Week 3 Lecture 3a - Disorders of Childhood (DN) Flashcards

To discuss the description, aetiology and treatment for developmental disorders, including autism, ADHD, and other externalizing problems.

1
Q

Define the term Developmental Disorders.

A
  • those conditions that are manifested in clinically significant ways during children’s developing years and are a source of concern to families and the educational system
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2
Q

What are three areas of controversy in the area of Developmental Psychology?

A
  1. The growing number of children diagnosed with a disorder
  2. The growing number of children on medication
  3. The change of reference for autism spectrum disorders in the DSM-5
    4: 24
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3
Q

What is an important consideration when looking at the concept of normality or abnormality?

A
  • context
  • take into account the developmental period of the child

4:00

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4
Q

How was there a change of reference of Autism Spectrum Disorders in DSM-5?

A
  • Changed in DSM-5
  • Aspergers was separate
  • Pervasive developmental disorders have all been put together
    • Autism, Aspergers now put on a continuum
    • Conduct & Oppositional Defiance moved into a separate category

7:15

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5
Q

What are two different ways that behaviours manifest in disordered children

A
  • Externalising
  • Internalising
    • Social Withdrawal, Anxiety, Depression
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6
Q

How do boys and girls differ in their behavioural manifestation of childhood disorders?

A
  • Girls - typically more internalising
  • Boys - typically more externalising

10:30

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7
Q

When can a diagnosis of ADHD be made?

A
  • Severe
  • Persistent
  • Problematic

“When hyperactive behaviours are extreme for the developmental period, persistent across conditions, and linked to significant impairments in functioning, the diagnosis of ADHD may be appropriate”

10:55

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8
Q

Give a conceptual understanding of the DSM-5 Criteria for ADHD?

A

6 or more behaviours listed under

  • Inattention &/or
  • Hyperactivity and Impulsivity
  • typically manifests before age 12
  • consistent across multiple settings
  • reduce quality of functioning
  • not exclusive during a psychotic disorder
  • not better explained by another disorder
  • there are three subtypes for diagnosis

(exam: think about the way this disorder manifests)

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9
Q

What are the three subtypes of ADHD?

A
  • Predominantly Inattentive Subtype
  • Predominantly Hyperactive Type
  • Combined type

can switch between types

16:00

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10
Q

What are three characteristics of Attention-Deficit/Hyperactivity Disorder?

A

 Inattention
 Hyperactive
 Difficulty interacting with peers

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11
Q

What is the prevalence of ADHD?

A
  • 3-7% of school-age children meet criteria
  • Difficult to diagnose prior 4-5y
  • ~4% adults ADHD
    • (4.4% = Kessler et al., 2006; males, divorced, unemployed, non-hispanic white)
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12
Q

What did Hoza et al., 2010’s study look at, and what were the findings?

A
  • looked at different aspects of childs behaviour
  • the study followed children for 6 years
  • found a viscious cycle of
    • Social Skills (reduced)
    • Aggression
    • Inflated view of self
  • these behaviours predicted poor outcomes
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13
Q

Why might it be difficult to diagnose ADHD prior to age 4-5yrs?

A
  • diagnostic criteria requires 2 or more settings
    • difficult as the child is not yet in school
  • behaviour may be perceived as appropriate for that developmental age
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14
Q

What were some of the findings in Polanezyk et al., (2007) - which pooled estimates of prevalence worldwide (gender, age, geographical location?

A
  • Males had higher prevalence (44 studies) than females (40 studies)
    • consistent finding
    • Male more likely to exhibit externalising
    • Females - internalising
    • yes there is a gender difference but must be
  • More prevalent in children (43 studies) than adolescents (23 studies)
  • Huge geographical differences in prevalence
    • may be due to culture differences in what are considered normal/abnormal behaviour
    • financial status of country
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15
Q

Does the comorbidity of externalising & internalising ADHD behaviours differ?

A
  • Externalising behaviours
    • overlap with conduct disorders
  • Internalising behaviours
    • overlap with Anxiety & Depression
    • ~30%adolescents may have comorbid intellectual disability(Jensenetal.,1997)
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16
Q

What did Kessler (2006) show about adult ADHD & other disorders

A
  • much more likely to have other comorbid disorders
    • mood disorders
    • anxiety disorders
    • substance use disorders
    • impulse control disorder

Kessler et al., 2006

22:00

17
Q

What did the NIMH Multimodal Treatment Study of ADHD (MTA) illustrate?

What are the likely comorbid disorders with ADHD?

A

The overlap of co-occuring disorders

  • ADHD alone - 31.8%
  • Oppositional defiant disorder 39.9%
  • Anxiety disorder - 38.7%
  • Conduct disorder - 14.3%
  • Tic Disorder - 10.9%
  • Mood Disorder - 3.8%

n = 579

no need to memorise numbers for exam - just the disorders

23:00

18
Q

What evidence points toward a genetic basis for ADHD?

What system is suspected to contribute to this disorder?

A
  • Heritability estimates = ~70-80% (Thapar et al., 2007)
  • suspected connection with Dopaminergic System
  • Candidate Genes
    • DRD4 (dopamine receptor gene)
    • DAT1 (dopamine transporter)
  • Move toward epigenetics
  • Genetic*Environmental Studies Req’d

25:14

slide23

19
Q

What paper published in the Lancet created controversy around ADHD?

A
  • Williams et al., (2010)
  • provided evidence that there was a genetic basis for ADHD & that it was not a purely social construct
  • response of people (media backlash)
    • because they said “direct evidence
  • message of the paper was lost
20
Q

Is there a neurobiological factor in ADHD?

A
  • Structural Differences in ADHD
  • ADHD =
  • Smaller right PFC
    • executive function, regulation, inhibition
  • Smaller Caudate Nucleas
  • Smaller Globus Pallidus E.g. Castellanos et al., 2002
    • both parts of basal ganglia (involved in regulation, selection, initiation of behaviours)

STRUCTURE = FUNCTION

28:00

21
Q

What behaviours are associated with Dopamine?

A

reward, gratification, attention

22
Q

What neural differences exist in ADHD compared to a typical brain?

A

Neural Differences in ADHD

  • Less activation in frontal areas during tasks
  • Reduced striatal activation during inhibition tasks
23
Q

Environmental Factors in ADHD?

A
  • Low birth weight?
  • Perinatal Factors inc. nicotine and alcohol
  • 22% mothers of ADHD children smoked one pack/day

vs.

  • 8% mothers of non-ADHD children smoked one pack/day
  • Environmental Factors
  • Food Preservatives? (not proven)
  • Lead Paint? (no evidence)

causal no - contributory yes

30:00

slide27

24
Q

What Pharmacological Treatments have been used for ADHD?

A
  • Stimulants
  • Most common – methylphenidate – prescribed since 1960s
  • In 2006, 2.5 million US children taking stimulant medication (10% of all boys)
  • Double-blind, placebo-controlled study. In 75% of ADHD children, stimulants:
  • Reduce disruptive behaviour
  • Improve Concentration
  • Improve goal-directed activity
  • Improve Classroom behaviour
  • Improve social interactions
  • Reduce aggression
  • Reduce Impulsivity

34:00

25
Q

What is an important consideration when looking at medication for a child with ADHD?

A
  • consider developmental stage of the child
  • sensitive periods
    • medication may give them an opportunity to learn during these periods
26
Q

Which study looked at alternative treatments for children with ADHD?

A

The Multi-Modal Treatment of Children
with ADHD Study

Compared:

  • Tested at Baseline - Treated for 14months – tested Periodically up to 24 months.
  1. Community Standard Care
  2. Medication Alone
  3. Psychosocial Treatment
  4. Combined Medication & Psychosocial Treatment
27
Q

What did the Multi-Modal ADHD study find with regard to

  • Parent Rated Inattention
  • Teacher Rated Inattention
  • Parent Rated Hyperactive/Impulsive Symptoms
A
  • no difference between Combined & Medication alone
  • no difference between Behavioural & Community Standard Care

but both

Combined & Medication alone were more effective than either

Behavioural & Community Standard Care

38:00

slide29

28
Q

What do the findings in the Multi-Modal ADHD study suggest?

A

Medical management is effective

& can have a positive impact on child during critically developing years

39:20

29
Q

What did the mutli-modal study show with regard to percentage ‘normalised’ behaviour 14 months later?

A
  • The combined medical & behavioural interventionshad the highest success rate
  • followed closely by medical management alone
  • then behavioural
  • then community care

39:50/slide32

Controls - 88%

Combined - 68%

Medical Management - 56%

Behavioural - 34%

Community Care - 25%

30
Q

What are the implications of the mulit-modal ADHD study with regard to medication?

A
  • Is medication the way forward?
  • Three year follow-up – no significant differences (Arnold et al., 2007)
  • Individual Differences
  • Side effects of medications

39:50

31
Q

What are some other psychological interventions for ADHD?

A
  • Parent-Teacher Training
  • Points System
  • Teachers understand needs of child
  • Peer tutoring
  • Teachers provide daily report

Designed to accommodate limitations NOT challenge behaviour.

MTA study provides support for intensive, behavioural intervention

32
Q

Is sleep a factor in ADHD?

A
  • Sleep problems may be increasing in modern society
  • Estimated 30-40% children obtain inadequate sleep
  • children manifest sleep deprivation differently than adults (almost opposite
  • Sleep < 7.7h (10th percentile) associated:
    • Higher hyperactivity/impulsivity scores (9.7 vs. 7.8).
    • Higher attention deficit score (17.3 vs. 14.5)
    • No difference in inattention
  • 7.7 hrs not enough - children ahould be getting 10 hours

45:00

slide35