Chapter 15 – Disorders Of Childhood And Adolescence Flashcards
What are five vulnerabilities to consider when evaluating the presence or extent of mental health problems in children and adolescents?
- They do not have as complex and realistic a view of themselves and their world as they will have later on; they have less self understanding; and they have not yet developed a stable sense of identity or a clear understanding of what is expected of them and what resources they may have to deal with problems.
- Immediately perceived threats are tempered less by considerations of the past or future and thus tend to be seen as disproportionately important. As a result, children often have more difficulty than adults in coping with stressful events.
- Children’s Limited perspectives, as might be expected, lead them to use unrealistic concepts to explain events. For young children, suicide or violence against another person may be undertaken without any real understanding of the finality of death.
- Children also are more dependent on other people then are adults. Although in some ways this dependency serves as a buffer against other dangers because the adults around him or her might protect a child against stressors in the environment, it also makes the child highly vulnerable to experiences of rejection, disappointment, and failure if these adults, because of their own problems, ignore the child
- Children’s lack of experience in dealing with adversity can make manageable problems seem insurmountable. On the other hand, although their inexperience and lack of self-sufficiency make them easily upset by problems that seem minor to the average adult, children typically recover more rapidly from their hurts
Discuss general issues in the classification of childhood and adolescent disorders
Until the 1950s no formal, specific system was available for classifying the emotional or behavioural problems of children and adolescents. Current ways of viewing psychological disorders in children and adolescents were inappropriate and inaccurate for several reasons:
The greatest problem was that the same classification system that had been developed for adults was used for childhood problems even though many childhood disorders such as autism, learning disabilities, and school phobias, have no counterpart in adult psychopathology.
The early systems also ignored the fact that in childhood disorders, environmental factors play an important part in the expression of symptoms. Symptoms are highly influenced by families acceptance or rejection of the behavior.
In addition, symptoms were not considered with respect to a child’s developmental level.
Disorder of childhood characterized by difficulties that interfere with task-oriented behavior, such as impulsivity, excessive motor activity, and difficulties in sustaining attention
Attention-deficit/hyperactivity disorder or ADHD
Perhaps as a result of their behavioural problems, children with ADHD are often lower in intelligence. Also tend to talk incessantly and to be socially intrusive and immature. Generally have many social problems because of their impulsivity and overactivity and have difficulty in getting along with their parents because they do not obey rules.
In general, they are not anxious even though their behaviours make it seem as if they are.
It is the most frequently diagnosed mental health condition in children in the US.
Occurs most frequently among preadolescent boys, being 6 to 9 times more prevalent among boys than girls. Occurs with the greatest frequency before age 8 and tends to become less frequent and to involve briefer periods thereafter. Also comorbid with other disorders such as oppositional defiant disorder.
Caused likely by both genetics and social environmental precursors. Temperament and learning appear likely to be factors.
Treatment: children are often prescribed medication, mostly Ritalin, an amphetamine, which decreases overactivity and distractibility and at the same time, increases their alertness. Side affects our decreased blood flow to the brain, which can result in impaired thinking ability and memory loss; disruption of growth hormone, leading to suppression of growth in the body and brain of the child; insomnia; psychotic symptoms. Shown to be effective in the short-term treatment, and there are new or variance of the drug referred to as extended release methylphenidate or Concerta. Other medications include pemoline, Strattera, and Adderall.
Psychological interventions include selective reinforcement in the classroom and family therapy. Also the use of behaviour therapy techniques featuring positive reinforcement and the structuring of learning materials and tasks in a way that minimizes error and maximize his immediate feedback and success.
Has a prevalence rate of 4.4% in adult patients.
Children may go on to have other psychological problems such as overly aggressive behaviour or substance abuse such as cocaine, and substantial increased risk for adult criminality. Girls were at high risk for antisocial, addictive, mood, anxiety, and eating disorders.
Central nervous system stimulant often used to treat ADHD
Ritalin
Drug, similar to Ritalin, used to treat ADHD. Exerts beneficial effects on classroom behaviour by enhancing cognitive processing but has less adverse side effects.
Pemoline
A medication used in the treatment of ADHD. A non-controlled treatment option that can be obtained readily. A non-stimulant medication that reduces the symptoms of ADHD but it’s mode of operation is not well understood. Side effects are decreased appetite, nausea, vomiting, and fatigue and the development of jaundice has been reported
Strattera
A habit forming drug comprised of a combination of dextroamphetamine and amphetamine. Reduce his symptoms of impulsivity and hyperactivity in children with ADHD. Has no advantage or improvement in results over Ritalin or Strattera.
Adderall
Legal term used to refer to illegal acts committed by minors
Juvenile delinquency
Childhood disorder that appears by age 6 and is characterized by persistent acts of aggressive or antisocial behaviour that may or may not be against the law.
The essential feature is a recurring pattern of negativistic, defiant, disobedient, and hostile behaviour toward authority figures that persists for at least six months. Usually begins by the age of eight.
Oppositional defiant disorder or ODD
Virtually all cases of conduct disorder are preceded developmentally by oppositional defiant disorder, but not all children with oppositional defiant disorder go on to develop conduct disorder within a three-year period. Risk factors for both include family discord, socioeconomic disadvantage, and antisocial behaviour in the parents
Childhood and adolescent disorders that can appear by age 9 and are marked by persistent acts of aggressive or antisocial behaviour that may or may not be against the law.
Involves a persistent, repetitive violation of rules and a disregard for the rights of others. Children show a deficit in social behaviour.
Manifest such characteristics as overt or covert hostility, disobedience, physical and verbal aggressiveness, quarrelsomeness, vengefulness, and destructiveness. Line, solitary stealing, and temper tantrum’s are common. Tend to be sexually uninhibited and inclined toward sexual aggressiveness and some may engage into cruelty to animals, fire setting, vandalism, robbery, and even homicidal acts.
Conduct disorder
Frequently comorbid with other disorders such as substance abuse disorder or depressive symptoms. Risk factor for unwed pregnancy and substance abuse in teenage girls. Early onset is highly associated with later development of antisocial personality disorder.
What are causal factors in oppositional disorder and conduct disorder?
A genetic predisposition leading to low verbal intelligence, mild neuropsychological problems, and a difficult temperament can set the stage for early onset conduct disorder. The child’s difficult temperament may lead to an insecure attachment because parents find it hard to engage in the good parenting that would promote a secure attachment. And the verbal intelligence and mild neuropsychological deficits help set the stage for a lifelong course of difficulties.
Children who develop conduct disorder at an earlier age are much more likely to develop psychopathy or antisocial personality disorder’s, then children who develop conduct disorder suddenly in adolescence. Link is stronger among lower socioeconomic class children. Most individuals who developed conduct disorder in adolescents do not go on to become adults psychopaths or antisocial personality but instead have problems limited to the adolescent years.
Psychosocial factors: children who are aggressive and socially unskilled are often rejected by their peers, and such rejection can lead to a spiralling sequence of social interactions with peers that exacerbates the tendency toward antisocial behavior. Parents and teachers may react to aggressive children with strong negative affect such as anger, and they may intern reject these aggressive children. The combination of rejection by parents, peers, and teachers leave these children to become isolated and alienated. Often turn to deviant peer groups for companionship, at which point a good deal of imitation of the antisocial behaviour of their deviant peer models may occur.
Family setting is typically characterized by an effective parenting, rejection, harsh and inconsistent discipline, and parental neglect. Parents have an unstable marital relationship, or emotionally disturbed or sociopathic, and do not provide the child with consistent guidance, acceptance, or affection.
What are treatments and outcomes for oppositional disorder and conduct disorder?
The cohesive family model: attempts to modify the child environment. In this family-group oriented approach, parents of children with conduct disorder are viewed as lacking in parenting skills and as behaving in inconsistent ways, thereby reinforcing inappropriate behaviour and failing to socialize their children. Children learn to escape or avoid parental criticism by escalating their negative behavior, this tactic then increases their parents aversive interactions and criticism. The child observe the increased anger in his or her parents and models as aggressive pattern. The parental attention to the child negative, aggressive behaviour actually serves to reinforce that behaviour instead of suppressing it. Viewing conduct problems as emerging from such interactions places a treatment focus squarely on the interaction between the child and the parents.
Behavioural and biologically-based treatments: treating depression and oppositional defined behaviour with the antidepressant medication fluoxetine or Prozac and cognitive behaviour therapy may reduce oppositionality.
Teaching control techniques to the parents of such children is particularly important so that they can function as therapists in reinforcing desirable behaviour and modifying the environmental conditions that have been reinforcing maladaptive behaviour in their children.
Describe the characteristics of children with anxiety disorders
Over sensitivity, unrealistic fears, shyness and timidity, pervasive feelings of inadequacy, sleep disturbances, and fear of school. May attempt to cope with their fears by becoming overly dependent on others for support and help. Often comorbid with depressive disorders. Greater preponderancy for anxiety-based disorder in girls than boys.
Childhood disorder characterized by unrealistic fears, oversensitivity, self-consciousness, nightmares, and chronic anxiety.
The most common of the childhood anxiety disorders, reportedly occurring in 2 to 41% of children.
They lack self-confidence, or apprehensive in new situations, and tend to be immature for their age. Described by their parents as shy, sensitive, nervous, submissive, easily discouraged, worried, and frequently moved to tears. Typically are overly dependent, particularly on their parents. The essential feature is excessive anxiety about separation from major attachment figures, such as their mother, and from familiar home surroundings. In many cases, a clear psychosocial stress or can be identified, such as the death of a relative or a pet.
Separation anxiety disorder
May be caused by the contribution of genetic factors and social and cultural factors. Anxious children often manifest and unusual constitutional sensitivity that makes an easily conditional by aversive stimuli.
The child can become anxious because of early illnesses, accidents, or losses that involved pain and discomfort. The traumatic effect of experiences such as hospitalizations make such children feel insecure and inadequate. The dramatic nature of certain life changes such as moving away from friends and into a new situation can also have an intensely negative effect. These children often have the modelling effect of an over anxious and protective parent to sensitizes a child to the dangers and threats of the outside world. The parents overprotectiveness communicate a lack of confidence in the child’s ability to cope, thus reinforcing the child’s feelings of inadequacy. Indifferent or detached parents or rejecting parents also foster anxiety.
Treatment: psychopharmacological treatments are becoming more common. Behaviour therapy procedures often help anxious children, including assertiveness training to provide help with mastering essential competencies and desensitization to reduce anxious behaviour. And cognitive behavioural therapy has been shown to be highly effective at reducing anxiety symptoms.
Describe childhood depression and bipolar disorder
Childhood depression includes behaviours such as withdrawal, crying, avoidance of eye contact, physical complaints, poor appetite, and even aggressive behaviour and in some cases suicide. Classified according to essentially the same DSM diagnostic criteria used for adults, however there are clear differences in hormonal levels and in the response to treatment. One modification used for diagnosing depression in children is that irritability is often found as a major symptom and can be substituted for depressed mood.
