chapter 16 psychological disorders of childhood copyright © 2006 pearson education canada inc
TRANSCRIPT
Chapter 16Psychological Disorders of Childhood
Copyright © 2006 Pearson Education Canada Inc.
Copyright © 2006 Pearson Education Canada Inc. 2
Overview
developmental psychopathology– study of abnormal behaviour in children
developmental norms– typical behaviour per age group?
internalizing disorders– problems affecting child’s internal world and are associated with
subjective distress (e.g., anxiety)
– Comorbidity– Is ADHD over diagnosed in N.A.?
Copyright © 2006 Pearson Education Canada Inc. 3
Case Study: Jeremy W.
trouble at school learning disability? acting out? irresponsive to disciplinary measures lack of input from father
Copyright © 2006 Pearson Education Canada Inc. 4
Externalizing Disorders
The most commonly diagnosed childhood disorders
Characterized by the failure to control behaviour according to the expectations of others
Externalizing symptoms include: rule violations, anger and aggression, impulsivity and deficits in attention
Copyright © 2006 Pearson Education Canada Inc. 5
Symptoms of Externalizing Disorders
Rule violations normal vs. abnormal age of onset persistence into adulthood
Negativity, Anger, & Aggression intent of anger
Remorse felt
Copyright © 2006 Pearson Education Canada Inc. 6
Symptoms of Externalizing Disorders
Impulsivity– Act before thinking
Hyperactivity– Squirming, fidgeting, or restless behaviour– Connors Teacher Rating Scale
Attention Deficits- distractibility, frequent shifts from activity to activity, careless
mistakes, poor organization
Copyright © 2006 Pearson Education Canada Inc. 7
ADHD
3% of children show symptomsMore boys than girlshyperactivity, attention deficit (impulsivity) All symptoms are independentChildren may have one or both symptomssymptom onset prior to age 7symptom persistence of 6 mos.
Copyright © 2006 Pearson Education Canada Inc.
Copyright © 2006 Pearson Education Canada Inc. 9
ADHD Subtypes
predominantly inattentive (ADD)predominantly hyperactive-impulsivecombined
Copyright © 2006 Pearson Education Canada Inc. 10
ODD
Closely related to ADHD (50%)Distinct, but overlappingnegative, hostile, defiant behaviourPrimarily in school aged childrensymptom persistence of 6 mos.significant impairment in child’s life
Copyright © 2006 Pearson Education Canada Inc. 11
ODD Symptoms(4 of the following are present)
Often loses temperOften argues with adults/authoritiesActively refuses to comply with adult’s requestsOften deliberately annoys peopleOften blames others for mistakesEasily annoyed by othersOften spiteful or vindictive
Copyright © 2006 Pearson Education Canada Inc. 12
ADHD vs. ODD
debate over usefulness of the distinction
likely distinct but overlapping½ kids with one have the other
Copyright © 2006 Pearson Education Canada Inc. 13
Conduct Disorder
persistent, repetitive pattern of serious rule violations– Often feels no remorse– antisocial and sometimes criminal acts– precursor to Antisocial Personality Disorder
Copyright © 2006 Pearson Education Canada Inc. 14© 2006 Pearson Education Canada Inc.
Copyright © 2006 Pearson Education Canada Inc. 15
Epidemiology
Canadian prevalence of ADHD is 3-7% 5-15% have ODD Externalizing disorders far more common in boys
Familial risk – risk ↑ with family adversity factors (e.g., low income,
overcrowding in home, maternal depression, paternal antisocial behaviour, conflict between parents)
Copyright © 2006 Pearson Education Canada Inc. 16
Etiology: Biological Factors
difficult temperament – child’s innate behavioural characteristics (e.g., slow to warm up)
behavioural genetics– Australian ADHD twin study (Levy et al, 1997) – underarousal of ANS
– concordance – MZ: 80%, DZ: 40%
neuropsychological anomalies – no markers
food additives/sweets (salicylate)– no evidence
Copyright © 2006 Pearson Education Canada Inc. 17
Etiology: Biological Factors
Genetics is less influential in ODD and Conduct D/O
No crime gene has been found
Copyright © 2006 Pearson Education Canada Inc. 18
Etiology: Social Factors
Socialization– parenting styles (i.e., authoritative,authoritarian, indulgent, neglectful)
indulgent parents – often relate to impulsivity & noncompliance
– coercion– love & discipline – more compliance– conflict & inconsistent discipline=externalization issues
Peers & Media – violence is modeled
Copyright © 2006 Pearson Education Canada Inc. 19
Etiology of ADHD
social factors– quality of parental-child interactions
psychological factors– problems in delaying gratification– moral reasoning
integrative model– externalizing disorders have multiple pathways– Interaction of biological, psychological, & social
factors
Copyright © 2006 Pearson Education Canada Inc. 20
Treatment
Psychostimulants– Ritalin, Adderall– robust effect on reducing inattention and hyperactivity
(75% improvement)– dose-response effects (individual differences)– side effects (decreased appetite, slowing physical
growth, sleeping difficulties, motor tics)– Overdiagnosis (i.e., quick fix)
Copyright © 2006 Pearson Education Canada Inc. 21
Treatment
Behavioural Family Therapy (BFT) Focus on rewards not punishments
Multisystemic Therapy Alternative schooling programs Group homes
Copyright © 2006 Pearson Education Canada Inc. 22
Symptoms of Internalizing Disorders
depressive symptoms fears and anxiety
– consideration of developmental course separation anxiety and school refusal
– separation anxiety disorder– school refusal
troubled peer relationships
Copyright © 2006 Pearson Education Canada Inc. 23
Historical Perspective
Witmer’s (1896) clinicincreasing child diagnoses in later
DSM editions
Copyright © 2006 Pearson Education Canada Inc. 24
Contemporary Perspective
numerous disorders listed in the DSM-IV-TR
examples:– Pica & Rumination Disorder– Tourette’s Disorder– Selective mutism– Enuresis & encopresis
Copyright © 2006 Pearson Education Canada Inc. 25
Short- & Long-Term Effects of Psychostimulants on ADHD
Hyperactivity/impulsivity
Inattention/learning
Short-termDramatic improvements;less active and morefocused; fewer socialproblems
More work completedbut no changes in gradesor standardized testscores
Long-term No demonstrated benefit No demonstrated benefit
Copyright © 2006 Pearson Education Canada Inc. 26
Epidemiology
prevalence– mood disorder: 2% Canadian children– anxiety disorder: 5-10% of young people
gender– more boys have externalizing disorders– more girls have internalizing disorders
suicide
Copyright © 2006 Pearson Education Canada Inc. 27
Etiology: Biological Factors
little systematic researchKagan’s work suggests genetic
predisposition to anxiety
Copyright © 2006 Pearson Education Canada Inc. 28
Etiology: Social Factors
reactive attachment disorder– anaclitic depression
insecure attachmentsearly separation
Copyright © 2006 Pearson Education Canada Inc. 29
Etiology: Psychological Factors
emotion regulation
Copyright © 2006 Pearson Education Canada Inc. 30
Treatments
ECT
antidepressant medications– SSRIs (note: dangerous side effects)
CBT