Child Psychopathology
Lecture10
Child Psychopathology
Childhood and adolescence as "constructs"
- Childhood (and adolescence) as specific phases in the life cycle
- Recent "invention"
Erikson and Freud
- trust vs. mistrust oral stage
- autonomy vs. shame anal stage
- initiative vs. guilt phallic stage
- industry vs. inferiority latency
- identity vs. role confusion
- intimacy vs. isolation genital stage
- generativity vs. stagnation
Piaget
- Sensorimotor
- Pre-operational
- Concrete Operational
- Formal Operations
Stage theories embody the notions that:
- children exist in a complex psychological and interpersonal milieu
- childhood is not "innocent" nor free from strife
- becoming a self occurs long after physical birth
DSM Disorders
Childhood anxiety
- phobias; separation-anxiety disorder
Childhood Depression
Disruptive Behavior Disorders
- oppositional defiant disorder
- conduct disorder
Attention-Deficit Hyperactivity Disorder (ADHD)
Autism
Also:
- Elimination Disorders
- Feeding and Eating Disorders of Childhood
- Disorders of Learning, Coordination and Communication
- Mental Retardation
Childhood Abuse & Trauma
- Maltreatment during infancy and toddlerhood
- Long-term impact of chronic stress (poverty, illness, parental discord, etc.)
Erikson, Freud & Piaget
trust vs. mistrust oral sensorimotor
autonomy vs. shame anal pre-operations
initiative vs. guilt phallic concrete operatios
Fundamental structure of "self" is at risk
Attachment Disorders
- Kids do not attach to care-givers
- Reject help
- Unable to regulate affect
- Attach indiscriminately to strangers
Phobias
- quite common in young children
young child does not necessarily know the
feared stimulus is really harmless
- child�s immaturity makes many more feared situations "realistic" dangers
Separation Anxiety Disorder
Symptoms
- often manifest as "school refusal"
Child�s psychopathology is imbedded in a relational context
- of parents
- siblings
- extended family
Childhood Depression
- Identical to adult mood disorders
- Depressive syndrome
- Suicidality
Disruptive Behavior Disorders
Rest on the assumption that by a certain age, kids ought to be "civilized," that is, willing to go along with existing social norms for activity, attentiveness and morality
- before 5, all children demonstrate conduct disorders
- normal, not pathological
DSM IV Disorders
Oppositional defiant disorder
- violate accepted standards for childhood behavior
- lose temper, "act out," fail to take responsibility for problems
Conduct disorder (childhood-onset & adolescent-onset types)
- violate standards plus rights of others
- violence against persons, animals and property
- fire-setting
Attention-Deficit Hyperactivity Disorder (ADHD)
Distinctions
- -inattentive type; -hyperactivity/impulsive type; -combined type
Symptoms
- consistent inability to focus attention
- child who can�t settle down
- behavioral hyperactivity
- tries to do several things at once
- heritable to a degree
- ADHD symptoms often remit as the child grows older
Child Therapy
Behavioral Conditioning
- anxiety, ADHD, disruptive behav. disorders
- exposure and implosion techniques
- systematic desensitization
Cognitive-behavioral techniques also employed with older children
- depression and anxiety
- child is enlisted as a "partner" in treatment
Play Therapy
Typically associated with psychoanalytic tradition
- relies on "projective hypothesis"
- children imbue their play with issues of concern to them
- fantasy as a built- in solution
Medication
- historical reluctance to prescribe psychotropic meds for kids
- now, increased use of anti-depressants (especially Prozac)
Case of "Michael"
Severe Disorders: Autism
- social isolation
- emotional isolation
- speech disturbances
(echolalia, pronoun reversal, neologisms & aphasia)
- reliance on self stimulation
- inappropriate affective reactions
(especially rage)
Savantism
Some autistic individuals show enhanced capabilities beyond the "normal"
- artistic talent
- musical prodigies
- capacity for advanced computations
Evaluating the "traumatogenic" theories
Little, if any support for the view that stress causes autism
Biological and perceptual theories of autism
Deficits in sound comprehension
- inability to decode sounds into meaningful units
- renders communication and social life incomprehensible
Stimulus over-selectivity
- attending to only one property of a stimulus
Behaviorists:
environmental stresses >>> withdrawal
- birth defects
- early developmental trauma
- poverty
Biology of autism
- Genetics of autism
- Prenatal factors
- Brain lesions