Disorders of Childhood and Adolescence

Disorders of Childhood and Adolescence

Abnormal functioning can occur at any time in life Children of all cultures typically experience at

least some emotional and behavioral problems as they encounter new people and situations

Surveys indicate that worry is a common experience Bedwetting, nightmares, temper tantrums, and restlessness are

other problems experienced by many children

Childhood and Adolescence


Adolescence can also be a difficult period Physical and sexual changes, social and academic

pressures, personal doubts, and temptation cause many teenagers to feel anxious, confused, and depressed

Bullying Over one-quarter of students report being bullied

frequently, and more than 70% report having been a victim at least once


Some disorders of children – childhood anxiety disorders and childhood depression – have adult counterparts

Other childhood disorders – elimination disorders, for example – usually disappear or radically change form by adulthood

There also are disorders that begin in birth or childhood and persist in stable forms into adult life These include autism spectrum disorder spectrum

disorder and intellectual developmental disorder

Separation Anxiety Disorder

displayed by 4 to 10% of all children

Extreme anxiety, often panic, whenever they are separated from home or a parent

Childhood Mood Problems: Major Depressive Disorder

Around 2% of children and 9% of adolescents currently experience major depressive disorder; as many as 20 percent of adolescents experience at least one depressive episode

Major Depressive Disorder

Depression in the young may be triggered by negative life events (particularly losses), major changes, rejection, or ongoing abuse

Childhood depression is characterized by such symptoms as headaches, stomach pain, irritability, and a disinterest in toys and games

Clinical depression is much more common among teenagers than among young children Suicidal thoughts and attempts are common in

teenagers

Bipolar Disorder

Often considered an adult mood disorder, whose earliest age of onset is the late teens Theorists suggest the diagnosis has become a clinical

“catchall” that is being applied to almost every explosive, aggressive child

The current shift in diagnoses has been accompanied by an increase in the number of children who receive adult medications

The DSM-5 task force concluded that the childhood bipolar label has been overapplied over the past two decades. To help rectify this problem, DSM-5 now includes a new category, disruptive mood dysregulation disorder (DMDD)

Disruptive Mood Dysregulation Disorder (DMDD)

Oppositional Defiant Disorder

Conduct Disorder

Children with conduct disorder, a more severe problem, repeatedly violate the basic rights of others Often aggressive and

may be physically cruel to people and animals

Many steal from, threaten, or harm their victims

Begins between 7 and 15 years of age

Conduct Disorder

Relational aggression: individuals are socially isolated and primarily display social misdeeds Slander Rumor-starting Friendship manipulation

More common among girls than boys

What Are the Causes of Conduct Disorder?

How Do Clinicians Treat Conduct Disorder?

Treatments for conduct disorder are generally most effective with children younger than 13

Today's clinicians are increasingly combining several approaches into a wide-ranging treatment program Sociocultural treatments Child-focused treatments Prevention

Sociocultural Treatments

Family interventions Parent-child interaction therapy Parent management training

Residential treatment Community-based

School programs

Child-Focused Treatments

Focus primarily on the child with conduct disorder Cognitive-behavioral interventions

Problem-solving skills training modeling, practice, role-playing, and systematic rewards

Anger Coping and Coping Power Program

Prevention Greatest hope for

reducing the problem of conduct disorder lies in prevention programs that begin in early childhood These programs try to

change unfavorable social conditions before a conduct disorder is able to develop

All such approaches work best when they educate and involve the family

Attention-Deficit/Hyperactivity Disorder

Children who display attention-deficit/hyperactivity disorder (ADHD) have great difficulty attending to tasks, behave overactively and impulsively, or both

The primary symptoms of ADHD may feed into one another, but in many cases one of the symptoms stands out more than the other

Attention-Deficit/Hyperactivity Disorder

Diagnostic Criteria for ADHD

What Are the Causes of ADHD?

Clinicians generally consider ADHD to have several interacting causes, including: Biological causes, particularly abnormal dopamine

activity, and abnormalities in the frontal-striatal regions of the brain

High levels of stress Family dysfunctioning

How Is ADHD Treated?

About 80% of all children and adolescents with ADHD receive treatment

There is, however, heated disagreement about the most effective treatment for ADHD The most commonly applied approaches are drug

therapy, behavioral therapy, or a combination Millions of children and adults with ADHD are currently

treated with methylphenidate (Ritalin), a stimulant drug that has been available for decades

Drug Therapy

Behavior Therapy and Combination Approaches

Behavioral therapy has been applied in many cases of ADHD Parents and teachers learn how to apply operant

conditioning techniques to change behavior These treatments have often been helpful, especially

when combined with drug therapy

Multicultural Factors and ADHD

Studies indicate that African American and Hispanic American children with significant attention and activity problems are less likely than white American children to be assessed for ADHD, receive an ADHD diagnosis, or undergo treatment for the disorder Those who do receive a diagnosis are less likely than

white children to be treated with the interventions that seem to be of most help, including the promising (but more expensive) long-acting stimulant drugs

In part, racial differences in diagnosis and treatment are tied to economic factors

Elimination Disorders

Children with elimination disorders repeatedly urinate or pass feces in their clothes, in bed, or on the floor

They have already reached an age at which they are expected to control these bodily functions These symptoms are not caused by physical illness

Enuresis

Encopresis

Comparison of Childhood Disorders

Long-Term Disorders That Begin in Childhood

Two groups of disorders that emerge during childhood are likely to continue unchanged throughout a person's life: Autism spectrum disorders Intellectual developmental disorder

Autism spectrum disorders are a group of disorders marked by impaired social interactions, unusual communications, and inappropriate responses to stimuli in the environment

Autism Spectrum Disorder

Autism spectrum disorder, or autism spectrum disorder, was first identified in 1943

Children with this disorder are extremely unresponsive to others, uncommunicative, repetitive, and rigid

Symptoms appear early in life, before age 3

Around 80% of all cases appear in boys

Autism Spectrum Disorder

As many as 90% of children the disorder remain significantly disabled into adulthood Even the highest-functioning adults with autism spectrum

disorder typically have problems in social interactions and communication, and have restricted interests and activities

Lack of responsiveness and social reciprocity Language and communication problems take various

forms One common speech peculiarity is echolalia, the exact

echoing of phrases spoken by others Another is pronominal reversal, or confusion of pronouns

Autism Spectrum Disorder: Asperger's Disorder

What Are the Causes of Autism Spectrum Disorder?

What Are the Causes of Autism Spectrum Disorder?

How Do Clinicians and Educators Treat Autism Spectrum Disorder?

Treatment can help people with autism spectrum disorder adapt better to their environment, although no known treatment totally reverses the autistic pattern

Treatments of particular help are cognitive-behavioral therapy, communication training, parent training, and community integration In addition, psychotropic drugs and certain vitamins

have sometimes helped when combined with other approaches





Intellectual Developmental Disorder

According to the DSM-5, people should receive a diagnosis of intellectual developmental disorder when they display general intellectual functioning that is well below average, in combination with poor adaptive behavior IQ must be 70 or lower The person must have difficulty in

such areas as communication, home living, self-direction, work, or safety

Symptoms must appear before age 18

Assessing Intelligence

Educators and clinicians administer intelligence tests to measure intellectual functioning These tests consist of a variety of questions and tasks

that rely on different aspects of intelligence Having difficulty in one or two of these subtests or areas of

functioning does not necessarily reflect low intelligence An individual's overall test score, or intelligence quotient (IQ), is

thought to indicate general intellectual ability

Assessing Intelligence

Many theorists have questioned whether IQ tests are indeed valid

Intelligence tests also appear to be socioculturally biased

If IQ tests do not always measure intelligence accurately and objectively, then the diagnosis of intellectual developmental disorder may also be biased That is, some people may receive the diagnosis partly

because of test inadequacies, cultural differences, discomfort with the testing situation, or the bias of a tester

Assessing Adaptive Functioning

Diagnosticians cannot rely solely on a cutoff IQ score of 70 to determine whether a person suffers from intellectual developmental disorder

Several scales, such as the Vineland and AAMR Adaptive Behavior Scales, have been developed to assess adaptive behavior For proper diagnosis, clinicians should observe the

functioning of each individual in his or her everyday environment, taking both the person's background and the community standards into account

What Are the Features of Intellectual Developmental Disorder?

The most consistent sign of intellectual developmental disorder is that the person learns very slowly

Other areas of difficulty are attention, short term memory, planning, and language Those who are institutionalized with intellectual

developmental disorder are particularly likely to have these limitations

What Are the Features of Intellectual Developmental Disorder?

Traditionally four levels of intellectual development disorder have been distinguished:

Mild IDD

Approximately 80% to 85% of all people with intellectual developmental disorder fall into the category of mild IDD (IQ 50–70) Interestingly, intellectual performance seems to improve

with age Research has linked mild intellectual

developmental disorder mainly to sociocultural and psychological causes, particularly: Poor and unstimulating environments Inadequate parent-child interactions Insufficient early learning experiences

Moderate, Severe, and Profound IDD

Approximately 10% of persons with intellectual developmental disorder function at a level of moderate IDD (IQ 35–49) They can care for themselves, benefit from vocational

training, and can work in unskilled or semiskilled jobs Approximately 3% to 4% of persons with

intellectual developmental disorder display severe IDD (IQ 20–34) They usually require careful supervision and can

perform only basic work tasks They are rarely able to live independently

Moderate, Severe, and Profound IDD

About 1% to 2% of persons with intellectual developmental disorder fall into the category of profound IDD (IQ below 20) With training they may learn or improve basic skills but

they need a very structured environment Severe and profound levels of intellectual

developmental disorder often appear as part of larger syndromes that include severe physical handicaps

What Are the Causes of Intellectual Developmental Disorder?

The primary causes of moderate, severe, and profound IDD are biological, although people who function at these levels are also greatly affected by their family and social environment Sometimes genetic factors are at the root of these

biological problems Other biological causes come from unfavorable conditions that

occur before, during, or after birth





Interventions for People with Intellectual Developmental Disorder

The quality of life attained by people with intellectual developmental disorder depends largely on sociocultural factors Intervention programs try to provide comfortable and

stimulating residences, social and economic opportunities, and a proper education

What is the Proper Residence?

Until recently, parents of children with intellectual developmental disorder would send them to live in public institutions – state schools – as early as possible

During the 1960s and 1970s, the public became more aware of these conditions and, as part of the broader deinstitutionalization movement, demanded that many people be released from these schools

What is the Proper Residence?

Since deinstitutionalization, reforms have led to the creation of small institutions and other community residences that teach self-sufficiency, devote more time to patient care, and offer education and medical services

Which Educational Programs Work Best?

Because early intervention seems to offer such great promise, educational programs for individuals with intellectual developmental disorder may begin during the earliest years

At issue are special education versus mainstream classrooms In special education, children with intellectual developmental

disorder are grouped together in a separate, specially designed educational program

Mainstreaming places them in regular classes Neither approach seems consistently superior Teacher preparedness is a factor that plays into decisions

about mainstreaming

When Is Therapy Needed?

People with intellectual developmental disorder sometimes experience emotional and behavioral problems Around 30% or more have a diagnosable psychological

disorder other than intellectual developmental disorder Some suffer from low self-esteem, interpersonal

problems, and adjustment difficulties These problems are helped to some degree by

individual or group therapy Psychotropic medication is sometimes prescribed

How Can Opportunities For Personal, Social, And Occupational Growth Be Increased?

People need to feel effective and competent to move forward in life

Those with intellectual developmental disorder are most likely to achieve these feelings if their communities allow them to grow and make many of their own choices


Socializing, sex, and marriage are difficult issues for people with intellectual developmental disorder and their families

With proper training and practice, individuals with intellectual developmental disorder can learn to use contraceptives and carry out responsible family planning The National Association for Retarded Citizens offers

guidance in these matters Some clinicians have developed dating skills programs


Adults with intellectual developmental disorder need the financial security and personal satisfaction that comes from holding a job Many can work in sheltered workshops, but there are

too few training programs available Additional programs are needed so that more people

with intellectual developmental disorder may achieve their full potential, as workers and as human beings

Documents

Disorders of Childhood and Adolescence