1. Chapter 16 Psychological Disorders of Childhood Copyright © 2006 Pearson Education Canada Inc.

2. 2 Overview developmental psychopathology – study of abnormal behaviour in children developmental norms – typical behaviour per age group? internalizing disorders – problems affecting child’s internal world and are associated with subjective distress (e.g., anxiety) – Comorbidity – Is ADHD over diagnosed in N.A.?

3. Copyright © 2006 Pearson Education Canada Inc. 3 Case Study: Jeremy W. trouble at school learning disability? acting out? irresponsive to disciplinary measures lack of input from father

4. Copyright © 2006 Pearson Education Canada Inc. 4 Externalizing Disorders The most commonly diagnosed childhood disorders Characterized by the failure to control behaviour according to the expectations of others Externalizing symptoms include: rule violations, anger and aggression, impulsivity and deficits in attention

5. Copyright © 2006 Pearson Education Canada Inc. 5 Symptoms of Externalizing Disorders Rule violations  normal vs. abnormal  age of onset  persistence into adulthood Negativity, Anger, & Aggression  intent of anger  Remorse felt

6. Copyright © 2006 Pearson Education Canada Inc. 6 Symptoms of Externalizing Disorders Impulsivity – Act before thinking Hyperactivity – Squirming, fidgeting, or restless behaviour – Connors Teacher Rating Scale Attention Deficits - distractibility, frequent shifts from activity to activity, careless mistakes, poor organization

7. Copyright © 2006 Pearson Education Canada Inc. 7 ADHD  3% of children show symptoms  More boys than girls  hyperactivity, attention deficit (impulsivity)  All symptoms are independent  Children may have one or both symptoms  symptom onset prior to age 7  symptom persistence of 6 mos.

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9. 9 ADHD Subtypes  predominantly inattentive (ADD)  predominantly hyperactive-impulsive  combined

10. Copyright © 2006 Pearson Education Canada Inc. 10 ODD  Closely related to ADHD (50%)  Distinct, but overlapping  negative, hostile, defiant behaviour  Primarily in school aged children  symptom persistence of 6 mos.  significant impairment in child’s life

11. Copyright © 2006 Pearson Education Canada Inc. 11 ODD Symptoms (4 of the following are present)  Often loses temper  Often argues with adults/authorities  Actively refuses to comply with adult’s requests  Often deliberately annoys people  Often blames others for mistakes  Easily annoyed by others  Often spiteful or vindictive

12. Copyright © 2006 Pearson Education Canada Inc. 12 ADHD vs. ODD  debate over usefulness of the distinction  likely distinct but overlapping  ½ kids with one have the other

13. Copyright © 2006 Pearson Education Canada Inc. 13 Conduct Disorder persistent, repetitive pattern of serious rule violations – Often feels no remorse – antisocial and sometimes criminal acts – precursor to Antisocial Personality Disorder

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15. Copyright © 2006 Pearson Education Canada Inc. 15 Epidemiology Canadian prevalence of ADHD is 3-7% 5-15% have ODD Externalizing disorders far more common in boys Familial risk – risk ↑ with family adversity factors (e.g., low income, overcrowding in home, maternal depression, paternal antisocial behaviour, conflict between parents)

16. Copyright © 2006 Pearson Education Canada Inc. 16 Etiology: Biological Factors  difficult temperament – child’s innate behavioural characteristics (e.g., slow to warm up)  behavioural genetics – Australian ADHD twin study (Levy et al, 1997) – underarousal of ANS – concordance – MZ: 80%, DZ: 40%  neuropsychological anomalies – no markers  food additives/sweets (salicylate)– no evidence

17. Copyright © 2006 Pearson Education Canada Inc. 17 Etiology: Biological Factors  Genetics is less influential in ODD and Conduct D/O  No crime gene has been found

18. Copyright © 2006 Pearson Education Canada Inc. 18 Etiology: Social Factors Socialization – parenting styles (i.e., authoritative,authoritarian, indulgent, neglectful) indulgent parents – often relate to impulsivity & noncompliance – coercion – love & discipline – more compliance – conflict & inconsistent discipline=externalization issues Peers & Media – violence is modeled

19. Copyright © 2006 Pearson Education Canada Inc. 19 Etiology of ADHD social factors – quality of parental-child interactions psychological factors – problems in delaying gratification – moral reasoning integrative model – externalizing disorders have multiple pathways – Interaction of biological, psychological, & social factors

20. Copyright © 2006 Pearson Education Canada Inc. 20 Treatment Psychostimulants – Ritalin, Adderall – robust effect on reducing inattention and hyperactivity (75% improvement) – dose-response effects (individual differences) – side effects (decreased appetite, slowing physical growth, sleeping difficulties, motor tics) – Overdiagnosis (i.e., quick fix)

21. Copyright © 2006 Pearson Education Canada Inc. 21 Treatment Behavioural Family Therapy (BFT) Focus on rewards not punishments Multisystemic Therapy Alternative schooling programs Group homes

22. Copyright © 2006 Pearson Education Canada Inc. 22 Symptoms of Internalizing Disorders depressive symptoms fears and anxiety – consideration of developmental course separation anxiety and school refusal – separation anxiety disorder – school refusal troubled peer relationships

23. Copyright © 2006 Pearson Education Canada Inc. 23 Historical Perspective Witmer’s (1896) clinic increasing child diagnoses in later DSM editions

24. Copyright © 2006 Pearson Education Canada Inc. 24 Contemporary Perspective numerous disorders listed in the DSM- IV-TR examples: – Pica & Rumination Disorder – Tourette’s Disorder – Selective mutism – Enuresis & encopresis

25. Copyright © 2006 Pearson Education Canada Inc. 25 Short- & Long-Term Effects of Psychostimulants on ADHD

26. Copyright © 2006 Pearson Education Canada Inc. 26 Epidemiology prevalence – mood disorder: 2% Canadian children – anxiety disorder: 5-10% of young people gender – more boys have externalizing disorders – more girls have internalizing disorders suicide

27. Copyright © 2006 Pearson Education Canada Inc. 27 Etiology: Biological Factors little systematic research Kagan’s work suggests genetic predisposition to anxiety

28. Copyright © 2006 Pearson Education Canada Inc. 28 Etiology: Social Factors reactive attachment disorder – anaclitic depression insecure attachments early separation

29. Copyright © 2006 Pearson Education Canada Inc. 29 Etiology: Psychological Factors emotion regulation

30. Copyright © 2006 Pearson Education Canada Inc. 30 Treatments ECT antidepressant medications – SSRIs (note: dangerous side effects) CBT