Chapter 15 Disorders of Childhood and Adolescence ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 15 Disorders of Childhood and Adolescence © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Maladaptive Behavior in Different Life Periods Developmental psychopathology Study of origins and course of individual maladaptation in context of normal growth processes © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Varying Clinical Pictures Some childhood disorders short-lived and nonspecific Others severely affect future development © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Varying Clinical Pictures Child inpatient psychiatric patients More likely than peers to die early in life More likely to die due to unnatural causes © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Varying Clinical Pictures True or false? Suicidal thoughts are uncommon in children. Suicidal thoughts are common in children. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Special Psychological Vulnerabilities of Young Children They do not have as complex and realistic view of themselves and their world as they will have later They have less self-understanding They have not yet developed stable sense of identity They have not yet developed a clear understanding of what is expected of them and what resources they might have to deal with problems © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Classification of Childhood and Adolescent Disorders No categories for children’s disorders DSM-I included only two childhood disorders Early diagnostic systems More attention paid to developmental factors in creating and using diagnoses for children Recent systems © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Common Disorders of Childhood Intellectual Disability is included in Neurodevelopmental Disorders. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

3 Types of (Attention-deficit hyperactivity disorder (ADHD) Predominately inattentive Predominately hyperactive/impulsive Combined Associated with numerous impairments Behavioral Cognitive Social and academic problems Technology Tip: Attention Deficit Disorder. This site contains a wealth of scholarly information and links related to ADHD. http://www.mentalhealth.com/dis/p20-ch01.html

The Causes of ADHD: Biological Contributions Genetic contributions ADHD seems to run in families DAT1 - gene has been implicated DAT1 – dopamine transporter gene – ritalin inhibits this gene and increases amount of dopamine

Attention-Deficit/ Hyperactivity Disorder Treatment methods Medications Behavior therapy Family therapy Treatment methods Medications (such as Ritalin, Pemoline, and Strattera) Behavior therapy Family therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Biological Treatment of ADHD Goal of biological treatments To reduce impulsivity and hyperactivity and to improve attention Stimulant medications Reduce core symptoms in 70% of cases Examples include Ritalin, Pemoline, Focalin, Cylert, Vyvanse, Adderall, Strattera Strattera = atomoxetine = selective norepinephrine-reuptake inhibitor – doesn’t produce the same highs when used in larger doses Side effects – insomnia, drowsiness, eating changes, irritability, dryness of mouth

Behavioral Treatment of ADHD Reinforcement programs To increase appropriate behaviors Decrease inappropriate behaviors May also involve parent training Technology Tip: CH.A.D.D. (Children and Adults with Attention Deficit Disorders). CH.A.D.D. is a non-profit organization devoted to educating the public about attention deficit and hyperactivity disorders. This site includes information on the symptoms of ADDHD, treatments, and as well as CH.A.D.D. chapters throughout the country. http://www.chadd.org/

Behavior Modification

Oppositional defiant disorder Recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least six months Conduct disorder Persistent, repetitive violation of rules and disregard for rights of others for at least 1 year Aggression to people and animals Destruction of property Theft Serious violations of rules © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Three Subtypes of Oppositional Defiant Disorder Angry/Irritable Mood Argumentative/Defiant Behavior Vindictiveness © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Oppositional Defiant Disorder and Conduct Disorder Possible causes Biological factors Personal pathology Family patterns Peer relationships © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Oppositional Defiant Disorder and Conduct Disorder Effective treatments = cohesive family model and behavioral techniques Ineffective treatment = Punitive treatments Punitive treatments appear to intensify rather than correct behavior © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Anxiety and Depression in Children and Adolescents Childhood Depression and Bipolar Disorder Anxiety Disorders of Childhood and Adolescence © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Anxiety Disorders of Childhood and Adolescence Separation anxiety disorder Excessive anxiety about separation from major attachment figures, such as their mother, and from familiar home surroundings. Most common of childhood anxiety disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Anxiety Disorders of Childhood and Adolescence Characteristics Unrealistic fears Oversensitivity Self-consciousness Nightmares Chronic anxiety © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Anxiety Disorders of Childhood and Adolescence Causes and treatments Pattern of early family relationships Psychopharmacological treatments and behavior therapy A likely cause of childhood anxiety disorder is a pattern of early family relationships that generates anxiety and prevents the child from developing more adaptive coping skills Psychopharmacological treatments and behavior therapy are common treatment methods © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Childhood Depression and Bipolar Disorder Occurs with high frequency Depressed mood can be replaced by irritability © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Childhood Depression and Bipolar Disorder Causal factors Biological and learning factors Medication plus psychotherapy Exposure to trauma Parental negative emotion/behavior © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Childhood Depression and Bipolar Disorder Extreme mood swings and aggressive, irritable behavior Increasingly diagnosed in children and adolescents © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Childhood Depression and Bipolar Disorder Treatment Antidepressant medications Supportive emotional environment Cognitive-behavioral therapy Research on the effectiveness of antidepressant medications with children is both limited and contradictory It is important to provide a supportive emotional environment for children to learn more adaptive coping strategies and emotional expression Studies have shown reduced symptoms with cognitive-behavioral therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Symptom Disorders: Enuresis, Encopresis, Sleepwalking, and Tics Functional enuresis Bedwetting that is not organically caused Age Gender Children over 4 who have not learned appropriate toileting for bowel movements may be diagnosed with functional encopresis Both are far more common in boys than girls © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Symptom Disorders: Enuresis, Encopresis, Sleepwalking, and Tics Parasomnias Sleepwalking Incidence level Tics Persistent, intermittent muscle twitches or spasms, usually limited to a localized muscle group Tourette’s disorder Extreme tic disorder involving multiple motor and vocal patterns 10-30% of children will have at least one incident of sleepwalking. Persistent, intermittent muscle twitches or spasms, usually limited to a localized muscle group occurring most frequently between the ages of 2 and 14 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Neurodevelopmental Disorders Pervasive developmental disorders Severely disabling conditions that are among most difficult to understand and treat Autism Spectrum Disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Autism Spectrum Disorder Wide range of problematic behaviors Social deficit Absence of speech Self-stimulation Impaired intellectual ability Preoccupation with maintaining sameness © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Autism Spectrum Disorder Cause Precise causes unknown Fundamental disturbance of central nervous system likely involved Most investigators agree that a fundamental disturbance of the central nervous system is involved © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Autism Spectrum Disorder Treatment Behavior of autistic children not normalized through treatment behavior modification techniques reduce some symptoms Newer instructional and behavior modification techniques have been helpful in improving the ability of less severely-impaired autistic children to function © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Academic Characteristics Reading (dyslexia) Deficits in: Written language (dysgraphia) Technology Tip: Learning Disabilities Association of America. This web site provides information and news updates on learning disabilities. This site is aimed at parents, teachers, and other professionals. http://www.ldanatl.org/ Mathematics (dyscalculia)

Dyslexia OBJECTIVE 5-7| Describe the five brain areas that would be involved if you read this sentence aloud.

Learning disabilities and intellectual disability Occur in children Can persist over life spans Limit future development and psychological growth © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Learning Disorders Diagnosis of learning disorders Clear impairment in school performance or daily living activities Impairment not due to intellectual disability or pervasive developmental disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Causal Factors in Learning Disorders Causes Possibly subtle central nervous system impairments © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Intellectual Disability Characterized by deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience (APA 2013, p. 31). © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

DSM-V Levels of Intellectual disability (ID) Mild ID IQ score between 55 and 70 Moderate ID IQ range of 40 to 54 Severe ID IQs ranging from 25 to 39 Profound ID IQ scores below 25

Causal Factors in Intellectual Disability Genetic-chromosomal factors Infections and toxic agents Trauma Ionizing radiation Malnutrition and other biological factors Some biological factors: © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Organic Retardation Syndromes Intellectual disability stemming primarily from biological causes Down Syndrome Phenylketonuria Cranial anomalies Cranial anomalies Macrocephaly Microcephaly Hydrocephaly © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Hydrocephalus © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Trisomy 21

Treatments, Outcomes, and Prevention Treatment methods Institutionalization Education and inclusion programming Treatment methods Institutionalization (usually a last resort) Education and inclusion programming Mainstreaming involves attending regular classes for much of the day © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Planning Better Programs to Help Children and Adolescents Wide range of treatment procedures Wide range of outcomes Attention to special factors Currently, there is a very wide range of treatment procedures Wide range of outcomes as well Attention to special factors can enhance programs designed to help children and adolescents © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Special Factors Associated with Treatment of Children and Adolescents Special factors associated with treatment for children and adolescents Child’s inability to seek assistance Vulnerabilities that place children at risk Need for treating parents as well as children Using parents as change agents Problems with placement outside family Intervening before problems become acute © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Child Advocacy Programs International recognition of rights of children Still confusion, inconsistency, and uncertainty International recognition of the rights of children can potentially have great impact Despite some gains, a great deal of confusion, inconsistency, and uncertainty still persists in the child advocacy movement as a whole © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Can society deal with delinquent behavior? Unresolved Issues Can society deal with delinquent behavior? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.