Disorders of Childhood

and Aging
Week 10
 Childhood and Adolescence

• Children of all cultures typically experience at least some

emotional and behavioral problems as they encounter
new people and situations

• Surveys indicate that worry is a very common

experience

• Bedwetting, nightmares, temper tantrums, and

restlessness are other problems experienced by
many children - considered “normal”
 Childhood and Adolescence

• Adolescence can also be a difficult period

• Physical and sexual changes, social and academic
pressures, personal doubts, and temptation cause many
teenagers to feel nervous, confused, and depressed

• A particular concern among children and adolescents is

being bullied

• Over 25% of students report being bullied frequently, and

more than 70% report having been a victim at least once
 Childhood and Adolescence

• Beyond these common concerns and

psychological difficulties, at least one-fifth
(20%) of all children and adolescents
in the US also experience a
diagnosable psychological disorder

• Boys diagnosed with disorders outnumber

girls, even though many of the adult
psychological disorders are more common in
women
 Childhood and Adolescence - anxiety
• Surveys indicate that between 8%
and 29% of all
children and adolescents display an anxiety
disorder

• Typically, anxiety disorders of young

children are dominated by behavioral
and somatic symptoms
• *They tend to center on specific, sometimes imaginary,
objects and events
• *They are often triggered by current events and
situations
 Separation Anxiety Disorder

• Separation anxiety disorder, one of the most

common childhood anxiety disorders,
• **4 to 10% of all children

• Sufferers feel extreme anxiety,

often panic, whenever they are
separated from home or a parent
• A separation anxiety disorder may develop into
a school phobia or school refusal – a
common problem in which children fear going
to school and often stay home for a long period
 Childhood and Adolescence - anxiety

• Despite the high prevalence of these

disorders, around two-thirds of
anxious children go untreated
 Childhood and Adolescence - Mood D/O

• Around 2% of children and 8% of adolescents

experience major depressive disorder;
• As many as 20 percent of adolescents
experience at least one depressive episode

• Depression in the young may be triggered by negative

life events (particularly losses), major changes,
rejection, or ongoing abuse

• Childhood depression is commonly characterized

symptoms such as headaches, stomach pain, irritability,
and a disinterest in toys and games
 Childhood and Adolescence - Mood D/O

• While there is no difference between rates

of depression in boys and girls before the
age of 12-13, girls are twice as likely as
boys to be depressed by the age of 16
• Several factors have been suggested, including
hormonal changes, (other hypotheses: increased
stressors ?, and increased emotional investment in
social and intimate relationships?)

• Another factor that has received attention is teenage

girls’ growing dissatisfaction with their bodies.
Social media effects.
 Childhood and Adolescence - Mood D/O

• For decades, conventional clinical wisdom held that

bipolar disorder is exclusively an adult mood disorder,
whose earliest age of onset is the late teens

• However, since the mid-1990s, clinical theorists

have begun to believe that many children
display bipolar disorder

• Most theorists believe that the growing numbers of

children diagnosed with this disorder reflect not an
increase in prevalence but a new diagnostic trend
 Childhood and Adolescence - Mood D/O
• Theorists believe the diagnosis is currently being over
applied to children and adolescents

• They suggest the label “bipolar disorder” has

become a clinical “catchall” that is being applied to
almost every explosive, aggressive child

• The DSM-5 task force concluded that the childhood

bipolar label has been over applied and, to rectify the
situation, DSM-5 included a new category:
• ***disruptive mood dysregulation disorder,
which is targeted for children with severe
patterns of rage***
 Childhood and Adolescence - Mood D/O

• This issue is particularly important because the

current shift in diagnoses has been accompanied by
an increase in the number of children who receive
adult medications
• Few of these drugs have been tested on and approved

specifically for use in children

 Oppositional Defiant Disorder and Conduct Disorder
• Children who consistently show extreme hostility and
defiance may qualify for a diagnosis of oppositional
defiant disorder or conduct disorder

• Children with oppositional defiant

disorder are argumentative and
defiant, angry and irritable, and, in
some cases, vindictive
• As many as 10% of children qualify for this
diagnosis
• The disorder is more common in boys than girls
before puberty, but equal in both sexes after
puberty
 Oppositional Defiant Disorder and Conduct Disorder

• Children with conduct disorder, a more

severe problem, repeatedly violate the
basic rights of others

• They are often aggressive and may be

physically cruel to people and animals

• Many steal from, threaten, or harm their

victims, committing crimes as shoplifting,
forgery, mugging, and armed robbery
• James Patrick Bulger (16 March 1990– 12 February
1993) was a boy from Kirkby, Merseyside, England,
who was murdered on 12 February 1993, at the age of
two.

• He was abducted, tortured and murdered by two ten-

year-old boys, Robert Thompson (born 23 August
1982) and Jon Venables (born 13 August 1982).

• Bulger disappeared from the New Strand Shopping

Centre in Bootle, while accompanying his mother. His
mutilated body was found on a railway line two-and-a-
half miles (4 km) away in Walton, Liverpool, two days
after his murder.

• Thompson and Venables were charged on 20 February

1993 with Bulger's abduction and murder.
 Oppositional Defiant Disorder and Conduct Disorder

• Conduct disorder usually begins between 7 and 15 years

of age

• As many as 10% of children, three-quarters of them

boys, qualify for this diagnosis

• Children with a mild conduct disorder may improve over

time, but severe cases frequently continue into adulthood
and develop into antisocial personality disorder or
other psychological problems
 What Are the Causes of 

Conduct Disorder?

• Many cases of conduct disorder have been linked to

genetic and biological factors,
• drug abuse, poverty,
• traumatic events, and
• exposure to violent peers or community violence
• troubled parent-child relationships/abuse,
• inadequate parenting,
• family conflict/marital conflict/family hostility

•
 Conduct Disorder Treatments
• treatments for conduct disorder are generally most effective
with children younger than 13

• Given the importance of family factors in conduct disorder,

therapists often use family interventions

• Other sociocultural approaches, such as residential

treatment in the community (foster care) and programs
at school, have also helped some children improve

• In contrast to these other approaches,

institutionalization in juvenile training centers has
not met with much success and may strengthen
delinquent behavior
 Conduct Disorder Treatments

• Treatments that focus primarily on the child with

conduct disorder, particularly cognitive-behavioral
interventions, have achieved some success

• Inproblem-solving skills training (a type

of CBT), therapists combine modeling,
practice, role-playing, and systematic
rewards (+ reinforcement)
 ADHD
• difficulty concentrating, staying on task,
deciding what is important. Appear impulsive
and overactive
• Learning or communication problems
• Poor school performance
• Difficulty interacting with other children
• Misbehavior, often serious
• Mood or anxiety problems

• in US 8.4% of children 3-17 yr have been Dx w/ADHD

• in US 12% of boys 3-17 yr have been Dx w/ADHD
• in US 4.7% of girls 3-17 yr have been Dx w/ADHD
 ADHD
• exact mechanism unknown -

•****? combo of lower NE (causing

inattention/distractibility) and lower DA
(causing impulsiveness - remember DA is
imp in reward pathways, planning and
problem solving)
• Ritalin and Adderall increase NE and DA and allows for
increased attention and more control of impulsivity
 ADHD

• The disorder usually persists through childhood,

but many children show a lessening of
symptoms as they move into mid-adolescence

• Between 35% and 60% continue to

have ADHD as adults
 ADHD
• About 80% of all children and adolescents with ADHD receive
treatment

• The most commonly used treatment:

• **drug therapy to increase DA and NE +

behavioral therapy (+ reinforcement), or a

combination

• It is estimated that 2.2 million children in the US, 3% of

all school children, take Ritalin or Adderall or other
stimulant drugs for ADHD
 ADHD

• Over diagnosed?? probably

• On the positive side, stimulant drugs are
apparently very helpful for those who do have
the disorder
 Behavior Therapy 

and Combination Approaches

• Behavioral therapy has been applied in many

cases of ADHD

• Parentsand teachers learn how to

apply operant conditioning techniques
to change behavior (POSITIVE
REINFORCEMENT!)

•
 Autism Spectrum Disorder

• Autism spectrum disorder is marked by:

• 1. extreme unresponsiveness to other people,
• 2. severe communication deficits, and
• 3. highly rigid and repetitive behaviors,
interests, and activities
 Autism Spectrum Disorder

• Symptoms appear early in life, before age 3

• Just 10-15 years ago, autism spectrum disorder

seemed to affect around 1 out of every 2000
children; it now appears that a least 1 in 600 and
perhaps as many as 1 in 88 children display
the disorder

• Around 80% of all cases appear in boys

 Autism Spectrum Disorder

• As many as 90% of children with the

disorder remain severely disabled
into adulthood and are unable to lead
independent lives

• Even the highest-functioning adults with

autism spectrum disorder typically have
problems in social interactions and
communication, and have restricted
interests and activities
 Autism Spectrum Disorder
• The individual’s lack of responsiveness and
social reciprocity – extreme aloofness and lack of
interest in people – has long been considered a central
feature of the disorder

• Autism spectrum disorder is also marked by limited

imaginative play and very repetitive and
rigid behavior
• The motor movements of people with this disorder may
be unusual. may include jumping, arm flapping, and
making faces.
• Children may at times seem overstimulated and/or
understimulated by their environments
 Autism Spectrum Disorder - causes

• Looking at families suggests a genetic factor in the

disorder
• Prevalence rates are higher among siblings and

highest among identical twins

 Autism Spectrum Disorder - causes

• BIOLOGY
• 1. Some studies have linked the disorder to prenatal

difficulties or birth complications

• 2. One biological explanation that has NOT been shown

to be true.

• In
1998, some investigators proposed that a postnatal
event – the MMR vaccine – might produce autism in
some children,

• Virtually
all research conducted since then has argued
against this theory and, in fact, the original study was
found to be flawed and has been retracted
 Autism Spectrum Disorder
• Treatment can help people with autism spectrum disorder
adapt better to their environment, although no known
treatment totally reverses the autistic pattern

• Treatments of particular help:

• 1. cognitive-behavioral therapy,
• 2. communication training,
• 3. parent training, and
• 4. community integration

• Behavioral approaches have been used in cases of

autism to teach new, appropriate behaviors –
including speech, social skills, classroom skills, and
self-help skills – while reducing negative behaviors
 Autism Spectrum Disorder

• Even when given intensive behavioral treatment, half of

the people with autism spectrum disorder
remain speechless
• They are often taught other forms of communication,
including sign language

• Parent training:
• behavioral programs train parents so they can apply
behavioral techniques at home
• In addition, individual therapy and support groups are

becoming more available to help parents deal with their

own emotions and needs
Disorders of Aging
 Disorders of Aging
• The psychological problems of elderly persons may be
divided into two groups:

• 1. Disorders that may be common in people of all

ages but are connected to aging
• Depressive, anxiety, and substance use disorders

• 2. Disorders of cognition that result from brain

abnormalities related to aging
• a. Delirium (a state of mental confusion),
• b. Mild neurocognitive disorders, and
• c. Major neurocognitive disorders
 Disorders of Aging
• Depression is one of the most common
mental health problems of older adults

• The features of depression are the same for

elderly people as for younger people

• As many as 20% of people experience this

disorder at some point during old age
• The rate is highest in older women

• Several studies suggest that depression

among older people raises their chances
of developing significant medical
problems
 Depression in Later Life

• Like younger adults, older people who are

depressed may be helped by psychotherapy,
antidepressant medications, or a combination

• It is sometimes difficult for elderly people to use

antidepressant drugs effectively and safely
because the body’s metabolism works
differently in later life

• With elderly people, antidepressant drugs have a

higher risk of causing some cognitive
impairment
 Anxiety Disorders in 

Later Life
• Anxiety is also very common among the elderly

• 6% of elderly men and 11% of elderly women

in the U.S. experience at least one of the anxiety
disorders

• GAD is particularly common, experienced by

up to 7% of all elderly persons

• The prevalence of anxiety

increases throughout old age
 Alzheimer’s Disease and Other Neurocognitive
Disorders
• People with a neurocognitive disorders
experience a significant decline in at least
one (often more than one) area of cognitive
functioning, such as:
• memory and learning, attention, visual
perception, planning and decision making,
language ability, or social awareness

• In certain types of neurocognitive disorders,

individuals may also experience changes in
personality and behavior

• At any given time, around 3% to 9% of the

world’s adult population are suffering from a
neurocognitive disorder. closely related to
age.
 Alzheimer’s Disease

• This disease is the most common type of

the neurocognitive disorders, accounting
for as many as two-thirds of all cases
• Around 5 million people in the U.S. currently have
this disease

• This disease sometimes appears in middle age (early

onset), but most often occurs after the age of 65
(late onset)

• Its prevalence increases markedly among people in

their late 70s and early 80s
 Alzheimer’s Disease
first case study was a 51 year old woman in
1902. German
psychiatrist Dr.
Alzheimer
 Alzheimer’s Disease
• This is a gradually progressive disease in which
memory impairment is the most prominent
cognitive dysfunction

• The time between onset and death is typically 7 to 10

years, although some people may survive for as
many as 20 years

• It usually begins with:

• 1. mild memory problems,
• 2. lapses of attention, and
• 3. difficulties in language and communication
 Alzheimer’s Disease

• Eventually sufferers also have:

• difficulty with simple tasks,
• distant memories are forgotten, and
• changes in personality often become very
noticeable

• Eventually they become fully dependent on other

people, they lose almost all knowledge of the past
and fail to recognize the faces of even close
relatives
Alzheimer’s Disease significant atrophy
seen in the brains of AD patients
 What causes of AD - Hypotheses
3 main ideas of causation:
1. reduced synthesis of ACH. Meds that increase ACH
appear to have a + effect early in the course of the
disease
2. Amyloid (a small protein)- Amyloid deposits
accumulate around neurons ( a protein gone bad)
with the effect being damage to dendrite, decreased
synaptic input. As plaques accumulate, the brain
begins to atrophy. THESE ARE OUTSIDE THE
NEURON
3. Tau Protein - proteins that stabilize microtubules in
neurons.THESE ARE INSIDE THE NEURON
Amyloid Plaques
What causes of AD - Hypotheses

When Tau proteins can’t bind

normally and form neurofibrillary
tangles inside nerve cell bodies
eventually killing the neuron
Tau proteins
Causes of Alzheimer’s -Summary

See both amyloid plaques

(deposits around neurons) and
tau-based neurofibrillary tangles
(in neurons.)
 Alzheimer's Disease -Treatment

• Most commonly used medication increases

Acetlylcholine (ACH) in the brain
• Only helps early in the course of the
disease