Child Psychopathology

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Child Psychopathology

• Sleep Disorders
• Elimination Problems
• Reading Chapter 12

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Normal course of sleep

• How many hours per day do you sleep on average?
• How many hours per day did sleep when 15 yrs.?
• What happens when you do not have enough sleep?
• Sleep deprivation impairs pre-frontal cortex,
  decreases concentration, loss of inhibition of
  emotions and basic drives
• How many hours do newborns sleep? The elderly?
• Developmentally, sleep becomes more organized and
  nocturnal
• Problems arise in toddlerhood (nighttime
  awakening), preschoolers (getting to sleep),
  elementary-school-age (bedtime rituals)

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Sleep Disorders Dyssomnias

• Protodyssomnia
• problems initiating and maintaining sleep
• Hypersomnia
• excessive sleepiness
• Narcolepsy
• bouts of REM sleep during wakefulness
• inherited, neurological disorder
• Breathing related sleep disorder
• Sleep apnea loss/ disruption of breathing

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Sleep Disorders Parasomnias

• Nightmares
• Occur during REM
• Common (up to 50 of children)
• Can recall if awakened
• Movement and vocals inhibited
• No ANS arousal
• Anytime

• Night Terrors
• Non-REM sleep
• Uncommon
• Cannot remember
• Ambulatory, vocal
• Cannot be awakened
• ANS arousal
• Early in evening

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Sleep Disorders

• Incidence and treatment of nightmares, night
  terrors, and somnambulism (sleep walking)

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Normal bedwetting behavior
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Enuresis Diagnostic criteria

• Involuntary discharge of urine during the day or
  night
• At least twice a week for three consecutive
  months
• Significant distress or impairment
• At least age 5 years or MA of 5
• Not accounted for by medical condition or
  physiological effects of a substance (diuretic)
• Specify nocturnal or diurnal, primary or secondary

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Treatment for enuresis

• Behavioral approaches
• Bell pad (Classical Conditioning)
• Overcorrection (Operant, punishment)
• Sticker charts (Reinforcement)
• Drugs Imipramine
• Family-based interventions
• Bathroom before bed, awakening
• Dietary manipulations
• restrict fluids, caffeine (e.g., COKE)

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Bowel movements and encopresis
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Encopresis Diagnostic criteria

• Passage of feces into inappropriate places
• once per month for 3 months
• child at least 4 years-old or MA of 4
• not accounted for by medical condition or
  physiological effects of a substance
• Specify With or without constipation and
  overflow incontinence

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Treatment for encopresis

• Behavioral approaches
• Reinforcement for appropriate tioleting
• Regular scheduling of tioleting
• Drugs, laxatives, enemas, mineral oil (goal
  empty large intestine)
• Family-based interventions
• Guilt, shame associated with tioleting, pressure
  to produce
• Dietary manipulations Fibre, non-binders,
  increase natural motility