Common mental health problems in childhood & adolescence

• What does “common” mean?

  Separating typical from atypical development
• What are the distinct features or causes of each disorder?

  Multifinality vs equifinality
• Developmental issues


  Same for 7-year-old as 37-year-old?
• Psychopathology


  • Behaviors, thoughts, emotions
  • Threat to self and/or threat to others
  • Three Ps (pathological, pervasive, persistent)
• What is ‘atypical’?


  Abnormality as deviation from the average

  • Abnormality referred to as statistical model
  • IQ of 100 is normal; <70 or >130 is “abnormal”
  • But what about behaviours not so easily measured on a numerical scale?

  Abnormality as deviation from the ideal

  • Alternative to statistical model
  • Who determines what is “ideal”?
  • Different cultures may have different “expectations” of what ‘normal’ is
• Classifying child psychopathology


  Diagnostic Approach: DSM-5, ICD-11

  • Rooted in medical tradition
  • Used diagnosis for aetiology of disorder
  • Reliability: reliability is needed to establish validity of a diagnosis

  Empirical Method: Psychiatric studies, journals

  • Rating scales
  • Based on statistical techniques
  • Useful for identifying risk factors
• Anxiety disorders


  • Separation anxiety = Fear of separation from caregiver
  • Specific phobias = Dogs, snakes, etc.
  • Generalized anxiety disorder = Worrying too much about many topics
  • Social anxiety disorder = Fear about social evaluation
• Causes of anxiety

  
• Depression


  DSM-5: experiencing five or more symptoms during the same 2-week period
• Depression: Symptoms


  • Depressed mood
  • Markedly diminished interest or pleasure in all, or almost all, activities
  • Significant weight loss, or decrease or increase in appetite
  • Slowing down of thought and reduction of physical movement
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness
  • Recurrent thoughts of death, recurrent suicidal ideation or attempt
• Depression: Complex picture developmentally

  
• Depression: Complex picture developmentally

  
• Depression: Complex picture developmentally

  
• Attention-deficit/hyperactivity disorder (ADHD)


  Persistent pattern of behaviour of inattention and hyperactivity/impulsivity, which far exceeds such behaviours observed in children at comparable levels of development
• ADHD: DSM-5 Symptoms [Inattention]

  • Lack of attention to detail
  • Difficulty sustaining attention
  • Does not seem to listen
  • Does not follow through on instructions
  • Difficulty organising tasks and activities
  • Avoids sustained mental effort
  • Loses and misplaces objects
  • Easily distracted
  • Forgetful in daily activities
• ADHD: DSM-5 Symptoms [Hyperactivity / Impulsivity]


  • Fidgets / squirms
  • Leaves seat frequently
  • Running about / restlessness
  • Excessively loud or noisy
  • Always on the go
  • Talks excessively
  • Blurts our answers
  • Difficulty waiting for his/her turn
  • Tends to act without thinking
• Attention-deficit/hyperactivity disorder (ADHD)


  DSM-5: Criterion 1: At least six Inattentive and/or at least six Hyperactive/Impulsive symptoms present for the past 6 months

  AND

  • Criterion 2: Several of these present before 12 years of age
  • Criterion 3: Behaviours noticeable in at least two settings (e.g., home, school)
  • Criterion 4: Must negatively impact social, academic, or work functioning
  • Criterion 5: Are not better explained by another mental disorder

  
• Causes of ADHD: Genetic influences

  • Twin studies: high heritability (~75%)
  • Specific candidate genes (e.g., dopamine & serotonin transporters)
  • Polygenic risk scores
• Causes of ADHD: Environmental influences

  • Parenting behaviour
  • Prenatal exposures
  • Environmental toxins
  • Household stressors
• Conduct disorder (CD)


  Repetitive and persistent pattern of behaviour in which the basic rights of others or major age appropriate societal norms or rules are violated
• Conduct disorder (CD): Symptoms

  DSM-5: at least three of the following 15 criteria in the past 12mos, and one in past 6mos

  AND

  Significant impairment in social, academic, or work functioning

  
• Conduct disorder: Specifiers


  Childhood-onset type: Individuals show at least one symptom characteristic of CD <10 years.

  Adolescent-onset type: Individuals show no symptom characteristic of CD <10 years.

  With limited prosocial emotions:

  • Lack of remorse or guilt = Lack of concern about consequences of his/her actions
  • Callous–lack of empathy = Cold and uncaring, unconcerned about others feelings
  • Unconcerned about performance = Lack of effort necessary to perform well
  • Shallow or deficient affect = Can turn emotions “on” or “off” quickly
• Conduct disorder: Developmental trajectories

  
• Conduct disorder and CU traits

  
• CU traits as a downward extension of psychopathy