Transcript Disorders of Childhood and Adolescence

Disorders of Childhood and
Adolescence
Disorders of Childhood and
Adolescence
 Studies in the United States and New Zealand
suggest prevalence 17-22%
 More boys are diagnosed with childhood
disorders than girls.
 Girls are more likely to have internalized
problems (anxiety and depression) and boys are
more likely to have externalized problems
(ADHD, conduct disorder, etc…)
 ADHD and Separation Anxiety are most
common.
Maladaptive Behaviors in Different
Life Periods
 Developmental Psychopathology- Must be
taken in the context of normal
developmental changes.
 Varying Clinical Picture (short lived and
less specific than adult disorders)
 Some childhood disorders may severely
affect future development (ADHD & I.Q.
also excess mortality associated with CD)
 Vulnerable due to less self-understanding.
Disorders of Childhood
 ADHD
 Conduct Disorder and Oppositional
Disorder
 Anxiety Disorders
 Symptom Disorders
 Autism
Attention Deficit Hyperactivity
Disorder
 Characterized by difficulties that interfere with





effective task-oriented behavior in children.
Often score 7-15 I.Q points below average
Hyperactive children are the most frequent
psychological referrals to mental health and
pediatric facilities.
6-9% more prevalent with boys than girls
Occurs with greatest frequency before age 8
Most frequent psychological referral to mental
health facilitiies
ADHD Criteria
 Either (1) or (2):
 six (or more) of the following symptoms of inattention have
persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level:
 often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities
 often has difficulty sustaining attention in tasks or play activities
 often does not seem to listen when spoken to directly
 often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions)
 often has difficulty organizing tasks and activities
 often avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort (such as schoolwork or
homework)
 often loses things necessary for tasks or activities (e.g., toys,
school assignments, pencils, books, or tools)
 is often easily distracted by extraneous stimuli
 is often forgetful in daily activities
 Hyperactivity
 often fidgets with hands or feet or squirms in seat
 often leaves seat in classroom or in other situations in which








remaining seated is expected
often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness)
often has difficulty playing or engaging in leisure activities quietly
is often "on the go" or often acts as if "driven by a motor"
often talks excessively
Impulsivity
often blurts out answers before questions have been completed
often has difficulty awaiting turn
often interrupts or intrudes on others (e.g., butts into conversations
or games)
ADHD Causal Factors
 Both biological and environmental
 Food additive theory unsupported
 Home environment may be a link in that
some studies show that parents of ADHD
children are more likely to have
personality disorders.
ADHD Treatments and Outcomes
 Both Behavioral Therapy and Medication reduce
symptoms.
 Medication
 40% of junior high & 15% high school students with
emotional and behavioral problems are prescribed
medication.
 75% effective rate in treating hyperactive child
 Reduces inattention but not impulsivity.
 Behavioral Treatment
 Demonstrates short-term gains. Reduces symptoms.
 Hyperactive bx tends to diminish in some
children. Impact however may remain (less
education, legal problems, etc….)
Conduct Disorder & Oppositional
Defiant Disorder
 Characterized by aggressive or antisocial
behavior.
 Virtually all who have conduct disorder
have oppositional defiant disorder first.
 Oppositional Defiant Disorder usually
appears by age 6. Conduct Dis. Age 9.
 Looks much like adult antisocial
personality disorder.
Oppositional Defiant Disorder Criteria
 A pattern of negativistic, hostile, and defiant








behavior lasting at least 6 months, during which
four (or more) of the following are present:
often loses temper
often argues with adults
often actively defies or refuses to comply with
adults' requests or rules
often deliberately annoys people
often blames others for his or her mistakes or
misbehavior
is often touchy or easily annoyed by others
is often angry and resentful
is often spiteful or vindictive
Conduct Disorder Criteria
 A repetitive and persistent pattern of behavior in which the







basic rights of others or major age-appropriate societal norms
or rules are violated, as manifested by the presence of three
(or more) of the following criteria in the past 12 months, with
at least one criterion present in the past 6 months:
Aggression to people and animals
often bullies, threatens, or intimidates others
often initiates physical fights
has used a weapon that can cause serious physical harm to
others (e.g., a bat, brick, broken bottle, knife, gun)
has been physically cruel to people
has been physically cruel to animals
has stolen while confronting a victim (e.g., mugging, purse
snatching, extortion, armed robbery)
has forced someone into sexual activity
[Continued Next Page]
 Destruction of property
 has deliberately engaged in fire setting with the intention of causing










serious damage
has deliberately destroyed others' property (other than by fire
setting)
Deceitfulness or theft
has broken into someone else's house, building, or car
often lies to obtain goods or favors or to avoid obligations (i.e.,
"cons" others)
has stolen items of nontrivial value without confronting a victim (e.g.,
shoplifting, but without breaking and entering; forgery)
Serious violations of rules
often stays out at night despite parental prohibitions, beginning
before age 13 years
has run away from home overnight at least twice while living in
parental or parental surrogate home (or once without returning for a
lengthy period)
is often truant from school, beginning before age 13 years
The disturbance in behavior causes clinically significant impairment
in social, academic, or occupational functioning.
Causal Factors: Conduct Disorders
 Self-Perpetuating Cycle
 Parent-Child relations characterized by
rejection and neglect
 Conduct Disorder has been associated
with divorce, hostility, and lack of
monitoring in the family.
Treatment
 Challenge is parent’s reluctance to
become involved in treatment and learn
new parenting behaviors.
Anxiety Disorders of Childhood
 Children typically cope with anxiety by becoming
overly dependent on others.
 Prevalence is higher in girls than boys.
 Separation Anxiety Disorder
 Most common childhood anxiety disorder
 Essential feature is excessive anxiety about
separation from major attachment figures.
 Characteristics Include: unrealistic fears,
oversensitivity, self-consciousness, nightmares, lack
confidence, chronic anxiety, apprehensive in new
situations, worry that parents will become ill or die,
difficulty sleeping, school refusal problems .
Anxiety Disorders: Treatment
 Psychopharmacological treatment is
questionable in it’s effectiveness
 Behavioral Therapy Procedures are
Effective
 Assertiveness Training, Mastering
Competencies, and Desensitization and In
Vivo Methods (using graded real life
situations)
 Group Therapy as a Modality is
Effective
Childhood Depression
 Prevalence greater in girls than boys (2x)
 Causal Factors Include:
 Biological Factors
 Learning Factors
 (negative parental behavior, divorce, modeling of depressed
mother, marital stress, mother-infant attachment, depressed
mothers are less responsive)
 Children of depressed mothers are more likely to become
depressed themselves and commit suicide
 Treatment
 Medication is no more effective than placebo
 Cognitive-Behavioral Therapy
 Providing a supportive emotional environment
Treatment Challenges for
Childhood Disorders
 Most childhood disorders develop out of
pathogenic family interactions
 Treatment of childhood disorders relies a
great deal on teaching parents behavioral
therapy interventions
 Parents are often key to the child’s
treatment and many parents are resistant.
 More difficult to get fathers involved than
mothers.