Disorders of Childhood and Adolescence

2. Disorders of Childhood and Adolescence • Abnormal functioning can occur at any time in life • Children of all cultures typically experience at least some emotional and behavioral problems as they encounter new people and situations • Surveys indicate that worry is a common experience • Bedwetting, nightmares, temper tantrums, and restlessness are other problems experienced by many children

3. Childhood and Adolescence

4. Childhood and Adolescence • Adolescence can also be a difficult period • Physical and sexual changes, social and academic pressures, personal doubts, and temptation cause many teenagers to feel anxious, confused, and depressed • Bullying • Over one-quarter of students report being bullied frequently, and more than 70% report having been a victim at least once

5. All victims of bullying are upset by it, but some individuals seem to be more traumatized by the experience than others. Why might this be so?

6. Childhood and Adolescence • Some disorders of children – childhood anxiety disorders and childhood depression – have adult counterparts • Other childhood disorders – elimination disorders, for example – usually disappear or radically change form by adulthood • There also are disorders that begin in birth or childhood and persist in stable forms into adult life • These include autism spectrum disorder spectrum disorder and intellectual developmental disorder

7. Separation Anxiety Disorder • displayed by 4 to 10% of all children • Extreme anxiety, often panic, whenever they are separated from home or a parent

8. Childhood Mood Problems: Major Depressive Disorder • Around 2% of children and 9% of adolescents currently experience major depressive disorder; as many as 20 percent of adolescents experience at least one depressive episode

9. Major Depressive Disorder • Depression in the young may be triggered by negative life events (particularly losses), major changes, rejection, or ongoing abuse • Childhood depression is characterized by such symptoms as headaches, stomach pain, irritability, and a disinterest in toys and games • Clinical depression is much more common among teenagers than among young children • Suicidal thoughts and attempts are common in teenagers

10. Bipolar Disorder • Often considered an adult mood disorder, whose earliest age of onset is the late teens • Theorists suggest the diagnosis has become a clinical “catchall” that is being applied to almost every explosive, aggressive child • The current shift in diagnoses has been accompanied by an increase in the number of children who receive adult medications • The DSM-5 task force concluded that the childhood bipolar label has been overapplied over the past two decades. To help rectify this problem, DSM-5 now includes a new category, disruptive mood dysregulationdisorder (DMDD)

11. Disruptive Mood Dysregulation Disorder (DMDD)

12. Oppositional Defiant Disorder

13. Conduct Disorder • Children with conduct disorder, a more severe problem, repeatedly violate the basic rights of others • Often aggressive and may be physically cruel to people and animals • Many steal from, threaten, or harm their victims • Begins between 7 and 15 years of age

14. Conduct Disorder • Relational aggression: individuals are socially isolated and primarily display social misdeeds • Slander • Rumor-starting • Friendship manipulation • More common among girls than boys

15. What Are the Causes of Conduct Disorder?

16. How Do Clinicians Treat Conduct Disorder? • Treatments for conduct disorder are generally most effective with children younger than 13 • Today's clinicians are increasingly combining several approaches into a wide-ranging treatment program • Sociocultural treatments • Child-focused treatments • Prevention

17. Sociocultural Treatments • Family interventions • Parent-child interaction therapy • Parent management training • Residential treatment • Community-based • School programs

18. Child-Focused Treatments • Focus primarily on the child with conduct disorder • Cognitive-behavioral interventions • Problem-solving skills training • modeling, practice, role-playing, and systematic rewards • Anger Coping and Coping Power Program

19. Prevention • Greatest hope for reducing the problem of conduct disorder lies in prevention programs that begin in early childhood • These programs try to change unfavorable social conditions before a conduct disorder is able to develop • All such approaches work best when they educate and involve the family

20. Attention-Deficit/Hyperactivity Disorder • Children who display attention-deficit/hyperactivity disorder (ADHD) have great difficulty attending to tasks, behave overactively and impulsively, or both • The primary symptoms of ADHD may feed into one another, but in many cases one of the symptoms stands out more than the other

21. Attention-Deficit/Hyperactivity Disorder

22. Diagnostic Criteria for ADHD

23. What Are the Causes of ADHD? • Clinicians generally consider ADHD to have several interacting causes, including: • Biological causes, particularly abnormal dopamine activity, and abnormalities in the frontal-striatal regions of the brain • High levels of stress • Family dysfunctioning

24. How Is ADHD Treated? • About 80% of all children and adolescents with ADHD receive treatment • There is, however, heated disagreement about the most effective treatment for ADHD • The most commonly applied approaches are drug therapy, behavioral therapy, or a combination • Millions of children and adults with ADHD are currently treated with methylphenidate (Ritalin), a stimulant drug that has been available for decades

25. Drug Therapy

26. Behavior Therapy and Combination Approaches • Behavioral therapy has been applied in many cases of ADHD • Parents and teachers learn how to apply operant conditioning techniques to change behavior • These treatments have often been helpful, especially when combined with drug therapy

27. Multicultural Factors and ADHD • Studies indicate that African American and Hispanic American children with significant attention and activity problems are less likely than white American children to be assessed for ADHD, receive an ADHD diagnosis, or undergo treatment for the disorder • Those who do receive a diagnosis are less likely than white children to be treated with the interventions that seem to be of most help, including the promising (but more expensive) long-acting stimulant drugs • In part, racial differences in diagnosis and treatment are tied to economic factors

28. Elimination Disorders • Children with elimination disorders repeatedly urinate or pass feces in their clothes, in bed, or on the floor • They have already reached an age at which they are expected to control these bodily functions • These symptoms are not caused by physical illness

29. Enuresis

30. Encopresis

31. Comparison of Childhood Disorders

32. Long-Term Disorders That Begin in Childhood • Two groups of disorders that emerge during childhood are likely to continue unchanged throughout a person's life: • Autism spectrum disorders • Intellectual developmental disorder • Autism spectrum disorders are a group of disorders marked by impaired social interactions, unusual communications, and inappropriate responses to stimuli in the environment

33. Autism Spectrum Disorder • Autism spectrum disorder, or autism spectrum disorder, was first identified in 1943 • Children with this disorder are extremely unresponsive to others, uncommunicative, repetitive, and rigid • Symptoms appear early in life, before age 3 • Around 80% of all cases appear in boys

34. Autism Spectrum Disorder • As many as 90% of children the disorder remain significantly disabled into adulthood • Even the highest-functioning adults with autism spectrum disorder typically have problems in social interactions and communication, and have restricted interests and activities • Lack of responsiveness and social reciprocity • Language and communication problems take various forms • One common speech peculiarity is echolalia, the exact echoing of phrases spoken by others • Another is pronominal reversal, or confusion of pronouns

35. Autism Spectrum Disorder: Asperger's Disorder

36. What Are the Causes of Autism Spectrum Disorder?

37. What Are the Causes of Autism Spectrum Disorder?

38. How Do Clinicians and Educators Treat Autism Spectrum Disorder? • Treatment can help people with autism spectrum disorder adapt better to their environment, although no known treatment totally reverses the autistic pattern • Treatments of particular help are cognitive-behavioral therapy, communication training, parent training, and community integration • In addition, psychotropic drugs and certain vitamins have sometimes helped when combined with other approaches

39. How Do Clinicians and Educators Treat Autism Spectrum Disorder?

40. How Do Clinicians and Educators Treat Autism Spectrum Disorder?

41. How Do Clinicians and Educators Treat Autism Spectrum Disorder?

42. How Do Clinicians and Educators Treat Autism Spectrum Disorder?

43. Intellectual Developmental Disorder • According to the DSM-5, people should receive a diagnosis of intellectual developmental disorder when they display general intellectual functioning that is well below average, in combination with poor adaptive behavior • IQ must be 70 or lower • The person must have difficulty in such areas as communication, home living, self-direction, work, or safety • Symptoms must appear before age 18

44. Assessing Intelligence • Educators and clinicians administer intelligence tests to measure intellectual functioning • These tests consist of a variety of questions and tasks that rely on different aspects of intelligence • Having difficulty in one or two of these subtests or areas of functioning does not necessarily reflect low intelligence • An individual's overall test score, or intelligence quotient (IQ), is thought to indicate general intellectual ability

45. Assessing Intelligence • Many theorists have questioned whether IQ tests are indeed valid • Intelligence tests also appear to be socioculturally biased • If IQ tests do not always measure intelligence accurately and objectively, then the diagnosis of intellectual developmental disorder may also be biased • That is, some people may receive the diagnosis partly because of test inadequacies, cultural differences, discomfort with the testing situation, or the bias of a tester

46. Assessing Adaptive Functioning • Diagnosticians cannot rely solely on a cutoff IQ score of 70 to determine whether a person suffers from intellectual developmental disorder • Several scales, such as the Vineland and AAMR Adaptive Behavior Scales, have been developed to assess adaptive behavior • For proper diagnosis, clinicians should observe the functioning of each individual in his or her everyday environment, taking both the person's background and the community standards into account

47. What Are the Features of Intellectual Developmental Disorder? • The most consistent sign of intellectual developmental disorder is that the person learns very slowly • Other areas of difficulty are attention, short­term memory, planning, and language • Those who are institutionalized with intellectual developmental disorder are particularly likely to have these limitations

48. What Are the Features of Intellectual Developmental Disorder? • Traditionally four levels of intellectual development disorder have been distinguished:

49. Mild IDD • Approximately 80% to 85% of all people with intellectual developmental disorder fall into the category of mild IDD (IQ 50–70) • Interestingly, intellectual performance seems to improve with age • Research has linked mild intellectual developmental disorder mainly to sociocultural and psychological causes, particularly: • Poor and unstimulating environments • Inadequate parent-child interactions • Insufficient early learning experiences

50. Moderate, Severe, and Profound IDD • Approximately 10% of persons with intellectual developmental disorder function at a level of moderate IDD (IQ 35–49) • They can care for themselves, benefit from vocational training, and can work in unskilled or semiskilled jobs • Approximately 3% to 4% of persons with intellectual developmental disorder display severe IDD (IQ 20–34) • They usually require careful supervision and can perform only basic work tasks • They are rarely able to live independently