Childhood Disorders Flashcards
What are normal childhood behaviors?
Disobedience, agression, temper tantrums
When do these normal behaviors become an issues?
When children enter school, they should be able to control their behaviors. Otherwise they are at risk for problems adjusting, learning, and peer rejection
Conduct Disorder
Repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.
Aggression to People and Animals (CD)
- Bullies, threatens, or intimidates others
- Initiates physical fights
- Uses a weapon that can cause serious physical harm to others
- Physically cruel to animals
- Physically cruel to people
- Steals while confronting a victim
- Forces someone into sexually activity
Destruction of Property (CD)
- Deliberately engages in fire setting with intention of causing serious damage
- Deliberately destroys others’ property
Serious Violation of Rules (CD)
- Stays out at night despite parental prohibitions, beginning before age 13
- Runs away from home overnight at least 2 times while living in a parental (or surrogate) home, or 1 lengthy running away episode
- Truant from school, beginning before age 13
Conduct Disorder Diagnosis
3 (or more) criteria symptoms
Criteria present in the past 12 months
At least 1 criterion present in the past 6 months
Clinically significant impairment
Criteria not met for Antisocial Personality Disorder (if over age 18)
Subtypes of Conduct Disorder
Childhood Onset
- 1 symptom present before age 10
- Male, aggressive, few friends, become antisocial adults
Adolescent Onset
- No symptoms before age 10
- Less aggressive, have friends, unlikely to be antisocial adults
Terrie E. Moffitt
- Adolescence-Limited and Life Course-Persistent Antisocial behavior
- Antisocial behavior increases almost 10 fold temporarily during adolescence
- Peak at 17
- A small group engage in antisocial behavior at every stage of development
Life-Course Persistent
Children’s problems interact cumulatively, culminating into a pathological personality
Adolescence-Limited
A maturity gap encourages teens to mimic antisocial behavior in ways that are normative
Studies of Antisocial Behavior
- A steep incline in antisocial behaviors between ages 7 and 17
- By age 28, almost 85% of former delinquents stop offending
- One study found that 5% to 6% of offenders are responsible for 50% of known crimes
Associated Features of CD
- Little empathy
- More aggressive in ambiguous situations
- Misperceive intentions of others as more hostile
- Callous
- Lack of guilt or remorse
- Blame others for misdeeds
- Low self-esteem even though they may present as “tough”
- Early onset of sexual behavior, drinking, smoking, using drugs, and risk taking acts
- Suicidal ideation, attempts, and completions are at a higher rate than expected
- May be associated with lower than average intelligence (especially verbal)
- Learning and communication disorders
- Some studies: lower heart rate and lower skin conductance
- Hard to evaluate remorse (they learn that expressing guilt may reduce or prevent punishment)
Predisposing Factors of Conduct Disorder
- Parental rejection and neglect
- Difficult infant temperament
- Inconsistent child rearing practices with harsh discipline
- Physical or sexual abuse
- Lack of supervision
- Early institutional living
- Frequent changes of caregivers
- Large family size
- History of maternal smoking during pregnancy
- Peer rejection
- Association with delinquent groups
- Neighborhood exposure to violence
- Familial psychopathology (ASPD, substance dependence)
CD Statistics
- More common in males
- 1% to 10% of the general population
- Higher in urban settings
- Cultural implications?
- Adaptive? (have to act out to fit in in prison, stealing to eat)
CD Trajectory
- Lying, shoplifting, physical fighting
- Burglary
- Rape, theft
Edmund Kemper (Coed Killer)
- IQ 136
- Sadistic tendencies
- Tortured animals at age 10
- Locked in basement
- Sent to live with grandparents at age 16
- Paranoid, grandiose delusions
- Shot grandparents
- Sent back to mom, went on serial killer rampage and killed mom
Aggressive Children and cues
- They take in less cues
- Are less likely to seek information in ambiguous situations
- Tend to selectively attend to more provocative and aggressive cues
Aggressive Girls
Predominant Behaviors
- Lying
- Shoplifting
- Running away
- Truant
- Using drugs
- Engaging in prostitution
Gender Differences
- Girls have lower levels of physical aggression and crime
- Show more status violations (e.g. running away) and conflicts with authority
- Harm is caused through damage to relationships or social status within a group rather than physical violence
CD Etiology
- Influenced by both genetic and environment factors
- The risk for conduct disorder is increased with a sibling who is conduct disordered
- More common in children of parents who have ASPD, Alcohol Dependence, Schizophrenia, AD/HD, or Conduct Disorder
CD Developmental Factors
- Aggressive children are unpopular and excluded from peer groups
- Aggression as the more important reason a child is rejected by peers
- Perform below average in school achievement
- Low achievement, low vocabulary, and poor verbal reasoning have been found to correlate significantly with delinquency
- Their social and interpersonal skills are below average for their age
- Stealing - one of the more robust risk factors for delinquency
Posttraumatic Stress Disorder (PTSD)
- A severe psychological reaction, lasting at least one month and involving intense fear, helplessness, or horror, to intensely traumatic events
- An intense re-experiencing of the traumatic event through recollection or nightmares
- Due to war, natural disaster, civilian catastrophe, or personal trauma
- Acute Stress Disorder (before one month)
PTSD in Childhood
Potential traumatic events - Violence (i.e. physical abuse) - Witnessing violence - Divorce - Psychological abuse - Bitten by a dog Specific traumatic events that result from human intent (physical abuse, sexual abuse, threats) are more likely to cause PTSD versus accidents or natural disasters
How PTSD appears in youth
- Distressing dreams
- Generalized nightmares of monsters
- Rescuing others
- Threats to self or others
- Reliving the trauma may occur through repetitive play (reenacting a car accident with toys)
- Stomach and headaches
- The feeling that life will be too short to include becoming an adult
- Omen formation - the belief in an ability to foresee untoward events
PTSD & risk factors
Not everyone who is exposed to a traumatic event will develop PTSD
Factors that increase the likelihood of being exposed to trauma:
- Being male
- Having less than a college education
- Having conduct problems in childhood
- A family history of psychiatric disorder
- Scoring high on a measure of extraversion and neuroticisms (easily upset)
Protective Factors and PTSD
Breslau and Colleagues
- Collected IQ data from 6 year old children
- When they reached age 17, evaluated for trauma and PTSD
- Above 115 IQ were less likely to have experienced a traumatic event by 17
- If they had been exposed to trauma they were less likely to develop PTSD
Childhood Depression
- Withdrawal
- Crying
- Avoidance of eye contact
- Physical complaints
- Poor appetite
- Aggression
- Irritability (substituted for depressed mood in adults)
- In extreme cases - suicide
Etiology in Childhood Depression
- Association between parental depression and behavioral and mood problems in children
- Prenatal exposure to alcohol
- Exposure to stressful events
- Exposure to negative parental behavior
- Childhood depression more common in divorced families
Bipolar in Children and Adolescents
- 1% of general population
- High co-morbid diagnosis of AD/HD
- Is bipolar in children the new AD/HD?
Anxiety Disorders in Childhood
- Often under-recognized
- As common and debilitating as Disruptive Behavior Disorders
- All can apply to adults (except Separation Anxiety Disorder)
- Symptoms tend to be less cognitive and more physical
Social Phobia
- Fear of social or performance situations in which embarrassment might occur
- Onset usually in adolescence
- Most common fear is public speaking
- Paralyzing fear of strangers
- Withdrawn, mute, tantrums
- Stranger fear is normal at 8 months old
- Prevalence is 2-13% of children/adolescents
- Well-adjusted at home, but academic and social impairments at school
Generalized Anxiety Disorder
- Anticipatory anxiety about performance situations
- Doubt own capabilities
- Constantly seek approval
- Parental love conditional on “good” behavior
Separation Anxiety Disorder
- Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached
- Prevalence: 2 to 5%
- Course: appears before age 18, lasts several years, intensity fluctuates
Normal separation anxiety
- Peaks around 12 months old
- Disappears and then reappears intensely following life stressor
ADHD Inattention Symptoms
- Poor attention to detail or careless mistakes
- Difficulty sustaining attention in tasks or play
- Does not seem to listen when spoken to directly
- Does not follow through on instructions and fails to finish schoolwork, chores, or duties
- Difficulty organizing tasks and activities
- Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
- Loses things necessary for tasks or activities
- Easily distracted by extraneous stimiuli
- Forgetful in daily activities
