DisordersofChildhood兒童期疾患分類和診斷（英文版資料）

1、Disorders of Childhood兒童期疾患分類和診斷（英文版資料）1Classification and Diagnosis of Childhood Disorders兒童期疾患的分類和診斷Developmental psychopathology 發(fā)展的心理病理學(xué)Studies disorders of childhood within the context of normal child development 在正常兒童發(fā)展的背景脈絡(luò)下研究兒童期的疾患Externalizing disorders 外化性疾患Characterized by outward behavio

2、rs 以外化性的行為為其特性Noncompliance, aggressiveness, overactivity, impulsiveness 不服從,攻擊,過動(dòng),沖動(dòng)More common in boys 在男孩較普遍Internalizing disorders 內(nèi)化性疾患Characterized by inward behaviors 以向化的行為為其特性Depression, anxiety, social withdrawal 憂郁,焦慮,社會(huì)退縮More common in girls 在女孩較普遍2Table 14.1 Chapters Where Disorders are

3、 Discussed That Occur in Both Children and Adults 在兒童和成人身上皆會(huì)發(fā)生的疾患章節(jié)3Attention Deficit/Hyperactivity Disorder注意力不足/過動(dòng)疾患Excessive levels of activity 過多的活動(dòng)Fidgeting, squirming, running around when inappropriate, incessant talking 不安,扭動(dòng),不恰當(dāng)?shù)淖邉?dòng),不停的說話Distractability and difficulty concentrating 分心和有困難集中Ma

4、kes careless mistakes, cant follow instructions, forgetful 粗心犯錯(cuò),不能聽從指令,健忘Must be severe and persistent 必須嚴(yán)重且持續(xù) Present for at least 6 months and cause impairments in functioning 持續(xù)至少六個(gè)月并產(chǎn)生功能的受損4Attention Deficit/Hyperactivity Disorder注意力不足/過動(dòng)疾患Three subcategories in DSM-IV-TR 在DSM-IV-TR中可分為三個(gè)亞型：Pred

5、ominantly inattentive type 主要為不注意型Predominantly hyperactive-impulsive type 主要為過動(dòng)-易沖動(dòng)型Combined type 復(fù)合型Differential diagnosis 鑒別診斷ADHD or Conduct Disorder? 注意力不足過動(dòng)疾患或品性疾患？ADHD注意力不足過動(dòng)疾患More off-task behavior, cognitive & achievement deficits 較多無法達(dá)成工作的行為,認(rèn)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 較多攻擊性, 常出現(xiàn)動(dòng)作外化行為,反社會(huì)性父母,家人敵意5Attention Deficit/Hyperactivity Disorder注意力不足/過動(dòng)疾患ADHD often comorbid with anxiety and depression 通常和焦慮和憂郁共病Prevalence estimates 2 to 7% 盛行率估計(jì)約2到7Symptoms persist beyond childhood 癥狀在兒童期之后仍持續(xù)Most still meet cri

7、teria in adolescence 大部分在青少年期仍符合準(zhǔn)則6Etiology of ADHD注意力不足過動(dòng)疾患的病因?qū)WGenetic factors 遺傳因素Twin studies 雙生子研究Heritability estimates as high as 70 to 80% 遺傳率估計(jì)有百分之70到80高Two dopamine genes implicated 二個(gè)多巴胺基因受到影響Neurobiological factors 神經(jīng)生物因素Underresponsive frontal lobes 額葉反應(yīng)性低Reduced cerebral blood flow 大腦血流

8、量減少Smaller frontal lobes, caudate nucleus, globus pallidus 額葉,尾核和蒼白球較小7Etiology of ADHD注意力不足過動(dòng)疾患的病因?qū)WPerinatal and prenatal factors 出生前后和產(chǎn)前因素Low birth weight 出生體重低Maternal tobacco and alcohol use 母親吸煙和酒精使用Environmental toxins 環(huán)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(dòng)疾患沒有相關(guān)Nicot

9、ine from maternal smoking 來自母親吸煙所產(chǎn)生尼古丁May damage dopaminergic system in fetus 可能損害胎兒多巴胺內(nèi)生性系統(tǒng)8Etiology of ADHD注意力不足過動(dòng)疾患的病因?qū)WPsychological Factors 心理因素Ineffective parenting, negative interactions 無效能的親職教育,負(fù)向互動(dòng)Probably interact with genetic and neurobiological factors 可能和遺傳和神經(jīng)生物因素產(chǎn)生交互影響Likely to exacerb

10、ate 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(huì)造成此疾患9Treatment of ADHD注意力不足過動(dòng)疾患的治療Stimulant 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 ConcertaStratteraSide effects 副作用Loss of appetite 失去食欲Sleep problems

11、 睡眠問題10Treatment of ADHD注意力不足過動(dòng)疾患的治療Psychological treatment 心理治療Operant conditioning 操作制約Parent training 父母親訓(xùn)練Classroom management and teacher training 課堂管理和老師的訓(xùn)練Classroom structure 課堂結(jié)構(gòu)Brief assignments 簡短的作業(yè)Immediate feedback 立即回饋Task-focused style 聚焦于作業(yè)的方式Breaks for exercise 中間休息以作運(yùn)動(dòng)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.從事違反社會(huì)規(guī)范,侵害他人權(quán)利和經(jīng)常犯法的行為模式Aggression 攻擊Cruelty towards other people or animals 虐待他人或動(dòng)物L(fēng)ying 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

13、12Oppositional Defiant Disorder (ODD)對(duì)立性反抗疾患ODD behaviors do not meet criteria for CD but child displays pattern of defiant behavior 對(duì)立性反抗疾患的行為并不符合品行疾患的準(zhǔn)則 但兒童呈現(xiàn)反抗的行為模式Argumentative 愛爭(zhēng)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 touc

14、hy 充滿敵意,懷恨,惡意或暴躁的Blame others for their problems 將自己的行為問題責(zé)怪他人Most often diagnosed in boys but may be as prevalent in girls 通常診斷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 通常會(huì)先被法庭發(fā)現(xiàn)其問題行為Juvenile delinquents 青少年罪犯Substance abuse common普遍有物質(zhì)濫用Comorbid with an

15、xiety and depression, especially for girls 與焦慮和憂郁共病,特別是針對(duì)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% 百分比點(diǎn)二到九14Figure 14.1 Arrest Rates Across Ages for Homicide, Forcible Rape, Robber, Aggravated Assault, and Auto Theft殺人、強(qiáng)暴、搶劫、攻擊、偷車者在各年齡層的逮捕率15Conduct Disorder (CD)品行疾患Moffitt (1993) two

16、 paths 在1993年Moffitt所提的兩條發(fā)展路徑Life-course-persistent 生命過程中持續(xù)出現(xiàn)Adolescence-limited 僅在青少年期出現(xiàn)Not 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(huì)持續(xù)攻擊行為到成年期Predictive factors 預(yù)測(cè)因子Low verbal IQ 低語文智商Parent with antisocial personality disorder 父母有反社會(huì)人格

17、疾患的問題Temperament 天生氣質(zhì)Dysfunctional parent-child interactions 父母與孩子間不良的互動(dòng)Poverty 貧窮Low social support 低社會(huì)支持16Figure 14.2 Etiology of Conduct Disorder品行疾患的病因?qū)W品行疾患的病因?qū)W社會(huì)心理神經(jīng)生物 品行疾患17Etiology of Conduct Disorder (CD)品行疾患的病因?qū)WGenetic factors 遺傳因素Heritability likely plays a part 遺傳可能扮演一部分因素Twin study data

18、show mixed results 雙生子研究資料呈現(xiàn)不一致的結(jié)果Adoption studies focused on criminal behavior, not conduct disorder 領(lǐng)養(yǎng)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(guān)證據(jù)支持遺傳影響Genetics and environment interact (Caspi et al., 2002) 遺傳和環(huán)境的交互影響Abuse as a child PLUS low MAOA activity most likely to develop CD 虐待孩

19、子加上低單胺氧化酶活性很可能發(fā)展品行疾患18Etiology of Conduct Disorder (CD)品行疾患的病因?qū)WNeurobiological factors 神經(jīng)生物因素Poor verbal skills 語文技巧不佳Difficulty with executive functioning 執(zhí)行功能的困難Low IQ 低智商Psychological factors 心理因素Deficient moral development, especially lack of remorse 有缺陷的道德發(fā)展,特別是缺乏同情Modeling and reinforcement of

20、 aggressive behavior 攻擊行為的模仿和增強(qiáng)Harsh and inconsistent parenting 嚴(yán)格和不致的教養(yǎng)方式Lack of parental monitoring 缺乏父母的監(jiān)控Cognitive bias (Kenneth Dodge) 認(rèn)知偏誤Neutral acts by others perceived as hostile 將他人的中性舉動(dòng)知覺成有敵意的19Figure 14.3 Dodges Cognitive Theory of AggressionDodge的攻擊認(rèn)知理論將模糊舉動(dòng)解讀成 有敵意對(duì)他人產(chǎn)生攻擊他人進(jìn)行報(bào)復(fù)對(duì)他人產(chǎn)生更進(jìn)步攻

21、擊20Etiology of Conduct Disorder (CD)品行疾患的病因?qū)WPeer 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Sociocultural factors 社會(huì)文化因素Poverty 貧窮Urban environment 都市的環(huán)境21Treatment of Conduct Disorder品行疾患的治療Family interventions 家人的介入Parental management training

22、(PMT; Gerald Patterson) 父母親管理訓(xùn)練Teach parents to reward prosocial behavior 教導(dǎo)父母獎(jiǎng)賞利社會(huì)行為Cognitive therapy 認(rèn)知治療Anger-control training 憤怒控制訓(xùn)練22Figure 14.4 Multisystemic Treatment of CD品行疾患的多系統(tǒng)化治療23Depression in Children and Adolescents兒童和青少年的憂郁Symptoms common to children, adolescents, and adults 兒童,青少年和成

23、人的共同癥狀Depressed mood 憂郁心情Inability to experience pleasure 無法經(jīng)驗(yàn)愉快Fatigue 疲累Problems concentrating 難以集中注意力Suicidal ideation 自殺意念Symptoms specific to children & adolescents 兒童和青少年的特定癥狀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 d

24、epression 早晨憂郁Loss of appetite 缺乏食欲Weight loss 體重減少24Depression in Children and Adolescents兒童和青少年的憂郁Depression recurrent 憂郁持續(xù)再發(fā)Prevalence 盛行率1% of preschoolers 學(xué)齡前兒童為百分之2 3% of school age children 學(xué)齡兒童為百分之二到三Adolescents 青少年Girls 女孩7 13% 百分之七到十三2x that of boys 比男孩高于兩倍25Etiology of Depression in Child

25、ren and Adolescents兒童和青少年憂郁的病因?qū)WGenetic factors 遺傳因素Family and relationship factors 家庭和人際關(guān)系因素A parent who is depressed 父母有方是憂郁的Cold and hostile family interactions 冷漠和敵意的家庭互動(dòng)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(guān)系Parental criticism 父母的批評(píng)26Treatment of De

26、pression in Children and Adolescents兒童和青少年憂郁的治療Much less research on childhood depression 對(duì)于兒童憂郁較少研究Medications 藥物治療SSRIs more effective than tricyclics 選擇性血清素抑制劑較三環(huán)抗郁劑來得有效Concerns about increased risk of suicide attempts 自殺嘗試的風(fēng)險(xiǎn)增加CBT plus Prozac more effective than either alone 認(rèn)知行為治療加上百憂解比起單獨(dú)使用任何一

27、種方式更為有效Prozac alone more effective than CBT alone 單獨(dú)使用百憂解比單獨(dú)使用認(rèn)知行為治療更為有效Interpersonal psychotherapy (IPT) 人際關(guān)系心理治療CBT in school setting 學(xué)校環(huán)境的認(rèn)知行為治療Treatment of depressed parent 憂郁父母的治療27Anxiety in Children and Adolescents兒童和青少年的焦慮Fears and worries common in childhood 在兒童期害怕和憂慮很普遍Anxiety disorder 焦慮疾

28、患More severe and persistent worry 更為嚴(yán)重和持續(xù)性的憂慮Must interfere with functioning 必須妨害日常生活功能Most childhood fears disappear but adults with anxiety disorders report feeling anxious as children 大部分兒童時(shí)期害怕會(huì)逐漸消失 但有焦慮疾患的成人報(bào)告當(dāng)還是小孩時(shí)就有焦慮的感覺“Ive always been this way” 我直都是這個(gè)樣子28School Phobia懼學(xué)癥Two types 二種類型Separat

29、ion anxiety 分離焦慮Worry about parental safety when separated 當(dāng)分離時(shí)擔(dān)心父母安全 Fear of school 對(duì)上學(xué)害怕Begins later in childhood 在兒童期較晚時(shí)開始More severe and pervasive avoidance 更為嚴(yán)重和廣泛性的逃避 29Social Phobia懼學(xué)癥Extreme shyness and withdrawal 極端害羞和退縮May exhibit selective mutism 可能呈現(xiàn)選擇性緘默癥的癥狀Refusal to speak in unfamilia

30、r social setting 不愿意在不熟悉的社會(huì)情境中說話Prevalence 盛行率1% of children and adolescents 兒童和青少年為百分之Etiology 病因?qū)WOverestimation of threat 對(duì)威脅的高估Underestimation of coping ability 對(duì)自我應(yīng)付能力的低估Poor social skills 社交技巧不佳30PTSD創(chuàng)傷后壓力癥候群Exposure to trauma 暴露于創(chuàng)傷Chronic physical or sexual abuse 長期身體或性虐待Community violence 小區(qū)暴

31、力Natural disasters 自然災(zāi)害Symptom categories 癥狀種類Flashbacks, nightmares, intrusive thoughts 經(jīng)驗(yàn)瞬間再現(xiàn),惡夢(mèng),侵入性思考Avoidance 逃避 Hyperarousal and vigilance 過度容易被激發(fā)和警覺Etiology 病因?qū)WPreexisting anxiety 原先即存在焦慮Family stress and coping styles 家庭壓力和應(yīng)對(duì)方式Parental response to trauma 父母親對(duì)創(chuàng)傷的反應(yīng)31Treatment of Anxiety Disord

32、ers in Childhood and Adolescence在兒童期和青少年期焦慮疾患的治療Exposure to feared object 暴露于所害怕的物體Reward approach behavior 獎(jiǎng)賞接近的行為Modeling 示范CBT Kendalls Coping Cat program Cognitive restructuring 認(rèn)知重組Psychoeducation 心理教育Modeling and exposure 示范和暴露Skills training 技巧訓(xùn)練Relapse prevention 再發(fā)預(yù)防Include family in treatm

33、ent 治療包括家人32Learning Disability學(xué)習(xí)障礙Evidence of inadequate development in a specific area of academic, language, speech or motor skills 在學(xué)業(yè)、語言、說話或運(yùn)動(dòng)技能領(lǐng)域有不適當(dāng)發(fā)展的證據(jù)e.g., arithmetic or reading 例如：數(shù)學(xué)或閱讀學(xué)習(xí)障礙Not due to mental retardation, autism, physical disorder or lack of educational opportunity 不是由于智能遲緩

34、,生理疾病或缺乏教育機(jī)會(huì)所造成Individual usually average or above average intelligence 個(gè)體通常有平均或高于平均的智力33Learning Disability學(xué)習(xí)障礙DSM-IV-TR categories 在DSM-IV-TR中的類別Learning disorders 學(xué)習(xí)疾患Communication disorders 溝通疾患Motor skills disorder 運(yùn)動(dòng)技能疾患Often identified and treated in school 通常在學(xué)校中被辨認(rèn)和治療Reading disorders more

35、common in boys 在男孩閱讀疾患更為普遍34Learning Disorders學(xué)習(xí)障礙Reading disorder (dyslexia) 閱讀疾患(失讀癥)Problems with word recognition and reading comprehension對(duì)于字的辨認(rèn)和閱讀理解有問題Disorder of written expression 文字表達(dá)疾患Problems writing including spelling, grammar, and punctuation errors 文字寫作問題包括：拼字,文法和標(biāo)點(diǎn)符號(hào)的錯(cuò)誤Mathematics dis

36、order 數(shù)學(xué)疾患Problems counting, remembering arithmetic facts, and alignment of numbers in columns 在算術(shù),記住數(shù)學(xué)事實(shí)和字段數(shù)字的排列上有問題35Communication Disorders溝通疾患Expressive Language disorder 語言表達(dá)疾患Difficulty expressing self in verbal speech 有困難以口語表達(dá)自己Speaks in short phrases 說簡短的詞組Forgets word meanings 忘記字義Phonologi

37、cal disorder 音韻疾患Vocabulary adequate but difficulty articulating speech sounds 有足夠字匯但有困難清晰的發(fā)音Complete recovery common with speech therapy 經(jīng)由語言治療普遍可以完全恢復(fù)Stuttering 口吃Frequent repetitions or prolongations of sounds 經(jīng)常語音重復(fù)或拖長Long pauses between words 在字的中間有較長的暫停Repeating words 重復(fù)字詞Body twitching and bl

38、inking 身體痙孿和眨眼80% recover by age 16 在年齡十六歲時(shí)，有八成會(huì)恢復(fù)36Motor Skills Disorder運(yùn)動(dòng)技能疾患Also known as developmental coordination disorder 也被稱為是發(fā)展性運(yùn)動(dòng)協(xié)調(diào)疾患Marked impairment in motor coordination 動(dòng)作協(xié)調(diào)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37Etiology of Learning Disabilities

39、: Dyslexia學(xué)習(xí)障礙的病因?qū)W：失讀癥Perceptual 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(duì)于此假設(shè)獲得較少支持Genetic factors 遺傳因素Evidence from family and twin studies 來自家庭和雙生子研究的相關(guān)證據(jù)Problems in language processing 在語言處理上有問題Speech perception 語音知覺Difficulty recognizing rhyme

40、 and alliteration 有困難辨認(rèn)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(xué)習(xí)句法規(guī)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38Treatment of Learning Disabilities學(xué)習(xí)障礙的治療Reading and writing disor

41、ders 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(dǎo)Readiness skills in younger children as preparation for learning to read 幼小小孩準(zhǔn)備就緒技巧作為學(xué)習(xí)閱讀的準(zhǔn)備Phonics instruction 語音的教導(dǎo)Communication disorders 溝通疾患Fast ForWord Involves computer games and audiotapes that

42、slow speech sounds 包括計(jì)算機(jī)游戲和語音較慢的錄音帶39Mental Retardation智能不足Significantly below average intellectual functioning智力功能顯著低于平均IQ less than 70 智商少于七十Deficits in adaptive functioning 適應(yīng)功能的缺陷Self-care, communication, home living, decision making, etc. 自我照顧,溝通,家居生活,做決定等等Onset before age 18 在十八歲前初發(fā)Most profes

43、sionals focus on strengths of individual to assess ability to function 多數(shù)專家會(huì)強(qiáng)調(diào)個(gè)案的優(yōu)勢(shì)以評(píng)估其功能40Table 14.3 Sample Items from Vineland Adaptive Behavior Scales來自Vineland適應(yīng)行為量表的例題41Table 14.4 DSM-IV-TR Categories of Mental Retardation智能不足在DSM-IV-TR的分類42Table 14.5 AAMR Definition of Mental Retardation美國智能不足

44、學(xué)會(huì)對(duì)智能不足的定義43Etiology of Mental Retardation: Neurological Factors智能不足的病因?qū)W：神經(jīng)學(xué)因素Downs syndrome 唐氏癥Chromosomal trisomy 染色體21有三條 (trisomy 21)47 instead of 46 chromosomes 有47個(gè)染色體而非23對(duì)Fragile X syndrome 脆性X癥候群Mutation in the fMRI gene on the X chromosome 在X染色體產(chǎn)生I基因的突變Recessive-gene disease 隱性基因疾病Phenylket

45、onuria (PKU) 苯酮尿癥Maternal 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(gè)月間HIV, rubella, syphilis 艾滋病毒, 德國麻疹,梅毒Encephalitis 腦膜炎Malnutrition營養(yǎng)不良Brain injuries from falls or auto accidents 跌倒或車禍所導(dǎo)致的大腦受傷Lead or mercury poisoning 鉛或汞中毒44Treatment of Mental Retardation智能不足的治療Res

46、idential treatment 住宿治療Small to medium sized community residences 小到中等大小的小區(qū)住處Behavioral treatments 行為治療Language, social, and motor skills training 語言,社會(huì)和動(dòng)作技巧訓(xùn)練Method of successive approximation to teach basic self-care skills in severely retarded 用逐步漸近的方法來教導(dǎo)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Cognitive treatments 認(rèn)知治療Problem-solving strategies 問題解決策略Computer assisted instruction 計(jì)算機(jī)輔助教學(xué)45Pervasive Developmental Disorders廣泛性發(fā)展疾患Autistic Disorder 自閉性疾患Retts Di