March 11 Childhood Disorders And Communication


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  • March 11 Childhood Disorders And Communication

    1. 1. Childhood Disorders & Communicating with Children
    2. 2. Conduct Disorder <ul><li>Symptoms </li></ul><ul><ul><li>violate basic rights of others and major societal norms; lack of remorse </li></ul></ul><ul><li>Comorbidity </li></ul><ul><ul><li>ADHD (30-90%) </li></ul></ul><ul><ul><li>Substance abuse </li></ul></ul><ul><ul><li>Anxiety and depression (15-30%) </li></ul></ul>
    3. 3. Biological Theories of CD <ul><li>Genetic influence </li></ul><ul><ul><li>Twin studies showed mixed results: </li></ul></ul><ul><ul><ul><li>A study of 3000 Vietnam war veterans suggested that family influence is stronger than genetic. </li></ul></ul></ul><ul><ul><ul><li>A study of 2600 twin pairs in Australia found a substantial genetic influence. </li></ul></ul></ul><ul><ul><li>Further twin studies suggest that some aggressive behaviors are heritable (I.e., cruelty towards animals); others (stealing, truancy) may not be. </li></ul></ul><ul><li>Neuropsychological deficits </li></ul><ul><ul><li>poor verbal skills, planning abilities, problem-solving skills </li></ul></ul>
    4. 4. Psychological theories of CD <ul><li>Lack of moral awareness </li></ul><ul><ul><li>Verlaan et al 2002 </li></ul></ul><ul><ul><ul><li>Parental style: Lax parental discipline and parental adjustment difficulties contribute to conduct disordered behavior </li></ul></ul></ul>
    5. 5. Psychological theories of CD <ul><li>Learning theories </li></ul><ul><ul><li>Bandura’s social learning theory </li></ul></ul><ul><ul><ul><li>People learn through the process of imitation </li></ul></ul></ul><ul><ul><ul><li>Bobo doll study (Bandura et al, 1961): Children who witnessed an adult being aggressive with a plastic Bobo doll were observed imitating this aggression while playing with other children. </li></ul></ul></ul><ul><ul><ul><li>Children can learn aggressiveness from parents who behave aggressively. (Bandura & Walters, 1963) </li></ul></ul></ul><ul><ul><li>Operant Conditioning - reward and punishment </li></ul></ul><ul><ul><ul><li>Aggression is an effective means to achieve a goal. </li></ul></ul></ul>
    6. 6. Psychological theories of CD <ul><li>Cognitive explanation of aggressive behavior </li></ul><ul><ul><li>Dodge et al (1982) </li></ul></ul><ul><ul><ul><li>Perceptual Bias & Cycle of Aggression: </li></ul></ul></ul><ul><ul><ul><ul><li>__________________________________ </li></ul></ul></ul></ul><ul><ul><ul><ul><li>__________________________________ </li></ul></ul></ul></ul><ul><ul><ul><ul><li>__________________________________ </li></ul></ul></ul></ul>
    7. 7. A biopsychosocial model of development of CD Biological Predisposition Sociocultural factors Parenting Biological Predisposition Sociocultural Context Mental Processes Conduct Disorder Peers
    8. 8. Overcontrolled behavior <ul><li>Separation Anxiety Disorder </li></ul><ul><li>School Phobia </li></ul><ul><li>Social Phobia </li></ul>
    9. 9. Separation anxiety disorder <ul><li>Symptoms </li></ul><ul><ul><li>Excessive worries about harm to major attachment figures along with fears of abandonment, refusal to attend school; avoidance of being alone. </li></ul></ul><ul><li>The symptoms must be experienced for at least 8 weeks. </li></ul>
    10. 10. Attachment style theories of Separation Anxiety Disorder <ul><li>Ainsworth & Bowlby (1953) </li></ul><ul><ul><li>Procedure </li></ul></ul><ul><ul><ul><li>An infant was left in a room for a brief period of time with a stranger, the mother having left the room. Researchers observed and classified infants behavior into 3 types: </li></ul></ul></ul><ul><ul><li>Secured attachment style </li></ul></ul><ul><ul><li>Anxious attachment style </li></ul></ul><ul><ul><li>Avoidant attachment style </li></ul></ul><ul><ul><ul><li>Which style is associated with separation anxiety disorder? </li></ul></ul></ul>
    11. 11. Childhood Disorders <ul><li>Undercontrolled Behavior </li></ul><ul><ul><li>ADHD </li></ul></ul><ul><ul><li>Conduct Disorder </li></ul></ul><ul><li>Overcontrolled Behavior </li></ul><ul><ul><li>Childhood fears and anxiety disorders </li></ul></ul><ul><li>Mental Retardation </li></ul><ul><li>Autism </li></ul>
    12. 12. Mental Retardation <ul><li>Traditional Criteria (in DSMIV) </li></ul><ul><ul><li>Significantly reduced intellectual functioning </li></ul></ul><ul><ul><ul><li>Mild mental retardation (50 to 70 IQ) </li></ul></ul></ul><ul><ul><ul><li>Moderate (35-55 IQ) </li></ul></ul></ul><ul><ul><ul><li>Severe mental retardation (20-40 IQ) </li></ul></ul></ul><ul><ul><ul><li>Profound mental retardation (below 20 to 25 IQ) </li></ul></ul></ul><ul><ul><li>Deficits in adaptive behavior </li></ul></ul><ul><ul><ul><li>Mastering Childhood skills </li></ul></ul></ul><ul><ul><li>Age of Onset: 18 </li></ul></ul>
    13. 13. Mental Retardation <ul><li>The New Approach of the American Association of Retardation </li></ul><ul><ul><li>Study on 200 people with severe retardation found that individuals varied greatly in their communication skills (McLean et al, 1996) </li></ul></ul><ul><ul><li>Identify seriousness of the disability, and focus on what an individual can do and focus on developing those skills. </li></ul></ul>
    14. 14. Etiology of Mental Retardation <ul><li>Biological Explanation </li></ul><ul><ul><li>No identified etiology </li></ul></ul><ul><ul><li>Genetic or chromosomal anomalies </li></ul></ul><ul><ul><ul><li>Down syndrome: have three copies of chromosome 21 (instead of the usual pair); a total of 47 instead of 46 chromosomes; trisomy. </li></ul></ul></ul><ul><ul><ul><li>Fragile X syndrome: X chromosome breaks into two; </li></ul></ul></ul><ul><ul><ul><li>Infectious Disease: Maternal infectious, I.e, German measles, accidents, environmental hazards, I.e., (lead poisoning) </li></ul></ul></ul>
    15. 15. Autistic Disorder <ul><li>Characteristics of Autistic Disorders </li></ul><ul><ul><li>Extreme autistic aloneness </li></ul></ul><ul><ul><ul><li>Less signs of attachment to their primary caregiver. </li></ul></ul></ul><ul><ul><ul><li>Do not engage parents in play </li></ul></ul></ul><ul><ul><ul><li>Rarely offer greetings, and tend to look passed people. </li></ul></ul></ul><ul><ul><ul><li>Less likely to engage in symbolic play </li></ul></ul></ul><ul><ul><ul><li>Inability to follow gaze </li></ul></ul></ul><ul><ul><ul><ul><li>Study: Children sat in front of the researchers with four pieces of chocolate between them. When the researcher looked at one piece, children usually follow the gaze and pass that piece of chocolate to the researcher. However, children with autism tend not to do these. (Baron Cohen et al 1995) </li></ul></ul></ul></ul>
    16. 16. Characteristics of Autism <ul><ul><li>Communication deficits </li></ul></ul><ul><ul><ul><li>Ecolalia </li></ul></ul></ul><ul><ul><ul><li>Pronoun reversal </li></ul></ul></ul><ul><ul><li>Obsessive-compulsive ritualistic acts </li></ul></ul>
    17. 17. Autism and Theory of Mind <ul><li>Children with autism lacks a Theory of Mind(TOM) </li></ul><ul><ul><li>False belief tasks </li></ul></ul><ul><ul><ul><li>This is Sally. Sally has a basket. This is Anne. Anne has a box. Sally goes out for a walk. Anne takes the marble out of the basket and put it into the box. Now Sally comes back . She wants to play with her marble. Where will Sally look for her marble? (Frith, 1989) </li></ul></ul></ul><ul><ul><li>4or 5 year old children said, ‘in the basket’; 3 years olds said, “in the box” </li></ul></ul><ul><ul><li>Explanation: </li></ul></ul>
    18. 18. Autism and Theory of Mind <ul><li>Controlled study </li></ul><ul><ul><li>Procedure: 4 year old children with autism, children with down syndrome, and children with no diagnosis performed the false belief task. </li></ul></ul><ul><ul><li>Findings: only 20 % of children with autism passed the task; while 80% of the other groups passed it. (Baron, Cohen et al 1985) </li></ul></ul><ul><ul><li>Explanation: </li></ul></ul>
    19. 19. Etiology of Autism <ul><li>Psychological bases </li></ul><ul><ul><li>Psychoanalytic theory: Bettelheim (1967) argues that a young infant with rejecting parents believe that he or she has no power to influence the world; therefore, he or she develops autism. </li></ul></ul><ul><ul><li>Behavior theory: inattention of the parents. </li></ul></ul><ul><li>Critics: So far there is no evidence to show that autistic children suffered this kind of maltreatment. </li></ul>
    20. 20. Etiology of Autism <ul><li>Genetic basis </li></ul><ul><ul><li>Identical twins: have identical genes. </li></ul></ul><ul><ul><li>Non-identical (fraternal) twins: don’t have identical genes </li></ul></ul><ul><ul><li>Twins study: </li></ul></ul><ul><ul><ul><li>The identical twin of an autistic adult almost always have communication disorders and fail to live independently. </li></ul></ul></ul><ul><ul><ul><li>The non-identifical twin of an autistic child tends to have normal social, language development and be able to live independently. (LeCouteur et al, 1996) </li></ul></ul></ul>
    21. 21. Communicating with Children <ul><li>Piaget’s theory of child development </li></ul><ul><li>Communication techniques </li></ul>
    22. 22. Piaget’s childhood development <ul><li>Sensory Motor Stage (Age 0 to 2) </li></ul><ul><li>Pre-operational Stage (Age 2 to 7) </li></ul><ul><li>Concrete Operational Stage (Age 7 to 11) </li></ul><ul><li>Formal Operation Stage (Age 11 to 16) </li></ul>
    23. 23. How much does a child understand? <ul><li>Law of conservation: </li></ul><ul><li>Moral realism: </li></ul><ul><li>Decentering: </li></ul><ul><li>Object permanence: </li></ul><ul><li>Animism: </li></ul><ul><li>Egocentricism: </li></ul><ul><li>Symbolism: </li></ul><ul><li>Abstract thinking and reasoning: </li></ul>
    24. 24. Communication Techniques <ul><li>Age appropriateness </li></ul><ul><ul><li>3-5 years old </li></ul></ul><ul><ul><ul><li>Simple vocabulary, culturally sensitive, attempt to decrease anxiety, use play therapy, use jokes, allow for the need to have control </li></ul></ul></ul><ul><ul><li>5-10 years old </li></ul></ul><ul><ul><ul><li>Facilitate child to assume responsibility, respect for privacy </li></ul></ul></ul><ul><li>11 years old and older </li></ul><ul><ul><li>Verbalize issues, confidentiality, allow sense of independence, avoid being judgmental, age-appropriate language. </li></ul></ul><ul><li>See textbook p. 401-3. </li></ul>
    25. 25. Communication techniques <ul><li>Use figurative language </li></ul><ul><ul><li>In insulin-dependent diabetes mellitus (IDDM), the pancreas does not make insulin. Insulin is needed to carry glucose from the blood to the cells where it is used as energy. Since there is no insulin, the glucose stays in the blood and the cells being to starve. One way to understand this is to think of the blood vessels as streets, the cells as houses, and the glucose as cars that travel on the street. Insulin acts as the driveways which allow the cars to leave the street and go into the garages. In IDDM, the cars stay on the street because there are no driveways (or insulin) to carry the glucose into the cell. Harmon and Hamby (1989) </li></ul></ul><ul><li>As a dental hygienist, can you use figurate language to talk to a child? </li></ul>