1. Psikologi Anak Pertemuan 9 Behavioral Disorders

2. 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

3. 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.

4. 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)

5. 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.

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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