《儿童期疾患》PPT课件(PPT 51页).pptx

1、PowerPoint Lecture Notes Presentation Disorders of Childhood兒童期疾患Abnormal Psychology,Tenth Editionby Ann M.Kring,Gerald C.Davison,John M.Neale,&Sheri L.Johnson 第1页，共51页。Classification and Diagnosis of Childhood Disorders兒童期疾患的分類和診斷lDevelopmental psychopathology 發展的心理病理學 Studies disorders of childhoo

2、d within the context of normal child development 在正常兒童發展的背景脈絡下研究兒童期的疾患lExternalizing disorders 外化性疾患 Characterized by outward behaviors 以外化性的行為為其特性 Noncompliance,aggressiveness,overactivity,impulsiveness 不服從,攻擊,過動,衝動 More common in boys 在男孩較普遍lInternalizing disorders 內化性疾患 Characterized by inward be

3、haviors 以向化的行為為其特性 Depression,anxiety,social withdrawal 憂鬱,焦慮,社會退縮 More common in girls 在女孩較普遍2第2页，共51页。Table 14.1 Chapters Where Disorders are Discussed That Occur in Both Children and Adults 在兒童和成人身上皆會發生的疾患章節3第3页，共51页。Attention Deficit/Hyperactivity Disorder注意力不足/過動疾患lExcessive levels of activity

4、過多的活動 Fidgeting,squirming,running around when inappropriate,incessant talking 不安,扭動,不恰當的走動,不停的說話lDistractability and difficulty concentrating 分心和有困難集中 Makes careless mistakes,cant follow instructions,forgetful 粗心犯錯,不能聽從指令,健忘lMust be severe and persistent 必須嚴重且持續 Present for at least 6 months and cau

5、se impairments in functioning 持續至少六個月並產生功能的受損4第4页，共51页。Attention Deficit/Hyperactivity Disorder注意力不足/過動疾患lThree subcategories in DSM-IV-TR 在DSM-IV-TR中可分為三個亞型：1.Predominantly inattentive type 主要為不注意型2.Predominantly hyperactive-impulsive type 主要為過動-易衝動型3.Combined type 複合型lDifferential diagnosis 鑑別診斷AD

6、HD or Conduct Disorder?注意力不足過動疾患或品性疾患？ADHD注意力不足過動疾患More off-task behavior,cognitive&achievement deficits 較多無法達成工作的行為,認知和成就上缺陷Conduct Disorder 品行疾患More aggressive,act out in most settings,antisocial parents,family hostility 較多攻擊性,常出現動作外化行為,反社會性父母,家人敵意5第5页，共51页。Attention Deficit/Hyperactivity Disorder

7、注意力不足/過動疾患lADHD often comorbid with anxiety and depression 通常和焦慮和憂鬱共病lPrevalence estimates 2 to 7%盛行率估計約2到7lSymptoms persist beyond childhood 症狀在兒童期之後仍持續Most still meet criteria in adolescence 大部分在青少年期仍符合準則6第6页，共51页。Etiology of ADHD注意力不足過動疾患的病因學lGenetic factors 遺傳因素 Twin studies 雙生子研究 Heritability e

8、stimates as high as 70 to 80%遺傳率估計有百分之70到80高 Two dopamine genes implicated 二個多巴胺基因受到影響lNeurobiological factors 神經生物因素 Underresponsive frontal lobes 額葉反應性低 Reduced cerebral blood flow 大腦血流量減少 Smaller frontal lobes,caudate nucleus,globus pallidus 額葉,尾核和蒼白球較小7第7页，共51页。Etiology of ADHD注意力不足過動疾患的病因學lPeri

9、natal and prenatal factors 出生前後和產前因素 Low birth weight 出生體重低 Maternal tobacco and alcohol use 母親吸菸和酒精使用lEnvironmental toxins 環境毒素 Food additives and sugar not related to ADHD 食品添加物和糖與注意力不足過動疾患沒有相關 Nicotine from maternal smoking 來自母親吸煙所產生尼古丁 May damage dopaminergic system in fetus 可能損害胎兒多巴胺內生性系統8第8页，共

10、51页。Etiology of ADHD注意力不足過動疾患的病因學lPsychological Factors 心理因素 Ineffective parenting,negative interactions 無效能的親職教育,負向互動 Probably interact with genetic and neurobiological factors 可能和遺傳和神經生物因素產生交互影響 Likely to exacerbate or maintain ADHD behaviors but not cause them 很可能惡化或維持ADHD的行為問題但不會造成此疾患9第9页，共51页。T

11、reatment of ADHD注意力不足過動疾患的治療lStimulant medications 興奮劑藥物治療 Reduce disruptive behavior 降低破壞性行為 Improve attention and concentration 改善注意力和專心 Ritalin 利他能 Adderall Concerta Strattera Side effects 副作用 Loss of appetite 失去食慾 Sleep problems 睡眠問題10第10页，共51页。Treatment of ADHD注意力不足過動疾患的治療lPsychological treatme

12、nt 心理治療 Operant conditioning 操作制約Parent training 父母親訓練Classroom management and teacher training 課堂管理和老師的訓練Classroom structure 課堂結構lBrief assignments 簡短的作業lImmediate feedback 立即回饋lTask-focused style 聚焦於作業的方式lBreaks for exercise 中間休息以作運動11第11页，共51页。Conduct Disorder(CD)品行疾患lPattern of engaging in behav

13、iors that violate social norms,the rights of others,and are often illegal.從事違反社會規範,侵害他人權利和經常犯法的行為模式 Aggression 攻擊 Cruelty towards other people or animals 虐待他人或動物 Lying 說謊 Stealing 偷竊 Vandalism 暴力行為 Often accompanied by lack of remorse and callousness 通常伴隨缺乏憐憫和無情12第12页，共51页。Oppositional Defiant Disor

14、der(ODD)對立性反抗疾患lODD behaviors do not meet criteria for CD but child displays pattern of defiant behavior 對立性反抗疾患的行為並不符合品行疾患的準則 但兒童呈現反抗的行為模式 Argumentative 愛爭論的 Loses temper 脾氣不佳 Lack of compliance 缺乏服從性 Deliberately aggravates other 故意激怒他人 Hostile,vindictive,spiteful,or touchy 充滿敵意,懷恨,惡意或暴躁的 Blame ot

15、hers for their problems 將自己的行為問題責怪他人lMost often diagnosed in boys but may be as prevalent in girls 通常診斷於男孩但女孩也可能很普遍13第13页，共51页。Conduct Disorder(CD)品行疾患lMany times first identified by legal authorities 通常會先被法庭發現其問題行為 Juvenile delinquents 青少年罪犯lSubstance abuse common普遍有物質濫用lComorbid with anxiety and d

16、epression,especially for girls 與焦慮和憂鬱共病,特別是針對女孩lPrevalence 盛行率 Boys 男孩 4 to 16%百分比四到十六 Girls 女孩 1.2 to 9%百分比點二到九14第14页，共51页。Figure 14.1 Arrest Rates Across Ages for Homicide,Forcible Rape,Robber,Aggravated Assault,and Auto Theft殺人、強暴、搶劫、攻擊、偷車者在各年齡層的逮捕率15第15页，共51页。Conduct Disorder(CD)品行疾患lMoffitt(199

17、3)two paths 在1993年Moffitt所提的兩條發展路徑1.Life-course-persistent 生命過程中持續出現2.Adolescence-limited 僅在青少年期出現lNot all aggressive or conduct-disordered boys continue aggressive behavior into adulthood 不是所有具攻擊性或品行疾患的男孩會持續攻擊行為到成年期Predictive factors 預測因子Low verbal IQ 低語文智商Parent with antisocial personality disorde

18、r 父母有反社會人格疾患的問題Temperament 天生氣質Dysfunctional parent-child interactions 父母與孩子間不良的互動Poverty 貧窮Low social support 低社會支持16第16页，共51页。Figure 14.2 Etiology of Conduct Disorder品行疾患的病因學lInsert Figure 14.2品行疾患的病因學社會心理神經生物 品行疾患17第17页，共51页。Etiology of Conduct Disorder(CD)品行疾患的病因學lGenetic factors 遺傳因素Heritabilit

19、y likely plays a part 遺傳可能扮演一部分因素Twin study data show mixed results 雙生子研究資料呈現不一致的結果Adoption studies focused on criminal behavior,not conduct disorder 領養研究著重在犯罪行為，而非品行疾患的行為問題Evidence for genetic influence 相關證據支持遺傳影響lGenetics and environment interact(Caspi et al.,2002)遺傳和環境的交互影響Abuse as a child PLUS l

20、ow MAOA activity most likely to develop CD 虐待孩子加上低單胺氧化酶活性很可能發展品行疾患18第18页，共51页。Etiology of Conduct Disorder(CD)品行疾患的病因學lNeurobiological factors 神經生物因素Poor verbal skills 語文技巧不佳Difficulty with executive functioning 執行功能的困難Low IQ 低智商lPsychological factors 心理因素Deficient moral development,especially lack

21、of remorse 有缺陷的道德發展,特別是缺乏同情Modeling and reinforcement of aggressive behavior 攻擊行為的模仿和增強Harsh and inconsistent parenting 嚴格和不致的教養方式Lack of parental monitoring 缺乏父母的監控Cognitive bias(Kenneth Dodge)認知偏誤Neutral acts by others perceived as hostile 將他人的中性舉動知覺成有敵意的19第19页，共51页。Figure 14.3 Dodges Cognitive Th

22、eory of AggressionDodge的攻擊認知理論lInsert figure 14.3將模糊舉動解讀成 有敵意對他人產生攻擊他人進行報復對他人產生更進步攻擊20第20页，共51页。Etiology of Conduct Disorder(CD)品行疾患的病因學lPeer influence 同儕影響Acceptance or rejection by peers 被同儕接受或拒絕Affiliation with deviant peers 與有偏差行為的同儕接近lSociocultural factors 社會文化因素Poverty 貧窮Urban environment 都市的環

23、境21第21页，共51页。Treatment of Conduct Disorder品行疾患的治療lFamily interventions 家人的介入 Parental management training(PMT;Gerald Patterson)父母親管理訓練Teach parents to reward prosocial behavior 教導父母獎賞利社會行為lCognitive therapy 認知治療 Anger-control training 憤怒控制訓練22第22页，共51页。Figure 14.4 Multisystemic Treatment of CD品行疾患的多

24、系統化治療lInsert Figure 14.423第23页，共51页。Depression in Children and Adolescents兒童和青少年的憂鬱lSymptoms common to children,adolescents,and adults 兒童,青少年和成人的共同症狀 Depressed mood 憂鬱心情 Inability to experience pleasure 無法經驗愉快 Fatigue 疲累 Problems concentrating 難以集中注意力 Suicidal ideation 自殺意念lSymptoms specific to chil

25、dren&adolescents 兒童和青少年的特定症狀 Higher rates of suicide attempts and guilt 較高比例的自殺嘗試和罪惡感Lower rates of 較低比例的 Early morning awakening 早晨易醒 Early morning depression 早晨憂鬱 Loss of appetite 缺乏食慾 Weight loss 體重減少24第24页，共51页。Depression in Children and Adolescents兒童和青少年的憂鬱lDepression recurrent 憂鬱持續再發lPrevalenc

26、e 盛行率 1%of preschoolers 學齡前兒童為百分之 2 3%of school age children 學齡兒童為百分之二到三 Adolescents 青少年Girls 女孩l7 13%百分之七到十三l2x that of boys 比男孩高於兩倍25第25页，共51页。Etiology of Depression in Children and Adolescents兒童和青少年憂鬱的病因學lGenetic factors 遺傳因素lFamily and relationship factors 家庭和人際關係因素 A parent who is depressed 父母有

27、方是憂鬱的 Cold and hostile family interactions 冷漠和敵意的家庭互動 Poor social skills 社交技巧不佳 Impaired relationships with peers and siblings 和同儕和兄弟姐妹有不良的關係 Parental criticism 父母的批評26第26页，共51页。Treatment of Depression in Children and Adolescents兒童和青少年憂鬱的治療lMuch less research on childhood depression 對於兒童憂鬱較少研究lMedic

28、ations 藥物治療 SSRIs more effective than tricyclics 選擇性血清素抑制劑較三環抗鬱劑來得有效 Concerns about increased risk of suicide attempts 自殺嘗試的風險增加 CBT plus Prozac more effective than either alone 認知行為治療加上百憂解比起單獨使用任何一種方式更為有效 Prozac alone more effective than CBT alone 單獨使用百憂解比單獨使用認知行為治療更為有效lInterpersonal psychotherapy(

29、IPT)人際關係心理治療lCBT in school setting 學校環境的認知行為治療lTreatment of depressed parent 憂鬱父母的治療27第27页，共51页。Anxiety in Children and Adolescents兒童和青少年的焦慮lFears and worries common in childhood 在兒童期害怕和憂慮很普遍lAnxiety disorder 焦慮疾患 More severe and persistent worry 更為嚴重和持續性的憂慮 Must interfere with functioning 必須妨害日常生活功

30、能lMost childhood fears disappear but adults with anxiety disorders report feeling anxious as children 大部分兒童時期害怕會逐漸消失 但有焦慮疾患的成人報告當還是小孩時就有焦慮的感覺“Ive always been this way”我直都是這個樣子28第28页，共51页。School Phobia懼學症lTwo types 二種類型1.Separation anxiety 分離焦慮Worry about parental safety when separated 當分離時擔心父母安全 2.F

31、ear of school 對上學害怕Begins later in childhood 在兒童期較晚時開始More severe and pervasive avoidance 更為嚴重和廣泛性的逃避 29第29页，共51页。Social Phobia懼學症lExtreme shyness and withdrawal 極端害羞和退縮lMay exhibit selective mutism 可能呈現選擇性緘默症的症狀 Refusal to speak in unfamiliar social setting 不願意在不熟悉的社會情境中說話lPrevalence 盛行率 1%of child

32、ren and adolescents 兒童和青少年為百分之lEtiology 病因學 Overestimation of threat 對威脅的高估Underestimation of coping ability 對自我應付能力的低估 Poor social skills 社交技巧不佳30第30页，共51页。PTSD創傷後壓力症候群lExposure to trauma 暴露於創傷Chronic physical or sexual abuse 長期身體或性虐待Community violence 社區暴力Natural disasters 自然災害lSymptom categories

33、症狀種類Flashbacks,nightmares,intrusive thoughts 經驗瞬間再現,惡夢,侵入性思考Avoidance 逃避 Hyperarousal and vigilance 過度容易被激發和警覺lEtiology 病因學Preexisting anxiety 原先即存在焦慮Family stress and coping styles 家庭壓力和應對方式Parental response to trauma 父母親對創傷的反應31第31页，共51页。Treatment of Anxiety Disorders in Childhood and Adolescence在

34、兒童期和青少年期焦慮疾患的治療lExposure to feared object 暴露於所害怕的物體 Reward approach behavior 獎賞接近的行為lModeling 示範lCBT Kendalls Coping Cat program Cognitive restructuring 認知重組 Psychoeducation 心理教育 Modeling and exposure 示範和暴露 Skills training 技巧訓練 Relapse prevention 再發預防 Include family in treatment 治療包括家人32第32页，共51页。Le

35、arning Disability學習障礙lEvidence of inadequate development in a specific area of academic,language,speech or motor skills 在學業、語言、說話或運動技能領域有不適當發展的證據 e.g.,arithmetic or reading 例如：數學或閱讀學習障礙lNot due to mental retardation,autism,physical disorder or lack of educational opportunity 不是由於智能遲緩,生理疾病或缺乏教育機會所造成l

36、Individual usually average or above average intelligence 個體通常有平均或高於平均的智力33第33页，共51页。Learning Disability學習障礙lDSM-IV-TR categories 在DSM-IV-TR中的類別 Learning disorders 學習疾患 Communication disorders 溝通疾患 Motor skills disorder 運動技能疾患lOften identified and treated in school 通常在學校中被辨認和治療lReading disorders more

37、 common in boys 在男孩閱讀疾患更為普遍34第34页，共51页。Learning Disorders學習障礙lReading disorder(dyslexia)閱讀疾患(失讀症)Problems with word recognition and reading comprehension對於字的辨認和閱讀理解有問題lDisorder of written expression 文字表達疾患 Problems writing including spelling,grammar,and punctuation errors 文字寫作問題包括：拼字,文法和標點符號的錯誤lMath

38、ematics disorder 數學疾患 Problems counting,remembering arithmetic facts,and alignment of numbers in columns 在算術,記住數學事實和欄位數字的排列上有問題35第35页，共51页。Communication Disorders溝通疾患lExpressive Language disorder 語言表達疾患Difficulty expressing self in verbal speech 有困難以口語表達自己Speaks in short phrases 說簡短的片語Forgets word m

39、eanings 忘記字義lPhonological disorder 音韻疾患Vocabulary adequate but difficulty articulating speech sounds 有足夠字彙但有困難清晰的發音Complete recovery common with speech therapy 經由語言治療普遍可以完全恢復lStuttering 口吃Frequent repetitions or prolongations of sounds 經常語音重複或拖長Long pauses between words 在字的中間有較長的暫停Repeating words 重複

40、字詞Body twitching and blinking 身體痙孿和眨眼80%recover by age 16 在年齡十六歲時，有八成會恢復36第36页，共51页。Motor Skills Disorder運動技能疾患lAlso known as developmental coordination disorder 也被稱為是發展性運動協調疾患 Marked impairment in motor coordination 動作協調上有明顯的受損e.g.,difficulty tying shoes,writing,catching a ball 例如：有困難綁鞋帶、寫作和接住球37第3

41、7页，共51页。Etiology of Learning Disabilities:Dyslexia學習障礙的病因學：失讀症lPerceptual deficits 知覺缺陷Mirror image or reversal of letters 鏡像或字母的顛倒 Little support for this hypothesis 對於此假設獲得較少支持lGenetic factors 遺傳因素Evidence from family and twin studies 來自家庭和雙生子研究的相關證據lProblems in language processing 在語言處理上有問題 Speec

42、h perception 語音知覺Difficulty recognizing rhyme and alliteration 有困難辨認韻律和頭韻Problems naming familiar objects rapidly 有困難快速的說出熟悉物體的名字Delays learning syntactic rules 學習句法規則的延遲Deficient phonological awareness 語音覺察有缺陷Inadequate left temporo-parietal-occipital functioning 不良的左顳-頂-枕葉功能38第38页，共51页。Treatment o

43、f Learning Disabilities學習障礙的治療lReading and writing disorders 閱讀和書寫文字疾患 Multisensory instruction in listening,speaking,and writing skills 聽,說,和寫的技巧的多重感官教導 Readiness skills in younger children as preparation for learning to read 幼小小孩準備就緒技巧作為學習閱讀的準備 Phonics instruction 語音的教導lCommunication disorders 溝通疾

44、患 Fast ForWord Involves computer games and audiotapes that slow speech sounds 包括電腦遊戲和語音較慢的錄音帶39第39页，共51页。Mental Retardation智能不足lSignificantly below average intellectual functioning智力功能顯著低於平均 IQ less than 70 智商少於七十lDeficits in adaptive functioning 適應功能的缺陷 Self-care,communication,home living,decision

45、making,etc.自我照顧,溝通,家居生活,做決定等等lOnset before age 18 在十八歲前初發lMost professionals focus on strengths of individual to assess ability to function 多數專家會強調個案的優勢以評估其功能40第40页，共51页。Table 14.3 Sample Items from Vineland Adaptive Behavior Scales來自Vineland適應行為量表的例題41第41页，共51页。Table 14.4 DSM-IV-TR Categories of Me

46、ntal Retardation智能不足在DSM-IV-TR的分類42第42页，共51页。Table 14.5 AAMR Definition of Mental Retardation美國智能不足學會對智能不足的定義43第43页，共51页。Etiology of Mental Retardation:Neurological Factors智能不足的病因學：神經學因素lDowns syndrome 唐氏症Chromosomal trisomy 染色體21有三條(trisomy 21)47 instead of 46 chromosomes 有47個染色體而非23對lFragile X syn

47、drome 脆性X症候群Mutation in the fMRI gene on the X chromosome 在X染色體產生I基因的突變lRecessive-gene disease 隱性基因疾病 Phenylketonuria(PKU)苯酮尿症lMaternal infectious disease,especially during 1st trimester 母親得到傳染性疾病,特別是在懷孕期的前三個月間HIV,rubella,syphilis 愛滋病毒,德國麻疹,梅毒lEncephalitis 腦膜炎lMalnutrition營養不良lBrain injuries from fa

48、lls or auto accidents 跌倒或車禍所導致的大腦受傷lLead or mercury poisoning 鉛或汞中毒44第44页，共51页。Treatment of Mental Retardation智能不足的治療lResidential treatment 住宿治療 Small to medium sized community residences 小到中等大小的社區住處lBehavioral treatments 行為治療 Language,social,and motor skills training 語言,社會和動作技巧訓練 Method of successi

49、ve approximation to teach basic self-care skills in severely retarded 用逐步漸近的方法來教導重度智能障礙的自我照顧技巧 e.g.,holding a spoon,toileting 例如：握住湯匙,如廁lCognitive treatments 認知治療 Problem-solving strategies 問題解決策略lComputer assisted instruction 電腦輔助教學45第45页，共51页。Pervasive Developmental Disorders廣泛性發展疾患lAutistic Disor

50、der 自閉性疾患lRetts Disorder Rett氏疾患lChildhood disintegrative disorder 兒童期崩解性疾患lAspergers disorder 亞斯伯格症46第46页，共51页。Autistic Disorder自閉性疾患lKanners(1943)autistic aloneness 在1943年Kanner首度提出自閉一詞lImpairments in social interactions 社會互動的受損 Deficient use of nonverbal behaviors 使用非語言行為的障礙Poorly developed peer