Final Exam Flashcards

Question

Diagnostic challenges of BD

Answer 1

-Same diagnostic criteria are used for adults and children -Children tend to have very short episodes, very frequent mood shifts, mixed mood, chronic difficulty in regulating moods -Children present with co-morbid problems -Mania in adolescents - associated with antisocial behaviour

Answer 2

- in some children, major depressive disorder may be an early stage of bipolar disorder —> more likely in those youngsters with an earlier onset of depression - experience relatively early onset of affective difficulties (Median duration for manic episode = 10.8 months; first affective episode = 11.75 years) - retrospective and prospective studies suggest that these children continue to show symptoms of affective disorders, social and academic impairment

Answer 3

Family history of bipolar disorder (genetics) - biological siblings and parents (immediate family members) - adult twins and adoption demonstrate a strong genetic component - multiple genes affecting amygdala and hormonal and neurotransmitter process, but shared with other disorders Environmental stressors - stressful life events, family relationships, parenting styles

Answer 4

Structured diagnostic interview: K-SADS Mania scales: Young Mania Rating Scales and GBI Parent/teacher/self-interviews

Answer 5

Pharmacotherapy is the first and most effective treatment Family involvement in treatment is very important

Answer 6

Oppositional defiant disorder Conduct disorder Intermittent explosive disorder Antisocial personality disorder Pyromania and kleptomania

Answer 7

Pervasive pattern of disregard of and violation of rights of others Met criteria for CD before the age of 15 ADHD—> ODD —> CD—> APD

Answer 8

A pattern of negativistic, hostile, and defiant behaviour Under age 5: symptoms have to occur on most days. Over age 5: symptoms have to occur at least once a week Has to impair functioning (ex. Academically, socially) At least 3 of these behaviours present for at least 6 months: - loses temper - touchy and easily annoyed - angry and resentful - argues with adults - actively defies or refuses to comply with adult request/rules - deliberately annoys others - blames others for own mistakes - is spiteful or vindictive

Answer 9

A pattern of repetitive and persistent acts of violence that violates the basic rights of others and goes against societal norms Mild, moderate, or severe Limited prosocial emotions (feeling guilty or not)

Answer 10

At least 3 of these behaviours are present during the last 12 months with at least one of them present in the last 6 months: Aggression toward people or animals - bullies, threatens, or intimidates - initiates physical fights - has used a weapon - is physically cruel to people or animals - has stolen while confronting a victim - has forced someone into sexual activity Destruction of property - engaged in fire setting with the intent to cause damage - has deliberately destroyed other’s property Deceitfulness or theft - has broken into house, building, or car - often lies to obtain goods or favours or to avoid obligations - has stolen items of nontrivial value without confronting victim Serious violation of rules - stays out at night despite parent prohibitions - has run away from home overnight at least twice - is often truant from school - beginning before age 13

Answer 11

Two syndromes: - aggressive behaviour: argues a lot, destroys things, purposefully disobedient, fights - rule-breaking behaviour: breaks rules, lies, steals, is truant Children can exhibit one or both of these problems Aggressive behaviour carries a higher degree of heritability than rule breaking behaviour

Answer 12

Expressed differently in boys and girls Aggression in boys: - defined as an intent to hurt or do harm to others (ex. Hitting, pushing, or threatening behaviours) Aggression in girls: - more directed to hurting another person’s feelings (relational aggression) - ex. leaving someone out of play/excluding from peer group, telling a person you won’t like them unless they do as you say, lying about someone so others won’t like her

Answer 13

Rate 1%-15% of ODD Rate 2%-10% of CD Comparable across countries

Answer 14

Loeber’s 3 pathways model: Authority conflict - stubborn behaviour, defiance, disobedience, truancy Covert - property damage, lying, fire setting, theft, burglary Overt - physical violence, bullying, and sever forms of violence (rape, attacks, strong arm)

Answer 15

Children can clearly learn to be aggressive by being rewarded for such behaviour Can also learn through exposure to aggressive models - vicarious learning Can build the child’s repertoire and lead to disinhibition of aggression - family violence is a source of modelled aggression - parents who punish their children physically serve as models of aggressive behaviour Children who exhibit excessive or antisocial behaviours - likely to have siblings/parents/grandparents with histories of conduct problems and records of aggressive and criminal behaviour

Answer 16

Low family SES Marital disruption Poor quality parenting Parental abuse and neglect Parenting style Handing down non-effective parenting from generation to generation Stressors that impact parenting quality Parental psychopathology: alcoholism or other parental psychopathology can impact parental effectiveness

Answer 17

Aggressive and conduct disorder related behaviours tend to run in the family Longitudinal studies suggest a genetic component to CD Inherited characteristics (body build, temperament, sensitivity to alcohol, irritability, sensation seeking, impulsivity) make an individual prone to conduct disorders - mediated by social conditions, family variables, and social learning experiences

Answer 18

Parent completes Likert scale 36 items for CD

Answer 19

Encoding (looking for and attending to aggression) Interpreting (misinterpreting of own and others’ emotions) Looking for alternative responses Selecting a specific response Enacting the response

Answer 20

Poorer problem solving skills Attribute hostile intent to neutral actions Generate fewer responses - and those generated are aggressive Expect that aggressive responses will produce positive outcomes Label arousal in conflict situations as “anger”

Answer 21

With co-morbid ADHD: stimulant medications Mood stabilizers: for extreme aggression and conduct disorder behaviours but works best with parent training and other interventions

Answer 22

Best option! Common features of parent training programs: - how to give commands - how to reinforce behaviours - how to discipline and ignore - prepare for difficult situations Incredible Years Training Series - parenting skills for use with children diagnoses with ODD and CD - comes with standardized videos to model parenting skills Cognitive problem solving skills - targets the interpersonal and social-cognitive aspects of CD behaviour - used in children 4-8 years of age - taught to cope with stressful situations - taped vignettes and discussions - uses child sized puppets, colouring books, and cartoon stickers and prizes Parent and child programs are superior in combination

Answer 23

ADHD predominantly inattentive subtype ADHD predominantly hyperactive/impulsive subtype ADHD combined type

Answer 24

Symptoms are present before the age of 12 Symptoms are displayed for at least 6 months Behaviours go beyond that expected developmentally Impairment identified in social/academic functioning Symptoms must occur in at least 2 different settings

Answer 25

Primary features: - inattentive - hyperactive/impulsive Secondary features: - motor skills - intelligence - cognition (executive functioning skills) - adaptive functioning skills - social behaviour - sleep (lack of sleep) - accidents (very accident prone)

Answer 26

Jump around from one task to another Does not attend to what is being said Is easily distracted Daydreams Has difficulty concentrating

Answer 27

Selective attention Sustained attention

Answer 28

Restless Fidgety Unable to sit still

Answer 29

Actigraphs: little accelerometers that register movements in different planes

Answer 30

In the afternoon

Answer 31

Difficulty controlling their own behaviour Ex. The child might act without thinking, interrupt others, cut in line, engage in dangerous behaviours, appear careless and irresponsible, immature and rude

Answer 32

Clumsiness Delay in motor milestones Poor performance in sports Difficulties with fine motor coordination and timing (particular difficulty in tasks involving complex movements and sequencing, like dancing) About 50% for children with ADHD have motor coordination problems

Answer 33

Overall, children perform worse on intelligence tests Many have co-morbid learning difficulties/disorders Reduced academic achievement 56% need tutoring 30% have to repeat a grade 30-40% end up I’m at least 1 special education placement 10-35% fail to graduate high school

Answer 34

Neuropsychological deficits cluster around executive functioning skills (ie. inhibition, working memory, sustained memory, etc.) Executive functioning skills include those involved in goal-directed behaviour and are involved in planning, organizing, and self-regulation

Answer 35

Deficiencies in everyday adaptive functioning skills (ie. brushing teeth, washing their face, getting ready for school) Deficits are in doing rather than knowing Parallel with clumsiness

Answer 36

-Quickly alienates themselves from peers —> worse if the child is non-compliant and aggressive -Can correct social behaviours but are disorganized, impulsive, or distracted during social activities -May not adequately process social emotional cues -Overrates peer relationships as positive

Answer 37

Problems falling asleep Needing less sleep Involuntary movements (leg restlessness, grinding teeth)

Answer 38

Children with ADHD tend to have more accidents and injuries (broken bones, bruises, lost teeth, poisonings) Parents report that children with ADHD are inattentive in risky situations and unaware of consequences of their actions (ie. walking into traffic)

Answer 39

Marked increased over the last 20 years 5-9% in school aged children 2-7% in community based samples and similar rates around the world Assessments using evidence based measures estimate about 20% of children have clinically significant concerns Presentation changes over time Diagnosis usually occurs in elementary school aged children and decrease into high school and beyond Some suggestions of differences in prevalence across social class, ethnicity, and culture

Answer 40

2:1 or 3:1 (boys:girls) in the general population 4:1 (boys:girls) in a clinical population

Answer 41

Boys: aggressive and antisocial behaviours, excessive running, climbing, escaping, etc. Girls: inattentive and disorganized - girls often do not meet diagnostic criteria on DSM - can go undiagnosed and miss out on early intervention - girls show many secondary features: executive functioning difficulties, academic problems, negative peer evaluations, higher rates of anxiety, mood disorders, and conduct problems

Answer 42

Symptoms emerge early and children do not often “outgrow” them (but sometimes do) Community based sample of low income boys between ages 2-10 show 4 developmental pathways: - chronic - medium - moderate - low

Answer 43

Brain damage

Answer 44

Right frontal corticies Caudate nucleus Globes palidus

Answer 45

ADHD involves the under-arousal of frontal cortices ADHD involves dopamine and norepinephrine deficiencies ADHD is heterogeneous- there are a number of expressions of symptomology that is reflected in the disruption of different brain regions or circuitry But the underlying neuropathology is still unclear

Answer 46

10-35% Strong genetic component!

Answer 47

Prenatal exposure to maternal smoking and alcohol has been linked to the risk of ADHD in the offspring Exposure to lead has been implicated in disrupting the development of brain areas associated with the control of attention/activity level and executive functioning skills

Answer 48

Developmental/family history Perinatal period/acquisition of milestones Examination of home/school environments Examination of co-occurring disorders

Answer 49

Used in the diagnosis of ADHD in children and adults Involved monitoring a continuous stimulus set for the Occitan ce of a target Typical results in ADHD: make errors in omission and commission

Answer 50

In 1937, Bradley and co observed that Benzidine improved the behaviour of children in an inpatient residential care ward Most commonly used medications are stimulants: methylphenidate, dextroamphetamines, and amphetamine Ritalin: peaks 2 hours and out of the system within 4.5 hours Concerta: peaks in 4 hours and out of the system within 8 hours Adderall: blend of dextroamphetamines and amphetampnes Strattera: norepinephrine reuptake Medications have limited time releases

Answer 51

Consequences for behaviour: - positive behaviour —> lead to desired social or play activities - negative behaviour —> lead to loss of opportunities, time out, loss of earned reinforcer Parent training programs: - teach parents child management techniques (for 4-12 year olds) Classroom management: - working with teachers and administrators to set up a code of conduct and consequences

Answer 52

Don’t work on 10-20% of cases and behavioural/inattention changes reach optimal levels in only 1/2 of the children who are responders Biological side effects: sleeping problems, decreased appetite, stomach pains, headaches, irritability, jitteriness, growth suppression Increase risk of child’s addiction to medication/recreational drugs?

Answer 53

Ages 6-9 600 kids total 4 treatment groups: medication only, behavioural interventions, combined treatment (medication and behavioural), community care (treatment as normal) Plus a normal comparison group (no ADHD) Measured core adhd symptoms at several time points First 14 months was most intense (weekly check-ins, medication, teacher follow ups) Findings: - medication alone and the combined treatment were both better than behavioural alone and community based treatment - medication is most effective, and the addition of behavioural treatments have additional benefits, but behavioural treatments alone are not as effective - if a child has both ADHD and anxiety, behavioural treatment was just as effective as medication and combined treatments - high income families benefited the most from combined treatment

Answer 54

The comprehension of language used by others

Answer 55

The production of language

Answer 56

The environment (ex. Immigration and bilingualism)

Answer 57

Receptive: turns to source of sound, startles in response to sudden sounds, watches your face as you talk Expressive: makes different cries for different needs, imitates coughs or other sounds

Answer 58

Receptive: responds to their name, understands being told “no” Expressive: gets what they want through sounds and gestures, plays social games with you, repeats babble sounds

Answer 59

Receptive: follow simple 1-step directions, look across the room to something you point and look at Expressive: uses three or more words, uses gestures to communicate - “waves”, gets your attention using sounds, gestures, and pointing while looking at your eyes

Answer 60

Receptive: follows 2-step directions Expressive: uses more than 100 words, uses at least 2 pronouns “you” “‘me” “mine”, combines two or more words in short phrases

Answer 61

Receptive: begins taking short turns with other children in reciprocal communication, shows concern when another child is hurt or sad Expressive: uses adult grammar - “two cookies” “I jumped”, uses more than 350 words, uses action words “run” “spill” “fall”, produces words with two or more syllables “com-pu-ter”

Answer 62

Graphemes Phonemes Syntax Grammar Semantics Pragmatics

Answer 63

Whether the child has deficits in expression and/or receptive language

Answer 64

Child fails to display developmentally appropriate and dialect appropriate speech sounds - difficulty articulating speech sounds - fail to display age-appropriate speech sounds - course of speech sound delayed - incorrect speech sounds - misarticulation - denotes

Answer 65

Difficulties comprehending the communication or others and difficulties with expressing language - difficulties with comprehension and production of language - may present as silent (mistaken for selective mutism) - may not respond to speech - may respond inappropriately to others’ speech

Answer 66

Standardized assessments reveal expressive deficits that fall below nonverbal intelligence and level of receptive language or comprehension - production of language is abnormal in standardized measures - limited amount of speech, small vocabulary, parts of sentences may be missing, generate unusual words, make errors is using plurals and verb tenses

Answer 67

Overall, rates of language impairment range from 3-7% of children in the general population Boys are reported as having higher rates than girls Language disorders usually appear by 3-4 years - but some impairments may only become evident with increased demand in schoolwork and language complexity

Answer 68

Language disorders - impairments in language expression and reception Reading disabilities - deficits in the ability to discern the meaning from words in text Written expression disabilities - deficits in the ability to transcribe and generate text Mathematics disabilities - deficits in numerical understanding, learning, representations, and retrieval of basic arithmetic facts

Answer 69

Discrepancy between IQ and academic achievement level Performance on a measure of general cognitive capacity (IQ) significantly exceeds performance on a specific test of achievement The discrepancy of 2 or more standard deviations between IQ and achievement scores is required

Answer 70

Core instruction - 75-90% (level I) Supplemental - 10-25% (level II) Intense - 2-10% (level III)

Answer 71

Learning disorders: these disabilities are specific deficits that appear discrepant with intelligence and other abilities Learning disabilities: refer to specific developmental problems in reading, writing, and arithmetic

Answer 72

Involves deficits in the ability to discern the meaning from words in running lines of text A number of defects in processes are involved: - visual-perceptual deficits - phonological processing - phonological awareness - irregular word forms - syntax, semantic components, and working memory

Answer 73

4-10% of school aged children 3:1 or 4:1 (boys:girls) High comorbidity with ADHD and CD (3.5% with both) Difficulties can emerge around grade 4 Difficulties can persist into adolescence and adulthood

Answer 74

Children will have difficulty in transcription and text generation or composition Transcription involves putting ideas into written form Deficiencies in poor handwriting, spelling, punctuation, capitalization, and word placement Handwriting: fine motor skills Spelling: draws on phonetic skills, word recognition, retrieval of learned letters, and words from memory Text generation: memory for words, understanding sentence structure, higher order executive functioning, and meta cognitive skills

Answer 75

6-10% of school aged children

Answer 76

Involves the understanding of numbers and the learning, representation, and retrieval of basic arithmetic facts In younger children, arithmetic abilities build on skills in understanding number, numerosity, and counting

Answer 77

5-8% of school aged children

Answer 78

Children often have difficulties with peers (less popular and face rejection) Have fewer friends, lower quality friendships, and higher levels of loneliness Have lower social competence than peers Have difficulties identifying emotions, understanding social situations, and in social problem solving

Answer 79

Learning disorders associated with a lowered sense of self worth Compared to same aged peers, students with learning disorders report more helplessness, lower self esteem, even when their school grades are comparable Consequences: academic failure —> give up in the face of difficulty —> experience more failure —> reinforces belief in their lack of ability and control —> academic failure…

Answer 80

Need to identify discrepancy between language or learning domain and IQ Uses standardized testing - Academic standardized testing - language specific testing

Answer 81

Intellectual disability is characterized by significant limitations both in intellectual functioning and in adaptive behaviour as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18. -AAIDD ID is linked to the social environment and level of supports that should be assessed

Answer 82

Mild: 50-70 Moderate: 35-50 Severe: 20-35 Profound: below 20

Answer 83

Focus more on functional descriptions of the child’s needs than IQ

Answer 84

Intelligence involves the knowledge possessed by a person, ability to learn or think, or the capacity to adapt to new situations. General ability, g, plus other abilities (motor, verbal)

Answer 85

How individuals process information

Answer 86

Stable and valid

Answer 87

What people do to take care of themselves/ relate to others in daily living Conceptual skills, social skills, and practical skills

Answer 88

Sensorimotor behaviours Communication Self help Primary socialization skills Ex. Can they: sort cups into different sizes? Organize by colour? Zip up their own zipper? Wave? Use a spoon to feed themselves? Say hi or bye? Follow directions? Ask for help?

Answer 89

Reasoning/ judgements about the environment Reasoning/ judgement about social relationships Ex. Can they: determine something looks dangerous? Recognize social norms? Dress themselves? Understand they need a coat because it’s cold out?

Answer 90

Mild: - usually develops social and communication skills in preschool - 6th level grade by late teens - may need guidance but often successful in the community Moderate: - usually develops communication skills in early childhood - unlikely to progress beyond 2nd grade - can adapt to supervised community living Severe: - may learn to talk at school age - limited ability to profit from pre-academic training - can adapt to community living Profound: - often has a neurological condition - sensorimotor impairments - requires constant supervision

Answer 91

May be 2-4x that found in the general population Most common are ADHD and ODD/CD

Answer 92

Overshadowing Cognitive/communication impairments of ID make it difficult to identify Criteria do not apply well to lower levels of disability

Answer 93

1-3% of the population has ID, which is greater than predicted by normal distribution Prevalence of ID depends on age and severity of ID Gender and SES also influence rates of ID

Answer 94

Biological condition accounting for ID Genetic processes, prenatal/perinatal/postnatal issues, or a combination of factors

Answer 95

At least 50% of variance in intelligence due to transmission of multiple genes More likely for mild ID

Answer 96

Higher prevalence of ID in lower SES - possibly due to less access to good nutrition, which is really important for development

Answer 97

Most common (1/800-1200) Trisomy 21 - error during meiosis Reduced brain size, reduced number/density of neurons, abnormal dendrites Moderate to severe disability Deficits in short-term memory/ auditory processing, delayed speech acquisition; good visual-spatial abilities

Answer 98

1/4000 males, 1/6000 females Moderate to severe ID Weakness in visual-spatial cognition, sequential information processing, etc. Many boys also have ASD

Answer 99

1/777-20000 Small deletions of several genes on chromosome 7 Mild to moderate ID Abnormal brain activation during tasks involving response inhibition, visual processing, and auditory processing of music/noise Deficits in short-term visual-spatial memory; short-term verbal memory and verbal ID typically stronger Excessively outgoing/friendly; generalized anxiety/ specific phobias

Answer 100

1/10000-15000 Micro deletion of chromosome material - genomic imprinting Abnormal functioning of hypothalamus/serotonin Hyperphagia (eating everything) is the leading cause of death IQ often >70 Relative strengths in spatial-perceptual organization and visual processing; relative weakness in short-term motor/auditory/visual memory Skin picking, concerns with exactness/order/cleanliness/sameness in environment (highly co-morbid with OCD)

Answer 101

Bayley scale - used in children 1-42 months - sensorimotor focus - developmental index rather than ID - identifies developmental delays Mullens scale of early development - used in children 0-48 months - expressive, receptive, gross motor, fine motor, visual reception - developmental index - assess early ID - ex. Putting different sized cups into each other, matching shapes to their places, counting blocks

Answer 102

Wechler scales of intelligence Stanford Binet 5th edition - fluid reasoning, general knowledge, qualitative reasoning, visual spatial processing, and working memory Leiter international performance scale 3rd edition - completely nonverbal measure of intelligence for nonverbal individuals - used in cognitively delayed, non-English speaking, hearing impaired, speech impaired, or individuals with ID - tests 3-75 years Individuals with ID typically fall below 70 for IQ (well below average)

Answer 103

Communication domain - receptive, expressive, written Daily living skills domain - personal, domestic, and community Socialization domain - interpersonal relationships, play and leisure, coping skills Motor skills domain - gross and fine motor Maladaptive behaviour domain - maladaptive behaviours index

Answer 104

Refers to an individual with a mental health disorder and a co-occurring developmental disability Approximately 1-3% of Canadians have a developmental disability, but prevalence rates of a dual diagnosis are really hard to determine Individuals with a DD often struggle to articulate symptoms related to a mental health disorder

Answer 105

No direct treatments to get rid of the disorders, but programs to help build daily living skills that may allow them to live independently

Answer 106

Communication and social interaction difficulties Subscribe to specific interests Repetitive behaviours

Answer 107

Sensory difficulties (ex. Loud noises, hates the feeling of jeans on legs) Cognitive skills (those with higher IQ have fewer autistic symptoms) Motor skills

Answer 108

1 in 68 children Comparable rates between socioeconomic, ethnic, and racial groups 1:4 girls to boys (but this is changing)

Answer 109

Awareness Widening criteria for diagnosis Diagnosis substitution Environmental factors

Answer 110

Leo kanner: Worked in a psych ward; found that some individuals (mostly boys) had very similar major characteristics which included communication difficulties, echolalia, language difficulties, high desire for repetition, very reactive to loud noises Hans Asperger: - worked in a psych ward; observed boys that had very similar behaviours, including those above, with the differences of average intelligence and average language

Answer 111

Persistent deficits in social communication and interactions Presence of restricted, repetitive, and stereotyped behaviours or interests

Answer 112

Social communication and interaction deficits (language use, nonverbal behaviours, communicative intent) Repetitive, restrictive, and stereotyped interests Inflexible and non-functional routines and rituals Insistence on sameness Repetitive motor mannerisms

Answer 113

Impairments must be present in early developmental period Clinically significant impairments (functional, interferes with quality of life) A global developmental delay or intellectual disability can co-occur, but not always - majority of individuals on the spectrum have average or above average IQ

Answer 114

DSM-4: No clinically significant delay in language Higher cognitive ability Fewer presentations of core symptoms Now: No longer recognized by the DSM-5

Answer 115

Sensory and perceptual sensitivities (hyper or hypo) - auditory, visual, smell, touch, synesthesia Intellectual challenges and strengths - 40-50% have some associated ID (IQ<70), higher IQ associated with decreased impairments Emotional and behavioural challenges - fear, aggression, hyperactivity, self-injurious behaviour High co-morbidity (70%) - ADHD, anxiety and depression, OCD, substance use, etc. Adaptive functioning skills - daily living skills, gross and fine motor skills, self-help skills, communication and social skills Splinter skills - music, mathematic, spelling; 25% with splinter skills Savant skills (autism savant syndrome) - remarkable skill/talent, exceeds typical development, 5% display savant skills

Answer 116

Heterogeneous - core symptoms may improve (but not disappear) - features fluctuate - mental health challenges

Answer 117

1 in 59 children 4:1 boys to girls

Answer 118

Pharmacological: - targets associated behavioural features, but not core features Behavioural intervention: - most supported treatment - targeted (specific deficits) or comprehensive (numerous features) Discrete trial training (DTT): - most common behavioural approach - teaches complex skills by breaking them down into smaller discrete components or skills Psychosocial interventions: - focus on improving social skills and emotional functioning

Answer 119

Age 2 However, age 4-5 is the average age of diagnosis

Answer 120

Altered brain growth, most implicated in the frontal lobe, temporal lobe-limbo system, and cerebellum

Final Exam Flashcards

(145 cards)