Midterm 2 Flashcards
(188 cards)
1
Q
what are the 10 different substances?
A
Alcohol, cannabis, opioids, hallucinogens, inhalants, sedatives, hypnotics, anxiolytics, tobacco, other
2
Q
what is a substance use disorder?
A
Problematic pattern of substance use leading to clinically significant impairment or distress as manifested by at least two symptoms occurring within a 12-month period
3
Q
what is the DSM criteria of substance abuse?
A
(1) Substance taken in larger amounts or over a longer period
(2) persistent desire or unsuccessful effort to cut down or control
(3) lots of time is spent in activities necessary to obtain substance, use the substance, or recover from its effects.
(4) craving or a strong desire or urge to use
(5) results in failure to fulfill major role obligations
(6) Continued substance use despite having persistent or recurrent social problems
(7) Important activities are given up or reduced
(8) use in situations in which it is physically hazardous (e.g., driving)
(9) use is continued despite knowledge of having a persistent or recurrent physical or psychological problem
(10) Tolerance
(11) Withdrawal
4
Q
what are early brief interventions?
A
Norm-based interventions
- Individualized feedback about:
* Actual drinking norms
* Comparison between individual’s drinking pattern and the norm
* Changes in perceived norms may mediate tx effects because interventions change norms around drinking
5
Q
what is family therapy?
A
- Multidimensional therapy
- Adolescent – use as a means of coping with stress
- Parents – increased parental monitoring
6
Q
what is alcoholics anonymous?
A
- Very popular – people experiencing problematic alcohol use seek out AA more than all other forms of treatment combined
- 12 steps
- Acknowledging that alcohol is a problem
- Recommend abstinence
- Supported by a peer
- Easily accessible
7
Q
what are the 3 hypotheses of participation in AA?
A
- Attendance may lead to lower alcohol use
- Low alcohol use –> more likely to go to AA
- Good prognosis (more motivation, less comorbidity) –> less likely to continue to use alcohol
8
Q
what is residential inpatient treatment?
A
- Short duration (4-6 weeks)
- Range of treatment programs
- Individual counselling, family therapy, treatment for comorbid disorders
- Often followed by outpatient (continued types of therapies)
9
Q
what kinds of impairments are anxiety disorders associated with?
A
significant impairments
- social (excluded, unliked, victimized), academic (concentration)
10
Q
what are core features of anxiety disorder?
A
Focus on threat or danger
Strong negative emotion or tension, displayed as:
- Physical sensations
- Cognitive shifts
- Behavioural patterns
11
Q
what are the diagnostic specifiers of specific phobia?
A
- Animal (e.g., spiders, insects, dogs)
- Natural environment (e.g., heights, storms, water)
- Blood, injection, injury (e.g., needles, invasive medical procedures)
- Situational (e.g., airplanes, elevators, enclosed places)
- Other (e.g., situations that may lead to choking or vomiting; in children, loud sounds or costumed characters)
12
Q
what is separation anxiety?
A
- Separation from or harm coming to loved ones
- Do not want to be separated from parents
- Worrying about events that might separate them from parents
- Earliest age of onset (7-8) + youngest age at referral
- Half will develop depression as well
- About 1/3 will have this anxiety persist into adulthood
13
Q
what is social anxiety?
A
- Fear of negative evaluation by others
- Fear of social situations in which person will be evaluated
- For children, must occur in peer settings (not just with adults)
14
Q
what is selective mutism?
A
- Failure to speak in specific situations and contexts in which speaking is expected, even though they may speak in other settings
- Reclassified as an anxiety disorder in DSM-5, but not clear that all children with selective mutism are anxious
15
Q
what is generalized anxiety disorder?
A
- Excessive, uncontrollable anxiety and worry
- Worrying can be episodic or almost continuous
- Worry excessively about minor everyday occurrences
- Somatic (physical sx as well)
- Equally common in boys as in girls
- Very comorbid with other anxiety disorders and depression
16
Q
what is a panic attack?
A
period of intense fear or discomfort that develops abruptly and is accompanied by at least four symptoms (e.g., sweating, shortness of breath, feeling like you are choking, chest pain, nausea)
17
Q
how does DSM classify panic disorder?
A
- Recurrent, unexpected panic attacks
- At least 1 attack followed by one month+ of one of the following:
- (a) persistent concern about having additional attacks
- (b) worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)
- (c) a significant change in behavior related to the attacks
(you can have panic attacks and not have panic disorder)
18
Q
what are obsessions?
A
- Recurrent, persistent thoughts, impulses, or images that are experienced as intrusive, inappropriate, and that cause marked anxiety or distress
- These thoughts are not simply excessive worries about real life problems
- The person attempts to ignore or suppress the thoughts or to neutralize them with another thought or action
- The person recognizes that the thoughts are a product of their own mind
19
Q
what are common obsessions?
A
- Contamination
- Harm to self or others
- Symmetry
20
Q
what are compulsions?
A
- Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
- The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded events or situations; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or they are clearly excessive
21
Q
what are common compulsions?
A
- Counting
- Checking
- Washing
22
Q
how do you diagnose anxiety?
A
● Semi-structured interview
● Assesses whether children meet diagnostic criteria for anxiety disorders
● Parent and youth report
● Children as young as 6-years-of age can provide reliable report on the ADIS
23
Q
Lifetime prevalence of any anxiety disorder during childhood and adolescence is:
A
32%
24
Q
___% of youth with selective mutism meet diagnostic criteria for another anxiety disorder
A
80%
25
___% of youth with selective mutism meet diagnostic criteria for social phobia
69%
26
____% of adolescents who meet criteria for Major Depression also meet criteria for an anxiety disorder
77%
27
___% of adolescents who meet criteria for an anxiety disorder also meet criteria for major depression
45%
28
what are the different “typical” age of onset for each fear?
- 2 years of age: Loud noises, animals, the dark, separation from parents
- 5 years of age: Animals, dark, separation from parents, bodily injuries, “bad” people
- 7 to 8 years of age: Dark, supernatural beings, staying alone, bodily injuries
29
what are the different ages of onset for anxiety disorders?
OCD (9 to 12 years)
- Some children will show it very early – 6 to 10 years
Generalized Anxiety Disorder (10 to 14 years)
Social Phobia – adolescence
Panic Disorder – adolescence
30
what is homotypic continuity?
anxiety disorder at one time may predict subsequent anxiety disorders later in development
- E.g., separation anxiety --> social anxiety
31
what is heterotypic continuity?
disorder itself may predict other types of disorders
- E.g., social anxiety --> depression
32
Twin studies indicate that __% of variability in anxiety is heritable
33%
33
what is the Two-stage model of fear acquisition?
● Stage 1: Fear develops through classical conditioning
- Unconditioned stimulus (US)
- Unconditioned response (UR)
- Conditioned stimulus (CS)
- Conditioned Response (CR)
● Stage 2: Avoidance behavior maintained through operant conditioning
- Avoidant behavior provides relief from anxiety
- This is a powerful reinforcer (negative reinforcement)
- Avoidant behavior increases
34
explain the maintenance model of OCD
- Obsession
- Appraisal – think about importance
- Anxiety & disgust –“I’m not going to do that”
- Neutralization – they want to neutralize the thought to get rid of bad feelings
- Distress – through a compulsion, they attempt to reduce distress (leads to increase in importance of compulsive behaviour to neutralize distress)
- leads to more obsessions over time
35
what are the symptom overlaps between GAD and MDD?
fatigue, sleep disturbance, irritability, concentration difficulties
- related to negative affectivity
36
what is race-based rejection sensitivity?
anxiety produced from people facing future racial/ethnic discrimination
- Important mediator among racial/ethnic minority groups
37
what is the difference in obsessions between normal people and those with OCD
the level of IMPORTANCE of these intrusive thoughts/obsessions
38
difference between injunctive and descriptive norms
- Injunctive norms: how much others approve or disapprove of drinking
- Descriptive norms: how much others actually drink
39
explain Social information processing and anxiety
* What do I pay attention to? (encoding)
- Attention to threat
* What does it mean? (interpretation)
- Attentional bias – anxious children show a bias for emotional faces
* What can I do? (response search)
* What will I do? (response decision)
* How well did I do it? (enactment)
40
what are SSRIs?
Selective Serotonin Reuptake Inhibitors
(Paxil, Prozac, Zoloft, Celexa)
- Work by stopping the reuptake of serotonin into the presynaptic neuron
- Increase the amount of serotonin in the synapse
41
what are the core components of effective interventions for anxiety?
(1) reduce cognitive biases
(2) reduce bodily tension
(3) exposure and habituation
42
explain the extinction paradigm
Repeated exposure to CS (when its presented in the absence of US) will extinguish the relationship between CS and CR
43
what is flooding?
all fears at once
- Can be very effective, but very distressing
- Best is graded exposure
44
how do you develop a graded exposure hierarchy?
- List anxiety triggers
- Rate each trigger
- Rank order triggers
45
what are treatment goals of CBT for OCD?
- Normalize intrusive thoughts
- Exposure and response prevention
46
what are the Treatments for pediatric anxiety disorders?
SSRIs, CBT
- For youth, cognitive-behavioral approaches usually recommended first
- Medication does not cure anxiety
- Suppresses symptoms
47
what is information transmission?
being told something is dangerous can make you fear it
48
what was the overall result of the CAMS study with combined, CBT & SSRI?
Combined is associated with best outcomes across all three diagnoses
- CBT = SSRI
49
what was the GAD and SAD result of the CAMS study with combined, CBT & SSRI?
- Social anxiety disorder: SSRI > CBT
- GAD: CBT > SSRI
50
what was the overall result of the POTS study with combined, CBT & SSRI?
* Combined treatment > CBT, meds, placebo
* CBT = Meds
* BUT ….
- Duke: combined > CBT, meds
- Penn: combined was not doing better than just the CBT group
- Suggests: with really good CBT, there might not be an added gain for SSRI meds especially if the meds administration isn’t that great and isn’t thorough
51
how do family factors influence pediatric anxiety?
* Modelling
* Information transmission
* Low expectations
52
what are the core features of depression?
dysphoria, irritability, anhedonia
53
what is dysphoria?
prolonged sadness
54
what is irritability?
- excessive sensitivity, hostility, and moodiness
- unique to children and adolescents
- manifestation in depression
55
what is anhedonia?
loss of pleasure or interest in previously enjoyable activities
56
difference between symptom, syndrome and disorder
* Symptom: Feeling or emotion of sadness, Very common, Fleeting
* Syndrome: Cluster of common symptoms, Extreme on dimension of negative mood/affect, More abnormal
* Disorder / Diagnosis: Cluster of common symptoms, Having a minimum duration of these symptoms, Always need to see some type of functional impairment of difficulties in everyday life
57
what is Major depressive disorder (MDD)?
* Defined by presence of a major depressive episode
* 5 Symptoms Total
* During the same two-week period
* At least one of:
- Depressed mood, most of the day, nearly every day OR irritability (children and adolescents only), most of the day, nearly every day
- Anhedonia (loss of interest or pleasure), most of the day, nearly every day
58
what are the additional MDD symptoms (nearly every day)?
- Significant weight or appetite change
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings or worthlessness or excessive guilt
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent thoughts of death, recurrent suicidal ideation or a suicide attempt
59
what is Persistent depressive disorder (dysthymia)?
* Depressed or irritable mood for most of the day, more days than not, as indicated by either subjective account or by observation by others, for at least 1 year
* Presence while depressed, of two (or more) of the following:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
60
what is pure dysthymic syndrome?
full criteria for MD episode haven’t been met in the preceding year
61
what is pure dysthymic syndrome with persistent major depressive episode?
full criteria for MD episode have been met in the previous year, but after episode ended you were still experiencing lower level symptoms for a very long time
62
what is pure dysthymic syndrome with intermittent major depressive episodes?
met criteria for one or more MD episodes during the past year
63
what is Disruptive mood dysregulation disorder (DMDD)?
* A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation
* B. The temper outbursts are inconsistent with developmental level
* C. The temper outbursts occur, on average, three or more times per week
* D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers)
* E. Symptoms are present for 12 months or more
* F. Not diagnosed before age 6 or after age 18 (disorder of childhood)
* G. Age at onset of the outbursts and irritable mood is before age 10
* H. Child has never met criteria (except duration) for a manic or a hypomanic episode (even lasting one day)
64
Children of depressed parents are more likely to be depressed. Why?
heritability + stress reactivity (Early exposure to stress which may sensitize person to later stress)
65
what is the Hypothalamic-Pituitary-Adrenal (HPA) axis?
- Hormonal response to stress
- Can measure it looking at cortisol in saliva (momentary) or hair (over time)
66
explain social information processing and depression
Encoding – attention
- Depression might be associated with bias to attending to negative info
Interpretation
- Tendency to draw negative conclusions from ambiguous events
Response search – generation
- Identify fewer assertive strategies
Response decision – evaluation among different dimensions
- Report themselves less able to carry out assertive strategies
67
what are behaviours of depressed individuals?
- Less prosocial
- Less assertive
- More avoidant and withdrawn
- Some children with depression are also more hostile and aggressive
68
explain the Stress Exposure Models of Depression
Depression results from exposure to stressful events
69
explain the Stress Generation Models
Depression may lead individuals to generate stressful life events
70
how are friends critically important for healthy development?
- Protect children from feelings of loneliness and depression
- Children with friendships are less likely to be victimized by peers
- Provides an opportunity to develop important social skills
71
what is co-rumination?
- Rumination is the tendency to dwell on problems and not solve them
- Co-rumination is when two friends do it together
72
explain the cycle of reassurance seeking
anxiety --> excessive reassurance and other unhelpful behaviour --> reduction in anxiety (reassuring) --> adverse impact on self/others
73
what is contagion?
when depressive symptoms spread across different people
74
what is subclinical depression?
- They will not quite make diagnostic criteria, but they have a significant number of symptoms
- Show significant impairment
- At greater risk for going on to develop depression as well as other disorders and difficulties
75
explain the results of the interpretation study on depression
Task 1: blend two words acoustically
* At-risk girls showed preference for negative words if depression-related (not threat-related negative words like hate)
* Control showed preference for positive word in neutral-positive pairings
- At-risk group did not show positive preference
Task 2: story completion
- At-risk girls responded more quickly than control girls when ending was negative
- No difference on positive words
- Shows availability of negative interpretations
76
what is interpersonal stress?
Stressors that are social in nature and that the individual has some degree of responsibility for
77
explain the diathesis-stress model in regards to depression
- Personal diatheses interact with stressful life events to disrupt normal mood
- Depression maintained by negative cognitive and behavioral processes
78
explain emotional spirals in depression
Negative events may breed negative moods --> negative moods, negative behaviors --> and negative behaviors, may produce negative thoughts and expectations for the future
79
what are the goals of cognitive techniques in CBT?
Help youths:
- Observe their thoughts, feelings, and behavior
- Consider alternative explanation
- Solve problems and make rational decisions
80
what are behavioural techniques in CBT for depression?
- keep track of mood and activity
- develop list of rewarding activities (pride and pleasure)
- change habits
- monitor IMPACT and refine plan
- process of behavioural activation - increasing pleasurable activities
81
what are Tricyclic antidepressants?
- Prevent the reuptake of norepinephrine and serotonin in the synapses or by increasing the responsiveness of receptors to these neurotransmitters
- Act on norepinephrine and serotonin
- No evidence of efficacy in youth
82
what are Monoamine oxidase inhibitors (MAOIs)?
- MAO is an enzyme that breaks down some neurotransmitters
- MAO inhibitors stop this enzyme thus increasing the level of neurotransmitters in the synapse
- Some mixed evidence of efficacy in teens
- Potentially lethal side effects
83
what are Selective serotonin reuptake inhibitors (SSRIs)?
- Inhibit the reuptake of serotonin so that more is available in the synapse
- Similar to tricyclics, but more specifically focused on serotonin
- Good evidence for fluoxetine (Prozac) in teens
- Tend not to be fatal in overdose
84
what are SNRIs?
- Like SSRIs, but also block norepinephrine
- Used in depression and anxiety
- Similar side effects to SSRIs
- Can take weeks to kick in
85
what are the side effects of SSRIs?
agitation, jitteriness, anger, hostility, nausea, stomach cramps
86
what behavioural processes does CBT target?
- Low reinforcement and negative life events
- Skill deficits
87
what is the FDA blackbox warning?
most serious warning FDA gives
88
how do we go about treating depression in preschoolers?
- therapy recommended as first approach (also PMT)
- If symptoms are severe and persist, fluoxetine (Prozac) has the best risk/benefit profile in older children and is recommended as the first choice in preschoolers
- If medication is used, must be closely monitored by a child psychiatrist
89
explain the results of depression treatment in the TADS study
- groups with active medication did better in terms of depression symptoms (compared to placebo and CBT alone)
- CBT + SSRI recommended for moderate to severe MDD (better for suicidal events)
- Suggests that skills gained in CBT protects against suicidal advance and ideation
- FOLLOW-UP: CBT group caught up in terms of improving depression symptoms
90
why did CBT on its own not outperform placebo in TADS?
- Response to CBT rates higher in previous txs with less severe patients
-Treatment manual very flexible
91
what were the results of the meta-regression analysis?
- Sub-clinical at baseline (meaningful impairing, but not diagnostic threshold) --> 63% lower risk depression at follow-up
- Clinical depression at baseline --> 45% lower risk
92
what were the predictors of positive outcomes of the meta-regression analysis? (for depression)
* Combination behavioral activation + thought challenging
* Involving parents in intervention
93
what were the results of the 2020 meta-analysis?
- CBT studies: effective
- Micro-finance/economic interventions (increase income): effective
- Interpersonal therapy: effective, but only 3 studies
- Integrated (mostly CBT combined with other techniques): most effective
94
why do some medications work for some and not others?
May be due to differences in brain development or metabolism
95
what were the results of the black box warning studies in youth?
* Did NOT find higher rates of suicidal ideation in youth treated with Prozac compared to placebo
* decrease in anti-depressant prescriptions after FDA warning
* suicide attempts trying to overdose on psych meds increased after FDA warning
* there was no change in completed suicides
96
what were the results of the black box warning on young adults?
* Same pattern as adolescents
* Decrease in use of antidepressants
* Sharp increase in suicide attempts
* No differences in suicides
97
what were the results of the black box warning on adults?
* Also saw a decrease in antidepressant use
* No change in attempted suicides or completed suicides
98
what is a manic episode?
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalization is necessary)
99
what symptoms need to be present for a manic episode to occur?
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractibility
- increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
- Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., sexual behavior, shopping, gambling)
100
what is a hypomanic episode?
Same as manic episode except:
- Lasting at least four consecutive days
- Represents a change in functioning for the person
- But no marked impairment in social or occupational functioning
101
what is bipolar 1?
- Manic episode (have to have a full one)
- May or may not show depression
- Specifier – with mixed features
102
what is bipolar 2?
- Major depressive episodes and hypomanic episodes
- Has not ever had a full manic episode
- Specifier – with mixed features
103
what is cyclothymia?
Period lasting at least 1 year (in children and adolescents, 2 years for adults) when there numerous hypomanic and depressive symptoms that do not meet full criteria for either a hypomanic, manic, or major depressive episode
104
what social impairments come with bipolar disorder?
Peers
- Poor social skills
- Frequently teased and victimized by peers
- Few friends
Families
- Poor relationships with siblings
- Frequent hostility and conflict with parents
* Risky sexual behaviour, drug use
105
what is bipolar disorder comorbid with?
ADHD and CD
106
what is lithium?
- A common treatment for adult bipolar disorder
- Mood stabilizer
- Approved for use in children aged 12 and older
- Serious side effects (related to toxicity)
- Compliance with instructions VERY important
- Have to visit physician regularly to monitor side effects
- Study: evidence that its reasonably effective, especially for acute mania and prevention of mood episodes
107
what are atypical antipsychotics?
- Wide-ranging class of antipsychotics
- effective for treatment of bipolar disorder in youth
108
what are antidepressant for bipolar disorder?
- Depression can be chronic and severe
- Mood stabilizer/antipsychotics may not help that
- Bipolar switch – induces mania
- Research is mixed
109
Recommendation for treating mania in youth is often as follows:
- Begin with one atypical antipsychotic
- If patient does not respond, or cannot tolerate the drug, taper, and then try a second atypical antipsychotic
- If patient does not respond to two or three atypical antipsychotics, switch to lithium
- If patient partly responded to antipsychotic, add lithium
110
what is mania in adolescence associated with?
psychosis, mixed episodes (mania/depression), extreme mood lability
111
how do you define recovery from bipolar disorder?
8 consecutive weeks in which an individual does not meet the DSM criteria for manic episode, hypomanic episode, depressive episode, or mixed episode
112
explain pre-pubertal onset with bipolar disorder
2x less likely to recover within a year than people with an adolescent onset
- Much more likely to struggle from manic episode as an adult
- homotypic continuity
113
what is a passive gene-environment correlation?
Not an interaction, but passive transference of risk
114
RTCs have shown support for which 2 family treatments for bipolar disorder?
(1) Multifamily Psychoeducational Psychotherapy
(2) Family-focused therapy
115
what were the results of the CFF-CBT study for pediatric bipolar disorder?
* At post-treatment, youth in CBT group had lower mania symptoms than youth in control group
* 88% of youth in CBT group were below the clinical cut-off for manic symptoms, at post-treatment, compared to 21% in the control group
* Saw similar pattern for parent-reported depression
* No difference for clinician-reported depression
116
explain the difference in bipolar presentation in adults vs kids
- Adults typically have discrete episodes (easily marked)
- In children, may see changes in mood even within the same day
117
what is the problem with the narrow vs broad phenotype?
- narrow: descriptive of adults, not necessarily children
- broad: includes irritability, not it's not a specific symptom of bipolar disorder
118
what is the peak onset of bipolar disorder?
15-19 (full episodes usually don’t occur until this age range)
119
who was the first IQ test developed by?
Alfred Binet and Theophile Simon
120
how was IQ testing seen by eugenecists?
as a way to identify people who they thought should not be allowed to have children
121
what are cognitive abilities?
a set of mental processes which improve and degrade over the course of the lifespan
122
what is intelligence?
a measured quantity which summarizes a person’s ability to apply knowledge and skills
- Basically aptitude
123
what is crystallized intelligence?
use of knowledge (facts, and other things you get through schooling and other life experiences)
- Do you know it or not know it
124
what is fluid intelligence?
Fluid: ability to use your mind to solve novel problems (raw processing power)
- Problem solving
- Fluid goes down across middle age and old age
125
what is mental age?
the level of age-graded problems a child is able to solve
- Used to identify kids who were lower or higher in functioning based on their chronological age
126
what is g?
underlying level of intelligence (general intelligence)
- Causes how well or poorly we perform in specific domains of cognitive functioning
127
what are the 5 WISC domains?
- verbal comprehension (similarities, vocab)
- visual spatial (block design, visual puzzles)
- fluid reasoning (matrix reasoning, figure weights)
- working memory (digit span, picture span)
- processing speed (coding, symbol search)
128
what is standard deviation?
measure of how tightly the scores are clustered around the mean score
129
what is the cut-off for giftedness and intellectual disability?
giftedness: 130+
intellectual disability: 70 and below
130
what is GAI?
- Provides an estimate of general intellectual ability that is less reliant on working memory and processing speed than the FSIQ
- Tasks: similarities, vocabulary, block design, matrix reasoning, figure weights (drops the other ones)
131
what is Gardner’s Theory of Multiple Intelligences?
Rejects IQ score and g
* Argues for 8 different dimensions of intelligence:
- musical-rhythmic
- linguistic-verbal
- intrapersonal
- existential
- logical-maths
- interpersonal
- naturalistic
- visual-spatial
- bodily-kinesthetic
132
what is Sternberg’s Triarchic Theory ?
Practical (street smarts)
- adapting to the environment you're in
- selecting environments in which you can succeed
- shaping environment to fit your strengths
Creative (dealing with novel problems)
- creating, inventing, discovering, imagining
Analytic
- planning, evaluating, analyzing, monitoring, comparing/contrasting, filtering info
133
Under Sternberg’s theory, successful intelligence allows one to:
- Establish and achieve reasonable goals
- Optimize your strengths and minimize weaknesses
- Adapt to the environment
- Use all three components of intelligence
134
what are test norms?
Standards of normal performance expressed as average scores and the range of scores around the average
135
what are criticisms of IQ tests?
* Test knowledge associated with the cultural majority
* Focus on speed of processing
136
how is intellectual disability defined in the DSM-5?
defined by lower levels of adaptive functioning, rather than strictly by intellectual functioning and IQ
- less reliance on IQ bc of the Flynn effect
137
what are the core features of ID?
* Deficits in INTELLECTUAL functioning including reasoning, problem solving, planning, abstract thinking, judgment as confirmed by both clinical assessment and individualized, standardized intelligence testing
- Confirmed through standardized intelligence testing
* Deficits in ADAPTIVE functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility; functioning is limited in one or more activities of daily life such as communication, social participation, and independent living, across multiple environments
- Should be present pretty early in development
138
what are the levels of severity of ID?
- Mild
- Moderate
- Severe
- Profound
139
what are the domains of adaptive functioning (to classify level of severity)?
- Conceptual
- Social
- Practical
140
what is the conceptual domain of adaptive functioning?
- receptive and expressive language
- reading and writing
- money concepts
- self directions
141
what is the social skills domain of adaptive functioning?
- interpersonal
- responsibility
- self-esteem
- gullibility
- navieté
- obeys laws
- follow rules
- avoid victimization
142
what is the practical domain of adaptive functioning?
- personal activities of daily living such as eating, dressing, mobility and toileting
- instrumental activities of daily living such as preparing meals, taking medication, using the phone, etc.
143
explain mild ID
- Applies to about 85% of persons with ID
- May have some social problems
- Typically not identified until elementary school years
- Children from lower SES families are more likely to have mild ID
144
explain moderate ID
- Applies to about 10% of persons with ID
- Usually identified during preschool years (little bit earlier)
- More pronounced difficulties
- Applies to many people with Down syndrome
145
explain severe ID
- applies to about 3%-4% of persons with ID
- often associated with clear organic cause
- little understanding of language and numbers, limited speech
- usually identified at a very young age
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explain profound ID
- applies to about 1%-2% of persons with ID
- usually identified in infancy
- dependent on other for all aspects of care
- almost always associated with clear organic cause and often co-occurs with severe medical conditions
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difference between genotype and phenotype
* Genotype: a collection of genes that pertain to intelligence
* Phenotype: the expression of the genotype in the environment (gene-environment interaction)
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what are organic causes of ID?
- Includes chromosome abnormalities, single gene conditions, and neurobiological influences (mitosis, cell division, etc.)
- Tend to be moderate, severe, and profound
- Prevalence comparable across SES groups
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what are cultural/familial causes of ID?
- Does not have a clear cause
- Includes family history of intellectual disability, economic deprivation, inadequate childcare, poor nutrition, and parental psychopathology
- Tend to be mild cases (most cases!)
- Higher rates in lower SES families
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what are chromosomal abnormalities?
- Most common cause of severe ID
- Down syndrome (chromosome 21, most cases are random events)
- Prader-Willi and Angelman (chromosome 15, most cases are random events)
- Fragile-X syndrome (X chromosome, inherited)
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what are single-gene problems?
- Phenylketonuria (PKU; inherited)
- Cannot metabolize amino acid phenylalanine, rising levels are toxic and impact intellectual development
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what is a neurobiological injury?
- Prenatal (e.g., Fetal Alcohol Syndrome)
- Perinatal (e.g., anoxia at birth)
- Postnatal (e.g., head injury)
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what are the characteristics displayed with down syndrome?
- The underlying symbolic abilities of children are believed to be largely intact
- There is considerable delay in expressive language development; expressive language is weaker than receptive language
- Fewer signals of distress or desire for proximity with primary caregiver
- Delayed, but positive, development of self-recognition
- Delayed and aberrant functioning in internal state language
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Association for Behavior Analysis (ABA) Task Force advocates that:
Each individual has the right to the least restrictive effective treatment and the right to treatment that results in safe and meaningful behavior change
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explain CBT for ID
- Self-instructional training and metacognitive training
- Verbal instructional techniques
- Teaching the child to be strategical and meta strategical
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what are the most most common comorbid disorders with ID?
Impulse control disorders, anxiety disorders, and mood disorders
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what are core features of ASD?
- impairment in communication (expressive)
- impairment in social interaction
- Repetitive patterns of behaviors and interests
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what social impairments do we see in ASD?
- Social imitation (echolalia)
- Joint attention: ability to coordinate attention to a social partner and an object of mutual interest (engaging with the same thing)
- Expressive nonverbal behavior (more difficulties orienting people towards things)
- Reciprocity: social back-and-forth
- Social “mind” (theory of mind)
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what is theory of mind?
Knowing that others have mental states (desires, beliefs, intentions) that guides their behavior
- Understanding that people have different perspectives
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why does self-stimulation (behaviours over and over again) occur?
Theories:
* A craving for stimulation to excite their nervous system
* A way of blocking out and controlling unwanted stimulation from environment that is too stimulating
* Maintained by sensory reinforcement it provides
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what Repetitive patterns of behaviors and interests do we see in ASD?
- Self-stimulation (same behaviour over and over again)
- Intense, narrow interests
- Rigid routines
- Preoccupation with parts of objects
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what is the DSM-5 definition of ASD?
A. Persistent deficits in social communication and interaction, as manifested by:
- Deficits in social-emotional reciprocity
- Deficits in non-verbal communicative behaviors used for social interaction
- Deficits in developing, maintaining, and understanding relationships
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following:
- Stereotyped or repetitive motor movements, use of objects, or speech
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or non-verbal behavior
- Highly restrictive, fixated interests that are abnormal in intensity and focus
- Hyper- or hypo-reactivity to sensory input
* Symptoms must be present during early developmental period
* Symptoms cause clinically significant impairment
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In ASD, how is severity rated (based on level of support)?
* (1) Requiring support
* (2) Requiring substantial support
* (3) Requiring very substantial support
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what is social communication disorder?
Defined by difficulties in social communication
- 1) Deficits in communication for social purposes
- 2) Impairment of ability to change contexts to needs of listener
- 3) Difficulties following rules for conversation and storytelling
* Restricted, repetitive patterns of interest have never been present
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what is Autism Diagnostic Observation Schedule (ADOS) ?
gold standard
- semi-structured observation
- use of presses
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what are presses in ASD diagnosis?
slight push during procedure to elicit types of difficulties associated with autism
- A certain pattern of behavior is likely to appear
- We know that children with autism are likely to behave a certain way
- E.g., unstructured presentation of toys, deviation from routine they were prepared for
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what is ADI-R – Autism Diagnostic Interview (revised) ?
Often paired with ADOS
- They complement each other to come up with a diagnosis
- Interview with parents/caregivers of child suspected of having ASD
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what is Asperger's disorder?
social interaction; restrictive/repetitive interests
- no language deficits
- not diagnostic
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why was the DSM-4 definition of ASD not adequate?
- Distinctions between others disorders were not meaningful
- Pervasive developmental delay not specified
- Didn’t have good stability or reliability
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why has the prevalence of autism increased over time?
Better identification and broader definitions
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name the very early ID tests
(1) using eye tracking to see what toddlers are looking at
- Toddlers with autism focus on geometric rather than social images
(2) Brain enlargement
- Recent data indicate that rate of cortical surface expansion between 6 and 12 months predicts diagnosis of autism at 24 months
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what are the strongest predictors of adult outcomes with ASD?
- Language
- IQ – higher IQ --> more positive outcomes (above 70)
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what are common comorbid conditions with ASD?
ID, epilepsy, ADHD
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how is ID different from ASD?
Children with ID have:
- No specific deficit in joint attention
- No specific deficit in theory of mind
- No specific deficit in pretend play
- Social behaviors appropriate for their mental age
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what is thimerosol?
Preservative in vaccines
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how is the ASD brain different?
Evidence of differences in brain structure and functioning in children with autism but NOT CLEAR IF CAUSAL
- Differences in structure
- Differences in function (decreased activation of mirror neurons, altered activation of facial recognition area)
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what is secretin?
Hormone produced in the intestinal glands
- Used to treat peptic ulcers
- Three children with autism received it for unrelated conditions and improvement in symptoms of autism noted
- Since that time: Several well-designed studies showing no effect
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how are Psychotropic medications used for ASD?
Currently used primarily to treat other psychiatric symptoms that may be present, rather than core features of autism
- SSRIs for anxiety/obsessive-compulsive behavior
- Stimulants for ADHD symptoms
- Antipsychotics for aggression and agitation
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what is oxytocin?
Oxytocin is a neuropeptide hormone implicated in social bonding and social behaviors
- Showed significant improvement in reading social information through eyes (in small trials)
- Caution: work with animals suggests may be long-term consequences (atypical mating behaviour)
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what are the Goals for treatment for kids with autism?
- Minimize core challenges
- Maximize independence and quality of life
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explain the overview of treatment strategies
- Engaging children in treatment
- Decreasing disruptive behaviors
- Teaching appropriate social behavior
- Increasing functional, spontaneous communication
- Promoting cognitive skills
- Teaching adaptive skills to increase responsibility and independence
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explain Applied behaviour analysis (ABA) in ASD
(1) Discrete Trial Training (operant conditioning)
- Therapist begins with a prompt that should elicit the desired skill/behavior
- Positively reinforce the desired behavior
- Shaping
(2) Reinforcing naturally occurring behaviors
- Read a story and reinforce use of language
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what is shaping?
someone may not exact display behaviour right away, but you want to reinforce approximations of that behaviour
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what are Developmental Social Pragmatic Models (DSP)?
- Aim to promote social communication and interaction by being responsive to the child
- More naturalistic interaction
- Build on the child’s communication
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what is Individual comprehensive ABA?
Intensive interventions consisting of 20 to 40 hours per week for 2 to 3 years
- Highest dose of treatment that we’ve looked at
- Start prior to the age of 5 years
- Communication, social skills, cognition, behavior management, pre-academic skills
- Note that there are limitations in this literature
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what is Teacher-Implemented, Focused ABA + DSP?
- Delivered in a classroom
- Less intensive than comprehensive interventions
- Combines ABA and DSP techniques
- Research has found that this approach is associated with greater joint engagement in play activities with caregivers and teachers
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what are the concerns with ABA and ASD?
- Historically, punishment used to shape behaviors
- Can be used to shape away behaviors that are atypical but not harmful
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when is ASD most often identified by parents?
in the months preceding a child's 2nd birthday
