Transcript Disorders of Childhood

Disorders of Childhood
Disorders of Childhood
Undercontrolled
(Externalizing)
Problems for Others
•Attention-Deficit/
Hyperactivity Disorder
•Conduct Disorder
More Prevalent in Boys
Overcontrolled
(Internalizing)
Problems for Self
•Childhood Depression
•Anxiety Disorders
More Prevalent in Girls
Attention-Deficit/Hyperactivity
Disorder
 A disorder in children marked by difficulties in
focusing adaptively on the task at hand, by
inappropriate fidgeting and antisocial behavior, and by
excessive non goal-directed behavior
 Many have difficulties getting along with peers and
establishing friendships
 About 20-25 percent have a learning disability
 Three subcategories: (1) children whose problems are
primarily those of poor attention; (2) children whose
difficulties result primarily from hyperactive-impulsive
behavior; and (3) children who have both sets of
problems.
Etiology of ADHD
 Genetic Factors - a predisposition is likely
inherited
 Environmental Toxins:
–
–
–
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Food Additives - unlikely
Refined Sugar - unsupported
Nicotine – likely
Alcohol and drugs - likely
 Psychodynamic - authoritarian parenting
Treatment of ADHD
 Stimulant drugs, in particular methylphenidate, or
Ritalin, have been prescribed for ADHD since the
early 1960’s.
– 6% of schoolchildren and 25% of special education
students use Ritalin
– Improve concentration, goal-directed behavior, class
behavior, and fine motor activity
– Many not improve academic achievement
– Significant side effects associated with use
 Behavior therapy for ADHD also effective
 Best approach - Stimulants + Behavior Therapy
Conduct Disorder
 Patterns of extreme disobedience in children,
including theft, vandalism, lying,and early drug
use.
 Often behavior is marked by callousness,
viciousness, and lack of remorse.
 May be precursor of antisocial personality
disorder
 Oppositional defiant disorder - an undercontrolled
disorder marked by high levels of disobedience to
authority but lacking the extremes of CD
Treatment of Conduct Disorder
 Difficult to treat, as with APD
 Juvenile incarceration leads to lower job
stability and more adult crime
 Gerald Patterson - Behavioral Parent
Management Training - reduces the rate of
criminal offense
 Scott Henggeler - Multisystemic Therapy
 Cognitive Skills Training
 Moral Reasoning Skills
Autistic Disorder
 Presence of markedly abnormal or impaired development
in social interaction and communication and a markedly
restricted repertoire of activity and interests
 Autism and Mental Retardation - approximately 80% of
autistic children score below 70 on IQ tests
 Autistic Savant - a mentally retarded person with
superior functioning in one narrow area of intellectual
activity
 Extreme Autistic Aloneness - In autistic children early
attachment is virtually absent
Autistic Disorder
 Communication Deficits - language delay,
echolalia, pronoun reversal, neologisms, literal use
of words
 Obsessive-compulsive and Ritualistic Acts autistic children become extremely upset over
changes in their daily activities and surroundings.
They may have OC behaviors (lining up toys in a
specific way) and are given to stereotypical
behavior (e.g., hand movements, rocking)
 Prognosis in Autistic Disorder - only 5 to 17% of
autistic children have good adjustment in adulthood
Etiology of Autistic Disorder
 Psychological Basis - Bettelheim - autistic
disorder caused by cold and rejecting
parents. No support.
 Biological Bases
– Genetic Factors - the risk of autism in the
siblings of people with autism is about 75 times
greater than if the index case does not have the
disorder
– Neurological Factors - EEG and MRI studies
have found abnormalities in autistic children
Mental Retardation
 Intelligence test scores below 75; 3 - 5% of
the population
 Deficits in adaptive functioning (e.g.,
toileting and dressing, use public
transportation)
 Time of onset before age 18 years (to rule
out traumatic injury or illnesses occurring in
later life)
Vineland Adaptive Behavior Scales
Age, Years
Adaptive Ability
2
Says at least fifty recognizable words.
Removes front-opening coat, sweater, or shirt
without assistance.
Tells popular story, fairy tale, lengthy joke, or plot of
a TV program.
Ties shoelaces into a bow without assistance.
Keeps secrets or confidences for more than one day.
5
8
11
16
Uses the telephone for all kinds of calls without
assistance.
Watches TV or listens to radio for information about
a particular area of interest.
Looks after own health.
Responds to hints or indirect cues in conversation.
Classification of MR
 Mild Mental Retardation (50-55 to 70-75 IQ)
– Able to maintain themselves in unskilled jobs
– May need help with social or financial problems
 Moderate Mental Retardation (35-40 to 50-55 IQ)
– Brain damage and other pathologies are frequent
– Most live dependently within family or group homes
 Severe Mental Retardation (20-25 to 35-40 IQ)
– Commonly have congenital physical abnormalities
– May be able to perform very simple work under supervision
 Profound Mental Retardation (below 20-25 IQ)
– Severe physical deformities and neurological damage
– Very high mortality rate during childhood
Deficiencies in
Community
use
Health
and safety
Social
skills
Attention to
stimuli
Short-term
memory
Self-care
skills
Functional
academic
skills
Deficiencies in
Known
Etiology
Control
function of
language
Unknown
Etiology
Executive
functioning
Processing
speed
Communication
Work
skills
Home
living
skills
Selfdirection
Etiology of Mental Retardation
 Genetic or Chromosomal Anomalies
– Down Syndrome or Trisomy 21
– Fragile X Syndrome
 Recessive-Gene Diseases
– Phenylketonuria (PKU)
 Infectious Diseases
– Cytomegalovirus, toxoplasmosis, rubella,
herpes simplex, and syphilis
– HIV
Down’s Syndrome Child
Child with Fragile X Syndrome
Learning Disabilities
 Learning Disorders
– Reading Disorder
– Mathematics Disorder
– Disorder of Written Expression
 Communication Disorders
– Expressive Language Disorder
– Phonological Disorder
– Stuttering
 Motor Skills Disorder
Etiology of Learning Disorders
 Biological -
– Family and twin studies confirm that there is a heritable
component to dyslexia.
– Autopsy studies have shown microscopic abnormalities in the
location, number, and organization of neurons on the left side of
the brain
– PET scans reveal that the temporoparietal cortex of dyslexic
children was not activated during cognitive tasks
 Psychological – Visual perceptual deficits - perceiving letters in reverse order or
mirror image
– Language processing - dyslexics have been found to process
visual stimuli more slowly than do normal people and to be less
likely to notice minor contrasts between stimuli