[Abnormal Psychology]

1
[Disorders Diagnosed in Infancy, Childhood and Adolescence]

Disorders Diagnosed in Infancy, Childhood, and

Adolescence

Objectives:
1. To discuss etiological considerations, clinical presentation, and theories
underlying diagnostic Nosology of specific psychiatric disorders
a) Attention-deficit Hyperactivity Disorder (ADHD)
b) Disruptive, Impulse-Control, and Conduct Disorder
c) Anxiety Disorders of Childhood and Adolescence
d) Elimination Disorders, Sleepwalking, Tics
e) Autism
At the end of this module, students are expected to:
1. To understand disease entities that are representative of mental
disorders seen in the pediatric age group
2. To explain specific psychopathological disorders, including its etiology
and clinical presentation
3. To explain current therapeutic strategies to address maladaptive
behavior
“Every adult, whether he is a follower or a leader, a member of a mass or of
an elite, was once a child. He was once small. A sense of smallness forms a
substratum in his mind, ineradicably. His triumphs will be measured against
this smallness; his defeats will substantiate it.” – Erik Erikson

Classification of Childhood Disorders

General Categories of Childhood disorders

Childhood disorders are generally categorized based on behaviors associated
with the disease. The two broad categories are externalizing and
internalizing disorders.

Externalizing disorders
These illnesses predominantly manifest with outward-directed behaviors,
such as overactivity, impulsiveness, and aggressiveness. In these behaviors,
children are usually unable to control their behavior according to socially
acceptable standards. Some examples of disorders under this category are

Course Module
attention-deficit/hyperactivity disorder, conduct disorder, and oppositional
defiant disorder.
The following are symptoms of externalizing disorders:
1. Rule violation
2. Aggressive behavior
3. Negativity
4. Being angry all the time
5. Impulsivity
6. Hyperactivity
7. Distractibility

Internalizing disorders
These illnesses predominantly manifest with inward-focused behaviors such
as social withdrawal, depression, and anxiety. Some examples of disorders
under this category are mood disorders and anxiety disorders.
Symptoms of internalizing disorders
1. Depressive symptoms
2. Anxiety
3. Refusal to go to school
4. Impaired social relationships
Some patients will exhibit clinical features of both disorders. Disease
categories were revised in the latest edition of the DSM (See Fig.1)

DSM-IV-TR DSM-V

Mental retardation Intellectual development disorder

Learning disorders Learning disorders

Pervasive developmental disorders Autism spectrum disorder

Motor skills disorders Motor disorders

Communication disorders Communication disorders

Feeding disorders of infancy or early Feeding and eating disorders

childhood

Conduct disorder Disruptive, impulse control and

conduct disorders
Oppositional defiant disorder

Other disorders of infancy, Anxiety disorders (includes adult and

childhood, or adolescence childhood disorders)
Separation anxiety disorder
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Selective mutism Included in communication disorders

Comparison of DSM-IV-TRFig. 1 Comparison of DSM-IV-TR and DSM-V

Classifications of childhood disorders

Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-Deficit/Hyperactivity Disorder (AD/HD) is one of the most

common mental disorders among children. In the United States, it is the most
frequently diagnosed mental health illness among children. It is frequently
diagnosed among preadolescent boys before 8 years of age (See Fig. 1)

Fig. 1 Marty, a 9-year-old child diagnosed with attention-

deficit/hyperactivity disorder (ADHD), dancing around his room (Liss,
S./Getty Images, 1998)

Clinical manifestations
ADHD is seen in children who manifest difficulties in carrying out task-
oriented behaviors. They clinical manifest with impulsivity, excessive motor
activity, fidgeting, and difficulty focusing on a single task. In school, teachers
commonly observe that children with ADHD are easily distracted. Also, they
often find it difficult to follow instructions. They can be found aimlessly
running or fidgeting. Because of these behavioral problems, children with
ADHD have academic difficulties, and some may even have learning
Course Module
disabilities. According to studies, they usually have a lower intelligence
quotient (IQ) than the average and poor overall academic functioning.

Aside from academic problems, children with ADHD also suffer from poor
quality of social interactions. They tend to talk incessantly, which other
people might find socially intrusive or immature. Because of their impulsivity
and overactivity, children have impaired relationships with their parents and
peers. Sometimes, their actions are interpreted as a result of anxiety, but
studies show that children with ADHD are not anxious.

Diagnosis
Based on the DSM-V criteria, children should have a persistent inattention
and/or hyperactivity pattern that interferes with functioning and
development for at least 6 months. At least 6 symptoms of inattention or
hyperactivity are required to be diagnosed with this disorder. These
symptoms should also be present prior to 12 years of age.

Symptoms of inattention
1. Often fails to give close attention to details or make careless mistakes in
schoolwork, work, or other activities.
2. Often has difficulty sustaining attention in tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow through on instructions and fails to finish
schoolwork, chores, or workplace duties.
5. Often has difficulty organizing tasks and activities.
6. Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort.
7. Often loses things necessary for tasks or activities.
8. Is often easily distracted by extraneous stimuli
9. Is often forgetful in daily activities

Symptoms of hyperactivity and impulsivity:

1. Often fidgets with or taps hands or feet or squirms in seat.
2. Often leaves seat in situations when remaining seated is expected.
3. Often runs about or climbs in situations where it is inappropriate.
4. Often unable to play or engage in leisure activities quietly.
5. Is often "on the go," acting as if "driven by a motor."
6. Often blurts out an answer before a question has been completed.
7. Often has difficulty waiting for his or her turn.
8. Often interrupts or intrudes on others.

Etiological considerations
The precise causative factor that leads to ADHD remains unknown. However,
several factors are associated with its development.
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[Disorders Diagnosed in Infancy, Childhood and Adolescence]

Genetic factors
Studies were carried out among twins and adopted children. These studies
suggest that there is a genetic component to the development of this
disorder. Heritability estimates were as high as 70-80% in some studies.
Genes associated with the neurotransmitter dopamine were also found to be
associated with the development of this disorder.

Neurobiological factors
Studies suggest that children with ADHD have a different brain structure
from children who behave normally. Parts of the brain that produce
dopamine were found to be smaller in children with ADHD. Dopamine is an
important neurotransmitter for movement and intellectual function.

Perinatal and Prenatal factors

Children who were born from mothers who abused alcohol and tobacco were
found to be more likely to develop symptoms of ADHD. Several studies also
suggest that low birth weight is a predictor of the development of ADHD.

Environmental toxins
Some researchers believe that exposure to environmental toxins plays a role
in the development of ADHD. Substances that were investigated include food
additives (food coloring), lead exposure, and nicotine exposure via maternal
smoking. Despite these researchers, no conclusive evidence exists to
establish direct causation of exposure to these substances to the
development of ADHD.

Psychological factors
Children with this disorder often have strained social relationships,
especially with their parents. Because of the nature of their disease, children
with ADHD find it difficult to obey their parents. As a result, this has a
negative consequence on parenting style and behavior. In addition, parents
who also have ADHD may show characteristics that may worsen the behavior
of children afflicted with ADHD. Studies show that familial characteristics
contribute to the exacerbation and maintenance of this disease.

Treatment
Course Module
 Stimulant medication
Medications are used to improve the symptoms of patients with ADHD.
Stimulant medications were shown to improve attention, alertness and
decrease hyperactivity among children with ADHD. As a result, children have
improved academic performance and social behavior. One of the most
commonly used stimulant drugs to treat ADHD is Methylphenidate (Ritalin).

Psychological treatment
Psychological treatment for patients with ADHD involves training both the
parents and teachers to monitor the children’s behavior and apply operant
conditioning to reinforce good behavior. For example, children are given
stickers or stars whenever they behave appropriately. Also, daily report
cards may be utilized to track the progress or decline in children’s behavior.
The goal of psychological treatment is to improve the child’s functional
outcome in terms of academic performance, social behavior, completing
household tasks and to control symptoms of hyperactivity and impulsivity.
The combination of medication treatment with behavioral conditioning
improves the success rate of treatment for patients with this disorder.

Disruptive, Impulse-Control, and Conduct Disorder

As the name implies, children who suffer from these disorders do not regard
social standards and societal norms. As a result, they violate the basic rights
of other people resulting in legal consequences. A disorder that is
representative of this category is conduct disorder, which is fairly common
in the United States, with an estimated prevalence of 9%.

Fig 2. Child exhibiting features of conduct disorder (ADHD & Depression

Clinic,n.d.)

Clinical manifestation
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[Disorders Diagnosed in Infancy, Childhood and Adolescence]

Children with conduct disorder manifest with unusual hostility towards

others, verbal aggressiveness, and destructiveness. These children engage in
habitual bullying, stealing, and lying. They are also capable of legal violations
such as arson, theft, trespassing, and homicide. Children with conduct
disorder may also have other problems, such as depression, anxiety, or
substance abuse disorder. This disorder is also associated with antisocial
personality disorder development, which we will discuss separately in a
different module.

Diagnosis
Based on the DSM-V criteria, children with conduct disorder should have a
persistent pattern of behavior that violates conventional social rules and
other people's basic rights. Children must have at least 3 of the following
symptoms for the past year, or at least 1 symptom for the past 6 months to
be diagnosed with conduct disorder.

Aggression to People and Animals

1. Often bullies, threatens, or intimidates others.
2. Often initiates physical fights.
3. Has used a weapon that can cause serious physical harm to others
4. Has been physically cruel to people.
5. Has been physically cruel to animals.
6. Has stolen while confronting a victim
7. Has forced someone into sexual activity

Destruction of Property
1. Has deliberately engaged in fire setting intending to cause serious
damage.
2. Has deliberately destroyed others’ property (other than fire setting).

Deceitfulness or Theft
1. Has broken into someone else’s house, building, or car.
2. Often lies to obtain goods or favors or to avoid obligations.
3. Has stolen items of nontrivial value without confronting a victim

Serious Violation of Rules

1. Often stays out at night despite parental prohibitions, beginning before
age 13 years.
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2. Has run away from home overnight at least twice while living in the
parental or parental surrogate home, or once without returning for a
lengthy period.
3. Is often truant from school, beginning before age 13 years.

Etiologic considerations
The following factors are associated with the development of conduct
disorder:

Genetic Factors
There are pieces of evidence that support the genetic component to the
development of conduct disorders. A large-scale twin study in Australia
supports genetic influence on the development of symptoms of conduct
disorder among children, rather than environmental influence. On the other
hand, adoption studies in Sweden, Denmark, and the United States show that
genetic and environmental factors influence criminal and antisocial behavior.

Neuropsychological factors
Children with conduct disorder were found to have neuropsychological
deficits, such as poor verbal skills, memory deficits, and difficulty planning
and solving problems. Also, objective tests show that children with conduct
disorder have lower IQ scores than average children.

Psychological factors
Children with conduct disorder have a deficiency in moral awareness, which
is the capacity to distinguish what is right from wrong. Normally, people
abide by conventional social rules and avoid harming others because it will
make them feel guilty. However, since children with conduct disorder lack
moral awareness, they usually show no remorse when harming others.

Behavioral theories can also explain the development and maintenance of

conduct disorders. Modeling and operant conditioning play a role in
developing this disorder. Children who grew up in harsh environments or
those who were physically abused are likely to develop an aggressive
attitude, as seen in conduct disorders. Parenting style is also important for a
child's development. Children who were born from parents who do not teach
the negative repercussions of poor behavior are more likely to feel less guilty
for their wrongdoings.

Peer influence
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[Disorders Diagnosed in Infancy, Childhood and Adolescence]

Studies link peer rejection to the development of aggressive behavior.

Children who are associated with socially deviant peers are also likely to
imitate the same behavior.

Sociocultural factors
Higher levels of juvenile delinquency were found among children who grew
up in impoverished environments. Some of the contributory factors that
were linked to aggressive behavior are unemployment, poor educational
facilities, poor family life, lack of parental supervision, and normative cultural
delinquency. Studies show that the combination of early aggressive behavior
in a child with poor socioeconomic background predicts early criminal
behavior.

Treatment

Family Interventions
The involvement of the child’s parents and family is important in controlling
the symptoms of conduct disorder. An example of a program that involves
the family in the treatment of patients with conduct disorder is parent
management training (PMT). In this treatment, parents are oriented on
how to modify their responses to their children so that social behavior is
enhanced. Principles of operant conditioning are being taught, wherein
parents gain knowledge on positive reinforcement when the child exhibits
good behavior. This program is further enhanced with cooperation from both
parents and teachers in monitoring children's behavior with conduct
disorder.

Multi-systemic treatment (MST)

In this form of treatment, the entire community, family, and school are
involved in the therapy. It is based on the principle that conduct disorders
are affected by multiple factors, including social relationships within the
community. Some activities that are being carried out during treatment
include identifying the social factors that aggravate or maintain the child's
symptoms, and the child's family members address these factors regularly.
This may require daily or weekly efforts from the child's family members.

Course Module
Anxiety Disorders of Childhood and Adolescence

During a child's normal development, he may experience fears and worries.

For example, a child may have a fear of dark places or certain animals.
However, as a child grows up, most of these fears are outgrown. If not,
children learn to adapt to what they are scared of. On the other hand,
children with anxiety disorders have maladaptive responses to normal
stimuli. This causes impairments in a child's overall functioning and
development. A disorder that is representative of this category is separation
anxiety disorder.

Fig. 3. Child exhibiting separation anxiety disorder symptoms (Postmedia

Network Inc, 2015)

Clinical Manifestation
Children with separation anxiety disorder are constantly worried that they
will be harmed once they are left alone away from their parents. These
children are often observed to trail behind one of his parents even when they
are at home. This disorder is usually diagnosed at the beginning of school
because it is the first time that children will be separated from their parents
for a considerable amount of time.
They usually exhibit overwhelming fear, self-conscious behavior, and
oversensitivity. They also tend to have nightmares and sleep disturbances.
Because they are always preoccupied with their fears, children with anxiety
disorders lack confidence in communicating with others. They are shy,
agitated, easily worried, and discouraged.

Diagnosis
Children with separation anxiety disorder exhibit excessive fear or anxiety
when being physically separated from their parents or to whomever they are
deeply attached. This causes significant impairment in a child’s functional
capacity. Three or more symptoms of anxiety should be persistent for at least
4 weeks in children and adolescents to be diagnosed with a separation
anxiety disorder.
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[Disorders Diagnosed in Infancy, Childhood and Adolescence]

Based on the DSM-V manual, the following are symptoms of anxiety:

1. Excessive distress when anticipating or experiencing separation from
home or major attachment figures.
2. Excessive worry about losing major attachment figure or about possible
harm to them, such as illness, injury, disasters, or death
3. Excessive worry about experiencing an untoward event that causes
separation from a major attachment figure. Examples are being
kidnapped or having an accident.
4. Refusal to go out, away from home, to school, or elsewhere because of
fear of separation
5. Excessive fear of being alone
6. Refusal to sleep away from home or away from a major attachment figure
7. Repeated nightmares involving the theme of separation
8. Repeated complaints of physical symptoms when separation from a
major attachment figure occurs or is anticipated.

Etiological considerations
Genetic and socio-cultural factors
Studies show that anxiety behaviors may be heritable in as much as 29-50%
of cases. However, socio-cultural also contribute to the development of
anxiety disorders in children. For example, results from one study showed
that there is an increased risk of developing anxiety and depression among
immigrant Latino youth.

Psychological factors
Parenting practices may also play a role in the development of anxiety
disorders. Overprotectiveness and parental control are associated with
childhood anxiety. Problems with emotion-regulation and insecure
attachment during infancy are also theorized to be psychological factors that
may contribute to the development of anxiety disorders.

Treatment
Medications
Treatment with anti-anxiety medications relieves symptoms in patients with
anxiety disorders. However, patients should be carefully evaluated for the
presence of other conditions that may be aggravated with the use of anti-
anxiety medications.

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 Psychological treatment
Behavioral therapy
This is commonly done in schools to help reduce symptoms of anxiety in
children with anxiety disorders. This involves training them to become more
confident by mastering basic academic skills. To reduce anxiety or fear
towards an object, desensitization therapy may be used. In this form of
therapy, the child is exposed gradually to the stimulus that arouses feelings
of fear. Exposure to the same stimuli appears to reduce anxiety.

Cognitive-behavioral therapy
In this form of therapy, children are taught how to recognize their emotions,
especially fear and anxiety, through group sessions. Therapists teach
children how to cope with their emotions more effectively. Parents also
participate in seminars or workshops wherein they are taught how to
manage children's anxious behavior. Studies show that cognitive-behavioral
therapy reduces anxiety among children.

Elimination Disorders, Sleepwalking, Tics

Elimination disorders
Two types of elimination disorders are:
Enuresis
This disorder is commonly known as “bed-wetting”, wherein children
inappropriately acquire the habit of urinating at night while they are asleep.
Enuresis may occur nightly or only in instances wherein the child is
unusually tired or stressed. This most commonly happens among 5 year-olds,
with an estimated incidence of 5-10%.

Studies suggest that the following may be associated factors in the

development of enuresis:
1. Improper learning of bladder control
2. Immaturity, which may be associated with maladaptive coping
mechanisms
3. Strained relationship with the family
4. Stressful events

Treatment of this condition involves the use of an anti-depressant

medication called imipramine. The way this medication treats this condition
remains unclear, but it may be related to lessening the deep stages of sleep,
which enables the child to recognize physiologic needs more efficiently. This
condition may also resolve spontaneously without any form of treatment.
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[Disorders Diagnosed in Infancy, Childhood and Adolescence]

Encopresis
This condition is less common than enuresis, with a prevalence rate of 1%
among 5 year-olds. Children with encopresis have poor toileting habits. They
frequently soil their clothing, especially when they are under stress. This is
usually diagnosed after the age of 4, wherein children are expected to have
undergone toilet training.

The etiology of this disorder is unknown. Some children report that they are
embarrassed to use bathrooms in school, while others do not know when
they needed to defecate. Children are usually treated with behavioral therapy
using the principles of conditioning to learn appropriate behavior. Some of
these children are also found to have constipation, for which medical
treatment can be provided.

Sleep-walking disorder
In the DSM-V, the sleep-walking disorder is classified under the category of
parasomnias. In children, this disorder usually occurs between the ages of 6
to 12. Children affected with this disorder are observed to walk
unconsciously during sleeping hours. According to studies, sleep-walking is
fairly common, and an estimated 10-30% of children can experience a single
episode of sleep-walking.
While sleep-walking, children's eyes may be partially or fully open. They may
also respond to commands and avoid hazards while walking. When they are
awakened, they are usually surprised to find themselves walking, and they do
not have a recollection of the episode. At present, there is no standard
treatment for sleep-walking disorder. However, behavioral therapy has been
described in one study.

Tic Disorders
A tic is a repetitive and persistent localized muscle twitch or spasm. Children
with tic disorders are usually observed to abnormally blink, twitch their
mouth, or clear their throats. This disorder commonly occurs between the
ages of 2 and 14. At times, children with tic disorders may perform certain
actions repetitively without being fully aware of it. An example of a severe
form of a tic disorder is Tourette's disorder; wherein repetitive movements
involve multiple motor and vocal patterns. Children affected with this
disorder suffer from uncontrollable urges to do stereotypical movements
Course Module
 such as moving their heads or a particular part of their body. Children may
also produce unusual sounds while doing uncontrollable movements. This
disease is produces impaired social skills and other behavioral problems.

Some children benefit from medications that suppress tic movements. Some
examples of medications that are being used for tic are Clonazepam,
clonidine, and tiapride. Behavioral therapy was also found to be helpful in
some studies. An example of this treatment is habit reversal treatment
(HRT), which involves awareness-training, relaxation training, appropriate
responses, and modification of the patient's overall action. However, some
children do not receive any treatment, allowing tics to persist throughout
adulthood.

Autism
Autism spectrum disorder is one of the most disabling developmental
disorders among children. Children with autism show multiple behaviors
that cause impairment in their social interaction with other people. This is
one of the most common developmental disorders in childhood. In the United
States, estimates are as high as 1 in 50. This condition usually persists into
adulthood (See Fig. 4).

Clinical manifestation

Children with autism have social and emotional disturbances. They do not
readily approach other people and usually have poor eye contact. They
usually do not initiate to engage with social interactions with other children.
They often refuse to play with others and would rather play by themselves.
Children have a deficiency in joint attention, which is the ability to pay
attention to others during social interaction.
Children with autism have communication deficits. They have delayed
language milestones compared to other children. For example, at 2 years of
age, children usually utter 2-word phrases to express themselves. An
example is "Me cookie", which means that they want a cookie. Usually,
children with autism are unable to do this. Autistic children usually exhibit
pronoun reversal and echolalia. In pronoun reversal, children refer to
themselves as "he/she" instead of "I". For example, when being asked what
he is doing, he will reply, "He is playing", rather than "I am playing". Echolalia
is when a child repeats what he hears from another person. For example, a
parent asks, "What do you want to eat?", the autistic child may respond by
saying, "What do you want to eat?".
Children with autism may display repetitive and ritualistic acts. For
example, they usually have a bedtime routine, and any slight change in that
routine may make them feel very upset. Sometimes, even a slight
rearrangement of their toys throws them into tantrums. Children with
autism may also show stereotypical movements like body rocking, spinning
objects, or flapping of hands.
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[Disorders Diagnosed in Infancy, Childhood and Adolescence]

Fig. 4 Six-year-old Gwendoline, an autistic child, works with Professor Gilbert

Lelord while under his care at Bretonneau hospital in Tours, France.
Bretonneau specializes in psychiatric problems in children. (Bisson,
B./Sygma via Getty Images, n.d.)

Diagnosis
According to DSM-V, patients with autism should have persistent deficits in
social communication and social interaction. They should also manifest with
at least two symptoms of restricted, repetitive patterns of behavior, interests,
or activities. These symptoms should be present in early childhood, causing
significant impairment in daily living.

Symptoms of deficits in communication

1. Deficits in social-emotional reciprocity, ranging from abnormal social
approach and failure of normal back-and-forth conversation; to reduced
sharing of interests, emotions, or affect; to failure to initiate or respond to
social interactions.

2. Deficits in nonverbal communicative behaviors used for social

interaction, ranging, for example, from poorly integrated verbal and
nonverbal communication; to abnormalities in eye contact and body
language or deficits in understanding and use of gestures; to a total lack
of facial expressions and nonverbal communication.
Course Module
3. Deficits in developing, maintaining, and understanding relationships,
ranging, for example, from difficulties adjusting behavior to suit various
social contexts; to difficulties in sharing imaginative play or in making
friends; to the absence of interest in peers.

Symptoms of repetitive behavior

1. Stereotyped or repetitive motor movements, use of objects, or speech
2. The insistence of sameness, inflexible adherence to routines, or ritualized
patterns of behavior
3. Highly restricted, fixated interests that are abnormal in intensity or focus.
4. Abnormally excessive or absent reaction to sensory stimuli (eg. Adverse
reaction to a certain scent or sound).

Etiologic considerations
Genetic Factors
Multiple studies done on twins support the evidence that autism spectrum
disorders may be genetically inherited. The risk of acquiring this disorder is
higher for children with siblings who have autism. Some researches link a
specific genetic abnormality to the development of autism. However, this
research needs to be validated with further studies.

Neurobiological Factors
Several studies suggest that there is an inherent neurological abnormality in
patients with an autism spectrum disorder. One study investigated if there is
a difference in the brain size of a child with autism compared to one who
does not have this condition. Results showed that children with autism have
an increase in the size of the brain by the time they reach 2 years old,
compared to normal children. The researchers attribute poor function to an
increase in the growth of the brain. Interestingly, the increase in brain size
does not continue past 4 or 5 years old. Also, other areas of the brain are
associated with the development of autism. The amygdala is a part of the
brain that is associated with emotional and social behavior. Studies show
that the amygdala of children with autism is larger than normal children. The
researchers suggest that this enlargement is secondary to poor function,
which is analogous to previously mentioned studies.
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[Disorders Diagnosed in Infancy, Childhood and Adolescence]

Treatment

Medications
In the past, some specialists prescribe anti-depressants, anti-psychotic
medications, and stimulants. However, the evidence does not support their
use unless there are no other ways to control a child's behavior. At present,
there are no approved medications for relieving the symptoms of autism.

Behavioral Treatment
The most successful intervention to improve the symptoms of n autism is
behavior therapy. The pioneer in this form of treatment is Ivan Lovaas. His
intervention involves one-on-one teaching sessions with children. This is
usually conducted in the children's homes instead of an institution. He used
operant conditioning principles by giving positive reinforcements when the
child behaves well and negative reinforcements in the form of punishment
when the child behaves poorly. Parents are also involved wherein they are
taught how to engage their children in social interactions. This form of
treatment improved intellectual functioning in children with autism.
However, one of the disadvantages of this treatment is that it requires a
therapist to work with the child for at least 40 hours per week for 2 years.

Activities and Exercises

Create a reviewer for this module that includes the following:
▪ Enumerate the discussed childhood illnesses
▪ List down the clinical manifestations, etiologic considerations, and
treatment for each category.
▪ Familiarize yourself with the diagnostic criteria for each disease
entity
▪ Familiarize yourself with the diagnostic classification for each disease
entity (DSM-IV-TR and DSM-V)
Take your short quiz and submit it before the deadline.

Course Module
 Glossary

Externalizing disorders - illnesses predominantly manifest with outward-

directed behaviors, such as overactivity, impulsiveness, and aggressiveness.

Desensitization - a form of therapy wherein repeated exposure to stimuli

will result to a reduced adverse reaction to it.

Habit reversal treatment is a form of treatment for tic disorders that

involves awareness-training, relaxation training, developing appropriate
responses, and modifying a patient's overall action.

Internalizing disorders - illnesses predominantly manifest with inward-

focused behaviors such as social withdrawal, depression, and anxiety.

Joint attention - the ability to pay attention when communicating with

another person.

Multi-systemic treatment- a form of treatment for children with conduct

disorders that involves comprehensive therapy in the community setting,
which gives focus on the child and his social relationships with his family,
peers, and school administrators.

Parent management training - a form of treatment for patients with

conduct disorder wherein parents are oriented on how to modify their
responses to their children so that social behavior is enhanced.

tic - a repetitive and persistent localized muscle twitch or spasm

References
Bisson, B. (n.d.). [Photograph found in Sygma]. In Getty Images. Retrieved
from [Link]
Butcher, J. N., Hooley, J. M., & Mineka, U. (2014). Abnormal psychology (16th
ed.). Upper Saddle River, New Jersey: Pearson.
Durand, V. M., & Barlow, D. H. (2016). Essentials of abnormal psychology (7th
ed.). Boston, MA: Cengage Learning.
Kearney, C. A., Trull, T. J., & Kearney, C. A. (2015). Abnormal psychology and
life: A dimensional approach. Stramford, CT: Cengage Learning.
Kring, A. M., Johnson, S. L., Davidson, G. C., & Neale, J. M. (2012). Abnormal
psychology (12th ed.). Essex County, MA: John Wiley & Sons.
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Liss, S. (1998). [Photograph found in The LIFE Images Collection, The LIFE
Images Collection]. In Getty Images. Retrieved from
[Link]
Parent Traps: Separation anxiety is real for both parents and children
[Photograph found in Postmedia Network Inc]. (2015). In Vancouver
Sun. Retrieved from [Link]
traps separation anxiety real both parents
children/11487329/[Link]

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