Please enable JavaScript.
Coggle requires JavaScript to display documents.
Childhood Disorders - Coggle Diagram
Childhood Disorders
.
Pathway to Psychological Services
- Observe problem behaviour
- Discuss with GP/specialist
- Referral to mental health professional
- Psychological assessment
- Also called psychological testing > individualised
- Used to measure and observe client’s behaviour > gives full picture of person’s strengths/limitations
- Used to test hypotheses about a patient
- A wide variety of tests and assessments
- Informs diagnosis and treatment planning
- Determining what is abnormal
- Rater-based measures typically include a set of symptoms that don’t directly map onto DSM criteria
- Normative cut-offs
- T-score (standard score)= distribution with M=50, SD=10 > t-scores more than 2 SDs (65+ or 70+) would be rare in a normative sample
Assessment methods for children
- Clinical interviews (clinical/developmental history, diagnostic interview
- Psychological tests (questionnaires, checklists, self-report, rater measures)
- Behavioural observations (clinic, home, school- ABC analysis (antecedent, belief, consequences)
- Specialised testing (IQ/neuropsychological testing, ASD/developmental delay)
- Third-party information (medical/school/legal records, prior psychological testing/reports)
- Comprehensive assessment is essential > gain knowledge about multiple settings (+ multiple reporters), multi-method, relevant developmental information
- For younger children, observation and rater measures are especially important
pathway to treatment
- Diagnose (diagnose the problem)
- Report (prepare report with recommendations
- Recommend (identify evidence-based interventions)
- Treatment (treat or refer to specialist MH professional)
Conduct disorder
- A repetitive and persistent pattern of behaviour involving 3 or more of
- Aggression to people and animals (bullying, physical fights, weapon use, cruelty, forced sexual activity)
- Destruction of property (fire-setting, other vandalism)
- deceitfulness/theft (B&E, conning, shoplifting, forgery)
- Seriously violation of rules (running away, truancy)
- Almost all adult mental disorders were preceded by a childhood conduct disorder
- If we treat conduct disorder, we can prevent a lot of mental health problems in adulthood.
-
What causes conduct disorders?
- Gerald Patterson’s Coercion Theory
- At a time when therapy for children wasn’t really improving their symptoms.
- Studied the micro behaviours that happened between parents and children that lead children to become aggressive
- Kids who had conduct disorder showed the same problem behaviours (whinging, etc) as normal children, but it was much more frequent, and contingent on parent behaviour.
- Coercive cycle > maintains arguing and defiance when a parent tells a child to do something, child refuses, and parent concedes.
- Might extend to other parent, teacher, and peer relationships.
-
how does child behaviour develop?
- Two key principles > parent modelling of behaviours and reinforcement of behaviours.
- Bobo Doll experiment:
- Children were presented people modelling certain behaviours in interacting with dolls and their reactions to these behaviours were observed.
Treating conduct disorders:
- Loss of a conditioned behaviour by removing consequences (reinforcement or punishment)
- Teaching parents of young children especially to increase their positive behaviours but using specific praise. Instead of putting a lot of attention on their negative behaviour, you put more attention on their good behaviour for reinforcement.
- Using appropriate behaviours as reinforcement: specific praise (attention), physical affection, tangible items, desired activities, quality time.
Parent Management Training (PMT)/ Behavioural Parent Training
-Most successful interventions for conduct problems
- Based in social learning and behaviour modification methods
- Therapist teaches caregivers skills to manage problem behaviours.
- Behavioural targets for strategic attention and planned ignoring
- Strategically attend to polite manners, selectively ignore bossiness or demandingness, etc etc.
Intervening in the parent-child relationship
- Constance Hanf’s Intervention
- Developed clinical intervention to strengthen the parent-child relationship and achieve authoritarian and “good enough” parenting.
- Teaching parents play therapy skills to build parent-child bond
- Teaching parents firm limit setting to manage disruptive child behaviours.
- Trained many leading world scholars of parenting interventions
Parent-Child Interaction Therapy
PMT program focused on relationship building and establishing firm boundaries for children
goals
- Establish a more positive parent-child relationship
- Decrease child behaviour problems and increase prosocial behaviours
- Improve parenting skills
- Foster optimal “authoritative” parenting style
research outcomes
- Reduces children’s oppositional non-compliant, aggressive, and destructive behaviour.
- Calms children and improves self-regulation
- Improves children’s self-esteem
- Reduces parent’s stress levels
- Improves family functioning and emotional well-being
- Gains maintain years after PCIT ends
- The most effective psychological intervention
phases
- Child-directed interaction (responsiveness)
- Special play > follow the child’s lead
- Praise: specific praise, enthusiastic, following appropriate behaviour, increases self-esteem
- Reflect: parroting what the child says, repeating, paraphrase or elaborate on what the child says, following appropriate talk, shows you're listening.
- Imitate: copying what the child is doing, following appropriate behaviour, communicates approval of child’s choices
- Describe: say what the child is doing, following appropriate behaviour, increases attention and concentration.
- Enjoy: act warm and happy, smiling/laughing/affectionate, following appropriate behaviour, improves the parent-child relationship
- DON’T give commands, ask unnecessary questions, or criticise/be sarcastic
- STOP the play for aggressive and destructive behaviour
- Parent directed interaction (demandingness)
- Once at mastery in play behaviour, they’ve built up the
- relationship enough for the child to comply with discipline.
- One-quarter of the world’s population are below the age of 15- An estimated 20-40% of children worldwide have a clinically diagnosable mental disorder, and there are many more with subclinical problems
- Mental health problems are overrepresented among the very poor
- Most (80%) children with mental health problems don’t receive the services they need.
- Psychopathy girls historically received less attention than boys.
- Childhood mental disorders overlap substantially
- Most mental illness is preceded by childhood mental illness
- 1 in 2 adults with a diagnosable mental illness had a childhood mental disorder
- Importance of multi-method assessment of children to establish persistence across time and pervasiveness across setting.
Antisocial personality disorder - continual and stable CD and ODD increases risk for antisocial personality disorder
- Pervasive pattern of disregard for/violation of other’s rights occurring since age 15 (3 or more)
- Repeated criminal behaviour
- Repeated lying or conning of others
- Impulsivity or poor planning
- Irritability and aggressive behaviour
- Reckless disregard for other’s safety
- Chronic irresponsibility
- Lack of remorse
- Evidence of conduct disorder before age 15 for diagnosis
Prevalence of disruptive behaviour disorders- Estimates vary across settings, ethnic groups (systematic), age (adolescence= girls more prevalent, adulthood= boys more prevalent), gender, and diagnostic method
- ODD: 3-16% (worldwide- 3.3%)
- CD: 2-16% (worldwide- 3.2%)
- Compared to ADHD 3-15% (worldwide- 5.3%)
- Comorbidities of disruptive behaviour disorders
- attention-deficit/hyperactive disorder: 65-90%
- Internalising problems
- ~33% (community)
- 75% (clinic-referred)
- Particularly for ODD angry/irritable mood
- Consequence of behaviour
- Learning disorders
- Substance abuse disorders
Oppositional defiant disorder
- Pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness involving 4 or more of
- Often loses temper
- Touchy, easily annoyed
- Angry, resentful
- Argumentative
- Defiant and non-compliant
- Deliberately annoys others
- Blames others for mistakes
- spitefulness/vindictiveness
optimal parenting
- Those that fall in the middle, you’re classified as “good enough” for most children > average demandingness and responsiveness.
- Optimal parenting style > authoritative > warm but firm
- Improved social competence
- Higher academic achievement
- Better psychological wellbeing
- Self-regulation skills and independence
- Less risk-taking behaviour
- Improved moral development
- Seen across cultures.