Disorders of Childhood and Adolescence Abnormal functioning can

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 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

All victims of bullying are upset by it, but some individuals seem to be more traumatized by the experience than others. Why might this be so?

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 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 Oppositional defiant disorder: Children with this disorder are repeatedly argumentative and defiant, angry and irritable, and, in some cases, vindictive. • Characterized by repeated arguments with adults, loss of temper, anger, and resentment • Children with this disorder ignore adult requests and rules, try to annoy people, and blame others for their mistakes and problems

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? Many cases of conduct disorder have been linked to genetic and biological factors, drug abuse, poverty, traumatic events, and exposure to violent peers or community violence They have most often been tied to troubled parent child relationships, inadequate parenting, family conflict, marital conflict, and family hostility

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 About half the children with ADHD also have: Learning or communication problems Poor school performance Difficulty interacting with other children Misbehavior, often serious Mood or anxiety problems

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 Many with ADHD are treated with methylphenidate (Ritalin), or other stimulant drugs It is estimated that 2. 2 million children in the US, 3% of all school children, take Ritalin or other stimulant drugs for ADHD

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: repeated involuntary (or in some cases intentional) bedwetting or wetting of one's clothes • Typically occurs at night during sleep but may also occur during the day • The problem may be triggered by a stressful event • Children must be at least 5 years of age to receive this diagnosis • Most cases of enuresis correct themselves without treatment

Encopresis– is less common than enuresis and less well researched • • Is usually involuntary Seldom occurs during sleep Starts after the age of 4 Is more common in boys than girls

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 The DSM 5 task force determined that Asperger’s Disorder is not a distinct disorder. Those who would previously receive a diagnosis of Asperger’s should now receive a diagnosis of autism spectrum disorder

What Are the Causes of Autism Spectrum Disorder? Psychological causes • Some theorists say people with autism spectrum disorder have a central perceptual or cognitive disturbance • Individuals fail to develop a theory of mind – an awareness that other people base their behaviors on their own beliefs, intentions, and other mental states, not on information they have no way of knowing • It has been theorized that early biological problems prevented proper cognitive development Sociocultural causes • Some clinical theorists have proposed that a high degree of family dysfunction, social and environmental stress is a factor in the disorder • Research does not support this theory

What Are the Causes of Autism Spectrum Disorder? Biological causes • While a detailed biological explanation for autism spectrum disorder has not yet been developed, promising leads have been uncovered • Examination of relatives keeps suggesting a genetic factor in the disorder • Prevalence rates are higher among siblings and highest among identical twins • Researchers have also identified specific biological abnormalities that may contribute to the disorder, particularly in the cerebellum

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? Cognitive Behavioral therapy • Behavioral approaches have been used in cases of autism spectrum disorder to teach new, appropriate behaviors – including speech, social skills, classroom skills, and self help skills – while reducing negative behaviors • Most often, therapists use modeling and operant conditioning • Therapies are ideally applied when they are started early in the children's lives • Given the recent increases in the prevalence of autism spectrum disorder, many school districts are now trying to provide education and training for autistic children in special classes • Most school districts, however, remain ill equipped to meet the profound needs of these students

How Do Clinicians and Educators Treat Autism Spectrum Disorder? Communication training • Even when given intensive behavioral treatment, half of the people with autism spectrum disorder remain speechless • They are often taught other forms of communication, including sign language and simultaneous communication • They may also use augmentative communication systems, such as “communication boards” or computers that use pictures, symbols, or written words, to represent objects or needs • Such programs also now use child initiated interactions to help improve communication skills

How Do Clinicians and Educators Treat Autism Spectrum Disorder? Parent training • Today's treatment programs involve parents in a variety of ways • For example, behavioral programs train parents so they can apply behavioral techniques at home • In addition, individual therapy and support groups are becoming more available to help parents deal with their own emotions and needs

How Do Clinicians and Educators Treat Autism Spectrum Disorder? Community integration • Many of today's school based and home based programs for autism spectrum disorder teach self help and self management, as well as living, social, and work skills • In addition, greater numbers of group homes and sheltered workshops are available for teens and young adults with autism spectrum disorder • These programs help individuals become a part of their community and also reduce the concerns of aging parents

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 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 (IQ 50– 70) Moderate (IQ 35– 49) Severe (IQ 20– 34) Profound (IQ below 20)

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? Chromosomal causes • The most common chromosomal disorder leading to intellectual developmental disorder is Down syndrome • Fewer than 1 of every 1000 live births result in Down syndrome, but this rate increases greatly when the mother's age is over 35 • Several types of chromosomal abnormalities may cause Down syndrome, but the most common is trisomy 21 • Fragile X syndrome is the second most common chromosomal cause of intellectual developmental disorder

What Are the Causes of Intellectual Developmental Disorder? Metabolic causes • In metabolic disorders, the body's breakdown or production of chemicals is disturbed • The metabolic disorders that affect intelligence and development are typically caused by the pairing of two defective recessive genes, one from each parent • Examples include: • Phenylketonuria (PKU) • Tay Sachs disease

What Are the Causes of Intellectual Developmental Disorder? Prenatal and birth related causes • As a fetus develops, major physical problems in the pregnant mother can threaten the child's healthy development • Low iodine may lead to cretinism • Alcohol use may lead to fetal alcohol syndrome (FAS) • Certain maternal infections during pregnancy (e. g. , rubella, syphilis) may cause childhood problems including intellectual developmental disorder • Birth complications, such as a prolonged period without oxygen (anoxia), can also lead to intellectual developmental disorder

What Are the Causes of Intellectual Developmental Disorder? Childhood problems • After birth, particularly up to age 6, certain injuries and accidents can affect intellectual functioning • Examples include poisoning, serious head injury, excessive exposure to x rays, and excessive use of certain chemicals, minerals, and/or drugs (e. g. , lead paint) • Certain infections, such as meningitis and encephalitis, can lead to intellectual developmental disorder if they are not diagnosed and treated in time

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 1960 s and 1970 s, 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