Psychological Disorders of Childhood

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Psychological Disorders of Childhood
Chapter 12 Psychological Disorders
Widom’s work offers yet another reason—as if more reasons were needed—why it is
so important to prevent the physical and sexual abuse of children. The long-term consequences of such abuse can be tragic not only for its immediate victims but also for
those victimized by the criminal actions and antisocial behavior of some abused children as they grow up (Weiler & Widom, 1996).
■ What do we still need to know?
Widom’s results suggest that one or more of the factors that lead teenagers to drop out
(or be thrown out) of high school might help create antisocial personality disorder even
in children who were not abused. Some of her more recent work suggests, too, that
exposure to poverty and other stressors can be as important as abuse in promoting
antisocial personality disorder (Horwitz et al., 2001). More research is obviously needed
to discover whether antisocial personality disorder stems from abuse itself, from one of
the factors accompanying it, or from some specific combination of known and stillunknown risk factors. The importance of combined and interacting risk factors is suggested by the fact that abuse is often part of a larger pool of experiences, such as exposure to deviant models, social rejection, poor supervision, and various stressful events.
Until we understand how all these potentially causal pieces fit together, we will not fully
understand the role played by childhood abuse in the chain of events leading to antisocial personality disorder.
We need to know more, too, about why such a small percentage of the abused
children in Widom’s sample displayed violence, criminal behavior, and antisocial personality disorder. These results raise the question of what genetic characteristics or environmental experiences serve to protect children from at least some of the devastating
effects of abuse (Flores, Cicchetti, & Rogosch, 2005; Rind & Tromovitch, 1997; Rind,
Tromovitch, & Bauserman, 1998). An understanding of what these protective elements
are might go a long way toward the development of programs for the prevention of
antisocial personality disorder.
A Sampling of Other
Psychological Disorders
䉴 How do children’s disorders differ from adults’ disorders?
The disorders described so far represent some of the most prevalent and socially disruptive psychological problems encountered in cultures around the world. Several others are mentioned in other chapters. In the chapter on consciousness, for example, we
discuss insomnia, night terrors, and other sleep disorders; mental retardation is covered
in the chapter on thought, language, and intelligence; sexual dysfunctions are mentioned
in the chapter on motivation and emotion; and posttraumatic stress disorder is
described in the chapter on health, stress, and coping. Here we consider two other significant psychological problems: disorders of childhood and substance-related disorders.
Psychological Disorders of Childhood
The physical, cognitive, emotional, and social changes seen in childhood—and the stress
associated with them—can create or worsen psychological disorders in children. Stress
can do the same in adults, but childhood disorders are not just miniature versions of
adult psychopathology. Because children’s development is still incomplete, and because
their capacity to cope with stress is limited, children are often vulnerable to special
types of disorders. The majority of childhood behavior problems can be placed in two
broad categories: externalizing disorders and internalizing disorders (Achenbach, 1997;
Lahey et al., 2004; Nigg, 2000).
A Sampling of Other Psychological Disorders
Normal behavior for children
in one culture might be considered hyperactive in other cultures. Do
people in the same culture disagree on
what is hyperactive? To find out, ask two
or three friends to join you in observing a
group of children at a playground, a
schoolyard, a park, or some other public
place. Ask your friends to privately identify which children they would label as
“hyperactive” and then count how many
of their choices agree with yours and
with one another’s.
The externalizing, or undercontrolled, category includes behaviors that disturb people in the child’s environment. Lack of control shows up as conduct disorders in from
1 to 10 percent of children and adolescents, mostly boys (American Psychiatric Association, 2000; Martin & Hoffman, 1990). Conduct disorders are characterized by a relatively stable pattern of aggression, disobedience, destructiveness, and other obnoxious
behaviors (Kalb & Loeber, 2003; Lahey et al., 1995). Often these behaviors involve criminal activity, and they may signal the development of antisocial personality disorder
(Lahey et al., 2005). A genetic predisposition toward conduct disorders is suggested by
the fact that many such children have parents who display antisocial personality disorder (Hicks et al., 2004). Children who are temperamentally inclined toward high activity levels are at greater risk for externalizing disorders (Mesman & Koot, 2000). There
is no doubt, though, that parental and peer influences, as well as academic problems
at school, also help to shape these children’s antisocial behavior (Laird et al., 2001;
Scourfield et al., 2004; Shaw et al., 2001).
Another kind of externalizing problem, attention deficit hyperactivity disorder (ADHD),
is seen in 3 to 7 percent of children, mainly boys (and in about 4 percent of adults, mainly
men; Kessler, Adler, et al., 2006). An ADHD diagnosis is given to children who, compared
with other children their age, are impulsive, inattentive, or both (Nigg, 2001; Wolraich
et al., 2005). Many of these children also have great difficulty sitting still or otherwise
controlling their physical activity. Their impulsiveness and lack of self-control contribute
to significant impairments in learning and to an astonishing ability to annoy and exhaust
those around them. Children diagnosed with ADHD also tend to perform poorly on tests
of attention, memory, decision making, and other information-processing tasks. As a
result, ADHD is being increasingly viewed as a neurological condition rather than just
“bad” behavior (Halperin & Schulz, 2006; Konrad et al., 2006; Krain & Castellanos, 2006;
Ollendick & Prinz, 2002; Sergeant, Geurts, & Oosterlaan, 2002).
ADHD may result from a genetic predisposition (Waldman & Gizer, 2006), but other
factors, such as brain damage, poisoning from lead or other household substances, and
low birth weight may also play causal roles (Hudziak et al., 2005; Linnet et al., 2003;
Mick et al., 2002; Sergeant, Geurts, & Oosterlaan, 2002; Spencer, 2002). In some cases,
problems in parenting may increase the risk for this disorder (Clarke et al., 2002).
Exactly how all these factors might combine is still not clear. Also uncertain is exactly
what constitutes hyperactivity. Cultural standards about acceptable activity levels in
children vary, so a “hyperactive” child in one culture might be considered merely
“active” in another. In fact, when mental health professionals from four cultures used
the same rating scale to judge hyperactivity in a videotaped sample of children’s behavior, the Chinese and Indonesians rated the children as significantly more hyperactive
than did their U.S. and Japanese colleagues (Jacobson, 2002; Mann et al., 1992). Such
findings remind us that sociocultural factors can be important determinants of what is
acceptable, and thus what is abnormal, in various parts of the world.
The second broad category of child behavior problems involves internalizing, or overcontrol. Children in this category experience significant distress, especially depression and
anxiety, and may be socially withdrawn. Those displaying separation anxiety disorder, for
example, constantly worry that they will be lost, kidnapped, or injured or that some harm
may come to a parent (usually the mother). The child clings desperately to the parent
and becomes upset or sick at the prospect of separation. Refusal to go to school (sometimes called “school phobia”) is often the result. Children who are temperamentally shy
or withdrawn are at higher risk for internalizing disorders, but these disorders are also
associated with environmental factors, including rejection by peers and (especially for
girls) being raised by a single parent (Mesman & Koot, 2000; Prinstein & La Greca, 2002).
A few childhood disorders, such as pervasive developmental disorders, do not fall into
either the externalizing or internalizing category. Children diagnosed with these disorders show severe deficits in communication and impaired social relationships. They also
often show repetitive, stereotyped behaviors and unusual preoccupations and interests
(American Psychiatric Association, 2000; Filipek et al., 1999). The disorders in this
group, also known as autistic spectrum disorders (Filipek et al., 1999; Rutter & Schopler,
1992; U.S. Surgeon General, 1999), share many of these core symptoms, although the
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