DisordersofChildhood儿童期疾患分类和诊断（英文版资料）

1、Disorders of Childhood儿童期疾患分类和诊断（英文版资料）1Classification and Diagnosis of Childhood Disorders儿童期疾患的分类和诊断Developmental psychopathology 发展的心理病理学Studies disorders of childhood within the context of normal child development 在正常儿童发展的背景脉络下研究儿童期的疾患Externalizing disorders 外化性疾患Characterized by outward behavio

2、rs 以外化性的行为为其特性Noncompliance, aggressiveness, overactivity, impulsiveness 不服从,攻击,过动,冲动More common in boys 在男孩较普遍Internalizing disorders 内化性疾患Characterized by inward behaviors 以向化的行为为其特性Depression, anxiety, social withdrawal 忧郁,焦虑,社会退缩More common in girls 在女孩较普遍2Table 14.1 Chapters Where Disorders are

3、 Discussed That Occur in Both Children and Adults 在儿童和成人身上皆会发生的疾患章节3Attention Deficit/Hyperactivity Disorder注意力不足/过动疾患Excessive levels of activity 过多的活动Fidgeting, squirming, running around when inappropriate, incessant talking 不安,扭动,不恰当的走动,不停的说话Distractability and difficulty concentrating 分心和有困难集中Ma

4、kes careless mistakes, cant follow instructions, forgetful 粗心犯错,不能听从指令,健忘Must be severe and persistent 必须严重且持续 Present for at least 6 months and cause impairments in functioning 持续至少六个月并产生功能的受损4Attention Deficit/Hyperactivity Disorder注意力不足/过动疾患Three subcategories in DSM-IV-TR 在DSM-IV-TR中可分为三个亚型：Pred

5、ominantly inattentive type 主要为不注意型Predominantly hyperactive-impulsive type 主要为过动-易冲动型Combined type 复合型Differential diagnosis 鉴别诊断ADHD or Conduct Disorder? 注意力不足过动疾患或品性疾患？ADHD注意力不足过动疾患More off-task behavior, cognitive & achievement deficits 较多无法达成工作的行为,认知和成就上缺陷Conduct Disorder 品行疾患More aggressive, ac

6、t out in most settings, antisocial parents, family hostility 较多攻击性, 常出现动作外化行为,反社会性父母,家人敌意5Attention Deficit/Hyperactivity Disorder注意力不足/过动疾患ADHD often comorbid with anxiety and depression 通常和焦虑和忧郁共病Prevalence estimates 2 to 7% 盛行率估计约2到7Symptoms persist beyond childhood 症状在儿童期之后仍持续Most still meet cri

7、teria in adolescence 大部分在青少年期仍符合准则6Etiology of ADHD注意力不足过动疾患的病因学Genetic factors 遗传因素Twin studies 双生子研究Heritability estimates as high as 70 to 80% 遗传率估计有百分之70到80高Two dopamine genes implicated 二个多巴胺基因受到影响Neurobiological factors 神经生物因素Underresponsive frontal lobes 额叶反应性低Reduced cerebral blood flow 大脑血流

8、量减少Smaller frontal lobes, caudate nucleus, globus pallidus 额叶,尾核和苍白球较小7Etiology of ADHD注意力不足过动疾患的病因学Perinatal and prenatal factors 出生前后和产前因素Low birth weight 出生体重低Maternal tobacco and alcohol use 母亲吸烟和酒精使用Environmental toxins 环境毒素Food additives and sugar not related to ADHD 食品添加物和糖与注意力不足过动疾患没有相关Nicot

9、ine from maternal smoking 来自母亲吸烟所产生尼古丁May damage dopaminergic system in fetus 可能损害胎儿多巴胺内生性系统8Etiology of ADHD注意力不足过动疾患的病因学Psychological Factors 心理因素Ineffective parenting, negative interactions 无效能的亲职教育,负向互动Probably interact with genetic and neurobiological factors 可能和遗传和神经生物因素产生交互影响Likely to exacerb

10、ate or maintain ADHD behaviors but not cause them 很可能恶化或维持ADHD的行为问题但不会造成此疾患9Treatment of ADHD注意力不足过动疾患的治疗Stimulant medications 兴奋剂药物治疗Reduce disruptive behavior 降低破坏性行为Improve attention and concentration 改善注意力和专心Ritalin 利他能Adderall ConcertaStratteraSide effects 副作用Loss of appetite 失去食欲Sleep problems

11、 睡眠问题10Treatment of ADHD注意力不足过动疾患的治疗Psychological treatment 心理治疗Operant conditioning 操作制约Parent training 父母亲训练Classroom management and teacher training 课堂管理和老师的训练Classroom structure 课堂结构Brief assignments 简短的作业Immediate feedback 立即回馈Task-focused style 聚焦于作业的方式Breaks for exercise 中间休息以作运动11Conduct Dis

12、order (CD)品行疾患Pattern of engaging in behaviors that violate social norms, the rights of others, and are often illegal.从事违反社会规范,侵害他人权利和经常犯法的行为模式Aggression 攻击Cruelty towards other people or animals 虐待他人或动物Lying 说谎Stealing 偷窃Vandalism 暴力行为Often accompanied by lack of remorse and callousness 通常伴随缺乏怜悯和无情

13、12Oppositional Defiant Disorder (ODD)对立性反抗疾患ODD behaviors do not meet criteria for CD but child displays pattern of defiant behavior 对立性反抗疾患的行为并不符合品行疾患的准则 但儿童呈现反抗的行为模式Argumentative 爱争论的Loses temper 脾气不佳Lack of compliance 缺乏服从性Deliberately aggravates other 故意激怒他人Hostile, vindictive, spiteful, or touc

14、hy 充满敌意,怀恨,恶意或暴躁的Blame others for their problems 将自己的行为问题责怪他人Most often diagnosed in boys but may be as prevalent in girls 通常诊断于男孩但女孩也可能很普遍13Conduct Disorder (CD)品行疾患Many times first identified by legal authorities 通常会先被法庭发现其问题行为Juvenile delinquents 青少年罪犯Substance abuse common普遍有物质滥用Comorbid with an

15、xiety and depression, especially for girls 与焦虑和忧郁共病,特别是针对女孩Prevalence 盛行率Boys 男孩4 to 16% 百分比四到十六Girls 女孩1.2 to 9% 百分比点二到九14Figure 14.1 Arrest Rates Across Ages for Homicide, Forcible Rape, Robber, Aggravated Assault, and Auto Theft杀人、强暴、抢劫、攻击、偷车者在各年龄层的逮捕率15Conduct Disorder (CD)品行疾患Moffitt (1993) two

16、 paths 在1993年Moffitt所提的两条发展路径Life-course-persistent 生命过程中持续出现Adolescence-limited 仅在青少年期出现Not all aggressive or conduct-disordered boys continue aggressive behavior into adulthood 不是所有具攻击性或品行疾患的男孩会持续攻击行为到成年期Predictive factors 预测因子Low verbal IQ 低语文智商Parent with antisocial personality disorder 父母有反社会人格

17、疾患的问题Temperament 天生气质Dysfunctional parent-child interactions 父母与孩子间不良的互动Poverty 贫穷Low social support 低社会支持16Figure 14.2 Etiology of Conduct Disorder品行疾患的病因学品行疾患的病因学社会心理神经生物 品行疾患17Etiology of Conduct Disorder (CD)品行疾患的病因学Genetic factors 遗传因素Heritability likely plays a part 遗传可能扮演一部分因素Twin study data

18、show mixed results 双生子研究资料呈现不一致的结果Adoption studies focused on criminal behavior, not conduct disorder 领养研究着重在犯罪行为，而非品行疾患的行为问题Evidence for genetic influence 相关证据支持遗传影响Genetics and environment interact (Caspi et al., 2002) 遗传和环境的交互影响Abuse as a child PLUS low MAOA activity most likely to develop CD 虐待孩

19、子加上低单胺氧化酶活性很可能发展品行疾患18Etiology of Conduct Disorder (CD)品行疾患的病因学Neurobiological factors 神经生物因素Poor verbal skills 语文技巧不佳Difficulty with executive functioning 执行功能的困难Low IQ 低智商Psychological factors 心理因素Deficient moral development, especially lack of remorse 有缺陷的道德发展,特别是缺乏同情Modeling and reinforcement of

20、 aggressive behavior 攻击行为的模仿和增强Harsh and inconsistent parenting 严格和不致的教养方式Lack of parental monitoring 缺乏父母的监控Cognitive bias (Kenneth Dodge) 认知偏误Neutral acts by others perceived as hostile 将他人的中性举动知觉成有敌意的19Figure 14.3 Dodges Cognitive Theory of AggressionDodge的攻击认知理论将模糊举动解读成 有敌意对他人产生攻击他人进行报复对他人产生更进步攻

21、击20Etiology of Conduct Disorder (CD)品行疾患的病因学Peer influence 同侪影响Acceptance or rejection by peers 被同侪接受或拒绝Affiliation with deviant peers 与有偏差行为的同侪接近Sociocultural factors 社会文化因素Poverty 贫穷Urban environment 都市的环境21Treatment of Conduct Disorder品行疾患的治疗Family interventions 家人的介入Parental management training

22、(PMT; Gerald Patterson) 父母亲管理训练Teach parents to reward prosocial behavior 教导父母奖赏利社会行为Cognitive therapy 认知治疗Anger-control training 愤怒控制训练22Figure 14.4 Multisystemic Treatment of CD品行疾患的多系统化治疗23Depression in Children and Adolescents儿童和青少年的忧郁Symptoms common to children, adolescents, and adults 儿童,青少年和成

23、人的共同症状Depressed mood 忧郁心情Inability to experience pleasure 无法经验愉快Fatigue 疲累Problems concentrating 难以集中注意力Suicidal ideation 自杀意念Symptoms specific to children & adolescents 儿童和青少年的特定症状Higher rates of suicide attempts and guilt 较高比例的自杀尝试和罪恶感Lower rates of 较低比例的Early morning awakening 早晨易醒Early morning d

24、epression 早晨忧郁Loss of appetite 缺乏食欲Weight loss 体重减少24Depression in Children and Adolescents儿童和青少年的忧郁Depression recurrent 忧郁持续再发Prevalence 盛行率1% of preschoolers 学龄前儿童为百分之2 3% of school age children 学龄儿童为百分之二到三Adolescents 青少年Girls 女孩7 13% 百分之七到十三2x that of boys 比男孩高于两倍25Etiology of Depression in Child

25、ren and Adolescents儿童和青少年忧郁的病因学Genetic factors 遗传因素Family and relationship factors 家庭和人际关系因素A parent who is depressed 父母有方是忧郁的Cold and hostile family interactions 冷漠和敌意的家庭互动Poor social skills 社交技巧不佳Impaired relationships with peers and siblings 和同侪和兄弟姐妹有不良的关系Parental criticism 父母的批评26Treatment of De

26、pression in Children and Adolescents儿童和青少年忧郁的治疗Much less research on childhood depression 对于儿童忧郁较少研究Medications 药物治疗SSRIs more effective than tricyclics 选择性血清素抑制剂较三环抗郁剂来得有效Concerns about increased risk of suicide attempts 自杀尝试的风险增加CBT plus Prozac more effective than either alone 认知行为治疗加上百忧解比起单独使用任何一

27、种方式更为有效Prozac alone more effective than CBT alone 单独使用百忧解比单独使用认知行为治疗更为有效Interpersonal psychotherapy (IPT) 人际关系心理治疗CBT in school setting 学校环境的认知行为治疗Treatment of depressed parent 忧郁父母的治疗27Anxiety in Children and Adolescents儿童和青少年的焦虑Fears and worries common in childhood 在儿童期害怕和忧虑很普遍Anxiety disorder 焦虑疾

28、患More severe and persistent worry 更为严重和持续性的忧虑Must interfere with functioning 必须妨害日常生活功能Most childhood fears disappear but adults with anxiety disorders report feeling anxious as children 大部分儿童时期害怕会逐渐消失 但有焦虑疾患的成人报告当还是小孩时就有焦虑的感觉“Ive always been this way” 我直都是这个样子28School Phobia惧学症Two types 二种类型Separat

29、ion anxiety 分离焦虑Worry about parental safety when separated 当分离时担心父母安全 Fear of school 对上学害怕Begins later in childhood 在儿童期较晚时开始More severe and pervasive avoidance 更为严重和广泛性的逃避 29Social Phobia惧学症Extreme shyness and withdrawal 极端害羞和退缩May exhibit selective mutism 可能呈现选择性缄默症的症状Refusal to speak in unfamilia

30、r social setting 不愿意在不熟悉的社会情境中说话Prevalence 盛行率1% of children and adolescents 儿童和青少年为百分之Etiology 病因学Overestimation of threat 对威胁的高估Underestimation of coping ability 对自我应付能力的低估Poor social skills 社交技巧不佳30PTSD创伤后压力症候群Exposure to trauma 暴露于创伤Chronic physical or sexual abuse 长期身体或性虐待Community violence 小区暴

31、力Natural disasters 自然灾害Symptom categories 症状种类Flashbacks, nightmares, intrusive thoughts 经验瞬间再现,恶梦,侵入性思考Avoidance 逃避 Hyperarousal and vigilance 过度容易被激发和警觉Etiology 病因学Preexisting anxiety 原先即存在焦虑Family stress and coping styles 家庭压力和应对方式Parental response to trauma 父母亲对创伤的反应31Treatment of Anxiety Disord

32、ers in Childhood and Adolescence在儿童期和青少年期焦虑疾患的治疗Exposure to feared object 暴露于所害怕的物体Reward approach behavior 奖赏接近的行为Modeling 示范CBT Kendalls Coping Cat program Cognitive restructuring 认知重组Psychoeducation 心理教育Modeling and exposure 示范和暴露Skills training 技巧训练Relapse prevention 再发预防Include family in treatm

33、ent 治疗包括家人32Learning Disability学习障碍Evidence of inadequate development in a specific area of academic, language, speech or motor skills 在学业、语言、说话或运动技能领域有不适当发展的证据e.g., arithmetic or reading 例如：数学或阅读学习障碍Not due to mental retardation, autism, physical disorder or lack of educational opportunity 不是由于智能迟缓

34、,生理疾病或缺乏教育机会所造成Individual usually average or above average intelligence 个体通常有平均或高于平均的智力33Learning Disability学习障碍DSM-IV-TR categories 在DSM-IV-TR中的类别Learning disorders 学习疾患Communication disorders 沟通疾患Motor skills disorder 运动技能疾患Often identified and treated in school 通常在学校中被辨认和治疗Reading disorders more

35、common in boys 在男孩阅读疾患更为普遍34Learning Disorders学习障碍Reading disorder (dyslexia) 阅读疾患(失读症)Problems with word recognition and reading comprehension对于字的辨认和阅读理解有问题Disorder of written expression 文字表达疾患Problems writing including spelling, grammar, and punctuation errors 文字写作问题包括：拼字,文法和标点符号的错误Mathematics dis

36、order 数学疾患Problems counting, remembering arithmetic facts, and alignment of numbers in columns 在算术,记住数学事实和字段数字的排列上有问题35Communication Disorders沟通疾患Expressive Language disorder 语言表达疾患Difficulty expressing self in verbal speech 有困难以口语表达自己Speaks in short phrases 说简短的词组Forgets word meanings 忘记字义Phonologi

37、cal disorder 音韵疾患Vocabulary adequate but difficulty articulating speech sounds 有足够字汇但有困难清晰的发音Complete recovery common with speech therapy 经由语言治疗普遍可以完全恢复Stuttering 口吃Frequent repetitions or prolongations of sounds 经常语音重复或拖长Long pauses between words 在字的中间有较长的暂停Repeating words 重复字词Body twitching and bl

38、inking 身体痉孪和眨眼80% recover by age 16 在年龄十六岁时，有八成会恢复36Motor Skills Disorder运动技能疾患Also known as developmental coordination disorder 也被称为是发展性运动协调疾患Marked impairment in motor coordination 动作协调上有明显的受损e.g., difficulty tying shoes, writing, catching a ball 例如：有困难绑鞋带、写作和接住球37Etiology of Learning Disabilities

39、: Dyslexia学习障碍的病因学：失读症Perceptual deficits 知觉缺陷Mirror image or reversal of letters 镜像或字母的颠倒Little support for this hypothesis 对于此假设获得较少支持Genetic factors 遗传因素Evidence from family and twin studies 来自家庭和双生子研究的相关证据Problems in language processing 在语言处理上有问题Speech perception 语音知觉Difficulty recognizing rhyme

40、 and alliteration 有困难辨认韵律和头韵Problems naming familiar objects rapidly 有困难快速的说出熟悉物体的名字Delays learning syntactic rules 学习句法规则的延迟Deficient phonological awareness 语音觉察有缺陷Inadequate left temporo-parietal-occipital functioning 不良的左颞-顶-枕叶功能38Treatment of Learning Disabilities学习障碍的治疗Reading and writing disor

41、ders 阅读和书写文字疾患Multisensory instruction in listening, speaking, and writing skills 听,说,和写的技巧的多重感官教导Readiness skills in younger children as preparation for learning to read 幼小小孩准备就绪技巧作为学习阅读的准备Phonics instruction 语音的教导Communication disorders 沟通疾患Fast ForWord Involves computer games and audiotapes that

42、slow speech sounds 包括计算机游戏和语音较慢的录音带39Mental Retardation智能不足Significantly below average intellectual functioning智力功能显著低于平均IQ less than 70 智商少于七十Deficits in adaptive functioning 适应功能的缺陷Self-care, communication, home living, decision making, etc. 自我照顾,沟通,家居生活,做决定等等Onset before age 18 在十八岁前初发Most profes

43、sionals focus on strengths of individual to assess ability to function 多数专家会强调个案的优势以评估其功能40Table 14.3 Sample Items from Vineland Adaptive Behavior Scales来自Vineland适应行为量表的例题41Table 14.4 DSM-IV-TR Categories of Mental Retardation智能不足在DSM-IV-TR的分类42Table 14.5 AAMR Definition of Mental Retardation美国智能不足

44、学会对智能不足的定义43Etiology of Mental Retardation: Neurological Factors智能不足的病因学：神经学因素Downs syndrome 唐氏症Chromosomal trisomy 染色体21有三条 (trisomy 21)47 instead of 46 chromosomes 有47个染色体而非23对Fragile X syndrome 脆性X症候群Mutation in the fMRI gene on the X chromosome 在X染色体产生I基因的突变Recessive-gene disease 隐性基因疾病Phenylket

45、onuria (PKU) 苯酮尿症Maternal infectious disease, especially during 1st trimester 母亲得到传染性疾病,特别是在怀孕期的前三个月间HIV, rubella, syphilis 艾滋病毒, 德国麻疹,梅毒Encephalitis 脑膜炎Malnutrition营养不良Brain injuries from falls or auto accidents 跌倒或车祸所导致的大脑受伤Lead or mercury poisoning 铅或汞中毒44Treatment of Mental Retardation智能不足的治疗Res

46、idential treatment 住宿治疗Small to medium sized community residences 小到中等大小的小区住处Behavioral treatments 行为治疗Language, social, and motor skills training 语言,社会和动作技巧训练Method of successive approximation to teach basic self-care skills in severely retarded 用逐步渐近的方法来教导重度智能障碍的自我照顾技巧e.g., holding a spoon, toileting 例如：握住汤匙,如厕Cognitive treatments 认知治疗Problem-solving strategies 问题解决策略Computer assisted instruction 计算机辅助教学45Pervasive Developmental Disorders广泛性发展疾患Autistic Disorder 自闭性疾患Retts Di