Childhood Disorders

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Childhood Disorders
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ADHD

• inattention, hyperactivity, impulsivity
• behavior is driven, disorganized
• 20-25 ADHD have LDs
• 45-60 of ADHD develop conduct D/O, drug abuse,
  or become juvenile delinquents

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ADHD

• boys 3x over girls
• found in most cultures/ethnic groups
• 2/3rds have symptoms persist into teens
• at risk for antisocial PD/O, substance abuse,
  legal problems, poor marriages, and accidents

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Is ADHD fact or fiction?

• In favor
• Opposed

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Biology of ADHD

• use to be called minimal brain damage
• modern view looks at neurological immaturity
• runs in families (as does antisocial, alcoholism,
  depression)
• prenatal birth complications, ETOH use by
  mother, exposure to lead

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ADHD Treatment

• Ritalin
• Dexedrine
• drug effects are for underarousal
• behavioral treatment
• combo therapy most long lasting

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Conduct Disorder

• bullies, threatens others
• physical fights, uses weapons
• commits crimes
• forcefully sexual
• lies
• violates curfews, truant, vandal, starts fires

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Conduct Disorder - cont

• as teens, 50 involved in crime drugs
• as adults, 75-85
• chronic unemployed
• relationship problems
• impulsive physical aggression/spouse abuse
• 35-40 diagnosed as antisocial pers. D/O

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Oppositional Defiant D/O

• argues with adults
• refuses to comply
• tries to annoy others
• loses temper
• blames others for his mistake
• angry, resentful, vindictive

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Development

• oppositional starts often in toddler preschool,
  declining by late childhood or early teens
• subgroup which is aggressive go on to develop
  conduct disorder
• almost all elementary conduct D/O had
  oppositional symptoms earlier

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Gender

• boys 3x gt girls
• girls aggression less physical than indirect
  verbal (alienation, ostracism, defamation of
  character, damage social status)

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Biology of Conduct/Oppositional

• parents often have antisocial personalities
• adopted sons criminal records more like
  biological fathers
• exposure to maternal drug use, poor prenatal
  nutrition, exposure to toxins, child abuse, birth
  complications and low birth weight

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Sociocultural Aspects to Conduct Oppositional
D/Os

• irritable , impulsive, awkward, overreactive,
  inattentive, slow learning children
• parents tend to maltreat neglect
• parents often teenagers themselves

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Treatment of Conduct D/O

• self-talk decreases impulsive/angry beh.
• behavioral techniques
• racial differences w/ African-Americans sent to
  jail, European-American to psychiatric
  hospitals/afforded treatment

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Separation Anxiety

• extremely distressed when separated from
  home/caregivers
• worries about losing caretakers
• reluctance/fear of going to school
• fearful about being alone

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Separation Anxiety - cont

• afraid to go to sleep without caretakers
• nightmares w/themes of separation
• physical complaints when separation from
  caretakers occurs or is anticipated.

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Separation Biology

• some toddlers shy, fearful, irritable
• cautious, quiet, and introverted as school-age
  children
• panic disorders more likely to develop
• panic disordered parents 3x likely to have
  separation anxiety in children
• twin studies inheritance for girl, not boys

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Autism

• a pervasive developmental disorder
• problems in social interactions
• problems in communication (including language
  deficits)
• problems in activities and interests
• onset before age 3 years
• boys gt girls (31)
• best prognosis is IQ of 50 speech by age 6 yrs

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Autistic Social Interactions

• as infants may not smile or coo with caregivers
• wont start play
• doesnt cuddle, even when afraid
• little to no eye-contact
• like solitary play

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Autistic Communications

• 50 dont have useful speech
• may show echolalia
• problems with modulating voice intonations and
  inflections

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Autistic Activities/Interests

• preoccupied with one object or part-object
• routines and rituals very important
• may fly into rage when routine changed
• self-stimulating use of stereotyped and
  repetitive behaviors

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Biological Factors

• concordance rates for MZ twins 60-80
• DZ, 0-10
• more genetic disorders (Fragile X, PKU) in
  autistic people
• 30 develop seizure disorders by teens

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Drug Treatment of Autism

• SSRIs reduce repetitive behaviors aggression
• antipsychotic agents
• Naltrexone reduces hyperactivity in some
• stimulants

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Psychosocial Treatment

• modeling reinforcement
• structured programs/schools
• deficits in cognitive, motor, and/or social
  skills
• reduction of distractions

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Psychosocial Treatment Results

• Lovass, 1987 - after 40 hrs/wk X 2 years in
  school with parents, 47 achieved intellectual
  and educational functioning vs 2 in
  institutional care