Disorders of Childhood and Adolescence. Studies in the United States and New Zealand suggest prevalence 17-22% More boys are diagnosed with childhood.

Disorders of Childhood and Disorders of Childhood and AdolescenceAdolescence

Disorders of Childhood and Disorders of Childhood and AdolescenceAdolescence

Studies in the United States and New Zealand Studies in the United States and New Zealand suggest prevalence 17-22%suggest prevalence 17-22%

More boys are diagnosed with childhood More boys are diagnosed with childhood disorders than girls.disorders than girls.

Girls are more likely to have internalized Girls are more likely to have internalized problems (anxiety and depression) and boys are problems (anxiety and depression) and boys are more likely to have externalized problems more likely to have externalized problems (ADHD, conduct disorder, etc…)(ADHD, conduct disorder, etc…)

ADHD and Separation Anxiety are most ADHD and Separation Anxiety are most common.common.

Maladaptive Behaviors in Different Maladaptive Behaviors in Different Life PeriodsLife Periods

Developmental Psychopathology- Must be Developmental Psychopathology- Must be taken in the context of normal taken in the context of normal developmental changes.developmental changes.

Varying Clinical Picture (short lived and Varying Clinical Picture (short lived and less specific than adult disorders)less specific than adult disorders)

Some childhood disorders may severely Some childhood disorders may severely affect future development (ADHD & I.Q. affect future development (ADHD & I.Q. also excess mortality associated with CD)also excess mortality associated with CD)

Vulnerable due to less self-understanding.Vulnerable due to less self-understanding.

Disorders of ChildhoodDisorders of Childhood

ADHDADHD Conduct Disorder and Oppositional Conduct Disorder and Oppositional

DisorderDisorder Anxiety DisordersAnxiety Disorders Symptom DisordersSymptom Disorders AutismAutism

Attention Deficit Hyperactivity Attention Deficit Hyperactivity DisorderDisorder

Characterized by difficulties that interfere with Characterized by difficulties that interfere with effective task-oriented behavior in children.effective task-oriented behavior in children.

Often score 7-15 I.Q points below averageOften score 7-15 I.Q points below average Hyperactive children are the most frequent Hyperactive children are the most frequent

psychological referrals to mental health and psychological referrals to mental health and pediatric facilities.pediatric facilities.

6-9% more prevalent with boys than girls6-9% more prevalent with boys than girls Occurs with greatest frequency before age 8Occurs with greatest frequency before age 8 Most frequent psychological referral to mental Most frequent psychological referral to mental

health facilitiieshealth facilitiies

ADHD CriteriaADHD Criteria Either (1) or (2): Either (1) or (2): six (or more) of the following symptoms of six (or more) of the following symptoms of inattentioninattention have have

persisted for at least 6 months to a degree that is maladaptive and persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: inconsistent with developmental level: often fails to give close attention to details or makes careless often fails to give close attention to details or makes careless

mistakes in schoolwork, work, or other activities mistakes in schoolwork, work, or other activities often has difficulty sustaining attention in tasks or play activities often has difficulty sustaining attention in tasks or play activities often does not seem to listen when spoken to directly often does not seem to listen when spoken to directly often does not follow through on instructions and fails to finish often does not follow through on instructions and fails to finish

schoolwork, chores, or duties in the workplace (not due to schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) oppositional behavior or failure to understand instructions)

often has difficulty organizing tasks and activities often has difficulty organizing tasks and activities often avoids, dislikes, or is reluctant to engage in tasks that often avoids, dislikes, or is reluctant to engage in tasks that

require sustained mental effort (such as schoolwork or require sustained mental effort (such as schoolwork or homework) homework)

often loses things necessary for tasks or activities (e.g., toys, often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) school assignments, pencils, books, or tools)

is often easily distracted by extraneous stimuli is often easily distracted by extraneous stimuli is often forgetful in daily activities is often forgetful in daily activities

HyperactivityHyperactivity often fidgets with hands or feet or squirms in seat often fidgets with hands or feet or squirms in seat often leaves seat in classroom or in other situations in which often leaves seat in classroom or in other situations in which

remaining seated is expected remaining seated is expected often runs about or climbs excessively in situations in which it is often runs about or climbs excessively in situations in which it is

inappropriate (in adolescents or adults, may be limited to subjective inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) feelings of restlessness)

often has difficulty playing or engaging in leisure activities quietly often has difficulty playing or engaging in leisure activities quietly is often "on the go" or often acts as if "driven by a motor" is often "on the go" or often acts as if "driven by a motor" often talks excessively often talks excessively ImpulsivityImpulsivity often blurts out answers before questions have been completed often blurts out answers before questions have been completed often has difficulty awaiting turn often has difficulty awaiting turn often interrupts or intrudes on others (e.g., butts into conversations often interrupts or intrudes on others (e.g., butts into conversations

or games) or games)

ADHD Causal FactorsADHD Causal Factors

Both biological and environmentalBoth biological and environmental Food additive theory unsupportedFood additive theory unsupported Home environment may be a link in that Home environment may be a link in that

some studies show that parents of ADHD some studies show that parents of ADHD children are more likely to have children are more likely to have personality disorders.personality disorders.

ADHD Treatments and OutcomesADHD Treatments and Outcomes Both Behavioral Therapy and Medication reduce Both Behavioral Therapy and Medication reduce

symptoms. symptoms. MedicationMedication

40% of junior high & 15% high school students with 40% of junior high & 15% high school students with emotional and behavioral problems are prescribed emotional and behavioral problems are prescribed medication.medication.

75% effective rate in treating hyperactive child75% effective rate in treating hyperactive child Reduces inattention but not impulsivity.Reduces inattention but not impulsivity.

Behavioral TreatmentBehavioral Treatment Demonstrates short-term gains. Reduces symptoms.Demonstrates short-term gains. Reduces symptoms.

Hyperactive bx tends to diminish in some Hyperactive bx tends to diminish in some children. Impact however may remain (less children. Impact however may remain (less education, legal problems, etc….)education, legal problems, etc….)

Conduct Disorder & Oppositional Conduct Disorder & Oppositional Defiant DisorderDefiant Disorder

Characterized by aggressive or antisocial Characterized by aggressive or antisocial behavior.behavior.

Virtually all who have conduct disorder Virtually all who have conduct disorder have oppositional defiant disorder first.have oppositional defiant disorder first.

Oppositional Defiant Disorder usually Oppositional Defiant Disorder usually appears by age 6. Conduct Dis. Age 9.appears by age 6. Conduct Dis. Age 9.

Looks much like adult antisocial Looks much like adult antisocial personality disorder.personality disorder.

Oppositional Defiant Disorder CriteriaOppositional Defiant Disorder Criteria

A pattern of negativistic, hostile, and defiant A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which behavior lasting at least 6 months, during which four (or more) of the following are present: four (or more) of the following are present:

often loses temper often loses temper often argues with adults often argues with adults often actively defies or refuses to comply with often actively defies or refuses to comply with

adults' requests or rules adults' requests or rules often deliberately annoys people often deliberately annoys people often blames others for his or her mistakes or often blames others for his or her mistakes or

misbehavior misbehavior is often touchy or easily annoyed by others is often touchy or easily annoyed by others is often angry and resentful is often angry and resentful is often spiteful or vindictive is often spiteful or vindictive

Conduct Disorder CriteriaConduct Disorder Criteria A repetitive and persistent pattern of behavior in which the A repetitive and persistent pattern of behavior in which the

basic rights of others or major age-appropriate societal norms basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months: at least one criterion present in the past 6 months: Aggression to people and animalsAggression to people and animals

often bullies, threatens, or intimidates others often bullies, threatens, or intimidates others often initiates physical fights often initiates physical fights has used a weapon that can cause serious physical harm to has used a weapon that can cause serious physical harm to

others (e.g., a bat, brick, broken bottle, knife, gun) others (e.g., a bat, brick, broken bottle, knife, gun) has been physically cruel to people has been physically cruel to people has been physically cruel to animals has been physically cruel to animals has stolen while confronting a victim (e.g., mugging, purse has stolen while confronting a victim (e.g., mugging, purse

snatching, extortion, armed robbery) snatching, extortion, armed robbery) has forced someone into sexual activity has forced someone into sexual activity [Continued Next Page][Continued Next Page]

Destruction of propertyDestruction of property has deliberately engaged in fire setting with the intention of causing has deliberately engaged in fire setting with the intention of causing

serious damage serious damage has deliberately destroyed others' property (other than by fire has deliberately destroyed others' property (other than by fire

setting) setting) Deceitfulness or theftDeceitfulness or theft has broken into someone else's house, building, or car has broken into someone else's house, building, or car often lies to obtain goods or favors or to avoid obligations (i.e., often lies to obtain goods or favors or to avoid obligations (i.e.,

"cons" others) "cons" others) has stolen items of nontrivial value without confronting a victim (e.g., has stolen items of nontrivial value without confronting a victim (e.g.,

shoplifting, but without breaking and entering; forgery) shoplifting, but without breaking and entering; forgery) Serious violations of rulesSerious violations of rules often stays out at night despite parental prohibitions, beginning often stays out at night despite parental prohibitions, beginning

before age 13 years before age 13 years has run away from home overnight at least twice while living in has run away from home overnight at least twice while living in

parental or parental surrogate home (or once without returning for a parental or parental surrogate home (or once without returning for a lengthy period) lengthy period)

is often truant from school, beginning before age 13 years is often truant from school, beginning before age 13 years The disturbance in behavior causes clinically significant impairment The disturbance in behavior causes clinically significant impairment

in social, academic, or occupational functioning. in social, academic, or occupational functioning.

Causal Factors: Conduct DisordersCausal Factors: Conduct Disorders Self-Perpetuating CycleSelf-Perpetuating Cycle Parent-Child relations characterized by Parent-Child relations characterized by

rejection and neglectrejection and neglect Conduct Disorder has been associated Conduct Disorder has been associated

with divorce, hostility, and lack of with divorce, hostility, and lack of monitoring in the family.monitoring in the family.

TreatmentTreatment

Challenge is parent’s reluctance to Challenge is parent’s reluctance to become involved in treatment and learn become involved in treatment and learn new parenting behaviors.new parenting behaviors.

Anxiety Disorders of ChildhoodAnxiety Disorders of Childhood

Children typically cope with anxiety by becoming Children typically cope with anxiety by becoming overly dependent on others.overly dependent on others.

Prevalence is higher in girls than boys.Prevalence is higher in girls than boys.

Separation Anxiety DisorderSeparation Anxiety Disorder Most common childhood anxiety disorderMost common childhood anxiety disorder Essential feature is excessive anxiety about Essential feature is excessive anxiety about

separation from major attachment figures.separation from major attachment figures. Characteristics Include: unrealistic fears, Characteristics Include: unrealistic fears,

oversensitivity, self-consciousness, nightmares, lack oversensitivity, self-consciousness, nightmares, lack confidence, chronic anxiety, apprehensive in new confidence, chronic anxiety, apprehensive in new situations, worry that parents will become ill or die, situations, worry that parents will become ill or die, difficulty sleeping, school refusal problems .difficulty sleeping, school refusal problems .

Anxiety Disorders: TreatmentAnxiety Disorders: Treatment

Psychopharmacological treatment is Psychopharmacological treatment is questionable in it’s effectiveness questionable in it’s effectiveness

Behavioral Therapy Procedures are Behavioral Therapy Procedures are EffectiveEffective Assertiveness Training, Mastering Assertiveness Training, Mastering

Competencies, and Desensitization and In Competencies, and Desensitization and In Vivo Methods (using graded real life Vivo Methods (using graded real life situations)situations)

Group Therapy as a Modality is Effective Group Therapy as a Modality is Effective

Childhood DepressionChildhood Depression Prevalence greater in girls than boys (2x)Prevalence greater in girls than boys (2x) Causal Factors Include:Causal Factors Include:

Biological FactorsBiological Factors Learning FactorsLearning Factors

(negative parental behavior, divorce, modeling of depressed (negative parental behavior, divorce, modeling of depressed mother, marital stress, mother-infant attachment, depressed mother, marital stress, mother-infant attachment, depressed mothers are less responsive)mothers are less responsive)

Children of depressed mothers are more likely to become Children of depressed mothers are more likely to become depressed themselves and commit suicide depressed themselves and commit suicide

TreatmentTreatment Medication is no more effective than placeboMedication is no more effective than placebo Cognitive-Behavioral TherapyCognitive-Behavioral Therapy Providing a supportive emotional environmentProviding a supportive emotional environment

Treatment Challenges for Treatment Challenges for Childhood DisordersChildhood Disorders

Most childhood disorders develop out of Most childhood disorders develop out of pathogenic family interactionspathogenic family interactions

Treatment of childhood disorders relies a Treatment of childhood disorders relies a great deal on teaching parents behavioral great deal on teaching parents behavioral therapy interventionstherapy interventions

Parents are often key to the child’s Parents are often key to the child’s treatment and many parents are resistant. treatment and many parents are resistant.

More difficult to get fathers involved than More difficult to get fathers involved than mothers. mothers.