Disorders of Childhood and Adolescence Chapter 15

1. Disorders of Childhood and AdolescenceChapter 15

3. Disorders of Childhood and AdolescencePervasive Developmental Disorders Pervasive Developmental Disorders: Severe qualitative impairment in verbal and nonverbal communication and social interaction (autistic disorder, Asperger’s disorder, etc.).

4. Disorders of Childhood and AdolescencePervasive Developmental Disorders Autism Spectrum Disorders: Severe impairment in social interaction and communication skills and display of stereotyped interests and behaviors. Autistic disorder Rett’s disorder Childhood disintegrative disorder Asperger’s disorder Pervasive developmental disorders not otherwise specified

5. -Table 15.1: Pervasive Developmental Disorders.-Table 15.1: Pervasive Developmental Disorders.

6. -Table 15.1: Pervasive Developmental Disorders.-Table 15.1: Pervasive Developmental Disorders.

7. 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). Disorders of Childhood and AdolescencePervasive Developmental Disorders -No remission shown with Autism. -Impairments result from maturation-related changes in various systems of the brain -Most recent reviews tend to estimate a prevalence of 1–2 per 1,000 for autism and close to 6 per 1,000 for ASD.-No remission shown with Autism. -Impairments result from maturation-related changes in various systems of the brain -Most recent reviews tend to estimate a prevalence of 1–2 per 1,000 for autism and close to 6 per 1,000 for ASD.

8. Disorders of Childhood and AdolescencePervasive Developmental Disorders

9. Problems diagnosing autism: Other medical conditions mimic behavioral characteristics. Symptoms seen in children with and without signs of neurological impairment. Shares characteristics with other disorders. Symptoms vary for each child. Overlap symptoms of other pervasive development disorders and often coexists with retardation. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorder -Adding to the difficulty with diagnosis is that the manifestations of autism cover a wide spectrum, ranging from individuals with severe impairments—who may be silent, mentally disabled, and locked into hand flapping and rocking—to less impaired individuals who may have active but distinctly odd social approaches, narrowly focused interests, and verbose, pedantic communication. -The “geek hypothesis” states that many high functioning autistics appear as social outcasts and geeks. -Autism is defined in the DSM-IV-TR as exhibiting at least six symptoms total, including at least two symptoms of qualitative impairment in social interaction, at least one symptom of qualitative impairment in communication, and at least one symptom of restricted and repetitive behavior. -Adding to the difficulty with diagnosis is that the manifestations of autism cover a wide spectrum, ranging from individuals with severe impairments—who may be silent, mentally disabled, and locked into hand flapping and rocking—to less impaired individuals who may have active but distinctly odd social approaches, narrowly focused interests, and verbose, pedantic communication. -The “geek hypothesis” states that many high functioning autistics appear as social outcasts and geeks. -Autism is defined in the DSM-IV-TR as exhibiting at least six symptoms total, including at least two symptoms of qualitative impairment in social interaction, at least one symptom of qualitative impairment in communication, and at least one symptom of restricted and repetitive behavior.

10. 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. Disorders of Childhood and AdolescencePervasive Developmental DisordersImpairments -A brain scan of a normal child while its mother calls its name leads to enhanced activity, especially in the emotional areas. -A brain scan of a child with autism in the same situation leads to little reaction of any kind. -Autistic children seem to lack a theory of mind. -Unable to attribute mental states to others. -Autistic children do fine on a task where they must match pictures of objects with line drawings of them. -They do poorly when the task involves matching pictures of people with line drawings.-A brain scan of a normal child while its mother calls its name leads to enhanced activity, especially in the emotional areas. -A brain scan of a child with autism in the same situation leads to little reaction of any kind. -Autistic children seem to lack a theory of mind. -Unable to attribute mental states to others. -Autistic children do fine on a task where they must match pictures of objects with line drawings of them. -They do poorly when the task involves matching pictures of people with line drawings.

11. 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. Disorders of Childhood and AdolescencePervasive Developmental DisordersImpairments

12. 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. Disorders of Childhood and AdolescencePervasive Developmental DisordersImpairments

13. Intelligence As many as ¾ of children with autism have IQ scores less than 70. Some display splinter skills such as drawing, puzzles, or rote memory. Disorders of Childhood and AdolescencePervasive Developmental DisordersImpairments -One Chinese boy with Autism could tell you the day of the week for any date in history as well as convert between the Chinese and American calendars. -These strengths might be due to the amount of time spent on isolated tasks rather than a particular overwhelming gift.-One Chinese boy with Autism could tell you the day of the week for any date in history as well as convert between the Chinese and American calendars. -These strengths might be due to the amount of time spent on isolated tasks rather than a particular overwhelming gift.

14. Asperger’s Disorder: Significant impairment in social interaction skills, limited and repetitive interests/activities, lack of emotional reciprocity. No significant delay in cognitive or linguistic development. Subtle difficulties with communication skills. Five times more common in males than females. Disorders of Childhood and AdolescencePervasive Developmental Disorders

15. 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. Disorders of Childhood and AdolescencePervasive Developmental Disorders -Though these both share many symptoms with traditional autism, they seem to have a completely different etiology.-Though these both share many symptoms with traditional autism, they seem to have a completely different etiology.

16. 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 Disorders of Childhood and AdolescencePervasive Developmental Disorders

17. Etiology: Familial autism Autism related to medical condition Autism associate with nonspecific brain dysfunction Autism without family history or associated brain dysfunction Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders -There is no single explanation for all cases of Autism. -Different medical conditions can produce symptoms similar to autism. -Autism may not be a single disorder, but a variety of different disorders with similar symptom manifestations.-There is no single explanation for all cases of Autism. -Different medical conditions can produce symptoms similar to autism. -Autism may not be a single disorder, but a variety of different disorders with similar symptom manifestations.

18. Explanations: Psychodynamic Theories Deviant Parent-child interactions lead to autism Refrigerator moms (parents who are successfully autistic that “happened to defrost long enough to have a child”) “Cold, humorless perfectionists who preferred reading, writing, playing music, or thinking.” Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders -This explanation places guilt onto parents who are already overwhelmed with raising an autistic child.-This explanation places guilt onto parents who are already overwhelmed with raising an autistic child.

19. Explanations: Family and genetic studies: 2-9% of siblings of autistic children have the disorder (100 to 200 times greater than general population). Greater for MZ than for DZ twins Folstein & Rutter: Diathesis stress model 36% concordance rate for identical twins In 12 of the 17 discordant MZ twin pairs there was evidence of birth trauma for the affected twin. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders -Perhaps a predisposition interacting with an environmental stressor.-Perhaps a predisposition interacting with an environmental stressor.

20. 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. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders -Teratogens related to the risk of autism include exposure of the embryo to thalidomide, valproic acid, or misoprostol, or to rubella infection in the mother.-Teratogens related to the risk of autism include exposure of the embryo to thalidomide, valproic acid, or misoprostol, or to rubella infection in the mother.

21. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders

22. 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. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders -The MNS operates when an animal performs an action or observes another animal of the same species perform the same action. -The MNS may contribute to an individual's understanding of other people by enabling the modeling of their behavior via embodied simulation of their actions, intentions, and emotions.-The MNS operates when an animal performs an action or observes another animal of the same species perform the same action. -The MNS may contribute to an individual's understanding of other people by enabling the modeling of their behavior via embodied simulation of their actions, intentions, and emotions.

23. Explanations: Biochemical: Elevated levels of serotonin, dopamine, and neural growth factors in some children with autism. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders -It is possible that aberrant immune activity during critical periods of neurodevelopment is part of the mechanism of some forms of ASD. -It is possible that aberrant immune activity during critical periods of neurodevelopment is part of the mechanism of some forms of ASD.

24. Explanations: Cognitive Theories Hyper-systemizing hypothesizes that autistic individuals can systematize—that is, they can develop internal rules of operation to handle internal events—but are less effective at empathizing by handling events generated by other agents. It extends the extreme male brain theory, which hypothesizes that autism is an extreme case of the male brain, defined psychometrically as individuals in whom systemizing is better than empathizing. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders

25. 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. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders -Several other pre- or post-natal environmental factors have been claimed to contribute to autism or exacerbate its symptoms, or may be important to consider in future research. They include certain foods, infectious disease, heavy metals, solvents, diesel exhaust, PCBs, phthalates and phenols used in plastic products, pesticides, brominated flame retardants, alcohol, smoking, illicit drugs, and vaccines.-Several other pre- or post-natal environmental factors have been claimed to contribute to autism or exacerbate its symptoms, or may be important to consider in future research. They include certain foods, infectious disease, heavy metals, solvents, diesel exhaust, PCBs, phthalates and phenols used in plastic products, pesticides, brominated flame retardants, alcohol, smoking, illicit drugs, and vaccines.

26. 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. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders

27. 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. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders -Discuss costs of treatment programs. -Discuss the role that the public school system has in paying to educate all children. -Describe case where parents said the public school was not doing their job, sent the child to a private institution, then sent the school district the bill.-Discuss costs of treatment programs. -Discuss the role that the public school system has in paying to educate all children. -Describe case where parents said the public school was not doing their job, sent the child to a private institution, then sent the school district the bill.

28. Prognosis: Mixed but better for high-functioning (especially Asperger’s) ~25% function in supported environment ~25% live independently with social impairment Prognosis better for those characterized as high functioning. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders -Albert Einstein probably had Asperger’s disorder or was a high functioning autistic.-Albert Einstein probably had Asperger’s disorder or was a high functioning autistic.

29. Disorders of Childhood and AdolescencePervasive Developmental DisordersAutistic Disorders State sponsored services stop at age 21 but autism does not stop. Many autistic people need constant lifetime support.

30. Disorders of Childhood and AdolescenceOther 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

31. Behavioral Symptoms Reported by Teachers of Children in Four Countries -Table 15.1: Behavioral Symptoms Reported by Teachers of Children in Four Countries.-Table 15.1: Behavioral Symptoms Reported by Teachers of Children in Four Countries.

32. 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. Disorders of Childhood and AdolescenceOther Developmental Disorders -Consideration of normal versus abnormal behavior is often a matter of degree rather than kind. -Labeling of a behavior as a problem is often the result of subjective interpretations. -Consideration of normal versus abnormal behavior is often a matter of degree rather than kind. -Labeling of a behavior as a problem is often the result of subjective interpretations.

33. Disorders of Childhood and AdolescenceAttention Deficit/Hyperactivity Disorders and Disruptive Behavior Disorders Socially disruptive behaviors, distressing to others: Attention Deficit/Hyperactivity Disorders (ADHD) Oppositional Defiant Disorder (ODD) Conduct Disorder (CD) Often co-occur and symptoms overlap Inattention, overactivity, aggression Early identification and intervention are imperative.

34. -Figure 15.2: Attention Deficit and Disruptive Behavior Disorders.-Figure 15.2: Attention Deficit and Disruptive Behavior Disorders.

35. Disorders of Childhood and AdolescenceAttention 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 -Prognosis: Better for those with only attentional problems -Attentional problems occur in 40% of children, persist in 5% -Associated with behavioral and academic problems -About 60% of children diagnosed with ADHD retain the disorder as adults.-Prognosis: Better for those with only attentional problems -Attentional problems occur in 40% of children, persist in 5% -Associated with behavioral and academic problems -About 60% of children diagnosed with ADHD retain the disorder as adults.

36. Disorders of Childhood and AdolescenceAttention 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). -DSM diagnosis requirements. -ADD symptoms can result from a variety of causes including head trauma and malnutrition.-DSM diagnosis requirements. -ADD symptoms can result from a variety of causes including head trauma and malnutrition.

37. Disorders of Childhood and AdolescenceAttention Deficit/Hyperactivity Disorder Etiology: Neurological/central nervous system -Growth curves show that ADHD patients' brain development trajectories, although lower in volume, parallel those of normal volunteers (NV). Solid lines compare the total brain volume in milliliters (vertical axis) of normal and ADHD males (top) and females (bottom) at different ages (horizontal axis) through childhood and adolescence.-Growth curves show that ADHD patients' brain development trajectories, although lower in volume, parallel those of normal volunteers (NV). Solid lines compare the total brain volume in milliliters (vertical axis) of normal and ADHD males (top) and females (bottom) at different ages (horizontal axis) through childhood and adolescence.

38. Disorders of Childhood and AdolescenceAttention Deficit/Hyperactivity Disorder Etiology: Some researchers believe that certain foods or food additives produce physiological changes in the brain or other parts of the body, resulting in hyperactive behaviors. Little support from research -When children are placed on a no sugar diet, parents report improvements in behavioral problems. -Reported improvements could come from expectancies or from increased parental attention as the parent gets more involved in the child’s life. -In blind experiments where children were sometimes given sugar-free diets and sometimes normal diets, there was no difference in the reported behaviors.-When children are placed on a no sugar diet, parents report improvements in behavioral problems. -Reported improvements could come from expectancies or from increased parental attention as the parent gets more involved in the child’s life. -In blind experiments where children were sometimes given sugar-free diets and sometimes normal diets, there was no difference in the reported behaviors.

39. Disorders of Childhood and AdolescenceAttention Deficit/Hyperactivity Disorder Etiology: Family variables: Could be heredity or environment. Higher prevalence rates in the first- and second-degree relatives of children with ADHD. Higher concordance rates among MZ than DZ twins. -Some studies show that there is a familial transmission of the disorder which does not occur through adoptive relationships. -Some studies show that there is a familial transmission of the disorder which does not occur through adoptive relationships.

40. Disorders of Childhood and AdolescenceAttention 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.

41. Disorders of Childhood and AdolescenceAttention 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. -Drug therapy alone fails to address problems such as antisocial behavior, poor peer relationships, and learning difficulties.-Drug therapy alone fails to address problems such as antisocial behavior, poor peer relationships, and learning difficulties.

42. Disorders of Childhood and AdolescenceOppositional 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 -Controversial diagnosis, very hard to distinguish between normal defiance and a disorder. -”significant impairment in social or academic functioning” added to the diagnostic criteria.-Controversial diagnosis, very hard to distinguish between normal defiance and a disorder. -”significant impairment in social or academic functioning” added to the diagnostic criteria.

43. Disorders of Childhood and AdolescenceConduct Disorders Conduct Disorders: Persistent pattern (at least 12 months) of antisocial behaviors that violate the rights of others. Behaviors may include bullying, lying, cheating, fighting, temper tantrums, destruction of property, stealing, setting fires, cruelty to people and animals, assaults, rape, and truant behavior. -Charles was well known to school officials for his many fights with his peers. After a stabbing incident at school, he was put on probation and then transferred to another junior high school. Two months later, at age fourteen, Charles was charged with armed robbery and placed in a juvenile detention facility. He had few positive peer contacts at the juvenile facility and seemed unwilling or unable to form close relationships. Some progress was achieved with a behavioral contact program that involved positive reinforcement from adults and praise for refraining from aggression in handling conflicts. He was transferred to a maximum-security juvenile facility when he seriously injured two of his peers, whose teasing had angered him. Charles completed a vocational training program in this second facility, but he couldn’t hold a regular job. He was sent to prison following conviction for armed robbery.-Charles was well known to school officials for his many fights with his peers. After a stabbing incident at school, he was put on probation and then transferred to another junior high school. Two months later, at age fourteen, Charles was charged with armed robbery and placed in a juvenile detention facility. He had few positive peer contacts at the juvenile facility and seemed unwilling or unable to form close relationships. Some progress was achieved with a behavioral contact program that involved positive reinforcement from adults and praise for refraining from aggression in handling conflicts. He was transferred to a maximum-security juvenile facility when he seriously injured two of his peers, whose teasing had angered him. Charles completed a vocational training program in this second facility, but he couldn’t hold a regular job. He was sent to prison following conviction for armed robbery.

44. Disorders of Childhood and AdolescenceConduct Disorders Characteristics Reflect individual dysfunction, not reaction to social and economic environment. Males display aggression, females more likely to display truancy, running away, substance abuse, prostitution, chronic lying. Prevalence: 1-10% of children/adolescents More common in males in urban settings

45. Disorders of Childhood and AdolescenceConduct 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) -Children and adolescents with conduct disorder have a greater tendency to seek novel situations and are less concerned about avoiding risk or harm. -Oppositional defiant disorder often precedes conduct disorder. -Less likely to outgrow conduct disorders than other childhood disorders. -Social alienation caused by symptoms seems to lead to other problems including depression and withdrawal. -Pattern of traits of children with conduct disorder mirror traits displayed by adults with antisocial personality disorder. -Most stable trait is level of aggression.-Children and adolescents with conduct disorder have a greater tendency to seek novel situations and are less concerned about avoiding risk or harm. -Oppositional defiant disorder often precedes conduct disorder. -Less likely to outgrow conduct disorders than other childhood disorders. -Social alienation caused by symptoms seems to lead to other problems including depression and withdrawal. -Pattern of traits of children with conduct disorder mirror traits displayed by adults with antisocial personality disorder. -Most stable trait is level of aggression.

46. -Figure 15.2: Multipath Model for Conduct Disorders. The dimensions interact with one another and combine in different ways to result in a conduct disorder.-Figure 15.2: Multipath Model for Conduct Disorders. The dimensions interact with one another and combine in different ways to result in a conduct disorder.

47. Disorders of Childhood and AdolescenceConduct 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. -Children fail to learn to respect authority and follow rules.-Children fail to learn to respect authority and follow rules.

48. Disorders of Childhood and AdolescenceConduct Disorders Treatment: Resistant to traditional forms of psychotherapy. Training in social and cognitive skills is promising. Parent management training has been successful. Curricular interventions for aggressive behavior on the playground reduce aggressive actions. -Some success in teaching children with conduct disorders verbal skills which allow them to enter groups, play cooperatively, and provide reinforcements to peers. -Any technique that brings together children with conduct disorder ought to be avoided as they learn from each other.-Some success in teaching children with conduct disorders verbal skills which allow them to enter groups, play cooperatively, and provide reinforcements to peers. -Any technique that brings together children with conduct disorder ought to be avoided as they learn from each other.

49. Disorders of Childhood and AdolescenceConduct DisordersSchool Violence Goldstein: Catch aggression when low to prevent it from escalating. Zero tolerance policies Exposure to violence in the community and the media. U.S. Safe and Comprehensive Schools Project Peer reporting of harmful behavior Shift in focus from harsh punishment to prevention.

50. Disorders of Childhood and AdolescenceAnxiety 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

51. Disorders of Childhood and AdolescenceReactive 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).

52. Disorders of Childhood and AdolescenceMood 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 -There has also been an increased awareness in recent years about bipolar disorder in children. -In children with bipolar, mood swings are much faster.-There has also been an increased awareness in recent years about bipolar disorder in children. -In children with bipolar, mood swings are much faster.

53. Disorders of Childhood and AdolescenceTic Disorders Tics: Involuntary, repetitive, nonrhythmic movements or vocalizations. Transient Tic Disorder: Characterized by tics; lasts longer than 4 weeks, less than 1 year. Chronic Tic Disorders: Characterized by tics that last longer than one year. Tourette’s Disorder: Multiple motor tics, plus one or more verbal tics that may develop into Coprolalia (compulsion to shout obscenities). Begins before age 18 and apparent for at least one year; 5-30:10,000 children; more males than females.

54. Disorders of Childhood and AdolescenceTic Disorders Etiology and treatment: Psychodynamic: Tics represent underlying aggressive or sexual conflicts Learning theory: Conditioned avoidance responses evoked by stress, reinforced by reducing anxiety. Treatment: Intentionally invoking tics repeatedly so that the tic becomes aversive rather than reinforcing.

55. Disorders of Childhood and AdolescenceTic Disorders Etiology and treatment: Biological: Genetic transmission (multigenerational families; link with ADHD and OCD) Cortical differences CNS impairment in dopamine system Treatments: Medication, psychosurgery

56. Disorders of Childhood and AdolescenceElimination 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

57. Disorders of Childhood and AdolescenceElimination 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.

58. Learning Disorders Characterized by academic functioning that is substantially below that expected of the person’s chronological age, measured intelligence, and age-appropriate education Prevalence: 2-10% Dropout rate at nearly 40% for those with learning disorders

59. Learning Disorders Etiology: Little known about causes. Possibilities include: Maturational Lag Misperceptions due to nervous system disorder Injuries Premature birth Heritability More boys than girls Slower learning linked to irregular spelling, pronunciation, and structure of English language

60. Learning Disorders Treatment: Are lifelong and do not simply go away with treatment Teaching skills that capitalize on abilities and strengths -Table 15.3: Learning Disorders. -Table 15.3: Learning Disorders.

61. 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. -Table 15.4: Mental Retardation. -Table 15.4: Mental Retardation.

62. 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). -A working definition of intelligence, as reflected by IQ scores, involves the ability to successfully interact with the world.-A working definition of intelligence, as reflected by IQ scores, involves the ability to successfully interact with the world.

63. Diagnosing Mental Retardation Prevalence: 1-3% (depends on definition of “adaptive” functioning) Characteristics: Dependency, passivity, low self-esteem, low tolerance for frustration, depression, and self-injurious behavior. -Describe operant conditioning procedure used to reduce self injury behavior in a severely retarded person.-Describe operant conditioning procedure used to reduce self injury behavior in a severely retarded person.

64. Issues Involved in Diagnosing Mental Retardation Questionable validity of IQ scores, especially for members of ethnic minority groups: Controversy of Herrnstein & Murray’s The Bell Curve Alternative explanations for racial differences: Familiarity with mainstream middle-class culture Cultural bias Larry P. v. Riles: IQ tests are culturally biased IQ tests cannot be used to place African American children into classes for the retarded.

65. 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.

66. 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. Issues Involved in Diagnosing Mental Retardation

67. 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

68. Estimated Number of Mentally Retarded People by Level of Retardation -Table 15.5: Estimated Number of Mentally Retarded People by Level of Retardation. -Table 15.5: Estimated Number of Mentally Retarded People by Level of Retardation.

69. Etiology of Mental Retardation Environmental factors: Absence of stimulation Lack of attention or reinforcement from parents or significant others Chronic stress and frustration Poverty Lack of adequate health care Poor nutrition Inadequate education

70. -Table 15.6: Predisposing Factors Associated with Mental Retardation.-Table 15.6: Predisposing Factors Associated with Mental Retardation.

71. 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

72. Rate of Down Syndrome Births -Rate of Down Syndrome Births. This figure shows the rate of live Down syndrome births by mothers’ ethnicity and age. For all groups, the rate of Down syndrome births increases after the maternal age of thirty.-Rate of Down Syndrome Births. This figure shows the rate of live Down syndrome births by mothers’ ethnicity and age. For all groups, the rate of Down syndrome births increases after the maternal age of thirty.

73. Etiology of Mental Retardation Tests for genetic anomalies: Amniocentesis: Screening procedure in which amniotic fluid is withdrawn from fetal sac during 14th-15th week to determine presence of fetal abnormalities. Chorionic Villus Sampling: Tests made of cells on villi on sac surrounding the fetus during 9th week of pregnancy. Other genetic anomalies: Turner’s syndrome, Klinefelter’s syndrome, phenylketonuria (PKU), Tay-Sachs disease, cretinism

74. Etiology of Mental Retardation Nongenetic biological factors (prenatal): Fetal Alcohol Syndrome (FAS): Group of congenital physical and mental defects found in some children born to alcoholic mothers. Small body size Microencephaly (brain is unusually small, leading to mild retardation) Academic and attentional difficulties Exacerbated by maternal smoking and poor nutrition

75. 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

76. 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

77. 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