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Learning Objectives
After reading this chapter, you should be able to do the following:
1.1 Critically evaluate the concept of a mental disorder as it applies to children and adolescents.Explain how mental health professionals diagnose youths using DSM-5.
1.2 Describe the prevalence of childhood disorders and how it varies as a function of children’s age, gender, socioeconomic status, and ethnicity.
1.3 Describe the characteristics of evidence-based practice and the types of professionals who help children and families in need.Identify and apply four ethical principles that are important when helping children and families.
There once was a craftsman who used all his skill to create a wonderful new pot. The pot was made of clay, shaped by his weathered hands, and baked into a beautiful form. The man glazed and decorated the pot, using colors and designs that were as unique as they were beautiful. When it was finished, the man carried the pot to a nearby well to fetch some water for his home. To his surprise, he discovered the pot had developed a small crack from the kiln, which caused water to leak from the bottom. At first, the crack was small, but over time it became larger and more noticeable.
One day, the man’s friend said, “That pot has a crack. By the time you get home, you’ve lost half of your water. Why don’t you throw it away and get a new one?” The man paused, turned to his friend, and replied, “Yes, it’s true that this pot leaks. But each day it waters the flowers on the path from the well to my home.” Sure enough, along the path had sprung countless wildflowers of all varieties, while in other areas, the land was barren. In response, the man’s friend simply nodded his approval1 (Image 1.1).
1Adapted from a story by Kevin Kling.
The story of the broken pot illustrates each person’s dignity and value. Everyone has unique gifts and talents, although sometimes they are hard to recognize. When studying children with psychological problems, it’s easy to focus on limitations and to lose sight of the children themselves. Many of these youths face significant challenges in performing everyday activities like bathing, dressing, or speaking. Other children struggle at school or when interacting with others. Still other youths have difficulty controlling their actions and emotions.
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Regardless of their disability, disorder, or diagnosis, these children have intrinsic worth. A challenge facing parents, teachers, and all people who interact with these youths is to not lose sight of the child when we focus on his or her problems. One of my clients, Will, was born with Down syndrome. Although he struggled with reading and math, he taught his classmates to be patient, to act with empathy, and to respect others who are different. Another client, Camden, had attention-deficit/hyperactivity disorder (ADHD). Even with medication and therapy, he had problems staying focused in class; however, he also had an excellent sense of humor and loved to play soccer. Still another client, Chloe, struggled with anxiety and depression, but family therapy helped to improve her relationship with her parents and her connection with others in her community.
If you’re reading this book, it’s likely that you enjoy interacting with children and helping others in need. I hope that this book will introduce you to the ways we can use psychological science and evidence-based strategies to help children and families. Students like you often find themselves on the front lines of treatment. Some work in residential treatment facilities with disruptive adolescents. Others serve as behavior therapists for children with developmental disabilities. Still other students volunteer with at-risk youths; they may tutor children with learning delays, serve as Big Brothers or Big Sisters to disadvantaged children, or facilitate after-school groups for children in high-risk neighborhoods. There is no shortage of people who want to help children in need; the difficulty is finding individuals who are willing to use scientific principles and evidence-based practices to help them. The field desperately needs bright, empathic students who are willing to devote their time and energy to help children using psychological science. I’m so happy that you are willing to take the first step on this rewarding journey.
1.1 Identifying Behavior Problems in Children
What Do We Mean by “Abnormal?”
Deviation, Disability, and Distress
There is no consensus on how to define abnormal behavior in children and no agreement on how best to differentiate abnormalities from normal functioning. However, mental health professionals have proposed three broad criteria that help identify psychological problems in youths: deviancy, disability, and distress (Cicchetti, 2016a; Dulcan, 2019).
One approach to defining abnormality is based on statistical deviation. Using this approach, abnormal behaviors are defined by their relative infrequency in the general population. For example, transient thoughts about death are fairly common among adolescents. However, recurrent thoughts about killing oneself are statistically rare and could indicate a mood disorder, such as depression. Consequently, psychologists might administer a rating scale to clients and identify youths who show symptoms well beyond the normal range, compared to other children and adolescents of the same age and gender (Achenbach, 2015).
The primary limitation of the statistical deviation approach to defining abnormality is that not all infrequent behaviors are indicative of mental disorders. Imagine a child who is tearful, prefers to stay in her room, does not want to play with friends, and is having problems completing schoolwork. From the statistical deviation perspective, we might diagnose this girl with depression because she shows mood problems that are rare among girls her age. However, if we learn that her grandfather died a few days before her assessment, we would likely interpret her behavior as a normal grief reaction, not as an indicator of depression. Although statistical infrequency may be an important component of a definition of abnormality, it is insufficient by itself. Statistical deviation does not take into account the context of children’s behavior.
A second approach to defining abnormality is based on disability or degree of impairment. From this perspective, abnormal behavior is characterized by thoughts, feelings, or actions that interfere with a child’s social or academic functioning. For example, an adolescent who feels sad because she broke up with her boyfriend would not be diagnosed with depression, as long as she is able to maintain relationships with friends, get along with her parents, and perform adequately in school. On the other hand, her behavior might be considered abnormal if she has difficulty in any of these three areas.
Defining abnormality by level of disability has a serious drawback: Many youths with psychological disorders do not show obvious signs of impairment. For example, 15-year-old Dorothy Dutiel killed herself and a classmate at her high school in Glendale, Arizona. Dorothy obtained a gun from another classmate who did not know that she was depressed and intended harm. After the incident, first responders found a handwritten note in Dorothy’s pocket that read, “I would like to clarify that [the student who gave me the gun] and his family are in no way affiliated with my actions. He was under the absolute impression I needed the gun for self-defense. I lied to receive this gun.” Dorothy’s classmate was unaware that she was depressed because she spent time with friends, continued to do well in school, and did not appear sad. Not all mental health problems are accompanied by overt impairment (Lynch, 2018).
A third approach to defining abnormality includes a child’s degree of emotional distress. People can show distress through depressed mood, irritability, anxiety, worry, panic, confusion, frustration, anger, or other feelings of dysphoria.
One problem with defining abnormality in terms of distress is that distress is