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PSYCHOLOGY
Fourth Canadian Edition
Chapter 15
Disorders of Childhood
Prepared by:
Tracy Vaillancourt, Ph.D.
Modified by: Réjeanne Dupuis, M.A.
Chapter Outline
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Classification of Childhood Disorders
Disorders of Uncontrolled Behaviours
Learning Disabilities
Autistic Disorder
Disorders of Overcontrolled Behaviours
Mood Disorders in Childhood and
Adolescence
Scope of the Problem
• Most adults w/ a first psychiatric diagnosis also
met criteria for a disorder in childhood
• 14% of Canadian children have clinical disorders
that cause significant distress and impairment
– Anxiety disorders most prevalent
– Mental health problems are leading cause of health
problems after infancy in Canada
– < 25% of children receive specialized treatment
– > 50% of children with 1 disorder have 2+ concurrent
disorders
ADHD
• Attention-deficit/hyperactivity disorder (ADHD)
– Deficits in attention
– Hyperactivity
– Impulsivity
• Three subcategories of ADHD:
− Primarily poor attention
• ADHD primarily inattentive
− Primarily hyperactive-impulsive behaviour
• ADHD primarily hyperactive
− Both sets of problems
• ADHD combined type
• Majority of all children
ADHD (cont.)
• Children with ADHD have
– Peer-relations difficulty
– Learning disabilities in 15-30%
– 50% placed in special education programs
because of their difficulties
– Comorbidity with anxiety disorders
– Considerable overlap with conduct problems
• Combined sub-type
ADHD (cont.)
• Prevalence: 5.29% worldwide
• More common in boys than in girls
•  severity of symptoms in adolescence
– 65-80% still meet criteria for disorder in
adolescence and adulthood
Biological Theories of ADHD
• Genetic component supported by adoption and
twin studies
– 75% is heritable
– Family environment does not make a significant
contribution
• Differences in brain structure and function
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Implication of frontal striatal circuitry
Reductions in volume in cerebrum and cerebellum
Delays in cortical maturation
Smaller basal ganglia volumes
Dysfunctions in dopaminergic and noreadrenerbic
systems
Theories (cont.)
• Environmental toxins
– 22% of mothers of children with ADHD
reported smoking pack of cigarettes/day
during pregnancy, compared with 8% of
mothers whose children were normal
Psychological Theories of
ADHD
• Diathesis-stress theory of ADHD
– Hyperactivity develops when predisposition to
disorder is coupled with an authoritarian
upbringing
– Learning may play a role in hyperactivity
• Reinforced by the attention it elicits thus increasing
in frequency or intensity
Note. These theories are not sustained by research
Treatment of ADHD
• Typically treated with drugs and behavioural
methods based on operant conditioning
• Stimulant Drugs
– Methylphenidate (MPH) or Ritalin
– Supported by double-blind studies comparing
stimulants with placebos
•  in concentration, goal-directed activity, classroom
behaviour, and social interactions and  in
aggressiveness and impulsivity in about 75%
• Psychological Treatment
– Parent training and changes in classroom
management based on operant conditioning
principles
Conduct Disorder and ODD
• Conduct Disorder
– Behaviours that violate basic rights of others and major societal
norms
• Oppositional Defiant Disorder (ODD)
– Diagnosed if child does not meet the criteria for conduct disorder
– Physical aggression, losing temper, arguing with adults, lack of
compliance with requests from adults, deliberately annoying
others, being angry, spiteful, touchy, or vindictive.
• Comorbidity is the norm rather than the exception
– ODD, conduct disorder, and ADHD
– Anxiety and depression are also common among children with
conduct disorder
• Prevalence
– 8% of boys and about 3% of girls aged 4 to 16
Etiology of Conduct
Disorders
• Biological Factors
– Genetic influence
• Aggressive behaviour clearly heritable
• Delinquent behaviour seems not to be
– Neuropsychological deficits
• Poor verbal skills, difficulty w/ executive
functioning, problems w/ memory
– Neurochemical correlates
Etiology of Conduct
Disorders
• Psychological Factors
– Hostile/ineffective parenting practices
– Lax parental discipline and parental adjustment
difficulties
– Learning theories
• Modelling and operant conditioning
– Cognitive Biases
• Social-information processing theory
– Socio-cultural context factors
• Neighbourhood and classroom environments
Biopsychosocial Model of CD
Treatment of Conduct Disorder
• Fairer distribution of income
• Alleviate material deprivation in lower SES groups
• Jailing juvenile delinquents does not reduce crime.
– In fact, harsh discipline (imposed by government or
parents), contributes to further delinquency and criminal
activity in adulthood
• Family Interventions
– Parental Management Training
• Multi-systemic Treatment
• Cognitive Approaches
Prevention of CD
• Beginning treatment as early as age 4
– Symptoms appear w/in first 2 years
• Identifying families and mothers at risk
– Prenatal and postnatal risks in mother
– Maternal antisocial behaviour and smoking
during pregnancy
• Early interventions
– The Family Check-up
– The Nurse-Family Partnership
Learning Disabilities
• Inadequate development in specific area of
academic, language, speech, or motor skills
• Not due to mental retardation, autism, a
demonstrable physical disorder, or deficient
educational opportunities
Learning Disabilities
• Usually of average or above-average
intelligence
• Term LD not used in DSM-IV-TR
– Learning disorders, communication disorders,
and motor skills disorder
• Usually identified and treated in school
system
• More common in males than in females
Learning Disorders
• Three categories renamed in DSM-V:
– Reading disorder  Dyslexia
– Mathematics disorder  Dyscalculia
– Disorder of written expression  May be
eliminated
Learning Disorders
• Reading Disorder (dyslexia)
– Significant difficulty with word recognition and reading
comprehension
– Written spelling as may also be a problem
– Prevalence 2 to 8% of school-age children
• Mathematics Disorder
– Difficulty rapidly and accurately recalling arithmetic facts,
counting objects correctly and quickly, or aligning numbers
in columns
• Disorder of Written Expression
– Impairment in ability to compose written word
• Spelling errors, errors in grammar, or very poor handwriting
Communication Disorders
• Expressive Language Disorder
– Difficulty expressing in speech
– Trouble finding words
• Phonological Disorder
– Speech is not clear
– Articulation poor for r, sh, th, f, z, l, and ch
• Stuttering
– Disturbance in verbal fluency characterized by one or
more of the following speech patterns
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Frequent repetitions
Prolongations of sounds
Long pauses between words
Substituting easy words for those that are difficult to articulate
Etiology of Learning Disabilities
• Biological Factors
– Heritable component
– Chromosome 13 (13q21) directly implicated as a
dyslexia phenotype
– Generalist Genes Hypothesis
– Brain Structure Differences
• Left temporoparietal cortex less activated
– Problems with perception of speech and analysis of
the sounds of spoken language and their relation to
printed words
• Family environment
Treatment of LD
• Most often occurs within special-education
programs in the public schools
• Individualized programs should be
implemented
• Duration of treatment should match the
severity of the LD
• Parental involvement is essential
Mental Retardation
• Mental retardation
– Sub-average intellectual functioning along
– Deficits in adaptive behaviour
– Occurring before age 18
• Traditional Criteria for Mental Retardation
1. Intelligence-Test Scores
2. Adaptive Functioning
3. Age of Onset
• Prevalence in general population is 3%
– Boys to girls ration is 1.6:1
Classification of Mental Retardation
• Four levels of MR
– Mild mental retardation
• 50–55 to 70 IQ
• 85% of people with MR
– Moderate mental retardation
• 35-40 to 50-55 IQ
• 10% of people with MR
– Severe mental retardation
• 20-25 to 35-40 IQ
• 3 to 4% of people with MR
– Profound mental retardation
• below 20 to 25 IQ
• 1-2% of people with MR
Etiology of Mental Retardation
• No Identifiable Etiology
– 30-40% of people with MR have no identifiable etiology
• Known Biological Etiology
– 25% of people with MR have a known biological cause
• Heredity Disorders (5%)
– Genetic or Chromosomal Anomalies
• Phenylketonuria (PKU); Fragile X syndrome
• Early alterations of embryonic development (~30%)
• Down syndrome, or trisomy 21; maternal alcohol consumption
• Late pregnancy and perinatal problems (10%)
• Fetal malnutrition, placental insufficiency, prematurity, low birth
weight, viral and other infections (e.g., HIV infection)
• Medical conditions in childhood + accidents (5%)
• Environment Influences (15-20%)
• Mercury, lead
Prevention and Treatment of MR
• Environmental
Interventions and
Enrichment Programs
• Residential Treatment
• Behavioural Interventions
Based on Operant
Conditioning
– Applied Behaviour
Analysis
• Cognitive Interventions
– Self-instructional training
Pervasive Developmental
Disorders
Autism
Asperger’s Syndrome
• Impairments in social
interaction, social
communication and
imagination
• Often regarded as a mild
form of autism
• Poor social relationships
• Stereotyped behaviour
• Language and
intelligence are intact
– Triad of impairments
• More boys than girls
• Onset— infancy or very
early childhood
• Often co-occurs with MR
and epileptic seizures
PDD (cont.)
Rett’s Disorder
• Very rare; found only in girls
• Development normal until
1st-2nd year of life
• Head growth decelerates
• Loses ability to use hands
purposefully
• Stereotyped movements
such as handwringing or
handwashing
• Walks in an uncoordinated
manner
• Poor speech
Childhood Disintegrative
Disorder
• Very rare
• Normal development in the
first 2 years of life then
significant loss of
– Social, play, language, and
motor skills
Characteristics of Autism
• Autism and MR
– 80% score below 70 on standardized IQ tests
• Extreme Autistic Aloneness
• Communication Deficits
– Echolalia
– Pronoun reversal
• Obsessive-Compulsive and Ritualistic Acts
Etiology of Autistic Disorder
• Psychological bases
– Psychoanalytic and behavioural perspectives
believed that parents play a crucial role in ASD
• Biological bases
– Genetic Factors
• Risk of autism in siblings of people with the disorder is
about 75 times greater
– Fragile X syndrome; Chromosomal abnormalities
• Linked genetically to broader spectrum of deficits in
communicative and social areas
Etiology of Autistic Disorder
• Neurological Factors and Environmental Risks
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Epileptic seizures (30% of adolescents with ASD)
Abnormal brainwave patterns
Larger brains but reduced brain volume
Abnormalities in the cerebellum
• See also Focus on Discovery 15.1
Treatment of Autistic
Disorder
• Most effective treatments use modelling and
operant conditioning techniques
– Example ABA
• Most commonly used medication for treating
problem behaviours in autistic children is
haloperidol (Haldol)
Childhood Fears and Anxiety
Disorders
• 1/3rd of Canadian children (ages 4 -11) rated by
parents as too fearful or anxious
• Fears and phobias reported more often for girls
than for boys
• 10 to 15% of children and adolescents have an
anxiety disorder
– Most common disorders of childhood
Separation Anxiety Disorder
• Unrealistic concern about separation from major
attachment figures
• Symptoms associated with SAD must be experienced for
at least eight weeks
– Unrealistic and persistent worries about harm to major
attachment figures
– Fears of abandonment
– Refusal to attend school
– Avoidance of being alone
– Experience of nightmares involving separation themes
– Experience of physical complaints in anticipation of being
separated from attachment figures
School Phobia
• Related to separation anxiety
– But not all children with SAD refuse to go to school
• Two types identified
1. More common type is associated with SAD
• Children worry constantly that some harm will befall parents
or themselves when they are away from parents
2. Second type associated with true phobia of school
• Either a fear specifically related to school or a more general
social phobia
• Generally begin refusing to go to school later in life
• Have more severe and pervasive avoidance of school
Social Phobia
• Selective Mutism
– Refusal to speak when it is expected of a
person
• Example: refusing to speak to a teacher
• Social Phobia
– Prevalence 1% of children and adolescents
– Processes and mechanisms
• Social learning
• Genetic factors
Treatment of Fears and Phobias
• Similar to that employed with adults
– Exposure to feared object while performing
some action to inhibit their anxiety
– CBT shows great promise in treating
childhood anxiety
Depression in Childhood and
Adolescence
• Resemble adult depression in terms of depressed mood,
inability to experience pleasure, fatigue, concentration
problems, and suicidal ideation
– But higher rates of suicide attempts and guilt in children
and adolescents
• Masked depression
– Acting aggressively or misbehaving at school or at home
• Prevalence
– < 1% of preschoolers
– 2 to 3% of school-age children
– Adolescents similar to adult rates
• 9% in females and 3 -5% in males
• Lifetime prevalence is 21.4% for females and 10.7% for
males
Etiology of Depression
• Genetic factors
• Family and other relationships as sources of stress
– Might interact with a biological diathesis
• Serious emotional problem in a parent
• Poor social skills and impaired relationships with siblings
and friends
• Likely stems from a complex interplay of
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Biological vulnerability factors
Parental factors
Psychosocial factors
“Social capital” resources
Treatment of Depression
• Controversy regarding effectiveness of drug
therapies
• Interpersonal therapy (IPT)
• CBT
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