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Ch 12.docx

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University of Toronto St. George

Ch 12  Peter-had conduct disorder-dont behave according to social norms o Suspended for getting into a fight with other child. Threw a chair at teacher o Stopped being aggressive when he was restrained by 2 adults o He was previously defiant, rude, verbally aggressive o Showing significant disturbance for more than 18 months o Sometimes he feels sad, lonely, frightened-when suspended or rents mad at him  Field is clinical psychology of childhood and adolescence  Importance of diagnosis is that someone who fulfills defined criteria for a defined period is usually, though not always, impaired in their functioning  Study of such abnormal functioning is known as psychopathology  Among diagnostic symptoms of an anxiety state might be “excessive or unrealistic worry about future events.”  Main scheme used in North America is DSM-IV-TR=Diagnostic and Statistical Manual of Mental Disorders-4 edition  Another one is ICD-10-CM=International Classification of Diseases, Tenth revision o Includes psychiatric disorders  Both schemes are bases on a medical model and focus on individuals rather than their contexts  Another way of conceptualizing emotional disorders (preferable) is using a continuum-no sharp distinctions btw having and not having disorder o Method of assessment involves checklists of symptoms or behaviour patterns, and sometimes questionnaires, which a parent or teacher completes for a particular child. If older, u do it yourself. o Clusters of behaviours are identified  In middle childhood two kinds of emotional disorder become important o Externalizing disorders-anger, hostility, aggression, stealing, lying, o Internalizing disorders-anxiety and depression with tendencies to withdraw  In adolescence, these disorders can continue while, in addition, other kinds of disorder may also occur such as drug abuse and eating disorders.  Designations of children as disturbed are made statistically to include the extreme 5-10 % of a population  The two principle emotion-bases externalizing disorders of children are called oppositional defiant disorder and conduct disorder o Oppositional defiant disorder-over 6 month period, the child frequently displays 4 or more of the following behaviours that lead to an impairment of social or school life. Temper, argues with parents, defies requests/rules, annoy, blames others, touchy, angry and resentful, spiteful or vindictive o Conduct disorder-similar but they include more seriously antisocial behaviour such as truanting(missing school) before 13, stealing, set fires, sex assault, fights, cruel to ppl/animals, weapon use  As to internalizing disorders, the two main types are anxiety and depression o Anxiety disorders are fears that are abnormal to intensity, duration, and how they are elicited-ex.overanxious disorder, separation anxiety disorder o In major depressive episode, child feels either vew low in mood or has no interest in anything for 2 weeks. Must also have 4 other symptoms such as weight changes, sleep disturbance, fatigue, feelings of worthlessness, inability to concentrate, and recurrent thoughts of death or suicide  Not included in diagnostic criteria, are understandings of how the diff levels of emotional experience relate to one another  There are several hypotheses about the relationship btw emotion and disorder o Predominance of one emotion system – most common view of disorders of emotion in childhood, where one emotion becomes prominent. It dominates other possible experiences, so depressed ppl experience more sadness than other emotions, or experience sadness more often than other ppl. A disorder would be a balance among emotions which, instead of being responsive to what happened in the world, is biased towards pre-established patterns of certain kinds, for instance patterns of angry emotions in an externalizing disorder, or sad and fearful emotions in an internalizing disorder. Another appraisal pattern is the depressogenic attributional style. As compared with the non-depressed, depressed child are more likely to make attributions for negative events that are stable (it will always be this way), internal (it is my fault), and global (all situations will be like this). Another version of emotional predominance is in terms of childrens goals. In externalizing disorders, this predominance of goals seems to be exaggerated, so that children with externalizing disorders have been found to value gaining control over another child more than cooperation, and to value aggressive solutions more positively than their non-aggressive counterparts o Inappropriate emotional responses-children with a disorder react to events with deviant emotional responses-laughing when someone else is distressed. In this view it is not that children necessarily show more of one emotion than another, but that elicitation of certain emotions seems unusual. Another child may be callous and unemotional, a trait that is seen as unusual, and is associated with externalizing disorders o Dysregulation- in a disorder, emotions are not properly regulated. They are inappropriate to the social context. Emotion dysregulation underlies both bullying and being victimized by bullies among children who have been physically or sexually abused. Dysregulation is the lack of effortful control, so that children with externalizing disorders, but not internalizing disorders, are impulsive, and low in effortful regulation of their emotions.  Psychiatric epidemiology-study of how many ppl show a particular disorder in the population, statistically relating the disorder to factors in peoples lives. Two kinds of statistics are important o Prevalence-proportion of population suffering from some disorder over a particular time period o Incidence-number of new onsets of a particular disorder in a given time  The first major study in childrens psychiatric epidemiology was by Rutter et al: The Isle of Wight study. Used parents/guardians of all 10 yr old living on isle of wight o Median rates of psychiatric disorder in childhood found at 8 % for preschoolers, 12 % for preadolescents, and 15 % for adolescents  Psychological instruments (interviews) assessing the presence of disorder have been developed for use with parents, teachers, and children. In these, the criteria for disorders have been defined so that two ppl interviewing the same child, or the same parent about the child on separate occasions, agree about whether or not the child has a disorder  Diagnoses differ according to whether the informant is a parent, teacher or child o Children are more closely in touch with fears and anxieties than parents and report more of them, parents are more in touch with externalizing behaviours than children, and report more of them. The reliability of children as respondents increases with age  Younger children show more externalizing behaviours, such as aggressive behaviour, screaming, cruelty to animals, then internalizing behaviours like sadness, anxiety, withdrawal  Questionnaire items were based on teh behaviours and emotional states commonly used in assessing psychiatric disorder-screams alot, shy or timid  Oppositional defiant disorder is more common in early childhood, but conduct disorder becomes more common later  Aggression, property violoations and opposition gradually decrease from age 4-8 wheras status violations like swearing or running away from home increase with age  From an early naturalistic study on aggression in children, reported that angry outbursts in children decline sharply in the second year. For girls the decline is much sharper than boy  3:1 ratio of boy to girls in prevalence of conduct disorder  Prevelance of anxiety increases with age during childhood  Night-fold increase in maternal reports of childrens worring from 3-8 yrs  Seperation anxiety disorder is more common in early childhood but overanxious disorder affecting many aspects of life is more common in adolescence  Girls are more likely than boys to show single symptoms of anxiety and to show anxiety disorders  Often anxiety occurs with depression-found that 17 % of preadolescents with anxiety disorder were also depressed, by adolescence found that it rises to 69%  Larson used experience sampling to ask preadolescents and adolescents to rate their mood through day. Adolescents emotions wer no more variable than younger childresns but the adolescents were found to have lower mood  Rates of depressive disorders increase in adolescence  In childhood, boys and girls are about equally likely to suffer from depression. By late adolescence, females become almost twice as likely as males to be depressed. But this is not the case for boys, whose level of reported symptoms remains constant from earlier childhood through adolescence.  Reasons for girls and boys differences in rates of disorders are not understood  Genetic factors, probably play moajor role  Bowlby/rutter-bowlbys understanding of separations of child from their parents in wartime, ppl came to understand how love btw adult caregivers and child developed into the cooperative activites on which family life and all culture are founded. Rutter was younger but trained in medicine like bowlby. He made the book called maternal deprivation reassessed. He defined the risks to child mental health. He is a principle force in the field, and was knighted in the uk for his services in child psychiatry  The stress diathesis hypothesis is a general idea about how such diff in outcome can occur. A stress is something that occurs in the enviro, like being orphaned. A diathesis is a predisposition, or vulnerability, to disorder that is inherent in the child, like genetics. But in combo, a stress occurring to a child with a particular diathesis can cause a disorder. In stats that is known as an interaction effect  In the area of disorders of childhood and adolescence, the several kinds of unhappiness have been understaood in terms of risks  Risks in the enviro are stresses that increase the likelyhood that a child will develop a disorder. They are not rigid causes. They have been found in epidemiological studies to increase the probability of disorder  Children exposed to serious and prolonged conflict btw their parents are at increased risk of deveelopeing externalizing disorders. One of the important mechanisms is exposure to overt hostility-parents angry shouting. Three aspects of poor marital relationships- frequency and severity of angry arguments, disagreement over child rearing issues, and periods of silent tension. It was frequency and severity of angry arguments that were associated with an increase in child disorders  Child disorders after their parents divorce have been found to be most strongly associated with continuing parental conflict  Children increased their aggressive behaviour after the adult agument  Through modeling, child may learn from their parents that anger is the way to deal with conflict. Child may become aroused by anger and their behaviour may be influenced by this increased arousal. Seeing negative emotion expressed btw parents may alter childs expectations about relationships such that they interpret neutral behaviour of other ppl in negative light. These are direct effects of marital disharmony. Indirect effects of parental conflict on childhood disturbance can occur because relationship btw each parent and child often suffer  Often children show a similar type of disorder to that shown by parents. Parental expression is more strongly related to internalizing disorders than to externalizing ones. Ten year follow up that parental depression was associated with childs depressive and anxiety disorder. Children who lived with parents with antisocial disorders like aggression were more likely to show externalizing disorder. In interaction children learn how to responds to the emotions of depressed caregiver. Children construct schemas of their own and their caregivers emotions. With their own depressed mothers, babies howed more gaze aversion and were more negative generally. T
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