Lecture 7 (Childhood disorders and Adolescent eating disorder)

Question 1

Externalising disorders vs Internal Disorders

Answer 1

Externalising
-> Creates problems for external world
-> Break age appropriate social rules / disobeying parents and teachers
-> anger/aggresion
-> impulsivity

Internalising
-> create problems for internal worlds
-> depression / anxiety / sadness

Question 2

ADHD criteria and types

Answer 2

A -> persistent pattern if inattention (A1) and/or hyperactivity-impulsivity (A2)

Inattention -> six or more for > 6 months
-> no attention to detail, difficulty sustaining attention
-> do not listen when spoken to, cant follow through on instruction
-> cant sustain mental effort
-> loses things, easily distracted, forgetful

Hyperactivity / impulsivity
-> fidgets, leaves seat when not supposed to, run or climb, difficulty playing quietly, on the go, talk excessively or blurt out answers before question is completed, difficulty waiting turn, interrupts or intrudes on others

B -> symptoms present before 12
C -> symptoms present two or more settings
D -> interfere with functioning
E -> no better explanations

Type ADHD-C -> combined inattention or hyperactivity
ADHD-PI -> predominately inattention
ADHD-HI -> hyperactivity-impulsivity predominate

Question 3

Criteria for ODD

Answer 3

A -> pattern of angry mood, argumentative behaviour, vindictiveness, > 6 months
at least 4 symptoms from any categories and exhibited during interaction besides sibling

Angry mood
-> loses temper, often touchy, angry and resentful
Argumentative/defiant
-> argues with authority figures
-> actively defies
-> deliberately annoys others
-> blames others for their mistakes
Vindictiveness
-> spiteful or vindictive at least twice for past 6 months

B -> disturbance in behaviour associated with distress in immediate social context, impacts functioning
C-> behaviour dont occur due to psychotic substance use

Specify severity
Mild -> only occur in one setting
Moderate -> 2 or more settings
Severe -> 3 or more settings

Question 4

Conduct disorder Criteria

Answer 4

Repetitive or persistent pattern where basic rights of others or major societal norms or rules violated 3 or more out of 15 symptoms in past 12 months (at least one in past 6 months)
Aggression to people and animals
Destruction of property
deceitfulness or theft
serious violation of rules

B -> clinically sig impairment
C -> if > 18, make sure not antisocial PD

Question 5

Epidemiology and Aetiology

Answer 5

ADHD most common in children and adolescents, 7.4% of all children
-> 4:1 b/g ratio -> maybe because boys are bit more expressive in their symptoms, smaller ratio when get older cos more girls are getting diagnosed

5.1% ODD in kids, 2.1% CD -> more males then females

for ADHD -> hyperactivity declines in adolescence
ADHD -> 50% persist into adulthood
ODD -> onset usually 2-3 years old, CD adolescence

Aetiology
Genetics -> strongly contribute to ADHD, less to ODD and CD
Temperamental risk -> difficulty in emotional regulation - high reactivity, poor frustration tolerance)
Parenting factors
ADHD -> smoking or substance use in utero
ODD -> neglectful parenting
CD -> neglectful parenting, maltreatment
Psychological factors -> lack of self-control, delay of gratification

Question 6

Treatment of ADHD,ODD,CD

Answer 6

ADHD
pre school -> behaviour interventions
everything above pre school -> combine meds and intervention
Behavioural interventions include triple P, classroom accomodations, organisational supports
Teach personal coping skills
-> make time and mental info physical (e.g. charts) and clocks
-> break up long tasks step by step
-> reinforcement
-> refill self regulation tank

ODD/CD
-> focus on triple P
-> CBT background targeting parents and helping them
-> it is a manual, but then parents can adapt it to tailor the individual and the family, teaches self-regulation in parents and child (e.g. learning what was wrong and getting child to evaluate their actions)
-> individual skills development
-> multisystemic therapy
-> residential programs

Question 7

Internalising disorders

Answer 7

defines depressive and anxiety disorders (criteria same as adults)
for kids depressive symptoms usually comorbid with externalising problems and anxiety -> depressed mood may show as irritability

Separation anxiety disorder
-> inappropriate fear concerning separation from home for 4+ weeks
-> distress anticipating separation
-> worry about losing figures
-> fear about being alone

Selective mutism
-> consistent failure to speak in certain social situations

Question 8

Epidemiology, Aetiology and treatment of internalising disorders

Answer 8

3.2% MDD prevalence
6.9% anxiety disorders -> 4.3% SAD, <1% selective mutism
Childhood depression predicts increase in suicide

Aetiology
-> bio factors high in SAD, predisposition to anxious symptoms
Social factors
-> experience of trauma, attachment issues, overprotectiveness, maltreatment
Psych factors
-> emotion regulation
-> rumination
-> caretaking from depressed parents -> kids feel guilty for not making parent happy

Treatment
-> individual psychotherapy
-> CBT -> components of psychoeducation, emotion regulation, vivo exposure (anxiety), contingency management
-> family therapy

Question 9

Criteria for eating disorders

Answer 9

Anorexia
-> significantly under weight
-> intense fear of gaining weight
-> disturbance in experience of body shape and weight
Type
-> restricting (fasting)
-> binge-eating / purging -> vomiting
Specifiers -> related to BMI -> Mild (17 or less), severe ( < 15) normal range is above 18.5

Bulimia Nervosa
Recurrent episodes of binge eating
Recurrent compensatory behaviour to prevent weight gain
Self evaluation is influenced by shape and weight
Occur at least once a week for 3 months
Disturbance doesnt occur exclusively as AN

Binge eating disorder
Same as BN with the binge eating occuring once a week per 3 months
But there is no compensatory behaviours with it

HIGH comorbidity with MDD, anxiety (PTSD), alc and substance use

Question 10

Epidemiology, aetiology, treatment of EDs

Answer 10

4-16% of Aus have ED
Much more in females than males
Anorexia has highest morbidity rate of all mental illnesses
10% will die in next 10 years
20% in next 30 years
20% of deaths come from suicide

Females from 15-24 with AN have 6-12 times annual death rate compared to all other causes

Medical compromises associated with ED can be stopped with early prevention

Aetiology
social factors
-> image of ideal promotes skimmy
-> ED increase with exposure to media
Family factors
-> young people with BN have more conflict and rejection in families
-> family may have a focus on diet
Psychophysiological factors
high genetics
perfectionism, depression, dysphoria, impulsive or obsessive behaviour
childhood obesity, early puberty

Negative body image
-> critical evaluation of weight or shape
-> negative evaluation of weight lead to disordered eating patterns

Equifinality
-> many pathways lead to developing an ED

Treatment
Meds, hospitalisation
MAUDSLEY method three stages involving family involvement
Stage 1 -> weight restoration
Stage 2 -> transition to individual taking more individual responsibility for maintaining nutrition
Stage 3 -> addressing developmental issues

Individual therapy
CBT-E
Goals -> remove ED psychopathology, correct mechanisms that maintain ED, ensure changes are sustainable