Chapter 13: Childhood Disorders
More than 1/3 of all children suffer from a significant emotional or behavioural
disorder by the time they are 16.
Nurture: psychological symptoms and disorders are linked to major stressors in
12.5% of children live below the poverty line.
o Most children who face one stressor face several stressors; e.g., victims of
violence, illicit drug use, engage in unprotected sex, and face racial/ethnic
discrimination and harassment.
More stressors = more likely to experience severe psychological symptoms.
Most children who face major stressors don’t develop severe psychological
symptoms or disorders (resilient children).
Having at least one healthy, competent adult to rely on seems to help.
Nature: many children do not have major stressors in their lives to link to their
Many psychological disorders are a result of nature and nurture (biological
predispositions x environmental stressors).
Temperament is a child’s arousability and general mood.
o Difficult temperaments are highly sensitive to stimulation, become upset
easily, and have trouble calming themselves when upset.
o Negative moods, and trouble adapting to new situations (particularly social
o More likely than other children to have both minor and major psychological
o They elicit more negative interactions from others, including their parents.
o Children with difficult temperaments make more problems for themselves
that contribute to their problems, it isn’t the actual difficult temperament
o Those who don’t receive high-quality parenting in response are at a higher
Childhood disorders = developmental psychopathology.
o When children’s behaviours cross the line into unusual or abnormal.
All children go through periods in which they are unusually fearful or easily
distressed, or engage in behaviours like lying or stealing, but these periods pass
Attention Deficit Hyperactivity Disorder
o A major focus of socialization is helping children learn to pay attention,
control their impulses, and organize their behaviours, so they accomplish
o Children who have trouble learning these skills are sometimes diagnosed
o Three subtypes: Most have the combined type; where the child has a mix of the
symptoms of inattention and hyperactivity-impulsivity (6 or more).
The predominantly inattentive type is when the child has more
symptoms of inattention (6 or more), and less of the hyperactivity-
Symptoms indicating a sluggish cognitive tempo are also
The predominantly hyperactivity-impulsivity type is mostly
hyperactivity-impulsive (6 or more), and less of the inattention.
o Many children do poorly in school, because they cannot pay attention or
quell their hyperactivity.
o 20-25% of children of ADHD have serious learning disabilities.
o Some children have poor relationships with others, and are outright rejected
by their peer group.
They’re intrusive, irritable, and demanding.
Want to play, but by their own rules. Explosive tempers if not going
o Sometimes their behaviour is so severe they’re diagnosed with conduct
o Between 45-60% of those with ADHD develop conduct disorder, abuse drugs,
or become juvenile delinquents.
o Conduct problems in childhood sometimes continue into adulthood.
o Has become a popular diagnosis to give when children are out of control at
home or school.
o Only 1-7% actually develops ADHD.
o Boys have a higher incidence of ADHD, across all age groups, but rates differ.
Prevalence rates are significantly higher for 6-8 year olds than 12-14
o Boys with ADHD tend to have more disruptive behaviour than girls
(underdiagnosed in girls, then?).
o ADHD is found across cultures and ethnic groups.
o ¾ of childhood ADHD symptoms persist into adulthood.
o Adults diagnosed with ADHD as children are at a higher risk for depression,
anxiety disorders, substance abuse, and ASPD.
o Many children grow out of their ADHD.
o Biological contributors
Formerly referred to as minimal brain damage, because it was thought
to be the result of brain damage.
Most children with ADHD have no history of brain damage, and those
with brain damage don’t develop ADHD.
Differ on psychological measures of neurological functioning and
cerebral blood flow.
Frontal lobes; caudate nucleus in the basal ganglia; the corpus
callosum, which attaches the two hemispheres.
Play a role in attention, the regulation of impulses, and
planning of complex behaviour. Immaturity Hypothesis: children with ADHD are neurologically
immature; brains are slower at developing.
Why they’re unable to maintain attention and control their
behaviour at a level expected of their age.
Also explains why symptoms decline with age.
Dopamine: lower D2/D3 receptors, and dopamine transporters (DAT)
in the midbrain.
D2/D3 = inattention.
Many tasks, therefore, are not intrinsically rewarding.
DAT is the target for many simulant medications in ADHD.
Although serotonin plays a role in impulsive and aggressive
behaviour, it does not appear to play a role in ADHD.
ADHD runs in families; 10-35% of the immediate family also has the
Comorbid with ASPD, alcoholism, and depression in families.
Not clear exactly what aspects of ADHD are inherited.
Many children have a history of prenatal and birth complications.
Maternal ingestions of large amounts of nicotine or
barbiturates during pregnancy, low birth weight, premature
delivery, and oxygen deprivation.
In preschool, many were exposed to lead-based products.
Two specific risk factors:
Exposure to maternal smoking during pregnancy.
Low birth weight or prematurity.
DAT1 and ADHD was stronger when mother drank during
DAT1 and hyperactive-impulsive symptoms was stronger
when mother smoked during pregnancy.
Studies do not support the hypothesis that hyperactivity is due to a
o Psychological and Social Contributors to ADHD
Children with ADHD are more likely to belong to families where there
are frequent disruptions (e.g., changes in residence or divorce).
Fathers are more prone to ASPD and criminal activity.
Interactions with mother are hostile.
Parental satisfaction and perceived competence is lower in mothers
with children who have ADHD.
Mothers’ parenting behaviours are linked with specific traits of ADHD.
o Treatments for ADHD
Most common is the use of stimulant drugs (e.g., Ritalin, Dexedrine,
70-85% of ADHD children respond to these drugs with
decreases in demanding, disruptive, and non-compliant
behaviour. Also show an increase in positive moods, and their ability to be
Work by increasing dopamine in the synapse (either by
enhancing its release or prevent its reuptake).
Side effects of stimulants:
Reduced appetite, insomnia, edginess, and gastrointestinal
Since 1997, there has been a 20% increase in physician referrals for
ADHD, and a marked 100.6% increase in Ritalin prescriptions.
Could be due increased recognition of the disorder.
Others argue that it represents and overuse of drugs.
Seems to be overdiagnosed and overtreated, or underdiagnosed and
undertreated in others.
Only 12% of those diagnosed with ADHD actually meet the
Other drugs like clonidine and guanfacine affect levels of
norepinephrine (help reduce tics), and increase cognitive
Side effects: dry mouth, fatigue, dizziness, constipation, and
Antidepressants are prescribed, particularly if they have depression.
Positive effects on cognitive performance, but are not as
effective as stimulants.
Medication = short-term gains.
Long-term gains = stimulant therapy with behaviour therapy.
Focuses on reinforcing attentive, goal-directed, prosocial
behaviour, which extinguishing impulsive and hyper
Parents also taught more effective parenting techniques.
Behavioural training for children and parents has been found
to be effective.
o E.g., Child receives a chip for good behaviour, and at the
end up of the week, can trade them in. They can lose
them for not listening. They get timeouts for bad
o Also helps children anticipate consequences for their
Almost 70% showed a reduction or complete discontinuation
of ADHD symptoms.
Conduct Disorder and Oppositional Defiant Disorder
o Those diagnosed with conduct disorder engage in other serious
transgressions of societal norms for behaviour.
o It’s like ASPD in adults.
o Children have chronic patterns of unconcern for the basic rights of others.
o In Ontario, it is estimate 5.5% of children meet the criteria for conduct
disorder. o As adolescents, ½ engage in criminal behaviour and drug abuse.
o As adults, 75% - 85% are chronically unemployed.
o Between 35-40% will be diagnosed with ASPD.
o More likely to show a wide range of psychological problems and violent
behaviour as adults.
o Boys who exhibited aggression early on were more likely to show chronic
conduct problems in adulthood.
o A less severe pattern of chronic misbehavior is referred to as oppositional
Frequently lose their temper/have temper tantrums, argue with
adults, and defy requests.
Where they differ from those with conduct disorder, is that they are
not aggressive towards people or animals, do not destroy property,
and do not show a pattern of theft or deceit.
Symptoms begin early in life; some children outgrow them.
Sometimes a precursor to conduct disorder.
o Boys are 3x as likely as girls to be diagnosed with conduct disorder or
oppositional defiant disorder.
Perhaps because the causes are more present in boys.
Boys tend to be more physically aggressive, so they draw more
attention to themselves.
o Girls with conduct disorder are just as likely to engage in stealing, lying, and
Show high rates of depression and anxiety disorders, severe marital
problems, criminal activity, and early and unplanned pregnancies.
o Biological Contributors
Children with conduct disorder are much more likely to have parents
Fathers are highly likely to have histories of criminal arrest and
alcohol abuse; mothers have a history of depression.
Twin and adoption studies indicate both are heritable.
Suggested that there are frontal lobe deficiencies.
May have been exposed to neurotoxins and drugs while in the womb
or preschool years.
May have been difficult babies.
Children learn to control their behaviour by associating punishments
with bad behaviour and rewards with good behaviour.
May have problems making these associations.
May not become as physiologically aroused by their rewards
and punishments as other children.
Boys with aggressive conduct disorder have unusually low levels of
cortisol (stress H).
Excreted by the hypothalamus-pituitary-adrenal axis.
Men who had higher blood serotonin levels were more likely to
commit a serious crime.
Serotonin levels weren’t correlated with women. Another popular theory is that aggression is linked to testosterone
(correlation of .14).
o Social Contributors to Conduct and Oppositional Defiant Disorders
Found more in urban, lower socioeconomic classes.
Quality of parenting = strongly related to whether they develop the
Children who are physically maltreated or neglected are more likely
to develop disruptive and delinquent behaviour.
Parental uninvolvement: children whose parents are not involved in
their everyday lives are more likely to develop conduct disturbances.
Parents often interact with their children with hostility, physical
violence, and ridicule.
Also more likely to give severe physical punishment to boys
than girls (may account for higher conduct disorders in boys).
Deviant peer groups tend to encourage delinquent acts (even
Individuals with antisocial tendencies tend to choose similar mates.
Those who have interpersonal relationships with normal
individuals are more likely to grow out of the behaviours.
Neuropsychological problems associated with antisocial behaviour
are linked with maternal drug use, poor prenatal care, prenatal and
postnatal exposure to toxins, child abuse, birth complications, and low
Children are more irritable, impulsive, awkward, overreactive,
More difficult to parent; more likely to be neglected.
Presence of interpersonal skills, positive adult relationships,
prosocial and pro-educational family values, and strong social
programs and supports.
o Cognitive Contributors
Process information about social interactions that promote aggressive
reactions to these interactions.
Automatically believe people are being aggressive towards
them; as such, they react aggressively.
Don’t believe that things are a result of the situation; believe
that things are done deliberately.
Intent rather than accidental.
Children with conduct disorder have a narrow range of responses;
Often consider non-aggressive responses to be a waste of time.
Self-fulfilling prophecy: children react negatively, which perpetuates
the notion that the world is against them.
o Drug Therapies
Medications have not proven to be useful.
SSRIs may reduce irritability and agitation. Neuroleptics and stimulants suppress aggressive behaviour.
Mood stabilizers (e.g., lithium) and anticonvulsants may be effective
for aggressive conduct disorder.
o Psychological and Social Therapies
Derived from social learning theory.
Cognitive behaviour therapy
Recognize triggers (done through naturalistic observation).
Alternative ways of deal with triggers (challenge their “me vs.
the world” cognition).
Maybe use self-talk (e.g., count to ten, breathe deep, etc.).
Therapists model solutions, and the children practice them in
Parents are also taught strategies for controlling their
behaviour as well as their child’s.
Therapists need to be sensitive to cultural differences.
o E.g., in children of colour, often useful to engage the
Relapse occurs due to poor parenting, substance abuse, or
Separation Anxiety Disorder…
Many infants become anxious and upset if separated from their primary caregivers;
part of normal development, understanding that just because you can’t see the
object anymore, doesn’t mean it doesn’t exist.
Children will find a way to comfort themselves until they are not so anxious
Some children continue to be extremely anxious when separated, even into
childhood and adolescents: cannot go to school, fall asleep, and have nightmares
with themes of separation (separation anxiety).
o May follow caregivers around the house.
o Exaggerated fear of natural disasters, robbers, kidnappers, and accidents.
o May experience somatic sensations (headache, nausea, etc.).
Many children go through this right after a traumatic event (e.g., getting lost in a
shopping mall), but it doesn’t stay with them.
Separation anxiety is diagnosed if children experience symptoms for at least four
weeks, and it impairs their lives.
About 3% of children under 11 years old suffer from this disorder.
More common in girls than boys.
Those with separation anxiety have more problems as adults.
o More likely to live with parents as adults, less likely to be married and have
o Tend to have family histories of anxiety and depression.
o Twin studies suggest it is more heritable in girls. o Children born high in behavioural inhibition (shy, fearful, irritable,
cautious, quiet, introverted) are more likely to suffer from separation
Tend to withdraw, and are clingy.
Parents are more likely to suffer from anxiety disorders, particularly
Have low levels of CRH (corticotropin-releasing hormone).
o Psychological and Sociocultural Contributors
May learn to be anxious from parents, or as an understandable
response to their environments.
Parents may be overprotective and model anxious reactions.
Families tend to be especially tight-knit.
Greatest risk: insecurely attached, behaviourally inhibited, and
Cognitive-behavioural therapies are most often used.
Develop new skills to cop and challenge their cognitions that feed
Taught relaxation exercises during times without their parents.
Parents must be willing to participate in the therapy, and are taught
how to cope with their reactions, as well as their child’s.
Effective in the short- and long-term.
Antidepressants, antianxiety (benzodiazepines), stimulants,
SSRIs are used most frequently.
Most children gain control over their bladder and bowel by age 4.