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Lecture 2

PS280-Z Lecture 2 – Thursday July 11th, 2013.docx

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Kathy Foxall

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th PS280-Z Lecture 2 – Thursday July 11 , 2013 Disorders of Childhood and Adolescence Historical Factors - The DSM-II – 6 independent categories for children, DSM-IV-TR includes 44 categories - Developmental psychopathology emerged as a separate field of study in the 1970s Three Principles of Developmental Psychopathology 1. Normal behaviour is multiply determined o Multiple factors/causes 2. The child/adult influence is reciprocal o Children are affected by adults and adults are affected by children 3. Children need to have certain experiences to develop normally Ontario Child Health Study (OCHS) - Prevalence disorders in children 4 to 16 years of age - Studied conduct disorder (CD), hyperactivity (ADHD), emotional disorder, and somatisation disorder - The 6-month prevalence rate for any of the disorders was 18% Special Issues when dealing with Children - Parents’ and teachers’ reports are often considered more important in assessment than the child’s input o Often we do not give enough attention to the child’s input - Focus on intervention is often not on the child, but on instructing others how to deal with behaviour problems (such as the family) o In some cases on the teachers - Children typically have little control over important aspects of their life o Children lack the cognitive capacity or emotional maturity to understand  Do not understand a need for change - Parents may not be working in the child’s best interests o Some parents are so invested in their children that it becomes problematic in that if their child has problems, they see this as a negative reflection of themselves  And if they see it like that, it means that the child really does not have problems Externalizing vs. Internalizing Disorders - Externalizing problems in childhood o We see the behaviour affecting other people – problematic for other people o The distress, the problem, the pathology is enacted in the world o Such as ADHD, oppositional defiant disorder, conduct disorder - Internalizing problems o The child that bears the harm of the symptoms Attention Deficit/Hyperactive Disorders - Present before age 7, persists 6 months or more - Display characteristics in two or more settings - Some also have a conduct disorder - 6% of Ontario school-aged children have ADHD o 3-5 times more common in boys than girls o Probably under-recognized in girls  Excessive talkativeness may be a symptom of ADHD o 8x more boys referred to clinics - Distracted by irrelevant stimuli - Organize information poorly, omit information, inaccurate detail - Attentional difficulties cause the most trouble for the child Types of ADHD 1. ADHD predominantly hyperactive-impulsive type 2. ADHD predominantly inattentive type (also known as ADD and seen more often in girls) 3. ADHD combined type (inattention and hyperactive) Co-Morbidity and Prognosis - Persists into teen years - Co-morbid with conduct disorder (40%) - Learning disabilities also common with ADHD - Montreal Hospital follow-up study o Followed clinical sample o Age 25-30, 1/3 outgrow all symptoms of ADHD o Firestone found that aggressive ADHD children were the ones who ran into the most trouble o Substance abuse and poorer academic and occupational records and antisocial personality disorder Etiology of ADHD - Biological predisposition is likely o Increased levels of ADHD and other psychiatric problems in families o Heritability between 30% and 50% - High levels of ADHD in children exposed to alcohol in utero o Fetal Alcohol Spectrum Disorder  Some symptoms can be seen at birth - Smoking in pregnancy o Much more likely to have ADHD for the child - Lead; evidence mixed (generally there is an association) Etiology of ADHD: Dietary Factors? - 1970s-80s - Feingold diet o Certain foods and additives were to be kept out of the child’s diet o Sugar - Highly subjective maternal evaluations of behaviour - Biological challenge tests had little effect - Elimination of diets have little effect Brain Functioning - PET scans - Reduced glucose metabolism in adults - Smaller right frontal region Treatment for ADHD - Pharmacological treatment o Ritalin (methylphenidate) is the most frequently prescribed, followed by Dexedrine (dextroamphetamine)  Popular drug of abuse  Side Effects: loss of appetite, loss of sleep, loss of weight, high blood pressure, etc  At very high doses people will seem and look as if they are schizophrenic  Once the drug is out of their system then they are back to normal - Behavioural and psychological treatments appear less useful - May assist with social skills and behaviour control o Hard to internalize behavioural control o When you give rewards, it might get better, but after the reward is taken away then the behaviour comes back - Supporting counselling may be useful to parents Reactive Attachment Disorder - First appeared in the DSM-III - Related to abuse or neglect in childhood o Disruptions in attachment in early life - Abuse, neglect, institutional living, multiple foster home placements - May be diagnosed as early as infancy - Inability to form normal relationships with other people o Impaired social development o Sociopathic behaviours - About a serious problem in the bond between the child and caregiver(s) o About love, loss of love, or broken love Symptoms of RAD - Unable to be close with others o Sometimes a pseudo closeness that isn’t real - Impulsive - Aggressive - Erratic mood swings - Disinhibited RAD – not a real attachment, tries to be very friendly with everyone - Inhibited RAD – the person is very distant Treatment of RAD - Children need to know that they are loved no matter what Oppositional Defiant Disorder (externalizing disorder) - ODD is diagnosed with children who behave in a negative, hostile, or defiant manner to a greater degree than other children (verbally fight a lot) Conduct Disorder (externalizing disorder) - Children with CD show a repetitive and persistent pattern of conduct in which the basic rights of others and major age-appropriate societal norms or rules are violated o Physically assaultive, dishonest, deceptive, steals, malicious, and lacks empathy o Another bad sign would be torturing animals (and getting pleasure out of it) – shows a lack of empathy o Bedwetting at an older age (probably related to neurological immatu
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