Psychological problems in childhood & adolescence

A few details……... CONTACTING ME: CONTACTING ME: Dr Sue Jackson Dr Sue Jackson Room 514 Easterfield Room 514 Easterfield Ext 8232 Ext Office hours: Mon, Office hours: Mon, , Thurs or make an appt , Thurs or make an appt.

COURSE OVERVIEW Classification & models Classification & models Child Abuse Child Abuse Childhood Anxiety: PTSD Childhood Anxiety: PTSD Attention Deficit Hyperactivity Disorder Attention Deficit Hyperactivity Disorder Conduct Disorder in Adolescence Conduct Disorder in Adolescence Depression in Adolescence Depression in Adolescence Anorexia in Adolescence Anorexia in Adolescence Approaches to therapy with children & adolescents Approaches to therapy with children & adolescents Review Review

THE READINGS ESSENTIAL: ESSENTIAL: Readings on closed reserve in library Readings on closed reserve in library SUPPLEMENTARY: SUPPLEMENTARY: Carr, A. (1999). The handbook of child and adolescent clinical psychology. London: Routledge Carr, A. (1999). The handbook of child and adolescent clinical psychology. London: Routledge

THE TEST ……..will cover all of child/adolescent lectures up and including August 2 nd ……..will cover all of child/adolescent lectures up and including August 2 nd ……..will be short answers ……..will be short answers ……..will be preceded by a review lecture ……..will be preceded by a review lecture

Today’s Lecture Questions What is the history of clinical child psychology? What is the history of clinical child psychology? What is the Diagnostic and Statistics Manual (DSM)and how does it categorise problems of childhood and adolescence? What is the Diagnostic and Statistics Manual (DSM)and how does it categorise problems of childhood and adolescence? How useful is the DSM for psychological problems of childhood and adolescence? How useful is the DSM for psychological problems of childhood and adolescence? What alternatives are there to the medical model on which DSM is based? What alternatives are there to the medical model on which DSM is based?

Some history…….. Discipline of clinical child psychology dates to 1896 Discipline of clinical child psychology dates to 1896 Lightner Witner- first psychological clinic for children in USA 1896 Lightner Witner- first psychological clinic for children in USA 1896 ADHD- 100 years old- Still (1902),a doctor, misbehaviour due to biological and moral “defects” ADHD- 100 years old- Still (1902),a doctor, misbehaviour due to biological and moral “defects” Conduct Disorder- roots in juvenile delinquency, end of C19th youth crime differentiated from adult crime Conduct Disorder- roots in juvenile delinquency, end of C19th youth crime differentiated from adult crime

Famous early child case studies Freud and the case of little Hans (1909) Freud and the case of little Hans (1909) Diagnosis by letter Diagnosis by letter Hans, five, developed fear of horses Hans, five, developed fear of horses Freud interpreted as fear of dad and sexual desire for mother Freud interpreted as fear of dad and sexual desire for mother

Little Albert John Watson (1920) John Watson (1920) Baby Albert- 11 months Baby Albert- 11 months Rat (unknown age) Rat (unknown age) Conditioned fear of rats in Albert Conditioned fear of rats in Albert If Albert alive today, probably still be rat phobic If Albert alive today, probably still be rat phobic

THE DSM DSM-1- two separate diagnoses for children (1952) DSM-1- two separate diagnoses for children (1952) DSM-II (1968) seven diagnoses DSM-II (1968) seven diagnoses DSM-III (1980) 40 diagnoses DSM-III (1980) 40 diagnoses DSM-IV-R 50 and still rising DSM-IV-R 50 and still rising Are children more psychologically disturbed than they were or are there other reasons for the rising number of problem? Are children more psychologically disturbed than they were or are there other reasons for the rising number of problem?

DSM and the production of mental health problems DSM & mental illness as socially constructed-some examples: DSM & mental illness as socially constructed-some examples: Historical: mental illness possession by devils, ‘draeoptomania’, illness of the slaves Historical: mental illness possession by devils, ‘draeoptomania’, illness of the slaves Social: homosexuality a mental disorder until late 1980s Social: homosexuality a mental disorder until late 1980s Cultural: ‘hallucinations’ may be of spiritual significance Cultural: ‘hallucinations’ may be of spiritual significance Mental illness as a “business”, diagnoses as a basis for service provision and for drug prescription Mental illness as a “business”, diagnoses as a basis for service provision and for drug prescription

DSM Child/Adolescent Disorders Disorders first diagnosed in infancy, childhood or adolescence: Disorders first diagnosed in infancy, childhood or adolescence: Mental retardation Mental retardation Learning disorders Learning disorders Motor skill disorders Motor skill disorders Communication disorders Communication disorders Pervasive developmental disorders Pervasive developmental disorders Attention deficit and disruptive behaviour Feeding and eating disorders Tic disorders Elimination disorders- enuresis, encopresis Other- separation anxiety, mutism, reactive attachment disorder

Child disorders classified with adult disorders Mood- in children unipolar depression only Mood- in children unipolar depression only Anxiety- generalised, obssessive-compulsive, PTSD Anxiety- generalised, obssessive-compulsive, PTSD Dissociative disorders - disrupted integration memory, identity, consciousness Dissociative disorders - disrupted integration memory, identity, consciousness Eating disorders Eating disorders

How useful is DSMIV for children & adolescents? 1. Reliability Clinician agreement on diagnosis poor e.g.: Clinician agreement on diagnosis poor e.g.: Conduct Disorder.62 Depression.62 Anxiety.52 ADHD Validity Significant overlap in factors that contribute to onset of problems (low validity) Significant overlap in factors that contribute to onset of problems (low validity)

How useful is DSMIV for children & adolescents? 3. Co-morbidity Community based studies (cited Carr) CD and ADHD 23.3% CD and ADHD 23.3% and Major Depression 16.9% and Major Depression 16.9% and anxiety disorders 14.8% and anxiety disorders 14.8% ADHD and Major Depression 10.5% ADHD and Major Depression 10.5% and Anxiety Disorders 11.8% and Anxiety Disorders 11.8% Anxiety and Major Depression 16.2% Anxiety and Major Depression 16.2%

How useful is DSMIV for children & adolescents? 4. Categorical approach “got it, ain’t got it” categorical approach doesn’t address social contexts/interactions “got it, ain’t got it” categorical approach doesn’t address social contexts/interactions 5. Ethical problems pathologising young people, stigmatisation pathologising young people, stigmatisation 6. “Adultmorphism” failure to incorporate developmental perspective failure to incorporate developmental perspective criteria of subjective distress and impairment in functioning often not applicable (Anna Freud) criteria of subjective distress and impairment in functioning often not applicable (Anna Freud)

How useful is DSMIV for children & adolescents? 7. Gender bias 21 childhood disorders, 17 more common in boys (girls>internalisng, boys>externalisng) 21 childhood disorders, 17 more common in boys (girls>internalisng, boys>externalisng) Conduct disorder- criteria > specific to boys e.g. sexual behaviour Conduct disorder- criteria > specific to boys e.g. sexual behaviour Different patterns for CD in boys and girls Different patterns for CD in boys and girls 8. Misdiagnosis is a significant problem Particularly due to comorbidity, developmental factors Particularly due to comorbidity, developmental factors

Externalising behaviours – aggression, non-compliance, drug abuse (relate to more conduct type problems, ADHD, ODD) Externalising behaviours – aggression, non-compliance, drug abuse (relate to more conduct type problems, ADHD, ODD) Internalising behaviours- crying, worrying, withdrawal (relate to anxiety, depression) Internalising behaviours- crying, worrying, withdrawal (relate to anxiety, depression) Dimensional model

Construction of dimensions: Child Behaviour Checklist Achenbach the author of CBCL Achenbach the author of CBCL Collection of behaviours from case studies and literature to form CBCL (118 items) Collection of behaviours from case studies and literature to form CBCL (118 items) 1800 parents of clinic children completed CBCL 1800 parents of clinic children completed CBCL Factor analysis leading to narrow band syndromes- e.g. wirhdrawn, aggression Factor analysis leading to narrow band syndromes- e.g. wirhdrawn, aggression Grouping of narrow band into wide band- internalising and externalising Grouping of narrow band into wide band- internalising and externalising Norms on 1400 non clinical children Norms on 1400 non clinical children Cut-off scores for children outside normal range- clinical Cut-off scores for children outside normal range- clinical

Critique Continuum- links ‘normal’ development to problems with extreme points on continuum leading to referral Continuum- links ‘normal’ development to problems with extreme points on continuum leading to referral Doesn’t account for more specific problems like autism, toileting problems, eating disorders Doesn’t account for more specific problems like autism, toileting problems, eating disorders Problems around agreement parent/teacher/child reports and subjectiveness of each- parents/teachers tend to be better informants for externalising problems, children better for internalising problems Problems around agreement parent/teacher/child reports and subjectiveness of each- parents/teachers tend to be better informants for externalising problems, children better for internalising problems

Today’s Lecture Questions At this point you should have some idea of how to answer them. At this point you should have some idea of how to answer them. Doing the readings should help you expand your knowledge a little more. Doing the readings should help you expand your knowledge a little more.