Comer, Abnormal Psychology, 8th edition

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Disorders of Childhood and Adolescence

• Abnormal functioning can occur at any time in
  life
• Children of all cultures typically experience at
  least some emotional and behavioral problems as
  they encounter new people and situations
• Surveys indicate that worry is a common
  experience
• Bedwetting, nightmares, temper tantrums, and
  restlessness are other problems experienced by
  many children

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Childhood and Adolescence
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Childhood and Adolescence

• Adolescence can also be a difficult period
• Physical and sexual changes, social and academic
  pressures, personal doubts, and temptation cause
  many teenagers to feel anxious, confused, and
  depressed
• Bullying
• Over one-quarter of students report being bullied
  frequently, and more than 70 report having been
  a victim at least once

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All victims of bullying are upset by it, but some
individuals seem to be more traumatized by the
experience than others. Why might this be so?
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Childhood and Adolescence

• Some disorders of children childhood anxiety
  disorders and childhood depression have adult
  counterparts
• Other childhood disorders elimination
  disorders, for example usually disappear or
  radically change form by adulthood
• There also are disorders that begin in birth or
  childhood and persist in stable forms into adult
  life
• These include autism spectrum disorder spectrum
  disorder and intellectual developmental disorder

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Separation Anxiety Disorder

• displayed by 4 to 10 of all children
• Extreme anxiety, often panic, whenever they are
  separated from home or a parent

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Childhood Mood Problems Major Depressive Disorder

• Around 2 of children and 9 of adolescents
  currently experience major depressive disorder
  as many as 20 percent of adolescents experience
  at least one depressive episode

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Major Depressive Disorder

• Depression in the young may be triggered by
  negative life events (particularly losses), major
  changes, rejection, or ongoing abuse
• Childhood depression is characterized by such
  symptoms as headaches, stomach pain,
  irritability, and a disinterest in toys and games
• Clinical depression is much more common among
  teenagers than among young children
• Suicidal thoughts and attempts are common in
  teenagers

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Bipolar Disorder

• Often considered an adult mood disorder, whose
  earliest age of onset is the late teens
• Theorists suggest the diagnosis has become a
  clinical catchall that is being applied to
  almost every explosive, aggressive child
• The current shift in diagnoses has been
  accompanied by an increase in the number of
  children who receive adult medications
• The DSM-5 task force concluded that the childhood
  bipolar label has been overapplied over the past
  two decades. To help rectify this problem, DSM-5
  now includes a new category, disruptive mood
  dysregulation disorder (DMDD)

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Disruptive Mood Dysregulation Disorder (DMDD)
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Oppositional Defiant Disorder
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Conduct Disorder

• Children with conduct disorder, a more severe
  problem, repeatedly violate the basic rights of
  others
• Often aggressive and may be physically cruel to
  people and animals
• Many steal from, threaten, or harm their victims
• Begins between 7 and 15 years of age

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Conduct Disorder

• Relational aggression individuals are socially
  isolated and primarily display social misdeeds
• Slander
• Rumor-starting
• Friendship manipulation
• More common among girls than boys

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What Are the Causes of Conduct Disorder?
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How Do Clinicians Treat Conduct Disorder?

• Treatments for conduct disorder are generally
  most effective with children younger than 13
• Today's clinicians are increasingly combining
  several approaches into a wide-ranging treatment
  program
• Sociocultural treatments
• Child-focused treatments
• Prevention

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Sociocultural Treatments

• Family interventions
• Parent-child interaction therapy
• Parent management training
• Residential treatment
• Community-based
• School programs

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Child-Focused Treatments

• Focus primarily on the child with conduct
  disorder
• Cognitive-behavioral interventions
• Problem-solving skills training
• modeling, practice, role-playing, and systematic
  rewards
• Anger Coping and Coping Power Program

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Prevention

• Greatest hope for reducing the problem of conduct
  disorder lies in prevention programs that begin
  in early childhood
• These programs try to change unfavorable social
  conditions before a conduct disorder is able to
  develop
• All such approaches work best when they educate
  and involve the family

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Attention-Deficit/Hyperactivity Disorder

• Children who display attention-deficit/hyperactivi
  ty disorder (ADHD) have great difficulty
  attending to tasks, behave overactively and
  impulsively, or both
• The primary symptoms of ADHD may feed into one
  another, but in many cases one of the symptoms
  stands out more than the other

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Attention-Deficit/Hyperactivity Disorder
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Diagnostic Criteria for ADHD
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What Are the Causes of ADHD?

• Clinicians generally consider ADHD to have
  several interacting causes, including
• Biological causes, particularly abnormal dopamine
  activity, and abnormalities in the
  frontal-striatal regions of the brain
• High levels of stress
• Family dysfunctioning

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How Is ADHD Treated?

• About 80 of all children and adolescents with
  ADHD receive treatment
• There is, however, heated disagreement about the
  most effective treatment for ADHD
• The most commonly applied approaches are drug
  therapy, behavioral therapy, or a combination
• Millions of children and adults with ADHD are
  currently treated with methylphenidate (Ritalin),
  a stimulant drug that has been available for
  decades

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Drug Therapy
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Behavior Therapy and Combination Approaches

• Behavioral therapy has been applied in many cases
  of ADHD
• Parents and teachers learn how to apply operant
  conditioning techniques to change behavior
• These treatments have often been helpful,
  especially when combined with drug therapy

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Multicultural Factors and ADHD

• Studies indicate that African American and
  Hispanic American children with significant
  attention and activity problems are less likely
  than white American children to be assessed for
  ADHD, receive an ADHD diagnosis, or undergo
  treatment for the disorder
• Those who do receive a diagnosis are less likely
  than white children to be treated with the
  interventions that seem to be of most help,
  including the promising (but more expensive)
  long-acting stimulant drugs
• In part, racial differences in diagnosis and
  treatment are tied to economic factors

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Elimination Disorders

• Children with elimination disorders repeatedly
  urinate or pass feces in their clothes, in bed,
  or on the floor
• They have already reached an age at which they
  are expected to control these bodily functions
• These symptoms are not caused by physical illness

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Enuresis
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Encopresis
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Comparison of Childhood Disorders
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Long-Term Disorders That Begin in Childhood

• Two groups of disorders that emerge during
  childhood are likely to continue unchanged
  throughout a person's life
• Autism spectrum disorders
• Intellectual developmental disorder
• Autism spectrum disorders are a group of
  disorders marked by impaired social interactions,
  unusual communications, and inappropriate
  responses to stimuli in the environment

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Autism Spectrum Disorder

• Autism spectrum disorder, or autism spectrum
  disorder, was first identified in 1943
• Children with this disorder are extremely
  unresponsive to others, uncommunicative,
  repetitive, and rigid
• Symptoms appear early in life, before age 3
• Around 80 of all cases appear in boys

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Autism Spectrum Disorder

• As many as 90 of children the disorder remain
  significantly disabled into adulthood
• Even the highest-functioning adults with autism
  spectrum disorder typically have problems in
  social interactions and communication, and have
  restricted interests and activities
• Lack of responsiveness and social reciprocity
• Language and communication problems take various
  forms
• One common speech peculiarity is echolalia, the
  exact echoing of phrases spoken by others
• Another is pronominal reversal, or confusion of
  pronouns

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Autism Spectrum Disorder Asperger's Disorder
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What Are the Causes of Autism Spectrum Disorder?
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What Are the Causes of Autism Spectrum Disorder?
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How Do Clinicians and Educators Treat Autism
Spectrum Disorder?

• Treatment can help people with autism spectrum
  disorder adapt better to their environment,
  although no known treatment totally reverses the
  autistic pattern
• Treatments of particular help are
  cognitive-behavioral therapy, communication
  training, parent training, and community
  integration
• In addition, psychotropic drugs and certain
  vitamins have sometimes helped when combined with
  other approaches

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How Do Clinicians and Educators Treat Autism
Spectrum Disorder?
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How Do Clinicians and Educators Treat Autism
Spectrum Disorder?
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How Do Clinicians and Educators Treat Autism
Spectrum Disorder?
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How Do Clinicians and Educators Treat Autism
Spectrum Disorder?
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Intellectual Developmental Disorder

• According to the DSM-5, people should receive a
  diagnosis of intellectual developmental disorder
  when they display general intellectual
  functioning that is well below average, in
  combination with poor adaptive behavior
• IQ must be 70 or lower
• The person must have difficulty in such areas as
  communication, home living, self-direction, work,
  or safety
• Symptoms must appear before age 18

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Assessing Intelligence

• Educators and clinicians administer intelligence
  tests to measure intellectual functioning
• These tests consist of a variety of questions and
  tasks that rely on different aspects of
  intelligence
• Having difficulty in one or two of these subtests
  or areas of functioning does not necessarily
  reflect low intelligence
• An individual's overall test score, or
  intelligence quotient (IQ), is thought to
  indicate general intellectual ability

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Assessing Intelligence

• Many theorists have questioned whether IQ tests
  are indeed valid
• Intelligence tests also appear to be
  socioculturally biased
• If IQ tests do not always measure intelligence
  accurately and objectively, then the diagnosis of
  intellectual developmental disorder may also be
  biased
• That is, some people may receive the diagnosis
  partly because of test inadequacies, cultural
  differences, discomfort with the testing
  situation, or the bias of a tester

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Assessing Adaptive Functioning

• Diagnosticians cannot rely solely on a cutoff IQ
  score of 70 to determine whether a person suffers
  from intellectual developmental disorder
• Several scales, such as the Vineland and AAMR
  Adaptive Behavior Scales, have been developed to
  assess adaptive behavior
• For proper diagnosis, clinicians should observe
  the functioning of each individual in his or her
  everyday environment, taking both the person's
  background and the community standards into
  account

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What Are the Features of Intellectual
Developmental Disorder?

• The most consistent sign of intellectual
  developmental disorder is that the person learns
  very slowly
• Other areas of difficulty are attention,
  shortterm memory, planning, and language
• Those who are institutionalized with intellectual
  developmental disorder are particularly likely to
  have these limitations

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What Are the Features of Intellectual
Developmental Disorder?

• Traditionally four levels of intellectual
  development disorder have been distinguished

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Mild IDD

• Approximately 80 to 85 of all people with
  intellectual developmental disorder fall into the
  category of mild IDD (IQ 5070)
• Interestingly, intellectual performance seems to
  improve with age
• Research has linked mild intellectual
  developmental disorder mainly to sociocultural
  and psychological causes, particularly
• Poor and unstimulating environments
• Inadequate parent-child interactions
• Insufficient early learning experiences

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Moderate, Severe, and Profound IDD

• Approximately 10 of persons with intellectual
  developmental disorder function at a level of
  moderate IDD (IQ 3549)
• They can care for themselves, benefit from
  vocational training, and can work in unskilled or
  semiskilled jobs
• Approximately 3 to 4 of persons with
  intellectual developmental disorder display
  severe IDD (IQ 2034)
• They usually require careful supervision and can
  perform only basic work tasks
• They are rarely able to live independently

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Moderate, Severe, and Profound IDD

• About 1 to 2 of persons with intellectual
  developmental disorder fall into the category of
  profound IDD (IQ below 20)
• With training they may learn or improve basic
  skills but they need a very structured
  environment
• Severe and profound levels of intellectual
  developmental disorder often appear as part of
  larger syndromes that include severe physical
  handicaps

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What Are the Causes of Intellectual Developmental
Disorder?

• The primary causes of moderate, severe, and
  profound IDD are biological, although people who
  function at these levels are also greatly
  affected by their family and social environment
• Sometimes genetic factors are at the root of
  these biological problems
• Other biological causes come from unfavorable
  conditions that occur before, during, or after
  birth

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What Are the Causes of Intellectual Developmental
Disorder?
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What Are the Causes of Intellectual Developmental
Disorder?
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What Are the Causes of Intellectual Developmental
Disorder?
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What Are the Causes of Intellectual Developmental
Disorder?
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Interventions for People with Intellectual
Developmental Disorder

• The quality of life attained by people with
  intellectual developmental disorder depends
  largely on sociocultural factors
• Intervention programs try to provide comfortable
  and stimulating residences, social and economic
  opportunities, and a proper education

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What is the Proper Residence?

• Until recently, parents of children with
  intellectual developmental disorder would send
  them to live in public institutions state
  schools as early as possible
• During the 1960s and 1970s, the public became
  more aware of these conditions and, as part of
  the broader deinstitutionalization movement,
  demanded that many people be released from these
  schools

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What is the Proper Residence?

• Since deinstitutionalization, reforms have led to
  the creation of small institutions and other
  community residences that teach self-sufficiency,
  devote more time to patient care, and offer
  education and medical services

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Which Educational Programs Work Best?

• Because early intervention seems to offer such
  great promise, educational programs for
  individuals with intellectual developmental
  disorder may begin during the earliest years
• At issue are special education versus mainstream
  classrooms
• In special education, children with intellectual
  developmental disorder are grouped together in a
  separate, specially designed educational program
• Mainstreaming places them in regular classes
• Neither approach seems consistently superior
• Teacher preparedness is a factor that plays into
  decisions about mainstreaming

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When Is Therapy Needed?

• People with intellectual developmental disorder
  sometimes experience emotional and behavioral
  problems
• Around 30 or more have a diagnosable
  psychological disorder other than intellectual
  developmental disorder
• Some suffer from low self-esteem, interpersonal
  problems, and adjustment difficulties
• These problems are helped to some degree by
  individual or group therapy
• Psychotropic medication is sometimes prescribed

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How Can Opportunities For Personal, Social, And
Occupational Growth Be Increased?

• People need to feel effective and competent to
  move forward in life
• Those with intellectual developmental disorder
  are most likely to achieve these feelings if
  their communities allow them to grow and make
  many of their own choices

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How Can Opportunities For Personal, Social, And
Occupational Growth Be Increased?

• Socializing, sex, and marriage are difficult
  issues for people with intellectual developmental
  disorder and their families
• With proper training and practice, individuals
  with intellectual developmental disorder can
  learn to use contraceptives and carry out
  responsible family planning
• The National Association for Retarded Citizens
  offers guidance in these matters
• Some clinicians have developed dating skills
  programs

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How Can Opportunities For Personal, Social, And
Occupational Growth Be Increased?

• Adults with intellectual developmental disorder
  need the financial security and personal
  satisfaction that comes from holding a job
• Many can work in sheltered workshops, but there
  are too few training programs available
• Additional programs are needed so that more
  people with intellectual developmental disorder
  may achieve their full potential, as workers and
  as human beings