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1、Copyright2005JohnWiley Sons NY 1 PowerPoint LectureNotesPresentationDisordersofChildhood兒童期疾患 AbnormalPsychology TenthEditionbyAnnM Kring GeraldC Davison JohnM Neale SheriL Johnson Copyright2005JohnWiley Sons NY 2 ClassificationandDiagnosisofChildhoodDisorders兒童期疾患的分類和診斷 Developmentalpsychopathology
2、發展的心理病理學Studiesdisordersofchildhoodwithinthecontextofnormalchilddevelopment在正常兒童發展的背景脈絡下研究兒童期的疾患Externalizingdisorders外化性疾患Characterizedbyoutwardbehaviors以外化性的行為為其特性Noncompliance aggressiveness overactivity impulsiveness不服從 攻擊 過動 衝動Morecommoninboys在男孩較普遍Internalizingdisorders內化性疾患Characterizedbyinwa
3、rdbehaviors以向化的行為為其特性Depression anxiety socialwithdrawal憂鬱 焦慮 社會退縮Morecommoningirls在女孩較普遍 Copyright2005JohnWiley Sons NY 3 Table14 1ChaptersWhereDisordersareDiscussedThatOccurinBothChildrenandAdults在兒童和成人身上皆會發生的疾患章節 Copyright2005JohnWiley Sons NY 4 AttentionDeficit HyperactivityDisorder注意力不足 過動疾患 Ex
4、cessivelevelsofactivity過多的活動Fidgeting squirming runningaroundwheninappropriate incessanttalking不安 扭動 不恰當的走動 不停的說話Distractabilityanddifficultyconcentrating分心和有困難集中Makescarelessmistakes can tfollowinstructions forgetful粗心犯錯 不能聽從指令 健忘Mustbesevereandpersistent必須嚴重且持續Presentforatleast6monthsandcauseimpai
5、rmentsinfunctioning持續至少六個月並產生功能的受損 Copyright2005JohnWiley Sons NY 5 AttentionDeficit HyperactivityDisorder注意力不足 過動疾患 ThreesubcategoriesinDSM IV TR在DSM IV TR中可分為三個亞型 Predominantlyinattentivetype主要為不注意型Predominantlyhyperactive impulsivetype主要為過動 易衝動型Combinedtype複合型Differentialdiagnosis鑑別診斷ADHDorConduc
6、tDisorder 注意力不足過動疾患或品性疾患 ADHD注意力不足過動疾患Moreoff taskbehavior cognitive achievementdeficits較多無法達成工作的行為 認知和成就上缺陷ConductDisorder品行疾患Moreaggressive actoutinmostsettings antisocialparents familyhostility較多攻擊性 常出現動作外化行為 反社會性父母 家人敵意 Copyright2005JohnWiley Sons NY 6 AttentionDeficit HyperactivityDisorder注意力不足
7、 過動疾患 ADHDoftencomorbidwithanxietyanddepression通常和焦慮和憂鬱共病Prevalenceestimates2to7 盛行率估計約2到7 Symptomspersistbeyondchildhood症狀在兒童期之後仍持續Moststillmeetcriteriainadolescence大部分在青少年期仍符合準則 Copyright2005JohnWiley Sons NY 7 EtiologyofADHD注意力不足過動疾患的病因學 Geneticfactors遺傳因素Twinstudies雙生子研究Heritabilityestimatesashi
8、ghas70to80 遺傳率估計有百分之70到80高Twodopaminegenesimplicated二個多巴胺基因受到影響Neurobiologicalfactors神經生物因素Underresponsivefrontallobes額葉反應性低Reducedcerebralbloodflow大腦血流量減少Smallerfrontallobes caudatenucleus globuspallidus額葉 尾核和蒼白球較小 Copyright2005JohnWiley Sons NY 8 EtiologyofADHD注意力不足過動疾患的病因學 Perinatalandprenatalfac
9、tors出生前後和產前因素Lowbirthweight出生體重低Maternaltobaccoandalcoholuse母親吸菸和酒精使用Environmentaltoxins環境毒素FoodadditivesandsugarnotrelatedtoADHD食品添加物和糖與注意力不足過動疾患沒有相關Nicotinefrommaternalsmoking來自母親吸煙所產生尼古丁Maydamagedopaminergicsysteminfetus可能損害胎兒多巴胺內生性系統 Copyright2005JohnWiley Sons NY 9 EtiologyofADHD注意力不足過動疾患的病因學 P
10、sychologicalFactors心理因素Ineffectiveparenting negativeinteractions無效能的親職教育 負向互動Probablyinteractwithgeneticandneurobiologicalfactors可能和遺傳和神經生物因素產生交互影響LikelytoexacerbateormaintainADHDbehaviorsbutnotcausethem很可能惡化或維持ADHD的行為問題但不會造成此疾患 Copyright2005JohnWiley Sons NY 10 TreatmentofADHD注意力不足過動疾患的治療 Stimulant
11、medications興奮劑藥物治療Reducedisruptivebehavior降低破壞性行為Improveattentionandconcentration改善注意力和專心Ritalin利他能AdderallConcertaStratteraSideeffects副作用Lossofappetite失去食慾Sleepproblems睡眠問題 Copyright2005JohnWiley Sons NY 11 TreatmentofADHD注意力不足過動疾患的治療 Psychologicaltreatment心理治療Operantconditioning操作制約Parenttraining父
12、母親訓練Classroommanagementandteachertraining課堂管理和老師的訓練Classroomstructure課堂結構Briefassignments簡短的作業Immediatefeedback立即回饋Task focusedstyle聚焦於作業的方式Breaksforexercise中間休息以作運動 Copyright2005JohnWiley Sons NY 12 ConductDisorder CD 品行疾患 Patternofengaginginbehaviorsthatviolatesocialnorms therightsofothers andareo
13、ftenillegal 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Crueltytowardsotherpeopleoranimals虐待他人或動物Lying說謊Stealing偷竊Vandalism暴力行為Oftenaccompaniedbylackofremorseandcallousness通常伴隨缺乏憐憫和無情 Copyright2005JohnWiley Sons NY 13 OppositionalDefiantDisorder ODD 對立性反抗疾患 ODDbehaviorsdonotmeetcriteriaforCDbutchilddisplay
14、spatternofdefiantbehavior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Losestemper脾氣不佳Lackofcompliance缺乏服從性Deliberatelyaggravatesother故意激怒他人Hostile vindictive spiteful ortouchy充滿敵意 懷恨 惡意或暴躁的Blameothersfortheirproblems將自己的行為問題責怪他人Mostoftendiagnosedinboysbutmaybeasprevalentingirls通常診斷於男孩但女孩也可能很普遍
15、Copyright2005JohnWiley Sons NY 14 ConductDisorder CD 品行疾患 Manytimesfirstidentifiedbylegalauthorities通常會先被法庭發現其問題行為 Juveniledelinquents 青少年罪犯Substanceabusecommon普遍有物質濫用Comorbidwithanxietyanddepression especiallyforgirls與焦慮和憂鬱共病 特別是針對女孩Prevalence盛行率Boys男孩4to16 百分比四到十六Girls女孩1 2to9 百分比 點二到九 Copyright20
16、05JohnWiley Sons NY 15 Figure14 1ArrestRatesAcrossAgesforHomicide ForcibleRape Robber AggravatedAssault andAutoTheft殺人 強暴 搶劫 攻擊 偷車者在各年齡層的逮捕率 Copyright2005JohnWiley Sons NY 16 ConductDisorder CD 品行疾患 Moffitt 1993 twopaths在1993年Moffitt所提的兩條發展路徑Life course persistent生命過程中持續出現Adolescence limited僅在青少年期出現Notallaggressiveorconduct disorderedboyscontinueaggressivebehaviorintoadulthood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Predictivefactors預測因子LowverbalIQ低語文智商Parentwithantisocialpersonalitydisorder父母有反社會人格疾患的問題Tempe
