Chapter 13 -- Disorders of Childhood

I. Attention Deficit Hyperactivity Disorder

A. Symptoms for at least 6 months (3 to 7% prevalence worldwide, 11% in U.S., twice as many males)
1. 6 or more signs of Inattention (e.g., careless mistakes, not listening well, not following instructions, easily distracted, forgetful)
2. 6 or more signs of Impulsivity/Hyperactivity (e.g., fidgeting, restlessness, "driven by a motor", interrupting, incessant talking)
3. Some symptoms before age 12 (4 signs above for adults)
4. Significant impairment in social, academic, or occupational functioning
B. Etiology
1. Heritability is 70 to 80%
2. Dopamine receptor (DRD4) and transporter (DAT1) genes implicated
3. Dopaminergic areas smaller in children with ADHD (frontal lobes, caudate nucleus)
4. Maternal tobacco and alcohol use increase risk
5. Parental commands and negative interactions increase risk
C. Treatment
1. Stimulant medications (Ritalin, Adderall)
2. Behavioral reinforcement and loss of privileges
3. Parental training
4. Supportive classroom (brief assignments, immediate feedback, task-focused style, breaks for exercise)

II. Externalizing Problems

A. Conduct Disorder (aggression, cruelty, destruction, lying, stealing, no remorse)
B. Oppositional Defiant Disorder (hostile, argumentative, and defiant behavior)
C. Etiology
1. 50% of antisocial behavior is heritable
2. Abuse as a child plus low MAOA activity
3. Poor verbal skills and low executive functioning
4. Lack of remorse
5. Harsh and inconsistent parenting
6. Peer rejection and deviancy
D. Treatment
1. Family interventions
2. Parental management training
3. Multisystemic therapy (community, agency, school, neighborhood, peers, family, child)

III. Internalizing Problems

A.Depression: high negative affect, low positive affect (2 to 3% prevalence)
B. Anxiety: high negative effect, sometimes low positive affect (3 to 5% prevalence)
C. Risk factors: depressed parent, rejection, less warmth, negative attributions
D. Treatment: medication, cognitive-behavioral therapy, parent training, interpersonal therapy

IV. Learning Disorders

A. Characteristics (5 to 10%)
1. Dyslexia: difficulty with word recognition and comprehension
2. Dyscalculia: difficulty with producing and understanding numbers
B. Treatment
1. Multisensory instruction, phonics
2. Improve cognitive skills in comprehension and memory
3. Improve behavioral skills in note taking and studying
4. Individualized Education Plans

V. Communication and Motor Disorders

VI. Intellectual Developmental Disorder

A. Definition: IQ of 70 or below, deficits in adaptive functioning (2% of population)
B. Causes
1. Down Syndrome (a third chromosome 21) (mild to moderate disability, brain becomes like Alzheimer’s)
2. Phenylketonuria (lack an enzyme which leads to lipid in nerve cells, neural damage, and death by age 5)
3. Fragile X Syndrome (defective X chromosome)
4. Fetal Alcohol Syndrome (results from mother drinking during pregnancy)
C. Intervention
1. Mainstreaming based on P.L. 94-142 (All Handicapped Children Act)
2. Behavioral Reinforcement techniques
3. Computer Assisted Instruction

VII. Autism Spectrum Disorders

A.Autism, Aspberger's, and Pervasive Developmental disorder (less than 1%)
1. Deficits in social interactions and communication
2. Repetitive and stereotyped behaviors
3. Larger than normal brains at age 2, but then brain growth stops, pruning of neurons may not be occurring, larger amygdalae
B. Intervention
1. Behavior and speech therapy to develop language
2. Parent training
3. Pivotal response treatment focuses on improving attention and responsiveness
4. Medication for problem behaviors (antipsychotics reduce aggression and stereotyped behaviors)