Chapter15 - Chapter 15 Chapter 15 Disorders of Childhood...

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Unformatted text preview: Chapter 15 Chapter 15 Disorders of Childhood and Adolescence Disorders of Childhood and Adolescence: Topics 0. 1. 2. 3. 4. ADHD ODD & CD Anxiety Depression Symptom disorders 5. Pervasive developmental disorders: Autism 6. Learning disorders 7. Retardation Disorders of Childhood and Adolescence: Topics 8. Overview of disorders of childhood and adolescence 9. ADHD 10. ODD & CD 11. Anxiety 12. Depression 13. Symptom disorders Maladaptive Behavior in Different Life Periods: Developmental 14. Developmental psychopathology is devoted to 14. studying the origins and course of individual maladaptation in the context of normal growth processes 15. View child in reference to normal childhood development 16. No sharp lines of demarcation in age Disorders of Childhood and Adolescence: Awareness 0. Prior to the 20th century ­ 17. No consideration of special characteristics of psychopathology in children 18. Children were viewed as miniature adults 19. In DSM I, only listed childhood schizophrenia and adjustment reaction of childhood 20. It was not until the second half of the 20th century that a diagnostic classification system focused clearly on the special problems of children Disorders of Childhood and Adolescence: Awareness 21. 1960’s mental health movement drew attention 22. Progress in understanding and treating children not as a downward extension of adults 23. DSM II (1968) added several categories of disorders 24. Recognition of developmental uniqueness 25. Even today, resources and knowledge of child psychopathology are inadequate Disorders of Childhood and Adolescence: Disorders of Childhood and Adolescence: Prevalence 1. Between 10% & 20% of children have psychological problems 2. Most common are ADHD and anxiety 3. Typically more problems with boys than girls 4. Girls often have eating disorders & anxiety Maladaptive Behavior in Different Life Periods: Vulnerability (I) 0. Young children are especially vulnerable to psychological problems because: 0. They do not have as complex and realistic a view of themselves and their world as they will later 1. They have less self­understanding 2. They have not yet developed a stable sense of identity 3. They have not yet developed a clear understanding of what is expected of them and what resources they might have to deal with problems Maladaptive Behavior in Different Life Periods: Vulnerability (II) 5. Young children are especially vulnerable to psychological problems because 26. Perceived threats are seen as disproportionately important 27. Limited perspective leads to unrealistic explanations of events 28. Dependence on others makes them more 28. vulnerable to rejection 29. Lack of experience makes problems seem more insurmountable Maladaptive Behavior in Different Life Periods 6. Some disorders are unique to children 30. E.g. autism, learning disorders 7. Childhood symptoms are influenced by environment (family, peers) 8. Behavior has to be viewed in context of age appropriateness or inappropriateness Attention­Deficit Hyperactivity Disorder: Description 9. In ADHD, the child shows impulsive, overactive behavior that interferes with his or her ability to accomplish tasks 10.Impulsive, excessive motor activity (fidgeting), attentional problems, difficulty getting along with others; socially immature; talk constantly; failure to obey rules; difficulty with parents & teachers Hyperactive kid in kid’s choir Attention­Deficit Hyperactivity Disorder: Prevalence 11.Most frequent referral to mental health and 11. pediatric facilities 12.6 ­ 9 times more boys than girls Attention­Deficit Hyperactivity Disorder: Causes 13.It still remains unclear to what extent the disorder results from environmental or biological factors 14.Is likely both genetics and personality as well as learning 15.Some indication of different EEG patterns Attention­Deficit Hyperactivity Disorder: Treatment 16.Treatment methods include: 17.Medications (such as amphetamines) 31. Ritalin (most common); Concerta (extended release); Strattera 32. Theory of insufficient cortical arousal 18.Behavior therapy (particularly cognitive­behavioral methods) 33. Selective reinforcement 34. Structured learning materials Attention­Deficit Hyperactivity Disorder: Long­term 19.Research suggests that some children with ADHD 19. go on to have other psychological problems later in life 35. 36. 37. 38. Aggressive behavior Substance abuse Interpersonal problems Occupational problems Oppositional Defiant Disorder and Conduct Disorder: Description 39. Oppositional defiant disorder (ODD) involves a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months 40. Conduct disorder (CD) involves a persistent, repetitive violation of rules and a disregard for the rights of others Oppositional Defiant Disorder and Conduct Disorder: Relationship 20.Conduct disorder is often preceded by oppositional defiant disorder 21.Oppositional defiant disorder (ODD) is usually apparent by age 8 22.Conduct disorder (CD) is usually apparent by age 9 23.Both groups are usually deficient in social skills Oppositional Defiant Disorder and Conduct Oppositional Defiant Disorder and Conduct Disorder: CD Description 24.CD characterized by: 41. 42. 43. 44. 45. 46. 47. 48. 49. Overt and covert hostility Disobedience and Aggressiveness Vengefulness Destructiveness Lying and stealing Tantrums Sexually uninhibited behavior Bullying Typically preceded by ODD Oppositional Defiant Disorder and Conduct Disorder: CD Causes 25.The possible causes of conduct disorder or delinquent behavior include 50. Biological factors (genetics) 0. Low verbal IQ, temperament 51. Personal pathology ­ temperament 52. Family patterns – harsh, rejecting, hostile 53. Peer relationships – poor social skills; contact with similarly aggressive dysfunctional peers 54. Social factors ­ lower SES; poor neighborhoods Oppositional Defiant Disorder and Conduct Disorder: CD Consequences 55. Early onset CD likely to lead to antisocial 55. personality disorder in adulthood 56. Punitive responses (typical response) to CD behavior appear to intensify rather than correct behavior Oppositional Defiant Disorder and Conduct Disorder: CD Treatment 26.Effective treatments tend to focus on: 57. The cohesive family model (modify child’s environment by training parents or move child) 58. Behavioral techniques (teaching control techniques, reinforce appropriate behavior) 59. Treatment depends on resources and cooperation from services and family Anxiety Disorders of Childhood and Adolescence: Description 27.Children with separation anxiety disorder exhibit 60. 61. 62. 63. 64. 65. Unrealistic fears Oversensitivity Shyness and timidity Self­consciousness and feelings of inadequacy Nightmares & other sleep disturbances Chronic anxiety (often co­morbid with depression) Anxiety Disorders of Childhood and Adolescence: Prevalence 66. Separation anxiety disorder is the most common of 66. childhood anxiety disorders 67. Children are vulnerable to fears and uncertainties as part of growing up 68. Disorders are often more extreme 69. Separation anxiety a function of dependence on others for support 70. Prevalence: 10%; more girls than boys Anxiety Disorders of Childhood and Adolescence: Selective Mutism 28.Selective mutism involves the persistent failure to speak in specific social situations 71. Problem such that it interferes with education and social adjustment 29.In many cases, children with selective mutism also have a diagnosis of developmental disorder/delay 72. Mutism in school setting 73. Associated with shyness Anxiety Disorders of Childhood and Adolescence: Causes 30.A likely cause of childhood anxiety disorder is early family relationships that generate anxiety and prevent the child from developing more adaptive coping skills 74. Also genetic based constitutional sensitivity that makes child easily conditionable to aversive stimuli 75. Additionally, contributed to by early illnesses, 75. parental modeling, overprotective parents Anxiety Disorders of Childhood and Adolescence: Treatment 31.Psychopharmacological treatments and behavior therapy are common treatment methods 76. SSRI’s used for medication 77. Behavior therapy – assertiveness training, social skills training, desensitization Childhood Depression: Description 32.Depression in children and adolescents occurs with high frequency 78. Withdrawal, crying, avoidance of eye contact 79. Physical complaints 80. Poor appetite 81. Irritability 82. (same criteria used as with adults) 83. Higher frequency in adolescents than children Childhood Depression: Causes 33.Biological factors 84. Association between parental depression and childhood depression (possibly genetic connection) 34.Learning factors 85. Early exposure to traumatic events, severe stress (could induce hyper­reactivity of response) 86. Children also learn through modeling by parents (negative affect) Childhood Depression: Treatment Childhood Depression: Treatment 35.Research on the effectiveness of antidepressant medications with children is both limited and contradictory 87. SSRI's often do work; problem with side­effects Childhood Depression: Treatment 36.Studies have shown reduced symptoms with cognitive­behavioral therapy 37.It is important to provide a supportive emotional environment for children to learn more adaptive coping strategies and emotional expression 88. Positive relationship with counselor Symptom Disorders: Definition 38.Involve a single outstanding symptom rather than a pervasive maladaptive pattern 89. E.g. functional enuresis; functional encopresis; somnambulism; tics; Tourette's syndrome 39.More common in boys than girls Symptom Disorders: Enuresis 40.Functional enuresis is described as bedwetting that is not organically caused 90. After the age of 5 (5 – 10 % 5 year olds) 41.Causes: 91. 92. 93. Neurological Small bladder/Weak sphincter Urinary track disorder 94. Faulty learning 94. 95. Family stress Symptom Disorders: Encopresis 42.Children over 4 who have not learned appropriate toileting for bowel movements may be diagnosed with functional encopresis 96. 97. 98. Boys more likely than girls Soiled clothes Treated medically and behaviorally Symptom Disorders: Somnambulism 43.10–30% of children will have at least one incident of sleepwalking (somnambulism) 99. Onset between 6 & 12 100. Leaves bed and walks around without being conscious of doing it Symptom Disorders: Tics 44.Tics (persistent, intermittent muscle twitches or spasms, usually limited to a localized muscle group) occur most frequently between the ages of 2 and 14 101. 102. E.g. clearing of throat that is habitual More likely males than females Symptom Disorders: Tourettes 45.Tourette’s syndrome is an extreme tic disorder involving multiple motor and vocal patterns 103. 104. Uncontrollable head movements Sounds of grunts, clicks, yelps, sniffs 105. Preceded by urge, relieved by execution 105. 106. Onset between 7 & 14 107. Treated by neuroepileptic drugs and behavior therapy Disorders of Childhood and Adolescence 46.Pervasive developmental disorders: Autism 47.Learning disorders 48.Retardation 49.Planning Better Programs to Help Children and Adolescents Pervasive Developmental Disorders: Definition 50.The pervasive developmental disorders are a group of severely disabling conditions that are among the most difficult to understand and treat 51.Possibly due to problems in structural make­up of brain 52.Present at birth 53.New: Autism spectrum disorders Pervasive Developmental Disorders: Asperger’s 54.Asperger’s disorder is a severe and sustained 54. impairment in social interaction 55.Marked stereotypic behavior and inflexible adherence to routine 56.Long term psychological disability 57.Can develop into autism, but typically there is no severe delay in language development and social interactions Autism: Prevalence 58.One of the most common, puzzling, and disabling of the pervasive developmental disorders is autistic disorder 108. Effects 30 to 60 people in every 10,000 109. Usually identified before 2 ½ years old 110. Its cardinal feature is child is apart or aloof from others; not cuddly, not smiling Autism: Characteristics 59.Problematic behaviors include 111. Social deficit – no apparent need for contact; lacking social understanding and interaction 112. Absence of speech – imitative deficit 113. Self­stimulation – repetitive movements such as head banging, spinning, rocking 114. Impaired intellectual ability – deficits in memory and social reasoning 115. Preoccupation with maintaining sameness – attachments formed with objects (e.g. keys) Autism: Rainman Autism: Rainman Autism: Causes 60.The precise causes of autism are unknown 61.Highly heritable 116. 117. 80­90% of risk accounted for by genetics Some association with fragile X syndrome Autism: Causes 62.Most investigators agree that a fundamental disturbance of the central nervous system is involved 63.Inborn deficit that impairs infant’s perceptual and cognitive functioning 118. Inability to process incoming stimuli and relate to the world Autism: Prognosis 64.The more severely impaired, the poorer the prognosis 65.It has not been possible to normalize the behavior of autistic children through treatment 66.Poor response to treatment 67.Even medications have little effect 68.Very difficult for parents to deal with Autism: Severely Impaired 69.Prognosis for severely impaired autistic children is very poor 70.Difficult to expect parents to be able to deal well 70. with a severely autistic child 71.The situation is stressful and impacts every member of the family 72.Care has to be taken to beware of treatment promises that claim 'cures' or dramatic changes Autism: Treatment 73.For the less severely impaired, newer instructional and behavior modification techniques have been helpful in: 119. 120. 121. Eliminating self­injurious behavior Mastering fundamentals of social behavior Developing language skills 74.Work done by Lovaas on one­on­one teaching using parents Learning Disorders: Diagnosis 75.The diagnosis of learning disorder is restricted to those cases in which: 76.A. There is clear impairment in school performance or in daily living activities 77.B. The impairment is not due to mental retardation or to a pervasive developmental disorder such as autism Learning Disorders: Diagnosis 78.In dyslexia, the individual manifests problems in word recognition and reading comprehension 79.Most common learning disorder 79. Learning Disorders: Features 80.Generally identified by a disparity between expected academic achievement and actual academic performance 81.No emotional problems; no behavioral or motivational difficulties 122. Often child is highly talented and motivated Learning Disorders: Features 82.Typically not understood or appreciated 123. 124. 125. Tendency to ‘blame the victim’ Attributes problem to child's character Adversely effects child’s self­esteem Learning Disorders: Causes 83.Learning disabilities are possibly the products of subtle central nervous system impairments 84.Possible underdevelopment of language area in left hemisphere ­ which may be genetic Learning Disorders: Treatment 85.Because we do not yet have a confident grasp of what is wrong with the average LD child, we have limited success in treating these children 86.There have been conflicting outcomes regarding benefits of direct instructional strategies Mental Retardation: Definition 87.The APA defines mental retardation as 87. “significantly sub­average general intellectual functioning … that is accompanied by significant limitations in adaptive functioning” 126. 127. 128. Must have begun before age 18 Defined as both level of performance and IQ No reference to causal factors Mental Retardation: Prevalence 88.Prevalence in US: 1% (2.6 million) 89.However definitions vary as to identification 129. Issue of performance levels inconsistent with IQ levels Mental Retardation: Levels (I) 90.Four levels of mental retardation: 91.Mild mental retardation includes the IQ range from 50–55 to approximately 70 (educable) 130. Social adjustment like that of adolescent 131. Requires some supervision; can become self­ supporting 132. Majority appear normal prior to the age of 15 Mental Retardation: Levels (II) 92.Four levels of mental retardation: 93.Moderate mental retardation includes the IQ range from 35–40 to 50–55 (4­7) (trainable) 133. 134. 135. Can learn basic skills May become partially independent May need supervision in daily activities Mental Retardation: Levels (III) Mental Retardation: Levels (III) 94.Four levels of mental retardation: 95.Severe mental retardation includes the IQ range from 20–25 to 35–40 (2­3) (dependent) 136. 137. 138. Motor, speech and sensory deficits Shorter life expectancy Other medical problems Mental Retardation: Levels (IV) 96.Four levels of mental retardation: 97.Profound mental retardation includes the IQ range below 20–25 (life­support) 139. 140. Physical deformities Very short life expectancy Mental Retardation: Biological Causes (I) 98.The following biological conditions may lead to mental retardation: 99.Genetic­chromosomal factors (Down’s) 100. 141. Often mild; runs in families 142. Possibly due to metabolic alterations due to genes Infections and toxic agents 143. Viral encephalitis, STD, HIV, german measles Mental Retardation: Biological Causes (II) 101. The following biological conditions may lead to mental retardation: 102. Trauma (physical injury at birth ­ hypoxia) 103. 103. 104. Ionizing radiation (x­rays) Malnutrition and other biological factors 144. Dietary deficiencies Mental Retardation: Biological Causes ­ Types 105. Mental retardation stemming primarily from biological causes include the following types: 106. Down syndrome ( 1 in 1000 babies) 145. Irreversible limitations; can get worse with age 107. Phenylketonuria (PKU)­ lacksliver enzyme to break down amino acid ­ build up causes brain damage Mental Retardation: Cranial Anomalies 108. Cranial anomalies: (alterations in head size and shape) 146. 147. 148. Macrocephaly (large headedness) 1. Abnormal growth of glial cells Microcephaly (small headedness) 2. Impaired development of cranium: moderate to profound retardation Hydrocephaly (cerebral fluid abnormality) 3. Damage occurs to brain tissue due to blockage to cerebral spinal pathway: severe to profound retardation Mental Retardation: Down’s 109. Down’s syndrome 149. Eye’s almond shaped; eyelid skin abnormally thick 150. Face – broad and flat; tongue – large; neck – 150. short and broad 151. Medical problems; short life expectancy 152. Greatest deficit – language functions 153. High risk for alzheimer’s 154. Risk for Down's increases with age of parents at conception Mental Retardation: Treatment (I) 110. 111. Treatment methods include: Institutionalization (usually a last resort) 155. Typically severe to profound mentally retarded 156. Sometimes mildly retarded with behavioral problems Mental Retardation: Treatment (II) 112. 113. 114. Treatment methods include: Education 157. 158. Availability woefully inadequate Focus on self­care and social behavior Mainstreaming 159. Putting in classes with other children can work in some cases Planning Better Programs to Help Children & Adolescents I 115. Special factors associated with treatment for children and adolescents include: 116. The child’s inability to seek assistance 160. Often not in a position to ask for help for 160. themselves 161. Dependent on adults Planning Better Programs to Help Children & Adolescents II 117. Special factors associated with treatment for children and adolescents include: 118. Vulnerabilities placing children at risk for developing emotional problems 162. Exposure to violence; inadequate homes; death of parent or friend; parental substance abuse; abuse 119. The need for treating parents as well as children (pathogenic family interaction) Planning Better Programs to Help Children & Adolescents III 120. Special factors associated with treatment for children and adolescents include: 121. The possibility of using parents as change agents to help child (reinforce adaptive behavior; extinguish maladaptive behavior) Planning Better Programs to Help Children & Adolescents IV 122. Special factors associated with treatment for children and adolescents include: 123. The problem of placing a child outside the 123. family (foster homes, group homes) 163. Depends on quality of placement 164. Parent psychopathology (drugs, depression) 124. The value of intervening before problems become acute (identify children at risk) Child Advocacy Programs (I) 125. (70 million children in US under 18) 126. Child advocacy programs have made important gains toward bettering conditions for mentally disabled children 165. United Nations: rights of children; human treatment of children Child Advocacy Programs (II) 127. A great deal of confusion, inconsistency, and uncertainty still persists in the child advocacy movement as a whole 166. Cutbacks in funding and other support End of Chapter 15 ...
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