Disorders of Childhood

Introduction to Childhood Development

× Brain Development

 The first is during gestation and early years of life when the brain is establishing its
cortical connections.
 Brain connections remain stable until about 12 years of age. During adolescence,
there is another critical period when the brain rewires itself in a different manner.

× Effects of Early Life Stress

 Early life stress reflects the situation in which the child is unable to cope given the
demands that he or she experiences.
 In terms of DSM disorders, these experiences increased the risk for a behavioral
disorder of 40% and a fear disorder by 15%.

× Theories of Attachment

John Bowlby

 Attachment is seen as the basis of early emotional relationships between a mother

and her child.
 A process in which the mother was able to reduce fear by direct contact with the
infant and provide support called a secure base.

Harry Harlow

 Harlow (1958) separated infant monkeys from their mothers after birth and placed
them in isolated cages.
 Two surrogate mothers- one made of wire and the other made of terry cloth
 Harlow concluded that it is the contact comfort and not the feeding per se that
binds the infant mother.

Mary Ainsworth

 Strange situation
 Secure attachment pattern
 Avoidant attachment pattern
 Anxious/ ambivalent pattern
 Disorganized /controlling attachment pattern

× Imitation Learning

 Mirror neurons: neurons in your brain that fire as if you had performance the same
actions as you observe.

× Theory of Mind

 The study of one’s ability to understand one’s own or another person’s mental state.

Attachment disorder

Reactive attachment disorder (RAD)

  A disorder that is the result of inadequate caregiving which may include institutional
settings.

• Emotionally withdrawn or inhibited type

• Indiscriminately social or disinhibited type

DSM- 5

× Describes a child with RAD as one who does not seek comfort or support from a traditional
attachment figure when distressed.

× Disinhibition has been classified as a separate disorder in DSM- 5 where it is called

disinhibited social engagement

Autism Spectrum Disorders

× Social interactions

× Communication

× Behavioral processes

Asperger’s syndrome

Developmental language delays may not be present

Individuals show average to above average cognitive skill

ICD-10 continues to describe Asperger’s syndrome as a separate disorder

Report that they do not see the world as others do

DIAGNOSTIC INDICATORS OF ASD

Symptoms are typically recognized during the second year of life.
a. Look for early developmental delays or any losses of social or language skills.
b. A “red flag” for ASD is the deterioration in social behaviors or use of language during the first 2
years of life for some individuals.
c. First symptoms of ASD involve delayed language development and/or lack of social interest or
unusual social interactions.

Special Talents

× 10% of individuals with autism spectrum disorder have special abilities in terms of music, art,
calculation, or memory

× Savant syndrome

Treatment for ASD

 Lovaas treatment program

1) Establishing a teaching relationship

2) Teaching foundational skills in terms of following directions, imitating behaviors and

identifying objects
 3) Focuses on beginning communication this includes initial speech processes and identifying
objects and actions

4) Continues communication processes such as labeling colors and shapes and developing the
basic concepts of language.

5) To continue communication processes and help the child adjust to school situations.

DIFFERENTIAL DIAGNOSIS OF ASD

 ASD is 4x more prevalent in males than females
 When an individual shows impairment in social communication but not restrictive
and repetitive behavior or interests, R/O social (pragmatic) communication Disorder.
 Intellectual disability is the appropriate diagnosis when there is no apparent
discrepancy between the level of social-communicative skills and other intellectual
skills.
 ADHD should be considered when ADHD symptoms exceeds that typically seen in
individuals of comparable mental age.

Attention Deficit/ Hyperactivity Disorder

 Inattention

 Hyperactivity and impulsivity

DIAGNOSTIC CRITERIA & ASSOCIATED

FEATURES

 ADHD begins in childhood, and symptoms must be present before age 12.
 Symptoms must be present in more than one setting. Typically symptoms vary
depending on context within a given setting.
 Mild delays in language, motor, or social development often co-occur with ADHD.
 Associated features may include low frustration tolerance, irritability, or mood
lability.

DIFFERENTIAL DIAGNOSIS OF ADHD

 With Oppositional Defiant Disorder (ODD) can be complicated, because some individuals
with ADHD develop secondary oppositional attitudes toward tasks that are challenging and
require attention and sustained activity.
 Intermittent Explosive Disorder reflects serious aggression toward others, which is not a
feature of ADHD.
 Children with ADHD may show significant changes in mood within the same day; such lability
is distinct from a manic episode, which must last 4 or more days. Bipolar disorder is rare in
preadolescents, even when severe irritability and anger are prominent.
 Children with ADHD may also be diagnosed with Disruptive mood dysregulation disorder.

Treatment for ADHD

 Medications that are stimulants

 Methylphenides; Ritalin
 Amphetamines; Adderall
 Dextroamphetamine; Dexedrine
  Psychosocial treatments

Conduct Disorder

 DSM- 5 criteria for a CD require that the youth show a persistent and repetitive pattern of
behavior.
 This pattern of behavior includes violating the rights of others and the rules of society during
the past 12 months.
 Aggression toward people and animals such as bullying or physical fights or cruelty
 Destruction of property including setting fires
 Theft and lying

Oppositional Defiant Disorder

 Angry or irritable mood which includes losing one ‘s temper, being easily annoyed and being
resentful and angry often
 Argumentative and defiant which includes arguing with authority figures or refusing to do
what they say as well as deliberately annoying others and blaming others
 Vindictive

Learning Disabilities

 The situation in which a child’s achievement is lower than that expected from his or her
scores on achievement or intelligence tests
 DSM- 5 specific learning disorder: a disorder in which a child shows problems in one of the
major school tasks.

Intellectual Development Disorder

 A disorder characterized by intellectual disabilities in which the person does not meet
normal developmental milestones.
1) Deficit in mental abilities
2) Lack of adaptive functioning in relation to one’s age & sociocultural
3) The onset of the disabilities took place prior to adolescence

Treatment of Intellectual Developmental Disorder

• Residential programs
 Designed to help individuals learn how to function and perform these daily tasks.
• Special education programs
 Designed to help children with developmental disorders

Essay Questions
a. What are the most important differential diagnoses of autism?
b. What features observed during diagnosis reliably differentiate other conditions
from autism?
c. What are the causes of neurodevelopmental disorders?