Externalising Disorders Flashcards
(31 cards)
Four disorders
o Conduct disorder
Adult – antisocial personality disorder
o Attention Deficit Hyperactivity Disorder
o Oppositional Defiant Disorder (lower level CD)
Common features of ODD and CD
o Breaking rules
o Argumentative
o Often aggressive
o Note
More than typical for age
CD takes precedence over ODD – can’t have both
Differences between ODD and CD
o ODD
More argumentative
Often touchy and angry
Often in one setting (e.g. home)
o CD
More social violations
More “severe” behaviours (e.g. fire setting, use of weapons)
Typically across settings
Often engages peers
• Core features of ADHD
o Difficulty with appropriate attentional focus and/or control over activity levels
o Must be more than typical for age
o E.g. unable to sustain attention, follow tasks, organise activities
o E.g. unable to sit still, wait turn, stay quiet
• Prevalence of externalising disorders in children
o Difficult diagnoses and very arbitrary cutoffs. Therefore rates vary widely. Around 10% of kids
o Great Smokey Mountains study
3% ODD
3% CD
1% ADHD
• Comorbidity
o Very high between each other – lots of overlap
o Depression
Difficulty with school, peers
o Anxiety – mostly ODD
CD may be protected
o Substance use – mostly CD
o Learning difficulties, MR
• Age and Gender
o Mostly male disorders
Especially CD – 4x
ADHD – 3-4x
Less ODD – 1.5-2x
o Disorders of childhood onset
ADHD by definition before age 7
ODD usually early childhood
CD mid/late childhood – rare after 16
• Social/personal correlates
o Academic difficulty/failure
o Truancy
o Peer rejection
o Association with similar peers (esp. CD)
o Family conflict
o Risky behaviours
o Unemployment, marginalisation, prison
• Antisocial personality Disorder
o Adult “version” of CD
o Violation of social and personal rights and rules
o Early history of CD
o Continued characteristics such as fighting, breaking law, deceitfulness, lack of remorse
• Characteristics of ADP
o Up to 2% of pop
o Largely male
o Tends to decrease with age
o Inconsistent work history
o History of fights, aggression, and risky behaviour
o Common comorbid substance abuse and mood disorders
o Common prison history
• Psychopathy vs. APD
o Psychopathy part of earlier systems – dropped in DSM=IV
o Limited affect
o Lack of remorse
o Self-gain focus
o ADP – involves antisocial behaviours e.g. fighting
o Can there be successful psychopaths?
• Much more likely to have future problems following ADHD
o 12x ODD
o 10x anxiety depression
o 3x impairment
o 2x juvenile justice
• Genetics - ADHD
o Risk for ADHD 2/8x greater among 1st degree relatives
o Twin studies – mean heritability - .76
o Specific candidate genes related to DA, NA and 5HT systems – strongest evidence related to DA receptors and DA transport
• Genetic factors in externalising behaviours
o Family concordance – especially in fathers, mothers often depressed
o Twin studies show strong evidence for heritable component – 50%
o Considerable evidence for GxE interactions
o Some hints that psychopathy might be more heritable than antisocial behaviour
• Biochemistry of ADHD
o Simple DA theory proposed by Levy (1991)
o Low levels of DA in striatum and frontal cortex
o More recent variations predict more complicated effects
o Complex influence of NorAdrenaline on DA
• Evidence for DA involvement in ADHD
o Manipulations of DA levels in animals influence attention, impulsivity & activity
o Stimulants to treat ADHD work largely through DA system
Reduce activity by increasing DA levels
o Imaging studies show DA abnormalities in specific brain regions
o Genes related to DA implicated in ADHD
• CNS arousal and antisocial behaviour
o Two theories – under and over arousal
o Under-arousal suggested to be associated with psychopathic behaviour (callous- unemotional)
o Early theory (Hare) – psychopaths characterised by low arousal and hence fail to learn about punishment and seek greater stimulation
o Evidence mixed – but better when definitions are clear
o Temperamental factors
Several temperaments – risk-taking, impulsivity, low regulation
Frick – callous-unemotional traits
• Low empathy, low emotion, disregard for others
• Seems to be more heavily genetically mediated
• Likely to characterise a subgroup of externalising children – more severe, more provocatively aggressive, more chronic
o Characteristics of callous-unemotional youth – Frick & White, 2008
o Intelligence
Reduced arousal
Decreased empathy but especially reduced recognition of fear and distress in others
Abnormalities in responsiveness to cues of punishment
Greater thrill-seeking and reduced fearfulness
More problems with verbal IQ then their peers
o Processing biases
Theory by Dodge and later Crick & Dodge – aggression directly predicted attributions of hostile intent
Evidence that externalising kids attribute more hostile intent from others directed to self
In turn, hostile intent predicts aggression
More aggressive and hostile environments – may be based on experience
• Fear recognition and eye gaze in callous-unemotional children
o High CU spent less time looking at eyes, even when told. When compared to low CU.
o When free gaze high CU kids got emotion right significant less than low CU. But this difference disappeared when told to look at eyes
• Importance of punishment and reward and CU
o CU kids thought violence would lead to tangible rewards and dominance and valued these as more important and thought punishment was less likely and less important.
• Low IQ related to conduct problems
o As IQ goes down both teacher and parent report of conduct problems goes up
• Hostile intent in aggressive children and their mothers
o Mothers characterise the vignette behaviour of overt and relational aggression as hostile considerable more than controls. This would have implications for how they interact with their children. This was found to a lesser extent to be true with all children.
