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Description : Check out this medical presentation on Pediatrics, which is titled "Disorders of Childhood", to know about the Classification and Diagnosis of Childhood Disorders.

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PowerPoint  Lecture Notes Presentation Chapter 13 Disorders of Childhood Abnormal Psychology, Thirteenth Edition by Ann M. Kring, Sheri L. Johnson, Gerald C. Davison, & John M. Neale © 2015 John Wiley & Sons, Inc. All rights reserved.
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Chapter Outline Chapter 13: Disorders of Childhood I. Classification and Diagnosis of Childhood Disorders © 2015 John Wiley & Sons, Inc. All rights reserved.
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Classification and Diagnosis of Childhood Disorders Developmental psychopathology Studies disorders within context of normal child development Relationship between child and adult psychopathology Some disorders are unique to children e.g., separation anxiety disorder Some disorders are primarily childhood disorders, but may continue into adulthood e.g., attention-deficit/hyperactivity disorder Some disorders are present in children and adults e.g., depression © 2015 John Wiley & Sons, Inc. All rights reserved.
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Classification and Diagnosis of Childhood Disorders DSM-5 splits childhood disorders into two chapters: Neurodevelopmental Disorders Disruptive, Impulse Control, and Conduct Disorder DSM-5 has new names for disorders e.g., mental retardation is now called intellectual disability (intellectual developmental disorder) © 2015 John Wiley & Sons, Inc. All rights reserved.
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Figure 13.1: DSM-5 Childhood Disorders © 2015 John Wiley & Sons, Inc. All rights reserved.
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Classification and Diagnosis of Childhood Disorders Externalizing disorders Characterized by outward-directed behaviors Noncompliance, aggressiveness, overactivity, impulsiveness Includes attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder More common in boys Internalizing disorders Characterized by inward-focused behaviors Depression, anxiety, social withdrawal Includes childhood anxiety and mood disorders More common in girls © 2015 John Wiley & Sons, Inc. All rights reserved.
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Attention-Deficit/Hyperactivity Disorder Excessive levels of activity Fidgeting, squirming, running around when inappropriate, incessant talking Distractibility and difficulty concentrating Makes careless mistakes, cannot follow instructions, forgetful May have difficulty with peer interactions © 2015 John Wiley & Sons, Inc. All rights reserved.
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DSM-5 Criteria for Attention-Deficit/Hyperactivity Disorder © 2015 John Wiley & Sons, Inc. All rights reserved.
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Attention-Deficit/Hyperactivity Disorder Three specifiers in DSM-5 to indicate which symptoms predominate Predominantly inattentive type Predominantly hyperactive-impulsive type Combined type Combined is the majority of diagnoses Differential diagnosis ADHD or Conduct Disorder? ADHD More off-task behavior, cognitive and achievement deficits Conduct Disorder More aggressive, act out in most settings, antisocial parents, family hostility © 2015 John Wiley & Sons, Inc. All rights reserved.
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Attention-Deficit/Hyperactivity Disorder ADHD often comorbid with anxiety and depression Prevalence estimates 8 to 11% worldwide Public policy can affect diagnosis rates More common in boys than girls May be because boys’ behavior more likely to be aggressive Symptoms persist beyond childhood Numerous longitudinal studies show 65 to 80% still exhibit symptoms 60% of adults continue to meet criteria for ADHD in remission © 2015 John Wiley & Sons, Inc. All rights reserved.
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Girls with Attention-Deficit/Hyperactivity Disorder Hinshaw et al. (2006) large, ethnically diverse study of girls Combined type had: More disruptive behaviors than inattentive type More comorbid diagnoses of conduct disorder or oppositional defiant disorder than girls without ADHD Viewed more negatively by peers than inattentive type or girls without ADHD Inattentive type Viewed more negatively by peers than girls without ADHD Girls with ADHD more likely to: Be anxious and depressed Exhibit neurological deficits (e.g., poor planning, problem-solving) Have symptoms of eating disorder and substance abuse by adolescence © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of ADHD Genetic factors Adoption and twin studies Heritability estimates as high as 70 to 80% Two dopamine genes implicated DRD4 Dopamine receptor gene DAT1 Dopamine transporter gene Mixed support for this gene Either gene associated with increased risk only when prenatal maternal nicotine or alcohol use is present Neurobiological factors Dopaminergic areas smaller in children with ADHD Frontal lobes, caudate nucleus, globus pallidus Poor performance on tests of frontal lobe function © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of ADHD Perinatal and prenatal factors Low birth weight Can be mitigated by later maternal warmth Maternal tobacco and alcohol use Environmental toxins Limited evidence that food additives or food coloring can have a small impact on hyperactive behavior No evidence that refined sugar causes ADHD Nicotine from maternal smoking Exposure to tobacco in utero associated with ADHD symptoms May damage dopaminergic system, resulting in behavioral disinhibition © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of ADHD Parent-child relationship Parents give more commands and have more negative interactions Family factors Interact with genetic and neurobiological factors Contribute to or maintain ADHD behaviors but do not cause them © 2015 John Wiley & Sons, Inc. All rights reserved.
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Treatment of ADHD Stimulant medications (Ritalin, Adderall, Concerta, Strattera) Reduce disruptive behavior Improve interactions with parents, teachers, peers Improve goal-directed behavior and concentration Reduce aggression Effective in about 75 percent of children with ADHD but there are side effects Loss of appetite, weight, sleep problems Medication plus behavioral treatment (MTA study) Slightly better than meds alone Improved social skills whereas meds alone did not Three-year follow-up found superior benefits of meds did not persist © 2015 John Wiley & Sons, Inc. All rights reserved.
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Treatment of ADHD Psychological treatment Parental training Change in classroom management Behavior monitoring and reinforcement of appropriate behavior Supportive classroom structure Brief assignments Immediate feedback Task-focused style Breaks for exercise © 2015 John Wiley & Sons, Inc. All rights reserved.
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Conduct Disorder (CD) Pattern of engaging in behaviors that violate social norms and the rights of others, and are often illegal Aggression Cruelty towards other people or animals Damaging property Lying Stealing Vandalism Often accompanied by viciousness, callousness, and lack of remorse © 2015 John Wiley & Sons, Inc. All rights reserved.
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Disorders Related to Conduct Disorder Intermittent explosive disorder: recurrent verbal or physical aggressive outbursts that are out of proportion to the circumstances. Aggression is impulsive and not preplanned Oppositional Defiant Disorder (ODD) behaviors do not meet criteria for CD (especially extreme physical aggressiveness) but child displays pattern of defiant behavior Argumentative, loses temper, lack of compliance, deliberately aggravates others, hostile, vindictive, spiteful, or touchy, blames others for own problems Comorbid with ADHD, learning and communication disorders Disruptive behavior of ODD more deliberate than ADHD Most often diagnosed in boys but may be as prevalent in girls © 2015 John Wiley & Sons, Inc. All rights reserved.
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DSM-5 Criteria for Conduct Disorder © 2015 John Wiley & Sons, Inc. All rights reserved.
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Conduct Disorder Substance abuse common Unclear whether it precedes or is concomitant with disorder Comorbid with anxiety and depression Comorbidity rates vary from 15 to 45% CD precedes anxiety and depression Prevalence Boys 4 to 16% Girls 1.2 to 9% © 2015 John Wiley & Sons, Inc. All rights reserved.
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Figure 13.2: Arrest Rates Across Ages for Homicide, Forcible Rape, Robbery, Aggravated Assault, and Auto Theft © 2015 John Wiley & Sons, Inc. All rights reserved.
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Conduct Disorder (CD) Two distinct CD types (Moffitt, 1993) Life-course-persistent pattern of antisocial behavior 10 – 15x more common in boys than girls Adolescence-limited Maturity gap between physical maturation and rewarding adult behaviors Follow-up longitudinal studies of life-course-persistent type show more severe problems into early adulthood, including: Academic underachievement Neuropsychological deficits ADHD Family psychopathology Poorer physical health Lower SES Violent behaviors © 2015 John Wiley & Sons, Inc. All rights reserved.
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Figure 13.3: Etiology of Conduct Disorder © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Conduct Disorder (CD) Genetic factors Heritability likely plays a part Twin study data show mixed results Adoption studies focused on criminal behavior, not conduct disorder Meta-analysis of twin and adoption studies suggest 40 – 50% of antisocial behavior is heritable Genetics a stronger influence when behaviors begin in childhood rather than adolescence Genetics and environment interact Abuse as a child PLUS low MAOA activity most likely to develop CD © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Conduct Disorder (CD) Neurobiological factors Poor verbal skills Difficulty with executive functioning Low IQ Lower levels of resting skin conductance and heart rate suggest lower arousal levels Psychological factors Deficient moral development, especially lack of remorse Modeling and reinforcement of aggressive behavior Harsh and inconsistent parenting Lack of parental monitoring Cognitive bias: Neutral acts by others perceived as hostile © 2015 John Wiley & Sons, Inc. All rights reserved.
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Figure 13.4: Dodge’s Cognitive Theory of Aggression © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Conduct Disorder (CD) Peer influences associated with CD Rejection by peers Affiliation with deviant peers Sociocultural factors Poverty Urban environment Higher rates of delinquent acts among African American males linked to living in poorer neighborhoods rather than race © 2015 John Wiley & Sons, Inc. All rights reserved.
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Treatment of Conduct Disorder Family interventions Family check-ups (FCU) associated with less disruptive behavior Parental management train (PMT) Teach parents to reward prosocial behavior Multisystemic therapy Deliver intensive community-based services © 2015 John Wiley & Sons, Inc. All rights reserved.
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Figure 13.5: Multisystemic Treatment of CD © 2015 John Wiley & Sons, Inc. All rights reserved.
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Depression and Anxiety in Children and Adolescents Commonly co-occur with ADHD and CD Also co-occur with each other Early research suggested that depression and anxiety could be distinguished from each other in the same way they are in adults: Depression – high negative affect, low positive affect Anxiety – high negative affect but not low levels of positive affect More recent research calls this finding into question © 2015 John Wiley & Sons, Inc. All rights reserved.
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Depression in Children and Adolescents Symptoms common to children, adolescents, and adults Depressed mood Inability to experience pleasure Fatigue Problems concentrating Suicidal ideation Symptoms specific to children and adolescents Higher rates of suicide attempts and guilt Lower rates of Early morning awakening Early morning depression Loss of appetite Weight loss Prevalence 1% of preschoolers 2 – 3% of school-age children 6% of girls and 4% of boys during adolescence © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Depression in Children and Adolescents Genetic factors Early adversity and negative life events Family and relationship factors A parent who is depressed Parental rejection only modestly associated with depression Children with depression and their parents interact in negative ways Less warmth More hostility Cognitive distortions and negative attributional style Stable attributional style Develops by early adolescence By middle school, attributional style serves as a cognitive diathesis for depression © 2015 John Wiley & Sons, Inc. All rights reserved.
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Treatment of Depression in Children and Adolescents Medications SSRIs more effective than tricyclics Meta-analysis showed medications most effective for anxiety other than OCD Less effective for depression and OCD Concerns about medications Side effects including diarrhea, nausea, sleep problems, and agitation Possibility of increased risk of suicide attempts Interpersonal psychotherapy (IPT) Focuses on peer pressures, transition to adulthood, and issues related to independence CBT More effective for Caucasian adolescents and those with pretreatment, good coping skills, and recurrent depression Psychotherapy generally only modestly effective with children and adolescents CBT no better than non-CBT therapies © 2015 John Wiley & Sons, Inc. All rights reserved.
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Anxiety in Children and Adolescents Fears and worries common in childhood Anxiety disorder More severe and persistent worry Must interfere with functioning Most childhood fears disappear but adults with anxiety disorders report feeling anxious as children “I’ve always been this way” Prevalence 3-5% of children and adolescents are diagnosed with anxiety disorder © 2015 John Wiley & Sons, Inc. All rights reserved.
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Anxiety Disorders in Children Separation anxiety disorder Worry about parental or personal safety when away from parents Typically first observed when child begins school Social anxiety disorder Extremely shy and quiet May exhibit selective mutism Refusal to speak in unfamiliar social setting Prevalence 1% of children and adolescents Etiology Overestimation of threat Underestimation of coping ability Poor social skills © 2015 John Wiley & Sons, Inc. All rights reserved.
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PTSD Exposure to trauma Chronic physical or sexual abuse Community violence Natural disasters Symptom categories Flashbacks, nightmares, intrusive thoughts Avoidance Negative cognitions and moods Hyperarousal and vigilance Some symptoms may differ from adults May exhibit agitation instead of fear or hopelessness © 2015 John Wiley & Sons, Inc. All rights reserved.
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OCD Prevalence 1 to 4% Symptoms similar to those in adults Most common obsessions: Contamination from dirt and germs Aggression Thoughts about sex and religion more common in adolescence OCD more common in boys than girls © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Anxiety Disorders Genetics Heritability estimates from 29 – 50% Genetics plays a stronger role in separation anxiety in context of more negative life events Parenting plays a small role in anxiety disorders Only 4% of variance Emotion regulation and attachment problems also play a role Perception of lack of acceptance by peers a factor in social phobia Risk factors for PTSD include: Family stress and coping style Past experience with trauma © 2015 John Wiley & Sons, Inc. All rights reserved.
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Treatment of Anxiety Disorders in Childhood and Adolescence Exposure to feared object Reward approach behavior CBT Kendall’s Coping Cat program Shows to be effective in two randomized clinical trials For children between 7 and 13 years old Cognitive restructuring Develop new ways to think about fears Psychoeducation Modeling and exposure Skills training and practice Relapse prevention Family involved in treatment © 2015 John Wiley & Sons, Inc. All rights reserved.
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Learning Disability Evidence of inadequate development in a specific area of academic, language, speech or motor skills e.g., arithmetic or reading Not due to mental retardation, autism, physical disorder, or lack of educational opportunity Individual usually of average or above average intelligence Often identified and treated in school Reading disorders more common in boys © 2015 John Wiley & Sons, Inc. All rights reserved.
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Specific Learning Disorder DSM-5 Criteria for Specific Learning Disorder: Difficulties in learning basic academic skills (reading, mathematics, or writing) inconsistent with person’s age, schooling, and intelligence Significant interference with academic achievement or activities of daily living Dyscalculia and dyslexia no longer distinct diagnoses Specifiers include impairments in reading, written expression, and mathematics © 2015 John Wiley & Sons, Inc. All rights reserved.
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Table 13.2: Learning, Communication, and Motor Disorders: DSM-5 © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Learning Disabilities: Impairment in Reading (Formerly Dyslexia) Genetic factors Evidence from family and twin studies Genes are those associated with typical reading abilities (generalist genes) Problems in language processing Speech perception Analysis of sounds and their relationship to printed words Difficulty recognizing rhyme and alliteration Problems naming familiar objects rapidly Delays learning syntactic rules Deficient phonological awareness Inadequate left temporal, parietal, occipital activation © 2015 John Wiley & Sons, Inc. All rights reserved.
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Figure 13.6: Areas of the Brain Implicated in Dyslexia: Frontal, Parietal, and Temporal Lobes © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Learning Disabilities: Impairment in Mathematics (Formerly Dyscalculia) Genetic and biological factors Evidence from twin studies suggest common genetic factors underlie both reading and math deficits Intraparietal sulcus implicated Has different cognitive deficits from dyslexia Children with only dyscalculia do not have deficits in phonological awareness © 2015 John Wiley & Sons, Inc. All rights reserved.
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Treatment of Learning Disabilities Reading and writing specifiers Multisensory instruction in listening, speaking, and writing skills Readiness skills in younger children as preparation for learning to read Phonics instruction Communication disorders Fast ForWord Involves computer games and audiotapes that slow speech sounds © 2015 John Wiley & Sons, Inc. All rights reserved.
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Intellectual Disability (Intellectual Developmental Disorder) Formerly called mental retardation in DSM-IV-TR Not preferred due to stigma Followed the guidelines of the American Association on Intellectual and Developmental Disabilities (AAIDD) The AAIDD Definition of Intellectual Disability: Intellectual disability is characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills This disability begins before age 18 Five Assumptions Essential to the Application of the Definition Limitations in present functioning must be considered within the context of community environments typical of the individual’s age, peers, and culture Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors Within an individual, limitations often coexist with strengths An important purpose of describing limitations is to develop profile of needed supports With appropriate personalized supports over a sustained period, the life functioning of the person with intellectual disability generally will improve © 2015 John Wiley & Sons, Inc. All rights reserved.
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Intellectual Disability (Intellectual Developmental Disorder) DSM-5 criteria: Intellectual deficits (e.g., in solving problems, reasoning, abstract thinking) determined by intelligence testing and broader clinical assessment Significant deficits in adaptive functioning relative to the person’s age and cultural group in one or more of the following areas: communication, social participation, work or school, independence at home or in the community, requiring the need for support at school, work, or independent life Onset before age 18 DSM-5 changes: There is explicit recognition that an IQ score must be considered within the cultural context of a person Adaptive functioning must also be assessed and considered within the person’s age and cultural group No longer distinguish among mild, moderate, and severe ID based on IQ scores alone © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Intellectual Disability: Neurological Factors Down syndrome Chromosomal trisomy 21: an extra copy of chromosome 21 47 instead of 46 chromosomes Fragile-X syndrome Mutation in the fMRI gene on the X chromosome Recessive-gene disease Phenylketonuria (PKU) Maternal infectious disease, especially during first trimester Cytomegalovirus, toxoplasmosis, rubella, herpes simplex, HIV, and syphilis Lead or mercury poisoning © 2015 John Wiley & Sons, Inc. All rights reserved.
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Treatment of Intellectual Disability Residential treatment Small to medium-sized community residences Behavioral treatments Language, social, and motor skills training Method of successive approximation to teach basic self-care skills in severely retarded e.g., holding a spoon, toileting Applied behavioral analysis Cognitive treatments Problem-solving strategies Computer-assisted instruction © 2015 John Wiley & Sons, Inc. All rights reserved.
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Autism Spectrum Disorder DSM-5 combines multiple diagnoses into one: Autism Spectrum Disorder Autistic disorder, Asperger’s disorder, pervasive developmental disorder not otherwise specified, and childhood disintegrative disorder Research did not support distinctive categories Share similar clinical features; vary only in severity Specifiers include with or without accompanying intellectual impairment, language impairment, or catatonia © 2015 John Wiley & Sons, Inc. All rights reserved.
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DSM-5 Criteria for Autism Spectrum Disorder © 2015 John Wiley & Sons, Inc. All rights reserved.
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Autism Spectrum Disorder Profound problems with the social world Rarely approach others, may look through people Problems in joint attention Pay attention to different parts of faces than do people without autism; focus on mouth, neglect eye region This neglect likely contributes to difficulties in perceiving emotion in other people Theory of mind Understanding that other people have different desires, beliefs, intentions, and emotions Crucial for understanding and successfully engaging in social interactions Typically develops between 2½ and 5 years of age Children with ASD seem not to achieve this developmental milestone © 2015 John Wiley & Sons, Inc. All rights reserved.
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Autism Spectrum Disorder Communication deficits Children with ASD evidence early language disturbances Echolalia: immediate or delayed repeating of what was heard Pronoun reversal: refer to themselves as “he” or “she” Literal use of words Repetitive and ritualistic acts Become extremely upset when routine is altered Engage in obsessional play Engage in ritualistic body movements Become attached to inanimate objects (e.g., keys, rocks) © 2015 John Wiley & Sons, Inc. All rights reserved.
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Autism Spectrum Disorder Comorbidity IQ < 70 is common Children with intellectual developmental disorder score poorly on all parts of an IQ test; children with ASD score poorly on those subtests related to language, such as tasks requiring abstract thought, symbolism, or sequential logic Prevalence 1 out of 110 children Found in all SES, ethnic, and racial groups Diagnosis of ASD is remarkably stable Prognosis Children with higher IQs who learn to speak before age six have the best outcomes © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Autistic Spectrum Disorder Genetic factors heritability estimates of around .80 Twin studies 47 to 90% concordance rates for MZ twins; 0-20% for DZ twins Genetic flaw Deletion on chromosome 16 © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Autistic Spectrum Disorder Neurobiological factors Brain size Although normal size at birth, brains of autistic adults and children are larger than normal Pruning of neurons may not be occurring “Overgrown” areas include the frontal, temporal, and cerebellar, which have been linked with language, social, and emotional functions Abnormally sized amygdalae predicted more difficulties in social behavior and communication © 2015 John Wiley & Sons, Inc. All rights reserved.
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Treatment of Autistic Spectrum Disorder Psychological treatments more promising than drugs Earlier treatment associate with better outcomes Intensive operant conditioning (Lovaas, 1987) Dramatic and encouraging results Parent training and education Pivotal response treatment (Koegel et al., 2003) Focus on increasing child’s motivation and responsiveness rather than on discrete behaviors Joint attention intervention and symbolic play used to improve attention and expressive skills Medication used to treat problem behaviors Haloperidol (Haldol) Antipsychotic Reduces aggression and stereotyped motor behavior Does not improve language and interpersonal relationships © 2015 John Wiley & Sons, Inc. All rights reserved.
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COPYRIGHT Copyright 2015 by John Wiley & Sons, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner. © 2015 John Wiley & Sons, Inc. All rights reserved.