Adolescent Problems - DSM – IV
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Disorders usually first diagnosed in
infancy, childhood, or adolescence
Mental Retardation
Learning Disorders
Developmental Coordination Disorder
(motor coordination)
Expressive Language Disorder
(standardized tests of expressive
language)
Phonological Disorder (speech sounds)
Stuttering
Autistic Disorder (social interaction
deficits)
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Rett’s Disorder (head size, hand
movement, social engagement –
deficits after early normality)
Childhood Disintegrative Disorder
(after normal development,
progressive deterioration of
language, social, physical skills)
Asperger’s Disorder (nonverbal
behaviors, peer skills, peer
enjoyment, emotional reciprocity)
ADHD
Pica (eating objects)
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Rumination (regurgitation, rechewing)
Feeding Disorder (failure to eat adequate
amount)
Tourette’s Disorder (motor, vocal outbursts)
Encopresis (feces)
Enuresis (wetting)
Separation Anxiety Disorder (excessive
anxiety)
Selective Mutism
Reactive Attachment Disorder (hypervigilant or
diffuse attachments)
Stereotypic Movement Disorder (repetitive and
non-functional motor behavior)
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Conduct Disorder (rights of others
are violated) – as early as 5-6,
usually in late childhood or early
adolescence, rarely after 16
Oppositional Defiant Disorder
(negativistic, defiant, disobedient,
hostile behavior toward authority
figures) – usually before age 8
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Externalizing problems
• Problem behavior theory
• Risky automobile driving
• Substance use
• Delinquency and crime
• Factors involved in risk behavior
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Internalizing problems
• Depression
• Eating disorders
Two Broad Problem Types
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Externalizing Problems – create difficulties in a person’s
external world (a.k.a. “undercontrolled”)
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Tend to go together (a person that fights is also more likely
to commit other crimes)
More common among males
Often motivated by desire for excitement, not necessarily
underlying unhappiness or psychopathology
Internalizing Problems – primarily affect a person’s internal
world (A.k.a. “overcontrolled”)
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Tend to go together (a person who is depressed is also more
likely to have an anxiety disorder)
More common in females
Associated with experiencing distress
Problem Behavior Theory
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Problem Behavior Syndrome = Pattern of
correlations between externalizing
problems
Theory: Problems have common origins
• Background factors – e.g., family income
• Personality factors – e.g., self-esteem
• Social factors – e.g., parental control
Monitoring
the Future,
2006
Any illicit
drug use
Cigarettes
Alcohol
LSD
Cocaine
Other
narcotics,
including
OxyContin,
Vicodin
Increase in 2002 due
to inclusion of more
types of drugs in the
survey question
Ecstasy
Shope’s Model of
Young Driver
Crash Risks (2002)
Driver Crash Involvement:
Property Damage
Rates per 100,000: 1997
Driver Crash Involvement:
Injury
Rates per 100,000: 1997
Driver Crash Involvement:
Fatality
Rates per 100,000: 1997
Prevention: Two Approaches
1.
Driver Education
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2.
Generally hasn’t worked too well…
Get your license faster…you’re out
there driving and getting into
accidents!
Graduated Driver Licensing (GDL)
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More effective
Address a variety of risk factors
Restrict the conditions under which
novices can drive
Graduated Licensing Strategy
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Three Stages to a GDL program:
L
1. Learning License – getting driving
experience under supervision of
experienced driver
N
2. Restricted License – can drive
unsupervised, but with restrictions
designed to reduce crashes (e.g.,
driving curfews)
3. Full License – after 1 year restricted
Substance Use
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Alcohol
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Cigarettes
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Illegal drugs (e.g., marijuana,
cocaine, LSD, ecstasy…)
Adolescent substance use became
target of a great deal of political attention,
public policy programs and research
In the 1980s and beyond….
Substance Use, 1975-1999
Source:
Monitoring the Future, 2000
Alcohol & Marijuana Use by Age
Notice the higher
levels of use during
age when unstructured
socializing is
most prevalent
Sequence of Substance Use
1. Drinking beer and wine
2. Smoking cigarettes and drinking
hard liquor
3. Smoking marijuana
4. Using “hard” drugs
Adolescents use in different ways…
Experimental
Social
curiosity “to see what it’s like”
Once or twice
Use during social activities with one
or more friends
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Medicinal
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To relieve unpleasant emotional
state such as sadness or anxiety
Addictive
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Dependency either physical or
psychological
Delinquency and Crime: Definitions
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Delinquency – when “juveniles” commit
crimes:
1. Status Offences – only a violation of the law
because committed by juvenile
2. Index Crimes – serious crimes at any age
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Violent Crimes
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Property Crimes
3. Nonindex Crimes – less serious offenses
such as gambling, disorderly conduct
Age and Crime
1842
1977
Two Types of Delinquency
(Moffit, 1993)
Life-course-persistent delinquents
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Pattern of problems from birth on up
Originate in neuropsychological deficits (difficult
temperament, LD)
Likely to grow up in high risk environment
Adolescent-delimited delinquents
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No signs of problems in infancy or childhood
Period of occasional criminal activity between
ages of 12-25 (e.g., vandalism, illegal drug use)
Preventing Crime & Delinquency
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Prevention programs for children who
show signs of risk for LCPD and for
adolescents engaging in serious
delinquency
Varied Strategies:
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Individual therapy
Group therapy
Vocational training
Outward Bound type programs
Scared Straight “Boot Camp” type programs
Preventing Crime & Delinquency
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Two problems with prevention programs:
1. Participation is typically non-voluntary or
against one’s will
2. Prevention comes too late (in adolescence)
after behavior patterns have been established
• The Multisystemic Approach has been met with some success
• MST includes parent training, job training, vocational
counseling, development of neighborhood activities and
centers – directing the energy of delinquents in positive
directions.
Preventing Crime & Delinquency
Multisytemic therapy (MST) vs. usual Juvenile Justice
Services for serious adolescent offenders
Note:
Lower is better!
Factors involved in Risk Behavior
Socialization and Delinquency
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What is a “socialized delinquent”?
An “unsocialized delinquent”?
Culture and Risk Behavior
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In traditional cultures, Schlegel and Barry
(1991) found that boys and not girls tend to
engage in risk behavior during adolescence
Evidence of antisocial behavior in less than half
of the cultures studied
In Western countries other than the USA,
engage in less risky driving behavior
USA has highest rates of violent crimes
Deaths from Suicide & Homicide
The USA has the highest
homicide rate;
Canada the highest suicide rate
15-year olds Who Report Smoking Daily
Levels of Depression
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Depression is an enduring period
of sadness:
• Depressed mood: enduring period of
sadness without any related
symptoms
• Depressive syndrome: addition of
symptoms such as frequent crying,
feeling guilty, lonely or worried
• Major Depressive Disorder: Episode
includes five or more symptoms
during a two-week period and disrupt
functioning
Major Depressive Disorder
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Depressed or irritable mood for most of the day,
nearly every day.
Reduced interest or pleasure in all or almost all
activities, nearly every day.
Significant weight loss or gain, or decrease in
appetite.
Insomnia or oversleeping.
Psychomotor agitation or retardation, observable by
others.
Low energy or fatigue.
Feelings of worthlessness or inappropriate guilt.
Diminished ability to think or concentrate.
Recurrent thoughts of death, recurrent suicidal
thoughts.
Treating Depression with CBT…
Cognitive Behavior
Therapy (CBT) recognizes
that depression is
characterized by negative
attributions, and a belief
that the situation is
permanent and
uncontrollable
The goal of CBT is to help
the young person recognize
the cognitive habits that are
promoting depression and
work to change those
habits. Strategies include
discussion, role play,
practicing new ways of
interacting
Relapse is less likely after CBT
treatment than drug treatment
Suicide: Risk Factors and Facts
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Risk factors:
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Third most
Depression
common cause of
death ages 15-19
Family disruption
Substance abuse problems
Relationship problems outside family
Result of series of difficulties over time
Females 4 times more likely than males to attempt suicide
Males 4 times more likely than females to complete suicide
Higher rates among White than Black youth
Rates highest among Native American youth
Rates are highest where guns are most available
Eating Disorders
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Anorexia Nervosa –
intentional self-starving
Bulimia – binge eating and
purging
Cultural ideal of thinness
Puberty and body changes
More common among upper and middle socioeconomic classes
Girls who read magazines like “Seventeen” are more
likely to strive for thinness
Warm and controlling parents
Occurs most often among females in teens and early 20s