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Chapter 15

PS280 Chapter Notes - Chapter 15: Oppositional Defiant Disorder, Separation Anxiety Disorder, Melanie Klein

Course Code
Kathy Foxall

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Chapter 15 – Behaviour and Emotional Disorders of Childhood and Adolescence
Historical Perspective of Child and Adolescent Mental Health
-Today most researchers study child psychopathology within a framework that stipulates
that mental disorders have some biological basis. (Has not always been the case)
-Initial accounts of abnormal child behavior were attributed to inadequate parenting,
which meant insufficient moral discipline in upbringing. Children were thought to be
incapable of self-reflection and reason, their behavioural problems were seen as a
reflection of their environments, hence they were not seen as having problems with their
brain functions.
-Advent of mandatory schooling for children created the opportunity to identify those
who had intellectual delays – the first problems to be identified and studied.
Treatment reflected importance of providing quality care to children (adequate
hygiene, nutrition, exercise, and teaching of moral well-being to parents to improve their
children’s behavior
-Causes of behavior turned to abnormal brain functioning in 19th century as a result of
observations that many disordered children had parents who were unwell or low in
intellectual functioning, based on observations that many disordered children had parents
who were unwell or low in intellectual functioning. A few prominent child psychiatrists
advocated for the need for psychiatric assessments and hospitalization for some very
dysfunctional or dangerous children. In the 20th century, Leo Kanners first textbook of
child provided the framework for assessing children and adolescents. This book included
sections on (1) personality problems arising from physical illness, (2) psychosomatic
problems, (3) problems with behavior, (4) practical guidance on how to obtain a mental
health history and the use of psychotherapy as a form of treatment. At that time child’s
guidance counselors were being introduced in schools in the United States and England.
These clinics employed child psychiatrists, psychologists, and social workers, reflecting
the developing knowledge in the field of educational psychology.
-The first of research and children’s mental disorders were descriptions of children with
infantile autism and behavioral manifestations of deficient maternal care and
overprotection. It was not until the 1960s that epidemiological studies of mental
disorders in children began to document that the prevalence of common child behavioral
problems. The first comprehensive population survey included 9 to 11-year-old and
Ontario child health study in the early 1980s addressed questions that continue to be of
importance of child psychiatry. For example what are the rates of youth psychiatric
disorders? What is the role of intellectual development, physical impairment and
potential social influences on the diagnosis and prevalence of children’s disorders? These
works were influential because the researchers demonstrated that some childhood
disorders persist into adolescence, and do so in characteristic ways.
-Although it has become clear that some disorders have an onset only in childhood (e.g.,
autism, Spectrum disorder, intellectual development disorder, genetic syndromes), other
disorders commonly diagnosed in children (e.g., anxiety disorders, mood disorders) may
have an onset or occur only in childhood or in adulthood. It remains to be demonstrated
rather than manifestations and symptoms of childhood- versus adult onset mood and
anxiety disorders are the same, but most research cutie supports the hypothesis that they

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-Treatments and child psychiatry encompassed mostly family therapy and psycho
analytic therapy, influenced by Anna Freud and Melanie Klein, prior to the discovery of
medications to treat hyperactivity in the 1960s. Since that time, there has been increasing
emphasis on the use of medications in children and adolescents, with consideration of not
only their efficacy for the disorders and question, by the particular their safety and side
effects on behavior and cognition in the developing person
Current issues in assessing and treating children and Adolescents
-It is imperative to study age-specific variation in symptoms and to establish what is
normal behavior or emotion for child based on his or her age
-This is not only because children may present with different symptoms based on their
cognitive stage, but also because change and development of new skills or brain
maturation may be a adaptive to children and reduce their impairments or symptoms
-More so than adults, you are influenced by their environments and the lives of others
around them because they have less autonomy for their decisions.
-What is challenging about gathering information from different sources (teachers,
parents, etc) is that those ratings Child psychological symptoms rarely agree with each
other, a lack of concordance that may be clinically relevant
-Factors particular two child and adolescent mental assessment, including developmental
variation in symptoms as well as impairment and informant bias, emphasize the
importance of comprehensive diagnostic assessment of the youth. Psychologists and
psychiatrists aim to identify mental disorder symptoms in patients, but seek additional
information about developmental, medical, social, and educational functioning to obtain a
more global picture of the child. Such information is required to direct the development
and implementation of treatment plans for the child and his or her family.
-In summary, the process of providing a diagnosis for a given clinical presentation and
determining whether this diagnosis is valid and reliable is an ongoing effort in the case of
adults, and even more so in the case of youth. Research studies designed to measure
continuity and change in children psychological symptoms are required to support the
possibility that some childhood problems do represent severe or long-term impairment
and therefore may merit diagnosis. Such research will be more robust when biologically-
based indicators of impairment (cognitive testing, genetic markers, physiological
parameters) are also measured.
Prevalence of Childhood Disorders
-mental disorders in childhood are typically divided into externalizing problems,
including attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder
(ODD), and conduct disorder (CD); and internalizing problems, including separation
anxiety disorder (SAD), selective mutism, reactive attachment disorder (RAD), anxiety
disorders, and mood disorders including the newly added DSM-5 disruptive mood
dysregulation disorder.
-Externalizing problems are also referred to as disorders of uncontrolled behavior,
whereas internalizing problems are also referred to as disorders overcontrolled behavior.
-Disruptive mood disorder – represents a perfect intersect between externalizing and
internalizing problems, highlighting once again, the complex city of mental problems

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and childhood and adolescence. Indeed, although a distinction between externalizing at
internalizing disorders is made, it is important to note that this distinction does not mean
that the two types of disorders cannot coexist in the same person. In fact, comorbidity is
the rule rather than that exception in mental health.
-Results from the recent National Comorbidity Survery Replication Adolescent
Supplement, a study 10 123 American youth aged 13-18, confirms this point. In this
nationally representative study, about 40% of youth with one psychiatric disorder met
diagnostic criteria for another psychiatric disorder. Moreover, longitudinal Studies show
that not only do children typically receive more than one diagnosis at a given time, but
their current diagnosis is often predictive of their receiving the same diagnosis in the
future (homotypic continuity) or receiving a different psychiatric diagnosis in the future
(heterotypic continuity). For example, Costello et al. (2013) found that children with a
history of a psychiatric disorder were three times more likely to have a diagnosis at
follow up compared to those with no previous disorder. They also found that panic
disorders, psychosis, verbal tics, encopresis (boys only), and enuresis showed the highest
level of homotypic continuity. IN terms of heterotypic continuity, they found strong
evidence from depression to anxiety and from ADHD to ODD.
-Only studies that (1) assess symptoms and impairment using a standardized assessment
protocol, (2) included multiple informants such as children, parents and teachers, and (3)
assess at least 1000 children were included in the summary prevalence rates.
-Anxiety disorders, conduct disorders, and ADHD Are the most common
psychiatric disorders among children and youth using data from North America
-Keeping in mind that many children and youth has comorbid conditions, it is not
surprising that the average community prevalence rate is 14.3%. T
his means that over 800,000 children and youth and Canada have a mental disorder that
causes them significant distress and is associated with noteworthy impairment and their
social, school, community, and/or family functioning.
-Recent epidemiological studies point to the fact that this rate is likely underestimated, at
least for American children and youth. In the NCS-A study, approximately 1 out of every
4 to 5 youth met criteria for a mental disorder, “with severe impairment across their
lifetime.” In another American study, the past year prevalence data in the early
elementary school years was also 1 in 5.
-The prevalence of mental disorders varies by the sex and the age of the child. For
example, children under the age of 8 rarely meet criteria for conduct disorder, disorder
that is more common in boys that in girls. Results from the NCS-A study showed that the
median age of onset for disorders vary considerably by type of disorder. Anxiety
disorders emerge by age 6, behavioral problems by age 11, mood disorders by age 13,
and substance use disorders by age 15. In the study, females are more likely than males
to be diagnosed (lifetime prevalence) with a mood disorder (18.3 vs. 10.5%), anxiety
disorder (38.0 vs. 26.1%), or eating disorder (3.8 vs. 1.5%), whereas males are more
likely than females to be diagnosed with a behavior disorder (23.5 vs. 15.5%) or
substance use disorder (12.5 vs. 10.2%)
Attention Deficit/Hyperactivity Disorder
-ADHD Is one of the most common psychiatric disorders in childhood and adolescence
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