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Unformatted text preview: Chapter 15
Disorders of Childhood and Adolescence
Disorders of Childhood and Adolescence: Topics
ODD & CD
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
10. ODD & CD
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:
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.
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
38. Aggressive behavior
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:
49. Overt and covert hostility
Disobedience and Aggressiveness
Lying and stealing
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
65. Unrealistic fears
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
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:
Small bladder/Weak sphincter
Urinary track disorder 94. Faulty learning
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
98. Boys more likely than girls
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
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
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
104. Uncontrollable head movements
Sounds of grunts, clicks, yelps, sniffs 105.
Preceded by urge, relieved by execution
Onset between 7 & 14
Treated by neuroepileptic drugs and behavior therapy Disorders of Childhood and Adolescence
46.Pervasive developmental disorders: Autism
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
Effects 30 to 60 people in every 10,000
Usually identified before 2 ½ years old
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
Absence of speech – imitative deficit
Selfstimulation – repetitive movements such as head banging, spinning, rocking
Impaired intellectual ability – deficits in memory and social reasoning
Preoccupation with maintaining sameness – attachments formed with objects (e.g. keys) Autism: Rainman
Autism: Causes 60.The precise causes of autism are unknown
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:
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
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”
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)
Social adjustment like that of adolescent
Requires some supervision; can become self
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)
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)
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)
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
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:
Trauma (physical injury at birth hypoxia) 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:
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)
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
Medical problems; short life expectancy
Greatest deficit – language functions
High risk for alzheimer’s 154.
Risk for Down's increases with age of parents at conception Mental Retardation: Treatment (I)
111. Treatment methods include:
Institutionalization (usually a last resort) 155.
Typically severe to profound mentally retarded
Sometimes mildly retarded with behavioral problems Mental Retardation: Treatment (II)
113. 114. Treatment methods include:
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:
The child’s inability to seek assistance 160.
Often not in a position to ask for help for 160.
Dependent on adults Planning Better Programs to Help Children & Adolescents II 117.
Special factors associated with treatment for children and adolescents include:
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:
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)
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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- Spring '08
- Abnormal Psychology