Disorders of Childhood & Adolescence

Transcription

1 Disorders of Childhood & Adolescence I. ISSUES A. Child vs. Adult Psychopathology - Problems less severe/frequent in childhood - Same problem can look different - Some problems primarily in childhood B. Types of Disorders 1. Internalizing (overcontrolled) = problems within - Less noticed by adults - More common in girls 2. Externalizing (undercontrolled) = manifested externally - Mostly boys - More referred for tx C. Normal vs. Abnormal Development - Normal at one age = abnormal at another - Period of rapid change - Harder to determine pathology in children Normal is age-dependent D. Child problems are reciprocal in nature 1. Blame the child - Infant temperament 2. Blame the parents - Schizophrenogenic & refrigerator mothers 3. Reciprocal process - difficult kids elicit worse caregiving - Intervention = parent-child interaction E. Children are dependent on others - more likely to get victimized - need parent/teacher involvement

2 II. BEHAVIORAL DISORDERS A. Attention- Deficit Hyperactivity Disorder (ADHD) - Inattention - Hyperactivity - Impulsivity Learning problems Discipline Poor peer relations - 3-6% of all children - Boys - Over-diagnosed? - CNS: BIS/BAS - Genetic - NOT sugar - Parenting can exacerbate, cannot cause 3. Treatment - 1/3 recover a. Stimulant medication - works for 75% - few side effects - effects are immediate - reduces inattention & impulsivity -> focus in classroom & at sports -> improves peer relations - cannot teach good behavior b. Behavior therapy - teach appropriate behavior via rewards & punishments - Parent training - School involvement - Must continue for long period - Best = Medication + behavior tx B. Oppositional Defiant Disorder (ODD) & Conduct Disorder (CD)

3 a. ODD - negativitist, hostile, defiant b. CD - truancy, fire-setting, theft, aggression, cruelty 3-4% to 10% - boys Family - Parenting: criticism & poor monitoring - Parent modeling of poor self-control & antisocial tendencies - Stressful events (divorce) Cognitive skills - hostile attributions - poor problem-solving Biology - some genetic evidence - lower baseline arousal 3. Treatment - Parent training: time out & positive reinforcement - Negotiation with adolescents - Cognitive treatments: problem-solving, self-control - Family Systems Therapy

4 III. COGNITIVE DISORDERS A. Autism very severe Inability to relate to other people - little communication - lack of affection/interest in others - self-absorption Absent or deficient speech ~ ½ = no speech, primitive gestures ~ = some words with oddities (e.g., echolalia) Behavior - limited, rigid - stereotyped, self-stimulatory behaviors - self-injurious & aggressive - preservation of sameness MR & LD = common in 10,000 (rare) % are boys 3. Etiology 1940s - Kanner: innate inability to relate (biological) 1950s - refrigerator mother => withdrawal (environment) - Current: neurological basis: prenatal or birth complications 4. Treatment - difficult; poor prognosis - 5% capable of jobs but still emotionally isolated - rest = mild care-taking skills - best: if speak before 5, higher IQ, & mild symptoms - Institutionalization is common Behavior modification - reinforce social behaviors - sign language - parents & teachers as co-therapists

5 Aversive conditioning Facilitation IV. MOOD & ANXIETY DISORDERS A. Anxiety - School Phobia - Separation Anxiety - Specific fears or phobias - Others as in adults (e.g., GAD) - Most fears are common in children - Extreme degree or duration, impairment - very common to uncommon - equal in boys & girls - Biology: fearful, anxious temperament - Learning: observe others fears parents reinforce fears overprotective parental style 3. Treatment Behavioral - Flooding - Systematic desensitization - Reward for success Cognitive - Re-appraisal of feared situation - Relaxation strategies Behavioral therapy = most effective Medication - not as well-documented in kids ** Best = include parents

6 B. Depression - Like adults sad, crying, hopeless, low self-worth, sleep & appetite problems, lethargy - Unlike adults behavioral problems, clinging, delinquency - but few consistencies - more like adults than not - similar to adult bereavement % boys & girls, more in teens - equally common in boys & girls Biological - possible genetic predisposition Learning - learned helplessness - reduced reinforcers Cognition - unrealistically negative - poor coping - poor social skills 3. Treatment Play therapy - child works through conflicts via play - no evidence for efficacy Social skills training Increase pleasant activities Cognitive therapy Medication - somewhat effective for children - less effective for adolescents Change the environment

7 V. EATING DISORDERS - Anorexia & Bulimia a. Anorexia - refusing to eat due to fear of weight gain - distorted body image - life-threatening b. Bulimia - bingeing & purging - distorted body image - not usually life-threatening - often normal weight Key = lack of control a. Anorexia - < 1% of year-olds b. Bulimia - < 5% of teens/young adults (4.5% female,.5% male) Identity issues - independence from parents - fear of growing sexuality Societal pressures for thinness 3. Treatment - Very difficult Family therapy - break power struggle - appropriate separation Cognitive therapy - Identify & express emotions - Boost self-esteem - Change irrational beliefs Hospitalization - IV fluids & goal weights

8 VI. ELIMINATION DISORDERS - Enuresis & Encopresis - wetting/soiling self beyond usual age (~5) - Primary = hasn t yet learned control vs. - Secondary = learned control but lost - Nighttime is more common - Daytime = maybe serious problem - Sense of no self-control (low self-esteem) - Enuresis: 15-20% of 5-year-olds 5% of 10-year-olds - Encopresis:.3-8% of children (usually secondary) - Boys Conflict with parents - self-control Emotional disturbance - anxiety, stress, family disruption Failure to learn - associate full bladder/bowel with toilet 3. Treatment - Easy & quick Eliminate biological causes Deal with emotional disturbance Behavioral techniques - wake in night after urination Wee Alert) - Praise for success - Mild punishment for wetting/soiling (wash sheets & clothes) Prevent: relaxed & positive toward toileting

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