Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Sleep Disorders
 The Regulatory Functions of Sleep
 sleep is the main activity of the brain in the first years of life
 sleep is essential for brain development and regulation
 sleep deprivation impairs functioning of the prefrontal
cortex, leading to decreased concentration and diminished
ability to inhibit or control basic drives, impulses, and
emotions
 sleep produces an “uncoupling” of neurobehavioral
systems, allowing for retuning of CNS components
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Sleep Disorders (cont.)
 Maturational Changes
 sleep patterns, needs, and problems change over the
course of maturation
 infants and toddlers have more night-waking problems
 preschoolers have more falling-asleep problems
 younger school-aged children have more going-to-bed
problems
 adolescents have more difficulty going to or staying
asleep, or having enough time to sleep
 adolescents have increased physiological need for sleep,
however, they often get less sleep than needed and are
chronically sleep-deprived
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Dyssomnias
 Disorders of initiating or maintaining sleep,
characterized by difficulty getting enough sleep, not
sleeping when one wants to, not feeling refreshed
from sleep
 Most of these sleep problems resolve themselves as
the child matures
 Quite common in childhood, with the exception of
narcolepsy
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Table 12.1 Dyssomnias
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Parasomnias
 Disorders in which behavioral or physiological events
intrude upon ongoing sleep
 Common afflictions of early to mid-childhood; children
typically grow out of them
 Include nightmares (often called REM parasomnias),
sleep terrors and sleepwalking (often referred to as
arousal parasomnias)
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Table 12.2 Parasomnias
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Table 12.3 Estimated Population Prevalence of Selected Chronic Diseases
and Conditions in Children, Ages 0-20 in the United States
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Sleep Disorders (cont.)
 Treatment
 behavioral interventions and establishing good
sleep hygiene can help children with difficulty
going to and staying asleep
 behavioral interventions for circadian rhythm
disorders can be effective when adolescent and
family are highly motivated
 treatment of nightmares consists of providing
comfort at the time of occurrence and making
efforts to reduce daytime stressors
 parents of children who sleepwalk should take
precautions to avoid chances of child being
injured; brief afternoon naps may be beneficial
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Elimination Disorders
 Enuresis
 involuntary discharge of urine during day or night
at least twice a week for three months or
accompanied by significant distress or impairment,
in a child at least 5 years old
 nocturnal enuresis most common (about 13-33%
of all 5-year olds) and affects boys more than girls
 diurnal enuresis more common in females;
believed to be associated with social anxiety or
preoccupation with a school event
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Elimination Disorders (cont.)
 Enuresis (cont.)
 more common among less educated, lower SES,
and institutionalized children
 may be primary, if never attained continence, or
secondary, if control established and then lost
(less common)
 causes include deficiency of antidiuretic hormone,
genetic predisposition, and immature signaling
mechanism
 most successful treatments are behavioral training
methods using either operant conditioning or
classical conditioning (especially the urine alarm)
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Elimination Disorders (cont.)
 Encopresis
 the passage of feces into inappropriate places at
least once per month for 3 months in a child at
least 4 years old
 2 DSM-IV subtypes: with or without constipation
and overflow incontinence (former more common)
 occurs in 1.5%-3% of children; declines rapidly
with age
 5-6 times more common in boys
 like enuresis, categorized as primary or secondary
 psychological problems likely result from, rather
than cause it
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Elimination Disorders (cont.)
 Encopresis (cont.)
 causes include untreated constipation and
abnormal defecation dynamics
 treatment includes the use of fiber, enemas, or
laxatives to treat the constipation, followed by
behavioral and biofeedback interventions to
establish healthy elimination patterns
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Chronic Childhood Illness
 A chronic illness is one that persists for more than 3
months or requires hospitalization for more than 1
month
 DSM-IV categories (somatoform disorders and
psychological factors affecting physical condition)
have limited applicability to children
 If medical condition accompanied by significant
adjustment or behavior problems child may be
diagnosed with an Adjustment Disorder
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Chronic Childhood Illness (cont.)
 There are normal variations in children’s expression
of health concerns
 children experience pain in the same ways as
adults
 children may use pain for secondary gains
 children often express fears, dislikes, and
avoidance through somatic complaints
 girls report more symptoms of pain and anxiety
 family influences (social learning) can impact
children’s expressions of pain and symptoms
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Chronic Childhood Illness (cont.)
 Chronic Illness in Children
 affects 10%-20% of children (about 1/3 have
moderate to severe conditions)
 asthma is the most common chronic illness in
childhood
 social class and ethnicity do not influence who is
affected by chronic illness, with the exception of
specific conditions genetically determined by racial
or ethnic decent (e.g., sickle cell disease)
 children of lower SES have lower survival rates
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Chronic Childhood Illness (cont.)
 Diabetes Mellitus
 lifelong metabolic disorder in which the body is
unable to metabolize carbohydrates as a result of
inadequate pancreatic release of insulin
 a progressive disease, with serious complications
occurring in young adulthood and beyond (life
expectancy 1/3 less than normal)
 requires daily treatments, including blood glucose
monitoring, dietary restraints, insulin injections
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Childhood Chronic Illness (cont.)
 Childhood Cancer
 in comparison to adults, onset in children is more
sudden and disease is often at a more advanced
stage when first diagnosed
 most common form is acute lymphoblastic
leukemia
 requires intensive medical treatment, especially
during the first 2-3 years
 approximately 80% of pediatric cancer patients
survive; 50% will have serious physical or mental
illness as adults and will require long-term care
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Chronic Childhood Illness (cont.)
 Development and Course
 chronic illness is associated with increased risk for
secondary psychological adjustment problems (often
internalizing problems)
 most children adapt successfully to their illness
 chronic illness may precipitate PTSD in family members, as
well as marital distress- although most families adapt
favorably
 healthy parental adjustment related to healthy child
adjustment
 siblings of children with a chronic illness experience
heightened social and mental health problems
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Figure 12.1 Percentages of children with a psychiatric disorder among three groups:
with chronic illness and disability, with illness and no disability, and physically healthy.
(Data from Cadman et al., 1987)
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Chronic Childhood Illness (cont.)
 Development and Course (cont.)
 children with severe, disruptive illnesses suffer
most in terms of social adjustment
 children with chronic illness may demonstrate
academic problems- may be due to primary effects
of the illness, or to secondary effects, such as
absenteeism, fatigue, or psychological stress
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Chronic Childhood Illness (cont.)
 The transactional stress and coping model takes into
account:
 illness parameters, including severity, prognosis,
and functional status
 child characteristics, including age, gender,
intellectual ability, self-concept, coping strategies
 family adaptation and functioning, including how
parents manage stress, parental coping
strategies, degree of support and cohesion among
members, and availability of utilitarian and
psychological resources
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Chronic Childhood Illness (cont.)
 Intervention
 psychosocial interventions can help children and
their families to reduce and manage stress,
enhance social problem-solving skills, learn childrearing practices, and become empowered
 families must be kept involved in intervention
efforts
 two main psychological approaches to helping
children cope with stressful medical procedures
and chronic and recurrent pain are providing
information and training in coping skills
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Adolescent Substance Abuse Disorders (SUDs)
 SUDs in adolescence include substance dependence and
substance abuse, resulting from self-administration of any
substance that alters mood, perception, or functioning
 Can lead to psychological and physiological dependence
 For a diagnosis of substance dependence, must show a
maladaptive pattern of substance use for at least 12 months,
with three or more clinical signs of distress such as tolerance
or withdrawal
 Criteria for substance abuse involves one or more harmful and
repeated negative consequences of substance abuse over the
last 12 months; given if individual does not meet criteria for
dependence
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Adolescent Substance Abuse Disorders (SUDs) (cont.)
 Prevalence and Course
 alcohol is the most prevalent substance used and
abused by adolescents; cigarettes are second
most common
 illicit substance use also common; typically
marijuana is used, but the use of other illicit drugs
such as MDMA, opiates, cocaine, and crack is
increasing
 8% of adolescents aged 12-17 met criteria for
substance abuse or dependence in 2001 survey
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Adolescent Substance Abuse Disorders (SUDs) (cont.)
 Prevalence and Course (cont.)
 rates peak around late adolescence and begin to
decline during young adulthood
 concern greatest when high-risk behaviors begin
well before adolescence, are ongoing, and occur
among peer group with similar behaviors
 high comorbidity with ADHD and conduct
problems
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Figure 12.3 Rates of lifetime substance use among high school students. (Data from
Monitoring the Future, 2002).
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Adolescent Substance Abuse Disorders (SUDs) (cont.)
 Causes
 personality characteristics such as increased
sensation seeking- a preference for novel,
complex and ambiguous stimuli
 positive attitudes about substance abuse and
having friends with similar attitudes, perceiving
oneself to be physically older than same-age
peers, and school connectedness
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Adolescent Substance Abuse Disorders (SUDs) (cont.)
 Causes (cont.)
 lack of parental involvement and parent-child
affection, inconsistent parenting and poor
monitoring, negative parent-child and inter-parent
interactions, and low parental expectations for
abstaining
 association with deviant and substance using
peers
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Adolescent Substance Abuse Disorders (SUDs) (cont.)
 Treatment and Prevention
 half of patients for SUDs relapse within first three months,
and only 20-30% remain abstinent
 Family based approaches that seek to modify negative
reactions between family members, improve communication,
and develop effective problem solving skills to deal with
areas of conflict
 Multisystemic Therapy (MST) involves intensive intervention
that targets family, peer, school, and community systems
 adolescents with more severe levels of abuse and unstable
living conditions, or comorbid psychopathology require
inpatient or residential setting
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Adolescent Substance Abuse Disorders (SUDs) (cont.)
 Treatment and Prevention (cont.)
 Life Skills Training emphasizes building drug
resistance skills, personal and social competence,
and altering cognitive expectancies around
substance abuse
 prevention efforts target social environment via
community and school norms, and include parent
involvement and education to improve parent-child
communication about substance use
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 12: Health-Related and Substance Abuse Disorders
Adolescent Substance Abuse Disorders (SUDs) (cont.)
 In the following video, advocates and researchers
discuss a program designed to reduce negative
outcomes in adolescence
 What mental health benefits are claimed for this
life skills training program?