PSYC 360 L18/19: Childhood Disorders

limitations of DSM for diagnosing childhood disorder

• dsm 5= static document, children change

• salient domains (key areas of development) likely to develop disorder in this domain

• normative process differs across development, symptoms change, underlying disorder can manifest with different symptoms at different times

externalizing disorders

behavioral disturbances directed outward through actions not feelings

• ADHD/ADD attention deficit hyperactivity, CD conduct disorder, ODD operationally defiant disorder

• 70% comorbidity with eachother so smb w adhd likely to have cd

disruptive disorders

a subset of external disorders where behaviors disrupt environment 

ADHD - attention deficit hyperactivity disorder 

symp

• inattention, hyperactivity, poor inhibition, distractability 

prog

• early adolescents. more M than F 2-3x 

prev

• 8% may be overdiagnosed 

adult ADHD

• symptoms persist but look diff/ may fit environment more 

History of ADHD construct

minimal brain dysfunction

• due to encephalitis relates to neurological injury 

DSM II hyperkinetic impulse disorder/ reaction of childhood

• impulsivity/ high rates of exercise, low concentration, distractability and inattention

• emerge out of unresolved childhood conflicts

• if neurological cause exists was called organic brain syndrom

DSM III ADD introduced

• with or without hyperactivity

• said attention is the primary factor 

DSM III-R

• ADD was removed bc not about attention but distractability

• replaced with ADHD 

• subtypes include attention problem / combined presentation

• people question if attention should define disorder 

• children w adhd no deificits in attention but distractability

DSM 5

• age onset changed from 7 to 12 years

• ADHD no longer grouped with conduct an oppositional 

• fits kids symp better than adults 

controversy regarding subtypes of ADHD

• Heterogeneity and equifinality: children with the same diagnosis can look very different.

• some skeptics argue that adhd is not a real disorder- they point to the much higher rates in the us than the rest of the world

• others argue that adhd is a valid category but don't agree with subtypes

• many theorists think that an attention disorder may be completely separate from what is now called adhd

2 major domains of symptoms for ADHD

the disinhibition perspective (impulsive/hyperactivity)

• cannot inhibit behavior so use executive functions to control

• compromise in executive function - act before thinking

sluggist daydream (inattention)

• difficulty orienting to new info

• daydreaming, mental fog, staring off, slow processing.

• Difficulty orienting to new information → trouble shifting attent

• may be separate disorder

Attention Problem in ADHD

• not primarily deficit of attnetion- child can still orient/ gather new info normally

• issue is the freedom from distractibility/ trouble staying focused when reinforcement competes for attention

Problems with the diagnostic label of adhd

• DSM III: ADD with and without hyperactivity , emphasized attention as primary symptom

• DSM II-R: replaced ADD with adhd. adhd now obsolete and not about attention

Conduct disorder

symp

• children who engage in agressive behavior toward animals, people 

• rule breaking, violation of laws, destruction of property 

• developmental precursor to antiscoial pd 

subtypes

• life course persistent/early starter: chronic, begins early into adulthood poor prognosis 

• adolescent limited/ late starter: emerge later, often recover, better prognosis 

limited prosocial emotion

• subtype qualifier for conduct disorder and early development of mask of insanity cleckley 

• lacks empathy and violent (criteria of lacking empathy for cd but not apd) 

gen dist

• more male than female 

• f more relational aggression 

prog

• aggression stable 

• early onset worse outcomes 

• later onset better outcomes

oppositional defiant disorder

symp

• precursor to cd

• defiant, argumentative, resistant

• family focused 

• must be more defiant than normative aspect 

gen dist

• more m than f 

prevalence

• 9% liftime boys, 2% girls 

prognosis

• same as cd

etiological models for cd

• heart disease: reflects variety of problems impacting circulatory system

• antisocial behavior: determined by risk factors

biological predictors

• genetics: hertiability of traits (impulsivity, irritability)

• endorcine: testosterone linked to aggression

• neurochemical models: low serotonin= low impulsve control

• ANS: low resting heart rate- biological marker of fearlessness and likely to be more aggressive

• neurogpyschological: low IQ leads to antisocial behavior

etiological model for cd cognitive predictor: ken dodge’s social information processing model of aggression

• encoding: agressive kids encode less info

  • al represents milk spilling internally

• interpretation: hostile attribution bias, interpret ambiguous stimuli as hostile

  • al figures out if bill spilled milk on purpose says its to be mean

• response access: fewer more aggressive options retrieved

  • al selects aggression

• response evaluation: believes aggression will work

• enactment: acts agressively

  • al hits bill

Intellectual disability lableing throughout DSM

• DSM III-IV: mental retardation 

• DSM 5: Intellectual disability to avoid stigma 

symptoms/ severity levels of ID - DSM 5

• defined by deficits in intellectual functioning, adaptive behavior, problems before age 18 and IQ below 70% impairment of skills 

• mild ID: 55-70 IQ, 85% of cases, minimal impairment in general living skill, no neurological damage

• moderate ID: 33-55 IQ, impairment more extreme/ needs cognitive support, limited living skills, impairment in fine motor skill

• severe/ profound ID: sever below 35 IQ, profound below 20 IQ. institutionalization, congenital physical abnormality, sensory motor problems, high mortality rates

AAID- american association of intellectual mental disease

• focuses on rehabilitation and support

• not solely diagnosis

• emphasizes individual strength and reduces stigma

etiological factors

• 75% cases no identifiable cause but for 25% involves

  • genetic abnormality: down syndrome, extra chromosome

  • genetically transmitted disease: PKU metabolic disorder prebenting phenylaline break down which builds toxic levels in the tissue

  • prenatal factors: utero exposed to HIV/ alc

  • postnatal event: head injury, encephallitis, meningitis

• vulnerability stress POV: some children have biological/environmental vulnerability that increases risk. with intervention can prevent id 

Enuresis

• bedwetting. noctural forms more common than diurnal

• 2 types

  • primary: child has never established bladder control at night

  • secondary: child has bladder control problems after period of being dry. typically children who are sexually abused

• bell and pad= treatment of choice

autism in the dsm

• dsm Iv: included groups of disorders for pervasive impairments in social functioning, communication, and intellectual functioning. autism, aspergers, pervasvie development all deeply related and differential diagnosis based on severity

• dsm 5: does away with asperger’s/ PDD NOS and has one broad autism spectrum category with 3 levels: requires support, requires substantial support and requires very much substantial support

Autism Spectrum Disorder

symp

• apparent by age 2 to 3

• marked by impairment in social functioning, little interest in social relationship -more deficit in social relation 

social deficits

• lack of social reciprocity, problems with non-verbal communication, unable to develop, understand, maintan relationship/ lack of interest in peers 

issues in behavioral sensory systems 

• sterrotyped repetitive behavior 

• insistence on order, highly fixated, restricted interest, hyper/hypo reactivity to sensort input, unusual interest in sensory experience

• highly comorbid 

etiology of autism spectrum disorder

• complex phenomenon and label captures children who have lots of diff problems

• etiology is diverse but pathways likely involve serious neurological insults

anxiety disorders in childhood

include GAD, phobia, OCD, SAD, PTSD. dsm 5: recognizes fearfulness part of childhood/ diagnoses accordingly ie: fear of adults understandable

phobias

• peak onset childhood, common, can be viewed as exageration of fears

separation anxiety disorders

• anxiety about separation from caregivers

• excessive fear about wellbeing of caregivers

• alot of times when kids have distress does not get detected bc kids cannot communicate 

• this disorder brings families to clinics bc rly disrupts the dynamic

school refusal

• extremely fearful about attending school

• may reflect fears regarding school environment which would be phobia but can be due to separataion anxiety

OCD

rare but still see

PTSD

common with kids