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Disorders of Childhood and Adolescence 10/26/
I. On Disorders in Childhood and Adolescence Child psychopathology- the study of disorders of childhood and adolescence. o DSM-I (1952) included childhood schizophrenia and adjustment reaction of childhood o DSM-II (1968) 6 childhood diagnoses o DSM-III (1980) 10 childhood diagnoses o DSM-IV (1994) 42 childhood diagnoses 1/5 kids have a diagnosable disorder that causes some interference w/ everyday functioning 1/10 suffers more significant functional impairment Pg. 46 Mental Retardation = Axis II, Clinical Syndromes = Axis I Pica- when a child eats a nonnutritive substance for at least one month. Tourrette’s- essential features include multiple motor tics and one or more vocal tics o Onset before age 7 o Persists into adulthood o More common in males than females o Often exists with OCD but not necessarily II. Mental Retardation- Axis II A. Diagnostic Criteria: o Significantly subaverage level of intellectual functioning (below 70) o Concurrent deficits or impairments in present adaptive functioning o Onset before 18 years of age
B. Onset before the age of 18; most common time of diagnosis is around 5 or 6 yrs., when entering kindergarten C. Approx. 1% of the population D. More common in males; for every 3 males, there are 2 females w/ mental retardation E. Degrees of mental retardation and prognosis: o Mild: IQ: 50- 85% of the retarded 6 th^ grade level o Moderate: 2 nd^ grade level Sheltered workshops o Severely: Requires close supervision o Profound: Requires constant aid and supervision F. Etiology- in approx. 30-40% of all cases, the cause of mental retardation is unknown o Heredity- inherited defect Tay-Sachs disease- a degenerative disease of the central nervous system; most common in Eastern European and Jewish ancestry o Early alterations of embryonic development- includes chromosomal changes or abnormalities that occur during the embryonic stage Ex: Down’s Syndrome- the most common chromosomal disorder, usually caused by an extra 21st^ chromosome; characterized by mild to severe mental retardation; can be taught to support themselves; 1/600-1/800 children has Downs III. Learning Disorders
o May act out in class o More likely to drop out of school 40% of kids w/ LD drop out of high school J. Etiology: o Genetic component o Prenatal things (drinking, smoking, etc.) o Medical conditions (lead poisoning, etc.) o SES o Larger families K. No cure, but individuals can learn to compensate for it IV. ADHD A. Diagnostic criteria on pg. 47 o Essential feature is a persistent pattern of inattention and/or hyperactivity-impulsivity, that is more frequent and severe than is typically observed in individuals at a comparable level of development B. Three subtypes of ADHD: o ADHD, combined type o ADHD, predominantly inattentive type o ADHD, predominantly hyperactive/impulsive type C. Elementary-age diagnosis D. Occurs in 3-5% of all elementary school children E. Significantly more common in boys F. ¼ kids with a learning disorder also have ADHD
G. More social problems, could have difficulty getting along with other kids; most common reason kids are taken to a psychiatrist/psychologist H. Symptoms typically decrease into adulthood I. Etiology: o Strong genetic component o Prenatal exposure to toxins (drinking, etc.) o Being deprived of oxygen during labor o No strong evidence that sugar or food additives cause ADHD J. Treated with stimulants, which seem to have a paradoxical effect Ritalin is the most commonly prescribed medication V. Autistic Disorder- has many other names; falls under “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence” AKA a “Pervasive Development Disorder (PDD)”. A. Diagnostic Criteria: o Qualitative impairment in social interaction- extreme difficulty socially interacting with someone o Qualitative impairment in communication- poor language development, if at all. o Restricted repetitive impairments and stereotyped patterns of behavior, interests, and activities- very routine; engage in odd mannerisms. B. Asperger’s Disorder- another PDD, separate from autism; will have difficulty socially interacting; will have different interests and know all the little facts about them; odd behavior patterns; unlike autism, someone with Asperger’s can develop communication skills and function, but they may still have difficulty forming relationships and interacting with others. o Autistic Spectrum Disorder- autism is at one end of the spectrum, and Asperger’s is at the other end. o The confusion between autism and Asperger’s may be clarified in the next edition of the DSM. C. Onset before the age of 3 D. DSM-IV-TR says that the prevalence is 5 cases per 10, o The CDC reported in 2007 that 1 out of 150 children would be born with autism; could even be as common as 1 out of 100. o These increasing statistics may be due to the fact that we are more aware of autism and the symptoms today; are they including individual’s with Asperger’s? or strictly autism?
o The acting out behavior is usually limited to the home environment. o More common in boys o Usually diagnosed between the age of 8- o Not all children with ODD grow up to develop a conduct disorder, but some do. It is the case, however, that almost all individuals with conduct disorder previously has ODD. o “ODD is to attention-deficit and disruptive behavior disorders as autistic disorder is to PDD” B. Conduct Disorder- (childhood-onset type; adolescent-onset type) pg. 48; must show at least three symptoms in the past 12 months. o Child violates society’s norms and the rights of other people; a much more significant and extreme level of ODD. o Criteria are not met for Antisocial Personality Disorder. o Childhood-onset type- onset of at least one criterion prior to 10 years of age; usually male; frequently display physical aggression toward others; disturbed peer relationships; more likely to develop adult Antisocial Personality Disorder; between 25-40% will develop APD. o Adolescent-onset type- absence of at least one criterion prior to age 10; less likely to display aggressive behaviors; tend to have more normal peer relationships; less likely to develop Antisocial Personality Disorder as an adult (only occurs in a few cases); more of the “acting out teenager”. o More generalized than ODD o More common in males than females o Occurs more often in urban settings, as opposed to rural settings. o Individually will almost always experience ODD prior to developing CD. C. Conduct Disorder and Juvenile Delinquency o Delinquency (acting unlawfully) is not synonymous with conduct disorder although the two of them frequently overlap Conduct – psychiatric construct Delinquency – legal construct D. Antisocial Personality Disorder (p. 49) o Can’t receive this diagnosis until 18 years
o Often time, they don’t feel bad about what they do (don’t experience remorse) o Psychopath/Sociopath – used synonymously in our case E. Causal factors of oppositional defiant disorder and conduct disorder o Genetic factors o Family factors o Peer factors o Social factors F. Treatment of oppositional defiant disorder and conduct disorder o Family Therapy- focus on the child, the parent, the family, the environment o Behavioral Control Techniques Use more reinforcement and less punishment VII. Enuresis (bed wetting) A. Diagnostic Criteria (p. 45) o At least 5 years old o 2x a week for 3 months o OR significantly distressing or dysfunctional o Not the result exclusively of medical condition or substance use B. Age of Onset o Primary Enuresis – begins around 5 o Secondary Enuresis – Begins after a period of established urinary continence – usually between 5- C. Prevalence
80% success rate 2 Foil sheets connected to an alarm Cloth pad inserted in between the 2 foil sheets If the child wets the bed, the circuit is completed and the alarm rings to awaken the child VII. Anxiety Disorders of Childhood and Adolescence Common among children More common in girls than in boys Typically does not continue into adolescence or adulthood Causal Factors o Constitutional Sensitivity o Behavioral inhibition – don’t like change o More or less, shy o Early Illnesses, accidents, or losses o Hospitalization o Overanxious and protective parents o Indifferent and detached parents A. Separation Anxiety (page 50) o Only given to someone with onset before age 18 (generally given much earlier in childhood) Disturbance has to last for at least 4 weeks o More common in girls o Separation Anxiety Disorder is not an extension of normal separation anxiety that children may experience in the first few years of life
B. School Phobia- used to be defined as an unrealistic fear that keeps children away from school; today it is considered simply another symptom of Separation Anxiety Disorder. o Characteristics: Not truants Average of above average IQs Average or good students Evenly distributed between the ages of 5 and 15 Equally likely to be boys or girls Professional parents o The goal is to reintegrate the child into the classroom; easier to do with a younger child. IX. Childhood Depression A. May experience a period of the blues; may experience symptoms of depression; may experience a full- blown case of depression and be diagnosed with a Major Mood Disorder (clinically depressed). B. 10-15% of children adolescents have symptoms of depression. o No such thing in the DSM as “childhood depression”; children and adults will be diagnosed similarly. o If the child is extremely irritable, it is counted as a symptom of being sad. o 15-20% of youth will experience an episode of minor depression before the age of 20. C. Before adolescence more common in boys After adolescence more common in girls D. Causal factors o Genetic component o Prenatal exposure to alcohol o Learning of maladaptive behaviors
B. On sleep o An EEG will show what stage of sleep you are in. Stage 1- falling feeling; very light sleep Stage 2- spindles (bursts of activity) Stage 3 & 4 have delta waves, and are often grouped together REM sleep- dreaming stage o Each sleep cycle lasts about 90 min. C. Sleep disturbances
- Nightmares, night terrors, and sleep terror disorder Nightmares- frightening dreams that typically occur during REM sleep; more likely to occur later at night or earlier in the morning. Nightmares/dreams are more likely to be recalled if as soon as we wake up, we consciously try to remember what it was about. Night terror- abrupt awakening form sleep, usually beginning with a panicky scream or cry, that typically begins during the first third of sleep (during Stage 4) and lasts about 1- minutes; child has no memory of the night terror in the morning. In order to constitute a disorder , the child must meet the criteria for a sleep disorder (pg. 51) There is a relationship between adult sleep terror disorder and increased psychopathology; it is often the case that they have some other emotional problem as well. Tend to run in families. More common in boys (children), equally common in adults.
- Sleepwalking (somnambulism)- rising from bed usually during the first third of sleep (during stage 4) and lasting only a few minutes (can last up to half an hour). 10-30% of children and adolescence will have at least one episode of sleepwalking o Sleepwalking disorder- recurrent episodes of sleepwalking Sleepwalkers should be awakened gently so that they aren’t alarmed or startled. No impairment of mental activity when being awakened. Individual will probably not remember the sleepwalking. Make sure that there is a safe environment for sleepwalkers (lock doors, baby gates, etc.) Decreases in frequency as you grow older We do not know why people sleepwalk; it does run in families. More common in girls (children), more common in men (adults)
Eating Disorders 10/26/
I. Anorexia Nervosa- literally means “lack of appetite induced by nervousness”; in actuality, involves an extremely thin individual who is intensely afraid of gaining weight.
Of individuals admitted to university hospitals, long-term mortality is 10% Death most commonly results from starvation and suicide (depressive symptoms are an associated feature) I. Etiology: Biological factors- chart next to pg. 43 Psychological- fear of growing up, need to control, malfunctioning family (perfectionists, not receiving attention, etc.) Social- stress, societal pressure to be slender J. Treatment Obstacles to treatment: o Do not acknowledge that they even have a problem o Reluctant to seek treatment o High treatment dropout rate Kinds of treatment: o Hospitalization (to get them to a normal body weight) o Family therapy o Long term support No evidence that medication helps II. Bulimia Nervosa - literally means “so hungry they could eat an ox”. A. Typically begins in late adolescence or early adult life (20-24 years old); slightly later than anorexia. B. 1-3% of adolescent girls and young women suffer from bulimia. C. 90% of bulimics are female.
D. 5 criteria (pg.52): o Recurrent episodes of binge eating (eating more than a normal amount w/ a sense of lack of control over eating). Don’t generally plan binging in advance; are often ashamed of their binging behaviors and will do it in secret; may have certain “triggers” to cause a binge; most bulimics are within a normal weight range. o Recurrent inappropriate compensatory behaviors in order to prevent weight gain. Purging (self-induced vomiting, laxatives). Nonpurging (fasting, excessive exercise). ALL bulimics binge, but NOT all bulimics purge. Vomiting is the most common compensatory behavior (80-90% of all cases of bulimia). o Binge eating and compensatory behaviors both occur on average, at least twice a week for 3 months. This type of criteria is not given for anorexia. o Self-evaluation is unduly influenced by body shape and weight. Appearance is more important than it should be to the individual. o The disturbance does not occur exclusively during episodes of Anorexia Nervosa. Anorexia takes precedent over bulimia (meet the criteria anorexia diagnosed with anorexia, not bulimia) E. Compensatory Behaviors F. Types of bulimia nervosa o Bulimia Nervosa, Purging Type- prevents weight gain by regularly engaging in purging behavior; 80-90%. o Bulimia Nervosa, Nonpurging Type- prevents weight gain by fasting or exercising excessively. G. Anorexia very thin, Bulimia not necessarily thin (normal weight range) H. Gastric/stomach problems (from vomiting), tooth decay (dentist is often the first one to recognize the bulimia), loss of hair. I. Bulimia is often chronic and intermittent over a period of many years; seldom incapacitating.
Cognitive Disorders 10/26/
I. Overview DSM category: “Delirium, Dementia, and Amnestic and other Cognitive Disorders” Cognitive disorders- the predominant disturbance in this category is a clinically significant deficit in cognition that represents a significant change from a previous level of functioning. For each disorder in this section, the etiology is either: o A general medical condition (although the specific general medical condition may not be identifiable) o A substance (i.e. a drug of abuse, medication, or toxin) o A combination of these two above factors II. Delirium A. Diagnostic criteria o Disturbance of consciousness o A change in cognition that is not related to dementia o The disturbance develops over a short period of time and tends to fluctuate during the course of the day (acute with intense symptoms) B. Medical diseases, the trauma of surgery, illicit drugs, medications, high fever, infections o The most common cause of delirium is either drug intoxication or drug withdrawal C. Course/prognosis: o Can occur at any age, but seems to be more common among elderly people o Typically reversible/will go away o Treatment usually involves medication of some kind o If left untreated for a long period of time, may cause some brain damage III. Amnesia A. Diagnostic criteria
o The development of memory impairment o Memory disturbance causes significant impairment in social/occupational functioning and represents a significant decline from a previous level of functioning o The memory disturbance does not occur exclusively during the course of a delirium or a dementia. o Anterograde amnesia- inability to learn new information o Retrograde amnesia- inability to recall previously learned information B. Caused by brain damage due to: o Strokes o Head injuries o Exposure to toxins o Chronic substance abuse o Not all brain damage is permanent. For example, Korsakoff’s syndrome is an amnesic disorder caused by a deficiency of vitamin B (thiamine). It can be reversed if detected early. IV. Dementia A. The causes are what differentiate the different kinds of dementia o Most typically depressive and chronic Diagnostic criteria: o The development of multiple cognitive deficits manifested by both memory impairment and one (or more) of the following: Aphasia- the deterioration of language function oftentimes manifested by difficulty producing the names of individuals and objects; ex: know what something is, but can’t get the word out. Apraxia- the impaired ability to execute motor activities despite intact motor abilities, sensory function, and comprehension of the required task; ex: want to wave their hand, and they understand it, but they can’t make it happen. Agnosia- the failure to recognize or identify objects despite intact sensory function; ex: Grandma does not know who you are. Disturbance in executive functioning- involves the inability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior; ex: can’t cook a meal because it involves too many different steps. o Cognitive deficits cause significant impairment in social/occupational functioning and represent a significant decline from a previous level of functioning.
