CHAPTER 8

Childhood Disorders

OBJECTIVES:
a. To determine the disorders involve in Childhood Disorders
b. To give the importance of knowledge in Childhood Disorders
c.) To explore the other disorders involve in Childhood Disorders

❖ Mental Retardation
Mental retardation refers to intelligence that is significantly below normal—
an IQ approximately equal to or less than 70 (where the mean IQ is set at 100)—and that
impairs daily functioning.
Although mental retardation cannot be cured, many types can be prevented, including
PKU-related retardation (through early detection and dietary modification) and retardation
caused by lead poisoning (by removing lead from the environment). Interventions are
designed to improve the person’s functioning by increasing his or her communication and
daily living skills.
Children whose symptoms make verbal communication diffi cult may be taught alternative
methods of communication, such as the Picture Exchange Communication System
(PECS).
Legally, children with mental retardation are entitled to special education and related
services, tailored to their individual needs through an individualized education program
(IEP).

❖ Pervasive Developmental Disorders

Pervasive developmental disorders are a set of disorders that have in
common severe deficits in communication and in social interaction skills, and may
also involve stereotyped behaviors and narrow interests. The word pervasive
indicates that the symptoms affect all areas of the individual’s life. Pervasive
developmental disorders primarily arise from neurological abnormalities and
dysfunctions.
Pervasive developmental disorders involve two types of problems:
(1) significant deficits in communication and social interaction skills, and
(2) stereotyped behaviors or narrow interests. Disorders in this category are
autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and
Rett’s disorder
Autistic disorder (or simply, autism) is characterized by significant problems with
communication, social interactions, and language use. Individuals with autism are
oblivious to other people and do not pay attention to or understand basic social rules and
cues. They may have extremely narrow interests involving repetitive play. Many people
with autism also have comorbid mental retardation when tested with conventional
intelligence tests; on tests that do not rely on verbal abilities, however, people with autism
tend to score in the average range or higher. In addition, some people with autism have
unique skills.
Asperger’s disorder is characterized by problems that are similar to—though less
severe than—those associated with autism. With Asperger’s, however, language and
cognitive development are in the normal range. People with Asperger’s avoid eye contact
and are often unaware of other people’s responses. They may be interested in social
relationships but because they do not generally understand conventional social rules,
forming and maintaining relationships is difficult.
Neurological factors that underlie autism include abnormal connections and
communication among different brain areas, in particular, between the frontal lobe and
the rest of the brain. Genes play a role in the development of autism and Asperger’s.
Psychological symptoms of autism include deficits in shifting attention and in mental
flexibility, and an impaired theory of mind. People with Asperger’s have less severe
problems in using a theory of mind than do people with autism. Social symptoms of autism
include problems in recognizing emotion in the voices or faces of others and in
understanding the give and take of social communication.
Interventions for autism include medication for comorbid disorders or symptoms of
anxiety, agitation, and aggression. Medication is not usually prescribed for symptoms of
Asperger’s disorder. Treatment for autism that targets psychological factors includes
applied behavior analysis to modify maladaptive behaviors. Treatments that target
psychological and social factors focus on teaching the individual to communicate, to
recognize conventional social cues, and to read the emotional expressions of others, as
well as how to initiate and respond in social situations.
In contrast to autism and Asperger’s disorder, childhood disintegrative disorder is
characterized by normal development up to at least 2 years of age, followed by a profound
loss of communication skills, normal types of play, and bowel control.
Rett’s disorder also involves the loss of skills already mastered, but the onset of the
disorder occurs between 5 months and 2 years of age. The child loses interest in other
people and the ability to control normal muscle movements. Mental retardation always
accompanies Rett’s disorder, which affects only females.

❖ Learning Disorders: Problems with the Three Rs

A learning disorder is characterized by a significant disparity between an
individual’s academic performance and the expected level of performance based
on the individual’s age, intelligence (assessed through an IQ test), and education
level. Achievement that is at least two standard deviations below the level of a
person’s IQ score is the general guideline for diagnosing learning disorders.

Type of learning disorder

• Reading disorder is characterized by difficulty with reading
accuracy, speed, or comprehension, to the point that the difficulty
interferes with academic achievement or activities of daily
functioning that involve reading.
• Mathematics disorder is characterized by difficulty with recognizing
numbers or symbols, paying attention to and remembering all the
different steps in a math problem, particular arithmetic skills such as
multiplication, or translating written problems into arithmetic symbols.
 • Disorder of written expression is diagnosed when poor spelling or
handwriting occurs along with significant grammatical or punctuation
mistakes or problems in paragraph organization.
Genes contribute to learning disorders. Dyslexia appears to result from disruptions in
brain systems that process language and in brain systems that process visual stimuli.
Motivation and social support influence an individual’s ability to overcome and
compensate for a learning disorder.
Treatment for learning disorders may involve accommodations and services mandated
by the Individuals with Disabilities Education Act (IDEA). Various cognitive techniques
can help a person learn to compensate for a learning disorder. Depending on the specific
learning disorder and the individual, some techniques may be more effective than others.

❖ Disorders of Disruptive Behavior and Attention

Conduct disorder is characterized by a violation of the basic rights of
others or of societal norms that are appropriate to the individual’s age. Conduct
disorder involves four types of behavior: aggression to people and animals,
destruction of property, deceitfulness or theft, and serious violation of rules.
Symptoms may be mild, moderate, or severe, and the disorder may begin in
childhood or adolescence. Conduct disorder is commonly comorbid with attention-
defi cit/hyperactivity disorder and substance use or abuse.
Childhood-onset conduct disorder with callous and unemotional traits
has the highest heritability among the various types of conduct disorder; this
variant is also associated with more severe symptoms. Individuals with childhood-
onset conduct disorder without callous and unemotional traits are less aggressive,
although they are likely to be aggressive impulsively, in response to (mis)perceived
threats. Adolescentonset conduct disorder tends to involve mild symptoms that are
usually transient.
Oppositional defiant disorder is characterized by a behavioral pattern of
disobedience, hostility, defiance, and negativity toward people in authority. The
behaviors are usually not violent nor do they cause severe harm, and they often
occur only in certain contexts. Some people with oppositional defi ant disorder go
on to develop conduct disorder; if an individual’s behaviors meet the criteria for
both oppositional defi ant disorder and conduct disorder, only conduct disorder is
diagnosed.
Attention-deficit/hyperactivity disorder (ADHD) is characterized by
inattention, hyperactivity, and/or impulsivity. The inattentive type of ADHD is
associated with academic problems, whereas the hyperactive/impulsive type is
associated with disruptive behaviors, accidents, and rejection by peers.
 Criticisms of the DSM-IV-TR diagnostic criteria for ADHD include the difficulty in
applying the criteria to adults, the arbitrariness of the age cutoff for the onset of
symptoms, and failure to acknowledge different symptoms in females.
Oppositional defi ant disorder, conduct disorder, and ADHD are highly comorbid, making
it difficult to sort out factors that contribute uniquely to one of the disorders.
Neurological factors that contribute to ADHD include frontal lobe problems (which lead to
the symptoms of inattention, impaired executive function and memory diffi culties). Too
little dopamine and imbalances in other transmitters may also play a role. Genes also
contribute to ADHD and conduct disorder, in part by affecting temperament.
Psychological factors that are associated with ADHD include low self-esteem and
difficulty recognizing facial expressions of anger and sadness. People with oppositional
defi ant disorder and conduct disorder tend to have either low self-esteem or overly high
self-esteem, are relatively unresponsive to the threat of punishment, and exhibit high
levels of emotional distress and poor frustration tolerance.
Social factors that contribute to ADHD include parents’ not giving children enough credit
for their positive behaviors. For oppositional defi ant disorder and conduct disorder, social
factors include abuse, neglect, inconsistent discipline, and lack of positive attention.
Treatments targeting psychological factors in ADHD, oppositional defiant disorder, and
conduct disorder may use behavioral methods—especially reinforcement programs—to
increase a person’s ability to tolerate frustration and to delay reward, and cognitive
methods to enhance social problem solving ability. Treatments that target social factors
in all three disorders include group therapy and comprehensive treatments such as
contingency management, parent management training, and multisystemic therapy.

❖ Other Disorders of Childhood

Separation anxiety disorder is characterized by excessive anxiety about
separation from home or from someone to whom the child is strongly attached.
Separation anxiety disorder is moderately heritable and is more likely to arise in
tight-knit families, whose members may inadvertently reinforce behaviors
associated with separation anxiety and punish behaviors associated with actual
separation. Separation anxiety disorder is treated with methods used to treat other
anxiety disorders: CBT that includes exposure and cognitive restructuring, along
with family therapy.
Communication disorders are characterized by problems in
understanding or using language.
Feeding and eating disorders are characterized by problems with eating
or with feeding in the case of infants or young children whose diet consists entirely
or mainly of liquids, such as formula or milk.
Elimination disorders is a set of psychological disorders characterized by
inappropriate urination or defecation.
Enuresis is another elimination disorder, which is characterized by a child’s persistently
urinating in bed or into his or her clothes; nighttime enuresis, or bedwetting, is common:
Approximately a tenth of children between 5 and 16 years old wet their beds, although
not necessarily nightly.
Tic disorders is a set of disorders characterized by persistent tics (motor or vocal) that
occur many times a day on most days.