Psikologi Anak
Pertemuan 9
Behavioral Disorders
Attention Deficit Hyperactivity Disorder
• Young children are normally inattentive,
active, exuberant, flighty, bored easily, lacking
in self-control
• If such behaviours are persistent and in excess,
there may be an indication of a problem.
• Children who are excessively active, unable to
sustain attention, and are deficient in impulse
control to a degree that is deviant for their
developmental level = ADHD
Diagnosis of ADHD
Two sets of symptoms:
• Inattention and hyperactivity/impulsivity.
• At least 6 inattentive symptoms and/or 6
hyperactive/impulsive symptoms must be present.
• Some symptoms must have manifested before age 7.
• Symptoms must have been present for at least 6 months to
a degree that is considered maladaptive and inappropriate
for the individual's age.
• Symptoms must cause impairment in two or more settings.
• Symptoms must not be better accounted for by another
disorder.
Inattentive Symptoms
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often fails to give close attention to
details or makes careless mistakes in
school work, work or other activities
often has difficulty sustaining attention
in tasks or play activities
often does not seem to listen when
spoken to directly
often does not follow through on
instructions and fails to finish school
work, chores, or duties in the work
place (this failure is not due deliberately
refusing to do it or not understanding
instructions)
often has difficulty organizing tasks or
activities
often avoids or is reluctant to engage in
tasks that require sustained mental
effort
often loses things necessary for tasks or
activities
often easily distracted by extraneous
stimuli
is often forgetful in daily activities
Hyperactive/Impulsive
Symptoms
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often fidgets with hands or squirms in
seat
often leaves seat in classroom or in other
situations in which remaining seated is
expected
often runs about or climbs excessively in
which it is inappropriate (in adolescents
and adults, may be limited to subjective
feelings of restlessness
often has difficulty playing or engaging in
leisure activities quietly
is often “on the go” or often acts as if
“driven by a motor”
often talks excessively
often blurts out answers before questions
have been completed
often has difficulty awaiting turn
often interrupts or intrudes on others
(eg. Butts into conversations or games)
ADHD Types
• ADHD, combined type: both inattentive and hyperactive
symptoms present (6 of 9 in each category).
• ADHD, predominantly inattentive type: if 6 inattentive
symptoms are met, but fewer than 6 hyperactive symptoms
are met.
– Used to be called ADD-term is no longer used.
– Accounts for only 10% of all ADHD cases.
– Some evidence that girls tend to be more prevalent in this
subtype.
• ADHD, predominantly hyperactive-impulsive type: if 6
hyperactive symptoms, but not 6 inattentive symptoms are
met.
Causes of ADHD
Aetiology is basically unknown, though risk
factors are clearly identified.
– Genetic
– Prenatal
– Neuropsychological
– Environmental
– Diet
Management of ADHD
Therapy
• Behaviour Modification
Medical
• Ritalin
– Psychostimulant
– thought to increase dopamine levels in the brain
• Antidepressants, SSRI’s (Prozac, etc.)
– Increase serotonin levels in the brain
Oppositional Defiant Disorder
• Pattern of negativistic, hostile and defiant
behaviour lasting at least 6 months
• Causes significant impairment
• Does not occur exclusively during a mood
disorder or psychotic episode
• Criteria not met for CD
ODD Characteristics
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Often loses temper
Often argues with adults
Often actively defies adult requests
Often deliberately annoys people
Often blames others for his/her mistakes
Often touchy, easily annoyed by others
Often angry and resentful
Often spiteful or vindictive
Progression of conduct problems
• Oppositional
– Argues, temper, impulsive, attention seeking
• Offensive
– Cruelty, disobeys, fights, swears, lies, cheats
• Aggressive
– Destroys, threatens, attacks, steals at home, bad
friends
• Delinquency
– Sets fires, steals outside home, truancy, runs away,
alcohol/drug use, vandalism
Associated features of ODD
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Low self-esteem
Mood lability
Low frustration tolerance
Swearing
Conflicts
Early use of alcohol, tobacco, illicit drugs
Difficult temperament
Persistent negative sibling interactions
Conduct Disorder
• Pattern of behaviour in which the basic rights
of others or major age-appropriate societal
norms or rules are violated
• Causes significant impairment
• If 18 years +, criteria not met for Antisocial PD
• Specify type based on age of onset and
severity
CD Characteristics
• Aggression to people and animals
• Bullies, threatens, intimidates, physically cruel,
stolen while confronting a victim
• Destruction of property
• Deceitfulness or theft
• Serious violations of rules
• Run away from home, stays out at night,
truant from school
Developmental paths/subtypes
of Conduct Disorder
2 distinct developmental pathways
• Childhood-onset (before age 10)
– Male, aggressive, disturbed peer relationships,
ODD early childhood
• Adolescent-onset (after age 10)
– More common, less aggressive, more
– normative peer relationships, more females
– Better prognosis
Etiology
• Genetics
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Adoption and twin studies
Deviant behaviour stable across generations
Extra Y chromosome (theory discounted)
Inheritance of a sensation-seeking temperament
• Chronic underarousal
• Environmental influence
– Parents of children with CD tend to be rejecting and use harsh
punishments
– Exposure to aggressive and criminal models (Social Learning
Theory)
– Reinforced by parent and teacher attention
– Parental neglect, exposure to antisocial models and harsh
punishment
Treatment
Parent training – family focus
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Help parents to increase children’s appropriate behaviours
Help parents to decrease inappropriate behaviours
– Giving attention for appropriate behaviour
– Giving rewards
– Ignoring
– Giving clear instructions
– Using consequences
Social problem-solving skills training – Child focus
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Addresses social cognitive deficits
– Hostile bias
– Actual problem-solving
– Social skills
– Perspective taking
– Anger management training
Multi-Systemic Therapy
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Focuses on systems in which behaviour is embedded: family, school, peers
Multiple influences within theses systems