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Flashcards in Childhood Abnormal Psychology Deck (20):

What kind of disorder is ADHD?

ADHD has features of both externalising disorders and neurodevelopmental disorders

Externalising disorders (ADHD, ODD, CD):
- Highly comorbid with each other
- more common in males than females 2:1
- hyperactivity and impulsivity features

Neurodevelopmental disorders (ADHD, ASD, learning)
- ADHD clusters with autism spectrum, learning problems
- neural capability features (underdeveloped)
- current conceptualisation of ADHD is neurodevelopental


What are the key features of ADHD?

Inattention; most forms of attention (perception, processing) are not affected. The major issue lies with persistence.
- impaired ability to sustain direction toward delayed endpoints
- impaired ability to resist distraction

Hyperactivity: Children with ADHD exhibit rapid and unmoderated emotional expression
- impaired emotional regulation skills (eg self-soothing)


What are the diagnostic criteria for ADHD?

A. Several symptoms present prior to age 12 years.
B. Several symptoms present in two or more settings
C. Clear evidence that the symptoms interfere with social, academic, or occupational functioning.
D. Not better explained by another condition


What are the commorbidities of ADHD?

- learning/academic problems (10-90%)
- affective disorder (15-75%)
- ODD (45-64%)
- conduct disorder (8-25%)
- anxiety disorder (8-30%)
- tic disorder (8-34%)


What are the developmental trajectories of ADHD?

Early stages (hyperactivity)
- hyperactivity symptoms are most pronounced in preschool, decrease over time

Later stages (inattention)
- inattention symptoms become increasingly apparent with age and increased demands
- this is typically when diagnosis and treatment occur


How do environmental factors increase biological risk?

Teratogens and toxins; pesticides, prenatal nicotine and lead

Dietary factors; synthetic food addictives,

Genetics; ADHD has a very high genetic component

Epigenetics: parenting style has a greater affect on children with genetic vulnerability


What are the possible explanations for the relationship between parenting and ADHD?

Levels of parental involvement and nature of discipline have a high correlation with ADHD. Explanations:

ADHD symptoms may elicit negative responses from parents and family members
- improvements in behaviour improve parental behaviour

Gene-environment (rGE) correlation
- Evocative rGE: Child characteristics that are genetically based evoke negative responses from parents
- Passive rGE: The same genes that underlie ADHD in the child underlie parenting problems in their parents
- parental ADHD correlates with negative parenting


What is the dual-pathway model of ADHD?

Two distinct processes, involving distinct but overlapping neural architecture, and both shaped by environmental processes

1. Deficits in inhibitory-based executive processes (A prerequisite for self-control, emotional regulation, cognitive flexibility)

2. Motivational dysfunction involving disruptive signaling of delayed reward (reduction in the control exerted by future rewards, which are discounted)

Delay aversion: negativity associated with this failure becomes associated with situations that signal the need to delay gratification --> avoid delay
- this can be amplified by inconsistent parental style


How do you establish a valid diagnosis of ADHD?

There is no single test to identify ADHD - Diagnosis must be multi-factorial

1. Clinical Interview: detailed history, psychiatric symptoms
2. Collateral interviews: with child, family, teachers
3. Age effects: normative vs clinical symptoms
4. Symptoms in ≥ 1 setting: group settings are vital to provide adequate distraction
5. Rating scales: various scales to rate severity


What are the treatment options for ADHD?

Combined treatment using both medication and Intensive Behavioural Therapy is most effective
- requires lower medication doses
- affective in social skills and family dynamics
- affective in managing aggression

Outcome is predicted by:
- ADHD symptom trajectory in the first 3 years predicted 55% of the outcomes
- higher socioeconomic position better likelihood of sucess
- combined-type ADHD has more difficulty


What is ODD and what are its key characteristics?

Oppositional Defiant Disorcder is a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months with 4 + symptoms

Symptoms are grouped along 3 dimensions:
- anger/irritability; often angry, touchy, loses temper
- argumentative/defiant behaviour; defies authority, blames others for actions, deliberately annoys others
- vindictiveness; has been spiteful or vindictive 2+ times in the last 6 months


What is the significance of the 3 dimensions of ODD?

Pattern of dimensions is uniquely predictive of impairment and comorbidity

Anger/irritability; mood disorders (negative affect)
Argumentative/defiant behaviour; ADHD
Vindictiveness; Callousness, empathetic deficits, instrumental aggression


What is coercion theory of conduct problems?

The dominant causal model of conduct problems; conduct problems are a manifestation of social learning (operant conditioning) between parents and children

Parent-child interactions play out as an Interlocking pattern of reinforcement:
- A 3-step escape-avoidant dance (attack-counterattack-positive outcome)
- Coercive cycles increase in speed and escalation over time with the child becoming more 'proficient'
- Gradually ‘differential attention’ patterns trap the child and parent in repeated, escalating cycles

Early development implications:
- Coercive patterns disrupt emerging self-regulation
- Coercive behaviour functions as a substitute social skill


What is 'deviancy training'?

The system of peer influence on conduct problems

Through the contingencies supplied by peers, antisocial children mutually reinforce such behaviour in one another
- selectively attending to deviant talk
- ignore / punishing prosocial talk
- juvenile delinquency

This provides and externalising trajectory


What is Conduct disorder?

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated (3+ symptoms 6 months)

1. Aggression to people and animals; bullying, fights, sexual aggression, physical cruelty, using weapons
2. Destruction of property; deliberates damaging property (by fire or otherwise)
3. Deceitfulness or theft; breaking&entering, conning people, shoplifting
4. Serious violations of rules; frequent truancy, not coming home at night, running away

Childhood onset (10yrs); exaggeration of normal rebellious process


What is the 'limited prosocial emotions' specifier for CD?

Also known as “callous-unemotional (CU) traits” 2+ of the following characteristics persistently over at least 12 months in multiple relationships and settings:
- Lack of remorse or guilt
- Callous-lack of empathy
- Unconcerned about performance
- Shallow or deficient affect

Children with these traits are more severe and chronic, less reactive to emotional cues, use proactive rather than reactive aggression and seek dominance

People with CU traits have reduced amygdala reactivity to fear stimuli

this is extremely heritable (compared to moderate normal CD)


What are the 4 guiding principles for treatment of CD?

1. Target the ecology of the child; since behaviour is imbedded in the ecological system of the child
- parent training for early/middle childhood
- parent training and youth focused components for adolescents

2. Take a developmental perspective; take into account the developmental trajectory of CD
- best intervention for that stage/age
- how to best involve the child

3. Be formulation/hypothesis-driven; look at the causal factors of the problem
- look at family adversity/ dysfunction/parenting style

4. Form a strong therapeutic team
- involve parents, child, friends perhaps


What are the best intervention for early, middle childhood interventions for CD?

Behavioural Family Intervention (BFI): Key parenting targets for child behaviour change Coercive cycles (reinforcement traps)

1. Positive Involvement; Rewards for Prosocial behaviour, create secure attachment
- differential attention (attention for being good, ignored for being bad)

2. Effective Discipline Strategies; Modeling of non-aggressive inter-personal style
- attachment neutral punishments (time out, quiet time, removal of fun but still safe)
- time out only works when its consistant, neutral and the opposite is desireable

3. Monitoring of child's activities; Positive social engagement


What are the best strategies for adolescent stage CD?

Key parenting targets for child behaviour change: Monitoring and supervision, the adolescent must be an active participant

- Child is increasingly capable of resisting the limitsetting strategies for younger children (time-out)

- problem-solving and communication best targeted with parents-children jointly.

- emerging cognitive resources (abstract reasoning, perspective taking, meta-cognition) can be used to engage in self-regulatory skills training not possible at
younger ages


What are the predictors of outcome for treatment of CDs?

Parent training success is about 60%. Predictors of poor outcomes for parent training include
- socioeconomic disadvantage,
- minority group status,
- younger maternal age,
- parental psychopathology

For the child, poorer outcomes are predicted by
- callous/unemotional traits
- severity of disconduct