Quiz 2 Flashcards
Describe Autism Spectrum Disorder
ASD is a complex neurodevelompental disorder characterized by significant and persistent deficits in two domains:
Describe the two domains
Deficits in social interaction and communication; restricted, repetitive and stereotyped patterns of behavior, interests and activities.
What other factors must be present to receive this diagnosis?
The onset must be during early development, occur in multiple settings, be pervasive, not be better explained by another disorder such as intellectual disability or COS.
What is the prevalence rate of ASD?
One in 68 children, 4-5 times more likely to occur in boys. 70 million people worldwide, all SES and ethnicities
What are some reasons why this seems to be an exponential increase in diagnosis over the last ten years?
Increased awareness by parents and professionals
More screening tools
Most importantly, the definition has been changed to narrow down/rule out IDs and things
Explain this in terms of etiological factors that explain this?
This would be the change in reporting practices, referral patterns and greater public awareness.
What are examples of deficits in domain 1?
Social emotional reciprocity
Non-verbal communication behaviors used for social interactions
Developing, maintaining and understanding relationships
What are some specific behavior examples of these deficits?
Reduced sharing of interests, reduced emotions or affect, failure to initiate or respond to social interactions, poorly integrated verbal and nonverbal communication, abnormalities in eye contact and body language, difficulty adjusting behavior to suit various social contexts, difficultly in sharing imaginative play, absence of interest in peers.
What are some specifiers of domain 2?
Stereotyped or repetitive motor movements, use of objects or speech. Insistence on sameness, inflexible adherence to routines. Ritualized patterns of verbal and non verbal behavior.
Restricted, fixed interests that are abnormal in intensity.
Hyper or hypo sensitivity/reactivity to aspects of environment.
What are some examples of behaviors exhibited as a result of domain 2 deficits?
Lining up of toys Immediate or delayed echolalia Extreme distress at small changes Difficulties with transitions Rigid thinking patterns Greeting rituals Need to take same route and same food Strong attachment to or preoccupations with unusual objects Excessively circumscribed or perseveration interests
What are some of the changes made to the DSM 5
Adding specifiers to indicate when other conditions are present or whether associated with another ND, mental or behavioral disorder
What are some of the findings regarding the etiology of genes and environment with ASD causes?
ASD has high heritability rate; found proportion of variance that explained ASD diagnosis was 60% and the rest due to shared and environmental experiences. and more than 600 genes have been implicated but no single one has large or significant effect on its own.
What report changed how ASD symptoms were described?
The national health statistics report separated out the questions about ASD instead of being lumped in with other DD questions
What study confirmed this result? Why was it not rigorous?
The Denmark study that examined children who were defined as ASD based on the new ICD-10 description. It was a telephone study though it had a very large sample of 677,000 children across five countries.
List the reasons the Wakefield study was scientific fraud.
Sample size of 12 children who all had the same constellation of symptoms; GI problems and a regressive DD. This is Type 1 Error. Also p-hacking; only picked out the 12 that gave results they liked.
It was not an RCT. Wakefield was trying to patent a vaccine by a competitor. The study could not be replicated.
A recent population study found what other possible etiological factor in the implication of ASD?
Parental age was examined among a sample of 5.7 million people in five countries. They looked at what age either parent was when the child was born and found two significant things.
What were the findings of this study?
That when mother and father were advanced in age, the risk increased that the child would have ASD. When there was a ten year or more age discrepancy between the parents, especially with fathers, the risk of the child having ASD increased.
Describe the concept of the medical model of ASD. The book?
ASD is a deficit or drastic deviation from normal behavior that needs to be fixed, like all mental disorders. The person is a problem that needs to be solved instead of understood. Treatment should be sought to normalize the child. Look at all the things that are implicated in the pathology. Elimination and amelioration. And pharma participates in influencing the disease model…
Describe the concept of neurodiversity.
Deficits are differences caused by biological factors and should be celebrated as part of human diversity and emphasizes adaptation rather than trying to match neurotypical functioning. It emphasizes identifying the strengths of the child rather than focus on deficits (which appears to strengthen parent-child bond).
What are the two clusters of ADHD?
Inattention cluster and hyperactivity/impulsivity cluster
Describe the sxs of inattention, selective attention and sustained attention.
Inability to sustain attention.
Ability to concentrate on relevant stimuli while at the same time ignoring irrelevant stimuli. Easily distracted. Mind elsewhere.
Ability to maintain persistent attention during boring or unchallenging tasks-avoids, dislikes, reluctant. Fail to follow through
Fail to give close attention to details, careless mistakes, forgetful
How many symptoms must be present for diagnosis? And with what?
6 of the nine in multiple settings, developmentally inappropriate behavior, not better explained by another mental disorder, sxs do not occur exclusively during the course of schizophrenia or another psychotic disorder, for at least six months and cause impairment.
7 for adult.
What are the three subtypes and how are they assigned?
If you have just six in one or the other cluster, you are ADHD-predominantly that type. If six in both clusters, ADHD combined type.
What are the five central impairments of ADHD?
Hyperactivity, impulsivity, poor self regulation, difficulty inhibiting behavior, reward and motivation deficits.
Why is ADHD a neurodevelopmental disorder?
Early onset and persistent course.
What does having ADHD-predominately inattention type predict?
Academic problems and peer neglect
What does ADHD-predominately hyp/imp type predict?
Aggressive behavior, peer rejection
What does hyperactivity mean?
The under control of motor activity, poor sustained inhibition of behavior, inability to delay a response or gratification, inability to inhibit dominant responses “being driven by a motor.” Extremely active but never accomplish anything.
Impulsivity is ?
Inability to inhibit immediate reaction. Hard to stop ongoing behavior or regulate behavior according to the demands of the situation. Interrupting, intruding, lashing out. Reckless behavior.
The book talks about cognitive impulsivity and emotional impulsivity. Describe
CI is disorganization, hurried thinking and need for supervision. EI is impatience, low frustration tolerance, hot temper, quick to anger, irritability
What are the types of medications used in the treatment of ADHD and what category of drug are they?
They are stimulants, schedule II drugs. Amphetamine, methylphenidate and dextroamphetamine.
What does it mean to be a schedule II and what other drugs are included here?
There is a high potential for abuse that can lead to severe psychological and physiological dependence.
Includes opioids, cocaine
Where in the brain is the target of the effects of stimulants?
The dorsal and ventral striatum which is responsible for motor activity, attention and cognitive function.
What is a downstream effect of stimulants?
Ability to remember things ; your working memory and processing speed.
Describe the effects of stimulants.
They increase the amount of DA in the brain. DA is linked to the reward system, pleasure processes. More DA available for neurons to use.
Describe the process of homeostasis as it relates to DA release.
The DA released at the pre-synaptic axon terminal into the intracelluar space. The job of DA transport proteins is to bind to the DA and take it back into the seminal vesicles. Stimulants block this action so more DA is available. However, because the post synaptic terminal recognizes all this extra DA, more receptors get created which is UP-REGULATION. Tolerance.
The MTA study was a landmark RCT study. What were the four cohorts of the study?
Medication treatment only, behavior training for kids and parents, combination of meds and behavior, and community care.
What longer term treatment yields the best outcomes for which functioning domains?
Combination treatment was the most superior with a moderate effect on all five domains. Those are oppositional/aggressive sxs, internalizing sxs, social skills, parent-child relations, academic functioning.
What are the benefits of state of the art treatment over that available in the community?
The relationship created for MTA kids due to close, consistent monitoring. Dosage and administration of medication, adherence to visits and treatments monitored.
Do some treatments work better for some patients than others? Were there readily identifiable factors that moderated the treatment?
Co-morbidity affected the outcome. If child had ADHD plus Anxiety, the Beh mgt was as efficacious as Med mgt.
It depended on family status so if on public assistance and ADHD plus ANX, Beh and Comb both better than Med mgt.
How and why did MTA treatment work? What accounts for the study findings?
Due to the impact of attendance and compliance with the txt protocol. The medication practices were high quality. Something about the combination of parent training allowed therapeutic effects of meds in the kids.
What is the overall behavioral health impact of the treatments and how was this measured?
At 27 weeks, another assessment was done. If kids no longer met the symptom criteria for ADHD, considered normalized. Comb-68% Med mgt-56% Beh-34% CC-25%
What treatment group worked the best for improvement in the five domains?
Combination
If CC kids are usually medicated, why was the Med mgt superior?
Regular contact between providers, parents and teachers was maintained for the families in the MTA study. For CC, lack of systematic and regular feedback
What were other suggestions based on the findings
More precise matching of patients to treatment using the patients comorbidity profile may mitigate initial clinical uncertainty, reduce the # of therapeutic trials until a a workable txt is found, and yield larger txt gains for specific patients.
What did the readings suggest as a reason for the increase in diagnosis of ADHD
The no child left behind policy-dx went up after states implemented; scores of ADHD kids could be dropped. High-stakes standardized testing, increased competition for slots in top colleges, less accommodating economy for kids who don’t get in to college.
What did Dr. Nigg say in his commentary?
When people don’t fit in, we react by giving them a label-medicalize, criminalize or moralize it.
What is the definition of antisocial behavior?
Inappropriately engaging in actions and attitudes that violate the expectations of societal and familial norms, and the personal or property rights of others.
Describe two inconsistencies regarding youth and society that the book talks about.
Kids with ASBs frequently come from circumstances in which they are exposed to physical and emotional abuse, neglect, poverty and exposure to criminal activity and yet society criminalizes and demonizes the behavior of these youth. Polices and practices that place youth with conduct problems together increase their antisocial and delinquent behavior.
What are the dimensional categories of ASBs? Examples of each.
Covert vs overt, Destructive vs non-destructive. Covert are hidden acts, overt are visible. Lying and stealing vs fighting and bullying. Cruelty to animals and property vs argumentative and irritable.
The book describes some stable patterns of ASBs and some statistics. Explain.
Longitudinal studies find aggressive acts such as persistent physical fighting to be highly stable. An early, persistent extreme pattern of ASB occurs in only 5% of children but accounts for 50% of all crime in the US and 30-50% of clinic referrals.
The book describes four categories of conduct problems that cross the two dimensions previously described. They are?
Covert-destructive or property violations.
Overt destructive or aggressive behavior.
Covert-nondestructive or status violations.
Overt-nondestructive or oppositional behavior.
Another proposal by Ken Dodge describes what dimension?
Reactive vs Proactive. Reactive is your perception that someone or something is out to harm you; the perception is that it is a threat or a provocation and you retaliate with impulsivity or aggression. Proactive is in the pursuit of a desired outcome for yourself-stealing, robbery.
