Learning Objectives

1. List special features of childhood disorders that make them different

from adult disorders, and describe how young children are especially
vulnerable to develop psychological problems.

Childhood disorders differ from adult disorders mainly in their

development context and the way they manifest and affect a child's
life. Special features of childhood disorders include their occurrence
during developmental stages when children are evolving rapidly both
physically and psychologically. This makes children particularly
vulnerable as their sense of self, understanding of the world, and
coping mechanisms are still forming.

Children's perception of themselves and their world is less complex

and less stable, leading to a higher susceptibility to psychological
challenges. They may also lack the experience and skills needed to
manage adversity effectively. Due to their development stage,
children may perceive threats as more immediate and significant,
which can overwhelm their coping abilities. Moreover, children are
more dependent on adults for support, making them particularly
susceptible to the impacts of their environment, including the
potential for negative influences such as abuse or neglect.

In terms of psychological problems, young children's behaviors must

be evaluated against typical developmental milestones. Behaviors that
might be expected at one age can be signs of a disorder at another.
Therefore, childhood disorders are often assessed with consideration
to age-appropriate norms and developmental trajectories.

In sum, childhood disorders are specialized due to the intersection of

developmental changes and psychological symptoms. This makes
early identification and intervention crucial to support a child's
potential for positive growth and adjustment.
2. Discuss general issues in the classification of childhood and adolescent
disorders.

These general issues highlight the complexity of diagnosing and

treating childhood and adolescent disorders, underscoring the need
for a nuanced approach that considers the unique aspects of
development during these life stages.

- Developmental Appropriateness: It's challenging to determine

what constitutes abnormal behavior in children because of the
wide variance in developmental stages. What is normal at one
age may be a sign of a disorder at another.
- Continuity and Change: Assessing whether a child's behavior is
a transient phase or an early sign of a long-term disorder is
difficult. Some behaviors that are problematic in childhood may
persist into adulthood, while others may resolve as the child
matures.
- Comorbidity: Childhood disorders often occur with other
disorders, making diagnosis and treatment more complex.
- Different Presentation: Some disorders manifest differently in
children than in adults. For example, depression in children can
appear as irritability rather than sadness.
- Diagnostic Criteria: Many of the diagnostic criteria for disorders
are based on adult presentations, which might not always fit for
children.
- Environmental Influence: Children's behavior is strongly
influenced by their environment. Issues in classification arise
when trying to discern if the behavior is a direct result of the
environment or indicative of a disorder.
- Lack of Child-Specific Research: There's a historical lack of
research specifically focused on childhood disorders, which has
implications for the development of appropriate diagnostic
criteria and treatment approaches.
- Cultural Considerations: Children's behaviors are often judged
against cultural norms, which can vary widely. What is
considered a disorder in one culture may be seen as appropriate
in another.
 - Changing Norms Over Time: As societal norms change,
behaviors that were once considered abnormal may become
accepted, leading to changes in diagnostic criteria.

3. Describe the clinical features, list several of the multiple causes, and
summarize approaches to treatment of attention-deficit hyperactivity
disorder(ADHD).

**Clinical Features:

Persistent Inattention: Difficulty sustaining attention, overlooking

details, and making careless mistakes in tasks.

Hyperactivity: Excessive fidgeting, restlessness, and an inability to

play or engage in activities quietly.

Impulsivity: Acting without thought, interrupting others, and difficulty

waiting for turns.

**Causes:

Genetic Factors: Family studies indicate a genetic component to

ADHD.

Brain Structure and Function: Smaller total brain volumes and

maturational delays, particularly in prefrontal regions involved in
attention and impulsivity.

Environmental Influences: Prenatal exposure to toxins, low birth

weight, and psychosocial factors such as family conflict and parenting
style.

**Treatment Approaches:

Medications: Stimulants (e.g., methylphenidate and amphetamines)

are commonly used to reduce symptoms of hyperactivity and
impulsivity.
 Behavioral Interventions: Parent management training, educational
support, and behavioral therapy to improve organizational and
planning skills.

Combined Treatments: Evidence suggests that a combination of

medication and behavioral interventions is often more effective than
either approach alone.

4. Describe the clinical features, causal factors, and treatment of conduct

disorder and oppositional defiant disorder (ODD).

**Conduct Disorder (CD):

Clinical Features:

- Persistent rule violations.

- Disregard for the rights of others.
- Variability in clinical presentation with subtypes based on the
predominant symptom pattern, such as rule violations,
deceit/theft, and aggressive behavior.

Causal Factors:

- Genetic predisposition leading to low verbal intelligence,

neuropsychological problems, and difficult temperament.
- Early-onset CD is linked to a higher likelihood of developing
psychopathy or antisocial personality disorder in adulthood,
especially among lower socioeconomic classes.
- Environmental factors such as family conflict, harsh and
inconsistent discipline, and association with deviant peers.

Treatment Approaches:

- Treatments focus on modifying the family and broader

environment.
 - Parent management training to reinforce prosocial behaviors
and ignore aggressive behaviors.
- Social problem-solving skills training for the child.
- Fast Track Prevention Program for at-risk children

Oppositional Defiant Disorder (ODD):

The information provided does not specifically break down the clinical
features, causes, and treatments for ODD separately from CD.
However, generally, ODD is characterized by a pattern of
angry/irritable mood, argumentative/defiant behavior, and
vindictiveness. Similar to CD, the causal factors can include a
combination of genetic, psychological, and environmental influences,
and treatment often involves parent management training and therapy
that targets social skills and problem-solving abilities

5. Describe the clinical features, causal factors, and treatment of the

anxiety disorders of childhood

**Clinical Features:

- Anxiety during childhood is a part of normal development, but

it becomes pathological when it is extreme, persistent, and
developmentally inappropriate.
- Common forms of anxiety disorders in children and adolescents
include specific phobias, social anxiety disorder, separation
anxiety disorder, and posttraumatic stress disorder.
- Separation anxiety disorder is marked by excessive fear of
separation from attachment figures and familiar surroundings.
Affected children may lack self-confidence, be shy, sensitive,
nervous, and easily discouraged.

**Causal Factors:

- Genetic factors may contribute, especially in disorders like

obsessive-compulsive disorder.
 - Social and cultural influences, including family stress and
minority family dynamics, can play significant roles.
- Early sensitivity and easy conditioning by aversive stimuli can
lead to a buildup of fear reactions. Children may become
anxious due to early negative experiences or changes in life
circumstances.

**Treatment Approaches:

- Psychopharmacological treatments are common and include

benzodiazepines for their calming effect and selective serotonin
reuptake inhibitors to increase serotonin availability.
- Cognitive-behavior therapy (CBT) is highly effective, with two-
thirds of treated children showing significant improvement.
Treatment typically involves psychoeducation, systematic
exposure to the feared stimulus, and positive reinforcement for
exposure.
- The intensity and duration of exposure are critical for successful
outcomes, with more challenging exposures leading to better
results

6. Describe the clinical features, causal factors, and treatment of

childhood depression.

Clinical Features:

- Childhood depression is characterized by symptoms similar to

adult depression: sadness, withdrawal, crying, poor sleep, and
appetite. Additionally, irritability can often be a major symptom
in children, and it can be considered as a substitute for
depressed mood in diagnostic criteria.

Causal Factors:

- The causal factors in childhood anxiety disorders also apply to

depressive disorders. Parental depression is associated with
 behavioral and mood problems in children, suggesting a
hereditary or environmental link.

Treatment Approaches:

- Approximately one-third of children and adolescents with

depression receive mental health treatment. Medications used
for adults, like antidepressants, are also used for children,
although their effectiveness in children has been mixed. Some
studies suggest drugs like fluoxetine (Prozac) can be more
effective than a placebo, but concerns about side effects and the
potential increase in suicidal thoughts and behaviors have been
raised.
- Psychological treatments, particularly Cognitive-Behavioral
Therapy (CBT), have been proven effective. Controlled studies
indicate significantly reduced symptoms in adolescents treated
with CBT. Comprehensive meta-analytic studies and
longitudinal follow-ups also support the effectiveness of
psychological interventions in treating child and adolescent
depression, noting that such treatments are especially effective
in the short term and can also decrease anxiety symptoms

7. Summarize what is known about the symptom disorders of functional

enuresis, functional encopresis, sleepwalking, and tics as they occur in
children and adolescents.

Functional Enuresis:

- Definition: Habitual, involuntary discharge of urine, usually at

night, in children over the age of 5.
- Types:
1. Primary: The child has never been continent.
2. Secondary: The child has regressed after being continent
for at least a year.
- Prevalence: About 5 to 10 percent among 5-year-olds, 3 to 5
percent among 10-year-olds, and 1.1 percent among 15-year-
olds.
 - Causes: Can be due to genetic predisposition, disturbed cerebral
control of the bladder, or psychological factors such as failure to
learn to inhibit bladder emptying, emotional problems, and
stressful events.
- Treatment: Conditioning procedures like the bell-and-pad
method are highly effective. Medications like imipramine or
desmopressin can be used but often have temporary effects and
may result in relapse.

Functional Encopresis:

- Definition: Inappropriate toileting for bowel movements after

age 4.
- Prevalence: Roughly 1 percent among 5-year-olds.
- Characteristics: More common in boys, with many cases also
presenting enuresis. Stress can trigger soiling, and some
children may not recognize the need to have a bowel movement.
- Causes: Often associated with constipation, requiring a physical
examination for diagnosis.
- Treatment: Includes both medical and psychological methods.
Conditioning procedures have moderate success, but a minority
of children do not respond well to these treatments.

Tics:

- Defined as persistent, intermittent muscle twitches or spasms,

usually limited to a localized muscle group.
- Can include actions like blinking, twitching the mouth, licking
the lips, shrugging the shoulders, clearing the throat, and
grimacing.
- Tics are most common between ages 8 and 14.
- Individuals may be unaware of the tic as it often becomes a
habitual action.

Tourette’s Disorder:

- Classified as a motor disorder involving multiple motor and

vocal patterns, which are often uncontrollable.
 - Typical symptoms include head movements accompanied by
sounds such as grunts, clicks, yelps, sniffs, or words.
- Many tics are preceded by an urge or sensation that is relieved
by executing the tic.
- About 0.5% of children and adolescents have Tourette’s
disorder.
- Around one-third of individuals with Tourette's disorder
manifest coprolalia, which involves the uttering of obscenities.
- The average age of onset is 7, with most cases starting before
age 14.
- The disorder often persists into adulthood and is more frequent
among males than females.
- Evidence suggests a strong biological basis for Tourette’s
disorder, although the exact cause is undetermined

8. Describe the clinical features, causal factors, and treatment of autism.

**Clinical Features:

- Autism spectrum disorder encompasses a range of problematic

behaviors, including deficits in language, perception, motor
development, reality testing, and social communication.
- Early signs can include a lack of social engagement, such as not
being cuddly, not reaching out, not smiling, or seeming
unaware of others.
- Self-stimulation behaviors like headbanging, spinning, and
rocking are often characteristic.
- Children with autism may not show typical needs for affection
or contact but still express emotions, indicating a deficit in
social understanding rather than a lack of emotional reactions.
- They often exhibit deficits in attention and may respond
inconsistently to auditory stimuli, showing distress or lack of
response to sounds.

**Causal Factors:
 - The exact causes of autism are not fully understood, but there is
a significant heritable component.
- A multitude of genes are associated with an increased risk of
autism, indicating various paths to developing the disorder.

**Treatment:

- Historically, the prognosis for many children with autism has

been poor due to insufficient treatment and a prevalence of
ineffective treatment fads.
- Intensive behavioral interventions, such as those developed by
Ivar Lovaas, which include over 40 hours per week of one-on-
one therapy, have shown positive results.
- The Early Start Denver Model (ESDM) has been successful,
showing significant improvements in IQ, language, adaptive
behavior, and a decrease in symptoms of autism. This model
focuses on interpersonal exchanges and communication and
requires substantial involvement from both therapists and
parents.

9. Review treatment approaches, outcomes, and prevention with regard

to mental retardation (Intellectual Disability).

**Treatment Approaches:

- Children with intellectual disabilities benefit from special

education and various rehabilitative measures.
- The effectiveness of these interventions can vary greatly
depending on the individual's specific condition and level of
disability.
- It's essential to tailor the educational and therapeutic strategies
to the child's unique needs to enhance their adaptive capacity.
 **Outcomes:

- The outcomes for children with intellectual disabilities have

improved due to these specialized programs.
- Parents play a crucial role in the childrearing process, which
can be challenging due to the associated higher incidence of
mental health problems in children with learning disabilities.
- Decisions about the care environment, such as home care
versus institutionalization, can significantly affect outcomes.

** Prevention:

- Early diagnosis is crucial, especially since severe and profound

intellectual disabilities can often be identified in infancy due to
physical malformations and grossly delayed development.
- While the text does not provide specific prevention strategies, it
is implied that early identification and intervention can mitigate
the progression and impact of intellectual disabilities.

10. Describe the clinical features, causal factors, and treatment of

learning disorders.

**Clinical Features:

- Learning disorders involve delays in cognitive development,

particularly affecting language, speech, mathematical, or motor
skills.
- Dyslexia is a well-known form of learning disorder,
characterized by difficulties in word recognition, reading
comprehension, spelling, and memory. Individuals with
dyslexia may also exhibit slow and erroneous reading.
- Diagnosis requires a clear impairment in school performance or
in daily living activities, not accounted for by intellectual
disability or pervasive developmental disorders like autism.

Causal Factors:
 - Learning disorders may result from subtle central nervous
system (CNS) impairments, including immaturity, deficiency,
or dysregulation in brain functions related to cognitive skills
acquisition.
- Dyslexia has been linked to a lack of normal asymmetrical brain
development and dysfunction in the left hemisphere's reading
network. Deficiency in physiological activation in the
cerebellum is also noted.
- There is a suggestion of genetic transmission for the
vulnerability to develop learning disorders.

Treatment:

- Effective treatments leading to significant improvements in

academic outcomes have been identified.
- Phonics instruction, which involves teaching children the
correspondence between letters and sounds and how to decode
and create syllables, is associated with marked improvements in
reading and spelling abilities.

Outcomes:

- While the exact causes of learning disorders are not fully

understood, current treatments can lead to significant academic
improvement.
- There is a gender discrepancy in diagnosis, with more boys than
girls identified as having a learning disorder. Comorbid
conditions such as ADHD, depression, or anxiety are common
in children with learning disorders.

Note: Accurate identification and effective intervention remain crucial

areas for improvement. The prevalence of learning disorders in
children is estimated to be between 2 to 10 percent, with dyslexia
being the most common form. The disparity between expected and
actual academic achievement is a key factor in identifying children
with these disorders
11. Explain the four levels of mental retardation, and describe the
functioning associated with each level.

**Mild Intellectual Disability:

- IQ scores range from 50–55 to approximately 70.

- Adults with mild intellectual disability have intellectual
functioning comparable to that of average 8- to 11-year-old
children.
- They are considered educable within the educational context,
although direct comparisons with children's information
processing ability may not hold.
- With life experience, individuals may perform better on
intelligence tests than their actual cognitive abilities might
suggest.

**Moderate Intellectual Disability:

- IQ scores range between 35–40 and 50–55

- Intellectual functioning in adulthood is similar to average 4- to
7-year-old children.
- Some individuals can learn to read and write to some extent
and may have a reasonable command of spoken language, but
learning rates are slow and conceptualization is very limited.
- Individuals may appear clumsy and ungainly.

**Severe Intellectual Disability:

- IQ scores range from 20–25 to 35–40.

- Individuals often have impaired speech development, sensory
defects, and motor handicaps.

**Profound Intellectual Disability:

- IQ scores are below 20–25.

 - Individuals are severely deficient in adaptive behavior,
mastering only the simplest tasks.
- Speech development is rudimentary, if present at all.
- Severe physical deformities, CNS pathology, retarded growth,
convulsive seizures, mutism, deafness, and other physical
anomalies are common.
- Individuals with profound intellectual disability require lifelong
custodial care and tend to have poor health and low resistance
to disease

12.Discuss the types of brain defects associated with mental retardation.

Microcephaly:

- Microcephaly involves decreased brain growth during infancy

leading to a smaller head circumference and typically results in
intellectual disability.
- Causes in about 60 percent of cases are identified as genetic
factors, brain damage in utero due to maternal disease or birth
complications, and brain damage after birth.

Infections and Toxic Agents:

- Intellectual disability can result from conditions due to

infections such as viral encephalitis or genital herpes.
- If a pregnant woman contracts certain infections like syphilis,
HIV-1, or German measles, or is exposed to toxic agents like
carbon monoxide, lead, or excessive alcohol, the child may
suffer brain damage leading to intellectual disability.

Genetic-Chromosomal Factors:

- Genetic and chromosomal factors are significant in the etiology

of severe types of intellectual disability, such as Down
syndrome and fragile X syndrome.
 - These genetic aberrations can cause metabolic alterations that
adversely affect brain development, potentially leading to
intellectual disability and other developmental anomalies.

Physical Injury (Trauma):

- Physical injury at birth, such as difficulties during labor or

malposition of the fetus, can cause brain damage and result in
intellectual disability.
- Bleeding within the brain is a common result of birth trauma.
- Hypoxia, or lack of sufficient oxygen to the brain, is another
type of birth trauma that may cause brain damage.

13.List and explain mental retardation stemming from biological causes,

especially Down syndrome, PKU, and cranial anomalies.

Down Syndrome:

- Down syndrome is associated with moderate to severe

intellectual disability.
- It is caused by a genetic abnormality where there is a triple
representation of chromosome 21 instead of the normal pair.
- The condition was first described by Langdon Down in 1866.
- The risk of conceiving a child with Down syndrome increases
with maternal age, particularly after the age of 35.

Phenylketonuria (PKU 苯丙酮尿症):

- PKU is a condition where a baby lacks a liver enzyme necessary

to break down phenylalanine, an amino acid found in many
foods.
- If PKU is undiagnosed and the child ingests significant
quantities of phenylalanine, it results in intellectual disability.
- PKU is a genetic disorder, and its effects on intellectual
development are preventable with early diagnosis and dietary
management.

Cranial Anomalies 颅骨异常:

 - Intellectual disability can occur with various conditions
involving alterations in head size and shape.
- These can include microcephaly (abnormally small head and
brain size) and macrocephaly (abnormally large head size),
among others.
- The specific causal factors for many cranial anomalies are not
firmly established, but they are often associated with
intellectual disability.

14.List and explain six special factors that must be considered in relation
to treatment for children.

1.Child’s Inability to Seek Assistance: Children often cannot seek help

on their own or transport themselves to treatment clinics; they rely on
adults to recognize their need for help and to take the initiative to
obtain it.

2.Inadequate Treatment and Preventive Programs: Programs for

addressing psychological problems in children are often insufficient
and fragmented across different agencies without a comprehensive
approach to a child's needs.

3.Vulnerabilities That Increase Risk: Familial and environmental

factors, such as abuse, divorce, turbulence, and homelessness, can
heighten the risk of emotional problems and maladaptive behaviors in
children.

4.Treating Parents and Children: Behavior disorders in children can

arise from family dynamics, including parents with psychiatric issues.
Therefore, treatment may need to involve both the child and the
parents.

5.Using Parents as Change Agents: Training parents to prompt and

reinforce prosocial behaviors while ignoring aggressive or antisocial
behaviors is effective. Clinicians may also work directly with the child
on developing social problem-solving skills.
 6. Prevention Programs: Programs like the Fast Track Prevention
Program train parents in behavior management and provide social
skills training and academic tutoring for children. Such interventions
can significantly reduce the development of disorders like conduct
disorder

15.Outline the findings regarding the prevalence of child abuse, list the
deficits seen among abused children, discuss potential causal factors in
child abuse, and summarize efforts to prevent child abuse.

**Prevalence of Child Abuse:

- 1% of children in the U.S. are documented victims of child

abuse or neglect annually; most cases involve neglect (78%),
followed by physical (18%) and sexual abuse (9%).
- Actual rates of abuse and neglect are likely much higher due to
underreporting.
- Cross-national studies report that approximately 8% of people
were physically abused and 2% sexually abused during
childhood.

**Deficits Among Abused Children:

- Children who experience physical or sexual abuse are at a

doubled risk of developing various psychological disorders and
suicidal behavior.
- Abused children may have problems with social adjustment and
interpersonal skills, which need to be addressed in treatment.

**Potential Causal Factors in Child Abuse:

- Familial and environmental factors like physical or sexual

abuse, parental divorce, family turbulence, and homelessness
can increase the risk of emotional problems.
- Parental substance abuse and harsh discipline are also
associated with a greater likelihood of children developing
psychological disorders and conduct disorders.

**Efforts to Prevent Child Abuse:

 - Specific details on prevention efforts are not outlined in the
provided quotes from the document. Generally, prevention
efforts may involve:
- Strengthening the support systems around the family, including
social services, education, and healthcare.
- Public awareness campaigns and education to help identify and
prevent abuse.
- Legislation and policies aimed at protecting children and
providing support for at-risk families.
- Training for professionals who work with children to recognize
and respond to signs of abuse.

16.Describe the need for mental health services for children, and review
the difficulties with recent efforts to increase the available resources.

Need for Mental Health Services for Children:

- Treatment and preventive programs for children's psychological

issues remain insufficient for the scale of need.
- Child advocacy programs have been developed to help children
access necessary services which they often cannot obtain on
their own.
- These programs aim to improve conditions for underserved
populations by systemic changes.
- A significant challenge is that services for children are
fragmented across different agencies, with no single entity
responsible for the holistic planning of a child's care

Difficulties with Increasing Resources:

- Advocacy efforts are often complicated and difficult due to the

fragmentation of services.
- There is no unified approach to considering all the needs of a
child, leading to gaps in service provision.
- The dependency of children on adults, primarily parents, for
help can be a barrier when adults are unaware or neglect their
responsibilities.
 - Advocacy efforts are also challenged by the lack of coordination
and comprehensive planning for the multifaceted needs of
children requiring help

17.Discuss delinquency as a major societal problem, summarize the many

causal factors involved in delinquency, and describe different ways
that society deals with delinquency.

**Delinquency as a Major Societal Problem:

- Juvenile delinquency involves acts such as property destruction,

violence against others, and violations of laws, committed by
individuals typically aged 8 to 18.
- It's widespread, with violence being a particular concern, and is
not recognized as a disorder in the DSM, indicating its
categorization as a legal issue rather than a medical one.

**Causal Factors in Delinquency:

- Adolescents often engage with peers of the same sex in

delinquent acts.
- Broad social conditions, including alienation, rebellion, social
rejection, and gang membership, are key factors.
- Continuous delinquents may progress from oppositional defiant
behavior to conduct disorder and eventually to adult antisocial
personality, but this is not the typical path.
- Genetic factors, though not conclusive, suggest a hereditary
component to antisocial behavior.
- Drug and alcohol abuse are directly associated with many
delinquent acts.
- Parental absence and family conflict, particularly in homes with
separation or divorce, significantly contribute to delinquency.

**Societal Responses to Delinquency:

- Adequate juvenile facilities and personnel can significantly aid
in rehabilitating delinquent youth by providing education, skill
development, purpose, and psychological counseling.
- Juvenile boot camps have been critiqued for not improving, and
possibly worsening, delinquent behavior.
- Gang membership can fulfill a need for belonging, status, and
approval, which are underlying emotional needs that should be
addressed in interventions.