Childhood and Adolescent Psychological Problems PSY2003

Diagnostic challenges

Developmental appropriateness

Communication limitations

Cultural norms

Rapid Developmental change

Risks of not treating

Progression to more serious disorders

Social, academic and occupational impairments

Increased risk of criminality, substance use, self harm, suicidality

Internalising Disorders

Anxiety

Depression

Anixety symptoms

Excessive worry, somatic complaints, avoidance

Anxiety subtypes

separation anxiety, GAD, OCD, social phobia

Depression symptoms

Clinginess, irritability, fatigue, low self-esteem, pessimism, physical complaints (e.g., headaches)

May be difficult to distinguish from normal mood changes

Externalising Disorders

ADHD

Oppositional Defiant Disorder (ODD)

Conduct Disorder (CD)

ADHD symptoms

Inattentive type: difficulty sustaining attention

Hyperactive/impulsive type: fidgeting, restlessness, interrupting

Combined type: both sets of symptoms

ODD symptoms

Defiance, irritability, vindictiveness

CD symptoms

More severe; aggressive behaviour, property destruction, deceit, rule violations

Psychosocial interventions

CBT

Parent management training

Family Therapy

Play therapy

Parent management training

Rewarding appropriate behaviour, managing defiance

Family Therapy

Systemic interventions targeting communication and structure

Play therapy

For younger children with limited verbal expression

Pharmacological Interventions

Stimulants

SSRIs

Antipsychotics

Note: Medications may carry greater risks in children due to developing brains

Stimulants

Primarily for ADHA

Antipsychotics

For severe aggression or CD, especially with comorbidity

DSM-5 CD

CD involves a repetitive and persistent pattern of violating societal norms and the rights of others

CD shown by ≥3 of the following within 12 months:

Aggression

Destruction of Property

Deceit/theft

Rule violations

Childhood onset CB

(<10 years): Worse prognosis, more severe aggression

Adolescent onset CB

(≥10 years): More influenced by peer environment

With/without Limited Prosocial Emotions (LPE) CD

LPE subtype includes lack of remorse, empathy, and shallow affect

Psychological factors of CD

Callous-Unemotional Traits (CU): Reduced guilt, low empathy, poor emotional regulation

Cognitive: Hostile attribution bias — misinterpreting benign cues as hostile

Neurocognitive deficits: Impairments in executive functioning, emotion recognition, verbal IQ

Environmental factors of CD

Prenatal (smoking, alcohol)

Parenting (Harsh discipline, neglect)

Social (peer rejection)

Low SES

CD heritability

~40-50% in general; higher (~67%) when CU traits are present

CD GWAS

Identified genes include RBFOX1, GABRA2, SLAC6A4, and OXTR, though findings are complex and not always interpretable

MAOA Gene function

Enzyme breaks down serotonin, dopamine, and norepinephrine

MAOA-L

Low activity variant

Linked to: Increased aggression

Poor impulse control

Heightened emotional reactivity

MAOA-L Gene x Environment interaction

Caspi et al.: Individuals with MAOA-L + history of childhood maltreatment are at significantly greater risk of CD

MAOA alone is not sufficient — risk emerges only under environmental stress

MAOA-L Amydala

Overactivity → emotional dysregulation, hyperresponsiveness to threat

Prefrontal cortex (vmPFC, OFC): Impaired decision-making, empathy, and reward processing

MAOA-L Anterior cingulate cortex

Poor emotion regulation and cognitive control

MAOA-L PFC

Impaired decision-making, empathy, and reward processing

GxE

Gene-Environment interaction - Genes moderate how individuals respond to environmental influences

Passive G-E correlation

Child inherits both genes and env from parents

Evocative G-E correltaion

Child's genetically influenced behaviour evokes responses from the environment (aggression leads to discipline)

Active G-E correlation

Child seeks out env that match genetic tendencies (deliquent peer groups)