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Psyc 241 - Final Exam > Childhood and Adolescent Disorders > Flashcards

Childhood and Adolescent Disorders Flashcards

(58 cards)

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1
Q

historical perspective

A

early 19th century - inadequate parenting, insufficient moral discipline in upbringing
reflection of environments

end of 19th century - abnormal brain functioning

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2
Q

current issues in assessing and treating children and adolescents

A

must study age specific variations - dif symptoms based on cognitive stage

youth more influenced by environments - lack of autonomy

children cannot self report

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3
Q

general prevalence of childhood disorders

A

18-22% between ages 4-17
anxiety disorders most common

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4
Q

types of comorbidity

A

homotypic continuity - current diagnosis predictive of receiving the same diagnosis in the future - panic disorders, psychosis, verbal tics, ecopresis, enuresis

heterotypic continuity - predictive of receiving a different diagnosis in the future - depression to anxiety, ADHD to ODD

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5
Q

ADHD clinical description

A

persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development

early childhood onset, 1/3 maintain diagnosis into adulthood

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6
Q

inattention symptoms

A

making careless mistakes, difficulty with attention, easily distracted, side tracked, problems with organization, messy, losing things, forgetful

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7
Q

hyperactivity symptoms

A

fidgeting, running around at inappropriate times, not remaining seated, talking excessively, blurting things out

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8
Q

ADHD specifiers

A

ADHD-I: predominantly inattentive, ADHD-H: predominately hyperactive, ADHD-HI: combined

ADHD-I - more common in girls, associated with academic problems
ADHD-H, HI - three times more common in boys, higher rates of comorbid conduct problems - motor hyperactivity symptoms often decrease over time

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9
Q

comorbidity and ADHD

A
  • 50% have at least one other psychiatric disorder
  • ODD or CD 40-60%, learning disorders 25%, anxiety disorders 25%, depression 30%, substance use disorders 40%
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10
Q

ADHD prevalence

A

2% preschool aged, 6% in children and adolescents, 4% adults

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11
Q

ADHD developmental trajectory

A

increased risk for developing another psychiatric disorder

begin substance use earlier than youth who do not have ADHD

four times greater risk of serious injury - motor vehicle accidents

lower occupational attainment and greater academic problems

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12
Q

ADHD brain structure and function

A
  • 3-8% reduction in brain size
  • abnormalities of the prefrontal cortex and basal ganglia
  • marked delay when attaining peak thickness through cerebellum - 10.5 years ADHD, 7.5 years controls
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13
Q

genetics and ADHD

A
  • heritability as high as 70-80%
  • extensive study of genes responsible for the recycling and transportation of the neurotransmitter dopamine, genes implicated in developmental process
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14
Q

prenatal risk factors ADHD

A

prenatal toxin exposure - poor diet, exposure to antidepressants, antihypertensives, illicit drugs, alcohol, tobacco, caffeine, mercury, lead, pregnancy or delivery complications

exposure to manganese, organophosphates, phthalates - particularly problematic for boys

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15
Q

psychosocial risk factors ADHD

A
  • low socio-economic status, large family size, paternal criminality, poor maternal mental health, child maltreatment, foster care placement, family dysfunction
  • inattentive symptoms - influenced by psychosocial risk factors
  • hyperactive-impulsive symptoms - influenced by by biological risk factors
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16
Q

gene-environment interactions and ADHD

A

maternal smoking and genetic predisposition

dopamine receptor in prefrontal cortex and inconsistent parenting

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17
Q

ADHD assessment

A

reports from more than one informant using valid and reliable assessment tools

basic assessment - administering a rating to parents and teachers - self report in adolescence

clinical interview - developmental history, onset of problems, degree of impairment in different settings, differential psychiatric and medical diagnosis, psychosocial issues, family mental health history

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18
Q

pharmacological treatment ADHD

A

stimulant medication - effective in approximately 80% - increase release of dopamine and NE from storage sites and blocking their reuptake by inhibition of the dopamine transport system

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19
Q

types of ADHD medication

A
  • short or long action methylphenidate, dextroamphetamine, amphetamine - increase vigilance, reaction time, short term memory, learning of new material in children with ADHD
  • atomoxetine - act on noradrenaline and serotonin - additional benefits in reducing ODD and anxiety symptoms
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20
Q

ADHD medication side effects

A

side effects - decreased appetite, weight loss, trouble falling asleep, headaches, increases in pulse and blood pressure - sometimes more irritable or angry

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21
Q

psychoeducational interventions ADHD

A

adults responsible for the child educated about symptoms, disorder course, deficits associated with ADHD

importance of routines, physical exercise, supervised or planned activities

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22
Q

academic skill faciliation and remediation ADHD

A

scheduled breaks from classroom activities, the use of reward systems, appropriate positioning of desks, auditory vs written instructions, use of agendas

testing to identify challenges - specific interventions

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23
Q

behavioural parent training ADHD

A

parents learn techniques to help the child modify their own behaviour by providing consistent rewards and attention when the child completes a task or ceases a negative behaviour

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24
Q

other treatments ADHD

Study These Flashcards
A
  • behavioural classroom management, behavioural peer intervention, organizational training
  • no evidence for family therapy, individual psychotherapy, social skills training
  • most effective - those that help children enhance their deficient self motivation and working memory
25
oppositional defiant disorder
frequently argue with adults, temper tantrums, deliberately annoy others, angry and irritable, spiteful, blame others for outbursts, defiant to authority generally diagnosed by age 8
26
ODD three symptom categories
angry/irritable mood argumentative/defiant behaviour vindictiveness
27
conduct disorder
behaviour that violates the basic rights of others or major societal norms, lack of remorse or guilt, callousness aggression towards people and animals destruction of propety deceitfulness or theft serious violation of rules
28
CD classifications
onset in childhood, adolescence, unspecfied mild, moderate, severe
29
CD and ODD sex differences
boys 3-4x more likely for CD, girls more likely at a later age slightly more boys diagnosed with ODD assortative mating - females with CD tend to date males with CD
30
ODD and CD comorbidity
92% with ODD met criteria for another disorder - mood, anxiety, impulse control, substance use highly comorbid with ADHD CD and substance abuse CD and ODD share a genetic influence
31
three pathways linked to internalizing disorders
failure model: engaging in externalizing behaviour increases probability of experiencing social failure - related to developing internalizing problems acting out model: youth may mask their mood problems by behaving aggressively reciprocal model: associations between externalizing problems and internalizing problems are reciprocal
32
dysruptive mood dysregulation disorder
chornic and severe irriability manifested clinically by frequent temper outbursts, persistently angry or irriable mood 2-5% prevalence onset before age 10
33
ODD and CD prevalence
ODD in preschool - 9-12%, 3-6% adolescence CD 8.1% boys, 2.8% girls true prevalence hampered by changes in DSM criteria
34
ODD and CD developmental trajectory
ODD -> CD -> ASPD trajectory is robust - more concern for those diagnosied with ODD and CD than just CD arguments that they are distinct ODD linked to mood disorders, CD antisocial
35
ODD and CD genetics
CD - 71% strong genetic basis for antisocial behaviour heritability estimates range from 44-72%
36
ODD and CD neurobiology
aggression - decreased glucose metabolism in frontal lobe damage to amygdala - impulsive aggressive behaviour serotonin abnormalities, low norepinephrine
37
hot executive functions
smaller brain structures and lower brain activity in these areas motivation and affective cognitive processing associated with self management skills when emotions run high - anterior cingulate cortex, insular cortex, frontal cortex
38
ODD and CD cognitive factors
poor executive functioning, low IQ, reading disorders, lack of empathy, poor social cognition
39
ODD and CD prenatal risk factors
maternal smoking, substance use, pregnancy and birth complications - CD most important is maternal stress and smoking during pregnancy
40
ODD and CD psychosocial risk factors
poor parenting - low monitoring, harsh and inconsistent, discpline, abuse - externalizing difficulties moderate relation with insecure attachemnt - strong relation to disorganized attachment peer rejection, association with deviant peers, poverty
41
ODD and CD gene environment interaction
MAOA - 80% with low activity version who were maltreated had a conduct disorder vs 40% with high activity differential susceptibility theory and biological sensitivity context theory - sources of vulnerability can increase risk of poorer outcomes or better outcomes with supportive environments
42
ODD and CD problem solving skills training
modelling and practice, role playing, reinforcement contingencies try to reduce hostile attributions never fully reach normal functioning
43
ODD and CD pharmacological treatment
first consideration if there is comorbid ADHD antipsychotic - moderate effect on disruptive and aggressive behaviour lithium for short term anger management
44
ODD and CD parent training
promote social behaviour while reducing negative behaviour idea that parents can reinforce antisocial behaviour
45
seperation anxiety disorder
distress when seperated from attachment figure, constant worry about caregiver, withdraw, timid, distress, worry about harm, nightmares about seperation 1/3 develop other anxiety or mood disorders
46
three trajectories for seperation anxiety disorder
high increasing group - 15.5% - 16x more likely to meet criteria for social anxiety disorder in adulthood moderate - 37.3% low - 47.2%
47
GAD in childhood
many worries, difficult to control worries, tired, restless, fatigued, irritable 6 months 1 physiological symptom
48
anxiety disorders comorbidity
mood disorders 71% met criteria for depression and anxiety 1/3 with SAD present with GAD, another 1/3 will develop GAD 73% heterotypic comorbidity
49
anxiety disorders prevalence
9% aged 4-11, 15% aged 12-17 equally common in boys and girls in youth
50
anxiety disorders developmental trajectory
anxiety age 11 - predictive of anxiety age 15 SAD predicts SAD anxiety in early childhood -> behavioural issues middle childhood -> depressive late childhood
51
temperament and anxiety
anxious temperament in infancy behavioural inhibition - withdrawal or fear in novel situations - persists throughout life, 2-4x more risk of anxiety disorders
52
brain structure and function and anxiety
amygdala - prolonged activation can lead to anxiety higher resting heart rates and blood pressure
53
anxiety and genetics
38% of children with parents with an anxiety disorder had one heritability 59% genetic factors explain 68% stability in anxiety symptoms
54
prenatal risk factors and anxiety
mother experiencing stress while pregnanct elevated cortisol in mother on developing brain
55
psychosocial risk factors and anxiety
genetic risk might be chanelled through environment vicarious learning, operation and classical conditioning relationship with poverty and psychoapthology
56
gene environement interactions and anxiety
fear conditioning anxiety following stressful life period
57
cognitive behavioural treatment and anxiety
most evidence helping parents learn to cope, gradual exposure to stimuli
58
pharmacological treatment of anxiety
SSRIs fluvoaxamine - reduction in 8 weeks 92% of those taking medication stayed well combined SSRI and CBT - best results aged 7-17

Psyc 241 - Final Exam (4 decks)

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