childhood + adolescent psychological problems

what are 4 difficulties associated with diagnosis psychological problems in childhood

• children may struggle to communicate how they feel → may describe somatic symptoms rather than psychological, making accurate diagnosis challenging

• children go through different developmental stages at different ages, and symptoms change with time → what constitutes as atypical behaviour may depend on child’s age

• labelling theory → diagnosis may cause conformity to that label

• cultural norms → differences in behavioural norms means that some societies will class behaviours as pathological, whether others would regard them as normal

what is the incidence rate of mental health issues for children + adolescents (2004)

• around 10% in 5-10 year olds

• 12.5% in 11-16 year olds, though this is reported as high as 20-25% in American studies

what are externalising disorders + what are 4 behavioural examples

disorders based on outward-directed behavioural problems → e.g. aggressiveness, hyperactivity, non-compliance or impulsivity

what are internalising disorders + what are 3 behavioural examples

disorders represented by more inward-looking + withdrawn behaviours → e.g. depression, anxiety + social withdrawal

what is the general consensus around ‘internalising’ + ‘externalising’ labels

these are relatively traditional terms that have been replaced by modern diagnostic categories, but they are still useful in regards to children specifically → difficulty articulating symptoms means that diagnosis = more behaviour focused

what are 2 examples of childhood anxiety

• separation anxiety → much more common + specific to childhood

• OCD → occurs similarly to adult OCD, but may present differently

what are features of diagnostic criteria of separation anxiety

• excessive anxiety surrounding separation from attached figure → distress + aversion to being along

• has to last for 4 weeks in children + 6 months in adulthood (criteria needs to be much more severe)

• criteria includes somatic symptoms e.g. headaches/nausea

how can OCD in childhood differ from OCD in adulthood

some children can get compulsions without obsessions

• traditional cycle → disturbing intrusive thoughts cause anxiety + stress, which causes sufferer to engage in compulsions (repetitive/ritualised behavioural patterns), which causes relief (reinforcing obsessions)

• childhood cycle → general stress + anxiety causes engagement in compulsions, which causes relief, reinforcing the anxiety + continuing the cycle

individual believes the compulsions will prevent a catastrophic event

what are 5 types of OCD compulsions

• checking → flicking light switches, locking doors etc., seeking reassurance from otehrs

• contamination → excessive cleaning/washing

• symmetry + order

• hoarding

symptoms must cause marked distress + difficulty performing daily functions due to being time-consuming/interfering with routine

how does childhood generalised anxiety disorder differ from adult form

functions similarly to adult anxiety, but more focus on pathological worry, e.g. about potential problems/threats

• different childhood anxieties are typical to particular ages, e.g. 4-7 may be afraid of separation + imaginary creatures, whether 11-13 may be afraid of social threats

• pathological worry tends to increase over time → e.g. 8 year olds have double the worry of 5 year olds

how common are specific phobias in childhood + when are they a concern

very common → specific phobias e.g. of water/heights are normal in early childhood + can appear/disappear quickly

• there is difficulty diagnosing phobias due to developmental trajectories → they can lead to an actual phobic disorder later in development if it persists

• social phobia is less common, but begins as fear of strangers → typical behaviour in early childhood unless it persists

how heritable is anxiety + what is 1 contributing genetic factor

anxiety is moderately heritable → 54%, though this changes from childhood to adulthood (due to it increasing)

• certain target genes in GABA system may increase disposition

what are 3 environmental factors that may increase anxiety risk in childhood

• trauma

• modelling/exposure to information → parent responses to information given will influence the child’s reaction to that information in the future

• parenting style → both overprotective/overbearing and neglectful styles can lead to anxiety

how does depression present differently + similarly in childhood to adulthood

diagnostic criteria is largely the same as adult with minor amendments:

• difficult to recognise due to children struggling to describe symptoms, so focuses more on observable behaviour

• more common ‘clingy’ behaviour, school refusal + exaggerated fears

• increased somatic complaints e.g. stomach/headaches

what is the heritability rate of depression + how does this change from childhood to adulthood

moderate heritability estimated for depression → large range between 30-70%, but usually estimated as 40-50%

• childhood heritability tends to be lower due to increased environmental influence → abuse/neglect are risk factors early in life

what are 6 domains of risk factors for adolescent depression

• cognitive → negative cognitions/attributional styles

• dispensational factors + psychopathologies → low self-esteem, internalising + externalising behaviour

• stress → major life events

• social + coping skills → interpersonal conflict with parents

• physical → physical illness, reduced level of activities, tobacco use

• academic → absenteeism + grade dissatisfaction

for what 2 main reasons is there an increased risk of depression in children of parents with depression

• genetic component → may pass a short form of 5-HTT etc.

• psychological components → behaviours affecting upbringing that may increase childhood risk

what are 3 potential psychological causes for children of depressed parents developing depression themselves

• if parent is depressed due to current environment e.g. poverty, child may inherit it due to sharing the environment

• potential childhood neglect due to not being able to respond to child’s emotions adequately → lack of support/interpersonal conflict

• low mood or negative attributional styles may be learnt from parental interaction

what is the ambiguous scenarios test + what does it assess

a test of positive or negative attributional style → subtle method of testing childhood/adolescent depression or anxiety

• given multiple scenarios e.g. ‘you give a speech + observe the audience’s reaction’ + patient has to finish the scenario based on what they envision

what are the 3 types of ADHD presentation

• predominantly inattentive

• predominantly hyperactive/impulsive

• combined presentation

what are potential treatments for childhood/adolescent psychological problems

• drug treatments → tend to be given the same treatments as adult but in lower doses

• family interventions

• CBT → may be less appropriate for young children, more appropriate for internalising disorders

• play therapy → more appropriate for young children who don’t have appropriate communicative abilities

what are 3 potential issues with prescribing drug treatments in childhood in comparison to adulthood

• drugs need to be consistently taken + may be less effective if inconsistent → child may require supervision

• addiction → medication may be necessary in some situations (e.g. drug misuse is more common in untreated ADHD), but often causes drug dependence

• intervening on a biological level may lead to neurochemical changes in a still-developing brain, which have long-term consequences

  • e.g. proscribing Prozac to adolescent mice produces more anxiety in adulthood

what are 3 types of family intervention

• systematic family therapy → focuses on communication, structure + organisation between family members

• parent management training → focuses on not rewarding antisocial/externalising behaviour

• functional family therapy → strengthens relationships

what effect does making decisions on treatment/support in partnership with children have on their mental health

shared decision-making tends to increase the efficacy of interventions → creates mutual understanding between clinician + child, meaning child is better understood + receives the most effective treatment for them

what are the differences between oppositional defiant disorder (ODD), conduct disorder (CD) + antisocial personality disorder (APD)

all externalising disorders, but:

• ODD = a milder form of CD

• CD is either childhood CD (before age 10) or adolescent CD (after age 10)

• CD can develop into APD in adulthood, but sometimes stays as CD

what are callous + unemotional (CU) traits + what 3 characteristics do children/adolescents with these often have

distinguished by a persistent pattern of behaviour that reflects a disregard for others, lack of empathy + generally deficient affect (associated with CD + APD). often observed with:

• distinct problems in emotional + behavioural regulation that distinguish them from other antisocial youth; more similar to adult psychopathy

• range of distinctive cognitive characteristics, e.g. less sensitive to punishment cues

• positively related to verbal intellectual skills → not associated with low general mental ability

what is challenging behaviour defined as (Ogundele, 2018)

culturally abnormal behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely placed in serious jeopardy, or seriously limit access to use of ordinary community facilities

• can include self-injury, physical/verbal aggression, non-compliance, disruption of environment + other stereotypies

what are 3 examples of disruptive behavioural problems (Ogundele, 2018)

• ADHD

• ODD

• CD

what is disruptive mood regulation disorder (DMDD) (Ogundele, 2018)

a type of ‘emotional problem’ → characterised by pervasively irritable/angry mood, including frequent episodes of severe temper tantrums/aggression (more than 3 a week) + persistently negative mood

• lasts more than 12 months in multiple settings

what are pervasive developmental disorders + what are 5 examples

characterised by pervasive qualitative abnormalities in reciprocal social interactions + patterns of communications, with restricted + stereotyped interests/activities. now called autism spectrum disorders. includes:

• autism

• Asperger syndrome (though considered out of date → autism spectrum)

• childhood disintegrative disorder (CDD) → acute onset of autism symptoms

• pervasive developmental disorder not otherwise specified (PDD-NOS)

• Rett syndrome

what is the 6-month prevalence rate for any mental health disorder in young people up to 17 (WHO, 2001)

20.9%, 13% being anxiety disorders + 10% DBDs

what are 10 common risk factors for development of childhood emotional/behavioural disorders (Ogundele, 2018)

• maternal psychopathology → e.g. low education, anxiety, antisocial behaviour

• adverse perinatal factors → e.g. alcohol in gestation, early labour onset

• poor child-parent relationships → poor supervision, harsh discipline

• adverse family life → dysfunctional family due to substance abuse, violence etc.

• household tobacco exposure

• poverty/adverse socio-economic environment

• early age of onset → more likely to experience more persistent + chronic trajectory

• child’s temperament

• developmental delay + intellectual disability

• child’s gender → boys more likely to suffer from DBD, whether depression predominantly affects girls