Disorders of Childhood and Adolescence Chapter 12

Chapter Outline Intellectual Disability Learning Disorders Pervasive Developmental Disorders Attention Deficit and Disruptive Behavior Disorders Childhood Disorders of Eating and Elimination

Pervasive Developmental Disorders Serious impairment in social interaction and communication Autism spectrum disorders Autistic disorder Asperger’s disorder Pervasive developmental disorder NOS An estimated 60 to 75% of children with autistic disorder or PDD-NOS have IQs below 70.

Functional Impairment of Autistic Disorder Life-long impairment Socially isolated Victims of bullying, teasing, or often ignored by classmates Prevalence 1 out of every 152 children More common in boys (4.7 boys for every 1 girl diagnosed) Onset before the age of three Parents are able to usually recognize that something is wrong around 12 to 18 months of age.

Do Vaccines Produce Autism? Fact: Until recently a child with intellectual disability was not given a second diagnosis even if the autistic behaviors were present and the diagnostic criteria has changed (autism spectrum disorder) leading to a rise in children with the disorder. Conclusion: Both environmental and biological factors contribute to autism, but current data do not support a causal role for MMR vaccine. Let’s examine the evidence 1. Initial research was correlational not causal. In one city, rates of autism continued to rise even when the vaccine was discontinued.

Etiology of Autistic Disorders Genetic syndromes and chromosomal abnormalities Unusually accelerated head and brain growth Structural and organizational abnormalities in the brains Under-activated fusiform gyrus

Ethics and Responsibility “Refrigerator mothers” in the 1950s and 1960s 1970s roots in neurobiology Discredited theories around vaccines and gluten-free diets Environmental factors such as medical technology, toxins, lifestyle, and technology

Treatment of Autistic Disorders Medication -Are not found to be effective for social or communication deficits -Atypical antipsychotics (help manage aggressive behavior and self-injury) -Stimulants (reduce hyperactivity) -SSRIs Behavioral interventions -Positive reinforcement and shaping -Applied behavior analysis (ABA) For self-injury -Aversive procedures

Attention-Deficit and Disruptive Behavior Disorders Childhood disorder characterized by inattentiveness, hyperactivity, and impulsivity Deficit in executive functioning Diagnosed in early elementary school Comorbidity with other psychological disorders

Functional Impairment and Etiology of ADHD More accidents and injuries Psychosocial difficulties 3 to 5% of children have ADHD More likely to have automobile accidents More likely to engage in criminal behavior Genetic factors Substance use during pregnancy Pregnancy complications Between 20 to 25% of children with ADHD have a family member with ADHD as well.

Figure 12.5 ADHD and Childhood Injuries

Treatment of ADHD A child’s age as a factor Level of functional impairment Behavioral parent training, classroom modification, social skills training, daily report card, and summer programs Medication -Stimulants (enhance the neurotransmitters of dopamine and norepinephrine) -Decrease core symptoms MTA

Conduct disorder and ODD is more common in boys than females. Fact or Fiction? Children diagnosed with conduct disorder or ODD are least likely to engage in serious violations of rules. Fact or fiction? No, these disorders are among the most difficult to treat and one of the common reasons a child is brought to seek mental health treatment. Both of the disorders engage in violating the rights of others and breaking societal rules. Conduct disorder and ODD is more common in boys than females. Fact or fiction? Technically yes, boys are more likely to be diagnosed at 13.4% versus girls at 9.1% with ODD and conduct disorder is also more common in boys at 2% to 16% versus 1% to 10% in girls. However, girls engage in what is called “relational aggression.”

Conduct Disorder and Oppositional Defiant Disorder Conduct disorder (continuous and repeated pattern of violating the basic rights of others or breaking societal rules with aggression toward people or animals, destruction of property, deceitfulness or theft, and serious rule violations) Oppositional defiant disorder (negative, hostile, or defiant behaviors that are less severe than those with conduct disorder)

Etiology of ODD and Conduct Disorder Higher among children from lower SES (worst inner city neighborhoods) Little known about cause of ODD Influence of family Psychological -Psychological disorders in parents -Poor parenting -Child abuse -SES Antisocial personality disorder as adults

Treatment of ODD and Conduct disorder Psychosocial interventions Level of functional impairment Behavioral (parent management training, classroom modification, social skills training, and summer programs) Medication -Unsuccessful when used alone -Atypical antipsychotic (Risperidone reduce symptoms of aggression) MST