Childhood & Adolescence

I. ISSUES

A. Child vs. Adult Psychopathology

- Problems less severe/frequentin childhood

- Same problem can look different

- Some problems primarily in childhood

B. Types of Disorders

1. Internalizing (overcontrolled)= problems within

- Less noticed by adults

- More common in girls

2. Externalizing (undercontrolled)= manifested externally

- Mostly boys

- More referred for tx

C. Normal vs. Abnormal Development

- Normal at one age = abnormal atanother

- Period of rapid change

- Harder to determine pathology inchildren

“Normal” is age-dependent

D. Child problems are reciprocal

1. Blame the child

- Infant temperament

2. Blame the parents

- Schizophrenogenic &refrigerator mothers

3. Reciprocal process

- difficult kids elicit worse caregiving & vice versa

- Intervention = parent-child interaction

E. Children are dependent on others

- more likely to get victimized

- need parent/teacher involvement

II. Behavioral Disorders

1.Attention- Deficit Hyperactivity Disorder(ADHD)

Description

• Inattention

- especially sustained attention

• Hyperactivity

• Impulsivity

• Inattentive Type

• Impulsive-Hyperactive Type

• Combined Type

• Adult ADD (not an actual dx)

Common complications

• Learning problems

• Discipline (-> ODD)

• Poor peer relations

Prevalence

• 3-6%

• Boys

• Over-diagnosed?

Etiology• Nervous system problem

- smaller brain (e.g, frontal lobe)BAS & BIS

• Polygenetic – 1 DA receptor implicated• Prenatal smoking• NOT sugar• Parenting can exacerbate, cannot cause

Treatment - 1/3 recover• Stimulant medication

- ↑ DA – blocks reuptake- agonist for BIS- works for 75%- few side effects- effects are immediate- reduces inattention & impulsivity-> focus in classroom & at sports-> improves peer relations & self-esteem- cannot teach good behavior

• Behavior therapy - Teach appropriate behavior via rewards

& punishments- Parent training- School involvement- Must continue for long period

• Best = Medication + behavior tx

• Summer ADHD Program

- point system

- parental involvement

- double-blind medication trials

Oppositional Defiant Disorder (ODD)& Conduct Disorder (CD)

Description

• ODD - negativitist, hostile, defiant

• CD - truancy, fire-setting, theft, aggression, cruelty

Prevalence

• 9% boys

• 2% girls

Etiology

Family

• Parenting: criticism & poor monitoring (indifference)

• Parent modeling of poor self-control & antisocial tendencies

• Stressful events (divorce)

Cognitive skills

• hostile attributions

• poor problem-solving

Biology

• some genetic evidence

• lower baseline arousal

Treatment• Parent training

- time out/lose privileges & positive reinforcement

• Negotiation with adolescents

• Cognitive treatments

- problem-solving, self-control

• Family Systems Therapy

III. Cognitive Disorders

Autism (on spectrum – to Asperger’s)

1.Inability to relate to other people

- little communication

- lack of affection/interest in others

- self-absorption

2.Absent or deficient speech

~ ½ = no speech, primitive gestures

~ ½ = some words with oddities(e.g., echolalia)

3.Behavior

limited, rigid

stereotyped, self-stimulatory behaviors

self-injurious & aggressive

preservation of sameness

• MR & LD = common

Prevalence

• 4-5 in 10,000 (rare)

• 75-80% are boys

Etiology• 1940s: Kanner: innate inability to relate

(biological)

• 1950s: Refrigerator mother => withdrawal(environment)

• Current: neurological basisprenatal or birth complications

Treatment

• Difficult; poor prognosis

• 5% capable of jobs

• Still emotionally isolated

• Rest = mild care-taking skills

• Best: if speak before 5, higher IQ,& mild symptoms

• Institutionalization is common

• Behavior modification

- reinforce social behaviors

- sign language

- parents & teachers as co-therapists

• Aversive conditioning

• Facilitation

IV. Anxiety & Mood Disorders

Anxiety

• School Phobia (not a dx)

• Separation Anxiety

• Specific fears or phobias

• Others as in adults (e.g., GAD)

• Fears are common

- Extreme degree or duration, impairment

Prevalence

• very common to uncommon

• equal in boys & girls

Etiology

• Biology: fearful, anxious temperament

• Learning: observe others’ fears

- parents reinforce fears

- overprotective parental style

TreatmentBehavioral

• Flooding

• Systematic desensitization

• Reward for success

Cognitive

• Re-appraisal of feared situation

• Relaxation strategies

• Behavioral therapy = most effective

• Medication - not well-documented in kids

• ** Best = include parents

Depression

• Like adults

- sad, crying, hopeless, low self-worth, sleep & appetite problems, lethargy

• Unlike adults

- behavioral problems, clinging, delinquency

• Few consistencies

- more like adults than not

- similar to adult bereavement

(with precipitant)

Prevalence

• 5-10% boys & girls, more in teens

• equally common in boys & girls

Etiology

Biological

• possible genetic predisposition

Learning

• learned helplessness

• reduced reinforcers

Cognition

• Unrealistically negative

• Poor coping

• Poor social skills

Treatment

• Play therapy (psychodynamic)

- child works through conflicts via play

- no evidence for efficacy

• Social skills training

• Increase pleasant activities

• Cognitive therapy – errors & coping

• Medication

- somewhat effective for children

- less effective for adolescents

• Change the environment*

V. Eating Disorders

Anorexia

• refusing to eat due to fear of weight gain

• distorted body image

• life-threatening

Bulimia - bingeing & purging

• distorted body image

• not usually life-threatening

• often normal weight

• Key = lack of control

Prevalence

• Anorexia – 1-3 % of 12-18 year-olds

• Bulimia - ~ 5% of teens/young adults

(4.5% female, .5% male)

Etiology

• Need for control

• Identity issues

- independence from parents

- fear of growing sexuality

• Societal pressures for thinness

Treatment• Family therapy

- break power struggle- appropriate separation

• Cognitive therapy- Identify & express emotions- Boost self-esteem- Change irrational beliefs

Different issues for anorexia and bulimia• Hospitalization

- IV fluids & goal weights

VI. Elimination Disorders

• Enuresis & Encopresis

- wetting/soiling self beyond usual age (~5)

• Primary = hasn’t yet learned control vs.

- Secondary = learned control but lost

• Nighttime is more common

- Daytime = maybe serious problem

• Sense of no self-control (low self-esteem)

Prevalence

• Enuresis: 15-20% of 5-year-olds

5% of 10-year-olds

• Encopresis: .3-8% of children

usually secondary

• Boys

Etiology

• Conflict with parents

- self-control

• Emotional disturbance

- anxiety, stress, family disruption

• Failure to learn

- associate full bladder/bowel with toilet

Treatment

• Eliminate biological causes

• Deal with emotional disturbance

• Behavioral techniques

- wake in night after urination (Wee Alert)

- praise for success

- mild punishment for wetting/soiling

• Prevent: relaxed & positive toward toileting