Abnormal Psychology

Eighteenth Edition

Chapter 15
Disorders of Childhood
and Adolescence
(Neurodevelopmental
Disorders)

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 Learning Objectives (1 of 2)
• 15.1 Explain how the understanding of psychological
disorders among children and adolescents differs from that
of adults.
15.2 Distinguish between developmentally normal and
abnormal anxiety and mood in children and adolescents.
15.3 Describe the presentation and prevalence of
oppositional defiant disorder and conduct disorder.
15.4 List and define elimination disorders.

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 Learning Objectives (2 of 2)
• 15.5 Summarize what is known about the characteristics,
course, and treatment of attention-deficit/hyperactivity
disorder and autism spectrum disorder.
15.6 Describe what is currently known about the causes
and treatment of learning disorders.
15.7 Define intellectual disability and name three known
causal factors involved in its development.
15.8 Discuss how the treatment of youth differs from that
of adults.

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Special Considerations in Understanding
Disorders of Childhood and Adolescence
(1 of 3)
Learning Objective 15.1: Explain how the understanding of psychological disorders
among children and adolescents differs from that of adults.

• It is important to view a child’s behavior in the context of

normal childhood development
• Developmental psychopathology focuses on
determining what is abnormal at any point in the
developmental process
• No sharp line of demarcation between the maladaptive
behavior patterns of childhood and those of adolescence
or between those of adolescence and those of adulthood

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Special Considerations in Understanding
Disorders of Childhood and Adolescence
(2 of 3)

Psychological Vulnerabilities of Young Children

• Young children are especially vulnerable to psychological
problems
– They do not have as complex and realistic view of themselves
and their world as they will have later
– Immediate threats seem disproportionately more important
– Lack of experience makes manageable problems seem
insurmountable
– They are more dependent on other people

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Special Considerations in Understanding
Disorders of Childhood and Adolescence
(3 of 3)
The Classification of Childhood and Adolescent
Disorders
• Early diagnostic systems
– No categories for children’s disorders
– DSM-I included only two childhood disorders
– Childhood disorders do not always have an adult
psychopathology

• DSM-5 includes diagnoses for a large number of

childhood and adolescent disorders
– All concerns from earlier versions of the DSM were addressed

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Anxiety and Depression in Children and
Adolescents (1 of 6)
Learning Objective 15.2: Distinguish between developmentally normal and abnormal
anxiety and mood in children and adolescents.

Anxiety Disorders of Childhood and Adolescence

• Often comorbid with other disorders
• Anxiety disorders are most common mental disorder
among children and adolescents
• Higher rates among girls than boys
• Most commonly take the form of specific phobias, social
anxiety disorder, separation anxiety disorder, and
posttraumatic stress disorder

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Figure 15.2 Prevalence of Anxiety
Disorders in Girls and Boys

As shown in these data from the National Comorbidity Survey–Adolescent Supplement, a

nationally representative sampling of 10,000 U.S. adolescents, anxiety disorders are
prevalent among youth and are much more commonly seen in girls than boys.

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Anxiety and Depression in Children and
Adolescents (2 of 6)
SEPARATION ANXIETY DISORDER
• Separation anxiety disorder is excessive anxiety about
separation from major attachment figures, such as their
parents, and from familiar home surroundings
– Lack self-confidence, are apprehensive in new situations,
immature for their age
– Slightly more common in girls than in boys; with time, the
disorder may go away on its own
– More likely to also experience other anxiety-based disorders,
such as phobias and obsessive-compulsive disorder

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Anxiety and Depression in Children and
Adolescents (3 of 6)
CAUSAL FACTORS IN ANXIETY DISORDERS
• Anxious children often show an early sensitivity
• Parents can foster anxiety in children through parenting
styles
– If overanxious or overprotective parents (the modeling effect)
– If indifferent, detached, or rejecting

• Cultural expectations and differences lead to different

patterns of anxiety in children

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Anxiety and Depression in Children and
Adolescents (4 of 6)
TREATMENTS AND OUTCOMES
• Same medications used to treat adult anxiety disorders
are generally used to treat children and adolescents
• Cognitive-behavior therapy (CBT) has been effective at
reducing anxiety symptoms in young children
• Exposure-based therapies are effective in the treatment
of adult, adolescent, and child anxiety

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Anxiety and Depression in Children and
Adolescents (5 of 6)
Childhood Depression and Bipolar Disorder
• Childhood depression is characterized by symptoms of
sadness, withdrawal, crying, poor sleep and appetite, and in
some cases thoughts of suicide or suicide attempts
– Irritability is often a major symptom; can be substituted for depressed
mood
– About 12 percent of children and adolescents are diagnosed with
depression
– Higher rates in girls than boys

• Bipolar disorder occurs less frequently but can be diagnosed

in children and adolescents
– May be comorbid with attention-deficit/hyperactivity disorder

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Figure 15.3 National trends in visits with a
diagnosis of bipolar disorder as a percentage
of total office-based visits by youth (ages 0–19).

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Anxiety and Depression in Children and
Adolescents (6 of 6)
CAUSAL FACTORS IN CHILDHOOD DEPRESSION
• Causal factors include genetics, in utero exposure to
alcohol, and exposure to negative parental behaviors or
negative emotional states
TREATMENTS AND OUTCOMES
• 38 percent receive mental health treatment
– Antidepressants are used, but associated with increase risk of
suicidal thoughts and behaviors
– Cognitive behavioral therapy reduces symptoms

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Disruptive, Impulse-Control, and Conduct
Disorder (1 of 7)
Learning Objective 15.3: Describe the presentation and prevalence of oppositional
defiant disorder and conduct disorder.

• Externalizing disorders need to be distinguished from

illegal activity
– Juvenile delinquency: legal term used to refer to violations of
the law committed by minors
– Breaking the law alone does not signify an externalizing disorder

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Disruptive, Impulse-Control, and Conduct
Disorder (2 of 7)
Oppositional Defiant Disorder
• Oppositional defiant disorder (ODD): recurrent pattern
of negativistic, defiant, disobedient, and hostile behavior
toward authority figures that persists for at least 6 months
– Subtypes:
▪ Angry/irritable mood
▪ Argumentative/defiant behavior
▪ Vindictiveness

• Often develops into conduct disorder

– Risks include family discord, socioeconomic disadvantage,
parental antisocial behavior

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Disruptive, Impulse-Control, and Conduct
Disorder (3 of 7)
Conduct Disorder
• Conduct disorder (CD) is characterized by persistent,
repetitive violation of rules and disregard for rights of
others
• Variability in clinical presentation
• Comorbidity with other disorders (e.g., substance abuse
disorder)
• Increases risk of pregnancy and substance abuse in girls
and later development of antisocial personality disorder

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Disruptive, Impulse-Control, and Conduct
Disorder (4 of 7)
Causal Factors in ODD and CD
A SELF-PERPETUATING CYCLE
• Evidence has accumulated that a genetic predisposition
leading to low verbal intelligence, mild
neuropsychological problems, and difficult temperament
can set the stage for early-onset CD
• A child’s difficult temperament may lead to insecure
attachment
• Strong heritable effects of conduct problems and
antisocial behavior

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Disruptive, Impulse-Control, and Conduct
Disorder (5 of 7)
AGE OF ONSET AND LINKS TO ANTISOCIAL
PERSONALITY DISORDER
• The younger CD develops, the greater likelihood of
psychopathy or antisocial personality as adults
– Link is stronger among lower-socioeconomic-class children
– 80% of boys with early-onset CD continue to have multiple
problems of social dysfunction as adults

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Disruptive, Impulse-Control, and Conduct
Disorder (6 of 7)
PSYCHOSOCIAL FACTORS
• Peer relationships
– Children who are aggressive and socially unskilled are often
rejected by their peers
– This rejection can lead to interactions with peers that exacerbate
the tendency toward antisocial behavior

• Family setting
– Rejection, harsh and inconsistent discipline, parental neglect
– Low socioeconomic status, poor neighborhoods, and parental
stress contribute to the cycle

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Disruptive, Impulse-Control, and Conduct
Disorder (7 of 7)
Treatments and Outcomes
• Modifying the child’s family and broader environment to
decrease problematic behaviors
• Cohesive family model
– Focus on ineffective parenting practices that may be reinforcing
the behavior

• Parent management training

• Reinforcing prosocial behaviors while ignoring aggressive
or antisocial behaviors

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Elimination Disorders (1 of 2)
Learning Objective 15.4: List and define elimination disorders.

Enuresis
• Enuresis refers to the habitual involuntary discharge of urine,
usually at night, after age of expected continence (5 years)
– Estimates of prevalence are 5 to 10% among 5-year-olds, 3 to 5% among
10-year-olds, and 1.1% among children ages 15 or older

• May result from a variety of organic conditions, including:

– Disturbed cerebral control of the bladder
– Neurological dysfunction
– Side effects of medication
– Having a small functional bladder capacity or weak urethral sphincter
– Other possible factors: faulty learning; personal immaturity; disturbed
family interactions and relationships; stressful events

• Decreases with age, but childhood treatment still preferable

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Elimination Disorders (2 of 2)
Encopresis
• Encopresis describes a symptom disorder of children
who have not learned appropriate toileting for bowel
movements after age 4
• More common in boys than girls
• Many children suffer from constipation, so an important
element in the diagnosis is a physical examination
• Treatments including medication and conditioning
procedures have reported moderate success

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Neurodevelopmental Disorders (1 of 9)
Learning Objective 15.5: Summarize what is known about the characteristics, course,
and treatment of attention-deficit/hyperactivity disorder and autism spectrum disorder.

• Neurodevelopmental disorders are a group of

conditions characterized by an early onset and persistent
course that are believed to be the result of disruptions to
normal brain development.
– They differ from anxiety and depression in that they must have
their onset during childhood.
– They differ from ODD and CD in that they are believed to be the
result of significant delays or disruptions in brain development
that persist into adulthood (with a few exceptions).

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Neurodevelopmental Disorders (2 of 9)
Attention-Deficit/Hyperactivity Disorder
• Attention-deficit/hyperactivity disorder (ADHD) is
characterized by persistent pattern of difficulties sustaining
attention and/or impulsiveness and excessive or exaggerated
motor activity
• To meet the criteria, the problems have to be:
– Numerous
– Persistent
– Causing problems at home, work, or school

• Lower IQ scores and deficits in neuropsychological testing

– Higher rate in boys

• Not the most prevalent, but the most frequently diagnosed

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Neurodevelopmental Disorders (3 of 9)
ADHD BEYOND ADOLESCENCE
• Approximately half of children with ADHD will continue to
meet criteria in adulthood
• Approximately 4% of U.S. adults meet criteria for ADHD
– Higher rates among those who are male, divorced, unemployed

CAUSAL FACTORS IN ATTENTION-DEFICIT/

HYPERACTIVITY DISORDER
• Causes include genetic and social-environmental factors
• Smaller brain volume and slower maturing brains

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Neurodevelopmental Disorders (4 of 9)
TREATMENTS AND OUTCOMES
• Ritalin is a stimulant medication that quiets children and
lowers their aggression.
– Troubling side effects
– Pemoline, Straterra, and Adderall are alternative medications
– Long-term benefits of stimulant medication includes lower rates
of substance abuse, car accidents, and suicides
– Misuse of stimulant medication

• Behavioral interventions include:

– Teaching the child organizational and planning skills and
techniques for decreasing distractibility and procrastination
– Teaching the parent techniques to reinforce adaptive behaviors

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Figure 15.5

The prevalence of stimulant use increased dramatically from the 1980s to the 1990s and remains at
this higher level today. This increase is driven by prescriptions for those 6 to 18 years old. (National
Expenditure Survey, 1987 and Medical Expenditure Panel Survey, 1996–2008.)

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Neurodevelopmental Disorders (5 of 9)
Autism Spectrum Disorder
• Autism spectrum disorder is a neurodevelopmental
disorder that involves a wide range of problematic
behaviors, including language and perceptual and motor
development; defective reality testing; and impairments in
social communication.
• Infants later diagnosed with autism show an increased
focus on inanimate objects and a decreased focus on
others’ eyes.

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Figure 15.6

In a recent study by Jones and Klin

(2014), the authors showed infants
videos of humans and objects and
found that children later diagnosed
with autism showed a decline in
their focus on the eyes of others
(choosing instead to focus on
inanimate objects). Part (A) shows
eye-gaze data from a 6-month-old
later diagnosed with autism, (B)
shows eye-gaze data from a
typically developing 6-month-old, (C)
shows the pattern of decline for two
children later diagnosed with autism,
and (D) shows the pattern of stability
for two typically developing children.

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Neurodevelopmental Disorders (6 of 9)
THE CLINICAL PICTURE OF AUTISTIC SPECTRUM
DISORDER
• A social deficit
– Aloof or seems apart from others
– Do not show any need for attention from or contact with others,
misread social cues, aversion to auditory stimuli, deficits in
locating and orienting to sounds

• An absence of speech
– May show echolalia, the parrot-like repetition of a few words

• Self-stimulation
– Head banging, spinning, and rocking are common

• Maintaining sameness
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Neurodevelopmental Disorders (7 of 9)
CAUSAL FACTORS IN AUTISM
• Precise causes unknown, complex disorder
• Genetic risk
– Hundreds of genes associated with increased risk
– Heredity
– De novo mutations that occur in the child’s genes, but are not
passed from parents

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Neurodevelopmental Disorders (8 of 9)
TREATMENTS AND OUTCOMES OF AUTISM
• Prognosis is poor because so many are insufficiently
treated
• Many children with autism are subjected to a range of
fads and “novel” approaches that have little to no support
for their effectiveness
• Newer instructional and behavior modification techniques
may reduce some symptoms

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Video: Humanoid Robot Russell Engages
Children with Autism

Click on the screenshot to view this video.

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Neurodevelopmental Disorders (9 of 9)
Tic Disorders
• A tic is a persistent, intermittent muscle twitch or spasm,
usually limited to a localized muscle group
– Examples: blinking the eye, twitching the mouth, licking the lips,
shrugging the shoulders, clearing the throat, and grimacing
– More common in males

• Tourette’s disorder is an extreme tic disorder involving

multiple motor and vocal patterns

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Specific Learning Disorders (1 of 2)
Learning Objective 15.6: Describe what is currently known about the causes and
treatment of learning disorders.

• Learning disorders are delays in cognitive development

in the areas of language, speech, mathematical, or motor
skills that are not necessarily due to any demonstrable
physical or neurological defect
– Clear impairment in school performance or daily activities

• In dyslexia, the individual has problems in word

recognition and reading comprehension; often, they are
markedly deficient in spelling and memory as well
– Best known and most widely researched

• Children with learning disorders can experience deep

emotional tension under normal learning circumstances

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Specific Learning Disorders (2 of 2)
Causal Factors in Learning Disorders
• Learning disorders are the product of subtle central
nervous system impairments.
• Recent work with functional magnetic resonance imaging
suggests that people with dyslexia have a deficiency of
physiological activation in the cerebellum.
• Various forms of learning disorders, or a vulnerability to
develop them, may be genetically transmitted.

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Video: Dyslexia: When Your Brain
Makes Reading Tricky

Click on the screenshot to view this video.

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Intellectual Disability (1 of 10)
Learning Objective 15.7: Define intellectual disability and name three known causal
factors involved in its development.

• Intellectual disability is characterized by deficits in

general mental abilities, such as reasoning, problem
solving, planning, abstract thinking, judgment, academic
learning, and learning from experience
– Also called intellectual development disorder

• Defined by intelligence and level of performance

• Onset prior to age 18

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Intellectual Disability (2 of 10)
Levels of Intellectual Disability
MILD INTELLECTUAL DISABILITY
• IQ scores range from 50-55 to approximately 70 (two
standard deviations below the mean).
• Individuals are considered educable.
• Intellectual levels as adults are comparable to those of
average 8- to 11-year-old children.
• Social adjustment often approximates that of adolescents.

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Intellectual Disability (3 of 10)
MODERATE INTELLECTUAL DISABILITY
• IQ scores range from 35-40 to 50-55.
• In adulthood, individuals attain intellectual levels similar
to those of average 4- to 7-year-old children.
• Some can be taught to read and write a little and may
achieve fair command of spoken language. However, the
rate of learning is slow, and the level of conceptualizing is
extremely limited.
• Partial independence in daily self-care, acceptable
behavior, and economic sustenance in a family or other
sheltered environment.

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Intellectual Disability (4 of 10)
SEVERE INTELLECTUAL DISABILITY
• IQ scores range from 20-25 to 35-40.
• Individuals commonly suffer from impaired speech
development, sensory defects, and motor handicaps.
• Some can develop limited levels of personal hygiene and
self-help skills, but they are always dependent on others
for care.

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Intellectual Disability (5 of 10)
PROFOUND INTELLECTUAL DISABILITY
• IQ scores that are below 20-25.
• Individuals are severely deficient in adaptive behavior
and unable to master any but the simplest of tasks.
• Severe physical deformities, CNS pathology, and
retarded growth are typical, along with convulsive
seizures, mutism, deafness, and other physical
anomalies.

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Table 15.1
Disability Severity and IQ Ranges
Diagnosed Level of Intellectual Corresponding IQ Range
Disability
Mild disability 50–55 to approximately 70
Moderate disability 35–40 to 50–55
Severe disability 20–25 to 35–40
Profound disability Below 20–25

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Intellectual Disability (6 of 10)
Causal Factors in Intellectual Disability
GENETIC-CHROMOSOMAL FACTORS
INFECTIONS AND TOXIC AGENTS
TRAUMA (PHYSICAL INJURY)
IONIZING RADIATION
MALNUTRITION AND OTHER BIOLOGICAL FACTORS

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Intellectual Disability (7 of 10)
Organic Intellectual Disability Syndromes
DOWN SYNDROME
• First described by Langdon Down in 1866, Down syndrome
is the best known of the clinical conditions associated with
moderate and severe intellectual disability.
• 5.9 births out of every 10,000 in the general population.
• Intellectual disability is permanent and most affects verbal and
language skills.
• Common physical features
• Shorter than normal life expectancy

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Table 15.2 Other Disorders Sometimes
Associated with Intellectual Disability (1 of 2)
Clinical Type Symptoms Causes
No. 18 trisomy Peculiar pattern of multiple congenital Autosomal anomaly of
syndrome anomalies, the most common being low- chromosome 18
set malformed ears, flexion of fingers,
small jaw, and heart defects
Tay-Sachs disease Hypertonicity, listlessness, blindness, Disorder of lipoid
progressive spastic paralysis, and metabolism, carried by a
convulsions (death by the third year) single recessive gene
Turner’s syndrome In females only; webbing of neck, Sex chromosome anomaly
increased carrying angle of forearm, and (XO)
sexual infantilism; intellectual disability
may occur but is infrequent
Klinefelter’s syndrome In males only; features vary from case to Sex chromosome anomaly
case, the only constant finding being the (XXY)
presence of small testes after puberty

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Table 15.2 Other Disorders Sometimes
Associated with Intellectual Disability (2 of 2)
Clinical Type Symptoms Causes
Niemann-Pick’s Onset usually in infancy, with loss of Disorder of lipoid
disease weight, dehydration, and progressive metabolism
paralysis
Bilirubin Abnormal levels of bilirubin (a toxic Often, Rh (ABO) blood
encephalopathy substance released by red cell group incompatibility
destruction) in the blood; motor between mother and fetus
incoordination frequent
Rubella, congenital Visual difficulties most common, with The mother’s contraction of
cataracts and retinal problems often rubella (German measles)
occurring together, and with deafness and during the first few months
anomalies in the valves and septa of the of her pregnancy
heart

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Intellectual Disability (8 of 10)
PHENYLKETONURIA
• Phenylketonuria (PKU) is a rare metabolic disorder in
which a missing liver enzyme prevents phenylalanine
from being broken down.
– 1 out of every 12,000 births
– Both parents must carry the recessive gene.
– The condition is reversible (through controlling diet), but if it is
left untreated, can lead to brain damage.
– Early detection can be achieved through urinalysis.

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Intellectual Disability (9 of 10)
CRANIAL ANOMALIES
• Macrocephaly (large-headedness) is an increase in the
size and weight of the brain that results in an
enlargement of the skull.
• Microcephaly (small-headedness) is caused by
decreased growth of the cerebral cortex, which results in
a small head circumference.
• Hydrocephaly is an accumulation of an abnormal
amount of cerebrospinal fluid, causing damage to the
brain.

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Intellectual Disability (10 of 10)
Treatments, Outcomes, and Preventions
• Institutionalization should be seen as a last resort and
only for those with severe intellectual disability.
• Mainstreaming is when a child attends regular classes
much of the day. This is intended for those with mild
impairments.

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Special Factors Associated with Treatment
of Children and Adolescents (1 of 2)
Learning Objective 15.8: Discuss how the treatment of youth differs from ]that of adults.

Special Factors Associated with Treatment of

Children and Adolescents
• The child’s inability to seek assistance
• Vulnerabilities that place children at risk for developing emotional
problems
• Possibility of using parents as change agents
• Need to treat parents as well as children
• Problem of placing a child outside the family
• Value of intervening before problems become acute

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Special Factors Associated with Treatment
of Children and Adolescents (2 of 2)
Child Advocacy Programs
• There are over 74 million people under the age of 18 in the
United States.
• Treatment and prevention programs for our society’s children
remain inadequate for dealing with the extent of psychological
problems among children and adolescents.
• Child advocacy programs attempt to secure services for
children in need.
• Today there is greater interdisciplinary involvement in attempts
to provide effective advocacy programs for children.

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