Chapter 14 Disorders of Childhood PDF 2024 BEHL 3004

10/20/2024 Copyright Notice Do not remove this notice. 1 BEHL 3004 Week 12, 2024 Rieger, Chapter 14 (Disorders of Childhood) Tutorial for this...

10/20/2024 Copyright Notice Do not remove this notice. 1 BEHL 3004 Week 12, 2024 Rieger, Chapter 14 (Disorders of Childhood) Tutorial for this week will be a review for the exam (particularly the tutorials) I’ll also post a separate recording about the exam Assessment #5 this week (Thursday-Friday) 2 1  10/20/2024 CHAPTER 14 DISORDERS OF CHILDHOOD Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-3 3 LEARNING OBJECTIVES 14.1 Describe the key behavioural and emotional problems of children that are identified by parents and identify the main challenges in examining the mental health problems of children 14.2 Describe key themes in the classification of childhood psychological disorders 14.3 Describe the main characteristics of the neurodevelopmental disorders 14.4 Describe the key features and factors that contribute to the development and maintenance of externalising disorders and the evidence-based approaches to the treatment of these disorders 14.5 Describe the key characteristics and treatment of separation anxiety disorder and selective mutism 14.6 Describe the various elimination disorders and their treatments Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-4 4 2  10/20/2024 Disorders of Childhood Overview (myths, history, etc.) Internalising Disorders Externalising Disorders Neurodevelopmental Disorders Elimination Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-5 5 Disorders of Childhood Overview (myths, history, etc.) Internalising Disorders Externalising Disorders Neurodevelopmental Disorders Elimination Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-6 6 3  10/20/2024 First, is There a Need to Focus on Children? Yes, for at least three reasons – Childhood Expressions/Variants of General Psychopathology – Childhood Specific Psychopathology – We may learn more about psychopathology by studying children Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-7 7 Psychopathology & Development Infancy Toddlerhood Preschool Middle Childhood Pre-Adolescence Adolescence Late Adolescence – (0-12 mths) (1 – 2½ yrs) (2½ – 6 yrs) (6 – 11 yrs) (11 – 13 yrs) (13 – 17 yrs) Young Adulthood (17 - 20 yrs) Autism Reactive Separation CD Substance Eating disorders Personality attachment anxiety Social/school abuse Schizophrenia Disorders ADHD disorder phobia Depression ODD LDs Bipolar Elimination Anxiety Gender disorders disorders dysphoria 8 4  10/20/2024 Psychological and Behavioural Disorders in Children Myths, realities, and research challenges: – Psychological and behavioural problems in children are very common. – Few children receive help. – Traditionally, research on childhood disorders has relied on adult models and intervention approaches. – It is essential to consider both risk and protective factors. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-9 9 Prevalence of Childhood Problems 10 5  10/20/2024 Psychological and Behavioural Disorders in Children Myths, realities, and research challenges: – There is ongoing debate on relative contribution of genetic and environmental factors. – ‘differential susceptibility’ hypothesis – Overall most children are inherently resilient and can deal with some adversity. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-11 11 The Classification of Childhood Disorders Prior to the twentieth century there was almost no recognition of psychological disorders in childhood. Children were seen as miniature adults. Early twentieth century saw greater recognition and interest in childhood disorders. Separate childhood disorders were not included until the DSM-III (1980). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-12 12 6  10/20/2024 The Classification of Childhood Disorders Prior to the DSM-5, most childhood conditions were listed under the category of Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence. In the DSM-5 (and 5-TR) childhood disorders now appear under different headings throughout the manual. One major criticism of the DSM-5 is that it does not take into account the dimensional nature of many childhood conditions. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-13 13 The Classification of Childhood Disorders Externalising disorders in children are behaviours that are under-controlled and directed at others. Internalising disorders in children are behaviours that are over-controlled and inner-directed. Some disorders don’t neatly fit. ADHD and disruptive mood dysregulation disorder are examples. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-14 14 7  10/20/2024 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-15 15 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-16 16 8  10/20/2024 Disorders of Childhood Overview (myths, history, etc.) Internalising Disorders Externalising Disorders Neurodevelopmental Disorders Elimination Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-17 17 Internalising Disorders Several disorders in the Depressive Disorders or Anxiety Disorders chapters A few relatively child-specific disorders – Separation anxiety disorder – Selective mutism Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-18 18 9  10/20/2024 Major Depressive Disorder (DSM-5-TR) A.Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure Note: Do not include symptoms that are clearly attributable to another medical condition. 1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood. 2) Markedly diminished interest in pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation) 3) Significant weight loss when not dieting or weight gain (e.g., a change of more that 5% of body weight in month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 4) Insomnia or hypersomnia nearly every day 5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 6) Fatigue or loss of energy nearly every day 7) Feelings of worthlessness of excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 8) Diminished ability to think or concentrate, or indecisiveness, nearly every day (ether by subjective account or as observed by others) 9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-19 19 Major Depressive Disorder (DSM-5-TR) A.Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure Note: Do not include symptoms that are clearly attributable to another medical condition. 1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood. 2) Markedly diminished interest in pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation) 3) Significant weight loss when not dieting or weight gain (e.g., a change of more that 5% of body weight in month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 4) Insomnia or hypersomnia nearly every day 5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 6) Fatigue or loss of energy nearly every day 7) Feelings of worthlessness of excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 8) Diminished ability to think or concentrate, or indecisiveness, nearly every day (ether by subjective account or as observed by others) 9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-20 20 10  10/20/2024 Persistent Depressive Disorder (DSM-5-TR) A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. A. Presence, while depressed, of two (or more) of the following: 1) Poor appetite or overeating 2) Insomnia or Hypersomnia 3) Low energy or fatigue 4) Low self-esteem 5) Poor concentration or difficulty making decisions 6) Feelings of hopelessness B. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-21 21 Persistent Depressive Disorder (DSM-5-TR) A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. A. Presence, while depressed, of two (or more) of the following: 1) Poor appetite or overeating 2) Insomnia or Hypersomnia 3) Low energy or fatigue 4) Low self-esteem 5) Poor concentration or difficulty making decisions 6) Feelings of hopelessness B. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-22 22 11  10/20/2024 Presentations of Depression Across Developmental Age Infants Preschool Apathy Extremely sombre and tearful Weight loss Lack bounce and enthusiasm Weeping Excessively clingy and whiny Withdrawal Fears of separation Overall decline in development Irritable Sleep disturbance Physical complaints Increase clinging Apprehension Passive and unresponsive Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-23 23 Presentations of Depression Across Developmental Age School Age Preteens Disruptive behaviour Increased self-blame Temper tantrums Low SE Combativeness Social inhibition Physical complaints Persistent sadness (weight loss, headaches) Loneliness Sleep problems Eating and sleep disturbance Academic and peer Suicidal thoughts and attempts problems Suicide threats may begin at this age Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-24 24 12  10/20/2024 Disruptive Mood Dysregulation Disorder (DSM-5-TR) A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. B. The temper outbursts are inconsistent with developmental level. C. The temper outbursts occur, on average, three or more times per week. D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers). E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D. F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these. G. The diagnosis should not be made for the first time before age 6 years or after age 18 years. H. By history or observation, the age at onset of Criteria A-E is before 10 years. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-25 25 Disruptive Mood Dysregulation Disorder (DSM-5-TR) I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met. Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania. J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]). Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned. K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-26 26 13  10/20/2024 Disruptive Mood Dysregulation Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-27 27 Specific Phobias (DSM-5-TR) A. Marked fear or anxiety about a specific object of situation (e.g., flying, heights, animals, receiving an injection, seeing blood). NOTE: In children, the fear or anxiety might be expressed by crying, tantrums, freezing or clinging. B. The phobic object or situation almost always provokes immediate fear or anxiety. C. The phobic object or situation is actively avoided or endured with intense fear or anxiety. D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context. E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupationall, or other important areas of functioning. G. The disturbance is not better explained by another mental disorder, …. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-28 28 14  10/20/2024 Specific Phobias (DSM-5-TR) A. Marked fear or anxiety about a specific object of situation (e.g., flying, heights, animals, receiving an injection, seeing blood). NOTE: In children, the fear or anxiety might be expressed by crying, tantrums, freezing or clinging. B. The phobic object or situation almost always provokes immediate fear or anxiety. C. The phobic object or situation is actively avoided or endured with intense fear or anxiety. D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context. E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupationall, or other important areas of functioning. G. The disturbance is not better explained by another mental disorder, …. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-29 29 Social Anxiety Disorder (DSM-5-TR) A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). NOTE: In children, the anxiety must occur in peer settings and not just during interactions with adults. B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others). C. The social situations almost always provoke fear or anxiety. NOTE: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking or failing to speak in social situations. D. The social situations are avoided or endured with intense fear or anxiety. E. The fear or anxiety is our of proportion to the actual threat posed by the social situation and to the sociocultural context. F. The fear, anxiety, or avoidance is persistent, typically last for 6 months or more. G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder. J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-30 30 15  10/20/2024 Social Anxiety Disorder (DSM-5-TR) A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). NOTE: In children, the anxiety must occur in peer settings and not just during interactions with adults. B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others). C. The social situations almost always provoke fear or anxiety. NOTE: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking or failing to speak in social situations. D. The social situations are avoided or endured with intense fear or anxiety. E. The fear or anxiety is our of proportion to the actual threat posed by the social situation and to the sociocultural context. F. The fear, anxiety, or avoidance is persistent, typically last for 6 months or more. G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder. J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-31 31 Generalised Anxiety Disorder (DSM-5-TR) A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it hard to control the worry C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months): Note: Only one item is required in children 1. Restlessness or feeling keyed up or on edge 2. Being easily fatigued 3. Difficulty concentrating or mind going blank 4. Irritability 5. Muscle tension 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance (e.g., drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). F. The disturbance is not better explained by another mental disorder…. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-32 32 16  10/20/2024 Generalised Anxiety Disorder (DSM-5-TR) A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it hard to control the worry C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months): Note: Only one item is required in children 1. Restlessness or feeling keyed up or on edge 2. Being easily fatigued 3. Difficulty concentrating or mind going blank 4. Irritability 5. Muscle tension 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance (e.g., drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). F. The disturbance is not better explained by another mental disorder…. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-33 33 Posttraumatic Stress Disorder (DSM-5-TR) B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic events. Note: Children older than 6 may express this symptom in repetitive play. 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: Children may have frightening dreams without recognizable content. 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum with the most extreme expression being a complete loss of awareness of present surroundings.) Note: Children may reenact the event in play. 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-34 34 17  10/20/2024 Posttraumatic Stress Disorder (DSM-5-TR) B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic events. Note: Children older than 6 may express this symptom in repetitive play. 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: Children may have frightening dreams without recognizable content. 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum with the most extreme expression being a complete loss of awareness of present surroundings.) Note: Children may reenact the event in play. 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-35 35 Posttraumatic Stress Disorder (DSM-5-TR) E. Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic events occurred, as evidenced by two (or more) of the following: 1. Irritable behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. 2. Reckless or self-destructive behavior. 3. Hypervigilance. 4. Exaggerated startle response. 5. Problems with concentration. 6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-36 36 18  10/20/2024 Separation Anxiety Disorder The diagnosis and epidemiology of separation anxiety disorder: – Fear is specifically related to separation experience and greatly reduced in the presence of the attachment figure. – Occurs in approximately 3–5 per cent of children; more common in girls. – Occurs most commonly in middle childhood. – Most cases improve over time. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-37 37 Separation Anxiety Disorder (DSM-5-TR) A. Developmentally inappropriate and excessive anxiety concerning separation from those to whom the individual is attached, as evidenced by three or more of: 1. Recurrent distress at separation from home or major attachment figures 2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death 3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure. 4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fears about separation 5. Persistently and excessively fear of or reluctance about being alone or without major attachment figures at home or in other settings 6. Persistent reluctance or refusal to go to sleep away from home or to go to sleep without being near a major attachment figure. 7. Repeated nightmares involving the theme of separation. 8. Repeated complaints of physical symptoms (e.g., headaches, stomach aches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated. B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults. C. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalised anxiety disorder; or concerns about having an illness anxiety disorder. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-38 38 19  10/20/2024 Separation Anxiety Disorder Aetiology of separation anxiety disorder: – There is evidence of the inheritance of a non-specific genetic vulnerability. – Parental anxiety may play a role. – Insecure attachment and parental absence also play a role. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-39 39 Separation Anxiety Disorder The treatment of separation anxiety disorder: – Cognitive behaviour therapy is the treatment of choice.  Involves psychoeducation, coping skills training, relaxation skills, exposure, and reinforcement. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-40 40 20  10/20/2024 Selective Mutism (DSM-5-TR) A. Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations. B. The disturbance interferes with educational or occupational achievement or with social communication. C. The duration of the disturbance is at least 1 month (not limited to the first month of school). D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation. E. The disturbance is not better explained by a communication disorder (e.g., childhood onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-41 41 Selective Mutism The aetiology and treatment of selective mutism: – May be a manifestation of a shy, inhibited temperament. – Some evidence that it is a variant of social anxiety disorder. – Treatment addresses three problems: – the child's high level of anxiety in social situations – the limited experience speaking in front of others – the high level of reinforcement for non-verbal communication. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-42 42 21  10/20/2024 Disorders of Childhood Overview (myths, history, etc.) Internalising Disorders Externalising Disorders Neurodevelopmental Disorders Elimination Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-43 43 Externalising Disorders Disruptive Mood Dysregulation Disorder and ADHD? Most are in the Disruptive, Impulse-Control, and Conduct Disorders chapter of the DSM-5, although that chapter also includes some adult disorders. Primary childhood disorders are: – Oppositional Defiant Disorder (ODD) – Conduct Disorder (CD) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-44 44 22  10/20/2024 Oppositional Defiant Disorder The diagnosis, epidemiology and aetiology of ODD: – Persistent patterns of angry/irritable mood, defiant behaviour – Difficulty regulating mood – One of the most common childhood diagnosis—affecting 4 per cent of children. – Alterations in androgens (linked to aggressiveness) and differences in frontal brain activation – Traumatic brain injury and autonomic under-arousal are implicated. – Parenting practices may play a role. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-45 45 Oppositional Defiant Disorder (DSM-5-TR) A. A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at 6 months as evidenced by at least four symptoms from any of the following categories and exhibited during interaction with at least one individual who is not a sibling. Angry Irritable Mood 1) Often loses temper. 2) Is often touchy or easily annoyed. 3) Is often angry or resentful. Argumentative/Defiant Behaviour 4) Often argues with authority figures or, for children and adolescents, with adults 5) Often actively defies or refuses to comply with requests from authority figures or with rules. 6) Often deliberately annoys others. 7) Often blames others for his or her mistakes or misbehaviour Vindictiveness 8) Has been spiteful or vindictive at least twice with the past 6 months. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-46 46 23  10/20/2024 Oppositional Defiant Disorder (DSM-5-TR) Note: The persistence and frequency of these behaviours should be used to distinguish a behaviour that is within normal limits from a behaviour that is symptomatic. For children younger than 5 years, the behaviour should occur on most days for a period of at least 6 months, unless otherwise noted (Criterion A8). For individuals 5 years or older, the behaviour should occur at least once per week for at least 6 months, unless otherwise noted (Criterion A8). While these frequency criteria provide guidance on a minimal level of frequency to define symptoms, other factors should also be considered, such as whether the frequency and intensity of the behaviours are outside a range that is normative for the individual’s developmental level, gender, and culture. B. The disturbance in behaviour is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning. C. The behaviours do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-47 47 Conduct Disorder (DSM-5-TR) The diagnosis, epidemiology and aetiology of conduct disorder: – Persistent pattern of violation of rules and the rights of others – Thought to develop from oppositional defiant disorder – May be a precursor to adult criminality and antisocial personality disorder – More common in boys than girls. The approximate prevalence rates are 3 per cent in childhood and 6 per cent in adolescence – Genetic factors and temperament play a role – Associating with anti-social peers and peer rejection can contribute to the development – Family environment and parental supervision are also important Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-48 48 24  10/20/2024 Conduct Disorder (DSM-5-TR) A. A repetitive and persistent pattern of behaviour in which the basic rights of others or major age appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months: – Aggression to people or animals – Destruction of property – Deceitfulness or theft – Serious violations of rules Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-49 49 Conduct Disorder (DSM-5-TR) Aggression to People or Animals 1. Often bullies, threatens, or intimidates others. 2. Often initiates physical fights 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun). 4. Has been physically cruel to people. 5. Has been physically cruel to animals. 6. Has stolen while confronting a victim (e.g., mugging purse snatching, extortion, armed robbery). 7. Has forced someone into sexual activity Destruction of property 8. Has deliberately engaged in fire setting with the intention of causing serious damage. 9. Has deliberately destroyed others’ property (other than by fire setting). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-50 50 25  10/20/2024 Conduct Disorder (DSM-5-TR) Deceitfulness or Theft 10. Has broken into someone else’s house, building or car. 11. Often lies to obtain goods or favours or to avoid obligations (i.e., “cons” others). 12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery). Serious Violations of Rules 13. Often stays out at night despite parental prohibitions, beginning before age 13 years. 14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period. 15. Is often truant from school, beginning before age 13 years. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-51 51 ODD/CD Differentiation ODD typically emerges 2 –3 years before CD ODD a precursor to CD? 6 yrs vs. 9 yrs BUT 2/3 of children 90% of children with CD have a with ODD don’t previous ODD diagnosis go on to develop CD Most children with ODD represents an extreme developmental variation that doesn’t escalate to more serious difficulties Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-52 52 26  10/20/2024 Externalising Disorders The treatment and prevention of externalising disorders: – Parenting interventions, such as 'Triple P-Positive Parenting Program' and the 'Incredible Years’ – Attachment-based approaches emphasise the quality of the parents’ relationship with the child – Family therapy focuses on the family as a system – Child-focused approaches include cognitive-behavioural interventions and problem-solving skills training – School-based approaches are guided by behaviour change principles – Combined approaches for longstanding externalising problems, and complicating family factors Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-53 53 Externalising Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-54 54 27  10/20/2024 Externalising Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-55 55 Disorders of Childhood Overview (myths, history, etc.) Internalising Disorders Externalising Disorders Neurodevelopmental Disorders Elimination Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-56 56 28  10/20/2024 Neurodevelopmental Disorders Disorders “with onset in the developmental period” (APA, 2022, p. 35) including: – Intellectual Disability (formerly mental retardation) – Autism Spectrum Disorder – Attention-Deficit/Hyperactivity Disorder – Specific Learning Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-57 57 Intellectual Disability The diagnosis, epidemiology and aetiology of intellectual disability: – Involves deficits in intellectual and adaptive functioning – Prevalence rate is approx. 1 per cent. More boys than girls are diagnosed – Increased risk of various types of physical and psychological disorders – Wide range of causes, many with genetic components – Exposure to toxic agents, maternal infection and low birth weight are also implicated – Treating underlying conditions, physical therapy, occupational therapy and speech therapy are useful Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-58 58 29  10/20/2024 Intellectual Disability (DSM-5-TR) A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing. B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community. C. Onset of intellectual and adaptive deficits during the developmental period. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-59 59 Intellectual Disability (DSM-5-TR) “Individuals with intellectual disability have scores of approximately two standard deviations or more below the population mean” (APA, p. 38) Specifiers: “The various levels of severity are defined on the basis of adaptive functioning, and not IQ scores, because it is adaptive functioning that determines the level of supports required. Moreover, IQ measures are less valid in the lower end of the IQ range. (APA, p. 38) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-60 60 30  10/20/2024 61 62 31  10/20/2024 Autism Spectrum Disorder A consolidation of four previously separate disorders: – Autistic disorder (i.e., autism) – Asperger’s disorder – Childhood disintegrative disorder – Pervasive developmental disorder not otherwise specified. “The revised diagnosis represents a new, more accurate, and medically and scientifically useful way of diagnosing individuals with autism-related disorders.” (APA, 2013) “ Researchers found that these separate diagnoses were not consistently applied across different clinics and treatment centers.” Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-63 63 Autism Spectrum Disorder The diagnosis and epidemiology of autism spectrum disorder: – Impairments in social interaction and social communication – Repetitive and restricted patterns of behaviour – Deficits in 'theory of mind' – Believed to have 1 per cent prevalence rate – Boys outnumber girls by 2:1 – Approximately 75 per cent of children with autism spectrum disorder have a poor outcome – Early intervention is critical—behaviour modification programs and pharmacotherapy can be helpful Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-64 64 32  10/20/2024 Autism Spectrum Disorder (DSM-5-TR) A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history: 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures: to a total lack of facial expressions and nonverbal communication. 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-65 65 Autism Spectrum Disorder (DSM-5-TR) B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history : 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-66 66 33  10/20/2024 Autism Spectrum Disorder (DSM-5-TR) C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level. With or without accompanying intellectual impairment With or without accompanying language impairment Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-67 67 Autism Spectrum Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-68 68 34  10/20/2024 Attention-Deficit/Hyperactivity Disorder (ADHD) Diagnosis and aetiology of attention-deficit/hyperactivity disorder (ADHD): – Defined by symptoms of:  inattention (e.g., being easily distracted), and/or  hyperactivity and impulsivity (e.g., fidgeting, moving about excessively) – Deficits in executive functioning are common – Several symptoms prior to age 12, and in 2 or more settings. – Prevalence is approximately 7.2 per cent Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-69 69 ADHD in the media 70 35  10/20/2024 Attention-Deficit/Hyperactivity Disorder (ADHD) Diagnosis and aetiology of attention-deficit/hyperactivity disorder (ADHD) continued: – Inherited vulnerability may entail neuropsychological impairment (e.g., executive functioning) – Autonomic under-arousal seen in preschoolers with ADHD – Children with ADHD seem to have lower responses to reinforcement – Parental inconsistency and lack of involvement has been associated with ADHD – Controversies over the role of diet in the aetiology of ADHD Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-71 71 ADHD in the DSM-5-TR A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2): 1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate). b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading). c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction). d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked). e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines). f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers). g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-72 72 36  10/20/2024 ADHD in the DSM-5-TR 2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. a. Often fidgets with or taps hands or feet or squirms in seat. b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place). c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.) d. Often unable to play or engage in leisure activities quietly. e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with). f. Often talks excessively. g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation). h. Often has difficulty waiting his or her turn (e.g., while waiting in line). i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-73 73 ADHD in the DSM-5-TR B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years. C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities). D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal). Specify whether: Combined presentation, predominantly inattentive presentation, or predominantly hyperactive/impulsive presentation. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-74 74 37  10/20/2024 Treatment of ADHD Stimulant medications (e.g., Ritalin) – Reduce disruptive behavior – Improve interactions with parents, teachers, peers – Improve goal-directed behavior and concentration – Reduce aggression – Side effects  Loss of appetite, weight, sleep problems Medication plus behavioral treatment – Slightly better than meds alone – Improved social skills whereas meds alone did not – Medication along rarely considered adequate Nutritional Interventions Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-75 75 Attention-Deficit/Hyperactivity Disorder (ADHD) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-76 76 38  10/20/2024 Specific Learning Disorder The diagnosis and epidemiology of reading disorder: – Characterised by difficulties in reading accuracy, fluency and comprehension which is not the result of a general intellectual disability – One of the most common of childhood disorders—between 4 and 7 per cent – High rates of comorbidity with behavioural problems and with ADHD – There is some evidence of a genetic component to reading disorder – Deficits in phonological awareness and deficits in working memory have been implicated – Limitations in the processing of written language Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-77 77 Specific Learning Disorder (DSM-5-TR) A. Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties: 1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words). 2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read). 3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants). 4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity). 5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures). 6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-78 78 39  10/20/2024 Specific Learning Disorder (DSM-5-TR) B. The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment. For individuals age 17 years and older, a documented history of impairing learning difficulties may be substituted for the standardized assessment. C. The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the individual’s limited capacities (e.g., as in timed tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy academic loads). D. The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-79 79 Disorders of Childhood Overview (myths, history, etc.) Internalising Disorders Externalising Disorders Neurodevelopmental Disorders Elimination Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-80 80 40  10/20/2024 Elimination Disorders Enuresis Encopresis Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-81 81 Enuresis The diagnosis and epidemiology of enuresis: – The involuntary emptying of the bladder in the absence of any organic cause, either at night (nocturnal enuresis) or daytime (diurnal enuresis) – Child must be at least 5 years old to meet criteria – Two categories:  Primary enuresis, where the child has never been dry  Secondary enuresis, where the child has had a period of dryness for at least six months  There are also subtype based on being nocturnal/diurnal. – Relatively common:  Boys 15–22 per cent  Girls 7–15 per cent  Most grow out of the disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-82 82 41  10/20/2024 Enuresis (DSM-5) A. Repeated voiding of urine into bed or clothes, whether involuntary or intentional B. The behaviour is clinically significant as manifested by either a frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. C. Chronological age is at least 5 years (or equivalent developmental level). D. The behaviour is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder). Specify whether: Nocturnal Only: Passage of urine only during nighttime sleep Diurnal Only: Passage of urine during waking hours Nocturnal and Diurnal: A combination of the two subtypes above Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-83 83 Enuresis The aetiology of enuresis: – Inherited factors are thought to play a significant role. – No specific factor has been pinpointed but may be related to general developmental immaturity as well as hormonal and physical factors. – Children with enuresis tend to have lower than average height and later development of milestones. – Other possible factors include: hyperactivity of the parasympathetic system, dysregulation of vasopressin and abnormal sleep patterns. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-84 84 42  10/20/2024 Enuresis The treatment of enuresis: – Conditioning approaches are most successful – Bell and pad method is the most effective intervention  Urine-sensitive pad placed on the bed and connected to an alarm  When the child wets, the alarm activates, and the child is woken  Thought to work by teaching the child to avoid the aversive situation of being woken at night by the alarm  Over time the child learns to avoid this through increased bladder control Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-85 85 Encopresis The diagnosis of encopresis: – Repetitive soiling in inappropriate places at least once a month for three months. – Medical or physical problems need to be ruled out first. – May be retentive, where the child tends to hold on as long as possible, or non-retentive, where soiling is intermittent. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-86 86 43  10/20/2024 Encopresis (DSM-5) A. Repeated passage of faeces into inappropriate places (e.g., clothing, floor), whether involuntary or intentional. B. At least one such event occurs each month for at least 3 months C. Chronological age is at least 4 years (or equivalent developmental level) D. The behaviour is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition except through a mechanism involving constipation. Specify whether: With constipation and overflow incontinence: There is evidence of constipation on physical examination or by history Without constipation and overflow incontinence: there is no evidence of constipation on physical examination or by history Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-87 87 Encopresis The epidemiology of encopresis: – Diagnosed in approximately 1.5–7.5 per cent of children – Tends to decline with age – Children with encopresis tend to have more:  Anxiety/depressive symptoms  Attention difficulties  Greater social problems  More disruptive behaviour  Poorer school performance Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-88 88 44  10/20/2024 Encopresis The aetiology of encopresis: – Cox et al. (1996) suggest that the child experiences constipation (resulting from physical or psychological factors) which leads to faecal impaction and hard stools. – Passage of stools is difficult and may be painful. – Child may begin to anticipate future difficulties and avoids going to the toilet leading to chronic constipation with overflow incontinence. – Shame and rejection can lead the child to lie about dirty underwear. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-89 89 Encopresis The treatment of encopresis: – Medical management combined with behavioural treatment is more effective than medical treatment alone – Behavioural interventions include psychoeducation for parents and children, combined with an appropriate reinforcement schedule to encourage children to use the toilet – A 1996 study found that of 324 children treated, 87 per cent showed improvements but 42 per cent were still soiling – Novel approaches using internet-based interventions hold some promise Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-90 90 45  10/20/2024 Any Questions? If so, post them online Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 14-91 91 46