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Abnormal Psychology
Leading Researcher Perspectives
Edited by Elizabeth Rieger
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Chapter 10
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Oppositional defiant disorder is characterised by a persistent pattern
of negativistic, spiteful, irritable and non-compliant behaviour.
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Figure 1 Differences in the proportion of problems between the persistent and
low/non-antisocial groups and between the experimental and low/nonantisocial groups throughout childhood and adolescence
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Continued on next slide
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continued
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Disorders of childhood are common, although they are
often unrecognised and untreated. Many adult disorders
can be traced back to childhood symptoms, highlighting
the importance of prevention and early intervention.
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Down Syndrome is a common cause of intellectual
impairment, which occurs when a third copy of
chromosome 21 is present in the genome.
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Proposed changes for childhood
disorders in DSM-V
Externalising disorders:
• In terms of oppositional defiant disorder, the current recommendations for the
DSM-V are to maintain the symptom structure, but to distinguish between
emotional symptoms (i.e., indications of an angry/irritable mood such as the child
losing his/her temper) and behavioural symptoms (e.g., indications of
defiant/headstrong behaviour such as the child arguing with or defying adults). In
addition, it is proposed that the exclusionary criteria for conduct disorder be
removed (so that a child will now be able to be diagnosed with both oppositional
defiant disorder and conduct disorder) and that the symptoms occur at different
frequencies and intensities for children at different ages in order to more clearly
demarcate behaviour that is developmentally normal at a certain age from that
which is not.
• For conduct disorder there are no proposed changes to the criteria, except for a
proposal to add callous, unemotional traits.
• For ADHD, adding more symptoms for diagnosing impulsivity (e.g., being
uncomfortable doing things slowly and finding it difficult to resist temptations) and
requiring fewer symptoms to meet the diagnosis in older individuals.
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Proposed changes for childhood
disorders in DSM-V (continued)
Internalising disorders:
• For separation anxiety disorder, it has been proposed that this be re-classified
from the category of ‘Disorders Usually First Diagnosed in Infancy, Childhood or
Adolescence’ to ‘Anxiety Disorders’, with some minor revisions to the criteria to
allow for its diagnosis in adults (e.g., impairment in the work context).
• Several new disorders have also been proposed, such as the addition of
posttraumatic stress disorder in preschool children to account for developmental
differences in the way in which trauma symptoms are experienced.
Elimination disorders:
• For enuresis, minor changes include the removal of the need for the child to be
distressed regarding the behaviour.
Learning disorders:
• Change to the name of reading disorder to ‘dyslexia’. Similarly, the name for the
mathematics disorder will be changed to ‘dyscalculia’.
• Because there is little evidence to support the DSM-IV-TR criterion of a
substantial discrepancy between the individual’s level of achievement in reading
and his/her intellectual ability, the primary criterion will be re-worded to ‘difficulties
in accuracy or fluency of reading that are not consistent with the person’s
chronological age, educational opportunities or intellectual abilities’.
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Proposed changes for childhood
disorders in DSM-V (continued)
Pervasive developmental disorders:
• A range of pervasive developmental disorders (e.g., Asperger’s syndrome) will be
subsumed under the autistic disorder category. Autism will be represented as a
single diagnostic category that is adapted to the individual’s clinical presentation
by specifying the individual’s clinical characteristics (e.g., severity of symptoms
and verbal abilities) and associated features (e.g., known genetic disorders,
epilepsy, and intellectual disability).
• There will be two (rather than three) main domains of criteria:
social/communication deficits, and fixated interests and repetitive behaviours.
Intellectual impairment:
• Changes mainly reflect more rigour in the definitions (e.g., the requirement that
psychometrically-sound and culturally-appropriate assessment tools be used to
determine the individual’s intellectual ability), and less reliance on IQ testing. For
example, severity levels will no longer be based on specific IQ cut-offs as this
practice failed to consider the individual’s level of functional skills.
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Chapter 10 Summary
• Disorders of childhood are common, although they are often
unrecognised and untreated. Many adult disorders can be traced back
to childhood symptoms, highlighting the importance of prevention and
early intervention.
• An important message of this chapter is the extent to which the family
environment can play a role in the development and maintenance of
psychological and behavioural problems in children. Fortunately, effective
evidence-based parenting interventions are available to assist parents in
changing their child’s behaviour and improving coping skills.
• The primary challenge now is to ensure that such interventions are
widely available and easily accessible to parents. Psychologists have
been at the forefront of tackling this issue by designing more flexible
interventions that reach more parents.
• In reaching broad sections of the community, such innovative
approaches have the potential to undermine pervasive myths that
downplay the severity of psychological problems in childhood and
prevent children gaining the help they need.
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