Transcript Psychological problems in childhood & adolescence

Psychological problems in
childhood & adolescence
A few details……...
CONTACTING ME:





Dr Sue Jackson
Room 514 Easterfield
Ext 8232
[email protected]
Office hours: Mon,
10.00-11.00, Thurs 4.00-5.00
or make an appt.
COURSE OVERVIEW










Classification & models
Classification & models
Child Abuse
Childhood Anxiety: PTSD
Attention Deficit Hyperactivity Disorder
Conduct Disorder in Adolescence
Depression in Adolescence
Anorexia in Adolescence
Approaches to therapy with children & adolescents
Review
THE READINGS




ESSENTIAL:
Readings on closed reserve
in library
SUPPLEMENTARY:
Carr, A. (1999). The handbook of child and
adolescent clinical psychology. London:
Routledge
THE TEST
……..will cover all of child/adolescent
lectures up and including August 2nd
 ……..will be short answers
 ……..will be preceded by a review lecture

Today’s Lecture Questions




What is the history of clinical child psychology?
What is the Diagnostic and Statistics Manual
(DSM)and how does it categorise problems of
childhood and adolescence?
How useful is the DSM for psychological
problems of childhood and adolescence?
What alternatives are there to the medical model
on which DSM is based?
Some history……..




Discipline of clinical child psychology dates to 1896
Lightner Witner- first psychological clinic for children
in USA 1896
ADHD- 100 years old- Still (1902) ,a doctor,
misbehaviour due to biological and moral “defects”
Conduct Disorder- roots in juvenile delinquency, end
of C19th youth crime differentiated from adult crime
Famous early child case studies




Freud and the case of
little Hans (1909)
Diagnosis by letter
Hans, five, developed
fear of horses
Freud interpreted as
fear of dad and sexual
desire for mother
Little Albert





John Watson (1920)
Baby Albert- 11 months
Rat (unknown age)
Conditioned fear of rats in Albert
If Albert alive today, probably still be rat phobic
THE DSM





DSM-1- two separate diagnoses for children
(1952)
DSM-II (1968) seven diagnoses
DSM-III (1980) 40 diagnoses
DSM-IV-R 50 and still rising
Are children more psychologically disturbed
than they were or are there other reasons for
the rising number of problem?
DSM and the production of
mental health problems





DSM & mental illness as socially constructed-some
examples:
Historical: mental illness possession by devils,
‘draeoptomania’, illness of the slaves
Social: homosexuality a mental disorder until late
1980s
Cultural: ‘hallucinations’ may be of spiritual
significance
Mental illness as a “business” , diagnoses as a basis
for service provision and for drug prescription
DSM Child/Adolescent Disorders






Disorders first
diagnosed in infancy,
childhood or
adolescence:
Mental retardation
Learning disorders
Motor skill disorders
Communication disorders
Pervasive developmental
disorders





Attention deficit and
disruptive behaviour
Feeding and eating
disorders
Tic disorders
Elimination disordersenuresis, encopresis
Other- separation anxiety,
mutism, reactive
attachment disorder
Child disorders classified with
adult disorders




Mood- in children unipolar depression only
Anxiety- generalised, obssessive-compulsive,
PTSD
Dissociative disorders -disrupted integration
memory, identity, consciousness
Eating disorders
How useful is DSMIV for
children & adolescents?
1. Reliability
 Clinician agreement on diagnosis poor e.g.:
Conduct Disorder .62
Depression
.62
Anxiety
.52
ADHD
.52
2. Validity
 Significant overlap in factors that
contribute to onset of problems
(low validity)
How useful is DSMIV for
children & adolescents?
3. Co-morbidity
Community based studies (cited Carr)
 CD
and ADHD
23.3%
and Major Depression 16.9%
and anxiety disorders 14.8%
 ADHD
and Major Depression 10.5%
and Anxiety Disorders 11.8%
 Anxiety
and Major Depression 16.2%
How useful is DSMIV for
children & adolescents?
4. Categorical approach
 “got it, ain’t got it” categorical approach doesn’t
address social contexts/interactions
5. Ethical problems
 pathologising young people, stigmatisation
6. “Adultmorphism”
 failure to incorporate developmental perspective
 criteria of subjective distress and impairment in
functioning often not applicable (Anna Freud)
How useful is DSMIV for
children & adolescents?
7. Gender bias
 21 childhood disorders, 17 more common in boys
(girls>internalisng, boys>externalisng)
 Conduct disorder- criteria > specific to boys e.g.
sexual behaviour
 Different patterns for CD in boys and girls
8. Misdiagnosis is a significant problem
 Particularly due to comorbidity, developmental
factors
Dimensional model

Externalising behaviours – aggression,
non-compliance, drug abuse
(relate to more conduct type
problems, ADHD, ODD)

Internalising behaviours- crying,
worrying, withdrawal (relate to
anxiety, depression)
Construction of dimensions:
Child Behaviour Checklist







Achenbach the author of CBCL
Collection of behaviours from case studies and
literature to form CBCL (118 items)
1800 parents of clinic children completed CBCL
Factor analysis leading to narrow band syndromese.g. wirhdrawn, aggression
Grouping of narrow band into wide bandinternalising and externalising
Norms on 1400 non clinical children
Cut-off scores for children outside normal rangeclinical
Critique



Continuum- links ‘normal’ development to
problems with extreme points on continuum
leading to referral
Doesn’t account for more specific problems like
autism, toileting problems, eating disorders
Problems around agreement parent/teacher/child
reports and subjectiveness of eachparents/teachers tend to be better informants for
externalising problems, children better for
internalising problems
Today’s Lecture Questions
At this point you should have some idea of
how to answer them.
 Doing the readings should help you expand
your knowledge a little more.
