412 pre-M1 Flashcards

Question

lifespan consequences associated with child psychopathology

Answer 1

- impacts on social, occupational functioning will be more severe if a problem goes untreated for longer (20% of kids with the most severe and chronic disorders face lifelong consequences)

Answer 2

- gender: males in childhood with externalizing problems, females in adolescence with internalizing problems (gender differences may emerge during puberty due to social and biological factors) - poverty and SES disadvantage: poverty linked with higher rates of many disorders - racial/ethnic disparities: may be partly due to how clinicans interpret certain behaviours (bias in diagnostic practices) - culture: meaning of behaviour is interpreted differently, expression of symptoms varies (taijin kyofusho vs. social anxiety), reporting of symptoms varies (reporting physical issues when there is an underlying mental reason)

Answer 3

- more likely to be diagnosed with disruptive disorders, and less likely to be diagnosed with mood and substance use disorders - likely to be kicked out of school, go to prison, develop other disorders

Answer 4

- more likely to be victimized by family and peers (verbal abuse, physical attacks, assault, sexual assault) - this disproportionate level of stressors contributes to the onset of different disorders

Answer 5

underlying vulnerability or tendency toward disorder can be contextual (family), biological (genetics), experience-based (certain triggering events)

Answer 6

situation or challenge that calls on resources (external negative event)

Answer 7

- some children are more susceptible to the effects of their environments, both good and bad (there are also protective factors)

Answer 8

- some children are more susceptible to the negative effects of a problematic environment - underlying vulnerability interacts with stress experience to produce disorder/no disorder (you still need stressors to get there, but your starting point is pushed closer) - diathesis will vary in your lifetime - social context will change, epigenetics, diet, lifestyle

Answer 9

- organizes nature and nurture - no disorder is caused by 'just genes' or 'just stress,' brain changes in response to the environment (plasticity), genes change in response to the environment (behavioural epigenetics) - not deterministic, just probabilistic - can have multiple interacting diatheses and stressors

Answer 10

the study of the causes of disorders

Answer 11

- problems that arise are a result of multiple interacting factors and causes to lead to the current presentation - must look beyond current symptoms to consider developmental pathways (disorders can morph from one to another) - children and environments are interdependent (transactional view)

Answer 12

- trajectory is smooth: gradual, incremental, quantitative (we can predict where we might be in the future)

Answer 13

- qualitative difference in kind, abrupt changes (where you are now isn't predictive of where you'll be later)

Answer 14

early patterns of adaptation evolve with structure over time

Answer 15

windows of time during which environmental influences on development will be enhanced (like language in early years or the months in fetal development)

Answer 16

development can be cumulative, skills are based on the accumulation of abilities you already have

Answer 17

- neurobiological: brain is the underlying cause of disorders - the brain's function is use-dependent (neural plasticity for nurture, also influence of nature) - early caregiving and nutrition will affect your brain development

Answer 18

- basic sensory and motor skills in first 3 years of life - perceptual and instinctive centers are affected by early childhood - PFC and cerebellum are rewired around 5-7 years - major restructuring due to pubertal development around 9-11 years and during adolescence - these are all sensitive periods - interfering will result in specific difficulties

Answer 19

- expression of genetic influences are malleable and responsive to social environment

Answer 20

- connections between genetic predispositions and observed behaviour

Answer 21

- causal factors in genetic mutations (identifying genes linked to childhood behaviours)

Answer 22

- simple association between gene and environment (kids with genes that code for reading aptitudes likely have parents that passed those genes and who created an environment that develops those abilities)

Answer 23

- you elicit reactions from your environment as a function of who you are/your genes (teachers pick up on reading abilities and enrolls in AP English)

Answer 24

- your genetic predispositions make you seek out certain environments (seeking challenging reading material)

Answer 25

- passive is more important earlier in life, then decreases (environments are created by other people) - active gets more important as you age (gaining more agency over your environment) - evocative stays the same over the course of development (you're always eliciting reactions from your environment)

Answer 26

- neurons that are more sensitive to a particular neurotransmitter cluster together

Answer 27

- reduces arousal and moderates emotional reactions like anger, hostility, aggression, linked to feelings of anxiety and discomfort - plays a role in anxiety disorders

Answer 28

- acts as a switch to turn on brain circuits to allow other neurotransmitters to promote or inhibit emotions or activity, involved in exploratory, pleasure, extroverted - plays a role in many disorders like schizophrenia, mood disorders, ADHD (lower levels of dopamine)

Answer 29

- facilitates/controls emergency reactions and alarm responses, important in emotional and behavioural regulation - not directly tied to any disorders

Answer 30

- information and motor coordination, inhibits children's tendency to explore environments, moderates and regulates critical behaviours like eating, sleeping, expressing anger - regulatory problems like eating and sleep disorders, OCD, schizophrenia and mood disorders

Answer 31

- emotions play a role in allowing infants to adapt to new surroundings - Bx and cognitive processes assist children in making sense of the world

Answer 32

- emotions are a core aspect of psychological experiences - tell us what to pay attention to/ignore - affect the quality of our social relationships - central feature of infant activity and regulation - internal monitoring - to guide future Bx (helping kids label what emotion they're feeling helps give insight into their experience and guide internal monitoring)

Answer 33

- individual differences in the threshold and intensity of emotional experiences (high highs and low lows vs. not ecstatic or depressed) - can be indicative of normal/abnormal development (rapidly fluctuating of extreme emotions or blunted affect)

Answer 34

- enhancing, maintaining, or inhibiting emotional arousal - important signal of normal/abnormal development

Answer 35

- temperament (emotional influence) - positive affect and approach - tendency to actively and confidently approach new experiences - lowers your vulnerability, more related to positive outcomes (differential susceptibility hypothesis)

Answer 36

- temperament dimension (emotional influence) - ability to shift and control attention and inhibit behavioural responses - very high on effortful control = inhibiting lots of responses, might be a more fearful and anxious kid

Answer 37

- temperament dimension (emotional influence) - tendency toward a low mood, easily frustrated, irritability especially in kids

Answer 38

- organized style of Bx that appears early in development - precursor to personality that is more biologically-based (vs. attachment style that is more learned) - shapes the transactional interaction between the kid and environment - can be linked to psychopathology or risk conditions

Answer 39

- balance of emotional reactivity and behavioural inhibition - might lower your vulnerability to developing psychopathology - good formula for normal, healthy development

Answer 40

- learning and development through operant conditioning - positive and negative reinforcement/punishment, extinction - Bx are a function of their antecedents and consequences

Answer 41

- how thought patterns develop over time

Answer 42

- how children think about themselves and others - mental representations of yourself, others, the world which are constantly being shaped by your experiences - latent learning: learning without reinforcement through modelling and watching (beyond operant/classical conditioning)

Answer 43

- applied behaviour analysis - classical conditioning - cognitive theorists - social-cognitive theories

Answer 44

- the process of establishing and maintaining an emotional bond with parents or other significant individuals - an internal working model of relationships comes from that first crucial relationship - assessed with the strange situation

Answer 45

- actively explores when the caregiver acts as a safe base - comfortable with the stranger if the caregiver is present - mildly distressed when caregiver leaves, but quickly calmed and happy to be reunited when the caregiver returns - parenting style is sensitive and responsive - 60% of infants display this type - protective function against disordered outcomes

Answer 46

- clingy, no exploratory behaviour when caregiver acts as a safe base - fearful of the stranger even when caregiver is present - extremely upset when the caregiver leaves, ambivalent when they return (like resentful) - parenting style is inconsistent and unresponsive - about 10% of infants display this type - risk factor for internalizing problems - phobias, anxiety, psychosomatic Sx, depression

Answer 47

- exploratory behaviour isn't as constructive as secure - indifferent to stranger and caregiver - indifferent to the caregiver's departure and return - parenting styles is rejecting-unresponsive or intrusive/overly stimulating - about 15% of infants display this type - risk factor for conduct disorders, aggressive Bx, depression

Answer 48

- no exploratory Bx - confused responses to stranger - unpredictable protests to caregiver leaving - confused upon caregiver's return (sometimes approaches, sometimes avoids) - parenting style is frightened/overwhelmed and frightening (abuse) - about 15% of infants display this type - no consensus about psychopathology risks - wide range of personality disorders

Answer 49

- family system as a place where risk or protective factors can be important - reciprocal influences between family members and complex relationships within families - processes that occur within disturbed families - maladaptive communication and exposure to stress - most attention is given to mother-child and marital couple (less to siblings and father-child) - how the family deals with typical and atypical stress is crucial to a child's adjustment and adaptation (coping skills, resources, family functioning, nature/severity of stress) - good trust and communication might make it easier to navigate stressors - major family and individual issues interfere with consistent childcare needs

Answer 50

- proximal and distal events in social and environmental contexts have large impacts on development - shared and nonshared environments

Answer 51

- produce similarities in developmental outcomes (similar risks and protective factors) - living in the same place, same school, same neighbourhood

Answer 52

- produce behavioural differences among siblings - not in the same classroom, not the same extracurriculars - might diverge in functioning over time

Answer 53

- microsystems influences the child directly (biological genetics and psychological characteristics, people closely related to the child that lay the foundation for future functioning) - mesosystems: interactions between agents in the microsystem (parent-teacher conferences) - exosystems: social settings that don't involve the child (how a parent is treated at work) - macrosystems: cultural elements of society, sociopolitics, geographic location - chronosystem: environmental changes that occur over a lifespan, changes the exo, meso, microsystems - recognizes GxE interactions (heritability varies depending on the ecological environment)

Answer 54

- S: conceptualizes development as a product of biological and environmental forces interacting - W: never provides a coherent picture of development (it always 'depends'), human development may be more predictable than this model implies - W: culture may not belong in the macrosystem, instead it should permeate through all levels of the system (updated model)

Answer 55

- characterizing a data set using measures of central tendency (mean, median, mode) and of spread (variance, standard deviation)

Answer 56

- using data from a sample to infer things about a corresponding population - must estimate whether the observed data is random or if it can be extended to apply to the population

Answer 57

- probability of obtaining a difference as big as the one observed when there is actually no difference (under the null hypothesis) - cutoff is typically .05

Answer 58

- t-tests (two groups) - ANOVA (more than two groups)

Answer 59

- correlation (r) - no causality - null hypothesis: r=0

Answer 60

- one outcome variable and more than one independent variable - multiple regression - unique contribution of each IV on the DV while controlling for the other IV

Answer 61

increase the chance of a negative outcome

Answer 62

- decrease the chance of a negative outcome (can be less of a bad thing or more of a good thing) - four type: protective, protective-stabilizing, protective-enhancing, protective-reactive

Answer 63

- keeps you at the same level while exposure to risk increases (works at all levels of risk, not just low-risk) - facing increasing bullying, but peer relationships are acting as a protective-stabilizing factor = well-being is unaffected

Answer 64

- works even better when risk exposure increases - competitiveness: outcomes are even better as you're put under more pressure/stress

Answer 65

- it works, but its positive effects become less strong as exposure to risk increases (not the same decrement/flatter drop as a regular protective factor) - listening to music will work well under low stress, but won't help very much under extreme stress

Answer 66

- association between IV and DV

Answer 67

- the association between an IV and the DV depends on the value of the other IV - relationship changing as a function of the third variable - effect of gender on depression gets larger as puberty continues (bigger and bigger gender differences in rates of depression)

Answer 68

- impact the process/mechanism/means through which a variable produces a particular outcome (explains why two other variables are related to each other) - can be partial or full mediation (no direct relationship leftover after you account for the mediator) - indirect effect: IV is indirectly associated with DV through [mediator]

Answer 69

- psychopathology/psychological Sx (interviews, rating scales, observation) *used by developmental psychopathologists - predictors, correlates, consequences of psychopathological Sx - Behavioural measures (rating scales, observations) - physiological (heart rate, skin conductance) - neural (EEG, MRI) - cognitive (tasks measuring memory, attention)

Answer 70

- clinical (diagnosis, Tx planning, Tx monitoring/progress) - research (etiology, correlates, course, treatment planning for various disorders, causal factors, mediators, moderators)

Answer 71

- clinicians rely on experience and intuition to arrive at a diagnosis by asking relevant questions - frequently used - less comprehensive (only asking questions that are relevant to the presenting problem, so may miss co-occurring problems or patient history) - potential for confirmatory biases, availability biases (basing decisions on examples that come to mind easily) so may miss diagnoses that would arise from other questions - combine information in idiosyncratic ways (not standardized or reliable) - client might only give information that is relevant to the questions they're asked without elaborating

Answer 72

- interviewer has a validated and systematically ordered set of questions to be presented to the client in order to make a comprehensive diagnosis - clinician has flexibility in asking questions (can follow-up with things they consider to be important) - clinical judgment is involved in determining when a symptom is present - needs training to be administered, length of the interview makes it less feasible (less widely used despite being the gold standard), but still more reliable and valid than unstructured - totaling the number of symptoms to give a diagnosis - requires lots of data reduction (analysis or recoding of narrative responses)

Answer 73

- questions are very fixed and interviewer has very little flexibility (can be administered by computer) - requires lots of data reduction (analysis or recoding of narrative responses)

Answer 74

- type of semi-structured interview - good coverage of many sorts of disorders - starts with a screener that tells you what to follow-up on (not everyone completes the entire interview) - questions correspond to DSM criteria, potential follow-ups, and rating scale - possible to 'skip out' a section is participants aren't endorsing the questions

Answer 75

- people knowledgeable about the child answer questions about behaviours and feelings (parents, siblings, teachers, child) - often used to measure psychopathology continuously (number of symptoms) and used to make a categorical decision - shorter than interviews, but not as comprehensive (potential tradeoff between validity/reliability of interviews and feasibility of checklists) - generally use self-report in conjunction with interviews for a comprehensive assessment (elevation on a rating scale alone does not equal diagnosis) - efficient way to track treatment progress - don't require much data reduction

Answer 76

- self-report interviews/rating scales rely on reporters who may not know what Bx is normal or clinically concerning - observation provides access to the circumstances in which the Bx occurs - naturalistic or structured (lab) - not always feasible - challenge to external validity (presence of an observer can change Bx) - may be difficult to see Bx of interest (low base-rate like physical aggression, covert like relational aggression) - data reduction depends on the complexity of the observation system

Answer 77

- IQ testing - academic achievement testing (reading, writing, math) to rule out learning difficulties - ADHD rating scales from teachers, parents, and self-report - semi-structured clinical interview (K-SADS) with parents and child

Answer 78

- often do not agree (correlations from .2 to .4) - behaviour changes based on context (situations in the environment may elicit certain symptoms - different demands) - parents might have a response bias (parents have their own lived experiences and personality - may interpret their child's hyperactivity as normal because they're hyperactive too) - there could be legitimate differences in the meaning of Bx across settings - teachers are exposed to a larger sample size of children so can assess common vs. uncommon Bx

Answer 79

- "or" rule: symptom is present if any informant says it is (will augment the number of symptoms endorsed) - "and" rule: symptom is present if all informants agree it is (will decrease the number of symptoms endorsed) - the rule you use depends on the presentation, how valid you feel the reports are (quality of reports), in what situation you think the Bx would present itself in (for uncommon Sx you might want to use the "and" rule to be able to endorse it) - inherently simplistic to combine reports, sometimes they should be evaluated separately because the discrepancies tell us something important about functioning in different contexts (for PDD, you would want to see that Bx manifested in multiple situations)

Answer 80

- reliability: consistency - validity: are we measuring what we think we're measuring - reliability is necessary for validity (you can't have a valid measure that isn't reliable, but you can have a reliable measure that isn't valid)

Answer 81

- do we get the same answers on different measurement occasions - some constructs should vary over time

Answer 82

- agreement between two people judging whether a construct is present (like diagnosis) - important for clinical interviews and observational measures like the strange situation

Answer 83

- how associated are two similar versions of the same test - WAIS vs. Raven's should result in similar IQ scores, both tests should be similar in difficulty

Answer 84

- correlations between two halves of the same test (score on the first half of the scale vs. the second half)

Answer 85

- consistency: taking a measure once, reports within that measure should be consistent - stability: involves one person taking multiple tests (across time or across various versions)

Answer 86

- scores on a new measure should be correlated with other well-established measures/indicators of the same construct

Answer 87

- scores on a new measure shouldn't be correlated with measures/indicators of a different construct - there might be some comorbidity, but not highly correlated

Answer 88

- a measure appears to measure what it's supposed to

Answer 89

- fairness of a measure (biased?) - people in different groups with similar abilities should score similarly across items on a test - if a measure is systematically according higher/lower scores to one group, it has measurement non-invariance - if there is bias, we cannot compare across groups

Answer 90

- taking one snapshot/study at one moment in time and comparing people within that study (across different ages within one study) - easy to implement, but we can't learn how people change over time - age effects are compounded by cohort effects (individual differences between different ages that act as a confound)

Answer 91

- studying the same subjects over time (within-subject comparisons without cohort effects - how did people change over time) - drawbacks: subjects drop out, effects of repeated testing (familiarity with content), requires foresight and funding, time consuming - potential for time of measurement effects (the particular span of time that you measured had an effect on the people you're studying) and practice effects

Answer 92

- combined longitudinal and cross-sectional (getting a cohort of 7 year-olds in 2007, a cohort of 7 year-olds in 2008, etc. and measure them over time) - disentangles age effects from cohort effects and time of measurement effects - very time-consuming and complex and expensive

Answer 93

- cross-sectional - longitudinal - sequential

Answer 94

- a large series (at least 9) of single case-study designs demonstrating efficacy OR - at least 2 between-group design experiments - the above are very old criteria that have been critiqued - shifting toward a systematic review of the literature followed by a committee reviewing the evidence

Answer 95

- examine the effect of treatment on a single child's behaviour - repeated measures of behaviour - replication of treatment effects - ABAB reversal design: baseline - intervention - return to baseline - reintroduce intervention - good internal validity, temporal ordering, causality (A changes B) - lacks external validity (single case generalization?) - difficult to interpret (second baseline isn't the same - is that because of the treatment or changes over time?) - ethics: should we remove a treatment that appears to be working? we want to implement it in as many populations as possible

Answer 96

- therapy experiment with experimental and control conditions and random assignment - test of intervention efficacy and test of theory (can help establish causes - internal validity: is the intervention is causing the change in outcome - construct validity: what about the intervention is causing the change in outcome - type of control group impacts conclusions (no-treatment/waitlist, attention-only, treatment as usual, another effective treatment)

Answer 97

- effectiveness? may not work in a real-life clinic - external validity - clinical trials often use WEIRD samples, people without comorbid disorders (external validity threat) - efficiency: does it contribute to a more efficient use of resources? - drop out rates (low SES, higher severity = difficult to remain in the trial) - differential attrition - uses averages: within the treatment group (even if it shows change), some individuals won't have improved

Answer 98

White Education Industrialized Rich Democratic

Answer 99

dropout rates differ systematically between the intervention and the control group

Answer 100

classification of disease, organization of bx and emotional dysfunction into meaningful groupings

Answer 101

- someone with the disorder is fundamentally different from someone without it - DSM: you meet criteria or you don't (also has dimensional classifications for severity) - different groups; separate distributions/populations = two modes

Answer 102

- outlines diagnoses and associated criteria - categorical system based on professional consensus - based on a medical model in which separate disorders have separate causes - labels help synthesize information and aid communication - people don't always fit into categories cleanly (spillover categories "unspecified" to help capture this) - cutoffs may miss people who might have severe impairment but won't have access to accommodations - current categories may be inadequate for genetic and neuroscience research

Answer 103

- everyone has certain levels of everything, some people may be at higher degrees = more impairment - often use continuous measures in research (not just interested in diagnoses, but in symptoms) - allows us to preserve valuable information, provides a measure of severity (could use that as a cutoff) - but how do we know which dimensions to include (like in RDoc)

Answer 104

- assessing based on key dimensions instead of diagnostic categories - domains/constructs + subconstructs: characteristics of brain functioning - units of analysis: ways to measure brain function (genes, molecules, cells, circuits, physiology, behaviour, self-report, paradigms)

Answer 105

- negative valence system: response to aversive situations (fear, anxiety, loss) - positive valence system: positively motivational situations (reward seeking, reward learning, habits, etc.) - cognitive systems: memory, attention, language - social processes: responses to interpersonal settings (perception and interpretation of people's actions) - arousal and regulatory systems: activation of neural systems as necessary for the situation (homeostatic regulation, circadian rhythms, sleep)

Answer 106

- if a measure is reliable, the answers to items within a measure should be related to each other

Answer 107

- argued that it is a product of Western culture, setting unrealistic expectations for kids, pharmacological companies profiting off medications - but the prevalence of ADHD is similar worldwide - the use of meds as Tx is 5x higher in North America - ADHD predicts impairment in social, school settings, higher mortality

Answer 108

- inability to sustain attention particularly for structured, repetitive, less-enjoyable tasks

Answer 109

- hyperactivity: inability to voluntarily inhibit dominant or ongoing bx - impulsivity: inability to control immediate reactions or to think before acting

Answer 110

(A) persistent (6 months) pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning (must be out of proportion to peers, cannot just be due to new demands of school/adjustment period) (B) several symptoms were present before age 12 (neurodevelopmental disorder) (C) several symptoms were present in two or more settings (genes will affect bx pervasively) (D) clear evidence that symptoms interfere with/reduce the quality of social, academic, occupational functioning (E) symptoms do not occur exclusively in the course of other disorders like schizophrenia

Answer 111

- six or more symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities - not solely due to oppositional behavior, defiance, hostility, or failure to understand tasks or instructions - For older adolescents and adults (age 17 and older), only five symptoms are required - fails to give close attention to details, makes careless mistakes - has difficulty sustaining attention in tasks or play - does not seem to listen when spoken to directly - doesn't follow through on instructions and fails to finish schoolwork, chores, duties - difficulty organizing tasks and activities (managing sequential activities, keeping belongings in order, poor time management) - avoids, dislikes engaging in tasks that require sustained mental effort - loses things necessary for tasks/activities - easily distracted by extraneous stimuli (for older teens, may include unrelated thoughts) - forgetful in daily activities

Answer 112

- 6 or more symptoms persist for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities - Sx aren't a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions - for older adolescents and adults (17 and older), only 5 symptoms are required - fidgets with or taps hands or feet or squirms in seat - leaves seat in situations when remaining seated is expected - runs about or climbs in situations where it is inappropriate (in adolescents, may be limited to feeling restless) - unable to play or engage in leisure activities quietly - "on the go" or 'driven by a motor' (uncomfortable being still for too long, other people cannot keep up) - talks excessively - blurts out answers before a question has been completed - difficulty waiting his or her turn - interrupts or intrudes on others (doing things without permission, for adults - taking over what others are doing)

Answer 113

- ADHD-C (combined): both Criterion A1 (inattention) and Criterion A2 (hyperactivity–impulsivity) are met for the past 6 months - ADHD-PI (predominantly inattentive): If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity–impulsivity) is not met for the past 6 months - ADHD-HI (predominantly hyperactive–impulsive): Criterion A2 (hyperactivity–impulsivity) is met but Criterion A1 (inattention) is not met for the past 6 months - in partial remission: full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning

Answer 114

- mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning - moderate: Symptoms or functional impairment between “mild” and “severe” are present. - severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning

Answer 115

- DSM is categorical, but new research suggests it's dimensional (sx present in everyone to varying degrees) - using inattention vs. HI may be a simplification (attentional difficulties are highly related to impulsivity and vice versa)

Answer 116

- rating scales and interviews - strong focus on observable signs of inattention/HI - K-SADS semistructured interview - SNAP-IV for parent/teacher report that maps closely onto symptomatology

Answer 117

- parents - teacher report is crucial (they have a normative framework = good idea of inter-individual variability) - NOT kids: often unreliable and tend to under-report (also a lack of self-insight) - categorization of ADHD depends on how information from reports are combined - if you look at parent reports OR teacher reports on their own = more diagnoses of ADHD-PI or ADHD-HI, but if you combine them with the 'or' rule, you see more ADHD-C (different sx prevalent in different settings)

Answer 118

- many different presentations implies that there might be different causes of the disorder - could imply that ADHD is actually multiple different disorders - HI can evolve to become combined, can change to PI as you age (natural progression of context and presentation) - most people go through all three subtypes - implying that ADHD is one disorder with different dimensions - there is one subtype of ADHD-PI that never changes throughout life (will never exhibit HI sx)

Answer 119

- sluggish cognitive tempo - subtype of ADHD-PI that never exhibit any HI sx (there are individuals for whom the correlation between inattention and HI is very low) - CDS can be differentiated from ADHD based on a meta-analysis - CDS sx are more correlated with each other than with ADHD sx (good reliability, test-retest, inter-rater)

Answer 120

- inspired by RDoc - 3 different domains based on temperament/neurobiology: mild (near the mean on temperament and ADHD characteristics), Surgent (high positive affect), Irritable (high on fear/anger, discomfort) - unresolved heterogeneity that may impair epidemiology - could use emotion-trait profiles to further differentiate between diverse presentations

Answer 121

- point: 5-9% in school-age - 6-month: 10.5% of 4-11 years - lifetime (adolescent sample): 8.7% - most common type is combined, 'and' rule decreases combined type - prevalence rates increase if using the 'or' rule

Answer 122

- more common in low-SES communities - racial differences unclear (minorities over-represented in low-SES) - hyperactivity can be see as more problematic in certain cultures (especially where you value social harmony)

Answer 123

- 3:1 favouring boys in community samples - 6:1 favouring boys in clinic samples (boys get treated more, probably because their sx are more evident) - in community samples, boys are more likely to be diagnosed with all types (but gender gap is more narrow for ADHD-PI) - in clinic samples, the gender gap for subtypes disappears (girls equally likely to be diagnosed with all subtypes)

Answer 124

- should be present at birth (but no reliable measures before age 3) - in preschool, if sx persist for a year, they're likely to have chronic challenges - marked HI in preschool because cognitive and motor sx are developing - elementary school, inattention becomes more noticeable, HI declines slightly through elementary (developing attentional processes, learning to conform to rules, but still higher than typical)

Answer 125

- used to be thought that sx resolved in adolescence - about 33% of kids with ADHD continue to meet criteria in adulthood, the rest may just decrease to a subclinical threshold

Answer 126

- recruited probands with ADHD and comparison group - followed up at 41 years (probands differed from controls on SES and IQ) - more likely to not finish high school - less likely to have a graduate degree - lower annual salary - more likely to have been divorced - more likely to be incarcerated - more likely to be dead (likely due to attention/safety problems)

Answer 127

- associated with impaired academic functioning (intellectual ability isn't lower, just difficulty expressing intelligence in academic setting) - lower physical health, higher mortality - social impairment (with family and peers), tend to have less friends (exacerbated by co-occurring ODD/CD) - formal speech and language disorders: speaking impulsively, speech production errors, excessive loud talking, difficulties listening)

Answer 128

- CD and ODD are more prevalent (about 50% meet criteria for ODD), anxiety (25-50%), depression (20-30%) tic disorders (20%), learning disabilities - earlier onset of ADHD = more likely to have ODD and CD

Answer 129

- twin studies show about 75% heritability estimates - environmental: factors that compromise the nervous system (maternal use of cigarettes, drugs) - parents with ADHD have different parenting techniques, more chaotic home environment that is conducive to HI and inattention (passive GxE interaction)

Answer 130

- stimulants like dextroamphetamine (Dexedrine) and methylphenidate (Ritalin, Concerta) - increase dopamine levels - increase activity in the PFC - fast-acting, but effects are temporary (when the drug is discontinued) - side effects include weight loss (decreased appetite), slows in growth, increased heart rate, difficulty falling asleep - can develop tolerance - often parents give kids 'drug holidays' when environmental demands are lower

Answer 131

- may not help in 20% of cases - won't get rid of sx completely, just reducing severity - may not help academic performance, peer relationships, family functioning in all kids - benefits may not be maintained and will stop once the meds are discontinued - tolerance is likely to occur, leading to reduced efficacy over time

Answer 132

- contingency management: help parents establish clear expectations and set rules, giving positive reinforcement, predictable and consistent punishment - not always as helpful as meds, but more likely to see long-term gains - structuring environments in ways that are conducive to positive bx

Answer 133

- contingency management in the classroom - evidence for effectiveness

Answer 134

- social skills training done in clinic or office using discussion and role-playing are not generally successful (in group therapy settings, ADHD peers together is too distracting) - but other programs targeting peer relationships in recreational settings (summer camps, sleep-away) that use contingency management techniques show significant improvement

Answer 135

- building skills to control attention and bx - verbal self-instruction, problem-solving - not enough evidence for benefits

Answer 136

- focused on helping with academic achievement, reducing impairment - implementing a prescriptive system to help with bx (stop forgetting things at school, keeping track of assignments)

Answer 137

- comparing outcomes for various tx (meds, bx, combined, treatment as usual) - enrolled 579 kids with ADHD-C according to parent and teacher report (80% male, aged 7-9) - random assignment to meds group, psychosocial tx (PMT, educational intervention, summer programs), combined meds + psychosocial, community treatment (TAU) - from baseline to follow-up, all groups improved on core sx of ADHD - only meds AND combined groups showed more improvement than psychosocial and TAU (only on core sx, not other areas of functioning) - combined and psychosocial groups showed more improvement on parent-child conflict than TAU (combined was no different than medication group) - combined and meds groups did not differ significantly from each other - bx was only better than TAU for parent-child conflict, but not for core sx - 8-year follow-up: no differences among any of the tx groups, but all doing better (still worse than a control group)

Answer 138

- Tx group: meds/combined = 62% responders, TAU/Bx = 30% responders - within meds/combined, parental depression high = 45% responded, parental depression low = 69% responders - within parental depression low, severity high = 41%, severity low = 73% responders - within parental depression high, severity high = 29%, severity low = 59% - within parental depression high, severity high, IQ high = 48%, IQ low = 10% - most important moderators for a bad prognosis were high parental depression, high severity, low cognitive abilities (IQ) - most important moderators for a good prognosis were low parental depression, low severity

Answer 139

(A) pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least 4 symptoms from any of the following categories (angry/irritable mood, argumentative/defiant bx, vindictiveness), and exhibited during interaction with a least one individual who is not a sibling (A8) persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from behavior that is symptomatic. For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months. For individuals 5 years or older the behavior should occur at least once per week for 6 months. Other factors should also be considered, such as whether the frequency and intensity of the behaviors are outside a range that is normative for the individual’s developmental level, gender, and culture. (B) he disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning. (C) The behaviors do not occur exclusively during the course of a psychotic, substance-use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood disorder.

Answer 140

- loses temper - touchy or easily annoyed - angry or resentful

Answer 141

- argues with authority figures or, for children and adolescents, with adults - actively defies or refuses to comply with requests from authority figures or with rules - deliberately annoys others - blames others for his or her mistakes or misbehavior

Answer 142

- Has been spiteful or vindictive at least twice within the past 6 months

Answer 143

- mild: sx are confined to one setting - moderate: some sx occur in at least two settings - severe: some sx are present in at least three settings

Answer 144

(A) repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least 3 of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months categories: aggression to people/animals, destruction of property, deceitfulness or theft, serious violations of rules (B) The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. (C) If the individual is 18 years or older, criteria are not met for Antisocial Personality Disorder

Answer 145

- bullies, threatens, or intimidates others - initiates physical fights - has used a weapon that can cause serious physical harm to others - Has been physically cruel to people. - has been physically cruel to animals - Has stolen while confronting a victim (mugging, extortion) - Has forced someone into sexual activity

Answer 146

- Has deliberately engaged in fire setting, with the intention of causing serious damage. - Has deliberately destroyed others’ property (other than by fire setting)

Answer 147

- Has broken into someone else’s house, building, or car. - lies to obtain goods or favors or to avoid obligations ('cons' others) - Has stolen items of nontrivial value without confronting a victim (shoplifting, forgery)

Answer 148

- stays out at night despite parental prohibitions, beginning before age 13 years. - Has run away from home overnight at least twice while living in parental or parental surrogate home, or once without returning for a lengthy period. - Is often truant from school, beginning before age 13 years

Answer 149

- childhood-onset: at least one sx is present before age 10 - adolescent-onset: no sx were present before age 10 - with limited prosocial emotions: individual must have displayed at least 2 of the following characteristics persistently over at least 12 months and in multiple relationships and settings. These characteristics reflect the individual’s typical pattern of interpersonal and emotional functioning over this period and not just occasional occurrences in some situations. Thus, to assess the criteria for the specifier, multiple information sources are necessary. In addition to the individual’s self-report, it is necessary to consider reports by others who have known the individual for extended periods of time

Answer 150

- at least 2 of the following present in the past 12 months in many interactions - lack of remorse or guilt: does not feel guilty when they do something wrong (excludes remorse only expressed when caught), general lack of concern about negative consequences of their actions - callous-lack of empathy: disregards/is unconcerned about the feelings of others, described as 'cold and uncaring', more concerned about the effects of their actions of themselves (even when they result in substantial harm to others) - unconcerned about performance: doesn't show concern about poor/problematic performance at school/work/activities, doesn't put in the effort required even when expectations are clear, often blames others for their poor performance - shallow/deficient affect: does not express feeling/show emotions to others except in ways that feel insincere, shallow, superficial (actions contradict emotions displayed, can turn emotions 'on' or 'off'), or emotional expressions are used for gain (to manipulate/intimidate)

Answer 151

- mild: Few if any conduct problems in excess of those required to make the diagnosis are present, and conduct problems cause relatively minor harm to other (lying, truancy) - moderate: The number of conduct problems and the effect on others are intermediate between those specified in “mild” and those in “severe” (stealing, vandalism) - severe: Many conduct problems in excess of those required to make the diagnosis are present, or conduct problems cause considerable harm to others (forced sex, physical cruelty)

Answer 152

- overt-covert: - destructive-nondestructive - aggression is overt and destructive *more at risk for later bx problems - property violations are covert and destructive - status violations (truancy, substance use, runaway) are covert and nondestructive - oppositional bx (stubborn, touchy, argues) is overt and nondestructive

Answer 153

- very common, cannot be used to diagnose ODD - sibling conflict, hostility, and negativity predicts greater emotional and bx problems over time - can lead to maladaptive bx problems in other relationships

Answer 154

- interviews and checklists - Disruptive Behaviour Diagnostic Observation Schedule: watching preschoolers interact with an interactive examiner, a busy examiner, with their parent (pressing for disruptive behaviour by testing their compliance, frustration, rule-breaking) - also used for CD - complementing a parent report

Answer 155

- 'with limited prosocial emotions' specifier - 2-6% of kids with CD have CU traits - when they do = earlier onset, aggression is more severe and instrumental - CU associated with insensitivity to punishment (harder to treat)

Answer 156

using aggression to get something out of it, to get what you want

Answer 157

- Clinical Assessment of Prosocial Emotions (CAPE1.1) semistructured interview - need multiple information sources

Answer 158

- in DSM-IV, a more severe presentation of ODD was qualified as CD - in DSM-5, you can have both diagnoses at the same time - ODD tends to start presenting at age 6, CD around age 9 (ODD developmentally precedes CD, but not in all cases) - some kids will have ODD that never evolves into CD - some kids will be diagnosed with CD without ever having had an ODD diagnosis

Answer 159

- lifetime: ODD: 12%, CD: 8% - 6-month: ODD: 7.5%, CD: 1.3% - cultural and contextual differences - strongly associated with poverty, exposure to violence - if disruptive bx only occurs in a negative environment where it is adaptive/protective, it shouldn't be diagnosed - only when disruptive bx occurs without negative environmental demands is it functionally impairing

Answer 160

- stress of poverty leads to an increase in childhood psychopathology (strong exposure to stressors) - predicts more problem bx in low SES environments

Answer 161

- families with genetic predispositions drift down towards poverty - disruptive behaviours aren't rewarded in our society (getting expelled, unable to hold a job) - predicts more problem bs in low SES environments

Answer 162

- longitudinal study of epidemiology of childhood disorders - positive association between pverty and disruptive bx - sample included many Indigenous youth living on a reservation - when a casino opened on the reservation, they gave the Indigenous families a stipend (more income which led to 4 groups: persistently poor, ex-poor, never poor, newly poor) - showed support for social causation theory (ex-poor kids reduced disruptive bx) - if social selection was true, the added income wouldn't have had an impact on disruptive bx - full mediator: increased income = improved parental supervision = fewer disruptive bx problems

Answer 163

- conduct problems are 2-4x more common in boys - gender gap reduces in early teens - early-onset persistent CD: 10:1 ratio - adolescent-limited CD: 2:1 ratio - girls start to engage in more covert nonaggressive bx (lying, truancy)

Answer 164

- physical aggression is more common in boys than girls - relational aggression is more common than physical in girls - the gender difference in relational aggression is small and not meaningful (girls engage in slightly more relational) - boys disruptive bx is more overt = noticed earlier

Answer 165

targeting social relationships

Answer 166

- 35% of youth with ODD have ADHD - 50% of youth with CD have ADHD - 50% of youth with ODD/CD have depression or anxiety

Answer 167

- cognitive/verbal challenges (not associated with intellectual impairment, may have specific verbal deficits) - academic functioning (underachievement, grade retention, dropout, suspension, expulsion, may lead to depression/anxiety in adulthood) - family functioning (high conflict, lack of family cohesion and emotional support) - peer problems (engage in aggression, likely to be rejected, form friendships with other antisocial peers which is associated with health risks like injury, substance abuse, STIs) - boys with conduct problems are 3-4x more likely to die before age 30 (more accidental deaths like overdoses) - relational aggression may be predictive of popularity with peers instead of aggression

Answer 168

- difficult temperament - fussy, irritable, hard to soothe - higher in negative affectivity, lower in positive affectivity, lower in surgency - may be linked to later ODD in boys

Answer 169

- can be difficult to diagnose due to improbable symptoms (truancy, staying out at night) so need to adapt to a younger age group - noncompliance, temper loss (temper tantrums), aggression (kicking, biting) are common (aggression increases until 27 months then should level out) - low desisters: start with low misbehaviour, and misbehaviour decreases even more - moderate desisters: start with moderate misbehaviour, but decreases at age 11 - high stable: lack of a normative decrease (higher risk for ODD and CD), significant behavioural and emotional dysregulation that will escalate if left untreated

Answer 170

- at least 1 sx before age 10 - 10:1 male to female - 50% persist into antisocial bx in adulthood - aggression in childhood - nonaggressive antisocial bx in middle childhood - serious delinquency in adolescence - diversification: adding more serious disruptive bx with age

Answer 171

- onset in adolescence, frequently with social change (peer influence) - 2:1 or 1:1 male to female - less extreme antisocial bx - less likely to commit violent offenses - less likely to persist into adulthood - snares: outcomes of antisocial bx that put people on problematic paths (unplanned pregnancy, dropping out of school, drug addiction) and could move you to the life-course pathway

Answer 172

- frequency (and whether you can shape the behaviour with reinforcement) - severity - flexibility - predictability (is Bx occurring when expected i.e. when a situation is overwhelming for a child or is it unexpected and random) - pervasiveness (in many settings)

Answer 173

- adoption and twin studies: about 50% - but there are occasional cases in which behaviour seems to come out nowhere (no parent psychopathology, siblings are fine) - strongest biological evidence for early-onset pathway

Answer 174

- low birth weight - malnutrition (protein deficiency) during pregnancy - lead poisoning - mother's use of nicotine, marijuana, alcohol during pregnancy

Answer 175

- childhood maltreatment is a universal risk factor for psychopathology & most people don't develop severe antisocial bx - low MAOA activity is linked to aggression (not metabolizing NTs like dopamine and norepinephrine) and a gene on the X chromosome - there's a main effect of childhood maltreatment (it increases = so does antisocial) - no main effect of low/high MAOA activity - significant interaction effect: relationship between childhood maltreatment and antisocial bx is moderated by your level of MAOA activity (lower MAOA = higher antisocial), childhood activity produces an even bigger risk with this vulnerability - there are other types of negative parenting that also contribute to psychopathology, not just maltreatment

Answer 176

- cycle of increasingly negative parent-child interactions (delay/escape strategies and demands by the child + inconsistencies from parent are reinforcing to all) - adult makes a request = child reacts with hostility = parent withdraws request or becomes reactive/hostile = child doesn't do what was asked - negative reinforcement: child learns that the parent's demands are withdrawn when they throw tantrums so they don't have to do what they don't want to do - positive punishment: parent's demands are constantly met with hostile behaviour (acts as the punishment) which decreases the likelihood of making more demands

Answer 177

- various steps in going from perception of a situation to interpretation and action - encoding: what to pay attention to - interpretation: what does it mean - response search: options for actions - response decision: what will I do - enactment: how well did I do it

Answer 178

- encoding: not much is known - interpretation: hostile attribution bias - response search: generate fewer responses overall, but more of them will be aggressive and less of them will be prosocial - response decision: outcome expectancy (believe they will get what they want) and self-efficacy (believe they will be good at implementing the aggressive response), they choose the aggressive option - enactment: not much is known (they're selecting the aggressive options and doing them, but unclear if they're actually good at them)

Answer 179

assuming negative intentions in neutral situations (impaired in the interpretation phase)

Answer 180

- parents: mothers show the hostile attribution bias, parents may unintentionally or outwardly approve of aggressive behaviours (see aggression as an appropriate response to a peer provocation) - peers may be reinforcing (kids think aggression works, probably because it usually does and they get what they want)

Answer 181

- PSST: microsystem (the individual) - PMT: agents within the microsystem (mesosystem) - MST: multiple levels

Answer 182

- targets cognitive processes upstream to change disruptive behaviour - underlying theory: social information processing - targets attentional biases (encoding), hostile attribution bias (interpretation), how well you generate and evaluate response options (response search and decision)

Answer 183

- PSST technique: train them to think of more solutions, how to examine them in role-playing/pros and cons, try new options even if you think they might not work (then kids get better results from using prosocial response which gets reinforced) - Say what the problem is - Think of solutions - Examine each one - Pick one and try it out - See if it works

Answer 184

- focuses on cognitive biases - hostile attribution - distortion in perceptions of aggressiveness: kids underestimate how aggressive they are and overestimate how aggressive other people are - faulty emotional identification: tendency to mislabel any high arousal (like anxiety) as anger, which leads them to react accordingly - gain emotional insight to label appropriately - response search/selection: teaching to focus on verbal solutions instead of direct action (aggressive kids tend to think prosocial options aren't likely to have good outcomes) - has some good evidence, but also critiqued

Answer 185

- inhibit early angry and aggressive responses - cognitively re-label stimuli perceived as threatening (change hostile attribution) - solve problems by generating alternative coping responses and choosing non-aggressive responses instead

Answer 186

- may not be enough because in the real world, problematic behaviours can be reinforced (outside the therapy setting) - these only target the individual, but there's a whole system they go home to that may promote unhelpful behaviours - may need to intervene at other levels than the microsystem (like parents)

Answer 187

- gold standard - reset the parent-child relationship: create opportunities to start feeling good around each other (instead of constant frustration) - since parents tend to only react to negative behaviours and miss the positive - try to motivate the kids to get attention from positive bx (reinforce small behaviours then work your way up to the ideal) - may not be as effective in kids with CU traits - stronger effects for preschoolers and elementary-schoolers than adolescents (teens show more impairment and people besides parents are reinforcing behaviours)

Answer 188

- operant conditioning: consequences of a bx determine the likelihood of it re-occurring - education: help parents establish realistic expectations of their child's behaviour (normative bx for kids that age), behaviour tends to get worse before it gets better when doing therapy - communication: give clear instructions to kids, setting clear and firm boundaries, set immediate and doable consequences for bad bx (there should be a rationale for punishment) - ABC model: change contingencies by modifying environments/antecedents, observe behaviours and their contexts, modify consequences

Answer 189

- removal of positive reinforcement/negative punishment/omission training - 1min per year of age - highly recommended strategy - has been shown to decrease detrimental bx in youths despite the general outcry against them in media - robust lack of association between time-outs and adverse outcomes in short-term and long-term - emerging studies about positive effects on well-being

Answer 190

- fit assessment: figure out what is driving the behaviour, which drivers/behaviours to target first - considers context in which bx is occurring to produce long-lasting change - integration of multiple evidence-based practices (because serious clinical problems arise from many interacting factors) - PSST, PMT, global reinforcement context (association with deviant peers) - intensive services: access to therapist 24/7, services in home and other settings, about 4 months of Tx - used with most severe cases (chronic juvenile offenders, violent bx, substance use)

Answer 191

- difference is clinically significant in people's lives: school performance, relationships, living skills (functional outcomes, not just statistical significance) - but mixed evidence for MST vs. other treatments (may not improve some functional outcomes like peer relations, academics but works for delinquency and family functioning) - strong theoretical basis for the therapy, but unclear if it's working better than other Tx (could be because it's only used in more severe cases)

Answer 192

- family functioning drives the effects of MST

412 pre-M1 Flashcards

(217 cards)