- Disorders of the undercontrolled Behaviour.
- Disruptive behaviour disorder
- Unable to control activity level, impulses and have difficulty concentrating.
- ADHD, CDD and ODD.
- More disturbing to children than to the children
- Disorders of overcontrolled behaviour
- Anxiety, GAD, SAD, Selective mutism.
- Problematic for the person, yet a pose a few problems for people around them.
- Two or more disorders occur together in the same individual
- A rule in mental health, not an exception
- Individual meets the diagnostic criteria for more than one disorder (can be due to over lap of
- A person receiving same diagnosis in the future.
- A disorder that is comorbid with another disorder in the same class (externalising (ODD) and
later developing another externalizing (CD))
- A person that a disorder that is comorbid with a disorder from a different class ( externalising to
Attention Deficit/ Hyperactivity Disorder (ADHD)
- Externalising disorder
- One of the most common childhood and adolescent disorder
- Distrubtive behaviour, unable to concentrate/ focus and inability controlling activity or
- Hyperactive = Motor + Verbal
- Behaviour = Impulsive or Erratic
- Emerge in early childhood, most get better as brain matures
- 1/3 retain ADHD till adulthood Gene-Environment Interaction
- G X E
- “Any Phenotypic Event” (observable characteristics) = Gene + Environment
- Nature via Nurture
- For example: Prenatal smoking.
Diathesis-Stress (Disorder- Stress) Perspective
- Environment stress has greatest toll on the person with genetic vulnerability
- Predisposed to a disorder genetically, yet environmental factor can encourage the expression of
- Interaction underlies all onset of disorders
- Although one (gene or stress) may be more important than the other (no 50% each)
- For example, Homozygous for Dopamine receptor gene in prefrontal are “vulnerable”, with
inconsistent parenting (environment stress), kids likely to have ADHD or ODD.
Methylphenidate (Ritalin) ADHD
- Stimulant Medication
- Most frequently subscribed medicine for ADHD
- Act on other neurotransmitters to increase their activity to compensate for level of other
neurotransmitters that cause abnormal behaviour.
- For example, in ADHD, increasing neurotransmitters that encourage more vigilant or calm
behaviour, and decrease aggressive
Oppositional Defiant Disorder (ODD)
- Unable to comprehend that their behaviour is not correct
- Refuse to follow instructions, Arguments, temper tantrums, annoying other, spiteful and
- Blame others for their behaviour
- Hostile behaviour
- Difficult to manage: Negativistic behaviour and poor attitude
- Diagnosed by 8 years
- DSM V: Separate irritable moods from defiant behaviour. Irritable mood can lead to mood and
Conduct Disorder (CD)
- Violating the rights of others
- Opposing laws/ rules
- Hostile behaviour
- DSM IV TR: o Aggression towards people/animals
o Violation of rules
o Destruction of property
- Mating with people with same disorder (people drawn to people like them)
- For Example: Two CD people date, marry and mate creating children with high genetic
predisposition to CD. Such parents have more negative behaviour, poor parenting etc
(environment + genetics)
- “Stabilize” one’s “mood”
- Psychotropic medications
- Treat mood disorders; extreme mood swings
- For example: CD patients take in lithium (a mood stabilizer), works well with in inpatients.
- Antipsychotic Medication
- For example: Risperidone , improve symptoms of outpatients in CD,
- Child negative behaviour diminishes the parents negative behaviour
- Averse reactions used to control the behaviour of another individual.
- For example, Crying or whining to stop parental conflict
Separation Anxiety Disorder (SAD)
- Unique to childhood
- Children have the fear of “separation” from caregiver or to whom the child is emotionally
- Panic and excessive anxiety at the thought of separation
- Symptom: Distress
- heightened insecurity
- Calm with caregiver
- Distress inward
- An underlying developmental disorder, that may change but the ways it manifested stays the
same. - Same diagnosis in the future
- Internal to external and vice versa.
- Underlying disorder stays the same, yet the manifestation of it changes.
- Different diagnosis in the future
- For example, prediction of one disorder from another.
Delibrative Self Harm (DSH)
- Purposely Physically injure oneself but not cause death
- 9.7 % = Attempted suicide
- 29.9 % = suicidal thoughts
- Males more likely to commit suicide
- Females 4 x more to participate in DSH
o Depression and one other psychiatric disorder
o Environmental factor: family member similar behaviour
o Prior similar behaviour
o Likelihood of occurrence, increases with chemicals and fire arms.
- Cognitive Behavioural Therapy:
o Your Life Counts
o Helping youth growing through difficulties
- Children display withdrawal or fear from new situations
- Occurs through life
- Temperament in early childhood that may be related to anxiety disorders in later life
- Atypical response of autonomic system to new situations
- Avoid others
Selective Serotonin Reuptake Inhibitors
- Fluvoxamine, parexetine (Paxil) and fluxotine(Prozac) and sertaline (Zoloft)
- Class of anti depressants
- Prevent reuptake for NT. So that NT reach optimal use.
- Social anxiety - Person capable of speaking chooses not to speak in social situations.
- Problem = can’t do talk therapy
What is the current mode to evaluate children?
Study family and children, using various scientific methods involving genetics, neuroimaging etc. The
medical condition, has some biological bases along with environment factors. Obtain a more global
picture of the child: developmental, medical, social and educational.
When was the first problem identified and studied in children
When going was made mandatory for children, it allowed the examination of children with mental
Who wrote the 1 book on child psychiatry, and when
1935 – Leo Kannar`s provided a framework to asses children
What were child guidance clinics?
USA and England, initiation of guidance clinics in schools. These clinic include psychiatrist, psychologists
etc, to work on educational psychology.
What were the first forms of research in childhood disorders?
Descriptions of children with infantile autism and behavioural manifestations of deficient maternal care
When it regular documentation of childhood behavioural problems begin
What was the first comprehensive population survey?
Isle of Wight Study, involving 9-11 years old.
What is the relationship between DSM and childhood disorders?
Incorporated in DSM in 1980.
What is the treatment based on?
Family therapy and psychoanalytic therapy by Anna freud and Melanie Klien.
What is the current zeitgeist? Since 1960, it is the use of medications. Yet important to examine the side effects on developing bodies
What are issues in studying child psychology?
1. Age variation in symptoms
2. What is normal behaviour based on a child`s age
3. What constitutes a disorder in a child, and how long, and severe must it be, to get treatment
What about youth
Less Autonomy, as influenced by environment and people around them
What can be a bias in research?
Usually parents and teachers who report the problem, yet their different sources thus both rarely talk
about the same symptoms.
Childhood disorders and DSMIV-TR
Disorders usually first diagnosed in childhood, infancy and adolescence. Yet anxiety and mood disorders
not included as they are the same disorder in childhood and adult.
What percentage of youth with one psychiatric disorder, met the diagnostic criteria for another
What are prevalence rates for ADHD, Anxiety and CD in a lab study?
- ADHD = 3.3 %
- CD = 3.3 %
- Anxiety = 6.5 %
Most common disorders in North America in children
ADHD, CD or ODD and anxiety.
What is average community prevalence?
14. 3 % or 800 000 children and youth have a mental disorder that gives them stress.
How many youth met the criteria for impairment across lifetime?
1 out of 4 or 5 What about prevalence in elementary school
1 in 5
What is the age of onset dependent on?
The type of disorder.
Female and male differentiations
- Mood, anxiety , eating
- Behavioural,, substance abuse
ADHD was earilier known as Minimal brain dysfunction and Hyperkinetic syndrome of childhood.
1970: ADD (Attention Deficit Disorder). Neuropsychiatric Disorder.
1. Functional impairment
2. Symptoms before age 7
Clinical Description Classification of Symptoms:
Subtypes 1) Hyperactivity
1) ADHD -1 (Girls)
- Academic problems (math)
- Problem: listening, learning & remembering
- Difficulty in organization
- Difficulty in motor control
- Social Problems
2) ADHD – H and ADHD – H1
- (3x boys > Girls)
- High comorbidity rates
- Get into trouble
- Intrupt others
- Talk to self
- React impulsively much more than ADHD1
- Adult: Decrease hyperactivity - Adult: Continue to figit
3) ADHD – H1 (3x boys > Girls)
Validity of ADHD Subtypes are unstable over time thus removal.
subtypes DSM V:
- All youth with ADHD have the combined type
- Clarify and specifically show what the most persistent
subtype of the past 6 months.
- No subtype, instead guidance on how to code the
Comorbidity 50 % have another psychiatric disorder
- CD ( 40 – 60%)
- Learning Disorder (25%)
- Anxiety (25%)
- Substance abuse (40%)
- Depression (30%)
Prevalence 2% = Preschool
6% = School going kids and youth
4% = Adults
Overall ADHD = Boys > Girls
Developmental Most children with ADHD, need management help even in
Trajectory youth and adulthood
- Comparable education and IQ
- Low attention at job
- Increase likelihood of motor accident
- Low IQ
- Early parents
- High rate of divorce
Etiology Introduction 1 large study on ADHD:
Multimodal study of treatment of ADHD
Brain Most complication brain function: sustain attention (To study
- Reduced brain size Abnormal in prefrontal cortex
(higher motor functioning) and basal ganglia
(learning, memory, emotion) and cerebellum (lack of
motor control – unable to balance)
- Neurotransmitters: Dopamine & Noradrenergic (
Abnormality in above brain regions = genes that
regulates these transmitters)
- Dopamine = Attention (basal + frontal)
Gene 50% + = ADHD – Genes
Study = genes involved with dopamine
No particular gene for ADHD
Parental Risk Prenatal toxin = ADHD factors - Anti-depressants
- Poor diet
- Mercury and lead
- Complications at birth
Psychological - Low socio-economic
risk factor - Low parental mental health
- Foster care
ADHD: large families, large distress ADHD
ADHD: Treatment improves family stress
Gene- - Dopamine in prefrontal cortex
environmental - Genetic predisposition + maternal smoking = ADHD
- 480 DAT-1 risk allele symptoms present for kids with
ADHD and prenatal smoking.
Assessment and Introduction - More than 1 clinician assessment
Treatment - Symptoms surveillance
- Clinical Interview
- Direct communication with teachers for school
Pharmaceutical 80% better with stimulant medication (all subtypes):
- Increase release of dopamine and noradrenergic, and
prevent their reuptake
- Alters norepinephrine
- Get better
Side effects: loss of appetite, headaches, increasein blood
pressure etc. Several years: low height and weight
Stay on meds from child to adult Clinician recommend
No benefit on academic function
Work best with other therapies
Short and long acting derivatives of methylphenidate,
dextroamphetamine and amphatemine.