Psychological problems in childhood & adolescence

A few details……...

CONTACTING ME:CONTACTING ME:

Dr Sue JacksonDr Sue Jackson Room 514 EasterfieldRoom 514 Easterfield Ext 8232Ext 8232 sue.jackson@vuw.ac.nzsue.jackson@vuw.ac.nz Office hours: Mon, Office hours: Mon, 10.00-11.00, Thurs 4.00-5.00 10.00-11.00, Thurs 4.00-5.00

or make an appt. or make an appt.

COURSE OVERVIEW

Classification & modelsClassification & models Classification & modelsClassification & models Child AbuseChild Abuse Childhood Anxiety: PTSDChildhood Anxiety: PTSD Attention Deficit Hyperactivity DisorderAttention Deficit Hyperactivity Disorder Conduct Disorder in AdolescenceConduct Disorder in Adolescence Depression in AdolescenceDepression in Adolescence Anorexia in AdolescenceAnorexia in Adolescence Approaches to therapy with children & adolescentsApproaches to therapy with children & adolescents ReviewReview

THE READINGS

ESSENTIAL:ESSENTIAL: Readings on closed reserve Readings on closed reserve

in library in library

SUPPLEMENTARY:SUPPLEMENTARY: Carr, A. (1999). The handbook of child and Carr, A. (1999). The handbook of child and

adolescent clinical psychology. London: adolescent clinical psychology. London: RoutledgeRoutledge

THE TEST

…………..will cover all of child/adolescent ..will cover all of child/adolescent lectures up and including August 2lectures up and including August 2ndnd

…………..will be short answers..will be short answers …………..will be preceded by a review lecture ..will be preceded by a review lecture

Today’s Lecture Questions

What is the history of clinical child psychology?What is the history of clinical child psychology? What is the Diagnostic and Statistics Manual What is the Diagnostic and Statistics Manual

(DSM)and how does it categorise problems of (DSM)and how does it categorise problems of childhood and adolescence?childhood and adolescence?

How useful is the DSM for psychological How useful is the DSM for psychological problems of childhood and adolescence?problems of childhood and adolescence?

What alternatives are there to the medical model What alternatives are there to the medical model on which DSM is based?on which DSM is based?

Some history……..

Discipline of clinical child psychology dates to 1896Discipline of clinical child psychology dates to 1896 Lightner Witner- first psychological clinic for children Lightner Witner- first psychological clinic for children

in USA 1896in USA 1896 ADHD- 100 years old- Still (1902) ,a doctor, ADHD- 100 years old- Still (1902) ,a doctor,

misbehaviour due to biological and moral “defects”misbehaviour due to biological and moral “defects” Conduct Disorder- roots in juvenile delinquency, end Conduct Disorder- roots in juvenile delinquency, end

of C19th youth crime differentiated from adult crimeof C19th youth crime differentiated from adult crime

Famous early child case studies

Freud and the case of Freud and the case of little Hans (1909)little Hans (1909)

Diagnosis by letterDiagnosis by letter Hans, five, developed Hans, five, developed

fear of horsesfear of horses Freud interpreted as Freud interpreted as

fear of dad and sexual fear of dad and sexual desire for motherdesire for mother

Little Albert

John Watson (1920)John Watson (1920) Baby Albert- 11 months Baby Albert- 11 months Rat (unknown age)Rat (unknown age) Conditioned fear of rats in AlbertConditioned fear of rats in Albert If Albert alive today, probably still be rat phobicIf Albert alive today, probably still be rat phobic

THE DSM

DSM-1- two separate diagnoses for children DSM-1- two separate diagnoses for children (1952)(1952)

DSM-II (1968) seven diagnoses DSM-II (1968) seven diagnoses DSM-III (1980) 40 diagnosesDSM-III (1980) 40 diagnoses DSM-IV-R 50 and still risingDSM-IV-R 50 and still rising Are children more psychologically disturbed Are children more psychologically disturbed

than they were or are there other reasons for than they were or are there other reasons for the rising number of problem?the rising number of problem?

DSM and the production of mental health problems

DSM & mental illness as socially constructed-some DSM & mental illness as socially constructed-some examples:examples:

Historical: mental illness possession by devils, Historical: mental illness possession by devils, ‘draeoptomania’, illness of the slaves ‘draeoptomania’, illness of the slaves

Social: homosexuality a mental disorder until late Social: homosexuality a mental disorder until late 1980s1980s

Cultural: ‘hallucinations’ may be of spiritual Cultural: ‘hallucinations’ may be of spiritual significancesignificance

Mental illness as a “business” , diagnoses as a basis Mental illness as a “business” , diagnoses as a basis for service provision and for drug prescription for service provision and for drug prescription

DSM Child/Adolescent Disorders

Disorders first Disorders first diagnosed in infancy, diagnosed in infancy, childhood or childhood or adolescence:adolescence:

Mental retardationMental retardation Learning disordersLearning disorders Motor skill disordersMotor skill disorders Communication disordersCommunication disorders Pervasive developmental Pervasive developmental

disordersdisorders

Attention deficit and Attention deficit and disruptive behaviourdisruptive behaviour

Feeding and eating Feeding and eating disordersdisorders

Tic disordersTic disorders Elimination disorders- Elimination disorders-

enuresis, encopresisenuresis, encopresis Other- separation anxiety, Other- separation anxiety,

mutism, reactive mutism, reactive attachment disorderattachment disorder

Child disorders classified with adult disorders Mood- in children unipolar depression onlyMood- in children unipolar depression only Anxiety- generalised, obssessive-compulsive, Anxiety- generalised, obssessive-compulsive,

PTSDPTSD Dissociative disordersDissociative disorders - -disrupted integration disrupted integration

memory, identity, consciousnessmemory, identity, consciousness Eating disordersEating disorders

How useful is DSMIV for children & adolescents?1.1. ReliabilityReliability Clinician agreement on diagnosis poor e.g.:Clinician agreement on diagnosis poor e.g.:Conduct Disorder .62Conduct Disorder .62Depression .62Depression .62Anxiety .52Anxiety .52ADHD .52ADHD .522.2. ValidityValidity Significant overlap in factors that Significant overlap in factors that

contribute to onset of problems contribute to onset of problems (low validity)(low validity)

How useful is DSMIV for children & adolescents?3. Co-morbidity3. Co-morbidity

Community based studies (cited Carr)Community based studies (cited Carr) CD and ADHD 23.3%CD and ADHD 23.3%

and Major Depression 16.9%and Major Depression 16.9%

and anxiety disorders 14.8%and anxiety disorders 14.8% ADHD and Major Depression 10.5%ADHD and Major Depression 10.5%

and Anxiety Disorders 11.8%and Anxiety Disorders 11.8% Anxiety and Major Depression 16.2%Anxiety and Major Depression 16.2%

How useful is DSMIV for children & adolescents?

4. Categorical approach4. Categorical approach ““got it, ain’t got it” categorical approach doesn’t got it, ain’t got it” categorical approach doesn’t

address social contexts/interactionsaddress social contexts/interactions

5. Ethical problems5. Ethical problems pathologising young people, stigmatisationpathologising young people, stigmatisation

6. “Adultmorphism”6. “Adultmorphism” failure to incorporate developmental perspectivefailure to incorporate developmental perspective criteria of subjective distress and impairment in criteria of subjective distress and impairment in

functioning often not applicable (Anna Freud)functioning often not applicable (Anna Freud)

How useful is DSMIV for children & adolescents?

7. Gender bias7. Gender bias 21 childhood disorders, 17 more common in boys 21 childhood disorders, 17 more common in boys

(girls>internalisng, boys>externalisng)(girls>internalisng, boys>externalisng) Conduct disorder- criteria > specific to boys e.g. Conduct disorder- criteria > specific to boys e.g.

sexual behavioursexual behaviour Different patterns for CD in boys and girlsDifferent patterns for CD in boys and girls8. Misdiagnosis is a significant problem8. Misdiagnosis is a significant problem Particularly due to comorbidity, developmental Particularly due to comorbidity, developmental

factorsfactors

Externalising behaviours – aggression, Externalising behaviours – aggression, non-compliance, drug abuse non-compliance, drug abuse (relate to more conduct type (relate to more conduct type problems, ADHD, ODD) problems, ADHD, ODD)

Internalising behaviours- crying, Internalising behaviours- crying,

worrying, withdrawal (relate to worrying, withdrawal (relate to anxiety, depression) anxiety, depression)

Dimensional model

Construction of dimensions: Child Behaviour Checklist Achenbach the author of CBCLAchenbach the author of CBCL Collection of behaviours from case studies and Collection of behaviours from case studies and

literature to form CBCL (118 items)literature to form CBCL (118 items) 1800 parents of clinic children completed CBCL1800 parents of clinic children completed CBCL Factor analysis leading to narrow band syndromes-Factor analysis leading to narrow band syndromes-

e.g. wirhdrawn, aggressione.g. wirhdrawn, aggression Grouping of narrow band into wide band- Grouping of narrow band into wide band-

internalising and externalisinginternalising and externalising Norms on 1400 non clinical childrenNorms on 1400 non clinical children Cut-off scores for children outside normal range-Cut-off scores for children outside normal range-

clinicalclinical

Critique

Continuum- links ‘normal’ development to Continuum- links ‘normal’ development to problems with extreme points on continuum problems with extreme points on continuum leading to referralleading to referral

Doesn’t account for more specific problems like Doesn’t account for more specific problems like autism, toileting problems, eating disordersautism, toileting problems, eating disorders

Problems around agreement parent/teacher/child Problems around agreement parent/teacher/child reports and subjectiveness of each- reports and subjectiveness of each- parents/teachers tend to be better informants for parents/teachers tend to be better informants for externalising problems, children better for externalising problems, children better for internalising problemsinternalising problems

Today’s Lecture Questions

At this point you should have some idea of At this point you should have some idea of how to answer them.how to answer them.

Doing the readings should help you expand Doing the readings should help you expand your knowledge a little more.your knowledge a little more.