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Disorders of Childhood and

Adolescence

• Child psychology:
– Emotional and behavioral manifestation of
Disorders of Childhood psychological disorders in children and
and Adolescence adolescents
• Prevalence of childhood disorders:
– One in five has serious emotional or behavioral
problem
– Two-thirds of those with mental illness received
no treatment

Disorders of Childhood and Disorders of Childhood and

Adolescence (cont’d.) Adolescence (cont’d.)

• Diagnosis requires that symptoms cause

significant impairment in daily functioning
over extended period of time
• Include:
– Internalizing disorders
– Externalizing disorders
– Neurodevelopmental disorders
• Conditions involving impaired neurological
development

Anxiety, Trauma, and Stressor-Related

Internalizing Disorders of Childhood Disorders in Early Life

• Conditions involving emotional symptoms • Most common mental health disorder in

directed inward childhood and adolescence (32%)
• Heightened reactions to trauma, stressors or • Can significantly affect academic, social, and
negative events and difficulty regulating interpersonal functioning and can lead to
emotions adult anxiety disorders
– Prevalent in early life and often lead to substance • Include:
use and suicide – Social phobia
– Separation anxiety disorder
– Selective mutism

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Anxiety, Trauma, and Stressor-Related
Disorders in Early Life (cont’d.)
• Post-traumatic stress disorder in early life:
– Recurrent, distressing memories of a shocking
experience, such as experience with death,
serious injury, or sexual violation
– Memories may entail:
• Distressing dreams
• Intense physiological or psychological reactions to
thoughts or cues associated with event and avoidance
of those cues
• Episodes of playacting the event
• Dissociative reactions
Depressive Disorders in Early Life
• Youth with depressive disorders have more
negative self-concepts and are more likely to
engage in self-blame and self-criticism
• Early-onset depressive symptoms tends to
predict a more chronic and severe course
• Evidence-based treatment for depression:
– Individual, group, or school-based cognitive-
behavioral therapy
– SSRIs increase suicidality but benefits may
outweigh risk
Pediatric Bipolar Disorder
• Debilitating disorder that parallels mood
variability, depressive episodes, and significant
departure from individual’s typical functioning
seen in adult bipolar disorder
– Episodes of recurring depression, rapid mood
changes, and distinct periods of abnormally-
elevated mood involving diminished need for
sleep, increased activity, distractibility,
talkativeness, and inflated self-esteem
• Lifetime prevalence: estimated 3%
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Anxiety, Trauma, and Stressor-Related
Disorders in Early Life (cont’d.)
• Post-traumatic stress disorder in early life:
– Children often display social withdrawal,
diminished positive affect, and disinterest in
previously-enjoyed activities
– Lifetime prevalence:
• 8% for girls and 2.3% for boys
– Effective treatments include:
• Trauma-focused cognitive-behavioral therapies
Nonsuicidal Self Injury (NSSI)
• Involves induction of bleeding, bruising, or
pain by means of intentional, self-inflicted
injury, without suicidal intent
• Intense negative affect or cognitions and a
preoccupation with engaging in self-harm
typically precede episodes of NSSI
• Expectation that mood will improve after
episode
Pediatric Bipolar Disorder (cont’d.)
• Rapid cycling of moods combined with
neurocognitively based difficulties processing
emotional stimuli and regulating behavior and
social-emotional functioning
• Elevated responsiveness to emotional stimuli,
reduced volume in amygdala, and other brain
abnormalities
• Medications are often combined with
psychosocial treatment
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Attachment Disorders
• Exposure to early environments devoid of
predictable caretaking and nurturing can
cause significant difficulties with emotional
attachment and social relationships
• Includes:
– Reactive attachment disorder (RAD)
– Disinhibited social engagement disorder (DSED)
Attachment Disorders (cont’d.)
• Disinhibited social engagement disorder:
– Indiscriminate, superficial attachments and
desperation for interpersonal contact
• Socialize effortlessly, but indiscriminately, and become
superficially “attached” to strangers or acquaintances
• History of harsh punishment or inconsistent parenting,
as well as emotional neglect and limited attachment
opportunities
• Exposure to maltreatment or maternal psychiatric
hospitalizations are particularly vulnerable
Externalizing Disorders of Childhood
• Also known as disruptive behavior disorders:
conditions associated with socially disturbing
symptoms and distressing others
• Include:
– Disruptive mood dysregulation disorder
– Oppositional defiant disorder
– Conduct disorder
• Early intervention is necessary
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Attachment Disorders (cont’d.)
• Reactive attachment disorder:
– Inhibited, avoidant social behaviors and
reluctance to seek or respond to attention or
nurturing
• Show little trust that needs will be attended to and do
not readily seek nor respond to comfort, attention, or
nurturing
• Use avoidance or ambivalence as psychological defense
• Limited positive emotion and may demonstrate
irritability, sadness, or fearfulness when interacting
with adults
Attachment Disorders (cont’d.)
• Course depends on severity of social
deprivation, abuse, neglect or disruptions in
caregiving, and subsequent events in the
child’s life
• Symptoms of RAD can disappear whereas
symptoms of DSED are more persistent
• Effective intervention:
– Providing stable, nurturing environment, and
opportunities to develop interpersonal trust and
social skills
Externalizing Disorders of Childhood
(cont’d.)
• Diagnosis is controversial, and requires a
pattern of behavior that is:
– Atypical for the child’s gender, age, and
developmental level
– Persistent
– Severe enough to cause significant impairment in
social, academic, or vocational functioning
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Disruptive Mood Dysregulation

Disorder Oppositional Defiant Disorder

• Characterized by chronic irritability and • Pattern of negativistic, argumentative, and

significantly exaggerated anger reactions hostile behavior in which children often:
• Patterns begin in early childhood – Lose their temper
• Diagnosis requires that symptoms persist – Argue and defy adult requests
beyond age six – Primarily directed toward parents, teachers, and
others in authority
• Predictive of later depressive and anxiety
– No serious violation of societal norms
disorders
• Two components:
• Clinicians need to rule out PBD due to
– Negative affect
symptom overlap
– Oppositional behavior

Conduct Disorders Conduct Disorders (cont’d.)

• Persistent pattern of behavior that violates • Prevalence:

rights of others – Approximately 2-9% of youth meet criteria
• Reflect dysfunctions in individual and include: – 50% display inattention and hyperactivity
– Serious violations of rules and social norms • Gender differences:
– Cruelty and deliberate aggression towards people – Males display confrontational aggression
or animals – Females display truancy, substance abuse, or
– Theft, deceit, and vandalism chronic lying
• Callous and unemotional subtype • More persistent than other childhood
– Often exhibit antisocial personality disorder in disorders
adulthood

Etiology of Externalizing Disorders

Etiology of Externalizing Disorders (cont’d.)

• Biological factors:
– Appear to exert greatest influence
– Aggressive behavior linked to brain abnormalities
and reduced activity in amygdala
– “Low MAOA” and childhood maltreatment
– Reduced autonomic nervous system activity
– Cortisol (stress levels)

Figure 15-1 Multipath Model of Conduct Disorder The dimensions interact with one
another and combine in different ways to result in a conduct disorder

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Etiology of Externalizing Disorders
(cont’d.)
• Social and sociocultural:
– Family and social context play large role
– Large families and marital breakdown
– Economic stress
– Crowded living conditions
– Harsh or inconsistent discipline
– Maternal or peer rejection
– Parent-child conflict and power struggles
– Limited parental supervision
Treatment of Externalizing Disorders
• Must consider family and social context of
behaviors and psychosocial skills deficits
• CD is particularly difficult to treat
• Effective when implemented before patterns
of disruptive behavior are established
• Parent-focused interventions regarding child
management techniques
Neurodevelopmental Disorders
• Involve impaired development of the brain
and central nervous system
• Symptoms become increasingly evident as
child grows and develops
• Include:
– Tic disorders (Group 1)
– Attention-deficit hyperactivity disorder (Groups 2
and 3)
– Autism spectrum disorders (Group 4 and 5)
– Intellectual and learning disorders (Group 6)
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Etiology of Externalizing Disorders
(cont’d.)
• Psychological factors:
– Difficult child temperament (irritable, resistant,
impulsive tendencies)
– Underlying emotional issues
– Depression frequently coexists with ODD and
DMDD
Treatment of Externalizing Disorders
(cont’d.)
• Psychosocial interventions that focus on:
– Assertiveness-training
– Anger management techniques
– Building skills in empathy, communication, social
relationships and problem-solving
• Mobilizing adult mentors
What to do?
1. You will enter breakout rooms with your
group mates.
2. Based on the assigned group of disorders, try
to understand them on your own. You can
consult the Internet about it (e.g. articles,
videos).
3. You need to have discuss what you learned in
your groups. Here are your guide questions:
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What to do?
a. What did you learn about these disorders?
b. Why are they considered to be disorders of children
or adolescents?
c. How do they impact children or adolescents based
on their symptoms?
d. How did you feel after learning them? (insights).
4. Come up with a one-page summary of significant
discussions that transpired in your discussion.
Deadline: Psy2A (11:00 AM); Psy3A (2:00 PM)
Tics and Tourette’s Disorder (cont’d.)
• Tics:
– Short-term suppression of a tic is possible, but
results in subsequent increases in the tic
– Some report feeling tension build prior to tic,
followed by a sense of relief after tic occurs
– Stress can increase frequency and intensity
– Provisional tic disorders (2.6% of children)
– Chronic motor or vocal tic disorders (3.7% of
children)
Tics and Tourette’s Disorder (cont’d.)
• Etiology:
– Both chronic tic disorder and TD appear to be
genetically transmitted
– Involvement of basil ganglia and orbital frontal
cortex
– Possible involvement of neurotransmitters
• Treatment:
– Psychotherapy can help with distress
• Habit reversal technique
– Antipsychotic medication used for severe tics
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Tics and Tourette’s Disorder
• Tics:
– Involuntary, repetitive movements or vocalizations
– Motor tic:
• Eye-blinking, facial-grimacing, head-jerking, foot
tapping, flaring of nostrils, and contractions of the
shoulders or abdominal muscles
– Vocal tics:
• Coughing, grunting, throat clearing, sniffling, or sudden
repetitive and stereotyped outburst of words
Tics and Tourette’s Disorder (cont’d.)
• Tourette’s disorder (TD):
– Characterized by multiple motor tics and one or
more vocal tic, present for at least one year
– Onset is prior to age 18
– About 8% show complete remission
– Symptoms can be severe or mild
– Coprolalia and motor movements involving self-
harm
– Comorbid conditions
Tics and Tourette’s Disorder (cont’d.)
Tourette's Syndrome: Introduction Meet Isabella, Devon, Nikki, Amanda as they attend
“Camp Tic-a-Palooza,” a camp designed for children with Tourette's Syndrome. Explore
the many difficulties they encountered when integrating with other children in school, and
even with their families.
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Attention-Deficit/Hyperactivity Attention-Deficit/Hyperactivity
Disorder Disorder (cont’d.)

• Characterized by persistent inattention and/or • Prevalence rates vary between studies

impulsive, hyperactive behaviors
• Symptoms must interfere with social,
academic, or occupational activities
• Diagnosis requires that symptoms begin
before age 12 and persist for at least six
months
• Poor regulation of attentional processes
– One study: 8.7%
– More than twice as likely in boys than in girls
• Symptoms tend to improve in late
adolescence
• Associated with behavioral and academic
problems
• Risk of coexisting conditions is four times
greater among children living in poverty

Attention-Deficit/Hyperactivity Attention-Deficit/Hyperactivity
Disorder: Etiology Disorder: Etiology (cont’d.)

• Biological dimension:
– Highly heritable with up to 80% of symptoms
explainable by genetic factors
• Rare inherited gene mutations
• Chromosomal DNA deletions and duplications
• Genes affecting regulation of dopamine and glutamate
– Hypotheses about neurological mechanisms
• Reduced activity in prefrontal cortex
• Differences in brain structure and circuitry in frontal
cortex, cerebellum, and parietal lobes ABC Video: Brain Activity and ADHD See an in-depth look at the brain and how the
• Low dopamine levels brains of people with ADHC differ and are similar to those who do not have ADHD using
brain imaging techniques

Attention-Deficit/Hyperactivity Attention-Deficit/Hyperactivity
Disorder: Etiology (cont’d.) Disorder: Etiology (cont’d.)

• Biological dimension: • Social and sociocultural dimensions:

– Prematurity – Sociocultural and social adversity including:
– Oxygen deprivation during birth • Stressors in family
– Low-birth weight • Low social class
• Foster care placement
– Lead and PCB exposure
– Cultural and regional expectations
– Viral infections, meningitis, and encephalitis
– Maternal smoking, drug, and alcohol abuse during • Psychological dimension:
pregnancy – Interpersonal conflict
– Possible involvement of food additives

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Attention-Deficit/Hyperactivity Attention-Deficit/Hyperactivity
Disorder: Etiology (cont’d.) Disorder: Treatment

• Stimulants such as methylphenidate (Ritalin)

receive most evidence-based support
– Normalize neurotransmitter functioning and
increased neurological activation in frontal cortex
– Increased rates of stimulant medication use in U.S.

Figure 15-3 Prevalence of ADHD Among Youth (Ages 4-17) by State, 2007-2008 The
prevalence of parent-reported attention-deficit/hyperactivity disorder varied significantly
from state to state, ranging from a low of 5.6% in Nevada to a high or 15.6% in North
Carolina. What might account for the variability in ADHD diagnoses from state to state?
Source: Centers for Disease Control and Prevention (2010b)

Attention-Deficit/Hyperactivity
Disorder: Treatment (cont’d.) Autism Spectrum Disorders

• Evidence that behavioral and psychological • Characterized by impairment in social

treatments are highly effective communication and restricted, stereotyped
• Modifying environment and social context can interests and activities
enhance feelings of competence, motivation, • Symptoms range from mild to severe
and self-efficacy • Prevalence:
• Coordination of all services result in most – Affects one out of 100-110 children
successful interventions – Four times as common in boys

Autism Spectrum Disorders (cont’d.) Autism Spectrum Disorders (cont’d.)

• Symptoms of autism spectrum disorder:

– Deficits in social communication and social
interaction
• Atypical social-emotional reciprocity
• Atypical nonverbal communication
• Difficulties developing and maintaining relationships

ABC Video: Underdiagnosed Autism in Girls Discover the ways in which autism is
more often diagnosed, and often easier to diagnose, in boys, and the problems this can
lead to for young girls with autism spectrum disorders

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Autism Spectrum Disorders (cont’d.) Autism Spectrum Disorders (cont’d.)

• Symptoms of autism spectrum disorder: • Problems diagnosing autism:

– Repetitive behavior or restricted interests or – Typical procedures include clinical observation,
activities involving at least two of following: parent interviews, developmental histories,
• Repetitive speech, movement, or use of objects autism screening inventories, communication
• Intense focus on rituals or routines and strong assessment, and psychological testing
resistance to change – Autism is usually diagnosed at age three or later
• Intense fixations or restricted interests
– Symptoms may appear following a period of
• Atypical sensory reactivity
normal social and intellectual development
– Autistic savants
• Individual with ASD who performs exceptionally well on
certain tasks

Autism Spectrum Disorders: Etiology

Autism Spectrum Disorders: Etiology (cont’d.)

• Biological dimension: • Biological dimension:

– Unique patterns of metabolic brain activity – Genetic factors
– Abnormally high levels or serotonin • Heritability estimated to be around .73 percent for
males and .87 for females
– Differences in brain anatomy and connectivity in
• Autistic traits have high heritability
brain regions associated with autistic traits
• Clear evidence for genetic susceptibility
– Accelerated growth or amygdala
– Innate vulnerability triggered by environment
– Accelerated head growth
– Nutritional deficits, changes in immune system,
– Genetic mutations implicated in familial autism low birth weight

Autism Spectrum Disorders: Etiology Autism Spectrum Disorders: Etiology

(cont’d.) (cont’d.)

• Psychological dimension:
– Children with ASD seldom make eye contact, seek
social connectedness, or bid for attention
– Prefer to be alone and ignore parental efforts at
connection
– High stress levels among family due to ASD
– Psychological and social factors play a role in
manifestation of symptoms, but ASD is primarily
Figure 15-5 Changes in the Prevalence of Autism Spectrum Disorder Among 8
Year-Old Children in 10 U.S. States 2002 to 2006 The prevalence of autism spectrum influenced by biological factors
disorder among 8-year-old children increased between 2002 and 2006 in all 10 state
sites monitored. What might account for these increases and the state-to-state variations
in prevalence of the disorder?
Source: Center for Disease Control and Prevention (2009b)

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Autism Spectrum Disorders:
Intervention and Treatment
• Prognosis is mixed; most children retain
diagnosis and require support for life
• Individuals with higher levels of cognitive-
adaptive functioning fare better than those
with intellectual disabilities and severe autistic
symptoms
• Significant recovery linked with intense early
intervention
Autism Spectrum Disorders:
Intervention and Treatment (cont’d.)
• Medications are used to decrease anxiety,
repetitive behaviors, and hyperactivity
– Minimally effective and may be harmful
– Risperidone alone received FDA approval:
– Preliminary research on effects of oxytocin
• Comprehensive treatment programs have
enabled children with ASD to develop more
functional skills
Intellectual Developmental Disorder
• Limitations in intellectual functioning and
adaptive behaviors including:
– Significantly below average general intellectual
functioning (generally IQ of 70 or less)
– Deficiencies in adaptive behavior that are lower
than would be expected based on age or cultural
background
• Only diagnosed when low intelligence is
accompanied by impaired adaptive
functioning
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Autism Spectrum Disorders:
Intervention and Treatment (cont’d.)
ABC Video: Autism Diagnosis Early intervention can help Autistic children lead more
normal lives. Find out what parents can do to help identify this disorder early-on.
Autism Spectrum Disorders:
Intervention and Treatment (cont’d.)
• Interventions with most significant gains:
– Social communication
– Environmental enrichment
– Reinforcing appropriate attention and response to
social stimuli
– Preventing repetitive behaviors
– Sustained practice of weaker skills
– Reducing environmental stress
– Improving sleep and nutrition
Intellectual Developmental Disorder
(cont’d.)
• Four distinct categories:
– Mild: IQ score 50-55 to 70
– Moderate: IQ score 35-40 to 50-55
– Severe: IQ score 20-25 to 35-40
– Profound: IQ score below 20-25
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Intellectual Developmental Disorder Intellectual Developmental Disorder

(cont’d.) (cont’d.)

• American Association on Intellectual and

Developmental Disabilities:
– IQ score may be used to approximate intellectual
functioning
– More important to focus on adaptive functioning
and nature of psychosocial supports needed
– Given ongoing, individualized support, overall
functioning of individual with ID will improve

Intellectual Developmental Disorder Intellectual Developmental Disorder:

(cont’d.) Etiology

• Prevalence: • Etiology differs depending on level of

– Approximately 1% of students in public school intellectual impairment
– Increases in low and middle income countries – Mild IDD is often idiopathic (no known cause)
– Coexisting conditions are common – Pronounced IDD related to genetic factors, brain
• One-fourth have seizure disorders abnormalities, or brain injury

Intellectual Developmental Disorder: Intellectual Developmental Disorder:

Etiology (cont’d.) Etiology (cont’d.)

• Genetic factors: • Down syndrome (DS):

– In up to 80 percent of cases of IDD, underlying – Extra copy of chromosome 21 originates during
cause is unknown gamete development
• Unidentified genetic factors – Majority have mild to moderate IDD
– Genetic variations – With support many can have jobs and live semi-
• Normal distribution of traits (upper vs. lower range) independently
– Genetic abnormalities – Medical interventions improve outcome, but
• Chromosomal abnormalities significant risks remain
– Down syndrome most common
– Prenatal detection of DS through amniocentesis
• Inheritance of single gene
– Fragile X syndrome most common (mild to severe ID)

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Intellectual Developmental Disorder: Intellectual Developmental Disorder:

Etiology (cont’d.) Etiology (cont’d.)

• Nongenetic biological factors:

– Influences during prenatal, perinatal, or postnatal
period
• Fetus is susceptible to viruses and infections, drugs and
alcohol, radiation, and poor nutrition
– Fetal alcohol spectrum effects and fetal alcohol syndrome
• Birth trauma, prematurity, and low birth weight
• Head injuries, brain infections, tumors, and prolonged
malnutrition
Developmental Disabilities Children with developmental disabilities are said to have • Exposure to environmental toxins, including lead
exceptionalities, which are diagnosed based on delays or differences in what we know of
typical development

Intellectual Developmental Disorder:

Etiology (cont’d.) Learning Disorders

• Psychological, social, sociocultural dimensions: • Academic disability characterized by reading,

– Genetic background interacts with environmental writing, and math skills deficits
factors • Primarily interferes with academic
• Effects of low SES
achievement and activities of daily living in
• Parents with mild IDD
which reading, writing, or math skills are
• Long-term effects of prematurity
needed (e.g., dyscalculia, dyslexia)
– Enriching and encouraging home environment, as
well as ongoing education intervention • Prevalence:
– Around 5% of students in public schools
– Boys are almost twice as likely as girls

Support for Individuals with

Learning Disorders (cont’d.) Neurodevelopmental Disorders

• Etiology: • Produce lifelong disability, goal of intervention

– Little is known about precise causes of LD is to build skills and develop potential to the
– Appear to have slower brain maturation fullest extent possible
– Lifelong differences in neurological processing of • Support should begin in infancy and extend
information related to basic academic skills across the life span
– May be similar to biological explanations for IDD • Different levels of support
and ADHD
– Runs in families, suggesting genetic component

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Support for Individuals (cont’d.)
• Support in childhood:
– Individualized home-based or school-based
programs
– Parent involvement is integral part of early
intervention programs
– School services are individualized to meet child’s
needs and to maximize learning opportunities
• Rates of improvement decrease once programs are
completed
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Support for Individuals (cont’d.)
• Support in adulthood:
– Programs focusing on specific job skills
– Institutionalization is rare, but many live with
family members
– “Least restrictive environment” possible
• As much independence and personal choice as is safe
and practical
• Most normalized living arrangements vary from setting
to setting
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