Children who suffer mental illness before age 16, overall numbers and gender ratio

Any disorder: 36%

boys more likely than girls

disorders include: anxiety, depression, behavioral, ADHD, substance abuse

Behavior disorders

(3)

1. ADHD
2. conduct disorder
3. oppositional defiant disorder

Elimination disorders

(2)

1. Enuresis
2. Encopresis

Learning disorders

(3)

1. Dyslexia
2. Mathematics disorder
3. Disorder of written expression

Motor skills disorder

(1)

Developmental coordination disorder

Communication disorders

(4)

1. expressive language disorder
2. mixed receptive-expressive language disorder
3. phonological disorder
4. stuttering

Pervasive developmenal disorders

(4)

1. Autism
2. Rhett's disorder
3. Childhood disintegrative disorder
4. Asperger's disorder

Tic Disorders

(3)

1. Tourette's
2. Chronic motor or focal tic disorder
3. Transient tic disorder

Feeding and eating disorders

(3)

1. Pica
2. Rumination disorder
3. feeding disorder of infancy or early childhood

ADHD

Incessant restlessness, extremely poor attention span, impulsive an disorganized behavior. Behavior observable in most areas of functioning: school, home, etc. being disorganized is one way to tell apart kids who are simply defiant from those who have ADHD.

• Hyperactivity and restlessness: nearly constant fidgeting and squirming, difficulty staying seated, running around (as if driven by a motor), climbing excessively, difficulty engaging in quiet activities, talks excessively
• Inattention: neglects details, doesn’t listen when others are speaking, doesn’t finish tasks, difficulty organizing behavior, loses things frequently, distracted, forgetful
• Impulsivity: blurts out while others are talking, difficulty waiting for things, often interrupts or intrudes on others

3 subtypes of ADHD

Predominately inattentive: less hyperactive, more spacy

Predominantly hyperactive and impulsive (rare on its own)

Combined type: represents MOST cases of ADHD. More likely to have a wider range of problems, which is perhaps why it is more diagnosed. 

Effect of stimulants on ADHD

(what kinds work?)

Paradoxical response to amphetamines

75% of children benefit from stimulants – Ritalin, Dexedrine, adderall, concerta (don’t know why this happens) – all have methylphenidate or amphetamine. Strattera is the only non-stimulant treatment (selective norepinephrine reuptake inhibitor)

Acts primarily on hyperactivity

Academic performance does not improve unless good study skills are taught along with meds.

Problems with stimulants: since 1990, prescriptions for stimulants have increased 400-500%

• DEA estimates 7-10% of male school-aged children in US take stimulants
• Adverse side effects
• Long-term effects unknown
• Potential for abuse – increased risk for later substance abuse problems

Groups at risk for ADHD

Boys diagnosed three times more frequently than girls (may be because girls have the inattentive type that goes unnoticed)

Presence of family disruption (frequent moves, divorce, parental interactions marked by hostility and conflict)

Other family members with ADHD

Prenatal and birth complications

Persistence of ADHD and comorbidity

• Most children (~75%) continue to show symptoms into adolescence and young adulthood
• Increased risk for antisocial personality, substance abuse, mood and anxiety disorders, marital problems, traffic accidents, legal infractions, difficulty in sustaining employment

Prevalence of ADHD

• 3-5% of school-aged children (point prevalence)
• 9-10% may be more accurate?
• May be symptoms of other disorders
• May not be getting treatment

Biological Theories of ADHD

• • Deficits in functioning in frontal lobes and caudate nucleus(also implicated in schizophrenia, who have similar difficulties with attention and planning): regulate planning, attention, and impulses
  • Immaturity hypothesis: lack of correlation between symptoms and actual brain injury
  • Dopamine

Conduct disorder

Behaviors that violate the basic rights of others adn the norms for social behavior

Proposed etiologies of conduct disorder

AND

oppositional defiant disorder

(9)

1. Genetic Predisposition
2. Deficits in brain regions involved in planning and controlling behavior
3. difficult temprament
4. Lower physiological arousal to punishment
5. Serotonin imbalances
6. higher testosterone level
7. Parents: poor supervision, uninvolvement, violence
8. Delinquent peer group
9. Cognitions that promote aggression

Oppositional defiant disorder

Argumentativeness, negativity, irritability, defiance, but behaviors not as severe as in conduct disorder

Treatments of conduct disorder

AND

oppositional defiant disorder

1. Antidepressants, neuroepileptics, stimulants, lithium
2. Cognitive-behavioral therapy focused around changing hostile conditions, teaching children to take other perspectives, teaching problem-solving skills

Conduct disorder, prevalance

3-7%

40% later diagnosed with antisocial personality disorder

80% unemployed

conduct and oppositional defiant

biology and comorbidity

Problems with frontal lobe

heritable

ADHD

Separation anxiety disorder

children who show much more than the usual anxiety when separated from caregivers

3% of kids under 11 years of age

biological theories of separation anxiety (2)

1. Biological predisposition: may be genetic link to anxiety disorders
2. Behavioral inhibition: children are born with an inhibited, fearful temperament

psychosocial theories (2) of separation anxiety

1. Traumatic or uncontrollable events
2. parenting experiences: parents may encourage fearful behavior

treatment of separation anxiety disorder

Cognitive-behavioral therapy -

children are taught self-talk to challenge negative thoughts and relaxation to quell anxiety

periods of separation from parents are increased gradually

parents are taught to model and reinforce nonanxious behavior

Enuresis

Unintended urination at least 2 times per week for 3 months, child over 5 years of age

Theories for enuresis

1. Biological: runs in families
2. Psychodynamic: emotional distress
3. behavioral: poor toilet training

treatments for enuresis

1. Antidepressants, synthetic anti-diuretic hormone
2. bell and pad

Encopresis

unintended defecation at least one time per month for 3 months; child over 4 years of age

usually occurs after episodes of severe constipation; changes in colon reduce ability to know when to use toilet, leading to accidents

treatment for encopresis (4)

1. Medication to clear out colon
2. laxatives or mineral oil to soften stools,
3. increase in dietary fiber
4. Behavioral: contracting to increase appropriate toilet use, diet change, relaxation methods

developmental coordination disorder

deficits in ability to walk, run, hold onto objects

6% children between 5 and 11 years

expressive language disorder

deficits in ability to express onself through language

limited vocabulary and sentence types

3-7% of children

mixed receptive-expressive language disorder

deficits both in the ability to express oneself through language and to understand the language of others

phonological disorder

use of speech sounds inappropriate for age or dialect

(rabbit=wabbit, blue=bu)

3% of 6-7 year olds

stuttering

severe problems in word fluency

causes of disorders in cognitive, motor and communication skills (5)

genetic factors

lead poisoning

birth defects

sensory dysfunction

impoverished environments

Mental retardation:

Diagnosis

•  
  • Significantly sub average general intellectual functioning. Pretty much only disorder with which diagnosis is based very much on statistics – a test
  • **Significant limitations in adaptive functioning (not enough to score poorly on IQ test)
    • Deficits in at least 2 of 11 adaptive skill areas:
      • Communication
      • Self-care
      • Home living
      • Social/interpersonal skills
      • Use of community resources (bus, library)
      • Self-direction (goals)
      • Functional academic skills
      • Work
      • Leisure
      • Health
      • Safety
  • Onset before 18 years of age (in NC, it’s 22)

AAMR

American Academy of Mental Retardation

Recommends not using IQ criterion until deficits in adaptive functioning have been identified

Recommend classifying levels of mental retardation by level of needed support/assistance

Mild Retardation

• IQ of 50-55 to 70
• Most people who have mental retardation
• Self-care by late childhood, can speak fluently, hold job, marry, have children, live independently with some help

Moderate retardation

• IQ of 35-40 to 50-55
• Hard to test with Wechsler Test (lowest score is in 40’s)
• Self-care by adolescence, can carry on simple conversations, read a little, do simple tasks, but usually unable to hold competitive employment or live independently

Severe retardation

• IQ of 20-25 to 35-40
• Can learn some self-care, work in sheltered workshop, difficulty speaking, reading, using numbers, need supervision

profound retardation

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• IQ below 20-25
• Few independent self-care skills, extensive supervision needed, very little language, often institutionalized

Down's Syndrome: biology

• • • Trisomy 21 – an extra chromosome in pair 21
    • Risk factor – age of mother

Fragile X

• The X chromosome shows a weak spot, where it appears to be bent or broken
• This is not as “clear” as Trisomy 21. It may be related to other developmental disabilities. No one really sure exactly what happens or how.

(2)

metabolic disturbances theory of mental retardation

• Metabolic disturbances – brain isn’t growing properly
  • Phenylketonuria (PKU): Inability to metabolize the amino acid phenylalanine
  • Tay-sachs disease: a defect of lipid metabolism due to the absence of the enzyme hexosominidase

environmental factors for mental retardation

• • Prenatal
    • Congenital disorders – disorders acquired during prenatal development but not transmitted genetically
    • Drugs – fetal alcohol syndrome (FAS)
    • Malnutrition
  • Postnatal
    • Toxins
    • Physical trauma
    • The effect of deprivation
  • Institutionalization – leads to bad cycle

mental retardation in adults

• People with Down’s syndrome, without fail, develop Alzheimer’s disease if they live long enough
• Mental retardation and other mental disorders – ex-depression in someone with mental retardation is not the same as someone without. Same goes for schizophrenia etc.

groups at risk for mental retardation

• More common in male
• Children around 5 or 6 years of age
• Lower SES for mild retardation
• African-Americans – but this might be unsubstantiated because AA’s score lower on IQ tests anyway
• Various pre- and post-natal variables

treatments for mental retardation

1. Behavioral: caregivers taught skills for enhancing positive behavior from child. rewards given to child as he/she masters skill.
2. Drug therapy: neuroepileptic to reduce aggressive/antisocial behavior. antipsychotics to reduce self-injury. antidepressants to help with sleep and depression
3. Social programs: early intervention, mainstreaming, group homes for adults, institutionalization

Symptoms of autism

must show before age 3

more than half are retarded

• deficits in social interaction
• deficits in communication - echolalia, or no speech at all
• deficits in activities and interests - sterotyped behavior such as rocking. narrow focus. need things to be ordered

Asperger's Syndome

• High functioning autism – impaired social functioning and other stereotyped behavior, but no mental retardation and no language deficits (but qualities of language are still strange)
• Think of a spectrum with Asperger’s on the lesser end and autism on the greater end.

Rhett's Disorder

Apparently normal development through first 5 months of life and normal head circumference at birth

between 5 and 48 months, loss of motor and social skills already learned, poor development of motor skills

Childhood disintegrative disorder

apparently normal development for the first 2 years, followed by significant loss of previously acquired skills between 2-10

abnormalities of functioning in social interaction, communication, activities

theories of autism

(6)

1. Deficits of theory of mind
2. genetic predisposition
3. chromosomal abnormalities - chromosome 15, sex chromosomes
4. neurological deficits
5. prenatal and birth complications
6. neurotransmitter imbalances