Ch. 13 Disorders of Childhood Flashcards
(94 cards)
1
Q
developmental psychopathology
A
study of childhood disorders within the context of lifespan development
2
Q
externalizing disorder
A
outward-directed behaviors
- aggressiveness, noncompliance, overactivity, impulsivity
- ADHD, Conduct Disorder, Oppositional Defiant Disorder
- when does that cross the threshold of disproportionate?
3
Q
hyperactive behaviors
A
- extreme for a particular developmental period
- persistent across many situations
- linked to significant impairments in functioning
- particular difficulty controlling activity in situations that require sitting still
4
Q
what else could be going on in hyperactive situations?
A
- academic settings differ with ages/grades
- boredom
- sugar/preservatives
- frontal lobes: executive functions; plan, working memory
- dysregulated stress response: early brain learning is what expected
5
Q
ADHD: difficulty getting along with peers
A
- aggressive, intrusive behaviors
- difficulty noticing subtle social cues; moving so quickly they never perceive it
- identified quickly and rejected/neglected by peers
6
Q
DSM-5-TR criteria for ADHD
A
- symptoms of inattention and/or hyperactivity-impulsivity interfere with school, work, or relationships
- these symptoms and behaviors don’t fit with what
7
Q
inattention
A
manifestations can include:
- making careless mistakes
- not listening well
- not following instructions
- being easily distracted
- being forgetful in daily activities
8
Q
hyperactivity-impulsivity
A
manifestations can include:
- fidgeting
- non Stop talking
- interrupting or intruding
9
Q
ADHD and comorbidities
A
- symptom onset before 12 years old
- two or more settings
- significant impairments in social, academic, or occupational functioning
- frequent peer rejection
- children: 6 symptoms of inattention and/or hyperactivity required
- 17 +: 5 symptoms required
10
Q
three ADHD specifiers
A
- predominately inattentive presentation
- predominately hyperactive-impulsive presentation
- combined presentation (most cases)
11
Q
ADHD & co-occuring disorders
A
- conduct disorder
- ADHD more associated with off-task behavior in school, cognitive achievement deficits, and better long-term prognosis
- anxiety and depression
- learning disorders
- substance use disorders
12
Q
ADHD prevalence
A
- 8-12%
- dramatic rise in past decade
- public policy influences:
access to comprehensive diagnostic testing
education policies - 3X more common in boys
symptoms persist beyond childhood
13
Q
girls with / without ADHD
A
- combined subtype more likely to have comorbid diagnosis of conduct or oppositional defiant disorder
- viewed more negatively by peers
- likely to have internalizing symptoms by early adulthood (anxiety and depression)
- exhibit neuropsychological deficits, particularly in executive functioning
- by adolescence, more likely to have symptoms of an eating disorder and substance abuse, have unplanned pregnancies, lower academic achievement, and more risky decisions
14
Q
genetic etiology of ADHD
A
- adoption and twin studies: 70-80% heritability
- candidate genes
- GWAS studies
15
Q
ADHD candidate genes
A
- dopamine genes (DRD4, DRD5, DAT1) increase risk when prenatal maternal nicotine or alcohol use are present
- SNAP-25 codes for protein that promotes plasticity
16
Q
ADHD GWAS studies
A
- inconsistent with the implicated genes, and many genes are identified are not specific to ADHD
- domino effect with other genes
- these genes are not always the identifying factors in studies
- public facing
17
Q
neurobiology etiology of ADHD
A
- differences in brain structure, function, and connectivity
- dopaminergic areas smaller in children
- perinatal and prenatal complications
- environmental toxins
18
Q
dopaminergic areas smaller in children
A
- amygdala, hippocampus, caudate nucleus, nucleus, accumbens, putamen
- poor performances on tests of frontal lobes functions
19
Q
perinatal and prenatal complications
A
low birth weight (but effects can be mitigated by maternal warmth)
20
Q
environmental toxins
A
- food additives
- no evidence that refined sugar → symptoms
- maternal smoking
21
Q
family influences of etiology ADHD
A
- parent-child relationships interacts with neurobiological influences
- parents give more commands and have more negative interactions
but children are often less compliant and more negative in interactions with their parents - many parents of children with ADHD have ADHD themselves
- contribute to maintaining or exacerbating ADHD symptoms
22
Q
treatments of ADHD
A
- stimulants (Ritalin, Adderall, Concerta, Strattera)
- medical + behavioral treatment (MTA study
- psychological treatment
23
Q
stimulants
A
- Ritalin, Adderall, Concerta, Strattera
- reduce disruptive behavior, aggression, and impulsivity
- improve ability to focus attention
- improve concentration, goal-directed activity, and classroom behavior
- improve social interactions with parents, teachers, and peers
- effective in about 75% of children with ADHD
24
Q
medical + behavioral treatment
A
combined treatment slightly better than medication alone, and yields improved functioning (social skills)
25
psychological treatment
- behavior monitoring (daily report cards)
- reinforcement of appropriate behavior
26
ADHD focus of treatment
- improving academic work
- completing household tasks
- learning specific social skills
- do not specifically focus on reducing symptoms
27
treatment of conduct disorder
- most effective when it addresses multiple systems involved in the life of a child
- Multisystemic Treatment (MST)
- each area of influence (genetic, neurobiological, and psychological)
28
Multisystemic Treatment (MST)
family, peers, school, neighborhood, culture, genetic makeup, history (everything up until point of assessment), stress & self control
29
conduct related disorders
- Intermittent explosive disorder (IED)
- Oppositional defiant disorder (ODD)
30
Intermittent explosive disorder (IED)
- recurrent verbal or physical aggressive outbursts that are out of proportion to the circumstances
- aggression is impulsive (not pre-planned)
31
Oppositional defiant disorder (ODD)
- loses temper, argumentative, lack of compliance, deliberately aggravates others, vindictive, spiteful, touchy
- could be abused to changes in development that occurs with adolescents and teens
- moves across situations in similar ways
- what leads to the outburst is more important than the outburst itself
- often comorbid with ADHD, but disruptive behavior is more deliberate than is the case for ADHD
32
conduct disorder
- defined by the impact of a child’s behavior on people and surroundings
- aggressive behavior: physical cruelty, serious role violations, property destruction, deceitfulness
- severity and frequency
- diagnostics specifier: “limited prosocial emotions”
33
limited prosocial emotions
- callous and unemotional traits: lack of remorse, empathy guilt, shallow emotions
- more severe course, cognitive deficits (pattern recognition), antisocial behavior (peer rejection & leaving people out of social groups), and poorer remorse to treatment
- do not respond well to treatment
34
DSM-5-TR criteria for conduct disorder
- pattern of repeated, destructive, and harmful behavior
aggression
property destruction
lying/stealing
breaking rules
- different levels of parental observation
- will pursue risky behaviors when left to their own devices
- approach situations differently depending on their history
35
longitudinal course of CD
- significant impairment in social, academic / occupational functioning
- substance abuse is common
- relationship is to impairment is bidirectional
36
comorbid related disorders with CD
- anxiety and depression (15-45%)
CD precedes depression as well as most anxiety disorders
CD comes first
- 7% preschool children exhibit symptoms of CD; early assessment is critical so their neurobiology can be redirected
37
Two Courses of CD (Moffitt, 1993)
- life-course-persistent
- adolescence-limited
38
life-course-persistent
pattern of antisocial behavior conduct problems by 3 years old and continues to adulthood
39
adolescence-limited
- typical childhoods, high levels of antisocial behavior during adolescence, and typical adulthoods
- physical maturation > opportunity to receive rewards for being an adult
- brain structures that involve self-regulation, self-control
- substance abuse, impulsivity, crime, and overall mental health troubles in mid-20s
- reflects the development of the hot system not maturing until about age 26
- whether or not they the learn the consequences of their actions and choices
40
CD prevalence and prognosis
- 5-6% prevalence; more often diagnosed in boys
does this mean that CDs are more common for boys?
- life-course-persistent more likely for persistent problems in adulthood
- Big Picture: CD in childhood sometimes goes away by adulthood
- remember that “conduct disorder” is much different “conduct problems”
41
etiology
the cause, set of causes, or manner of causation of a disease or condition
- psychopathology is symptom driven
42
genetic influences of etiology of CD
- heritability (always) plays a part
Gene X Environment interactions are very important here → epigenetics
- aggressive behavior is more heritable than other no-rule breaking behavior
- conduct problems + callous/unemotional traits is more heritable than conduct problems alone
- aggressive , anti-social behaviors that begin in childhood are more heritable than those that begin in adolescence
43
neurobiological etiology of CD
- brain areas:
reduced activity in amygdala, striatum, PFC
support empathetic and emotional responses
- autonomic NS:
lower resting skin conductance and heart rate; lower arousal
- people do not always experience / avoid punishment
- poor verbal skills, difficulty with executive functioning, and problems with memory
44
psychological influences of etiology on CD
- differences in moral awareness, especially lack of remorse
- differences in social informal processing
- ambiguous acts interpret as evidence of hostile intent
- connection to Assessment? Projective assessments like Rorsharch
- perceived Hostile Intent → Aggressive retaliation
- vicious cycle: peers remember retaliation and are more aggressive in their interactions with individuals
45
peer influences of etiology on CD
- acceptance / rejection
causally linked to aggressive behavior
rejection predicts later aggressive behavior
- implications for socioemotional development are very important to consider
- attachment
- development of the self
- self-regulation and self-control
46
childhood depression
- ages 7 - 17
- depressed mood, inability to experience pleasure, fatigue, concentration problems, suicidal ideation
- recurrent
- comorbid with anxiety
47
childhood depression prevalence
girls (15.9%) twice that of boys (7.77%)
- depression is different for boys due to display roles of sadness, emotionality, crying
- boys are not seeking help as often as girls
48
etiology of depression: influences
- parents with depression
- early adversity & negative life events
- stress response
- cognitive distortions and negative attributional style
- attributional style stabilizes in adolescence
49
children who have parents with depression
child with depressed parent 4X greater risk than those without depressed parent
- gene-environment interaction
- short allele of serotonin transporter gene + significant interpersonal stress
50
early adversity & negative life events
- financial hardship, maternal depression, chronic illness
- alcoholism, domestic violence, food insecurity
51
stress response
- cortisol taken first thing in the morning predicts onset of depression
- volume of hippocampus grows more slowly
- affects memory and cognition in response to cortisol
52
cognitive distortions and negative attributional style
how we describe how events happen → why did you fail a test? I'm a dumb person
53
attributional style stabilizes in adolescence
by middle school, serves as a cognitive diathesis for depression
- release personal responsibility of depression
54
treatment of depression
- antidepressants
- cognitive behavioral therapy (CBT)
55
antidepressants
- side effects include diarrhea, nausea, sleep problems, and agitation
things go fast, rev high
- possibility of increased risk of suicidal ideation and suicide attempts
- doctors usually do not prescribe them as first option for children
56
cognitive behavioral therapy (CBT)
- more effective in school settings and associated with reductions of symptoms
cognitive distortions & attributional styles
- benefits may not last
- most beneficial for caucasian adolescents, those with good pre-treatment coping skills, and those with recurrent (rather than chronic) depression
57
prevention of depression
selective prevention programs
- family, environment, and / or personal risk factors inform targeting
universal programs (less effective)
- large groups, typically schools
- psychoeducation
ex. n assembly given about coping skills
58
childhood anxiety
- fears and worries are common (more so in girls)
dependent on adults in their lives
- in order to be classified as “disorder” functioning must be impaired
- prevent acquisition of skills and participation in activities with peers
implications across the lifespan
not able to practice and build social skills
59
prevalence of childhood anxiety
3 - 5% of children and adolescents; higher in minority youth
- possible reasons?
stress, a different layer of vulnerability
60
separation anxiety
- constant worry that parents will be harmed when child is away
evolved adaptation that child and caregiver remain in proximity
caregiver will be hurt or harmed unless they are with the child
- shadowing at home
- first observed when children start school
- linked to other internalizing / externalizing disorders at later ages
61
DSM-5-TR criteria for social anxiety
- great deal of distressed when separated from caregiver
- intense worry for caregiver safety
- refusing to go to school
- refusing to sleep away from home
- bad dreams / nightmares about separation
- physical problems when separated
regress & bedwetting
toddler & infant behavior
62
post-traumatic stress disorder (PTSD)
- exposure to trauma
- age 2 - 17
-symptoms:
intrusive flashbacks
avoidance
negative cognitions and moods
not self-directed in very young children
increased arousal and reactivity (i.e., heightened stress response)
- distinct differences from 6 years and younger
63
obsessive-compulsive disorder (OCD)
- prevalence 1 - 4 %
- similar symptoms to those of adults
- more common in boys
- most common obsessions:
dirt or contamination
aggression
- sex or religion become more common on adolescence
64
etiology of anxiety disorders: genetic influences
- 29 - 50 % heritability
- stronger role in separation anxiety with more negative life events
- parental control and overprotectiveness (small role)
- constant fear of danger or threat
- emotion regulation and attachment problems
65
etiology of anxiety disorders: social influences
- experiences with bullying, overestimation of danger and underestimation of ability to cope
- decreased in confidence of ability to cope
- PTSD Environmental Influences
family stress, coping styles, past experience with trauma
66
treatment of anxiety disorders
- CBT Kendall’s Coping Cat
- behavior therapy
67
CBT Kendall’s Coping Cat
- confront fears and develop new ways to think about them
- exposure to feared situations
- relapse preventions
- parents included
- catch negative thought patterns and prevent them from going forward
68
social anxiety treatment
behavior therapy and group CBT
69
ocd treatment
CBT first line treatment; plus medication if severe
70
ptsd treatment
CBT (individual or group)
71
specific learning disorder
- problems in specific area of academic, language, speech, or motor skills
not due to intellectual developmental disorder or deficient educational opportunities
- average or above intelligence with specific affected area
- impedes progress in school
- often identified and treated in the school system
72
dyslexia
- significant difficulty with word recognition, reading fluency, and reading comprehension
upside down, out of sequence, backwards
- 5 - 15 % of school-age children
- not a distinct disorder of DSM-5-TR
73
dyslexia specifiers
- impairment in reading → dyslexia
- impairment in written expression → agraphia
- impairment in math → dyscalculia
74
intellectual developmental disorder
- deficits in problem solving, reasoning, abstract thinking
- determined by intelligence testing and broader clinical assessment
- given in laboratory setting → children may struggle due to the environment
75
three defining components of IDD
- significant problems in intellectual functioning
- significant problems in adaptive behavior across contexts
pretty good measure of one’s intelligence
- problems being before age 18
76
three domains of severity of IDD
conceptual, social, practical
77
traditional IDD treatment
- individualized educational program (IEP)
school based intervention
based on strengths, weaknesses, and the amount of instruction needed
78
genetic etiology of IDD
down syndrome, Fragile-X syndrome, PKU
79
environmental etiology of IDD
- maternal infectious disease
1st trimester → serious consequences
- encephalitis and meningococcal meningitis in infancy or early childhood
- lead or mercury poisoning
low income households
80
treatment of IDD
- residential
- behavioral
“baby steps” to goal
ABA - operant conditioning to increase target behaviors and reduce inappropriate / harmful behaviors
reinforcement / punishment
- cognitive problem-solving strategies
- computer-assisted instruction
81
autism spectrum disorder
- social and emotional differences, not deficits
- different way of navigating the world
- “profound” problems with the social world
- rarely approach others, may appear to “look through” people
- problems with joint attention
obsessive fixations
- pay less attention to speaking faces; particularly the eyes and the mouth
- overlook or are not interested in social cues of others
82
ASD social and emotional differences
Theory of Mind
- understanding that people have different desires, beliefs, intentions, and emotions
- critical for engaging in social interactions
- typical development: 2 ½ - 5 years
children with ASD typically miss this milestone
- may recognize emotions without understanding them / meaning
83
ASD communication differences
- early language “disturbances”
- echolalia: immediate or delayed repeating of what was heard
- pronoun reversal; referring to self as “he” or “she”
- literal use of words
84
ASD repetitive and ritualistic behaviors
- extreme upset with interruption of routine
- focused and reoccupied on specific things
- “peculiar” ritualistic hand movements and other rhythmic movements
- become attached to inanimate objects
85
DSM-5-TR criteria for ASD: social
significant problems in social communication and social interactions such as:
- understanding emotions of others, reluctance to approach others, trouble with back-forth conversations
- maintaining eye contact, showing facial expressions, or using gestures to communicate with others
- forming and keeping peer relationships
86
DSM-5-TR criteria for ASD: behavior
repeated and ritualistic behaviors, interests, or activities such as:
- repeating same speech, movement, or use of object
- extreme desire to maintain routine
- preoccupation with small number of interests or objects
- very sensitive to sensory input or unusually interested in sensory environment (i.e., enchanted by lights or spinning objects)
87
ASD prevalence and comorbidity
- onset in early childhood; evidence in first three months
- 1:54 (4X higher rate in boys)
comorbidity:
- IDD
- specific learning disorder
- separation anxiety, social anxiety, general anxiety, and specific phobias
88
ASD prognosis
- diagnosis is stable over time
- children with higher IQ scores who learn to speak before age 6 have best outcomes
- many adults with ASD function independently, but continue to show impairments in social relationships
- remember that a difference does not immediately imply an impairment
89
genetic etiology of ASD
- .50 - .80 heritability
- linked to broad spectrum of deficits / differences in communication and social interactions
- shared environmental factors account for 50% risk of ASD
- GWAS studies indicate 5 unique loci and 7 that overlap with genetic risk of schizophrenia and depression
- be AWARE of reductionism
90
neurobiological etiology of ASD
- brain size is normal at birth, but are much larger than normal
- synaptic pruning
- enlarged cerebellum
- abnormally sized amygdalae
91
treatment of ASD
- intensive operant conditioning (Lovass, 1987)
- joint attention intervention and symbolic play
- medication
92
Intensive operant conditioning (Lovass, 1987)
- 40 hrs/ week for more than two years
- parents also trained
- dramatic and encouraging results
- larger increase in IQ scores, advancement to next grades
- this is controversial due to punishment component
93
joint attention intervention and symbolic play
improved attention and expressive skills
94
medication for ASD
antipsychotics
- less effective than behavioral treatment
- used to treat problem behaviors
- weight gain, fatigue, tremors
