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PSYCHOLOGICAL PROBLEMS OF CHILDHOOD:Kinds of Internalizing Disorders

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Abnormal Psychology ­ PSY404
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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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Table of Contents:
  1. ABNORMAL PSYCHOLOGY:PSYCHOSIS, Team approach in psychology
  2. WHAT IS ABNORMAL BEHAVIOR:Dysfunction, Distress, Danger
  3. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Supernatural Model, Biological Model
  4. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Free association, Dream analysis
  5. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Humanistic Model, Classical Conditioning
  6. RESEARCH METHODS:To Read Research, To Evaluate Research, To increase marketability
  7. RESEARCH DESIGNS:Types of Variables, Confounding variables or extraneous
  8. EXPERIMENTAL REASEARCH DESIGNS:Control Groups, Placebo Control Groups
  9. GENETICS:Adoption Studies, Twin Studies, Sequential Design, Follow back studies
  10. RESEARCH ETHICS:Approval for the research project, Risk, Consent
  11. CAUSES OF ABNORMAL BEHAVIOR:Biological Dimensions
  12. THE STRUCTURE OF BRAIN:Peripheral Nervous System, Psychoanalytic Model
  13. CAUSES OF PSYCHOPATHOLOGY:Biomedical Model, Humanistic model
  14. CAUSES OF ABNORMAL BEHAVIOR ETIOLOGICAL FACTORS OF ABNORMALITY
  15. CLASSIFICATION AND ASSESSMENT:Reliability, Test retest, Split Half
  16. DIAGNOSING PSYCHOLOGICAL DISORDERS:The categorical approach, Prototypical approach
  17. EVALUATING SYSTEMS:Basic Issues in Assessment, Interviews
  18. ASSESSMENT of PERSONALITY:Advantages of MMPI-2, Intelligence Tests
  19. ASSESSMENT of PERSONALITY (2):Neuropsychological Tests, Biofeedback
  20. PSYCHOTHERAPY:Global Therapies, Individual therapy, Brief Historical Perspective
  21. PSYCHOTHERAPY:Problem based therapies, Gestalt therapy, Behavioral therapies
  22. PSYCHOTHERAPY:Ego Analysis, Psychodynamic Psychotherapy, Aversion Therapy
  23. PSYCHOTHERAPY:Humanistic Psychotherapy, Client-Centered Therapy, Gestalt therapy
  24. ANXIETY DISORDERS:THEORIES ABOUT ANXIETY DISORDERS
  25. ANXIETY DISORDERS:Social Phobias, Agoraphobia, Treating Phobias
  26. MOOD DISORDERS:Emotional Symptoms, Cognitive Symptoms, Bipolar Disorders
  27. MOOD DISORDERS:DIAGNOSIS, Further Descriptions and Subtypes, Social Factors
  28. SUICIDE:PRECIPITATING FACTORS IN SUICIDE, VIEWS ON SUICIDE
  29. STRESS:Stress as a Life Event, Coping, Optimism, Health Behavior
  30. STRESS:Psychophysiological Responses to Stress, Health Behavior
  31. ACUTE AND POSTTRAUMATIC STRESS DISORDERS
  32. DISSOCIATIVE AND SOMATOFORM DISORDERS:DISSOCIATIVE DISORDERS
  33. DISSOCIATIVE and SOMATOFORM DISORDERS:SOMATOFORM DISORDERS
  34. PERSONALITY DISORDERS:Causes of Personality Disorders, Motive
  35. PERSONALITY DISORDERS:Paranoid Personality, Schizoid Personality, The Diagnosis
  36. ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Poly Drug Use
  37. ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Integrated Systems
  38. SCHIZOPHRENIA:Prodromal Phase, Residual Phase, Negative symptoms
  39. SCHIZOPHRENIA:Related Psychotic Disorders, Causes of Schizophrenia
  40. DEMENTIA DELIRIUM AND AMNESTIC DISORDERS:DELIRIUM, Causes of Delirium
  41. DEMENTIA DELIRIUM AND AMNESTIC DISORDERS:Amnesia
  42. MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS
  43. MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS
  44. PSYCHOLOGICAL PROBLEMS OF CHILDHOOD:Kinds of Internalizing Disorders
  45. LIFE CYCLE TRANSITIONS AND ADULT DEVELOPMENT:Aging