1. Page 1 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Models of Development and Mental Health Lecture 2: Risk and Resilience

2. Page 2 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Risk & Resilience – Key Terms Risk factors increase the likelihood that psychopathology will result Protective factors reduce the likelihood that psychopathology will result Vulnerability factors intensify the response to the risk Prevalence: total number of cases describe how common or rare a disorder is Incidence: number of new cases at given time -changes over time in rates of a clinical disorder Epidemiology: the study of patterns of disease/disorder distribution in human populations

3. Page 3 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Risks, & Protective Factors (Adapted from Wenar & Kerig, 2000) ContextRisksVulnerabilitiesProtective factors OrganicGenetic disorderTemperamentEasy temperament IntrapersonalLow IQGenderCompetence Interpersonal: family Marital difficultiesPoor relationshipsParental supervision Interpersonal: peer Antisocial peergroup Poor social skills Good peer relationships SuperordinatePovertyNon conformistCultural tolerance

4. Page 4 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Protective mechanisms 1.Reducing risk impact –by altering the meaning or riskiness of the variable and –by alternating the child’s exposure to intimate involvement in the risk 2.Reducing negative chain reactions 3.Promoting self-esteem and self-efficacy 4.Opening up opportunities/occurrence of turning points

5. Page 5 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Understanding risk factors and mechanisms Problems with concept of risk factors implies that risk is absolute implies a main effect for one factor implies that risk is a fixed attribute of the person Risk processes or mechanisms: Chain reactions or effects (changes in the way the individual processes experiences, and vicious cycles of maladaptation) Negative turning points

6. Page 6 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Questions we need to ask about mental health difficulties or psychiatric disorders How common are disorders of childhood, adolescence and adulthood? What is meant by risk and resilience, and how do these mechanisms work? What factors appear to place children at risk for developing disorders? What can account for continuity/stability? What needs do these disorders reflect and create within individuals, families, communities, and societies? What policies and interventions are in place to support families and how well do they meet existing needs?

7. Page 7 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Identifying mental health difficulties Traditionally, medical model of diagnosis –Informs intervention –Access to service Diagnostic Systems: Psychiatry & Clinical Psychology Developmental Psychopathology –Normal to abnormal spectrum –Research on: what is normal? What is abnormal? –E.g. Post Traumatic Stress Disorder Normal reaction to an abnormal event

8. Page 8 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Categorical approaches to classification DSM-IV-TR (APA) – 5 axes ICD (WHO) – 6 axes Axis I: Clinical Disorders e.g. depressive disorder Axis II: Personality Disorders; Mental Retardation Axis III: General Medical Conditions Axis IV: Psychosocial and Environmental Problems Axis V: Global Assessment of Functioning (GAF) (ICD 10 additional axis of intellectual level) Use of behaviourally specific terms to objectively describe and operationally define Assumption that diagnostic criteria identical across development

9. Page 9 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Dimensional (multivariate statistical approach) Child Behavior Checklist (CBCL) Achenbach (1991) Externalising/Internalising difficulties Sub-scales Evaluates behaviours on a continuum Compatible with notion of continuity between normality and abnormality highlight the severity of a disorder limited in capturing rare disturbances

10. Page 10 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Functions of Classification Carr (1999) Way of ordering information to make it manageable Allows for development of epidemiological information about incidence and prevalence of clinical disorders Provides a language for clinicians to communicate relevant information

11. Page 11 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Continuous Assessment Assignment What is resilience? Critically evaluate the contribution of the research literature on this concept to our understanding of the emergence and maintenance of mental health difficulties

12. Page 12 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Essay – some pitfalls Not giving a comprehensive answer to the question –Creating your own title: dangers of not addressing the question –Neglecting to address emergence AND maintenance –Devoting too much space in essay to one aspect of the question, with inadequate coverage of another –Overreliance on theoretical contributions without drawing on empirical research literature

13. Page 13 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Essay – more pitfalls Overreliance on a few references, reflecting a narrow range of reading Describing the concepts without offering a critique You may choose to discuss mental health difficulteis in general or to draw on particular difficulties to illustrate your arguments– choose wisely! –Reference to many difficulties may weaken argument –Coverage of one difficulty only may rely on narrow range of reading and not address the question asked

14. Page 14 © Rosaleen McElvaney, PhD Models of Development and Menatl Health 2009 Core areas of Reading Resilience, Risk Literature Emergence and Maintenance of mental health difficulties