Childhood Disorders

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Chapter 13

• Childhood Disorders

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Externalizing vs. Internalizing

• Externalizing disorders
• Disorders that include behaviors that are
  aggressive or disruptive.
• E.g., ADD/ADHD, Conduct disorder, oppositional
  defiant disorder, Tic disorders
• Internalizing disorders
• Disorders that stem from an underlying anxiety or
  depression.
• E.g., Separation anxiety disorder, reactive
  attachment disorder, other anxiety and mood
  disorders not unique to children
• These disorders are often overlooked.

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Separation Anxiety Disorder

• Children can be diagnosed with OCD, GAD, panic
  disorder, PTSD, depression, etc.
• However, separation anxiety disorder is specific
  to childhood.
• Marked by the display of heightened anxiety and
  distress in the child when that child is
  separated from caregivers.
• May stem from a slow development of object
  permanence.

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Separation Anxiety Disorder

• Excessive distress when separated from home or
  caregivers or when anticipating separation.
• Persistent and excessive worry about losing, or
  harm coming to, caregivers.
• Persistent reluctance or refusal to go to school
  or elsewhere because of fear of separation.
• Excessive fear of being alone.
• Reluctance to go to sleep without caregivers
  nearby.
• Repeated nightmares involving themes of
  separation.
• Repeated complaints of physical symptoms when
  separation occurs or is anticipated.

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Separation Anxiety Disorder

• Often develops after the child experiences some
  major life stress (parental separation, divorce).
• More likely to be seen in children coming from
  families that are caring and close-knit (that
  dont promote independence).
• Problems in attachment during the first two years
  of life (e.g., insecure attachment).
• Anxious-inhibited temperament
• Behavioral treatments very effective for this
  disorder.

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Reactive Attachment Disorder

• The child must exhibit a disturbed and
  developmentally inappropriate pattern of social
  relating in most situations before the age of 5.
• Meets one of the following
• Failure to initiate or respond in a
  developmentally appropriate way to most social
  interactions, as shown by inhibited, overly
  vigilant, or highly ambivalent and contradictory
  responses (inhibited type)
• Indiscriminate sociability, with noticeable
  inability to show appropriate selective
  attachment (e.g., excessive familiarity with
  strangers) (disinhibited type)

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Reactive Attachment Disorder

• Behaviors stem from a childs reaction to
  pathological care from a caregiver (e.g.,
  childhood abuse, neglect)
• Child must also have experienced
• Persistent disregard of basic emotional needs for
  comfort, stimulation, and affection
• Persistent disregard of basic physical needs
• Repeated changes of primary caregiver that
  prevent formation of stable attachments

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Elimination Disorders

• Enuresis
• Wetting of the bed or clothes at least twice a
  week for three months.
• Most often occurs at night.
• Quite common (15 to 20 of 5 year-olds)

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Enuresis

• May have its root in anxiety or an inability to
  express fears and need for attention.
• Bell and pad method most effective treatment

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Encopresis

• Repeated defecation into clothing or onto the
  floor.
• Rarer than enuresis (fewer than 1 and more
  common in boys).
• Underlying cause is not directly clear, although
  may stem from episodes of severe constipation.
• May also be rooted in anxiety.
• In severe cases, you may see fecal build-up or
  hardening or even leakage of fecal material.

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Pervasive Development Disorders

• Characterized by severe and lasting impairment in
  several areas of development, including social
  interactions, communication with others, everyday
  behaviors, interests, and activities.
• Autism is the most common
• Others include Aspergers syndrome, Retts
  disorder, and childhood disintegrative disorder.

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Autism

• Deficits in social interaction
• Little use of nonverbal behaviors that indicate a
  connection
• Failure to develop peer relationships
• Little expression of pleasure when others are
  happy
• Little reciprocity in social interactions
• Deficits in communication
• Delay in, or total absence of, spoken language
• In those who do speak, trouble initiating and
  maintaining conversations.
• Lack of make-believe play or imitation of others

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Autism

• Deficits in activities and interests
• Pre-occupation with certain activities or toys
  compulsive adherence to routines and rituals.
• Stereotyped and repetitive movements, such as
  head banging.
• Preoccupation with parts of objects and unusual
  uses of objects.
• Preference for sameness, routine, and lack of
  social contact may be due to an attempt to
  control exposure to overstimulation.

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Autism

• Effects 2 to 5 people, on average, in every
  10,000.
• About 75 of individuals with autism are also
  mentally retarded and most require lifelong care.
• The rate of autism is four to five times higher
  in boys than in girls.
• Girls more likely to exhibit severe mental
  retardation.

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Theories

• Two deficits that may be central to autism are in
  theory of mind and executive functions.
• Theory of mind
• The ability to infer the mental states of others
  (e.g., their intentions, beliefs, and desires)
  and to engage in abstract or symbolic thinking.
• Executive functions
• The cognitive operations (e.g., planning,
  inhibition of response, flexibility, and working
  memory) that are thought to be driven by the
  prefrontal cortex.

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Treatment

• To be successful, interventions must be intensive
  (at least 15 hours per week) and last six months
  or more.
• Behavioral training
• Shaping
• Prompting
• Discrimination training (learning when to make a
  response and when a response is not appropriate)
• SSRIs (improves some behavioral symptoms of
  autism)

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Aspergers Syndrome

• Milder form of Autism.
• Characterized by autism-like deficits in social
  interaction and in activities and interests.
• No delays in language.
• In the first three years of life, children with
  Aspergers show normal exploratory behavior (that
  is often absent in children with autism).

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Aspergers Syndrome

• Difficulties with interpersonal relationships.
• Display unusual obsessive-like behaviors (e.g.,
  memorizing, counting).
• Usually average intelligence although sometimes
  display extraordinary cognitive abilities.
• Formal in speech.
• Little professor syndrome.

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Conduct Disorder

• Chronic pattern of unconcern for the rights of
  others.
• 3 to 7 of children.
• Boys more often diagnosed with the disorder (3X
  more likely).
• Associated with the later development of
  Antisocial Personality Disorder, as well as
  criminality and violent behavior.

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Conduct Disorder

• Bullies, threatens, or intimidates others.
• Initiates physical fights.
• Uses weapons in fights.
• Engages in theft and burglary.
• Is physically abusive to people and animals.
• Forces others into sexual activity.
• Lies and breaks promises often.
• Violates parents rules.
• Runs away from home.
• Sets fires deliberately.
• Vandalizes
• Skips school often.

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Oppositional Defiant Disorder

• Less severe than conduct disorder.
• Symptoms
• Often loses temper
• Often argues with adults
• Refuses to comply with requests or rules
• Tries to annoy others
• Blames others for his/her mistakes
• Easily annoyed
• Angry and resentful
• Spiteful or vindictive
• Onset is earlier than conduct disorder.
• May develop in to conduct disorder.

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Theories

• Temperament of impulsivity
• Genetics
• Exposure to neurotoxins and drugs in the womb
  (may result in poor neurodevelopment which
  manifests itself through poor impulse control).
• Low cortisol
• High serotonin
• Higher levels of testosterone (dependent upon a
  context of social deviance)

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Social Factors

• Family environment marked by abuse, neglect,
  substance use, psychopathology
• Poor parenting
• Maladaptive cognitive processing (biased towards
  interpreting interactions as being aggressive)
• Maladaptive behavior reinforced by peer group or
  parents
• Modeling