Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 31: Child Psychiatry

evident in childhood. It was meant to include adolescents who presented with “severe subjective distress regarding uncertainty about a variety of issues relating to identity” to the point where they became impaired. Identity problem is not currently conceptualized as a psychi- atric disorder, rather it refers to uncertainty about issues, such as goals, career choice, friendships, sexual behavior, moral values, and group loyalties. An identity problem can cause severe dis- tress for a young person and can lead a person to seek psycho- therapy or guidance; however, it is not included in the DSM-5. It sometimes occurs in the context of such mental disorders as mood disorders, psychotic disorders, and borderline personal- ity disorder. A study examining Intolerance of Uncertainty (IU), that is, the tendency to react negatively to uncertain situations, in 191 adolescents found that IU is correlated with adolescent social anxiety, worry, and to a lesser extent, depression. Epidemiology No reliable information is available regarding overall prevalence; however, factors increasing risk for identity problems include psychiatric disorders, psychosocial difficulties, and the pressures of assimilation as an ethnic minority into mainstream society. Etiology The causes of identity problems often are multifactorial and include the pressures of a dysfunctional families, the influ- ences of coexisting mental disorders, and the degree to which adolescents feel integrated into their school and family envi- ronments. In general, adolescents with social skills deficits, major depressive disorder, psychotic disorders, and other men- tal disorders report feeling alienated from their peer group and family members, and experience some turmoil. Children who have had difficulty mastering expected developmental tasks all along are likely to have difficulty with the pressure to establish a well-defined identity during adolescence. Erikson used the term identity versus role diffusion to describe the developmental and psychosocial tasks challenging adolescents to incorporate past experiences and present goals into a coherent sense of self. Clinical Features The essential features of identity problem seem to revolve around the question, “Who am I?” Conflicts are experienced as irreconcilable aspects of the self that the adolescent cannot integrate into a coherent identity. As Erikson described iden- tity problem, youth manifests severe doubting and an inabil- ity to make decisions, a sense of isolation, inner emptiness, a growing inability to relate to others, disturbed sexual function- ing, a distorted time perspective, a sense of urgency, and the assumption of a negative identity. The associated features fre- quently include marked discrepancy between the adolescent’s self-perception and the views that others have of the adolescent; moderate anxiety and depression that are usually related to inner preoccupation, rather than external realities; and self-doubt and uncertainty about the future, with either difficulty making choices or impulsive experiments in an attempt to establish an independent identity. Adolescents with identity problem may join “outcast” cult-like groups. A study examining relationships of social context and identity of high-risk Hispanic adolescents

accompany school failures—damage self-esteem emotionally and cognitively, disabling future performance and clouding expectations for success. Generally, children with academic problems require either school-based intervention or individual attention. Tutoring on an individual and frequent basis is an effective technique for increasing academic production and is typically included in a comprehensive educational program. Tutoring has proved of value in preparing for standardized multiple choice examinations, such as the Scholastic Aptitude Test (SAT), as well as for increasing academic achievement in daily school subjects. Taking examinations, either school-based or standard- ized exams repetitively and using relaxation skills are tech- niques of great value in diminishing interference of test anxiety. R eferences Chen JJ. Relation of academic support from parents, teachers and peers to Hong Kong adolescents’ academic achievement: The mediating role of academic engagement. Genet Soc Gen Psychol Monogr. 2005;131:77. Henry KL, Smith EA, Caldwell LL. Deterioration of academic achievement and marijuana use onset among rural adolescents. Health Educ Res. 2007;22:372– 384. Ingesson SG. Stability of IQ measures in teenagers and young adults with devel- opmental dyslexia. Dyslexia. 2006;12:81. Ivanovic DM, Leiva BP, Perez HT, Olivares MG, Diaz NS, Urrutia MS, Almagia AF, Toro TD, Miller PT, Bosch EO, Larrain CG. Head size and intelligence, learning, nutritional status and brain development. Head, IQ, learning, nutrition and brain. Neuropsychologica. 2004;42:1118. Kempe C, Gustafson S, Samuelsson S. A longitudinal study of early reading diffi- culties and subsequent problem behaviors. Scand J Psychol. 2011;52:242–250. Knifsend CA, Graham S. Too much of a good thing? How breadth of extracurricu- lar participation relates to school-related affect and academic outcomes during adolescence. J Youth Adolescence. 2012;41:379–389. Lucio R, Hunt E, Bornovalova M. Identifying the necessary and sufficient number of risk factors for predicting academic failure. Dev Psychol. 2012;48:422–428. Pascoe L, Roberts G, Doyle LW, Lee KJ, Thompson DK, et al. Preventing aca- demic difficulties in preterm children: A randomised controlled trial of an adaptive working memory training intervention-IMPRINT study. BMC Pediatr. 2013;13:144–156. Reinke WM, Herman KC, Petras H, Ialongo NS. Empirically derived subtypes of child academic and behavior problems: Co-occurrence and distal outcomes. J Abnorm Psychol. 2008;36:759–770. Roberts G, Quach J, Gold L, Anderson P, Richards F, Mensah F, et al. Can improv- ing working memory prevent academic difficulties? A school-based randomised controlled trial. BMC Pediatr. 2011;11:57–66. Williams BL, Dunlop AL, Kramer M, Dever BV, Hogue C, et al. Perinatal origins of first-grade academic failure: Role of prematurity and maternal factors. Pedi- atrics. 2013;131:693–700. 31.17c Identity Problem The normative developmental process for an adolescent was conceptualized by the developmentalist Erik Erikson as an ado- lescent “crisis of identity.” The transition between a childhood identity and the process of accepting a more mature sense of self is the resolution of the “crisis.” Consolidation of identity encompasses cognitive, psychodynamic, psychosexual, neuro- biological, and cultural development. As identity is confirmed in adolescence, a sense of self-sameness and continuity over time unfolds. The notion of an identity crisis in adolescence gained widespread attention by clinicians and the popular media during the late 1960s and early 1970s, when many ado- lescents displayed rejection of mainstream cultural values and ideas and demonstrated alternative lifestyles. The concept of identity disorder as a psychiatric diagnosis was embraced in the 1980s when the DMS-III was devised, as a disorder usually first