Chapter 15 – Summary
Childhood disorders are often organized into externalizing disorders and internalizing disorders. Externalizing disorders are characterized by such behaviors as aggressiveness, noncompliance, overactivity, and impulsiveness. They include attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder. Internalizing disorders are characterized by such behaviors as depression, social withdrawal, and anxiety and include childhood anxiety and mood disorders.
Attention-deficit/hyperactivity disorder (ADHD) is a persistent pattern of inattention and/or hyperactivity and impulsivity that is more frequent and more severe than what is typically observed in youngsters of a given age. There is growing evidence for genetic and neurological factors in its etiology. Stimulant drugs, such as Ritalin, and reinforcement for staying on task have some effectiveness in reducing the symptoms.
Conduct disorder is sometimes a precursor to antisocial personality disorder in adulthood though many children carrying the diagnosis do not go to that extreme. It is characterized by high and widespread levels of aggression, lying, theft, vandalism, cruelty to other people and animals, and other acts that violate laws and social norms. Among the apparent etiological and risk factors are a genetic predisposition, inadequate learning of moral awareness, modeling and direct reinforcement of antisocial behavior, negative peer influences, and living in impoverished and crime-ridden areas. The most promising approach to treating young people with conduct disorder involves intensive intervention in multiple systems including the family, school, and peer systems.
Learning disorders are diagnosed when a child fails to develop to the expected degree in a particular academic, language, or motor skill area. These disorders are usually identified and treated within the school system rather than through mental health clinics. There is mounting evidence that the most widely studied of the learning disorders, dyslexia, has genetic and other biological components. However, the most widespread interventions for dyslexia are educational.
The traditional diagnostic criteria for mental retardation appear before the age of eighteen and include sub-average intellectual functioning and deficits in adaptive behavior. Contemporary analyses, however, focus more on the strengths of individuals with mental retardation than on their assignment to a particular level of severity. This shift in emphasis is associated with increased efforts to design psychological and educational interventions that make the most of individuals’ abilities.
The more severe forms of mental retardation have a biological basis, such as the chromosomal trisomy that causes Down syndrome. Certain infectious diseases in the pregnant mother, such as HIV, rubella, and syphilis, and illnesses that effect the child directly, such as encephalitis, can stunt cognitive and social development as can malnutrition, severe falls, and automobile accidents that injure the brain. Environmental factors are considered the principal causes of mild retardation. People with mild retardation are often from lower-class homes living in an environment of social and educational deprivation.
Researchers try to prevent mild retardation by giving children at risk for mild retardation through impoverished circumstances special preschool training and social opportunities. Many children with mental retardation, who would formerly have been institutionalized, are now being educated in the public schools under the provisions of Public Law 94-142. In addition, using applied behavioral analysis, self-instructional training, and modeling, behavior therapists have been able to treat successfully many of the behavioral problems of individuals with mental retardation and to improve their intellectual functioning.
Autistic disorder, one of the pervasive developmental disorders, begins before the age of two and a half. The major symptoms are a failure to relate to other people, communication problems, which consist of either a failure to learn any language or speech irregularities, such as echolalia and pronoun reversal, and preservation of sameness, an obsessive desire to keep daily routines and surroundings exactly the same.
Autistic disorder was originally thought to be the result of coldness and aloofness in parents and their rejection of their children, but recent research gives no credence to such notions. Although the specific biological basis of autism has yet to be isolated, a biological cause is suspected for a number of reasons: its onset is very early; family and twin studies give compelling evidence of a genetic predisposition; abnormalities have been found in the brains of autistic children; a syndrome similar to autism can develop following meningitis and encephalitis; and many autistic children have the low intelligence associated with brain dysfunctions.
The most promising treatments of autism are psychological in nature and involve modeling and operant conditioning procedures. Although the prognosis for autistic children remains poor in general, recent work suggests that intensive behavioral treatment involving parents as their children’s therapists may allow some of these children to participate meaningfully in normal social intercourse. Various drug treatments have been proved less effective than behavioral interventions.