CHAPTER 14

1. CHAPTER 14 DISORDERS OF CHILDHOOD AND ADOLESCENCE

2. MENTAL DISORDERS IN CHILDREN AND ADOLESCENTS AGES 9-17

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

4. 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

5. 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

6. 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

7. RATES OF ADHD

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

9. 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

10. 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

11. FREQUENCY OF OPPOSITIONAL DEFIANT DISORDER

12. 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

13. DEVELOPMENTAL MODEL OF CONDUCT DISORDER

14. 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

15. 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

16. SEPARATION ANXIETY DISORDER

17. 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

18. 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

19. 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.

20. RATES OF DEPRESSIONIN BOYS AND GIRLS

21. 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.