What is the difference between Internal and External disorders?
Directions: Read the passage and answer the following question.
There is a strong correlation between learning disabilities (LDs) and both DSM-IV Axis 1 psychiatric disorders and other measures of psychological distress such as lowered self-esteem and lack of social competence (Beitchman and Young, 1997; American Academy of Child and Adolescent Psychiatry, 1998). This is true whether one begins by studying a group of learning-disabled children (Maughan et al., 1996; Boetsch et al., 1997; Fergussen and Lynskey, 1997) or by studying a group identified as psychiatrically disturbed (Munir and Boulefard, 1995; Cohen, 1996). If the starting point of a study was children identified by the educational system as having emotional disturbance (ED), between 30% and 75% were additionally identified as having LDs (Fessier, Rosenberg, and Rosenberg, 1991; Duchnowski et al., 1993; Forness and Kavale, 1997). The most commonly associated psychiatric problem is an externalizing disorder-usually attention-deficit/hyperactivity disorder (ADHD), or a conduct disorder (CD), or both-although internalizing disorders (anxiety, depression) are also found. The type of psychiatric disorder (externalizing or internalizing) may be of importance in predicting which students will successfully complete treatment. CD worsens the prognosis, and internalizing disorders improve it (Mattison, Spitznagel, and Felix, 1998). Internalizing disorders in the young child may become externalizing disorders in adolescence. Externalizing disorders, especially CD, may progress to antisocial personality disorder in late adolescence or early adulthood. In all cases, psychotherapy can be difficult to institute or to manage successfully, because the youngsters tend to be defensive and fearful of criticism.
The Foundation Schools are programs in the greater Washington, D.C., area that provide therapeutic and educational help to students referred by the local public schools. These are students with emotional disorders severe enough to prevent them from benefiting from regular school. The youngsters referred to Foundation Schools' special education programs often have multiple and varying DSM-IV diagnoses. This was true in the case of the youngsters (Lakeisha and Arthur) in the first two case studies in this chapter. It should also be noted that both Lakeisha and Arthur had been given both internalizing and externalizing diagnoses at various points in their past.
Because reading disorders are the most-studied combined LD group, a brief review of the research in this area is useful. The relationships between reading disorders and behavior disorders is complicated and not completely worked out yet (Hinshaw, 1992; Moffitt, 1993; Beitchman, Brownlie, and Wilson, 1996; Maughan et al., 1996; Fergussen and Lynskey, 1997; Prior et al., 1999). Rutter (cited in Maughan and Yule, 1994) proposed three broad hypotheses to account for the reading-behavior problem links. First, the behavior problem may be primary and lead to reading problems by interfering with the child's learning. Second, the reading problem may be primary and lead to the behavior problem, perhaps through academic failure, frustration, and lowered self-esteem. Third, both difficulties may stem from a common root in genetic, temperamental, or environmental adversities. These models may interact in reciprocal and unidirectional ways, leading to the final result. Research has not settled which model is most accurate. Fergussen and Lynskey (1997) found that children with reading disabilities had early-onset conduct problems prior to the onset of reading problems. This supports the first model. The connection of reading disorder with ADHD (Lambert and Sandoval, 1980) and the observation that youngsters with ADHD show subpar preschool achievement tests (Mariani and Barkley, 1995) also tend to support the first model. Shaywitz (1996) has reported language delays and inattention to the sounds of words (trouble playing rhyming games with words or confusing words that sound alike) in preschool children at risk of dyslexia-second model. Hinshaw (1992) reported that the overlap of externalizing problems with cognitive and academic readiness deficits early in development suggest the influence of antecedent variables. Low socioeconomic status, family adversity, subaverage IQ, language deficits, and neurodevelopmental delays were explored as possible underlying factors-third model. Moffitt (1993) describes a neuropsychological model in which attention deficits, verbal deficits, and executive dysfunction interact with environmental responses to produce CD.