Disorders of Childhood 12/2/02

Pervasive Developmental Disorders Severe childhood disorders characterized by impairment in verbal and non-verbal communication and social interaction Abnormalities occur in the developmental process itself Examples: Autistic Disorder, Asperger’s Disorder

Autistic Disorder: 3 main areas of impairment SOCIAL: “autistic aloneness” Lack of interest in interacting with others (e.g., through eye contact, smiling, gesturing, shared attention, playing, making friendships) Strong attachments to objects, but not people May not understand that other people have thoughts and feelings

Autistic Disorder: 3 main areas of impairment COMMUNICATION (verbal and nonverbal): Half of autistic children do not develop language Many have speech oddities (e.g., echolalia = echoing the words of others) Pronoun reversals: using “he” or “you” instead of “I”

Autistic Disorder: 3 main areas of impairment ACTIVITIES / INTERESTS: Repetitive/self-stimulatory behaviors(e.g., spinning objects, hand flapping, whirling around) Lack of imaginative behavior Obsessive-compulsive / ritualistic behaviors (e.g., preoccupation with schedules, routines, and sameness; lining up objects)

Autistic Disorder A majority of individuals with autism have mental retardation (i.e., IQ score < 70) Contemporary theories stress a biological etiology of autism, involving genetic factors and/or organic central nervous system impairment

Asperger’s Disorder Milder / higher-functioning form of autism characterized by severe impairments in the SOCIAL domain, some impairment in the ACTIVITIES/INTERESTS domain, and no significant delays in COMMUNICATION and cognitive development

Disruptive Behavior Disorders Characterized by undercontrolled, or externalizing behavior (i.e., “acting out”; socially disruptive behavior that is inappropriate given the age of the child and/or setting of the behavior) Behavior is typically distressing and/or annoying to those in child’s social environment Examples: ADHD, ODD, Conduct Disorder

Attention Deficit / Hyperactivity Disorder (ADHD) Involves attentional problems (e.g., distractibility, inattention, trouble completing tasks) and/or hyperactivity (e.g., impulsivity, high motor activity, interrupting) Symptoms occur before age 7, and in at least 2 settings

ADHD Research on the etiology of ADHD implicates biological, genetic, and psychological factors A majority of kids with ADHD respond positively to stimulant medications; however, the benefits are only short-term. Cognitive-behavioral parenting and self- control therapies are important for long- term benefits.

Oppositional Defiant Disorder (ODD) Involves noncompliance, hostility, losing temper easily, arguing, irritability, deliberately annoying or blaming others High comorbidity with ADHD May be a precursor to Conduct Disorder

Conduct Disorder (CD) Involves antisocial behaviors that violate others’ rights (e.g., lying, stealing, fighting, bullying, truancy, cruelty to people or animals, criminal behaviors) Prognosis for child-onset CD is worse than for adolescent-onset CD; worse for aggressive children

Anxiety Disorders Characterized by overcontrolled, or internalizing behavior (i.e., fears, worries, shyness, nervousness, apprehensiveness) Example: Separation Anxiety Disorder

Separation Anxiety Disorder Involves excessive anxiety about separating from parents or home (e.g., fears about harm coming to parents, avoidance of being alone, distress and physical complaints when separation is anticipated; school phobia = refusal to go to school)

Tic Disorders Tics are involuntary and repetitive movements or vocalizations Motor tics often involve the face/head (e.g., eye blinking, grimacing, head jerking), but may also involve limbs (e.g., flexing elbows, tapping foot) Vocal tics: throat clearing, coughing, sniffing, grunting, barking sounds

Tourette’s Syndrome Involves multiple motor and vocal tics Bodily sensations/urges frequently precede tics Coprolalia (compulsion to shout obscenities) is rare High comorbidity with Obsessive- Compulsive Disorder and/or ADHD Stimulant medication can bring on tics