Lecture 14: Disorders of Childhood

Question 1

Behavioural indicators of disorder

Answer 1

• Developmental delay
• Developmental regression or deterioration
• Extremely high or low frequency or intensity of behaviour
• Behavioural difficulty persisting over time
• Behaviour inappropriate to situation
• Abrupt changes in behaviour
• Several problem behaviours
• Behaviour qualitatively different from normal

Question 2

Identification of problems of youth

Answer 2

• Development, cultural, gender, situational, norms
• Changing views of abnormality
• Role of adults

Question 3

How problems must be expressed in childhood - DSM5

Answer 3

• Behavioural externalising disorders = conduct, oppositional defiant, disruptive
• Emotional internalising disorders = anxiety, depression
• Neurodevelopmental & learning disorders = intellectual disability, autism spectrum, communicating + learning disorders, ADHD
• Problems related to physical & mental health = health-related & substance use disorders, feeding + eating disorders, child maltreatment

Question 4

Gender prevalence

Answer 4

• Higher for males = autism, oppositional disorder, drug abuse, intellectual disability, ADHD, conduct disorder, language disorder, reading disability
• Higher for females = anxieties & fears, depression, E.D

Question 5

ADHD

Answer 5

Neurodevelopmental disorder reflecting different development of brain affecting attentional processes which impacts upon a child’s behaviour compromising their ability to function in their envs.

Question 6

Causes of ADHD

Answer 6

• Genetic factors = ADHD runs in families
  = executive functions
  = autonomic under-arousal
  = need more frequent & high incentive rewards
  = aversion to delay
  = temporal processing (underestimate passage of time)
• Psychosocial factors = neurobiological effects of living in a disadvantaged enc.

Question 7

ADHD controversies

Answer 7

• Food additives cause ADHD

- Some evidence that diet can impact symptoms for some children

Question 8

Frequency

Answer 8

• About 5% of all school age children
• 3:1 male to female
• Increased rates in children who = live in urban areas, have health problems, are dev. impaired, from lower SES situations

Question 9

ADHD diagnosis

Answer 9

• Symptoms of inattention
• Hypersensitivity
• Impulsivity
• Additional criteria

Question 10

1) Symptoms of inattention - at least 6 of following

Answer 10

• Make careless mistakes
• Difficulty sustaining attention
• Avoid things that require sustained mental effort
• Seems to not listen when spoke to
• Fails to follow through on chores etc.
• Has difficulty in organising activities
• Easily distracted
• Forgetful
• Loses things

Question 11

Hypersensitivity - at least 6 of following

Answer 11

• Fidgets with hands/feet or squirms in seat
• Runs + climbs excessively
• Leaves seat
• Talks excessively
• Cannot play quietly
• “on the go”

Question 12

Impulsivity

Answer 12

• Blurts out answers before Q is completed
• Difficulty waiting turn
• Often interrupts others

Question 13

Additional criteria

Answer 13

• Can be one of 3 types = ADHD Predominantly Inattentive, ADHD Predominantly Hyperactive/Impulsive or ADHD Combined presentation
• Needs to be counter to dev. level as normal kids do these things
• Symptoms must be = occurring before 12 & for at least 6 months
  = pervasive across settings
  = interfere with areas of functioning

Question 14

Common comorbid conditions

Answer 14

• Academic underachievement & LDs
• Aggression & conduct issues
• Emotional liability
• Social skills deficits

Question 15

Behavioural-externalising disorders

Answer 15

• Problems of under-control where behaviours tend to put young in conflict with others
• Disruptive, impulsive, antisocial…
• Young people with these have high rates of referral in MH, youth, justice

Question 16

DSM Diagnosis of conduct disorder

Answer 16

• Repetitive + persistent pattern of behaviour that violates basic rights of others & societal norms
• 15 criteria organised into 4 categories = 1) aggression to people & others
  = 2) destruction of propoerty
  = 3) deceitfulness or theft
  = 4) serious violation of rules
• 3 or more behaviours over past 12 mnths with at least 1 in last 6 months
• Behaviour must cause clinically meaningful impariment in social/academic functioning

Question 17

Are conduct problems a mental problem?

Answer 17

Depends on the context

Question 18

ADHD changes over development

Answer 18

• Overt activity levels decreased through childhood
• Regulation skills increased with age & in consistent envs.
• Attention deficits remain, with some capacity for compensation

Question 19

Assessment

Answer 19

• Connor’s parent & teacher rating scales

- Full clinical assessment interview with parents + child

Question 20

Factors that decrease likelihood of making a diagnosis in childhood

Answer 20

• Girls
• Giftedness
• ADHD-Inattentive type
• Good supportive family
• Good social skills
• Good sporting ability

Question 21

Treatment

Answer 21

• Medication = ritalin
• School = learning programs, env. adaptation, behaviour programs
• Family = parenting training, family/individual therapy, social stressors