Chp. 16: Childhood Disorders

Stress during childhood and adolescence

• cyberbullying (need legislation)

• COVID pandemic (isolation, family stress, etc.)

Psychological disorders of childhood adolescence

• some have adult counterparts

• other usually disappear or radically change form by adulthood (i.e., autism spectrum disorder, intellectual disability)

Childhood anxiety disorders

• some level of anxiety is a typical part of childhood

• common events

• parental problems or inadequacies

• genetic influences such as anxious temperament

Separation anxiety disorder

• Extreme anxiety, often panic, whenever they are separated from home or parent

• Can lead to school refusal

• Somatic symptoms can be quite high

Selective mutism

Marked by failure to speak in certain social situations when speech is expected, despite ability to speak in other situations.

• often begins as early as preschool years

• different that being an introvert

• may be misclassified as intellectual disability

Checklist for selective mutism

• Persistently does not speak in certain social situations in which speech is expected, although speaking in other situations presents no problem

• Academic or social interference

• Individual’s symptoms last 1 month or more, and are not limited to the first 4 weeks of a new school year

• Symptoms not due to autism spectrum disorder, thought disorder, or language or communication disorder

Treatments for childhood anxiety disorders

• Psychodynamic, cognitive-behavioral, family, and group therapies, separately or in combination, have been used most often

• Play therapy

• Parent by-in can be difficult

Major depressive disorder

• may be triggered by negative life events, major changes, rejection, or ongoing abuse

• characterized by symptoms like headaches, stomach pain, irritability, and disinterest in toys and games

• is more common among teenagers than among young children

Treatments for major depressive disorder

• CBT

• interpersonal psychotherapy

• antidepressant drugs (can increase suicidality)

Bipolar & disruptive mood dysregulation disorder (DMDD)

• Thought to be an adult mood disorder, whose earliest age of onset is late teens

• Theorists suggest the bipolar disorder has become a “catch all” that is being applied to almost every explosive, aggressive child

• “big behaviors” that are hard to manage

• Shift in diagnoses has been accompanied by an increase in the number of children who receive adult medications

• DSM includes new category: disruptive mood dysregulation disorder (DMDD)

Checklist for disruptive mood dysregulation disorder

• For at least a year → individual repeatedly displays severe outbursts of temper that are extremely out of proportion to triggering situations and different from ones displayed by most other individuals of their age

• Outbursts occur at least 3 times per week and are present in at least 2 settings (home, school, w/ peers)

• Individual repeatedly displays irritable or angry mood between the outbursts (almost all the time)

• Individual receives initial diagnosis between 6-18 years of age

Disruptive mood dysregulation disorder (DMDD)

Marked by severe recurrent temper outbursts along with a persistent irritable or angry mood.

Play therapy

Helps children express their conflicts and feelings indirectly by drawing, playing with toys, and making up stories.

Oppositional defiant disorder

Children are repeatedly argumentative, defiant, angry, irritable, and perhaps vindictive/vengeful.

• repeated arguments w/ adults, loss of temper, anger and resentment

• ignore adult requests and rules, try to annoy people, and blame others for mistakes and problems

Conduct disorder

Children repeatedly violate the basic rights of others and display significant aggression.

• often aggressive

• physically cruel to people and animals

• steal from, threaten, or harm victims

Conduct disorder: overt-destructive pattern

Openly aggressive and confrontational behaviors.

Conduct disorder: overt-nondestructive pattern

Openly offensive but nonconfrontational behaviors such as lying.

Conduct disorder: covert-destructive pattern

Secretive and destructive behaviors.

Conduct disorder: covert-nondestructive pattern

Secretly commit nondestructive behaviors.

Relational aggression

Individual is socially isolated and primarily performs social misdeeds

• slander

• rumor-starting

• friendship manipulation

• more common in girls

Consequences of conduct disorder

• school suspension, foster home placement, incarceration

• juvenile delinquency label

• females: more relational way

• males: actively harming someone

Causes of conduct disorder: links

• genetic and biological factors

• drug abuse

• poverty

• traumatic events

• exposure to violent peers or community violence

Causes of conduct disorder: case ties

• troubled parent-child relationships

• inadequate parenting

• family conflict

• marital conflict

• family hostility

• family skills

Treatment for conduct disorder

• Better to catch it early

• Treatments are generally most effective w/ children younger than 13

• Increasingly combining several approaches into wide-ranging treatment program

Treatment for conduct disorder: parent-management training

• Parent-child interaction therapy (PCIT)

• Video modeling

• Internet-delivered parent-child interaction therapy (iPCIT)

• Family therapy

• Multisystemic therapy

Treatment for conduct disorder: child-focused treatment

• Cognitive-behavioral interventions

• Problem-solving skill training

• Coping Power Program

• Drug therapy → stimulant drugs

Treatment for conduct disorder: residential treatment

• Treatment foster care

• Juvenile training centers

Treatment for conduct disorder: prevention

• Training opportunities

• Recreational facilities

• Health care 

Elimination disorders

• repeatedly urinate or pass feces in their clothes, in bed, or on floor

• have already reached an age at which they are expected to control these bodily functions (symptoms aren’t caused by physical illness)

Enuresis

Marked by repeated bed-wetting or wetting of one’s clothes.

• can be triggered by stressful event

• most cases correct themselves without treatment

Encopresis

Characterized by repeated defecating in inappropriate places, such as one’s clothing

• seldom occurs during sleep

• more common in boys

• starts after age 4

Neurodevelopmental disorders

Group of disabilities in the functioning of the brain that emerge at birth or during very early childhood and affect one’s behavior, memory, concentration, or ability to learn.

• ADHD

• Autism Spectrum Disorder

• Intellectual Disability

Attention-deficit/hyperactivity disorder (ADHD)

Marked by the inability to focus attention, or by overactive and impulsive behavior, or both.

Kids w/ ADHD can also have:

• learning or communication problems

• poor school performance

• difficulty interacting w/ other children

• misbehavior, often serious

• mood or anxiety problems

ADHD’s interacting causes

• irregular dopamine activity and irregularities in frontal-striatal regions of the brain

• lack of balance of type 1 (unexpected things) and type 2 (focusing on things controllable) attention processes

• attention circuit: faulty interconnectivity

• high levels of stress

• family dysfunctioning

Treatment for ADHD

• common approaches: drug therapy, behavioral therapy, or combination of 2

• many doctors require testing for children now (cannot be based on parent report, could be misdiagnosis)

Drug therapy for ADHD

• Children currently treated w/ methylphenidate (Ritalin); Adderall being increasingly prescribed

• Long-term effects including applicability to children of minoritized groups

• Inaccurate diagnosis

• Misuse

• Stimulants → don’t take as long to see affects

• Non-stimulants 

• Can produce paradoxical effect (producing opposite effect that is wanted)

CBT therapy and treatment combinations for ADHD

• operant conditioning → token economy

• therapeutic summer camps

• parent management training

• most improvement from treatment combinations

Multicultural factors and ADHD

• Black and Hispanic children w/ significant attention and activity problems are less likely to be assessed, receive a diagnosis, or undergo treatment for disorder

• Racial and ethnic differences in diagnosis and treatment are tied to economic factors, social bias and stereotyping, parent and teacher perceptions

Autism spectrum disorder

Marked by substantial unresponsiveness to others, significant communication deficits, and highly repetitive and rigid behaviors, interests, and activities.

• appears early in life (before age 3)

• mostly long lasting into adulthood

Language and communication problems for ASD

• echolalia: repeating of words or parts of words

• delayed echolalia: repetition of words or phrases after a time delay

• pronominal reversal: individual confuses personal pronouns

• nonverbal behaviors

• highly rigid and repetitive behaviors, interests, activities extending beyond speech patterns

Sociocultural explanations for ASD

• family dysfunction

• parent personality characteristics

• way family interacts

• research doesn’t support this theory

Psychological explanations of ASD

• central perceptual or cognitive disturbance (isn’t supported)

• theory of mind disorder (mentalization

• mind blindness

Biological explanations for ASD

• genetic factors

• prenatal difficulties or birth complications

• irregular cerebellum structure - brain circuit dysfunction

• MMR vaccine theory (not proven)

Neurodiversity

Perspective that holds that all brains differ from each other and that some people’s brains develop or work differently from the brains of most other people without implying that the neurodivergent people are pathological or deficient.

CBT interventions and treatment for autism

Teach new, appropriate behaviors while reducing negative behaviors.

• modeling

• operant conditioning

Communication training interventions and treatment for autism

Ones who are speechless may be taught other forms of communication

• sign language

• simultaneous communication

• augmentative communication systems

• child-initiated interactions

• joint attention training

Parent training interventions and treatment for autism

Parent behavioral programs to train parents to apply behavioral techniques at home

• individual therapy and support groups

• parent associations and lobbies

Intellectual disability

Display general intellectual functioning that is well below average, in combination with poor adaptive behavior.

• IQ of 70 or lower

• must have difficulty in such areas as communication, home living, self-direction, work, or safety

• symptoms must appear before 18

Assessing intelligence

• Educators and clinicians administer intelligence tests to measure intellectual functioning

• Many theorists question validity of IQ tests

• Sociocultural bias, accuracy and objectivity, test inadequacies, cultural differences, testing situation discomfort, tester bias

Assessing adaptive functioning

• Diagnosticians cannot rely solely on cutoff IQ score of 70 to determine whether person ha an intellectual disability

• Several scales developed to assess adaptive behavior

• Hardest to assess

• Some parents do tasks for their kids

Features of intellectual disability

• Most consistent sign is that person learns very slowly

• Won’t acknowledge that they don’t understand

• Other areas of difficulty are attention, short-term memory, planning, and language

• Those who are institutionalized w/ intellectual disability are particularly likely to have these limitations

• Mild, moderate, severe, profound

4 levels of intellectual development disorder: Mild

• IQ 50-75

• intellectual performance seems to benefit from schooling, need assistance under stress (accommodations)

Sociocultural and psychological causes

• poor and unstimulating environments

• inadequate parent - child interactions

• insufficient early learning experiences

Biological factors

• fetal exposure to alcohol, drugs, or malnutrition during pregnancy

4 levels of intellectual development disorder: moderate

• IQ 35-49

• can care for themselves

• benefit from vocational training

• can work in unskilled or semiskilled jobs

4 levels of intellectual development disorder: severe

• IQ 20-35

• usually require careful supervision and can perform only basic work tasks

• rarely able to live independently

4 levels of intellectual development disorder: profound

• IQ under 20

• training they may learn or improve basic skills

• need very structured environment

Chromosomal causes of intellectual disability

• down syndrome (trisomy 21)

• fragile x syndrome (language impairment, some behavior problems)

Metabolic causes of intellectual disability

• body’s breakdown or production of chemicals is disturbed (2 defective recessive genes)

• PKU - screening and special diet before 3 months

Prenatal and birth-related causes of intellectual disability

• physical problems in pregnancy can threaten fetus’s healthy development

• low iodine - cretinism (hypothyroidism)

• FAS

• exposure to certain infections during pregnancy

• birth complications

Childhood problems/causes of intellectual disabillity

• up to age 6 - injuries and accidents can affect intellectual functioning

• poisoning, lead poisoning

• serious head injury

• excessive exposure to X rays

• excessive use of certain chemicals, minerals, and/or drugs

• certain infections (meningitis, encephalitis)

Interventions/treatments for people w/ intellectual disability

• quality of life attained by people depends largely on sociocultural factors

• programs try to provide comfortable and stimulating residences, social and economic opportunities, and a proper education

Interventions/treatments for intellectually disabled: proper residence

• majority of children live at home or community residence matched to disability, preference, and available resources

• day centers

Interventions/treatments for intellectually disabled: educational programs that work best

• free, appropriate educational program mandated by federal law (IEP)

• early intervention - dependent of level of functioning

• special education vs. mainstream classrooms

• teacher preparedness

Interventions/treatments for intellectually disabled: when therapy is need

• sometimes experience emotional and behavioral problems

• individual or group therapy (teaching basic skills)

• psychotropic medication - if there is co-occurring disorder

Interventions/treatments for intellectually disabled: promoting personal, social, and occupational growth

• youth clubs (e.g., Special Olympics)

• dating skills program

• sheltered workshops

• complete range of educational and occupational training services