Ch.16: Disorders Of Childhood And Adolescence

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Child psychopathology

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Emotional and behavioral manifestations of psychological disorders in Children and adolescents

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Considerations in determining whether a child has an actual disorder

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Age, developmental level, environmental factors, are symptoms likely to go away as child matures, is the behavior present in most situations, do symptoms occur because parent expects too much or too little from Child

** and are symptoms causing significant impairment and daily functioning over an extended period of time

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Are childhood disorders rare,?

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NO

1 and 5 children have a serious emotional or behavioral problem

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Boys versus girls

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Boys demonstrated more inattention hyperactivity symptoms whereas girls reported more depression and PTSD

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What is the most prevalent psychiatric disorder in adolescence?

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1Specific phobia

2 Oppositional Defiant Disorder

3 depression

View table 16.1 on page 482

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Prevalence of treatment for adolescents

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2/3 receive no treatment

Lack of intervention is particularly pronounced for black Hispanic and Asian American adolescents

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Neurodevelopmental disorders

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Conditions involving impaired development of the brain and central nervous system that are evident early in a child's life

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Internalizing symptoms

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Emotional symptoms directed inward

E.g. expressing heightened reactions to trauma stressors or negative events,

Example of disorders: stresspr related disorders, anxiety, and depression which often lead to substance abuse

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Types of internalizing disorders

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Anxiety, PTSD, attachment disorder, depressive disorders, pediatric bipolar disorder, and self-injury

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Specific phobia in early to mid childhood

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This type of anxiety can significantly affect academic, social, and interpersonal functioning and can lead to adult anxiety

- display exaggerated autonomic responses fearful (apprehensive) of new situations

-fearful temperament can be worsened by controlling, unwarm, and overprotective parenting style

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Youth with PTSD

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Experience recurrent distressing memories of a shocking experience

-May experience distressing dreams, intense physical or psychological reactions two thoughts, episodes of play-acting event without apparent distress, or dissociative reactions (re-experiencing trauma but unaware of current surroundings)

- often display negative affect (shame guilt fear), social withdrawal, diminished positive effect, anger, aggression, temper tantrums, difficulty sleeping, difficulty concentrating, & exaggerated startle response

Treatment : school-based cognitive behavioral therapy

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Types of Attachment disorders

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Reactive attachment disorder(RAD)

Disinhibited social engagement disorder(DSED)

Evident before Age 5

Diagnosed when early circumstances prevent child from forming stable attachments

Situations that can disrupt attachment include persistent neglect of a psychological or physiological safety frequent changes in primary caregiver

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Reactive attachment disorder RAD

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- I have little trust that their needs will be attended to

- do not seek or respond to comfort attention or nurturing

-Are inhibited or avoidant with family and caregivers

- show limited positive emotion

- demonstrate irritability sadness or fearfulness

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Disinhibited social engagement disorder DSED

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Socialized effortlessly and readily become superficially attached to stranger

Easily approach and interact with unfamiliar adults

Frequently Venture away from caregivers

Usually have a history of harsh punishment inconsistent parenting emotional neglect and limited attachment opportunities

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Prognosis of RAD versus DSED

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RAD often disapears when child is given predictable caregiving

DSED symptoms are persistent and issues with Intimate Relationships may continue into adulthood

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Depressive disorders in early life

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Most often affect females and older adolescentsVulnerable to environmental factors due to lack of maturity and skills to deal with stressors

Vulnerable to environmental factors due to lack of maturity and skills to deal with stressors

Possible due to maltreatment, parental illness, loss of attachment figure

Possible due to maltreatment, parental illness, loss of attachment figure

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Pediatric bipolar disorder PBD

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Occur equally between males and females

Dipslay

1. Recurring depression

2. Rapid mood changes

3. Periods of abnormally elevated mood involving increased activity talkativeness and inflated self-esteem

- display Rapid Cycling of moods combined with neurocognitively base difficulties processing emotional stimuli and regulating behavior and social functioning

- after occurs within family history

- treatment combines medication with psychosocial intervention

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Non-suicidal self-injury NSSI

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Induction of bruising bleeding or pain done intentionally to self

- intense negative affect or cognitions offered and proceed the act

**anger, highly self-critical, and difficulty expressing emotions

- Act is often done to improve mood and form feelings of temporary sense of calm/ well-being

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Types of Externalizing disorders

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Symptoms of disruptive behavior that are socially disturbing and distressing to others

Diagnosis is often difficult to distinguish between one another

Disruptive mood dysregulation disorder (DMDD)

Oppositional Defiance disorder (ODD)

Conduct disorder (CD)

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Diagnostic requirements for externalizing disorders

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1. Atypical for child's age and development

2. Persistent for at least one year

3. Cause significant impairment in Social, academic, or vocational functioning

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DMDD

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-Episodes of temper triggered by common childhood stressors

-Anger exaggerated in both intensity and duration

-Considered a depressive disorder even though symptoms are directed outward they reflect irritable, angry, or sad mood

-Must persist Beyond age 6 and occur before age 10 to ensure diagnosis is not based on effects of puberty

-Predictive of later depressin

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ODD

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Negative, argumentative, resentful, spiteful, vindictive, and hostile Behavior

Lose temper, argue, and defy adult request, but do not demonstrate serious violations of societal norms

Defiant behavior is primarily directed toward parents, teachers, and other in authority

Half of those with this have attention deficit hyperactivity disorder

Sometimes evolves into conduct disorder but can often resolved with early intervention

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Conduct disorder

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Persistent pattern of antisocial behavior that violates rights of others, social norms

Deliberately cruel to people or towards animals

Display minimal guilt or remorse

How many demonstrate strong pleasure response to people experiencing pain

Prognosis is poor and often leads to criminal adult dehavior

Can be comorbid w/ ADHD

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Biological Etiology of CD

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Biological factors appear to form greatest influence

Abnormal neurocircuitry with reduced activity in amygdala in situations associated with fear

Reduced autonomic nervous system activity (associated with high need for stimulation to achieve optimal arousal)

Low MAOA genotype(fear regulating)

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The roles of family and social environment on CD

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Marital breakdown, economic stress, crowded living, harsh or inconsistent discipline, maternal or peer rejection, parents experiencing psychotic conditions, impatient parenting, and parent-child conflict (power struggles)

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Patterns of Parental failure to effectively intervene with misbehavior

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1. Parent addresses misbehavior or makes an unpopular request

2. Child responds by arguing or counteracting

3. Parent withdraws from conflict or gives in to child's demands

** subsequently does not learn to respect authority

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Treating CD

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Difficult to treat but treatment is most effective when implemented before patterns of destructive Behavior are firmly established

-Behavior managemant progranms to teach parents how to proberly react

- psychosocial intervention involving assertive training, anger management, building empathy, communication, social and problem solving skills

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Elimination disorders

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Disorders involving bladder or bowel control

Experience significant distress sensitivity to real or imagined parental disappointment and fear of peer ridicule

Withdraw from peer relationships and maybe ostracized

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Enuresis

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Periodic voiding of urine during the day or night into one's clothes or bed or onto the floor

Child must be at least 5 years old and void inappropriately at least twice per week for at least 3 months

Only 1% continue to have symptoms in adulthood

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Etiology of enuresis

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-Psychological stressors such as death of parent or loved one, disturbed family patterns, presence of other emotional problems acvociated with less severe bedwetting

- usually due to hereditary factors if it is severe such as delays in maturation of urinary tract, development of normal rhythm, or small bladder

-Treatment: Relapse is less likely with alarm system versus medication

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Encopresis

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Defecating on to one's close, the floor, or other inappropriate places

Must be at least 4 and have defecated at least once a month for at least 3 months

- often have a history of constipation

- comorbid with ODD, CD, ADHD, and obsessive-compulsive symptoms

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Neurodevelopmental disorders

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Impaired development of the brain and central nervous system

Symptoms ( learning communication and behavioural difficulties )become increasingly evident as child grows and develops

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Tics disorder

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Involuntary repetitive movement OR vocalizations, occasionally persist into adulthood

Motor tics eye blinking, facial grimacing, head jerking, foot tapping, flaring of the nostrils, contractions of shoulders or abdominal muscles

Vocal tics coughing, grunting, throat clearing, sniffing, sudden repetitive or stereotyped outbursts of words

*** often feel tension build-up before a tic followed by a sense of relief after the TIC occurs

-more prevelant in boys

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Provisional tic disorder

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Last less than a year (most are transient and disappear w/o treatment)

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Chronic motor or vocal tic disorder

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Last more than a year sometimes continues through adolescence

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Tourettes disorder (TD)

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Characterized by multiple motor tics AND one or more vocal tic

Both motor and vocal tics must be present for at least one year

First noticed between ages 7 and 10 and increases in Middle teen years but improves in early adulthood and eventually show complete remission

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Coprolalia

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Uttering swear words or motor movement involving self-harm occur in less than 10% of those with TD

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Etiology of tics disorder and TD

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Appear to be genetically administered and is highly comorbid with OCD

Use antipsychotic meds to reduce severity with psychotherapy

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ADHD

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Symptoms begin before 12 and persist for at least 6 months and must display in 2 or not settings

1. Inattention(intense focus or irrelevant stimuli)

2. Hyperactivity and impulsivity(act w/o considering consequences)

3. Or a combination of these

- have most difficulty in unstructured situations with activities demanding attention with insufficient stimuli

- most frequently diagnosed disorder in school-age children

- associated with behavioral academic problems, disciplinary referrals, low grades, poor test

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Onset of ADHD

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Often and proves in late adolescence

Between 30 to 50% of those diagnosed experience continued symptoms of inattention and fidgeting difficulty sitting still and impulsive actions throughout adulthood

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Biological dimension of ADHD

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80% of disorder can be explained by genetics

No specific Gene strongly linked to symptoms but inherited gene mutations, chromosomal DNA duplications/ deletions, and genes affecting the regulation of neurotransmitter dopamine have been implicated

Has a Gene×gene or a Gene×enviroment interaction

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Hypothesis of Neurological mechanisms producing ADHD

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1.Reduced activity in prefrontal cortex with low arousal of inhibitory mechanisms affecting them for civility organizational planning on working memory and attentional process

2. Abnormal circuitry in frontal cortex, and cerebellum parietal lobes; slower development associated with attention and motor planning

3. Inadequate dopamine affecting signal flow to and from frontal lobes

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Biological factors implicated in the development of ADHD

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Prematurity, oxygen deprivation, low birth weight, lead exposure, viral infection, meningitis, and cephalitis, maternal smoking or drug alcohol abuse

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Treatment for ADHD

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Meds continue to receive most evidence-based support find normalizing neurotransmitters in frontal cortex and thereby increasing attention and reducing impulsivity

Used throughout day and sometimes throughout lifespan

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Behavioral and psychosocial treatments for ADHD

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Provide reward system, classroom management strategies, self controll training, parental training

Modifying enviromental context is highly effective allowing and movement or opportunities to optimize cognitive stimulation

Enhance feelings of confidence motivation and self efficiency

Example: providing access recess breaks can reduce inappropriate behavior

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Autism spectrum disorder ASD

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Impairment in social communication skills and stereotyped interest and behaviors

Make up 0.6% of Public School population

Condition significantly affects cognitive/intellectual development

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Characteristics of ASD

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1. Deficits in social communication and interaction

A. Atypical social-emotional reciprocity (one-sided , limited social interaction)

B. Atypical nonverbal communication( little to no eye contact, pushing others)

C. Difficulties developing maintaining relationships (lack interest in others, treat others as objects, fail to see physical/ emotional responses)

2. Repetitive behavior, restricted interest or activities involving 2 of these

A. Repetitive speech movement or use of objects (echolalia: repeating what others say, head banging, arm flapping)

B. Intense focus on rituals routines and strong resistance to change

C. Intense fixations or restricted interests

D. Atypical sensory reactivity

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More facts on autism

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-2/3 have IQ score lower than 70

- Splinter skills (do well and isolated tasks but performed poorly and verbal tasks requiring language skills and symbolic thinking)

- no medical test confirm autism

- often diagnosed until Age 3 or later

- not a developmental delayed but reflects differences in development that cause impairment in everyday functioning

not a developmental delayed but reflects differences in development that cause impairment in everyday functioning

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Biological etiology of autism

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-Most important role in the cause of autism

-Biomarkers involved in the development of the disorder confirm interaction of genetic×environmental risk factors

- patterns of metabolic brain activity

- poor connectivity involving amygdala

- abnormally high levels of Serotonin

- decreasing size occipital lobe

- accelerated head growth(more co on in girls w/ autism)

- mitochondrial dysfunction

- genetic mutations affecting synaptic connections

- High concordance rate with 73% for males and 87% for females

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More on ASD

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Is a heterogeneous disorder with multiple causes

Nutritional deficiencies, changes in the music system, abnormal immune response, closely spaced pregnancies, sometimes symptoms improve and abruptly return

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Psychological dimension for autism

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Although psychological and social factors such as child-rearing practices, parent-child interactions, reactions from peers play a role in the manifestation of symptoms, autism is primarily influenced by a wide variety of biological factors

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Programs for autism often include

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- High degree of structure and predictable routine

- intensive symmetrically plan developmentally appropriate educational activities

- behavior modification procedures

- parent education

- opportunities to apply learned skills to new environments

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More on treatment for autism

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Most effective gains involve emphasis on social communication and social in imitation, prevention of repetitive behaviors, sustained practice of weaker skills, reduction of environmental stress

Medications used to decrease anxiety, repetitive behaviors, and hyperactivity in those with ASD

Use oxytocin to increase social interaction

Antipsychotics used as well

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Intellectual disability ID

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Lifelong cognitive deficits with significant and limitations in intellectual functioning and adaptive behaviors

1. Significantly sub-average General intellectual functioning (is of 70 or lower)

2. Deficiencies in adaptive Behavior( skills required for communication, self care, social interactions, health and safety, )

Range from mild(iq between 50-70), moderate, severe, and profound (iq below 20)

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American Association of intellectual and developmental disabilities asserts that ID

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Diagnosis of ID is used to find determine support needed to maximize adaptive functioning

Providing individualized support functioningwill help improve overall functioning

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Idiopathic

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Having no known cause usually seen in mild ID

Most people with mild ID are physically and emotionally healthy with no specific psychological anomaly

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Genetic factors of ID

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Genetic anomalies such at chromonal abnormalities or inheritance of a single Gene

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Fragile X syndrome

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Limited production of proteins required for brain development

Results and Mild to severe ID

Males have stronger impairment prone to communication and social difficulties including anxious, and attentive, and fearful or aggressive behavior

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Down syndrome

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Produces an extra copy of chromosome 21 during gamete development

Most common and easily recognized chromosomal disorder resulting in IDProduces an extra copy of chromosome 21 during gamete developmentExtra chromosome produces unregulated expression of certain genes resulting in physical and neurological characteristics seenIncidense of having a child with Ds increases by age (in females)

Extra chromosome produces unregulated expression of certain genes resulting in physical and neurological characteristics seen

Incidense of having a child with Ds increases by age (in females)

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More facts of DS

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Majority have mild-to-moderate ID

With support many have jobs and live semi independent

Has a significant increase in infectious disease, leukemia, demntia, premature aging, act

Hispanic mothers are more likely to give birth to a child with SD

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Non genetic biological factors of ID

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Many things that cause ad are preventable or controllable

- viruses and infections, drugs and alcohol, radiation, poor nutrition, iodine deficiency, artificial sweeteners(pku), prematurity, low birth weight

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Fetal alcohol Spectrum disorders

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Associated with reduced cognitive functioning, attentional difficulties, lower information processing, and for working memory

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Fetal alcohol syndrome FAS

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Much more severe

Retarded growth, facial abnormalities, central nervous system dysfunction, and altered brain development

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Social dimension of ID

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Inadequate educational opportunities lack of healthcare, poor nutrition, living in poverty, poor educational system influence whether they reach their genetic potential

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Learning disorders LD

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Someone with at least average intellectual abilities demonstrates basic math reading or writing skill development that is subsequently below levels that would be expected

Dyslexia or dyscalculia

5% in public schools have LD

Some grow out of it while for others it is life long

Commonly comorbid w/ ADHD

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Etiology of LD

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Littlest currently known

Lower brain maturation with eventual catch up

Higher in English speaking countries (irregular spellling/pronunciation )

Alcohol use during pregnancy, runs in families, genetic component

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Comorbidity of nerodecelopmental disorders

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ADHD comorbid with ASD and ticks / Tourette's

ASD and ID have overlapping genetic influences

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Individualized education plan IEP

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Summarizing child's current level of functioning and academics, communication, motor skills, social skills, adaptive Behavior, identify annual goals, and specifies support needed for child to meet stated goals

Required by law for those with severe ASD, ID, LG, or ADHD ages 3 to 21

However Improvement often decreases once program is completed