Disorders of Childhood and Adolescence. Externalizing Disorders Disorders with behaviors that are...

Disorders of Childhood and Adolescence

Externalizing Disorders

Disorders with behaviors that are disruptive and often aggressive

Attention-deficit Disorder, with or without Hyperactivity (ADD/ ADHD)

Tic disorders (Tourette’s) Oppositional defiant disorder (ODD) Conduct disorder

Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Internalizing Disorders

Related to worries and disturbing thoughts rather than to overt behaviors

Separation Anxiety Disorder Social phobia Generalized anxiety disorder Obsessive-compulsive disorder Depression Eating Disorders


Frequency of Disorders in Children and Adolescents, aged 9-17

Type of Disorder Percent Affected

Anxiety Disorders 13.0

Mood Disorders 6.2

Disruptive Disorders 10.3


Attention Deficit Disorder (ADD/ ADHD) Either criteria for inattention or hyperactivity-

impulsivity must be met. Attention Deficit Behaviors may include

Does not seem to listen or follow through on instructions Difficulty in organizing activities and tasks Easily distracted by other stimuli Forgetful in daily activities

Hyperactive Behaviors may include Fidgets, runs about excessively Hard to play quietly Talks excessively Gluts out answers Can’t wait turn Abnormal Psychology, 11/e

by Sarason & Sarason © 2005

Issues in ADHD

How common? 7 out of 100 children 4 boys to 1 girl

Consequences? Deficiencies in academic and social skills Poor school achievement Negative self-view Problematic interactions with parents and

teachers


Rates of ADHD


Risk Factors for ADHD

Genetic inheritance Brain functioning Neurotransmitter activity Environmental factors


Treatment of ADHD Stimulant medication (e.g. Ritalin) Antidepressant medication Behavioral intervention

Classroom intervention Parent training

Combination of medications and behavioral intervention is most efficacious


Tic Disorders Tics

Involuntary, sudden, recurrent, stereotyped motor movements or vocalizations

Tourette’s Syndrome Large motor ticks (shoulders, trunk, arms, legs)

combined with uttering obscenities (coprolalia) Genetic basis likely

Both often occur together with ADHD Treatment for Tourette’s Syndrome

Antidepressant medication Relaxation therapy


Oppositional Defiant Disorder Pattern of negativistic, defiant, hostile behavior

lasting more than six months and not typical for age or developmental level

Cause impairment in social, academic functioning

Examples: Loses temper Argues with adults Refuses to comply with requests Deliberately annoys others Angry and resentful Spiteful and vindictive Abnormal Psychology, 11/e

by Sarason & Sarason © 2005

Oppositional Defiant Disorder

Risk factors Genetic Family relationships Poor or inconsistent parenting


Rates of Oppositional Defiant Disorder


Conduct Disorder More serious than ODD Aggressive behavior that violates social

norms and rights of others Examples

Threatens or causes harm to people and animals Property damage, theft, deceitfulness Serious violations of rules Behaviors would constitute antisocial personality

disorder if child were over 18 years


Conduct Disorder Risk Factors

Negative family environment Lack of social and academic skills

ADHD and ODD often associated with later development of conduct disorder


Treatment of Conduct Disorder

Prevention Develop social, emotional, and cognitive skills

Cognitive-behavioral interventions Cognitive review of situation before reacting,

thinking aloud Time out; behavioral shaping Positive encounters with clinicians and other

adults to develop pro-social behaviors Interventions must involve parents


Separation Anxiety Disorder Defined by excessive anxiety or panic when absent

from major attachment figures, lasting for more than four weeks, and impairing functioning

Often develops after some stress (loss of parent, relative, or pet or serious family illness, parental separation or divorce)

Usually from caring families Sometimes the result of failure to achieve secure

attachment bond in early childhood Diminishes after the age of 10 years


Separation Anxiety Disorder


Other Anxiety Disorders Commonly Seen in Children Social phobia

Shun contact with unfamiliar people, especially if under pressure to perform.

Generalized anxiety disorder In situations associated with pressure to perform, seek out peers

to establish dependent relationships; overly eager to please peers.

Obsessive-compulsive disorder Persistent intrusion of intense, unwanted thoughts with

compulsions to perform ritualistic, repetitive behaviors; mostly concerned with dirt and contamination, performing washing rituals.

These disorders often persist into adulthood; may also develop into agoraphobia or depression


Treatment of Anxiety Disorders

Antidepressant or anti-anxiety medication Family treatment Cognitive-behavioral interventions, as used

for adults


Symptoms of Childhood Depression Birth to 2 years

Whining, withdrawal, delays in physical, cognitive, language development

Nightmares, night terrors, clinginess 3 to 5 years

Sadness, weight loss, tiredness, thoughts of suicide, anger, apathy, irritability

6 to 12 years Similar to adults with verbalization of thoughts and feelings;

sometimes delinquent behavior; somatic problems; irritability and anger; poor school performance

13 to 18 years Similar to adults; possible volatile moods, rage, low self-

esteem, sexual acting out, substance abuse, suicidal thoughts and behavior.


Rates of Depression in Childhood


Other Types of Child and Adolescent Therapies

Play therapy Talk and play techniques; puppetry

Family therapy Family systems approach

Effectiveness Unclear how effective in clinical settings, though

research settings indicate some positive effects.


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