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Final Exam: Comparison of Critical Issues in Oppositional Defiant Disorder, Generalized

Anxiety Disorder, and Major Depressive Disorder

Jacqueline Munroe
University of Calgary
December 5, 2012











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Comparison of Critical Issues in Oppositional Defiant Disorder, Generalized
Anxiety Disorder and Major Depressive Disorder
Part 1- Critical Issues in ODD
My reading on conduct disorder (CD) and oppositional defiant disorder (ODD) was of
particular interest to me this year. The critical issue I would like to discuss is the issue of ODD as
an actual childhood disorder, as opposed to normal developmental behaviours. This has been a
challenging topic as I have always thought that by implementing good classroom management,
consistent routines, and clear, high expectations, even my most difficult students (ODD
designations, FASD) have fallen into classroom routines and appropriate behaviours. I have been
with my current class for over 3 months, and no longer believe this to be the case. I am currently
faced with a grade 3 student who was expelled for the latter half of grade 2 (for hitting the
principal with a stick, spitting on his chair, spitting on students, threatening the lives of other
students, attacking them etc.). I began in September unaware that last year a teacher with 15
years of experience had quit this particular group (over 60% special needs) in December, and
retired from teaching at 45. Needless to say, they are truly a challenging bunch! Regardless, I
had a great start to the year, was firm and consistent (with expectations and consequences)
incorrectly assumed I had conquered the behaviours everyone had been talking about, regarding
my own little student. However, roughly 3 months into school, the behaviours are returning as
described from last year, regardless of my letting them happen. My student is beginning the
playground threats once again, the outside fights, peeing on the floor in the bathroom, denying
all fault, flipping desks, breaking school supplies, just a general lack of respect for people and
things. This student also appears to possess a misconstrued sense of what has occurred. I have to
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wonder, is there more legitimacy to ODD than I originally thought? Could it be possible that I
have one of those minority children who will go on to develop conduct disorder, a more
extreme form of ODD? Is he already there with his aggressive ways? It would seem to me that
this student genuinely does not recall doing anything inappropriate due to some distorted sense
of what has transpired. This recent decline, has led me back to this particular chapter, as I
attempt to really formulate my own opinion on what is occurring in the mind of one of my
students, and how I can best approach the situation.
Understanding of the Area Relative to Current Thinking
Currently, the legitimacy of oppositional defiant disorder (ODD) as a true childhood
disorder is unresolved (Mash & Barkley, 2003). Criteria for a diagnosis of this disorder are
problematic since many of the behaviours that must be seen in order to warrant a mental disorder
(ODD) could be considered typical developmental behaviours (2003). Reflected in this
unresolved legitimacy of ODD, are uncertain rates of prevalence. Estimates range from 1% to
20%, with a median prevalence of about 3% (2003). Oppositional defiant disorder can be
described in terms of the typical tantrums, defiance and stubbornness common in early childhood
(2003). Deviations from normal trajectories occur due to a lack of expected decline in these
behaviours and escalation in aggressive behaviours such as anger (yet less aggression that what
would be seen in conduct disorder) (APA, 2000). Current thinking related to ODD in children is
that criteria change may be needed in order to determine what actually constitutes
psychopathology (2003). To be diagnosed with the controversial ODD, children must display
four of the following behaviours that occur more frequently than one would expect to see in the
general population: often loses temper, often argues with adults, often actively defies the
requests of adults, often deliberately annoys people, often blames others for his or her mistakes,
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is often touchy or easily annoyed by others, is often angry or resentful, is often spiteful or
vindictive. This behaviour must lead to social, academic, or occupational functioning
impairments. The behavioural disturbance cannot be a reflection of a psychotic or mood
disorder, nor can criteria also be met for conduct disorder or antisocial personality disorder
(2000). Issues in diagnosing ODD are that these particular children will typically be defiant to
those adults or peers that they know well (2003). However, the behaviours will often be seen in
the home setting (but may also be seen in a school setting or in the community). These children
frequently attribute their behaviour to unreasonable demands (2000). In the presence of someone
they do not know well (a doctor, or psychologist for example) the behaviour may not necessarily
be observed (2003) making it more difficult to observe the behaviours during an assessment and
making a diagnosis more challenging.
While antisocial behaviours may be common for all at some point in development, early
aggression, impulsivity, hyperactivity, and neurological impairments characterize a subgroup of
rare antisocial children (Mash Barkley, 2003). According to Wakefield, harmful dysfunction
(2003, p.156) is one way to characterize this, in that the dysfunctional behaviour pattern must
actually result in impairments or suffering (harm). Many agree that a developmental relationship
does exist between ODD in childhood and conduct disorder (CD) in adolescence in that a
progression exists from one to the other (ODD to CD) (2003). However, the behaviours that
characterize ODD typically occur about 3 years earlier (at age 6) than those that characterize CD
(age 9) (2003). Studies have found that, despite popular belief, children diagnosed with ODD
often do not go on to develop the more extreme conduct disorder (CD) later in development
(2003).

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Critically Analyze Your Understanding of the Area
My understanding of ODD is that a subset of children and youth who display antisocial
behaviours fall under the category of mental disorder, warranting this diagnosis. However,
within this group of children, the consistency seen is in patterns of behaviour (patterns of
aggression, patterns of defiance) and does not extend into consistency between causation and
long-term course of impairments (Mash & Barkley, 2003). This inability to link similarities
between groups (causation, future outcome) begs the question of ODD being a disorder at all?
Could it be that some cases of ODD are simply the early presentation of CD, as opposed to the
less intense version of it? I suppose a hypothesis could be that ODD appears less intense as it is
typically the diagnosis applied to younger children, who have less freedom to conduct violent
and destructive acts. My understanding of this area is that only a small minority (25%) of
children with ODD go on to develop conduct disorder (2003). Therefore, one has to consider the
possibility that 25% of children are being correctly diagnosed and the other 75% are more a
product of their environment and of poor or neglectful parenting techniques. If a disorder should
be characterized by patterns, then why is it that in 25% of children these patterns simply end, in
25% of children behaviours increase in intensity and progress to CD, and in 50% of children
symptoms are maintained? Is it simply a matter of negative temperament for the 50%? Or
insecure attachment problems that relate to relational problems later on? The lack of consistency
in longer term course is worry some when considering the legitimacy of a diagnosis. Similarly,
the fact that this behaviour typically occurs in the home setting (but may extend to other settings)
is also a clear red flag. The behaviour should not be dependent on where or with whom the child
is with, but should be due to some impairment within the child. The fact that some children with
ODD may only display this behaviour at home begs the question, reiterates my previous
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statement of is it simply poor parenting skills or poor personality fits? Clearly environmental
plays a contributing role in ODD, as oppositional defiant disorder is more prevalent in families in
which there is marital discord (2003). Similarly, mothers with depression will more often have
children who present with patterns and behaviours of ODD, but it is unsure how the two are
related (2003). Again, this leads to the idea that external factors may hugely contribute to the
antisocial behaviours presented in ODD as opposed to internal factors within the child ( I
suppose it could be that environmental factors may trigger the disorder in a child who may be
somehow prone). Since aggression towards people or animals, lack of theft, or deceit,
differentiates ODD from CD, could it also be that the vast majority of these children are simply
acting out, perhaps to gain the attention of a depressed mother, or parents too busily involved in
their own marital strife? I have to wonder if ODD, like ADHD is simply over diagnosed, and that
the true psychopathology can be seen in the 25% of children who go on to develop CD.
Discuss How Your Experiences in This Course Helped Shaped Your Understanding
Through this course, I have come to question what is presented to me in terms of how
children are diagnosed. For example, in different circumstances, and with different teachers my
grade 3 class in Northern Alberta, which consists of about 60% special needs students, would
appear to have numerous children who present with symptoms and behaviours of ODD (3).
However, through high expectations and routines, my class no longer appears this way (with one
mind boggling exception). Therefore, regardless of diagnostic criteria, my experience this year,
coupled with what I have learned in this course, has made me really understand that we can
never simple take the diagnostic criteria and apply it to a child, regardless of support from parent
or teacher ratings and interviews. Observations must be carefully conducted, ideally in more than
one setting in order to account for the many factors that could impacting the childs behaviour. I
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understand how easily a misdiagnose could be made if one relies too heavily on the DSM-IV.
After reviewing the diagnostic criteria for ODD, I could have easily diagnosed 3 of my
students with this (they already are) at the onset of the year. They presented with these symptoms
absolutely. Little did I know that among them, one is having untoward things occur at home,
which is resulting in daily self-defecation, one comes from extreme poverty and is constantly
hungry and infected with lice, and the other, is my mystery, who would actually more fit the CD
diagnosis that the less severe ODD diagnosis. My preconceived notion regarding ODD prior to
this course was that it was little more than an excuse for teachers who cannot control their more
colourful students, and parents who have similar problems. I have always thought that various
teaching strategies result in poor behaviour (befriending, being too maternal, being too lenient,
etc.) yet after having taught in various northern districts (in Alberta and BC) and never having
come across a student who did not simply fall into line makes me now reconsider my one little
student who seems (despite my various efforts that have been successful in the past) unable to do
this. While I have rethought my preconceived notions and am more open to the possibility of
ODD than I was in the past, I am of the mindset that perhaps for the children who actually
progress to CD; it may be the legitimate diagnose (further opinion would be appreciated)!
A Professional Plan or Course of Action on Oppositional Defiant Disorder
Since I will be teaching for at least the next three years, I will try to make use of the
many professional development (PD) opportunities presented elsewhere in Alberta, of which I
am able to attend to better my practice. I actually had not considered using my PD to consolidate
my knowledge gained in this program, and am thankful that I now have a purpose when
choosing professional development. Each February, our district had a Spring Fling in which we
must all meet in Edmonton to attend various PD seminars. Oppositional defiant disorder, conduct
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disorder and antisocial behaviours will be my focus for at least one of the seminars, as dealing
with challenging behaviours is always a topic of interest for teachers.
How Have Experiences With the Topic to Date Enhanced or Challenged Abilities to Collaborate
With Other Professionals
My current school is situated in a town of approximately 900 people, with a huge
francophone influence. The French speaking population remains consistent; however, the
English speaking children come from families that are more transient. As we know, these
children often present with more challenges, partly due to consistently rotating schools, and
somewhat less structured lives. A few weeks ago, a woman was brought in from Calgary (who
was heavily involved in a private school there) to teach the staff restitution. Last year, I had
attempted to gain work as a teacher in Calgary. My many resume handouts and school visits in
the Calgary area made me aware of just how different the clientele can be in the private school
setting, as compared to the children who are in the farming town I am currently in. I definitely
found myself getting frustrated when listening to our two day discussion regarding the restitution
practices of choice, fixing mistakes, and returning to the group strengthened. Thoughts drifted to
my students who have basic needs that are not being met consistently each day. How can they
self-regulate and self-monitor when they are hungry, tired, itchy from lice, and filthy!
Implementing restitution is supposed to be our schools attempt to correct the many intense
behaviour issues we are experiencing on the English side. While I believe that children can
certainly be taught to self-correct and gain a sense of what is right internally (aside from my
children who are lacking in basic need fulfillment) I also have to wonder about how this applies
to my child who is afflicted with either ODD or CD? My principal treats him with restitution
gloves, letting him simply come back to class after uttering a threat to kill another student, based
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on the fact that he denied ever doing it. My learning in this program and this course, do
sometimes make me question the practices going on in the school and whether or not, what we
are implementing at an incredibly costly, school wide level will even target those students who
need the intervention the most?
Part 2 - Compare and Contrast Generalized Anxiety Disorders and Childhood Depression
I decided to delve into generalized anxiety disorder (GAD) and childhood depression as
my two disorders to critically compare and contrast. Since we can always attribute more meaning
to what we consider personally relevant, depressive episodes seem to run in my family. Both my
brother and sister have suffered from depressive episodes periodically in their lives, with my
brothers episodes of depression beginning in adolescence and lasting for months at a time, and
my sisters post-partum depression being an ongoing issue that began around 2 years ago. I am
interested to explore how anxiety disorders relate to depression as I know that my brother suffers
from discomfort around people as well. I sometimes wonder that if he could become more at
ease around others and suffer from less anxiety, he would suffer from fewer bouts of depression
as the two often appear to present simultaneously. I hope to gain a more in depth understanding
of what my family deals with, as I apply higher level thinking skills to compare and contrast
these two seemingly related disorders.
Identification of Generalized Anxiety Disorder and DSM-IV Criteria
While children can be diagnosed with various forms of anxiety disorders, depending on
the source of their anxiety, I have chosen to focus mainly on generalized anxiety disorder (GAD)
to gain a more all-encompassing understanding of anxiety and how it is made manifest and
impairments that it may cause. Roughly 3% of children suffer from GAD, with adolescent
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estimates in the 10% range (Mash & Barkley, 2003). The main feature of GAD is obsessive and
uncontrollable anxiety in a number of situations (mainly related to future events) that occur more
often than not, for a time period of 6 months or more (APA, 2000). This anxiety causes distress
in social, academic, or occupational functioning and cannot be due to physiological substances
for the purpose of a GAD diagnosis (2000). A child who would meet criteria for GAD would
experience intense worry regarding events that have a very low likelihood of actually occurring
(2003). Children must also display one of the following physiological symptoms: restlessness
(feeling on edge), easily fatigued, difficulty concentrating, irritability, muscle tension, or sleep
disturbances (2000). The anxiety or worry must not be related to an axis I disorder (clinical
syndrome) (2000). Intensity of worries that differentiate between clinic referred children and
non-referred control groups (2003).
Identification of Major Childhood Depressive Disorder
In order to understand major depressive disorder, one must first consider the diagnostic
criteria for a major depressive episode. The symptoms experienced in a major depressive episode
must cause significant impairments in social or occupational functioning (APA, 2000). To begin,
children (and adults) must have experienced five or more of the following symptoms over a two
week span, in combination with either depressed mood, or loss of interest: significant weight loss
or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigues or loss of
energy, feelings of worthlessness, diminished concentration, and recurrent thoughts of death
(Mash & Barkley, 2003). These symptoms cannot meet criteria for a mixed episode, be due to
physiological effects of substances, nor can they be accounted for by bereavement (2003). In
terms of major depressive disorder, single episode, the presence of a single major depressive
episode must have occurred (2003). For major depressive disorder, recurrent, the presence of 2
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or more major depressive episodes must have occurred (2003). Major depressive episode cannot
be accounted for by schizophrenia related disorders, delusional disorder, or psychotic disorder
not otherwise specified, nor can there have ever been present a manic, mixed, or hypomanic
episode (2003).
Critical Issues of Generalized Anxiety Disorder- Diagnostic Issues
The most common disorders thought to affect children are related to anxiety, making
anxiety issues the top referral reason to mental health services among this group (Mash &
Barkley, 2003). Less than 20% of children requiring mental health services actually obtain the
care they require, and the suggested reason for this is due to the under identification of
internalizing disorders, such as anxiety and depression (2003). Speaking as a teacher, I can say
that I have had yet to make a referral for a student who presented with internalizing disorders
(even though I had suspected anxiety or depression). It really is the cases that if they are not
presenting with disruptive externalizing behaviours, your teaching is not being impacted, thus
you tend to simply leave the child alone. Report card comment may make reference to how a
child is very quiet during class discussion even though it is obvious that quiet really is not
completely representative of what they are. Similarly, comments may be included that make
reference to furthering or supporting the development of friendships in the classroom which is
code for, your child does not have typical social interactions with others of a similar age (I often
see this in children who appear anxious). Interestingly, while it would seem that children with
internalizing disorders are less impaired in social or academic functioning than those with
externalizing disorders, studies would suggest that this is not the case. Rather, findings suggest
that those with internalizing problems (anxiety, depression) are equally as impaired as those with
externalizing problems (CD, ODD).
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While it is clear that one diagnostic issue is simply a tendency to under report and in turn
underdiagnose anxiety disorders, a further complication to this disorder is the commonplace
feeling of anxiety. Diagnostic challenges related to GAD are that worries are a part of normal
development and exact measures of what constitutes pathological levels of worry can be
somewhat unclear. It is appropriate for young children to fear the dark, but through repeated
exposure and nothing bad resulting from the feared situation, their anxiety naturally decreases
(Mash & Barkley, 2003). While it is developmentally appropriate to undergo some feeling of
anxiety during certain situations, it is difficult to identify what intensity of anxiety constitutes
pathological levels, as opposed to normal or adaptive levels (2003). However, further study is
needed before this question can be answered, and clarification of the diagnostic criteria to a more
specific level can be achieved (2003).
The DSM-IV has identified specific time intervals for symptoms related to anxiety, as
well as evidence of distress to the childs typical daily routine (Mash & Barkley, 2003). Studies
have shown that the current criterion identifies typical, transient anxiety, and fear responses that
are expected in normal development, determined through structured interviews (2003). The DSM
represents a categorical approach to diagnosis that leads to diagnostic unreliability (2003).
Firstly, clinicians are not always in agreement when it comes to a particular diagnosis. Secondly,
frequently assigning a classification of not otherwise specified when full criteria is not met is
not always reliable. Thirdly, high comorbidity rates may confuse the diagnosis, and lastly, failure
to include specifiers to indicate severity of behaviours and symptoms (2003) can lead to
uncertainty amongst the diagnoses of various professionals. For example, features of anxiety
such as panic attacks, worry, social anxiety, and negative affect are shared with other diagnostic
categories (2003). With a categorical diagnosis, a specific number of symptoms must be present
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for the child to be diagnosed, however, if the child is showing symptoms from various disorders,
but not the minimum diagnosis for any one, then nothing is diagnosed and no code can be
assigned to them (2003). Interventions, Planning, treatment and recommendations, therefore,
would be withheld for the children who did meet certain categorical requirements.
Critical Comparison of Diagnostic Issues in Anxiety Disorder and Major Depressive Disorder
As mentioned above, both GAD and Major Depressive Disorder are internalizing
disorders, making them less likely to be identified than externalizing disorder (Mash & Barkley,
2003). These children typically are not disruptive; therefore, the harm they may cause is often to
themselves as they suffer in relative silence. Both anxiety and depression can be considered basic
human emotions to lifes stressors. Specific time periods in ones life may result in
symptomology of anxiety and depression. For example, a young child fearing separation from its
mother is considered normal behaviour, as are symptoms of depression following the separation
of ones parents. In order for both depression and anxiety to take on a pathological intensity, these
normal human emotions must interfere with the social, academic, or occupational functioning of
daily life, for a prolonged period of time (2003). However, as previously mentioned, while
anxiety serves an adaptive purpose, allowing one to either confront or escape from potentially
dangerous situations, over time and through repeated exposure with no negative outcome, the
bodys response to anxiety decreases. Depression can be thought of in similar terms in so far as
social withdrawal is often a symptom see in depression, yet another tendency to retreat.
However, unlike in anxiety this withdrawal does not appear to serve an adaptive function in
evolutionary terms. Similarly, it would seem that once an episode of depression occurs, more
will likely follow (2003). One question that results from various uses of the word depression
(and the different assessment methods used to assess this state) is whether or not we should be
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assessing depression as a dimension or category (2003). It is suggested that the high levels of
comorbidities may result from our categorical methods of defining disorders (2003). In anxiety
disorder, the dimensional approach has been suggested as opposed to the categorical approach.
Dimensional systems are based on quantitative analysis of behaviours that are clustered together
most frequently (2003). Similarly, in disorders of depression, if it were viewed as a dimension,
than those who suffered from this would vary in terms of degree of severity (2003).
Critical Issue in Major Depressive Disorder- Developmental Course of Depression
Depression is thought to generally begin in adolescence (for girls in particular) and is
believed to be rare in young children (Mash & Barkley, 2003). However, in children the typical
age of onset is around 11 (2003). As seen in many disorders, the earlier age of onset, the more
severe course the disorder will take in the future. The duration of depressive episodes, double
depression, as well as recurrent and continuity, are factors which believe to impact childrens
outcomes for depression.
Major depressive episodes of children and adolescents have an average time of 7-9
months of recovery (2003). The majority of people who experience these episodes will remit
within a few months and a minority may have longer episodes (2003).
While controversy exists regarding the legitimacy of dysthymia (as it is seen as a less
severe form of depression) it is suggested that the typical episode length for this similar and
somewhat controversial disorder is 4 years (Mash & Barkley, 2003). Findings show that over
70% of children afflicted with dysthymic disorder go on to develop episodes of major depressive
disorder approximately 2 years after the onset of the dysthymia, and are hit with what is called
double depression (Mash & Barkley, 2003, p. 244). This double combination appears to be
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associated with considerable impairments in functioning, more severe than impairments seen in
either disorder alone. While current beliefs regarding depression are that it is a recurrent
condition in adults (40% experience a recurrent in 2 years, 80% in 5-7 years), studies are
beginning to find that this is also true of childhood depression (2003).
Evidence suggests that the earlier the onset for depression, the more negative the
prognosis (Mash & Barkley, 2003). Two studies tracking depressed children through adulthood
support the perception of depression taking on a lifelong course (2003). For example, the
presence of depression at 21 years old was predicted through teacher reports on measures of
anxiety/depression at age 6 and through self and parent reports at age 9 (2003). History of
familial depression also increases the likelihood of developing major depressive episodes in
adulthood (2003). It has been suggested that childhood depression may predict later
psychopathology (mood dysregulation), but possibly not specifically depression, rather overall
maladjustment (2003). Depression with an early onset may also predict substance abuse, anxiety
disorders, personality disorders, suicidal attempts, social problems, and occupational or
economic impairments (2003). Once again, this internalizing disorder which likely disrupts very
few people and goes unrecognized and untreated has serious long term implications for the
individual and society in general (2003).
Critical Comparison of Developmental Course of Depression and Anxiety Disorder-Similarities
As mentioned, in normal developmental trajectories feelings of anxiety and depression
are expected, however, having chronic feelings of anxiety and depression is considered
pathological. Relatively few studies have been conducted on the developmental course of anxiety
or depression from childhood to adulthood (2003). Age of onset is quite similar for both and is
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between 10-13 years (2003). Similar to findings on depression, mounting evidence suggests that
certain anxiety disorders can have a relative early onset, lead to comorbid disorders and adult
presentation of depression and suicidal behaviour (2003). Also, children diagnosed with GAD, as
with depression early on demonstrated elevated risk for substance abuse in adulthood even when
depression was controlled for (2003). Similarly, anxiety in youth is thought to predict cigarette
smoking and eventual nicotine dependence in adolescence, which in turn appears associated with
an elevated risk of GAD in adulthood (2003). Interestingly, while internalizing disorder such as
anxiety and depression would not seem to be related to the outward behaviours that present in
ODD, there does appear to be an overlap with both disorders (2003). Finally, both GAD and
major depressive disorder that appears early in childhood, seems to lead to future emotional,
social, and economic problems in left untreated.
Critical Comparison of Developmental Course of Depression and Anxiety Disorder-Differences
While anxiety disorders are often comorbid with depression, depression is often
comorbid with anxiety (2003). However, unlike GAD, depression appears to also be comorbid
with conduct disorders, ADHD, and eating disorders (2003). In examination of GAD, rather
than other anxiety disorders, it would appear that the developmental course is unstable over time
(50% maintain criteria) with about 25% of children progress to CD 5 years later, and 25% who
no longer met criteria (2003). Depression appears to have a more stable course overall, in terms
of early onset leading to chronic depression in adulthood (2003). What appears relatively specific
to anxiety disorders is educational underachievement and early parenthood (2003). Again, this is
an internalizing disorder that like depression if left untreated has high costs to individuals and
society (2003). Depression also seems to present in episodes, and if comparing to GAD in
particular, an overall constant level of anxiety is more likely the presentation (2003). Research
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indicates that children with ODD also display the hyperactive-impulsive form of ADHD at more
frequent rates (50%) than what would occur in the general population (2003).
Why should we be more aware of anxiety disorder if these children seem to be simply
getting by without impacting anyone else around them? Well, studies have shown that anxiety
disorders appear to negatively impact a large range of psychosocial factors such as academics,
family, and social functioning (Mash & Barkley, 2003). While these impairments may not result
from the anxiety itself, depression and ADHD appear to be comorbid factors to anxiety (2003).
When children present with anxiety (an internalizing disorder) and depression (an externalizing
disorder) the treatment focus is likely to be on the externalizing disorder, however, issues here
are that what if the depression would subside if the anxiety were treated? I would have to think
that if left untreated, the anxiety would simply result in another depressive episode or major
depressive disorder. While anxiety is a typical feeling, pathological levels can lead to further
anxiety disorders in adulthood, comorbidity with major depressive disorder, psychiatric
hospitalizations, and suicide attempts (2003). The long term cost of leaving this internalizing
disorder untreated is too great to ignore the subtle signs of anxiety in children.
Conclusion
While GAD is a disorder of anxiety, and major depressive disorder is a disorder of mood,
they appear to be more similar than dissimilar. Both are observed in the typically developing
population at some point in time, both are prone to a chronic course in adulthood if age of onset
is in childhood. What I have learned over the course of this final exam, is to be more aware of
the children who are struggling with internalizing disorders. It is sad to recognize that they really
do get left behind in terms of referrals. However, I have to wonder if the school psychologists are
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even able to assess for these disorder (non-academic problems). I suspect that since I have cases
of ODD (also non-academic problems) they likely are. I think that as teachers, we are so focused
on fixing the problems that are observable and occurring in our classroom in the moment that we
really do not consider the problems that are beneath the surface. I need to keep in mind over my
next 3 years of teaching, that what may not present like an urgent classroom issues, must still be
given due attention and resources (in the form of referrals).













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References

Association, A. P. (2000). Diagnostic and Statistical Manual of Mental Disorders (4 ed.).
Arlington: American Psychiatric Association.
Mash, E., & Barkley, R. (Eds.). (2003). Child Psychopathology. Ney York: The Guilford Press.













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Critical Issues in Major Depressive Disorder- Comorbidities
Comorbidities



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Similar to anxiety disorders, because those with depressive type symptoms have more
internalizing than externalizing symptoms,




Critical Issues in Major Depressive Disorder- Genetic Models and Familial Patterns
Evidence supporting the idea that depression is genetic, results from adult studies, yet variance in
depression can also be accounted for in terms of environment. Heritability rates are
approximately 35% but may be higher in adolescence. Children appear to be more susceptible to
environmental factors that may contribute to depression such as family discourse, difficult
parent-child relationships, stressful life events and conditions. Having a depressed parent is one
of the highest predictors of depression in children and puts children at risk for developing
anxiety and behavioural disorders as well. In terms of parent child relationships, it would appear
that mothers of depressed children set higher standards for their childs success, dominate in
interactions with their child and demonstrate less overall support to their child (smiling, positive
behaviours). Parenting characteristics seen in depressed mothers that are believed to be
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associated with depression in children in they show more negative and less engaged behaviours
and fewer positive behaviours overall











Evidence regarding the predictability for ODD as a precursor to CD is crucial when
determining diagnostic legitimacy.