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3140 CH 13.docx

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York University
PSYC 3140
Joel Goldberg

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 their environment.  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 disorders.  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 ones). o More likely than other children to have both minor and major psychological problems. 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 doing it. o Those who don’t receive high-quality parenting in response are at a higher risk.  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 quickly. Behaviour Disorders…  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 long-term goals. o Children who have trouble learning these skills are sometimes diagnosed with ADHD. 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- impulsivity.  Symptoms indicating a sluggish cognitive tempo are also indicative.  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 their way. o Sometimes their behaviour is so severe they’re diagnosed with conduct disorder. 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 year olds. 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 disorder.  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.  Gene-environment interaction:  DAT1 and ADHD was stronger when mother drank during pregnancy.  DAT1 and hyperactive-impulsive symptoms was stronger when mother smoked during pregnancy.  Studies do not support the hypothesis that hyperactivity is due to a bad diet. 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, and Adderall).  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 goal-directed.  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 upset.  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 criteria.  Other drugs like clonidine and guanfacine affect levels of norepinephrine (help reduce tics), and increase cognitive performance.  Side effects: dry mouth, fatigue, dizziness, constipation, and sedation.  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 behaviours.  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 behaviour. o Also helps children anticipate consequences for their behaviour.  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 defiant disorder.  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 substance abuse.  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 with ASPD.  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 full syndrome.  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 promoting opportunities).  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 birth weight.  Children are more irritable, impulsive, awkward, overreactive, and inattentive.  More difficult to parent; more likely to be neglected.  Protective factors:  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; usually aggressive.  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 role-playing.  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 extended family.  Relapse occurs due to poor parenting, substance abuse, or other psychopathologies. 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 anymore.  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 children.  Biological Contributors 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 anxiety.  Tend to withdraw, and are clingy.  Parents are more likely to suffer from anxiety disorders, particularly panic disorders.  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 anxious parents. o Treatments  Cognitive-behavioural therapies are most often used.  Develop new skills to cop and challenge their cognitions that feed their anxiety.  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, antihistamines.  SSRIs are used most frequently. Elimination Disorders…  Most children gain control over their bladder and bowel by age 4.  Ch
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