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Comer, Abnormal Psychology, 6e Chapter 17,1,Chapter 17,Disorders of Childhood and Adolescence,Slides & Handouts by Karen Clay Rhines, Ph.D.Seton Hall University,2,Comer, Abnormal Psychology, 6e Chapter 17,Disorders of Childhood and Adolescence,Abnormal functioning can occur at any time in lifeSome patterns of abnormality, however, are more likely to emerge during particular periods,3,Comer, Abnormal Psychology, 6e Chapter 17,Childhood and Adolescence,Theorists often view life as a series of stages on the road from birth to deathFreud proposed that each child passes through the same five stages of psychosexual development: oral, anal, phallic, latency, and genitalErikson added the stage of “old age”Although theorists may disagree with the details of these schemes, most agree with the idea that we face key pressures during each stage in life and either grow or decline depending on how we meet those pressures,4,Comer, Abnormal Psychology, 6e Chapter 17,Childhood and Adolescence,People often think of childhood as a carefree and happy time yet it can also be frightening and upsettingChildren of all cultures typically experience at least some emotional and behavioral problems as they encounter new people and situationsSurveys indicate that worry is a common experience Bedwetting, nightmares, and temper tantrums are other problems experienced by many children,5,Comer, Abnormal Psychology, 6e Chapter 17,Childhood and Adolescence,Adolescence can also be a difficult periodPhysical and sexual changes, social and academic pressures, personal doubts, and temptation cause many teenagers to feel anxious, confused, and depressed,6,Comer, Abnormal Psychology, 6e Chapter 17,Childhood and Adolescence,Along with these common psychological difficulties, at least one-fifth of all children and adolescents in North America also experience a diagnosable psychological disorderBoys with disorders outnumber girls with disorders, even though most of the adult psychological disorders are more common in women,7,Comer, Abnormal Psychology, 6e Chapter 17,Childhood and Adolescence,Certain disorders of children childhood anxiety disorders and childhood depression have adult counterpartsIn contrast, other childhood disorders conduct disorders, ADHD, and elimination disorders, for example usually disappear or radically change form by adulthoodThere also are disorders that begin in birth or childhood and persist in stable forms into adult lifeThese include mental retardation and autism,8,Comer, Abnormal Psychology, 6e Chapter 17,Oppositional Defiant Disorder and Conduct Disorder,Children consistently displaying extreme hostility and defiance may qualify for a diagnosis of oppositional defiant disorder This disorder is characterized by repeated arguments with adults, loss of temper, anger, and resentmentChildren with this disorder ignore adult requests and rules, try to annoy people, and blame others for their mistakes and problemsApproximately 8% of children qualify for this diagnosisThe disorder is more common in boys than girls before puberty but equal in both sexes after puberty,9,Comer, Abnormal Psychology, 6e Chapter 17,Oppositional Defiant Disorder and Conduct Disorder,Children with conduct disorder, a more severe problem, repeatedly violate the basic rights of othersThey are often aggressive and may be physically cruel and violentMany steal from, threaten, or harm their victims, committing such crimes as shoplifting, vandalism, mugging, and armed robbery,10,Comer, Abnormal Psychology, 6e Chapter 17,Oppositional Defiant Disorder and Conduct Disorder,Conduct disorder usually begins between 7 and 15 years of ageAround 10% of children, three-quarters of them boys, qualify for this diagnosisChildren with a mild conduct disorder may improve over time, but severe cases frequently continue into adulthoodThese cases may turn into antisocial personality disorder or other psychological problems,11,Comer, Abnormal Psychology, 6e Chapter 17,Oppositional Defiant Disorder and Conduct Disorder,Many clinical theorists believe that there are actually several kinds of conduct disorderOne term distinguishes four patterns:Overt-destructiveOvert-nondestructiveCovert-destructiveCovert-nondestructiveSome individuals display only one of these patterns, while others display a combination of themIt may be that the different patterns have different causes,12,Comer, Abnormal Psychology, 6e Chapter 17,Oppositional Defiant Disorder and Conduct Disorder,Other researchers distinguish yet another pattern of aggression found in certain cases of conduct disorder relational aggression in which individuals are socially isolated and primarily display social misdeedsRelational aggression is more common in girls than boys,13,Comer, Abnormal Psychology, 6e Chapter 17,Oppositional Defiant Disorder and Conduct Disorder,More than one-third of boys and one-half of girls with conduct disorder also display attention-deficit/hyperactivity disorder (ADHD)In most cases, ADHD is believed to precede and help cause the conduct disorder,14,Comer, Abnormal Psychology, 6e Chapter 17,Oppositional Defiant Disorder and Conduct Disorder,Many children with conduct disorder also experience depressionIn such cases, the conduct disorder typically precedes the onset of depressive symptomsThis combination of symptoms places the individual at higher risk for suicide,15,Comer, Abnormal Psychology, 6e Chapter 17,Oppositional Defiant Disorder and Conduct Disorder,Many children with conduct disorder are suspended from school, placed in foster homes, or incarceratedWhen children between the ages of 8 and 18 break the law, the legal system often labels them juvenile delinquents,16,Comer, Abnormal Psychology, 6e Chapter 17,What Are the Causes of Conduct Disorder?,Cases of conduct disorder have been linked to genetic and biological factors, drug abuse, poverty, traumatic events, and exposure to violent peers or community violenceThey have most often been tied to troubled parent-child relationships, inadequate parenting, family conflict, marital conflict, and family hostility,17,Comer, Abnormal Psychology, 6e Chapter 17,How Do Clinicians Treat Conduct Disorder?,Because disruptive behavior patterns become more locked in with age, treatments for conduct disorder are generally most effective with children younger than 13A number of interventions have been developed but no one of them alone is the answer for this difficult problemGiven that conduct disorder affects all spheres of a childs life, todays clinicians are increasingly combining several approaches into a wide-ranging treatment program,18,Comer, Abnormal Psychology, 6e Chapter 17,How Do Clinicians Treat Conduct Disorder?,Sociocultural TreatmentsGiven the importance of family factors in conduct disorder, therapists often use family interventionsOne such approach is called parent-child interaction therapyA related family intervention is videotape modelingWhen children reach school age, therapists often use a family intervention called parent management trainingThese treatments often have achieved a measure of success,19,Comer, Abnormal Psychology, 6e Chapter 17,How Do Clinicians Treat Conduct Disorder?,Sociocultural TreatmentsOther sociocultural approaches, such as residential treatment in the community and programs at school, have also helped some children improveOne such approach is treatment foster careIn contrast to these other approaches, institutionalization in “juvenile training centers” has not met with much success and may, in fact, strengthen delinquent behavior,20,Comer, Abnormal Psychology, 6e Chapter 17,How Do Clinicians Treat Conduct Disorder?,Child-Focused TreatmentsTreatments that focus primarily on the child with conduct disorder, particularly cognitive-behavioral interventions, have achieved some success in recent yearsIn problem-solving skills training, therapists combine modeling, practice, role-playing, and systematic rewards,21,Comer, Abnormal Psychology, 6e Chapter 17,How Do Clinicians Treat Conduct Disorder?,Child-Focused TreatmentsAnother child-focused approach, Anger Coping and Coping Power Program, has children participate in group sessions that teach them to manage anger more effectivelyStudies indicate that these approaches do reduce aggressive behaviors and prevent substance use in adolescenceRecently, drug therapy also has been used,22,Comer, Abnormal Psychology, 6e Chapter 17,How Do Clinicians Treat Conduct Disorder?,PreventionIt may be that the greatest hope for reducing the problem of conduct disorder lies in prevention programs that begin in early childhoodThese programs try to change unfavorable social conditions before a conduct disorder is able to develop,23,Comer, Abnormal Psychology, 6e Chapter 17,Attention-Deficit/Hyperactivity Disorder,Children who display attention-deficit/hyperactivity disorder (ADHD) have great difficulty attending to tasks or behave overactively and impulsively, or bothThe primary symptoms of ADHD may feed into one another, but often one of the symptoms stands out more than the other,24,Comer, Abnormal Psychology, 6e Chapter 17,Attention-Deficit/Hyperactivity Disorder,Problems common to the disorder:Learning or communication problemsPoor school performanceDifficulty interacting with other childrenMisbehavior, often seriousMood or anxiety problems,25,Comer, Abnormal Psychology, 6e Chapter 17,Attention-Deficit/Hyperactivity Disorder,Around 5% of schoolchildren display ADHD, as many as 90% of them boysThose whose parents have had ADHD are more likely than others to develop itThe disorder usually persists through childhood but many children show a lessening of symptoms as they move into adolescenceBetween 35% and 60% continue to have ADHD as adults,26,Comer, Abnormal Psychology, 6e Chapter 17,What Are the Causes of ADHD?,Clinicians generally consider ADHD to have several interacting causes, including:Biological causes, particularly abnormal dopamine activityHigh levels of stress,27,Comer, Abnormal Psychology, 6e Chapter 17,What Are the Causes of ADHD?,Sociocultural theorists also point out that ADHD symptoms and a diagnosis of ADHD may themselves create interpersonal problems and produce additional symptoms in the childThree other explanations have received considerable press: ADHD is typically caused by sugar or food additivesADHD results from environmental toxins such as leadExcessive exposure to television can contribute to ADHD,28,Comer, Abnormal Psychology, 6e Chapter 17,How Do Clinicians Assess ADHD?,ADHD is a difficult disorder to assessIdeally, the childs behavior should be observed in several environmental settings because symptoms must be present across multiple settings in order to meet DSM-IV-TRs criteriaIt also is important to obtain reports of the childs symptoms from their parents and teachers,29,Comer, Abnormal Psychology, 6e Chapter 17,How Is ADHD Treated?,There is heated disagreement about the most effective treatment for ADHDThe most common approach has been the use of stimulant drugs such as methylphenidate (Ritalin)These drugs have a quieting effect on as many as 80% of children with ADHD and sometimes increase their ability to solve problems, perform in school, and control aggressionHowever, some clinicians worry about the possible long-term effects of the drugs,30,Comer, Abnormal Psychology, 6e Chapter 17,How Is ADHD Treated?,Behavioral therapy is also applied widely in cases of ADHDParents and teachers learn how to apply operant conditioning techniques to change behaviorThese treatments have often been helpful, especially when combined with drug therapy,31,Comer, Abnormal Psychology, 6e Chapter 17,How Is ADHD Treated?,Because children with ADHD often display other (comorbid) psychological disorders as well, researchers have further tried to determine which treatments work best for different combinations of disorders,32,Comer, Abnormal Psychology, 6e Chapter 17,The Sociocultural Landscape: ADHD and Race,Race seems to come into play with regard to ADHDA number of studies indicate that African American and Hispanic American children with significant attention and activity problems are less likely than white American children to be assessed for ADHD, receive an ADHD diagnosis, or undergo treatment for the disorderThose who do receive a diagnosis are less likely than white children to be treated with the interventions that seem to be of most help,33,Comer, Abnormal Psychology, 6e Chapter 17,The Sociocultural Landscape: ADHD and Race,In part, racial differences in diagnosis and treatment are tied to economic factorsA growing number of clinical theorists further believe that social bias and stereotyping may contribute to the racial differences seen in diagnosis and treatment,34,Comer, Abnormal Psychology, 6e Chapter 17,The Sociocultural Landscape: ADHD and Race,While many of todays clinical theorists correctly alert us that ADHD may be generally overdiagnosed and overtreated, it is important that they also recognize that children from certain segments of society may, in fact, be underdiagnosed and undertreated,35,Comer, Abnormal Psychology, 6e Chapter 17,Elimination Disorders,Children with elimination disorders repeatedly urinate or pass feces in their clothes, in bed, or on the floorThey have already reached an age at which they are expected to control these bodily functionsThese symptoms are not caused by physical illness,36,Comer, Abnormal Psychology, 6e Chapter 17,Enuresis,Enuresis is repeated involuntary (or in some cases intentional) bedwetting or wetting of ones clothesIt typically occurs at night during sleep but may also occur during the dayThe problem may be triggered by a stressful eventChildren must be at least 5 years of age to receive this diagnosisPrevalence of enuresis decreases with age,37,Comer, Abnormal Psychology, 6e Chapter 17,Enuresis,Research has not favored one explanation for the disorder over othersPsychodynamic theorists explain it as a symptom of broader anxiety and underlying conflictsFamily theorists point to disturbed family interactionsBehaviorists often view it as the result of improper toilet trainingBiological theorists suspect that the physical structure of the urinary system develops more slowly in some children,38,Comer, Abnormal Psychology, 6e Chapter 17,Enuresis,Most cases of enuresis correct themselves without treatmentTherapy, particularly behavioral therapy, can speed up the process,39,Comer, Abnormal Psychology, 6e Chapter 17,Encopresis,Encopresis repeatedly defecating in ones clothing is less common than enuresis and less well researchedThe problem:Is usually involuntarySeldom occurs during sleepStarts after the age of 4Is more common in boys than girls,40,Comer, Abnormal Psychology, 6e Chapter 17,Encopresis,Encopresis causes intense social problems, shame, and embarrassmentCases may stem from stress, constipation, improper toilet training, or a combination of all threeThe most common treatments are behavioral and medical approaches, or combinations of the twoFamily therapy has also been helpful,41,Comer, Abnormal Psychology, 6e Chapter 17,Long-Term Disorders That Begin in Childhood,Two of the disorders that emerge during childhood are likely to continue unchanged throughout a persons life:Pervasive developmental disordersMental retardationClinicians have developed a range of treatment approaches that can make a major difference in the lives of people with these problems,42,Comer, Abnormal Psychology, 6e Chapter 17,Pervasive Developmental Disorders,Pervasive developmental disorders are a group of disorders marked by impaired social interactions, unusual communications, and inappropriate responses to stimuli in the environmentThe group includes autistic disorder, Aspergers disorder, Retts disorder, and childhood disintegrative disorderBecause autistic disorder initially received so much more attention than the others, these disorders are often referred to as autistic-spectrum disorders,43,Comer, Abnormal Psychology, 6e Chapter 17,Autistic Disorders,Autistic disorder, or autism, was first identified in 1943Children with this disorder are extremely unresponsive to others, uncommunicative, repetitive, and rigidSymptoms appear early in life, before age 3There has been a steady increase in the number of children diagnosed and it appears that at least one in 600 and maybe as many as one in 200 children display the disorderAround 80% of all cases appear in boys,44,Comer, Abnormal Psychology, 6e Chapter 17,Autistic Disorders,As many as 90% of children with autism remain severely disabled into adulthood and are unable to lead independent livesEven the highest-functioning adults with autism typically have problems in social interactions and communication and have restricted interests and activities,45,Comer, Abnormal Psychology, 6e Chapter 17,What Are the Features of Autism?,The central feature of autism is the individuals lack of responsiveness, including extreme aloofness and lack of interest in peopleLanguage and communication problems take various formsOne common speech peculiarity is echolalia, the exact echoing of phrases spoken by othersAnother is pronominal reversal, or confusion of pronouns,46,Comer, Abnormal Psychology, 6e Chapter 17,What Are the Features of Autism?,Autism is also marked by limited imaginative play and very repetitive and rigid behaviorThis has been called a “perseveration of sameness”Many sufferers become strongly attached to particular objects plastic lids, rubber bands, buttons, water and may collect, carry, or play with them constantly,47,Comer, Abnormal Psychology, 6e Chapter 17,What Are the Features of Autism?,The motor movements of people with autism may be unusualOften called “self-stimulatory” behaviors; may include jumping, arm flapping, and making facesChildren with autism may engage in self-injurious behaviorsChildren may at times seem overstimulated and/or understimulated by their environments,48,Comer, Abnormal Psychology, 6e Chapter 17,Aspergers Disorder,Those with Aspergers disorder (or syndrome) experience the kinds of social deficits, impairments in expressiveness, idiosyncratic interests,