Abnormal Behavior in Childhood and Adolescence

1. Abnormal Behavior in Childhood and Adolescence Pauline Cabrera BS Psych IV

2. Key Concepts • “Behavior” • The way in which a person responds to a specific set of conditions (Microsoft Encarta, 2009)

3. “Abnormal” • Unusual or unexpected, especially in a way that causes alarm or anxiety (Microsoft Encarta, 2009)

4. “Abnormal Behavior” • includes any activity judged to be outside the normal behavior pattern for animals of that particular class and age, including the vices, the fixed patterns of abnormality. (Medical -dictionary.thefreedictionary.com, 2011)

5. “Childhood” • Somebody’s earliest years: the state of being a child (Microsoft Encarta, 2009) • “Adolescence” • Time preceding adulthood: the period from puberty to adulthood (Microsoft Encarta, 2009)

6. Mental Retardation • “Intellectual Disability” – DSM-V • It is a condition diagnosed before age 18 that includes below-average general intellectual function, and a lack of the skills necessary for daily living. (MedlinePlus, 2011)

7. Developmental delay • an overly inclusive term and should generally be used for infants and young children (< 5 y) in which the diagnosis is unclear, such as those too young for formal testing.

8. MR/ID originates during the developmental period (ie, conception through age 18 years) and results in significantly sub-average general intellectual function with concurrent deficits in functional life skills. • The diagnosis of MR/ID requires an intelligence deficit of at least 2 standard deviations (SDs) below the mean IQ. This generally translates into an intelligence quotient (IQ) score of 70-75, given a population mean of 100. • Equivalent deficits in at least 2 areas of functional life skills or adaptive skills also must be present to meet the diagnostic criteria for MR/ID.

9. Adaptive skills encompass functional life skills within the domains of • communication, • self-care, • home living, • social and interpersonal skills, • use of community resources, • self-direction, • functional academic skills, • work, • leisure, • health, • and safety.

10. Mental retardation affects about 1 - 3% of the population. • Approximately 10% of children have some learning impairment, while as many as 3% manifest some degree of MR/ID. • The population prevalence of these combined disorders of learning rivals that of the common childhood disorder asthma.

11. A family may suspect mental retardation if the child's motor skills, language skills, and self-help skills do not seem to be developing, or are developing at a far slower rate than the child's peers. • Failure to adapt (adjust to new situations) normally and grow intellectually may become apparent early in a child's life. • In the case of mild retardation, these failures may not become recognizable until school age or later.

12. Intellectual Disability Categorization

13. Causes • Infections (present at birth or occurring after birth) • Congenital CMV • Congenital rubella • Congenital toxoplasmosis • Encephalitis • HIV infection • Listeriosis • Meningitis • Chromosomal abnormalities • Chromosome deletions (cri du chat syndrome) • Chromosomal translocations (a gene is located in an unusual spot on a chromosome, or located on a different chromosome than usual) • Defects in the chromosome or chromosomal inheritance (for example, fragile X syndrome, Angelman syndrome, Prader-Willi syndrome) • Errors of chromosome numbers (such as Down syndrome)

14. Environmental • Deprivation syndrome • Genetic abnormalities and inherited metabolic disorders • Adrenoleukodystrophy • Galactosemia • Hunter syndrome • Hurler syndrome • Lesch-Nyhan syndrome • Phenylketonuria • Rett syndrome • Sanfilippo syndrome • Tay-Sachs disease • Tuberous sclerosis • Metabolic • Congenital hypothyroid • Hypoglycemia (poorly regulated diabetes) • Reye syndrome • Hyperbilirubinemia (very high bilirubin levels in babies)

15. Nutritional • Malnutrition • Toxic • Intrauterine exposure to alcohol, cocaine, amphetamines, and other drugs • Lead poisoning • Methylmercury poisoning • Trauma (before and after birth) • Intracranial hemorrhage before or after birth • Lack of oxygen to the brain before, during, or after birth • Severe head injury • Unexplained(this largest category is for unexplained occurrences of mental retardation)

16. Symptoms • Language delay • One of the first signs-- including expressive language (speech) and receptive language (understanding). • Red flags include no mama/dada/babbling by 12 months, no 2-word phrases by age 2, and parents reporting they are concerned that the child may be deaf. • Fine motor/adaptive delay • Significant delays in activities such as self-feeding, toileting, and dressing • Prolonged, messy finger feeding and drooling are signs of oral-motor incoordination. • Cognitive delay • have difficulties with memory, problem-solving and logical reasoning. • This may be expressed early on with preacademic difficulties or difficulty following directions (particularly multipart directions).

17. Social delays • may display lack of interest in age-appropriate toys and delays in imaginative play and reciprocal play with age-matched peers. • Gross motor • Delays in gross motor development infrequently accompany the cognitive, language, and fine motor/adaptive delays associated with MR/ID unless the underlying condition results in both MR/ID and cerebral palsy. • Subtle delays in gross motor acquisition, or clumsiness, may be identified in the developmental assessment.

18. Behavioral disturbances • Even before an age at which psychopathology can be identified, infants and toddlers who go on to have MR/ID may be more likely to have difficult temperaments, hyperactivity, disordered sleep, and colic (excessive crying). • Associated behaviors may include aggression, self-injury, defiance, inattention, hyperactivity, sleep disturbances, and stereotypic behaviors. • Neurologic and physical abnormalities • Prevalence of MR is increased among children with seizure disorders, microcephaly, macrocephaly, history of intrauterine or postnatal growth retardation, prematurity, and congenital anomalies.

19. Learning Disabilities • Learning disability is a general term that describes specific kinds of learning problems. A learning disability can cause a person to have trouble learning and using certain skills. (Medicinenet.com, 2011)

20. Characteristics of Learning Disabled Students - What Kinds of Students Have Learning Disabilities? • Despite their difficulty in certain skill areas, learning disabled students are usually of average or higher intelligence.  • Some students with LDs are also gifted.

21. Learning disabilities are neurological differences in processing information that severely limit a person’s ability to learn in a specific skill area. • Everyone has differences in learning abilities, but people with learning disabilities have severe learning problems that persist throughout their lives. • Learning disabled people may have difficulty in school or on the job. • Learning disabilities may also impact independent living and social relationships. (Logsdon, 2011)

22. Learning disabilities (LD) vary from person to person. • One person with learning disabilities may not have the same kind of learning problems as another person with learning disabilities.

23. The skills most often affected are: Reading

24. Writing

25. Speaking

26. Reasoning

27. Doing math

28. More signs and symptoms… • may have trouble learning the alphabet, rhyming words, or connecting letters to their sounds;  • may make many mistakes when reading aloud, and repeat and pause often;  • may not understand what he or she reads;  • may have real trouble with spelling;  • may have very messy handwriting or hold a pencil awkwardly;  • may struggle to express ideas in writing;  • may learn language late and have a limited vocabulary;  • may have trouble remembering the sounds that letters make or hearing slight differences between words; 

29. may have trouble understanding jokes, comic strips, and sarcasm;  • may have trouble following directions;  • may mispronounce words or use a wrong word that sounds similar;  • may have trouble organizing what he or she wants to say or not be able to think of the word he or she needs for writing or conversation;  • may not follow the social rules of conversation, such as taking turns, and may stand too close to the listener;  • may confuse math symbols and misread numbers;  • may not be able to retell a story in order (what happened first, second, third); or  • may not know where to begin a task or how to go on from there.

30. Types of Learning Disabilities • Basic reading and reading comprehension are the two broad categories of reading disabilities. Dyslexia is another term by which reading disabilities are known. • Language comprehension and speaking and expressive language are the two main types of language disorders. • Basic writing and expressive writing are the two types of writing disorders. Some diagnostic systems refer to writing disorders as dysgraphia. • Basic math and applied math are the two main types of math disorders. Some diagnostic systems refer to math disorders as dyscalculia.

31. Researchers think that learning disabilities are caused by differences in how a person's brain works and how it processes information. • Children with learning disabilities are not "dumb" or "lazy." • In fact, they usually have average or above average intelligence. Their brains just process information differently.

32. Disabilities of Learning and Heredity - Are Learning Disabilities Biological? • True learning disabilities (LDs) are believed to be an organic type of disability resulting from neurological processing problems that cause difficulty with learning and applying skills in one or more academic areas. • Evidence suggests that a child's chances of having a learning disability increase when parents or other relatives also have learning disabilities. • This suggests that heredity may play a role in some cases. However, there are other possible causes of LDs that can be prevented in some cases.

33. Communication Disorders • It involves a wide variety of problems in speech, language, and hearing. (Keller, 2005) • For example, speech and language disorders include stuttering, aphasia, dysfluency, voice disorders (hoarseness, breathiness, or sudden breaks in loudness or pitch), cleft lip and/or palate, articulation problems, delays in speech and language, autism, and phonological disorders.

34. Speech and language impairments and disorders can be attributed to environmental factors, of which the most commonly known are High Risk Register problems, which include drugs taken during pregnancy, common STD's such as syphilis, and birthing trauma to name a few. • Communication disorders can also stem from other conditions such as learning disabilities, dyslexia, cerebral palsy, and mental retardation.

35. Causes • Hearing disorders and deafness • There are two main types of hearing loss. • One happens when your inner ear or auditory nerve is damaged. This type is permanent. • The other kind happens when sound waves cannot reach your inner ear. Earwax build-up, fluid or a punctured eardrum can cause it. • Untreated, hearing problems can get worse. • Possible treatments include hearing aids, cochlear implants, special training, certain medicines and surgery. (MedlinePlus.com, 2011)

36. Voice problems, such as dysphonia or those caused by cleft lip or palate • Many things we do can injure our vocal cords. • Talking too much, screaming, constantly clearing your throat or smoking can make you hoarse. • These can also lead to problems such as nodules, polyps and sores on the vocal cords. • Other causes of voice disorders include infections, upward movement of stomach acids into the throat, growths due to a virus, cancer and diseases that paralyze the vocal cords. • Treatment for voice disorders varies depending on the cause. Most voice problems can be successfully treated when diagnosed early.

37. Speech problems like stuttering • Stuttering is a problem that affects the flow of your speech. If you stutter, you may • Make certain words sound longer than they should be • Find it hard to start a new word • Repeat words or parts of words • Get tense when you try to speak. You may blink your eyes rapidly, or your lips and jaw may tremble as you struggle to get the words out • Stuttering can affect anyone. However, it is most common in young children who are still learning to speak. Boys are three times more likely to stutter than girls. Most children stop stuttering as they grow older. Less than 1 percent of adults stutter. • Scientists don't fully understand why some people stutter. The problem seems to run in families. There is no cure, but stuttering therapy for young children can keep it from becoming a lifelong problem.

38. Developmental disabilities • Nervous system disabilities affecting how the brain, spinal cord and nervous system function. • They cause mental retardation, including Down syndrome and fragile X syndrome. • They also cause learning and behavioral disorders, such as autism • Sensory-related disabilities, which can cause vision, hearing and sight problems • Most developmental disabilities have no cure, but you can often treat the symptoms. Physical, speech and occupational therapy might help. Special education classes and psychological counseling can also help.

39. Learning disorders • People with learning disorders may have problems • Listening or paying attention • Speaking • Reading or writing • Doing math

40. Brain injury • Symptoms of a TBI may not appear until days or weeks following the injury. Serious traumatic brain injuries need emergency treatment. • Treatment and outcome depend on the injury. TBI can cause a wide range of changes affecting thinking, sensation, language, or emotions. • TBI can be associated with post-traumatic stress disorder. • People with severe injuries usually need rehabilitation.

41. Stroke • A stroke is a medical emergency. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. • There are two kinds of stroke. • The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. • The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. • "Mini-strokes" or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted.

42. Autism • It is a developmental disorder that is characterized by impaired development in communication, social interaction, and behavior.

43. It is classified as a pervasive developmental disorder (PDD), a category of disorders that is often described interchangeably with the broad spectrum of developmental disorders affecting young children and adults called the autistic spectrum disorders (ASD). • The range of these disorders varies from severely impaired individuals with autism to other individuals who have abnormalities of social interaction but normal intelligence--Asperger's syndrome. The ways in which autism is exhibited can differ greatly. • Additionally, autism can be found in association with other disorders such as mental retardation and certain medical conditions. The degree of autism can range from mild to severe. Mildly affected individuals may appear very close to normal. Severely afflicted individuals may have an extreme intellectual disability and unable to function in almost any setting.

44. What are the symptoms of autism? • The current Diagnosis and Statistical Manual of Mental Disorders-Fourth Edition, Treatment Revision (DSM-IV-TR) identifies three features that are associated with autism: • impairment in social interaction,  • communication, and  • behavior.

45. 1. Individuals with autism fail to develop normal personal interactions in virtually every setting. This means that affected persons fail to form the normal social contacts that are such an important part of human development.

46. 2. • Communication is usually severely impaired in persons with autism. • What the individual understands (receptive language) as well as what is actually spoken by the individual (expressive language) are significantly delayed or nonexistent. • Deficits in language comprehension include the inability to understand simple directions, questions, or commands. • There may be an absence of dramatic or pretend play and these children may not be able to engage in simple age-appropriate childhood games such as Simon Says or Hide-and-Go-Seek. • Teens and adults with autism may continue to engage in playing with games that are for young children.

47. 3. • Persons with autism often exhibit a variety of repetitive, abnormal behaviors. • There may also be a hypersensitivity to sensory input through vision, hearing, or touch (tactile). • As a result, there may be an extreme intolerance to loud noises or crowds, visual stimulation, or things that are felt. • Birthday parties and other celebrations can be disastrous for some of these individuals. • Wearing socks or tags on clothing may be perceived as painful. Sticky fingers, playing with modeling clay, eating birthday cake or other foods, or walking barefoot across the grass can be unbearable. • On the other hand, there may be an underdeveloped (hyposensitivity) response to the same type of stimulation. This individual may use abnormal means to experience visual, auditory, or tactile (touch) input. • This person may head bang, scratch until blood is drawn, scream instead of speaking in a normal tone, or bring everything into close visual range. He or she might also touch an object, image or other people thoroughly just to experience the sensory input.

48. Children and adults who have autism are often tied to routine and many everyday tasks may be ritualistic. • Something as simple as a bath might only be accomplished after the precise amount of water is in the tub, the temperature is exact, the same soap is in its assigned spot and even the same towel is in the same place. • Any break in the routine can provoke a severe reaction in the individual and place a tremendous strain on the adult trying to work with him or her.

49. There may also be non-purposeful repetition of actions or behaviors. • Persistent rocking, teeth grinding, hair or finger twirling, hand flapping and walking on tiptoe are not uncommon. • Frequently, there is a preoccupation with a very limited interest or a specific plaything. A child or adult may continually play with only one type of toy. The child may line up all the dolls or cars and the adult line up their clothes or toiletries, for example, and repeatedly and systematically perform the same action on each one. • Any attempt to disrupt the person may result in extreme reactions on the part of the individual with autism, including tantrums or direct physical attack. Objects that spin, open and close, or perform some other action can hold an extreme fascination. • If left alone, a person with this disorder may sit for hours turning off and on a light switch, twirling a spinning toy, or stacking nesting objects. • Some individuals can also have an inappropriate bonding to specific objects and become hysterical without that piece of string, paper clip, or wad of paper.

50. Other symptoms in young children include the following: • Avoids cuddling or touching • Frequent behavioral outbursts, tantrums • Inappropriate attachments to objects • Maintains little or no eye contact • Over- or undersensitivity to pain, no fear of danger • Sustained abnormal play • Uneven motor skills • Unresponsiveness to normal teaching methods and verbal clues (may appear to be deaf despite normal hearing)