CHILD PSYCHOLOGY
Q. Discuss the key factors with examples in increasing risk for the
development of disorders in children and adolescents.
New pressures and social changes may place children at increased risk for the development of
disorders at younger ages. Many stressors today are quite different from those faced by our
parents and grandparents. Some have been around for generations: chronic poverty, inequality,
family breakup, single parenting, and so on. Others are now more recent or more visible:
homelessness adjustment problems of children in immigrant families, inadequate child care for
working parents, and conditions associated with the impact of prematurity, parental HIV, and
cocaine or alcohol abuse on children’s growth and development. Higher rates of fetal survival
have contributed to a greater number of children with behavior and learning difficulties who
require specialized services at a younger age.
It is important to remember that the manner in which one’s circumstances affect the course (e.g.,
progression of a disorder should be distinguished from how they may initially contribute to the
problem. That is, environmental stressors, such as poverty, child abuse, or lack of safety, may act
as nonspecific stressors that bring about poor adaptation or even the onset of a disorder in some
vulnerable children.
Examples of major factors in the development and expression of child psychopathology are the
following:
1. Poverty and socioeconomic disadvantages
In many cases, the background and circumstances of children and youths with mental health
problems provide obvious clues to their origins. Some of the most telling clues are the
experiences of poverty, disadvantage, and violence faced by many, which can have a cumulative
effect on their mental health (Luthar, 2006). Growing up in poverty is a substantial the well-
being of children and adolescents, especially in terms of impairments in learning ability and
school achievement. Moreover, low income is tied to many other forms of disadvantage: less
education, low-paying inadequate health care, single-parent status, limited resources, poor
nutrition, and greater exposure to violence.
Children from poor and disadvantaged families suffer more conduct disorders, chronic illness,
school problems, and emotional cognitive/learning problems than children who are not poor
(McMahon & Luthar, 2007; Farah et al., 2006). Economic deprivation alone is not responsible
for these higher rates, because many children do succeed under harsh circumstances.
Nevertheless, the greater the degree of inequality, powerlessness, and lack of control over their
lives, the more children’s physical and metaphysic are undermined (Aber, Jones, & Raver,
2007).
Case study:
A 6-year-old boy was referred for assessment and treatment recommendations by his school
counselor because of anxiety, school difficulties, and possible attention deficit hyperactivity
disorder (ADHD). The boy was from a two-parent family and had a 14-year-old brother. Both
parents were employed, the father as a cargo delivery driver and the mother in a hospital
cafeteria. The boy’s mother had started shift work 6 months previously and was working 6 days
a week so that the family could meet increasing rent costs. They lived in a small two-bedroom
apartment and the boy slept on the pull-out couch in the living room because his 14-year-old
brother demanded privacy. The family could no longer afford after-school care for the boy as
they had done the previous year, so he was picked up from school by the brother and watched
TV and played video games every day after school while his parents were working. The mother
described the boy’s recent separation anxiety, difficulty concentrating, trouble falling asleep, and
tantrums during transitions at school. Teachers reported the boy was frequently anxious and
inattentive in class.
Poverty is a risk factor for mental health conditions in childhood and is associated with lower
academic achievement and impaired cognitive development secondary to direct effects on the
developing hypothalamic-pituitary-adrenal axis and indirect effects on a child’s environment.
Due to financial problems parents had to work overtime due to which the children were getting
neglected. The wasn’t getting proper parental care due to which he developed mental health
issues. He experienced separation anxiety because his mother left him at home with his siblings.
2. Sex differences
Boys and girls express their problems in different ways. For example, hyperactivity, autism,
childhood disruptive behavior disorders, and learning and communication disorders are more
common in boys than in girls; the opposite is true for most anxiety disorders, adolescent
depression, and eating disorders.
Sex differences in problem behaviors are negligible in children under the age of 3 but increase
with age. Boys show higher rates of early-onset disorders that involve some form of
neurodevelopmental impairment, and girls show more emotional disorders, with a peak age of
onset in adolescence.
For example, boys generally have higher rates of reading disorders; autism spectrum disorders,
attention deficit disorder, and early-onset persistent conduct problems whereas girls have higher
rates of depression and eating disorders (Rutter et al., 2004).
Major dimensions of internalizing and externalizing behaviors: Internalizing problems
include anxiety, depression, somatic complaints, and withdrawn behavior; externalizing
problems encompass more acting-out behaviors such as aggression and delinquent behavior.
The types of child-rearing environments predicting resilience in the face of adversity also
differ for boys and girls. Resilience in boys is associated with households in which there is a
male role model (such as a father, grandfather, or older brother), structure, rules, and some
encouragement of emotional expressiveness. In contrast, girls who display resilience come from
households that combine risk-taking and independence with support from a female caregiver
(such as a mother, grandmother, or older sister) (Werner, 2005).
Case study:
Recent large-scale epidemiological studies have assessed the rates of mental disorders in the
United States. There are gender differences in particular types of psychiatric disorders. Women
exceed men in internalizing problems of anxiety and depression, in which problematic feelings
are turned inward against the self. This includes both milder and more severe forms of
depression, as well as most types of anxiety, including generalized anxiety disorder and phobias.
Greater depression means that more women than men live with feelings of profound sadness and
loss, serious problems with negative self-concept, and feelings of guilt, self-reproach, and self-
blame. Women experience a great loss of energy, motivation, and interest in life more often than
men. They more frequently feel that life is hopeless, coupled with a deep sense of helplessness to
improve their circumstances.
In contrast, men more frequently exhibit externalizing problems of substance abuse and
antisocial behavior, which are more destructive and problematic to others. Greater substance
abuse means that men more often consume excessive amounts of alcohol and other drugs – in
both quantity and frequency – than women. They more often experience extreme physical
consequences from substances, such as blackouts or hallucinations. Greater antisocial behavior
includes disruptive disorders in childhood and adolescence – such as attention
deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder – as well as
antisocial personality disorder in adulthood. This means that, beginning at an early age, males
are more often aggressive or antisocial in a wide range of areas, including violence toward
people and animals, the destruction of property, lying, and stealing.
In sum, neither men nor women exceed the other in mental health problems, but rather
experience very different kinds of problems.
3. Race and Ethnicity
Racial and ethnic minority persons comprise a substantial and vibrant segment of many
countries, enriching each society with many unique strengths, cultural traditions, and important
contributions.
The majority of cultural anthropologists today believe that race is a socially constructed concept,
not a biological one (Sternberg, Grigorenko, & Kidd, 2005). This helps explain why very few
emotional and behavioral disorders of childhood occur at different rates for different racial
groups. However, once the effects of socioeconomic status (SES), sex, age, and referral status
are controlled for (i.e., the unique contributions of these factors are removed or accounted for),
few differences in the rate of children’s psychological disorders emerge in relation to race or
ethnicity.
Specifically, the majority culture has neglected to incorporate respect for or understanding of the
histories, traditions, beliefs, languages, and value systems of culturally diverse groups.
Misunderstanding and misinterpreting behaviors have led to tragic consequences, including
inappropriately placing minorities in the criminal and juvenile justice systems.
Minority children and youths face multiple disadvantages, such as poverty and exclusion from
society’s benefits. This exclusion is often referred to as marginalization and can result in a sense
of alienation, loss of social cohesion, and rejection of the norms of the larger society.
His paper reports a case study on Maneesha Rai, a Nepalese girl living in Hong Kong and an
“out of school” student. Based on in-depth interviews, a case was constructed of her previous
school days and current “out of school” days. These provided a vivid picture of her life and
several themes were created using schema analysis that help explain the reasons for her
“dropping out” of school after Form Five. It has been common to attribute school failure for
ethnic minority students in Hong Kong to problems with Chinese language education. Yet
Maneesha’s case study shows that her experience of failure in other subjects such as
Mathematics and Science contributed to her lack of successful schooling. Maneesha’s school
failure was more than simply a consequence of academic failure. Rather, there were many other
interrelated factors such as peer and community factors, dropout history in the family, racism,
differences in schooling culture found that contributed to her school failure. In addition,
Maneesha, like many of her ethnic minority friends, enjoyed the freedom afforded her in Hong
Kong, but it seemed such freedom also meant inadequate attention from her teachers.
4. Culture
The values, beliefs, and practices that characterize a particular ethnocultural group contribute to
the development and expression of children’s disorders and affect how people and institutions
react to a child’s problem (Achenbach & Rescorla, 2007). Because the meaning of children’s
social behavior is influenced by cultural beliefs and values, it is not surprising that children
express their problems differently across cultures. For example, shyness and oversensitivity in
children have been found to be associated with peer rejection and social maladjustment in
Western cultures, but to be associated with leadership, school competence, and academic
achievement in Chinese children in Shanghai (Chen, Rubin, & Li, 1995).
Similarly, some disorders, particularly those with a strong neurobiological basis (e.g., ADHD,
autistic disorder), may be less susceptible to cultural influences. Nonetheless, social and
cultural beliefs and values are likely to influence the meaning given to these behaviors, the ways
in which they are responded to, their forms of expression, and their outcomes.
Case Study:
Zai, a 16‐year‐old bilingual (Hmong/English) Hmong student, was referred to counseling by one
of his teachers. She described Zai as a very bright, somewhat shy, but engaging student with a
small circle of friends. He was an excellent second baseman on the school’s softball team and
particularly enjoyed gym class. Lately, however, Zai had appeared increasingly withdrawn and
occasionally seemed distressed at the end of the day. His grades were still very good, but he
seemed distracted and was becoming less conscientious about turning in his assignments. A
check of Zai’s fi le revealed that his grades were indeed excellent, and his physical history was
unremarkable. The records gave no indication that Zai’s parents had ever been involved with the
school. Zai told that he had been upset recently because of his relationship with his family. Zai
was the second eldest of five children. His family had immigrated to the United States in 1990
from Cambodia, so Zai and his brothers and sisters had been born here and were all U.S. citizens.
Zai had a foot firmly planted in two cultures—Hmong and American. His parents worked to
maintain their traditions and customs and spoke only Hmong at home. Zai and his siblings were
therefore immersed in the Hmong culture at home, but as they attended school and spent more
time away from home, they became increasingly Western in their thoughts and behaviors.
According to Zai, all of his siblings had learned to assimilate into a more Western style at school
and were more Hmong at home. In Hmong tradition, males have more power and rights than
females. And often the eldest son has the most prestige among the off spring. However, his older
brother was, in Zai’s view, not living up to the role of eldest son. According to Zai, Pao, a senior
in high school, drank beer, did not study, and never helped with any chores around the house.
Pao’s behavior was an affront to Zai, not only because Zai felt it was inappropriate behavior for
the eldest, but because Zai was left to care for his younger siblings and serve as cultural
interpreter for Zai’s parents, who were not fluent in English. Zai, I initially felt overwhelmed as
well. He sensed his strong feeling of hopelessness and caught glimpses of unacknowledged and
unexpressed anger. Zai described a little outbuilding in his family yard that would make a great
study room. His parents insisted that Zai not use that room, however, so that Pao could keep his
personal items there. The personal items, according to Zai, were beer and “junk” that Pao did not
want his family to see. Zai said that Pao never really used the building for anything other than
storage, and Zai’s occasional usage of the building to study surely would not inconvenience Pao.
Although not ideal, the need for English‐speaking children to translate the English language and
negotiate Western practices is common among some Hmong families. As parents struggle to
learn English and work to retain honored traditions, they may lag behind their children’s ability
to understand and respond to U.S. customs.
5. Child maltreatment and non-accidental trauma
Children and adolescents are being neglected and abused at an alarming rate worldwide (WHO,
2007). Each year nearly 1 million verified cases of child abuse and neglect occur in the United
States (U.S. Department of Health and Human Services, 2006), and more than 60,000 in Canada
(Trocmé et al., 2005).
These related forms of non-accidental trauma—being the victim of violence at school or being
exposed to violent acts in their homes or neighborhoods—lead to significant mental health
problems in children and youths. Due to the increasing significance of these acts, more attention
is being given to developing ways to prevent, and help youngsters exposed to maltreatment and
trauma.
Case study:
J is a 4-year-old adopted Caucasian male who at the age of 2 years and 4 months was brought by
his adoptive mother to primary care with symptoms of behavioral dyscontrol, emotional
dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment
issues. J was given diagnoses of reactive attachment disorder (RAD) and ADHD.
His mother was neglectful with feeding and frequently left him crying, unattended or with
strangers. He was taken away from his mother’s care at 7 months due to neglect and placed with
his aunt. After 1 month, his aunt declined to collect him from daycare, deciding she was unable
to manage him. The owner of the daycare called Child Services and offered to care for J,
eventually becoming his present adoptive parent.
J was a very needy baby who would wake screaming and was hard to console. More recently he
wakes in the mornings anxious and agitated. He is often indiscriminate and inappropriate
interpersonally, unable to play with other children. When in significant distress he regresses, and
behaves as a cat, meowing and scratching the floor.
There is no doubt that negative effects of early childhood deprivation had significant impact on
developmental outcomes in this patient. Significant family history of mental illness also
predisposes him to early challenges. His mother neglected him due to which he developed
ADHD. Neglect and/or abuse experienced early in life is a risk factor for mental health
problems .
6. Special issues concerning adolescents and sexual minority youths
Early to mid-adolescence is a particularly important transitional period for healthy versus
problematic adjustment. Substance use, risky sexual behavior, violence, accidental injuries, and
mental health problems are only a few of the major issues that make adolescence a particularly
vulnerable period. Disturbingly, mortality rates more than doubled between early adolescence
(ages 10 to 14) and later adolescence (ages 15 to 19), primarily as the result of risk-taking
behaviors (Irwin & Duncan, 2002).
Late childhood and early adolescence is also a time in which sexual minority youths face
multiple challenges that can affect their health and well-being. Growing up in a society that is
predominately heterosexual, and largely biased against other sexual identities, makes
adolescence a particularly difficult time for lesbian, gay, or bisexual (LGB) youths.
In response to mounting concerns, special needs and problems of adolescents are receiving
greater attention, especially because serious consequences are preventable. Health promotion
efforts to reduce harm from normal risk-taking and experimentation in adolescence, for
example, are being implemented in primary health care settings, schools, and community
programs (Irwin & Duncan, 2002).
Case Study:
Tim, a 10 year-old boy. His mother complains that he is shutting himself away in his bedroom
and refusing to communicate with other members of the family. She says that he paces his room
up and down, talking to himself and muttering to himself in anger. He agrees that he is angry all
the time, has tantrums and gets angry very easily. On one occasion he had left the house and
been missing for some three hours. His mother had to inform the police and he was found
roaming in the neighborhood. He is said to be aggressive towards his sister. He does not like the
word 'no' and challenges his mother whenever possible. He complains of not having any
freedom. There have been problems at school too. He has been falling behind in his work and
takes a 'don't care' attitude towards schoolwork. I understand he had been subject to some low
grade bullying at school. He has few friends and is unhappy both at home and at school. His
parents are separated and went through an acrimonious divorce. At one stage, Tim's father took
Tim and his sister away. They were returned to their mother following a Court Order. The
children now reside with his mother and his stepfather. I feel that Tim has been adversely
affected by the divorce, separation and the events that followed. Surprisingly, his 8-yearold
sister, Susan, is well adjusted and is doing well at school.
7. Lifespan implications
Over the long term, the impact of children’s mental health problems is most severe when the
problems continue untreated for months or years. The developmental tasks of childhood are
challenging enough without the added burden of emotional or behavioral disturbances that
interfere with the progress and course of development. About 20% of the children with the most
chronic and serious disorders face sizable difficulties throughout their lives (Costello & Angold,
2006). They are least likely to finish school and most likely to have social problems or
psychiatric disorders that affect many aspects of their lives throughout adulthood.
The lifelong consequences associated with child psychopathology are exceedingly costly in
terms of economic impact and human suffering. The costs are enormous with respect to demands
on community resources such as health, education, mental health, and criminal justice systems;
loss in productivity; the need for repeated and long-term interventions; and the human suffering
of both the afflicted children and the family and community members they encounter.
Fortunately, children and youths can overcome major impediments when circumstances and
opportunities promote healthy adaptation and competence.
Case Study:
The mother and father
are healthy, unemployed, number of sib-
lings: 5, the younger brother (4 years old)
has bronchial asthma, the others are healthy,
grandmother survived stroke. Mother and
father smoke, live in a “shanty” cottage,
drink water from the stream
The mother and father
are healthy, unemployed, number of sib-
lings: 5, the younger brother (4 years old)
has bronchial asthma, the others are healthy,
grandmother survived stroke. Mother and
father smoke, live in a “shanty” cottage,
drink water from the stream
The mother and father
are healthy, unemployed, number of sib-
lings: 5, the younger brother (4 years old)
has bronchial asthma, the others are healthy,
grandmother survived stroke. Mother and
father smoke, live in a “shanty” cottage,
drink water from the stream
The mother and father
are healthy, unemployed, number of sib-
lings: 5, the younger brother (4 years old)
has bronchial asthma, the others are healthy,
grandmother survived stroke. Mother and
father smoke, live in a “shanty” cottage,
drink water from the stream
Tom was first referred by his teacher in March of his kindergarten year. The presenting problem
was that he had not talked in school either to the teacher or to his peers. Although a complete
diagnostic appraisal was not completed before the end of the school year, it was decided at a case
conference to have him repeat kindergarten if he still was not talking at the end of the year.
Concentrated attention was not focused on the case until March of Tom's second year in
kindergarten, although contact had been maintained by the school psychologist and speech
consultant with the teacher and nurse teacher at the school. At this time, Tom still had not talked.
The psychological examination consisted of several individual sessions with Tom, observations
in the classroom, and conferences with his teacher and both parents. The district speech
consultant was also involved in all phases of the examination. The school nurse teacher had
given him an audiometric examination and found some evidence of a hearing loss.
