Childhood Disorders Chapter 10 Extra Credit By: Erika Garcia

Prevalence of Mental Disorders in Children  Estimated percentages of children who sufferpsychological disorders by age 16 years. It isimportant to note that children can be diagnosedwith more than one disorder. DiagnosisTotalGirlsBoys Any Disorder36.7%31.0%42.3%

Study of Childhood Disorders  The study of childhood disorders is known as developmental psychopathology.  Developmental psychopathologists try to understand when children’s behaviors cross the line from the normal difficulties of childhood into abnormal problems that warrant concern.  Behavior Disorders: attention-deficit/hyper-activity disorder, conduct disorder, and oppositional defiant disorder.

Attention- Deficit/Hyperactivity Disorder  Children who have tremendous trouble learning skills such as: paying attention in class, controlling their impulses, and organizing their behaviors so that they can accomplish long-term goals, may be diagnosed with ADHD.  There are three subtypes of ADHD: -Predominantly inattentive type -Predominantly hyperactive-impulsive type -Combined type

Three Types of ADHD  Predominantly inattentive type- diagnosed if six or more symptoms of inattention but fewer than six symptoms of hyperactivity-impulsivity are present.  Predominantly hyperactive-impulsive type- diagnosed if six or more symptoms of hyperactivity-impulsivity but fewer than six symptoms of inattention are present.  Combined type- diagnosed if six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.

The Facts  Children with ADHD often do poorly in school.  20 to 25 percent of children with ADHD may have a serious learning disability that makes it doubly hard for them to concentrate in school and to learn.  Between percent of children with ADHD develop a conduct disorder, abuse drugs, or violate the law.  ADHD runs in families, siblings of children with ADHD are 3-4 times more likely to develop it than siblings of children without the disorder.  ADHD is associated with low birth weight, premature delivery, and difficult delivery leading to oxygen deprivation.  The popular notion that hyperactivity in children is caused by dietary facts has not been supported in controlled studies.

Treatment for ADHD  Most children with ADHD are treated with stimulant drugs, such as Ritalin, Dexedrine, and Adderall.  The stimulants may work by increasing levels of dopamine in the synapses of the brain, enhancing release and inhibiting reuptake of this neurotransmitter.  Other drugs that treat ADHD include atomoxetine, clonidine, and guanfacine, which are not stimulants but affect norepinephrine levels.

Conduct Disorder  Conduct disorder: syndrome marked by chronic disregard for the rights of others, including specific behaviors such as stealing, lying, and engaging in acts of violence.  The conduct problems of some youth diminish with age, a pattern called adolescent-limited antisocial behavior, while others continue to violate social norms in adolescence and adulthood, a pattern called life-course-persistent antisocial behavior.

Oppositional Defiant Disorder  The criteria for oppositional defiant disorder are that children show at least four of the following symptoms for at least six months: a.) frequently lose their temper b.) quarrel with grownups c.) actively disobey requests of rules d.) intentionally irritate others e.) blame others for their errors or misconduct f.) are easily annoyed by other people g.) are angry and resentful h.) are spiteful or vindictive

The Facts  Boys are three times more likely than girls to be diagnosed with conduct disorder or oppositional defiant disorder.  Boys with conduct disorder tend to be more physically aggressive than girls with conduct disorder.  Children with conduct disorder are more likely to have parents with antisocial personalities.  Their fathers tend to have a history of criminal arrest and alcohol abuse, and their mothers tend to have a history of depression.

Cont.  Several specific genes have been associated with an increased risk of conduct disorder and oppositional defiant disorder, primarily genes involved in the regulation of the neurotransmitters dopamine, serotonin, and norepinephrine.  Children with conduct disorder have a slower heart rate than children without the disorder.  These disorders are often found more frequently in children from lower socioeconomic classes and in urban areas.  Children who are physically abused or severely neglected by their parents are more likely to develop disruptive and delinquent behavior.  In has been shown that those who form close relationships with others who do not have a conduct disturbance are much more likely to grow out of their behaviors.

Treatment  Psychological and Social Therapies: aim to change children’s ways of interpreting interpersonal interactions by teaching them to take and respect perspective of others (self-talk).  Drug Therapies: stimulants are the most widely prescribed drug for conduct disorders. Studies have shown that stimulants are moderately effective in reducing aggressions in children with conduct disorders.

Separation Anxiety Disorder  Separation anxiety disorder is a syndrome of childhood and adolescence marked by the presence of abnormal fear and worry over becoming separated form one’s caregiver as well as clinging behaviors in the presence of the caregiver.  Separation anxiety disorder is not diagnosed unless symptoms persist for at least four weeks and significantly impair the child’s functioning.  Left untreated, the disorder can recur throughout childhood and adolescence, significantly interfering with the child’s academic progress and peer relationships.

Biological, Psychological, and Sociocultural Factors  Children with separation anxiety disorder tend to have family histories of anxiety and depressive disorders.  Children may learn to be anxious from their parents or as an understandable response to their environment.

Treatment for Separation Anxiety  Cognitive-behavioral therapies most often are used to treat separation anxiety disorder.  Children are taught new skills for coping and for challenging cognitions that feed their anxiety.  As therapy progresses, periods of separation from parents are increased in number and duration.  Drugs used to treat childhood anxiety disorders include: antidepressants and anti-anxiety drugs

Elimination Disorders Children who are unable to gain sufficient control over their bladder and bowel movements by about age 4 might be diagnosed with one the two elimination disorders: enuresis or encopresis.

Enuresis  Bell and pad method is also used. The child sleeps on a pad that has a sensory device to detect urine, if the child wets during her sleep, a bell rings and wakes her.  Children over 5 are diagnosed with enuresis when they have wet the bed or their clothes at least twice a week for 3 months. (Most only wet at night)  Enuresis runs in families and approx 75 percent of children with enuresis have biological relatives who had the disorder.  Tricyclic antidepressants are commonly used to treat enuresis.

Encopresis  It is typically treated by a combination of medicines to clear out the colon, laxatives or mineral oil to soften stools.  They also recommend the child to sit on the toilet for a certain amount of time each day.  Encopresis involves repeated defecation into clothing or onto the floor and is rarer than enuresis.  To be diagnosed, children must have at least one such event a month for at least 3 months and must be at least 4 years of age.

Disorders of Cognitive, Motor, and Communication Skills  When deficits in fundamental skills are severe enough to interfere with a child’s progress, the child may be diagnosed with a learning disorder, a motor skills disorder, or a communication disorder.

Learning Disorders The DSM-IV-TR describes three specific learning disorders. They are diagnosed only when an individuals performance on standardized tests of these skills is significantly below that expected for his or her age, schooling, and overall level of intelligence as indicated by intelligence tests.

Learning Disorders Cont.  Mathematics disorder includes problems in understanding mathematical terms, recognizing numerical symbols, clustering objects into groups, counting, and understanding mathematical principles.  Reading disorder involves deficits in the ability to read and usually is apparent by the fourth grade. If affects about 4 percent of children, more commonly boys.  Disorder of written expression involves deficits in the ability to write. Children with this rare disorder have severe trouble spelling, constructing a sentence or paragraph, or writing legibly.

Motor Skills Developmental coordination disorder, involves deficits in fundamental motor skills, such as walking, running, or holding on to objects.

Communication Disorders  Children with mixed receptive-expressive language disorder have problems understanding the language produced by others.  Children with phonological disorder do not use speech sounds appropriate for their age or dialect.  Communication disorders involve deficits in the ability to communicate verbally because of a limited vocabulary, stuttering, or an inability to articulate words correctly.  Children with expressive language disorder have a limited vocabulary, difficulty in learning new words, difficulty in retrieving words, and poor grammar.

Causes and Treatment of Disorders of Cognitive, Motor, and Communication Skills  Abnormalities in brain structure and functioning have long been thought to cause learning disorders.  Environmental factors linked to the learning disorders include lead poisoning, birth defects, sensory deprivation, and low socioeconomic status.  The treatment of these disorders usually involves therapies designed to build missing skills.

Mental Retardation  Mental retardation involves deficits in a widerange of skills and is defined as significantly sub-average intellectual functioning.  In addition to low test scores, a diagnosis ofmental retardation requires that a child showdeficits relative to his or her age group in at leasttwo of the following skill areas: communication,self-care, home living, social or interpersonal skills,use of community resources, self-direction,academic skills, work, leisure, health, andpersonal safety.  There are four levels of mental retardation: mild,moderate, severe, and profound.

Levels of Mental Retardation  Moderate- have significant delays in language, may be physically clumsy and have some trouble dressing and feeding themselves.  Profound- require full-time custodial care, cannot dress themselves completely. Tend not to interact with others socially.  Mild- can feed and dress themselves with minimal help, may or may not have average motor skills, and can learn to talk and write in simple terms.  Severe- have very limited vocabularies and speak in two or three word sentences have significant deficits in motor developmental and may play with toys inappropriately.

Genetic Factors to Mental Retardation Intellectual skills are at least partially inherited, families with children with mental retardation tend to have high incidences of a variety of intellectual problems, including the different levels of mental retardation and autism. There are two metabolic disorders that are genetically transmitted and cause mental retardation are phenylketonuria and Tay- Sachs disease.

Brain Damage During Gestation and Early Life Fetal alcohol syndrome- children whose mothers abuse alcohol during pregnancy are at an increased risk of this syndrome. Children with FAS have an average IQ of 68, along with poor judgment, distractibility, and difficulty perceiving social cues.

Sociocultural Factors Children with mental retardation are more likely to come from low socioeconomic backgrounds, this may be because their parents also have mental retardation and have not been able to acquire well-paying jobs. Poor mothers are also less likely to receive good prenatal care, increasing the risk of pre-mature birth. Poor children also are less likely to have parents who read to them and are involved in their schooling.

Treatments for Mental Retardation Interventions for mentally retarded children must be comprehensive, intensive, and long-term to show benefits. 1.Behavioral Strategies 2.Drug Therapy 3.Social Programs

Behavioral Strategies A child’s parents or caregivers and teachers work together to enhance the child’s positive behaviors and reduce negative behaviors. Behavioral methods do not simply focus on isolated skills but rather are integrated into a comprehensive program designed to maximize the individuals ability to function in community.

Drug Therapy Medications are used to reduce seizures, which are common among people with mental retardation; to control aggressive or self- injurious behavior; and to improve mood. Anti-depressant medications can reduce depressive symptoms, improve sleep patterns, and help control self-injurious behavior in individuals with mental retardation.

Social Programs 1.Early Intervention Programs- intensive one- on-one interventions to enhance their development of basic skills; efforts to reduce the social conditions that might interfere with the children’s development. 2.Mainstreaming- placing children with mental retardation into regular classrooms.

Social Programs Cont. 3. Group Homes- many adults with mental retardation live in group homes, where they receive assistance in the tasks of daily living and training in vocational and social skills. 4. Institutionalization- very common in the past but not so common anymore.

Pervasive Developmental Disorders  The pervasive developmental disorders involve severe and lasting impairment in several areas of development, including social interactions, communication with others, and everyday behaviors, interests, and activities.  Autism- a disorder in which children show deficits in all these areas.

Diagnosis of Autism  Autism involves three types of deficits.  The first type us deficits in social interactions.  The second type of deficit involvescommunication, children with autism do notdevelop useful speech.  The third type of deficit concerns theactivities and interests of children, ratherthan engaging in symbolic play with toys,they are pre-occupied with one part of atoy or an object.

Diagnosis of Autism Cont.  Routines and rituals often are extremely important to children with autism.  Children autism often do poorly on measures of intellectual ability.  Symptoms of autism usually have their onset before age 3.  With age children with autism may not be interested in playing with other children, preferring to remain in solitary play.

Asperger’s Disorder and Other Pervasive Developmental Disorders  Asperger’s disorder is characterized by deficits in social interactions and in activities and in activities and interests that are similar to those in autism.  It differs from autism because there are no significant delays or deviance in language and, in the first 3 years of life, children show normal levels of curiosity about the environment and acquire most normal cognitive skills.  The children usually have average IQ scores.

Contributors to Autism The siblings of children with autism are 50 times more likely to have the disorder. Neurological factors probably play a role in autism. Studies have suggested a variety of structural and functional deficits in the brains of individuals with autism, including in the cerebellum, the cerebrum, the amygdala, and possibly the hippocampus.

Treatments for Autism  The atypical antipsychotic medications are used to reduce obsessive and repetitive behaviors and to improve self-control.  Naltrexone, a drug that blocks receptors for opiates, has been shown to be useful in reducing hyperactivity in some children with autism.  Stimulants are used to improve attention.

Nolen-Hoeksema, S. (2011). Abnormal psychology. (5 ed.). New York: Mc-Graw Hill Companies.