1. Disorders of childhood and adolescence (p. 495) Over 20 percent of children in the United States, ages 9 to 17, have a diagnosable mental or addictive disorder associated with at least minimal impairment. Without effective intervention early in life, untreated disorders may create lifelong problems.
2. Pervasive developmental disorders (p. 497) Pervasive developmental disorders are severe disturbances affecting language, social relations, and emotions, distortions that would be abnormal at any developmental stage. Prevalence of autistic disorder is about 2 to 20 per 10,000 children; the other pervasive developmental disorders occur at a rate of about 22 in 10,000.
   Autistic disorder was first described by Leo Kanner in 1943 and is characterized by great impairment in social interaction and/or communication, stereotyped interests and activities, and delays or abnormal functioning in major areas before age 3. Autistic children interact with others as though people were unimportant objects. Half do not speak; the other half often show echolaliaechoing whatever was just saidor pronoun reversal (where you is said instead of I). Most autistic children are mentally retarded, although splinter skills (special abilities) are found, most dramatically in autistic savants. Misdiagnosis as mental retardation only or as a different disorder or condition is common. Research shows that autistic children are less able than matched children to identify human characteristics. They seem not to have a theory of mind; they are unable to appreciate that others think.
   About 22 in 10,000 children show some, but not all, of the characteristics of autistic disorder along with severe social impairment and would be diagnosed with pervasive developmental disorders that do not meet the criteria for autistic disorders. These include Aspergers disorder (similar symptoms to autism, but more highly functional); childhood disintegrative disorder (at least two years of normal development), Retts disorder (normal for at least five months, onset between age 5 and 48 months, and deceleration of head growth seen only in females), and pervasive developmental disorder not otherwise specified. Because they are new, little research on the causes of these disorders is available.
   One early theory about the cause of autistic disorder was a psychodynamic view that parent-child interactions produce withdrawal. Current knowledge gives no justification for this idea. No single cause is likely to be found, although most research points to a biological cause. Some studies show high concordance rates for MZ twins (36 percent), central nervous system impairment, and elevated serotonin and dopamine levels. The prognosis for children with pervasive developmental disorders is mixed. Those with severe retardation have worse outcomes, and those with greater verbal skills have more favorable outcomes. Treatment has involved intensive behavior modification, which has been effective in eliminating echolalia and self-stimulation while increasing verbal and social behaviors and enabling autistic adults to be competitively employed. Medications such as haloperidol and have produced mixed results; while secretin has not faired well under recent investigation, family involvement is important, as is careful transitioning into the mainstream. Recently SSRIs have been used as a treatment.
3. Other developmental disorders (p. 506) The definition of less severe childhood disorders often depends on the tolerance of the referring agent. Developmental problems are reported in normal as well as clinical populations. Cultural norms also influence what behaviors are considered problems. Diagnosis guidelines are vague and rely heavily on clinical judgment. Some disorders that focus on impairments are attention deficit/hyperactivity disorder (ADHD), disruptive disorders, separation anxiety disorders, tic disorders, reactive attachment disorder, stuttering, enuresis, and encopresis.
4. Attention deficit/hyperactivity disorders and disruptive behavior disorders (p. 508) Attention deficit1hyperactive disorder (ADHD) is characterized by attention problems and may involve heightened motor activity. There are three types: predominantly hyperactive impulsive, predominantly inattentive, and combined (showing both hyperactivity and inattentiveness). ADHD is a relatively common disorder, far more common in boys than in girls. In some cases, ADHD children continue to have antisocial or psychiatric problems as adults; those with attention problems but not hyperactivity have better outcomes. Research on specific brain impairments causing ADHD has produced conflicting findings. Food additives and sugar are not significant factors. Family variables seem related to ADHD, but it is not clear whether genetics or environment are at work. Seventy-five to 90 percent of children with ADHD respond to stimulant medications, although there is concern about whether children are being overmedicated.
   Children with ADHD are typically treated with stimulant medication, but there is considerable controversy about the overmedication of children and the poorly supervised prescription of drugs. Self-instructional procedures, modeling, and parent training programs have been as effective as drug therapy.
   Oppositional defiant disorder is characterized by negativistic and hostile behavior, but without serious violations of others rights. DSM-IV-TR criteria include significant impairment in social and academic functioning, a raising of the threshold for diagnosis.
   Conduct disorder involves a persistent pattern of antisocial behavior in which others rights are violated. It is relatively common, particularly in boys, and can be subtyped according to age of onset (prior to age ten and after age 10). Oppositional defiant disorder often precedes conduct disorder and is coexistent with ADFID. Violence is quite likely among these children. Prognosis is poor, particularly if there is sexual aggression. Theories of cause include psychodynamic ideas concerning underlying anxiety, genetic factors, and inadequate parental behavior. Cognitive behavioral treatment that combines social skills and parent management training holds the most promise for treating conduct disorder.
5. Anxiety disorders (p.516) Separation anxiety disorder is marked by excessive anxiety when the child is separated from parents or home. Somatic symptoms are prominent. This and other childhood anxiety disorders are probably caused by an interaction between the childs temperament (very early personality style) and the home environment that parents establish. School phobia is one result of such anxiety, but that may be a separate syndrome. The causes of separation anxiety disorder may include overdependence on the mother (psychodynamic) and parental reinforcement of avoidance fears (learning). Prognosis is better when separation anxiety disorder is treated in childhood rather than in adolescence.
6. Reactive attachment disorder (p. 518) Reactive attachment disorder is a serious problem that develops in infancy or early childhood, expressed in the childs extreme disturbance in relating to others socially. The disorder arises from situations of extreme abuse, neglect, institutional upbringing, or repeated changes in primary caregiver that have result in an inability to meet the childs physical or emotional needs that affect attachment formation. Rebirthing therapy has been used ineffectively and may put vulnerable children at risk; children with reactive attachment disorder need to feel they are in a safe and nurturing environment, caretakers should learn parenting skills, and children need to learn to set goals related to their specific symptoms.
7. Mood disorders (p. 518) Childhood depression is not listed under childhood disorders in DSM-IV-TR, but depression can occur in children as early as infancy. Prevalence of childhood depression ranges from 2 percent to 7 percent among children and adolescents. It is a particular concern for this age group because of the high risk for suicide. The symptoms for depression are much the same as in adults, although children are more likely to exhibit somatization; bipolar disorder in children involves more rapid cycling of moods. However, the most common form of mood disorder in children is reactive depression. Many factors may be responsible for mood disorders in childhood, and its connection with abuse is notable. Treatment requires support and cognitive and social skills training.
8. Tic disorders (p. 519) Tics are involuntary, repetitive movements or vocalizations. Many children have a single, transient tic such as eye blinking. Others have one or multiple tics for a year or longerchronic tic disorder. Tourette's syndrome is a puzzling disorder in which childhood tics evolve into grunting and barking, and finally coprolalia (the compulsion to shout obscenities). Stress appears to be a factor in causing these disorders, although multiple tics and Tourettes syndrome appear to be transmitted in families, and may be related to obsessive compulsive disorder or ADHD and may stem from an impairment of the central nervous system involving the dopamine system. Treatment can involve haloperidol or clonodine, which acts on dopamine receptors; although not without its risks, psychosurgery has also been used.
9. Elimination disorders (p. 523) Enuresis (urination in inappropriate places that is usually involuntary) and encopresis (defecation in inappropriate places) may have biological and psychological origins. Treatment may include medication and behavior modification procedures.