Chapter 12 –Disorders of Childhood and
Adolescence
I.
Classification
A. DSM categories
1. Kids can be
diagnosed with almost all adult disorders (e.g., anxiety, depression)
2. There are
also disorders diagnosed only in kids, primarily in kids, or which one must
exhibit as a child initially (our focus)
B. Often grouped into
Internalizing vs. Externalizing (Disruptive Behavior) problems, and
Developmental problems
II.
Attention-Deficit/Hyperactivity Disorder (ADHD)
A. Symptoms of
inattention
ex: easily distracted, difficulty organizing or
sustaining attn
B. Symptoms of
hyperactivity/impulsivity
ex: fidgety, restless, interrupts, can’t sit
still, blurts out answers
C. For ADHD, can have primarily A, primarily B, or both.
D. Etiology: mixed evidence for a variety of causes;
clearly a genetic component, other biol/environ
factors as well
E. Treatment and
Treatment Issues
1. Ritalin
(methylphenidate) and other meds
a. generally pretty effective in reducing
symptoms
b. somewhat less effective in reducing
things like academic difficulties
c. issues re medication
i. “good-behavior
drug” or facilitator for child’s own behavior?
ii. implications
of medicating kids? What message does
that send in general?
iii. potential for abuse?
iv. may affect physical growth
2. Behavioral
Approaches
a. differential reinforcement/other
operant methods (e.g., “daily report card” at school)
b. gradual increase in goals
c. parent-training, social skills
training
3. Evaluation
of treatments
a.
Meds alone, BT alone, and
combo all effective in reducing symptoms
b.
Combo of meds and beh tx seems best, although not
in every analysis
4. Is ADHD overdiagnosed?
a. are rigid settings the problem or the
kid’s behavior?
b. are there other reasons for kid’s
behavior?
c. cormorbidity
with conduct disorder
III.
Conduct Disorder
A. Symptoms can be
clustered:
1. aggression to people and/or animals
2. destruction of property
3. deceitfulness or theft
4. serious violation of rules
B. Etiology
1. Biological
factors: some evidence for genetic
component, possible neuropsych deficits
2.
Parenting/Family Life:
a. inconsistent/harsh
parenting
b. modeling of abusive behavior
c. lack of moral sense in family
environment
d. failure to reason/explain with
children
3. Impact of
Deviant Peer Groups
4. Cognitive
Perspective
C. Treatment
1. Family
Interventions/Parent Training
2. Multisystemic Therapy (MST)
3. Behavioral
contracting
4. Anger-management, problem-solving, cognitive
challenging, moral skills training
IV.
Oppositional Defiant Disorder
A. Less severe form of
Conduct Disorder?
B. Sxs
include arguing; annoying behavior; angry, hostile, resentful, negative
attitude, resentment: “brattiness”
C. ONLY diagnosed if
criteria for CD not met
V. Mental
Retardation
A. Coded on Axis II,
and MUST be present prior to age 18
B. Must have both:
1.
Significantly subaverage IQ (or IQ equivalent)
2. Significant
limitations in adaptive functioning
ex: in communication, self-care, social skills,
etc
C. Level of MR
determined primarily by IQ score:
1. mild MR: 50-55 à abt 70 (abt 85%)
2. moderate MR: 35-40 à
50-55 (abt 10%)
3. severe MR: 20-25 à
35-40 (abt 3-4%)
4. profound MR:
<20-25 (abt 1-2%)
5. “severity unspecified” – when can’t test IQ
D. AAMR approach
1. focus not on severity of disability
2. focus IS on what remediation/support is needed to increase
adaptive functioning
E. Etiology
1. Known for
sure in abt 25% of cases
ex: Down Syndrome, PKU, lead poisoning
2. Most cases
have no known etiology
F. Prevention and
Treatment Issues
1. when possible, address known cause
2. behavioral approaches (eg,
3. alternative communication systems
4. assisted living/working programs
5. Issue: mainstreaming, “least restrictive
environment”
V. Learning
Disorders
A. Disorders of
B. Diagnosed based on
a SIGNIFICANT discrepancy between expectation (based on age/IQ) and specific
achievement
1. BUT, DSM dx and state requirements for accommodations not always the
same
2. Recent move
from failure-based model: “response to intervention”
model - child’s response to intervention is < expected
C. Etiology
1. genetic component, organic deficits/abnormalities
2. CAN be due
in part to perceptual deficits, but must be > deficits alone should lead to
3. language processing and other such deficits (e.g.,
difficulty recognizing phonemes)
D. Prevention and
Treatment Issues
1.
Individualized instruction, specific educational programs
2.
Environmental and/or task modifications (accommodations)
3. Issue: Are LDs really “mental disorders”?
4. Issue: Are LD diagnoses sought out or assigned
inappropriately?
VI.
Autistic Disorder (Autism)
A. Most well-known of
the Pervasive Developmental Disorders
1. Asperger’s also increasingly well known, but of
questionable utility?
B. Symptoms include:
1. impairment in social interaction
2. impairment in communication
3.
repetitive/stereotyped patterns of behavior, interests, activities
C. Must be evident
before age 3
D. Usually, but not
always, accompanied by MR
à
how are MR and autism different?
1. some with autism DON’T have MR (ex:
2. may have area of remarkable ability (“idiot savant” or
“autistic savant”)
3. patterns on IQ tests more varied
E. Etiology
1. Older
theory: psychogenic à
“refrigerator moms”
2.
Current: biologically determined,
with neurological differences
3. Lots of
other theories embraced by parents, but with lots of evidence countering them
and none to support them
F. Treatment and
Treatment Issues
1. Behavioral
Approaches
a. basic behavioral approaches (eg, pos reinf), intensive beh tx
(applied beh analysis – Lovaas)
b. aversive tx
2. “facilitated communication”
3. medication (antipsychotics, stimulants)
VIII. Tourette’s
Syndrome
A. Must have both
motor AND vocal tics
B. Diagnosed with Tic
Disorder, not Tourette’s, if only one
C. Swearing?
IX.
Separation Anxiety Disorder