1- what  are  the  implication  of  field  of  psychopathology to the  field  prevention  science   implication for treatment  + implication  for  assessment  + implication for  prevention  ?2-  for example   i have a child   suffers  from  hyperactivity   how  can i  do  attachment  ?
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Canadian Journal of Behavioural Science, 1991, 23(3), 257-2K1
Developmental Psychopathology in the Context of the Family:
Illustrations from the Study of Child Maltreatment
Dante Cicchetti & Paul W. Howes
Mt. Hope Family Center
Department of Psychology
University of Rochester
ABSTRACT We present a developmental psychopathology framework for conceptualizing childhood rnaladaptation within the context of the maltreating family. We
direct our attention toward research on maltreatment at three distinct levels of
analysis: 1) the individual development of maltreated children; 2) the child-rearing
context in maltreating families; and 3) parent-child interaction in maltreating families.
It is suggested that the theoretical synthesis of developmental psychopathology and
family systems can provide insight into and understanding of maltreatment that surpasses a simple summation of their parts. In particular, we note parallels between
constructs derived from developmental psychopathology and constructs of import
to family systems theory, including: notions of inter-systemic influences; their
respective emphases on hierarchical integration, differentiation, and organization;
and examinations of stage-salient issues of individual and family development across
the life-span. We conclude by proposing a series of future directions for improving
the existing state of research knowledge on maltreating families.
RESUME Nous presentons un encadrement de psychopathologie developpementalc
pour conceptualiser la m&adaptation au cours de l’enfance a I’interieur du contexte de la fainiMe maltraitante. Nous aimerions attirer votre attention sur la recherche
traitant du maltraitement a trois niveaux distincts d’analyse: I) le ddveloppement
individuel des enfants maltraitcs 2) I’elevage des enfants dans le contexte des families
maltraitantcs et 3) I’interaction parent-enfant dans les families d’enfants maltraites.
On suggcrc que la synthese thgorique de psychopathologie developpementale et les
systemes familiaux peuvent nous donner une idee et une comprehension du mauvais
traitement qui depassc un simple resume de leur part. II est inteYessant de noter
qu’il existe des paralleles entre les construits qui decoulent de la psychopathologie
developpementale et les construiis qui peuvent avoir un impact sur la theoric des
systemes familiaux, y compris les notions d’influences inter-systemiques; leur
emphase respectif sur I’integration hieYarchjque, la differentiation et I’organisation;
et les examens des faits saillants du de’veloppement de la famille el de l’individu
au cours de sa vie. Nous concluons en proposant une s6rie de directives pour 1’avenir
afin d’am^liorer l’ctat des connaissances portant sur la recherche qui existe sur les
families maltraitantcs.
In this paper, we provide an integrative conceptual framework for investigating
child rnaladaptation and psychopathology within the context of the family. Currently,
the field of psychopathology is witnessing a resurgent interest in studying the links
Acknowledgment: We wish to acknowledge the support of the Foundation for Child Development,
the William T. Grant Foundation, the Kenworthy Swift Foundation, the John D. and Catherine T.
MacArthur Foundation Network on Early Childhood, the A.L. Mailman Family Foundation Inc., the
National Center on Child Abuse and Neglect, the National Institute of Mental Health, the Smith Richardson
Foundation, Inc., the Spencer Foundation, and the Spunk Fund, Inc. We thank F.ric Mash and Sheree
Toth Tor their constructive feedback and Donna Bowman tor typing this manuscript.
Requests for reprints should be sent to Dante Cicchetti, Mt. Hope Family Center, Department of
Psychology, University of Rochester, 187 Edinburgh Street, Rochester, New York 14608.
257
258
D. CICCHETTI & P.W. HOWES
between family relationships and the development and maintenance of behavioural
and mental disorders. An earlier research focus on the role of the family in the ontogenesis of psychopathology, conducted during the 1950’s and 1960’s, was followed
by a long hiatus during which family factors in the adaptive process were accorded
minimal import and attention. A confluence of issues, including (1) the ushering
in of research on the genetics and neurobiology of psychopathology, (2) methodological and interpretive flaws in these early cross-sectional family studies, (3) the
mistaken conviction that intrafamilial disturbances were the primary cause of mental
disorders, and (4) that there were distinct patterns of family dynamics underlying
each type of psychopathology, all conspired to bring about a major reduction in the
study of the family and psychopathology (Goldstein, 1988).
During the past two decades, a number of theoretical, methodological, and measurement advances have occurred in our knowledge both of psychopathology and of the
family. For example, etiological models of disorder now arc more complex than
were their early predecessors (Engel, 1977; Zubin & Spring, 1977) and there is
a growing realization that longitudinal designs can best uncover the processes and
mechanisms underlying psychopathology. As such, investigations of the role of the
family in maladaptation have been carried out increasingly on high-risk populations
(e.g., infant, child, adolescent, and adult) and have become more lifespan and
developmental in focus (see Brody & Sigel, 1990). Theoretical advances in conceptualizing the family as a critical context for healthy child development (e.g., Bclsky,
1981; Minuchin, 1985) have been accompanied by empirical studies exploring interrelationships within normal families (Hinde & Stevenson-Hinde, 1988) as well as
families exhibiting psychopathology (e.g., Goldstein, 1988). Advances in observational coding, greatly enhanced by the introduction of video cameras, have included
coding systems that go beyond analyses of individuals or dyads to systems focused
on triads and entire families (e.g., Burgess & Conger, 1978; Howes, Markman,
& Lindahl, submitted; Vuchinich, Emery, & Cassidy, 1988), the use of microanalytic
sequential analyses of interactions (Cairns, 1979; Maccoby & Martin, 1983), and
the integration of social and physiological data (e.g., Berkman & Syme, 1979;
Gottman & Katz, 1989). Moreover, research in developmental psychology has highlighted the bidirectionality of effects, including ways in which the behaviour of children can influence their parents (Bell, 1968). Furthermore, the identification of
indirect effects on development and the use of triadic concepts have led to a broader
conceptualization of the child embedded within the family system (Bclsky, 1981;
Bronfenbrenncr, 1977). For example, children may be affected by relationships in
which they are not the central players (Cummings, Zahn-Waxler, & Radke-Yarrow,
1981) and by environments with which they do not directly interact (e.g., the parents’
workplace, the parents’ circle of friends, and the community; Bronfenbrenner, 1979).
The multi-disciplinary energies devoted toward the study of family process have
ushered in an exciting era for research aimed at elucidating the relations between
family functioning and child outcome (sec, for example, Brody & Sigel, 1990; Hinde
& Stcvenson-Hindc, 1988; Kaye & Furstenbcrg, 1985; L’Abate, 1985; Sigel &
Brody, 1990). In particular, insights from the disciplines of family therapy, history,
sociology, demography, psychopathology, and developmental psychology have
enhanced our understanding of the links between family relationships and child adaptation (Furstcnberg, 1985; Hareven, 1984). We are especially interested in how the
DEVELOPMENTAL PSYCHOPATHOLOGY
259
emergent discipline of developmental psychopathology might provide an overarching
framework or “macroparadigm” (Achenbach, 1990) for integrating concepts,
theories, and measurement strategies from the aforementioned multi-disciplinary perspectives. In this paper, we present a developmental psychopathology framework
for conceptualizing childhood maladaptation and psychopathology within the context of the family. We focus upon child maltreatment occurring in the family in order
to elucidate our viewpoint, but the basic developmental psychopathology paradigm
can be applied to any disorder or high-risk condition (for illustrations see, Cicchctti,
1990a,b; Cicchetti & Beeghly, 1990; Cicchetti & Schneider-Rosen, 1986). Our
presentation consists of three sections: theoretical foundations; the ecology of child
maltreatment; and toward an emergent family systems approach.
I. THEORETICAL FOUNDATIONS
Developmental Psychopathology
A developmental psychopathology perspective can assist us in our articulation of
how child maladaptation and psychopathology can arise within the family environment. Because maltreatment occurs within dysfunctional family systems, and because
an extensive literature has documented the negative sequelae associated with maltreatment (Cicchetti & Carlson, 1989), the role of the family in the genesis and perpetuation of child psychopathology can be illustrated in considerable detail. The discipline
of developmental psychopathology has been based upon the assumption that a developmental approach can be applied to any unit of behaviour or domain of inquiry and
to all normal as well as atypical populations (see Cicchetti, 1990a). Developmental
psychopathologists stress that we can learn about normal functioning by studying
how developmental pathways go awry and become pathological, and, likewise, that
we can enhance our knowledge of pathology by understanding normal developmental
trajectories (Cicchctti, 1984; Rutter, 1986). Developmental psychopathology employs
a multi-disciplinary perspective which suggests that multiple domains of development such as perceptual, cognitive, socioemotional, linguistic-representational, and
biological processes should be studied (Cicchctti, 1984, 1990a; Rutter & Garmczy,
1983). The acceptance of the view that a variety of factors play a role in the etiology,
course, and sequelae of maladaptive and pathological development also has arisen
from this perspective.
Accordingly, any consideration of atypical patterns of development must take into
account the unique characteristics of the child, his or her age, gender, and stagelevel of functioning, the experiences to which he or she has been exposed, and the
stable or unstable nature of environmental conditions. Additionally, the characteristics
of the caregiving environment, the compatibility of the child-caregiver dyad, the
continuity of adaptive or maladaptive behavioral patterns, and advances or lags in
different behavioural and biological systems must be considered.
Organizational Perspective on Development
According to the organizational approach, development is characterized by qualitative reorganizations, among and within behavioral and biological systems, which
take place by means of differentiation and hierarchical integration (Cicchetti &
Schneider-Rosen, 1986). This orthogenetic principle (Werner, 1948) is used to explain
260
D. CICCHETTI & P.W. HOWES
adaptation to the environment and how integrity of function may persist under
changing conditions.
In recent years, there has been a good deal of research on the continuity of competence in children from normal families based upon a series of stage-salient issues
that have been proposed and agreed upon by a number of developmentalists (Sroufc
& Rutter, 1984). Instead of construing development as a series of unfolding tasks
that need to be accomplished and then decrease in importance, we see development
as being comprised of a number of important age- and stage-appropriate tasks that
remain critical to the child’s continual adaptation but decrease in salience relative
to other newly emerging developmental tasks. For example, attachment is not a
developmental issue of only the first year of life; rather, once an attachment relationship develops, it continues to undergo transformations and reintegrations with
subsequent emergent competencies over the course of development (Cicchetti,
Cummings, Grcenberg, & Marvin, 1990). Consequently, children are continually
renegotiating the balance between being connected to others and being independent
and autonomous as they encounter each new developmental issue. Thus, each stagesalient issue represents a life-span developmental task that requires continual coordination and integration in the individual’s adaptation to the environment.
Normal development is described in terms of a series of interlocking sociocmotional,
cognitive, social-cognitive, linguistic, and representational competencies. Competence at one period of development, which tends to make the individual broadly adapted
to his or her environment, prepares the way for the formation of competence at the
next (Sroufe & Rutter, 1984). Normal development is marked by the integration of
earlier competencies into later modes of functioning. It follows then that early adaptation tends to promote later adaptation and integration (cf. Erikson, 1950).
Pathological development, conversely, may be conceived of as a lack of integration among socioemotional, cognitive, social-cognitive, linguistic, and representational competencies, or as an integration of pathological structures (Cicchetti, 1990c).
Because early structures arc incorporated into later structures, an early perturbation
in functioning may ultimately lead to the emergence of more severe future disturbances. In accord with this conceptualization, early negative consequences of child
maltreatment — for example, impaired expression of affect and the formation of
insecure attachment relationships with caretakers (Aber & Cicchetti, 1984) — may
be incorporated into the structures of maltreated children that are relevant to relating
to peers. In this light, it becomes clear how incompetent peer relationships may also
be linked to later maladaptive and pathological functioning (e.g., adaptation to school,
identity formation, etc.).
Transactional Models and Child Maltreatment
Rather than relying on the historical emphasis on single etiological factors such
as parental psychopathology, abject poverty, situational stress, or social isolation,
theorists and researchers increasingly define the course of child maltreatment as being
multifactorial in origin (Belsky, 1980; Cicchetti & Rizlcy, 1981). Similarly, children’s developmental outcomes are viewed as having multiple, interrelated causal
factors, rather than as being the direct outcomes of singular antecedents (Cicchetti
& Rizley, 1981; Sameroff & Chandler, 1975). Consequently, an adequate model
for conceptualizing the role of maltreatment phenomena in the etiology of child
DKVELOPMENTAL PSYCHOPATHOI.OGY
261
psychopathology must be complex and developmental, allowing for multiple pathways
to both adaptive and maladaptive outcomes.
Proponents of the transactional model contend that the various factors which operate
in normal or pathological conditions do not occur in isolation, but together impact
upon the developmental process through a hierarchy of dispositions (Cicchctti, 1987).
According to Sameroff and Chandler (1975), the multiple transactions among
parental, child, and environmental characteristics contribute to the outcomes of child
development in a reciprocal, dynamic fashion. Thus, if a child manifests pathological development over time, it is presumed that the chid has been involved in a continuous maladaptive transactional process. The longstanding manifestation of child
maladaptation is shaped by parental and environmental support, while the child’s
characteristics help to determine the nature of the “environment.” Because the child
and the environment arc seen as reciprocally influencing each other, it follows that
development at a later point reflects not only the quality of earlier adaptation, but
also the intervening environmental inputs. As time elapses, and as the child develops,
both the match between child and parent, as well as salient parent characteristics,
may change. In such a case, declining quality of adaptation would demonstrate continuity of development.
Cicchetti and Braunwald (1984) elaborate on a model derived from transactional
theory (Cicchetti & Rizley, 1981) to account for the processes leading to the formation of competence. Following the organizational perspective, adaptation at a particular point in the life course implies the successful resolution of the developmental
task or tasks most salient for that period (Sroufe, 1979). Cicchetti and Braunwald’s
model underscores the ongoing transaction between a variety of factors that may
serve to support or to inhibit competent behaviour at any particular point in development. Within this model there arc two broad categories that effect developmental
outcome: (I) potentiating factors, which increase the probability of manifesting
incompetence, and (2) compensatory factors, which increase the likelihood of
manifesting competence. Under each category, two temporal dimensions are distinguished: transient, fluctuating factors, and more permanent, enduring conditions.
Family Systems Theory
Though the organizational and transactional perspectives have largely focused on
individual and dyadic-relational patterns of adaptation, we believe that these models’
emphases on reciprocal interaction, inter-systemic influences, and the complexity
of relational networks form a natural conceptual bridge between developmental psychopathology and family systems theory (Hinde, 1989; Kaye, 1985; Minuchin, 1985,
1988; Sroufe & Flecson, 1986, 1988; Stevenson-Hinde, 1990). In order to establish
a foundation for these linkages, we next briefly review some of the central tenets
of family systems theory. Six basic principles of family systems theory are described
by Minuchin (1985):
1. All systems are considered to be an organized whole, with all elements of the
system being interdependent.
2. Patterns present within systems are circular, not linear.
3. The stability of patterns within systems are maintained by homeostatic elements.
4. Open systems are not static, but are in states of flux and evolution.
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D. CICCHETTI & P.W. HOWES
5. In complex systems, sub-systems also are present.
6. Sub-systems arc separated by boundaries, and the interactions which occur across
boundaries are guided by rules and patterns.
In applying these principles to developmental psychology, Minuchin (1985) emphasizes the importance of examining the parent-child triad rather than focusing solely
on dyadic interaction; exploring the functions of child behaviour within the family
system; and directing attention toward the spousal and parent-sibling sub-systems.
Having highlighted the theoretical similarities among the organizational, transactional, and family system’s perspectives, we next direct our attention toward
research at three distinct levels of analysis: 1) individual development of maltreated
children; 2) the child-rearing context in maltreating families; and 3) parent-child
interaction in maltreating families. Considering these empirical contributions allows
for the elucidation of convergent themes that apply to each level, thereby furthering
our goal of integrating diverse areas of inquiry. These convergent themes, while
reviewed within individual studies that cannot be viewed separately as “transactional,” provide a multi-level focus from multiple sources that is transactional
in its scope.
II. THB ECOLOGY OF CHILD MALTREATMENT
The Process and Organization of Individual Development in Maltreated Children
When considering individual/ontogenic development, the most critical determinant
of eventual competence or incompetence is the negotiation of the central issues of
each developmental period (Cicchctti, 1989). It is important to recognize the contributions which the caregiving environment exerts on the child’s ability to resolve
these developmental issues.
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