Child Psychopathology
Study of how disorders arise and change with time
Childhood is associated with significant developmental changes
Disruptions of early skills will likely disrupt development of later skills
Prevalence
1 in 5 children/adolescents has a moderate to severe psychological disorder
Problems are most likely to emerge around the age of school entry (6-7)
Mental disorders are more common among boys until adolescence
Normal vs. Abnormal
Developmentally appropriate behavior is not diagnosed
This requires a mastery of developmental psychology
Consequences of Childhood Problems
Some problems continue into adolescence and adulthood
Others interfere with the process of development, leading to other problems later in life
Childhood problems may increase emotional reactivity
Trauma- and Stressor-Related Disorders
Reactive Attachment Disorder
Disinhibited Social Engagement Disorder
PTSD for Children
Anxiety Disorders
Separation Anxiety Disorder
Selective Mutism
Depressive Disorders
Disruptive Mood Dysregulation Disorder
Feeding and Eating Disorders
Pica
Rumination Disorder
Avoidant/Restrictive Food Intake Disorder
Elimination Disorders
Enuresis
Encopresis
Disruptive, Impulse-Control, & Conduct Disorders
Oppositional Defiant Disorder
Conduct Disorder
Oppositional Defiant Disorder (ODD)
Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting
6+ months
- Angry, resentful, easily annoyed
- Argues with adults, deliberately annoys others
- Active defiance, externalizes blame
� Relatively common (3.3%)
� Usu
Conduct Disorder (CD)
Pattern of violating others' rights or age-appropriate norms
- Aggression to people and animals
- Property destruction
- Deceitfulness or theft
- Serious rule violation
� More severe than ODD
� Prevalence varies from 2-10% (median = 4%), but CD is one of
Causes of ODD & CD
Genetic factors
Parenting
Lack of social and academic skills
- Comorbid ADHD or learning disorders are extremely common
Assessing CD
Barry et al. (2012) recommended:
- Structured interview (Diagnostic Interview Schedule for Children)
- Broad-band behavior rating scales (BASC-2, ASEBA)
- Behavioral observations
- Performance-based measures
- Narrow-band measure of CU traits
Neurodevelopmental Disorders
� Typically manifest early in life (usually before school entry)
� Characterized by developmental deficits, ranging from narrow to global
� High co-occurence
Disorders:
� Intellectual Disabilities
� Communication Disorders
� Autism Spectrum Disorder
� Att
Autism Spectrum
� Persistent deficits in communication and social interaction across multiple contexts
� Restricted, repetitive patterns of behavior, interests, or activities
� Evident early in life and impair daily functioning
� The impairments in communication and soci
Attention-Deficit/Hyperactivity Disorder (ADHD)
� Persistent pattern of inattention and/or hyperactivity-impulsivity
� Several symptoms present by age 12
� Several symptoms present in 2+ settings
� Clear evidence that symptoms interfere with functioning
� Note that the number of symptoms required is di
ADHD: Central Features
� Inattention
� Impulsivity
� Hyperactivity
ADHD: Facts
� Prevalence estimated as 3-7% among school-age children (DSM-5 says 5%)
� DSM-5 lists adult prevalence as 2.5%
� More common among boys (2:1)
ADHD: Associated Problems
� Academic performance
- 56% require tutoring; 30% will repeat a grade
� Learning disorders
- 20% of ADHD children will have an LD
� ODD and CD
- 23-50% of ADHD adolescents will have Conduct Disorder
� Poor social adjustment
ADHD: Psychological Factors
� Constant negative feedback from teachers, parents, and peers
� Peer rejection and resulting social isolation
� Such factors foster low self-image
Neurobiology of ADHD
� Reduced activity of the frontal cortex and basal ganglia
� Right hemisphere malfunction
� Abnormal frontal lobe development and functioning
Other Biological Factors of ADHD
� Allergens and food additives do not cause ADHD.
� Maternal smoking may increase the risk of having a child with ADHD.
� Increasing evidence to support role of genetic factors
Barkley's Theory of ADHD
� ADHD represents "a developmental delay in response inhibition processes."
� Impulsiveness (i.e., behavioral disinhibition) is the core of ADHD.
� Deficits in behavioral inhibition impact the executive functions, making this far more than a problem with
Assessing ADHD in Children Under 12
� Parental interview
� School visit/classroom observation
� Home visit/behavioral observation
� Child interview/interaction
� Further testing if needed
Multi-Informant Assessment
� Parent and child interviews
� Behavioral observations
� Achenbach System of Empirically Based Assessment (ASEBA)
- Child Behavior Checklist (6-18)
- Teacher's Report Form (6-18)
- Youth Self-Report (11-18)
ADHD: Medication
� Stimulant medications reduce core symptoms in 70% of cases
- Medication improves compliance and decreases negative behaviors in many children
- Beneficial effects do not last following drug discontinuation
- Side effects: insomnia, drowsiness, irritabil
The ADHD Controversy
� Overdiagnosis?
- Are we diagnosing normal children for behaving like normal children?
� Implications of medication?
- Are we just using medication to control our children?
- Little is known about long-term effects of stimulant medication
Adult ADHD
� 50% of ADHD children will experience symptoms in adulthood
� Adults with ADHD complete less education and are increasingly vulnerable to most mental
disorders.
Child vs. Adult ADHD
� ADHD manifests differently throughout the lifespan.
� The most visible childhood feature (hyperactivity) diminishes with age.
� Cognitive impulsiveness persists; behavioral impulsiveness is less evident.
� Low frustration tolerance persists, but behavio
Critical Requirements of Adult ADHD
1. Credible evidence must exist that diagnostic criteria were met in childhood, at least by the middle school years.
2. Clear evidence must exist that ADHD symptoms currently cause impairment in multiple settings.
3. There are no other explanations that b
Assessing Adult ADHD
� There is no one agreed upon protocol.
� Our Clinic protocol begins with a standard initial assessment interview and then involves many specialized components.
- Structured interview, PAI, school records, self-report and other report data
1. Childhood Diagnosis
� Established retrospectively through:
- Client report
- Corroborating data from parents
- School records
2. Current Symptoms
� Established through:
- Client self report and behavioral observations
- Corroborating data from family/significant others
3. Rule Out Other Explanations
� Established through:
- Structured interview
- Psychological testing (PAI)
Diagnostic Challenges
� The core symptoms are common.
� ADHD exists on a continuum.
� The diagnosis of adults relies heavily on retrospective data.
� Many other disorders are often comorbid.
� The diagnosis is popular, and the criteria are well known
.
� ADHD may be viewed as