17.7 PUTTING IT...together
Clinicians Discover Childhood and Adolescence
Early in the twentieth century, mental health professionals virtually ignored children. At best, they viewed them as small adults and treated their psychological disorders as they would adult problems (Peterson & Roberts, 1991). Today the problems and needs of young people have caught the attention of researchers and clinicians. Although all of the leading models have been used to help explain and treat these problems, the sociocultural perspective—
Because children and adolescents have limited control over their lives, they are particularly affected by the attitudes and reactions of family members. Clinicians must therefore deal with those attitudes and reactions as they try to address the problems of the young. Treatments for conduct disorder, ADHD, intellectual disability, and other problems of childhood and adolescence typically fall short unless clinicians educate and work with the family as well.
At the same time, clinicians who work with children and adolescents have learned that a narrow focus on any one model can lead to problems. For years, autism spectrum disorder was explained exclusively by family factors, misleading theorists and therapists alike and adding to the pain of parents already devastated by their child’s disorder. In addition, in the past, the sociocultural model often led professionals wrongly to accept anxiety among young children and depression among teenagers as inevitable, given the many new experiences confronted by the former and the latter group’s preoccupation with peer approval.
CLINICAL CHOICES
Now that you’ve read about disorders common among children and adolescents, try the interactive case study for this chapter. See if you are able to identify Gabriel’s symptoms and suggest a diagnosis based on his symptoms. What kind of treatment would be most effective for Gabriel? Go to LaunchPad to access Clinical Choices.
The increased clinical focus on the young has also been accompanied by more attention to young people’s human and legal rights. More and more clinicians have called on government agencies to protect the rights and safety of this often powerless group. In doing so, they hope to fuel the fights for better educational resources and against child abuse and neglect, sexual abuse, malnourishment, and fetal alcohol syndrome.
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As the problems and, at times, mistreatment of young people receive more attention, the special needs of these individuals are becoming more visible. Thus the study and treatment of psychological disorders among children and adolescents are likely to continue at a rapid pace. Now that clinicians and public officials have “discovered” this population, they are not likely to underestimate their needs and importance again.
DSM-5 CONTROVERSY
Loss of Services?
In past editions of the DSM, people qualified for a diagnosis of Asperger’s disorder if they displayed the severe social deficits and restricted and repetitive behaviors found in autistic disorder but otherwise had normal language, adaptive, and cognitive skills. With the elimination of Asperger’s disorder from DSM-
SUMMING UP
DISORDERS COMMON AMONG CHILDREN AND ADOLESCENTS Emotional and behavioral problems are common in childhood and adolescence, but in addition, at least 20 percent of all children and adolescents in the United States have a diagnosable psychological disorder. A particular concern among children is that of being bullied. According to surveys, more than 25 percent of students are bullied frequently and more than 70 percent have been victims of bullying at least once. Cyberbullying is on the rise. pp. 564–
565 Anxiety disorders are particularly common among children and adolescents. This group of problems includes adultlike disorders, such as social anxiety disorder and generalized anxiety disorder, and the childhood form of separation anxiety disorder, which is characterized by excessive anxiety, often panic, whenever a child is separated from a parent. Those with separation anxiety disorder have great trouble traveling away from their family, and they often refuse to visit friends’ houses, go on errands, or attend camp or school. Many cannot even stay alone in a room and cling to their parent around the house. Some also have temper tantrums, cry, or plead to keep their parents from leaving them. pp. 565–
569 Two percent of children and 8 percent of adolescents experience depression. Depression in the young may be triggered by negative life events (particularly losses), major changes, rejection, or ongoing abuse. Childhood depression is often characterized by such symptoms as headaches, stomach pain, irritability, and a disinterest in toys and games. Although there is no difference between the rates of depression in boys and girls before the age of 13, girls are twice as likely as boys to be depressed by the age of 16. In the past two decades, there has also been an enormous increase in the number of children and adolescents who receive diagnoses of bipolar disorder. Such diagnoses are expected to decrease now that DSM-
5 has added a new childhood category, disruptive mood dysregulation disorder. pp. 569– 573 
Children with oppositional defiant disorder and conduct disorder exceed the normal breaking of rules and act very aggressively. Children with oppositional defiant disorder argue repeatedly with adults, ignore adult rules and requests, and feel intense anger and resentment. Those with conduct disorder, a more severe pattern, repeatedly violate the basic rights of others. Children with this disorder often are violent and cruel and may deliberately destroy property, steal, and run away. Several types of conduct disorders have been identified. Clinicians have treated children with conduct disorders by using approaches such as parent-
child interaction therapy, video modeling, parent management training, treatment foster care, problem- solving skills training, and the Coping Power Program. Some individuals with this disorder have been institutionalized in juvenile training centers. A number of prevention programs have also been developed. pp. 574– 578 605
Children with an elimination disorder—enuresis or encopresis—repeatedly urinate or pass feces in inappropriate places. Behavioral approaches, such as the bell-
and- battery technique, are effective treatments for enuresis. pp. 579– 582 NEURODEVELOPMENTAL DISORDERS Neurodevelopmental disorders are a group of disabilities in the functioning of the brain that emerge at birth or during very early childhood and affect the person’s behavior, memory, concentration, and/or ability to learn. They often have a significant impact throughout the person’s life. Attention-
deficit/hyperactivity disorder, autism spectrum disorder, and intellectual disability are all neurodevelopmental disorders. Children who display attention-
deficit/hyperactivity disorder (ADHD) attend poorly to tasks, behave overactively and impulsively, or both. Ritalin and other stimulant drugs and behavioral programs are often effective treatments. pp. 582– 587 People with autism spectrum disorder are extremely unresponsive to others, have severe communication deficits, and display very rigid and repetitive behaviors, interests, and activities. The leading explanations of this disorder point to cognitive deficits, such as failure to develop a theory of mind; and biological abnormalities, such as abnormal development of the cerebellum, as causal factors. Although no treatment totally reverses the autistic pattern, significant help is available in the form of cognitive-
behavioral treatments, communication training, training and treatment for parents, and community integration. pp. 587– 594 People with intellectual disability are significantly below average in intelligence and adaptive ability. Mild ID, by far the most common level of intellectual disability, has been linked primarily to environmental factors such as unstimulating environments during a child’s early years, inadequate parent–
child interactions, and insufficient learning experiences. Moderate, severe, and profound ID are caused primarily by biological factors, although people who function at these levels also are affected enormously by their family and social environment. The leading biological causes of intellectual disability are chromosomal abnormalities, metabolic disorders, prenatal problems, birth complications, and childhood diseases and injuries. Today intervention programs for people with intellectual disability emphasize the importance of a comfortable and stimulating residence, either the family home or a small institution or group home that follows the principles of normalization. Other important interventions include proper education, therapy for psychological problems, and programs offering training in socializing, sex, marriage, parenting, and occupational skills. One of the most intense debates in the field of education centers on whether people with intellectual disability profit more from special classes or from mainstreaming. Research has not consistently favored one approach over the other. pp. 595–
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