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Childhood & Adolescence I.ISSUES A.Child vs. Adult Psychopathology - Problems less severe/frequent in childhood - Same problem can look different - Some.

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Presentation on theme: "Childhood & Adolescence I.ISSUES A.Child vs. Adult Psychopathology - Problems less severe/frequent in childhood - Same problem can look different - Some."— Presentation transcript:

1 Childhood & Adolescence I.ISSUES A.Child vs. Adult Psychopathology - Problems less severe/frequent in childhood - Same problem can look different - Some problems primarily in childhood

2 B.Types of Disorders 1. Internalizing (overcontrolled) = problems within - Less noticed by adults - More common in girls

3 2. Externalizing (undercontrolled) = manifested externally - Mostly boys - More referred for tx

4 C.Normal vs. Abnormal Development - Normal at one age = abnormal at another - Period of rapid change - Harder to determine pathology in children “Normal” is age-dependent

5 D.Child problems are reciprocal 1.Blame the child - Infant temperament 2.Blame the parents - Schizophrenogenic & refrigerator mothers

6 3.Reciprocal process - difficult kids elicit worse caregiving & vice versa - Intervention = parent-child interaction

7 E.Children are dependent on others - more likely to get victimized - need parent/teacher involvement

8 II.Behavioral Disorders 1.Attention- Deficit Hyperactivity Disorder (ADHD) Description Inattention - especially sustained attention Hyperactivity Impulsivity

9 Inattentive Type Impulsive-Hyperactive Type Combined Type Adult ADD (not an actual dx)

10 Common complications Learning problems Discipline (-> ODD) Poor peer relations

11 Prevalence 3-6% Boys Over-diagnosed?

12 Etiology Nervous system problem - smaller brain (e.g, frontal lobe) BAS & BIS Polygenetic – 1 DA receptor implicated Prenatal smoking NOT sugar Parenting can exacerbate, cannot cause

13 Treatment - 1/3 recover Stimulant medication - ↑ DA – blocks reuptake - agonist for BIS - works for 75% - few side effects - effects are immediate - reduces inattention & impulsivity -> focus in classroom & at sports -> improves peer relations & self-esteem - cannot teach good behavior

14 Behavior therapy - Teach appropriate behavior via rewards & punishments - Parent training - School involvement - Must continue for long period Best = Medication + behavior tx

15 Summer ADHD Program - point system - parental involvement - double-blind medication trials

16 Oppositional Defiant Disorder (ODD) & Conduct Disorder (CD) Description ODD - negativitist, hostile, defiant CD - truancy, fire-setting, theft, aggression, cruelty

17 Prevalence 9% boys 2% girls

18 Etiology Family Parenting: criticism & poor monitoring (indifference) Parent modeling of poor self-control & antisocial tendencies Stressful events (divorce)

19 Cognitive skills hostile attributions poor problem-solving Biology some genetic evidence lower baseline arousal

20 Treatment Parent training - time out/lose privileges & positive reinforcement Negotiation with adolescents Cognitive treatments - problem-solving, self-control Family Systems Therapy

21 III. Cognitive Disorders Autism (on spectrum – to Asperger’s) 1.Inability to relate to other people - little communication - lack of affection/interest in others - self-absorption

22 2.Absent or deficient speech ~ ½ = no speech, primitive gestures ~ ½ = some words with oddities (e.g., echolalia)

23 3.Behavior limited, rigid stereotyped, self-stimulatory behaviors self-injurious & aggressive preservation of sameness

24 MR & LD = common

25 Prevalence 4-5 in 10,000 (rare) 75-80% are boys

26 Etiology 1940s: Kanner: innate inability to relate (biological) 1950s: Refrigerator mother => withdrawal (environment) Current: neurological basis prenatal or birth complications

27 Treatment Difficult; poor prognosis 5% capable of jobs Still emotionally isolated Rest = mild care-taking skills Best: if speak before 5, higher IQ, & mild symptoms

28 Institutionalization is common Behavior modification - reinforce social behaviors - sign language - parents & teachers as co-therapists Aversive conditioning Facilitation

29 IV. Anxiety & Mood Disorders Anxiety School Phobia (not a dx) Separation Anxiety Specific fears or phobias Others as in adults (e.g., GAD) Fears are common - Extreme degree or duration, impairment

30 Prevalence very common to uncommon equal in boys & girls

31 Etiology Biology: fearful, anxious temperament Learning: observe others’ fears - parents reinforce fears - overprotective parental style

32 Treatment Behavioral Flooding Systematic desensitization Reward for success Cognitive Re-appraisal of feared situation Relaxation strategies

33 Behavioral therapy = most effective Medication - not well-documented in kids ** Best = include parents

34 Depression Like adults - sad, crying, hopeless, low self-worth, sleep & appetite problems, lethargy Unlike adults - behavioral problems, clinging, delinquency

35 Few consistencies - more like adults than not - similar to adult bereavement (with precipitant)

36 Prevalence 5-10% boys & girls, more in teens equally common in boys & girls

37 Etiology Biological possible genetic predisposition Learning learned helplessness reduced reinforcers

38 Cognition Unrealistically negative Poor coping Poor social skills

39 Treatment Play therapy (psychodynamic) - child works through conflicts via play - no evidence for efficacy Social skills training Increase pleasant activities

40 Cognitive therapy – errors & coping Medication - somewhat effective for children - less effective for adolescents Change the environment*

41 V. Eating Disorders Anorexia refusing to eat due to fear of weight gain distorted body image life-threatening

42 Bulimia - bingeing & purging distorted body image not usually life-threatening often normal weight Key = lack of control

43 Prevalence Anorexia – 1-3 % of year-olds Bulimia - ~ 5% of teens/young adults (4.5% female,.5% male)

44 Etiology Need for control Identity issues - independence from parents - fear of growing sexuality Societal pressures for thinness

45 Treatment Family therapy - break power struggle - appropriate separation Cognitive therapy - Identify & express emotions - Boost self-esteem - Change irrational beliefs Different issues for anorexia and bulimia Hospitalization - IV fluids & goal weights

46 VI. Elimination Disorders Enuresis & Encopresis - wetting/soiling self beyond usual age (~5) Primary = hasn’t yet learned control vs. - Secondary = learned control but lost

47 Nighttime is more common - Daytime = maybe serious problem Sense of no self-control (low self-esteem)

48 Prevalence Enuresis: 15-20% of 5-year-olds 5% of 10-year-olds Encopresis:.3-8% of children usually secondary Boys

49 Etiology Conflict with parents - self-control Emotional disturbance - anxiety, stress, family disruption Failure to learn - associate full bladder/bowel with toilet

50 Treatment Eliminate biological causes Deal with emotional disturbance Behavioral techniques - wake in night after urination (Wee Alert) - praise for success - mild punishment for wetting/soiling Prevent: relaxed & positive toward toileting


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