2. Choose ONE of the following disorders discussed in your textbook: Autism Spectrum Disorder or Attention Deficit/Hyperactivity Disorder. For the disorder you have chosen, summarize the diagnostic criteria for that disorder. Then, create an example (NOT ONE FROM YOUR TEXT) of a young person exhibiting symptoms that would lead to that diagnosis and show how the observed behaviors are indicative of the symptoms of the disorder. Then, briefly describe treatments for that disorder. (350 words.)

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For this week, read Chapter 13, Abnormal Behavior in Childhood and Adolescence and answer the following questions

1. Summarize some of the challenges in determining if a particular behavior in childhood and adolescence is “normal” behavior or “abnormal” behavior. Briefly describe risk factors for mental health problems in children and adolescents. (300 words.)

2. Choose ONE of the following disorders discussed in your textbook: Autism Spectrum Disorder or Attention Deficit/Hyperactivity Disorder. For the disorder you have chosen, summarize the diagnostic criteria for that disorder. Then, create an example (NOT ONE FROM YOUR TEXT) of a young person exhibiting symptoms that would lead to that diagnosis and show how the observed behaviors are indicative of the symptoms of the disorder. Then, briefly describe treatments for that disorder. (350 words.)



Abnormal Behavior in Childhood and Adolescence An autistic woman, Donna Williams, reflects on what it is like to be an autistic child. In this excerpt from her memoir Nobody Nowhere, she speaks about her need to keep the world out. She was about 3 years old when her parents took her to a doctor out of concern that she appeared malnourished. Psychological disorders of childhood and adolescence often have a special poignancy—perhaps none more than autism. These disorders affect children at ages when they have little capacity to cope. Some of these problems, such as autism and intellectual disability (formerly called mental retardation), prevent children from fulfilling their developmental potentials. Some psychological problems in children and adolescents mirror those found in adults—problems such as mood disorders and anxiety disorders. In some cases, the problems are unique to childhood, such as separation anxiety; in others, such as attention-deficit/hyperactivity disorder (ADHD), the problem manifests itself differently in childhood than in adulthood Normal and Abnormal Behavior in Childhood and Adolescence Determining whether a child’s behavior is abnormal depends on our expectations about what is normal for a child of a given age in a given culture. We need to consider whether a child’s behavior falls outside the range of developmental and cultural norms. For example, deter-mining that 7-year-old Jimmy is hyperactive depends on the types of behaviors deemed reasonable for children of the same age and cultural background (Drabick & Kendall, 2010; Kendall & Drabick, 2010). Many problems are first identified when a child enters school. Although these problems may have existed earlier, they may have been tolerated or not seen as “problems” in the home. Sometimes, the stress of starting school contributes to their onset. However, keep in mind that what is socially acceptable at a particular age, such as intense fear of strangers at about nine months, may be socially unacceptable at more advanced ages. Many behavior patterns we might consider abnormal among adults—such as intense fear of strangers and lack of bladder control—are perfectly normal for children at certain ages. Many children are misdiagnosed when clinicians fail to take developmental expectations into account. Researchers estimate that nearly 1 million American children may have been misdiagnosed with ADHD in kindergarten and treated with medication simply because they were the young-est (and hence least mature) children in their classes (“Nearly One Million,” 2010). As the lead researcher, Todd Edler, told a reporter, “If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6.” t / F Many of the psychological disorders affecting children and ado-SOURCE: © Lee Lorenz/The New Yorker Collection/www.cartoonbank.com truth or fiction Many behavior patterns considered normal for children would be considered abnormal in adults. ✓ TRUE Many behavior patterns that would be considered abnormal among adults—such as intense fear of strangers and lack of bladder control—are perfectly normal for children at certain ages. lescents are classified in the DSM-5 category of neurodevelopmental disorders. These disorders involve an impairment of brain functioning or development that affects a child’s psychological, cognitive, social, or emotional devel-opment. This category of mental disorders includes the following types of disorders we discuss in this chapter: • Autism spectrum disorder • Intellectual disability • Specific learning disorder • Communication disorders • Attention-deficit/hyperactivity disorder In this chapter, we also review other disorders affecting children and adolescents, includ-ing disruptive behavior disorders (oppositional defiant disorder and conduct disorder), problems relating to anxiety and depression, and elimination disorders. Cultural Beliefs about What Is Normal and Abnormal 13.1 Explain the differences between normal and abnormal behavior in childhood and adolescence and the role of cultural beliefs in determining abnormality. Cultural beliefs help determine whether people view behavior as normal or abnormal. Because children rarely label their own behavior as abnormal, definitions of normality depend largely on how a child’s behavior is filtered through a cultural lens (Callanan & Waxman, 2013; Norbury & Sparks, 2013). Cultures vary with respect to the types of behav-iors they classify as unacceptable or abnormal as well as the threshold for labeling child behaviors as deviant. In an illustrative study, groups of American and Thai parents were presented with vignettes depicting two children, one with problems of “overcontrol” (e.g., shyness and fears) and one with problems of “undercontrol” (e.g., disobedience and fighting). Thai parents rated both types of problems as less serious and worrisome than American parents did (Weisz et al., 1988). Thai parents also rated the children in the vignettes as more likely to improve over time, even without treatment. These view-points are embedded within traditional Thai-Buddhist beliefs and values, which tolerate broad variations in children’s behavior and assume that change is inevitable. Like definitions of abnormality, methods of treatment differ for children. Children may not have the verbal skills to express their feelings through speech or the attention span required to sit through a typical therapy session. Therapy methods must be tailored to the level of the child’s cognitive, physical, social, and emotional development. For example, psychodynamic therapists have developed techniques of play therapy in which children enact family conflicts symbolically through their play activities, such as by playacting with dolls or puppets. Or they might be given drawing materials and asked to draw pictures, in the belief that their drawings will reflect their underlying feelings. As with other forms of therapy, child therapy needs to be offered in a culturally sensitive framework. Therapists need to tailor their interventions to the cultural back-grounds and social and linguistic needs of children in order to establish effective thera-peutic relationships. Prevalence of Mental Health Problems in Children and Adolescents 13.2 Describe the prevalence of psychological disorders in children and adolescents. truth or fiction About one in 10 cases of adult psychological disorders began before age 18. ✓ FALSE Actually, about one in two cases of adult disorders began by age 14. nEEding bUt nOt gEtting tREatmEnt. Sadly, most children and adolescents with diagnosable psychological disorders, even those who have severely disturbed behavior, do not receive mental health treatment. Fewer than half get the help they need. Just how common are mental health problems among America’s chil-dren and adolescents? Unfortunately, quite common. Approximately four of 10 adolescents (40.3%) have experienced a diagnosable mental disorder during the past year (Kessler, Avenevoli, et al., 2012). About one in 10 children suffer from a mental disorder severe enough to impair development (“A Children’s Mental Illness ‘Crisis,’” 2001). Another reason to be concerned about mental health problems in childhood and adolescents is that among adults, half of the cases of psychological disorders started by age 14 (Insel, 2014). t / F In children 6 to 17 years of age, the most commonly diagnosed psychological disorders are learning disorders (11.5%) and attentiondeficit/hyperactivity disorder (8.8%; Blanchard, Gurka, & Blackman, 2006). If we limit our scope to adolescents, anx-iety-related disorders top the list of the most commonly diagnosed disorders (Kessler, Avenevoli, et al., 2012). Depression too is all too common, as seen in the results of a telephone survey that was based on a national probability sample of American youth ages 12 to 17. The survey found that 7% of the boys and 14% of the girls had suffered from major depression in the preceding 6-month period of time (Kilpatrick et al., 2003). Despite the prevalence of childhood psychological disorders, the great majority of children with psychological disorders fail to get the treatment they need. Only about one third of adolescents with diagnosable mental disorders and fewer than half of children and adolescents with severe impairment or disturbed behavior receive any form of mental health treatment (Merikangas et al., 2011; Olfson, Druss, & Marcus, 2015). Children with internalized problems, especially anxiety and depression, are at higher risk of going untreated than those with externalized problems (problems involv-ing acting out or aggressive behavior) that are disruptive or annoying to others. Risk Factors for Childhood Disorders 13.3 Identify risk factors for psychological disorders in childhood and adolescence and describe the effects of child abuse. Many factors contribute to increased risk of developmental disorders, including genetic susceptibility, prenatal influences on the developing brain, environmental stressors low socioeconomic level and living in decaying neighborhoods), and family factors (such as inconsistent or harsh discipline, neglect, or physical or sexual abuse; e.g., Hicks et al., 2013; Lewis et al., 2013; Plasschaert & Bartolomei, 2013; Salvatore et al., 2015). Children of depressed parents also stand a higher risk of developing psychological dis-orders, perhaps because parental depression contributes to greater levels of family stress (Essex et al., 2006; Weissman et al., 2006). Children with behavior problems from poorer, economically disadvantaged families are more likely to be labeled “bad kids” than to receive a diagnosis and professional help. Ethnicity and gender are other discriminating factors. For reasons that remain unclear, ethnic minority children stand a higher risk of developing problems such as ADHD and anxiety and depressive dis-orders (Anderson & Mayes, 2010; Miller, Nigg, & Miller, 2009). Boys are at greater risk for developing many childhood disorders, ranging from autism to hyperactivity to elimination disorders. Problems of anxiety and depression also affect boys proportionally more often than girls. In adolescence, however, anxiety and mood disorders become more common in girls and remain so throughout adulthood (USDHHS, 1999). t / F Child maltreatment—which involves neglect or physical, sexual, or emotional abuse—is linked to a wide range of physical and psychological problems in both child-hood and adulthood (e.g., Fuller-Thomson, West, & Baird, 2015; Geller, 2013; Herringa et al., 2013; Paul & Eckenrode, 2015; Whitelock, Lamb, & Rentfrow, 2013). (Effects of childhood sexual abuse are discussed in Chapter 10.) Despite the common belief that physical and sexual abuse is more harmful to children than emotional abuse and neglect, evidence shows that these different forms of child maltreatment have the same, broad, negative effects on children’s behavior and emotional wellbeing (Vachon et al., 2015). In fact, a recent major review showed that emotional abuse and neglect was even more strongly connected to the development of depression than were other forms of maltreatment (Infurna et al., 2016). Also important to consider is that even milder forms of physical punishment in childhood that may not rise to the level of physical abuse or neglect, such as spanking, smacking, and pushing, increase the risk of the later development of anxiety or mood disorders in adulthood (Afifi et al., 2012). Physically abused or neglected children often have difficulty forming healthy peer relationships and healthy attachments to others. They may lack the capacity for empa-thy or fail to develop a sense of conscience or concern about the welfare of others. They may act out in ways that mirror the cruelty they’ve experienced in their lives, such as by torturing or killing animals, setting fires, or picking on smaller, more vulnerable children. Other common psychological effects of neglect and abuse include lowered self-esteem, depression, immature behaviors such as bed-wetting or thumb-sucking, suicide attempts and suicidal thinking, poor school performance, behavior problems, and failure to venture beyond the home to explore the outside world. The behavioral and emotional consequences of child abuse often extend into adulthood, increasing the likelihood of depression and other mental health problems (Miller-Perrin, Perrin, & Kocur, 2009; Nakai et al., 2014). Child sexual and physical abuse is hardly an isolated problem. About 3.5 million cases of child abuse are reported to authorities annually in the United States An inter-national study of data drawn from the United States and 21 other countries showed that about 8% of men and 20% of women reported suffering sexual abuse before the age of 18 (Pereda et al., 2009). In the United States, one in eight children (12%) suffer documented maltreatment involving neglect or physical, emotional, or sexual abuse before age 18 (Wildeman et al., 2014). Sadly, between 1,000 and 2,000 children in the United States die each year as the result of abuse or neglect, more than twice the rate (adjusted for popula-tion size) of Great Britain, France, Canada, or Japan (Koch, 2009). As horrific as these num-bers are, they greatly understate the problem, as most incidents of child maltreatment are never publicly reported. Autism and Autism spectrum disorder The word autism derives from the Greek autos, meaning self. The term was first used in 1906 by the Swiss psychiatrist Eugen Bleuler to refer to a peculiar style of thinking among people with schizophrenia. Autistic thinking is the tendency to view oneself as the center of the universe, to believe that external events somehow refer to oneself. In 1943, another psychiatrist, Leo Kanner, applied the diagnosis “early infantile autism” to a group of disturbed children who seemed unable to relate to others, as if they lived in their own private worlds. Unlike children with intellectual disability, these children seemed to shut out any input from the outside world, creating a kind of “autistic alone-ness” (Kanner, 1943). Watch the video Xavier: Autism Spectrum Disorders to see the case of Xavier who, despite the typical lack of communication seen in autism, engages with others and is able to express himself. The DSM-5 places autism (previously Watch XaviER: aUtiSm SpECtRUm diSORdERS called autistic disorder) in a broader diagnos-tic category called autism spectrum disorder (ASD), which includes a range of autism-related disorders that vary in severity. DSM-5 identifies ASD on the basis of a common set of behaviors representing persistent deficits in communication and social interactions and restricted or fixated interests and repetitive behaviors (see Table 13.2). Not all of these problem behaviors need to be present, but there must be evidence of problem behaviors across a range of settings or contexts. Clinicians need to rate the severity of ASD as severe, moderate, or mild. The more severe the disorder, the greater the level of support that is needed. Table 13.2 Key Features of Autism Spectrum Disorder (ASD) problem behaviors Examples Impaired social interactions and communication • Unable to maintain normal back and forth conversations • Does not initiate or respond to social interactions • Fails to engage in give-and-take of social interactions or to share feelings or thoughts with others or engage in imagi-nary play with others • Language deficits that may range from complete lack of speech to delays in use of spoken language to speaking only in simple sentences • Abnormalities in speech may be present, such as stereotyped or repetitive speech, as in echolalia; idiosyncratic use of words; speaking about the self in the second or third person (using “you” or “he” to mean “I”) • Difficulties interacting nonverbally with others, such as failure to maintain eye contact, or use of odd body language or gestures • Lack of interest in peer interactions or difficulty making friends or maintaining relationships, or understanding the bases of relationships Restricted, repetitive, and stereotyped behavior patterns • Shows restricted range of interests or becomes fixated on particular interests or unusual objects (e.g., carrying a piece of string) • Insists on sameness or routines (e.g., always uses same route to go from one place to another, eating the same foods every day, or insisting on lining up toys), becomes extremely upset at small changes in routines, has difficulty shifting focus or activities • Shows stereotyped or repetitive movements (e.g., hand flicking, head banging, rocking, spinning) • Shows preoccupation with parts of objects (e.g., repetitive spinning of wheels of toy car) • Shows either little or excessive reactivity to environmental stimuli (e.g., may fail to respond to pain or changes in temperature, may become fascinated with lights, may show extreme distress to certain sounds Asperger’s disorder was a distinct diagnosis in the previous edition of the DSM but aUtiSm. Children with autism lack the ability to relate to others and seem to live in their own private worlds. is now classified in the DSM-5 as a form of autism spectrum disorder—but only if diag-nostic criteria for ASD are met. Asperger’s disorder refers to a pattern of abnormal behav-ior involving social awkwardness and stereotyped or repetitive behaviors but without the significant language or cognitive deficits associated with more severe forms of autistic spectrum disorder. Children with Asperger’s don’t show the profound deficits in intellectual, verbal, and self-care skills we find in children with the classic form of autism (Harmon, 2012). They may have remarkable verbal skills, such as reading newspapers at age 5 or 6, and may develop an obsessive interest in, and body of knowledge about, an obscure or narrow range of topics, like the interstate highway system, or, as in one case, vacuum cleaners (Osborne, 2002; Wallis, 2009). Many parents of children with Asperger’s are understandably concerned that their children may not qualify for the DSM-5 diag-nosis of autism spectrum disorder and therefore not receive the treatment services they need or be eligible for reimbursement for these services (Carey, 2012a; Mestel, 2012). The reported prevalence of ASD has been rising steadily over the past 20 years or so (CDC, 2014a). Government researchers estimate that about one in 50 children (2%)—more than 1 million U.S. children—are affected by autism spectrum disorder, up from one in 86 reported in 2007 (Blumberg et al., 2013). The estimate is based on a nationwide phone survey of parents, not on careful diagnosis of cases. However, government offi-cials believe the estimate reflects the proportion of American families struggling with some form of autism. The jump in reported cases of autism in recent years does not mean the disorder is occurring more often. Experts attribute much of the rise in reported cases to changes in diagnostic practices and greater awareness of the disorder among health care professionals (Blumberg et al., 2016; Hansen, Schendel, & Parner, 2014). Scientists are investigating whether other factors—perhaps prenatal or childhood infections, or environmental factors such as exposure to environmental toxins—may be contributing to increased rates of autism (Weintraub, 2011; Xiang et al., 2015 …
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