Disorders of Childhood and Adolescence
Disorders of Childhood and Adolescence PSYCH 3830
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This 8 page Class Notes was uploaded by Margaret Bloder on Thursday February 25, 2016. The Class Notes belongs to PSYCH 3830 at Clemson University taught by Pam Alley in Winter 2016. Since its upload, it has received 13 views. For similar materials see Abnormal Psychology in Psychlogy at Clemson University.
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Date Created: 02/25/16
Disorders in Childhood and Adolescence I. On Disorders in Childhood and Adolescence A. Historical development in the study and treatment of child psychopathology In the DSM I, there were only two childhood disorders (childhood schizophrenia and adjustment reaction of childhood). Neither of these are in the current DSM In 1975, Congress passed the Education of all Handicapped Children Act (revised in 1977, renamed individuals with disabilities education act): I.D.E.A. o Assures that every child is entitled to a free public school education o Each child with a special need needs to have an individualized program that addresses their specific needs o Child should be placed in the least restrictive environment (ex: put them in a classroom with other children) o Parental participation is encouraged o Served learning disorders (ADHD, autism), emotional problems, speech impairments B. Prevalence About 1/5 children have some kind of special need that causes some interference About 1/10 children have some kind of problem that causes significantly more disturbance C. Reorganization of Childhood and Adolescent Disorders in the DSM DSM-IV-TR Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence Mental Retardation Learning Disorders ADHD Autistic Disorder Asperger’s Disorder Separation Anxiety Disorder (had to be under 18 to be diagnosed) Oppositional Defiant Disorder Conduct Disorder Enuresis Personality Disorders Antisocial Personality Disorder Sleep Disorders Sleep Terror Disorder Sleepwalking Disorder DSM-5 Neurodevelopmental Disorders Intellectual Disability Specific Learning Disorder ADHD Autism Spectrum Disorder Anxiety Disorders Separation Anxiety Disorder (any age can get it) Depressive Disorders Disruptive Mood Dysregulation Disorder (new diagnosis) Elimination Disorders Enuresis Disruptive, Impulse-Control, and Conduct Disorders Oppositional Defiant Disorder Conduct Disorder Antisocial Personality Disorder Personality Disorders Antisocial Personality Disorder Sleep-Wake Disorders Non-Rapid Eye Movement Sleep Arousal Disorder II. Anxiety in Children and Adolescents A. On anxiety in children and adolescents: Etiology Behavioral inhibition (genetic component) Environment factors (have been hospitalized, accident of some kind, abused, parents who are overly protective or parents who are detached More common in girls Often times remit before adulthood B. Separation Anxiety Disorder Diagnostic Criteria Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidence by three of the following: o Recurrent excessive distress when separated from home o Persistent and excessive worry about losing major attachment figures o Persistent and excessive worry that an event will lead to separation from one’s major attachment figures o Persistent reluctance or refusal to go away from home (to school, to work) o Persistently and excessively fearful or reluctant to be alone o Persistent reluctance or refusal to go to sleep alone o Repeated nightmares involving the theme of separation o Repeated complaints of physical symptoms when anticipating or following separation from major attachment figures The duration of the disturbance is at least 4 weeks in children and adolescents and 6 months in adults The disturbance causes clinically significant distress or impairment in functioning Demographics Time of onset: childhood More common in girls More common in children who come from close-knit families Most typically diagnosed in elementary age Prevalence declines with age Tends to come and come/wax and wane Separation Anxiety Disorder vs. Normal Separation Anxiety in Children Normal separation anxiety is excepted in the first 2-3 years of age Healthy, secure attachment to primary care giver Not a factor of developing separation anxiety disorder C. School Phobia (not a disorder) Used to be defined as an unrealistic fear that keeps children away from school Now, defined as the fear of leaving one’s parents, not the fear of school itself Considered a possible symptom of Separation Anxiety Disorder Treatment: re-integrate child into school gradually, parent goes to school with child, move the parent out gradually III. Depression in Children and Adolescents A. Major Depressive Disorder Criteria is same for children and adolescents as for adults But, instead of sadness, children may get cranky/irritable More common in females beginning in early adolescence B. Persistent Depressive Disorder Symptoms must be present for only one year in children and adolescents Chronic C. Disruptive Mood Dysregulation Disorder New disorder in the DSM-5 Specific to children; onset must be prior to age 10 in order to get this diagnosis Chronic, severe, persistent, irritability Predominant in boys Etiology Environmental factors (parent’s divorce, abused, depressed mother, etc.) Genetic component Treatment Anti-depressants Play therapy for children: put them in a less stressful setting. This type of therapy is difficult, takes a lot of training Cognitive therapy (adolescents) IV. Disorders Associated with Defiance and Aggression ODD CD APD (all three more common in males) A. Oppositional Defiant Disorder (ODD) First symptoms usually evident during preschool years and rarely later than early adolescence Involves a pattern of hostile and defiant behavior that is usually limited to the home Includes loss of temper, arguing, refusal of requests, anger, resentfulness, and deliberate annoyance of others Sometimes develops into a Conduct Disorder (as they get older) Onset is typically gradual Some remit with time, others have counseling B. Conduct Disorder (CD): more serious disorder Usually emerges in middle childhood through middle adolescence Involves a pattern of conduct in which societal norms and the basic rights of others are violated over the course of the past year in a variety of settings (in the home, at school, with peers) Includes stealing, lying, running away from home, school truancy, fighting, destruction of others’ property, fire setting, and cruelty to animals Typically preceded developmentally by Oppositional Defiant Disorder May develop into Antisocial Personality Disorder typically if onset is in early childhood Prevalence has increased over time; higher in city (urban) areas than in rural areas Doesn’t limit behavior just to home C. Antisocial Personality Disorder (APD): even more serious Not diagnosed until 18 years of age Involves pattern of disregard for and violation of the rights of others Includes irritability, aggressiveness, stealing and harassing others, deceitfulness, recklessness, irresponsibility, and lack of remorse (they feel entitled) Typically preceded developmentally by Conduct Disorder It’s important to recognize the difference between Conduct Disorder and Juvenile Delinquency, the difference between Antisocial Personality Disorder and Psychopathy, and the difference between Antisocial Personality Disorder and criminal behavior Causal Factors Might be a genetic component (temperamental predisposition) Many environmental factors (mom & dads parenting style, stress in family setting, abused, poor peer relationship, lower SE group) Treatment Family therapy is the treatment of choice Advise parents to use authoritative style Also teach parents behavior techniques (reinforcement) Helping parents modify environmental conditions (create structure: a time to eat, sleep, play, do homework, etc.) V. Sleep-Wake Disorders in Children and Adolescents A. Normal Sleeping Patterns in Childhood Children usually sleep well through the night and take a nap up until 5 years of age Elaborate bedtime routine (helps to transition from day to night, repetitive and reassuring) Many children have a transitional object (bunny, blanket, etc.) o These children tend to be more confident B. Sleep Patterns across the Lifespan Newborn: 18 hours a day, wake up every 2-3 hours; 3 months of age start to sleep through the night 6 months: more than half of their sleeping is done at night; less naps during the day 5 years: about 11 hours of sleep at night 9 years: about 10 hours 13 (adolescents): about 9 hours Late adulthood (65+): about 6 hours C. Classifying Sleep Disturbances in the DSM-5 Isolated or infrequent episodes of nightmares, night terrors, or sleepwalking are relatively common in the general population These sleep related events are only classified as a disorder if they are recurrent and are accompanied by either distress or impaired functioning They are classified in a category called Sleep-Wake Disorders under Parasomnias Parasomnias are disorders characterized by abnormal events occurring in association with sleep and/or specific sleep stages Individuals who experience abnormal sleep episodes involving night terrors or sleepwalking are both diagnosed with Non-Rapid Eye Movement (NREM) Sleep Arousal Disorder D. Sleep Disturbances 1. Nightmares: Frightening dreams during REM sleep (most likely occur in second half of sleep) 2. Night Terrors: Abrupt awakening during Stage 4 sleep which begins with a panicky scream or cry and typically lasts 1-10 minutes (child is unresponsive and will have amnesia when wakes up) 3. Sleepwalking: Rising from bed during Stage 4 sleep that typically lasts only a few minutes (typically within the first 2-3 hours) E. Nightmare Disorder vs. NREM Sleep Arousal Disorders Nightmare Disorder NREM Sleep Arousal Disorder Occurs during REM sleep Occurs during Stage 4 sleep Occurs during second half of Occurs during first third of sleep sleep Awakens easily Typically does not awaken Reports vivid dreams fully Has amnesia for the episode Includes night terrors and sleepwalking VI. Enuresis Diagnostic Criteria Repeated voiding of urine into bed or clothes The behavior is clinically significant as manifested by either a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning (can be less time if causes distress/impairment Chronological age is at least 5 years The behavior is not due exclusively to the direct physiological effect of a substance or a general medical condition (ex: if diabetes is the cause of wetting bed, will not get diagnosis of Enuresis) *Strong genetic component Types of Enuresis 1. Primary: diagnosed in a child who never established urinary continence (continence=can control wetting) 2. Secondary: diagnosed in a child who has regressed after at least a year of established urinary continence Bell and Pad Method Technique developed by Mowrer and Mowrer using classical conditioning to treat individuals with Enuresis The child sleeps on a pad wired to an alarm the first drops of urine set off the alarm and wake the child the child comes to associate a full bladder with awakening
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