PSYCHOLOGICAL PROBLEMS OF CHILDHOOD:Kinds of Internalizing Disorders

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Abnormal Psychology PSY404

Lesson 44

PSYCHOLOGICAL PROBLEMS OF CHILDHOOD

Developmental Psychopathology approach is absolutely essential to disorders of childhood, because

children change rapidly during the first 20 years of life. Psychologists become concerned only when a

child's behavior deviates substantially from developmental norms, behavior that is typical for children

of a given age.

Psychological problems that commonly begin during childhood are listed in the DSM-IV-TR category

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence.

Other than mental retardation and pervasive developmental disorders, the most important disorders in

this category are the various externalizing disorders.

Two kinds of disorders

1- Externalizing Disorders

2- Internalizing Disorders

We have covered the externalizing disorders in lecture no 43

1- Externalizing Disorders

Externalizing disorders create difficulties for the child's external world. Externalizing disorders are

characterized by children's failure to control their behavior according to the expectations of parents,

peers, teachers, and/or legal authorities--for example, as a result of hyperactive behavior or conduct

problems.

Kinds of Pervasive Developmental Disorder

i. Autistic Disorder

ii. Attention Deficit Hyperactivity Disorder (ADHD)

iii. Oppositional Deficit Disorder (ODD)

iv. Conduct Disorder

v. Asperger's Disorder

vi. Childhood Disintegrative Disorder

vii. Rett's Disorder

Symptoms of Externalizing Disorders

Many externalizing symptoms involve violations of age-appropriate social rules, including disobeying

parents or teachers, violating social or peer group norms (e.g., annoying others), and perhaps violating

the law.

Some misconduct is normal, perhaps even healthy, for children.

However, the rule violations in externalizing disorders are not trivial and are far from "cute."

Externalizing behavior is a far greater concern when it is frequent, intense, lasting, and pervasive.

2- Internalizing Disorders

Internalizing disorders are psychological problems that primarily affect the child's internal world--for

example, excessive anxiety or sadness.

DSM-IV-TR does not list internalizing disorders as separate psychological disorders of childhood;

rather, the manual notes that children may qualify for many "adult" diagnoses, such as anxiety or mood

disorders.

Symptoms of Internalizing Disorders

Children's internalizing symptoms include sadness, fears, and somatic complaints, as well as other

indicators of mood and anxiety disorders--for example, feeling worthless or tense.

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DSM-IV-TR does not have a separate category for children's internalizing disorders, but the manual

does identify some unique ways in which children experience the symptoms.

In assessing children's internalizing problems, mental health professionals must obtain information

from multiple informants--parents, teachers, and the children themselves.

When assessing children directly, child clinical psychologists are sensitive to different signs that may be

indicative of depression at different ages.

Depression in children and adolescents often is comorbid both with externalizing problems and with

anxiety.

Three findings from fear research are important to note.

· First, children develop different fears for the first time at different ages, and the onset of new

fears may be sudden and have no apparent cause in the child's environment.

· A second finding is that some fears, particularly fears of uncontrollable events such as disasters,

are both common and relatively stable across different ages.

· Third, many other fears, especially specific ones like fears of monsters or normal worries about

death, become less frequent as children grow older.

Kinds of Internalizing Disorders

1- DSM-IV-TR contains a diagnosis for separation anxiety disorder, which is defined by symptoms

such as persistent and excessive worry for the safety of an attachment figure, fears of getting lost or

being kidnapped, nightmares with separation themes, and refusal to be alone.

Separation anxiety disorder is especially problematic when it interferes with school attendance.

2- School refusal, also known as school phobia, is characterized by an extreme reluctance to go to school,

and is accompanied by various symptoms of anxiety, such as stomachaches and headaches.

Children with internalizing or externalizing problems often have troubled peer relationships.

In 1896, the psychologist Lightner Witmer established the first psychological clinic for children in the

United States.

Despite the early origins of child clinical psychology, children were largely ignored in early

classifications of mental disorders.

DSM-I contained only two separate diagnoses for children, and DSM-II listed only seven childhood

disorders.

DSM-III recognized a much wider range of childhood disorders, and in fact, contained a proliferation

of diagnostic categories, 40 in all.

Although laudable, the new effort was overly ambitious.

Many of the new diagnoses were severely criticized and subsequently were dropped.

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3- Pica is the persistent eating of nonnutritive substances, such as paint or dirt.

Many infants and toddlers put nonnutritive substances in their mouths, but the feeding disorder pica is

rarely diagnosed, except among mentally retarded children.

4- Rumination disorder, the repeated regurgitation and rechewing of food, is another infrequent

feeding disorder.

5- Tourette's disorder is a rare problem (4 to 5 cases per 10,000 people) that is characterized by

repeated motor and verbal tics.

6- Stereotypic movement disorder is self-stimulation or self-injurious behavior that is serious enough

to require treatment, as may occur in mental retardation or pervasive developmental disorder.

7- Selective mutism involves the consistent failure to speak in certain social situations (for example, in

school) while speech is unrestricted in other situations (for example, at home).

8- Reactive attachment disorder is another rarely diagnosed problem, although it may be more

prevalent than we would hope.

Reactive attachment disorder is characterized by severely disturbed and developmentally inappropriate

social relationships.

9- Encopresis and enuresis are common problems. The terms refer, respectively, to inappropriately

controlled defecation and urination.

Eating disorders have increased dramatically since thinness has become a national obsession.

10- Victims of anorexia nervosa so relentlessly pursue extreme thinness that they may starve

themselves to death.

11- Victims of bulimia nervosa go on frequent eating binges, then take laxatives or force themselves to

vomit to keep from gaining weight. These eating disorders, which share many important features, are

disproportionately prevalent among adolescent girls and young women.

Primary hypersomnia is excessive sleepiness characterized by prolonged or daytime sleep, lasting at

least a month and significantly interfering with life functioning.

Primary hypersomnia is similar to narcolepsy, irresistible attacks of refreshing sleep, lasting at least 3

months.

12- Breathing-related sleep disorder involves the disruption in sleep due to breathing problems such

as the temporary obstruction of the respiratory airway.

The parasomnias include nightmare disorder, sleep terror disorder, and sleepwalking disorder.

13- People with nightmare disorder are frequently awakened by terrifying dreams.

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14- Sleep terror disorder also involves abrupt awakening from sleep, typically with a scream, but it

differs from nightmare disorder in important respects.

15- Sleepwalking disorder involves rising from the bed during sleep and walking about in a generally

unresponsive state.

Occasional episodes of sleepwalking are fairly common, especially among children.

Like all sleep disorders, sleepwalking disorder tends to be diagnosed only if it causes significant distress

or impairs the person's ability to function.

Many listed childhood disorders not in fact mental disorders.

Child's behavior is intimately linked with the family, school, and peer contexts.

Because of this, some experts have suggested that diagnosing individual children is misleading and

misguided.

Instead, children's psychological problems could be classified within the context of key relationships,

particularly the family.

Frequency of Internalizing Disorders

· The prevalence of externalizing disorders generally decreases as children grow older, but the

opposite is true for internalizing disorders.

· Suicide is the leading cause of death among teenagers, trailing only automobile accidents and

natural causes.

· In comparison to adult suicide attempts, suicide attempts among adolescents are more impulsive,

more likely to follow a family conflict, and are more often motivated by anger rather than

depression.

· Evidence simply is lacking or inadequate on the development of many other psychological

problems of childhood.

Treatment of Internalizing Disorders

· Relatively few treatments for anxiety or mood disorders have been developed or studied specifically

as they apply to children.

· For example, medications known to alleviate depression in adults have rarely been studied among

children and adolescents, and may be no more effective than placebos in treating their depression.

· Researchers already have begun to correct the neglect of treatment research on children's

internalizing disorders.

· Some forms of cognitive behavior therapy and interpersonal therapy show promise for treating

children's depression, and cognitive behavior therapy and family therapy have produced positive

results in treating children's anxiety.

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