Transcript abnormal PSYCHOLOGY Third Canadian Edition

abnormal
PSYCHOLOGY
Third Canadian Edition
Chapter 15
Disorders of Childhood
Prepared by:
Tracy Vaillancourt, Ph.D.
Scope of the Problem
• 14% of Canadian children have clinical
disorders that cause significant distress
and impairment
– anxiety disorders most prevalent
– < 25% of children receive specialized
treatment
– > 50% of children with 1 disorder have 2+
concurrent disorders
ADHD
• Attention-deficit/hyperactivity disorder (ADHD)
– Deficits in attention
– Hyperactivity
– Impulsivity
• Three subcategories of ADHD:
• primarily poor attention
– ADHD primarily inattentive
• primarily hyperactive-impulsive behaviour
– ADHD primarily hyperactive
• both sets of problems
– ADHD combined type
– majority of all children
ADHD cont.
• Children with ADHD have
– Peer-relations difficulty
– Learning disabilities in math, reading, or
spelling
• 15-20%
– 50% placed in special education programs
because of their difficulties
– Considerable overlap with conduct problems
• combined sub-type
ADHD cont.
• Prevalence= 3 to 5% worldwide
• More common in boys than in girls
•  severity of symptoms in adolescence
– 65-80% still meet criteria for disorder in adolescence and adulthood
Biological Theories of ADHD
• Genetic component supported by adoption and
twin studies
– 50% of offspring have disorder (1 affected parent)
– family environment does not make a significant
contribution
• Frontal lobes under-responsive to stimulation
• Cerebral blood flow  in frontal lobes
•  frontal lobes, caudate nucleus, globus
pallidus
• Poorer performance on neuropsychological tests
of frontal-lobe functioning
Theories cont.
• Environmental toxins
– 22% of mothers of children with ADHD
reported smoking pack of cigarettes/day
during pregnancy, compared with 8% of
mothers whose children were normal
Psychological Theories of ADHD
• Diathesis-stress theory of ADHD
– hyperactivity develops when predisposition to
disorder is coupled with an authoritarian
upbringing
– Learning may play a role in hyperactivity
• reinforced by the attention it elicits thus increasing
in frequency or intensity
Treatment of ADHD
• Typically treated with drugs and behavioural
methods based on operant conditioning
• Stimulant Drugs
– Methylphenidate (MPH) or Ritalin
– Supported by double-blind studies comparing
stimulants with placebos
•  in concentration, goal-directed activity, classroom
behaviour, and social interactions and  in aggressiveness
and impulsivity in about 75%
• Psychological Treatment
– Parent training and changes in classroom
management based on operant conditioning
principles
Conduct Disorder and ODD
• Conduct Disorder
– Behaviours that violate basic rights of others and major societal norms
• Oppositional Defiant Disorder (ODD)
– Diagnosed if child does not meet the criteria for conduct disorder
– Physical aggression, losing temper, arguing with adults, lack of
compliance with requests from adults, deliberately annoying others,
being angry, spiteful, touchy, or vindictive.
• Comorbidity is the norm rather than the exception
– ODD, conduct disorder, and ADHD
– Anxiety and depression are also common among children with conduct
disorder
• Prevalence
– 8% of boys and about 3% of girls aged 4 to 16
Etiology of Conduct Disorders
• Biological Factors
– Genetic influence
• Aggressive behaviour clearly heritable
• Delinquent behaviour seems not to be
• Neuropsychological deficits
– poor verbal skills, difficulty with executive
functioning and problems with memory
Etiology of Conduct Disorders
• Psychological Factors
– Children with conduct disorder seem to be deficient in
moral awareness
– Lax parental discipline and parental adjustment
difficulties
– Learning theories
• modelling and operant conditioning
– Cognitive Biases
• social-information processing theory
– Socio-cultural context factors
• neighbourhood and classroom environments
Biopsychosocial Model of CD
Treatment of Conduct Disorder
• Fairer distribution of income
• Alleviate material deprivation in lower SES groups
• Jailing juvenile delinquents does not reduce crime.
– In fact, harsh discipline (imposed by government or parents),
contributes to further delinquency and criminal activity in
adulthood
• Family Interventions
– Parental Management Training
• Multi-systemic Treatment
• Cognitive Approaches
Learning Disabilities
• Inadequate development in specific area
of academic, language, speech, or motor
skills
• Not due to mental retardation, autism, a
demonstrable physical disorder, or
deficient educational opportunities
Learning Disabilities
• Usually of average or above-average
intelligence
• Term LD not used in DSM-IV-TR
– learning disorders, communication disorders,
and motor skills disorder
• Usually identified and treated in school
system
• More common in males than in females
Learning Disorders
• Three categories:
– Reading disorder
– Disorder of written expression
– Mathematics disorder
Learning Disorders
• Reading Disorder (dyslexia)
– Significant difficulty with word recognition and reading
comprehension
– Written spelling as may also be a problem
– Prevalence 2 to 8% of school-age children
• Disorder of Written Expression
– Impairment in ability to compose written word
• Spelling errors, errors in grammar, or very poor handwriting
• Mathematics Disorder
– Difficulty rapidly and accurately recalling arithmetic facts,
counting objects correctly and quickly, or aligning numbers in
columns
Communication Disorders
• Expressive Language Disorder
– Difficulty expressing in speech
– Trouble finding words
• Phonological Disorder
– speech is not clear
– articulation poor for r, sh, th, f, z, l, and ch
• Stuttering
– Disturbance in verbal fluency characterized by one or more of
the following speech patterns
•
•
•
•
frequent repetitions
prolongations of sounds
long pauses between words
substituting easy words for those that are difficult to articulate
Etiology of Learning Disabilities
• Etiology of Dyslexia
– Heritable component
– Chromosome 13 (13q21) directly implicated
as a dyslexia phenotype
• Brain Structure Differences
– left temporoparietal cortex less activated
• Problems with perception of speech and
analysis of the sounds of spoken language
and their relation to printed words
Treatment of LD
• Most often occurs within special-education
programs in the public schools
Mental Retardation
• Mental retardation
– sub-average intellectual functioning along
– deficits in adaptive behaviour
– occurring before age 18
• Traditional Criteria for Mental Retardation
1. Intelligence-Test Scores
2. Adaptive Functioning
3. Age of Onset
Classification of Mental Retardation
• Four levels of MR
– Mild mental retardation
• 50–55 to 70 IQ
• 85% of people with MR
– Moderate mental retardation
• 35-40 to 50-55 IQ
• 10% of people with MR
– Severe mental retardation
• 20-25 to 35-40 IQ
• 3 to 4% of people with MR
– Profound mental retardation
• below 20 to 25 IQ
• 1-2% of people with MR
Etiology of Mental Retardation
• No Identifiable Etiology
– many people with MR have no identifiable etiology
• Known Biological Etiology
– 25% of people with MR have a known biological cause
– Genetic or Chromosomal Anomalies
• Down syndrome, or trisomy 21
• Fragile X syndrome
– Recessive-Gene Diseases Several
• Phenylketonuria (PKU)
– Infectious Diseases
• Cytomegalovirus, toxoplasmosis, rubella, herpes simplex, syphilis
and HIV infection
– Accidents
– Environmental Hazards
• mercury, lead
Prevention and Treatment of MR
• Environmental
Interventions and
Enrichment Programs
• Behavioural Interventions
Based on Operant
Conditioning
– Applied Behaviour Analysis
• Residential Treatment
• Cognitive Interventions
– Self-instructional training
• Computer-Assisted
Instruction
Pervasive Developmental Disorders
Autism
Asperger’s Syndrome
• Impairments in social
interaction, social
communication and
imagination
• Often regarded as a mild
form of autism
• Poor social relationships
• Stereotyped behaviour
• Language and
intelligence are intact
– triad of impairments
• More boys than girls
• Onset— infancy or very
early childhood
• Often co-occurs with MR
and epileptic seizures
PDD cont.
Rett’s Disorder
• Very rare; found only in girls
• Development normal until
1st-2nd year of life
• Head growth decelerates
• Loses ability to use hands
purposefully
• Stereotyped movements such
as handwringing or
handwashing
• Walks in an uncoordinated
manner
• Poor speech
Childhood Disintegrative
Disorder
• Very rare
• Normal development in the first
2 years of life then significant
loss of
– social, play, language, and
motor skills
Characteristics of Autism
• Autism and MR
– 80% score below 70 on standardized IQ tests
• Extreme Autistic Aloneness
• Communication Deficits
– Echolalia
– Pronoun reversal
• Obsessive-Compulsive and Ritualistic Acts
Etiology of Autistic Disorder
• Biological bases
– Strongly evidence in support of a biological
basis
• Genetic Factors
– Risk of autism in siblings of people with the
disorder is about 75 times greater
• 60 to 91% concordance for MZ twins
• 0 to 20% concordance for DZ twins
– Linked genetically to broader spectrum of
deficits in communicative and social areas
Etiology of Autistic Disorder
• Neurological Factors
– Abnormal brainwave patterns
– Larger brains but reduced brain volume
– Abnormalities in the cerebellum
• See also Focus on Discovery 15.1
Treatment of Autistic Disorder
• Most effective treatments use modelling
and operant conditioning techniques
– Example ABA
• Most commonly used medication for
treating problem behaviours in autistic
children is haloperidol (Haldol)
Childhood Fears and Anxiety
Disorders
• 1/3rd of Canadian children (ages 4 -11) rated by
parents as too fearful or anxious
• Fears and phobias reported more often for girls
than for boys
• 10 to 15% of children and adolescents have an
anxiety disorder
– Most common disorders of childhood
Separation Anxiety Disorder
• Unrealistic concern about separation from major
attachment figures
• Symptoms associated with SAD must be experienced for
at least eight weeks
– unrealistic and persistent worries about harm to major
attachment figures
– fears of abandonment
– refusal to attend school
– avoidance of being alone
– experience of nightmares involving separation themes
– experience of physical complaints in anticipation of being
separated from attachment figures
School Phobia
• Related to separation anxiety
– But not all children with SAD refuse to go to school
• Two types identified
– 1. more common type is associated with SAD
• children worry constantly that some harm will befall parents
or themselves when they are away from parents
– 2. second type associated with true phobia of school
• either a fear specifically related to school or a more general
social phobia
• generally begin refusing to go to school later in life
• have more severe and pervasive avoidance of school
Social Phobia
• Selective Mutism
– Refusal to speak when it is expected of a
person
• Example: refusing to speak to a teacher
• Social Phobia
– Prevalence 1% of children and adolescents
– Processes and mechanisms
• social learning
• genetic factors
Treatment of Fears and Phobias
• Similar to that employed with adults
– Exposure to feared object while performing
some action to inhibit their anxiety
– CBT shows great promise in treating
childhood anxiety
Depression in Childhood and
Adolescence
• Resemble adult depression in terms of depressed mood,
inability to experience pleasure, fatigue, concentration
problems, and suicidal ideation
– but higher rates of suicide attempts and guilt in children and
adolescents
• Masked depression
– acting aggressively or misbehaving at school or at home
• Prevalence
– < 1% of preschoolers
– 2 to 3% of school-age children
– adolescents similar to adult rates
• 9% in females and 3 -5% in males
• lifetime prevalence is 21.4% for females and 10.7% for males
Etiology of Depression
• Genetic factors
• Family and other relationships as sources of stress
– might interact with a biological diathesis
• Serious emotional problem in a parent
• Poor social skills and impaired relationships with siblings
and friends
• Likely stems from a complex interplay of
–
–
–
–
biological vulnerability factors
parental factors
psychosocial factors
“social capital” resources
Treatment of Depression
• Controversy regarding effectiveness of
drug therapies
• Interpersonal therapy (IPT)
• CBT
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