Lecture 10

MALADAPTIVE BX IN DIFFERENT DEVELOPMENTAL PERIODS

 ______________________is devoted to studying the origins and course of individual
maladaptation in the context of normal growth processes

CLASSIFICATION OF CHILDHOOD & ADOLESCENT DISORDERS

 Early diagnostic systems included no categories for children’s disorders

ATTENTION DEFICIT/HYPERACTIVY DISORDER

 In ADHD, the child shows impulsive, overactive behavior that interferes with his or her
ability to accomplish tasks

 It still remains unclear to what extent the disorder results from environmental or biological
factors

 Treatment methods include:

ODD & CD
 __________________________involves a recurrent
pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures
that persists for at least 6 months
 _________________involves a persistent, repetitive violation of rules and a disregard for
the rights of others

 The possible causes of conduct disorder or delinquent behavior include:

 Biological factors
 Personal pathology
 Family patterns
 Peer relationships

ANXIETY & DEPRESSION IN CHILDREN & ADOLESCENTS

 Anxiety Disorders of Childhood and Adolescence
 Childhood Depression and Bipolar Disorder

SEPERATION ANXIETY DISORDER

 is the most common of childhood anxiety disorders

 Children with separation anxiety disorder exhibit

SELECTIVE MUTISM
 Selective mutism involves the persistent failure to speak in specific social situations

 In many cases, children with selective mutism also have a diagnosis of developmental
disorder/delay

CHILDHOOD DEPRESSION & BIPOLAR DISORDER

 Depression in children and adolescents occurs with high frequency

 Bipolar disorder is characterized by extreme mood swings and aggressive, irritable

behavior

 Research on the effectiveness of antidepressant medications with children is both limited

and contradictory

SYMTPOM DISORDERS IN CHILDHOOD

 _______________________is described as bedwetting that is not organically caused

 Children over 4 who have not learned appropriate toileting for bowel movements may be
diagnosed with ___________________________

 10-30% of children will have at least one incident of sleepwalking (somnambulism)

 Tics occur most frequently between the ages of 2 and 14

 ___________________is an extreme tic disorder involving multiple motor and vocal

patterns

PERVASIVE DEVELOPMENTAL DISORDERS

 group of severely disabling conditions that are among the most difficult to understand and
treat
 AUTISM
 Autism involves a wide range of problematic behaviors including:

ASPERGERS DISORDER
 Often referred to as an autistic spectrum disorder

 Treatment often involves medication and behavioral treatment

Learning disorders
 The diagnosis of learning disorder:
 There is clear impairment in school performance or in daily living activities
 The impairment is not due to mental retardation or to a pervasive developmental
disorder such as autism

 In___________________, the individual manifests problems in word recognition and

reading comprehension

Mental retardation
 DSM-IV-TR defines mental retardation as “significantly subaverage general intellectual
functioning…that is accompanied by significant limitations in adaptive functioning”

 The following five biological conditions may lead to mental retardation:

 Genetic-chromosomal factors
 Infections and toxic agents
 Trauma (physical injury)
 Ionizing radiation
 Malnutrition and other biological factors
 Special factors with treatment
 Special factors associated with treatment for children and adolescents include:
 The child’s inability to seek assistance
 Vulnerabilities that place children at risk
 Need for treating parents as well as children
 Using parents as change agents
 Problems with placement outside family
 Intervening before problems become acute

THERAPY
Why do folks seek therapy?
 People seeking therapy may
 Be in stressful current life circumstances
 Have long-standing problems
 Be reluctant and enter therapy at the request of a physician, spouse, or other
 Seek personal growth

Who provides mental health services?

 Members of many different professions provide advice and counsel including:
 Physicians
 Clergy

The therapeutic relationship

 The key elements of an effective working alliance between client and therapist include:
 A sense of working collaboratively on the problem
 Agreement between patient and therapist about the goals and tasks of therapy
 An affective bond between patient and therapist

Measuring success in therapy

 Estimated gains depend on

Would change occur anyways?

 Improvement often occurs without professional intervention
 Psychotherapy can accelerate improvement
 What tx should be applied?
 Evidence-Based Treatment

 Medication or Psychotherapy?

 Combined Treatments

Evidence-based tx
 Efficacy is determined via randomized clinical trials in which therapy is compared to
placebo

 Therapies under investigation are typically manualized to control variability between

therapists

Medication or psychotherapy?
 Advances in psychopharmacology have allowed many to remain unhospitalized

Combined treatment
 In the past, it was thought that medication and psychotherapy were incompatible

 Today, they are frequently combined

Behavioral therapy
 Behavior therapy is a direct and active treatment that

 Behavior therapy approaches include:

  Exposure therapy
 Aversion therapy
 Modeling
 Reinforcement approaches
 Token economies

Cognitive & cognitive-behavioral therapies

 attempts to change a person’s behavior by

 Rational emotive behavior therapy

 Stress-inoculation therapy

 Beck’s cognitive therapy

 Efficacy of cognitive therapy has been well-documented

Humanistic-experiential therapies
 Humanistic-experimental therapies include:
 Client-centered therapy
 Gestalt therapy
 Process-experiential therapy

Psychodynamic therapies
 Psychodynamic therapy is mainly practiced in two basic forms:
 Classical psychoanalysis
 Psychoanalytically oriented psychotherapy

 Elements of Freudian psychoanalysis include:

 Free association
 Analysis of dreams
 Analysis of resistance
 Analysis of transference
 Eclecticism & integration
 Therapists today are more likely to label their orientation as eclectic than to adhere to a
single approach

 _____________________, which focuses on changing current relationships to reduce

depression, is an example of an eclectic form of therapy

Social values & psychotherapy

 Therapists’ own value judgments can affect decisions they make about treating clients

PSYCHOTHERAPY & CULTURAL DIVERSITY….

Biological approaches to tx
 Antipsychotic Drugs
 Antidepressant Drugs
 Anti-Anxiety Drugs
 Lithium and Other Mood-Stabilizing Drugs
 Electroconvulsive Therapy
 Neurosurgery

Antipsychotic drugs
 Antipsychotic drugs are used to treat psychotic disorders such as:
 Schizophrenia
 Psychotic mood disorders

 One side effect of traditional antipsychotics is_______________________

 Atypical antipsychotic drugs

Antidepressant drugs
 The most widely prescribed antidepressant drugs are______________________________
 Older antidepressants include:
 Monoamine oxidase inhibitors
 Tricyclic antidepressants
 Trazodone

Anti-anxiety drugs
 The most widely prescribed anti-anxiety drugs are benzodiazepines

 Buspirone also has been shown to be effective

Lithium & mood-stabilizers

 Lithium is very effective in treating bipolar mood disorders

 Other mood-stabilizing drugs include:

 Divalproic acid
 Carbamazepine

Electroconvulsive therapy
 Electroconvulsive therapy is now used to treat severe mood disorders

 It is a safe, effective, and important form of treatment, often used after others have failed

Neurosurgery
 Antipsychotic drugs have decreased the use of psychosurgery

 Psychosurgery appears to be effective with debilitating OCD, self-mutilation, or anorexia

 Deep brain stimulation is a more recent surgical approach