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Chapter 15
Disorders of Childhood
Ch 15
Classification Issues
• Distinguishing abnormal childhood behavior
requires a knowledge from developmental
psychology of what is normal for a child at a
particular age or stage
• Disorders can be viewed as categories or on a
continuum (dimension)
– Control represents a dimensional variable
• Overcontrolled (internalizing)children show
emotional inhibition
• Undercontrolled (externalizing) children show
excessive behaviors (extreme aggressiveness)
Ch 15.1
Table 15.1 Diagnoses that May
be Applied to Children
Developmental
Psychopathology
• Behavior genetics & neurobiological traumas
• Infant / child temperaments and “the problem of the
match” with parental temperaments and expectations
• Attachment theory (Bowlby, Ainsworth, Sroufe)
– Secure vs. insecure attachment
– Insecure attachment category may be related to later
childhood disorders
• “anxious-resistant” category - internalizing disorders
• “avoidant”category - externalizing disorders
• How do temperament & attachment interact?
– Evidence is inconclusive, but see Bokhorst et al. (2004)
Disorders of Undercontrolled
Behavior
• Undercontrolled behavior is excessive or
inappropriate for the situation
• DSM-IV recognizes two classes of
undercontrolled behavior:
– Attention-deficit/hyperactivity disorder (ADHD) involves
• An inability to concentrate on task for an appropriate period of
time
• Difficulties in controlling motor movements in class and other
situation (fidgeting, talking)
Ch 15.2
ADHD Issues
• Hyperactive children have difficulties in
establishing peer relations
– Aggressive ADHD children have different social goals
(being disruptive) than do non-ADHD peers
• ADHD can co-occur with learning disabilities (1530% of ADHD children have co-morbid LDs)
• ADHD shows within category differences
– Some children have attention deficit, some have
hyperactivity, and some have both
• ADHD prevalence is 2-7% in US
• ADHD with conduct disorder = worse prognosis
Ch 15.3
Table 15.2 Prevalence of Symptoms and
Behaviors in Adolescents with and without
ADHD
ADHD: Facts and Statistics
• Prevalence (BD, 3rd. Edition)
– Occurs in 4%-12% of children who are 6 to 12 years
of age
– Symptoms are usually present around age 3 or 4
– 68% of children with ADHD have problems as adults
• Gender Differences
– Boys outnumber girls 4 to 1
• Cultural Factors
• Probability of ADHD diagnosis is greatest in the
United States
Biological Theories of ADHD
• Family and twin studies document a role for
genetic transmission in ADHD
• Frontal lobe function is abnormal in ADHD
children
– Frontal lobe is underresponsive to stimulation
in ADHD children
– Frontal lobe is smaller in ADHD children
– ADHD children do poorly on psychological tests
that measure the functioning of the frontal lobe
Ch 15.4
Psychological Theories of
ADHD
• Bettelheim proposed a psychoanalytic view of
ADHD in which hyperactivity results from stress
brought on by parental personality (authoritarian,
impatient, resentful)
• Learning theory suggests that hyperactivity is
reinforced by the attention it elicits, thereby
increasing in frequency and intensity;
hyperactivity may represent modeling of older
siblings or peers
Ch 15.5
Treatment of ADHD
• Stimulant drugs such as methylphenidate (Ritalin) reduce
disruptive behavior and improve concentration
– Improve compliance and decrease negative behaviors in many
children
– Medications do not affect learning and academic performance
– Beneficial effects are not lasting following drug discontinuation
• Psychological therapy for ADHD involves
– Parent training
– Classroom management programs based on operant-conditioning
techniques
– Aim to increase appropriate behaviors and decrease inappropriate
behaviors
• Combined Bio-Psycho-Social Treatments
– Are highly recommended
Ch 15.6
Disorders of Undercontrolled
Behavior
• Conduct Disorder involves behaviors that violate
the rights of others
–
–
–
–
Aggression and cruelty toward people or animals
Property damage
Lying and stealing
Conduct disorder is marked by callousness and lack of
remorse
• Conduct disorder is more common in boys
• Oppositional Defiant Disorder (ODD) distinction
Ch 15.7
Figure 15.1 Arrest rates across ages for
homicide, forcible rape, robbery, assault,
and auto theft
Etiology of Conduct Disorder
• Genetic factors may play a greater role in
aggressive behavior, but a lesser role in
delinquency-related behaviors
– e.g. stealing, running away
• Psychological factors include
– Deficiencies in moral training and awareness
– Modeling of aggressive behavior (Bandura)
– Cognitive distortions in which ambiguous actions are
interpreted as hostile
Ch 15.8
Fig 15.2
Treatment of Conduct
Disorder
• Family intervention involves training parents to
reward prosocial behaviors in their children
• Multisystem treatment targets the child, the
community, the school and the family
• Cognitive approaches involve
– Anger control training
– Teaching moral development reasoning
Ch 15.9
Learning Disabilities
• Learning disabilities refer to inadequate
development in a specific area of academic,
language or motor skills
– The deficit is not due to mental retardation, autism or
reduced educational opportunities
• DSM covers 3 areas of learning disabilities
– Learning disorders
– Communication disorders
– Motor skills involve impairment of motor coordination
Ch 15.10
Learning Disorders
• Learning Disorders refer to conditions that impair
development in the classroom
• Specific learning disorders identified in DSM-IV
include
– Reading disorder (Dyslexia) involves difficulty in word
recognition and comprehension
– Disorder of written expression involves an inability to
compose the written word
– Mathematics disorder involves difficulty in recalling
math facts, errors in addition
Ch 15.11
Communication Disorder
• Communication disorders include
– Expressive language disorder involves a difficulty in
speech expression
• Difficulty in finding the correct word for a concept
• Use of grammar is below grade level
– Phonological disorder refers to a difficulty in articulating
speech sounds, but can comprehend words
– Stuttering involves a problem in verbal fluency in which
words are repeated or prolonged
Ch 15.12
Mental Retardation
• Mental retardation is defined as
– Subaverage intellectual functioning
• IQ score below 70-75
– Deficits in adaptive behaviors such as dressing,
use of money, use of tools and of public
transportation
– Onset prior to age eighteen
• Not due to adult accidents or disease
• Typical onset is in infancy
• American Association of Mental Retardation’s approach
– Focus on remedial supports to facilitate higher functioning
Ch 15.13
Table 15.3 Sample Items from
Vineland Adaptive Behavior Scales
Mental Retardation
Ch 15.14
Etiology of Mental Retardation
• No cause is evident for 75% of cases of mental
retardation, the remaining 25% are often related
to biological causes
• Biological causes include:
– Genetic anomalies such as Down’s syndrome (Trisomy
21)
– Fragile X syndrome – Abnormality on X chromosome
– Recessive-gene diseases such as PKU
– Infectious diseases such as Rubella and HIV
– Environmental hazards such as mercury or lead
poisoning
Ch 15.15
Autistic Disorder
• Autistic disorder involves children who
– Prefer to be alone
– Prefer to have a constant environment
– Have severely limited language skills
• DSM-IV “Pervasive Developmental Disorder” distinguishes
autism as a developmental disorder different from
schizophrenia in adults
• Prevalence of autism is infrequent (.05 % of
births)
– Autism occurs more frequently (4x) in boys relative to
girls
Ch 15.16
Table 15.4 Parental Report of Social
Relatedness in Children before Age 6
Autistic Disorder: Facts and
Statistics
• Prevalence and Features of Autism (BD, 3rd. Edition)
– Rare condition – Affecting 2 to 20 persons for every 10,000
people
– More prevalent in females with IQs below 35, and in males with
higher IQs
– Autism occurs worldwide
– Symptoms usually develop before 36 months of age
• Autism and Intellectual Functioning
– 50% have IQs in the severe-to-profound range of mental
retardation
– 25% test in the mild-to-moderate IQ range (i.e., IQ of 50 to 70)
– Remaining people display abilities in the borderline-to-average IQ
range
– Better language skills and IQ test performance predicts better
lifetime prognosis (50% never acquire useful speech)
Etiology of Autism:
Psychological Theories
• Bettelheim argued that parental rejection
induces autistic disorder
• Behavioral theory suggests that autism
results from inattentive parents, especially
the mother
• Follow-up studies have found little support
for psychological explanations of autism
Ch 15.17
Biological Etiology of Autism
• Genetic factors play a strong role in transmission
of autistic disorder
– Siblings of a person with autistic disorder have a 75 fold
increase in risk
– Twin studies show greater concordance for autism in
MZ twins (60-91% than in DZ twins (0-20%)
• Neurological studies consistently find structural
abnormalities in the cerebellum of autistic children
(e.g., substantially reduced sized)
Ch 15.18
Treatment of Autistic Disorder
• Drug treatment often involves the administration
of haloperidol
– Reduces social withdrawal and odd motor behaviors
– Haloperidol does not alter the abnormal interpersonal
relations or language impairments of autism
• Efficacy of psychodynamic therapy is unknown
• Behavior therapy approach (Lovaas)
– Uses modeling and operant conditioning to reinforce
language and prosocial behaviors
– Parent education training increases treatment
generalization beyond hospital settings
Ch 15.19