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Adolescent Problems - DSM – IV

Adolescent Problems - DSM – IV. Disorders usually first diagnosed in infancy, childhood, or adolescence Mental Retardation Learning Disorders Developmental Coordination Disorder (motor coordination) Expressive Language Disorder (standardized tests of expressive language)

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Adolescent Problems - DSM – IV

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  1. Adolescent Problems - DSM – IV • Disorders usually first diagnosed in infancy, childhood, or adolescence • Mental Retardation • Learning Disorders • Developmental Coordination Disorder (motor coordination) • Expressive Language Disorder (standardized tests of expressive language) • Phonological Disorder (speech sounds) • Stuttering • Autistic Disorder (social interaction deficits)

  2. Rett’s Disorder (head size, hand movement, social engagement – deficits after early normality) • Childhood Disintegrative Disorder (after normal development, progressive deterioration of language, social, physical skills) • Asperger’s Disorder (nonverbal behaviors, peer skills, peer enjoyment, emotional reciprocity) • ADHD • Pica (eating objects)

  3. Rumination (regurgitation, rechewing) • Feeding Disorder (failure to eat adequate amount) • Tourette’s Disorder (motor, vocal outbursts) • Encopresis (feces) • Enuresis (wetting) • Separation Anxiety Disorder (excessive anxiety) • Selective Mutism • Reactive Attachment Disorder (hypervigilant or diffuse attachments) • Stereotypic Movement Disorder (repetitive and non-functional motor behavior)

  4. Conduct Disorder (rights of others are violated) – as early as 5-6, usually in late childhood or early adolescence, rarely after 16 • Oppositional Defiant Disorder (negativistic, defiant, disobedient, hostile behavior toward authority figures) – usually before age 8

  5. Externalizing problems • Problem behavior theory • Risky automobile driving • Substance use • Delinquency and crime • Factors involved in risk behavior • Internalizing problems • Depression • Eating disorders

  6. Two Broad Problem Types • Externalizing Problems – create difficulties in a person’s external world (a.k.a. “undercontrolled”) • Tend to go together (a person that fights is also more likely to commit other crimes) • More common among males • Often motivated by desire for excitement, not necessarily underlying unhappiness or psychopathology • Internalizing Problems – primarily affect a person’s internal world (A.k.a. “overcontrolled”) • Tend to go together (a person who is depressed is also more likely to have an anxiety disorder) • More common in females • Associated with experiencing distress

  7. Problem Behavior Theory • Problem Behavior Syndrome = Pattern of correlations between externalizing problems • Theory: Problems have common origins • Background factors – e.g., family income • Personality factors – e.g., self-esteem • Social factors – e.g., parental control

  8. Monitoring the Future, 2006 Any illicit drug use

  9. Cigarettes

  10. Alcohol

  11. LSD

  12. Cocaine

  13. Other narcotics, including OxyContin, VicodinIncrease in 2002 due to inclusion of more types of drugs in the survey question

  14. Ecstasy

  15. Shope’s Model of Young Driver Crash Risks (2002)

  16. Driver Crash Involvement: Property Damage Rates per 100,000: 1997

  17. Driver Crash Involvement: Injury Rates per 100,000: 1997

  18. Driver Crash Involvement: Fatality Rates per 100,000: 1997

  19. Prevention: Two Approaches • Driver Education • Generally hasn’t worked too well… • Get your license faster…you’re out there driving and getting into accidents! • Graduated Driver Licensing (GDL) • More effective • Address a variety of risk factors • Restrict the conditions under which novices can drive

  20. Graduated Licensing Strategy • Three Stages to a GDL program: • Learning License – getting driving experience under supervision of experienced driver • Restricted License – can drive unsupervised, but with restrictions designed to reduce crashes (e.g., driving curfews) • Full License – after 1 year restricted L N

  21. Substance Use • Alcohol • Cigarettes • Illegal drugs (e.g., marijuana, cocaine, LSD, ecstasy…) Adolescent substance use became target of a great deal of political attention, public policy programs and research In the 1980s and beyond….

  22. Substance Use, 1975-1999 Source: Monitoring the Future, 2000

  23. Alcohol & Marijuana Use by Age Notice the higher levels of use during age when unstructured socializing is most prevalent

  24. Sequence of Substance Use • Drinking beer and wine • Smoking cigarettes and drinking hard liquor • Smoking marijuana • Using “hard” drugs

  25. Adolescents use in different ways…

  26. Delinquency and Crime: Definitions • Delinquency – when “juveniles” commit crimes: • Status Offences – only a violation of the law because committed by juvenile • Index Crimes – serious crimes at any age • Violent Crimes • Property Crimes 3. Nonindex Crimes – less serious offenses such as gambling, disorderly conduct

  27. Age and Crime 1842 1977

  28. Two Types of Delinquency (Moffit, 1993) Life-course-persistent delinquents • Pattern of problems from birth on up • Originate in neuropsychological deficits (difficult temperament, LD) • Likely to grow up in high risk environment Adolescent-delimited delinquents • No signs of problems in infancy or childhood • Period of occasional criminal activity between ages of 12-25 (e.g., vandalism, illegal drug use)

  29. Preventing Crime & Delinquency • Prevention programs for children who show signs of risk for LCPD and for adolescents engaging in serious delinquency • Varied Strategies: • Individual therapy • Group therapy • Vocational training • Outward Bound type programs • Scared Straight “Boot Camp” type programs

  30. Preventing Crime & Delinquency • Two problems with prevention programs: • Participation is typically non-voluntary or against one’s will • Prevention comes too late (in adolescence) after behavior patterns have been established • The Multisystemic Approach has been met with some success • MST includes parent training, job training, vocational counseling, development of neighborhood activities and centers – directing the energy of delinquents in positive directions.

  31. Preventing Crime & Delinquency Multisytemic therapy (MST) vs. usual Juvenile Justice Services for serious adolescent offenders Note: Lower is better!

  32. Factors involved in Risk Behavior

  33. Socialization and Delinquency • What is a “socialized delinquent”? An “unsocialized delinquent”?

  34. Culture and Risk Behavior • In traditional cultures, Schlegel and Barry (1991) found that boys and not girls tend to engage in risk behavior during adolescence • Evidence of antisocial behavior in less than half of the cultures studied • In Western countries other than the USA, engage in less risky driving behavior • USA has highest rates of violent crimes

  35. Deaths from Suicide & Homicide The USA has the highest homicide rate; Canada the highest suicide rate

  36. 15-year olds Who Report Smoking Daily

  37. Levels of Depression • Depression is an enduring period of sadness: • Depressed mood: enduring period of sadness without any related symptoms • Depressive syndrome: addition of symptoms such as frequent crying, feeling guilty, lonely or worried • Major Depressive Disorder: Episode includes five or more symptoms during a two-week period and disrupt functioning

  38. Major Depressive Disorder • Depressed or irritable mood for most of the day, nearly every day. • Reduced interest or pleasure in all or almost all activities, nearly every day. • Significant weight loss or gain, or decrease in appetite. • Insomnia or oversleeping. • Psychomotor agitation or retardation, observable by others. • Low energy or fatigue. • Feelings of worthlessness or inappropriate guilt. • Diminished ability to think or concentrate. • Recurrent thoughts of death, recurrent suicidal thoughts.

  39. Treating Depression with CBT… The goal of CBT is to help the young person recognize the cognitive habits that are promoting depression and work to change those habits. Strategies include discussion, role play, practicing new ways of interacting Cognitive Behavior Therapy (CBT) recognizes that depression is characterized by negative attributions, and a belief that the situation is permanent and uncontrollable Relapse is less likely after CBT treatment than drug treatment

  40. Suicide: Risk Factors and Facts Third most common cause of death ages 15-19 • Risk factors: • Depression • Family disruption • Substance abuse problems • Relationship problems outside family • Result of series of difficulties over time Females 4 times more likely than males to attempt suicide Males 4 times more likely than females to complete suicide Higher rates among White than Black youth Rates highest among Native American youth Rates are highest where guns are most available

  41. Eating Disorders • Anorexia Nervosa – intentional self-starving • Bulimia – binge eating and purging Cultural ideal of thinness Puberty and body changes More common among upper and middle socioeconomic classes Girls who read magazines like “Seventeen” are more likely to strive for thinness Warm and controlling parents Occurs most often among females in teens and early 20s

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