Download Document

DEPARTMENT: BEHAVIORAL
SCIENCE
FACILITATOR:
DR. ISAACK LEMA
TOPIC: CHILDHOOD PSYCHOPATHOLOGY
GROUP 15 MEMBERS
KAVUBA .N. NKAYAMBA (Slides 1 - 4)
ANDREW SIMBANO MSUYA(Slides 5 - 7)
DANIEL AMOS RODGERS(Slide 8 -14)
AMAL ABDALLAH AWADH (Slide 8 -19)
MELISSA MARIA COELHO (Slide 20 - 26)
HONEST F.A MUNISHI (Slide 27 - 35)
BELIGNA SALVIU KAPINGA (Slide 36 - 39)
RAJABU HUSSEIN RAMADHANI (Slide 40 -42)
JOLINED LAMECK KALINJUMA (Slide 43 - 44)
2
OUTLINES
 DEFINITION OF TERMS
 INTRODUCTION
 CHILDHOOD PSYCHOPATHOLOGY AS PRECURSORS FOR ADULT PSYCHOPATHOLOGY
 DISRUPTIVE BEHAVIOR PROBLEMS
 CHILDHOOD ANXIETY AND DEPRESSION
 SYMPTOM BASED POBLEMS OF CHILDHOOD
 TREATMENT OF CHILDHOOD PSYCHOLOGICAL PROBLEMS
 SUMMARY
 CONCLUSION
 RECOMMENDATION
 REFERENCES
3
OBJECTIVES
By the end of this presentation, one should be able to:
 To understand Childhood Psychopathology
 To know the difficulties in Diagnosis of Childhood Psychological
Problems
 To understand Disruptive Behavior Disorders
 To understand Childhood Anxiety and Depression
 To understand Symptom Based Disorders
 To understand the different types of Treatment to Childhood
Psychological Problems
4
DEFINITION OF TERMS
Childhood psychopathology;children and adolescents.
refers to the scientific study of mental disorders in
Hyperactivity - a higher than normal level of activity.An organ can be described as
hyperactive if it’s more active than it’s normal functioning.
Impulsivity;-doing things or tending to do things suddenly and without careful thought.
Externalizing disorders – are mental disorders characterized by externalizing
behaviours,maladaptive behaviour directed towards individuals environment,which cause
impairment or interference in life functioning.
Ritalin - is the CNS stimulant, it affects chemicals in the brain and nerves that contribute
to hyperactivity and impulse control.
Play therapy - therapy in which emotionally disturbed children are encouraged to act out
their fantasies and express their feelings through playing.
5
 Internalizing disorders;- are mental disorders characterized by inward-looking
withdrawn behaviors, which in children may represent the experience of depression,
anxiety and active attempts to withdraw.
Sleep walking disorders;-is the disorders that causes people to get up and walk while
they are asleep.
Social phobia;-is an anxiety disorders in which a person has an excessive and
unreasonable fear of social situation.
Theory of mind;-the ability to attribute mental
states,beliefs,intents,desires,pretending,knowledge to one self and others and to
understand that others have beliefs,desires,intentions and perspectives that are
different from one’s own.
6
INTRODUCTION
Since modern views of mental illness began to emerge in the late 18th and early 19th
centuries, the study of psychopathology in children has lagged behind that of adults.
However, it is now well established that many childhood disorders are common, earlyoccurring, and chronic, and that they exact a high toll from children, their families and
society.
Furthermore, disorders of childhood often shows significant homotypic and heterotypic
continuity with later child and adult psychopathology, further supporting the relevance
of childhood psychopathology for long term adjustment.
Looking backward from adulthood, epidemiological researches have found that many
adult with mental disorder first developed psychopathology as children. Thus interest
in the study of child psychopathology has rightly increased dramatically.
7
DISRUPTIVE BEHAVIOR DISORDERS
Disruptive behavior disorders are a group of behavioral problems. They are called
“disruptive” because affected children literally disrupt the people and activities
around them (including at home, at school and with peers).
The most common types of disruptive behavior disorder are attention deficit
hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct
disorder (CD).
8
Attention Deficit Hyperactivity Disorder
(ADHD)
“Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms
that include inattentiveness, hyperactivity and impulsiveness”.
Types of ADHD
There are actually three types of ADHD, and one of them doesn’t include symptoms of
impulsive and hyperactive behavior.
ADHD, Predominantly Hyperactive-Impulsive Presentation: Kids who have this type of
ADHD have symptoms of hyperactivity and feel the need to move constantly. They also
struggle with impulse control.
ADHD, Predominantly Inattentive Presentation: Kids who have this type of ADHD have
difficulty paying attention. They’re easily distracted but don’t have issues with
impulsivity or hyperactivity. This is sometimes referred to as attention-deficit
disorder (or ADD).
ADHD, Combined Presentation: This is the most common type of ADHD. Kids who have
it show all of the symptoms described above.
9
A Hyperactive
Child
10
Symptoms of ADHD
Symptoms of ADHD fall into three categories: inattention, impulsivity and distractibility.
Signs of Inattention
Forgets things, seems “day dreamy” or confused and appears to not be listening
Finds it hard to concentrate and jumps quickly from one activity to another
Gets bored with an activity unless it’s very enjoyable
Struggles to get organized and finish tasks
Has difficulty learning new things and following directions
Is smart but doesn’t understand or “get” things you expect him to or that his peers
grasp easily
11
Signs of Impulsivity
Is impatient and has trouble waiting for a turn
Blurts out inappropriate things and interrupts people
Overreacts to feelings and emotional situations
Doesn’t understand the consequences of his actions
Signs of Hyperactivity
Talks almost constantly
Moves nonstop even when sitting down
Moves from place to place quickly and frequently
 Fidgets and has to pick up everything and play with it
 Has trouble sitting still for meals and other quiet activities
12
Child with
ADHD
Struggling to cope
13
Conditions Related to ADHD
Kids with ADHD often have other conditions as well. Doctors refer to this as comorbidity. Some
conditions look a lot like ADHD because they have some of the same symptoms.
It’s important that the child’s issues are properly identified so as an appropriate treatment program
can be started.
Issues that often coexist with ADHD are:
Learning disabilities.
Social (pragmatic) communication disorder. This condition makes it hard for a child to converse in
socially appropriate ways.
Auditory processing disorder. This can make it hard for kids to understand and follow spoken
directions.
Motor and oral (vocal) tic disorders. The most commonly known tic disorder is Tourette
syndrome, there are others as well. Tic disorders can cause body movements and vocal sounds
that kids can’t control.
Behavior disorders. Oppositional defiant disorder is common in children with the combined type
of ADHD. So is conduct disorder.
Emotional regulation issues. Such as anxiety disorders, depressive disorders and obsessivecompulsive and related disorders can cause symptoms beyond a child’s control.
14
Oppositional Defiant Disorder
Oppositional defiant disorder is defined in the American Psychiatric Association’s Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as including persistent symptoms of
“negativistic, defiant, disobedient, and hostile behaviors toward authority figures.”
In many cases, particularly without early diagnosis and treatment, these symptoms worsen over
time—sometimes becoming severe enough to eventually lead to a diagnosis of conduct disorder.
Symptoms of ODD
Frequent and/or extreme temper tantrums
Tendency to be easily annoyed by others
Often actively defies or refuses to comply with requests from authority figures or with rules
Takes argumentative stance with adults
Rude, uncooperative and confrontational attitude
Use of mean-spirited language when upset
Deliberate attempts to upset and annoy others
Frequent bursts of anger or resentful attitude
Tendency to place blame on others
Outward and belligerent defiance
Revengeful attitude
15
16
Conduct Disorder
Conduct disorder is a more extreme condition than ODD.
Defined in the DSM-IV as “a repetitive and persistent pattern of behavior in which the
basic rights of others or major age appropriate social rules are violated”.
Symptoms of CD
Children who have conduct disorder are often hard to control and unwilling to follow
rules. They act impulsively without considering the consequences of their actions. They
also don’t take other people’s feelings into consideration.
The child may have conduct disorder if they persistently display one or more of the
following behaviors:
aggressive conduct,
deceitful behavior and
destructive behavior
17
Aggressive Conduct
Aggressive conduct may include:
Intimidating or bullying others,
physically harming people or animals on purpose,
 committing rape,
using a weapon.
Deceitful Behavior:
Lying,
breaking and entering,
 stealing,
forgery
Destructive Behavior:
arson and other intentional destruction of property.
18
Violation of Rules:
Skipping school,
running away from home,
drug and alcohol use,
sexual behavior at a very young age
Boys who have conduct disorder are more likely to display aggressive and
destructive behavior than girls. Girls are more prone to deceitful and ruleviolating behavior.
Additionally, the symptoms of conduct disorder can be mild, moderate, or severe
19
CHILDHOOD ANXIETY AND DEPRESSION
ANXIETY DISORDERS
Anxiety is a feeling of worry nervousness or unease, typically about an
imminent event or something with an uncertain outcome. In childhood, anxiety
is primarily manifested as a withdrawn behavior (internalizing). Children tend to
avoid activities where they have to socialize with others (e.g: school) express a
desire to stay at home, and communicate exaggerated fears over such things as
death of carers or of being bullied by peers.
Types of childhood anxiety problems and their features
 Separation Anxiety
As the name suggests, it is an intense fear of being separated from parents or
carers. It is commonly found in many children at the end of the first year of life,
which gradually subsides. However in others it persists well into the school years
and may also reappear in later childhood following specific life stressors such as
death of a relative or pet, an illness, a change of schools.
20
Symptoms
 An unrealistic and lasting worry that something bad will happen to the
parent or caregiver if the child leaves, fear of being alone, nightmares
about being separated, bed wetting, repeated temper tantrums etc
 Children tend to become clinging and demanding of their parents and
especially of events such as separation from, or the death of a parent
or carer.
 Physical complaints include such as stomach upset, headaches, nausea
and vomiting.
21
 Obsessive compulsive disorder(OCD)
Is now recognized as a common anxiety disorder found in children. Its phenomenology is very
similar to adult OCD, with the main features of it in children manifesting as intrusive,
repetitive thoughts, obsessions and compulsions.
Symptoms
Most common obsessions (recurrent thoughts or images) are contamination,
aggression, fear of dirt, becoming ill, germs, symmetry and exactness.
Common compulsive behaviors (recurrent actions) in children include washing,
checking orders, touching rituals, repeating and reassurance seeking.
In children though compulsions without obsessions can be quite common which
are frequently tactile and may be accompanied by behavioral tics.
22
 Generalized Anxiety Disorder (GAD)
Definition: A pervasive condition in which the sufferer experiences continual
apprehension and anxiety about future events, which leads to chronic and
pathological worrying about those events.
In children this usually takes the form of anticipatory anxiety, in which the
main feature is chronic worrying about potential problems and threats. It is
differentiated form other forms of childhood anxiety problems by being
associated with significantly increased levels of pathological worrying.
What children worry about appears to be determined by their age. E.g.: it
was found that 4-7 year olds tend to worry about personal harm, separation
from parents and imaginary creatures, while 11-13 year olds worry more
about social threats and being punished. The number of worries also
increases by age.
23
 Specific Phobias
Definition: Excessive, unreasonable, persistent fear triggered by a specific object or
situation.
Are often common in normal development of children e.g.: fear of
heights(acrophobia), water(hydrophobia), spiders(arachnophobia), strangers(social
phobia)etc. which often occurs in the absence of individual learning experiences. They
tend to represent characteristics of normal stages of child development as it may
appear suddenly and intensely but then disappears after some time. However for
some kids these fears may persist and become problematic, preventing normal daily
functioning.
One such example in childhood is social phobia which begins first as fear of strangers
which if it persists in later years the child finds it difficult to speak or be in presence of
people. If pushed into social situations they will often become mute, blush or show
extreme emotional responses (e.g.: burst into tears)
24
General Anxiety Disorder
Insectophobia
25
CHILDHOOD DEPRESSION
Depression is a state of low mood and aversion to activity that can affect a person's
thoughts, behavior, feelings and sense of well being.
Childhood depression is different from the normal "blues" and everyday emotions that
occur as a child develops. Just because a child seems sad doesn't necessarily mean he or
she has significant depression. If the sadness becomes persistent, or if disruptive behavior
that interferes with normal social activities, interests, schoolwork, or family life develops, it
may indicate that he or she has a depressive illness.
Depression in childhood is very difficult to identify and parents and teachers regularly fail to
recognize the symptoms especially in very young children
Symptoms depression manifests itself as:
 Clingy behavior, irritability or anger, physical complaints (such as stomach
aches, headaches) that don't respond to treatment, continuous feelings of sadness and
hopelessness, social withdrawal, increased sensitivity to rejection, changes in appetite
either increased or decreased, sleeplessness or excessive sleep, vocal outbursts or crying,
difficulty concentrating, thoughts of death or suicide etc.
26
SYMPTOM BASED DISORDERS
ENURESIS
Is repeated involuntary discharge to bed or clothes wetting. The occurrence of
involuntary discharging at night at 5yr, the age when volitional control of micturition is
expected. Enuresis may be,
Primary (75%)
recurrent involuntary passage of urine during sleep by a child aged 5yrs and older.
Nocturnal urinary control never archived. Someone with primary nocturnal enuresis has
wet the bed since he or she was a baby (primary nocturnal enuresis is most common form)
Secondary (25%)
some children always wet the bed at night.
SNE is a condition that develop at least six months-or even several years-after a person has
learned to control his or her bladder. NE account for about one quarter of children with
bedwetting. By age of 10years,up to 8% of children will develop SNE.
27
SYMPTOMS OF ENURESIS
For sleeping children who are old enough to control their bladders, the symptoms of bedwetting
are obvious. Regularly finding urine-soaked sheets is a clear sign of the problem. Also, a child
may wake and cry during the night when the wetting occurs, or wake up caregivers to alert them.
 Repeated voiding of urine into bed or clothes (whether involuntary or intentional
 Chronological age is at least 5 years (or equivalent developmental level).
 The behavior is not due exclusively to the direct physiological effect of a substance (e.g., a
diuretic) or a general medical condition (e.g., diabetes, spina bifida, a seizure disorder).
The most common complication of bedwetting is the impact on self-esteem and the emotional
distress it causes children. Assuring children that the occurrences are accidental (and not blaming
the condition on them) is key to managing the psychological effects. Many children who wet the
bed may fear staying overnight at a friend's house in case they wet the bed there.
28
ENCOPRESIS
Is voluntary or involuntary fecal soiling in children who have usually already been toilet
trained. Persons with encopresis often leak stool into their clothes.
 Encopresis is a term that refers to the symptoms exhibited by children aged 4 years or
older who have not yet learned appropriate control of bowel movements.
 Although parents may find it frustrating, encopresis is very rarely thought to be caused
by a child misbehaving. They usually can't help it and some children may not even realize
they've had an accident.
 Children who have this problem may feel ashamed, guilty, frustrated or angry, and may
act secretively to try to hide the problem.
 Encopresis is commonly caused by constipation, by reflexive withholding of stool, by
various physiological, psychological, or neurological disorders, or from surgery (a
somewhat rare occurrence). But a minority of patients has no apparent history of
constipation or painful defecation. No good prospective data suggest that encopresis is
primarily a behavioral or psychological. The behavioral difficulties associated with
encopresis are most likely the result of the condition rather than its cause.
29
 Encopresis, along with enuresis, is classified as an elimination disorder in the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It may be
divided into 2 subtypes:
 Encopresis with constipation
 encopresis without constipation.
30
Signs and symptoms
History of constipation or painful defecation (~80-95% of children with
encopresis), sometimes remote.
Inability to differentiate passing gas and passing feces in underwear
Soiling episodes usually occurring during the daytime (soiling during sleep is
uncommon)
With retentive encopresis, the colon has become stretched out of shape, so they
may intermittently pass extremely large bowel movements.
Long periods of time between bowel movements, possibly as long as a week.
Lack of appetite.
Abdominal pain.
Repeated urinary tract infection
31
SOMNAMBULISM
Is a sleep disorder belonging to the parasomnia family. Sleepwalking occurs during incomplete
arousal in NREM sleep, predominantly during slow wave sleep (SWS) . It typically occurs in the
first third of the night when there is the greatest preponderance of SWS.
SYMPTOMS
Sleepwalking can include;
 simple behaviors, such as sitting up in bed and walking around the bedroom, and more
dangerous activities such as leaving the house, falling out of windows, and attacking others.
This can result in injuries to the sleepwalker and others.
 Although sleepwalking cases generally consist of simple, repeated behaviors, there are
occasionally reports of people performing complex behaviors while asleep, although their
legitimacy is often disputed.
 Sleepwalkers often have little or no memory of the incident, as their consciousness has altered
into a state in which it is harder to recall memories. Although their eyes are open, their
expression is dim and glazed over. Sleepwalking may last as little as 30 seconds or as long as 30
minutes.
32
 Sleepwalking events are common in childhood and decrease with age. According to
Larvie, Malhotra and Pillar, the peak age is 4–8 years, when prevalence is 20% frequency
of events. Another report states that the peak age is eleven or twelve, with an estimated
25% of children having experienced at least one episode.
 25–33% of somnambulists have nocturnal enuresis" (bed-wetting). Like sleepwalking,
enuresis is more common in children and fades away as the child ages. Some children
who sleepwalk are also affected by night terrors.
 Kids Health, says, "Sleepwalking is not usually a sign that something is emotionally or
psychologically wrong with a child. And it doesn't cause any emotional harm.
33
Mechanism
Sleep stages
Sleep is categorized into stages of a cycle between REM sleep and NREM sleep. NREM sleep is
further divided into four stages:
 stage 1 a light sleep period,
 stage 2 a consolidated sleep period, and
 stage 3 and 4 slow wave sleep periods.
This is followed by stage 3, stage 2, stage 1, and a REM period
 Sleepwalking generally occurs during the first third of the night during the slow wave NREM
sleep stage. High delta activity within the brain usually accompanies slow wave NREM sleep,
and when 20–50% of all activity is delta activity, stage 3 is scored.
 When delta activity reaches 50% or higher, stage 4 is scored. Usually, if sleepwalking occurs at
all, it will only occur once in a night.
34
Automatism
Researchers sometimes disagree about the classification of sleepwalking as an automatism. These
repetitive actions may include chewing, lip-smacking, pulling at clothing, or wandering around looking
confused. Epileptic automatisms are also associated "with the absence attacks of petit mal epilepsy.
Some actions that take place during sleepwalking could be classified as "automatisms". The
distinction between "non-insane automatism" and "insane automatism" may be important in the
legal context.
Symptoms of sleepwalking
The most obvious sign is getting out of bed and walking around. But sleepwalking actually can involve
a range of other behaviors, including:
 sitting up in bed and repeating movements, such as rubbing eyes or tugging on pajamas
 looking dazed (sleepwalkers' eyes are open but they do not see the same way they do when
they are fully awake)
 being clumsy
 not responding when spoken to
 being difficult to wake up
 sleep talking
 urinating in undesirable places
35
TREATMENT OF CHILDHOOD PSYCHOLOGICAL PROBLEMS
DRUG THERAPY
Drug based treatments of psychological problems in childhood and adolescence are becoming more
widely used. SSRIs have been used to increasingly to treat childhood depression, example fluoxetine
(Prozac) are more successful at treating symptoms and childhood anxiety disorders. Nevertheless,
there are a number of reasons we should be cautious about recommending the use of drug
treatment with childhood disorders.
For example;

Complete remission of symptoms is rarely found especially in treatment of childhood
depression using SSRIs.

SSRIs have a number of undesirable side effects in children including nausea and
headaches .

Doubts about the use of antidepressant drugs have been raised and warnings have been
released.
36
BEHAVIOURAL THERAPY
Behaviour therapy is a useful way of changing quite specific behaviors and can provide
learning based interventions that allow individuals to change old patterns or learn new ones.
Examples include;
The treatment of symptom based disorders such as enuresis.
The development of behaviour change programmes for children with disruptive behaviour
disorders.
A widely used method of classical conditioning method for treating enuresis is BELL AND
BATTERY TECHNIQUE (Mikkelsen, 2001) to help a child wake when experiencing full bladder. A
sensor is placed in a child’s underwear when he or she goes to bed hence when a single drop of
urine is detected by the sensor it sets off an auditory alarm that allows the child to associate the
alarm ( unconditional stimulus, UCS) with the sensation of full bladder (conditioned stimulus,
CS)
37
FAMILY INTERVENTIONS
Family interventions are popular forms of intervention for many childhood psychological
problems especially since many childhood psychological problems are based on parentchild relationships as a possible cause of symptoms.
Family interventions take a number of forms
Systemic family therapy, it is a family intervention technique based on the view that
childhood problems result from inappropriate family structure.
Parent training programmes, these attempt to teach parents a range of techniques
for controlling and manage their children symptoms and mostly in children
diagnosed with conduct disorder.
Functional family therapy (FFT), it incorporates elements of systematic family
therapy and cognitive behaviour therapy(CBT) and also it represents maladaptive
ways of regulating distance between family members so as to improve
communication (Alexander and Parsons)
38
 COGNITIVE BEHAVIOURAL THERAPY(CBT)
CBT is becoming as increasingly useful treatment method for children and adolescences
especially those suffering from anxiety and depression. The purpose of CBT is to help
depressed children become aware of problematic thoughts and feelings, a typical
treatment programmed involves
 Recognition of anxious feelings and reactions.
 Understanding the role cognition and self awareness in anxious situations.
 Learning the use of problems solving and coping skills to manage anxiety.
 Using self-evaluation and self-reinforcement strategies to facilitate the maintenance
of coping.
 Implementation of plan of what to do in order to cope when in anxious situation.
CBT has been successful in treatment of a range of childhood disorders
39
PLAY THERAPY
Play therapy covers a useful set of techniques that can be used with younger children who are
less able to communicate and express their feelings verbally (Carmichael, 2006). Play in itself can
have curative properties and can enable children to feel less anxious or depressed. However, it
can also be used to help children express their concerns, to control their behavior (e.g. by learning
restraint when a child is impulsive or an aggressive) and to learn copying strategies and adaptive
responses when experiencing stress (e.g. Pedro Carrol & Reddy, 2005: G.I 1991)
Through play therapy, children develop a positive relationship with therapist, learn to
communicate with others, express feelings, modify behavior, develop problem – solving skills
and learn a variety of ways of relating to others.
Play therapy is a term used to cover a range of therapies that build on the normal
communicative and learning processes of children. Clinician may use play therapy to help
children articulate what is troubling them, to control their behavior (e.g. impulsive or aggressive
behavior), and to learn adaptive responses when they are experiencing emotional problems or
skills deficits. Below are two examples of specific play therapies,
Slow motion game-is the one designed to help the children to practice self control for
example, jenga, operation, perfection and don’t break the ice
Puppet game-is the one enable the children to communicate any distress they are feeling
40
Family Therapy
41
SUMMARY
There are a number of difficulties involved in the identification, diagnosis and treatment of
childhood psychological problems which are not usually encountered in adult mental health
problems,
Firstly, children are often unable to communicate any distress they are feeling and may lack
the self-awareness to identify individual symptoms of psychopathology, such as anxiety or
depression.
Secondly, childhood psychopathology is a relatively neglected area of clinical research: much
of childhood psychopathology was previously rather simplistically labeled as either
internalizing (reminiscent of anxiety or depression) or externalizing (exhibiting signs of
disruptive and aggressive behavioral problems).
 However, research in this area has increased significant in recent year, and we are now able
to identify specify childhood disorders such as childhood depression, OCD and generalized
anxiety disorder, as well as two important disruptive behavior disorders – ADHD and conduct
disorder.
42
CONCLUSION
Being medical personnel it is our responsibility to understand childhood
psychopathology in order to help children from anxiety, depression and to treat
psychological problems since medical personnel exerts stronger influence in
treating children psychological problems.
RECOMMENDATION
We as Nurses and Doctors we have to understand childhood psychology in order
to treat childhood psychological problems such as enuresis, encopresis.
To understand childhood depression, and symptoms of childhood depression such
as change in appetite, feeling sadness and hopeless, thoughts of death or
committing suicide and how to control it.
43
REFERENCES:
https://www.understood.org/en/learning-attention-issues/child-learningdisabilities/add-adhd/understanding-adhd
https://en.wikipedia.org
http://www.healthline.com/health/conduct-disorder#Overview1
www.understood.org/en/learning-attention-issues/child-learning-disabilities/addadhd/understanding-adhd
www.m.webmd.com/depression/features
44
THANK
YOU
45