Disorders of Childhood and Adolescence


Abnormal functioning can occur at any time in life
Children of all cultures typically experience at
least some emotional and behavioral problems as
they encounter new people and situations

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Surveys indicate that worry is a common experience
Bedwetting, nightmares, temper tantrums, and restlessness are
other problems experienced by many children
Childhood and Adolescence
Childhood and Adolescence

Adolescence can also be a difficult period


Physical and sexual changes, social and academic
pressures, personal doubts, and temptation cause
many teenagers to feel anxious, confused, and
depressed
Bullying

Over one-quarter of students report being bullied
frequently, and more than 70% report having been a
victim at least once
Childhood and Adolescence



Some disorders of children – childhood anxiety
disorders and childhood depression – have adult
counterparts
Other childhood disorders – elimination disorders,
for example – usually disappear or radically
change form by adulthood
There also are disorders that begin in birth or
childhood and persist in stable forms into adult
life

These include autism spectrum disorder spectrum
disorder and intellectual developmental disorder
Separation Anxiety Disorder


displayed by 4 to
10% of all children
Extreme anxiety,
often panic,
whenever they are
separated from
home or a parent
Childhood Mood Problems: Major Depressive
Disorder

Around 2% of children
and 9% of adolescents
currently experience
major depressive
disorder; as many as 20
percent of adolescents
experience at least one
depressive episode
Major Depressive Disorder



Depression in the young may be triggered by
negative life events (particularly losses), major
changes, rejection, or ongoing abuse
Childhood depression is characterized by such
symptoms as headaches, stomach pain,
irritability, and a disinterest in toys and games
Clinical depression is much more common
among teenagers than among young children

Suicidal thoughts and attempts are common in
teenagers
Bipolar Disorder

Often considered an adult mood disorder, whose
earliest age of onset is the late teens



Theorists suggest the diagnosis has become a clinical
“catchall” that is being applied to almost every explosive,
aggressive child
The current shift in diagnoses has been accompanied by an
increase in the number of children who receive adult
medications
The DSM-5 task force concluded that the childhood
bipolar label has been overapplied over the past two
decades. To help rectify this problem, DSM-5 now
includes a new category, disruptive mood
dysregulation disorder (DMDD)
Disruptive Mood Dysregulation Disorder (DMDD)
Oppositional Defiant Disorder
Oppositional defiant disorder: Children with this
disorder are repeatedly argumentative and defiant,
angry and irritable, and, in some cases, vindictive.
• Characterized by repeated arguments with adults, loss of
temper, anger, and resentment
• Children with this disorder ignore adult requests and
rules, try to annoy people, and blame others for their
mistakes and problems
Conduct Disorder

Children with
conduct disorder, a
more severe problem,
repeatedly violate the
basic rights of others
Often aggressive and
may be physically cruel
to people and animals
 Many steal from,
threaten, or harm their
victims
 Begins between 7 and
15 years of age

Conduct Disorder

Relational aggression: individuals are socially
isolated and primarily display social misdeeds
Slander
 Rumor-starting
 Friendship manipulation


More common among girls than boys
What Are the Causes of Conduct Disorder?
Many cases of conduct
disorder have been
linked to genetic and
biological factors, drug
abuse, poverty, traumatic
events, and exposure to
violent peers or
community violence
They have most often
been tied to troubled
parent-child
relationships, inadequate
parenting, family conflict,
marital conflict, and
family hostility
How Do Clinicians Treat Conduct Disorder?


Treatments for conduct disorder are generally
most effective with children younger than 13
Today's clinicians are increasingly combining
several approaches into a wide-ranging treatment
program
Sociocultural treatments
 Child-focused treatments
 Prevention

Sociocultural Treatments

Family interventions
Parent-child interaction therapy
 Parent management training
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
Residential treatment


Community-based
School programs
Child-Focused Treatments


Focus primarily on the child with conduct disorder
Cognitive-behavioral interventions

Problem-solving skills training


modeling, practice, role-playing, and systematic rewards
Anger Coping and Coping Power Program
Prevention

Greatest hope for
reducing the problem of
conduct disorder lies in
prevention programs
that begin in early
childhood


These programs try to
change unfavorable social
conditions before a
conduct disorder is able to
develop
All such approaches work
best when they educate
and involve the family
Attention-Deficit/Hyperactivity Disorder


Children who display attentiondeficit/hyperactivity disorder (ADHD) have great
difficulty attending to tasks, behave overactively
and impulsively, or both
The primary symptoms of ADHD may feed into
one another, but in many cases one of the
symptoms stands out more than the other
Attention-Deficit/Hyperactivity Disorder
About half the children with
ADHD also have:
Learning or
communication
problems
Poor school
performance
Difficulty
interacting with
other children
Misbehavior,
often serious
Mood or
anxiety
problems
Diagnostic Criteria
for ADHD
What Are the Causes of ADHD?

Clinicians generally consider ADHD to have
several interacting causes, including:
Biological causes, particularly abnormal dopamine
activity, and abnormalities in the frontal-striatal regions
of the brain
 High levels of stress
 Family dysfunctioning

How Is ADHD Treated?


About 80% of all children and adolescents with
ADHD receive treatment
There is, however, heated disagreement about
the most effective treatment for ADHD
The most commonly applied approaches are drug
therapy, behavioral therapy, or a combination
 Millions of children and adults with ADHD are currently
treated with methylphenidate (Ritalin), a stimulant drug
that has been available for decades

Drug Therapy
Many with ADHD are
treated with
methylphenidate
(Ritalin), or other
stimulant drugs
It is estimated that 2.2
million children in the
US, 3% of all school
children, take Ritalin or
other stimulant drugs for
ADHD
Behavior Therapy and Combination Approaches

Behavioral therapy has been applied in many
cases of ADHD
Parents and teachers learn how to apply operant
conditioning techniques to change behavior
 These treatments have often been helpful, especially
when combined with drug therapy

Multicultural Factors and ADHD

Studies indicate that African American and
Hispanic American children with significant
attention and activity problems are less likely than
white American children to be assessed for
ADHD, receive an ADHD diagnosis, or undergo
treatment for the disorder
Those who do receive a diagnosis are less likely than
white children to be treated with the interventions that
seem to be of most help, including the promising (but
more expensive) long-acting stimulant drugs
 In part, racial differences in diagnosis and treatment are
tied to economic factors

Elimination Disorders


Children with elimination disorders repeatedly
urinate or pass feces in their clothes, in bed, or
on the floor
They have already reached an age at which they
are expected to control these bodily functions

These symptoms are not caused by physical illness
Enuresis
Enuresis: repeated involuntary (or in
some cases intentional) bedwetting or
wetting of one's clothes
• Typically occurs at night during sleep but may also
occur during the day
• The problem may be triggered by a stressful event
• Children must be at least 5 years of age to receive
this diagnosis
• Most cases of enuresis correct themselves without
treatment
Encopresis
Encopresis– is less common than
enuresis and less well researched
•
•
•
•
Is usually involuntary
Seldom occurs during sleep
Starts after the age of 4
Is more common in boys than girls
Comparison of Childhood Disorders
Long-Term Disorders That Begin in Childhood

Two groups of disorders that emerge during
childhood are likely to continue unchanged
throughout a person's life:
Autism spectrum disorders
 Intellectual developmental disorder


Autism spectrum disorders are a group of
disorders marked by impaired social interactions,
unusual communications, and inappropriate
responses to stimuli in the environment
Autism Spectrum Disorder



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Autism spectrum disorder, or
autism spectrum disorder, was
first identified in 1943
Children with this disorder are
extremely unresponsive to
others, uncommunicative,
repetitive, and rigid
Symptoms appear early in life,
before age 3
Around 80% of all cases appear
in boys
Autism Spectrum Disorder

As many as 90% of children the disorder remain
significantly disabled into adulthood
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Even the highest-functioning adults with autism spectrum
disorder typically have problems in social interactions and
communication, and have restricted interests and activities
Lack of responsiveness and social reciprocity
Language and communication problems take various
forms

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One common speech peculiarity is echolalia, the exact
echoing of phrases spoken by others
Another is pronominal reversal, or confusion of pronouns
Autism Spectrum Disorder: Asperger's Disorder
The DSM-5 task force determined that
Asperger’s Disorder is not a distinct
disorder. Those who would previously
receive a diagnosis of Asperger’s
should now receive a diagnosis of
autism spectrum disorder
What Are the Causes of Autism Spectrum
Disorder?
Psychological causes
• Some theorists say people with autism spectrum disorder have
a central perceptual or cognitive disturbance
• Individuals fail to develop a theory of mind – an awareness
that other people base their behaviors on their own beliefs,
intentions, and other mental states, not on information they
have no way of knowing
• It has been theorized that early biological problems prevented
proper cognitive development
Sociocultural causes
• Some clinical theorists have proposed that a high degree of
family dysfunction, social and environmental stress is a factor in
the disorder
• Research does not support this theory
What Are the Causes of Autism Spectrum
Disorder?
Biological causes
• While a detailed biological explanation for autism
spectrum disorder has not yet been developed,
promising leads have been uncovered
• Examination of relatives keeps suggesting a
genetic factor in the disorder
• Prevalence rates are higher among siblings
and highest among identical twins
• Researchers have also identified specific
biological abnormalities that may contribute to
the disorder, particularly in the cerebellum
How Do Clinicians and Educators Treat Autism
Spectrum Disorder?


Treatment can help people with autism spectrum
disorder adapt better to their environment,
although no known treatment totally reverses the
autistic pattern
Treatments of particular help are cognitivebehavioral therapy, communication training,
parent training, and community integration

In addition, psychotropic drugs and certain vitamins
have sometimes helped when combined with other
approaches
How Do Clinicians and Educators Treat Autism
Spectrum Disorder?
Cognitive-Behavioral therapy
• Behavioral approaches have been used in cases of autism
spectrum disorder to teach new, appropriate behaviors –
including speech, social skills, classroom skills, and self-help
skills – while reducing negative behaviors
• Most often, therapists use modeling and operant conditioning
• Therapies are ideally applied when they are started early in the
children's lives
• Given the recent increases in the prevalence of autism spectrum
disorder, many school districts are now trying to provide
education and training for autistic children in special classes
• Most school districts, however, remain ill equipped to meet the
profound needs of these students
How Do Clinicians and Educators Treat Autism
Spectrum Disorder?
Communication training
• Even when given intensive behavioral treatment, half of
the people with autism spectrum disorder remain
speechless
• They are often taught other forms of communication,
including sign language and simultaneous
communication
• They may also use augmentative communication
systems, such as “communication boards” or
computers that use pictures, symbols, or written words,
to represent objects or needs
• Such programs also now use child-initiated interactions
to help improve communication skills
How Do Clinicians and Educators Treat Autism
Spectrum Disorder?
Parent training
• Today's treatment programs involve parents
in a variety of ways
• For example, behavioral programs train
parents so they can apply behavioral
techniques at home
• In addition, individual therapy and support
groups are becoming more available to help
parents deal with their own emotions and
needs
How Do Clinicians and Educators Treat Autism
Spectrum Disorder?
Community integration
• Many of today's school-based and home-based
programs for autism spectrum disorder teach
self-help and selfmanagement, as well as living,
social, and work skills
• In addition, greater numbers of group homes
and sheltered workshops are available for teens
and young adults with autism spectrum disorder
• These programs help individuals become a
part of their community and also reduce the
concerns of aging parents
Intellectual Developmental Disorder

According to the DSM-5, people
should receive a diagnosis of
intellectual developmental
disorder when they display
general intellectual functioning
that is well below average, in
combination with poor adaptive
behavior



IQ must be 70 or lower
The person must have difficulty in
such areas as communication, home
living, self-direction, work, or safety
Symptoms must appear before
age 18
Assessing Intelligence

Educators and clinicians administer intelligence
tests to measure intellectual functioning

These tests consist of a variety of questions and tasks
that rely on different aspects of intelligence


Having difficulty in one or two of these subtests or areas of
functioning does not necessarily reflect low intelligence
An individual's overall test score, or intelligence quotient (IQ), is
thought to indicate general intellectual ability
Assessing Intelligence



Many theorists have questioned whether IQ tests
are indeed valid
Intelligence tests also appear to be socioculturally
biased
If IQ tests do not always measure intelligence
accurately and objectively, then the diagnosis of
intellectual developmental disorder may also be
biased

That is, some people may receive the diagnosis partly
because of test inadequacies, cultural differences,
discomfort with the testing situation, or the bias of a
tester
Assessing Adaptive Functioning


Diagnosticians cannot rely solely on a cutoff IQ
score of 70 to determine whether a person suffers
from intellectual developmental disorder
Several scales, such as the Vineland and AAMR
Adaptive Behavior Scales, have been developed
to assess adaptive behavior

For proper diagnosis, clinicians should observe the
functioning of each individual in his or her everyday
environment, taking both the person's background and
the community standards into account
What Are the Features of Intellectual
Developmental Disorder?


The most consistent sign of intellectual
developmental disorder is that the person learns
very slowly
Other areas of difficulty are attention, shortterm
memory, planning, and language

Those who are institutionalized with intellectual
developmental disorder are particularly likely to have
these limitations
What Are the Features of Intellectual
Developmental Disorder?

Traditionally four levels of intellectual
development disorder have been distinguished:
Mild (IQ 50–70)
Moderate (IQ 35–49)
Severe (IQ 20–34)
Profound (IQ below 20)
Mild IDD

Approximately 80% to 85% of all people with
intellectual developmental disorder fall into the
category of mild IDD (IQ 50–70)


Interestingly, intellectual performance seems to improve
with age
Research has linked mild intellectual
developmental disorder mainly to sociocultural
and psychological causes, particularly:
Poor and unstimulating environments
 Inadequate parent-child interactions
 Insufficient early learning experiences

Moderate, Severe, and Profound IDD

Approximately 10% of persons with intellectual
developmental disorder function at a level of
moderate IDD (IQ 35–49)


They can care for themselves, benefit from vocational
training, and can work in unskilled or semiskilled jobs
Approximately 3% to 4% of persons with
intellectual developmental disorder display severe
IDD (IQ 20–34)
They usually require careful supervision and can
perform only basic work tasks
 They are rarely able to live independently

Moderate, Severe, and Profound IDD

About 1% to 2% of persons with intellectual
developmental disorder fall into the category of
profound IDD (IQ below 20)


With training they may learn or improve basic skills but
they need a very structured environment
Severe and profound levels of intellectual
developmental disorder often appear as part of
larger syndromes that include severe physical
handicaps
What Are the Causes of Intellectual
Developmental Disorder?

The primary causes of moderate, severe, and
profound IDD are biological, although people who
function at these levels are also greatly affected
by their family and social environment

Sometimes genetic factors are at the root of these
biological problems

Other biological causes come from unfavorable conditions that
occur before, during, or after birth
What Are the Causes of Intellectual
Developmental Disorder?
Chromosomal causes
• The most common chromosomal disorder leading to
intellectual developmental disorder is Down syndrome
• Fewer than 1 of every 1000 live births result in Down
syndrome, but this rate increases greatly when the
mother's age is over 35
• Several types of chromosomal abnormalities may
cause Down syndrome, but the most common is
trisomy 21
• Fragile X syndrome is the second most common
chromosomal cause of intellectual developmental
disorder
What Are the Causes of Intellectual
Developmental Disorder?
Metabolic causes
• In metabolic disorders, the body's breakdown
or production of chemicals is disturbed
• The metabolic disorders that affect
intelligence and development are typically
caused by the pairing of two defective
recessive genes, one from each parent
• Examples include:
• Phenylketonuria (PKU)
• Tay-Sachs disease
What Are the Causes of Intellectual
Developmental Disorder?
Prenatal and birth-related causes
• As a fetus develops, major physical problems in the
pregnant mother can threaten the child's healthy
development
• Low iodine may lead to cretinism
• Alcohol use may lead to fetal alcohol syndrome (FAS)
• Certain maternal infections during pregnancy (e.g.,
rubella, syphilis) may cause childhood problems
including intellectual developmental disorder
• Birth complications, such as a prolonged period without
oxygen (anoxia), can also lead to intellectual
developmental disorder
What Are the Causes of Intellectual
Developmental Disorder?
Childhood problems
• After birth, particularly up to age 6, certain injuries
and accidents can affect intellectual functioning
• Examples include poisoning, serious head injury,
excessive exposure to x-rays, and excessive
use of certain chemicals, minerals, and/or drugs
(e.g., lead paint)
• Certain infections, such as meningitis and
encephalitis, can lead to intellectual
developmental disorder if they are not
diagnosed and treated in time
Interventions for People with Intellectual
Developmental Disorder

The quality of life attained by people with
intellectual developmental disorder depends
largely on sociocultural factors

Intervention programs try to provide comfortable and
stimulating residences, social and economic
opportunities, and a proper education
What is the Proper Residence?


Until recently, parents of children with intellectual
developmental disorder would send them to live
in public institutions – state schools – as early as
possible
During the 1960s and 1970s, the public became
more aware of these conditions and, as part of
the broader deinstitutionalization movement,
demanded that many people be released from
these schools
What is the Proper Residence?

Since deinstitutionalization, reforms have led to
the creation of small institutions and other
community residences that teach self-sufficiency,
devote more time to patient care, and offer
education and medical services
Which Educational Programs Work Best?


Because early intervention seems to offer such great
promise, educational programs for individuals with
intellectual developmental disorder may begin during
the earliest years
At issue are special education versus mainstream
classrooms




In special education, children with intellectual developmental
disorder are grouped together in a separate, specially
designed educational program
Mainstreaming places them in regular classes
Neither approach seems consistently superior
Teacher preparedness is a factor that plays into decisions
about mainstreaming
When Is Therapy Needed?

People with intellectual developmental disorder
sometimes experience emotional and behavioral
problems
Around 30% or more have a diagnosable psychological
disorder other than intellectual developmental disorder
 Some suffer from low self-esteem, interpersonal
problems, and adjustment difficulties


These problems are helped to some degree by
individual or group therapy

Psychotropic medication is sometimes prescribed
How Can Opportunities For Personal, Social, And
Occupational Growth Be Increased?


People need to feel effective and competent to
move forward in life
Those with intellectual developmental disorder
are most likely to achieve these feelings if their
communities allow them to grow and make many
of their own choices
How Can Opportunities For Personal, Social, And
Occupational Growth Be Increased?


Socializing, sex, and marriage are difficult issues
for people with intellectual developmental
disorder and their families
With proper training and practice, individuals with
intellectual developmental disorder can learn to
use contraceptives and carry out responsible
family planning
The National Association for Retarded Citizens offers
guidance in these matters
 Some clinicians have developed dating skills programs

How Can Opportunities For Personal, Social, And
Occupational Growth Be Increased?

Adults with intellectual developmental disorder
need the financial security and personal
satisfaction that comes from holding a job
Many can work in sheltered workshops, but there are
too few training programs available
 Additional programs are needed so that more people
with intellectual developmental disorder may achieve
their full potential, as workers and as human beings
