Chapter 17 Disorders of Childhood and Adolescence Flashcards
Gender differences
prior to puberty=more boys
post puberty
>boys externalize (acting out, conduct disorder, sub. abuse, ADHD)
>girls internalize (depression, eating disorders)
Childhood Depression Symptoms
sadness, grief hopelessness, helplessness low self-esteem acting out, angry, irritable somatic complaints very anxious
Childhood Depression Etiology
dysfunctional family, losses, divorce, attachment problems
HX of poor affective regulation (attitude)
genetic predisposition
biochemical imbalance
Disorders seen in CHILDHOOD
- ADHD
- oppositional-defiant disorder
- learning disorders
- separation-anxiety disorder
- phobias
- tic disorders
- elimination disorders (enuresis, encopresis)
- sleep disorders
- OCD
- Autism Spectrum Disorder
- Adjustment disorders
- Depression and early BP disorder
- PTSD
- attachment disorder
- Childhood onset schizophrenia (RARE)
Disorders seen in ADOLESCENCE
mostly boys 1. Conduct Disorder 2. Substance use disorders mostly girls 3. depression 4. eating disorders 5. social anxiety disorder
children under 10 years
depression/anxiety is equally distributed among boys and girls
Autism Spectrum Disorder
- Deficits in social-emotional reciprocity
- Deficits in non-verbal communicative behaviors used for social interaction
- Deficits in developing, maintaining, understanding relationships
- At least 2 of…
>stereotyped or repetitive movements, use of objects/speech
>Insistence on sameness, inflexible adherence to routines, ritualized patterns of verbal/nonverbal behavior
>highly restricted, fixated interests that are abnormal in intensity/focus
>Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment - symptoms present in early developmental period
- cause clinically significant impairment in social, occupational, or other important areas of life
- symptoms not better explained by diagnosis of intellectual disability
Autism core deficit
- inability to relate to others and take perspective
(cognitively/emotionally) - difficulty to perceive and understand the overall meaning of events
Asperger’s
higher functioning autism
speech ok but communication impaired
single interest that is pursued obsessively
savants
special memory abilities in areas of music, calculation, or drawing (photographic memory)
Epidemiology of Autism Spectrum
1 in 88 children
evident by age 3
life-long disorder
5:1 (males:females)
Neurobiological Factors in Autism
Genetic
age of father
cerebellum abnormalities
amygdala and hippocampus abmormaliteis
fewer connections in corpus callous (speech)
abnormal frontal lobe functioning (fewer connections
between L/R)
more EEG abnormalities
more pregnancy and birth complications
excessive brain growth in 1st yr of lifeTreatment of Autism
- Behavior modification
- no medication for inability to relate
- medication for OCD/anxiety (SSRI’s)
- medication for mood (mood stabilizers/antidepressants)
- medications for agitation (antipsychotics in low dosage)
ADHD
- Inattention
- Hyperactivity-Impulsivity
* **symptoms occur in 2 or more settings
* **some symptoms must be present before age 12
Inattention (at least 6)
fails to pay attention to details difficulty sustaining attn not listening when spoken to not following instructions not completing tasks disorganized messy work losing things for tasks easily distracted forgetful in daily activities (also may be hyper focused if really like task)
Hyperactivity-Impulsivity (at least 6)
HYPERACTIVITY -fidgeting w/ hands or feet -squirming in seat -runs/climbs about excessively -has difficulty playing quietly -always on the go -often talks excessively IMPULSIVITY -blurts out answers -has difficulty awaiting turn -interrupts or intrudes on others
Types of ADHD
- Hyperactive-Impulsive type
- Inattentive type (often misdiagnosed as “dreamer”)
- Combined type (most people)
Prevalence/Gender of ADHD
7-9%
4:1 boys
boys==hyperactive
girls==inattentive
onset and course of ADHD
prior to age 12
2/3 ADHD continues into adolescence
50% diagnosed continue as adults
untreated can take toll on life
Etiology
- Biological (strongest)
- neurobiological disorder
- genetics
- dopamine/norepinephrine
- dysfunction in frontal lobes and basal ganglia - Psycho-social/ cultural factors
- chaos in home
- crowded living conditions, sedentary activity
- overstimulation (technology)
- larger classes (less tolerance)
- modern society doesn’t teach children how to quiet down
Treatment of ADHD
- MEDICATIONS
* *stimulants (standard)- improve 70% school aged kids
- increase dopamine activity (shuts down overactive lobe
- *antidepressants
- prozac, wellbutrin, strattera**
- BEHAVIORAL APPROACHES
* *immediate rewards
* *consistent parenting with clear consequences
* *structured environment
* *establish routines
* *modify school environment
* *teach self-instructional procedures
Comorbidity with ADHD
substance use oppositional defiant disorder conduct disorder depression anxiety disorders OCD spectrum learning disabilities (more boys than girls)
Disruptive Behavior Disorders
- Oppositional Defiant Disorder (ODD)
2. Conduct Disorder (CD)
Oppositional Defiant Disorder (ODD)
pattern of negativistic, hostile, and defiant behavior that may include…..
- temper
- argues with adults
- defies or refuses to comply with adult requests
- deliberately annoys people
- touch and easily annoyed by others
- angry resentful, blaming
- spiteful, vindictive
- *****GETS ALONG WITH PEERS
Conduct Disorder (CD)
repetitive pattern of behavior that violates social norms and the basic rights of others, including peers…
- aggression, intimidation bullying
- physical/sexual cruelty to humans or animals
- destroying property, fire setting
- lying cheating, stealing
- truant from school (before age 13)
- staying out at night (before age 13)
