Disorders of Childhood and Adolescences

11/20/2014
Defining Disorders of Childhood and Adolescence
Challenges
o Children are developing and changing rapidly
o Children may not communicate directly
o Often rely on parent report
o Must consider family context
Developmental Psychopathology - view abnormal behavior within
the context of normal development
Deviates from what is expected for a child at that age and in that
sociocultural context
Persistent and severe
Impairs child or others
More severe events---earlier in life; less severe events---later in life
Childhood and Adolescence
Some disorders of children childhood anxiety disorders and
childhood depression have adult counterparts
Other childhood disorders elimination disorders, for example
usually disappear or radically change form by adulthood
There also are disorders that begin in birth or childhood and persist
in stable forms into adult life
o These include autism spectrum disorder and intellectual
disability (previously called mental retardation)
Disorders Usually First Diagnosed in Infancy, Childhood, or
Adolescence
All of these chapters are gone. They are in different chapters. A lot
of chapters are integrated in other chapters
A separate chapter in DSM-IV
Mental Retardation

 Pervasive Developmental Disorders

Attention Deficit and Disruptive Behavior Disorders
Elimination Disorders
Tic Disorders
ETC
DSM 5 Changes
Disorders Usually Diagnosed in Infancy, Childhood, or Adolescence
is no longer be a separate grouping
Many disorders that were in this chapter are now integrated
throughout manual
Others are in the two chapters on the next slide ..
Disruptive, Impulse Control, and Conduct Disorders
Neurodevelopmental disorders
Autism spectrum disorders
o Aspergers syndrome is GONE!
o They rank them in autism spectrum disorder
intellectual disability (intellectual developmental disorder)
o New label to mental retardation
ADHD
Tic disorders
Etc.
Externalizing Versus Internalizing
Alternate way of conceptualizing childhood disorders often used in
research

Externalizing create difficulties for external world, failure to

conform to rules or expectations of others
o Creating problems for other people
o Conduct disorders
o Oppositional defiant disorder
o ADHD
Internalizing - affect the childs internal world, sadness or anxiety
o Anxiety
o Depression
Disruptive Mood Dysregulation Disorder (Temper Dandrums)
A new mood disorder in DSM-5 so not a lot of research
Childhood disorder (6-18 years)
Severe recurrent temper outbursts three times a week for at least
a year
Persistent irritable or angry mood between outbursts
An alternative to diagnosing bipolar disorder in children
Attention-Deficit/ Hyperactivity Disorder
Maybe it is a neurological problems
Persistent pattern of inattention and/or hyperactivity see handout
Symptoms present before age 12
Symptoms present in two or more settings
Symptoms reduce quality of functioning
Conduct Disorder

The patterns must be present for 12 months

The earlier these outcomes occur, the more severe the issues
Persistent pattern of behavior in which basic rights of others or
major societal norms are violated
Must meet 3 of 15 criteria that fall into the following areas:
aggression to people or animals, destruction of property,
deceitfulness or theft, serious violations of rules
o Physical fights
o Weapons
o Physically violence
o Forced to sexual things
o Destroying other peoples property
o Running away from home or school
Causes of Externalizing Disorders
Biological
Temperament
Some kids are born with this temperament
Genetics
Maybe inherited
Neuropsychological abnormalities
ADHD may represent minimal brain dsyfunction
Food additives and sugar
Social
Parenting styles

 Influences of media, peers

Psychological
Self control
Moral reasoning
Interventions
Empathy building
o Discriminate anothers emotional state
o Assume the perspective and role of another
o Respond emotionally to another
Anger management
o Attend to internal state
o Practice adaptive self statements
o Practice competing response
o Counter with empathy
o Think through nonviolent solutions
o Reward self for nonviolent solutions
Impulse control
Biological goal is to reduce impulsivity and hyperactivity and
improve attention
Ritalin
Adderall
Effective in about 70% of cases of ADHD at least temporarily

 Controversies and concerns

Autism Spectrum Disorder
In DSM 4, there were 2 categories:
o Autistic Disorder
Defined in 1943 by Kanner
o Aspergers Disorder
Defined in 1944 by Asperger
DSM 5 both have been combined in autism spectrum disorder
Autism Spectrum Disorder: Key Features
Impairment in social communication and interaction
o Echolalia echoing everything you say to them
o You: Hey john
o The child: (Repeats) Hey John
Restrictive, repetitive, and stereotyped patterns of behavior,
interests, or activities
o No variability in kids
o Lack of imagination
o They do not engage in things other kids do
o They are rocking back and forth
Symptoms must be present from early childhood
o The symptoms had to be present before age 3
o Sometimes from birth Response as a kid is weird (no
responsive)

 Symptoms cause impairment in functioning

Autism spectrum disorder: severity
Specify severity for both A and B
o Level 1 Requiring support
o Level 2 Requiring substantial support
o Level 3 requiring very substantial support
Also specify: With or without accompanying intellectual impairment,
with or without accompanying language impairment
Treatment = Behavior intervention
Reinforcement for good behaviors
Ignorance for bad behaviors
Autism Spectrum Disorder: Some Facts
Prevalence on rise in recent years
Rise to theories regarding environmental causes e.g., vaccines
Do poorly on IQ tests
29%- mild to moderate impairment
42%- severe impairment
Best predictor of outcome IQ and language development before
age 6
Video of Ricky:
As a child, he was more spontaneous and active
Long term, as an adult, he is robotic, and lost most of his skills
Autism Spectrum Disorder: Causal Factors

Bettleheim: refrigerator parents

o Psychological disorder caused by the parents
o Canner identified autism (signs of symptoms) and described
the parents as being cold, distant people who could not
respond to their expectations
o No research for this theory so it can be wrong
Theory of the Mind: Sally Ann Task
o The kids with autism cannot get the perspective of another
person. They will say that the marble is in Anns box rather
than in Sallys basket. They cannot understand another
persons perspective.
Biological factors
o Genetic factors: families with one child with autism have a
3%-5% chance of having another child with that disorder
o Neurological abnormalities: e.g., cerebellum
They might have smaller cerebellum
o Not really biological factors and it is not consistent
Treatment Approaches
Behavioral modification Lovaas
o Material cue (food) with social cue (smile and kiss)
o Will these reinforcement work at home and in school?
Emphasis on teaching adaptive behavior and communication skills
o Shaping
o Reinforcement
Intellectual Disability (Intellectual Developmental Disorder)
Deficits in intellectual functioning (must be confirmed by clinical
assessment and individualized, standardized intelligence testing)
Deficits in adaptive functioning

 Onset during developmental period (before age 18)

Intellectual Disability
Levels of severity
o Mild
50-70
85%
o Moderate
35-49
10%
o Severe
20-34
3-4%
o Profound
below 20 1-2%
Causes
o Chromosomal abnormality: Downs syndrome
o Genetic: Fragile X syndrome, PKU
o Prenatal factors
o Cultural-familial
Education: mainstreaming
o Keep the kids in mainstream of life
o Some kids need to be in special classes, they need extra help
because you need to the kid in mainstream. They need to be
interacting with reality and normal people.