Week 3 Lecture 3b - Disorders of Childhood (55:30) DN Flashcards Preview

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Lecture Summary

  • Early diagnosis of disorders of childhood is critical for prognosis and intervention
  • Much is known about developmental disorders., yet understanding of causal role is still in its infancy
  • Biological aetiology does not always equate to biological treatments e.g., ASD
  • Treatment is currently focussed on managing symptoms rather than eradicating the disorder
  • Children with developmental disorders can lead enriched lives with appropriate support and intervention.




What is one of the most extreme disorder a child can be diagnosed with?

Conduct Disorder


How does Conduct Disorder Manifest?

1. Repetitive and persistent behaviour pattern that violates the basic rights of others or conventional social norms.

3 or more of (15) of the following over last 12months, and at least one in previous 6mths

  • a) Aggression to people and animals
  • b) Destruction of property
  • c) Deceitfulness or theft
  • d) Serious violation of rules

2. Significant impairment in social, academic or occupational functioning

3. If older than 18y, criteria for Anti-Social Personality Disorder not met.


Summarise phenotype of Conduct Disorder?

  • Extreme behaviour
  • Aggression to people, animals, property
  • Violation of social norms


What is the prevalence of Conduct Disorder?

  • 9.5% (Nock et al., 2006)
  • 4-16% boys
  • 1.2 - 9% girls
  • Incidence and Prevalence peak at 17yrs 




What are the three sub-types of Conduct Disorder?

  • Childhood-onset type - development (3y+)
    • usually male, aggressive behaviour
  • Adolescent-onset type
    • less likely to show aggressive behaviour
    • have more normative peer relationships
    • more balanced male:female ratio than childhood type
  • Lifetime persistence type (DSM-5 Unspecified onset???)
    • most common in boys (x 10-15)




What disorders have found to be comorbid with conduct disorder

concurrent disorders

  • ADHD
  • neurodevelopmental difficulties
  • 50% will develop Anti- social P.D.


What is the long term prognosis for children with conduct disorder?

  • Life-course type have severe problems
  • Psychopathology
  • Lower education
  • Partner/Child abuse
  • Violent behaviour
  • Adolescent-limited type - “grow- out’ of disorder
  • 50% will develop Anti- social P.D.






What does the literature say about the Aetiology of Conduct Disorder?

literature is mixed

  • Social
  • Environmental
  • Psychological
  • Neurobiological
    • Genetic link - Heritability estimates - 40-50% genetic




Aetiology of Conduct Disorder? 2


  • Neuropsychological Deficits
  • Psychological Factors
    • Behaviour imitation
    • Reinforcement of aggression
    • Kenneth Dodge - social-cognitive framework 
  • Peer Influences
  • Social Influences


1:03 slide43


What did Caspi et al., (2002) find when looking at the genetic/environmental interaction in Conduct disorder?

  • Genetic x Environmental interaction
  • MAOA gene (warrior gene) (x chromosome) and maltreatment (environmental)
    • Is antisocial behaviour predicted by?
      • MAOA activity? NO (gene)
      • Maltreatment? NO (environment)
      • MAOA + maltreatment? YES genetic environmental interaction


How are Social-Cognitive factors relevant to aggressive behaviours observed in Conduct Disorder?

  • individuals not concerned with repercussions
  • social emotions e.g., empathy, guilt moral awareness are missing
  • the individuals social cognitive framework is atypical




What are risk factors for Conduct Disorder due to Peer Influences?

A lot of peer influence in Conduct disorder

e.g., Gang culture - Belonging to a group


What 'Social Influences' are risk factors for Conduct Disorder

  • urban living
  • unemployment
  • reduced education
  • disruptive family life 
  • family monitoring
  • deviant peers


  • surprising that one particular study found no environmental factor





What is Oppositional Defiance Disorder?

  • 1. A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least 6 months as evidence by at least four from:
    • a) Angry/irritable mood
    • b) Argumentative/Defiant behaviour
    • c) Vindictiveness
  • 2. The disturbance in behaviour is associated with distress in the individual or others in his or her immediate social context, or it impacts negatively on social, emotional, occupational or other important areas of functioning.
  • 3. The behaviours do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysegulation disorder.


Why is the prevalence of Oppositional Defiance disorder higher than Conduct Disorder?

because it isn't as extreme as Conduct Disorder


(Clare said this, but really need to think this through??)


What is the prevalence of Oppositional Defiance Disorder?

  • Prevalence – 1-16%
  • Pre-puberty –mainly boys
  • Post-puberty – exclusively boys
  • Comorbidity with ADHD is high (50-65%)


How is OD both similar & different to ADHD?

  • Similar
    • in the way it manifests
  • Different
    • OD is more calculated/planned behaviour
    • ADHD child is generally reacting not planning it


What is the prognosis for individuals diagnosed with Oppositional Defiance Disorder?

  • Better than CD
  • Mild forms remit 
  • Moderate becomes progressively worse after 5y 
  • Sometimes crosses over to Conduct Disorder


When would a child move from a diagnosis of Oppositional Defiance Disorder to one of Conduct Disorder?

When the behaviour becomes aggressive/violent toward people, animals, property


What are the two main forms of treatment for Oppositional Defiant Disorder?

  • Stimulants
  • Parent Management Training
    • based on operant conditioning (rewarding good behaviours)





What is the DSM-5 definition of Autism Spectrum Disorder (ASD)?

  • A. Persistent deficits in social communication and social interactions across multiple contexts, as manifested by:
    • a. Deficits in social-emotional reciprocity
    • b. Deficits in nonverbal communicative behaviours sued for social interaction
    • c. Deficits in developing, maintaining, and understanding relationships
  • B. Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following:
    • a. Stereotyped and repetitive motor movements, use of objects or speech.
    • b. Insistence on sameness, inflexible adherence to routines, or ritualised patterns of verbal or nonverbal behaviour.
    • c. Highly restricted, fixated interests that are abnormal in intensity or focus.
    • d. Hyper- or hypo reactivity to sensory input or unusual; interests in sensory environment, such as fascination wit lights or spinning objects.
    • e. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment.
  • C. Symptoms must be present in the early developmental period
  • D. Symptoms cause clinically significant impairments in social, occupational, or other important areas of current functioning.
  • E. Disturbances are not better explained by intellectual disability


  • Specificity
  • Severity




How is Autism diagnosed?

  • based on series of semi-structured interviews between
    • Clinical Psychologist
    • Caregiver &
    • Child
  • not clear cut - prolonged, highly specialised proposed


Summarise Autism Spectrum Disorder?

  • Social Communication Deficits
  • Patterns of behaviour (repetitive/restricted)
  • Symptoms present early
  • Clinically significant impairments in functioning
  • Not better explained by intellectual disability


With the change to Autism Spectrum Disorders in DSM-5, what two additional factors form part of a diagnosis?

  • Specificity 
  • Severity


Why is a severity scale necessary?

because there is a spectrum of disorders from mild to extremely severe


Why is a specificity scale necessary for Autism Spectrum Disorder?

  • allows you to specify with or without
    • intellectual impairment
    • language impairment
  • Language used to appear in DSM-IV-TR
  • no longer a feature along spectrum in DSM-5
  • it is now a specifier




What were the hallmark features of ASD in earlier versions of the DSM?

How has this changed in DSM-5?

  • Earlier Versions
    • Social
    • Repetitive Actions
    • Communication 
  • DSM-5
    • Social
    • Repetitive Actions
  • Communication is no longer a hallmark feature it is now a specifier





Why did Autism get more attention than Aspergers


Leo Kanner - published in English

Hans Asperger - did not




Autism, a brief history?

  • 1943 - Leo Kanner
  • observed early infantile autism
  • shut off from the outside world
  • not recognised in DSM until 1980

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