Download Disorders of Infancy, Childhood, & Adolescence

Childhood & Adolescence
I. ISSUES
A. Child vs. Adult Psychopathology
- Problems less severe/frequent
in childhood
- Same problem can look different
- Some problems primarily in childhood
B. Types of Disorders
1. Internalizing (overcontrolled)
= problems within
- Less noticed by adults
- More common in girls
2. Externalizing (undercontrolled)
= manifested externally
- Mostly boys
- More referred for tx
C. Normal vs. Abnormal Development
- Normal at one age = abnormal at
another
- Period of rapid change
- Harder to determine pathology in
children
“Normal” is age-dependent
D.
Child problems are reciprocal
1. Blame the child
- Infant temperament
2. Blame the parents
- Schizophrenogenic &
refrigerator mothers
3. Reciprocal process
- difficult kids elicit worse caregiving
& vice versa
- Intervention = parent-child interaction
E.
Children are dependent on others
- more likely to get victimized
- need parent/teacher involvement
II. Behavioral Disorders
1.Attention- Deficit Hyperactivity Disorder
(ADHD)
Description
• Inattention
- especially sustained attention
• Hyperactivity
• Impulsivity
• Inattentive Type
• Impulsive-Hyperactive Type
• Combined Type
• Adult ADD (not an actual dx)
Common complications
• Learning problems
• Discipline (-> ODD)
• Poor peer relations
Prevalence
• 3-6%
• Boys
• Over-diagnosed?
Etiology
• Nervous system problem
- smaller brain (e.g, frontal lobe)
BAS & BIS
• Polygenetic – 1 DA receptor implicated
• Prenatal smoking
• NOT sugar
• Parenting can exacerbate, cannot cause
Treatment - 1/3 recover
• Stimulant medication
- ↑ DA – blocks reuptake
- agonist for BIS
- works for 75%
- few side effects
- effects are immediate
- reduces inattention & impulsivity
-> focus in classroom & at sports
-> improves peer relations & self-esteem
- cannot teach good behavior
• Behavior therapy
- Teach appropriate behavior via rewards
& punishments
- Parent training
- School involvement
- Must continue for long period
• Best = Medication + behavior tx
• Summer ADHD Program
- point system
- parental involvement
- double-blind medication trials
Oppositional Defiant Disorder (ODD)
& Conduct Disorder (CD)
Description
• ODD - negativitist, hostile, defiant
• CD - truancy, fire-setting, theft,
aggression, cruelty
Prevalence
• 9% boys
• 2% girls
Etiology
Family
• Parenting: criticism & poor monitoring
(indifference)
• Parent modeling of poor self-control &
antisocial tendencies
• Stressful events (divorce)
Cognitive skills
• hostile attributions
• poor problem-solving
Biology
• some genetic evidence
• lower baseline arousal
Treatment
• Parent training
- time out/lose privileges & positive
reinforcement
• Negotiation with adolescents
• Cognitive treatments
- problem-solving, self-control
• Family Systems Therapy
III. Cognitive Disorders
Autism (on spectrum – to Asperger’s)
1.Inability to relate to other people
- little communication
- lack of affection/interest in others
- self-absorption
2.Absent or deficient speech
~ ½ = no speech, primitive gestures
~ ½ = some words with oddities
(e.g., echolalia)
3.Behavior
limited, rigid
stereotyped, self-stimulatory behaviors
self-injurious & aggressive
preservation of sameness
• MR & LD = common
Prevalence
• 4-5 in 10,000 (rare)
• 75-80% are boys
Etiology
• 1940s: Kanner: innate inability to relate
(biological)
• 1950s: Refrigerator mother => withdrawal
(environment)
• Current: neurological basis
prenatal or birth complications
Treatment
•
•
•
•
•
Difficult; poor prognosis
5% capable of jobs
Still emotionally isolated
Rest = mild care-taking skills
Best: if speak before 5, higher IQ,
& mild symptoms
• Institutionalization is common
• Behavior modification
- reinforce social behaviors
- sign language
- parents & teachers as co-therapists
• Aversive conditioning
• Facilitation
IV. Anxiety & Mood Disorders
Anxiety
• School Phobia (not a dx)
• Separation Anxiety
• Specific fears or phobias
• Others as in adults (e.g., GAD)
• Fears are common
- Extreme degree or duration, impairment
Prevalence
• very common to uncommon
• equal in boys & girls
Etiology
• Biology: fearful, anxious temperament
• Learning: observe others’ fears
- parents reinforce fears
- overprotective parental style
Treatment
Behavioral
• Flooding
• Systematic desensitization
• Reward for success
Cognitive
• Re-appraisal of feared situation
• Relaxation strategies
• Behavioral therapy = most effective
• Medication - not well-documented in kids
• ** Best = include parents
Depression
• Like adults
- sad, crying, hopeless, low self-worth,
sleep & appetite problems, lethargy
• Unlike adults
- behavioral problems, clinging,
delinquency
• Few consistencies
- more like adults than not
- similar to adult bereavement
(with precipitant)
Prevalence
• 5-10% boys & girls, more in teens
• equally common in boys & girls
Etiology
Biological
• possible genetic predisposition
Learning
• learned helplessness
• reduced reinforcers
Cognition
• Unrealistically negative
• Poor coping
• Poor social skills
Treatment
• Play therapy (psychodynamic)
- child works through conflicts via play
- no evidence for efficacy
• Social skills training
• Increase pleasant activities
• Cognitive therapy – errors & coping
• Medication
- somewhat effective for children
- less effective for adolescents
• Change the environment*
V. Eating Disorders
Anorexia
• refusing to eat due to fear of weight gain
• distorted body image
• life-threatening
Bulimia - bingeing & purging
• distorted body image
• not usually life-threatening
• often normal weight
• Key = lack of control
Prevalence
• Anorexia – 1-3 % of 12-18 year-olds
• Bulimia - ~ 5% of teens/young adults
(4.5% female, .5% male)
Etiology
• Need for control
• Identity issues
- independence from parents
- fear of growing sexuality
• Societal pressures for thinness
Treatment
• Family therapy
- break power struggle
- appropriate separation
• Cognitive therapy
- Identify & express emotions
- Boost self-esteem
- Change irrational beliefs
Different issues for anorexia and bulimia
• Hospitalization
- IV fluids & goal weights
VI. Elimination Disorders
• Enuresis & Encopresis
- wetting/soiling self beyond usual age (~5)
• Primary = hasn’t yet learned control vs.
- Secondary = learned control but lost
• Nighttime is more common
- Daytime = maybe serious problem
• Sense of no self-control (low self-esteem)
Prevalence
• Enuresis: 15-20% of 5-year-olds
5% of 10-year-olds
• Encopresis: .3-8% of children
usually secondary
• Boys
Etiology
• Conflict with parents
- self-control
• Emotional disturbance
- anxiety, stress, family disruption
• Failure to learn
- associate full bladder/bowel with toilet
Treatment
• Eliminate biological causes
• Deal with emotional disturbance
• Behavioral techniques
- wake in night after urination (Wee Alert)
- praise for success
- mild punishment for wetting/soiling
• Prevent: relaxed & positive toward toileting