childhood & adolescence i.issues a.child vs. adult psychopathology - problems less...
TRANSCRIPT
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Childhood & Adolescence
I. ISSUES
A. Child vs. Adult Psychopathology
- Problems less severe/frequentin childhood
- Same problem can look different
- Some problems primarily in childhood
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B. Types of Disorders
1. Internalizing (overcontrolled)= problems within
- Less noticed by adults
- More common in girls
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2. Externalizing (undercontrolled)= manifested externally
- Mostly boys
- More referred for tx
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C. Normal vs. Abnormal Development
- Normal at one age = abnormal atanother
- Period of rapid change
- Harder to determine pathology inchildren
“Normal” is age-dependent
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D. Child problems are reciprocal
1. Blame the child
- Infant temperament
2. Blame the parents
- Schizophrenogenic &refrigerator mothers
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3. Reciprocal process
- difficult kids elicit worse caregiving & vice versa
- Intervention = parent-child interaction
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E. Children are dependent on others
- more likely to get victimized
- need parent/teacher involvement
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II. Behavioral Disorders
1.Attention- Deficit Hyperactivity Disorder(ADHD)
Description
• Inattention
- especially sustained attention
• Hyperactivity
• Impulsivity
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• Inattentive Type
• Impulsive-Hyperactive Type
• Combined Type
• Adult ADD (not an actual dx)
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Common complications
• Learning problems
• Discipline (-> ODD)
• Poor peer relations
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Prevalence
• 3-6%
• Boys
• Over-diagnosed?
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Etiology• Nervous system problem
- smaller brain (e.g, frontal lobe)BAS & BIS
• Polygenetic – 1 DA receptor implicated• Prenatal smoking• NOT sugar• Parenting can exacerbate, cannot cause
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Treatment - 1/3 recover• Stimulant medication
- ↑ DA – blocks reuptake- agonist for BIS- works for 75%- few side effects- effects are immediate- reduces inattention & impulsivity-> focus in classroom & at sports-> improves peer relations & self-esteem- cannot teach good behavior
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• Behavior therapy - Teach appropriate behavior via rewards
& punishments- Parent training- School involvement- Must continue for long period
• Best = Medication + behavior tx
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• Summer ADHD Program
- point system
- parental involvement
- double-blind medication trials
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Oppositional Defiant Disorder (ODD)& Conduct Disorder (CD)
Description
• ODD - negativitist, hostile, defiant
• CD - truancy, fire-setting, theft, aggression, cruelty
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Prevalence
• 9% boys
• 2% girls
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Etiology
Family
• Parenting: criticism & poor monitoring (indifference)
• Parent modeling of poor self-control & antisocial tendencies
• Stressful events (divorce)
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Cognitive skills
• hostile attributions
• poor problem-solving
Biology
• some genetic evidence
• lower baseline arousal
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Treatment• Parent training
- time out/lose privileges & positive reinforcement
• Negotiation with adolescents
• Cognitive treatments
- problem-solving, self-control
• Family Systems Therapy
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III. Cognitive Disorders
Autism (on spectrum – to Asperger’s)
1.Inability to relate to other people
- little communication
- lack of affection/interest in others
- self-absorption
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2.Absent or deficient speech
~ ½ = no speech, primitive gestures
~ ½ = some words with oddities(e.g., echolalia)
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3.Behavior
limited, rigid
stereotyped, self-stimulatory behaviors
self-injurious & aggressive
preservation of sameness
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• MR & LD = common
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Prevalence
• 4-5 in 10,000 (rare)
• 75-80% are boys
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Etiology• 1940s: Kanner: innate inability to relate
(biological)
• 1950s: Refrigerator mother => withdrawal(environment)
• Current: neurological basisprenatal or birth complications
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Treatment
• Difficult; poor prognosis
• 5% capable of jobs
• Still emotionally isolated
• Rest = mild care-taking skills
• Best: if speak before 5, higher IQ,& mild symptoms
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• Institutionalization is common
• Behavior modification
- reinforce social behaviors
- sign language
- parents & teachers as co-therapists
• Aversive conditioning
• Facilitation
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IV. Anxiety & Mood Disorders
Anxiety
• School Phobia (not a dx)
• Separation Anxiety
• Specific fears or phobias
• Others as in adults (e.g., GAD)
• Fears are common
- Extreme degree or duration, impairment
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Prevalence
• very common to uncommon
• equal in boys & girls
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Etiology
• Biology: fearful, anxious temperament
• Learning: observe others’ fears
- parents reinforce fears
- overprotective parental style
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TreatmentBehavioral
• Flooding
• Systematic desensitization
• Reward for success
Cognitive
• Re-appraisal of feared situation
• Relaxation strategies
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• Behavioral therapy = most effective
• Medication - not well-documented in kids
• ** Best = include parents
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Depression
• Like adults
- sad, crying, hopeless, low self-worth, sleep & appetite problems, lethargy
• Unlike adults
- behavioral problems, clinging, delinquency
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• Few consistencies
- more like adults than not
- similar to adult bereavement
(with precipitant)
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Prevalence
• 5-10% boys & girls, more in teens
• equally common in boys & girls
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Etiology
Biological
• possible genetic predisposition
Learning
• learned helplessness
• reduced reinforcers
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Cognition
• Unrealistically negative
• Poor coping
• Poor social skills
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Treatment
• Play therapy (psychodynamic)
- child works through conflicts via play
- no evidence for efficacy
• Social skills training
• Increase pleasant activities
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• Cognitive therapy – errors & coping
• Medication
- somewhat effective for children
- less effective for adolescents
• Change the environment*
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V. Eating Disorders
Anorexia
• refusing to eat due to fear of weight gain
• distorted body image
• life-threatening
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Bulimia - bingeing & purging
• distorted body image
• not usually life-threatening
• often normal weight
• Key = lack of control
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Prevalence
• Anorexia – 1-3 % of 12-18 year-olds
• Bulimia - ~ 5% of teens/young adults
(4.5% female, .5% male)
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Etiology
• Need for control
• Identity issues
- independence from parents
- fear of growing sexuality
• Societal pressures for thinness
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Treatment• Family therapy
- break power struggle- appropriate separation
• Cognitive therapy- Identify & express emotions- Boost self-esteem- Change irrational beliefs
Different issues for anorexia and bulimia• Hospitalization
- IV fluids & goal weights
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VI. Elimination Disorders
• Enuresis & Encopresis
- wetting/soiling self beyond usual age (~5)
• Primary = hasn’t yet learned control vs.
- Secondary = learned control but lost
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• Nighttime is more common
- Daytime = maybe serious problem
• Sense of no self-control (low self-esteem)
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Prevalence
• Enuresis: 15-20% of 5-year-olds
5% of 10-year-olds
• Encopresis: .3-8% of children
usually secondary
• Boys
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Etiology
• Conflict with parents
- self-control
• Emotional disturbance
- anxiety, stress, family disruption
• Failure to learn
- associate full bladder/bowel with toilet
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Treatment
• Eliminate biological causes
• Deal with emotional disturbance
• Behavioral techniques
- wake in night after urination (Wee Alert)
- praise for success
- mild punishment for wetting/soiling
• Prevent: relaxed & positive toward toileting