence-based interventions are available, although with few exceptions they are cognitive-behavioral ones. However, we conclude that the evidence base even for these interventions is not overly robust at this time, and that we must evaluate other commonly practiced interventions such as play therapy, family systems therapy, and psychodynamic-based therapies before their routine use can be endorsed. We also identify important developmental, contextual, and relationship variables that qualify these efficacious findings and encourage the pursuit of additional process and outcome research. We conclude our discourse by suggesting that we must move beyond reliance upon manual-based treatments to the development of principle-based interventions that draw upon these specific evidence-based interventions but move beyond and unify them. Although much progress has occurred in the past 50 years, much work remains to be done. This is an exciting time in the child and adolescent psychotherapy arena.
Timothy F. Piehler
Peer relationships during adolescence play a powerful role in youth adjustment. This chapter summarizes research regarding two distinct yet related social processes that have been observed within adolescent peer interactions to be predictive of problem behaviors: coercion and contagion. The mechanisms underlying these two processes are outlined, including positive reinforcement involved in deviancy training (a form of contagion) as well as escape conditioning involved in coercion. The chapter details some of the commonalities between the two processes as seen in adolescence as well as key differences and risk factors unique to each. Several recent studies that simultaneously examined both coercion and contagion in peer interactions are highlighted. Finally, a number of future directions are outlined, including advancing analytic methods to better understand bidirectional effects and further investigating the role of these processes in internalizing symptoms in adolescence.
Coercive Family Processes in the Development of Externalizing Behavior: Incorporating Neurobiology into Intervention Research
A multilevel social learning and neurobiological model of developmental and behavior change processes related to externalizing spectrum symptoms and disorders is described. Coercive family social processes related to the development of externalizing disorders and which serve as key proximal targets of change in empirically supported social learning family interventions are considered from theoretical and research perspectives. Conceptual models are offered which integrate research on coercive family processes with emerging neuroscience research to account for and enhance the durability and generality of changes in externalizing symptoms and adaptive functioning engendered by social learning family interventions. Extant research that examines the complementary roles of coercive social processes and neurobiological processes as mediators of change engendered by social learning interventions is described and evaluated. Finally, recommendations are made to guide subsequent intervention research in which social learning and neurobiological processes are treated as complementary, multilevel mechanisms of change in social learning interventions targeting externalizing disorders.
Jennifer M. Park, Joseph F. McGuire, and Eric A. Storch
Hoarding behaviors occur frequently in youth yet, relative to adults, have received little empirical attention. There are significant differences in the clinical and developmental presentation of children and adults with hoarding symptoms. As such, phenomenological inferences made from adult hoarding samples may not directly carryover to youth. The authors review the literature available on hoarding behaviors in children and adolescents, including clinical characteristics, comorbidity, assessment measures, and treatment options. A developmentally sensitive model of childhood hoarding is presented as well as recommendations for future research.
Christopher Jarrold and Carmel Conn
Individuals with autism tend to produce much less pretense in free play contexts than one would expect, and understanding the reason for this deficit has implications for theories of pretend play in general. A particularly influential account (Leslie, 1987) suggests that problems in pretense in autism result from deficits in theory of mind that are known to be associated with the condition, thereby drawing a link between the representational processes involved in pretend play and theory of mind. Here we review evidence that suggests that the deficits in pretend play seen in autism are not as marked as this account would predict. Instead, problems in producing creative pretend play might result from executive difficulties in the control of behavior or might reflect the fact that play behavior in autism develops in an atypical sociocultural context. These suggestions are more consistent with theoretical accounts that emphasize the gradual development of pretend play skills in childhood. However, a remaining question is whether the pretend play that one observes on occasions among individuals with autism is associated with the same motivation, playfulness, and symbolism as is pretend play in typically developing children.
Julia Huemer, Rebecca E. Hall, and Hans Steiner
Eating disorders are significant disorders of adolescence and young adulthood. They are truly psychosomatic in character, presenting with complex mixtures of somatic and psychiatric symptoms. We propose that the most useful model for empirical study and clinical practice targeting them is based on developmental psychiatry. In contradistinction to the descriptive model, developmentally based approaches can accommodate both continuity and discontinuity between pathology and normality, complexity of mental states and clinical presentation, and social and temporal context as determinants of psychopathology. The model conceptualizes etiology along multiple layers of accumulating risk and protective factors that—once a critical level of accumulation is reached—result in full-blown syndromal disorders. We outline the implications of this model for diagnosis and treatment.
Richie Poulton, Jessica R. Grisham, and Gavin Andrews
We illustrate the value of a developmental perspective for understanding anxiety disorders by: (1) reviewing evidence for continuity of the anxiety phenotype from childhood to adulthood to show how these findings have implications for nosology, research, and prevention; (2) use posttraumatic stress disorder (PTSD) to reveal how developmental origins can be identified much earlier in life, far removed from traumatic precipitating events; (3) consider the interplay of biological, cognitive, personality, and environmental factors in etiology of panic disorder, with or without agoraphobia; and (4) take an in-depth look at obsessive-compulsive disorder (OCD) to highlight how a developmental approach may be essential for progress to be made in our understanding of this and other anxiety disorders.
Sheila E. Crowell, Christina M. Derbidge, and Theodore P. Beauchaine
Suicidal behaviors are observed across most of the life span, beginning in late childhood. At present, however, few life span developmental studies of suicide risk have appeared in the literature. Rather, almost all research on suicide and related behaviors has been conducted with samples circumscribed by age (e.g., adolescents, elderly). Moreover, until recently most of this work was conducted among those with depression or borderline personality disorder, of whom only subsets manifest suicidal behaviors. In this chapter, we review existing research on suicide and suicide risk from a developmental psychopathology perspective. Although precipitating events leading to suicide and suicide attempts vary widely across the life span, core functions of the behaviors are remarkably similar. Indeed, common psychological and interpersonal processes may heighten risk for suicide, regardless of age. We explore how specific biological vulnerabilities interact with such processes across time to promote ineffective coping, risk for suicide, and the emergence of multiple forms of psychopathology among adolescents and young adults. We conclude by offering several developmental hypotheses of suicide risk into adulthood and later life.
Developmental Concerns in Psychopharmacological Treatment of Children and Adolescents with Eating Disorders
Jennifer O. Hagman and Guido K.W. Frank
This chapter reviews the limited studies relevant to psychopharmacology in children and adolescents with eating disorders and discusses approaches to treating comorbid diagnoses. Promising research in neuroscience is presented and future directions that may lead to more effective interventions are discussed. No randomized controlled trials demonstrate efficacy for any psychotropic medication for children or adolescents with eating disorders. All medications used in children and adolescents specifically for treatment of an eating disorder are considered “off-label” as there are no medications approved by the U.S. Food and Drug Administration (FDA) for this use in this population. Severe food restriction and emaciation, or binge eating and purging during periods of critical brain development may alter brain function permanently and make recovery challenging. There is insufficient evidence at this time to support prescribing selective serotonin reuptake inhibitors (SSRIs) or atypical neuroleptics for the treatment of anorexia nervosa, and evidence for efficacy of SSRIs for bulimia nervosa exists only for adults.
Developmental Considerations in Choosing Treatment Settings for Child and Adolescent Eating Disorders
Simon G. Gowers and Claire Bullock
The treatment of children and adolescents should always include consideration of their developmental needs, not just in terms of the style of therapy but also when choosing the service setting. Eating disorders generally arise in young people for whom the developmental demands of adolescence pose particular challenges, suggesting that promoting normal development should be a significant aim of treatment. A particular challenge concerns the thorny issue of whether a young person should be treated in the home (primarily under the care of parents) or in a hospital (in a more dependent setting, but one in which, paradoxically, the child generally has more independence from the family). A range of inpatient and community models are presented. The research literature is scant but provides little support for lengthy psychiatric inpatient care for the majority, with outpatient care being more cost-effective and, when delivered by specialists, resulting in higher levels of patient and parent satisfaction.
Rebecca Carr and Rebecka Peebles
The number of eating disorder cases reported is on the rise, which is causing concern in the medical and scientific communities. The data show that many cases of eating disorders develop during adolescence. Consequently, extensive research directed at finding a developmental trigger for eating disorders has been initiated. The influence of mass media (i.e., television, radio, movies, magazines, the Internet, etc.) on this issue is consistently referenced in the literature as a possible mechanism, specifically because the mass media has been shown to be a powerful influence on adolescent behavior. As the number of media outlets increase, presumably this influence will grow stronger. To quantify the role of mass media with respect to this issue, a systematic literature review was conducted to assess media influence on eating behaviors and eating disorder pathology, as well as its influence on perceived “body satisfaction.” Results show that, although the media cannot be blamed for all eating disorder causation, it does play a significant role in the propagation of an ideal body type for many adolescents. Images of ultra-thin models have been correlated to heightened body dissatisfaction and an increase in unsafe dieting behaviors. Conversely, the increased presence of commercials for junk food has been correlated to more snacking, subsequently causing weight gain, thus contributing to the rise of obesity in the United States. It can be concluded from this study that, whereas the media has been found to contribute to the rise in childhood obesity as well as eating disorders, it can also be a useful tool in spreading positive health information. More research is needed to identify the best approaches for the media to provide positive messages in this regard. Further recommended research includes the media influence on adolescent males, since they are a population seldom included in present studies and the literature.