childhood disorders

• These are psychiatric disorders that are most likely to first arise in childhood and adolescence.
• Entails a developmental perspective
• Disorders of childhood reflect aberrations in the typical developmental trajectory
• This makes childhood disorders difficult to diagnose – we have to be very careful not to pathologise typical behaviour.
• Culture also plays a strong role in diagnosing problematic childhood behaviours
• Disorders of childhood can cast a long shadow (reduced educational attainment, reduced employment and earnings, relationship difficulties, justice system encounters, etc.)
• Externalising behaviours

  • Non compliance
  • Hyperactivity
  • Disruptive behaviour 
  • Impulsivity 
  • Aggressiveness

   
• Externalising disorders 

  • ADHD, conduct disorder, oppositional defiant disorder
• • inward-focused behaviours: 
  • Depression
  • Anxiety
  • social withdrawal
• • disorders in which acquisition of cognitive, language, motor, or social skills is disturbed
• Inattention in ADHD

  • Behaviours in childhood, making careless mistakes, inattention
  • Mostly observed when enter structures like school 
  • cannot follow instructions, forgetful, avoids tasks that take sustained effort, easily distracted
• hyperactivity/impulsivity in ADHD

  • Have to take developmental perspective,
  • Fidgeting, squirming, can’t sit still, incessant talking, blurting out answers in class, can’t take turns
• ADHD criteria

  • Must be present before age 12 - early onset
  • be more extreme than expected for the child’s developmental stage
  • be persistent across different situations (e.g., home, school)
  • associated with significant functional impairment
• ADHD is most commonly diagnosed in the United States
• • ADHD Symptoms usually appear ~age 3-4
• • Boys outnumber girls 3:1 in ADHD
• Over half of children with ADHD continue to have difficulties as adults; up to 15% still meet diagnostic criteria (“adult ADHD”)
• Adults with ADHD are more likely to divorce, have lower education, lower earnings, have substance use, be obese, be imprisoned, die prematurely
• • ADHD heritability estimates as high as 70-80% 
• • ADHD - value of reward decays much more steeply than people without ADHD
• Perinatal and prenatal factors

  • Low birth weight
  • Maternal tobacco and alcohol use
• Environmental toxins

  • Lead
  • May be small effect of food additives on hyperactive behaviour (doesn’t cause ADHD)
• • Stimulants
  • Reduce disruptive behaviour and impulsivity
  • Improve interactions with parents, teachers, peers
  • Improve goal-directed behaviour and concentration
  • Reduce aggression
• • Parental training -
  • Behaviour monitoring and reinforcement of appropriate behaviour (reward charts, points systems)
  • Focus not on reducing symptoms, but improving ability to function in domains which are important for success → academic work, task completion, social skills etc.
• • Supportive classroom structure for ADHD
  • Brief assignments
  • Immediate feedback
  • Task-focused style
  • Breaks for exercise
• Conduct disorder

  • Behaviour characterised by violating rights of others
• conduct disorder symptoms

  • Aggression to people and animals 
  •  Destruction of property 
  • Deceitfulness or theft 
  • Serious violation of rules. 
  • Significant impairment in social, academic, or occupational functioning
• Neurobiological factors of conduct disorder

  • Poor verbal skills and executive functioning, IQ
  • Impaired emotional processing, e.g. reduced neural responses to others’ distress
  • Lower levels of resting skin conductance and heart rate suggest lower arousal levels 
  • May be related to absence of fear of punishment, lack of concern for others distress (later… psychopathy?)
  • Reduced reactions to threat etc
• Cognitive bias in conduct disorder: Neutral acts by others perceived as hostile
• • Environment:
  • Modelling and reinforcement of aggressive behaviour which happens in home 
• 40 – 50% of antisocial behaviour is heritable.
• • Intermittent Explosive Disorder: 
  • Recurrent verbal or physical aggressive outbursts that are out of proportion  
• depression symptoms specific to children and adolescents

  • Higher rates of suicide attempts and guilt 
  • less waking up early
  • weight loss
  • appetite loss
• concern about medicating children

  • modest increase risk of suicide attempts
• separation anxiety disorder is worry about parental or personal safety when away from parents
• separation anxiety first observed when begins school
• social anxiety disorder - symptoms in children

  • extremely shy or quiet
  • selective mutism
• parenting explains 4% of variance in childhood anxiety disorders
• heritability of childhood anxiety disorders is 29-50%
• behavioural inhibition - tendency to become distressed and withdraw when faced with novel situations