15--Childhood Disorders

Special Considerations in Understanding Disorders of Childhood and Adolescence

  • Important to view children's behaviors in the context of normal development.

  • Developmental psychopathology studies the origins and course of maladaptation within typical growth processes.

Vulnerability of Children and Adolescents

  • Lack a stable sense of identity and emotional resources to cope with problems.

  • Difficulty handling stressful events due to limited life experiences.

  • Increased dependency on others, which can have positive or negative impacts.

Ethical Considerations in Treatment

  • Ethical implications of involuntary treatment for children who refuse therapy.

  • Issues for therapists in managing parental refusal to seek treatment.

  • Questions regarding age-related rights to refuse treatment.

  • Considerations of child abuse in cases where medical treatment is withheld.

Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Characterized by difficulties in sustaining attention, impulsiveness, and excessive motor activity.

  • Symptoms can include distractibility, failure to follow directions, impulsivity, and social immaturity.

  • Originally divided into ADD and ADHD; now combined into ADHD.

ADHD Statistics

  • Prevalence: 13% in boys, 4% in girls (10% overall).

  • Girls tend to exhibit more inattention than hyperactivity.

  • Symptoms typically manifest before age 8, then diminish.

  • Comorbidity with Oppositional Defiant Disorder is common.

Causal Factors for ADHD

  • Genetics, prenatal exposure to substances (like alcohol).

  • Neurodevelopmental aspects: smaller brain size, delayed frontal lobe development.

Treatment Methods for ADHD

  • Medications: stimulants (Ritalin, Adderall, Vyvanse, Concerta, Strattera).

  • Behavioral therapies focusing on positive reinforcement.

  • New interventions include external Trigeminal Nerve Stimulation (eTNS).

Anxiety Disorders in Children and Adolescents

  • More common in girls (9%) than boys (6%).

  • Separation Anxiety Disorder is the most prevalent childhood anxiety disorder.

  • Symptoms include excessive worry upon separation from caregivers and difficulties in sleeping.

Causes and Treatment of Anxiety Disorders

  • Hereditary factors and overprotective parenting can contribute.

  • Treatments include psychopharmacology (Fluoxetine) and psychotherapy (Cognitive Behavior Therapy is most effective).

Child and Adolescent Depression

  • Similar to adult Major Depressive Disorder; irritability may substitute for sadness.

  • Epidemiology shows 12% prevalence (girls: 16%, boys: 8%).

Causes and Treatments for Depression

  • Risk factors include parental depression, prenatal alcohol exposure, and traumatic events.

  • Effective treatments: Cognitive Behavior Therapy and SSRIs (controversial due to risks of suicidal ideation).

Elimination Disorders: Enuresis and Encopresis

  • Enuresis: Involuntary urination past age 5; causes include biological issues and psychosocial factors. Treatments include medication and conditioning approaches.

  • Encopresis: Inappropriate defecation after age 4; presents along with constipation issues. Treatment involves both medical and psychological strategies.

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)

  • ODD: Characterized by negativism and defiance; prevalent by age 8.

  • CD: Persistent rule-breaking with aggression; average onset age is 12. More common in boys.

Causal Factors for ODD/CD

  • Genetic predisposition, low intelligence, and psychosocial factors like rejection and poor parental influences.

  • Early onset of CD worsens prognosis, but later onset may have better outcomes.

Autism Spectrum Disorder (ASD)

  • Encompasses a range of behaviors including social deficits and fixation on sameness.

  • Signs typically emerge between ages 2 and 3 with a higher prevalence in boys (1 in 59 children).

Causal Factors and Treatments for ASD

  • Brain abnormalities and genetic factors contribute to the disorder.

  • Treatments focus on adapting to challenges through behavioral analysis and medications for associated symptoms.

Intellectual Disability

  • Defined by deficits in mental functioning and low adaptive skills; requires IQ of 70 or lower for diagnosis.

  • Severity ranges from mild to profound, dictating the level of support required.

Learning Disabilities

  • Characterized by discrepancies between IQ and specific academic skills such as reading and math.

  • Causal factors include genetic influences, trauma, and environmental conditions.