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Disorders of Childhood and Adolescence


... include specific phobias, social phobias, generalized anxiety disorder, and OCD ... form of school phobia, although most cases of school phobia have other causes ... – PowerPoint PPT presentation

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Title: Disorders of Childhood and Adolescence

Chapter 17
  • Disorders of Childhood and Adolescence

Slides Handouts by Karen Clay Rhines,
Ph.D. Seton Hall University
Disorders of Childhood and Adolescence
  • Abnormal functioning can occur at any time in
  • Some patterns of abnormality, however, are more
    likely to emerge during particular periods
  • Sometimes the special pressures of the particular
    life stage help trigger the dysfunctioning
  • In other cases, unique experiences or biological
    abnormalities may be the key factor

Childhood and Adolescence
  • Theorists often view life as a series of stages
    on the road from birth to death
  • Freud proposed five stages of psychosexual
    development oral, anal, phallic, latency, and
  • Erikson added the old age stage
  • Although theorists may disagree with the details
    of these schemes, most agree with the idea that
    we face key pressures during each stage in life
    and either grow or decline depending on how we
    meet those pressures

Childhood and Adolescence
  • People often think of childhood as a carefree and
    happy time yet it can also be frightening and
  • 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
  • Bedwetting, nightmares, and temper tantrums are
    other problems experienced by many children

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

Childhood and Adolescence
  • Along with these common psychological
    difficulties, around one-fifth of all children
    and adolescents in North America also experience
    a diagnosable psychological disorder
  • Boys with disorders outnumber girls, even though
    most of the adult psychological disorders are
    more common in women

Childhood Anxiety Disorders
  • As in adults, the anxiety disorders experienced
    by children and adolescents include specific
    phobias, social phobias, generalized anxiety
    disorder, and OCD
  • One form of anxiety listed separately in the DSM
    and specific to children is separation anxiety

Childhood Anxiety Disorders
  • Separation anxiety disorder is characterized by
    extreme anxiety, often panic, when the sufferer
    is separated from home or a parent
  • Many cannot travel away from their families and
    may be unable to stay alone in a room
  • It is estimated that about 4 of children and
    young adolescents suffer from this disorder
  • Girls are diagnosed more often than boys

Childhood Anxiety Disorders
  • Separation anxiety disorder sometimes takes the
    form of school phobia, although most cases of
    school phobia have other causes
  • Childhood anxiety disorders are generally
    explained in much the same way as adult anxiety
    disorders, with biological, behavioral, and
    cognitive factors pointed to most often
  • The special features of childhood may play an
    important role

Childhood Anxiety Disorders
  • Psychodynamic, behavioral, cognitive, and family
    therapies, separately or in combination, have
    been used to treat anxiety disorders in children,
    often with success
  • Clinicians have also used drug therapy and play
    therapy as part of treatment

Childhood Depression
  • Children, like adults, may develop depression
  • Between 2 and 4 of children under 17 years of
    age experience major depressive disorder
  • The symptoms are likely to include physical
    discomfort, irritability, and social withdrawal
  • There appears to be no difference in the rates of
    depression in boys and girls before age 11
  • By age 16, girls are twice as likely as boys to
    be depressed

Childhood Depression
  • Explanations of childhood depression are similar
    to those of adult depression
  • Theorists have pointed to factors such as loss,
    learned helplessness, negative cognitions, and
    low serotonin or norepinephrine activity

Childhood Depression
  • Like depression in adults, childhood depression
    is often helped by cognitive therapy or
    interpersonal approaches
  • Family therapy may also be effective
  • Antidepressant medications have not proved
    consistently useful in cases involving children,
    but they do seem to help some depressed

Disruptive Behavior Disorders
  • Children displaying extreme hostility and
    defiance may qualify for a diagnosis of
    oppositional defiant disorder
  • This disorder is characterized by repeated
    arguments with adults, loss of temper, anger, and
  • Children with this disorder ignore adult requests
    and rules, try to annoy people, and blame others
    for their mistakes and problems
  • Between 2 and 16 of children will display this
  • The disorder is more common in boys than girls
    before puberty but equal in both sexes after

Disruptive Behavior Disorders
  • Children with conduct disorder display a more
    extensive and severe antisocial pattern and
    repeatedly violate the basic rights of others
  • They are often aggressive and may be physically
    cruel and violent
  • Many steal from, threaten, or harm their victims,
    committing such crimes as shoplifting, vandalism,
    mugging, and armed robbery

Disruptive Behavior Disorders
  • Conduct disorder usually begins between 7 and 15
    years of age
  • Between 1 and 10 of children display this
    pattern, boys more than girls
  • Children with a mild conduct disorder may improve
    over time, but severe cases frequently continue
    into adulthood
  • These cases may turn into antisocial personality
    disorder or other psychological problems

Disruptive Behavior Disorders
  • Many children with conduct disorder are suspended
    from school, placed in foster homes, or
  • When children between the ages of 8 and 18 break
    the law, the legal system often labels them
    juvenile delinquents

Disruptive Behavior Disorders
  • Cases of conduct disorder have been linked to
    genetic and biological factors, drug abuse,
    poverty, traumatic events, and exposure to
    violent peers or community violence
  • They have most often been tied to troubled
    parent-child relationships, inadequate parenting,
    family conflict, marital conflict, and family

Disruptive Behavior Disorders
  • Because disruptive behavior patterns become more
    locked in with age, treatments for conduct
    disorder are generally most effective with
    children younger than 13
  • Given the importance of family factors in this
    disorder, therapists often use family

Disruptive Behavior Disorders
  • Sociocultural approaches such as residential
    treatment programs have helped some children
  • Individual approaches are sometimes effective as
    well, particularly those that teach the child how
    to cope with anger
  • Recently, the use of drug therapy has been tried
  • Institutionalization in juvenile training centers
    has not met with much success and may, in fact,
    increase delinquent behavior

Disruptive Behavior Disorders
  • It may be that the 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

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

Attention-Deficit/ Hyperactivity Disorder
  • Problems common to the disorder
  • Learning or communication problems
  • Poor school performance
  • Difficulty interacting with other children
  • Misbehavior, often serious
  • Mood or anxiety problems

Attention-Deficit/ Hyperactivity Disorder
  • Around 5 of schoolchildren display ADHD, as many
    as 90 of them boys
  • Many children show a lessening of symptoms as
    they move into adolescence
  • At least half continue to have problems
  • One-third of those affected have symptoms into
  • Those whose parents have had ADHD are more likely
    than others to develop it

Attention-Deficit/ Hyperactivity Disorder
  • Clinicians generally consider ADHD to have
    several interacting causes, including
  • Biological causes
  • High levels of stress
  • Family dysfunctioning
  • Each of these causes has received some research

Attention-Deficit/ Hyperactivity Disorder
  • Sociocultural theorists also point out that ADHD
    symptoms and a diagnosis of ADHD may themselves
    create interpersonal problems and produce
    additional symptoms in the child
  • Two other explanations have received considerable
    press (though neither has been supported by
  • ADHD is typically caused by sugar or food
  • ADHD results from environmental toxins such as

Attention-Deficit/ Hyperactivity Disorder
  • There is heated disagreement about the most
    effective treatment for ADHD
  • The most common approach has been the use of
    stimulant drugs such as methylphenidate (Ritalin)
  • These drugs have a quieting effect on as many as
    80 of children with ADHD and sometimes increase
    their ability to solve problems, perform in
    school, and control aggression
  • However, some clinicians worry about the possible
    long-term effects of the drugs

Attention-Deficit/ Hyperactivity Disorder
  • Behavioral therapy is also applied widely in
    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

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

  • Enuresis is repeated involuntary (or in some
    cases intentional) bedwetting or wetting of ones
  • It typically occurs at night during sleep but may
    also occur during the day
  • The problem may be triggered by a stressful event
  • Children must be at least 5 years of age to
    receive this diagnosis
  • Prevalence of enuresis decreases with age

  • Research has not favored one explanation for the
    disorder over others
  • Psychodynamic theorists explain it as a symptom
    of broader anxiety and underlying conflicts
  • Family theorists point to disturbed family
  • Behaviorists often view it as the result of
    improper toilet training
  • Biological theorists suspect that the physical
    structure of the urinary system develops more
    slowly in some children

  • Most cases of enuresis correct themselves without
  • Therapy, particularly behavioral therapy, can
    speed up the process

  • Encopresis repeatedly defecating in ones
    clothing is less common than enuresis and less
    well researched
  • The problem
  • Is usually involuntary
  • Seldom occurs during sleep
  • Starts after the age of 4
  • Is more common in boys than girls

  • Encopresis causes intense social problems, shame,
    and embarrassment
  • Cases may stem from stress, constipation, or
    improper toilet training
  • The most common treatments are behavioral and
    medical approaches, or combinations of the two
  • Family therapy has also been helpful

Long-Term Disorders That Begin in Childhood
  • Two of the disorders that emerge during childhood
    are likely to continue unchanged throughout a
    persons life
  • Autism
  • Mental retardation
  • Clinicians have developed a range of treatment
    approaches that can make a major difference in
    the lives of people with these problems

  • Autistic disorder, or autism, 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
  • Only 5 of every 10,000 children are affected, and
    80 are boys

  • As many as 90 of children with autism remain
    severely disabled into adulthood and are unable
    to lead independent lives
  • Even the highest-functioning adults with autism
    typically have problems in social interactions
    and communication and have restricted interests
    and activities
  • Several other disorders are similar to autism but
    differ to some degree in symptoms or time of
  • These disorders are categorized as pervasive
    developmental disorders

What Are the Features of Autism?
  • The central feature of autism is the individuals
    lack of responsiveness, including extreme
    aloofness and lack of interest in people
  • Language and communication problems take various
  • One common speech peculiarity is echolalia, the
    exact echoing of phrases spoken by others

What Are the Features of Autism?
  • Autism is also marked by limited imaginative play
    and very repetitive and rigid behavior
  • This has been called a perseveration of
  • Many sufferers become strongly attached to
    particular objects plastic lids, rubber bands,
    buttons, water and may collect, carry, or play
    with them constantly

What Are the Features of Autism?
  • The motor movements of people with autism may be
  • Often called self-stimulatory behaviors may
    include jumping, arm flapping, and making faces
  • Children with autism may engage in self-injurious
  • Children may at times seem overstimulated and/or
    understimulated by their environments

What Causes Autism?
  • A variety of explanations for the disorder have
    been offered
  • Sociocultural explanations are now seen as having
    been overemphasized
  • Recent work in the psychological and biological
    spheres has persuaded clinical theorists that
    cognitive limitations and brain abnormalities are
    the primary causes of the disorder

What Causes Autism?
  • Sociocultural causes
  • Theorists initially thought that family
    dysfunction and social stress were the primary
    causes of autism
  • Notion of refrigerator parents
  • These claims had enormous influence on the public
    and the self-image of parents, but research
    totally failed to support this model
  • Some clinicians have proposed a high degree of
    social and environmental stress as a factor, a
    theory also unsupported by research

What Causes Autism?
  • Psychological causes
  • According to some theorists, people with autism
    have a central perceptual or cognitive
  • One theory holds that individuals fail to develop
    a theory of mind an awareness that other people
    base their behaviors on their own beliefs,
    intentions, and other mental states, not on
    information they have no way of knowing
  • Repeated studies have shown that people with
    autism have this kind of mindblindness
  • It has been theorized that early biological
    problems prevented proper cognitive development

What Causes Autism?
  • Biological causes
  • While a clear biological explanation for autism
    has not yet been developed, promising leads have
    been uncovered
  • Family studies suggest a genetic factor in the
  • Prevalence rates are higher among siblings and
    highest among identical twins
  • Chromosomal abnormalities have been discovered in
    10 to 12 of people with the disorder

What Causes Autism?
  • Biological causes
  • Some studies have linked autism to prenatal
    difficulties or birth complications
  • Some theorists have proposed that a postnatal
    event the MMR vaccine might produce autism in
    some children, although subsequent research has
    found no link
  • Researchers have also identified specific
    biological abnormalities that may contribute to
    the disorder

What Causes Autism?
  • Biological causes
  • Many researchers believe that autism may have
    multiple biological causes
  • Perhaps all relevant biological factors lead to a
    common problem in the brain a final common
    pathway that produces the features of the

How Is Autism Treated?
  • Treatment can help people with autism adapt
    better to their environment, although no
    treatment yet known totally reverses the autistic
  • Treatments of particular help are behavioral
    therapy, communication training, parent training,
    and community integration

How Is Autism Treated?
  • Behavioral therapy
  • Behavioral approaches have been used in cases of
    autism to teach new, appropriate behaviors,
    including speech, social skills, classroom
    skills, and self-help skills, while reducing
    negative ones
  • Most often, therapists use modeling and operant
  • Therapies are ideally applied when people with
    autism are young

How Is Autism Treated?
  • Communication training
  • Even when given intensive behavioral treatment,
    half of the people with autism remain speechless
  • Many therapists include sign language and
    simultaneous communication a method of
    combining sign language and speech into therapy
  • They may also use augmentative communication
    systems, such as communication boards or
    computers that use pictures, symbols, or written
    words to represent objects or needs

How Is Autism Treated?
  • Parent training
  • Todays treatment programs involve parents in a
    variety of ways
  • For example, behavioral programs train parents so
    they can apply behavioral techniques at home
  • In addition, individual therapy and support
    groups are becoming more available to help
    parents deal with their own emotions and needs

How Is Autism Treated?
  • Community integration
  • Many of todays school-based and home-based
    programs for autism teach self-help,
    selfmanagement, and living skills
  • In addition, greater numbers of group homes and
    sheltered workshops are available for teens and
    young adults with autism
  • These programs help individuals become a part of
    their community and also reduce the concerns of
    aging parents

Mental Retardation
  • According to the DSM-IV, people should receive a
    diagnosis of mental retardation when they display
    general intellectual functioning that is well
    below average, in combination with poor adaptive
  • IQ must be 70 or below
  • The person must have difficulty in such areas as
    communication, home living, self-direction, work,
    or safety
  • Symptoms must appear before age 18

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
  • Having difficulty in one or two of these subtests
    or areas of functioning does not necessarily
    reflect low intelligence
  • An individuals overall test score, or
    intelligence quotient (IQ), is thought to
    indicate general intellectual ability

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
    mental retardation may also be biased
  • That is, some people may receive the diagnosis
    partly because of cultural difference, discomfort
    with the testing situation, or the bias of the

Assessing Adaptive Functioning
  • Diagnosticians cannot rely solely on a cutoff IQ
    score of 70 to determine whether a person suffers
    from mental retardation
  • 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 persons
    background and the community standards into

What Are the Characteristics of Mental
  • The most consistent sign of mental retardation is
    that the person learns very slowly
  • Other areas of difficulty are attention,
    shortterm memory, planning, and language
  • Those who are institutionalized with mental
    retardation are particularly likely to have these

What Are the Characteristics of Mental
  • The DSM-IV describes four levels of mental
  • Mild (IQ 5070)
  • Moderate (IQ 3549)
  • Severe (IQ 2034)
  • Profound (IQ below 20)

Mild Retardation
  • Some 85 of all people with mental retardation
    fall into the category of mild retardation (IQ
  • They are sometimes called educably retarded
    because they can benefit from schooling
  • People with mild retardation typically need
    assistance but can work in unskilled or
    semiskilled jobs
  • Intellectual performance seems to improve with age

Mild Retardation
  • Research has linked mild mental retardation
    mainly to sociocultural and psychological causes,
  • Poor and unstimulating environments
  • Inadequate parent-child interactions
  • Insufficient early learning experiences

Mild Retardation
  • Although these factors seem to be the leading
    causes of mild mental retardation, at least some
    biological factors may also be operating
  • Studies have linked mothers moderate drinking,
    drug use, or malnutrition during pregnancy to
    cases of mild retardation

Moderate, Severe, and Profound Retardation
  • Approximately 10 of persons with mental
    retardation function at a level of moderate
    retardation (IQ 3549)
  • They can care for themselves and benefit from
    vocational training
  • About 4 of persons with mental retardation
    display severe retardation (IQ 2034)
  • They usually require careful supervision and can
    perform only basic work tasks

Moderate, Severe, and Profound Retardation
  • About 1 of persons with mental retardation fall
    into the category of profound retardation (IQ
    below 20)
  • With training they may learn or improve basic
    skills but they need a very structured
  • Severe and profound levels of mental retardation
    often appear as part of larger syndromes that
    include severe physical handicaps

What Are the Causes of Mental Retardation?
  • The primary causes of moderate, severe, and
    profound retardation are biological, although
    people who function at these levels are also
    greatly affected by their family and social
  • Sometimes genetic factors are at the root of
    these biological problems
  • Other biological causes come from unfavorable
    conditions that occur before, during, or after

What Are the Causes of Mental Retardation?
  • Chromosomal causes
  • The most common chromosomal disorder leading to
    mental retardation is Down syndrome
  • Several types of chromosomal abnormalities may
    cause Down syndrome, but the most common is
    trisomy 21
  • Fragile X syndrome is the second most common
    chromosomal cause of mental retardation

What Are the Causes of Mental Retardation?
  • Metabolic causes
  • In metabolic disorders, the bodys breakdown or
    production of chemicals is disturbed
  • The metabolic disorders that affect intelligence
    are typically caused by the pairing of two
    defective recessive genes, one from each parent
  • Examples include
  • Phenylketonuria (PKU)
  • Tay-Sachs disease

What Are the Causes of Mental Retardation?
  • Prenatal and birth-related causes
  • As a fetus develops, major physical problems in
    the pregnant mother can threaten the childs
    healthy development
  • Low iodine may lead to cretinism
  • Alcohol use may lead to fetal alcohol syndrome
  • Certain maternal infections during pregnancy
    (e.g., rubella, syphilis) may cause childhood
    problems including mental retardation
  • Birth complications, such as a prolonged period
    without oxygen (anoxia), can also lead to mental

What Are the Causes of Mental Retardation?
  • Childhood problems
  • After birth, particularly up to age 6, certain
    injuries and accidents can affect intellectual
  • Examples include poisoning, serious head injury,
    excessive exposure to x-rays, and excessive use
    of certain chemicals, minerals, and/or drugs
  • Certain infections, such as meningitis and
    encephalitis, can lead to mental retardation if
    they are not diagnosed and treated in time

Interventions for People with Mental Retardation
  • The quality of life achieved by people with
    mental retardation depends largely on
    sociocultural factors
  • Thus, intervention programs try to provide
    comfortable and stimulating residences, social
    and economic opportunities, and a proper education

Interventions for People with Mental Retardation
  • What is the proper residence?
  • Until recently, parents of children with mental
    retardation would send them to live in public
    institutions state schools as early as
  • These overcrowded institutions provided basic
    care, but residents were neglected, often abused,
    and isolated from society

Interventions for People with Mental Retardation
  • What is the proper residence?
  • During the 1960s and 1970s, the public became
    more aware of these sorry conditions, and, as
    part of the broader deinstitutionalization
    movement, demanded that many people be released
    from these schools
  • People with mental retardation faced similar
    challenges by deinstitutionalization as people
    with schizophrenia

Interventions for People with Mental Retardation
  • What is the proper residence?
  • Since deinstitutionalization, reforms have led to
    the creation of small institutions and other
    community residences that teach self-sufficiency,
    devote more time to patient care, and offer
    education and medical services
  • Residences include group homes, halfway houses,
    local branches of larger institutions, and
    independent residences
  • These programs follow the principle of
    normalization they try to provide living
    conditions similar to those enjoyed by the rest
    of society

Interventions for People with Mental Retardation
  • What is the proper residence?
  • Today the vast majority of children with mental
    retardation live at home rather than in an
  • Most people with mental retardation, including
    almost all with mild mental retardation, now
    spend their adult lives either in the family home
    or in a community residence

Interventions for People with Mental Retardation
  • Which educational programs work best?
  • Because early intervention seems to offer such
    great promise, educational programs for
    individuals with mental retardation may begin
    during the earliest years
  • At issue are special education versus mainstream
  • In special education, children with mental
    retardation are grouped together in a separate,
    specially designed educational program
  • Mainstreaming places them in regular classes with
    nonretarded students
  • Neither approach seems consistently superior

Interventions for People with Mental Retardation
  • Which educational programs work best?
  • Many teachers use operant conditioning principles
    to improve the self-help, communication, social,
    and academic skills of individuals with mental
  • Many schools also employ token economy programs

Interventions for People with Mental Retardation
  • When is therapy needed?
  • People with mental retardation sometimes
    experience emotional and behavioral problems
  • At least 10 have a diagnosable psychological
    disorder other than mental retardation
  • Some suffer from low self-esteem, interpersonal
    problems, and adjustment difficulties
  • These problems are helped to some degree with
    individual or group therapy
  • Medication is sometimes prescribed

Interventions for People with Mental Retardation
  • How can opportunities for personal, social, and
    occupational growth be increased?
  • People need to feel effective and competent in
    order to move forward in life
  • Those with mental retardation are most likely to
    achieve these feelings if their communities allow
    them to grow and make many of their own choices

Interventions for People with Mental Retardation
  • How can opportunities for personal, social, and
    occupational growth be increased?
  • Socializing, sex, and marriage are difficult
    issues for people with mental retardation and
    their families
  • With proper training and practice, the
    individuals can learn to use contraceptives and
    carry out responsible family planning
  • The National Association for Retarded Citizens
    offers guidance in these matters
  • Some clinicians have developed dating skills

Interventions for People with Mental Retardation
  • How can opportunities for personal, social, and
    occupational growth be increased?
  • Some states restrict marriage for people with
    mental retardation
  • These laws are rarely enforced
  • Between one-quarter and one-half of all people
    with mild mental retardation eventually marry

Interventions for People with Mental Retardation
  • How can opportunities for personal, social, and
    occupational growth be increased?
  • Adults with mental retardation need the financial
    security and personal satisfaction that comes
    from holding a job
  • Many can work in sheltered workshops, but there
    are too few training programs available
  • Additional programs are needed so that more
    people with mental retardation may achieve their
    full potential, as workers and as human beings
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