PSYC30014 Child Psychopathology Week 11 2024 PDF

PSYC30014 The Psychopathology of Everyday Life Semester 1, 2024 Child Psychopathology (Week 11) Dr Rowena Conroy ([email protected]) Acknowledgment of Country Welcome, Introductions  Objectives - for students to: Develop an Learn about the Learn about...

PSYC30014 The Psychopathology of Everyday Life Semester 1, 2024 Child Psychopathology (Week 11) Dr Rowena Conroy ([email protected]) Acknowledgment of Country Welcome, Introductions  Objectives - for students to: Develop an Learn about the Learn about classification Gain knowledge about understanding about epidemiology of mental and aetiology of central tenets of the challenges associated health problems across psychological disorders Developmental with identifying childhood that commonly present Psychopathology psychopathology in youth during childhood framework (focusing on some not covered elsewhere in this subject) A mother shares with you her concerns about her daughter: “She has always been a sensitive child and a loner, but I thought she was getting along all right - except that recently she has started having some really strange ideas. The other day we were driving on the highway to town, and she said, “I could make all these cars wreck if I just raised my hand.” I thought she was joking but she had a serious expression on her face and wasn’t even looking at me. Another time she wanted to go outside when the weather was bad, and she got furious at me because I didn’t make it stop raining. And now she’s started pleading and pleading with me every night to look in on her after she has gone to sleep to be sure her leg isn’t hanging over the side of the bed. She says there is some kind of crab creature in the dark waiting to grab her if her foot touches the floor. What worries me is that she believes all these things can really happen. I don’t know if she’s crazy or watching too much T.V. or what’s going on.” Adapted from Wenar & Kerig (2000). Developmental Psychopathology: From infancy through adolescence. Might this young person have a Mental Health Disorder? What might we want to know first? Consider the following behaviours Using sexually explicit Crying when separating Wetting the bed language from caregiver Daily tantrums An inability to read At what ages might these represent age-appropriate behaviours? Jack is 6 years old. His parents disagree about whether Jack should see a psychologist. One parent is concerned that “there is something wrong” because Jack has not been sleeping in his own bed, is refusing to stay at birthday parties unless his parents stay with him, and having tantrums (including physical aggression) when his parents tell him it is time to get into the car and go to school. The other parent thinks that Jack is “just a shy kid” and “will grow out of it”. What do we want to know?  ❖Frequency & intensity of cognitions, physiological signs, behaviours, emotional responses (etc.) ❖Impact on functioning Determining ❖Deviation from norms abnormality in youth ❖Is the behaviour appropriate to context? – e.g.: Developmental context (developmental stage) Family context Cultural context Historical context Psychopathology in Youth - Epidemiological Considerations Mental Health Disorders are common in childhood Lawrence et al. (2015) The Mental Health of Children and Adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Department of Health, Canberra. Lifetime (childhood) prevalence Around 20% of individuals experience a psychological disorder at some time during childhood e.g., Perou et al. (2013); MMWR Suppl, 62(2), 1‐35); see also https://www.cdc.gov/childrensmentalhealth/data.html What types of difficulties do we see? Lawrence et al. (2015) The Mental Health of Children and Adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Department of Health, Canberra. Prevalence of many mental health difficulties higher than in general population for certain groups, including Australian Aboriginal and Torres Strait Islander youth CALD background LGBTIQA+ youth Those living in rural/remote locations Comorbidity Around 40% of children with one mental health disorder also have another (e.g., Merikangas et al. (2010), Pediatrics. 125(1):75‐81) Adolescents with Depression 50 - 75% also have an anxiety disorder Cummings et al. (2014). Psychol Bull, 140(3):816‐845 Children with an Anxiety Disorder 40 - 60% have at least one other anxiety disorder Leyfer et al. (2013). J Anxiety Disord, 27(3):306‐311 Children with Autism Spectrum Disorder Up to 80% have clinically significant anxiety symptoms; 40 - 60% have an anxiety disorder Nadeau et al. (2011). Neuropsychiatry, 1(6):567‐578 Adolescents with Oppositional Defiant Disorder Around 90% meet criteria for another disorder (anxiety disorders; depression; substance use disorders, ADHD) Nock et al. (2007). J Child Psychol Psychiatry, 48(7):703‐713  High comorbidity ❖Shared aetiology? ❖Challenges with drawing categorical boundaries? ❖Impairments associated with one disorder become risk factors for another? Prevalence by age Overall prevalence: adolescents > younger children BUT also disorder-specific findings – e.g.: Depression, Anxiety Disorders, Eating disorders: higher prevalence in adolescents than younger children The opposite for some disorders – e.g., ADHD, ODD Merikangas et al. (2010). Pediatrics, 125(1):75‐81; Costello et al. (2003). Arch Gen Psychiatry, 60(8):837‐844.  Prevalence by sex Disorder-specific findings, also Depression, Anxiety Disorders, PTSD, and Eating Disorders all more prevalent in girls ODD, and ADHD, ASD, Specific Learning Disorders occur more frequently in boys Merikangas et al. (2010). Pediatrics, 125(1):75‐81; Costello et al. (2003). Arch Gen Psychiatry, 60(8):837‐844 Interactions between sex and age – e.g.: Depression: Equal prevalence in pre-adolescents Girls > Boys in adolescence ODD: Boys > Girls in pre-adolescents Equal prevalence in adolescence Merikangas et al. (2010). Pediatrics, 125(1):75‐81; Costello et al. (2003). Arch Gen Psychiatry, 60(8):837‐844 Depression in Adolescents (2005 vs 2015) 9% for those born in 15% for ‘millennials’ 1990s Patalay et al. (2019). Int J Epidemiol, 48(5):1650‐1664. Anxiety Disorders across Childhood A 51% increase in reported prevalence between 2004 and 2017 Vizard et al (2018). Mental health of children and young people in England, 2017. Leeds, UK: Health and Social Care Information Centre Autism Spectrum Disorder From 1 per to 1 in 88 in to 1 in 54 in 5,000 in 1990 2012 2016 Christensen et al. (2016). MMWR Surveill Summ, 65(SS-3): 1–23; https://www.cdc.gov/ncbddd/autism/data.html Increasing rates Increased awareness/understanding? Decreased stigma? Changed diagnostic criteria? Risk factors more prevalent? Relatively few access services Lawrence et al. (2015) The Mental Health of Children and Adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Department of Health, Canberra. Only 56% of these had used services for emotional and behavioural problems in the past 12 months Barriers to accessing services ❖Stigma? (parents, children) ❖Availability/Accessibility? ❖Under-identification? “She’s just a moody teenager” “He’s just shy” “I was like that at his age; he’ll grow out of it” Childhood mental health disorders have associated ❖Distress ❖Functional impairment (child, family) ❖Cascading effects on development Adult disorders: origins in childhood Kessler et al. (2005): Half of adults with mental health disorders: onset of disorder by 14 years of age … and 75% before 24 years Kessler et al (2005). Arch Gen Psychiatry. 2005;62(6):593‐602. Categorical Approaches to Classification in Childhood  ❖Same criteria as for adults, for the most part ❖Some disorders: developmental specifiers (e.g., depression) ❖Some disorders: behaviours need to be “inconsistent with developmental level” (e.g., ODD) DSM-5 and ‘development’ ❖PTSD: a Preschool Subtype ❖Some disorders – most likely manifest during childhood (e.g., separation anxiety disorder) ❖Neurodevelopmental Disorders – by definition, childhood-onset of symptoms Today Consideration of some disorders not covered elsewhere; a subset within each of the following categories: Neurodevelopmental Disorders Disruptive, Impulse-Control, and Conduct Disorders Diagnostic features Aetiological considerations DSM-5 Neurodevelopmental Disorders ❖ A group of disorders with onset in childhood … though not always diagnosed in early developmental period ❖ A range of developmental deficits (e.g., motor, communication, social, cognitive) … impacting on functioning across domains (e.g., social, academic, daily living, family) ❖ High heritability ❖ More common in boys than girls ❖ Typically multifactorial in origin (singular causes rare) ❖ High levels of comorbidity DSM-5 Neurodevelopmental Disorders Communication Disorders Intellectual Disability Language Disorder; Speech Specific Learning Disorders (Intellectual Developmental Sound Disorder; Social Disorder) & Global (in Reading, Writing, (Pragmatic) Communication Developmental Delay Mathematics) Disorder; Childhood Onset Fluency Disorder (Stuttering) Motor Disorders: Developmental Coordination Attention Deficit Autism Spectrum Disorder Disorder, Stereotypic Hyperactivity Disorder Movement Disorder, Tic Disorders  Intellectual Disability – Key Diagnostic Criteria (Abbreviated) Deficits in intellectual functions such as reasoning, problem solving, planning, abstract thinking, judgement, academic learning, and learning from experience, confirmed by both clinical assessment and individualised, standardised intelligence testing AND 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 - Across Conceptual, Social, and Practical AND Onsetdomains of intellectual and adaptive deficits was during the developmental period Severity: based on IQ and adaptive functioning across Conceptual, Social, Practical domains  Intellectual Disability – some statistics ❖Prevalence: 1 – 3 % of the population ❖More common among males (1.5 : 1) ❖At least 500 causes known ❖Many cases of ID are of unknown aetiology ❖Specific aetiologies found for about 25% of those with mild-moderate ID; around 70% of those with severe/profound ID ❖High prevalence in people with Autism (≃30%)  Intellectual Disability – Risk Factors Chromosomal Prenatal and birth Medical Environmental factors abnormalities/Genetic complications conditions/Treatments conditions - e.g.: Prenatal exposures - e.g., Severe malnourishment Neurological disorders – Down Syndrome, Fragile Alcohol, Lead e.g. Epilepsy X Syndrome, Prader-Willi Prenatal iodine Post-natal exposure to Metabolic conditions – Syndrome deficiency toxic substances - e.g.: e.g. Phenylketonuria Maternal infections (e.g., Lead Brain radiation Rubella, Cytomegalovirus; Radiation CMV) Mercury Acquired brain injury – Complications of e.g.. Infections, TBI, birth/prematurity (e.g., Stroke hypoxia, periventricular haemorrhage)  Autism Spectrum Disorder – Key Diagnostic Criteria (Abbreviated) A. Persistent deficits in social communication and social interaction B. Restricted, repetitive patterns of behavior, interests, or activities C. Symptoms 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).  ❖ Prevalence: around 1/50; Males:Females = 4:1 Though ??under-recognition in women/girls ❖ Aetiology poorly understood (despite extensive research into pre-natal biological/environmental factors) Autism Spectrum ❖ Known correlates include Disorder Some genetic disorders – Risk Factors Strong familial influence Differences in early brain development (Early brain overgrowth - marked in frontal areas; reduced cortical pruning; Atypical patterns of activation/connectivity - various regions & networks) Advanced parental (esp. paternal) age  Attention Deficit Hyperactivity Disorder (ADHD) “a persistent pattern of inattention and/or hyperactivity-impulsivity that – Key diagnostic criteria interferes with functioning or (Abbreviated) development”  Inattention symptoms Fails to give close attention to details / makes careless mistakes in schoolwork, work, or other activities Has difficulty sustaining attention in tasks or play activities Does not seem to listen when spoken to directly Does not follow through on instructions & fails to finish schoolwork, chores or duties in workplace Has difficulty organizing tasks and activities Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort Loses things necessary for tasks or activities Is easily distracted by extraneous stimuli Is forgetful in daily activities  Hyperactivity/Impulsivity symptoms Fidgets with or taps hands or feet or squirms in seat Leaves seat in situations when remaining seated is expected Runs about or climbs excessively in situations in which it is inappropriate Unable to play or engage in leisure activities quietly “On the go” acting as if “driven by a motor” Talks excessively Blurts out an answer before a question has been completed Has difficulty waiting turn Interrupts or intrudes on others Presentations (ADHD) Predominantly Predominantly Inattentive Hyperactive/Impulsive Combined (75% of children with ADHD) ADHD Childhood prevalence ≃ 5-7% Boys: Girls = 3:1 But sex differences hold only for combined and hyperactive subtypes  ADHD – Risk Factors Environmental Influences Genetics Neurobiological findings Include Strong Heritability (>70%) Differences in regions Maternal smoking & alcohol Multiple genes; Particularly involved in attention and during pregnancy those involved in dopamine executive and inhibitory Low birth weight & and serotonin pathways control prematurity High prevalence associated Structural differences: Toxins – e.g., lead, other with some genetic conditions especially in prefrontal areas pollutants – e.g., Fragile X Neurochemical differences: Higher prevalence in context Lowered Dopamine and of psychosocial adversity Norepinephrine (Noradrenaline) levels (reuptake problems)  A paradigm shift - led from within Autism field Increasing attention to voices of those with lived experience Criticisms of deficit-focused models/research ‘medical models’ A comment about interventions that appear to have the goal of ‘normalcy’ Neurodiversity Increasing attention to strengths of neurodivergent individuals questions about “goodness of fit” between neurodivergent individuals and their environment/context ‘Neurodiversity’ a term coined in late 1990s From Pellicano & den Houting (2022) – see your Readings list  “….conditions involving problems in the self-control of emotions and behaviors. While other disorders in DSM-5 may also involve problems in emotional and/or DSM-5 behavioral regulation, the disorders in this chapter are Disruptive, unique in that these problems are manifested in behaviors that violate the rights of others (e.g., Impulse- aggression, destruction of property) and/or that bring Control, and the individual into significant conflict with societal norms or authority figures… ” DSM-5 (APA, 2013) Conduct Disorders Prevalence in childhood – around 6% Boys > Girls DSM-5 Disruptive, Impulse-Control, and Conduct Disorders Oppositional Defiant Intermittent Explosive Conduct Disorder Disorder Disorder Antisocial Personality Pyromania Kleptomania Disorder Other Specified and Unspecified Disruptive, Impulse-Control, and Conduct Disorders  Oppositional Defiant Disorder – Key Diagnostic Criteria (abbreviated) Angry/irritable mood loses temper – often… touchy or easily annoyed angry and resentful Argumentative/Defia argues with authority figures (for children/adolescents: with adults nt Behaviour – often actively defies/refuses to comply with requests from authority figures / with rules … deliberately annoys others blames others for his/her mistakes or misbehaviour Vindictiveness Spiteful or vindictive  Aggression to often bullies, threatens, or intimidates others people and often initiates physical fights animals has used a weapon that can cause serious physical harm to others has been physically cruel to people has been physically cruel to animals Conduct has stolen while confronting a victim has forced someone into sexual activity Disorder – Key Destruction of property deliberately engaged in fire setting with intention of causing serious damage Diagnostic deliberately destroyed others' property (other than by fire setting) Criteria (Abbreviated) Deceitfulness or theft has broken into someone else’s house, building, or car often lies to obtain goods/favours / to avoid obligations (i.e., “cons” others) has stolen items of nontrivial value without confronting a victim Serious violations often stays out @ night despite parental prohibitions (from