Final Flashcards
(135 cards)
1
Q
Historical Background of Autism
A
Autism and childhood-onset schizophrenia were previously lumped together as a single condition
In 1943, Kanner coined the term “early infantile autism”
-kanner believed autism resulted from an inborn inability to form loving relationships with other people and described parents of these children as being cold/detached
2
Q
DSM-5 Defining Features of ASD
A
Impairments in social interaction
Impairments in communication
Restricted repetitive and stereotyped patterns of behavior, interests, and activities
3
Q
Autism Across the Spectrum
A
Three factors contribute to the spectrum nature of autism
- children with autism may differ in level of intellectual ability, from profound disability to above-average intelligence - substantially based on IQ
- children with autism vary in the severity of their language problems
- the behavior of children with autism changes with age - with respects to development
4
Q
Phenomenology of Autism
A
Social Relatedness
Communication
Behavior and Interests
5
Q
Social Relatedness
A
non-verbal behavior (avoiding eye contact, facial expression)
minimal interest in others (eg sharing enjoyment, social-emotional reciprocity)
6
Q
Communication
A
language delay idiosyncratic language (eg no reciprocity)
7
Q
Behavior and Interests
A
inflexible adherence to daily routines
stereotyped movements
pre-occupation w/sensory qualities of objects
8
Q
the real rain man video
A
was diagnosed with mental retardation but his memory was unlike anything (Savant)- they wanted to place him in a mental hospital - his social gestures were awkward, tics with hands, gets agitated easily, spoke monotonous and with a grunt - his memory is amazing but fundamental skills are difficult (telling time, catching the bus, brushing his hair)
9
Q
Core Characteristics of ASD
A
Deficits in social interaction
communication deficits
repetitive behaviors and interests
10
Q
Core Characteristics of ASD: Deficits in social interaction
A
- social imitation (motor or vocal)
- make believe play (reciprocity)
- social expressiveness (facial expressions)
- orienting to social stimuli
- responsiveness to others (empathy)
- processing of emotional info or sharing emotions with others (take 18-24 month old into lab with parent - take child’s hand and for first time put shaving cream into it - most will look at their mom or dad once they know it’s not threatening - they want to share the moment)
- joint social attention
- ability to see others as social agents
11
Q
Core characteristics of ASD: communication deficits
A
- proto-imperative is intact, but impaired proto-declarative
- may use instrumental but not expressive gestures
- about 50% of children with autism do not develop any useful language
- use qualitatively deviant forms of communication (intonation, patterns of sound)
- impairments in the pragmatic use of language (literally force and of others on to objects of interest
- difficulty communicating emotion (“I” statements and “me” statements are difficult to communicate)
12
Q
proto-imperative
A
consult book - statement
13
Q
proto-declarative
A
consult book - declaring something about yourself
14
Q
instrumental gestures
A
consult book
15
Q
expressive gestures
A
consult book
16
Q
ASD and pragmatic use of language
A
children with ASD have problems with pragmatic use of language
17
Q
Speech and Language (ASD)
A
qualitative observations prosody pragmatics meta-linguistics mental states narrative
18
Q
prosody
A
pitch, rate, phrasing of speech
19
Q
pragmatics
A
taking turns, ‘checking in’ with partner (eg stroy-telling)
people with ASD will tell a story that they have no clue or desire whether or not you’re interested in the conversation - when someone is clearly uninterested they will continue regardless
20
Q
meta-linguistics
A
irony, sarcasm, teasing we often use these three things in conversation - have to teach them to recognize these through tone, pitch, syllable emphasis, etc. - ASD are very literal
21
Q
mental states
A
theory of mind, intention
22
Q
narrative
A
story coherence
23
Q
core characteristics of ASD: repetitive behaviors and interests
A
- perseveration or abnormal preoccupations
- ritualistic behavior
- stereotyped body movements
- insistences of sameness
- self-stimulatory behavior
24
Q
Associated Characteristics of ASD
A
Family Stress
Accompanying Disorders and Symptoms
25
Associated Characteristics of ASD: Family Stress
- raising a child with autism is stressful
- frustrated and experience delays in receiving help
- parents may be socially ostracized by friends and strangers
try to help parents through support groups for treatments for themselves and teach them about self-care (to remember to take care of themselves as well)
26
Associated Characteristics of ASD: Accompanying Disorders and Symptoms
- most often associated with intellectual disability
- other common co-occurring symptoms include hyperactivity, learning disabilities, anxieties, mood problems, self-injurious behavior
since DSM-5 they can have Autism and ADHD but that was not the case previously
27
Intellectual Deficits and Strengths (ASD)
- about 7-% of autistic children with autism have co-occurring intellectual impairment
- a common pattern is low verbal scores and high nonverbal scores
- about 25% have splinter skills or islets of ability
- 5% (autistic savants) display isolated and remarkable talents
28
General Deficits (ASD)
```
executive functions (higher-order planning and regulatory behaviors)
weak drive for central coherence (strong human tendency to interpret stimuli in a relatively global way o account for broader context)
-do well on tasks requiring focus on parts of stimulus (don't do as well on tasks requiring focus on the whole)
```
29
Theory of Mind
'what children know about the minds of others' (aspect of social intelligence; making inferences about cognition in others)
-critical acquisition for social interaction (eg irony, sarcasm, teasing): literal interpretation
--example : parent 'pretends' to use a banana as a phone by holding it to her ear, talking, and listening. the child doesn't understand the imitative or play aspect - children with ASD have deficits in theory of mind
30
standard false-belief task
this is one way to assess Theory of Mind:
Sally places marble in the basket and leaves the room. Ann moves the marble to the box. Where will Sally look for the marble?
Sally's desire for the marble - true
Sally's belief concerning the location of the marble- false (from the attributers point of view)
theory of mind - you realize that other people can think something different than you - so children that fail this (because they know where Ann moved the marble to) (listen to recording - think that Sally would have some knowledge of that too
31
Theory of Mind Deficits (ASD)
- Autistics fail false-belief tasks: typically developing children solve around 4 years old
- not a function of IQ because children with Down's Syndrome can solve task
- higher functioning PDD children can eventually learn but still fail second order false-belief task
32
example of second order false-belief task:
a man and a woman are n a room, the woman puts a book in a drawer. she then leaves the room, the man hides the book in another location. unbeknownst to him, the woman is watching him through a window and sees him moving the book. examiner asks the child: "when the woman comes back in, where will the man think that she thinks the book is?"
33
Prevalence and Course of ASD
worldwide, about 1 child per 150 (about 1%) may suffer from some form of autism; about 1 million individuals in the US
-autistic disorder: 22 of 10,000
occurs in all social classes and cultures
3-4 times more common in boys; when girls are affected they tend to have more severe intellectual impairments (gender paradox)
34
Age of Onset (ASD)
most often identified by parents in the months preceding child's second birthday, with diagnosis made in preschoool period or later
earliest point in development for reliable detection: 12-18 months
-AAP recommends that all children be screened at 18-24 months (standard part of routine check of toddlers - not just in psychology)
35
Course and Outcome (ASD)
- often gradual improvements with age, but likely to continue to experience many problems, with some symptoms worsening in adolescence
- complex obsessive-compulsive rituals may develop in late adolescence in adulthood (may even get worse)
- usually a chronic and lifelong condition with continuing handicaps w/moderate independence
- continuing problems in communication, stereotyped behaviors and interests
- IQ and language development are best predictors of adult outcomes
36
Causes of Autism
it is generally accepted that autism is a biologically based neurodevelopmental disorder with multiple causes (vulnerability of ASD is substantially heritable - listen to recording)
- problems in Early developments
- genetic influences
37
Causes of Autism: problems in Early developments
sometimes problems during pregnancy, at birth, or immediately following birth
controversial proposal links autism to vaccinations
38
Causes of Autism: genetic influences
chromosomal and gene disorders
| family and twin studies
39
family and twin studies (ASD)
2-7% of siblings and extended family members of individuals with autism have the disorder
concordance rates
-60-90% in identical twins
-heritability of an underlying autism liability is 80%
-broader autism trait
40
broader autism trait
non-autistic relatives of individuals with autism display higher than normal rates of social, language, and cognitive deficits that are similar in quality to those found in autism but are less severe
41
treatment of autism
There is no known cure for autism
Goals; minimize core problems, maximize independence
Most benefit is likely to come from program of:
-early intervention that involve parents and use special educational methods (requires multi-modal treatment...listen to recording)
-community-based education, community living
-developmentally oriented
Treatment strategies, goals, and expectations vary for different children with autism
42
comprehensive treatment programs for ASD include:
early intervention
techniques to reduce self-injurious, self-stimulation, or other disruptive behaviors
teaching social and communication skills
-interventions that involve the parents to the greatest degree possible
interventions to help the parents cope with the demands of having a child with autism
43
Adolescent Substance Use Disorders (SUDs)
SUDs in adolescence include substance dependence and substance abuse
44
Criteria for substance abuse
involve one or more harmful and repeated negative consequences of substance use over the last 12 months
-diagnosis of substance abuse is not given if the individual meets criteria for substance dependence
45
Substance Abuse
Use of drug interferes with ability to function
-fails to meet work or family obligations
No physiological dependence
46
Substance Dependence
(addiction)
Involves either tolerance or withdrawal
dependence has to do with physiological tolerance or withdrawal
47
Tolerance
greater amounts of substance are needed to produce the desired effect
48
Withdrawal
unpleasant physiological and psychological consequences when individual discontinues or reduces substance use
-restlessness, anxiety, cramps, death
49
Prevalence of SUDs
Alcohol is the most prevalent substance used and abused by adolescents
Adolescent cigarette smoking has been declining
-daily marijuana use has increased
Use of other illicit drugs such as MDMA, opiates, cocaine, and crack has increased
Estimated 12% of American adolescents
-Meet the criteria for substance abuse or dependence
50
Trends in annual prevalence use (SUDs)
listen to recording for explanation of chart slide 5
51
Course of SUDs
Rates typically peak around late adolescence then decline during young adulthood
- alcohol use influences involvement in other high-risk behaviors, especially unsafe sexual activity, smoking, and drinking and driving
- girls who report dating aggression are 5x more likely to use alcohol than girls in nonviolent relationships; boys are 2.5x more likely
52
Sex and Ethnicity (SUDs)
Sex differences in lifetime prevalence rates are converging due to increased substance use among girls
Af Am youth have substantially lower usage rates than whites
hispanics have the highest rate of lifetime usage for powder cocaine, crack cocaine, heroin, and methamphetamines
53
Illicit Drug Use : ages 12+
Listen to recording for details of graph on slide 8
54
Personality Characteristics (SUDs)
Increased sensation seeking preference for novel, complex, and ambiguous stimuli
Positive attitudes about substance abuse and having friends with similar attitudes
-alcohol expectancies
Perceiving oneself to be physically older than same-age peers and striving for adult social roles
55
Adolescent Drug use and Psychological Health : A longitudinal inquiry
Shedler and Block UC Berkeley
N=101 18 yo
initially recruited at 3 yo
assessed at 3, 4, 5, 7, 11, 14, and 18 yo
diverse social class and parent education 66% Af Am 25% white, 8% Asian
Question: Are there significant personality differences between "abstainers" "experimenters" and "frequent users" ?
listen to recording for answer
56
Childhood Precursors: Frequent Users
At age 7, compared to experimenters: little concern for moral issues somatic problems, indecisive, untrustworthy, lacks confidence, cannot admit mistakes
at age 11, compared to experimenters: deviant from peers, emotionally labile, inattentive, gives up easily, suspicious/distrustful over-reactive
57
Childhood Precursors: Abstainers
At age 7: conventional in thought, eager to please, planful, verbally modest, doesn't actively seek autonomy
at age 11: anxious/fearful, not lively or energetic, constricted, not open to new experiences, cautious, looks to others for direction, lacks assertiveness
58
Family Factors and Substance Use
Parental alcohol use (Hawkins et al 1997)
-environmental or genetic mediation (or both)?
Psychiatric, marital, or legal problems in the family linked to drug abuse
lack of emotional support from parents increases use of cigarettes, marijuana, and alcohol
lack of parental monitoring linked to higher drug usage (chassin et all 1996; Thomas et al 2000)
59
Social Context (SUDs)
social influence or social selection?
- Bullers et al (21001) found evidence for both
- peers might be modeling the negative behavior for the adolescent
- we actively seek out peers that are more consistent, more similar to us
- having peers who drink influences drinking behavior (social influence) but individuals also choose friends with drinking patterns similar to their own (social selection)
Less peer influence during adolescence - drug users selection of similar friends or projecting own use into reports regarding peers
Key question: peer rejection as causing later substance problems or as INDICATING other risk factors accounting for substance problems?
60
Prevalence of Alcohol Abuse
Lifetime prevalence
-20% for men
-8% for women
8.5% of Americans met DSM criteria for alcohol abuse or dependence at a given time (must smaller number than the lifetime prevalence)
Rates of dependence among younger women are increasingly approaching that of men
Bing drinking
-5 drinks in short period
-often linked to social contexts (eg "group" drinking)
White Adolescents and adults more likely to abuse alcohol than Af Ams
Gap narrows for HS drop outs
-dropping out associated with greater drug and alcohol use for both whites and Af Ams
Abuse common in Native Am tribes
61
Short Term effects of Alcohol
enters the blood stream through small intestine
-metabolized by the liver
Effects vary by gender, height, weight, liver efficiency
biphasic effect (two phases)
-initially stimulates (sociability and well-being)
late depresses (increase in negative emotions)
62
Neurobiological Influences (SUDs)
the mesocorticolimbic dopamine pathway (reward pathway) is the center of psychoactive drug activation in the brain
- PFC
- VTA (ventral tegmental area)
- Nucleus accumbens
structures that have circuitry that connects them, associated with the network that is useful in reward (listen to recording)
rewarding - pleasure, laughter, etc.
how quickly can they stop that rewarding behavior - how quickly can they disengage
63
Expectations of Positive Effects (SUDs)
listen to recording for explanation of graphs
if the reason for drinking would be because of reducing stress than we would see different data than Figure 4.1
-what they report and what the actual effects are are two very different things
64
Substance use and social context
listen to recording for details of slide
65
Perception of peer substance use
students' average estimate of the amount that their peers drink on their twenty-first birthday is 10.58 drinks. Students who drink on their 21st birthday report consuming an average of 7.42 drinks. THe higher the estimate of peer drinking on the 21st birthday, the more alcohol the student tends to consume on this occasion
what students perceive their friends are doing and what their friends are actually doing are not consistent
the more we perceive our friends drinking, the more we drink
66
Etiology : genetic factors (SUDs)
greater concordance in MZ than DZ twins
-me: alcohol, caffeine, smoking, marijuana, & drug abuse in general
-women: role genetics less clear (fewer available studies - finding are mixed)
ability to tolerate larger quantities of alcohol may be ian inherited diathesis
-asians have low rates of alcohol abuse
67
Etiology : neurobiological factors (SUDs)
incentive-sensitization theory robinson & berridge 1983, 2003)
-wanting (craving for drug)
-liking (pleasure obtained by taking the drug-positive reinforcing qualities)
dopamine system becomes sensitive to the drug and associated cues (eg needles, rolling papers, etc)
-sensitivity to cues induces & strengthens wanting (become active in anticipation of the drug from the cues)
68
Treatment and Prevention (SUDs)
```
Family-based approaches
Motivational interviewing (MI)
```
adolescents with more severe levels of abuse, unstable living conditions, or comorbid psychopathology require an inpatient or residential setting
effective approaches address multiple influences (peer, family, school, and community) on the individual
69
Family-based approaches (SUDs)
seek to:
-modify negative interactions btwn family members, improve communication, and develop effective problem-solving skills to address areas of conflict
70
Motivational interviewing (MI)
- a patient-centered and directive approach
- addresses ambivalence and discrepancies btwn a person's current values and behaviors and their future goals
- you want to use the exact language that they use and help address this
- identify/highlight the discrepancies (this is what you said but this is what you're doing)
- have them articulate what's important to them what are their behaviors and what they hope to achieve
- cognitive dissonance
71
cognitive dissonance
how do people resolve that dissonance? you either have to change your view or assume that it is the exception- you have to work with the person to narrow these discrepancies
72
ambivalence
-mixed feelings - strong emotions in both directions
| "I wanna quit but all of my friends that I like to hang out with do these behaviors"
73
Substance abuse and violence (how does it work?)
1 - substance use CAUSES violence
2 - violence LEADS to substance use
3 - relationship is RECIPROCAL (over the course of time this would be transactional (look up what transactional is))
4 - relationship reflects "third" variable (eg potential common causes)
there are ANY number or implications - these are not necessarily the answer
74
substance use CAUSES violence
Psychopharmacological model:
intoxication effects induce or cause disinhibition, cognitive/perceptual changes, neurochemical
chronic substance use may also influence:
-withdrawal
-sleep deprivation
-nutritional deficits
-neuropsychological impairment
-enhance psychopathology or negative personality traits
75
violence LEADS to substance use
aggressive individuals more likely to select (or be pushed into) social contexts where substance use encouraged/accepted
lifestyles of violent individuals conducive to significant substance use/abuse
-unstable employment
76
third variable problem
potential shared traits or characteristics?
- temperament
- genetic liability
- parental modeling (substance use & violence)
- disrupted familial relationships
- socioeconomic influences
77
comorbidity (SUDs)
why elevated comorbidity?
- self-medication hypothesis
- less appreciation for the (-) consequences of use
- poor judgment with respect to peer group selection
- substance use/abuse exacerbates mental health disorders and psychopathology
- psychopathology accelerates onset of abuse or dependence
78
self-medication hypothesis
use alcohol and drugs to manage or ameliorate their symptoms
79
less appreciation for the (-) consequences of use
listen to recording
80
poor judgment with respect to peer group selection
listen to recording
81
substance use/abuse exacerbates mental health disorders and psychopathology
listen to recording
82
psychopathology accelerates onset of abuse or dependence
listen to recording
expression unrelated to nicotine use or onset but significantly predicts nicotine addiction
it can't tell you who is likely to have tried it but it DOES predict who becomes dependent
83
Prevalence of eating disorders
DSM-IV Anorexia Nervosa - close to 0
DSM-IV Bulimia Nervosa - about 5%
Subclinical Anorexia Nervosa - about 7%
Ballet dancers with Anorexia Nervosa - about 10%
College women with subclinical Bulimia Nervosa (just symptoms) - about 15%
teen girls who feel fat - nearly 80%
84
Anorexia Nervosa
refusal (not an inability) to maintain minimally normal body weight; intense fear of gaining weight; and significant disturbance in perception and experiences of body size
DSM-5 subtypes
- restricting type - individual loses weight through diet, fasting or excessive exercise
- bing-eating/purging type
85
Anorexia Nervosa: Epidemiology
```
Prevalence patients (eg children, people of color, immigrants, low SES)
-more common in men than originally believed
```
86
Anorexia Nervosa: onset, course, comorbidity
- onset early to middle teen years
- usually triggered by dieting and stress
- often comorbid with depression, OCD, anxiety disorders, and alcohol use disorders
87
Physical changes in Anorexia Nervosa
- low BP, heart rate decrease, kidney & gastrointestinal problems
- loss of bone mass
- brittle nails, dry skin, hair loss
- lanugo : soft downy body hair
- depletion of potassium and sodium : can cause tiredness, weakness and death
88
Bulimia Nervosa
binges often triggered by stress and negative emotions
typical food choices:
- cakes
- cookies
- ice cream
- other easily consumed/high calorie foods
avoiding a craved food can increase likelihood of binge
loss of control during binge
-shame and remorse often follow
89
Bulimia Nervosa: epidemiology
- point prevalence: 0.4-3%
- lifetime prevalence: 1-6%
- increasing prevalence in past 10 years
- more prevalent in women than men
- occurs primarily in older adolescents and young adults
- comorbid with depression, anxiety, substance abuse, conduct disorder
90
physical changes in Bulimia Nervosa
- menstrual irregularities
- potassium depletion
- laxative use depletes electrolytes which can cause cardiac irregularities
- loss of dental enamel from vomiting (teeth appear "jagged")
91
Anorexia vs Bulimia: comparison
DIFFERENCES:
eating/weight
AN: extreme diet; below minimally normal weight
BN: binge eating/compensatory behavior; normal weight
view of disorder
AN: denial of anorexia; proud of "diet"
BN: aware of problem; secretive/ashamed of bulimia
Feelings of control
AN: comforted by rigid self-control
BN: distressed by lack of control
SIMILARITIES
Self-evaluation: unduly influenced by body weight/shape
Comorbidity of AN/BN: some cases of AN also binge and purge; many case of BN have history of AN
SES, age, gender: prevalent among HIGH SES, young, female
92
Binge Eating Disorder
similar to bulimia without the compensatory behaviors
- involves periods of eating more than other people would, accompanied by feeling of loss of control
- affects 1.5-3% of adolescents
- has negative health correlates
93
medical complications of eating disorders
- cardiovascular complications
- gastrointenstinal complications
- fluid/electrolyte complications
- skeletal complications
- renal complications
- endocrine, hormonal, and reproductive complications
- skin and dental complications
- re-feeding syndrome
94
Assessment of Body Image
the further the distance btwn rating of current image and ideal image is most predictive of developing and eating disorder
95
Spectrum of Eating Disorders
Risk Factors ----->
healthytypicalpathologicalsubclinical EDED
re increasing in the risk factors and decreasing in the protective factors
96
Outcomes of Adolescents with EDs
longitudinal study
random sample of HS girls in W. Oregon
89% caucasian
what is the "adult psychosocial adjustment" as a function of adolescent diagnostic group
-ED vs major depression (MD) vs non-mood disorder (NMD) vs no disorder
eating disorder group has higher levels of low self-esteem, low family support and depression
-ED have higher levels of depression than the depressed group over the course of 14 months
the also showed higher levels of low social network & using treatment
-the only outcome in which depression showed higher levels than ED was in low life satisfaction
97
Etiology of Eating Disorders: Genetics
family and twin studies support genetic link
-higher MZ concordance rates for both anorexia and bulimia
body dissatisfaction, desire for thinness, binge eating, and weight preoccupation all heritable
adoption studies are needed
Grice et al found linkage on chromosome 1 but there is need for a replication study
98
Etiology of Eating Disorders: Neurobiological Factors
Hypothalamus not directly involved
low levels of endogenous opioids
-substances that reduce pain, enhance mood, & suppress appetite
-released during starvation (may reinforce restricted eating of anorexia)
-low levels of opioids in bulimia promote craving (reinforce binging)
serotonin and dopamine may also play a role
99
Etiology of Eating Disorders: Sociocultural Factors
- societal emphasis on thinness
- dieting, especially among women, has become more prevalent (often precedes onset)
- body dissatisfaction and preoccupation with thinness also predict eating disorders
- societal objectification of women leads to self-objectification
- unrealistic media portrayals fuel body dissatisfaction
100
Etiology of Eating Disorders: Cross cultural factors
- anorexia found in many cultures
- bulimia most common in industrialized, western countries (as countries become more industrialized, bulimia rates increase)
- preoccupation with thinness also culturally influenced
101
Etiology of Eating Disorders: Ethnic Factors
white teens as compared to AfAm teens
-more body dissatisfaction (BMI increases linked to greater body dissatisfaction)
-more dieting
white and hispanic college student exhibit more body dissatisfaction than AfAm students
SES: eating disorders less linked to SES than in previous years
102
Etiology of Eating Disorders: Family Characteristics
Disturbed family relationships
-high levels of family conflict
-low levels of support
Family Characteristics
-may result from, not be a cause of, eating disorder
-not specific to eating disorders: also found in families of individuals with other types of psychopathy
Minuchin's proposed family characteristics
-enmeshment, overprotectiveness, rigidity, lack of conflict resolution
-psychotherapy on the family level
103
Etiology of Eating Disorders: Cognitive Behavioral View
anorexia:
- focus on body dissatisfaction and fear of fatness
- certain behaviors (restrictive eating, excessive exercise) negatively reinforcing (reduce anxiety about weight)
- feelings of self control brought about by weight loss are positively reinforcing
- criticism from family and peers regarding weight can also play a role
bulimia:
- self-worth strongly influenced by weight
- low self-esteem
- rigid restrictive eating triggers lapses which can become binges (many "off-limit" foods, restraint scale measures dieting and overeating)
- disgust with oneself and fear of gaining weight lead to compensatory behavior (eg vomiting, laxative use)
- stress, negative affect trigger binges
104
Treatment of EDs
```
most individuals don't receive treatment
-often deny problem
antidepressants
-effective for bulimia but not anorexia
-drop out and relapse rates high
family therapy
CBT for bulimia
-challenge societal ideals of thinness
-challenge beliefs about weight and dieting
-CBT more effective than medication
```
105
Treatment for AN and BN
- hospitalization in some cases
- antidepressants and SSRIs may be helpful for BN, but not AN
- psychosocial interventions are proving to be effective and are generally more effective than medications alone
- resolution f family problems may be crucial
- anorexia is generally less responsive to treatment than bulimia
106
AN Treatment
family-based interventions often required to restore healthy communication patterns, and CBT may be used to modify rigid beliefs, self-esteem, and self-control processes
107
BN Treatment
CBT that focus on attitudes, beliefs, and behaviors supporting problematic eating are effective; interpersonal therapy addresses situational and personal issues contributing to the development and maintenance of the disorder
108
Most Common Barriers to seeking treatment : EDs
- financial difficulties (59%)
- no or inadequate health insurance (48%)
- belief that treatment won't help (38%)
- fear of stigma (35%)
- Lack of knowledge about treatment resources (35%)
109
National Growth and Health Study, Wave II
```
Epidemiological Sample, three sites
-berkeley, CA
-Cincinnati, OH
-Washing, DC
Two stage assessment of EDs and other DSM Axis I disorders
```
Sample:
1061 Black Women
985 White Women
mean age: Black women 21.46; white women 21.26
nearly 2-fold higher prevalence of AN, BN, and Binge Eating in White Women to Black Women
- Also higher compensatory behaviors (listen to recording)
- in berkeley, but not in DC, black and white women differed significantly in weight control behaviors (diet pills, diuretics, fasting)
- mean age of onset significantly earlier in white women compared to black women
- likely, study hasn't captured full "window of risk" for black women
- of the 61 women with BN or binge eating disorder, 11 white women (26%) and 1 black woman (5%) reported having receive treatment for the eating disorder
110
Controversies in Abnormal Psychology
General
Taxonomy/disorders
Treatment
111
General
Repressed Memories - related to experiences of abuse and trauma, person may not recall until many years after it happened (listen to recording for definition
Expert Testimony - how do we use research and science (listen to recording)
112
Taxonomy/disorders
dissociative identity disorder
-is this a real thing, how do we know? what is it based on? it isn't well known scientifically but doesn't mean it doesn't exist
113
Treatment
psychopharmacology of preschool children - medication for mental/behavioral/emotional problems for these children - when FDA does research trials for treatment efficacy, those studies don't usually include children (definitely NOT young children)
increased risk for suicide - SSRIs in adolescents: for some idividuals when their mood improves, there is an increased risk of suicide - they become high functioning enough to then actually commit the suicide (Before they were too depressed to commit suicide)
-physicians prescribe powerful medications to kids that the FDA hasn't said that "yes it is safe for that subgroup of the population" - off label prescriptions
Herbal treatments - no scientific evidence that these work (not substantiated through science)
114
Science and Public Policy : when worlds collide
what is the responsibility of scientists, public policy makers, and the community at large?
- stem-cell research (listen to recording)
- gene therapy (listen to recording)
what happens when scientific evidence is controversial or inflammatory?
-racial differences in IQ (listen to recording)
counter-factual to intuition or 'common sense?'
(listen to recording)
115
What is Meta-analysis?
meta-analysis quantitatively aggregates the results of different studies of the same question
- smoking and lung cancer?
- aspirin and the risk for heart disease?
- is CBT effective for major depression?
Careful characterization of study characteristics to 'control' for different methods
- age, gender, setting, DSM III-R vs DSM-IV
- overall effect size (eg 1/2 standard deviation)
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Rind et al. (1998) Meta-Analysis
Question: what is the association btwn child sexual abuse (CSA) psychopathology?
Method: N=59 (studies), >15k college students, self-report CSA
Results: Average correlations, r=.04-.13 across 18 different measures of psychopathology
- moderators: type of pathology, type of abuse (eg length, severity, frequency)
- 11% of women, 37% men reported abuse as positive
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criticism of Rind et al. Meta Analysis
public outcry over results
Dr Laura and others summarily dismiss results, and more importantly the methodology
- religious groups, family research council
- man-boy love association endorses article on web
LISTEN TO RECORDING
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addressing the criticisms of Rind et al. Meta Analysis
file-drawer-problem (rosenthal, 1995)
- are there differences btwn published and unpublished manuscripts? probably (meta analysis based on only published studies - listen to recording - need to include unpublished studies in the meta-analysis as well)
- effect sizes for both groups were comparable
sample
-college students vs community vs clinic-referred
statistics
-use of confidence intervals provides a plausible range of 'true' correlations btwn CSA and psychopathology
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congress enters the fray of Rind et al. Meta Analysis
congress condemns the study
American psychological association (APA) is at the forefront of the controversy
APA, after initially defending the article (eg review process), collapses under the scrutiny
-recognizing funding (among other things) is at stake
American Association for the Advancement of Science (AAAS) invited to re-review article
-no reason to second guess peer review
listen to recording
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alternative interpretations of Rind et al. Meta Analysis
youth are frequently resilient and understanding factors that contribute to positive outcomes despite risk is valuable
paper focused on CSA: maltreatment, neglect
what about non-psychopathology outcomes?
- negative social relationships
- academic or occupational problems
- sexual promiscuity, self-mutilation
- use of mental health services
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what happens when interventions harm?
Iatrogenic effects (negative unintended effects)
- increase in problem behavior post-intervention
- psychosocial treatment for substance disorders (7-15%; moos, 2005)
- educational tracks and school achievement
- stimulant medication (eg ritalin) INCREASE risk for alcohol and substance disorders?
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Inclusion Criteria (listen to recording for what?)
1. Longitudinal design (ie medication treatment preceded substance outcomes)
2. dichotomous ADHD vs non-ADHD (1 study of reading disorder vs non-reading disorder - n=239 medicated, n= 63 unmedicated
3. dichotomous (+) abuse/dependence vs (-)
4. available data to calculate proportions or reported odds ratios
5. publication btwn 1980 and February 2012
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Participants (for what?)
N=2565 (mostly caucasian boys); 60% medicated
Demographic Moderators
- mean age at baseline (ADHD assessment)
- mean age at follow-up
- sex (% male)
- Race (% caucasian)
methodological moderators
- % ADHD in the medicated group
- sample source (ie clinic-referred vs other)
- DSM version (ie DSM-III/DSM-III-R vs DSm-IV)
- mean number of years of follow-up
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results (for what?)
children with ADHD were no more or less likely to develop nicotine, alcohol or marijuana dependences than children without ADHD
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Peer Groups and Problem Behavior (Dishion et al 1999)
Long history of research on peer influences on behavior problems in youth
- deviancy training
- peer rejection (more negatively regarded by peers have more behavior problems)
- 'causal' vs 'indicator' models
theory of group-based interventions
-group homes, peer diversion programs, boot camps
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Adolescent Transitions Program
parent: monitoring, consistency
peer: peer reinforcement, prosocial goals, etc
sample: n=119 (boys & girls)
4 groups: parent, peer, combined, placebo
clinically significant benefits in the short-term (fewer negative parent-child interactions)
but longer term follow-up showed:
-kids (teacher-reported) delinquency gets worse in the peer only group, control group gets better afterward
-Teacher-reported tobacco frequency was worse - iatrogenic effects
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explanation of iatrogenic effects in Adolescent Transitions Program
1. positive reinforcement (laughter, attention, interest in the deviant behavior of others) - maybe they were positively reinforced for their bad behaviors by their peers
2. environment provides motivation to commit more delinquent acts
3. diversity of acts is a predictor of stability and prognosis; thus 'exchangeable' delinquency?
peer only (like group homes) settings may provide peer delinquency contagion - perfect for youth to change their skill sets (teaching peers about selling drugs or white collar crimes) they are changing and reinforcing each other's bad behaviors
these are all good mediators of being in the red treatment conditions and having bad outcomes (why or how the IV is related to - listen to recording)
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why clinicians use pseudo-scientific methods
experience as a source of knowledge/expertise?
- not so much: experts look the same as those just starting out (no difference - not that novices are better or worse)
- experience and competence are NOT positively related
- clinicians given identical info: experienced clinicians are NOT more accurate
- clinicians vs graduate students? NOT more accurate
- remember the study on marital experts
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Impediments to learning from experience
why don't mental health outcomes get better with more experienced clinicians?
- availability heuristics
- confirmatory biases
We use HEURISTICS!!!
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availability heuristics
correlation - ease of which you can recall something and how true you think that thing is true - overestimate how prevalent something is, etc. (listen to recording)
people will recall things that...
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confirmatory biases
look for things that confirm what you already know to be true
when you believe things (even though literature says otherwise) you will look for evidence that affirms your beliefs (justify what you're already doing rather than learning from experience)
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Heuristics
- a rule of thumb or mental shortcut
- often based on experience
- does a good job most of the time
- save us time and energy
- expertise plays a role...
- not guaranteed to be correct...and errors tell us important things
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controversies: treatment studies
can be difficult to conduct
control group: "would you mind not receiving any treatment for as long as possible so we can see how much better the group of people who received state-of-the art treatment is doing compared to you?"
- you can't withhold treatment - often times you have to do a waitlist group
- hard to balance ethical (listen to recording)
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controversies: genetic research
what kind of long term effects will this have on our species
| -narrowing population diversity?
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controversies: sample characteristics
graham (1992): "most of the subjects were white and middle class..." things are still improving - long way to go
af ams used as comparison of abilities
-a lot of people are concerned because you can proliferate these group differences - you need to have a theory for why you think there are going to be group differences
