Child and adolescent psychopathology: exploring context, risk and outcome

Abstract

Child and adolescent psychological research has highlighted key areas that require further exploration. Social functioning has been emphasised as a key area of research requiring further insight into its relationship with child and adolescent psychological disorders and risk variables. Significant sex differences have been reported in relation to childhood trauma where myriad approaches have been utilised. Sex specific methodologies have yet to be utilised to improve measurement of childhood trauma. Alternative factor models to the most common two factor model of Internalising and Externalising have been reported. Despite this, many alternative structural models have not been directly compared using confirmatory factor analysis. Research has also highlighted the effectiveness of an alternative three factor model to represent the co-occurrence of child and adolescent psychopathology. Consequently, the three areas that this thesis aimed to tackle are: the complexity of child and adolescent psychological disorder within the context of social functioning; the measurement of childhood trauma using sex specific methodologies; and the exploration of the dimensionality of psychopathology.

Chapter 2: Child and adolescent psychological disorders are associated with myriad risk variables. Psychological disorders are also associated with poor outcomes in terms of social functioning. Moreover, risk variables are also consistently associated with poor social functioning. Thus, it was hypothesised that social functioning may mediate the relationship between risk and psychological distress. The subsequent mediation analysis established social functioning as a partial mediator for child psychological disorder using the British Child and Adolescent Mental Health Survey.

Chapter 3: Childhood trauma is likely to co-occur with significant sex differences. Consequently, latent class analysis was used to profile trauma separately for males and females as significant sex differences were consistently reported. Males were likely to experience assaultive trauma such as being in a serious accident, physical abuse and witnessing severe domestic violence. Consistent with previous research females were more likely to experience trauma of a sexual nature. These trauma classes were predictive of a range of psychological disorders.

Chapter 4: The confirmatory factor analysis resulted in two models with acceptable fit: the two factor model (Internalising and Externalising); and the three factor model (Distress, Fear and Externalising). In terms of their fit indices both were highly comparable. However, research highlighted that the three factor model readily accounts for the high co-occurrence of psychological disorder.

Chapter 5: The MIMIC models demonstrated unique profiles of risk for each dimension. It also demonstrated that the three factor model was the most accurate representation of child and adolescent psychopathology as the Distress and Fear dimensions had distinct etiological profiles of risk.

The clinical implications of this research are that the importance of social functioning is demonstrated through its establishment as a mediator of child and adolescent psychopathology. Sex specific methodological approaches provided a new level of accuracy in measuring childhood trauma. The results supported previous research that females are vulnerable to sexual forms of trauma. These forms of trauma profile may be used in clinical settings to tailor intervention and support programmes according to each sex specific trauma profile. Similarly, the risk for specific psychological disorders may be built into a comprehensive care package. The measurement of psychological disorder demonstrated that a single factor used to cover Distress and Fear dimension disorders is inadequate and does not account for the unique profile of risk for Fear dimension disorders or the co-occurrence of psychological disorders. Consequently, the unique etiological profiles of risk for each dimension may be beneficial to clinicians in terms of what risk variables may be associated with specific outcomes. Future research may wish to utilise a longitudinal methodological approach to examining these areas.

Date of Award	Aug 2014
Original language	English
Supervisor	Jamie Murphy (Supervisor)