L7 Disorders of Childhood and Adolesence

Disorders of Childhood and Adolescence

Learning Objectives

  • Understanding of psychological disorders among children vs. adults.

  • Distinction between developmentally normal vs. abnormal anxiety and mood.

  • Presentation and prevalence of oppositional defiant disorder (ODD) and conduct disorder (CD).

  • Characteristics, course, and treatment of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

  • Definition of intellectual disability and causal factors.

  • Differences in treatment approaches for youth vs. adults.

Prevalence and Treatment of Psychological Disorders

General Statistics

  • Approximately 1 in 7 (14%) adolescents aged 10-19 globally experience mental health issues, often unrecognized.

  • U.S. data on specific prevalence among adolescents for various disorders is crucial for understanding treatment needs.

Hong Kong Case Study (2008)

  • Anxiety Disorder: 6.9%

  • Oppositional Defiant Disorder: 6.8%

  • ADHD: 3.9%

  • Conduct Disorder: 1.7%

  • Depressive Disorder: 1.3%

  • Substance Use Disorder: 1.1%

Special Considerations in Childhood Disorders

Understanding Psychological Vulnerabilities

  • Children's behavior must be contextualized within normal development stages.

  • Young children may lack a complex self-view and often misinterpret immediate threats as significant.

Classification of Disorders

  • Early diagnostic systems had limited categories for children's disorders.

  • DSM-5 expanded to include numerous childhood and adolescent disorder diagnoses.

Typical Age Ranges for Disorders

  • Infancy (0-12 months): Autism Spectrum Disorder, Intellectual Disability

  • Toddlerhood (1-2 years): Separation Anxiety Disorder, Reactive Attachment

  • Preschool (3-6 years): Learning Disorders, Anxiety Disorders

  • Middle Childhood (6-11 years): ADHD, ODD, Depression

  • Adolescence (11-20 years): Conduct Disorder, Eating Disorders, Substance Use Disorders.

Risk and Protective Factors

Contextual Factors

  • Biological: Genetic risks, prenatal stress, damage; temperament specifics.

  • Individual: Cognitive deficits, self-esteem, emotional dysregulation.

  • Family: Abuse, parental mental health, secure attachment vs. neglect.

  • Social: Peer relationships, bullying, social support systems.

Cultural Influences

  • Cultural expectations and community violence can shape mental health outcomes.

The Science of Early Childhood Development

  • Brain development is shaped over time, largely from birth to age five.

  • Neural connections develop in a hierarchy; early experiences impact future neural strength.

  • Cognitive, emotional, and social capacities are intertwined throughout life.

Anxiety and Depression in Children and Adolescents

Anxiety Disorders

  • Most common mental disorder; significant gender differences with higher rates in girls.

  • Common forms: Specific phobias, Social Anxiety, Separation Anxiety Disorder.

  • Causal Factors: Trauma, parental dynamics, cultural differences.

  • Treatment: Effective use of medications for anxiety and Cognitive Behavioral Therapy (CBT).

Childhood Depression and Bipolar Disorder

  • Features: Sadness, withdrawal, irritability, potential thoughts of suicide.

  • Bipolar is less common but possible in youth, often comorbid with ADHD.

Disruptive, Impulse-Control, and Conduct Disorders

Oppositional Defiant Disorder (ODD)

  • Characterized by negativistic, defiant, disobedient behaviors lasting at least 6 months.

  • Can escalate into Conduct Disorder.

Conduct Disorder (CD)

  • Persistent violations of rules and rights of others; potential comorbidities include substance abuse.

  • Causal Factors: Genetic predisposition, environmental influences, socioeconomic status.

Treatment Approaches

  • Focus on modifying family dynamics and behavior management training.

Neurodevelopmental Disorders

Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Characterized by inattention, impulsivity, and hyperactivity.

  • Higher prevalence in boys; approx. half may continue into adulthood.

  • Treatment: Stimulant medications like Ritalin; behavioral interventions add support.

Autism Spectrum Disorder (ASD)

  • Challenging developmental conditions affecting communication and behavior.

  • Symptoms include deficits in social interactions, communication, and repetitive behaviors.

  • Causal Factors: Genetics; precise causes remain largely unknown.

Learning Disorders

  • Defined as significant delays in academic skills that affect daily functioning.

  • Common form: Dyslexia; involves challenges with word recognition and comprehension.

  • Causal Factors: Genetic predisposition and central nervous system impairments.

  • Interventions: Increasing focus on early phonics instruction and personalized education plans.

Intellectual Disability

Definitions and Levels

  • Characterized by deficits in intellectual and adaptive functioning,

  • Mild: IQ 50-70; individuals are educable and can manage daily tasks.

  • Moderate: IQ 35-50; limited independence; learning at slower rates.

  • Severe: IQ 20-35; high dependency needs.

  • Profound: IQ below 20; significant challenges and dependent on others.

Causal Factors

  • Genetic, infections, physical trauma, malnutrition.

Treatment and Special Considerations

Treatment Adaptations for Youth

  • Unique vulnerabilities and inability to seek help.

  • Consideration of involving parents in treatment is significant.

Child Advocacy

  • Advocacy programs seek to provide adequate mental health services for children and adolescents, with a goal of early intervention.