MALADAPTIVE

BEHAVIOUR IN
DIFFERENT
LIFE PERIODS
 Introduction

 The field of Developmental Psychopathology is devoted to studying

the origins and course of individual mal-adaptation in the context of
normal growth processes.

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

childhood development (Silk et al,2000)

 Despite the somewhat distinctive characteristics of childhood

disturbances at different ages, there is no sharp line of demarcation
between the mal-adaptive behavior patterns of childhood and
those of adolescence , or between those of adolescence and
those of adulthood.
 Varying Clinical Picture

 The clinical picture of childhood disorders tends to be distinct from

the clinical picture of disorders in other life periods . Some of the
emotional disturbances of childhood may be relatively short lived
and less specific than those occurring in adulthood . However, some
childhood disorders severely affect future development.

 The suicide risk among some disturbed adolescents is long-lasting

and requires careful follow-up and attention (Fortune et al, 2007)
 Psychological Vulnerabilities Of
Young Children

 They do not have as complex and realistic a view of themselves and

their world as they will have later;

 Immediately perceived threats are tempered less by considerations of

the past or future and thus tend to be seen as disproportionately
important

 Children’s limited perspectives, as might be expected, lead them to use

unrealistic concepts to explain events

 Children are also more dependent on other people, than are adults

 Children’s lack of experience in dealing with adversity can make

manageable problems seem insurmountable
 Classification of Childhood and
Adolescent Disorders

 Until the 1950s no formal, specific system was available for classifying
the emotional or behavioural problems of children and adolescents.
Kraepelin’s (1883) classic textbook on the classification of mental
disorders did not include childhood disorders.

 In 1952, the first formal psychiatric nomenclature (DSM-I) was published,

and childhood disorders were included. This system was quite limited as
it included only two childhood emotional disorders: childhood
schizophrenia and adjustment reaction of childhood.

 In 1966, the Group for the Advancement of Psychiatry provided a

classification system for children that was detailed and comprehensive.
Thus in the 1968 revision of the DSM (DSM-II), several additional
categories were added.
 Classification of Childhood and
Adolescent Disorders
 There was a growing concern, both among clinicians to diagnose and treat
childhood problems and among researchers to broaden our understanding of
childhood psychopathology, that the then-current ways of viewing
psychological disorders in children were inappropriate and inaccurate for the
following reasons:-

o The same classification system that had been developed for adults was used
for childhood problems even though many childhood disorders (such as autism,
learning disabilities, etc) have no counterpart in adult psychopathology.
o The early systems also ignored the fact that in childhood disorders,
environmental factors play an important part in the expression of symptoms-
that is, symptoms are highly influenced by a family’s acceptance or rejection
of the behaviour.
o In addition, symptoms were not considered with respect to a child’s
developmental level. Some of the problem behaviors might be considered age
appropriate, and troubling behaviours might be that the child will eventually
outgrow.
 Classification of Childhood and
Adolescent Disorders
 In DSM-IV-TR ,disorders of childhood are referred to as Disorders
Usually First Diagnosed in Infancy, Childhood or Adolescence.

 At present, the DSM IV-TR provides diagnoses for a large number of

childhood and adolescent disorders diagnosed on Axis I. In addition,
several disorders, involving mental retardation, are diagnosed on
Axis II.

 Some of these disorders are Attention-Deficit/Hyperactivity Disorder,

Oppositional Defiant Disorder, Conduct Disorder, Pervasive
Developmental Disorders such as Autism, Asperger’s Disoder and so
forth.
Attention - Deficit/Hyperactivity
Disorder
 Description and Characteristics
 Hyperactivity characterized by difficulties that interfere with
effective task oriented behaviour: impulsivity, excessive or
exaggerated motor activity such as aimless or haphazard running
or fidgeting and difficulties in sustaining attention (Nigg et al 2005)

 Children with ADHD are highly distractible and often fail to follow
instructions or respond to demands placed on them. (Wender, 2000)

 Children affected are often lower in intelligence, usually about

7-15 IQ points below average

 They tend to talk incessantly and to be socially intrusive and

immature

 Poor academic functioning generally leads to deficits on

neuropsychological testing (Biederman et al, 2004)
 Problems

 Such children face social problems because of

their impulsivity and overactivity

 They do not obey rules, thus have difficulty in

getting along with parents

 They are mostly viewed negatively by peers as

well (Haze et al, 2005)

 They are NOT ANXIOUS, even though their

overactivity, restlessness and distractibility are
frequently interpreted as anxiety

 Behaviour problems in elementary classes

accompanied with learning disabilities –
difficulty in reading or writing
 Specifications

 Hyperactivity is one of the most commonly diagnosed mental

health conditions in US.

 Occurrence is more frequent in preadolescent boys; prevalence

is 9 times more in boys than girls

 Occurs in greatest frequency before age 8, lessens thereafter

involving briefer episodes

 Comorbid with: Oppositional defiant disorder

 Residual effects such as attention difficulties may persist into

adolescence or adulthood
 Criteria (DSM IV-TR)
Either (1) or (2):
1. Six( or more) of the following symptoms of inattention have persisted for at least
6 months to a degree that is maladaptive and inconsistent with developmental
level :
Inattention
a. Often fails to give close attention to details or makes careless mistakes in
schoolwork, work or other activities
b. Often has difficulty sustaining attention in tasks or play activities.
c. Often does not seem to listen when spoken to directly
d. Often does not follow through on instructions and fails to finish schoolwork,
chore, or duties in the workplace(not due to oppositional behavior or failure
to understand instructions)
e. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental effort ( such as schoolwork)
f. Often has difficulty organizing tasks and activities
g. Often loses things necessary for tasks or activities( eg,books ,pencil)
h. Is often easily distracted by extraneous stimuli
i. Is often forgetful in daily activities
 Criteria (DSM IV-TR)
2. Six (or more) of the following symptoms of hyperactivity/impulsivity have
persisted for at least 6 months to a degree that is maladaptive and inconsistent
with developmental level:

Hyperactivity
a. Often fidgets with hands or feet or squirms in seat
b. Often leaves seat in classroom or in other situations in which remaining seated
is expected
c. Often runs about or climbs excessively in situations in which it is inappropriate
(in adolescents or adults may be limited to subjective feelings of restlessness)
d. Is often “on the go” or often acts as if “driven by a motor”
e. Often talks excessively
f. Often has difficulty playing or engaging in leisure activities quietly

Impulsivity
g. Often blurts out answers before questions have been completed
h. Often has difficulty awaiting turn
i. Often interrupts or intrudes on others
 Criteria (DSM IV-TR)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment

were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings

D. There must be clear evidence of clinically significant impairment in social ,

academic, or in occupational functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive

Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are
not better accounted for by another mental disorder (eg. Mood Disorder,
Anxiety Disorder)
 Case Study: Gina, a student with Hyperactivity

Gina was referred to a community clinic because of overactive,

inattentive and disruptive behaviour. Her hyperactivity and uninhibited
behaviour caused problems for her teacher and other students as she
does not follow instructions and fails to finish schoolwork. She would
impulsively hit other children, knock things off their desks, erase material
on the blackboard, and damage books and other school property.
She seemed to be in perpetual motion, talking incessantly, moving about,
and darting from one area of the classroom to another. She demanded
an inordinate amount of attention from her parents and her teacher, and
she was intensely jealous of other children, including her own brother and
sister. Despite her hyperactive behaviour, inferior school performance,
and other problems, she was considerably above average in intelligence.
Nevertheless, she felt stupid and had a serious devaluated self-image.
Neurological tests revealed no significant organic brain disorder.
 Causal Factors

 The causes of ADHD still remain unclear as to what extent the

disorder results from environmental or biological factors (Carr et al,
2006).

 There is a general agreement that processes operating in the brain

are disinhibiting the child’s behaviour (Nigg, 2001), and some
research has found different EEG patterns occurring in children with
ADHD than in children without ADHD (Barry et al, 2003).

 Recent research points to both genetic (Sharp et al, 2009) and

social environmental precursors (Hechtman, 1996).
 Causal Factors

 While some researchers believe that biological factors such as

genetic inheritance will turn out to be important precursors to the
development of ADHD (Durston, 2003), but firm conclusions await
further research.
 Research on psychological causes too have yielded inconclusive
results, although temperament and learning appear likely to be
factors. A study by Goos et al, 2007 has suggested that family
pathology, particularly parental personality can be transmitted to
children.
 However ADHD is currently considered to have multiple causes and
effects (Hinshaw et al, 1997). It is believed that whatever may be
the cause or causes influential in ADHD, the mechanisms underlying
the disorder must be understood and explored.
 Treatments
 The treatment of ADHD with the use of drugs has great appeal in
the medical community. Research has shown how different drugs
help reduce different symptoms exhibited by children with ADHD.
 One of the most frequently used drug is Ritalin, an amphetamine
which has a quieting effect on children by decreasing overactivity
and distractibility. The other medications for treating ADHD include
Pemoline, Strattera, Adderall.
 Some authorities prefer using psychological interventions in
conjunction with medications (Levin et al, 2007). The behavioural
intervention techniques include selective reinforcement in classroom
and family therapy.
 Another effective approach involves the use of behaviour therapy
techniques featuring positive reinforcement and structuring of
learning materials and tasks. The use of psychosocial treatment of
ADHD has also shown positive results.
 ADHD Beyond Adolescence

 Those who retain symptoms, go on to have other psychological

problems such as overly aggressive behaviour or substance abuse in
their early teens or early adulthood (Berkley et al, 2004)
 In a study by Satterfield et al, 2007; it was reported that boys with
conduct problems were later found prone to adult criminality
 In another study by Beiderman et al, 2010; it was observed that girls with
ADHD were later prone to mood, anxiety, eating, addictive, antisocial
disorders
 More longitudinal research has been useful to make predictions
 Predicting number of children whose problem may persist in later years
cannot be said with certainty
 However, significant number of adolescents continue to face problems
in adulthood and also continue their treatment (Doyle, 2006) along with
those for major depression or bi-polar disorder (Klassen et al, 2010)
Thank You