670 CHAPTER 14
Other Disorders of Childhood
Children can exhibit a wide variety of odd or unusual behaviors that in and of
themselves do not necessarily indicate psychopathology:- Many children become anxious (temporarily) about separating from loved ones
such as parents, particularly during early childhood and adolescence. Younger
children may put up a fuss about being dropped off at school; older children may
“freak out” about going away from home for the summer. - Some children learn to speak and understand language quickly; others learn ver-
bal communication skills more slowly. - Children may go through phases that involve odd eating habits such as being
picky eaters or occasionally chomping on a crayon. - Children who have been toilet-trained can have accidents and “go” in places other
than the toilet. - Attention-defi cit/hyperactivity disorder (ADHD) is characterized
by inattention, hyperactivity, and/or impulsivity. The inattentive
type of ADHD is associated with academic problems, whereas
the hyperactive/impulsive type is associated with disruptive be-
haviors, accidents, and rejection by peers. - Criticisms of the DSM-IV-TR diagnostic criteria for ADHD include
the diffi culty in applying the criteria to adults, the arbitrariness
of the age cutoff for the onset of symptoms, and failure to ac-
knowledge different symptoms in females. - Oppositional defi ant disorder, conduct disorder, and ADHD are
highly comorbid, making it diffi cult to sort out factors that con-
tribute uniquely to one of the disorders. - Neurological factors that contribute to ADHD include frontal lobe
problems (which lead to the symptoms of inattention, impaired
executive function and memory diffi culties). Too little dopamine
and imbalances in other transmitters may also play a role. Genes
also contribute to ADHD and conduct disorder, in part by affect-
ing temperament. - Psychological factors that are associated with ADHD include low
self-esteem and diffi culty recognizing facial expressions of an-
ger and sadness. People with oppositional defi ant disorder and
conduct disorder tend to have either low self-esteem or overly
high self-esteem, are relatively unresponsive to the threat of
punishment, and exhibit high levels of emotional distress and
poor frustration tolerance. - Social factors that contribute to ADHD include parents’ not giv-
ing children enough credit for their positive behaviors. For op-
positional defi ant disorder and conduct disorder, social factors
include abuse, neglect, inconsistent discipline, and lack of posi-
tive attention. - Treatment targeting neurological factors in ADHD involves
medication—typically methylphenidate or atomoxetine.
Treatments targeting psychological factors in ADHD, oppo-
sitional defiant disorder, and conduct disorder may use be-
havioral methods—especially reinforcement programs—to
increase a person’s ability to tolerate frustration and to delay
reward, and cognitive methods to enhance social problem-
solving ability. Treatments that target social factors in all three
disorders include group therapy and comprehensive treat-
ments such as contingency management, parent management
training, and multisystemic therapy.Making a Diagnosis
- Reread Case 14.5 about Brad, and determine whether or not his
symptoms meet the criteria for conduct disorder. Specifi cally,
list which criteria apply and which do not. If you would like more
information to determine his diagnosis, what information—
specifi cally—would you want, and in what ways would the infor-
mation infl uence your decision? How severe do you consider his
symptoms to be? - Reread Case 14.6 about Danny, and determine whether or not
his symptoms meet the criteria for oppositional defi ant disor-
der. Specifically, list which criteria apply and which do not. If
you would like more information to determine his diagnosis,
what information—specifi cally—would you want, and in what
ways would the information infl uence your decision? - Reread Case 14.7 about Edward Hallowell, and determine
whether or not his symptoms meet the criteria for attention-
defict/hyperactivity disorder. Specifically, list which criteria
apply and which do not. Which type(s) of symptoms does he
seem to have? If you would like more information to determine
his diagnosis, what information—specifically—would you
want, and in what ways would the information infl uence your
decision?