Chapter 13 Childhood and Adolescence

ABNORMAL PSYCHOLOGY IN A CHANGING
WORLD, NINTH EDITION

Jeffrey S. Nevid/ Spencer A. Rathus/ Beverly Greene
Chapter 13
Abnormal Behavior in
Childhood and Adolescence
© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

Neurodevelopmental Disorders
Many of the psychological disorders affecting children
and adolescents are classified in the DSM-5 category of
neurodevelopmental disorders.
These disorders include:

– Autism spectrum disorder
– Intellectual disability
– Specific learning disorder
– Communication disorders
– Attention-deficit hyperactivity disorder

Cultural Beliefs About
What Is Normal and Abnormal
• Cultural beliefs help determine whether people view
behavior as normal or abnormal.
• Because children rarely label their own behavior as
abnormal, definitions of normality depend largely on
how a child’s behavior is filtered through the family’s
cultural lenses.
• Cultures vary with respect to the types of behaviors
they classify as unacceptable as well as the threshold
for labeling child behaviors as deviant.

Prevalence of Mental Health Problems
in Children and Adolescents
• According to a report from the U.S. Surgeon General, 1 in 10
children suffers from a mental disorder severe enough to impair
development (“A Children’s Mental Illness ‘Crisis,’” 2001).
• The most commonly diagnosed psychological disorders in

children age 6 to 17 are learning disabilities (11.5%) and
attention-deficit hyperactivity disorder (8.8%) (Blanchard, Gurka,
& Blackman, 2006).
• A telephone survey based on a national probability sample of

American youth ages 12 to 17 found that 7% of the boys and 14%
of the girls had suffered from major depression in the 6-month
period preceding the survey (Kilpatrick et al., 2003).

Risk Factors for Childhood Disorders
• Many factors contribute to increased risk of developmental
disorders, including genetic susceptibility, environmental
stressors (such as living in decaying neighborhoods), and
family factors (such as inconsistent or harsh discipline,
neglect, or physical or sexual abuse).
• Children with parents who suffer from depression also stand

a higher risk of developing psychological disorders, perhaps
because it leads to greater family stress (Essex et al., 2006,
Weissman et al., 2006).
• Gender is yet another discriminating factor.

Autism
• The word autism derives from the Greek autos, meaning “self.”
• The term was first used in 1906 by the Swiss psychiatrist Eugen
Bleuler to refer to a peculiar style of thinking among people with
schizophrenia.
• Autistic thinking is the tendency to view oneself as the center of
the universe, to believe that external events somehow refer to
oneself.
• In 1943, another psychiatrist, Leo Kanner, applied the diagnosis
“early infantile autism” to a group of disturbed children who
seemed unable to relate to others, as if they lived in their own
private worlds.

Autism and Autism
Spectrum Disorder
• Autism Spectrum Disorder (ASD) – includes a
range of autism-related disorders that vary in severity.
• Asperger’s disorder and childhood disintegrative

disorder (listed as distinct disorders within the autism
spectrum in the previous DSM-IV TR) are now
classified as forms of autism spectrum disorder.

How Common Is Autism
Spectrum Disorder?
• In 2013, researchers estimated that 2% of children
(more than 1 million children in total) in the U.S.
were affected by some form of autism spectrum
disorder.
• Investigators have linked increased risk of autism to
children with older fathers.
• Researchers have consistently failed to find links
between autism and use of childhood vaccines like
the MMR (measles, mumps, rubella) vaccine
(Fombonne, 2008; Weintraub, 2011).
Autism
• Autism is more common in boys than in girls, about
four times as common (Baron-Cohen, Knickmeyer,
& Belmonte, 2005).
• The disorder generally becomes evident in toddlers
between 18 and 30 months of age, but the average
child is not diagnosed until about age 6.
• Delays in diagnosis can be detrimental, because the
earlier children with autism are diagnosed and
treated, the better they generally are.

Features of Autism
• Perhaps the most poignant feature of autism is the child’s utter
aloneness.
• Other features include language and communication problems
and ritualistic or stereotyped behavior.
• The child may also be mute, or if some language skills are
present, they may be characterized by peculiar usage, as in
echolalia (parroting back what the child has heard in a high-
pitched monotone); pronoun reversals (using “you” or “he”
instead of “I”); use of words that have meaning only to those
who have intimate knowledge of the child; and tendencies to
raise the voice at the end of sentences, as if asking a question.

Theoretical Perspectives
• An early and now discredited belief held that the autistic
child’s aloofness was a reaction to parents who were cold
and detached—“emotional refrigerators” who lacked the
ability to establish warm relationships with their children.
• Psychologist O. Ivar Lovaas and his colleagues (1979)

suggest that children with autism have perceptual deficits
that limit them to processing only one stimulus at a time.
• As a result, they are slow to learn by means of classical

conditioning (association of stimuli).

Treatment
• Using operant conditioning methods, therapists and parents engage
in the painstaking work, systematically using rewards and mild
punishments to increase the child’s ability to attend to others, to
play with other children, to develop academic skills, and to
eliminate self-mutilative behavior.
• The most widely used behavioral treatment programs are highly
intensive and structured, offering a great deal of individual, one-to-
one instruction.
• In a classic study, psychologist O. Ivar Lovaas of UCLA
demonstrated impressive gains in autistic children who received
more than 40 hours of one-to-one behavior modification each week
for at least 2 years (Lovaas, 1987).

Intellectual Disability
• Intellectual Disability– A generalized delay or impairment
in the development of intellectual and adaptive abilities.
• The course of intellectual disability is variable.
• Many children with intellectual disability improve over time,

especially if they receive support, guidance, and enriched
educational opportunities.
• Those who are reared in impoverished environments may fail

to improve or may deteriorate further.
Causes of Intellectual Disability
• The causes of intellectual disability include biological
factors, psychosocial factors, or a combination of these
factors (APA, 2000).
• Biological causes include chromosomal and genetic

disorders, infectious diseases, and maternal alcohol use
during pregnancy.
• Psychosocial causes include exposure to an

impoverished home environment marked by the lack of
intellectually stimulating activities during childhood.

Down Syndrome and Other
Chromosomal Abnormalities
• Down syndrome – A condition caused by the presence
of an extra chromosome on the 21st pair and
characterized by intellectual disability and various
physical anomalies.
• Down syndrome occurs in about 1 in 800 births.
• It usually occurs when the 21st pair of chromosomes in

either the egg or the sperm fails to divide normally,
resulting in an extra chromosome.
Fragile X Syndrome and Other Genetic
Abnormalities
• Fragile X syndrome – An inherited form of intellectual
disability caused by a mutated gene on the X chromosome.
• The syndrome is the second most common form of

intellectual disability overall, after Down syndrome.
• The disorder is caused by a defective gene in an area of the X

sex chromosome that appears fragile, hence the name.
• This affects 1 out of 1,000 to 1,500 males and 1 out of 2,000

to 2,500 females (Hall et al., 2008; Maher, 2007).
Fragile X Syndrome and
Other Genetic Abnormalities
• Phenylketonuria (PKU) – A genetic disorder that
prevents the metabolization of phenylpyruvic acid,
leading to intellectual disability unless the diet is strictly
controlled.
• It is caused by a recessive gene that prevents the child
from metabolizing the amino acid phenylalanine, which
is found in many foods.
• Phenylketonuria (PKU) is a genetic disorder that occurs
in 1 in 10,000 to 15,000 births (Widaman, 2009).

Prenatal Factors
• Some cases of intellectual disability are caused by maternal
infections or substance abuse during pregnancy.
• Rubella (German measles) in the mother, for example, can be

passed along to the unborn child, causing brain damage resulting
in intellectual disability.
• It may also play a role in autism. Although the mother may

experience mild symptoms or none at all, the effects on the fetus
can be tragic.
• Other maternal infections that may cause intellectual disability

in the child include syphilis, cytomegalovirus, and genital
herpes.
Cultural-Familial Causes
• Most cases of intellectual disability fall in the mild range
of severity and have no apparent biological cause or
distinguishing physical feature.
• Cultural–familial intellectual disability – A mild form of

intellectual disability that is influenced by impoverishment
of the home environment.
• Children in impoverished families may lack toys, books,

or opportunities to interact with adults in intellectually
stimulating ways.
Intervention
• The services that children with intellectual disability need
depend on the level of severity and type of intellectual
disability.
• With appropriate training, children with mild

retardation may approach a sixth-grade level of
competence.
• They can acquire vocational skills and support

themselves minimally through meaningful work.

Intervention
• People with intellectual disability who are capable of functioning
in the community have the right to receive less-restrictive care
than is provided in large institutions.
• People with intellectual disability stand a high risk of developing
other psychiatric disorders, such as anxiety and depression, as
well as behavioral problems (Einfeld et al., 2006; McGillivray &
McCabe, 2006).
• People with intellectual disability often need psychological help
dealing with adjustment to life in the community.
• Many have difficulty making friends and become socially
isolated.

Learning Disorders
• Dyslexia – A learning disorder characterized by
impaired reading ability.
• Learning disorder – A deficiency in a specific learning
ability in the context of normal intelligence and
exposure to learning opportunities.
• Learning disorders are typically chronic disorders that
affect development well into adulthood.
• Children with learning disorders tend to perform poorly
in school.

Specific Learning Disorder
• Specific Learning Disorder – the DSM-5 applies a

single diagnosis of specific learning disorder to
encompass various types of learning disorders or
disabilities involving significant deficits in skills related
to reading, writing, arithmetic and math, and executive
functions.

Types of Learning Disorders
• Problems with Reading (often referred to as dyslexia) –
characterizes children who have poorly developed skills in
recognizing words and comprehending written text.
• Dyslexia is estimated to affect about 4% of school-age

children (APA, 2000) and is much more common in boys
than in girls (Rutter et al., 2004).
• Boys with dyslexia are also more likely than girls to show
disruptive behavior in class and so are more likely to be
referred for evaluation.

• Problems with Writing – refers to children with grossly deficient
writing skills
– deficiency may be characterized by errors in spelling, grammar, or
punctuation, or by difficulty in composing sentences and paragraphs
– severe writing difficulties generally become apparent by age 7; milder
cases may not be recognized until the age of 10 or later
• Problems with Arithmetical and Mathematic Reasoning

Skills –
– may have problems understanding basic mathematical terms or
operations, such as addition or subtraction; decoding mathematical
symbols (+, =, etc.); or learning multiplication tables.
– problem may become apparent as early as the first grade (age 6) but is not
generally recognized until about the second or third grade

Problems with Executive Functions
– Executive function skills are a set of higher mental

abilities involved in organizing, planning, and
coordinating tasks needed to manage one’s task or
assignments.
– Children with deficits in executive function skills may

frequently fall behind in school work, fail to keep track
of homework assignments, or fail to plan ahead in order
to complete assignments on time.

Understanding and Treating
Learning Disorders
• Much of the research on learning disorders focuses on dyslexia,
with mounting evidence pointing to underlying abnormalities in
the way the brain of a dyslexic child processes visual and
auditory information (Golden, 2008; Hoeft et al., 2006; Nicolson
& Fawcett, 2008).
• People with dyslexia have difficulty processing the sounds
corresponding to particular letters (e.g., seeing an f or a ph or a
gh and saying or hearing in our minds an f sound).
• Recently, scientists speculated that dyslexia may take two
general forms, one more genetically influenced and the other
more environmentally influenced.

Communication Disorders
• Communication disorders are persistent difficulties in
understanding or using language.
• The categories of communication disorders include
language disorder, speech sound disorder, childhood
onset fluency disorder, and social (pragmatic)
communication disorder.
• Each of these disorders interferes with academic or

occupational functioning or ability to communicate
socially.

Communication Disorders
• Language disorder – involves impairments in the ability to
produce or understand spoken language.
• Speech sound disorder – is a persistent difficulty articulating the

sounds of speech in the absence of defects in the oral speech
mechanism or neurological impairment.
• Childhood onset fluency disorder (also referred to as stuttering) –

is a disturbance in the ability to speak fluently.
• Social (pragmatic) communication disorder – continuing and

profound difficulties communicating verbally and nonverbally with
other people in their natural contexts (e.g., in school, at home, or in
play).

Behavior Problems
The DSM-5 includes three diagnoses that all involve
problem behaviors that can seriously interfere with the
child’s functioning in school, at home, and in the
playground.
These disorders include:

– Attention-deficit hyperactivity disorder (ADHD)
– Conduct disorder
– Oppositional defiant disorder (ODD)

Attention-Deficit
Hyperactivity Disorder
• Attention-deficit hyperactivity disorder (ADHD) – A
behavior disorder characterized by excessive motor
activity and inability to focus one’s attention.
• Hyperactivity – An abnormal behavior pattern

characterized by difficulty in maintaining attention and
extreme restlessness.
• ADHD affects between 7% and 9% of school-age

children, or some 2 million American youngsters total
(Galanter, 2013; Kasper, Alderson, & Hude, 2012; Smith,
2011).
Attention-Deficit Hyperactivity Disorder
• ADHD is divided into three subtypes:
(a) a predominantly inattentive type
(b) a predominantly hyperactive or impulsive type
(c) a combination type characterized by high levels of both inattention and

hyperactivity–impulsivity (APA, 2000)
• The disorder is usually first diagnosed during elementary school, when

problems with attention or hyperactivity–impulsivity make it difficult for the
child to adjust to school.

• We know that ADHD tends to run in families, which is
suggestive of a genetic contribution.
• But more direct evidence comes from findings of a higher

concordance rate for the disorder among monozygotic (MZ)
twins than among DZ (dizygotic) twins (Burt, 2009; Waldman
& Gizera, 2006).
• Rapidly accumulating evidence from brain-imaging studies of

children with ADHD shows dysfunctions in parts of the brain,
especially the prefrontal cortex, that regulate attention and
impulsive behavior (Hart et al., 2013; Ivanov et al., 2010;
Klein, 2011; Nakao et al., 2011; Shaw et al., 2011).
Treatment
• It may seem odd that many of the drugs used to help ADHD
children calm down and attend better in school are actually
stimulants, such as the widely used drug Ritalin and longer-
acting stimulants, including Concerta, a one-dose-a-day drug.
• Perhaps it’s not so odd that these drugs are effective,

especially when you consider that stimulant drugs activate the
prefrontal cortex, the part of the brain that regulates
attentional processes and control over impulsive, acting-out
behaviors associated with ADHD

Conduct Disorder
• Conduct disorder – A psychological disorder in
childhood and adolescence characterized by disruptive,
antisocial behavior.
• Whereas children with ADHD seem literally incapable of
controlling their behavior, children with conduct disorder
purposefully engage in patterns of antisocial behavior
that violate social norms and the rights of others.
• Whereas children with ADHD throw temper tantrums,
children diagnosed as conduct disordered are
intentionally aggressive and cruel.

Oppositional Defiant Disorder
• Oppositional defiant disorder (ODD) – A
psychological disorder in childhood and adolescence
characterized by excessive oppositionality or tendencies
to refuse requests from parents and others.
• Children with ODD tend to be negativistic or

oppositional.
• They defy authority by arguing with parents and teachers

and refusing to follow requests or directives.

on ODD and CD
• Some theorists believe that oppositionality is an
expression of an underlying temperament described as the
“difficult-child” type (Rey, 1993).
• Others believe that unresolved parent–child conflicts or

overly strict parental control lie at the root of the disorder.
• Psychodynamic theorists look at ODD as a sign of fixation

at the anal stage of psychosexual development, when
conflicts between the parent and child emerge over toilet
training.
Treatment Approaches
• In parent training programs, parents learn behavioral
techniques to:
(a) change aggressive and oppositional behavior
(b) increase their adaptive behavior
• Treatment includes the following goals for parents to

develop:
(a) more consistent discipline strategies
(b) use of positive reinforcement
(c) increasing frequency of positive interactions between the
parent and the child

Childhood Anxiety and Depression
• Anxiety is abnormal, however, when it is excessive and
interferes with normal academic or social functioning or
becomes troubling or persistent.
• Children, like adults, may suffer from different types of

diagnosable anxiety disorders, including specific phobias, social
phobias, generalized anxiety disorder (GAD), obsessive–
compulsive disorder (OCD), and posttraumatic stress disorder
(PTSD).
• Although these disorders may develop at any age, we consider

further a type of disorder that typically develops during early
childhood: separation anxiety disorder.
Separation Anxiety Disorder
• Famed attachment researcher Mary Ainsworth (1989)
chronicled the development of attachment behaviors and
found that separation anxiety normally begins during the first
year.
• The sense of security normally provided by bonds of
attachment apparently encourages children to explore their
environments and become progressively independent of their
caregivers.
• Separation anxiety disorder – A childhood disorder
characterized by extreme fear of separation from parents or
other caretakers.

Childhood Anxiety Disorders
• Theoretical perspectives on anxiety disorders in children
parallel to some degree explanations of anxiety disorders in
adults.
• Psychoanalytic theorists argue that childhood anxieties and
fears, like their adult counterparts, symbolize unconscious
conflicts.
• Cognitive theorists focus on the role of cognitive biases.
• Anxious children tend to show the types of cognitive distortions
found in adults with anxiety disorders, including interpreting
ambiguous situations as threatening and expecting bad things
to happen (Eldar et al., 2012; Micco et al., 2013; Muris & Field,
2013).

Childhood Depression
• Depressed children and adolescents typically have
feelings of hopelessness; distorted thinking patterns and
tendencies to blame themselves for negative events; and
lower self-esteem, self-confidence, and perceptions of
competence.
• They report episodes of sadness and crying, feelings of

apathy, as well as insomnia, fatigue, and poor appetite.
• They may also experience suicidal thoughts or even

attempt suicide.

Childhood Depression
• All in all, the distorted cognitions of depressed children
include the following patterns of thinking:
– 1. Expecting the worst (pessimism)
– 2. Catastrophizing the consequences of negative events
– 3. Blaming themselves for disappointments and negative
outcomes even when unwarranted
– 4. Minimizing accomplishments and focusing only on
negative aspects of events

Suicide in Children and Adolescents
• In addition to increasing age, other factors associated with heightened
risk of suicide in children and adolescents include the following (Dervic,
Brent & Oquendo, 2008; Fergusson & Woodward, 2002; NIMH, 2003;
Pelkonen & Marttunen, 2003):
• Gender
• Geography
• Ethnicity
• Depression and hopelessness
• Previous suicidal behavior
• Prior sexual abuse
• Family problems
• Stressful life events
• Substance abuse
• Social contagion

Elimination Disorders
• Fetuses and newborn children eliminate waste
products reflexively. As children develop and
undergo toilet training, they develop the ability to
inhibit the natural reflexes that govern urination and
bowel movements.
• For some children, however, problems with control

elimination persist in the form of enuresis and
encopresis, disorders of elimination that are not due
to organic causes.

Enuresis
• The term enuresis derives from the Greek roots en-,
meaning “in,” and ouron, meaning “urine.”
• Enuresis – Failure to control urination after one has

reached the expectable age for attaining such control.
• Enuresis, like so many other developmental disorders, is

more common among boys.
• Enuresis is estimated to affect 7% of boys and 3% of girls

by age 5.

• Psychodynamic explanations of enuresis suggest that it
represents the expression of hostility toward the children’s
parents.
• It may represent regression in response to the birth of a

sibling or some other stressor or life change.
• Learning theorists point out that enuresis occurs most

commonly in children whose parents attempted to train
them early.

Treatment of Enuresis
• Enuresis usually resolves itself as children mature.
• Behavioral methods have been shown to be helpful

when enuresis endures or causes parents or children
great distress.
• One dependable example is the use of a urine alarm

method, a variation of the technique introduced by
psychologists O. Hobart Mowrer in the 1930s, or drug
therapy.

Encopresis
• Encopresis – Lack of control over bowel movements that is not
caused by an organic problem in a child who is at least 4 years
old.
• Like enuresis, this condition is most common among boys.
• Soiling may be voluntary or involuntary and is not caused by an

organic problem, except in cases in which constipation is
involved.
• Among the possible predisposing factors are inconsistent or

incomplete toilet training and psychosocial stressors, such as the
birth of a sibling or beginning school.
Treatment of Encopresis
• Behavior therapy techniques are helpful in treating
encopresis (Loening-Baucke, 2002).
• Involves the parents rewarding (by praise and other

means) successful attempts at self-control and using
mild punishments for continued accidents.

The End

Chapter 13 Childhood and Adolescence

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ABNORMAL PSYCHOLOGY IN A CHANGING

WORLD, NINTH EDITION

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

These disorders include:

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• The most commonly diagnosed psychological disorders in

• A telephone survey based on a national probability sample of

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• Children with parents who suffer from depression also stand

• Gender is yet another discriminating factor.

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• Asperger’s disorder and childhood disintegrative

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• Psychologist O. Ivar Lovaas and his colleagues (1979)

• As a result, they are slow to learn by means of classical

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• The course of intellectual disability is variable.

• Many children with intellectual disability improve over time,

• Those who are reared in impoverished environments may fail

• Biological causes include chromosomal and genetic

• Psychosocial causes include exposure to an

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• Down syndrome occurs in about 1 in 800 births.

• It usually occurs when the 21st pair of chromosomes in

• The syndrome is the second most common form of

• The disorder is caused by a defective gene in an area of the X

• This affects 1 out of 1,000 to 1,500 males and 1 out of 2,000

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• Rubella (German measles) in the mother, for example, can be

• It may also play a role in autism. Although the mother may

• Other maternal infections that may cause intellectual disability

• Cultural–familial intellectual disability – A mild form of

• Children in impoverished families may lack toys, books,

• With appropriate training, children with mild

• They can acquire vocational skills and support

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• Specific Learning Disorder – the DSM-5 applies a

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• Dyslexia is estimated to affect about 4% of school-age

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• Problems with Arithmetical and Mathematic Reasoning

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

– Executive function skills are a set of higher mental

– Children with deficits in executive function skills may

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• Each of these disorders interferes with academic or

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• Speech sound disorder – is a persistent difficulty articulating the

• Childhood onset fluency disorder (also referred to as stuttering) –

• Social (pragmatic) communication disorder – continuing and

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

These disorders include:

© 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

• Hyperactivity – An abnormal behavior pattern

• ADHD affects between 7% and 9% of school-age