Psikologi Anak Pertemuan 9 Behavioral Disorders

Attention Deficit Hyperactivity Disorder Young children are normally inattentive, active, exuberant, flighty, bored easily, lacking in self-control If such behaviours are persistent and in excess, there may be an indication of a problem. Children who are excessively active, unable to sustain attention, and are deficient in impulse control to a degree that is deviant for their developmental level = ADHD

Diagnosis of ADHD Two sets of symptoms: Inattention and hyperactivity/impulsivity. At least 6 inattentive symptoms and/or 6 hyperactive/impulsive symptoms must be present. Some symptoms must have manifested before age 7. Symptoms must have been present for at least 6 months to a degree that is considered maladaptive and inappropriate for the individual's age. Symptoms must cause impairment in two or more settings. Symptoms must not be better accounted for by another disorder.

Inattentive Symptoms Hyperactive/Impulsive Symptoms often fails to give close attention to details or makes careless mistakes in school work, 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 school work, chores, or duties in the work place (this failure is not due deliberately refusing to do it or not understanding instructions) often has difficulty organizing tasks or activities often avoids or is reluctant to engage in tasks that require sustained mental effort often loses things necessary for tasks or activities often easily distracted by extraneous stimuli is often forgetful in daily activities Hyperactive/Impulsive Symptoms often fidgets with hands 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 which it is inappropriate (in adolescents and 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 often blurts out answers before questions have been completed often has difficulty awaiting turn often interrupts or intrudes on others (eg. Butts into conversations or games)

ADHD Types ADHD, combined type: both inattentive and hyperactive symptoms present (6 of 9 in each category). ADHD, predominantly inattentive type: if 6 inattentive symptoms are met, but fewer than 6 hyperactive symptoms are met. Used to be called ADD-term is no longer used. Accounts for only 10% of all ADHD cases. Some evidence that girls tend to be more prevalent in this subtype. ADHD, predominantly hyperactive-impulsive type: if 6 hyperactive symptoms, but not 6 inattentive symptoms are met.

Causes of ADHD Aetiology is basically unknown, though risk factors are clearly identified. Genetic Prenatal Neuropsychological Environmental Diet

Management of ADHD Therapy Behaviour Modification Medical Ritalin Psychostimulant thought to increase dopamine levels in the brain Antidepressants, SSRI’s (Prozac, etc.) Increase serotonin levels in the brain

Oppositional Defiant Disorder Pattern of negativistic, hostile and defiant behaviour lasting at least 6 months Causes significant impairment Does not occur exclusively during a mood disorder or psychotic episode Criteria not met for CD

ODD Characteristics Often loses temper Often argues with adults Often actively defies adult requests Often deliberately annoys people Often blames others for his/her mistakes Often touchy, easily annoyed by others Often angry and resentful Often spiteful or vindictive

Progression of conduct problems Oppositional Argues, temper, impulsive, attention seeking Offensive Cruelty, disobeys, fights, swears, lies, cheats Aggressive Destroys, threatens, attacks, steals at home, bad friends Delinquency Sets fires, steals outside home, truancy, runs away, alcohol/drug use, vandalism

Associated features of ODD Low self-esteem Mood lability Low frustration tolerance Swearing Conflicts Early use of alcohol, tobacco, illicit drugs Difficult temperament Persistent negative sibling interactions

Conduct Disorder Pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated Causes significant impairment If 18 years +, criteria not met for Antisocial PD Specify type based on age of onset and severity

CD Characteristics Aggression to people and animals Bullies, threatens, intimidates, physically cruel, stolen while confronting a victim Destruction of property Deceitfulness or theft Serious violations of rules Run away from home, stays out at night, truant from school

Developmental paths/subtypes of Conduct Disorder 2 distinct developmental pathways Childhood-onset (before age 10) Male, aggressive, disturbed peer relationships, ODD early childhood Adolescent-onset (after age 10) More common, less aggressive, more normative peer relationships, more females Better prognosis

Etiology Genetics Environmental influence Adoption and twin studies Deviant behaviour stable across generations Extra Y chromosome (theory discounted) Inheritance of a sensation-seeking temperament Chronic underarousal Environmental influence Parents of children with CD tend to be rejecting and use harsh punishments Exposure to aggressive and criminal models (Social Learning Theory) Reinforced by parent and teacher attention Parental neglect, exposure to antisocial models and harsh punishment

Treatment Parent training – family focus Help parents to increase children’s appropriate behaviours Help parents to decrease inappropriate behaviours Giving attention for appropriate behaviour Giving rewards Ignoring Giving clear instructions Using consequences Social problem-solving skills training – Child focus Addresses social cognitive deficits Hostile bias Actual problem-solving Social skills Perspective taking Anger management training Multi-Systemic Therapy Focuses on systems in which behaviour is embedded: family, school, peers Multiple influences within theses systems