Getting Rid of All Mental Health Diagnoses
Getting Rid of All Mental Health Diagnoses
Imagine all the world leaders issue a joint declaration stating that as of today, we are getting rid of all mental health diagnoses as they are nothing more than social constructs. Please take a position regarding this declaration. Responding to your peers( you cannot see the replies before you submit your own post)
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E DOCTOR OF NURSING PRACTICE (DNP) PROGRAM SCHOOL OF SOCIAL ECOLOGY PSY 153C – LECTURE 2.3 Research Methods in DP: General Assessment Issues THE SCHOOL OF SOCIAL ECOLOGY Kate Simon, PhD Assessment Why do we do it? Clinical • Diagnosis • Treatment planning • Treatment monitoring and progress Research • • • • Epidemiology Determining correlates Assessing predictors and outcomes Examining interventions THE SCHOOL OF SOCIAL ECOLOGY 2 General Issues Related to Assessment in Children 3 THE SCHOOL OF SOCIAL ECOLOGY General Assessment Issues: Confidentiality: • Consenting versus assenting for treatment Suggestion creating a pre-treatment contract re: child patient confidentiality, when to breach confidentiality, how much of session will include parent, etc. THE SCHOOL OF SOCIAL ECOLOGY General Assessment Issues: Do a complete assessment Talk to child alone, parent(s), school, other providers, etc. Also observe the child with the parent Consider observing the child in other activities (e.g., at school, home) if relevant to presenting problem 5 THE SCHOOL OF SOCIAL ECOLOGY General Issues Child Abuse • Reporting will hurt your therapeutic relationship with child and parent • But reporting is the mandate of therapists • That said, don’t go hunting for abuse reports from children 6 THE SCHOOL OF SOCIAL ECOLOGY Apply your Knowledge • What is the difference between assessing an adult versus a child? • What additional and/or different steps do you need to take to assess a child? THE SCHOOL OF SOCIAL ECOLOGY Summary *Getting Rid of All Mental Health Diagnoses
General considerations involve not just the child but also the family system * Ethical guidelines/rules differ with respect to children 8 THE SCHOOL OF SOCIAL ECOLOGY E DOCTOR OF NURSING PRACTICE (DNP) PROGRAM SCHOOL OF SOCIAL ECOLOGY PSY 153C – LECTURE 2.2 Research Methods in DP: Advanced Research Methods THE SCHOOL OF SOCIAL ECOLOGY Kate Simon, PhD Advanced Research Methods in Developmental Psychopathology 2 THE SCHOOL OF SOCIAL ECOLOGY -Categorical versus dimensional measurement of psychopathology -The nuances of testing developmental pathways 3 THE SCHOOL OF SOCIAL ECOLOGY Topic 1: How do we conceptualize mental health problems? In other words, How do we conceptualize mental disorders and what are the implications of this method of conceptualization for research/assessment/treatment? THE SCHOOL OF SOCIAL ECOLOGY Dimensional versus Categorical Classification Research is ongoing to determine which system better maps onto the presentation of different problems Categorical Someone who has that disorder is fundamentally different than someone who does not Dimensional Present in everyone to varying degrees 5 THE SCHOOL OF SOCIAL ECOLOGY Categorical Approach Major nosological framework in developmental psychopathology: Diagnostic and Statistical Manual of Mental Disorders (DSM) – 5 Outlines diagnoses and associated criteria Categorical system Disorders are viewed to be discrete categories • Depression, social anxiety, oppositional defiant disorder Professional consensus Medical model • Discrete disorders with separate causes 6 THE SCHOOL OF SOCIAL ECOLOGY Categorical Measurement Advantages • Synthesis of information • Aids communication Disadvantages • People/Children often do not fit into categories • Comorbidity • Impaired but does not meet criteria • Loss of information through oversimplification • Current categories proving inadequate for genetic and neuroscience research (e.g., Rdoc) • May not be the most valid groupings 7 THE SCHOOL OF SOCIAL ECOLOGY Dimensional Approach & Measurement Research Domain Criteria (RDoC) • Rather than using diagnostic categories, move towards assessing key dimensions • Negative affect • Anger regulation Dimensional measurement • Independent traits or dimensions of behavior exist • People are higher or lower on those dimensions Advantages • Getting Rid of All Mental Health Diagnoses
Allows us to retain valuable information • Provides a measure of severity THE SCHOOL OF SOCIAL ECOLOGY Disadvantages • Which dimensions? • Becomes very complicated very quickly • Harder to communicate findings, to consolidate extant work Categorical 9 THE SCHOOL OF SOCIAL ECOLOGY Dimensional 10 THE SCHOOL OF SOCIAL ECOLOGY How do we measure pathways/development in developmental psychopathology? THE SCHOOL OF SOCIAL ECOLOGY The goal of the field of DP is to understand psychological (and psychopathological development) in its true complexity Yet, the whole enterprise of research demands we focus the microscope in on some factors and zoom out on other factors So how do we preserve some complexity and endeavor to understand the under what conditions and how of mental disorders? 12 THE SCHOOL OF SOCIAL ECOLOGY Understanding Mechanisms in the Relationship between Variables Moderators • influence the direction or strength of the relationship Mediators • (partially or wholly) account for the relationship between two variables 13 THE SCHOOL OF SOCIAL ECOLOGY Moderation Question to ask: Under what conditions Or When Are x and y related 14 THE SCHOOL OF SOCIAL ECOLOGY Moderation Example Cognitive Insight moderator Coping Cat Therapy Treatment Condition Independent variable Change in anxiety symptoms Dependent variable Anxiety Symptoms 8 6 4 High Cognitive Insight 2 Low Cognitive Insight 0 T1 T2 THE SCHOOL OF SOCIAL ECOLOGY Child’s level of cognitive insight (moderates – changes the strength/direction of the relationship) between IV (treatment) and DV (change in anxiety symptoms) 15 Mediation Question to ask: WHY are x and y related 16 THE SCHOOL OF SOCIAL ECOLOGY Mediation Example Life Stressor (trauma with caregiver) mediator Genetic Vulnerability Independent variable Development of Separation Anxiety Dependent variable X The life stressor of experiencing a trauma with caregiver such as they are in a care accident (mediates – explains the relationship) between IV (genetic vulnerability) and DV (development of anxiety symptoms) THE SCHOOL OF SOCIAL ECOLOGY 17 Apply your Knowledge • What is the difference between a categorical and a dimensional system of understanding psychopathology? • Which would you prefer to use if you are tracking a kid’s progress in treatment and why?Getting Rid of All Mental Health Diagnoses
THE SCHOOL OF SOCIAL ECOLOGY Let’s Play the Moderator or Mediator Game! 1. Depression is associated with early puberty, but only among girls. 2. Second generation immigrants are more likely to develop anxiety, but only when their parents show low levels of acculturation. 3. Substance use in adolescence is linked to ADHD in childhood, partly because of their mutual association with deviant peers. THE SCHOOL OF SOCIAL ECOLOGY Summary * Often view psychopathology dimensionally within DP, but medical model (DSM-v) uses categorical approach * Moderators and mediators key to a DP framework, to enhancing specificity of risk/resilience predictions 20 THE SCHOOL OF SOCIAL ECOLOGY E DOCTOR OF NURSING PRACTICE (DNP) PROGRAM SCHOOL OF SOCIAL ECOLOGY PSY 153C – LECTURE 2.1 Research Methods in DP: Correlational & Experimental Designs THE SCHOOL OF SOCIAL ECOLOGY Kate Simon, PhD Research Methods Correlational Experimental Majority of research in field is correlational Minority is experimental (CANNOT INFER CAUSATION!) (CAN INFER CAUSATION, BUT DIFFICULT TO CONDUCT) 2 THE SCHOOL OF SOCIAL ECOLOGY Determining Cause But then, how can we determine what causes psychopathology? Correlational research can’t, so why bother? Inferring cause based on timing Manipulating an IV and measuring DV THE SCHOOL OF SOCIAL ECOLOGY Two Types of Correlational Studies • Cross-sectional: Measuring people at one point in time and examining how two or more factors co-vary (go together). • Longitudinal: Measuring people at multiple points in time to examine whether one factor predicts changes in another factor; also referred to as a prospective longitudinal design. THE SCHOOL OF SOCIAL ECOLOGY Establishing Causality: From Weakest to Strongest Methods Theoretical expectation that A would cause B A and B have to be related empirically (correlation) Elimination of other possible causes • Case-control design, prospective design, single-case designs, RCT Temporal ordering: A occurs before B • Prospective design Responsiveness: Changing A leads to change in B • Single-case designs, RCT THE SCHOOL OF SOCIAL ECOLOGY Strongest Method (aside from experimental) for Establishing Risk/Resilience: Prospective Designs Identify children and follow them over time Establishes temporal link Who goes on to develop a disorder? What happens to children who have a disorder? 6 THE SCHOOL OF SOCIAL ECOLOGY Prospective Designs: Who Goes On to Develop a Disorder? Follow children over time and see who goes on to develop a particular problem Risk and protective factors • Occur before the disorder and either increase or decrease the likelihood of the disorder occurring • Getting Rid of All Mental Health Diagnoses
Child abuse and conduct disorder • Having a high-quality intimate relationship and depression 7 THE SCHOOL OF SOCIAL ECOLOGY Prospective Designs: What Happens to Children Experiencing Psychological Disorders? Prospective studies also allow us to determine what happens to children with a particular difficulty Follow children with a particular disorder and find out what happens to them Are psychological symptoms stable over time? Is depression in childhood associated with depression in adulthood? Are psychological symptoms in childhood associated with more global problems in impairment? Social difficulties Employment difficulties 8 THE SCHOOL OF SOCIAL ECOLOGY Prospective Designs • Internal validity • Have to rule out other possible factors • Example: Association between psychological symptoms in childhood and socioeconomic functioning in adulthood • Measure psychological symptoms in 1983 • ADHD, CD, anxiety and depression • In 2001, re-interviewed the children who are now adults • Assessed their income, years of education, employment • Found that ADHD, CD, and depression were associated negatively with socioeconomic functioning THE SCHOOL OF SOCIAL ECOLOGY 9 Prospective Designs Advantages Disadvantages •Getting Rid of All Mental Health Diagnoses
Establishes temporal order • Not relying on retrospective report • Takes a long time • Have to be very careful about ruling out the effects of other factors • Aging effects – is this change a function of getting older, rather than the variable of interest • Depending on what you are interested in, may be hard to find enough people • E.g., if you are interested in determining who develops a rare disorder, you would need to start with a lot of people to ensure that some of them go on to develop that disorder • Does not establish that A changes B 10 THE SCHOOL OF SOCIAL ECOLOGY Testing Your Knowledge • Dr. Tanaka conducts a study examining the social behaviors of 3 and 6 year-old children, finding that 6 year olds show more advanced social skills. This is an example of a: • A. cross-sectional study • B. longitudinal study • C. case control design • D. none of the above 11 THE SCHOOL OF SOCIAL ECOLOGY Apply your Knowledge
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