Chapter 12 (Childhood Disorders)

BEHL 3004 Week 12, 2024

• Rieger, Chapter 14 (Disorders of Childhood) will be reviewed for the exam.
• This week's tutorial will be a review for the exam, particularly the tutorials.
• A separate recording regarding the exam will be posted.
• Assessment #5 is due this week (Thursday-Friday).

Learning Objectives

• Describe key behavioral and emotional child problems identified by parents, along with challenges in assessing mental health.
• Describe key themes in classifying childhood psychological disorders.
• Describe the main characteristics of neurodevelopmental disorders.
• Describe key features and factors contributing to externalizing disorders, and evidence-based treatment approaches.
• Describe the key characteristics and treatment of separation anxiety and selective mutism.
• Describe various elimination disorders and their treatments.

Disorders of Childhood

• Overview (myths, history, etc.)
• Internalising Disorders
• Externalising Disorders
• Neurodevelopmental Disorders
• Elimination Disorders

Psychological and Behavioural Disorders in Children

• Myths, realities, and research challenges: Psychological and behavioral problems are very common in children.
• Few children receive help.
• Traditionally, childhood disorders research relies on adult models.
• It's critical to consider both risk and protective factors.

Prevalence of Childhood Problems

• A table detailing the prevalence of various disorders (anxiety, depressive, ADHD, Conduct) among 4-17-year-olds and severity levels.

Classification of Childhood Disorders

• Prior to the 20th century, there was little recognition of psychological disorders in childhood.
• Children were viewed as miniature adults.
• Early 20th century saw increased recognition of childhood disorders.
• Separate childhood disorders weren't included in the DSM-III until 1980.
• A critical aspect of DSM-5 is its lack of considering the dimensional nature of childhood conditions.
• Externalising disorders in children involve under-controlled behaviors directed at others.
• Internalising disorders in children involve over-controlled, inner-directed behaviors.
• Examples of disorders that don't neatly fit these categories include ADHD and disruptive mood dysregulation disorder.

Specific Phobias (DSM-5-TR)

• Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, injections, seeing blood).
• The phobic object or situation almost always evokes immediate fear or anxiety.
• The phobic object or situation is actively avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual danger and sociocultural context.
• The fear, anxiety, or avoidance is persistent (typically 6+ months).
• Causes clinically significant distress or impairment in social, occupational, or other important areas.

Social Anxiety Disorder (DSM-5-TR)

• Marked fear or anxiety about one or more social situations.
• Fear that the individual will act in a way or show anxiety symptoms negatively evaluated.
• Social situations almost always evoke fear/anxiety.
• Social situations are avoided or endured with intense fear.
• Markedly out of proportion to the actual threat and sociocultural context.
• The fear or avoidance persists typically for 6+ months.

Generalised Anxiety Disorder (DSM-5-TR)

• Excessive anxiety and worry (apprehensive expectation) about numerous events/activities for at least 6 months.
• Difficulty controlling worry.
• Associated with at least three of six symptoms (e.g., restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance).
• The anxiety causes significant distress/impairment.

Posttraumatic Stress Disorder (DSM-5-TR)

• Presence of one or more intrusion symptoms related to a traumatic event(s) beginning after the event(s).
• Intrusive memories, distressing dreams, dissociative reactions, intense psychological distress at exposure to cues that symbolize or resemble the event, marked physiological reactions.
• Marked impairments in arousal and reactivity (e.g., irritability, anger outbursts, recklessness/self-destructiveness).
• Symptoms persist in multiple settings.

Separation Anxiety Disorder (DSM-5-TR)

• Inappropriate and excessive anxiety surrounding separation from attachment figures.
• Occurs in approximately 3-5% of children, more common in girls.
• The disturbance occurs in 4+ weeks for adolescents/children, and 6+ months in adults.

Aetiology of Separation Anxiety Disorder

• Evidence of genetic vulnerability for separation anxiety.
• Parental anxiety plays a role.
• Insecure attachment and parental absence also contribute.

Treatment of Separation Anxiety

• Cognitive behavioral therapy is the primary treatment.
• Includes psychoeducation, coping skills, relaxation, exposure and reinforcement

Selective Mutism (DSM-5-TR)

• Consistent failure to speak in specific social situations while speaking in other situations.
• Disturbance interferes with social or educational functioning.
• The failure to speak is not connected to language knowledge or comfort levels.
• The disturbance is not attributed to autism, schizophrenia, etc.

Aetiology and Treatment of Selective Mutism

• Possible manifestation of shyness or inhibited temperament.

• Some evidence suggests it's a form of social anxiety disorder.

• Treatment targets high anxiety in social situations, limited speaking experience, and reinforcement for non-verbal communication.

Disruptive Mood Dysregulation Disorder (DSM-5-TR)

• Severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.
• Temper outbursts inconsistent with developmental level.
• Average of three or more temper outbursts per week.
• Mood between outbursts—persistently irritable or angry most of the day.
• Criteria have been present for 12+ months, without 3+ consecutive symptom-free months.
• Present in at least two of three settings (home, school, peers).
• Diagnosis shouldn't occur before age 6 or after age 18.
• Symptoms began before age 10.

Conduct Disorder (DSM-5-TR)

• Persistent pattern of violating the rights of others or societal norms.
• Demonstrated through 3+ of a specified list of behaviours, present during the past 12 months, with at least one present during the past 6 months.
• Includes actions such as aggression toward people or animals and property damage to deceitfulness and theft.

Oppositional Defiant Disorder (DSM-5-TR)

• Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting 6+ months, with 4+ symptoms from any category, during interactions with at least one person who is not a sibling.

• Includes symptoms like frequently losing temper, being touchy/easily annoyed, being angry/resentful.

Attention Deficit Hyperactivity Disorder (ADHD)

• Defined by symptoms of inattention and/or hyperactivity-impulsivity.
• Symptoms present prior to age 12, and in multiple environments.
• Prevalence approximately 7.2%.

Treatment of ADHD

• Stimulant medications (e.g., Ritalin) may improve behaviour, interaction with others, and concentration.
• Medication plus behavioral treatment may yield better results than medication alone.

Specific Learning Disorder (DSM-5-TR)

• Characterised by difficulties in acquisition and use of specific academic skills demonstrated by ongoing difficulties for 6 months, despite interventions.
• Difficulties with accuracy, fluency and comprehension of reading, written expression, and/or mathematical reasoning, which are not explained by a general intellectual disability.

Elimination Disorders

• Enuresis: Involuntary urination; either nocturnal or diurnal (daytime) and can be primary or secondary.
• Encopresis: Repetitive soiling (involuntary or intentional); either constipation-related or not.

Treatment of Enuresis & Encopresis

• Enuresis typically treated with conditioning approaches (e.g., bell-and-pad method).
• Encopresis is often treated with a combination of medical management and behavioral strategies, encompassing psychoeducation for parents and children, reinforcement schedules for using the toilet, and other targeted interventions.

Any Questions?

• If any questions arise, post online.