Developmental psychopathology links the study of usual development with the study of children with unusual brain or behavior patterns (Cicchetti, 2013b; Hayden & Mash, 2014). Every topic already described, including “genetics, neuroscience, developmental psychology, . . . must be combined to understand how psychopathology develops and can be prevented” (Dodge, 2009, p. 413).

At the outset, four general principles should be emphasized.

At every age, people with disorders often have unusual brain patterns, which means that understanding the functioning of their brains might help them thrive among people with more typical neurological development. During middle childhood, school learning is crucial. For that reason, we focus first on intellect.

APTITUDE, ACHIEVEMENT, AND IQ In theory, aptitude is the potential to master a specific skill or subject, such as the potential to become an accomplished musician, engineer, or student. Learning aptitude is usually measured by answers to a series of questions. The assumption is that there is one general intelligence, called g (for general). An IQ (intelligence quotient) test consists of questions that, taken together, measure g, thought to be learning potential.

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In theory, achievement is what has actually been learned, distinct from aptitude. School achievement tests compare scores to norms established for each grade. For example, children of any age who read as well as the average third-grader would be at the third-grade level in reading achievement.

The words in theory precede the definitions of aptitude and achievement above because, although potential and accomplishment are supposed to be distinct, the data find substantial overlap. IQ and achievement scores are strongly correlated.

It was once assumed that aptitude was a fixed characteristic, present at birth. Longitudinal data show otherwise. Young children with a low IQ can become above-average or even gifted adults, like my nephew David (discussed in Chapter 1). Indeed, the average IQ scores of entire nations have risen substantially every decade for the past century—a phenomenon called the Flynn effect, named after the researcher who first described it (Flynn, 1999, 2012).

Because changes in cohort and education produced intellectual growth in children, IQ tests need to be revised, updated, and renormed to keep the average score at 100—which would have been 115 two generations ago. Both major IQ tests for children, the Stanford-Binet and the Wechsler Intelligence Scale for Children (WISC), are now in fifth editions, with changes to criteria for average scores.

Psychologists now agree that the brain is like a muscle, affected by mental exercise—encouraged or discouraged by the social setting. Brain structures grow or shrink depending on past experience. This is proven in language and music and probably is true in other areas as well (Zatorre, 2013). Both speed and memory are affected by experience, evident in the Flynn effect. During middle childhood, speed of thought is crucial for high IQ, with working memory also influential (Demetriou et al., 2013).

CRITICISMS OF IQ TESTING Since scores change over time, some scientists doubt whether any test can measure the complexities of the human intellect, especially if the test is designed to measure g, general aptitude. According to some experts, children inherit many abilities, some high and some low (e.g., Q. Zhu et al., 2010).

A leading developmentalist, Howard Gardner, contends that humans have multiple intelligences, not just one. Gardner originally described seven intelligences: linguistic, logical-mathematical, musical, spatial, bodily-kinesthetic (movement), interpersonal (social understanding), and intrapersonal (self-understanding), each associated with a particular brain region (Gardner, 1983). He subsequently added naturalistic (nature, as in biology, zoology, or farming) and spiritual/existential (Gardner, 1999, 2006; Gardner & Moran, 2006).

Although every normal person has some of all nine intelligences, Gardner believes each individual excels in particular ones. For example, someone might be gifted spatially but not linguistically (a visual artist who cannot describe her work) or might have interpersonal but not naturalistic intelligence (an insightful clinical psychologist whose houseplants die).

Gardner’s concepts regarding multiple intelligences influence the curriculum in many primary schools. For instance, children might be allowed to demonstrate their understanding of a historical event via a poster with drawings instead of writing a paper with a bibliography.

Many other scholars (including Robert Sternberg, whose ideas are explained in Chapter 12) find that cultures and families dampen or accelerate particular intelligences. What would happen, for instance, if two children were born with equal creative, musical ability but one child’s parents were musicians and the other child’s parents were tone-deaf? Probably only the first child would develop impressive musical intelligence.

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A multi-cultural perspective emphasizes that every test reflects the culture of the people who create, administer, and take it. This is obvious for achievement tests: A child may score low because of home, school, or culture, not because of ability. Indeed, IQ tests are still used partly because achievement tests may be unfair to some bright children.

But IQ tests also are affected by culture. Some experts try to use culture-free aptitude tests, asking children to identify pictures, draw shapes, repeat stories, hop on one foot, name their classmates, sort objects, and so on. To be sensitive to the child’s experience, most IQ tests require that a friendly, trained adult ask questions of one child at a time.

Yet culture may still drag IQ scores down. Perhaps a child is told “never talk to strangers.” That child might not answer the tester’s questions.

Might measuring the brain directly avoid cultural bias? Yes, in theory, but not in practice. Variation is vast in children’s brains: Experts are hesitant to judge intelligence via any brain scan (e.g., Goddings & Giedd, 2014). Furthermore, plasticity makes the results of brain scans, like IQ scores, likely to change.

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Developmental psychopathology is relevant lifelong because “[e]ach period of life, from the prenatal period through senescence, ushers in new biological and psychological challenges, strengths, and vulnerabilities” (Cicchetti, 2013b, p. 458). Turning points, opportunities, and past influences are always apparent.

In middle childhood, the challenge for every child is to learn basic skills. Some children find that mastering academic skills is much more difficult than other children do. Fortunately, most learning problems can be mitigated if treatment is early and properly targeted.

Therein lies the crux of the issue: Although early treatment is best, early and accurate diagnosis is difficult, not only because many disorders are comorbid but also because symptoms differ by age. As you learned in Chapter 4, infants have temperamental differences that might or might not become problems, and in Chapter 6, that aggression and shyness are sometimes normal but sometimes ominous. Difference is not necessarily deficit, but some differences signal that intervention is needed. Which is which?

Two basic principles of developmental psychopathology complicate diagnosis and treatment (Hayden & Mash, 2014; Cicchetti, 2013b). First is multifinality, which means that one cause can have many (multiple) final manifestations. For example, an infant who has been flooded with cortisol may become quick to cry or rage or the opposite, unusually placid.

The second principle is equifinality (equal in final form), which means that one symptom can have many causes. For instance, a nonverbal first-grader may have autism spectrum disorder, a hearing deficit, no experience in the school language, or extreme shyness.

The complexity of diagnosis is evident in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (American Psychiatric Association, 2013), often referred to as DSM-5. A major problem is recognizing the cutoff between normal childish behavior and pathology. Some suggest that childhood psychopathology was under-diagnosed in early editions of the DSM and is over-diagnosed in DSM-5 (Hayden & Mash, 2014).

Perhaps. Both multifinality and equifinality make early diagnosis complex: Some children are considered pathological when really they are not, while other children are not diagnosed when early diagnosis and intervention would help. The following three examples are a beginning, because everyone needs to know something about children with special needs. Teachers, counselors, doctors, and nurses need to know much more.

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Someone with attention-deficit/hyperactivity disorder (ADHD) is often inattentive, unusually active, and impulsive. DSM-5 says symptoms must start before age 12 (in DSM-IV it was age 7) and must impact daily life. (DSM-IV said impaired, not just impacted.)

Some impulsive, active, and creative actions are quite normal. However, children with ADHD “are so active and impulsive that they cannot sit still, are constantly fidgeting, talk when they should be listening, interrupt people all the time, can’t stay on task, . . . accidentally injure themselves.” They are “difficult to parent or teach” (Nigg & Barkley, 2014, p. 75).

There is no biological marker for ADHD. Current research, nonetheless, suggests the origin of the disorder is in brain regulation, because of genes, complications of pregnancy, or toxins (such as lead) (Nigg & Barkley, 2014).

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ADHD is often comorbid. Explosive rages, later followed by deep regret, are typical for children with many disorders, including ADHD. One surprising comorbidity is deafness: Children with severe hearing loss often are affected in balance and activity, and that seems to make them prone to developing ADHD (Antoine et al., 2013). In this way, ADHD is an example of equifinality; many causes produce one disorder.

U.S. rates of ADHD among children were about 5 percent in 1980. Currently, rates are 7 percent of 4- to 9-year-olds, 13 percent of 10- to 13-year-olds, and 15 percent of all 14- to 17-year-olds (Schwarz & Cohen, 2013). Rates in other nations are lower than in the United States, but rates are rising everywhere (e.g., Al-Yagon et al., 2013; Hsia & Maclennan, 2009; van den Ban et al., 2010). Increasing incidence worries developmentalists for three reasons:

Many adults (71 percent in one study) who were diagnosed with ADHD as children say they no longer have the condition (Barbaresi et al., 2013). Do people overcome or outgrow ADHD, do adults minimize symptoms, or were these adults misdiagnosed? All are possible.

Treatment for ADHD involves: (1) training for the family and child, (2) special education for teachers, and (3) medication. Each of these three is complicated. As equifinality posits, causes vary, so treatment that helps one child may be wrong for another (Mulligan et al., 2013).

SPECIFIC LEARNING DISORDER The DSM-5 diagnosis of specific learning disorder now includes disabilities in both perception and processing of information, evident in unexpected low achievement in reading, math, or writing (including spelling) (Lewandowski & Lovett, 2014). Children with specific learning disorders have difficulty mastering skills that most children acquire easily.

Disabilities in reading, writing, and math undercut academic achievement, destroy self-esteem, and qualify a child for special education (according to U.S. law) or formal diagnosis (according to DSM-5). Hopefully, such children find (or are taught) ways to compensate, and other abilities shine. Winston Churchill, Albert Einstein, and Hans Christian Andersen are all said to have had specific learning disorder.

The most common type of specific learning disorder is dyslexia—-unusual difficulty with reading. Dozens of types and causes of dyslexia have been identified, so no single strategy helps every child (O’Brien et al., 2012).

Early theories hypothesized that visual difficulties—for example, reversals of letters (reading god instead of dog) and mirror writing (b instead of d)—caused dyslexia, but experts now believe that the origin is more auditory (in speech and hearing) than visual (Gabrieli, 2009; Swanson, 2013). Traditionally, dyslexia was not diagnosed until a child with normal IQ, vision, and hearing had difficulty reading. Now dyslexia is recognized at age 5 or earlier.

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Another specific learning disorder is dyscalculia—unusual difficulty with math. For example, when asked to estimate the height of a normal room, second-graders with dyscalculia might answer “200 feet,” or, when asked which card is higher, the 5 or the 8 of hearts, a child might use his or her fingers to count each card’s hearts (Butterworth et al., 2011).

For specific learning disorders, the problem may originate in the brain, but plasticity allows early remediation to improve brain connections before the young child’s eagerness to learn has been crushed by failure. Almost everyone can learn basic skills if they are given extensive and targeted teaching, encouragement, and practice.

AUTISM SPECTRUM DISORDER Of all the children with special needs, those with autism spectrum disorder (ASD) are probably the most troubling. Their problems are severe, but both causes and treatments are hotly disputed. As a result, as Thomas Insel, director of the National Institute of Mental Health says, parents and advocates of children with autism spectrum disorder are “the most polarized, fragmented community” (quoted in Solomon, 2012, p. 280).

Many children with ASD show symptoms in the first year of life, but some seem normal and then suddenly regress at about age 2 or 3, perhaps because a certain level of brain development, or a particular medical insult, occurs (Klinger et al., 2014). Most are diagnosed at age 4 or later (MMWR, March 28, 2014), although earlier intervention is best.

Autism spectrum disorder has three characteristics: (1) poor social understanding, (2) impaired language, and (3) unusual play patterns, such as fascination with trains, lights, or spinning objects. In the past, children who developed slowly were usually diagnosed as having a “pervasive developmental disorder” or as “mentally retarded.” (The term “mental retardation,” used in DSM-IV, has been replaced with “intellectual disability” in DSM-5.)

Much has changed. Far more children are diagnosed with autism spectrum disorder, and far fewer with intellectual disability. In the United States, among 8-year-olds, one child in every 68 is said to have ASD (MMWR, March 28, 2014). Rates are five times higher among boys than girls and about one-third higher among European Americans than Hispanic, Asian, or African Americans.

The DSM-5 autism spectrum disorder diagnosis, formerly reserved for children who were mute or violent, now includes mild, moderate, and severe categories. Mildly impaired children with ASD appear normal at first and may be talented in some specialized area, such as drawing or geometry. Many (46 percent) score in the “normal” or “above normal” range on IQ tests (MMWR, March 28, 2014).

Often children with autism spectrum disorder have a hypersensitive sensory cortex: They are unusually upset by noise, light, and other sensations. Hundreds of genes and dozens of brain abnormalities are more common in people with ASD than in the general population.

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Why are far more children diagnosed with ASD in 2015 than in 1990? Has the incidence really increased or are children diagnosed who would not have been earlier (Klinger et al., 2014). Children who once were diagnosed with Asperger syndrome are now said to have “autism spectrum disorder without language or intellectual impairment” (American Psychiatric Association, 2013, p. 32). Is that more accurate?

As more is understood, many people wonder whether ASD is a disorder needing cure or an indication that parents and society foolishly expect everyone to be fluent talkers, gregarious, and flexible—the opposite of autism spectrum disorder. If the latter, children are diagnosed too readily. Advocates of neurodiversity suggest that the neurological variations should be accepted, appreciated, celebrated—not pathologized (Kapp et al., 2013).

Equifinality certainly applies to ASD: A child can have symptoms for many reasons; no single gene causes the disorder. That makes treatment difficult; an intervention that helps one child is worthless for another.

It is known that biology is crucial (genes, copy number abnormalities, birth complications, prenatal injury, perhaps chemicals during fetal or infant development) and that family nurture does not cause ASD but may modify it. Social and language engagement of the child early in life seems the most promising treatment.

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The overlap of the biosocial, cognitive, and psychosocial domains means that parents, teachers, therapists, and researchers need to work together to help each child. However, deciding whether or not a child should receive special education, and what that education should be, is complex. Parents and educators often disagree.

LABELS, LAWS, AND LEARNING In the United States, recognition that the distinction between normal and abnormal is not clear-cut (the first principle of developmental psychopathology) led to a series of reforms. According to the 1975 Education of All Handicapped Children Act, children with special needs must be educated in the “least restrictive environment.” The law has been revised, but the goal remains that children with special needs should not be segregated unless efforts to remediate problems within the regular classroom have failed.

Consequently, children with special needs usually learn in regular classes. Sometimes a class is an inclusion class, which means that children with special needs are “included” in the general classroom, with “appropriate aids and services” (ideally from a trained teacher who works with the regular teacher).

A more recent educational strategy is called response to intervention (RTI) (Fletcher & Vaughn, 2009; Shapiro et al., 2011; Ikeda, 2012). All children are taught specific skills—for instance, learning the sounds that various letters make. Then each child is tested. Those who did not master the skill receive special “intervention”—individualized teaching, usually within the regular class. They are tested again, and, if need be, intervention occurs again.

Only when repeated, focused intervention does not work are children referred for testing and observation to understand why they did not respond to the extra help. Then the school may propose an individual education plan (IEP), which is supposed to remedy the problem.

Unfortunately, much is unknown about which remediation is best. The special needs that attract most research are not the more common ones (see Figure 7.7). One example: In the United States, “research funding in 2008–2009 for autistic spectrum disorder was 31 times greater than for dyslexia and 540 times greater than for dyscalculia” (Butterworth & Kovas, 2013, p. 304).

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Internationally, the connection between special needs and education varies, for cultural and historical reasons more than child-related ones (Rotatori et al., 2014). In many African and Latin American nations, almost no child receives special education in public schools. In the United States, more children are designated with special needs than in any other nation.

GIFTED AND TALENTED Children who are unusually gifted may have special educational needs, but they are not covered by federal laws in the United States. Instead, each U.S. state selects and educates gifted and talented children in a particular way. Educators, political leaders, scientists, and everyone else argue about who is gifted and what should be done about them.

A hundred years ago, the definition was simple: high IQ. A famous longitudinal study followed a thousand “genius” children (Terman, 1925). Even today, some school systems define “gifted” as having an IQ of 130 or above (attained by 1 child in 50). Other children are unusually talented, perhaps recognized by their parents at a young age but not usually by their teachers. Mozart composed music at age 3; Pablo Picasso created works of art at age 4.

A hundred years ago, school placement was simple, too: The gifted were taught with children who were their mental age, not their chronological age. Today that is rarely done because many such children missed social skills and friendship. One woman remembers:

Nine-year-old little girls are so cruel to younger girls. I was much smaller than them, of course, and would have done anything to have a friend. Although I could cope with the academic work very easily, emotionally I wasn’t up to it. Maybe it was my fault and I was asking to be picked on. I was a weed at the edge of the playground.

[Rachel, quoted in Freeman, 2010, p. 27]

Calling herself a weed suggests that she never overcame her conviction that she was less cherished than the other children.

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Historically, many famous musicians, artists, and scientists were child prodigies whose fathers recognized their talent (often because the father was talented) and taught them. Often they did not attend regular school. Mozart’s father transcribed his earliest pieces and toured Europe with his gifted son. Picasso’s father removed him from school in second grade so he could create all day.

That solution also had pitfalls. Although intense early education at home nourishes talent, neither Mozart nor Picasso had happy adult lives or learned basic skills. Picasso said he never learned to read or write, and Mozart had a poor understanding of math and money. Similar problems are evident in gifted young singers, film stars, and athletes.

Neuroscience has recently discovered that children who develop their musical talents with extensive practice in early childhood grow specialized brain structures, as do child athletes and mathematicians. Since plasticity means that children learn whatever their context teaches, special talents may be enhanced with special education, an argument for elementary school classes that are designated for gifted and talented children where their talents can develop while they learn basic social and academic skills.

A related kind of child is the one who is unusually creative (Sternberg et al., 2011). The child may be a divergent thinker, finding many solutions and questions for every problem. Such children joke in class, resist drudgery, ignore homework, and bedevil their teachers. They may become innovators, inventors, and creative forces.

They refuse to be convergent thinkers, who choose the correct answer on school exams. One divergent thinker was Charles Darwin, whose “school reports complained unendingly that he wasn’t interested in studying, only shooting, riding, and beetle-collecting” (Freeman, 2010, p. 283). Other creative geniuses who were poor students were Freud, Newton, Einstein, and more recently, Steve Jobs.

As you can see, all three types of children—high-IQ, unusually talented, and unusually creative—might need to be educated apart from more ordinary children. On the other hand, some nations, and school districts within the United States, believe all children should learn together. Maybe yes, maybe no. As you have read, all children grow well and learn much in middle childhood, yet variations in health, disorders, and abilities are evident. The next chapter continues this theme: Varied family structures further diversify this period of life.