Chapter 16 Disorders of Childhood and Adolescence
Developmental Psychopathology - study of the origins and course of individual
malapdaptation in the context of the normal growth process.
ADHD - (attention deficit hyperactivity disorder) involves problems with lack of effective
task-oriented behavior, impulsivity, excessive motor activity, distractibility, excessive
talking, immaturity, and socially intrusive behavior (6 months for a diagnosis).
Intelligence - ADHD children, on average, are 7-10 IQ points below children without the
diagnosis.
Prevalence and Gender - The disorder is thought to occur in about 3 - 5% of school aged
children. It is 6 - 9 times more common in males. For many, symptoms (of one sort or
another) persist into adulthood.
DSM-IV lists three "subtypes":
[1] Combined- symptoms of inattention and hyperactivity are equally represented
[2] Predominantly inattentive - symptoms of inattention are more problematic
[3] Predominantly hyperactive - symptoms of hyperactivity are more problematic
Treatments:
Ritalin - (methylphenidate) is an amphetamine. In children with ADHD it decreases
overactivity and helps focus attention. Side effects can include disruption of thinking
and memory, decreases in growth hormone, insomnia, and transient psychotic
symptoms.
Behavioral interventions - include positive reinforcement for on task behaviors, etc.
Oppositional Defiant and Conduct Disorder:
Juvenile delinquency - is a "legal term" (as is insanity), not a psychiatric term.
Oppositional defiant disorder- symptoms include negativistic and defiant attitude,
disobedience, and hostility towards authority. Many, but not all, will go on to
develop "conduct disorder."
Risk factors - include low socioeconomic status, family discord, and parental antisocial
personality.
Conduct disorder - involved a more severe pattern that repeatedly "violates rules" and
"infringes on the rights of others." Examples are stealing, vandalism, fire-starting,
aggressiveness, substance abuse etc.
Causal factors - for both diagnoses include genetic predisposition, low verbal intelligence,
mild neuropsychological problems, and a difficult "temperament." Environmental
influences include peer, parent, and teacher rejection.
Link to antisocial personality - children who make the transition from early onset
oppositional defiant disorder to adolescent conduct disorder are much more likely to
become antisocial adults. "Adolescent (late) onset" cases are more likely to outgrow
these behaviors. They also tend to lack the above mentioned "risk factors."
Treatments - Behavioral techniques involving parental control are often used but are
difficult to maintain.
Anxiety disorders of childhood and adolescence - commonly associated characteristics are
oversensitivity, fearfulness, shyness, timidity, inadequacy, and fear of school.
Prevalence and Gender differences - Anxiety disorders in children are common (about 9%)
with them being more common in females.
Separation anxiety disorder - is the only “true children’s order” in DSM-IV. Diagnostic
criteria include many general symptoms of anxiety but especially worry over something
happening to a parent or other caregiver. Children can be diagnosed with OCD and
other adult anxiety disorders.
Causal factors in anxiety - include unusual constitutional “sensitivity,” early illness or loss,
modeling of an anxious parent, and indifferent or detached parents.
Treatments - for anxiety often consist of behavioral methods such as assertiveness training
and modeling.
Childhood depression - is diagnosed with essentially the same criteria as adult depression.
Causal factors are similar to those described above for the anxiety disorders. Patterns
of mothre-infant “attachment” may be particularly important (e.g., maternal depression).
Peer rejection and teasing can also contribute to depression in children.
Treatment - A good therapeutic relationship is often useful for older children and
adolescents. Antidepressants do NOT seem to be very useful.
Tourette’s Syndrome - involves uncontrollable motor activity (movements, tics) and verbal
activity. “Coprolalia” involves the uncontrolled blurting out of obscenities. Tourette’s is
associated with the presence of other disorders and especially OCD.
Treatment for Tourette’s - may involve neuroleptics (antipsychotics) to suppress tics as well
as behavioral control and relaxation techniques.
Autism - is a dramatic and rare “pervasive developmental disorder” (there are others too).
Prevalence and Gender - It is rare (7 in 10,000) and occurs four times as often in males.
“Refrigerator Mothers” - in the 1940s, Kanner suggested that cold and unresponsive
mothering was at fault. This is now known to be false.
Clinical picture - involves failure to bond with parents, lack of desire for closeness or
communication, lack of social understanding, “echolalic speech,” self stimulation (head
banging or rocking), obsession with maintaining “sameness,” attachment to odd objects
(e.g., a rock), and fascination with movement and bright colorful visual stimuli.
“Savants” - Some autistics have uniques abilities in areas such as math or art. However,
this is the exception rathe than the rule. Cognitive functioning in usually below average.
Causal factors - Accd. to our authors, it is probably the most heritable type of
psychopathology discussed in our book. Defective genes and chromosomal
abnormalities (e.g., fragile x syndrome) may be the cause. Prenatal exposure to
radiation or toxins may be a factor as well.
Treatments and Outcomes - Antipsychotics (e.g., Haldol) are sometimes used but data do
not support their effectiveness. Behavioral interventions are used to stop self injurious
behaviors. Prognosis in generally “poor.”
Learning disorders: There are many learning disorders listed in DSM. A “LD” would be
indicated when academic performance is markedly lower than would be expected given
the individual’s overall level of intelligence. These are more common in MALES.
A pre-existing diagnosis of mental retardation would preclude a LD diagnosis.
Dyslexia - is probably the best known “LD.” It involves difficulties in word recognition and
comprehension of language. Like other Lds, it is more common among males.
Causal factors in LD - are not well understood. Failure of the brain to develop normal
“hemispheric assymetry” may be a factor (prevalence of Lds are unusually high in left
handed persons). A gene region on chromosome 6 has been implicated in dyslexia.
For many, symptoms persist into adulthood. Problems with self confidence are common
as are personality abnormalities.
Mental Retardation: Is defined by [1] significantly below average intelligence AND [2]
significant deficits in “adaptive functioning.”
Axis II of DSM - is where MR is coded, reflecting its developmental and lifelong nature
Levels of MR - As the level of MR becomes more severe, fewer people fall into each level.
Mild - IQ of 70 -50, considered “educable” with the IQ of an 8 - 11 year old and may be
able to become self-supporting
Moderate - IQ of 50 -35, considered “trainable” with the IQ of a 4 - 7 year old and may be
able to manage self care and earn income in a sheltered environment.
Severe - IQ of 35 - 20, considered “dependent” and have limited hygiene and self care
skills.
Profound - IQ below 20, considered “life support” and are unable to master even simple
tasks. Many neurological and physical problems are present. There are obvious
physical abnormalities and grossly delayed development, Lifespan tends to be
shortened.
Causal factors in MR - include genetic and chromosomal abnormalities, prenatal infections,
birth trauma, maternal illness or substance abuse, and numerous others.
Down Syndrome - results from an extra chromosome on the 21st pair (also called Trisomy
21). Both severe retardation and characteristic physical abnormalities are seen.
Maternal age (over 40) may be a risk factor. Down syndrome does tend torun in
families and a connection seems to exist with Alzheimer’s disease.
Phenylketonuria (PKU) - At birth, the liver fails to produce an enzyme needed to metabolize
phenylalanine (an amino acid found in many foods). If the foods are consumed, toxins
build up and neurological damage results. This is commonly tested for now and diet
can prevent the condition. Both parents must carry the RECESSIVE GENE for the
condition to appear.
Treatment and outcome - MR is a lifelong condition. One point that is agreed upon is that
the individual should have the most “normal” environment that his/her level of functioning
will allow. Institutionalization is viewed as a “last resort.”
“Mainstreaming” - Attending of regular schools and classes if preferred if the child can
function reasonably well in that environment.