Disorders of childhood and adolescence include wide range of problems
Involve failure to pass developmental milestone on time
Involve disruption of developmentally acquired skill
Some are psychological disorders that normally have onset prior
to adulthood
Disorders may have no counterpart in adult psychopathology
Deciding what is abnormal more difficult in childhood and adolescence
Disorders differ in course and outcome from adult psychological
disorders
Most children do not think of themselves as having treatable psychological
disorders
Issues in Child Psychopathology
Prevalence
One out of every five children and adolescents has moderate or
severe psychological disorder
Admission rates begin to increase at age six or seven
Psychological disturbances more common in boys than in girls
Classification and Diagnosis
Classified as syndromes
Empirical method groups together pre-adult problems that occur
together in same children or age group
Disruptive behavior disorders
Disorders of emotional distress
Habit disorders
Learning and communication disorders
Most of DSM-IV and DSM-IV-TR diagnostic categories
can be grouped under four headings
Disruptive behavior disorders
Disorders of emotional distress
Habit disorders
Learning and communication disorders
Children change rapidly
Children may not fit neatly into one category
Long-Term Consequences
Stability is one type of predictability; antisocial behavior is
stable
Continuity of developmental adaptation leads to other different
disorders
Reactivity to particular stressors relates to disorders creating
stresses
Some childhood disorders do predict adult disorders often indirectly
Some children and adolescents respond well to treatment
Disruptive Behavior Disorders
Disruptive behavior disorders involve poorly controlled, impulsive,
acting-out behavior in situations in which self-control is expected
Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) involves
short attention span and hyperactivity
More common in boys than girls; 3Ð5% of elementary school children
said to have ADHD
Some believe that it is too readily applied to children who are
difficult to control
Symptoms affect every area of child's functioning
Behavior often distinguished less by its excessiveness than
by its haphazard quality
Activity seems purposeless and disorganized
Affects child's academic progress
ADHD children tend to have poor social adjustment
DSM-IV-TR divides syndrome into three subtypes
Predominantly inattentive type
Predominantly hyperactive/impulsive type
Combined type; most ADHD children more likely to have wide
range of problems
Most ADHD children still show the disorder in adolescence
Many ADHD children will develop antisocial behavior
Cognitive problems tend to persist into adolescence
Conduct Disorder
Conduct disorder (CD) characterized by indifference to
rights of others, reckless behavior, and cruel behavior
Aggression against people or animals
Destruction of property
Deceitfulness or theft
Serious violation of rules
One of most common syndromes of childhood and adolescence; estimated
prevalence 4-16%; boys outnumber girls
Age of onset important
Childhood-onset with at least one symptom before age 10; usually
male; physically aggressive; have few friends; more likely to
develop antisocial personality disorder
Adolescent-onset with no symptoms before age 10; less aggressive,
have friends
Many with conduct disorders commit serious crimes
Many children come from disorganized and unhappy families, leading
to poor prognosis
Groups at Risk for Disruptive Behavior Disorders
Gender is strongest risk factor for disruptive behavior disorders
Boys outnumber girls nine to one in ADHD
Boys outnumber girls in conduct disorders
Gender difference subject to recent debate
May be due to artifact of reporting
May be due to differential socialization
May be due to difference of seriousness of crimes
Socioeconomic factors such as correlates of poverty play role
in conduct disorders
Disorders of Emotional Distress
Disorders of emotional distress are internalizing disorders whereby
conflict is turned inward
Diagnosis is difficult when child lacks verbal and conceptual skills;
must rely on child's behavior
Anxiety Disorders
Separation Anxiety Disorder
Separation anxiety is intense fear and distress upon separation
from parents or caregivers
Seen in almost all children; peaks at about 12 months
In some it persists into school years; disappears and reappears
triggered by stress characterizes separation anxiety disorder
Child may have fears of horrible things happening while separated
from parents
Parent-child conflicts common and exacerbate disorder
Estimated prevalence is 4-13% of children and adolescents
Social Phobia
Social phobia is fear of social or performance situations
in which embarrassment may occur
Most children grow out of fear of strangers by age two and
a half; children with social phobia do not
Social phobia may not generalize to all social situations
Children with social phobia are often well adjusted at home
and have normal relationships with parents
At school, child is withdrawn, interfering with academic progress
and social relationships
Generalized Anxiety Disorder (GAD)
In generalized anxiety disorder child experiences anticipatory
anxiety, doubting his/her own capabilities
Family dynamics may play role
Anxiety tends to breed failure, which brings on the very problems
child was anticipating, creating vicious cycle
Childhood Depression
Parents and teacher often fail to notice depression in children
Childhood depression resembles adult depression
Symptoms of depression are often expressed differently by
children than by adults
Prevalence is 2-5%; adolescents may be more vulnerable than
younger children
Studies suggest that depressed children are at risk for mood
disorders as much as depressed adults
Groups at Risk for Disorders of Emotional Distress
Girls more likely to develop separation anxiety disorder,
social phobia, and generalized anxiety disorder
Young boys more vulnerable to depression
Teenage girls more likely to develop disorders of emotional
distress
Eating Disorders
Anorexia Nervosa
Anorexia nervosa is severe restriction of food intake caused
by fear of weight gain
Most cases are female between ages of 12 and 18
Anorexia nervosa is physically dangerous
Most dramatic sign of anorexia is emaciation; DSM-IV-TR
criterion is body weight less than 85% of what is normal for age and
height of patient
Other criteria are intense fear of becoming fat, unrealistic body
image, and amenorrhea
There are two behavioral patterns
Restricting type refuses to eat
Binge-eating/purging type eats and then purges
Most anorexics have normal appetites, at least in early stages
of disorder
May become preoccupied with food
Collect cookbooks and prepare elaborate meals for others
Fear of obesity most typical feature of anorexia
Some see disorder as way of avoiding an adult sexual role and
pregnancy
Some view disorder as daughter's weapon against her parents,
suggesting disturbed family relationships
Bulimia Nervosa
Bulimia nervosa characterized by uncontrolled binge eating
plus compensation
Base their self-esteem on body shape
Binge often triggered by stress or unhappiness
Bulimia resembles anorexia with regard to onset and gender difference
Childhood Obesity
Rate of obesity in children and adolescence is 20%
Excess weight can contribute to physical disorders and can have
psychological consequences
Teasing by peers
Especially acute for girls
Obesity is due to combination of physiological and psychological
factors
Family routine plays role in childhood obesity
Balance of physical exercise versus television watching
Diet
Groups at Risk for Eating Disorders
Girls at greater risk for anorexia and bulimia
Cultural ideals of female attractiveness have contributed to problem
Increase in occurrence may be due to increased awareness and reporting
of disorders
Risk for eating disorders spreading to pre-teenage group
Many girls have only partial syndromes
Efforts to identify at-risk girls to prevent full-syndrome eating
disorders from developing
Elimination Disorders
Enuresis Disorder
Enuresis is lack of bladder control past age at which such
control is usual
Daytime wetting is less common and may be sign of more serious
psychological problems
Clinician decides age that separates normal accidents from enuresis
DSM-IV-TR specifies minimum age of 5 years
Wetting must occur at least twice a week
Suffering serious distress or impaired functioning
Rate of enuresis at age 5 is 7% for boys and 3% for girls; at
age 10, 3% for boys and 2% for girls
Enuresis may be of two types
Primary enuresis occurs when child has never achieved bladder
control and may last into middle childhood; may have organic abnormality
Secondary enuresis occurs when child achieves bladder control
and loses it, usually due to stress
Most enuretic children are not emotionally disturbed; emotional
problem may be result of disorder
Enuresis may cause social problems
Bed-wetting almost always clears up
Encopresis Disorder
Encopresis is lack of bowel control
May occur with enuresis, which it resembles
Can be classified as primary or secondary
More common in boys than girls
Child experiences mockery and wrath from parents
Encopresis has prevalence of 1%
Typically occurs as part of larger disorder such as disruptive
behavior disorder or part of severe family problems
Childhood Sleep Disorders
Insomnia
Most common response to stress in early childhood is insomnia
Insomnia is usually in form of difficulty falling asleep or staying
asleep
Child does not decide if problem needs treatment; parents often
see it as attention-getting behavior
Sleeping problem may have physiological cause, but most often
related to worry
Nightmares and Night Terrors
Nightmares occur more frequently in childhood than in later years
Shows no particular physiological arousal
May or may not be awakened by dream
Usually able to describe dream in detail
Occurs during REM sleeps
Less prevalent but more disturbing are sleep terrors
Child shows intense physiological arousal
Very hard to comfort
Has no memory of episode next morning
Terrors occur during first few hours of sleep in non-REM sleep
Sleepwalking (Sonambulism)
Sleepwalking is more common in young
Child falls asleep but about two hours later performs complex
action
Eyes are open and child does not bump into things
Event can last 15 seconds to 30 minutes
Child usually returns to bed
Not acting out dreams
Occurs during non-REM sleep
Usually not a serious problem
Learning and Communication Disorders
Learning Disorders (LD)
Learning disorders involves person's skill in one of three
areas substantially below what would be expected for age, education,
and intelligence of person and interferes with adjustment
Reading disorder
Disorder of written expression
Mathematics disorder
Occurrence is 5-15%, with majority of them boys
About 25% of children with conduct disorders, ADHD, and depression
also have learning disorders
Various medical conditions involve learning disorders
Many cases of learning disorders involve distortions of visual
and auditory perception
Struggle to distinguish sounds of different words or make
associations between words they hear
Perceptual problems usually occur in more than one sense system
Some children also show disturbances in memory and other cognitive
functions
Difficulties with sequential thinking and organizing thoughts
May be related to attention deficits
Children often do poorly in school and experience low self-esteem
and low motivation
Are at risk for dropping out of school
Tend to have employment problems
Groups at Risk for Learning Disorders
Boys are more likely than girls to develop learning disorders
Reading disorder occurs at equal rates in both boys and girls
Socioeconomic factors operate as well
Standardized tests may discriminate against certain groups
In the past, disproportionately higher numbers of White middle-class
children diagnosed as having learning disorder
In the past, disproportionately higher numbers of African-American
children diagnosed as mentally retarded
There is much variability in learning disorders
Children with same symptoms have different underlying disorders
Same disorders may produce different symptoms in different
children
Learning disorders can be attributed to wide range of causes
Approaches to treatment extremely varied
Communication Disorders
Delayed Speech and other Gaps in Communication
Prolonged delay in speech may be early sign of problem
Problems with articulation as in enunciation
Difficulties with expressive language in putting thoughts
into words
Difficulties with receptive language in understanding language
of others
Most serious and longer-lasting
Can be disastrous for a child in school
Special education usually necessary
Stuttering
Interruption of fluent speech through blocked, prolonged,
or repeated words, syllables, or sounds is called stuttering
Hesitant speech is most common
Persistent stuttering occurs in 1% of population and is more
common among boys
Many children outgrow stuttering
Organic theories have been proposed; problem with physical
articulation of sounds in mouth and larynx
Stuttering is probably psychogenic, with parents creating
anxiety that disturbs their speech, making them even more anxious
Disorders of Childhood and Adolescence: Theory and Therapy
Psychodynamic Perspective
Conflict and Regression
Childhood developmental disorders stem from id/impulses and
prohibitions from parents and superego
Encopresis can be interpreted as a disguised expression of
hostility
Enuresis interpreted as sign of regression
Anorexia viewed as regression
Ego psychologists view anorexia as related to adolescent's
drive for autonomy
Play Therapy
Best treatment is one that allows patient to bring to surface
and work through unconscious conflicts
Play therapy allows child to draw and play with toys
Toys used for expressing aggression
Dolls and puppets for play-acting family conflicts
Therapists interact with parents as well
Specific approach varies from therapist to therapist
The Behavioral Perspective
Inappropriate Learning
Childhood disorders stem from inadequate learning or inappropriate
learning
Inadequate learning is a failure to learn relevant cues for
performing desired behaviors
Inappropriate learning refers to reinforcement of undesirable
behavior
Relearning
Behavior therapists use entire behavioral repertoire to replace
child's maladaptive responses with adaptive responses
Classical conditioning used to treat nocturnal enuresis
Anxiety disorders can be treated using systematic desensitization
Modeling can be useful in treatment of phobias
Operant conditioning has been successful in treatment of ADHD
Token economy has been used for certain behavior disorders
Cognitive Perspective
Negative Cognitions in Children
Problem behaviors in children stem from negative beliefs,
faulty attributions, poor problem solving, and other cognitive
factors
Real trigger in depression is cognitive factors not events
Changing Children's Cognitions
Goal of cognitive therapy in ADHD is to teach how to modify
their impulsiveness through self-control skills and reflective
problem solving by using self-instructional training
Self-instructional training works well for specific tasks
Skills learned from self-instructional training may not
generalize if not carefully reinforced
Attribution retaining involves teaching children to make attributions
that are less internal, less stable, and less global
Usefulness of cognitive therapy depends greatly on age of
child
Cognitive therapy often combined with behavioral strategies
The Interpersonal Perspective
Child plays a critical role in family, and child's disorder reflects
a disturbance in family
Family psychopathology underlies many childhood disorders and
must be addressed if child's problems are to be relieved
Anorexia has been treated successfully through family therapy
Girls' families tend to be overprotective, rigid, and superficially
close
Family therapy lunch sessions used where girl is instructed
that she has won over her parents and told that she must eat to
live
The Sociocultural Perspective
Cultural patterns shape the child's disorder
There are cultural differences in expression of symptoms among
American and Thai children
To identify cause of disorders, the culture as well as the individual
should be considered
Risk for conduct disorders correlated strongly with poverty-related
factors
To address disorders, society must address those factors
Anorexia and bulimia may be influenced by culture
The Neurosciences Perspective
Childhood and adolescent disorders may have biological component
Anorexia involves both biological and psychological causes
Anorexics are hungry
Psychological factors override hunger
ADHD seems most likely to have biological basis
Most ADHD children have paradoxical response to amphetamines
Amphetamines given to normal people cause them to act like
hyperactive children
Three-fourths of ADHD children benefit from stimulants
There are side effects of Ritalin
Academic performance usually does not improve and child
must continue to be taught skills
Potential for abuse
Drugs must be prescribed with caution
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