Week 3 Lecture 3a - Disorders of Childhood (DN) Flashcards Preview

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Define the term Developmental Disorders.

  • those conditions that are manifested in clinically significant ways during children’s developing years and are a source of concern to families and the educational system


What are three areas of controversy in the area of Developmental Psychology?

1. The growing number of children diagnosed with a disorder

2. The growing number of children on medication

3. The change of reference for autism spectrum disorders in the DSM-5






What is an important consideration when looking at the concept of normality or abnormality?

  • context 
  • take into account the developmental period of the child




How was there a change of reference of Autism Spectrum Disorders in DSM-5?

  • Changed in DSM-5
  • Aspergers was separate
  • Pervasive developmental disorders have all been put together
    • Autism, Aspergers now put on a continuum
    • Conduct & Oppositional Defiance moved into a separate category 




What are two different ways that behaviours manifest in disordered children

  • Externalising
  • Internalising
    • Social Withdrawal, Anxiety, Depression


How do boys and girls differ in their behavioural manifestation of childhood disorders?

  • Girls - typically more internalising
  • Boys - typically more externalising



When can a diagnosis of ADHD be made?




  • Severe
  • Persistent
  • Problematic


“When hyperactive behaviours are extreme for the developmental period, persistent across conditions, and linked to significant impairments in functioning, the diagnosis of ADHD may be appropriate”




Give a conceptual understanding of the DSM-5 Criteria for ADHD?

6 or more behaviours listed under 

  • Inattention &/or
  • Hyperactivity and Impulsivity


  • typically manifests before age 12
  • consistent across multiple settings
  • reduce quality of functioning
  • not exclusive during a psychotic disorder
  • not better explained by another disorder
  • there are three subtypes for diagnosis

(exam: think about the way this disorder manifests)


What are the three subtypes of ADHD?

  • Predominantly Inattentive Subtype
  • Predominantly Hyperactive Type
  • Combined type

can switch between types




What are three characteristics of Attention-Deficit/Hyperactivity Disorder?

 Inattention
 Hyperactive
 Difficulty interacting with peers


What is the prevalence of ADHD?

  • 3-7% of school-age children meet criteria
  • Difficult to diagnose prior 4-5y
  • ~4% adults ADHD
    • (4.4% = Kessler et al., 2006; males, divorced, unemployed, non-hispanic white)


What did Hoza et al., 2010's study look at, and what were the findings?


  • looked at different aspects of childs behaviour
  • the study followed children for 6 years
  • found a viscious cycle of
    • Social Skills (reduced)
    • Aggression
    • Inflated view of self
  • these behaviours predicted poor outcomes




Why might it be difficult to diagnose ADHD prior to age 4-5yrs?

  • diagnostic criteria requires 2 or more settings
    • difficult as the child is not yet in school
  • behaviour may be perceived as appropriate for that developmental age


What were some of the findings in Polanezyk et al., (2007) - which pooled estimates of prevalence worldwide (gender, age, geographical location?

  • Males had higher prevalence (44 studies) than females (40 studies)
    • consistent finding
    • Male more likely to exhibit externalising
    • Females - internalising
    • yes there is a gender difference but must be 
  • More prevalent in children (43 studies) than adolescents (23 studies)
  • Huge geographical differences in prevalence
    • may be due to culture differences in what are considered normal/abnormal behaviour
    • financial status of country


Does the comorbidity of externalising & internalising ADHD behaviours differ?

  • Externalising behaviours
    • overlap with conduct disorders
  • Internalising behaviours
    • overlap with Anxiety & Depression
    • ~30%adolescents may have comorbid intellectual disability(Jensenetal.,1997)


What did Kessler (2006) show about adult ADHD & other disorders

  • much more likely to have other comorbid disorders
    • mood disorders
    • anxiety disorders
    • substance use disorders
    • impulse control disorder


Kessler et al., 2006



What did the NIMH Multimodal Treatment Study of ADHD (MTA) illustrate?


What are the likely comorbid disorders with ADHD?

The overlap of co-occuring disorders 

  • ADHD alone - 31.8%
  • Oppositional defiant disorder 39.9%
  • Anxiety disorder - 38.7%
  • Conduct disorder - 14.3%
  • Tic Disorder - 10.9%
  • Mood Disorder - 3.8%

n = 579

no need to memorise numbers for exam - just the disorders 



What evidence points toward a genetic basis for ADHD?

What system is suspected to contribute to this disorder?

  • Heritability estimates = ~70-80% (Thapar et al., 2007)
  • suspected connection with Dopaminergic System
  • Candidate Genes
    • DRD4 (dopamine receptor gene)
    • DAT1 (dopamine transporter)
  • Move toward epigenetics
  • Genetic*Environmental Studies Req’d





What paper published in the Lancet created controversy around ADHD?

  • Williams et al., (2010)
  • provided evidence that there was a genetic basis for ADHD & that it was not a purely social construct
  • response of people  (media backlash)
    • because they said "direct evidence
  • message of the paper was lost


Is there a neurobiological factor in ADHD?

  • Structural Differences in ADHD
  • ADHD =
  • Smaller right PFC
    • executive function, regulation, inhibition
  • Smaller Caudate Nucleas
  • Smaller Globus Pallidus E.g. Castellanos et al., 2002
    • both parts of basal ganglia (involved in regulation, selection, initiation of behaviours)




What behaviours are associated with Dopamine?

reward, gratification, attention 


What neural differences exist in ADHD compared to a typical brain?

Neural Differences in ADHD

  • Less activation in frontal areas during tasks
  • Reduced striatal activation during inhibition tasks


Environmental Factors in ADHD?


  • Low birth weight?
  • Perinatal Factors inc. nicotine and alcohol


  • 22% mothers of ADHD children smoked one pack/day


  • 8% mothers of non-ADHD children smoked one pack/day


  • Environmental Factors
  • Food Preservatives? (not proven)
  • Lead Paint? (no evidence)

causal no - contributory yes




What Pharmacological Treatments have been used for ADHD?


  • Stimulants
  • Most common – methylphenidate – prescribed since 1960s
  • In 2006, 2.5 million US children taking stimulant medication (10% of all boys)
  • Double-blind, placebo-controlled study. In 75% of ADHD children, stimulants:
  • Reduce disruptive behaviour
  • Improve Concentration
  • Improve goal-directed activity
  • Improve Classroom behaviour
  • Improve social interactions
  • Reduce aggression
  • Reduce Impulsivity



What is an important consideration when looking at medication for a child with ADHD?

  • consider developmental stage of the child
  • sensitive periods
    • medication may give them an opportunity to learn during these periods


Which study looked at alternative treatments for children with ADHD?

The Multi-Modal Treatment of Children
with ADHD Study



  • Tested at Baseline - Treated for 14months – tested Periodically up to 24 months.

1. Community Standard Care
2. Medication Alone
3. Psychosocial Treatment
4. Combined Medication & Psychosocial Treatment


What did the Multi-Modal ADHD study find with regard to

  • Parent Rated Inattention
  • Teacher Rated Inattention
  • Parent Rated Hyperactive/Impulsive Symptoms

- no difference between Combined & Medication alone

- no difference between Behavioural & Community Standard Care

but both

Combined & Medication alone were more effective than either

Behavioural & Community Standard Care





What do the findings in the Multi-Modal ADHD study suggest?

Medical management is effective

& can have a positive impact on child during critically developing years




What did the mutli-modal study show with regard to percentage 'normalised' behaviour 14 months later?

  • The combined medical & behavioural interventionshad the highest success rate
  • followed closely by medical management alone
  • then behavioural
  • then community care


Controls - 88%

Combined - 68%

Medical Management - 56%

Behavioural - 34%

Community Care - 25%


What are the implications of the mulit-modal ADHD study with regard to medication?

  • Is medication the way forward?
  • Three year follow-up – no significant differences (Arnold et al., 2007)
  • Individual Differences
  • Side effects of medications





What are some other psychological interventions for ADHD?

  • Parent-Teacher Training
  • Points System
  • Teachers understand needs of child
  • Peer tutoring
  • Teachers provide daily report

Designed to accommodate limitations NOT challenge behaviour.

MTA study provides support for intensive, behavioural intervention


Is sleep a factor in ADHD?

  • Sleep problems may be increasing in modern society
  • Estimated 30-40% children obtain inadequate sleep
  • children manifest sleep deprivation differently than adults (almost opposite


  • Sleep < 7.7h (10th percentile) associated:
    • Higher hyperactivity/impulsivity scores (9.7 vs. 7.8).
    • Higher attention deficit score (17.3 vs. 14.5)
    • No difference in inattention
  • 7.7 hrs not enough - children ahould be getting 10 hours