childhood and adolescent psychological problems (Davey - chapter 16) | Quizlet

externalizing disorders

- disorders based on outward-directed behaviour problems

- aggressiveness, hyperactivity, non-compliance or impulsiveness

(also internalizing disorders more inward-looking and withdrawn behaviours like - depression, anxiety, and active attempts to socially withdraw)

identification and diagnosis

- What is normal for a particular age? (e.g. bed wetting above 5 is not)

- children often don't have the abilities to express themselves properly

- lack of self-knowledge, communication skills, preciseness

- cultural norms

- changes occur rapidly -> can escalate quickly and dramatically

childhood psychopathology as the precursor of adult psychopathology

- preschool behaviour problems predict psychopathology in alter life

- developmental psychopathology:

-> research concerned with mapping how early childhood experiences may act as a risk factor for later diagnosable psychological disorders

-> attempts to describe the pathways by which early experiences may generate adult psychological problems

- childhood experiences may contribute in several ways:

-> e.g. anxiety: persists to anxiety later in life

-> adverse effect on subsequent development and indirectly lead to different forms of maladjustment

-> precursor for more severe disorder (phobia - panic disorder)

-> e.g., maltreatment influences indirect: heightened reactivity to stressors etc.

-> may change completely or disappear

developmental psychopathology

- An area of research concerned with mapping how early childhood experiences may act as risk factors for later diagnosable psychological disorders.

-It also attempts to describe the pathways by which early experiences may generate adult psychological problems.

prevalence of childhood and adolescent psychological disorders

- 10-20% of children and adolescents have a diagnosable disorder

-> boys often conduct disorders

-> girls emotional disorders

- co-morbidity common (2% more than one disorder)

- risk factors include:

-> lone parents, parental psychopathology, repeated early separation from parents, harsh or inadequate parenting, exposure to abuse or neglect, and adverse peer group influences

2 disruptive behaviour problems in DSM-5

attention deficit hyperactivity disorder (ADHD) and

conduct disorder

- are characterised by impulsive, disruptive, and poorly controlled behaviour.

attention deficit hyperactivity disorder (ADHD)

- manifest itself as lack of attention, hyperactivity, or impulsivity.

- ADHD significantly affects educational achievement and social integration.

2 ADHD subtypes

-> ADHD, predominantly inattentive presentation (just enough symptoms for inattention)

-> ADHD, predominantly hyperactive/impulsive presentation (just enough for H./I.)

=> if both elements are present it is called combined presentation

- 50% of combined presentation diagnosis will also be diagnosed with ODD or CD

- violations of social norms and basic rights

- usually first recognized by parents after begin school

prevalence of ADHD

- 5% of school children and 2.5% of adults diagnosed

- half of those diagnosed as children will carry the diagnosis into adulthood

-> more common in boys

Aetiology of ADHD

- biological

(genetics, neuroscience, prenatal factors,envrionmental toxins)

- psychological factors

(parent-child interaction, TOM deficits,)

biological factors of ADHD

- particularly important -> vulnerability in specific environmental situations

genetics:

- one of the most heritable psychiatric disorders (76%)

- abnormalities with dopamine, norepinephrine and serotonin

neuroscience:

- smaller brain and develop more slowly

-> main areas affected being the frontal, parietal, temporal, and occipital lobes, frontal cortex, basal ganglia, cerebellum

=> e.g. impaired executive functioning

prenatal factors:

- smoking and drinking

- birth complications

environmental toxins:

- food colorings…

- exposure to nicotine

psychological factors

Parent-child interactions:

- appears to run in families

- parents with ADHD may reinforce any symptoms, or they may be less effective parents

- Dysfunctional parent–child interactions may contribute (no evidence that these are sole cause).

Theory of mind deficits:

- some suggest ADHD sufferers have theory of mind (TOM) deficits -> studies are inconsistent

conduct disorder (CD)

- behaviour that is aggressive, causes vandalism, property loss or damage, deceitful- ness and lying, and serious violation of accepted rules

- regularly co-morbid with impulse disorders

- more common in males

- lack of inhibition to control impulses

- two main subtypes of conduct disorder:

1. childhood-onset conduct disorder:

- onset of at least on criterion characteristic prior to 10 years of age

2. adolescent-onset conduct disorder:

- symptoms only after the age of 10 years

- less physical aggression

- better peer relationships

two main subtypes of conduct disorder

1. childhood-onset conduct disorder:

- onset of at least on criterion characteristic prior to 10 years of age

2. adolescent-onset conduct disorder:

- symptoms only after the age of 10 years

- less physical aggression

- better peer relationships

oppositional defiant disorder (ODD)

A mild form of disruptive behaviour disorders reserved for children who do not meet the full criteria for conduct disorder.

prevalence of CD

- lifetime prevalence 9.5%, median age of onset is 11.6 years

- 4-16% in boys (mostly violent behaviour)

- 1.2-9% in girls (lying, running away, theft, prostitution, ...)

biological factors of CD

Genetic factors:

- genetic component with heritability ca. 45-67%

- serotonin and monoamine neurotransmitter abnormality

-> socio-emotional information processing in prefrontal cortex

Neuropsychological deficits:

- associated with neuropsychological deficits in cognitive functioning

-> executive functioning, verbal IQ, and memory

-> reduced activity in amygdala, ventral stratium and prefrontal cortex (emotion and reward)

Parental factors:

- maternal smoking and drinking during pregnancy

- prenatal (and postnatal) malnutrition, especially deficits in proteins, iron, and zinc

issues related to CD diagnosis

- under 18 years of age

- social context has to be taken into account (e.g. stealing bc of poverty?)

- might sometimes be oppositional defiant disorder (ODD)

-> mild form: do not meet the full criteria for conduct disorder

-> might be a precursor

psychological factors of CD

family environment and parent-child relationship:

- unemployment, parents with antisocial personality disorder, many conflicts, poverty, social deprivation…

- nature of parent-child interactions during childhood

-> abuse, disrupted care, maltreatment, harsh parenting, inconsistency in discipline

Media and peer influences:

- mimic the violent activities that they see around them in the media or by their peers

- media violence has its effect primarily on children who are already emotionally and psychiatrically disturbed

-> vicious cycle of associating with aggressive peers - more exposure violence

-> being rejected by peers has been shown to cause increased aggressiveness

cognitive factors:

- fail to acquire a moral awareness - achieve goals by e.g., using violence

socioeconomic factors:

-poverty, low socioeconomic class, unemployment, urban living, poor educational achievement

cognitive factors of CD

- fail to acquire a moral awareness - achieve goals by e.g., using violence

-> high interpretation/information bias (e.g. more interpreting others behaviour as violent)

- social-information processing model of antisocial an aggressive behaviour:

-> hostile attributional bias:

=> interpret not only ambiguous cues as signalling hostility, but also many cues that are generated with benign intentions

socioeconomic factors of CD

- associated with poverty, low socioeconomic class, unemployment, urban living, poor educational achievement

- these things may even be a cause rather than a consequence

childhood anxiety

- anxiety is primarily manifested as with­ drawn behaviour (internalising).

- child avoids activities where they may have to socialise with others

- will be clinging and demanding of parents and carers they will express a desire to want to stay at home

- Many childhood anxiety disorders do tend to be recognisable as those also found in adulthood

seperation anxiety (DSM-5)

- intense fear of being separated from parents or carers.

- commonly found in many children at the end of the first year of life but usually gradually subsides

-> may cause social anxiety in school age

- can be triggered by specific life stressors

- prevalence approximately 4% in children between 6 and 12 years of age

obsessive compulsive disorder (OCD)

- very similar to adult OCD

- intrusive, repetitive thoughts, obsessions and compulsions

-> fear of contaminations and aggression main fears

-> compulsions (e.g. behavioural ritulas) without obsessions (e.g. intrusive thoughts) can be quite common in children

- boys have an earlier age and more likely to have sexual obsessions

- girls exhibit more hoarding compulsions

- age of onset can be as early as 3-4 years but mean age of onset is more likely to be around 10 years

- co-morbid with tic disorders or Tourette's syndrome, anxiety and eating disorders

tic disorders

Uncontrollable physical movements such as facial twitches, rapid blinking or twitches of the mouth.

Tourette's syndrome

A disorder in which motor and vocal tics occur frequently throughout the day for at least 1 year.

internalizing disorders

- disorder represented by more inward-looking and withdrawn behaviours

- depression, anxiety, and active attempts to socially withdraw

- Childhood anxiety and depression

- Diagnosable forms of childhood anxiety include separation anxiety, OCD, GAD, specific phobias, and social phobia.

generalized anxiety disorder (GAD)

- antici­patory anxiety: pathological worrying

-> perseverative worrying that an individual finds uncontrollable

- caused by negative info processing bias, attentional bias, interpretation bias and lack of executive functioning

- what a child worries about tends to be determined by their age

- 4–7-year-olds: personal harm, separation from parents, imaginary creatures

- 11–13-year-olds: social threats and being punished

pathological worrying

perseverative worrying that an individual finds uncontrollable

specific phobias

- normally children go through phases of 'phobia' but here they don't disappear

- e.g., social phobia often being in childhood as a fear of strangers

- prevalence of specific phobia in 8-9-year-olds is 7% for boys and 10% for girls

aetiology of childhood anxiety

genetic factors:

- heritability averag­ing 54%

- Genetic factors play a relatively nonspecific role in childhood anxiety by determining general levels of temperament probably transmitted through many gene variants.

trauma and stress:

- trauma and stress and exposure to threat-relevant info increases anxious responding (abuse, extreme experiences, illness, accidents)

modelling and exposure to information:

- modelling and exposure to info from different sources

-> peers, authoritative people, media

- e.g parenting style:

- dysfunctional forms of parenting

-> detached, rejecting, over-controlling, overprotective, demanding…

-> reactions to temperament

-> psychological and adjustment problems during childhood

childhood and adolescent depression

- In early childhood, depression will manifest as clingy behaviour, school refusal, and exaggerated fears and also somatic complaints

- nearly same diagnostics as adult depression

-> children: more somatic complaints, social withdrawal…

- adolscence: retarded thinking, hypersomnia, suicidal, self-harm…

- prevalence

-> less than 1% in pre-schoolers

-> 2 and 3% for school-age children

-> ~ 5% in 17-19

--> between 11 and 28% of adolescents aged up to 19 years of age will have a diagnosed episode of major depression

aetiology of childhood and adolescent depression

genetic:

- only a modest genetic component

risk factors:

- risk factors (see pic): the greater the number, the greater the possibility

- childhood abuse or neglect, younger than 5 years of age include parental marital partner changes, mother’s health problems in pregnancy, child’s health....

psychological:

(a) the role of parent‐child interaction and

(b) the develop­ment of dysfunctional cognitions that shape and support depressive thinking in childhood.

=> Studies suggest a modest genetic component to childhood depression and a substantial environmental component.

childhood depression is comorbid with...

.. other psychological problems and can have detrimental effects on educational and social functioning.

pessimistic inferential styles

- attribution of negative events to stable, global causes

- more likely to experience increases in self‐ reported -depressive symptoms following negative events than children who do not possesses this inferential style

-> reared by a depressed parent may contribute to childhood depression, and as the child grows older it may develop a this inferential style.

influence of parents on childhood and adolescent depression

- interaction

-> transmit their negative mood to their children

-> children may model the behavioural symptoms of depression exhibited by their parents

-> parents may not be able to properly respond to their children's emotional experiences

- dysfunctional cognitions

-> pessimistic inferential style: attribution to stable, global causes

-> catastrophising

-> infer negative characteristics

treatment of childhood and adolescent psychological problems

- requires a coordinated provision of services that extends across educational, health, and social services.

- often require a multifaceted approach:

-> specific symptoms

-> general emotional states and cognitions

-> behavioural problems

-> intrafamily relationships

drug treatment

- are used for childhood anxiety and depression, and ADHD

- should be cautious about recommending the use of drugs

- rarely a complete elimination of symptoms

- undesirable side effects

- doubts about the safety and efficacy

- ritalin is a stimulant used for ADHD treatment, may act on neurotransmitters norepinephrine and dopamine

Ritalin (methylphenidate)

A stimulant medication that is used to treat ADHD in around half of those diagnosed with the disorder.

behaviour therapy

- systematic desensitization

-> for anxiety problmes

- bell-and-battery technique

-> pair alarm with urine: conditioning

- selective Reinforcement (ADHD):

time-out (TO)

- reducing disruptive behavioursby removing the child from the situation

- e.g. time-out chair for periods between 5 and 15 minutes

-> disruptive behaviour is positively reinforced by the attention it receives from peers and adults

behaviour management techniques:

- even taught to parents as an aid to controlling and responding to their children in the home

-> e.g., identify and reward positive behaviours etc.

family interventions

systemic family therapy:

- inappropriate family structure and organization

- boundaries between parents and children, and the ways in which they communicate

parent management training:

- acceptable rather than antisocial behaviours are reinforced

- conduct disorders

functional family therapy (FFT):

- strengthening relationships in the family by opening up communication between parents and children

systematic desensitization

A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.

time-out (TO)

- reducing disruptive behaviours by removing the child from the situation

- directing them, for example, to sit in a specific time-out chair for periods between 5 and 15 minutes

-> disruptive behaviour is positively reinforced by the attention it receives from peers and adults -> therefore the time out helps giving no attention to negative behaviour

behaviour management techniques

- can be used in a range of environments

- can even be taught to parents as an aid to controlling and responding to their children in the home

-> e.g., teaching parents to identify and reward posi­tive behaviour also helps to prevent parents from focus­sing on the negative and disruptive behaviours (children with ADHD and CS)

bell‐and‐battery technique

A widely used classical conditioning method for treating nocturnal enuresis (bett nässen).

cognitive behaviour therapy (CBT)

- helps depressed individuals become aware of pessimistic and negative thoughts, depressive beliefs and causal attributions

- has been successfully adapted to treat childhood and adolescent depression and anxiety, as well as a number of other childhood psychological problems.

- increase social interactions

- improve problem-solving skills

- goal setting and attainment

- involve parents

- for anxious children, a typical treatment programme involves:

-> recognition of anxious feelings and somatic reactions

-> understanding the role of cognitions and self-talk in anxious situations

-> learning the use of problem solving and coping skills to manage anxiety

-> using self-evaluation and self-reinforcement strategies to facilitate the maintenance of coping

-> implementing a plan of what to do in order to cope in an anxious situation

- less effective for children under 4 years of age

systemic family therapy

- view that childhood problems result from inappropriate family structure and organization

- boundaries between parents and children, and the ways in which they communicate

parent management training

- teach parents to modify their responses to their children so that acceptable rather than antisocial behaviours are reinforced

- used especially with the families of children diagnosed with conduct disorders

functional family therapy (FFT)

- strengthening relationships in the family by opening up communication between parents and children

- elements of systematic family therapy and CBT

play therapy

- a range of play-based therapeutical and assessment techniques

- used with younger children who are less able to communicate and express feelings

- play itself can be curing with anxiety and depression

- helps to express, learn coping and manage behaviour

- develop positive relationship with therapist

prevention strategies

- school‐based prevention programmes

- especially to help children to develop strategies for managing common mental health problems such as depression and anxiety.