Chapter 15 Disorders of Childhood

1. Chapter 15 Disorders of Childhood Ch 15

2. Classification Issues • Distinguishing abnormal childhood behavior requires a knowledge from developmental psychology of what is normal for a child at a particular age or stage • Disorders can be viewed as categories or on a continuum (dimension) • Control represents a dimensional variable • Overcontrolled (internalizing)children show emotional inhibition • Undercontrolled (externalizing) children show excessive behaviors (extreme aggressiveness) Ch 15.1

3. Table 15.1 Diagnoses that May be Applied to Children

4. Developmental Psychopathology • Behavior genetics & neurobiological traumas • Infant / child temperaments and “the problem of the match” with parental temperaments and expectations • Attachment theory (Bowlby, Ainsworth, Sroufe) • Secure vs. insecure attachment • Insecure attachment category may be related to later childhood disorders • “anxious-resistant” category - internalizing disorders • “avoidant”category - externalizing disorders • How do temperament & attachment interact? • Evidence is inconclusive, but see Bokhorst et al. (2004)

5. Disorders of Undercontrolled Behavior • Undercontrolled behavior is excessive or inappropriate for the situation • DSM-IV recognizes two classes of undercontrolled behavior: • Attention-deficit/hyperactivity disorder (ADHD) involves • An inability to concentrate on task for an appropriate period of time • Difficulties in controlling motor movements in class and other situation (fidgeting, talking) Ch 15.2

6. ADHD Issues • Hyperactive children have difficulties in establishing peer relations • Aggressive ADHD children have different social goals (being disruptive) than do non-ADHD peers • ADHD can co-occur with learning disabilities (15-30% of ADHD children have co-morbid LDs) • ADHD shows within category differences • Some children have attention deficit, some have hyperactivity, and some have both • ADHD prevalence is 2-7% in US • ADHD with conduct disorder = worse prognosis Ch 15.3

7. Table 15.2 Prevalence of Symptoms and Behaviors in Adolescents with and without ADHD

8. ADHD: Facts and Statistics • Prevalence (BD, 3rd. Edition) • Occurs in 4%-12% of children who are 6 to 12 years of age • Symptoms are usually present around age 3 or 4 • 68% of children with ADHD have problems as adults • Gender Differences • Boys outnumber girls 4 to 1 • Cultural Factors • Probability of ADHD diagnosis is greatest in the United States

9. Biological Theories of ADHD • Family and twin studies document a role for genetic transmission in ADHD • Frontal lobe function is abnormal in ADHD children • Frontal lobe is underresponsive to stimulation in ADHD children • Frontal lobe is smaller in ADHD children • ADHD children do poorly on psychological tests that measure the functioning of the frontal lobe Ch 15.4

10. Psychological Theories of ADHD • Bettelheim proposed a psychoanalytic view of ADHD in which hyperactivity results from stress brought on by parental personality (authoritarian, impatient, resentful) • Learning theory suggests that hyperactivity is reinforced by the attention it elicits, thereby increasing in frequency and intensity; hyperactivity may represent modeling of older siblings or peers Ch 15.5

11. Treatment of ADHD • Stimulant drugs such as methylphenidate (Ritalin) reduce disruptive behavior and improve concentration • Improve compliance and decrease negative behaviors in many children • Medications do not affect learning and academic performance • Beneficial effects are not lasting following drug discontinuation • Psychological therapy for ADHD involves • Parent training • Classroom management programs based on operant-conditioning techniques • Aim to increase appropriate behaviors and decrease inappropriate behaviors • Combined Bio-Psycho-Social Treatments • Are highly recommended Ch 15.6

12. Disorders of Undercontrolled Behavior • Conduct Disorder involves behaviors that violate the rights of others • Aggression and cruelty toward people or animals • Property damage • Lying and stealing • Conduct disorder is marked by callousness and lack of remorse • Conduct disorder is more common in boys • Oppositional Defiant Disorder (ODD) distinction Ch 15.7

13. Figure 15.1 Arrest rates across ages for homicide, forcible rape, robbery, assault, and auto theft

14. Etiology of Conduct Disorder • Genetic factors may play a greater role in aggressive behavior, but a lesser role in delinquency-related behaviors • e.g. stealing, running away • Psychological factors include • Deficiencies in moral training and awareness • Modeling of aggressive behavior (Bandura) • Cognitive distortions in which ambiguous actions are interpreted as hostile Ch 15.8

15. Fig 15.2

16. Treatment of Conduct Disorder • Family intervention involves training parents to reward prosocial behaviors in their children • Multisystem treatment targets the child, the community, the school and the family • Cognitive approaches involve • Anger control training • Teaching moral development reasoning Ch 15.9

17. Learning Disabilities • Learning disabilities refer to inadequate development in a specific area of academic, language or motor skills • The deficit is not due to mental retardation, autism or reduced educational opportunities • DSM covers 3 areas of learning disabilities • Learning disorders • Communication disorders • Motor skills involve impairment of motor coordination Ch 15.10

18. Learning Disorders • Learning Disorders refer to conditions that impair development in the classroom • Specific learning disorders identified in DSM-IV include • Reading disorder (Dyslexia) involves difficulty in word recognition and comprehension • Disorder of written expression involves an inability to compose the written word • Mathematics disorder involves difficulty in recalling math facts, errors in addition Ch 15.11

19. Communication Disorder • Communication disorders include • Expressive language disorder involves a difficulty in speech expression • Difficulty in finding the correct word for a concept • Use of grammar is below grade level • Phonological disorder refers to a difficulty in articulating speech sounds, but can comprehend words • Stuttering involves a problem in verbal fluency in which words are repeated or prolonged Ch 15.12

20. Mental Retardation • Mental retardation is defined as • Subaverage intellectual functioning • IQ score below 70-75 • Deficits in adaptive behaviors such as dressing, use of money, use of tools and of public transportation • Onset prior to age eighteen • Not due to adult accidents or disease • Typical onset is in infancy • American Association of Mental Retardation’s approach • Focus onremedial supports to facilitate higher functioning Ch 15.13

21. Table 15.3 Sample Items from Vineland Adaptive Behavior Scales

22. Mental Retardation Ch 15.14

23. Etiology of Mental Retardation • No cause is evident for 75% of cases of mental retardation, the remaining 25% are often related to biological causes • Biological causes include: • Genetic anomalies such as Down’s syndrome (Trisomy 21) • Fragile X syndrome – Abnormality on X chromosome • Recessive-gene diseases such as PKU • Infectious diseases such as Rubella and HIV • Environmental hazards such as mercury or lead poisoning Ch 15.15

24. Autistic Disorder • Autistic disorder involves children who • Prefer to be alone • Prefer to have a constant environment • Have severely limited language skills • DSM-IV “Pervasive DevelopmentalDisorder” distinguishes autism as a developmental disorder different from schizophrenia in adults • Prevalence of autism is infrequent (.05 % of births) • Autism occurs more frequently (4x) in boys relative to girls Ch 15.16

25. Table 15.4 Parental Report of Social Relatedness in Children before Age 6

26. Autistic Disorder: Facts and Statistics • Prevalence and Features of Autism (BD, 3rd. Edition) • Rare condition – Affecting 2 to 20 persons for every 10,000 people • More prevalent in females with IQs below 35, and in males with higher IQs • Autism occurs worldwide • Symptoms usually develop before 36 months of age • Autism and Intellectual Functioning • 50% have IQs in the severe-to-profound range of mental retardation • 25% test in the mild-to-moderate IQ range (i.e., IQ of 50 to 70) • Remaining people display abilities in the borderline-to-average IQ range • Better language skills and IQ test performance predicts better lifetime prognosis (50% never acquire useful speech)

27. Etiology of Autism: Psychological Theories • Bettelheim argued that parental rejection induces autistic disorder • Behavioral theory suggests that autism results from inattentive parents, especially the mother • Follow-up studies have found little support for psychological explanations of autism Ch 15.17

28. Biological Etiology of Autism • Genetic factors play a strong role in transmission of autistic disorder • Siblings of a person with autistic disorder have a 75 fold increase in risk • Twin studies show greater concordance for autism in MZ twins (60-91% than in DZ twins (0-20%) • Neurological studies consistently find structural abnormalities in the cerebellum of autistic children (e.g., substantially reduced sized) Ch 15.18

29. Treatment of Autistic Disorder • Drug treatment often involves the administration of haloperidol • Reduces social withdrawal and odd motor behaviors • Haloperidol does not alter the abnormal interpersonal relations or language impairments of autism • Efficacy of psychodynamic therapy is unknown • Behavior therapy approach (Lovaas) • Uses modeling and operant conditioning to reinforce language and prosocial behaviors • Parent education training increases treatment generalization beyond hospital settings Ch 15.19