Introduction to Abnormal Child and Adolescent Psychology. Robert Weis
culture, race, and ethnicity can affect the diagnostic process in at least four ways. First, members of minority groups living in the United States often have different cultural values that affect their views of children, beliefs about child-rearing, and behaviors they consider problematic. For example, non-Latino White parents often place great value on fostering children’s social–emotional development and encouraging child autonomy. These parents often provide warm and responsive behavior during parent–child interactions. In contrast, many African American parents place relatively greater value on children’s compliance; consequently, they may have high expectations for their children and adopt less permissive parenting strategies. Clinicians need to be aware of cultural differences in socialization goals and parents’ ideas about appropriate and inappropriate child behavior (Comas-Diaz & Brown, 2018).
Second, recent immigrants living in the United States often encounter psychosocial stressors associated with acculturation. Acculturation stressors can include assimilation into the mainstream culture, separation from extended family and friends, language differences, limited educational and employment opportunities, and prejudice. Some immigrants do not share the same legal status as members of the dominant culture. For these reasons, the sheer number of psychosocial stressors encountered by these families is greater than those encountered by families who are members of the dominant culture (Vu, Castro, Cheah, & Yu, 2019).
Third, language and cultural differences can cause problems in the assessment and diagnosis of minority youths. The assessment and diagnostic process was designed predominantly for English-speaking individuals living in the United States and other Western societies. The words that describe some psychological symptoms are not easily translated into other languages. Furthermore, many symptoms reported by individuals from other cultures do not readily map onto DSM-5 diagnostic criteria. Psychological tests are almost always developed with English-speaking children and adolescents in mind. For example, children raised in Columbus, Ohio, will likely find the following question on an intelligence test fairly easy: “Who was Christopher Columbus?” However, immigrant children who recently moved to the city might find the question extremely challenging. Psychologists must be aware of differences in language and cultural knowledge when interpreting test results (Benisz, Dumont, & Kaufman, 2018).
Fourth, ethnic minorities are often underrepresented in mental health research. Over the past 2 decades, researchers have made considerable gains in understanding the causes of and treatment for a wide range of child and adolescent disorders. However, researchers know relatively little about how differences in children’s ethnicity and cultural backgrounds might place them at greater risk for certain disorders or affect treatment. Furthermore, researchers have only recently begun to create treatment programs designed specifically for ethnic minority youths. For example, special therapies have been developed to help Latino children cope with traumatic events using culturally relevant support. Youths meet in groups to learn mindfulness techniques and other coping strategies that are consistent with their social–cultural attitudes and values. Clearly, more research needs to be done to investigate the interplay between psychopathology and culture (Hoskins, Duncan, Moskowitz, & Ordóñez, 2018).
Review
Children’s development and functioning must be understood in light of their culture, race, ethnicity, and identities.
Mental health professionals should be especially sensitive to (1) the way social and cultural factors affect families’ expectations for their children and ideas about child-rearing, (2) families’ immigration history and degree of acculturation, (3) the way language can influence how families describe their children’s behavior, and (4) the degree to which ethnic minority families are underrepresented in mental health research.
1.2 The Prevalence Childhood Disorders
How Common Are Mental Disorders in Children?
Prevalence and Incidence
Researchers conduct epidemiological studies to estimate the prevalence of psychological disorders in the general population. Prevalence refers to the percentage of individuals in a given population who have a medical or psychological condition. To estimate the prevalence of psychological disorders among children and adolescents, epidemiologists gather information from parents, teachers, and mental health professionals. Sometimes, epidemiologists also collect data from children and adolescents themselves, especially when questions deal with behaviors, thoughts, or feelings that might be hidden from parents (e.g., alcohol and other drug use, suicidal ideation). Epidemiologists can use this information to determine point prevalence, the percentage of youths with a disorder at a given point in time, and lifetime prevalence, the percentage of youths with a disorder at any point in their lifetime.
Sometimes, epidemiologists want to determine the likelihood that a child will develop a disorder in a given period of time. Incidence refers to the percentage of new cases of a disorder in a discrete period of time—usually 1 year. Because incidence only refers to new cases of a disorder, it is typically a much smaller number than prevalence. For example, the lifetime prevalence of autism spectrum disorder is approximately 1.8%; that is, roughly 1.8% of youths in the United States have been diagnosed with autism. However, the incidence of autism is approximately 0.3%; that is, in any given year, approximately 0.3% of children will be diagnosed with autism for the first time (Centers for Disease Control and Prevention, 2020c).
Determining the prevalence of children’s mental health problems is challenging for several reasons. First, there is no single agency that tracks the prevalence of mental disorders in children and adolescents. Instead, prevalence must be estimated using data from many individual studies conducted by different research teams (Costello & Angold, 2016).
Second, epidemiological studies use different methods to collect data, yielding slightly different results. For example, the National Health Interview Survey (NHIS) estimates the prevalence of childhood disorders by interviewing 12,000 parents each year. In contrast, the National Youth Risk Behavior Survey estimates behavior and substance use problems in adolescents by administering questionnaires to 16,000 high school students annually. These different research methods (e.g., interviewing parents vs. administering questionnaires to teens) can yield different findings. For example, parents are very good at reporting the severity of children’s disruptive behavior but are less accurate in estimating children’s difficulties with depression or use of alcohol. In contrast, adolescents may be more accurate reporters of their own mood and substance use, but they may underestimate the severity of their behavior problems (Kamphaus, Reynolds, & Dever, 2014; Stiffler & Dever, 2015).
Third, it is difficult to gather high-quality data. Many people do not want to participate in lengthy surveys, others do not understand the questions asked of them, and still others provide inaccurate information. Conducting large-scale interviews or surveys is also costly and time-consuming.
Despite these methodological obstacles, researchers have conducted several large epidemiological studies designed to estimate the prevalence of childhood disorders. Collectively, these studies include data from tens of thousands of children and their caregivers, using a variety of research strategies. Altogether, these data suggest that 13% to 15% of youths experience a psychological disorder in any given year. Slightly more than 20% of youths experience a disorder at some point before adulthood (Perou et al., 2016).
Recent data indicate that the overall prevalence of children’s mental health problems is on the rise. For example, in the past decade, there has been a 24% increase in the number of children receiving mental health or substance abuse treatment in the United States. The number of youths prescribed medication to treat psychological disorders has also increased approximately 28% during that same time (Visser, Danielson, & Bitsko, 2014). Finally, the rate of hospital admissions for children with psychological disorders, such as depression, has increased 80% in the past 20 years (Pfuntner, Wier, & Stocks, 2013).
Table 1.2 shows the prevalence of specific mental disorders among children and adolescents in the United States. As you might suspect, ADHD is the most common condition. Almost 9% of youths are diagnosed with this disorder at some