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Chapter 15 Disorders of Childhood. Ch 15. Classification Issues. Distinguishing abnormal childhood behavior requires a knowledge from developmental psychology of what is normal for a child at a particular age or stage Disorders can be viewed as categories or on a continuum (dimension)

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Chapter 15 Disorders of Childhood

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Chapter 15

Disorders of Childhood

Ch 15

classification issues
Classification Issues
  • Distinguishing abnormal childhood behavior requires a knowledge from developmental psychology of what is normal for a child at a particular age or stage
  • Disorders can be viewed as categories or on a continuum (dimension)
    • Control represents a dimensional variable
      • Overcontrolled (internalizing)children show emotional inhibition
      • Undercontrolled (externalizing) children show excessive behaviors (extreme aggressiveness)

Ch 15.1

developmental psychopathology
Developmental Psychopathology
  • Behavior genetics & neurobiological traumas
  • Infant / child temperaments and “the problem of the match” with parental temperaments and expectations
  • Attachment theory (Bowlby, Ainsworth, Sroufe)
    • Secure vs. insecure attachment
    • Insecure attachment category may be related to later childhood disorders
      • “anxious-resistant” category - internalizing disorders
      • “avoidant”category - externalizing disorders
  • How do temperament & attachment interact?
    • Evidence is inconclusive, but see Bokhorst et al. (2004)
disorders of undercontrolled behavior
Disorders of Undercontrolled Behavior
  • Undercontrolled behavior is excessive or inappropriate for the situation
  • DSM-IV recognizes two classes of undercontrolled behavior:
    • Attention-deficit/hyperactivity disorder (ADHD) involves
      • An inability to concentrate on task for an appropriate period of time
      • Difficulties in controlling motor movements in class and other situation (fidgeting, talking)

Ch 15.2

adhd issues
ADHD Issues
  • Hyperactive children have difficulties in establishing peer relations
    • Aggressive ADHD children have different social goals (being disruptive) than do non-ADHD peers
  • ADHD can co-occur with learning disabilities (15-30% of ADHD children have co-morbid LDs)
  • ADHD shows within category differences
    • Some children have attention deficit, some have hyperactivity, and some have both
  • ADHD prevalence is 2-7% in US
  • ADHD with conduct disorder = worse prognosis

Ch 15.3

table 15 2 prevalence of symptoms and behaviors in adolescents with and without adhd
Table 15.2 Prevalence of Symptoms and Behaviors in Adolescents with and without ADHD
adhd facts and statistics
ADHD: Facts and Statistics
  • Prevalence (BD, 3rd. Edition)
    • Occurs in 4%-12% of children who are 6 to 12 years

of age

    • Symptoms are usually present around age 3 or 4
    • 68% of children with ADHD have problems as adults
  • Gender Differences
    • Boys outnumber girls 4 to 1
  • Cultural Factors
  • Probability of ADHD diagnosis is greatest in the United States
biological theories of adhd
Biological Theories of ADHD
  • Family and twin studies document a role for genetic transmission in ADHD
  • Frontal lobe function is abnormal in ADHD children
    • Frontal lobe is underresponsive to stimulation in ADHD children
    • Frontal lobe is smaller in ADHD children
    • ADHD children do poorly on psychological tests that measure the functioning of the frontal lobe

Ch 15.4

psychological theories of adhd
Psychological Theories of ADHD
  • Bettelheim proposed a psychoanalytic view of ADHD in which hyperactivity results from stress brought on by parental personality (authoritarian, impatient, resentful)
  • Learning theory suggests that hyperactivity is reinforced by the attention it elicits, thereby increasing in frequency and intensity; hyperactivity may represent modeling of older siblings or peers

Ch 15.5

treatment of adhd
Treatment of ADHD
  • Stimulant drugs such as methylphenidate (Ritalin) reduce disruptive behavior and improve concentration
    • Improve compliance and decrease negative behaviors in many children
    • Medications do not affect learning and academic performance
    • Beneficial effects are not lasting following drug discontinuation
  • Psychological therapy for ADHD involves
    • Parent training
    • Classroom management programs based on operant-conditioning techniques
    • Aim to increase appropriate behaviors and decrease inappropriate behaviors
  • Combined Bio-Psycho-Social Treatments
    • Are highly recommended

Ch 15.6

disorders of undercontrolled behavior12
Disorders of Undercontrolled Behavior
  • Conduct Disorder involves behaviors that violate the rights of others
    • Aggression and cruelty toward people or animals
    • Property damage
    • Lying and stealing
    • Conduct disorder is marked by callousness and lack of remorse
  • Conduct disorder is more common in boys
  • Oppositional Defiant Disorder (ODD) distinction

Ch 15.7

etiology of conduct disorder
Etiology of Conduct Disorder
  • Genetic factors may play a greater role in aggressive behavior, but a lesser role in delinquency-related behaviors
    • e.g. stealing, running away
  • Psychological factors include
    • Deficiencies in moral training and awareness
    • Modeling of aggressive behavior (Bandura)
    • Cognitive distortions in which ambiguous actions are interpreted as hostile

Ch 15.8

treatment of conduct disorder
Treatment of Conduct Disorder
  • Family intervention involves training parents to reward prosocial behaviors in their children
  • Multisystem treatment targets the child, the community, the school and the family
  • Cognitive approaches involve
    • Anger control training
    • Teaching moral development reasoning

Ch 15.9

learning disabilities
Learning Disabilities
  • Learning disabilities refer to inadequate development in a specific area of academic, language or motor skills
    • The deficit is not due to mental retardation, autism or reduced educational opportunities
  • DSM covers 3 areas of learning disabilities
    • Learning disorders
    • Communication disorders
    • Motor skills involve impairment of motor coordination

Ch 15.10

learning disorders
Learning Disorders
  • Learning Disorders refer to conditions that impair development in the classroom
  • Specific learning disorders identified in DSM-IV include
    • Reading disorder (Dyslexia) involves difficulty in word recognition and comprehension
    • Disorder of written expression involves an inability to compose the written word
    • Mathematics disorder involves difficulty in recalling math facts, errors in addition

Ch 15.11

communication disorder
Communication Disorder
  • Communication disorders include
    • Expressive language disorder involves a difficulty in speech expression
      • Difficulty in finding the correct word for a concept
      • Use of grammar is below grade level
    • Phonological disorder refers to a difficulty in articulating speech sounds, but can comprehend words
    • Stuttering involves a problem in verbal fluency in which words are repeated or prolonged

Ch 15.12

mental retardation
Mental Retardation
  • Mental retardation is defined as
    • Subaverage intellectual functioning
      • IQ score below 70-75
    • Deficits in adaptive behaviors such as dressing, use of money, use of tools and of public transportation
    • Onset prior to age eighteen
      • Not due to adult accidents or disease
      • Typical onset is in infancy
  • American Association of Mental Retardation’s approach
    • Focus onremedial supports to facilitate higher functioning

Ch 15.13

etiology of mental retardation
Etiology of Mental Retardation
  • No cause is evident for 75% of cases of mental retardation, the remaining 25% are often related to biological causes
  • Biological causes include:
    • Genetic anomalies such as Down’s syndrome (Trisomy 21)
    • Fragile X syndrome – Abnormality on X chromosome
    • Recessive-gene diseases such as PKU
    • Infectious diseases such as Rubella and HIV
    • Environmental hazards such as mercury or lead poisoning

Ch 15.15

autistic disorder
Autistic Disorder
  • Autistic disorder involves children who
    • Prefer to be alone
    • Prefer to have a constant environment
    • Have severely limited language skills
  • DSM-IV “Pervasive DevelopmentalDisorder” distinguishes autism as a developmental disorder different from schizophrenia in adults
  • Prevalence of autism is infrequent (.05 % of births)
    • Autism occurs more frequently (4x) in boys relative to girls

Ch 15.16

autistic disorder facts and statistics
Autistic Disorder: Facts and Statistics
  • Prevalence and Features of Autism (BD, 3rd. Edition)
    • Rare condition – Affecting 2 to 20 persons for every 10,000 people
    • More prevalent in females with IQs below 35, and in males with higher IQs
    • Autism occurs worldwide
    • Symptoms usually develop before 36 months of age
  • Autism and Intellectual Functioning
    • 50% have IQs in the severe-to-profound range of mental retardation
    • 25% test in the mild-to-moderate IQ range (i.e., IQ of 50 to 70)
    • Remaining people display abilities in the borderline-to-average IQ range
    • Better language skills and IQ test performance predicts better lifetime prognosis (50% never acquire useful speech)
etiology of autism psychological theories
Etiology of Autism: Psychological Theories
  • Bettelheim argued that parental rejection induces autistic disorder
  • Behavioral theory suggests that autism results from inattentive parents, especially the mother
  • Follow-up studies have found little support for psychological explanations of autism

Ch 15.17

biological etiology of autism
Biological Etiology of Autism
  • Genetic factors play a strong role in transmission of autistic disorder
    • Siblings of a person with autistic disorder have a 75 fold increase in risk
    • Twin studies show greater concordance for autism in MZ twins (60-91% than in DZ twins (0-20%)
  • Neurological studies consistently find structural abnormalities in the cerebellum of autistic children (e.g., substantially reduced sized)

Ch 15.18

treatment of autistic disorder
Treatment of Autistic Disorder
  • Drug treatment often involves the administration of haloperidol
    • Reduces social withdrawal and odd motor behaviors
    • Haloperidol does not alter the abnormal interpersonal relations or language impairments of autism
  • Efficacy of psychodynamic therapy is unknown
  • Behavior therapy approach (Lovaas)
    • Uses modeling and operant conditioning to reinforce language and prosocial behaviors
    • Parent education training increases treatment generalization beyond hospital settings

Ch 15.19