CHAPTER 14 DISORDERS OF CHILDHOOD AND ADOLESCENCE

MENTAL DISORDERS IN CHILDREN AND ADOLESCENTS AGES 9-17 DisorderPercent Affected Anxiety Disorders13.0 Mood Disorders6.2 Disruptive Disorders10.3

EXTERNALIZING DISORDERS Disorders with behaviors that are disruptive and often aggressive Attention-deficit/hyperactivity disorder (ADHD) Tic disorders (Tourette’s) Oppositional defiant disorder (ODD) Conduct disorder

INTERNALIZING DISORDERS Related to worries and disturbing thoughts rather than to overt behaviors Separation anxiety disorder Social phobia Generalized anxiety disorder Obsessive-compulsive disorder Depression

ADHD Either criteria for inattention or hyperactivity- impulsivity must be met. Inattention – Behaviors include Does not seem to listen or follow through on instructions Difficulty in organizing activities and tasks Easily distracted by other stimuli Forgetful in daily activities Hyperactivity- Behaviors include Fidgets, runs about excessively Hard to play quietly Talks excessively Gluts out answers Can’t wait turn

ADHD How common? 7 out of 100 children 4 boys to 1 girl Consequences? Deficiencies in academic and social skills Poor school achievement Negative self-view Problematic interactions with parents and teachers Causes? Genetic inheritance Environmental factors Brain functioning Neurotransmitter activity

RATES OF ADHD

ADHD TREATMENT Stimulant medication Antidepressant medication Behavioral intervention Classroom intervention Parent training Combination of medications and behavioral intervention is most efficacious

TIC DISORDERS Tics Involuntary, sudden, recurrent, stereotyped motor movements or vocalizations Tourette’s Large motor ticks (shoulders, trunk, arms, legs) combined with uttering obscenities (coprolalia) Genetic basis Both often occur together with ADHD Treatment for Tourette’s Antidepressant medication Relaxation therapy

OPPOSITIONAL DEFIANT DISORDER Pattern of negativistic, defiant, hostile behavior lasting more than six months and not typical for age or developmental level Cause impairment in social, academic functioning Examples: Loses temper Argues with adults Refuses to comply with requests Deliberately annoys others Angry and resentful Spiteful and vindictive Causes Genetic Family relationships

FREQUENCY OF OPPOSITIONAL DEFIANT DISORDER

CONDUCT DISORDER More serious than ODD Aggressive behavior that violates social norms and rights of others Examples Threatens or causes harm to people and animals Property damage, theft, deceitfulness Serious violations of rules Behaviors would constitute antisocial personality disorder if child were over 18 years Causes Negative family environment Lack of social and academic skills ADHD and ODD often associated with later development of conduct disorder

DEVELOPMENTAL MODEL OF CONDUCT DISORDER

TREATMENT FOR CONDUCT DISORDER Prevention Develop social, emotional, and cognitive skills Cognitive-behavioral interventions Cognitive review of situation before reacting, thinking aloud Positive encounters with clinicians and other adults to develop prosocial behaviors Interventions must involve parents

SEPARATION ANXIETY DISORDER Excessive anxiety or panic when absent from major attachment figures, lasting for more than four weeks, and impairing functioning Often develops after some stress (loss of parent, relative, or pet or serious family illness, parental separation or divorce) Usually from caring families Sometimes the result of failure to achieve secure attachment bond in early childhood Diminishes after the age of 10 years

SEPARATION ANXIETY DISORDER

OTHER ANXIETY DISORDERS Social phobia Shun contact with unfamiliar people, especially if under pressure to perform. Generalized anxiety disorder In situations associated with pressure to perform, seek out peers to establish dependent relationships; overly eager to please peers. Obsessive-compulsive disorder Persistent intrusion of intense, unwanted thoughts with compulsions to perform ritualistic, repetitive behaviors; mostly concerned with dirt and contamination, performing washing rituals. Causes – Genetic; serotonin imbalance

TREATMENT OF ANXIETY DISORDER Family treatment Cognitive-behavioral interventions Antidepressant or antianxiety medication Children with obsessive-compulsive disorder report that they treat themselves by exposure to feared situation and refraining from performing ritual

DEPRESSION SYMPTOMS Birth to 2 years Whining, withdrawal, delays in physical, cognitive, language development Nightmares, night terrors, clinginess 3 to 5 years Sadness, weight loss, tiredness, thoughts of suicide, anger, apathy, irritability 6 to 12 years Similar to adults with verbalization of thoughts and feelings; sometimes delinquent behavior; somatic problems; anger; poor school performance 13 to 18 years Volatile moods, rage, low self-esteem, sexual acting out, substance abuse, suicidal thoughts and behavior.

RATES OF DEPRESSION IN BOYS AND GIRLS

CHILD AND ADOLESCENT THERAPY Play therapy Talk and play techniques Behavioral Time out Operant conditioning Cognitive-behavioral Teaching child coping skills – identifying problems, planning responses, thinking aloud Family therapy Family systems approach Effectiveness Unclear how effective in clinical settings, though research settings indicate positive effects.