Week 9 Disorders of childhood and adolescence

Question 1

Timeline for childhood disorders

Answer 1

Anxiety disorders - age 6
behavior disorders age 11,
mood disorders age 13,
Suicidal thoughts and behaviors -rare in children - increase dramatically starting age 12
and substance use disorders age 15.

Question 2

Approximately ____ of children and adolescents meet criteria for at least one mental disorder by the age of 18 years

Answer 2

half (49.5 percent)

Question 3

Anxiety disorders are the ____common mental disorder among children and adolescents, occurring at some point in the lifetime of approximately ___ percent of U.S. youth

Answer 3

most
32

Question 4

Anixety disorders in children occur at higher rates among ____ (38 percent) than _____ (26 percent), and most commonly take the form of specific phobias (19 percent), social anxiety disorder (9 percent), separation anxiety disor-der (8 percent), and posttraumatic stress disorder (5 percent)

Answer 4

girls
boys

Question 5

Separation anxiety disorder is characterized by surroundings

Answer 5

excessive anxiety about separation from major attachment figures, such as mothers, and from familiar home

Question 6

Separation anxiety is slightly more common in ____(9 percent) than ____ (6 percent)

Answer 6

girls
boys

Question 7

_______rapidly inhibit the central nervous system (CNS), providing a calming effect, and _______ , which increase the availability of serotonin over time

Answer 7

benzodiazepines
selective serotonin reuptake inhibitors

Question 8

__-__ ___ has been shown to be highly effective at reducing anxiety symptoms in young children, with approximately two-thirds of children and adolescents showing significant improvement from this treatment

Answer 8

Cognitive-behavior therapy (CBT)

Question 9

Exposure-based therapies have proven to be quite effective in the treatment of adult, adolescent, and child_____.

Answer 9

anxiety

Question 10

Importantly, recent research has shown that the more time the child spends engaged in exposures to the fear stimulus, and the more difficult those exposures are (e.g., facing something that is really feared vs. only mildly feared), the _____ the outcome of the intervention

Answer 10

better

Question 11

One modification used for diagnosing depression in children is that ______is often found as a major symptom and can be substituted for depressed mood

Answer 11

irritability

Question 12

Bipolar disorder occurs less frequently (__ percent), but it can be diagnosed in children and adolescents

Answer 12

3

Question 13

Approximately ___percent of children and adolescents meet criteria for major depression at some point in their lives, with higher rates in girls (__percent) than boys (___ percent)

Answer 13

12
16
8

Question 14

There appears to be an association between parental _____ and behavioral and mood problems in children

Answer 14

depression

Question 15

Two of the most common externalizing disorders are…

Answer 15

oppositional defiant disorder
and conduct disorder

Question 16

Oppositional defiant disorder (ODD) is characterized by a…

Answer 16

recurrent pattern of negativistic, defiant, disobedient and hostile behavior toward authority figures that persists for at least 6 months

Question 17

Oppositional defiant disorder (ODD) is grouped into three subtypes:

Answer 17

angry/irritable mood,
argumentative/defiant behavior,
and vindictiveness.

Question 18

virtually all cases of conduct disorder are preceded developmentally by ____, but not all children with ___ go on to develop conduct disorder within a 3-year period

Answer 18

ODD
ODD

Question 19

risk factors for both ODD and conduct disorder include (4)

Answer 19

family discord,
socioeconomic disadvantage,
antisocial behavior in the parents,
and overlapping neural correlates

Question 20

Conduct disorder (CD) is characterized by a…

Answer 20

persistent, repetitive violation of rules and a disregard for the rights of others

Question 21

CD has a median age of onset of 12 years…and is more prevenalt among…

Answer 21

(meaning half of those who ever develop this disorder have it by age 12) and a lifetime prevalence of 10 percent

CD is more common among boys (12 percent) than girls (7 percent).

Question 22

CD diagnoses based on the following (5)

Answer 22

(1) rule violations (26 percent of those with CD),
(2) deceit/theft (13 percent),
(3) aggressive behavior (3 percent),
(4) severe forms of subtypes 1 and 2 (29 percent), and
(5) a combination of subtypes 1, 2, and 3 (29 percent)

Question 23

DSM-5 Criteria for. . . Conduct Disorder

Answer 23

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

Aggression to People and Animals
1. Often bullies, threatens, or intimidates others.
2. Often initiates physical fights.
3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).

4. Has been physically cruel to people. 5. Has been physically cruel to animals. 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
5. Has forced someone into sexual activity. Destruction of Property 8. Has deliberately engaged in fire setting with the intention of causing serious damage.
6. Has deliberately destroyed others’ property (other than by fire setting).
   Deceitfulness or Theft
7. Has broken into someone else’s house, building, or car. 11. Often lies to obtain goods or favors or to avoid obliga-tions (i.e., “cons” others).
8. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).

Serious Violations of Rules
13. Often stays out at night despite parental prohibitions, beginning before age 13 years.

14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
15. Is often truant from school, beginning before age 13 years.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

Question 24

Between ___ and ___ percent of people who have a mental disorder during adulthood had a history of CD and/or ODD during childhood or adolescence

Answer 24

25 and 60

Question 25

genetic predisposition leading to low verbal intelligence, mild neuropsychological problems, and difficult temperament can set the stage for early-onset ___

Answer 25

CD

Question 26

The link between ___ and antisocial personaity is stronger among lower-socioeconomic-class children

Answer 26

CD

Question 27

standard talk therapies are not effective in treating ODD and ___

Answer 27

CD

Question 28

2 successful ways of treating children with ODD and CD

Answer 28

1. Parent management training: an approach in which the clinician teaches the parents how to effectively prompt and reinforce prosocial behaviors while ignoring aggressive or antisocial behaviors, has been shown to be quite successful.
2. The clinician meets with the child to teach social problem-solving skills (such as how to generate and perform more adaptive responses to others) also has proven effective.

Question 29

section—“elimination disorders” (enuresis and encopresis)—involve

Answer 29

a single outstanding symptom rather than a pervasive maladaptive pattern.

Question 30

The term enuresis refers to…

Answer 30

the habitual involuntary dis-charge of urine, usually at night, after the age of expected continence (age 5).

Question 31

Children who have primary functional enuresis have _______while children who have secondary functional enuresis have…

Answer 31

never been continent;
been continent for at least a year but have regressed.

Question 32

Prevalence of enuresis are __ to __ percent among 5-year-olds, __ to __ percent among 10-year-olds, and __.1 percent among children ages 15 or older

Answer 32

5 to 10
3 to 5
1

Question 33

psychological and environmental factors that can play a role in enuresis are: (4)

Answer 33

(1) failure to learn how to inhibit reflexive bladder emptying;
(2) psychological immaturity, associated with or stemming from emotional problems;
(3) disturbed family interactions, particularly those that lead to sustained anxiety; and (4) stressful events

Question 34

Conditioning procedures have proved to be highly
effective treatment for ______ (include example name)

Answer 34

enuresis (bell and pad)

Question 35

The term ______ describes a symptom disorder of children who have not learned appropriate toileting for bowel movements after age 4.

Answer 35

encopresis

Question 36

The average age of children with encopresis was ___, with a range of ages ___ to ___.

Answer 36

7
4 to 13

Question 37

The rate of ADHD is much higher in boys (13 percent) than in girls (___percent) and is commonly comorbid with other externalizing disorders such as ___ and ___

Answer 37

4
ODD and CD

Question 38

Interestingly, however, most cases of adult ADHD are characterized by symptoms of inattention (95 percent), whereas a much smaller percentage are characterized by hyperactivity (___percent)

Answer 38

35

Question 39

It is estimated that approximately 4 percent of U.S. adults meet criteria for ADHD, with higher rates among those who are (3)

Answer 39

male,
divorced, and
unemployed

Question 40

DSM-5 Criteria for. . . Attention-Deficit/Hyperactivity Disorder

Answer 40

A. A persistent pattern of
inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):

1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.

a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).

b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).

d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the work-place (e.g., starts tasks but quickly loses focus and is easily sidetracked).

e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).

f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, review-ing lengthy papers).

g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).

i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, re-turning calls, paying bills, keeping appointments).

2. Hyperactivity and impulsivity:

Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.

a. Often fidgets with or taps hands or feet or squirms in seat.

b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the class-room, in the office or other workplace, or in other situations that require remaining in place).

c. Often runs about or climbs in situations where it is inappropriate.

(Note: In adolescents or adults, may be limited to feeling restless.)

d. Often unable to play or engage in leisure activities quietly.

e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).

f. Often talks excessively.

g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).

h. Often has difficulty waiting his or her turn (e.g., while waiting in line).

i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).

D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

Question 41

The drug _____ is very different from Ritalin; it exerts beneficial effects on classroom behavior by enhancing cognitive processing and has fewer adverse side effects than Ritalin

Answer 41

Pemoline

Question 42

The behavioral intervention techniques that have been developed for ADHD include (3)

Answer 42

teaching organizational and planning skills,
techniques for decreasing distractibility and procrastination,
parenting techniques focused on providing reinforcement for adaptive child behavior

Question 43

Autism spectrum disorder (which we refer to as “autism”) is a….

Answer 43

is a neurodevelopmental disorder that involves a wide range of problematic behaviors including deficits in lan-guage and perceptual and motor development; defective reality testing; and impairments in social communication.

Question 44

__.__% of children and adolescents meet criteria for autism (__.__% of boys and __.__% of girls)

Answer 44

2.4

3.5
1.2

Question 45

children diagnosed with autism by age ___ tend to be similarly diag-nosed at age ___.

Answer 45

2
9

Question 46

Recent research suggests that early signs of problems with social communication can be detected in the first ___ months of an infant’s life

Answer 46

6

Question 47

DSM-5 Criteria for… Autism Spectrum Disorder

Answer 47

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaus-tive; see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to ab-normalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to diffi-culties in sharing imaginative play or in making friends; to absence of interest in peers.

B. Restricted, repetitive patterns of behavior, interests, or activi-ties, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transi-tions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoc-cupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper-or hyporeactivity to sensory input or unusual inter-est in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touch-ing of objects, visual fascination with lights or movement).

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strat-egies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual dis-ability (intellectual developmental disorder) or global develop-mental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Question 48

echolalia

Answer 48

the parrot-like repetition of a few words.

Question 49

___ to ___ percent of siblings of children diagnosed with autism also have the disorder, and approximately 20 percent have some symptoms of the disorder

Answer 49

2 to 14

Question 50

They are trying to determine what portion of the genetic risk of autism is inherited (___percent) and what portion is due to de novo genetic mutations (__percent).

Answer 50

52
3

Question 51

intensive behavioural training/therapy (conditioning) has led to very successful outcomes in Autism. Program lasts…

Answer 51

40 hours a week for 2 years.

Of the treated children in the study by Lovaas and colleagues, 47 percent achieved normal intel-lectual and educational functioning, compared with only 2 percent of children in the untreated control condition.

Question 52

lifetime prevalence of tic disorders (TDs) is ___.6 percent for transient tic disorder (TTD), 3.7 percent for chronic tic disorder (CTD), and ___.6 percent for Tourette’s disorder

Answer 52

2
0

Question 53

The average age of onset for Tourette’s disorder is ___, and most cases have an onset before age 14.

Answer 53

7

Question 54

Among medications, antipsychotic and noradrenergic
drugs are most effective for the treatment of ______ and ___disorders

Answer 54

Tourette’s
tic

Question 55

Learning disorders are

Answer 55

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.

Question 56

Estimates suggest that 2 to 10 percent of children have a learning disorder, most often classified as dyslexia (80 per-cent), with about 30 percent of children with a learning dis-order also suffering from a comorbid disorder such as ADHD, depression, or anxiety

Question 57

Significantly more boys than girls are diagnosed as having a learning disorder, but estimates of the extent of this gen-der discrepancy have varied widely from study to study

Question 58

Specifically, there appears to be dysfunc-tion in the left hemisphere’s reading network among peo-ple with dyslexia

Question 59

functional magnetic resonance imaging (see Chapter 4) has suggested that people with dyslexia have a deficiency of physiological activation in the cerebellum

Question 60

Intellectual disability is characterized by

Answer 60

deficits in general mental abilities, such as reasoning, prob-lem solving, planning, abstract thinking, judgment, aca-demic learning, and learning from experience

Question 61

The prevalence of diag-nosed intellectual disability in the United States is esti-mated to be about __ percent,

Answer 61

1

Question 62

IQ of Mild Moderate Severe Profound intellectual disability

Answer 62

50-55 to 70
35-40 to 50-55 (of 7-year old)
20-25 to 35-40
Below 20-25.

Question 62

IQ of Mild Moderate Severe Profound intellectual disability

Answer 62

50-55 to 70
35-40 to 50-55 (of 7-year old)
20-25 to 35-40
Below 20-25.

Question 63

Down Syndrom prevalence reported to be ____ per 10,000 of the general population

Answer 63

5.9 (or 0.059%)

Question 64

In _________, a baby appears normal at birth but lacks a liver enzyme needed to break down phenylalanine, an amino acid found in many foods. The genetic error results in intellectual disability only when significant quantities of phenylalanine are ingested, which is virtually certain to occur if the child’s condition remains undiagnosed

Answer 64

phenylketonuria (PKU)

Question 65

______ occurs in about 1 in 12,000 births

Answer 65

phenylketonuria (PKU)

Question 66

macrocephaly

Answer 66

(“large-headedness”)

Question 67

microcephaly

Answer 67

(“small-head-edness”) - more than three standard deviations below that of children of the same age and sex and is caused by decreased growth of the cerebral cortex during infancy

Question 68

Primary microcephaly refers to…., and secondary microcephaly refers to….

Answer 68

decreased brain growth during pregnancy
decreased brain growth during infancy

Question 69

Children with microcephaly fall within the ___,___,___ categories of intellectual disability and most show little language development and are extremely limited in mental capacity.

Answer 69

moderate, severe, and profound

Question 70

Hydrocephaly is a relatively rare disorder in which…the degree of intellectual impairment

Answer 70

the accumulation of an abnormal amount of cerebrospinal fluid within the cranium causes damage to the brain tissues and enlargement of the skull.

The degree of intellectual impairment varies, being severe or profound in advanced cases

Question 71

4 times when children can receive care without parental consent:

Answer 71

court order,
mature child,
emancipated child,
emergency situation