disorders of childhood and adolescence
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Disorders of Childhood and Adolescence
Abnormal functioning can occur at any time in life Children of all cultures typically experience at
least some emotional and behavioral problems as they encounter new people and situations
Surveys indicate that worry is a common experience Bedwetting, nightmares, temper tantrums, and restlessness are
other problems experienced by many children
Childhood and Adolescence
Childhood and Adolescence
Adolescence can also be a difficult period Physical and sexual changes, social and academic
pressures, personal doubts, and temptation cause many teenagers to feel anxious, confused, and depressed
Bullying Over one-quarter of students report being bullied
frequently, and more than 70% report having been a victim at least once
Childhood and Adolescence
Some disorders of children – childhood anxiety disorders and childhood depression – have adult counterparts
Other childhood disorders – elimination disorders, for example – usually disappear or radically change form by adulthood
There also are disorders that begin in birth or childhood and persist in stable forms into adult life These include autism spectrum disorder spectrum
disorder and intellectual developmental disorder
Separation Anxiety Disorder
displayed by 4 to 10% of all children
Extreme anxiety, often panic, whenever they are separated from home or a parent
Childhood Mood Problems: Major Depressive Disorder
Around 2% of children and 9% of adolescents currently experience major depressive disorder; as many as 20 percent of adolescents experience at least one depressive episode
Major Depressive Disorder
Depression in the young may be triggered by negative life events (particularly losses), major changes, rejection, or ongoing abuse
Childhood depression is characterized by such symptoms as headaches, stomach pain, irritability, and a disinterest in toys and games
Clinical depression is much more common among teenagers than among young children Suicidal thoughts and attempts are common in
teenagers
Bipolar Disorder
Often considered an adult mood disorder, whose earliest age of onset is the late teens Theorists suggest the diagnosis has become a clinical
“catchall” that is being applied to almost every explosive, aggressive child
The current shift in diagnoses has been accompanied by an increase in the number of children who receive adult medications
The DSM-5 task force concluded that the childhood bipolar label has been overapplied over the past two decades. To help rectify this problem, DSM-5 now includes a new category, disruptive mood dysregulation disorder (DMDD)
Disruptive Mood Dysregulation Disorder (DMDD)
Oppositional Defiant Disorder
Conduct Disorder
Children with conduct disorder, a more severe problem, repeatedly violate the basic rights of others Often aggressive and
may be physically cruel to people and animals
Many steal from, threaten, or harm their victims
Begins between 7 and 15 years of age
Conduct Disorder
Relational aggression: individuals are socially isolated and primarily display social misdeeds Slander Rumor-starting Friendship manipulation
More common among girls than boys
What Are the Causes of Conduct Disorder?
How Do Clinicians Treat Conduct Disorder?
Treatments for conduct disorder are generally most effective with children younger than 13
Today's clinicians are increasingly combining several approaches into a wide-ranging treatment program Sociocultural treatments Child-focused treatments Prevention
Sociocultural Treatments
Family interventions Parent-child interaction therapy Parent management training
Residential treatment Community-based
School programs
Child-Focused Treatments
Focus primarily on the child with conduct disorder Cognitive-behavioral interventions
Problem-solving skills training modeling, practice, role-playing, and systematic rewards
Anger Coping and Coping Power Program
Prevention Greatest hope for
reducing the problem of conduct disorder lies in prevention programs that begin in early childhood These programs try to
change unfavorable social conditions before a conduct disorder is able to develop
All such approaches work best when they educate and involve the family
Attention-Deficit/Hyperactivity Disorder
Children who display attention-deficit/hyperactivity disorder (ADHD) have great difficulty attending to tasks, behave overactively and impulsively, or both
The primary symptoms of ADHD may feed into one another, but in many cases one of the symptoms stands out more than the other
Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria for ADHD
What Are the Causes of ADHD?
Clinicians generally consider ADHD to have several interacting causes, including: Biological causes, particularly abnormal dopamine
activity, and abnormalities in the frontal-striatal regions of the brain
High levels of stress Family dysfunctioning
How Is ADHD Treated?
About 80% of all children and adolescents with ADHD receive treatment
There is, however, heated disagreement about the most effective treatment for ADHD The most commonly applied approaches are drug
therapy, behavioral therapy, or a combination Millions of children and adults with ADHD are currently
treated with methylphenidate (Ritalin), a stimulant drug that has been available for decades
Drug Therapy
Behavior Therapy and Combination Approaches
Behavioral therapy has been applied in many cases of ADHD Parents and teachers learn how to apply operant
conditioning techniques to change behavior These treatments have often been helpful, especially
when combined with drug therapy
Multicultural Factors and ADHD
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 disorder Those who do receive a diagnosis are less likely than
white children to be treated with the interventions that seem to be of most help, including the promising (but more expensive) long-acting stimulant drugs
In part, racial differences in diagnosis and treatment are tied to economic factors
Elimination Disorders
Children with elimination disorders repeatedly urinate or pass feces in their clothes, in bed, or on the floor
They have already reached an age at which they are expected to control these bodily functions These symptoms are not caused by physical illness
Enuresis
Encopresis
Comparison of Childhood Disorders
Long-Term Disorders That Begin in Childhood
Two groups of disorders that emerge during childhood are likely to continue unchanged throughout a person's life: Autism spectrum disorders Intellectual developmental disorder
Autism spectrum disorders are a group of disorders marked by impaired social interactions, unusual communications, and inappropriate responses to stimuli in the environment
Autism Spectrum Disorder
Autism spectrum disorder, or autism spectrum disorder, was first identified in 1943
Children with this disorder are extremely unresponsive to others, uncommunicative, repetitive, and rigid
Symptoms appear early in life, before age 3
Around 80% of all cases appear in boys
Autism Spectrum Disorder
As many as 90% of children the disorder remain significantly disabled into adulthood Even the highest-functioning adults with autism spectrum
disorder typically have problems in social interactions and communication, and have restricted interests and activities
Lack of responsiveness and social reciprocity Language and communication problems take various
forms One common speech peculiarity is echolalia, the exact
echoing of phrases spoken by others Another is pronominal reversal, or confusion of pronouns
Autism Spectrum Disorder: Asperger's Disorder
What Are the Causes of Autism Spectrum Disorder?
What Are the Causes of Autism Spectrum Disorder?
How Do Clinicians and Educators Treat Autism Spectrum Disorder?
Treatment can help people with autism spectrum disorder adapt better to their environment, although no known treatment totally reverses the autistic pattern
Treatments of particular help are cognitive-behavioral therapy, communication training, parent training, and community integration In addition, psychotropic drugs and certain vitamins
have sometimes helped when combined with other approaches
How Do Clinicians and Educators Treat Autism Spectrum Disorder?
How Do Clinicians and Educators Treat Autism Spectrum Disorder?
How Do Clinicians and Educators Treat Autism Spectrum Disorder?
How Do Clinicians and Educators Treat Autism Spectrum Disorder?
Intellectual Developmental Disorder
According to the DSM-5, people should receive a diagnosis of intellectual developmental disorder when they display general intellectual functioning that is well below average, in combination with poor adaptive behavior IQ must be 70 or lower The person must have difficulty in
such areas as communication, home living, self-direction, work, or safety
Symptoms must appear before age 18
Assessing Intelligence
Educators and clinicians administer intelligence tests to measure intellectual functioning These tests consist of a variety of questions and tasks
that rely on different aspects of intelligence Having difficulty in one or two of these subtests or areas of
functioning does not necessarily reflect low intelligence An individual's overall test score, or intelligence quotient (IQ), is
thought to indicate general intellectual ability
Assessing Intelligence
Many theorists have questioned whether IQ tests are indeed valid
Intelligence tests also appear to be socioculturally biased
If IQ tests do not always measure intelligence accurately and objectively, then the diagnosis of intellectual developmental disorder may also be biased That is, some people may receive the diagnosis partly
because of test inadequacies, cultural differences, discomfort with the testing situation, or the bias of a tester
Assessing Adaptive Functioning
Diagnosticians cannot rely solely on a cutoff IQ score of 70 to determine whether a person suffers from intellectual developmental disorder
Several scales, such as the Vineland and AAMR Adaptive Behavior Scales, have been developed to assess adaptive behavior For proper diagnosis, clinicians should observe the
functioning of each individual in his or her everyday environment, taking both the person's background and the community standards into account
What Are the Features of Intellectual Developmental Disorder?
The most consistent sign of intellectual developmental disorder is that the person learns very slowly
Other areas of difficulty are attention, short term memory, planning, and language Those who are institutionalized with intellectual
developmental disorder are particularly likely to have these limitations
What Are the Features of Intellectual Developmental Disorder?
Traditionally four levels of intellectual development disorder have been distinguished:
Mild IDD
Approximately 80% to 85% of all people with intellectual developmental disorder fall into the category of mild IDD (IQ 50–70) Interestingly, intellectual performance seems to improve
with age Research has linked mild intellectual
developmental disorder mainly to sociocultural and psychological causes, particularly: Poor and unstimulating environments Inadequate parent-child interactions Insufficient early learning experiences
Moderate, Severe, and Profound IDD
Approximately 10% of persons with intellectual developmental disorder function at a level of moderate IDD (IQ 35–49) They can care for themselves, benefit from vocational
training, and can work in unskilled or semiskilled jobs Approximately 3% to 4% of persons with
intellectual developmental disorder display severe IDD (IQ 20–34) They usually require careful supervision and can
perform only basic work tasks They are rarely able to live independently
Moderate, Severe, and Profound IDD
About 1% to 2% of persons with intellectual developmental disorder fall into the category of profound IDD (IQ below 20) With training they may learn or improve basic skills but
they need a very structured environment Severe and profound levels of intellectual
developmental disorder often appear as part of larger syndromes that include severe physical handicaps
What Are the Causes of Intellectual Developmental Disorder?
The primary causes of moderate, severe, and profound IDD are biological, although people who function at these levels are also greatly affected by their family and social environment Sometimes genetic factors are at the root of these
biological problems Other biological causes come from unfavorable conditions that
occur before, during, or after birth
What Are the Causes of Intellectual Developmental Disorder?
What Are the Causes of Intellectual Developmental Disorder?
What Are the Causes of Intellectual Developmental Disorder?
What Are the Causes of Intellectual Developmental Disorder?
Interventions for People with Intellectual Developmental Disorder
The quality of life attained by people with intellectual developmental disorder depends largely on sociocultural factors Intervention programs try to provide comfortable and
stimulating residences, social and economic opportunities, and a proper education
What is the Proper Residence?
Until recently, parents of children with intellectual developmental disorder would send them to live in public institutions – state schools – as early as possible
During the 1960s and 1970s, the public became more aware of these conditions and, as part of the broader deinstitutionalization movement, demanded that many people be released from these schools
What is the Proper Residence?
Since deinstitutionalization, reforms have led to the creation of small institutions and other community residences that teach self-sufficiency, devote more time to patient care, and offer education and medical services
Which Educational Programs Work Best?
Because early intervention seems to offer such great promise, educational programs for individuals with intellectual developmental disorder may begin during the earliest years
At issue are special education versus mainstream classrooms In special education, children with intellectual developmental
disorder are grouped together in a separate, specially designed educational program
Mainstreaming places them in regular classes Neither approach seems consistently superior Teacher preparedness is a factor that plays into decisions
about mainstreaming
When Is Therapy Needed?
People with intellectual developmental disorder sometimes experience emotional and behavioral problems Around 30% or more have a diagnosable psychological
disorder other than intellectual developmental disorder Some suffer from low self-esteem, interpersonal
problems, and adjustment difficulties These problems are helped to some degree by
individual or group therapy Psychotropic medication is sometimes prescribed
How Can Opportunities For Personal, Social, And Occupational Growth Be Increased?
People need to feel effective and competent to move forward in life
Those with intellectual developmental disorder are most likely to achieve these feelings if their communities allow them to grow and make many of their own choices
How Can Opportunities For Personal, Social, And Occupational Growth Be Increased?
Socializing, sex, and marriage are difficult issues for people with intellectual developmental disorder and their families
With proper training and practice, individuals with intellectual developmental disorder can learn to use contraceptives and carry out responsible family planning The National Association for Retarded Citizens offers
guidance in these matters Some clinicians have developed dating skills programs
How Can Opportunities For Personal, Social, And Occupational Growth Be Increased?
Adults with intellectual developmental disorder need the financial security and personal satisfaction that comes from holding a job Many can work in sheltered workshops, but there are
too few training programs available Additional programs are needed so that more people
with intellectual developmental disorder may achieve their full potential, as workers and as human beings
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