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Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 14: Student Handout Answer Key 1 Chapter 14 — Disorders of Childhood and Adolescence Slides, handouts, and answers keys created by Karen Clay Rhines, Ph.D., Seton Hall University Handout 3: Childhood and Adolescence People often think of childhood as a carefree and happy time – yet it can also be frightening and upsetting Children of all cultures typically experience at least some emotional and behavioral problems as they encounter new people and situations Surveys indicate that worry is a common experience Bedwetting, nightmares, and temper tantrums are other problems experienced by many children Handout 5: Childhood and Adolescence Along with these common psychological difficulties, around 20% of all children and adolescents in North America also experience a diagnosable psychological disorder Boys with disorders outnumber girl, even though most of the adult psychological disorders are more common in women Handout 6: Childhood Anxiety Disorders As in adults, the anxiety disorders experienced by children and adolescents include specific phobias, social phobias, generalized anxiety disorder, and OCD One form of anxiety listed separately in the DSM and specific to children is separation anxiety disorder Handout 8: Childhood Anxiety Disorders Separation anxiety disorder sometimes takes the form of school phobia, although most cases of school phobia have other causes Childhood anxiety disorders are generally explained in much the same way as adult anxiety disorders, with biological, behavioral, and cognitive factors pointed to most often The special features of childhood may play an important role Handout 9: Childhood Anxiety Disorders Psychodynamic, behavioral, cognitive, and family therapies, separately and in combination, have been used to treat anxiety disorders in children, often with Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 14: Student Handout Answer Key 2 success Clinicians have also used drug therapy and play therapy as part of treatment Handout 10: Childhood Depression Children, like adults, may develop depression Between 2 and 4% of children under 17 years of age experience major depressive disorder The symptoms are likely to include physical discomfort, irritability, and social withdrawal There appears to be no difference in the rates of depression in boys and girls before age 11 By age 16, girls are twice as likely as boys to be depressed Handout 11: Childhood Depression Explanations of childhood depression are similar to those of adult depression Theorists have pointed to factors such as loss, learned helplessness, negative cognitions, and low serotonin or norepinephrine activity Handout 13: Disruptive Behavior Disorders Children displaying extreme hostility and defiance may qualify for a diagnosis of oppositional defiant disorder This disorder is characterized by repeated arguments with adults, loss of temper, anger, and resentmen Children with this disorder ignore adult requests and rules, try to annoy people, and blame others for their mistakes and problems Between 2 and 16% of children will display this pattern The disorder is more common in boys than girls before puberty but equal in both sexes after puberty Handout 14: Disruptive Behavior Disorders Children displaying extreme hostility and defiance may also qualify for a diagnosis of conduct disorder Children with this disorder display a more extensive and severe antisocial pattern and repeatedly violate the basic rights of others They are often aggressive and may be physically cruel and violent Many steal from, threaten, or harm their victims, committing such crimes as Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 14: Student Handout Answer Key 3 shoplifting, vandalism, mugging, and armed robbery Handout 15: Disruptive Behavior Disorders Conduct disorder usually begins between 7 and 15 years of age Between 1 and 10% of children display this pattern, boys more than girls Children with a mild conduct disorder may improve over time, but severe cases frequently continue into adulthood These cases may turn into antisocial personality disorder or other psychological problems Handout 20: Disruptive Behavior Disorders It may be that the greatest hope for reducing the problem of conduct disorder lies in prevention programs that begin in early childhood These programs try to change unfavorable social conditions before a conduct disorder is able to develop Handout 21: Attention-Deficit/Hyperactivity Disorder Children who display attention-deficit/hyperactivity disorder (ADHD) have great difficulty attending to tasks or they behave overactively and impulsively, or both The primary symptoms of ADHD may feed into one another, but often one of the symptoms stands out more than the other Handout 24: Attention-Deficit/Hyperactivity Disorder Clinicians generally consider ADHD to have several interacting causes including: Biological causes High levels of stress Family dysfunctioning Each of these causes has received some research support Handout 26: Attention-Deficit/Hyperactivity Disorder There is heated disagreement about the most effective treatment for the disorder The most common approach has been the use of stimulant drugs such as methylphenidate (Ritalin) These drugs have a quieting effect on as many as 80% of children with ADHD and Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 14: Student Handout Answer Key 4 sometimes increase their ability to solve problems, perform in school, and control aggression However, some clinicians worry about the possible long-term effects of the drugs Handout 27: Attention-Deficit/Hyperactivity Disorder Behavioral therapy is also applied widely in cases of ADHD Parents and teachers learn how to apply operant conditioning techniques to change behavior These treatments have often been helpful, especially when combined with drug therapy Handout 28: Elimination Disorders Children with elimination disorders repeatedly urinate or pass feces in their clothes, in bed, or on the floor They have already reached an age at which they are expected to control these bodily functions These symptoms are not caused by physical illness Handout 29: Enuresis Enuresis is repeated involuntary (or in some cases intentional) bedwetting or wetting of one’s clothes It typically occurs at night during sleep but may also occur during the day The problem may be triggered by a stressful event Children must be at least 5 years of age to receive this diagnosis The prevalence of enuresis decreases with age Handout 32: Encopresis Encopresis – repeatedly defecating in one’s clothing – is less common than enuresis and is less well researched The problem: Is usually involuntary Seldom occurs during sleep Starts after the age of 4 Is more common in boys than girls Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 14: Student Handout Answer Key Handout 35: Autism Autistic disorder, or autism, was first identified in 1943 Children with this disorder are extremely unresponsive to others, uncommunicative, repetitive, and rigid Symptoms appear early in life, before age 3 Only 5 of every 10,000 children are affected, and 80% are boys Handout 36: Autism As many as 90% of children with autism remain severely disabled into adulthood and are unable to lead independent lives Even the highest-functioning adults with autism typically have problems in social interactions and communication and have restricted interests and activities Several other disorders are similar to autism but differ to some degree in symptoms or time of onset These disorders are categorized as pervasive developmental disorders Handout 37: What Are the Features of Autism? The central feature of autism is the individual’s lack of responsiveness, including extreme aloofness and lack of interest in people Language and communication problems take various forms One common speech peculiarity is echolalia, the exact echoing of phrases spoken by others Handout 39: What Are the Features of Autism? The motor movements of people with autism may be unusual Often called “self-stimulatory” behaviors; may include jumping, arm flapping, and making faces Children with autism may engage in self-injurious behaviors Children may at times seem overstimulated and/or understimulated by their environments Handout 41: What Causes Autism? Sociocultural causes Theorists initially thought that family dysfunction and social stress were the primary causes of autism (e.g., the notion of “refrigerator parents”) 5 Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 14: Student Handout Answer Key 6 These claims had enormous influence on the public and the self-image of parents but research totally failed to support this model Some clinicians proposed a high degree of social and environmental stress, a theory also unsupported by research Handout 43: What Causes Autism? Biological causes While a clear biological explanation for autism has not yet been developed, promising leads have been uncovered Family studies suggest a genetic factor in the disorder Prevalence rates are higher among siblings and highest among identical twins Chromosomal abnormalities have been discovered in 10 to 12% of people with the disorder Handout 45: What Causes Autism? Biological causes Many researchers believe that autism may have multiple biological causes Perhaps all relevant biological factors lead to a common problem in the brain – a “final common pathway” – that produces the features of the disorder Handout 47: How Is Autism Treated? Behavioral therapy Behavioral approaches have been used in cases of autism to teach new, appropriate behaviors, including speech, social skills, classroom skills, and self-help skills, while reducing negative ones Most often, therapists use modeling and operant conditioning Therapies are ideally applied when people with autism are young Handout 49: How Is Autism Treated? Parent training Today’s treatment programs involve parents in a variety of ways For example, behavioral programs train parents so they can apply behavioral techniques at home In addition, individual therapy and support groups are becoming more available to help parents deal with their own emotions and needs Handout 51: Mental Retardation According to the DSM-IV, people should receive a diagnosis of mental retardation when they display general intellectual functioning that is well below average, in combination with poor adaptive behavior Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 14: Student Handout Answer Key IQ must be 70 or below The person must have difficulty in such areas as communication, home living, selfdirection, work, or safety 7 Symptoms must appear before age 18 Handout 53: Assessing Intelligence Many theorists have questioned whether IQ tests are indeed valid Intelligence tests also appear to be socioculturally biased If IQ tests do not always measure intelligence accurately and objectively, then the diagnosis of mental retardation may also be biased That is, some people may receive the diagnosis partly because of cultural difference, discomfort with the testing situation, or the bias of the tester Handout 55: What Are the Characteristics of Mental Retardation? The most consistent sign of mental retardation is that the person learns very slowly Other areas of difficulty are attention, short-term memory, planning, and language Those who are institutionalized with mental retardation are particularly likely to have these limitations Handout 56: What Are the Characteristics of Mental Retardation? The DSM-IV describes four levels of mental retardation: Mild (IQ 50–70) Moderate (IQ 35–49) Severe (IQ 20–34) Profound (IQ below 20) Handout 57: Mild Retardation Some 85% of all people with mental retardation fall into the category of mild retardation (IQ 50–70) They are sometimes called “educably retarded” because they can benefit from schooling People with mild retardation typically need assistance but can work in unskilled or semiskilled jobs Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 14: Student Handout Answer Key Intellectual performance seems to improve with age Handout 60: Moderate, Severe, and Profound Retardation Approximately 10% of persons with mental retardation function at a level of moderate retardation (IQ 35–49) They can care for themselves and benefit from vocational training About 4% of persons with mental retardation display severe retardation (IQ 20–34) They usually require careful supervision and can perform only basic work tasks Handout 61: Moderate, Severe, and Profound Retardation About 1% of persons with mental retardation fall into the category of profound retardation With training they may learn or improve basic skills but they need a very structured environment Severe and profound levels of mental retardation often appear as part of larger syndromes that include severe physical handicaps Handout 63: What Are the Causes of Mental Retardation? Chromosomal causes The most common chromosomal disorder leading to mental retardation is Down syndrome Several types of chromosomal abnormalities may cause Down syndrome, but the most common is trisomy 21 Fragile X syndrome is the second most common chromosomal cause of mental retardation Handout 64: What Are the Causes of Mental Retardation? Metabolic causes In metabolic disorders, the body’s breakdown or production of chemicals is disturbed The metabolic disorders that affect intelligence are typically caused by the pairing of two defective recessive genes, one from each parent Examples include: Phenylketonuria (PKU) Tay-Sachs disease Handout 69: Interventions for People with Mental Retardation What is the proper residence? 8 Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 14: Student Handout Answer Key 9 During the 1960s and 1970s, the public became more aware of these sorry conditions, and as part of the broader deinstitutionalization movement, demanded that many people be released from these schools People with mental retardation faced similar challenges by deinstitutionalization as people with schizophrenia Handout 70: Interventions for People with Mental Retardation What is the proper residence? Since deinstitutionalization, reforms have led to the creation of small institutions that teach self-sufficiency, devote more time to patient care, and offer education and medical services Residences include group homes, halfway houses, local branches of larger institutions, and independent residences These programs follow the principle of normalization – they try to provide living conditions similar to those enjoyed by the rest of society Handout 72: Interventions for People with Mental Retardation Which educational programs work best? Because early intervention seems to offer such great promise, educational programs for individuals with mental retardation may begin during the earliest years At issue are special education versus mainstream classrooms In special education, children with mental retardation are grouped together in a separate, specially designed educational program Mainstreaming places them in regular classes with nonretarded students Neither approach seems consistently superior Handout 74: Interventions for People with Mental Retardation When is therapy needed? People with mental retardation sometimes experience emotional and behavioral problems At least 10% have a diagnosable psychological disorder other than mental retardation Some suffer from low self-esteem, interpersonal problems, and adjustment difficulties These problems are helped to some degree with individual or group therapy Medication is sometimes prescribed