Health Problems 28 Understanding Disorders Of Childhood

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AN OVERVIEW 30 EXTERNALIZING DISORDERS: ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER (ADHD) 32 Symptoms and Subtypes 32 Epidemiology 33 Developmental Course 33 Accompanying Disorders and Symptoms 34 Associated Features 34 Causes 35

Summary and Integration 36


Epidemiology and Accompanying Disorders 38 Gender, Ethnicity, and Culture 40

Accompanying Disorders and Symptoms 41 Associated Features 41 Causes 42

Summary and Integration 43 CURRENT ISSUES AND FUTURE DIRECTIONS 44 Defining Disorders of Childhood and Adolescence 44 Healthy Functioning 45 Context 45 Comorbidity 46 Prevalence 46 Gender Differences 46 Socioeconomic Status 47 Ethnicity and Culture 47 Causal Processes 48 Continuities and Discontinuities 49 Risk and Resilience 50 IMPLICATIONS FOR TREATMENT AND PREVENTION 51 REFERENCES 51

From the time that modern views of mental illness emerged in the late eighteenth and early nineteenth centuries, significantly less attention has been given to mental health problems in children than it has to problems in adults (Rie, 1971). Even today there are far fewer categories for diagnosing mental disorders in children, and these categories vary in their sensitivity to developmental parameters and context. Current knowledge of child and adolescent disorders is compromised by a lack of child-specific theories, by an unsystematic approach to research (Kazdin, 2001), and by the inherent conceptual and research complexities (Kazdin & Kagan, 1994), which may explain why there are far fewer empirically supported treatments for children than for adults (Chambless & Ollendick, 2001). Despite these caveats, tremendous advances have been made over the last decade (Mash & Barkley, 1996; Mash & Wolfe, 2002; Rutter & Sroufe, 2000).

During the writing of this chapter, Eric Mash was supported in part by a University of Calgary Killam Resident Fellowship.

New conceptual frameworks, new knowledge, and new research methods have greatly enhanced our understanding of childhood disorders (Cicchetti & Cohen, 1995; Sameroff, Lewis, & Miller, 2000) as well as our ability to assess and treat children with these problems (Mash & Barkley, 1998; Mash & Terdal, 1997b).

We begin with a discussion of the significance of children's mental health problems and the role of multiple interacting influences in shaping adaptive and maladaptive patterns of behavior. Next we provide a brief overview of disorders of childhood and adolescence and related conditions as defined by current diagnostic systems (American Psychiatric Association; APA, 2000). We then consider two common categories of problems in children and adolescents: externalizing disorders (disruptive behavior disorders; attention-deficit/ hyperactivity disorder, ADHD), and internalizing disorders (mood disorders, anxiety disorders). We illustrate current issues and approaches to child and adolescent disorders by focusing on ADHD and anxiety disorders as examples. In doing so we consider the main characteristics, epidemiology, developmental course, associated features, proposed causes, and an integrative developmental pathway model for each of these disorders. We conclude with a discussion of current issues and future directions for the field.

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