Neurodevelopmental Disorders PDF

Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page...

Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 MODULE 10 NEURODEVELOPMENTAL DISORDERS This module will cover disorders that begin early in life, specifically those that diverge from the usual childhood and adolescent development path. Students will understand how these disorders relate to pathology in behaviors that may even endure throughout a person’s lifespan. Topic Learning Objective: TLO 24: Examine developmental disorders in the context of child and adolescent development theories. TLO 25: Evaluate normal from delayed intellectual functioning in individuals. TLO 26: Explain childhood to adolescent psychological disorders. INTRODUCTION: It is important to view a child’s behavior in the context of normal childhood development (Silk et al., 2000). We cannot consider a child’s behavior abnormal without determining whether the behavior in question is appropriate for the child’s age. Disorders that begin early in life and remain with the individual throughout life are known as neurodevelopmental disorders. The clinical picture of childhood disorders tends to be distinct from those in other life periods. Some of the emotional disturbances of childhood may be relatively short-lived and less specific than those occurring in adulthood. However, some childhood disorders severely affect future development. The developmental disorders of children and adolescents include problems in eating (overeating and self-starvation), eliminating, sleeping and speaking, paying attention, and learning, as well as disorders characterized by feelings of anxiety, depression, and those characterized by antisocial conduct. These disorders are called “developmental” because they involve serious divergences from the usual path of childhood or adolescent development. Some children fail to develop age-appropriate behavior (four-year-olds who do not speak, eight-year-olds who are terrified of going to school) Others persist in a behavior more appropriate to a younger child (eight-year-olds who wet their beds) Still, other children develop an expected form of behavior on time but with a problem with language development (stuttering speech or perceiving letters or words in reverse)  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 Despite some similarities with adult disorders, those of children and adolescents are worth to be studied separately for several reasons Special Psychological Vulnerabilities of Young Children Young children are especially vulnerable to psychological problems (Ingram & Price, 2001). In evaluating the presence or extent of mental health problems in children and adolescents, one needs to consider the following: They do not have as complex and realistic a view of themselves and their world as they will have later; they have less self-understanding; and they have not yet developed a stable sense of identity or a clear understanding of what is expected of them and what resources they might have to deal with problems. Immediately perceived threats are tempered less by considerations of the past or future and thus tend to be seen as disproportionately important. As a result, children often have more difficulty than adults in coping with stressful events (Mash & Barkley, 2006). For example, children are at risk for posttraumatic stress disorder after a disaster, especially if the family atmosphere is troubled—a circumstance that adds additional stress to the problems resulting from the natural disaster (Menaghan, 2010). Children’s limited perspectives, as might be expected, lead them to use unrealistic concepts to explain events. For young children, suicide or violence against another person may be undertaken without any real understanding of the finality of death. Children also are more dependent on other people than are adults. Although in some ways, this dependency serves as a buffer against other dangers because the adults around him or her might “protect” a child against stressors in the environment, it also makes the child highly vulnerable to experiences of rejection, disappointment, and failure if these adults, because of their own problems, ignore the child (Lengua, 2006). Children’s lack of experience in dealing with adversity can make manageable problems seem insurmountable (Scottet al., 2010). On the other hand, although their inexperience and lack of self-sufficiency make them easily upset by problems that seem minor to the average adult, children typically recover more rapidly from their hurts. From Butcher, Mineka & Hooley, (2014). Abnormal Psychology. pages 510-511  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 UNIT 1: INTELLECTUAL DISABILITY INTELLECTUAL DEVELOPMENTAL DISORDER is a diagnosis used to characterize individuals with intellectual and adaptive deficits that first became evident when they were children. The ICD uses the term “intellectual developmental disorder” and to ensure compatibility, the DSM-5 places this term in parentheses after the term intellectual disability. In DSM-IV, it is termed mental retardation. To receive a diagnosis of intellectual disability, the individual must meet conditions that fall into three sets of criteria: First set of criteria: Includes deficits in the general intellectual abilities that an intelligence test might measure, including reasoning, problem-solving, judgment, ability to learn from experience and learning in an academic context. Second set of criteria: involves impairment in adaptive functioning, relative to a person’s age and cultural group, in a variety of daily life activities such as communication, social participation, and independent living. Third criterion relates to the age of onset. Specifically, the disorder must begin prior to the age of 18. Once clinicians determine the diagnosis of intellectual disability is appropriate, the next step is to rate the severity of the disability as mild, moderate, severe, or profound. LEVEL OF SEVERITY FOR INTELLECTUAL DISABILITY:  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 Source: Patel, Dilip R. et.al. 2018. Intellectual disability: Definition, Evaluation and Principles of Treatment ETIOLOGY OF INTELLECTUAL DISABILITY: 1. Genetic Abnormalities: Genetic abnormalities are a significant cause of intellectual disability. Metabolic disturbances, hormonal problems and chromosomal aberrations are considered to be the culprit to the genetic abnormalities. In the case of metabolic disturbances, the following can be accountable to the abnormality: a) Infantile Cerebral Lipoidosis (Tay-Sachs Disease) caused by a recessive gene where there is a disturbance of the fat metabolism. Children with Tay-Sachs Disease, has deficits in intellectual functioning due to a lack of hexosaminidase A, an enzyme that helps break down toxic chemical in nervous tissue called ganglioside. It is a defective gene on chromosome 15. The symptoms usually appear between the age of one month and one year, but there is a late infantile form which only appears in the second and third year. The child becomes apathetic, shows muscular weakness, is unable to steady his head, loses his ability to grasp objects. A visual deterioration leads the child to blindness with death occurring within a few years. b) Phenylketonuria (PKU) caused by a recessive gene. It consists of a disturbance of the protein metabolism, where the child lacks an enzyme to breakdown phenylalanine, an amino acid found in proteins. A build-up of phenylalanine in the body can cause serious damage to the developing nervous system. It can result to severe intellectual disability, hyperactivity and erratic and unpredictable behavior. Seizures of the grand mal type and severe eczema are common. PKU can be detected soon after birth and treatment with diet, restricted phenylalanine prevents and eventually great limit cerebral damage when started before the child is 15 months of age. c) Galactosemia is a disorder in the metabolism process of carbohydrates which results in an accumulation of galactose in the bloodstream. The child with Galactosemia starts showing the symptoms when he is placed on the usual milk diet. He loses appetite, vomits and develops diarrhea. The high galactose in the blood leads to hypoglycemia (low sugar level) which causes enlargement of the liver, convulsions and intellectual disability (mental retardation). If untreated, can lead to death. Early diagnosis with proper treatment may prevent permanent cerebral damage.  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 d) fragile X syndrome is a common form of intellectual disability in males. It is a genetic disorder caused by a changed in the FMRI. A small part of the gene’s code is repeated in a “fragile” area of the X chromosome and the more the number of repeats, the greater the deficit. Because males have only one X chromosome, this genetic defect is more likely to occur in males. Children with fragile X syndrome may appear normal most part of their life but they show some signs of physical abnormalities including large head circumference and subtle abnormalities in the facial appearance such as large forehead and long face, flat feet, large body size and large testicles after they start puberty. Parents notice delays in achieving benchmarks such as crawling, walking, hyperactive or impulsive behavior, hand clapping, biting, speech and language delays and tendency to avoid eye contact. In the case of chromosomal aberrations: a) Down Syndrome (Trisomy 21). This frequent variety of mental deficiency, described by a British physician Langdon Down. In 1950, French geneticist, Jerome Lejeune, found that individuals with the Down Syndrome always have an extra chromosome in pair 21. Trisomy 21 occurs in varying degrees and its concomitant intellectual disability ranges from severe to moderate, although some cases of mild deterioration have been reported. Common characteristics include a small round skull, limited brain development, a large protruding tongue, and a short broad neck; the skin is dry and lacks elasticity, hands are large and palm of the hands has only one crease, fingers are short especially in the fifth finger and genitals are underdeveloped. Because such children are susceptible to serious cardiac and respiratory diseases, their life expectancy is shorter than average. If they survive, they develop at a later stage in life an Alzheimer’s Disease. Trisomy 21 children have good disposition. They are friendly and happy. They crave for affection and they have strong tendency for imitativeness. These assets can be properly used in the training of these children. However, they are also capable of considerable stubbornness and not all of them fit the “happy child” stereotype. b) The Klinefelter Syndrome only found in males, is cause by an extra chromosome in pair 23, the gender chromosome. Instead of the XY pair, they have XXY which results in testicular atrophy. Only about 25% have any degree of mental retardation, and it is usually mild. Klinefelter's syndrome individuals have a below average IQ, typically between 80 and 90. Klinefelter syndrome boys tend to have academic difficulties, delayed speech and language acquisition, diminished short-term memory, decreased data-retrieval skills, reading difficulties, dyslexia, and attention deficit disorder. According to some reports, they have a passive personality and decreased libido.  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 c) Turner’s Syndrome. This abnormality, on the other hand, is found only in women, which is caused by an anomaly on the sex chromosomes. Instead of having XX, they only have one X. The symptom include mild intellectual disability usually only detected when schooling starts. Females with Turner syndrome (TS) often demonstrate a unique cognitive profile characterized by relative strengths in verbal domains. These children have particular difficulties with the perception of space, hence, weaknesses in visual-spatial and executive areas. Several studies also suggest that girls with TS are at risk for social cognitive and emotion processing difficulties. 2. Environmental Hazards: Environmental hazards that mothers experience while pregnant are the second category of causes of intellectual disability. Called teratogens, include drugs and toxic chemicals, maternal malnutrition and infections in the mother during critical phases of fetal development. a) Infection of the fetus such as measles (Rubella – German Measles) during the first trimester of her pregnancy, may cause mental retardation and other congenital anomalies such as deafness and cardiac malformations. Mothers who also contract influenza during pregnancy has been associated to intellectual disability that cause malformation of the infantile brain. b) Intoxication. Toxic substances taken by or injected by the mother during pregnancy can cause neurological damage and consequent intellectual disability. Common forms of intoxication are lead poisoning (such as lead-based paint), carbon monoxide, LSD, nicotine and alcohol. Fetal Alcohol Syndrome (FAS) may lead to pronounced problems in the executive functioning of the brain. Hence, children with FAS find it difficult to perform tasks that require them to regulate their attentional control and perform mental manipulation (Kodituwakku, 2009). In addition, these children are at risk for developing a variety of negative outcome as they mature including dropping out of school, committing criminal acts and developing diagnoses of other mental health problems including substance use disorders. Their adaptive abilities are challenged further by the tendency to engage in inappropriate sexual behavior and they have difficulty living independently and staying employed (Bertrand et.al., 2004) UNIT 2: AUTISM SPECTRUM DISORDER This neurodevelopmental disorder is one of the most puzzling disorders occurring in early childhood. It can also be one of the most disabling childhood disorders. The constellation of diagnostic criteria associated with this disorder can persist for an individual’s entire life, but, depending on its severity, the individual can receive help to function satisfactorily with treatment.  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 Unlike the previous developmental disorders which do not totally disable children, the problems of a child with autism are called pervasive since it encompasses all aspects of the child’s functioning. Autism affects intelligence, speech, movement, social relationships, independent living and everything. To diagnose autism spectrum disorder, clinicians evaluate children along two core domains: 1. Social and communication disturbances. 2. Restricted range of interests and performance of repetitive behaviors and activities. Every child with autism, like every normal child, is unique. Hans Christian Andersen, author of famous children’s books; Susan Boyle – Britain’s Got Talent Singer; Albert Einstein, Bill Gates, Steve Jobs, Nikola Tesla and many more are among the famous yet successful people diagnose with Autism. Children with autism show varying degrees of impairments and capabilities. A cardinal and typical sign is that they seem apart or aloof from others, even in the earliest stages of life (Hillman & Synder, 2007). Parents would remember that as babies who never were cuddly, never reaching out when being picked up, never smiling or looking at them while being fed and never appearing to notice the comings and goings of people. THE CLINICAL PICTURE OF AUTISM SPECTRUM DISORDER: 1. Social Deficit (Disturbance in social relationships). Typically, they do not show any need for affection or contact with anyone. They also usually do not even seem to know or care who their parents are. They may take the form of withdrawal from all social contact, into a state of what has been called “extreme autistic aloneness.” They lack emotional reactions and lack social understanding – a deficit in the ability to attend to social cues from others. They are also thought of as having “mind blindness” – an inability to take the attitude of others or to “see” things as others do. The recoil from social contact is even sharper in older children. They avoid looking anyone in the eye and act as if they do not exist. If they form any attachment at all, they may be obsessive attachments to inanimate objects like sticks or pieces of paper or something equally improbable. Children with autism may exhibit rage, panic, crying to nothing that an observer can identify. Tantrums are common and they respond to the environment inappropriately. 2. Language Deficits (An Absence of Speech). Children with autism do not effectively learn by imitation (smith & Bryson, 1994). This dysfunction may explain their characteristic absence or severely limited use or impaired speech. More than half of those diagnosed do not speak at all, others babble, scream, say little that can be understood. They could not communicate reciprocally. If speech is present, it is almost never use to communicate  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 except in the most rudimentary fashion, such as by saying “yes or no” or by the use of echolalia – the parrot-like repetition of a few words. 3. Cognitive deficits (Impaired Intellectual Ability). Children with autism are significantly impaired on memory tasks when compared with both normal children and children with intellectual disability. They show a particular deficit in representing mental states; that is, they appear to have deficits in social reasoning but can manipulate objects. Their cognitive impairment is greatly reflected rather in adaptive behaviors than seen in mentally retarded children without autism. However, some children with autism are quite skilled at fitting objects together, such as working on puzzles. 4. Self-Stimulation (Disturbed Motor Behavior). Self-stimulation is often characteristic of children with autism. It usually takes the form of repetitive movements such as head banging, spinning, rocking, and hand flapping – these involve the fine or gross muscles of the hands, face, trunks, or legs. Left to themselves. Most children with autism spend as much as 90% of their time in these bizarre forms of self-stimulation. 5. Maintaining/Persevering Sameness. Many children with autism are preoccupied with and form strong attachments to unusual objects such as rocks, lights, switches, keys and others. They are usually anxious and obsessive about keeping their surroundings utterly unvarying. Toys must always be put in the same place on the same shelves. Meals must be an unvarying ritual of following a sequence. If a child senses a variation in his things or activities, he usually responds with a tantrum. Clinicians have noted that many normal children when they are about two to three years old, insist on unvarying sameness in routines. They have suggested that the development of autistic children may have stalled at this point. ASPERGER’S DISORDER (HIGH-FUNCTIONING AUTISM SPECTRUM DISORDER) Greta Thunberg, the young Swedish environmental activist who founded the school strike for climate, has Asperger’s Disorder. This disorder is named after Hans Asperger, a Viennese physician who, during WWII, described a group of boys who possessed rather good language and cognitive skills but had marked social problems because they acted like pompous “little professors” and were physically awkward. Greta and others diagnosed with Asperger’s Disorder are high-functioning individuals with autism spectrum disorder. According to the Autism Society: Children with autism are frequently viewed as aloof and uninterested in others. This is not the case with Asperger’s Disorder. Individuals with Asperger’s Disorder usually want to fit in and interact with others, but often, they don’t know how to do it. They may be socially awkward, not understand conventional social rules, or show a lack of empathy. They may have limited eye contact, seem unengaged in a conversation, and not understand the use of gestures or sarcasm.  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 One of the major differences between Asperger’s Disorder and autism is that, by definition, there is no speech delay in Asperger’s. Children with Asperger’s Disorder frequently have good language skills; they simply use language in different ways. Speech patterns may be unusual, lack inflection, or have a rhythmic nature, or may be formal but too loud or high-pitched. Children with Asperger’s Disorder may not understand the subtleties of language, such as irony and humor, or they may not understand the give- and-take nature of a conversation. Another distinction between Asperger’s Disorder and autism concerns cognitive ability. While some individuals with autism have intellectual disabilities, by definition, a person with Asperger’s Disorder cannot have a “clinically significant” cognitive delay, and most possess average to above-average intelligence. NOTE ON AUTISTIC SAVANT SYNDROME: This is an unusual variant in the Autism Spectrum that occurs in people with autism spectrum disorder who possess an extraordinary skill. In spite of generally diminished skill, they can show astonishing proficiency in one isolated skill, such as extraordinary performance in extremely complicated numerical operations, exceptional art skills, musical skills, literary skills, etc. (Watch Movies like Rain Man, 1988; Little Man Tate,1991; A Brilliant Young Mind,2015). The autistic savant syndrome typically appears at an early age. Their tendency to focus intensely on the physical attributes of objects may give them this uncanny set of abilities. Their way to compensate is their ability to concentrate intensely, which is typical. ETIOLOGY OF AUTISM SPECTRUM: Some children develop autism during prenatal life, and for instance, these children were exposed to measles as fetuses became autistic. Autism is also associated with high levels of complications in pregnancy and birth. Evidence pointing to patterns of familial inheritance supports the theory that autism spectrum disorder is biologically based. Studies have also been undertaken to clarify possible neurological abnormalities in the central nervous system, specifically in the left hemisphere, which account for this disorder. Some researchers suggest that altered connectivity involves neural circuits in brain activity when the brain is awake but at rest. It is suspected that individuals with this disorder may be less able to share information from the two hemispheres of their brain. It clearly also has a biochemical component, as levels of serotonin and dopamine are elevated, and some children have benefitted from drug therapy While studies on determining neurological abnormalities for this disorder are advancing, the behavioral perspective remains the most realistic approach to treatment. In addition, with support in developing their adaptive skills, children diagnosed with autism can  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 develop ways to cope with their symptoms and can be highly successful in their chosen field. When they turn as adults, they may be able to gain considerable self-insight into their strengths and weaknesses as they also learn to acquire social skills. UNIT 3: CHILDHOOD-ADOLESCENT DISORDERS The challenge in understanding childhood and adolescent psychological disorders spans not only concerns on developmental milestones but also issues on critical environmental influences such as parenting, family relations, and socioemotional and behavioral domains. However, it is considered vital that early detection and intervention are needed to promote child mental and behavioral health. Some studies indicate that childhood and adolescent mental illness are key risk factors for diagnosing psychiatric problems in some adults (Copeland et.al, 2009) According to the World Health Organization, worldwide 10-20% of children and adolescents experience mental disorders. Half of all mental illnesses begin by the age of 14, and three-quarters by mid-20s. Neuropsychiatric conditions are the leading cause of disability in young people in all regions. If untreated, these conditions severely influence children’s development, their educational attainments, and their potential to live fulfilling and productive lives. Children with mental disorders face major challenges with stigma, isolation, and discrimination, as well as lack of access to health care and education facilities, in violation of their fundamental human rights. COMMON DISORDERS: A. ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD) ADHD is characterized by difficulties that interfere with effective task-oriented behavior in children – particularly impulsivity, excessive or exaggerated motor activity. Their inability to focus and sustain attention can affect almost every area of their functioning – to academic progress and social adjustment. The behavior of ADHD children can vary in time. In school, children with ADHD are highly distractible and often fail to follow instructions or respond to demands placed on them (Wender, 2000). As a result of their behavioral problems, they are often lower in intelligence, usually about 7 to 15 IQ points below average (Barkley, 1997). Children with ADHD generally have many social problems because of their impulsivity and overactivity. They tend to talk incessantly and to be socially intrusive and immature. Hyperactivity children usually have great difficulty in getting along with their parents because they do not obey rules. Their behavior problems also result in their being viewed negatively by their peers (Hoza et.al., 2005).  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 The prevalence of this disorder occur most frequently observed among preadolescent boys and greatest frequency before 8 years old. ADHD is also found to be comorbid with other disorders such as oppositional defiant disorder (ODD). Causal Factors in Attention Deficit/Hyperactivity Disorder: The cause or causes of ADHD in children have much be debated. It still remains unclear to what extent the disorder results from environmental or biological factors (Carr et.al, 2006; Hinshaw et.al., 2007) and recent research points to both genetic (Sharp et.al., 2009). The psychological causes have also yielded inconclusive results, although temperament and learning appear likely to be factors to consider. Family pathology, particularly parental personality and parental alcohol exposure can influence the severity of problems in children with ADHD. Refer to DSM-5 for the diagnostic Criteria of ADHD. B. DISRUPTIVE, IMPULSE-CONTROL AND CONDUCT DISORDERS When children become disruptive in school, personal and peer-related activities, changes in family dynamics and routine follow (Hinshaw, 2008). Disruptive behaviors at home can spill over to other areas of functioning (academic, social, psychological) and requires much attention. This disorder has symptoms related to problematic self-control of emotions and behaviors, with exception of the antisocial personality disorder. The disruptive behavior disorders typically are diagnoses that contain distinguishing characteristics, such as lack of self- control, defiance and aggressive behaviors. Children and adolescents who suffer from this disorder are faced with situations that conflict with societal norms and lead to many troubles with authority figures. The disruptive, impulse-control and conduct disorders share three (3) of the five personality traits: disinhibition, excessive constraint and negative emotionality. Disinhibition: the child’s inability to defer immediate gratification. The child/adolescent want things immediately. The desire for immediate gratification is so strong that he/she does not consider anything beyond the immediate moment and is unable to examine the consequences of his/her actions. The child/adolescent, in the process, does not apply learning from the past experience or consider social sanctions or what is socially acceptable. The emphasis is on obtaining what is desired in the here and now. Excessive Constraint: sometimes called rigid perfectionism. In this perspective the child/adolescent exhibits rule-governed behaviors that is rigid beyond what would be expected in the situation.  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 The rigid perfectionism is severe enough that it impairs social functioning and cause the individual to actively avoid situations where s/he might lack self-control. If unable to regulate emotions, the individual may become frustrated with the lack of emotional management that can lead to uncontrolled aggressive behaviors. Negative Emotionality: these children/adolescents experience repeated high levels of negative emotions such as anxiety, depression, guilt, shame or worry. Normal daily events are often accompanied by feelings of intense worry. Attention and focus are set on negative effects, with an inability to move beyond repetitive obsessive thoughts. B.1] OPPOSITIIONAL DEFIANT DISORDER (ODD) is categorized under disruptive, impulse- control and conduct disorders. ODD is grouped in three subtypes: (1) angry/irritable mood, (2) argumentative/defiant behavior and (3) vindictiveness. The essential feature of this disorder is a recurrent pattern of negativistic, defiant, disobedient and hostile behaviors towards authority figures that persists for at least 6 months. The disorder usually begins by age 8, whereas full blown conduct disorders typically begins from middle childhood to adolescence. B.2] CONDUCT DISORDER (CD) is a diverse cluster of problem behaviors in which age- appropriate and expected rules of conduct is ignored. It involves persistent violations of the rights of others and violations of major social rules. Individuals with CD show delinquent behaviors that include being aggressive to others and even animals, bullying, destruction of property, deceitfulness or theft, school truancy or running away from home. Studies indicate that a predisposing condition to the development of conduct disorders include being raised in harsh environments involving trauma, abuse and neglect (Wang and Kenny, 2014). B.3] IMPULSE-CONTROL DISORDERS involves engaging in repetitive behaviors often those that are harmful, to which the individual feels are beyond their control. Before acting on their impulses, these individuals experience tension and anxiety that they can relieve only by following through their impulses. After acting on their impulses, they experience a sense of pleasure or gratification. However, later, they can regret that they have engaged in such behavior. Pyromania – deliberately setting fires. To be diagnosed with this condition, the person must not set fires for monetary reasons or have other medical or psychiatric conditions. Pyromania is different from arson. Prevalence to this condition are likely more in males but also appears to be rare. Kleptomania – driven by a persistent urge to steal. Unlike shoplifters or thieves, they do not actually like to have the object. They seek excitement from the act of stealing and yet they feel that their urge is unpleasant, unwanted, intrusive and senseless. The diagnosis for this is very tricky because there is an overlap with mood anxiety and other  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 impulse-control disorders, personality, and bipolar disorders. Hence, clinicians must be very thorough in their assessment. C. ANXIETY AND DEPRESSION IN CHILDREN AND ADOLESCENTS No one is totally insulated from negative experiences. Children and adolescents are not spared from anxiety-producing situations and the experience of trauma. Most children are vulnerable to fears and uncertainties as normal part of growing up and because of this, children are predisposed to develop mental health problems that includes anxiety and depression. C.1] SEPARATION ANXIETY DISORDER classified under the anxiety disorder, is the most common of the childhood anxiety disorders. Children with separation anxiety disorder exhibit unrealistic fears, oversensitivity, self-consciousness, nightmares and chronic anxiety. They lack self-confidence, are apprehensive in new situations and tend to be immature for their age. Parents described these children/adolescents as sensitive, easily moved to tears, submissive, nervous and shy. The essential feature is excessive anxiety about separation from major attachment figures. C.2] CHILDHOOD DEPRESSION AND BIPOLAR includes behavior such as withdrawal, crying, avoidance of eye contact, physical complaints, poor appetite, aggressive behavior and even some cases of suicide. In the past, the diagnostic criteria for this disorder has followed essentially the same criteria for diagnosis adults. However, biologically and developmentally, children and adults do not share the same path such as their neurological conditions and hormonal levels. Signs and symptoms of bipolar disorder may overlap with symptoms of other disorders that are common in young people, such as attention-deficit/hyperactivity disorder (ADHD), conduct problems, major depression, and anxiety disorders. Diagnosing bipolar disorder can be complicated and requires a careful and thorough evaluation by a trained, experienced mental health professional when dealing with this conditions in children and adolescents.  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 Disruptive Mood Dysregulation Disorder (or DMDD) (under Depressive Disorders) DMDD is a new addition to DSM-5 that aims to combine bipolar disorder that first appears in childhood with oppositional behaviors (Axelson, 2013). DMDD was added in DSM-5 to appropriately address the concern about classifying and treating children with chronic, persistent irritability who present classic bipolar disorder. It is characterized by severe and recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation. The key feature of DMDD is chronic irritability that is present in between episodes of anger or temper tantrums. A diagnosis requires symptoms to be present in at least two settings (at home, at school, or with peers) for 12 or more months, and symptoms must be severe in at least one of these settings. Onset of DMDD must occur before age 10, and a child must be at least 6 years old to receive a diagnosis of DMDD. Causal Factors in childhood depression: 1. Biological Factors. Studies show that there is a correlation between parental depression and behavioral and mood problems in children. Children of parents with major depression are more impaired and have more psychological diagnoses compared to children of parents with no psychological disorders (Kramer et.al. 1998).  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 2. Learning Factors. Children learning maladaptive behaviors also appear to influence developing childhood depression. Studies also noted that children’s exposure to early traumatic events can increase the risk of developing the disorder. Children who have experienced past painful, stressful events are susceptible to depressive states and make them vulnerable to suicide thinking under stress (Silberg et.al. 1999) D. ELIMINATION DISORDERS: D.1] ENURESIS refers to the habitual involuntary discharge of urine, a lack of bladder control past the age when such control is usual. The diagnostic criteria for this disorder has not be changed since DSM-IV. Primary enuresis – where children have never achieved bladder control; whenever they have to urinate, day or night, they wet themselves. Primary enuresis may last until middle childhood and occasionally it lasts into adolescence. The condition may stem from organic, possible genetic anomalies. Secondary enuresis – where children have lost the bladder control they once have, almost always as a result of stress. This is usually temporary. D.2] ENCOPRESIS describes a symptom of disorder of children who have not learned appropriate toileting for bowel movements after age 4. This is less common than enuresis. E. EATING DISORDERS Eating behavior in children ought to be interpreted as a crucial part of development, because children’s feelings about eating are bound up with their feelings about those who feed and sustain them – parents and others. Eating may symbolize being loved and cared for, or – if there is anxiety connected with mealtime – it may be a focus of conflicting feelings. Because eating is closely bound to the person’s emotional life, psychologists assume that eating disorders mirror emotional problem Eating problems were found to be common to adolescents. Teens who have this disorder experience persistent disturbances of eating or eating-related behaviors that result in changes in how they eat or retain their food. These go beyond dieting or occasional overeating, can significantly impair their physical and psychological functioning. E.1] ANOREXIA NERVOSA is a severe restrictions of food intake caused by fear of gaining weight. Its prevalence is more in young girls than boys and in most cases, the onset is between ages 12 to 18 years old. However, there are cases that can occur in prepuberty or even as last as thirty. The dramatic sign is weight loss. It is further accompanied by amenorrhea, peculiar patterns of handling food and a weight phobia. E.2] BULIMIA NERVOSA is an eating disorder involving alternation between the extremes of earing large amounts of food in a short time, and then compensating for the added  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 calories either vomiting or other extreme actions to avoid gaining weight. People with eating disorder engage in binge eating and purging. Etiology of Eating Disorders: Eating disorders reflect a complex set of interactions among an individual’s genetic vulnerability, experiences with eating, body image and exposure to sociocultural influences. Some researchers also took a biological perspective to the disorder and were particularly interested in the role of dopamine, which is involved in feelings of reward and pleasure including those related to eating. According to this view, binge eaters feel relief from depression and anxiety. References: American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Butcher, James N., Hooley, Jill M. and MINEKA, Susan (2014). Abnormal Psychology 16th Edition. Pearson Education, Inc. Dziegielewski, Sophia F. (2015). DSM-5TM in Action. John Wiley & Sons, Inc. Hong et.al. (2009). Cognitive Profile of Turner Syndrome. Dev. Disabil Res. Rev. doi: 10:1002/ddrr.79. https://www.ncbi.nlm.nih.gov Patel, Dilip R. et.al. (2018). Intellectual Disability: Definition, Evaluation and Principles of Treatment. Pediatric Medicine. http://dx.doi.org./10.21037/pm.2018.12.02 Whitbourne, Susan Krauss (2017). Abnormal Psychology: Clinical Perspectives on Psychological Disorders 8th Edition. McGraw-Hill Education. SLU Manual. Psychopathology (Psych 16)