Childhood Disorders

1. Childhood Disorders • Behavior disorders - ADHD, CD, ODD • Separation anxiety disorder • Elimination disorders - eneuresis, encopresis • Disorders of cognitive, motor, communication skills - learning disorders • Mental retardation • Pervasive developmental disorders - autism, Asperger’s disorder

2. Attention-Deficit/Hyperactivity Disorder - Categories of Symptoms • Inattention • Hyperactivity • Impulsivity

3. Symptoms of Inattention • Neglects details, makes careless errors • Difficulty w/ sustaining attention • Doesn’t seem to listen when others talk • Difficulty w/ organizing

4. More Symptoms of Inattention • Avoids activities requiring sustained effort & attn. • Loses things frequently • Easily distracted • Forgetful

5. Hyperactivity Symptoms • Fidgets, squirms • Leaves seat when inappropriate • Runs about or climbs excessively • Trouble engaging in quiet activities • Often acts as if “driven by motor • Often talks excessively

6. Impulsivity Symptoms • Blurts out responses while others talking • Difficulty waiting turn • Often interrupts or intrudes

7. ADHD Theories • Neurological immaturity - slowed brain development (consistent w/ fact that sx’s decline w/ age) • Dopamine • Runs in families, antisocial fathers • Prenatal, birth complications • Maybe food allergies in some, not sugar

8. ADHD Tx • Stimulants (Ritalin, etc.) decrease demanding, disruptive behavior, improve mood & goal-directedness • (Stimulants) work by increasing dopamine levels • No. of children prescribed stimulants increased 2 1/2 X in recent yrs.

9. Behavior Therapy w/ ADHD • Best results when meds accompanied by tx • Reinforcing positive behaviors • Extinguishing negative behaviors

10. Conduct Disorder • Bullies, threatens, or intimidates • Initiates physical fights • Uses weapons in fights • Engages in theft, burglary • Physically abuses people, animals • Lies, breaks promises

11. More on Conduct Disorder • Violates rules about staying out all night • Runs away from home • Set fires deliberately • Vandalizes, destroys others’ property • Often skips school

12. More on Conduct Disorder • As adolescents, half engage in drug abuse, criminal behavior • 34-40% dx’d as antisocial personality disorder as adults • As adults, 75-85% chronically unemployed

13. Gender & Conduct Disorder • Boys 3X more likely to be dx’d • Boys w/ CD more aggressive than girls w/ it • Antisocial behavior may take different form in girls • Verbal aggression, character defamation • Ostracism, alienation • Girls w/ CD equally likely to lie, steal, abuse substances

14. Oppositional Defiant Disorder • Often loses temper • Often argues w/ adults • Often refuses to comply w/ requests, rules • Deliberately tries to annoy others • Blames others for mistakes, misbehavior

15. More ODD Criteria • Touchy or easily annoyed • Angry, resentful • Spiteful, vindictive • Disorder often starts very early but some outgrow by late childhood, early adolescence • Arguably is early form of CD, same or separate disorder?

16. Biological Contributors to CD, ODD • Problems often start in infancy, difficult babies (irritable, demanding, non-compliant, impulsive, respond to frustration w/ aggression) • Both are heritable, antisocial behavior runs in families

17. Other Biological Contributors • Possible neurological deficits (corr. w/ ADHD) • Low arousal, testosterone, serotonin (as w/ ____)

18. Tx of CD, ODD • SSRI’s, antipsychotics, lithium • Cognitive-behavioral tx • Identify situational triggers for anger • Keep diaries of emotions, behaviors • Teach empathy • Learn to see others’ motives as benign • Calming self-talk • Teach problem solving, behavioral alternatives

19. Childhood Disorders • Behavior disorders - ADHD, CD, ODD • Separation anxiety disorder • Elimination disorders - eneuresis, encopresis • Cognitive, motor, communication skill disorders (learning disorders/disabilities) • Mental retardation • Pervasive developmental disorders - autism, Asperger’s

20. Autism • Formerly dx’d in 1 child in 10,000 • Now dx’d in 1 in 166 • More often occurs in boys (1 in 114) • Usually accompanied by mental retardation, exception is autistic savant (Rainman)

21. Autism • One of the pervasive developmental disorders - these involve severe, lasting impairment in several areas of development • Autism - deficits in • Social interaction • Communication • Activities & interests

22. Deficits in Social Interactions • Little nonverbal indicating connection - eye contact, facial expression, posture, gestures • Failure to develop normal peer relationships • Little pleasure when others are happy • Little reciprocity in social interactions

23. Deficits in Communication • Delayed or absent speech • Significant trouble in initiating, maintaining conversation • Unusual language, echolalia, phrase repetition, pronoun reversal • Lack of make-believe play or imitation of others

24. Deficits in Activities, Interests • Preoccupation w/ certain activities or toys • Compulsive adherence to routine, rituals • Stereotyped, repetitive movements, e.g., hand flapping, head banging • Echopraxia • Preoccupation w/ parts of objects, unusual uses of objects

25. Etiology of Autism • Earlier thought to be due to cold mothers • Deficits in theory of mind - inability to understand that people have mental states which can be used to connect w/ others

26. More on Autism Etiology • Disruption in normal development & organization of brain: • Larger heads & brains • Structural, functional deficits • Different brain activation in response to faces • Possible serotonin, norepinephrine imbalances

27. Autism Treatment • Meds help overactivity, stereotyped behavior, sleep disturbance, tension • SSRI’s reduce repetitive & aggressive behavior, improve interaction • Behavioral techniques & structured education key - 47% of those given this for 40 hrs./wk. for 2 yrs. achieved normal intellectual/educational level

28. Asperger’s Disorder • Harder to dx than autism • Cognitively normal • Deficits in social interaction, activities, interests