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CHAPTER 15
CHAPTER OUTLINE
I.
II.
Pervasive developmental disorders. Pervasive developmental disorders are severe
disturbances affecting language, social relations, and emotions, distortions that would
be abnormal at any developmental stage. Prevalence of autistic disorder is about 2 per
10,000 children; the other pervasive developmental disorders occur at a rate of about
6.7in 1,000. Autistic disorder was first described by Leo Kanner in 1943 and is
characterized by great impairment in social interaction and/or communication,
stereotyped interests and activities, and delays or abnormal functioning in major areas
before age 3. Autistic children interact with others as though people were unimportant
objects. Half do not speak; the other half often show echolalia—echoing whatever was
just said—or pronoun reversal (where “you” is said instead of “I”). Most autistic
children are mentally retarded, although splinter skills (special abilities) are found, most
dramatically in autistic savants. Misdiagnosis as mental retardation only or as a
different disorder or condition is common. About 22 in 10,000 children show some, but
not all, of the characteristics of autistic disorder along with severe social impairment
and would be diagnosed with pervasive developmental disorders that do not meet the
criteria for autistic disorders. These include Asperger’s disorder (similar symptoms to
autism, but more highly functional); childhood disintegrative disorder (at least two
years of normal development), Rett’s disorder (normal for at least five months, onset
between age 5 and 48 months, and deceleration of head growth seen only in females),
and pervasive developmental disorder not otherwise specified. Biological dimension
evidence points to genetic factors playing a prominent role in the causes for autism
spectrum disorders. Concordance rates for autism are much higher for MZ
(monozygotic) than DZ (dizygotic) twins. Furthermore, the prevalence of autistic
disorder among siblings of individuals with autistic disorder ranges from 2 to 14
percent. In terms of the psychological dimension some research suggests that autism
may be a disorder involving cognitive impairments that affect perception, particularly in
the recognition and response to others. Early psychodynamic theories that involve
social relationships of autism stressed the importance of deviant parent-child
interactions in producing this condition. Kanner (1943), who named the syndrome,
concluded that cold and unresponsive parenting is responsible for the development of
autism. In terms of the sociocultural dimension Autism appears to vary according to
sociocultural and demographic characteristics. Studies have found higher or equal
prevalence of the disorder among African American mothers and lower prevalence
among Mexican-born mothers than among white, Asian, and U.S.-born Hispanic
mothers. The prognosis for children with pervasive developmental disorders is mixed.
Most children diagnosed with autism retain their diagnosis at 9 years of age. However,
many, especially those with initial higher levels of functioning (e.g., those with
Asperger’s syndrome), improve. A minority have good outcomes. Because patients with
these disorders have communication or social impairments, pervasive developmental
disorders are very difficult to treat. Therapy with the parents, family therapy, drug
therapy, and behavior modification techniques are all currently being used, with some
success
Attention deficit/hyperactivity disorder and disruptive behavior disorders.
Attention deficit1hyperactive disorder (ADHD) is characterized by attention problems
and may involve heightened motor activity. There are three types: predominantly
hyperactive impulsive, predominantly inattentive, and combined (showing both
hyperactivity and inattentiveness). ADHD is a relatively common disorder, far more
common in boys than in girls. In some cases, ADHD children continue to have
antisocial or psychiatric problems as adults; those with attention problems but not
hyperactivity have better outcome. Attention-deficit/hyperactivity disorder is an earlyonset, highly prevalent neurobehavioral disorder, with genetic, biologic, and
environmental etiologies, that persists into adolescence and adulthood in a sizable
majority of afflicted children of both sexes. 75 to 90 percent of children with ADHD
respond to stimulant medications. Children with ADHD are typically treated with
stimulant medication, but there is considerable controversy about the overmedication of
children and the poorly supervised prescription of drugs. Oppositional defiant disorder
is characterized by negativistic and hostile behavior, but without serious violations of
others’ rights. DSM-IV-TR criteria include “significant impairment in social and
academic functioning,” a raising of the threshold for diagnosis. Conduct disorder
involves a persistent pattern of antisocial behavior in which others’ rights are violated.
Etiology, many cases of conduct disorder begin in early childhood. Some infants who
are especially “fussy” seem to be at risk for developing conduct disorder. The etiology
of conduct disorder probably involves an interaction of genetic/constitutional,
psychological, social-familial, and sociocultural factors. Although conduct disorders
have resisted traditional forms of psychotherapy, training in social and cognitive skills
appears promising. One program, for example, focused on helping aggressive boys
develop verbal skills to enter groups, play cooperatively, and provide reinforcement for
peers. The cognitive element included using problem-solving skills to identify behavior
problems, generate solutions to them, and select alternative behaviors. In addition, the
children learned positive social skills through viewing videotapes and role-playing with
therapists and peers.
III. Elimination disorders. Enuresis (urination in inappropriate places that is usually
involuntary) and encopresis (defecation in inappropriate places) may have biological
and psychological origins. Treatment may include medication and behavior
modification procedures.
IV. Learning disorders. Disorders of childhood and adolescence also include cognitive and
academic functioning. Learning disorders are characterized by academic functioning
that is substantially below that expected in terms of the person’s chronological age,
measured intelligence, and age-appropriate education. The disturbance significantly
interferes with academic achievement or with activities of daily living. Learning
disabilities are lifelong and cannot simply go away with treatment. However, persons
with learning disabilities can adjust and adapt in order to function effectively in society.
Severity of the disorder varies, and appropriate action involves the accurate assessment
of the limitations of the disorder and individualized interventions. What has been
helpful is to teach children with learning disabilities skills to capitalize on their abilities
and strengths while correcting and compensating for disabilities and limitations.
V. Mental retardation. Mental retardation (MR) is a disability characterized by
significant limitations both in intellectual functioning and in adaptive behaviors as
expressed in conceptual, social, and practical adaptive. Prevalence figures for the
United States are 1 to 3 percent, depending primarily on the definition of adaptive
functioning. Levels of Retardation DSM-IV-TR specifies four different levels of mental
retardation, which are based on IQ score ranges, as measured on the revised Wechsler
scales (WISC-R and WAIS-R): (1) mild (IQ score 50–55 to 70), (2) moderate (IQ score
35–40 to 50–55), (3) severe (IQ score 20–25 to 35–40), and (4) profound (IQ score
below 20 or 25). In terms of Etiology mental retardation is thought to be produced by
biological, psychological, social, and sociocultural factors. These factors are largely
included into environmental conditions (such as poor living conditions), biological
conditions, or some combination of the two. It can be caused by injury, disease, or a
brain abnormality. The etiology is dependent to some extent on the level of mental
retardation. Mild retardation is generally idiopathic (having no known cause) and
familial, whereas severe retardation is typically related to genetic factors or to brain
damage. Because mental retardation is a disability rather than a disease that can be
“cured,” the goal of intervention is to develop the person’s potential to the fullest extent
possible. Early intervention programs such as Head Start have not produced dramatic
increases in intellectual ability among at-risk children (those from low-income
families). School services received by children diagnosed with mental retardation can
vary greatly between school districts. Employment programs for people with mental
retardation can achieve more than was previously thought. Living arrangements,
institutionalization of people with mental retardation is declining, as more individuals
are placed in group homes or in situations in which they can live independently or semi independently within the community.
VI. Implications. In this chapter, we have discussed the symptoms, causes, and
treatment/prevention of childhood disorders. Because we are dealing with a population
(i.e., children and adolescents) and not a disorder (e.g., depression), many kinds of
disorders are included. Thus, some such as autism spectrum disorders and mental
retardation have a strong biological etiology. Heredity, conditions during pregnancy,
and early infant factors are likely to play a strong role in these disorders. Nevertheless,
even in these and other childhood disorders, we see that psychological, social, and
sociocultural factors are implicated.