Chapter 17

1. Slides & Handouts by Karen Clay Rhines, Ph.D. Seton Hall University Chapter 17 Disorders of Childhood and Adolescence Comer, Abnormal Psychology, 6e – Chapter 17

2. Disorders of Childhood and Adolescence • Abnormal functioning can occur at any time in life • Some patterns of abnormality, however, are more likely to emerge during particular periods Comer, Abnormal Psychology, 6e – Chapter 17

3. Childhood and Adolescence • Theorists often view life as a series of stages on the road from birth to death • Freud proposed that each child passes through the same five stages of psychosexual development: oral, anal, phallic, latency, and genital • Erikson added the stage of “old age” • Although theorists may disagree with the details of these schemes, most agree with the idea that we face key pressures during each stage in life and either grow or decline depending on how we meet those pressures Comer, Abnormal Psychology, 6e – Chapter 17

4. Childhood and Adolescence • People often think of childhood as a carefree and happy time – yet it can also be frightening and upsetting • Children of all cultures typically experience at least some emotional and behavioral problems as they encounter new people and situations • Surveys indicate that worry is a common experience • Bedwetting, nightmares, and temper tantrums are other problems experienced by many children Comer, Abnormal Psychology, 6e – Chapter 17

5. Childhood and Adolescence • Adolescence can also be a difficult period • Physical and sexual changes, social and academic pressures, personal doubts, and temptation cause many teenagers to feel anxious, confused, and depressed Comer, Abnormal Psychology, 6e – Chapter 17

6. Childhood and Adolescence • Along with these common psychological difficulties, at least one-fifth of all children and adolescents in North America also experience a diagnosable psychological disorder • Boys with disorders outnumber girls with disorders, even though most of the adult psychological disorders are more common in women Comer, Abnormal Psychology, 6e – Chapter 17

7. Childhood and Adolescence • Certain disorders of children – childhood anxiety disorders and childhood depression – have adult counterparts • In contrast, other childhood disorders – conduct disorders, ADHD, and 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 • These include mental retardation and autism Comer, Abnormal Psychology, 6e – Chapter 17

8. Oppositional Defiant Disorder and Conduct Disorder • Children consistently displaying extreme hostility and defiance may qualify for a diagnosis of oppositional defiant disorder • This disorder is characterized by repeated arguments with adults, loss of temper, anger, and resentment • Children with this disorder ignore adult requests and rules, try to annoy people, and blame others for their mistakes and problems • Approximately 8% of children qualify for this diagnosis • The disorder is more common in boys than girls before puberty but equal in both sexes after puberty Comer, Abnormal Psychology, 6e – Chapter 17

9. Oppositional Defiant Disorder and Conduct Disorder • Children with conduct disorder, a more severe problem, repeatedly violate the basic rights of others • They are often aggressive and may be physically cruel and violent • Many steal from, threaten, or harm their victims, committing such crimes as shoplifting, vandalism, mugging, and armed robbery Comer, Abnormal Psychology, 6e – Chapter 17

10. Oppositional Defiant Disorder and Conduct Disorder • Conduct disorder usually begins between 7 and 15 years of age • Around 10% of children, three-quarters of them boys, qualify for this diagnosis • Children with a mild conduct disorder may improve over time, but severe cases frequently continue into adulthood • These cases may turn into antisocial personality disorder or other psychological problems Comer, Abnormal Psychology, 6e – Chapter 17

11. Oppositional Defiant Disorder and Conduct Disorder • Many clinical theorists believe that there are actually several kinds of conduct disorder • One term distinguishes four patterns: • Overt-destructive • Overt-nondestructive • Covert-destructive • Covert-nondestructive • Some individuals display only one of these patterns, while others display a combination of them • It may be that the different patterns have different causes Comer, Abnormal Psychology, 6e – Chapter 17

12. Oppositional Defiant Disorder and Conduct Disorder • Other researchers distinguish yet another pattern of aggression found in certain cases of conduct disorder – relational aggression – in which individuals are socially isolated and primarily display social misdeeds • Relational aggression is more common in girls than boys Comer, Abnormal Psychology, 6e – Chapter 17

13. Oppositional Defiant Disorder and Conduct Disorder • More than one-third of boys and one-half of girls with conduct disorder also display attention-deficit/hyperactivity disorder (ADHD) • In most cases, ADHD is believed to precede and help cause the conduct disorder Comer, Abnormal Psychology, 6e – Chapter 17

14. Oppositional Defiant Disorder and Conduct Disorder • Many children with conduct disorder also experience depression • In such cases, the conduct disorder typically precedes the onset of depressive symptoms • This combination of symptoms places the individual at higher risk for suicide Comer, Abnormal Psychology, 6e – Chapter 17

15. Oppositional Defiant Disorder and Conduct Disorder • Many children with conduct disorder are suspended from school, placed in foster homes, or incarcerated • When children between the ages of 8 and 18 break the law, the legal system often labels them juvenile delinquents Comer, Abnormal Psychology, 6e – Chapter 17

16. What Are the Causes of Conduct Disorder? • Cases of conduct disorder have been linked to genetic and biological factors, drug abuse, poverty, traumatic events, and exposure to violent peers or community violence • They have most often been tied to troubled parent-child relationships, inadequate parenting, family conflict, marital conflict, and family hostility Comer, Abnormal Psychology, 6e – Chapter 17

17. How Do Clinicians Treat Conduct Disorder? • Because disruptive behavior patterns become more locked in with age, treatments for conduct disorder are generally most effective with children younger than 13 • A number of interventions have been developed but no one of them alone is the answer for this difficult problem • Given that conduct disorder affects all spheres of a child’s life, today’s clinicians are increasingly combining several approaches into a wide-ranging treatment program Comer, Abnormal Psychology, 6e – Chapter 17

18. How Do Clinicians Treat Conduct Disorder? • Sociocultural Treatments • Given the importance of family factors in conduct disorder, therapists often use family interventions • One such approach is called parent-child interaction therapy • A related family intervention is videotape modeling • When children reach school age, therapists often use a family intervention called parent management training • These treatments often have achieved a measure of success Comer, Abnormal Psychology, 6e – Chapter 17

19. How Do Clinicians Treat Conduct Disorder? • Sociocultural Treatments • Other sociocultural approaches, such as residential treatment in the community and programs at school, have also helped some children improve • One such approach is treatment foster care • In contrast to these other approaches, institutionalization in “juvenile training centers” has not met with much success and may, in fact, strengthen delinquent behavior Comer, Abnormal Psychology, 6e – Chapter 17

20. How Do Clinicians Treat Conduct Disorder? • Child-Focused Treatments • Treatments that focus primarily on the child with conduct disorder, particularly cognitive-behavioral interventions, have achieved some success in recent years • In problem-solving skills training, therapists combine modeling, practice, role-playing, and systematic rewards Comer, Abnormal Psychology, 6e – Chapter 17

21. How Do Clinicians Treat Conduct Disorder? • Child-Focused Treatments • Another child-focused approach, Anger Coping and Coping Power Program, has children participate in group sessions that teach them to manage anger more effectively • Studies indicate that these approaches do reduce aggressive behaviors and prevent substance use in adolescence • Recently, drug therapy also has been used Comer, Abnormal Psychology, 6e – Chapter 17

22. How Do Clinicians Treat Conduct Disorder? • Prevention • It may be that the greatest hope for reducing the problem of conduct disorder lies in prevention programs that begin in early childhood • These programs try to change unfavorable social conditions before a conduct disorder is able to develop Comer, Abnormal Psychology, 6e – Chapter 17

23. Attention-Deficit/Hyperactivity Disorder • Children who display attention-deficit/hyperactivity disorder (ADHD) have great difficulty attending to tasks or behave overactively and impulsively, or both • The primary symptoms of ADHD may feed into one another, but often one of the symptoms stands out more than the other Comer, Abnormal Psychology, 6e – Chapter 17

24. Attention-Deficit/Hyperactivity Disorder • Problems common to the disorder: • Learning or communication problems • Poor school performance • Difficulty interacting with other children • Misbehavior, often serious • Mood or anxiety problems Comer, Abnormal Psychology, 6e – Chapter 17

25. Attention-Deficit/Hyperactivity Disorder • Around 5% of schoolchildren display ADHD, as many as 90% of them boys • Those whose parents have had ADHD are more likely than others to develop it • The disorder usually persists through childhood but many children show a lessening of symptoms as they move into adolescence • Between 35% and 60% continue to have ADHD as adults Comer, Abnormal Psychology, 6e – Chapter 17

26. What Are the Causes of ADHD? • Clinicians generally consider ADHD to have several interacting causes, including: • Biological causes, particularly abnormal dopamine activity • High levels of stress Comer, Abnormal Psychology, 6e – Chapter 17

27. What Are the Causes of ADHD? • Sociocultural theorists also point out that ADHD symptoms and a diagnosis of ADHD may themselves create interpersonal problems and produce additional symptoms in the child • Three other explanations have received considerable press: • ADHD is typically caused by sugar or food additives • ADHD results from environmental toxins such as lead • Excessive exposure to television can contribute to ADHD Comer, Abnormal Psychology, 6e – Chapter 17

28. How Do Clinicians Assess ADHD? • ADHD is a difficult disorder to assess • Ideally, the child’s behavior should be observed in several environmental settings because symptoms must be present across multiple settings in order to meet DSM-IV-TR’s criteria • It also is important to obtain reports of the child’s symptoms from their parents and teachers Comer, Abnormal Psychology, 6e – Chapter 17

29. How Is ADHD Treated? • There is heated disagreement about the most effective treatment for ADHD • The most common approach has been the use of stimulant drugs such as methylphenidate (Ritalin) • These drugs have a quieting effect on as many as 80% of children with ADHD and sometimes increase their ability to solve problems, perform in school, and control aggression • However, some clinicians worry about the possible long-term effects of the drugs Comer, Abnormal Psychology, 6e – Chapter 17

30. How Is ADHD Treated? • Behavioral therapy is also applied widely in cases of ADHD • Parents and teachers learn how to apply operant conditioning techniques to change behavior • These treatments have often been helpful, especially when combined with drug therapy Comer, Abnormal Psychology, 6e – Chapter 17

31. How Is ADHD Treated? • Because children with ADHD often display other (comorbid) psychological disorders as well, researchers have further tried to determine which treatments work best for different combinations of disorders Comer, Abnormal Psychology, 6e – Chapter 17

32. The Sociocultural Landscape: ADHD and Race • Race seems to come into play with regard to ADHD • A number of studies indicate that African American and Hispanic American children with significant attention and activity problems are less likely than white American children to be assessed for ADHD, receive an ADHD diagnosis, or undergo treatment for the disorder • Those who do receive a diagnosis are less likely than white children to be treated with the interventions that seem to be of most help Comer, Abnormal Psychology, 6e – Chapter 17

33. The Sociocultural Landscape: ADHD and Race • In part, racial differences in diagnosis and treatment are tied to economic factors • A growing number of clinical theorists further believe that social bias and stereotyping may contribute to the racial differences seen in diagnosis and treatment Comer, Abnormal Psychology, 6e – Chapter 17

34. The Sociocultural Landscape: ADHD and Race • While many of today’s clinical theorists correctly alert us that ADHD may be generally overdiagnosed and overtreated, it is important that they also recognize that children from certain segments of society may, in fact, be underdiagnosed and undertreated Comer, Abnormal Psychology, 6e – Chapter 17

35. Elimination Disorders • Children with elimination disorders repeatedly urinate or pass feces in their clothes, in bed, or on the floor • They have already reached an age at which they are expected to control these bodily functions • These symptoms are not caused by physical illness Comer, Abnormal Psychology, 6e – Chapter 17

36. Enuresis • Enuresis is repeated involuntary (or in some cases intentional) bedwetting or wetting of one’s clothes • It typically occurs at night during sleep but may also occur during the day • The problem may be triggered by a stressful event • Children must be at least 5 years of age to receive this diagnosis • Prevalence of enuresis decreases with age Comer, Abnormal Psychology, 6e – Chapter 17

37. Enuresis • Research has not favored one explanation for the disorder over others • Psychodynamic theorists explain it as a symptom of broader anxiety and underlying conflicts • Family theorists point to disturbed family interactions • Behaviorists often view it as the result of improper toilet training • Biological theorists suspect that the physical structure of the urinary system develops more slowly in some children Comer, Abnormal Psychology, 6e – Chapter 17

38. Enuresis • Most cases of enuresis correct themselves without treatment • Therapy, particularly behavioral therapy, can speed up the process Comer, Abnormal Psychology, 6e – Chapter 17

39. Encopresis • Encopresis –repeatedly defecating in one’s clothing – is less common than enuresis and less well researched • The problem: • Is usually involuntary • Seldom occurs during sleep • Starts after the age of 4 • Is more common in boys than girls Comer, Abnormal Psychology, 6e – Chapter 17

40. Encopresis • Encopresis causes intense social problems, shame, and embarrassment • Cases may stem from stress, constipation, improper toilet training, or a combination of all three • The most common treatments are behavioral and medical approaches, or combinations of the two • Family therapy has also been helpful Comer, Abnormal Psychology, 6e – Chapter 17

41. Long-Term Disorders That Begin in Childhood • Two of the disorders that emerge during childhood are likely to continue unchanged throughout a person’s life: • Pervasive developmental disorders • Mental retardation • Clinicians have developed a range of treatment approaches that can make a major difference in the lives of people with these problems Comer, Abnormal Psychology, 6e – Chapter 17

42. Pervasive Developmental Disorders • Pervasive developmental disorders are a group of disorders marked by impaired social interactions, unusual communications, and inappropriate responses to stimuli in the environment • The group includes autistic disorder, Asperger’s disorder, Rett’s disorder, and childhood disintegrative disorder • Because autistic disorder initially received so much more attention than the others, these disorders are often referred to as autistic-spectrum disorders Comer, Abnormal Psychology, 6e – Chapter 17

43. Autistic Disorders • Autistic disorder, or autism, was first identified in 1943 • Children with this disorder are extremely unresponsive to others, uncommunicative, repetitive, and rigid • Symptoms appear early in life, before age 3 • There has been a steady increase in the number of children diagnosed and it appears that at least one in 600 and maybe as many as one in 200 children display the disorder • Around 80% of all cases appear in boys Comer, Abnormal Psychology, 6e – Chapter 17

44. Autistic Disorders • As many as 90% of children with autism remain severely disabled into adulthood and are unable to lead independent lives • Even the highest-functioning adults with autism typically have problems in social interactions and communication and have restricted interests and activities Comer, Abnormal Psychology, 6e – Chapter 17

45. What Are the Features of Autism? • The central feature of autism is the individual’s lack of responsiveness, including extreme aloofness and lack of interest in people • Language and communication problems take various forms • One common speech peculiarity is echolalia, the exact echoing of phrases spoken by others • Another is pronominal reversal, or confusion of pronouns Comer, Abnormal Psychology, 6e – Chapter 17

46. What Are the Features of Autism? • Autism is also marked by limited imaginative play and very repetitive and rigid behavior • This has been called a “perseveration of sameness” • Many sufferers become strongly attached to particular objects – plastic lids, rubber bands, buttons, water – and may collect, carry, or play with them constantly Comer, Abnormal Psychology, 6e – Chapter 17

47. What Are the Features of Autism? • The motor movements of people with autism may be unusual • Often called “self-stimulatory” behaviors; may include jumping, arm flapping, and making faces • Children with autism may engage in self-injurious behaviors • Children may at times seem overstimulated and/or understimulated by their environments Comer, Abnormal Psychology, 6e – Chapter 17

48. Asperger’s Disorder • Those with Asperger’s disorder (or syndrome) experience the kinds of social deficits, impairments in expressiveness, idiosyncratic interests, and restricted and repetitive behaviors that characterize individuals with autism, but at the same time they often have normal intellectual, adaptive, and language skills Comer, Abnormal Psychology, 6e – Chapter 17

49. Asperger’s Disorder • Clinical research suggests that there may be several subtypes of Asperger’s disorder, each having a particular set of symptoms • Asperger’s disorder appears to be more prevalent than autism • Approximately 1 in 250 individuals displays this pattern, with 80% of them boys • It is important to diagnose and treat the disorder early in life so that the individual has a better chance of success in life Comer, Abnormal Psychology, 6e – Chapter 17

50. What Are the Causes of Pervasive Developmental Disorders? • Much more research has been conducted on autism than on Asperger’s disorder or other pervasive developmental disorders • Currently, many clinicians and researchers believe that the other disorders are caused by factors similar to those responsible for autism Comer, Abnormal Psychology, 6e – Chapter 17