Externalizing Disorders Psychology 311 Abnormal Psychology Listen to the audio lecture while viewing these slides 1 Background Many types ADHD Oppositional Defiant Disorder Tourette Disorder Others Includes disorders with behaviors that are disruptive and often aggressive Cause concerns to parents and teachers Kids break rules Cause significant harm to property and people Excessively active 2 Attention-Deficit/Hyperactivity Disorder (ADHD) Is defined by symptoms Inattention Hyperactivity Impulsivity Frequently occurs with Learning Disabilities Depression Anxiety Conduct disorder Oppositional-Defiant Disorder 3 Background Cont. Is higher in the US Is considered a medical condition Problem Many energetic children are classified inappropriately as having ADHD Now, diagnostic criteria require a child must experience some performance impairment. 4 Three Subtypes Inattention Hyperactivity and oversensitivity Combination of 1 and 2 5 Inattention Type Symptoms occur often for 6 months Person has an inability to focus or stay on task Does not complete assignments Does not listen Person has difficulty organizing tasks Avoids sustained mental effort Is easily distracted by stimuli Is forgetful in daily tasks Looses things necessary for daily tasks Does not follow through on directions 6 1
Hyperactivity and Oversensitivity Type Fidgets and squirms Leaves seat when staying is expected Runs about or moves excessively in inappropriate situations Finds it hard to play quietly Is always on the go Motor driven Talks excessively Combination of the Above Person has symptoms from the previous two categories Impulsive symptoms Blurts out answers Difficult to wait their turn Interrupts others 7 8 Note Some symptoms are present before age 7 Person may have some impairment at home and at school Symptoms must be marked enough to be clinically significant Symptoms cannot be part of another disorder More Prevalent in Boys 4 to 1 in the general population 9 to 1 in clinical studies Why Maybe boys are more aggressive in general Get reported more often Girls simply are less attentive, not reported as often 9 10 Diagnosis Can be largely subjective Who is doing the judging What is the child doing at the time What is the environment like Was a baseline of the behavior established 11 Consequences of ADHD Deficiencies in academics and social skills School Person does not focus No organization of assignments Missed work Lower performance Have a spiral of decreasing performance Expands to social settings Children are more aggressive and rude Kids are not well liked 12 2
Possible Causes Unknown Probably a result of genetics and environment Monozygotic twins have more ADHD than Dizygotic twins 13 Treatment Drugs Both stimulants and antidepressants are used Stimulants Most commonly used Ritalin, Dexedrine, Cylert Antidepressants Used only if stimulants do not work Note: Need to know if there is a history of bipolar disorder in the family Can lead to acute agitation One study, mother and father both with bipolar disorder had an eight year-old son hang himself after being put on a stimulant 14 Why Drugs Work Shut down some brain structures Frontal cortical structures Activate others Midbrain structures 15 Behavioral Interventions Can be very effective if used correctly Problem Takes more time Teachers say We do not have the time Takes consistent application across settings Must be done at school and home Must be trained to use techniques effectively Most teachers are not trained or are poorly trained Result Want kid put on drugs 16 Social Consequences Drugging of American Children Do not want boys to be boys Etc. Long-Term Outcomes Difficulties seem to persist into adulthood Have poorer relations More marital problems Difficulties at work More auto accidents 17 Often Parents realize they have ADHD after a child is diagnosed 18 3
Tic Disorders Are involuntary, rapid, not rhythmic stereotyped motor movements or vocalizations Rarely last more than a second at a time Behavior is irresistable, but can suppress for a short period of time Often occurs with ADHD or Obsessive- Compulsive Disorder Behaviors Nose twitching, eye blinking, tooth clicking, tongue out, clapping Vocalizations, Barking Grunting Throat clearing sniffing 19 20 Diagnosis Occurs before age 18 See page 478 Progression Usually become worst until about age 10 By age 18, over ½ had few tics 21 22 Tourette s Disorder Tends to run in families Is a type of tic Disorder Can begin before age 2 4 times more frequent in boys than girls Usually is a single tic of the eye, nose, or mouth Progresses to shoulders, arms, trunk, legs Usually correlated with uttering Oppositional Defiant Disorder Children can often be deviant, defiant, disobedient, and even hostile Is normal to push limits If behavior is severe enough to interfere with a child s functioning and relations, then the child is diagnosed with ODD All kids may act in this way For a diagnosis, a child must act this way more frequently than their peers Is typical to see stages as they learn obscenities 23 appropriate behaviors 24 4
Characteristics Loses temper Argues with adults Refuses to comply with requests Intentionally annoys others Blames others Is angry and resentful 25 Points to Note 1. Diagnosis is not usually made until age 10 Peeks in the mid-teen years Not seen in adults Slightly more boys than girls 2. Family Factors One parent has experienced one of the following OCD, ADHD, antisocial, mood, substance disorder Serious marital conflict 26 Negative parenting Conduct Disorder Seems to influence OCD Will continue over time Parenting programs seem quite helpful in creating stable improvements over time Is less serious than ODD Usually: important social norms are violated rights of others are violated aggressive actions cause harm Occurs more often in boys than girls Behavior peaks about age 10 27 28 Behaviors Aggression Bullying, weapons, physical cruelty, forced sexual activity, mugging, hurting animals Property Damage Is deliberate Fires, breaking windows Theft Breaking and entering Serious rule violation Staying out all night Skipping school before age 15 Items must be severe enough to create impairment in some area of functioning 29 Points ADHD and ODD are often associated with the later development of conduct disorder Diagnosis of conduct disorder strongly predicts a later diagnosis of Antisocial Personality Disorder Substance Abuse Disorders Adult Offender 30 5
Causes Rates run higher in families when one adult has a psychiatric disorder Debate is still out regarding how much genetics is a factor Runs in families, but how much is learned behavior or environmental Poor parenting plays a factor Lack of social and academic skills Do not tend well to social information Do not read social cues well Lack adaptive problem solving 31 Treatment Most effective treatment is PREVENTION Help children develop skills Help them aspire, motivate them Help them experience other rewarding options Social support also seems to be a critical element 32 Conclusions Many disorders Some contribute or cause lots of social problems Lots of learning and environmental factors impact these disorders Prevention is often the best treatment. Stop problem behaviors early. 33 6