chapter 16 psychological disorders of childhood copyright © 2006 pearson education canada inc

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.?


Case Study: Jeremy W.

trouble at school learning disability? acting out? irresponsive to disciplinary measures lack of input from father


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


Symptoms of Externalizing Disorders

Rule violations normal vs. abnormal age of onset persistence into adulthood

Negativity, Anger, & Aggression intent of anger

Remorse felt


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


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.


ADHD Subtypes

predominantly inattentive (ADD)predominantly hyperactive-impulsivecombined


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


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


ADHD vs. ODD

debate over usefulness of the distinction

likely distinct but overlapping½ kids with one have the other


Conduct Disorder

persistent, repetitive pattern of serious rule violations– Often feels no remorse– antisocial and sometimes criminal acts– precursor to Antisocial Personality Disorder


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)


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



Genetics is less influential in ODD and Conduct D/O

No crime gene has been found


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


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


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)


Treatment

Behavioural Family Therapy (BFT) Focus on rewards not punishments

Multisystemic Therapy Alternative schooling programs Group homes


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


Historical Perspective

Witmer’s (1896) clinicincreasing child diagnoses in later

DSM editions


Contemporary Perspective

numerous disorders listed in the DSM-IV-TR

examples:– Pica & Rumination Disorder– Tourette’s Disorder– Selective mutism– Enuresis & encopresis


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


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



little systematic researchKagan’s work suggests genetic

predisposition to anxiety


Etiology: Social Factors

reactive attachment disorder– anaclitic depression

insecure attachmentsearly separation


Etiology: Psychological Factors

emotion regulation


Treatments

ECT

antidepressant medications– SSRIs (note: dangerous side effects)

CBT

chapter 16 psychological disorders of childhood copyright © 2006 pearson education canada inc

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attention slide

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vindictive slide

childs life slide

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odd symptoms

odd externalizing disorders