Midterm 1 Flashcards
(179 cards)
1
Q
Characteristics of Abnormal Behavior
A
Disability/functional impairment
personal distress
violation of social norms
dysfunction
2
Q
disability/functional impairment
A
Chronic alcohol consumption results in job loss - academic probation - creates a functional impairment
excessive social anxiety prohibits someone leaving home (to what extent is it impeding their development?)
3
Q
personal distress
A
hopelessness of depression
fear associated with being bullied by peers
4
Q
violation of social norms
A
antisocial behavior of the sociopath
conduct disorder
5
Q
dysfunction (wakefield, 1992)
A
or harmful dysfunction
a) deviation from social values and norms
b) failure of a mechanism’s naturally selected function
more of a biological factor
6
Q
why should we care about mental disorders
A
common conditions associated with lower functioning significant economic consequences negatively influences 'physical' health public health concern
7
Q
common conditions
A
eg prevalent
8
Q
associated with lower functioning
A
eg social relationships, occupational, academically, conduct disorder
9
Q
significant economic consequences
A
eg health expenses, loss of productivity
10
Q
negatively influences ‘physical’ health
A
eg “risk” and “reciprocal” influences
11
Q
public health concern
A
eg ‘risky’ behavior
12
Q
Worldwide Disability (2001)
A
estimating how consequential diseases are worldwide
Neuropsychiatric disorders 13%
HIV/AIDS 6%
Injuries 12%
psychological problems are becoming more and more consequential
13
Q
Children’s mental health problems
A
1 in 8 children, including infants and toddlers, has a significant mental health problem that significantly impairs functioning
many others are at risk for later development of a psychological disorder
25% of children who require mental health services receive only 12% of treatment dollars - those who need it most are least likely to get it
the majority of children needing mental health services do not receive them
by 2020 the demand for children’s mental health sevices is expected to double
14
Q
psychopathology
A
studies of the nature, development, and treatment of mental disorders
15
Q
nature
A
MRI studies of schizophrenia during cognitive tasks
animal models of anxiety, ADHD, addiction
-primates, rodents, fruit fly (autism)
16
Q
development
A
what predicts the onset vs. the stability of depression?
why do some victims of abuse develop mental health problems and why do others develop problem-free?
17
Q
treatment
A
is cognitive behavioral treatment more effective for social phobia than psychodynamic psychotherapy?
how effective are prevention programs for drug abuse?
18
Q
what is a paradigm (kuhn, 1992)
A
a conceptual framework that guides scientific inquiry
-theoretical/empirical approach
-assumptions, definitions, methods
advances in psychopathology research will likely result from multiple paradigms that integrate concepts and methods
19
Q
theoretical foundations
A
understanding developmental processes and of individual and situational events that can influence outcome (eg how does development go awry?)
etiology
20
Q
etiology
A
biological, psychological, and environmental processes interact to produce outcomes over time
-multiple, interactive causes - rather than one-dimensional models - help in understanding the complexity of disorders
how do they combine - not look at things individually
21
Q
abnormal development is multiply determined
A
children and their environments are interactive and dynamic (“transactional”)
- children and environments are reciprocal (eg the parent influences the child and the child influences the parent)
22
Q
development involves…
A
continuities and discontinuities
23
Q
continuity
A
developmental changes are persistent and continuous
-stability
24
Q
discontinuity
A
developmental changes are inconsistent and perhaps non-linear
-long spans of disorders with breaks (eg depression for 2 years and the a 5 year break, etc)
25
risk factors
variables that PRECEDE a NEGATIVE outcome and INCREASE the chances that the outcome with occur
- chronic poverty
- parental mental illness
- community disasters
- family breakup
- pregnancy and birth complications
26
protective factors
variables that REDUCE the chances of a child developing a disorder
-if you smoke - you can exercise for a protective factor to reduce the risk of smoking
27
Development is...
dynamic and interactive
- the child constitution interacts with the environment over time
- there are cross influences - cross time influences
- what happened to a person at 1 year old affects where they are at age 2 and so on
28
biological perspectives
neurobiology
| neuroplasticity and the role of experience
29
neurobiology
brain and nervous system functions as underlying causes of psychopathology
-MRI (magnetic resonance imaging)
30
neuroplasticity and the role of experience
brain shows use-dependent anatomical differentiation throughout the course of development
experience plays critical role: transaction between ongoing brain development and experiences
-prenatal environment
-childhood illness and diet
-early caregiving (eg maltreatment)
31
key principles from behaviorism
positive reinforcement
| negative reinforcement
32
positive reinforcement
behaviors followed by pleasant stimuli (eg giving someone something) are strengthened or at minimum they are maintained (ie those behaviors increase in frequency)
-students complain about difficult midterms --> professor makes final exam easier
shaping
33
shaping
reward a sequence of responses that approximate the final response
eg successive reinforcement for phobias
-control the environment, continued exposure with a positive reward
sometimes with anxiety disorders people can't even say the word so the first weeks would be just to say the word, then move to showing a picture of the phobia, etc - using systematic desensitization
34
Negative Reinforcement
TAKING SOMETHING AWAY
behaviors that terminate a negative stimulus are reinforced (eg increase in frequency)
-this is not a punishment
-seatbelts and car 'beeping' (the beeping stops when you buckle up)
-parents and children (child tantrum stops when giving what they want - parent is negatively reinforced, child is positively reinforced)
Psychopathology
- withdrawal symptoms related to substance dependence
- psychological "distress" (eg depression, anxiety)
- relationship interaction patterns: romantic relationships, parent-child relationships
35
Genetics and Psychopathology
genetic influences on virtually all phenotypes
| excellent example of integrating genetics and traditional psychopathology research
36
genetic influences on virtually all phenotypes
(eg observable characteristic)
| -personality, IQ, height, religiosity, political affiliation, diabetes, cancer, health behavior
37
excellent example of integrating genetics and traditional psychopathology research
- how heritable are common mental disorders?
- can we find specific genes?
- are there separate 'risk' and 'protective' genes?
- how are genes and the environment related?
38
Important genetic terms/concepts
heritability
| phenotype
39
heritability
amount of phenotypic variability due to genetic factors (eg h2 = .65 means 65% of observed variability)
H2 is a population statistic, not an individual indicator
heritability ranges from 0-100% (or 0-1.0)
40
phenotype
disorders caused by a single genetic variant with mendelian transmission (eg cystic fibrosis, down's)
-if they have that gene then 100% of them have the disease
Complex : mental disorders, quantitative traits (eg height, personality, IQ, weight, blood pressure, brain anatomy) there is NO ONE cause
- multiple genes interacting with one another and the environment
- no 1:1 correspondence between gene(s) and complex phenotypes
- pleiotropy
- genetic heterogeneity
41
pleiotropy
single gene influencing multiple phenotypes
42
genetic heterogeneity
one phenotype influenced by many genes
there is no ONE cause
43
Twin Studies
the logic of behavior genetics
-monozygotic (MZ) twins are genetically identical
-dizygotic (DZ) twins and full-siblings share 50% of genes
-what is the probability an MZ twin is affected with the same disease as the other MZ twin if it is 100% genetic?
-are more biologically related relatives more similar?
-do traits that 'run in families' always suggest genetics?
-No! why not? environmental influences (eg modeling)
you don't just share DNA, you also have the same parents, you are raised in the same house, etc.
44
Family relationship --> genetic relatedness
monozygotic twins 100%
first degree relatives (DZ twins, full siblings) 50%
second degree relatives (aunt, uncle, half siblings) 25%
third degree relatives (cousin) 12.5%
general population 1%
mother nature has provided a great way to estimate heritability based on genetic variability
45
What twin studies tell us
the risk of developing schizophrenia based on the relationship to person with schizophrenia
can infer heritability of a disease (eg bipolar disorder is more heritable than unipolar 8x vs 3x more likely)
46
Common Environment
```
shared environment
# of books in the house
SES
absence of parent
maternal depression
same school
makes twins SIMILAR
```
47
Unique Environment
```
non shared environment
peer influences
birth order
sex differences
victimization
parents treat children differently
outside influences
makes twins DIFFERENT
```
48
Heritability of common traits/disorders
listen to recording for importance of slide 26 in week 1 slides
49
adoption studies
try to disentangle genetics from environmental influences
50
common design strategies
twin study - objective: differences in genetic relatedness, same environment - key comparisons : identical twins together, fraternal twins together
adoption study - objective: same genetic relatedness, different environments - key comparisons : identical twins together, identical twins apart
THIS WILL BE ON THE TEST
51
Gene/Environment Correlations
refer to genetic effects on individual differences in liability to exposure to particular environmental circumstances
- Active gene-environment correlation
- Evocative gene-environment correlation
- Passive gene-environment correlation
52
Active gene-environment correlation
child genes influence their behaviors that influence how children select their environments
selection of environments is not random, those choices partially reflect genetic traits
hanging out with the friend who is a "bad influence"
attempting to surf the biggest/deadliest wave in Hawaii
gambling
going out to the bar
53
Evocative gene-environment correlation
child genes influence child behaviors that evoke different types of responses in other people
the responses aren't random: temper tantrums, irritable, ungrateful children aren't going to be treated the same way as a child who is conscientious and eager to please
in a study on antisocial behavior: the children were all adopted and categorized based on biological mothers' behaviors and they measured antisocial behavior compared to adoptive mother's negative parenting
-children whose mothers were antisocial are more antisocial (genetically) so they evoke more harsh, angry negative emotions from their adoptive parents
54
Passive gene-environment correlation
parental genes influence parental behaviors that influence the kind of rearing environment that they provide
- environments that parents "create" or provide for children are associated with children's development
- is it causal or is it that the parents who are more likely to do things such as smoke during pregnancy or verbally abuse a child or put headphones on their belly so their fetus can listen to music, are not random? we think environments CAUSE things in child's development but we don't know for sure that it is 100% environment or some genetics as well
55
family studies
show that both genes and environment have an influence on a child
56
gene-environment interaction
concern (variation in the population) genetically influenced individual differences in the sensitivity to specific environmental factors/experiences (or vice versa)
- highlight to synergistic relation between genes and the environment
- nature and nurture (NOT VERSUS)
- specifies the conditions under which genetic or environmental risk is expressed
- molecular genetics measure specific genetic variants whereas behavior genetics is anonymous (genetic effects are inferred)
57
Caspi et al. 2003 likelihood of developing depression
these data suggest that the interactions depend - seem substantially dependent on genetic influence AND the environment
listen to recording about this study
58
Caspi et al. 2002 antisocial behavior
only looked at Monoamine Oxidase A in boys
large difference in the severe case (depends on abusive environment AND whether low MAOA or High)
our genes could be relatively dormant for specific traits
59
Diathesis- Stress
a paradigm
integrative model incorporates multiple causal factors
diathesis
stress
psychopathology reflects more than one cause
the stress is a heuristic (listen to recording - slide 37 week 1)
60
diathesis
```
underlying prdisposition (biological and/or psychological)
increases one's risk of developing disorder (increased probability)
```
61
stress
environmental events or experiences
| -may occur at any point after conception : "trigger" or "activates"
62
Take home messages about psychopathology
advances in psychopathology were derived from theoretical innovations (eg behaviorism) and integration with biology and animal models
psychopathology is defined by measurable behavior with clear impairment/distress
-appraised within a particular social/cultural context
paradigms include psychoanalytic theory, neuroscience, genetics, and diathesis-stress
63
Coca-cola vs Pepsi
- in the 1970s coca cola had a 3:1 sales lead over Pepsi in Dallas. Pepsi commissioned a taste testing study to compare the two brands of soda
- participants were coke-drinkers in the Dallas area
- subjects were asked to express a preference. To avoid bias, Coke was labeled "Q" and Pepsi was labeled "M"
- Pepsi reports that results indicate that more than half of the participants chose Pepsi over Coke and used this study WIDELY in their ads
64
alternative explanations for the Pepsi effects
Participants: who are these people? is dalla representative of all Americans? age, gender? perhaps coke drinkers 'prefer a change' of pace (eg no comparison group)
experimental method:
-labeling - the letter "M" is more popular than the letter "Q"...experimental confound
-experimenter bias - did those administering the drink know the code and this affect presentation?
-order effect - were the M drinks always served first?
-were samples the same? was one colder than the other?
Data Analyses:
-is more than half statistically significant? more than half could be 51 to 49 which is not statistically significant
65
followup: coke vs pepsi
in a follow-up, cok did a taste test in Dallas in which 2 cups of Coke were compared, one in an "M" cup and one in a "Q" cup
more than half the participants chose the "M" cup although the drinks were identical
Coke said this substantiated possible confound in the Pepsi taste study
Pepsi responded by repeating the study with the same design but using different letters of the alphabet on the cups, but still always used 1 letter for Pepsi and another for Coke
they still maintain that their conclusions are supported
66
Concepts in Research Methods
```
Principles, procedures and practices
way of critical thinking
parsimony
plausible rival hypotheses (refutation)
findings vs conclusions
```
67
Principles, procedures and practices
HOW the science is conducted
68
way of critical thinking
theories, hypotheses, refutation, limitations
69
parsimony
simplicity and elegance
70
plausible rival hypotheses
(refutation) alternative explanation (theory, design/methods)
placebo effects, experimenter bias
71
findings vs conclusions
what was found in the study vs explanation
72
Common Research Designs
Case Study
Correlation
Experiment
73
Case Study
Collection of detailed biographical information
74
Correlation
study of the relationship between two or more variables; measured as they exist in nature
are variables X and Y systematically related?
-do people with more stress have more headaches
variables measured, not manipulated
correlation does not imply causality
-school achievement and the # household appliances (household appliances is not causal but it is an indication of something - wealth)
directionality problem
- X may cause Y: Going to USC may decrease IQ
- Y man cause X: having low IQ may lead you to SC
Third variable problem
-variable Z causes both Variables X and Y (eg SES)
75
Experiment
includes:
- a manipulated IV,
- a DV
- preferably at least one control group
- random assignment
provides info about causal relationships
can evaluate treatment effectiveness
Experimental effect (differences between groups)
76
Correlational vs Experimental Designs
correlation: all participants complete same measures --->measure recent life stress ---> measure blood pressure ---> correlate life stress and blood pressure
Experiment: all participants randomly assigned ---> give speech in front of an audience or sit quietly ---> (manipulation check) measure blood pressure ---> compare blood pressure readings of the two groups
77
Cross Sectional Design
causes and effects measured at the same time
| limited to reporting associations but cannot make more formative statements (eg directionality)
78
Longitudinal Design
studies same participants and constructs over time
high risk method
Prospective
Retrospective
allows to disentangle "temporal order" (eg does variable x precede condition y)
doesn't prove that x causes y but it proves that y doesn't cause x
79
high risk method
-include those who are at greatest risk for developing a disorder
80
Prospective
follow forward (eg chilhood to adolescence)
81
Retrospective
follow backward (eg ask adults about their childhood behavior)
82
Important Research Constructs
what happens in terms of how the study is conducted that can explain the variation in the data
internal validity
external validity
83
internal validity
extent to which experimental effect is due to the IV
- History
- Instrumentation
84
History
period/cohort effects (ef catastrophes)
85
Instrumentation
updated measures (eg SAT)
86
external validity
results generalize beyond the study
-"site" for Tx studies (eg community vs UCLA)
how well do the results generalize past the immediate study 0 given how the study was done (procedure and participant characteristics), how confident are we that this could generalize to the general public?
87
Analogue Experiment
```
experiments (direct manipulation) aren't always possible
-ethical or practical constraints
-examine related or similar behavior in the lab
Lange et al J. Abnormal Psychology
-observation
-challenge
-design
-finding?
-explanations?
```
88
observation
parent substance use in families of children with behavior problems
89
challenge
direction of association?
90
design
undergrads interact w/child confederates (normal vs. problem); "drinking period" after having been 'primed' by future interaction w/same child
91
finding?
increase in drinking but for men only
92
explanations?
type of alcohol, time of day that the study was conducted (may not drink in the earlier part of the day), parents vs someone spending a short time with a child (hours vs minutes with a kid)
93
Levels of Adult Alcohol consumption induced by interactions w/child confederates exhibiting normal versus externalizing behaviors
```
Sample/design
N = 32 college students (50% male)
randomly assigned to child "type"
2 "trained" child confederates
18" of observed interactions
post interaction stimulus
```
male college students after spending time with troubled child drank considerably more than males who spent time with normal child and females who spend time with troubled child
94
Reliability
consistency of measurement
Types:
Test-Retest
Parallel Forms
Inter-Rater Agreement
95
Test-Retest
measure of stability
similarity of scores across repeated test administrations or observations (eg experimental SAT questions)
time 1 compared with time 2
high reliability if r> .95
96
Parallel Forms
A measure of equivalence
give 2 different forms to the same people
compare form 1 with form 2
97
Inter-Rater Agreement
measure of observer agreement (eg coding social behavior)
have 2 people rate behaviors
# of agreements/# of total obs
evaluate % age
two people do the same task and see how reliable they are
98
Validity
How well does a test measure what it is supposed to?
extent to which a measure is associated with another measure
examples include:
-predictive
-concurrent
-incremental
standardization and norms
99
predictive validity
does the measure predict another variable measured in the future (GPA and income/Salary)
how well a test helps infer performance on another related measure
results from one test correspond to results of other measures of the same phenomenon
does the SAT predict college GPA
100
concurrent validity
two measures administered at the same time (hopelessness and depression)
results from one test correspond to results of other measures of the same phenomenon
is there a high correlation between intelligence test and concurrent GPA
101
reliability and validity
a test can be reliable WITHOUT being valid; but a test CANNOT be valid without being reliable
102
the validity of marital researchers?
who are the marital experts?
Journal of marriage and family
method: view video of 10 couples discussing a marital problem for 3 minutes. Answer two questions: will they still be married five years later; rate their marital satisfaction at the time of the taping on a 1-10 scale
marital researchers were the worst at accuracy in judging marital satisfaction
marital therapists, undergraduates, and clinical grad students were next
recent divorces, newlyweds, and long-term marriages were the best
103
moderators
predictors, correlates, and treatment of psychopathology are dynamic processes
simple 1:1 relationships do not represent the complexity of the 'real world'
-# years education predicting future outcome? (moderated by field/profession - eg prof vs attorney?)
-family-based treatments for mental disorders may depend on psychopathology in the family
-common moderators in psychology: gender, age, SES, race-ethnicity
changes the nature of the relationship between the dependent and independent variables
104
Menarche and Antisocial Behavior
moderated by school factors
menarche=menstrual cycle
the association of age of menarche and antisocial behavior is moderated by the type of school the female attends
females at mixed sex schools in general showed higher signs of ASB
but early maturers are mixed sex schools showed the highest levels
105
parenting and ASB (wooton et al. 1997) moderators
callous-unemotional traits moderat parenting and ASB
negative and ineffective parenting have long been associated with aggression and ASB
-but the prediction is far from perfect (eg, some kids are aggressive regardless of parenting)
-under what circumstances is the association between parenting and ASB stronger or weaker?
-what do the scatter plots suggest?
looking at subgroups of kids gives more information
N (not callous) changes as a function of parenting C (callous-unemotional) doesn't
106
Mediators
mediating variables (how 1 variable causes another variable)
-the process, mechanism, or means through which a variable produces a particular outcome
-mediators tell us HOW a variable influences another
Eating popcorn at the movies and going to the bathroom (drinking soda would be the possible mediator - could also be getting up to wash hands)
Daycare and frequency of illness (exposure to other children)
Poverty and negative child outcomes (partially mediated by stress and disrupted parenting)
ADHD and later depression ("Dual failure" - academic failure and peer rejection)
107
there isn't always ONE mediator
A) Mother's negative mood and frequent hassles ------->child's behavior problems
B)Mother's negative mood and frequent hassles --> Mother's use of discipline ---> Child's behavior problems
mother's use of discipline helps to account for this relationship
mediators: the type of discipline used by mothers on days they are feeling distressed mediates the relationship between maternal distress and child behavior problems
108
DIagnosis
the classification of disorders by symptoms
109
classification
system for representing the major categories or dimensions of child psychopathology and the boundaries an relations among them
110
Idiographic
child's unique situation
111
Nomothetic
general categories
112
Advantages of diagnosis
facilitates communication among professionals
advances the search for causes and treatments
cornerstone of clinical care
113
DSM-5
diagnostic and statistical manual of mental disorders
widely accepted system
-classifies mental disorders
diagnostic criteria fro behaviors that
-fit a pattern
-cause dysfunction or subjective distress
-are present for a specified duration (eg 6 months to a year)
-are not otherwise explainable by another better explanation (ruling out other options)
make a reasonable effort to make sure symptoms aren't caused by something else - not simply checking off the boxes
114
Criticisms of Classification
stigma against mental illness
categories do not capture a person's uniqueness
Inaccurate classification and iatrogenic effects
115
stigma against mental illness
- treated differently by others
| - difficulty finding a job
116
categories do not capture a person's uniqueness
-the disorder doesn't define the person (she is an individual with schizophrenia, not a schizophrenic - not all schizophrenics are the same)
117
Inaccurate classification and iatrogenic effects
-self-fulfilling prophecy
-treatments 'intended to help' may have negative effects
(unintended acts with negative consequences)
118
Categorical Classification System
presence/absence of a disorder
-you are or aren't anxious
does the person have high blood pressure? ---> yes or no
119
Dimensional Classification System
Continuous quantitative dimension
-degree to which a symptom is present
-how anxious are you on a scale of 1 to 10?
where does the person's blood pressure fall on a continuum of measurement?
120
Categorical vs. Dimensional Systems
"classical/pure" categorical approach assumes that every diagnosis has a clear underlying cause and that each disorder is fundamentally different from other disorders
-categorical approach has advantages for research and understanding
dimensional classification approaches assume that many independent dimensions or traits of behavior exit and that all children possess these to varying degrees
-dimensional systems may better capture an individual's functioning
121
Interrater Reliability (diagnosis)
extent to which clinicians agree on the diagnosis
patient -->dr X Bipolar disorder/Patient --> dr Y Bipolar disorder ---> Reliable diagnosis
patinet -->dr x Bipolar disorder/Patient --> Dr. Y Schizophrenia ---> not reliable
122
Inter-rater reliability of selected DSM diagnoses
For most DSM diagnostic categories, reliability is good
Reliability in everyday settings may be lower than in formal research settings
```
BP Disorder .84
Major Depression .80
Schizo .79
Alcohol Abuse 1.0
Any Eating Disorder .77
Panic Disorder .65
```
123
psychological Assessment
techniques employed to:
- describe client's problem
- determine causes of problem
- arrive at a diagnosis
- develop a treatment strategy
- monitor treatment progress
Ideal assessment involves multiple measures and methods
-interviews, personality inventories, etc.
124
Assessing Disorders
multi-method assessment approach that emphasizes the importance of:
- obtaining info from different informants
- in a variety of settings
- multiple methods that include interviews, observations, questionnaires, and tests
Evaluate a child's strengths and weaknesses across many domains
125
Behavioral Assessment
evaluates the child's thoughts, feelings and behaviors in specific settings to formulate hypotheses of the problem
- target behaviors are the primary problems of concern and the factors that control or influence them
- ABC's of Assessment
- coal is to identify as many potentially contributing factors as possible, and to develop hypotheses about which are most important and/or most easily changed
126
ABC's of Assessment
Antecedents, the Behaviors and the Consequences of behaviors
127
Characteristics of Clinical Interviews
"a question rightly asked is half answered." - CGJ Jacobi
- Interviewer attends to how questions are answered (does client ignore question? appropriate emotion?)
- Paradigm influences information sought (CBT vs Psychodynamic....Thoughts vs early childhood)
- Good rapport essential (eg empathic, accepting)
- formal (structured) vs informal (open-ended) - structure interviews ask the same questions in a predetermined order
128
Intelligence Testing
evaluating intellectual and educational functioning is a key component in clinical assessments
- "overall capacity of an individual to understand and cope with the world around him/her" - Wechsler
- emphasizes fluid reasoning abilities, higher order reasoning, and info processing speed
you have to make sure that every time a question is read that the wording is the same, etc. so that you can be confident that the differences in results are due to true differences in intelligence and not just because they were administered differently
129
Hypothetical MMPI-2 Profile
I'm troubled by discomfort in the pit of my stomach every few days or often (true=hypochondrias)
Once in a while I laugh at a dirty joke (false=depression)
I am worried about sex matters (true = hysteria)
my way of doing things is apt to be misunderstood (true=psychopathic deviate)
at times i enjoy being hurt by someone i love (true=schizo)
- there is a lie scale to tell if someone is being dishonest
- items that are frequently endorsed, such as "I have never had a bad though before" suggests that perhaps that person is trying to present in a specific way
- multiple strategies are important because any one strategy is susceptible
130
Scoring the Szondi
asked to pick 3 pictures you like and 3 that you dislike
```
categories you pick
-indicate underlying conflicts
-doesn't matter whether you like or dislike them
categories you don't pick
-indicate true personality
THIS HAS MANY PROBLEMS
```
131
Projective Tests
When you present an individual with a vague stimuli, the person has to project themselves onto the image and theoretically the image is getting into your personality
Drawings, Rorschach Inkblot test
132
Rorschach Inkblot Test
collectively these are projective tests
interested in looking at how you use the card (are you using just a piece of it, color, form)
looking at how you derived at what you are saying
133
Thematic Apperception Test (TAT, CAT)
the cards vary in their theme
| some of them are positive, some negative (listen to recording for full explanation - slide 19 on lecture 4)
134
Cognitive Ability
IQ Tests
Picture Completion
Block Design
135
Sample Neuropsychological Tests
Stroop Test
| Wisconsin Card Sorting Task
136
Stroop Test
Interference test that measures inhibitory control
137
Wisconsin Card Sorting Task
Principally a measure of cognitive flexibility
138
Developmental Pathways
Multifinality
| Equifinality
139
Multifinality
```
Similar early experiences lead to different outcomes
SAME START POINT
-maltreatment
MULTIPLE NEGATIVE OUTCOMES
-substance use
-violent offending
-depression/anxiety
-poor health
-marital difficulties
```
140
Equifinality
```
Different factors lead to similar outcome
MULTIPLE START POINTS
-early abuse
-prenatal exposure
-familial instability
-poverty
SHARED OUTCOMES
-academic failure
-peer rejection
-substance abuse
```
141
Conduct Disorder (Equifinality)
possible beginnings:
genetic pattern
familial characteristics
environmental features
142
ADHD: Inattention (A1)
principally sustained inattention or task persistence (attention is multidimensional - selective attention and sustained attention - sustained attention is the main focus of ADHD)
- fails to give close attention to details, careless mistakes
- often has difficulty sustaining attention in tasks
- often does not seem to listen when spoken to directly
- often doesn't follow through on instructions and fails to finish school work, chores, or duties
- often has difficulty organizing tasks and activities
- often avoids, dislikes, or is reluctant to engage tasks that require sustained mental effort
- often loses things necessary for tasks or activities
- often easily distracted by extraneous stimuli
- often forgetful in daily activies
143
Selective Attention
ability to select where to attend when presented with multiple stimuli
144
Sustained Attention
one's ability to sustain attention for an extended period of time
145
ADHD: Hyperactivity (A2)
can you self regulate?
principally poor inhibitory control
-often fidgets with hands or feet or squirms in seat
-often leaves seat in class or in other situations where remaining seated is expected
-often runs about or climbs excessively (later in development can manifest as restlessness)
-often has difficulty playing quietly
-often talks excessively
-often blurts out answers before the question
-often has difficulty awaiting turn
-often interrupts or intrudes on others (eg conversations)
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Diagnostic Criteria for ADHD
- must meet at least 6 of the criteria within A1 and/or A2 and have experienced for at least the past 6 months
- several inattentive or hyperactive-impulsive symptoms were present prior to age 12
- criteria for the disorder are met in two or more settings (eg at home, school or work, with friends or relatives, or in other activities)
- there must be clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning
- the symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better accounted for by another mental disorder
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DSM-5 Changes to ADHD criteria
Ages 17 and older - 5 or more symptoms of inattention and/or hyperactivity
several symptoms must be present prior to age 12 (changed from age 7 onset)
autism spectrum disorder no longer exclusionary with respect to ADHD
no formal subtypes ("specifiers")
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ADHD Subtypes
don't exist formally but there are differences - not every kid with ADHD looks the same
- Predominantly Inattentive
- Predominantly Hyperactive-Impulsive
- Combined
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Predominantly Inattentive
- slow processing, deficits with info retrieval, anxiety/mood disorders, more gender equity (1.5:1) ADHD is more prevalent in boys than girls, but girls are more likely to express predominantly inattentive
- different pattern of peer difficulties (ignored instead of rejected)
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Predominantly Hyperactive-Impulsive
- Almost exclusively found among young children
| - mostly thought of as a precursor to combine
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combined
-most prevalent form of ADHD
-associated with aggression, defiance, peer rejection, suspension and placement in special ed classes
children haven't been asked to it still and pay attention for extended periods of time until 1st grade
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demographic characteristics of ADHD
prevalence: 5-7% of school-aged children, but higher in recent estimates (Barkley, 2005)
- over-diagnosed in some communities and under-diagnosed in other settings
- studies suggest ADHD is related to SES and race-ethnicity
reliable sex differences, mostly for ADHD-combined
-may partly reflect biases (eg delays in referrals)
Cross culturally valid (24 countries)
- it isn't global but it can be found in other countries
- when countries have structured educational models there is a higher prevalence
- using standardized methods to diagnose
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What affects estimates of ADHD prevalence?
- Age of participants (some of the hyperactivity attenuates as they get older - but for some it doesn't go away entirely)
- Informants (parents vs teachers vs youth)
- research methods (sample, interview vs rating scale)
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comorbidity
2 or more disorders diagnosed in the same person
conduct problems and aggression
- up to 50% of ADHD children will have co-occurring aggression/conduct problems
- ADHD + aggression portends significant persistence and poor outcomes
internalizing problems
- 25-33% will have significant mood disturbance
- depression and anxiety most common, but also bipolar
- important because it changes treatment recommendations
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ADHD disrupts development
- likely that ADHD is present at birth, but difficult to identify (toddlers/preschoolers)
- hyperactivity-impulsivity usually appears first and slowly dissipates over time (but not in everyone)
- inattention/disorganization generally persistent
- deficits in attention increase as school demands increase
- most children still have ADHD as teens with impairment into adulthood
- question of 'growing out' depends on your question...symptoms vs impairment (some of their symptoms will naturally go away but all of the problems associated with it don't go away)
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Clinical and Health Outcomes
studies on the predictive validity of ADHD
Multifinality defines ADHD
-higher health care expenses(unrelated to mental health)
-Substandard academic achievement (more academic problems lower levels of achievement)
-poor social functioning (peer relationships are much more confrontational (negative))
-eating pathology (girls with adhd compared without adhd showed more binge eating, different attitudes about eating, etc.)
-substance problems
-Occupational instability
-accidental injuries (big source of the higher health care expenses)
-driving risks and auto accident (driving simulation showed more impaired driving to real world situation)
-workplace competency (rated far less competent than those workers without adhd)
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prospective association of childhood ADHD and substance abuse/dependence : metaanalysis
compared children with ADHD to those without and followed to see lifetime substance abuse
listen to recording for results of slide 14 in ADHD lecture
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family context of ADHD
Parent Psychopathology
- consistent evidence that parents of children with ADHD have psychological problems themselves
- maternal depression
- maternal ADHD
- Paternal ASPD (antisocial personality disorder)
- substance disorders and alcohol consumption
- direction of influence?
Parent-Child Interaction
- less responsive, more negative/directive
- evident in preschool, school-age and adolescent youth (ie across development)
miscellaneous family correlates
- parenting stress (higher levels of stress when dealing with a child with ADHD)
- marital discord/dissatisfaction
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social context of ADHD
social skills
- less cooperation, empathy, etc.
- applies to interactions with peers, siblings, teachers, parents
peer relationships
- higher rates of rejection
- impressions are stable and immediate (formed in a matter of hours and very difficult to change)
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Social Context : Lee & Hinshaw 2004
impressions with respect to peers - summer camp was meant to be as regular a setting as they could set it (while collecting data) - gathering info from the kids about their thoughts and emotions about other kids in class after the 1st day - same procedure on the last day and found out how many times a child was nominated as 1 of the 3 kids that others liked the least correlated at .75
within a matter of hours if you are negatively appraised you are likely to be negatively appraised 6 weeks later
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Controversies in ADHD: Is ADHD a real disorder?
yes it is very real and very valid
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Controversies in ADHD: Is ADHD over diagnosed?
just because it is real and valid doesn't mean that people aren't misdiagnosed
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Controversies in ADHD: overmedication of children?
yes, there's no one size fits all in diagnosis or treatment so it is difficult to know what to prescribe and how much
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Controversies in ADHD: Cancer risk for ritalin?
listen to recording slide 17 ADHD lecture
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Controversies in ADHD: treatments with natural supplements
there is no scientific evidence on this
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Controversies in ADHD: gender
until 2001 virtually nothing was known about girls with ADHD (particularly longitudinally)
-the WORLD'S sample size was N=102(with 79 of them controls!)
lots of research still to be done on gender and (listen to recording slide 17)
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Stimulant medication
ritalin is effective, but negative effects?
-in non-human animals, ritalin increases consumption of substances (rats given rat version of stimulant increases use of Methamphetamine and cocaine)
-
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are ADHD children treated with ritalin more, less, or as likely as ADHD children not treated with ritalin to develop alcohol/substance abuse/dependence?
research procedure: meta-analysis
15 long-term studies
N= 2500 ADHD youth
average ages (8 years and 20 years)
Results:
- Nicotine dependence - same chance of developing dependence between stimulant and non stimulant medical treatment
- alcohol abuse/dependence - stim med didn't have increased or decreased likelihood
- marajuana abuse/dependence - stimulant med doesn't seem to have an effect either way
in all measures there was no difference in likelihood between stimulant and non stimulant groups
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(Causal) risk factors for ADHD
- pregnancy, birth and early development
- genetics
- neurobiological factors
- Diet and Allergy
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pregnancy, birth and early development
- low birth weight, malnutrition, neurological trauma, etc. may be related to later symptoms of ADHD
- maternal substance abuse associated with ADHD (could be that mother has ADHD or could be the exposure to the toxins - not really sure which is the factor)
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genetics
heritability estimated at .75 (75% due to genetic factors)
| -DA transporter gene and DA receptor gene
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neurobiological factors
- strong evidence for neuro-cognitive etiology and dysfunction
- frontostriatal circuitry (prefrontal cortex and basal ganglia)
- smaller cerebral volumes & smaller cerebellum
- NE and serotonin (helps identify candidate genes)
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Diet and Allergy
no empirical support as causes of ADHD
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Treatment for ADHD: Parent Training
parenting doesn't cause ADHD but it doesn't mean that it doesn't have an effect
1. Rationale
2. Structure, Structure, Structure
3. Clarity of Communication
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Treatment for ADHD: Parent Training : Rationale
-parents of children with ADHD/DBD have elevated stress, psychopathology, and poor parenting skills
-"child effects" on parenting and parental behavior
-parenting predicts long-term course (ie prognosis, development of comorbidity)
-changes in parenting significantly mediate
many effective treatments
stimulants have been found to have appetite disruption, sleep disruption, diminished height
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Treatment for ADHD: Parent Training : Structure, Structure, Structure
- morning routine, after school, evening, bedtime - consistencies in routine (eg eating, bed time, etc.)
- chart behavior (daily report cards) - they respond well to rewards (much more than normal)
- token economy with incentives and consequences (have child participate in selection process of rewards and punishments, hierarchical reinforcements - daily vs. weekly levels - three key negative behaviors and three key positive behaviors and reward them accordingly)
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Treatment for ADHD: Parent Training : Clarity of Communication
- ensure child's attention: say their name, make eye contact
- use command directive, not a question (they need to be told what to do, don't ask them if they want to do something because the answer won't be what you want to hear)
- specific and concrete ("be a good" girl doesn't work - name a specific behavior that they need to do well)
- developmentally appropriate
- state consequences (ie reminders), follow through
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pharmacology of stimulant medication
- historically, studies of stimulants in rodents focused on very high dosages (which increased hyperactivity)
- low oral dose of stimulant medication decreased motor activity in juvenile rates (not about opposite or paradoxical effects -in order to successfully control inhibitory control, it needs to be energized in a way to be able to control the behavior - it doesn't effect behavior directly - it just stimulates the part of the brain to exercise the control)
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biochemical effects of low dose MPH
stimulant medication blocks DA transporter and enhances DA release in nucleus accumbens and dorsal striatum
at low levels of MPH:
-minimal sensitization and no euphoria
-largest increase of DA in PFC: how is that relevant to ADHD?
INCREASED DA and NE in PFC is the central mechanism of action for stimulant medication
