Disorders of Childhood and Adolescence - Abnormal Psychology - Lecture Slides, Slides of Abnormal Psychology

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Disorders of Childhood and Adolescence docsity.com Pe é Ug Com: 1@ public via’ aelevision and azities, file suffer ror Som mental courte of eer experie 96 100), Concerns. about the éverptes “a spears tea veo efforts to prohibit msl pending requiring, ofsin some cases, € éven & of ac ch id bal cing. seats at 5 DEcr ed: giildten rathe! than with: ai fs ae Pop aes, ee Es agg OP teed ee de ead taBLe 15.1 DISORDERS CHART PERVASIVE bye mel Sa DISORDER Autistic Disorder © Qualitative impairment in social interaction and communication ¢ Restricted, stereotyped interest and activities © Delays or abnormal functioning in one of the above major areas before the age of three PREVALENCE About 0.2% of children; affects more boys than girls AGE OF ONSET Early childhood As many as 75% have low !Q; lack of speech and/or social withdrawal common; prognosis poor Pervasive ¢ Severe and pervasive impairment Developmental in reciprocal social interaction or Disorder Not restricted, stereotyped interests Otherwise Specified — * Does not fully meet onset age, specific behavior pattern, or other criteria for any specific pervasive developmental disorder 0.3% of children Varies in childhood Varies depending on uniqueness of the disorder Rett Syndrome ¢ Normal development for at least five months/onset between 5 and 48 months Deceleration of head growth © Loss of previously acquired movements and development of stereotyped hand movements * Loss of social engagement ¢ Appearance of poorly coordinated movements Marked delay and impairment in language S About .01% of children; diagnosed almost exclusively in females; often classified as form of autism 6 to 18 months Generally lifelong, with marked delay in cognitive, language, and social skills docsity.com Childhood Disintegrative Disorder Normal development for at least two years Loss of previously acquired skills in two or more areas: language, social skills, bowel or bladder control, play, or motor skills Qualitative impairment in social interaction and communication Restricted, stereotyped interest and activities About .002%; often classified as form of autism Normal development for at least two years; loss occurs between 2 and 10 years Normal development during first two years of life followed by disintegration of social, verbal, and motor skills Asperger's Syndrome Qualitative impairment in social interaction Repetitive, stereotyped interest and activities No significant delay in language No delay in cognitive development (appropriate self-help skills, adaptive behaviors, and curiosity) 0.1%; affects many more boys than girls Early childhood Impairment in social skills and emotional reciprocity; does not seem to affect language and cognitive development docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders • Autistic Disorder: Qualitative impairment in: – Social interaction and/or communication. • Appears to view other people as just another object. – Restricted, stereotyped interest and activities – Delays or abnormal functioning in a major area prior to age 3 – Prevalence: 1:1,000 children, 4-5 times more likely in boys than in girls • ~ 75% have IQ below 70, ~20% are average or above (splinter skills and autistic savants). docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders Impairments • Research on social unresponsiveness and unusual communication patterns lends support to clinical observations in some areas: –Autistic children are more interested in inanimate objects than in humans. –Autistic infants don’t engage in social gazing or in pretend play. –Unable to attribute mental states to others or understand thoughts/feelings of others. • Are brutally honest and don’t understand humor. docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders Impairments • Verbal and Nonverbal Communication –About 50% of autistic children do not develop meaningful speech. –Oddities such as echolalia often present. –Reversal of pronouns common, I instead of me or you instead of I. docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders Impairments • Activities and Interests –Unusual repetitive habits or interests. –May show intense interest in self-produced sounds. –Minor changes in the environment can produce tantrums or rages. – Show a lack of imaginary activities. docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders • Childhood Disintegrative Disorder: Autistic-like symptoms after at least two years of normal development. • Rett’s Disorder (only occurs in females): –Onset between 5-48 months, after initially normal development –Deceleration of head growth, loss of purposeful hand skills replaced by stereotyped hand movements, severely impaired language development, loss of social interaction skills. docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders • Pervasive Developmental Disorder Not Otherwise Specified: –Pervasive and severe impairment in reciprocal social interactions, communication abnormalities and limited interests/activities. –Atypical for age of onset/specific behavior patterns docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders Autistic Disorders • Etiology: – Familial autism –Autism related to medical condition –Autism associate with nonspecific brain dysfunction –Autism without family history or associated brain dysfunction docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders Autistic Disorders • Explanations: –Central Nervous System Impairment: • Brain dysfunction could be inherited. • Children with autism have higher rates of other chromosomal malfunctions (i.e. pku). • ¼ to 1/3 of those with autism also have seizures. • Certain brain structure differences found but no consistent pattern of differences found. docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders Autistic Disorders docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders Autistic Disorders • Explanations: –Mirror Neuron System Impairment: • The mirror neuron system (MNS) theory of autism hypothesizes that distortion in the development of the MNS interferes with imitation and leads to autism's core features of social impairment and communication difficulties. docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders Autistic Disorders • Explanations: –Mercury as a cause • Vaccines often contain high levels of mercury as a stabilizing agent. • Pregnant mothers that eat a lot of fish that are high in mercury? –WiFi might disrupt the formation of an efficient neural network in the developing brain. docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders Autistic Disorders • Screening: Parents are usually the first to notice unusual behaviors in their child. • As postponing treatment may affect long-term outcome, any of the following signs is reason to have a child evaluated by a specialist without delay: – No babbling by 12 months. – No gesturing (pointing, waving goodbye, etc.) by 12 months. – No single words by 16 months. – No two-word spontaneous phrases by 24 months. – Any loss of any language or social skills, at any age. docsity.com Disorders of Childhood and Adolescence Pervasive Developmental Disorders Autistic Disorders • Treatment: – Difficult to treat due to communication/social impairments. – Some limited success with: Parents, family therapy, drug therapy, and behavior modification. – Asperger’s: Verbally mediated therapies – Drug therapy: Antipsychotics, secretin – Behavior modification to decrease harmful behaviors and increase appropriate behaviors. docsity.com Disorders of Childhood and Adolescence Other Developmental Disorders • Childhood disorders: Vague, arbitrary interpretations of deviation from “norm”. – Cultural factors play a role in determinations – Common disorders: • Attention Deficit/Hyperactivity Disorders • Disruptive Disorders • Separation-Anxiety Disorders • Tic Disorders • Reactive Attachment Disorder • Elimination Disorders docsity.com Behavioral Symptoms Reported by Teachers of Children in Four Countries docsity.com Disorders of Childhood and Adolescence Other Developmental Disorders • Problems with diagnosis: –Difference between normal/abnormal may be a matter of degree. – “Abnormal” behavior may be a child’s adaptation to a difficult situation. –Diagnostic guidelines are vague and depend on “clinical judgment”. – Judgment of whether a problem exists is “in the eye of the beholder”. –Diagnosis becomes a label. docsity.com Disorders of Childhood and Adolescence Attention Deficit/Hyperactivity Disorders • Attention Deficit Hyperactivity Disorder: Socially disruptive behaviors (attentional problems or hyperactivity) present before age 7 and persist for at least 6 months. • Three types: – predominantly hyperactive-impulsive – predominantly inattentive – combined • Prevalence: 3-7% of school-aged children, more in boys than in girls • Persists through adolescence; 30-50% continue with symptoms into adulthood docsity.com Disorders of Childhood and Adolescence Attention Deficit/Hyperactivity Disorders I. Either A or B: A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level: Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. Often has trouble keeping attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). Often has trouble organizing activities. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools). Is often easily distracted. Often forgetful in daily activities. B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: Often fidgets with hands or feet or squirms in seat. Often gets up from seat when remaining in seat is expected. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless). Often has trouble playing or enjoying leisure activities quietly. Is often "on the go" or often acts as if "driven by a motor". Often talks excessively. Impulsiveness Often blurts out answers before questions have been finished. Often has trouble waiting one's turn. Often interrupts or intrudes on others (e.g., butts into conversations or games). II. Some symptoms that cause impairment were present before age 7 years. III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home). IV. There must be clear evidence of significant impairment in social, school, or work functioning. V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder). docsity.com Disorders of Childhood and Adolescence Attention Deficit/Hyperactivity Disorder • Etiology: –Neurological/central nervous system docsity.com Disorders of Childhood and Adolescence Attention Deficit/Hyperactivity Disorder • Etiology: – Based on the fact that stimulant medications have been used effectively to treat ADHD, it is believed that the disorder may be caused by inadequate levels of dopamine in the central nervous system. docsity.com Disorders of Childhood and Adolescence Attention Deficit/Hyperactivity Disorder • Treatment: – Drug therapy (controversial) • 75-90% of children with ADHD respond positively to stimulant medication (mainly Ritalin). • Treats symptoms rather than causes. • Direct effects on the school achievement of ADHD children are seldom seen. – Family dynamics/child management • If behavior is a response to environment, then… – Optimal: Medication plus behavioral treatment. docsity.com Disorders of Childhood and Adolescence Oppositional Defiant Disorder • Oppositional Defiant Disorder: Pattern of negativistic, argumentative, and hostile behavior in which the child often: – Loses temper – Argues with adults – Defies or refuses adult requests – Refuses to take responsibility for actions, anger, resentment, blaming others, and spiteful/ vindictive behavior – However, no serious violations of others’ rights – Associated with parent-child conflict docsity.com Disorders of Childhood and Adolescence Conduct Disorders • Two types: – Childhood-onset (at least one conduct problem before age 10) • Higher chronicity, more serious, poor prognosis. • Greater risk for adult antisocial personality disorder and criminal behavior. – Adolescent-onset (conduct problem first occurs after age 10) • Also display internalizing symptoms (withdrawal, depression) docsity.com Sociocultural Dimension + Large family size * Crowding CONDUCT + Gender differences DISORDERS + Poverty docsity.com Disorders of Childhood and Adolescence Conduct Disorders • Etiology: – Psychodynamic: Anxiety conflict from inadequate relationship with parents . – Biological: Genetic factors – Behavioral: Ineffective punishment of misbehavior: • Lack of parental monitoring. • Inconsistent disciplinary practices. • Failure to use positive management techniques or teach social process skills. • Failure to teach academic success skills. docsity.com Disorders of Childhood and Adolescence Anxiety Disorders • Exaggerated autonomic responses and apprehensiveness in new situations • Internalizing, overcontrolled disorders • Good prognosis, often spontaneous • Separation Anxiety Disorder (SAD): Excessive anxiety over separation from parents and home at least 4 weeks, prior to age 18; includes school phobia. – Psychodynamic: Overdependence on mother – Learned behavior – Cognitive-behavioral treatment effective – Medication sometimes used docsity.com Disorders of Childhood and Adolescence Reactive Attachment Disorder • Reactive Attachment Disorder: Extreme disturbance in relating to others socially. – Inhibited Type: Difficulty with age-appropriate responding or initiation of social interactions. – Disinhibited Type: Socializes easily but indiscriminately, may become superficially attached to strangers or casual acquaintances. – History of circumstances in which child’s physical or emotional needs affecting formation of attachments were not met (e.g., abuse, repeated changes in primary caregiver). docsity.com Disorders of Childhood and Adolescence Mood Disorders • 2-7% of children and adolescents (as early as infancy) may have depressive disorders. • More prevalent in adolescence and for females • Similar characteristics as adults but more negative self- concepts, self-blame, self-criticism; bipolar children have more rapid cycling. • Link to child abuse • Treatments: Social skills training, cognitive behavioral therapy, family therapy, supportive family therapy, medication docsity.com Disorders of Childhood and Adolescence Tic Disorders • Etiology and treatment: –Biological: • Genetic transmission (multigenerational families; link with ADHD and OCD) • Cortical differences • CNS impairment in dopamine system • Treatments: Medication, psychosurgery docsity.com Disorders of Childhood and Adolescence Elimination Disorders • Enuresis: A child at least 5 years old urinates during the day or night into his/her clothes or bed, or on the floor, at least twice weekly for at least 3 months. –Prevalence: 5-10% of 5-year olds, 3-5% of 10- year-olds, 1% into adulthood – Etiology: Psychological stressors and/or biological determinants (e.g., delayed maturation of urinary tract). – Treat with medications and/or behavioral methods docsity.com Disorders of Childhood and Adolescence Elimination Disorders • Encopresis: A child at least 4 years old defecates in his/her clothes, on the floor, or other inappropriate places at least once a month for at least 3 months (NOT due to laxative use) – Prevalence: 1% grade school children, more boys than girls – Associated with functional constipation, plus social problems, ostracism, rejection – Treat with medical evaluation, behavioral and family therapies, education about toileting regimens and well- organized bowel management program. docsity.com Learning Disorders • Treatment: – Are lifelong and do not simply go away with treatment – Teaching skills that capitalize on abilities and strengths docsity.com Mental Retardation • Mental Retardation: Significant subaverage general intellectual functioning accompanied by deficiencies in adaptive behavior, with onset before age 18. • Movement away from institutionalization of retarded individuals: – 75% of mentally retarded children can become completely self-supporting adults if given appropriate education and training. docsity.com Diagnosing Mental Retardation • DSM-IV-TR criteria: – Significant subaverage general intellectual functioning (IQ score of 70 or less). –Concurrent deficiencies in adaptive behavior (social and daily living skills, lower degree of independence than expected for age). –Onset before age 18 (with onset after age 18 it would be considered dementia). docsity.com Issues Involved in Diagnosing Mental Retardation • Cultural Bias –Is the test based on a particular culture such that people not familiar with the culture are at a disadvantage? –By this definition - yes, IQ tests are biased. • It is very difficult (if not impossible) to construct a culture-free test. docsity.com Issues Involved in Diagnosing Mental Retardation • Predictive Bias – Is the test more predictive of future behavior for some groups and not for others? – This is a statistical definition of bias. – IQ are not biased in terms of their ability to predict equally well for all groups. – They have predictive validity for all groups -- equally good predictive ability for school performance and for job performance across groups. – If we define fairness in terms of predictive bias, IQ tests are not biased. docsity.com Levels of Retardation • DSM-IV-TR classifications: –Mild: IQ score 50-55 to 70 –Moderate: IQ score 35-40 to 50-55 – Severe: IQ score 20-25 to 35-40 –Profound: IQ score below 20-25 • AAMR considers limitations in intellectual and adaptive skills – Focuses on adaptive functioning docsity.com TABLE i 5.6 PREDISPOSING FACTORS ASSOCIATED WITH MENTAL RETARDATION FACTOR PERCENTAGE OF CASES EXAMPLES Heredity 5 Errors of metabolism (Tay-Sachs), single gene abnormalities (tuberous sclerosis), chromosome aberrations (translocation Down syndrome, fragile X syndrome) Alteration of embryonic development 30 Chromosomal changes (Down syndrome, trisomy 21), prenatal damage due to toxins (fetal alcohol syndrome), infections Pregnancy and perinatal complications 10 Malnutrition, prematurity, hypoxia, traumas, infections Infancy or childhood medical conditions 5 Traumas, infections, lead ingestion Environmental influences and other 15-20 Social, linguistic, and nurturance deprivation; severe mental conditions mental disorders (autistic disorder) Etiology unknown 30-40 Etiological factors cannot be identified e docsity.com Etiology of Mental Retardation • Genetic factors: Normal genetic variation and genetic abnormalities: – Fragile X Syndrome (affects higher control processes) – Down Syndrome: Condition produced by the presence of an extra chromosome (trisomy 21) resulting in mental retardation and distinctive physical characteristics • Prevalence: 1:1,000, but increases as mother’s age at birth increases docsity.com Rate of Down Syndrome Births 120 Rate (per 10,000) a ow oO SoS 6 6 a ° i) o <20 20-24 25-29 30-34 35-39 >39 Maternal age (years) =~ White American —— African American —— Hispanic American (B docsity.com Etiology of Mental Retardation • Nongenetic biological factors (perinatal): –Birth trauma, prematurity, asphyxiation, low birth weight • Nongenetic biological factors (postnatal): –Head injuries (often resulting from child abuse), infections, tumors, malnutrition, ingestion of toxic substances (e.g., lead) • Most common birth condition associated with mental retardation: Prematurity and low birthweight docsity.com Programs for People with Mental Retardation • Early interventions (e.g. Head Start) • School services: –Modified regular classroom assignments and direct instructions to teach learning skills – Special education programs • Employment programs docsity.com Programs for People with Mental Retardation • Living arrangements: –Group homes and independent/semi- independent living within the community are replacing institutionalization – “Least restrictive environment” – Living with one’s own family docsity.com