Psychological problems in childhood & adolescence

1. Psychological problems in childhood & adolescence

2. A few details……... CONTACTING ME: • Dr Sue Jackson • Room 514 Easterfield • Ext 8232 • sue.jackson@vuw.ac.nz • Office hours: Mon, 10.00-11.00, Thurs 4.00-5.00 or make an appt.

3. COURSE OVERVIEW • Classification & models • Classification & models • Child Abuse • Childhood Anxiety: PTSD • Attention Deficit Hyperactivity Disorder • Conduct Disorder in Adolescence • Depression in Adolescence • Anorexia in Adolescence • Approaches to therapy with children & adolescents • Review

4. THE READINGS • ESSENTIAL: • Readings on closed reserve in library • SUPPLEMENTARY: • Carr, A. (1999). The handbook of child and adolescent clinical psychology. London: Routledge

5. THE TEST • ……..will cover all of child/adolescent lectures up and including August 2nd • ……..will be short answers • ……..will be preceded by a review lecture

6. Today’s Lecture Questions • What is the history of clinical child psychology? • What is the Diagnostic and Statistics Manual (DSM)and how does it categorise problems of childhood and adolescence? • How useful is the DSM for psychological problems of childhood and adolescence? • What alternatives are there to the medical model on which DSM is based?

7. Some history…….. • Discipline of clinical child psychology dates to 1896 • Lightner Witner- first psychological clinic for children in USA 1896 • ADHD- 100 years old- Still (1902) ,a doctor, misbehaviour due to biological and moral “defects” • Conduct Disorder- roots in juvenile delinquency, end of C19th youth crime differentiated from adult crime

8. Freud and the case of little Hans (1909) Diagnosis by letter Hans, five, developed fear of horses Freud interpreted as fear of dad and sexual desire for mother Famous early child case studies

9. John Watson (1920) Baby Albert- 11 months Rat (unknown age) Conditioned fear of rats in Albert If Albert alive today, probably still be rat phobic Little Albert

10. THE DSM • DSM-1- two separate diagnoses for children (1952) • DSM-II (1968) seven diagnoses • DSM-III (1980) 40 diagnoses • DSM-IV-R 50 and still rising • Are children more psychologically disturbed than they were or are there other reasons for the rising number of problem?

11. DSM and the production of mental health problems • DSM & mental illness as socially constructed-some examples: • Historical: mental illness possession by devils, ‘draeoptomania’, illness of the slaves • Social: homosexuality a mental disorder until late 1980s • Cultural: ‘hallucinations’ may be of spiritual significance • Mental illness as a “business” , diagnoses as a basis for service provision and for drug prescription

12. Disorders first diagnosed in infancy, childhood or adolescence: Mental retardation Learning disorders Motor skill disorders Communication disorders Pervasive developmental disorders Attention deficit and disruptive behaviour Feeding and eating disorders Tic disorders Elimination disorders- enuresis, encopresis Other- separation anxiety, mutism, reactive attachment disorder DSM Child/Adolescent Disorders

13. Child disorders classified with adult disorders • Mood- in children unipolar depression only • Anxiety- generalised, obssessive-compulsive, PTSD • Dissociative disorders -disrupted integration memory, identity, consciousness • Eating disorders

14. How useful is DSMIV for children & adolescents? 1.Reliability • Clinician agreement on diagnosis poor e.g.: Conduct Disorder .62 Depression .62 Anxiety .52 ADHD .52 2.Validity • Significant overlap in factors that contribute to onset of problems (low validity)

16. How useful is DSMIV for children & adolescents? 3. Co-morbidity Community based studies (cited Carr) • CD and ADHD 23.3% and Major Depression 16.9% and anxiety disorders 14.8% • ADHD and Major Depression 10.5% and Anxiety Disorders 11.8% • Anxiety and Major Depression 16.2%

17. How useful is DSMIV for children & adolescents? 4. Categorical approach • “got it, ain’t got it” categorical approach doesn’t address social contexts/interactions 5. Ethical problems • pathologising young people, stigmatisation 6. “Adultmorphism” • failure to incorporate developmental perspective • criteria of subjective distress and impairment in functioning often not applicable (Anna Freud)

18. How useful is DSMIV for children & adolescents? 7. Gender bias • 21 childhood disorders, 17 more common in boys (girls>internalisng, boys>externalisng) • Conduct disorder- criteria > specific to boys e.g. sexual behaviour • Different patterns for CD in boys and girls 8. Misdiagnosis is a significant problem • Particularly due to comorbidity, developmental factors

19. Dimensional model • Externalising behaviours – aggression, non-compliance, drug abuse (relate to more conduct type problems, ADHD, ODD) • Internalising behaviours- crying, worrying, withdrawal (relate to anxiety, depression)

20. Construction of dimensions: Child Behaviour Checklist • Achenbach the author of CBCL • Collection of behaviours from case studies and literature to form CBCL (118 items) • 1800 parents of clinic children completed CBCL • Factor analysis leading to narrow band syndromes-e.g. wirhdrawn, aggression • Grouping of narrow band into wide band- internalising and externalising • Norms on 1400 non clinical children • Cut-off scores for children outside normal range-clinical

21. Critique • Continuum- links ‘normal’ development to problems with extreme points on continuum leading to referral • Doesn’t account for more specific problems like autism, toileting problems, eating disorders • Problems around agreement parent/teacher/child reports and subjectiveness of each- parents/teachers tend to be better informants for externalising problems, children better for internalising problems

22. Today’s Lecture Questions • At this point you should have some idea of how to answer them. • Doing the readings should help you expand your knowledge a little more.