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PSY100H1 (1,821)
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Chapter 13

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Chapter 13 • Overview: more than 1/3 of all children suffer from a significant behavioural or emotional disorder by 16; boys more vulnerable than girls; linked to major stressors which have cumulative effect; 12.5% of children live below poverty line in Canada • Resilient children: many children who face major stressors not develop severe psychological symptoms or disorders; at least one healthy, competent adult or other high quality interactions with parents • Temperament: child’s arousability and general mood; biological factor implicated in development of many disorders; difficult temperaments consist of sensitivity to stimulation, trouble calming oneself, negative mood and difficulty adapting to new situations; can elicit more negative interactions from others • Developmental psychology: study of childhood disorders; understand when children’s behaviours cross from normal difficulties into abnormal problems; understand impact of normal development on the form abnormal behaviours take Behaviour disorders • Attention-deficit/hyperactivity disorder: inattention, hyperactivity and impulsivity; trouble controlling impulses, paying attention and organizing behaviours to accomplish long-term goals; behaviour driven and disorganized • Inattention symptoms o Does not pay attention to details and makes careless mistakes o Difficulty sustaining attention o Does not seem to be listening when others talk o Does not follow through on instructions or finish tasks o Difficulty organizing behaviours o Avoids activities that require sustained effort and attention o Loses things frequently o Is easily distracted o Is forgetful • Hyperactivity symptoms o Fidgets with hands or feet and squirms in seat o Leaves his or her seat when inappropriate o Runs around or climbs excessively o Has difficulty engaging in quiet activities o Often acts as if “driven by a motor” o Often talks excessively • Impulsivity symptoms o Blurts out responses while others are talking o Has difficulty waiting his or her turn o Often interrupts or intrudes on others • Combined type: most common; presence of six or more of the symptoms of inattention and six or more of the symptoms of hyperactivity-impulsivity • Predominantly inattentive type: six or more symptoms of inattention but fewer than six symptoms of hyperactivity-impulsivity present; some argue certain symptoms indicating a sluggish cognitive tempo, which include slow retrieval of information from memory and slow processing of information, low levels of alertness, drowsiness and daydreaming, should be considered • Predominantly hyperactive-impulsive type: six or more symptoms of hyperactivity-impulsivity but fewer than six symptoms of inattention • Other difficulties: 20-25% have serious learning disabilities; poor relationships with others; may also be diagnosed with conduct disorder; symptoms persist from childhood into young adulthood for about ¾ of children; increased risk for ASPD, substance abuse, marital problems • Prevalence: only 1-7% of children develop; boys have a higher incidence for all age groups but rates differ; higher prevalence for 6-8 year olds than 12-14 year olds; boys have more disruptive behaviours which could lead to underidentification in girls • Biological contributors: formerly referred to as minimal brain damage; sufferers differ from healthy kids on measures of neurological functioning and cerebral blood flow; areas of brain most likely involved are frontal lobe, caudate nucleus within basal ganglia, corpus callosum and pathways between structures; important roles in deployment of attention, regulation of impulses and planning of complex behaviour; dopamine most consistently implicated; remove allergen additives from food o Immaturity hypothesis: children with ADHD are neurologically immature (brains slower in developing); unable to maintain attention and control behaviour at an age-appropriate level; explain why symptoms decline with age o Genetic links: runs in families; between 10-35% of immediate family members of children with ADHD are also likely to have the disorder; ASPD, alcoholism and depression also run in these families; twin studies and adoption studies also suggest genetic factors play a role; dopamine transporter genes may be abnormal o Prenatal and birth complications: maternal ingestion of large amounts of nicotine or barbiturates during pregnancy, low birthweight, premature delivery and difficult delivery, leading to oxygen deprivation; moderate to severe drinking by mothers can lead to kinds of problems in inhibiting behaviours seen in children with ADHD; also high concentrations of lead • Psychological and social contributors: ADHD kids more likely to experience frequent disruptions in childhood and have antisocial/criminal fathers and hostile mothers who report lower parenting competence and satisfaction; child places stress on home environment and creates more conflict; may need to reshape family’s interactions to reduce symptoms • Drug treatments: stimulants like Ritalin, Dexedrine and Adderall most common treatment; decreases in demanding, disruptive and non-compliant behaviour and increases in positive mood, goal direction and interactions; may work by increasing dopamine level in synapses by enhancing release and inhibiting reuptake; side effects include higher frequency of tics, insomnia, edginess, GI upset and reduced appetite; 20% increase in Ritalin referrals since 1997; greater use due to increase in recognition of the disorder and treatment seeking for children with ADHD OR inappropriate overuse of drugs; other drugs include clonidine and guanfacine (affect norepinephrine) which reduce tics and increase cognitive performance; atomexetine also approved; antidepressants also prescribed which reduce depression and have some positive effects on cognitive performance (esp. bupropion); only produces short term gains • Behavioural training programs: longer term gains can be had by combining stimulant therapy with behaviour therapy (68% in one study, meds second) that focuses on reinforcing attentive, goal directed and prosocial behaviours and extinguishing impulse and hyperactive behaviours; improve functioning for family and child; teach behavioural methods to promote positive and extinguish maladaptive behaviours; focus on parents’ own psychological problems and impairments in parenting skills • Conduct disorder: serious transgressions of societal norms for behaviour and chronic patterns of unconcern for basic rights of others • Symptoms: bullying, threatening or intimidating 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 about staying out at night, runs away from home, sets fires deliberately, vandalizes and destroys property, often skips school • Prevalence: 5.5% of kids aged 4-16 years meet diagnosis in Ontario; high cost to society; trouble conforming to norms into adolescence and adulthood; as adolescents, about ½ engage in criminal behaviour and drug abuse; chronic unemployment, unstable personal relationships and aggression and violent in adulthood • Oppositional defiant disorder: less severe pattern of chronic misbehaviour; frequently lose temper or have tantrums, argue with adults, defy requests and rules, deliberately annoy others, blame others for own mistakes, easily annoyed, angry and resentful and spiteful or vindictive; do NOT destroy property, show pattern of theft/deceit or show aggression to people/animals • Prevalence: symptoms begin very early in life (toddler and preschool years); some seem to outgrow behaviours by late childhood or early adolescence; a subset go on to develop CD; boys three times more likely to be diagnosed with both and to be more physically aggressive; girls more likely to be indirect and verbal and alienate, ostracize and defame others • Biological contributors: runs in families; parents with antisocial personalities, alcohol abuse, depression; heritable; 82% of variability in CD due to genetic factors; fundamental neurological deficits in frontal lobes, brain systems involved in planning and controlling behaviour (frequently co-occurs with ADHD); exposure to neurotoxins and drugs while in womb/pre-school years; often signs of trouble in diagnosed children, even in infancy; more difficult temperament; high serotonin levels in men or testosterone in those with deviant peers; more difficulty learning from punishments/rewards because are less physiologically aroused; unusually low levels of cortisol • Social contributors: more frequent in children in lower socioeconomic classes and rural areas; downward social drift (parents are antisocial) versus causal role of poverty; quality of parenting received related to whether one develops the full syndrome; if parents are abusive, neglectful or uninvolved delinquency results; more severe punishments for boys may account for higher rates; deviant peer groups or relationships with those with disturbances encourage delinquent acts; biological/family factors can coincide; neuropsychological problems associated with antisocial behaviours linked to maternal drug use • Cognitive contributors: process information about social interactions in ways that promote aggressive reactions; narrow range of responses and assumptions; negative ramifications will contribute to assumptions world is against child; changing thinking patterns can change tendencies to act aggressively • Drug therapies: meds have not proved consistently helpful; SSRIs can reduce irritable and agitated behaviours; neuroleptics and stimulant drugs suppress aggressive behaviour; mood stabilizers like lithium and anticonvulsants might be effective for aggressive conduct disorder • Psychological and social therapies: derived from social learning theory; focus on changing ways of interpreting interactions, teaching them to consider perspectives of others; use self-talk to control impulses and use more adaptive ways of solving conflicts than aggression; try to involve parents • CBT: first step to teach kids to recognize situations that trigger anger (observation in natural settings); analyze thoughts and consider alternate interpretations; next taught to use self-talk to avoid negative reactions; teach adaptive problem solving skills; try to teach parents to reinforce positive behaviours and discourage aggressive ones; treatments are effective but relapse is common if parents have issues; booster sessions of additional therapy help avoid relapse; have most long- term positive effects if therapy begins early in disturbed child’s life • Separation anxiety disorder: emotional disorder specific to childhood; children show much more than usual anxiety when separated from caregivers; can continue into childhood and adolescence; may refuse to go to school, can’t sleep at night, have nightmares with themes of separation, exaggerated fears, avoid activities; many children go through short episodes of a few days of these symptoms after traumatic events • Diagnosis: symptoms for at least four weeks and impairment of daily functioning; excessive distress when separate 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/elsewhere, excessive fear of being alone, reluctance to sleep without caregivers near by, repeated nightmares involving fears of separation, repeated complaints of physical symptoms where separation occurs • Prevalence: about 3% of children under 11 suffer SAD; more common in girls than boys; can recur frequently throughout childhood and adolescence; more likely to have psychiatric problems as adults, live at home and be unmarried • Biological contributors: family histories of anxiety and depressive disorders; heritable, but more so in girls than boys; some children born high in behavioural inhibition (kind of temperament) and are shy, fearful and introverted; avoid novel situations and are excessively aroused when exposed to unfamiliar situations; abnormalities on gene regulating CRH (important role in stress response); parents prone to anxiety disorder and panic attacks • Psychological and sociological contributors: can learn to be anxious from parents, as an understandable response to an environment or following a traumatic event; parents can be overprotective and model anxious reactions to separation; close-knit families do not encourage developmentally appropriate levels of independence; insecurely attached kids who are behaviourally inhibited and have anxious parents are particularly at risk • Treatments: CBT most often used; develop new coping skills and challenge cognitions that feed anxiety; relaxation exercises and challenge fears of separation; increase separation from parents as therapy progresses; teach parents to model non-anxious reactions; effective in short term and can maintain effects in long-term; can use antidepressants (benzodiazepines), stimulants and antihistamines; SSRIs most frequently used and shown to be effective in reducing anxiety symptoms; in 2000, province mandated screening and outcome measurement for children’s mental health organizations (well-validated clinical tools to detect at risk kids and monitor clinical outcomes) • Elimination disorders: involve uncontrolled wetting and defecation far beyond age (four) at which children usually gain control over these functions • Enuresis: unintended urination at least two times a week for three months; child over five years of age; most wet only at night; 15-20% of five year olds wet the bed at least once per months; by adolescence, prevalence decreases to 1-2%; • Causes: about 75% of children with enuresis have biological relatives with the disorder; inherited unusually small bladder or lower bladder threshold for involuntary voiding; 5-10% of kids have urinary tract infections; psychodynamic and family systems theorists say its due to conflicts and anxiety caused by disruptions and dysfunction in family; behaviourists say its lax or inappropriate toilet training (lack of bladder control) • Treatment: tricyclics often prescribed but have dangerous side effects and overdose can be fatal; increases in norepinephrine can help with bladder control; about half of kids treated with imipramine show reductions in wetness but up to 95% relapse when its discontinued; synthetic antidiuretic dormone has emerged as drug of choice as it concentrated urine and releases its output from kidney to bladder; reduces wetting but relapse is common o Bell and pad method: pad with sensory device to detect urine is placed under sleeping child; if child wets, bell rings and wakens child; use classical conditioning to teach child when to wake up and urinate; 70% cured in four weeks • Encopresis: repeated defecation into clothing or onto floor; rarer than enuresis; at least one such event a month for at least three months; must be at least four years old; fewer than 1% of children can be diagnosed; more common in boys; usually begins after one or more episodes of severe constipation; can result from environmental factors (withholding of bowel movements for some reason), genetic predisposition toward decreased bowl motility, food intolerance or certain medication; constipation can cause distention of the colon, decreasing the child’s
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