Abnormal psychology chapter 16

Fragile X syndrome

1 of every 6,000 births; fragile X chromosome Mild to moderate intellectual dysfunction, language impairment, sometimes behavior problems

Down Syndrome

1 of every 700 live births with rate increasing when mother's age is 35+ Distinct facial characteristics; range of personality characteristics; IQ Causes: trisomy 21

Depressive and Bipolar Disorders During Childhood

2 percent of children and 8 percent of adolescents currently experience major depressive disorder. As many as 20 percent of adolescents experience at least one depressive episode. Some clinicians suggest children can experience bipolar disorder.

Bullying

20 percent of students report being bullied frequently; more than 50 percent report having been a victim at least once. All victims of bullying are upset by it, but some individuals seem to be more traumatized by the experience than are others. Why might this be so?

Child Abuse

5 to 16 percent of children in the U.S. are physically abused each year; abusers are usually the child's parents. Victims of child abuse may suffer both immediate and long-term psychological effects. Short-term effects: Anxiety, depression, bed-wetting Long-term effects: Lack of social acceptance, alcohol and substance abuse, impulsivity As many as one-third of abused grow up to be abusive, neglectful, or inadequate parents. The psychological needs of children who have been abused should be addressed as early as possible. Psychological abuse may include severe rejection, excessive discipline, scapegoating and ridicule, isolation, and refusal to provide help for a child with psychological problems.

Conduct disorder

A more severe problem, in which children repeatedly violate others' basic rights. 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 Overt-destructive pattern Overt-nondestructive pattern Covert-destructive pattern Covert-nondestructive pattern As many as 10 percent of children, three-fourths of them boys, qualify for this diagnosis. Children with a mild conduct disorder may improve over time, but severe cases frequently continue into adulthood and develop into antisocial personality disorder or other psychological problems. Overt-destructive pattern: Individuals display openly aggressive and confrontational behaviors Overt-nondestructive pattern: Dominated by openly offensive but nonconfrontational behaviors such as lying Covert-destructive pattern: Characterized by secretive destructive behaviors Covert-nondestructive pattern: Individuals secretly commit nondestructive behaviors

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. Bed-wetting, nightmares, temper tantrums, and restlessness

treatment for ADHD

About 80 percent of all children and adolescents with ADHD receive treatment. Most commonly applied approaches are drug therapy, behavioral therapy, or a combination of the two.

Intellectual disability (replaces mental retardation)

According to DSM-5, people should receive a diagnosis of intellectual disability when they display general intellectual functioning that is well below average, in combination with poor adaptive behavior. IQ score of 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.

Multicultural factors and ADHD

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. In part, racial and ethnic differences in diagnosis and treatment are tied to economic factors; social bias and stereotyping; parent and teacher perceptions of ADHD. 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

Childhood problems in intellectual disabilities

After birth, particularly up to age 6, certain injuries and accidents can affect intellectual functioning. Poisoning, lead poisoning Serious head injury Excessive exposure to X rays Excessive use of certain chemicals, minerals, and/or drugs (e.g., lead paint) Certain infections, such as meningitis and encephalitis, can lead to intellectual disability if they are not diagnosed and treated in time.

Profound ID (IQ under 20)

Approximately 1 to 2 percent of persons with intellectual disability; with training they may learn or improve basic skills, but they need a very structured environment. Severe and profound levels of intellectual disability often appear as part of larger syndromes that include severe physical handicaps.

Moderate ID (IQ 35 to 49)

Approximately 10 percent of persons with intellectual disability; can care for themselves, benefit from vocational training, and can work in unskilled or semiskilled jobs

Severe ID (IQ 20 to 35)

Approximately 3 to 4 percent of persons with intellectual disability display; usually require careful supervision and can perform only basic work tasks; rarely able to live independently

Mild ID (IQ 50 to 75)

Approximately 80 to 85 percent of all people with intellectual disability; intellectual performance seems to benefit from schooling; need assistance under stress Sociocultural and psychological causes: Poor and unstimulating environments Inadequate parent-child interactions Insufficient early learning experiences Biological factors Mother's moderate drinking, drug use, or malnutrition during pregnancy

Some disorders begin in birth or childhood and persist in stable forms into adult life

Autism spectrum disorder Intellectual disability

Autism spectrum disorder

Autism spectrum disorder, or autism, was first identified in 1943. Children with this disorder may be extremely unresponsive to others, uncommunicative, repetitive, and rigid. Symptoms appear early in life, before age 3. At least 1 in 60 children display pattern; around 80 percent occur in boys. As many as 90 percent of children with 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 that take various forms Echolalia; delayed echolalia; pronominal reversal; nonverbal behaviors Highly rigid and repetitive behaviors, interests, activities extending beyond speech patterns marked by limited imaginative play and very repetitive and rigid behavior—called perseveration of sameness. Many individuals become strongly attached to particular objects—plastic lids, rubber bands, buttons, water—and may collect, carry, or play with them constantly. The motor movements of people with autism spectrum disorder may be unusual. Often called "self-stimulatory" behaviors; may include jumping, arm flapping, and making faces May include self-injurious behaviors Children may at times seem overstimulated and/or understimulated by their environments.

Clinicians generally consider ADHD to have several interacting causes

Biological causes, particularly abnormal dopamine activity, and abnormalities in the frontal-striatal regions of the brain Balance of Type 1 and Type 2 attention processes Attention circuit; faulty interconnectivity High levels of stress Family dysfunctioning Sociocultural theorists also point out that ADHD symptoms and a diagnosis of ADHD may themselves create interpersonal problems and produce additional symptoms in the child.

disruptive mood dysregulation disorder (DMDD)

Bipolar disorder is often considered an adult mood disorder, whose earliest age of onset is the late teens. Theorists suggest the bipolar disorder diagnosis has become a clinical "catch-all" 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. 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 includes a new category Most theorists believe that the growing numbers of children diagnosed with bipolar disorder reflect not an increase in prevalence, but a new diagnostic trend. Few of the drugs prescribed for bipolar adults have been tested on and approved specifically for use in children.

Metabolic causes of intellectual disorder

Body's breakdown or production of chemicals is disturbed; affect intelligence and development; typically caused by the pairing of two defective recessive genes, one from each parent Phenylketonuria (PKU) is most common; screening and special diet before 3 months 1 of every 14,000 children

causes for Encopresis

Cases may stem from stress, constipation, improper toilet training, or a combination of all three. The most common treatments are behavioral and medical approaches, or combinations of the two. Family therapy has also been helpful.

Covert-destructive pattern

Characterized by secretive destructive behaviors

At least 25 percent of all children and adolescents experience an anxiety disorder

Childhood versus adult anxiety disorders

Attention-deficit/hyperactivity disorder

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

Elimination Disorders

Children with these 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.

Oppositional defiant disorder

Children with this disorder are repeatedly argumentative and defiant, angry and irritable, and, in some cases, vindictive. Characterized by repeated arguments with adults, loss of temper, anger, and resentment Children ignore adult requests and rules, try to annoy people, and blame others for their mistakes and problems.

Child-focused treatment

Cognitive-behavioral interventions; problem-solving skill training; Coping Power Program; drug therapy (stimulant drugs)

How do clinicians and educators treat autism spectrum disorder?

Cognitive-behavioral therapy Communication training Parent training Community integration No known treatment totally reverses the autistic pattern. Behavioral approaches have been used to teach new, appropriate behaviors—including speech, social skills, classroom skills, and self-help skills—while reducing negative behaviors Most often, therapists use modeling and operant conditioning. Therapies are ideally applied when they are started early in the children's lives. Given the recent increases in the prevalence of the disorder, many school districts are trying to provide education and training for autistic children in special classes. Most school districts remain ill equipped to meet the profound needs of these students. Communication training Even when given intensive behavioral treatment, half of all people with autism spectrum disorder remain speechless. They may be taught other forms of communication, including sign language and simultaneous communication. Some may use augmentative communication systems, such as "communication boards" or computers that use pictures, symbols, or written words, to represent objects or needs. Such programs use child-initiated interactions to help improve communication skills. Parent behavioral programs to train parents to apply behavioral techniques at home; individual therapy and support groups; parent associations and lobbies Many school-based and home-based programs for autism spectrum disorder teach self-help and self-management, as well as living, social, and work skills. Greater numbers of group homes and sheltered workshops are available for teens and young adults with autism spectrum disorder. These programs help individuals become a part of their community and reduce the concerns of aging parents.

treatment for major depressive disorder

Cognitive-behavioral therapy, interpersonal psychotherapy, antidepressant drugs (black box controversy)

Some level of anxiety is a normal part of childhood

Common events Parental problems or inadequacies Genetic influences such as anxious temperament

Effects of bullying

Depression Suicidal thinking and attempts Anxiety Low self-esteem Sleep problems Somatic symptoms Substance use and abuse School problems and/or phobias Antisocial behavior

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 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. While there is no difference between rates of depression in boys and girls before age 13, girls are twice as likely as boys to be depressed by age 16.

Treatments for Childhood Anxiety Disorders

Despite the high prevalence of childhood and adolescent anxiety disorders, two-thirds of anxious children go untreated. Psychodynamic, cognitive-behavioral, family, and group therapies, separately or in combination, have been used most often (i.e., psychotropic drug therapy in combination with psychotherapy). Play therapy: Children play with toys, draw, and make up stories; in doing so, they are thought to reveal the conflicts in their lives and their related feelings.

Assessing adaptive functioning

Diagnosticians cannot rely solely on a cutoff IQ score of 70 to determine whether a person has an intellectual disability. Several scales developed to assess adaptive behavior.

Bullies tend to

Display antisocial behaviors Perform poorly in school Drop out of school Bring weapons to school Drink alcohol Smoke cigarettes Use drugs

Separation anxiety disorder

Displayed by at least 4 percent of all children Extreme anxiety, often panic, whenever they are separated from home or a parent; school refusal

Overt-nondestructive pattern

Dominated by openly offensive but nonconfrontational behaviors such as lying

Chromosomal causes intellectual disability:

Down syndrome Fragile X syndrome The primary causes of moderate, severe, and profound ID are biological, although people who function at these levels are also greatly affected by their family and social environment.

Assessing intelligence

Educators and clinicians administer intelligence tests to measure intellectual functioning. An individual's overall test score, or intelligence quotient (IQ), is thought to indicate general intellectual ability. Many theorists question validity of IQ tests. Sociocultural bias; accuracy and objectivity; test inadequacies; cultural differences; testing situation discomfort; tester bias Intelligence 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. Many theorists have questioned whether IQ tests are valid. IQ tests also appear to be socioculturally biased. If IQ tests do not always measure intelligence accurately and objectively, then the diagnosis of intellectual disability may be biased. Some people may receive a diagnosis partly because of test inadequacies, cultural differences, discomfort with the testing situation, or the tester's bias.

child abuse forms

Emotional abuse Sexual abuse Surveys suggest that, worldwide, 20 percent of women and as many as 9 percent of men were forced into sexual contact with an adult during childhood, many of them with a parent or stepparent.

Checklist: Disruptive Mood Dysregulation Disorder

For at least a year, individual repeatedly displays severe outbursts of temper that are extremely out of proportion to triggering situations and different from ones displayed by most other individuals of his or her age Outbursts occur at least three times per week and are present in at least two settings (home, school, with peers) Individual repeatedly displays irritable or angry mood between the outbursts Individual receives initial diagnosis between 6 and 18 years of age

Which educational programs work best for people with intellectual disabilities?

Free, appropriate educational program mandated by federal law; IEP Early intervention; dependent of level of functioning Special education versus mainstream (inclusion) classrooms Teacher preparedness At issue are special education versus mainstream classrooms. In special education, children with intellectual disability 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.

Many conduct disorder links

Genetic and biological factors, drug abuse, poverty, traumatic events, and exposure to violent peers or community violence

Developmental psychopathological explanation

Genetic variability (e.g., MAOA gene)

checklist for selective mutism

Individual persistently does not speak in certain social situations in which speech is expected, although speaking in other situations presents no problem. Academic or social interference Individual's symptoms last 1 month or more, and are not limited to the first 4 weeks of a new school year. Symptoms not due to autism spectrum disorder, thought disorder, or language or communication disorder

Relational aggression

Individuals are socially isolated and primarily display social misdeeds; more common among girls than boys Slander Rumor-starting Friendship manipulation

Overt-destructive pattern

Individuals display openly aggressive and confrontational behaviors

Covert-nondestructive pattern

Individuals secretly commit nondestructive behaviors

About half the children with ADHD also have

Learning or communication problems Poor school performance Difficulty interacting with other children Misbehavior, often serious Mood or anxiety problems Approximately 7 to 10 percent of schoolchildren display ADHD, as many as 70 percent of them boys. Those whose parents have had ADHD are more likely than others to develop it. The disorder usually persists through childhood, but many children show a lessening of symptoms as they move into mid-adolescence. As many as 60 percent continue to have ADHD as adults. ADHD is a difficult disorder to assess. Ideally, the child's behavior should be observed in several environmental settings, because symptoms must be present across multiple settings to meet the DSM-5 criteria. It is important to obtain reports of the child's symptoms from parents and teachers. Clinicians also commonly employ diagnostic interviews, rating scales, and psychological tests.

Prenatal and birth-related causes of intellectual disorder

Major physical problems in the pregnant mother can threaten her fetus's healthy development. Low iodine may lead to cretinism (severe congenital hypothyroidism); rarer today. Alcohol use may lead to fetal alcohol syndrome (FAS). Certain maternal infections during pregnancy (e.g., rubella, syphilis) may cause childhood problems including intellectual disability. Birth complications, such as a prolonged period without oxygen (anoxia), can lead to intellectual disability.

Drug therapy for ADHD

Millions of children and adults with ADHD are currently treated with methylphenidate (Ritalin); Adderall being increasingly prescribed. Long-term effects including applicability to children of minority groups Inaccurate diagnosis Misuse

What are the features of intellectual disability?

Most consistent sign of intellectual disability is that the person learns very slowly. Other areas of difficulty are attention, shortterm memory, planning, and language. Those who are institutionalized with intellectual disability are particularly likely to have these limitations. Traditionally four levels of intellectual development disorder have been distinguished: Mild (IQ 50-70) Moderate (IQ 35-49) Severe (IQ 20-34) Profound (IQ below 20)

kids and school stress

Not always, according to a large survey of parents and their children aged 8 to 17. For example, although 44 percent of the child respondents report that they worry about school, only 34 percent of the parent respondents believe that their children are worried about school.

Cognitive-behavioral therapy and treatment combinations for ADHD

Operant conditioning (e.g., token economy) Therapeutic summer camps Parent management training Most improvement from treatment combinations These outdoor campers learn to work together, plan, and delay gratification while participating in a group task—all part of a summer program for children with ADHD and learning disabilities. Such programs typically apply cognitive-behavioral principles, exercise, and fitness training to help campers develop better attention, coping, teamwork, and social skills.

Parent management training

Parent-child interaction therapy (PCIT); video modeling; Internet-delivered parent-child interaction therapy (iPCIT); family therapy; multisystemic therapy

When is therapy needed for people with intellectual disabilities?

People with intellectual disability sometimes experience emotional and behavioral problems Individual or group therapy Psychotropic medication 30 percent or more have a diagnosable psychological disorder other than intellectual disability. Some suffer from low self-esteem, interpersonal problems, and adjustment difficulties.

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.

2020 COVID-19 pandemic

Pressures and stresses of childhood and adolescence increased with emergence of COVID-19 pandemic and society's efforts to contain the virus. Surveys conducted during the pandemic found increases in the number of children who generally felt edgy (54 percent), annoyed (47 percent), worried (47 percent), sad (44 percent), and apathetic (54 percent), as well as increases in the intensity of such negative feelings.

Intellectual disability

Previously called mental IDD.

causes for Enuresis

Psychodynamic theorists explain it as a symptom of broader anxiety and underlying conflicts. Family theorists point to disturbed family interactions. Behaviorists often view it as the result of improper, unrealistic, or coercive toilet training. Biological theorists suspect that the physical structure of the urinary system develops more slowly in some children.

Enuresis

Repeated involuntary (or in some cases intentional) bed-wetting or wetting of one's clothes Typically occurs at night during sleep, but may also occur during the day May be triggered by a stressful event Children must be at least 5 years of age to receive this diagnosis. Most cases of enuresis correct themselves without treatment. Prevalence of the disorder decreases with age. Individuals with enuresis typically have a close relative who has had or will have the same disorder.

Cyberbullying and Legislation

Rise in anti-bullying legislation across the U.S. Anti-bullying laws have grown from one state in 1999 (Georgia) to all 50 states today.

Consequences of conduct disorder

School suspension; foster home placement; incarceration Juvenile delinquency label Gender differences

What are the causes of autism spectrum disorder?

Sociocultural causes: Family dysfunction; parent personality characteristics (refrigerator parents) Research does not support this theory Psychological causes: Central perceptual or cognitive disturbance Theory of mind disorder (mentalization); mind-blindness Biological causes: Genetic factors; prenatal difficulties or birth complications Abnormal cerebellum structure; brain circuit dysfunction MMR vaccine theory (not proven)

Encopresis

Soiling; defecation into clothing Less common than enuresis and less well researched Usually involuntary Seldom occurs during sleep Starts after the age of 4 More common in boys than in girls Encopresis causes intense social problems, shame, and embarrassment

Cyberbullying

Takes place through e-mail, text messaging, websites and apps, instant messaging, chat rooms, or posted videos or photos Girls are at least 50 percent more likely than boys to be cyberbullied on a regular basis.

Interventions for People with Intellectual Disability

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

Variety of therapies for child abuse

Therapeutic and educational groups Prevention programs Early detection programs Early detection programs that (1) educate all children about child abuse, (2) teach them skills for avoiding or escaping from abusive situations, (3) encourage children to tell another adult if they are abused, and (4) assure them that abuse is never their fault.

Prevention

Training opportunities; recreational facilities; health care

Residential treatment

Treatment foster care; juvenile training centers

How do clinicians treat conduct disorder?

Treatments are generally most effective with children younger than age 13. Today's clinicians are increasingly combining several approaches into a wide-ranging treatment program. iPCIT (Internet-delivered parent-child interaction therapy)

Case ties

Troubled parent-child relationships, inadequate parenting, family conflict, marital conflict, family hostility, family skills

What is the proper residence for people with intellectual disabilities?

Until recently, public institutions (e.g., state schools) used as early as possible. During the 1960s and 1970s, deinstitutionalization movement encouraged release of many people. Today, majority of children with intellectual disability live at home or community residence matched to disability, preference, and available resources. Small institutions and community residences teach self-sufficiency and follow normalization principles.

Promoting personal, social, and occupational growth

Youth clubs, Special Olympics Dating skills programs Sheltered workshops Complete range of educational and occupational training services People with intellectual disability have normal interpersonal and sexual needs—needs for which they may receive training and supervision in various programs. Here a couple with Down syndrome twirl each other on the dance floor during the Night to Shine—a dance party in Portland, Maine, for people with special needs.

Neurodevelopmental disorders

a group of disabilities in the functioning of the brain that emerge at birth or during very early childhood and affect the individual's behavior, memory, concentration, and/or ability to learn

What are the causes of conduct disorder?

case ties and developmental psychopathological explanation

Selective mutism

children consistently fail to speak in certain social situations but show no difficulty at all speaking in others. Disorder often begins as early as the preschool years May be misclassified as intellectual disability About 1 percent of all children

some children disorders have adult counter parts

e.g., childhood anxiety disorders and childhood depression

some children disorders radically change form by adulthood

e.g., elimination disorders

psychological abuse

may include severe rejection, excessive discipline, scapegoating and ridicule, isolation, and refusal to provide help for a child with psychological problems.