Clinical Psychology: Disorders of Childhood and Adolescence (Neurodevelopmental Disorders)

Introduction to Disorders of Childhood

  • Definition: Disorders that first appear during childhood.

  • Context: Understanding disorders requires knowledge of normal development.

  • Field: Developmental Psychopathology studies the evolution of these disorders.

Prevalence Rates

  • Source: National Comorbidity Study

  • Data Representation: Compares the percentage of disorders among ages 13-18:

    • Anxiety Disorders: 35%

    • Behavioral Disorders: 20%

    • Substance Use Disorders: 15%

    • Additional rates for the years categorically listed in a graphical representation.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

  • Areas of Focus:

    • Anxiety and Depression in Children: Criteria closely resembles that of adults, with specific modifications such as:

    • Separation Anxiety Disorder

    • Depressive Symptoms: Irritability replaces sad mood in children.

    • Bipolar Disorder: Classified as Disruptive Mood Dysregulation Disorder (DMDD).

    • Disruptive, Impulse-Control, and Conduct Disorders

    • Elimination Disorders

    • Neurodevelopmental Disorders

Anxiety and Depression in Childhood

  • Anxiety Disorders:

    • Similar to adult criteria, with specific childhood adaptations.

  • Depression:

    • Manifest through irritability rather than sorrow; specific guidelines apply.

  • Bipolar Disorder:

    • Diagnosis rejection of occurrences of DMDD to reduce bipolar over-diagnosis among children.

Disruptive Mood Dysregulation Disorder (DMDD)

  • Introduction: Intended to clarify diagnosis to prevent over-diagnosis of bipolar disorder in children.

  • Key Features:

    • This is characterized by temper dysregulation without the standard features of depression or mania.

    • The empirical support for DMDD diagnosis is critiqued as lacking strength.

Disorders Related to Anger Dyscontrol

  • A notable section in DSM for mood disorders and anxiety exists; however, disorders relating specifically to anger do not have an equivalent section.

  • Previous exclusions include: Idiosyncratic Alcohol Intoxication, Sadistic Personality Disorder.

Internalizing vs. Externalizing Disorders

  • Externalizing Disorders: Includes problems directed outward, such as:

    • Conduct Disorder (CD)

    • Oppositional Defiant Disorder (ODD)

Conduct Disorder (CD)

  • Features of CD: Distinct characteristics fall into four main categories:

    • Aggression to people/animals.

    • Destruction of property.

    • Deceitfulness or theft.

    • Serious rule violations.

  • Age criteria: Diagnosed in individuals aged 15 or younger.

  • Subtype: Callous-unemotional (CU) traits signify a particularly severe variant of the disorder.

Antisocial Personality Disorder (ASPD)

  • Transition from Conduct Disorder: No diagnosis exists for individuals aged 16-17; must be at least 18 years old for ASPD.

  • Significant findings indicate that approximately 40% of individuals with CD may progress to meet ASPD criteria.

  • Legal implications are influenced by the state’s recognition of ASPD in judicial proceedings.

Prognosis of Conduct Disorder

  • Worsened Outcomes: Determined by:

    • Childhood Onset: Early manifestations before age 10 increase severity.

    • Indications of animal torture and presence of callous-unemotional traits also correlate with poorer prognoses.

Gender Bias in Conduct Disorder

  • Demographics: Predominantly male diagnoses, indicating potential gender bias in diagnostic criteria.

Environmental Contributions to Externalizing Disorders

  • Factors influencing development:

    • Tough urban environmental contexts.

    • Inconsistent parenting.

    • Parental role modeling.

    • Peer support mechanisms as oppositional to peer pressure.

Oppositional Defiant Disorder (ODD)

  • Symptoms:

    • Argumentative and defiant behavior.

    • Angry and irritable disposition.

    • Vindictive tendencies.

  • Prognosis: Approximately 25% of cases may develop into CD; early onset around age 8; lifetime prevalence estimated at 10%.

Management of Conduct Disorder (CD)

  • Clinical Management Variations:

    • Adjusted based on the presence of Limited Prosocial Emotions (LPEs) and impulsive-aggressive behavior severity.

    • Age-related interventions involve psychosocial interventions paired with training and potential medication adjustments when necessary, such as the usage of risperidone.

Diagnostic Criteria and Effects of ADHD

  • Examination Basis: Parents and teacher reports required for a definitive diagnosis.

  • Diagnostic Age: Symptoms must manifest before age 12; increased threshold for adult diagnostic criteria shifts to age 5.

  • Links to School Performance: High prevalence of ADHD correlates with significant life consequences—approximately 50% of individuals do not finish high school.

Epidemiology of ADHD

  • Prevalence Data: Visible trends indicate a 22% increase in ADHD parent-reported diagnoses from 2003 to 2007; contemporary estimates depict rates between 3%–???.

  • Medications and Treatments from 2020-2023: Documentation of ADHD treatment rates across different states varied significantly, with medication use reported frequently in instances alongside behavioral treatments.

Intellectual Disabilities

  • Definition: Low intelligence becomes clinically significant typically when it impacts functional adaptive behavior.

  • Identification: IQ scores, while historically referenced, do not strictly confine diagnostic parameters; emphasis now on adaptive functioning deficits.

Classification of Intellectual Disabilities

  • Four levels defined by degree of severity:

    • Mild: Historically characterized by IQ of 50-70, making up 80% of cases. Often unclear etiology.

    • Moderate: IQ range of 35-49, involving physical disabilities, expected to acquire basic self-care routines.

    • Severe: IQ of 29-34, requiring sustained supervision and limited job skills.

    • Profound: IQ below 20, demanding full custodial care and intervention.

Special Considerations for Treatment in Children/Adolescents

  • Unique Challenges: Consider the inability of children to seek help independently, their vulnerabilities, and the importance of parent-targeted interventions.

    • Parents are viewed as vital change agents in the treatment of childhood disorders.