Adolescent Problems - DSM

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Adolescent Problems - DSM IV

• Disorders usually first diagnosed in infancy,
  childhood, or adolescence
• Mental Retardation
• Learning Disorders
• Developmental Coordination Disorder (motor
  coordination)
• Expressive Language Disorder (standardized tests
  of expressive language)
• Phonological Disorder (speech sounds)
• Stuttering
• Autistic Disorder (social interaction deficits)

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• Retts Disorder (head size, hand movement, social
  engagement deficits after early normality)
• Childhood Disintegrative Disorder (after normal
  development, progressive deterioration of
  language, social, physical skills)
• Aspergers Disorder (nonverbal behaviors, peer
  skills, peer enjoyment, emotional reciprocity)
• ADHD
• Pica (eating objects)

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• Rumination (regurgitation, rechewing)
• Feeding Disorder (failure to eat adequate amount)
• Tourettes Disorder (motor, vocal outbursts)
• Encopresis (feces)
• Enuresis (wetting)
• Separation Anxiety Disorder (excessive anxiety)
• Selective Mutism
• Reactive Attachment Disorder (hypervigilant or
  diffuse attachments)
• Stereotypic Movement Disorder (repetitive and
  non-functional motor behavior)

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• Conduct Disorder (rights of others are violated)
  as early as 5-6, usually in late childhood or
  early adolescence, rarely after 16
• Oppositional Defiant Disorder (negativistic,
  defiant, disobedient, hostile behavior toward
  authority figures) usually before age 8

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• Externalizing problems
• Problem behavior theory
• Risky automobile driving
• Substance use
• Delinquency and crime
• Factors involved in risk behavior
• Internalizing problems
• Depression
• Eating disorders

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Two Broad Problem Types

• Externalizing Problems create difficulties in a
  persons external world (a.k.a.
  undercontrolled)
• Tend to go together (a person that fights is also
  more likely to commit other crimes)
• More common among males
• Often motivated by desire for excitement, not
  necessarily underlying unhappiness or
  psychopathology
• Internalizing Problems primarily affect a
  persons internal world (A.k.a. overcontrolled)
• Tend to go together (a person who is depressed is
  also more likely to have an anxiety disorder)
• More common in females
• Associated with experiencing distress

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Problem Behavior Theory

• Problem Behavior Syndrome Pattern of
  correlations between externalizing problems
• Theory Problems have common origins
• Background factors e.g., family income
• Personality factors e.g., self-esteem
• Social factors e.g., parental control

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Monitoring the Future, 2006 Any illicit drug
use
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Cigarettes
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Alcohol
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LSD
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Cocaine
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Other narcotics, including OxyContin,
VicodinIncrease in 2002 due to inclusion of
more types of drugs in the survey question
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Ecstasy
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Shopes Model of Young Driver Crash Risks (2002)
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Driver Crash Involvement Property Damage
Rates per 100,000 1997
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Driver Crash Involvement Injury
Rates per 100,000 1997
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Driver Crash Involvement Fatality
Rates per 100,000 1997
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Prevention Two Approaches

• Driver Education
• Generally hasnt worked too well
• Get your license fasteryoure out there driving
  and getting into accidents!
• Graduated Driver Licensing (GDL)
• More effective
• Address a variety of risk factors
• Restrict the conditions under which novices can
  drive

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Graduated Licensing Strategy

• Three Stages to a GDL program
• Learning License getting driving experience
  under supervision of experienced driver
• Restricted License can drive unsupervised, but
  with restrictions designed to reduce crashes
  (e.g., driving curfews)
• Full License after 1 year restricted

L
N
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Substance Use

• Alcohol
• Cigarettes
• Illegal drugs (e.g., marijuana, cocaine, LSD,
  ecstasy)

Adolescent substance use became target of a
great deal of political attention, public policy
programs and research In the 1980s and beyond.
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Substance Use, 1975-1999
Source Monitoring the Future, 2000
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Alcohol Marijuana Use by Age
Notice the higher levels of use during age when
unstructured socializing is most prevalent
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Sequence of Substance Use

1. Drinking beer and wine
2. Smoking cigarettes and drinking hard liquor
3. Smoking marijuana
4. Using hard drugs

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Adolescents use in different ways
Experimental curiosity to see what its like Once or twice
Social Use during social activities with one or more friends
Medicinal To relieve unpleasant emotional state such as sadness or anxiety
Addictive Dependency either physical or psychological
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Delinquency and Crime Definitions

• Delinquency when juveniles commit crimes
• Status Offences only a violation of the law
  because committed by juvenile
• Index Crimes serious crimes at any age
• Violent Crimes
• Property Crimes
• 3. Nonindex Crimes less serious offenses such
  as gambling, disorderly conduct

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Age and Crime
1842
1977
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Two Types of Delinquency
(Moffit, 1993)

• Life-course-persistent delinquents
• Pattern of problems from birth on up
• Originate in neuropsychological deficits
  (difficult temperament, LD)
• Likely to grow up in high risk environment
• Adolescent-delimited delinquents
• No signs of problems in infancy or childhood
• Period of occasional criminal activity between
  ages of 12-25 (e.g., vandalism, illegal drug use)

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Preventing Crime Delinquency

• Prevention programs for children who show signs
  of risk for LCPD and for adolescents engaging in
  serious delinquency
• Varied Strategies
• Individual therapy
• Group therapy
• Vocational training
• Outward Bound type programs
• Scared Straight Boot Camp type programs

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Preventing Crime Delinquency

• Two problems with prevention programs
• Participation is typically non-voluntary or
  against ones will
• Prevention comes too late (in adolescence) after
  behavior patterns have been established

• The Multisystemic Approach has been met with some
  success
• MST includes parent training, job training,
  vocational counseling, development of
  neighborhood activities and centers directing
  the energy of delinquents in positive directions.

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Preventing Crime Delinquency
Multisytemic therapy (MST) vs. usual Juvenile
Justice Services for serious adolescent offenders
Note Lower is better!
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Factors involved in Risk Behavior
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Socialization and Delinquency

• What is a socialized delinquent? An
  unsocialized delinquent?

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Culture and Risk Behavior

• In traditional cultures, Schlegel and Barry
  (1991) found that boys and not girls tend to
  engage in risk behavior during adolescence
• Evidence of antisocial behavior in less than half
  of the cultures studied
• In Western countries other than the USA, engage
  in less risky driving behavior
• USA has highest rates of violent crimes

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Deaths from Suicide Homicide
The USA has the highest homicide rate Canada
the highest suicide rate
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15-year olds Who Report Smoking Daily
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Levels of Depression

• Depression is an enduring period of sadness
• Depressed mood enduring period of sadness
  without any related symptoms
• Depressive syndrome addition of symptoms such as
  frequent crying, feeling guilty, lonely or
  worried
• Major Depressive Disorder Episode includes five
  or more symptoms during a two-week period and
  disrupt functioning

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Major Depressive Disorder

1. Depressed or irritable mood for most of the day,
   nearly every day.
2. Reduced interest or pleasure in all or almost all
   activities, nearly every day.
3. Significant weight loss or gain, or decrease in
   appetite.
4. Insomnia or oversleeping.
5. Psychomotor agitation or retardation, observable
   by others.
6. Low energy or fatigue.
7. Feelings of worthlessness or inappropriate guilt.
8. Diminished ability to think or concentrate.
9. Recurrent thoughts of death, recurrent suicidal
   thoughts.

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Treating Depression with CBT
The goal of CBT is to help the young person
recognize the cognitive habits that are promoting
depression and work to change those habits.
Strategies include discussion, role play,
practicing new ways of interacting
Cognitive Behavior Therapy (CBT) recognizes that
depression is characterized by negative
attributions, and a belief that the situation is
permanent and uncontrollable
Relapse is less likely after CBT treatment than
drug treatment
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Suicide Risk Factors and Facts

• Risk factors
• Depression
• Family disruption
• Substance abuse problems
• Relationship problems outside family
• Result of series of difficulties over time

Third most common cause of death ages 15-19
Females 4 times more likely than males to attempt
suicide
Males 4 times more likely than females to
complete suicide
Higher rates among White than Black youth
Rates highest among Native American youth
Rates are highest where guns are most available
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Eating Disorders

• Anorexia Nervosa intentional self-starving
• Bulimia binge eating and purging

Cultural ideal of thinness
Puberty and body changes
More common among upper and middle socioeconomic
classes
Girls who read magazines like Seventeen are
more likely to strive for thinness
Warm and controlling parents
Occurs most often among females in teens and
early 20s