412 pre-M1

Question 1

what are the main issues in child psychology

Answer 1

• defining normal/abnormal behaviour for various ages, sexes, cultural backgrounds
• causes and correlates
• predictions for long-term outcomes
• methods of treatment and prevention
• figuring out the ‘problem’ (children are referred by adults)

Question 2

psychological disorder

Answer 2

• pattern of cognitive, behavioural, emotional, physical symptoms
• causes distress, disability (interferes with daily functioning), distress and disability increase risk of harm

Question 3

competence

Answer 3

child’s ability to adapt successfully within an environment

Question 4

developmental competence

Answer 4

ability to use internal and external resources to achieve adaptation

Question 5

developmental tasks

Answer 5

assessing competence in conduct and academic achievement

Question 6

developmental tasks infancy to preschool

Answer 6

• attachment to caregiver
• language
• differentiation of the self from the environment

Question 7

developmental tasks middle childhood

Answer 7

• Self-control, compliance
• School adjustment
• Academic achievement
• Getting along with peers
• Following rules, prosocial conduct

Question 8

developmental tasks adolescence

Answer 8

• Transition to secondary
• Academic achievement
• Extracurriculars
• Close friendships within/across gender
• Cohesive self-identity

Question 9

developmental pathway

Answer 9

• sequence and timing of behaviours and relationships between behaviours
• maltreatment can alter the initial course of development

Question 10

multifinality

Answer 10

• similar beginning can lead to various outcomes

Question 11

equifinality

Answer 11

• many different beginnings can lead to the same outcome

Question 12

risk factor

Answer 12

precedes a negative outcome of interest and increases the chances that the negative outcome will occur

Question 13

protective factor

Answer 13

• personal or situational variable that reduces the chances for child to develop a disorder
• strength of the individual, strength of the family, strength of the school and community

Question 14

resilience

Answer 14

sustained competence while under stress or rebound to a previously healthy level of competence after a traumatic experience

Question 15

poverty and SES disadvantage

Answer 15

• impairments in learning ability and school achievement
• affects the PFC: reduced impulse control and judgment
• greater inequality and powerlessness = greater impact on mental health

Question 16

more common disorders in boys

Answer 16

hyperactivity, autism, childhood disruptive disorders, learning and communication disorders (more neurodevelopmental disorders with onset in childhood)

Question 17

more common disorders in girls

Answer 17

anxiety, depression, eating disorders (emotional disorders with onset in adolescence)

Question 18

externalizing problems

Answer 18

• acting-out (aggression and delinquent behaviour)
• higher prevalence in boys at a younger age, then decreases and converges with girls rates at age 18

Question 19

internalizing problems

Answer 19

• anxiety, depression, somatic symptoms, withdrawn behaviour
• equal prevalence at an early age for boys and girls, then diverges to be higher for girls at age 18

Question 20

resilience predictors in boys

Answer 20

• male role model, structure and rules, encouragement of emotional expression

Question 21

resilience predictors in girls

Answer 21

• encouragement of risk-taking and independence, support from a female caregiver

Question 22

potential signs of abnormal behaviour

Answer 22

• norm violation (norms are culturally-bound and depends on your reference group)
• statistical rarity (also depends on reference group, some Bx may be statistically rare but don’t cause problems like high IQ, some DSM disorders aren’t statistically rare)
• personal discomfort (may depend on the person)
• maladaptive Bx (interfering with daily life)
• deviation from an ideal (depends on the expectations, some people don’t find their own Bx to fall short of ideals despite being disorders)

Question 23

abnormal Bx definition

Answer 23

• pattern of Sx associated with distress, disability, increased risk of harm or suffering
• adaptational failure (failure to meet developmental milestones with typical Bx as a benchmark)

Question 24

Denver Development Screening Test (DDST)

Answer 24

• shows when certain Bx are expected relative to a large reference sample
• to see whether kids are developing according to norms

Question 25

lifespan consequences associated with child psychopathology

Answer 25

• impacts on social, occupational functioning will be more severe if a problem goes untreated for longer (20% of kids with the most severe and chronic disorders face lifelong consequences)

Question 26

contributions to development of psychopathology

Answer 26

• gender: males in childhood with externalizing problems, females in adolescence with internalizing problems (gender differences may emerge during puberty due to social and biological factors)
• poverty and SES disadvantage: poverty linked with higher rates of many disorders
• racial/ethnic disparities: may be partly due to how clinicans interpret certain behaviours (bias in diagnostic practices)
• culture: meaning of behaviour is interpreted differently, expression of symptoms varies (taijin kyofusho vs. social anxiety), reporting of symptoms varies (reporting physical issues when there is an underlying mental reason)

Question 27

bias in diagnostic practices in terms of Black youth

Answer 27

• more likely to be diagnosed with disruptive disorders, and less likely to be diagnosed with mood and substance use disorders
• likely to be kicked out of school, go to prison, develop other disorders

Question 28

LGBTQ+ youth

Answer 28

• more likely to be victimized by family and peers (verbal abuse, physical attacks, assault, sexual assault)
• this disproportionate level of stressors contributes to the onset of different disorders

Question 29

diathesis

Answer 29

underlying vulnerability or tendency toward disorder
can be contextual (family), biological (genetics), experience-based (certain triggering events)

Question 30

stress

Answer 30

situation or challenge that calls on resources (external negative event)

Question 31

differential susceptibility

Answer 31

• some children are more susceptible to the effects of their environments, both good and bad (there are also protective factors)

Question 32

diathesis-stress

Answer 32

• some children are more susceptible to the negative effects of a problematic environment
• underlying vulnerability interacts with stress experience to produce disorder/no disorder (you still need stressors to get there, but your starting point is pushed closer)
• diathesis will vary in your lifetime - social context will change, epigenetics, diet, lifestyle

Question 33

strengths of the diathesis-stress model

Answer 33

• organizes nature and nurture - no disorder is caused by ‘just genes’ or ‘just stress,’ brain changes in response to the environment (plasticity), genes change in response to the environment (behavioural epigenetics)
• not deterministic, just probabilistic - can have multiple interacting diatheses and stressors

Question 34

etiology

Answer 34

the study of the causes of disorders

Question 35

developmental psychopathology perspective

Answer 35

• problems that arise are a result of multiple interacting factors and causes to lead to the current presentation
• must look beyond current symptoms to consider developmental pathways (disorders can morph from one to another)
• children and environments are interdependent (transactional view)

Question 36

continuous development

Answer 36

• trajectory is smooth: gradual, incremental, quantitative (we can predict where we might be in the future)

Question 37

discontinuous development

Answer 37

• qualitative difference in kind, abrupt changes (where you are now isn’t predictive of where you’ll be later)

Question 38

organization of development

Answer 38

early patterns of adaptation evolve with structure over time

Question 39

sensitive periods

Answer 39

windows of time during which environmental influences on development will be enhanced (like language in early years or the months in fetal development)

Question 40

differentiation and integration

Answer 40

development can be cumulative, skills are based on the accumulation of abilities you already have

Question 41

biological perspectives

Answer 41

• neurobiological: brain is the underlying cause of disorders
• the brain’s function is use-dependent (neural plasticity for nurture, also influence of nature)
• early caregiving and nutrition will affect your brain development

Question 42

maturation of the brain

Answer 42

• basic sensory and motor skills in first 3 years of life
• perceptual and instinctive centers are affected by early childhood
• PFC and cerebellum are rewired around 5-7 years
• major restructuring due to pubertal development around 9-11 years and during adolescence
• these are all sensitive periods - interfering will result in specific difficulties

Question 43

gene-environment interaction

Answer 43

• expression of genetic influences are malleable and responsive to social environment

Question 44

behavioural genetics

Answer 44

• connections between genetic predispositions and observed behaviour

Question 45

molecular genetics

Answer 45

• causal factors in genetic mutations (identifying genes linked to childhood behaviours)

Question 46

passive GxE interaction

Answer 46

• simple association between gene and environment (kids with genes that code for reading aptitudes likely have parents that passed those genes and who created an environment that develops those abilities)

Question 47

evocative GxE interaction

Answer 47

• you elicit reactions from your environment as a function of who you are/your genes (teachers pick up on reading abilities and enrolls in AP English)

Question 48

active GxE interaction

Answer 48

• your genetic predispositions make you seek out certain environments (seeking challenging reading material)

Question 49

when are GxE influential over a lifetime

Answer 49

• passive is more important earlier in life, then decreases (environments are created by other people)
• active gets more important as you age (gaining more agency over your environment)
• evocative stays the same over the course of development (you’re always eliciting reactions from your environment)

Question 50

brain circuits

Answer 50

• neurons that are more sensitive to a particular neurotransmitter cluster together

Question 51

benzodiazepine-GABA functions and psychopathology

Answer 51

• reduces arousal and moderates emotional reactions like anger, hostility, aggression, linked to feelings of anxiety and discomfort
• plays a role in anxiety disorders

Question 52

dopamine functions and psychopathology

Answer 52

• acts as a switch to turn on brain circuits to allow other neurotransmitters to promote or inhibit emotions or activity, involved in exploratory, pleasure, extroverted
• plays a role in many disorders like schizophrenia, mood disorders, ADHD (lower levels of dopamine)

Question 53

norepinephrine functions and psychopathology

Answer 53

• facilitates/controls emergency reactions and alarm responses, important in emotional and behavioural regulation
• not directly tied to any disorders

Question 54

serotonin functions and psychopathology

Answer 54

• information and motor coordination, inhibits children’s tendency to explore environments, moderates and regulates critical behaviours like eating, sleeping, expressing anger
• regulatory problems like eating and sleep disorders, OCD, schizophrenia and mood disorders

Question 55

psychological perspectives

Answer 55

• emotions play a role in allowing infants to adapt to new surroundings
• Bx and cognitive processes assist children in making sense of the world

Question 56

emotional influences

Answer 56

• emotions are a core aspect of psychological experiences
• tell us what to pay attention to/ignore
• affect the quality of our social relationships
• central feature of infant activity and regulation
• internal monitoring - to guide future Bx (helping kids label what emotion they’re feeling helps give insight into their experience and guide internal monitoring)

Question 57

emotional reactivity:

Answer 57

• individual differences in the threshold and intensity of emotional experiences (high highs and low lows vs. not ecstatic or depressed)
• can be indicative of normal/abnormal development (rapidly fluctuating of extreme emotions or blunted affect)

Question 58

emotion regulation

Answer 58

• enhancing, maintaining, or inhibiting emotional arousal
• important signal of normal/abnormal development

Question 59

surgency

Answer 59

• temperament (emotional influence)
• positive affect and approach
• tendency to actively and confidently approach new experiences
• lowers your vulnerability, more related to positive outcomes (differential susceptibility hypothesis)

Question 60

effortful control

Answer 60

• temperament dimension (emotional influence)
• ability to shift and control attention and inhibit behavioural responses
• very high on effortful control = inhibiting lots of responses, might be a more fearful and anxious kid

Question 61

negative affectivity

Answer 61

• temperament dimension (emotional influence)
• tendency toward a low mood, easily frustrated, irritability especially in kids

Question 62

temperament

Answer 62

• organized style of Bx that appears early in development
• precursor to personality that is more biologically-based (vs. attachment style that is more learned)
• shapes the transactional interaction between the kid and environment
• can be linked to psychopathology or risk conditions

Question 63

high self-regulation temperament

Answer 63

• balance of emotional reactivity and behavioural inhibition
• might lower your vulnerability to developing psychopathology
• good formula for normal, healthy development

Question 64

applied behaviour analysis

Answer 64

• learning and development through operant conditioning
• positive and negative reinforcement/punishment, extinction
• Bx are a function of their antecedents and consequences

Question 65

cognitive theory

Answer 65

• how thought patterns develop over time

Question 66

social-cognitive perspective

Answer 66

• how children think about themselves and others
• mental representations of yourself, others, the world which are constantly being shaped by your experiences
• latent learning: learning without reinforcement through modelling and watching (beyond operant/classical conditioning)

Question 67

behavioural and cognitive influences

Answer 67

• applied behaviour analysis
• classical conditioning
• cognitive theorists
• social-cognitive theories

Question 68

attachment

Answer 68

• the process of establishing and maintaining an emotional bond with parents or other significant individuals
• an internal working model of relationships comes from that first crucial relationship
• assessed with the strange situation

Question 69

secure attachment characteristics

Answer 69

• actively explores when the caregiver acts as a safe base
• comfortable with the stranger if the caregiver is present
• mildly distressed when caregiver leaves, but quickly calmed and happy to be reunited when the caregiver returns
• parenting style is sensitive and responsive
• 60% of infants display this type - protective function against disordered outcomes

Question 70

resistant attachment characteristics

Answer 70

• clingy, no exploratory behaviour when caregiver acts as a safe base
• fearful of the stranger even when caregiver is present
• extremely upset when the caregiver leaves, ambivalent when they return (like resentful)
• parenting style is inconsistent and unresponsive
• about 10% of infants display this type
• risk factor for internalizing problems - phobias, anxiety, psychosomatic Sx, depression

Question 71

avoidant attachment characteristics

Answer 71

• exploratory behaviour isn’t as constructive as secure
• indifferent to stranger and caregiver
• indifferent to the caregiver’s departure and return
• parenting styles is rejecting-unresponsive or intrusive/overly stimulating
• about 15% of infants display this type
• risk factor for conduct disorders, aggressive Bx, depression

Question 72

disorganized-disoriented attachment

Answer 72

• no exploratory Bx
• confused responses to stranger
• unpredictable protests to caregiver leaving
• confused upon caregiver’s return (sometimes approaches, sometimes avoids)
• parenting style is frightened/overwhelmed and frightening (abuse)
• about 15% of infants display this type
• no consensus about psychopathology risks - wide range of personality disorders

Question 73

family context in child psychopathology

Answer 73

• family system as a place where risk or protective factors can be important
• reciprocal influences between family members and complex relationships within families
• processes that occur within disturbed families - maladaptive communication and exposure to stress
• most attention is given to mother-child and marital couple (less to siblings and father-child)
• how the family deals with typical and atypical stress is crucial to a child’s adjustment and adaptation (coping skills, resources, family functioning, nature/severity of stress)
• good trust and communication might make it easier to navigate stressors
• major family and individual issues interfere with consistent childcare needs

Question 74

family, social, cultural perspectives

Answer 74

• proximal and distal events in social and environmental contexts have large impacts on development
• shared and nonshared environments

Question 75

shared environment

Answer 75

• produce similarities in developmental outcomes (similar risks and protective factors)
• living in the same place, same school, same neighbourhood

Question 76

nonshared environment

Answer 76

• produce behavioural differences among siblings
• not in the same classroom, not the same extracurriculars
• might diverge in functioning over time

Question 77

Bronfenbrenner’s bioecological model

Answer 77

• microsystems influences the child directly (biological genetics and psychological characteristics, people closely related to the child that lay the foundation for future functioning)
• mesosystems: interactions between agents in the microsystem (parent-teacher conferences)
• exosystems: social settings that don’t involve the child (how a parent is treated at work)
• macrosystems: cultural elements of society, sociopolitics, geographic location
• chronosystem: environmental changes that occur over a lifespan, changes the exo, meso, microsystems
• recognizes GxE interactions (heritability varies depending on the ecological environment)

Question 78

strengths and weaknesses of the bioecological model

Answer 78

• S: conceptualizes development as a product of biological and environmental forces interacting
• W: never provides a coherent picture of development (it always ‘depends’), human development may be more predictable than this model implies
• W: culture may not belong in the macrosystem, instead it should permeate through all levels of the system (updated model)

Question 79

descriptive statistics

Answer 79

• characterizing a data set using measures of central tendency (mean, median, mode) and of spread (variance, standard deviation)

Question 80

inferential statistics

Answer 80

• using data from a sample to infer things about a corresponding population
• must estimate whether the observed data is random or if it can be extended to apply to the population

Question 81

p-value

Answer 81

• probability of obtaining a difference as big as the one observed when there is actually no difference (under the null hypothesis)
• cutoff is typically .05

Question 82

stats to observe the difference between groups

Answer 82

• t-tests (two groups)
• ANOVA (more than two groups)

Question 83

stats to observe whether two continuous variables are related to each other

Answer 83

• correlation (r)
• no causality
• null hypothesis: r=0

Question 84

stats for more than two variables

Answer 84

• one outcome variable and more than one independent variable
• multiple regression - unique contribution of each IV on the DV while controlling for the other IV

Question 85

risk factor

Answer 85

increase the chance of a negative outcome

Question 86

protective factor

Answer 86

• decrease the chance of a negative outcome (can be less of a bad thing or more of a good thing)
• four type: protective, protective-stabilizing, protective-enhancing, protective-reactive

Question 87

protective-stabilizing factor

Answer 87

• keeps you at the same level while exposure to risk increases (works at all levels of risk, not just low-risk)
• facing increasing bullying, but peer relationships are acting as a protective-stabilizing factor = well-being is unaffected

Question 88

protective-enhancing factor

Answer 88

• works even better when risk exposure increases
• competitiveness: outcomes are even better as you’re put under more pressure/stress

Question 89

protective-reactive factor

Answer 89

• it works, but its positive effects become less strong as exposure to risk increases (not the same decrement/flatter drop as a regular protective factor)
• listening to music will work well under low stress, but won’t help very much under extreme stress

Question 90

main effect

Answer 90

• association between IV and DV

Question 91

interaction/moderation

Answer 91

• the association between an IV and the DV depends on the value of the other IV
• relationship changing as a function of the third variable
• effect of gender on depression gets larger as puberty continues (bigger and bigger gender differences in rates of depression)

Question 92

mediator variables

Answer 92

• impact the process/mechanism/means through which a variable produces a particular outcome (explains why two other variables are related to each other)
• can be partial or full mediation (no direct relationship leftover after you account for the mediator)
• indirect effect: IV is indirectly associated with DV through [mediator]

Question 93

what types of measures are there and which one do developmental psychopathologists use?

Answer 93

• psychopathology/psychological Sx (interviews, rating scales, observation) *used by developmental psychopathologists
• predictors, correlates, consequences of psychopathological Sx
• Behavioural measures (rating scales, observations)
• physiological (heart rate, skin conductance)
• neural (EEG, MRI)
• cognitive (tasks measuring memory, attention)

Question 94

why measure psychopathology?

Answer 94

• clinical (diagnosis, Tx planning, Tx monitoring/progress)
• research (etiology, correlates, course, treatment planning for various disorders, causal factors, mediators, moderators)

Question 95

unstructured interviews

Answer 95

• clinicians rely on experience and intuition to arrive at a diagnosis by asking relevant questions
• frequently used
• less comprehensive (only asking questions that are relevant to the presenting problem, so may miss co-occurring problems or patient history)
• potential for confirmatory biases, availability biases (basing decisions on examples that come to mind easily) so may miss diagnoses that would arise from other questions
• combine information in idiosyncratic ways (not standardized or reliable)
• client might only give information that is relevant to the questions they’re asked without elaborating

Question 96

semi-structured interviews

Answer 96

• interviewer has a validated and systematically ordered set of questions to be presented to the client in order to make a comprehensive diagnosis
• clinician has flexibility in asking questions (can follow-up with things they consider to be important)
• clinical judgment is involved in determining when a symptom is present
• needs training to be administered, length of the interview makes it less feasible (less widely used despite being the gold standard), but still more reliable and valid than unstructured
• totaling the number of symptoms to give a diagnosis
• requires lots of data reduction (analysis or recoding of narrative responses)

Question 97

structured interviews

Answer 97

• questions are very fixed and interviewer has very little flexibility (can be administered by computer)
• requires lots of data reduction (analysis or recoding of narrative responses)

Question 98

Kiddie Schedule of Affective Disorder & Schizophrenia (K-SADS)

Answer 98

• type of semi-structured interview
• good coverage of many sorts of disorders
• starts with a screener that tells you what to follow-up on (not everyone completes the entire interview)
• questions correspond to DSM criteria, potential follow-ups, and rating scale
• possible to ‘skip out’ a section is participants aren’t endorsing the questions

Question 99

rating scales

Answer 99

• people knowledgeable about the child answer questions about behaviours and feelings (parents, siblings, teachers, child)
• often used to measure psychopathology continuously (number of symptoms) and used to make a categorical decision
• shorter than interviews, but not as comprehensive (potential tradeoff between validity/reliability of interviews and feasibility of checklists)
• generally use self-report in conjunction with interviews for a comprehensive assessment (elevation on a rating scale alone does not equal diagnosis)
• efficient way to track treatment progress
• don’t require much data reduction

Question 100

observation

Answer 100

• self-report interviews/rating scales rely on reporters who may not know what Bx is normal or clinically concerning
• observation provides access to the circumstances in which the Bx occurs
• naturalistic or structured (lab)
• not always feasible
• challenge to external validity (presence of an observer can change Bx)
• may be difficult to see Bx of interest (low base-rate like physical aggression, covert like relational aggression)
• data reduction depends on the complexity of the observation system

Question 101

what does a thorough assessment for ADHD look like

Answer 101

• IQ testing
• academic achievement testing (reading, writing, math) to rule out learning difficulties
• ADHD rating scales from teachers, parents, and self-report
• semi-structured clinical interview (K-SADS) with parents and child

Question 102

reason for disagreement among informants

Answer 102

• often do not agree (correlations from .2 to .4)
• behaviour changes based on context (situations in the environment may elicit certain symptoms - different demands)
• parents might have a response bias (parents have their own lived experiences and personality - may interpret their child’s hyperactivity as normal because they’re hyperactive too)
• there could be legitimate differences in the meaning of Bx across settings
• teachers are exposed to a larger sample size of children so can assess common vs. uncommon Bx

Question 103

how to combine data from multiple informants

Answer 103

• “or” rule: symptom is present if any informant says it is (will augment the number of symptoms endorsed)
• “and” rule: symptom is present if all informants agree it is (will decrease the number of symptoms endorsed)
• the rule you use depends on the presentation, how valid you feel the reports are (quality of reports), in what situation you think the Bx would present itself in (for uncommon Sx you might want to use the “and” rule to be able to endorse it)
• inherently simplistic to combine reports, sometimes they should be evaluated separately because the discrepancies tell us something important about functioning in different contexts (for PDD, you would want to see that Bx manifested in multiple situations)

Question 104

reliability and validity

Answer 104

• reliability: consistency
• validity: are we measuring what we think we’re measuring
• reliability is necessary for validity (you can’t have a valid measure that isn’t reliable, but you can have a reliable measure that isn’t valid)

Question 105

test-retest reliability

Answer 105

• do we get the same answers on different measurement occasions
• some constructs should vary over time

Question 106

inter-rater reliability

Answer 106

• agreement between two people judging whether a construct is present (like diagnosis)
• important for clinical interviews and observational measures like the strange situation

Question 107

parallel-form reliability

Answer 107

• how associated are two similar versions of the same test
• WAIS vs. Raven’s should result in similar IQ scores, both tests should be similar in difficulty

Question 108

split-half reliability

Answer 108

• correlations between two halves of the same test (score on the first half of the scale vs. the second half)

Question 109

reliability: consistency vs. stability

Answer 109

• consistency: taking a measure once, reports within that measure should be consistent
• stability: involves one person taking multiple tests (across time or across various versions)

Question 110

convergent validity

Answer 110

• scores on a new measure should be correlated with other well-established measures/indicators of the same construct

Question 111

discriminant validity

Answer 111

• scores on a new measure shouldn’t be correlated with measures/indicators of a different construct
• there might be some comorbidity, but not highly correlated

Question 112

face validity

Answer 112

• a measure appears to measure what it’s supposed to

Question 113

measurement invariance

Answer 113

• fairness of a measure (biased?)
• people in different groups with similar abilities should score similarly across items on a test
• if a measure is systematically according higher/lower scores to one group, it has measurement non-invariance
• if there is bias, we cannot compare across groups

Question 114

cross-sectional design

Answer 114

• taking one snapshot/study at one moment in time and comparing people within that study (across different ages within one study)
• easy to implement, but we can’t learn how people change over time
• age effects are compounded by cohort effects (individual differences between different ages that act as a confound)

Question 115

longitudinal design

Answer 115

• studying the same subjects over time (within-subject comparisons without cohort effects - how did people change over time)
• drawbacks: subjects drop out, effects of repeated testing (familiarity with content), requires foresight and funding, time consuming
• potential for time of measurement effects (the particular span of time that you measured had an effect on the people you’re studying) and practice effects

Question 116

sequential design

Answer 116

• combined longitudinal and cross-sectional (getting a cohort of 7 year-olds in 2007, a cohort of 7 year-olds in 2008, etc. and measure them over time)
• disentangles age effects from cohort effects and time of measurement effects
• very time-consuming and complex and expensive

Question 117

correlational designs

Answer 117

• cross-sectional
• longitudinal
• sequential

Question 118

criteria for well-established treatments

Answer 118

• a large series (at least 9) of single case-study designs demonstrating efficacy OR
• at least 2 between-group design experiments
• the above are very old criteria that have been critiqued
• shifting toward a systematic review of the literature followed by a committee reviewing the evidence

Question 119

single-case experimental design

Answer 119

• examine the effect of treatment on a single child’s behaviour
• repeated measures of behaviour
• replication of treatment effects
• ABAB reversal design: baseline - intervention - return to baseline - reintroduce intervention
• good internal validity, temporal ordering, causality (A changes B)
• lacks external validity (single case generalization?)
• difficult to interpret (second baseline isn’t the same - is that because of the treatment or changes over time?)
• ethics: should we remove a treatment that appears to be working? we want to implement it in as many populations as possible

Question 120

randomized control/clinical trial (RCT)

Answer 120

• therapy experiment with experimental and control conditions and random assignment
• test of intervention efficacy and test of theory (can help establish causes
• internal validity: is the intervention is causing the change in outcome
• construct validity: what about the intervention is causing the change in outcome
• type of control group impacts conclusions (no-treatment/waitlist, attention-only, treatment as usual, another effective treatment)

Question 121

RCT disadvantages

Answer 121

• effectiveness? may not work in a real-life clinic - external validity
• clinical trials often use WEIRD samples, people without comorbid disorders (external validity threat)
• efficiency: does it contribute to a more efficient use of resources?
• drop out rates (low SES, higher severity = difficult to remain in the trial) - differential attrition
• uses averages: within the treatment group (even if it shows change), some individuals won’t have improved

Question 122

WEIRD sample

Answer 122

White Education Industrialized Rich Democratic

Question 123

differential attrition

Answer 123

dropout rates differ systematically between the intervention and the control group

Question 124

nosology

Answer 124

classification of disease, organization of bx and emotional dysfunction into meaningful groupings

Question 125

categorical classification

Answer 125

• someone with the disorder is fundamentally different from someone without it
• DSM: you meet criteria or you don’t (also has dimensional classifications for severity)
• different groups; separate distributions/populations = two modes

Question 126

DSM-5

Answer 126

• outlines diagnoses and associated criteria
• categorical system based on professional consensus
• based on a medical model in which separate disorders have separate causes
• labels help synthesize information and aid communication
• people don’t always fit into categories cleanly (spillover categories “unspecified” to help capture this)
• cutoffs may miss people who might have severe impairment but won’t have access to accommodations
• current categories may be inadequate for genetic and neuroscience research

Question 127

dimensional classification

Answer 127

• everyone has certain levels of everything, some people may be at higher degrees = more impairment
• often use continuous measures in research (not just interested in diagnoses, but in symptoms)
• allows us to preserve valuable information, provides a measure of severity (could use that as a cutoff)
• but how do we know which dimensions to include (like in RDoc)

Question 128

Research Domain Criteria (RDoc)

Answer 128

• assessing based on key dimensions instead of diagnostic categories
• domains/constructs + subconstructs: characteristics of brain functioning
• units of analysis: ways to measure brain function (genes, molecules, cells, circuits, physiology, behaviour, self-report, paradigms)

Question 129

domains and subconstructs in RDoc

Answer 129

• negative valence system: response to aversive situations (fear, anxiety, loss)
• positive valence system: positively motivational situations (reward seeking, reward learning, habits, etc.)
• cognitive systems: memory, attention, language
• social processes: responses to interpersonal settings (perception and interpretation of people’s actions)
• arousal and regulatory systems: activation of neural systems as necessary for the situation (homeostatic regulation, circadian rhythms, sleep)

Question 130

internal consistency

Answer 130

• if a measure is reliable, the answers to items within a measure should be related to each other

Question 131

Is ADHD real?

Answer 131

• argued that it is a product of Western culture, setting unrealistic expectations for kids, pharmacological companies profiting off medications
• but the prevalence of ADHD is similar worldwide
• the use of meds as Tx is 5x higher in North America
• ADHD predicts impairment in social, school settings, higher mortality

Question 132

inattention

Answer 132

• inability to sustain attention particularly for structured, repetitive, less-enjoyable tasks

Question 133

hyperactivity-impulsivity (HI)

Answer 133

• hyperactivity: inability to voluntarily inhibit dominant or ongoing bx
• impulsivity: inability to control immediate reactions or to think before acting

Question 134

ADHD DSM-5 criteria

Answer 134

(A) persistent (6 months) pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning (must be out of proportion to peers, cannot just be due to new demands of school/adjustment period)
(B) several symptoms were present before age 12 (neurodevelopmental disorder)
(C) several symptoms were present in two or more settings (genes will affect bx pervasively)
(D) clear evidence that symptoms interfere with/reduce the quality of social, academic, occupational functioning
(E) symptoms do not occur exclusively in the course of other disorders like schizophrenia

Question 135

ADHD inattention criteria (9)

Answer 135

• six or more symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities
• not solely due to oppositional behavior, defiance, hostility, or failure to understand tasks or instructions
• For older adolescents and adults (age 17 and older), only five symptoms are required
• fails to give close attention to details, makes careless mistakes
• has difficulty sustaining attention in tasks or play
• does not seem to listen when spoken to directly
• doesn’t follow through on instructions and fails to finish schoolwork, chores, duties
• difficulty organizing tasks and activities (managing sequential activities, keeping belongings in order, poor time management)
• avoids, dislikes engaging in tasks that require sustained mental effort
• loses things necessary for tasks/activities
• easily distracted by extraneous stimuli (for older teens, may include unrelated thoughts)
• forgetful in daily activities

Question 136

ADHD HI criteria

Answer 136

• 6 or more symptoms persist for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities
• Sx aren’t a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions
• for older adolescents and adults (17 and older), only 5 symptoms are required
• fidgets with or taps hands or feet or squirms in seat
• leaves seat in situations when remaining seated is expected
• runs about or climbs in situations where it is inappropriate (in adolescents, may be limited to feeling restless)
• unable to play or engage in leisure activities quietly
• “on the go” or ‘driven by a motor’ (uncomfortable being still for too long, other people cannot keep up)
• talks excessively
• blurts out answers before a question has been completed
• difficulty waiting his or her turn
• interrupts or intrudes on others (doing things without permission, for adults - taking over what others are doing)

Question 137

ADHD specifiers

Answer 137

• ADHD-C (combined): both Criterion A1 (inattention) and Criterion A2 (hyperactivity–impulsivity) are met for the past 6 months
• ADHD-PI (predominantly inattentive): If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity–impulsivity) is not met for the past 6 months
• ADHD-HI (predominantly hyperactive–impulsive): Criterion A2 (hyperactivity–impulsivity) is met but Criterion A1 (inattention) is not met for the past 6 months
• in partial remission: full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning

Question 138

ADHD severity specifiers

Answer 138

• mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning
• moderate: Symptoms or functional impairment between “mild” and “severe” are present.
• severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning

Question 139

is ADHD categorical or dimensional

Answer 139

• DSM is categorical, but new research suggests it’s dimensional (sx present in everyone to varying degrees)
• using inattention vs. HI may be a simplification (attentional difficulties are highly related to impulsivity and vice versa)

Question 140

assessment of ADHD

Answer 140

• rating scales and interviews
• strong focus on observable signs of inattention/HI
• K-SADS semistructured interview
• SNAP-IV for parent/teacher report that maps closely onto symptomatology

Question 141

who reports on child ADHD

Answer 141

• parents
• teacher report is crucial (they have a normative framework = good idea of inter-individual variability)
• NOT kids: often unreliable and tend to under-report (also a lack of self-insight)
• categorization of ADHD depends on how information from reports are combined
• if you look at parent reports OR teacher reports on their own = more diagnoses of ADHD-PI or ADHD-HI, but if you combine them with the ‘or’ rule, you see more ADHD-C (different sx prevalent in different settings)

Question 142

heterogeneity in ADHD presentation

Answer 142

• many different presentations implies that there might be different causes of the disorder
• could imply that ADHD is actually multiple different disorders
• HI can evolve to become combined, can change to PI as you age (natural progression of context and presentation)
• most people go through all three subtypes - implying that ADHD is one disorder with different dimensions
• there is one subtype of ADHD-PI that never changes throughout life (will never exhibit HI sx)

Question 143

cognitive disengagement syndrome

Answer 143

• sluggish cognitive tempo
• subtype of ADHD-PI that never exhibit any HI sx (there are individuals for whom the correlation between inattention and HI is very low)
• CDS can be differentiated from ADHD based on a meta-analysis
• CDS sx are more correlated with each other than with ADHD sx (good reliability, test-retest, inter-rater)

Question 144

temperament profiles research in ADHD

Answer 144

• inspired by RDoc
• 3 different domains based on temperament/neurobiology: mild (near the mean on temperament and ADHD characteristics), Surgent (high positive affect), Irritable (high on fear/anger, discomfort)
• unresolved heterogeneity that may impair epidemiology - could use emotion-trait profiles to further differentiate between diverse presentations

Question 145

ADHD prevalence rates

Answer 145

• point: 5-9% in school-age
• 6-month: 10.5% of 4-11 years
• lifetime (adolescent sample): 8.7%
• most common type is combined, ‘and’ rule decreases combined type
• prevalence rates increase if using the ‘or’ rule

Question 146

epidemiology contextual differences in ADHD

Answer 146

• more common in low-SES communities
• racial differences unclear (minorities over-represented in low-SES)
• hyperactivity can be see as more problematic in certain cultures (especially where you value social harmony)

Question 147

epidemiology gender rates for ADHD

Answer 147

• 3:1 favouring boys in community samples
• 6:1 favouring boys in clinic samples (boys get treated more, probably because their sx are more evident)
• in community samples, boys are more likely to be diagnosed with all types (but gender gap is more narrow for ADHD-PI)
• in clinic samples, the gender gap for subtypes disappears (girls equally likely to be diagnosed with all subtypes)

Question 148

developmental course of ADHD

Answer 148

• should be present at birth (but no reliable measures before age 3)
• in preschool, if sx persist for a year, they’re likely to have chronic challenges
• marked HI in preschool because cognitive and motor sx are developing
• elementary school, inattention becomes more noticeable, HI declines slightly through elementary (developing attentional processes, learning to conform to rules, but still higher than typical)

Question 149

prognosis for adulthood in ADHD

Answer 149

• used to be thought that sx resolved in adolescence
• about 33% of kids with ADHD continue to meet criteria in adulthood, the rest may just decrease to a subclinical threshold

Question 150

adulthood outcomes (Klein et al.)

Answer 150

• recruited probands with ADHD and comparison group - followed up at 41 years (probands differed from controls on SES and IQ)
• more likely to not finish high school
• less likely to have a graduate degree
• lower annual salary
• more likely to have been divorced
• more likely to be incarcerated
• more likely to be dead (likely due to attention/safety problems)

Question 152

correlates of ADHD

Answer 152

• associated with impaired academic functioning (intellectual ability isn’t lower, just difficulty expressing intelligence in academic setting)
• lower physical health, higher mortality
• social impairment (with family and peers), tend to have less friends (exacerbated by co-occurring ODD/CD)
• formal speech and language disorders: speaking impulsively, speech production errors, excessive loud talking, difficulties listening)

Question 153

comorbidity with ADHD

Answer 153

• CD and ODD are more prevalent (about 50% meet criteria for ODD), anxiety (25-50%), depression (20-30%) tic disorders (20%), learning disabilities
• earlier onset of ADHD = more likely to have ODD and CD

Question 154

heritability and environmental influences for ADHD

Answer 154

• twin studies show about 75% heritability estimates
• environmental: factors that compromise the nervous system (maternal use of cigarettes, drugs)
• parents with ADHD have different parenting techniques, more chaotic home environment that is conducive to HI and inattention (passive GxE interaction)

Question 155

medication for ADHD Tx

Answer 155

• stimulants like dextroamphetamine (Dexedrine) and methylphenidate (Ritalin, Concerta)
• increase dopamine levels
• increase activity in the PFC
• fast-acting, but effects are temporary (when the drug is discontinued)
• side effects include weight loss (decreased appetite), slows in growth, increased heart rate, difficulty falling asleep
• can develop tolerance - often parents give kids ‘drug holidays’ when environmental demands are lower

Question 156

drawbacks of medications for ADHD

Answer 156

• may not help in 20% of cases
• won’t get rid of sx completely, just reducing severity
• may not help academic performance, peer relationships, family functioning in all kids
• benefits may not be maintained and will stop once the meds are discontinued
• tolerance is likely to occur, leading to reduced efficacy over time

Question 157

parent management training for ADHD

Answer 157

• contingency management: help parents establish clear expectations and set rules, giving positive reinforcement, predictable and consistent punishment
• not always as helpful as meds, but more likely to see long-term gains
• structuring environments in ways that are conducive to positive bx

Question 158

behavioural classroom management for ADHD

Answer 158

• contingency management in the classroom
• evidence for effectiveness

Question 159

behavioural peer interventions for ADHD

Answer 159

• social skills training done in clinic or office using discussion and role-playing are not generally successful (in group therapy settings, ADHD peers together is too distracting)
• but other programs targeting peer relationships in recreational settings (summer camps, sleep-away) that use contingency management techniques show significant improvement

Question 160

cognitive interventions for ADHD

Answer 160

• building skills to control attention and bx
• verbal self-instruction, problem-solving
• not enough evidence for benefits

Question 161

organizational skills training for ADHD

Answer 161

• focused on helping with academic achievement, reducing impairment
• implementing a prescriptive system to help with bx (stop forgetting things at school, keeping track of assignments)

Question 162

multimodal treatment of ADHD (MTA study)

Answer 162

• comparing outcomes for various tx (meds, bx, combined, treatment as usual)
• enrolled 579 kids with ADHD-C according to parent and teacher report (80% male, aged 7-9)
• random assignment to meds group, psychosocial tx (PMT, educational intervention, summer programs), combined meds + psychosocial, community treatment (TAU)
• from baseline to follow-up, all groups improved on core sx of ADHD
• only meds AND combined groups showed more improvement than psychosocial and TAU (only on core sx, not other areas of functioning)
• combined and psychosocial groups showed more improvement on parent-child conflict than TAU (combined was no different than medication group)
• combined and meds groups did not differ significantly from each other
• bx was only better than TAU for parent-child conflict, but not for core sx
• 8-year follow-up: no differences among any of the tx groups, but all doing better (still worse than a control group)

Question 163

MTA study moderators

Answer 163

• Tx group: meds/combined = 62% responders, TAU/Bx = 30% responders
• within meds/combined, parental depression high = 45% responded, parental depression low = 69% responders
• within parental depression low, severity high = 41%, severity low = 73% responders
• within parental depression high, severity high = 29%, severity low = 59%
• within parental depression high, severity high, IQ high = 48%, IQ low = 10%
• most important moderators for a bad prognosis were high parental depression, high severity, low cognitive abilities (IQ)
• most important moderators for a good prognosis were low parental depression, low severity

Question 164

Oppositional Defiant Disorder (ODD) criteria

Answer 164

(A) pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least 4 symptoms from any of the following categories (angry/irritable mood, argumentative/defiant bx, vindictiveness), and exhibited during interaction with a least one individual who is not a sibling
(A8) persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from behavior that is symptomatic. For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months. For individuals 5 years or older the behavior should occur at least once per week for 6 months. Other factors should also be considered, such as whether the frequency and intensity of the behaviors are outside a range that is normative for the individual’s developmental level, gender, and culture.
(B) he disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.
(C) The behaviors 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 disorder.

Question 165

ODD angry/irritable mood

Answer 165

• loses temper
• touchy or easily annoyed
• angry or resentful

Question 166

ODD argumentative/defiant bx

Answer 166

• argues with authority figures or, for children and adolescents, with adults
• actively defies or refuses to comply with requests from authority figures or with rules
• deliberately annoys others
• blames others for his or her mistakes or misbehavior

Question 167

ODD vindictiveness

Answer 167

• Has been spiteful or vindictive at least twice within the past 6 months

Question 168

ODD severity specifiers

Answer 168

• mild: sx are confined to one setting
• moderate: some sx occur in at least two settings
• severe: some sx are present in at least three settings

Question 169

conduct disorder (CD) criteria

Answer 169

(A) repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least 3 of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months
categories: aggression to people/animals, destruction of property, deceitfulness or theft, serious violations of rules
(B) The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
(C) If the individual is 18 years or older, criteria are not met for Antisocial Personality Disorder

Question 170

CD aggression to people/animals

Answer 170

• bullies, threatens, or intimidates others
• initiates physical fights
• has used a weapon that can cause serious physical harm to others
• Has been physically cruel to people.
• has been physically cruel to animals
• Has stolen while confronting a victim (mugging, extortion)
• Has forced someone into sexual activity

Question 171

CD destruction of property

Answer 171

• Has deliberately engaged in fire setting, with the intention of causing serious damage.
• Has deliberately destroyed others’ property (other than by fire setting)

Question 172

CD deceitfulness or theft

Answer 172

• Has broken into someone else’s house, building, or car.
• lies to obtain goods or favors or to avoid obligations (‘cons’ others)
• Has stolen items of nontrivial value without confronting a victim (shoplifting, forgery)

Question 173

CD serious violations of rules

Answer 173

• stays out at night despite parental prohibitions, beginning before age 13 years.
• Has run away from home overnight at least twice while living in parental or parental surrogate home, or once without returning for a lengthy period.
• Is often truant from school, beginning before age 13 years

Question 174

CD specifiers

Answer 174

• childhood-onset: at least one sx is present before age 10
• adolescent-onset: no sx were present before age 10
• with limited prosocial emotions: individual must have displayed at least 2 of the following characteristics persistently over at least 12 months and in multiple relationships and settings. These characteristics reflect the individual’s typical pattern of interpersonal and emotional functioning over this period and not just occasional occurrences in some situations. Thus, to assess the criteria for the specifier, multiple information sources are necessary. In addition to the individual’s self-report, it is necessary to consider reports by others who have known the individual for extended periods of time

Question 175

CD with limited prosocial emotions sx

Answer 175

• at least 2 of the following present in the past 12 months in many interactions
• lack of remorse or guilt: does not feel guilty when they do something wrong (excludes remorse only expressed when caught), general lack of concern about negative consequences of their actions
• callous-lack of empathy: disregards/is unconcerned about the feelings of others, described as ‘cold and uncaring’, more concerned about the effects of their actions of themselves (even when they result in substantial harm to others)
• unconcerned about performance: doesn’t show concern about poor/problematic performance at school/work/activities, doesn’t put in the effort required even when expectations are clear, often blames others for their poor performance
• shallow/deficient affect: does not express feeling/show emotions to others except in ways that feel insincere, shallow, superficial (actions contradict emotions displayed, can turn emotions ‘on’ or ‘off’), or emotional expressions are used for gain (to manipulate/intimidate)

Question 176

CD severity specifiers

Answer 176

• mild: Few if any conduct problems in excess of those required to make the diagnosis are present, and conduct problems cause relatively minor harm to other (lying, truancy)
• moderate: The number of conduct problems and the effect on others are intermediate between those specified in “mild” and those in “severe” (stealing, vandalism)
• severe: Many conduct problems in excess of those required to make the diagnosis are present, or conduct problems cause considerable harm to others (forced sex, physical cruelty)

Question 177

two dimensions of disruptive behaviour

Answer 177

• overt-covert:
• destructive-nondestructive
• aggression is overt and destructive *more at risk for later bx problems
• property violations are covert and destructive
• status violations (truancy, substance use, runaway) are covert and nondestructive
• oppositional bx (stubborn, touchy, argues) is overt and nondestructive

Question 178

research about sibling fighting

Answer 178

• very common, cannot be used to diagnose ODD
• sibling conflict, hostility, and negativity predicts greater emotional and bx problems over time
• can lead to maladaptive bx problems in other relationships

Question 179

assessment of ODD

Answer 179

• interviews and checklists
• Disruptive Behaviour Diagnostic Observation Schedule: watching preschoolers interact with an interactive examiner, a busy examiner, with their parent (pressing for disruptive behaviour by testing their compliance, frustration, rule-breaking) - also used for CD
• complementing a parent report

Question 180

callous-unemotional (CU) traits

Answer 180

• ‘with limited prosocial emotions’ specifier
• 2-6% of kids with CD have CU traits - when they do = earlier onset, aggression is more severe and instrumental
• CU associated with insensitivity to punishment (harder to treat)

Question 181

instrumental aggression

Answer 181

using aggression to get something out of it, to get what you want

Question 182

how to assess limited prosocial emotions

Answer 182

• Clinical Assessment of Prosocial Emotions (CAPE1.1) semistructured interview
• need multiple information sources

Question 183

CD and ODD comorbidity

Answer 183

• in DSM-IV, a more severe presentation of ODD was qualified as CD
• in DSM-5, you can have both diagnoses at the same time
• ODD tends to start presenting at age 6, CD around age 9 (ODD developmentally precedes CD, but not in all cases)
• some kids will have ODD that never evolves into CD
• some kids will be diagnosed with CD without ever having had an ODD diagnosis

Question 184

prevalence rates ODD and CD

Answer 184

• lifetime: ODD: 12%, CD: 8%
• 6-month: ODD: 7.5%, CD: 1.3%
• cultural and contextual differences
• strongly associated with poverty, exposure to violence
• if disruptive bx only occurs in a negative environment where it is adaptive/protective, it shouldn’t be diagnosed
• only when disruptive bx occurs without negative environmental demands is it functionally impairing

Question 185

social causation

Answer 185

• stress of poverty leads to an increase in childhood psychopathology (strong exposure to stressors)
• predicts more problem bx in low SES environments

Question 186

social selection

Answer 186

• families with genetic predispositions drift down towards poverty
• disruptive behaviours aren’t rewarded in our society (getting expelled, unable to hold a job)
• predicts more problem bs in low SES environments

Question 187

Great Smoky Mountains study

Answer 187

• longitudinal study of epidemiology of childhood disorders
• positive association between pverty and disruptive bx
• sample included many Indigenous youth living on a reservation
• when a casino opened on the reservation, they gave the Indigenous families a stipend (more income which led to 4 groups: persistently poor, ex-poor, never poor, newly poor)
• showed support for social causation theory (ex-poor kids reduced disruptive bx)
• if social selection was true, the added income wouldn’t have had an impact on disruptive bx
• full mediator: increased income = improved parental supervision = fewer disruptive bx problems

Question 188

gender differences in disruptive bx

Answer 188

• conduct problems are 2-4x more common in boys
• gender gap reduces in early teens
• early-onset persistent CD: 10:1 ratio
• adolescent-limited CD: 2:1 ratio
• girls start to engage in more covert nonaggressive bx (lying, truancy)

Question 189

types of aggression in males/females

Answer 189

• physical aggression is more common in boys than girls
• relational aggression is more common than physical in girls
• the gender difference in relational aggression is small and not meaningful (girls engage in slightly more relational)
• boys disruptive bx is more overt = noticed earlier

Question 190

relational aggression

Answer 190

targeting social relationships

Question 191

comorbidities with ODD/CD

Answer 191

• 35% of youth with ODD have ADHD
• 50% of youth with CD have ADHD
• 50% of youth with ODD/CD have depression or anxiety

Question 192

correlates of ODD/CD

Answer 192

• cognitive/verbal challenges (not associated with intellectual impairment, may have specific verbal deficits)
• academic functioning (underachievement, grade retention, dropout, suspension, expulsion, may lead to depression/anxiety in adulthood)
• family functioning (high conflict, lack of family cohesion and emotional support)
• peer problems (engage in aggression, likely to be rejected, form friendships with other antisocial peers which is associated with health risks like injury, substance abuse, STIs)
• boys with conduct problems are 3-4x more likely to die before age 30 (more accidental deaths like overdoses)
• relational aggression may be predictive of popularity with peers instead of aggression

Question 193

conduct problems in infants

Answer 193

• difficult temperament
• fussy, irritable, hard to soothe
• higher in negative affectivity, lower in positive affectivity, lower in surgency
• may be linked to later ODD in boys

Question 194

conduct problems in preschoolers

Answer 194

• can be difficult to diagnose due to improbable symptoms (truancy, staying out at night) so need to adapt to a younger age group
• noncompliance, temper loss (temper tantrums), aggression (kicking, biting) are common (aggression increases until 27 months then should level out)
• low desisters: start with low misbehaviour, and misbehaviour decreases even more
• moderate desisters: start with moderate misbehaviour, but decreases at age 11
• high stable: lack of a normative decrease (higher risk for ODD and CD), significant behavioural and emotional dysregulation that will escalate if left untreated

Question 195

early-onset/life-course consistent pathway

Answer 195

• at least 1 sx before age 10
• 10:1 male to female
• 50% persist into antisocial bx in adulthood
• aggression in childhood
• nonaggressive antisocial bx in middle childhood
• serious delinquency in adolescence
• diversification: adding more serious disruptive bx with age

Question 196

late-onset pathway/adolescent-limited

Answer 196

• onset in adolescence, frequently with social change (peer influence)
• 2:1 or 1:1 male to female
• less extreme antisocial bx
• less likely to commit violent offenses
• less likely to persist into adulthood
• snares: outcomes of antisocial bx that put people on problematic paths (unplanned pregnancy, dropping out of school, drug addiction) and could move you to the life-course pathway

Question 197

how do we distinguish typical misbehaviour from a problem, especially in preschoolers

Answer 197

• frequency (and whether you can shape the behaviour with reinforcement)
• severity
• flexibility
• predictability (is Bx occurring when expected i.e. when a situation is overwhelming for a child or is it unexpected and random)
• pervasiveness (in many settings)

Question 198

heritability of disruptive disorders

Answer 198

• adoption and twin studies: about 50%
• but there are occasional cases in which behaviour seems to come out nowhere (no parent psychopathology, siblings are fine)
• strongest biological evidence for early-onset pathway

Question 199

prenatal factors and birth complications (disruptive behaviour disorders)

Answer 199

• low birth weight
• malnutrition (protein deficiency) during pregnancy
• lead poisoning
• mother’s use of nicotine, marijuana, alcohol during pregnancy

Question 200

genotype x maltreatment interaction

Answer 200

• childhood maltreatment is a universal risk factor for psychopathology & most people don’t develop severe antisocial bx
• low MAOA activity is linked to aggression (not metabolizing NTs like dopamine and norepinephrine) and a gene on the X chromosome
• there’s a main effect of childhood maltreatment (it increases = so does antisocial)
• no main effect of low/high MAOA activity
• significant interaction effect: relationship between childhood maltreatment and antisocial bx is moderated by your level of MAOA activity (lower MAOA = higher antisocial), childhood activity produces an even bigger risk with this vulnerability
• there are other types of negative parenting that also contribute to psychopathology, not just maltreatment

Question 201

coercion theory

Answer 201

• cycle of increasingly negative parent-child interactions (delay/escape strategies and demands by the child + inconsistencies from parent are reinforcing to all)
• adult makes a request = child reacts with hostility = parent withdraws request or becomes reactive/hostile = child doesn’t do what was asked
• negative reinforcement: child learns that the parent’s demands are withdrawn when they throw tantrums so they don’t have to do what they don’t want to do
• positive punishment: parent’s demands are constantly met with hostile behaviour (acts as the punishment) which decreases the likelihood of making more demands

Question 202

social information processing

Answer 202

• various steps in going from perception of a situation to interpretation and action
• encoding: what to pay attention to
• interpretation: what does it mean
• response search: options for actions
• response decision: what will I do
• enactment: how well did I do it

Question 203

social information processing deficits in kids with disruptive disorders

Answer 203

• encoding: not much is known
• interpretation: hostile attribution bias
• response search: generate fewer responses overall, but more of them will be aggressive and less of them will be prosocial
• response decision: outcome expectancy (believe they will get what they want) and self-efficacy (believe they will be good at implementing the aggressive response), they choose the aggressive option
• enactment: not much is known (they’re selecting the aggressive options and doing them, but unclear if they’re actually good at them)

Question 204

hostile attribution bias

Answer 204

assuming negative intentions in neutral situations (impaired in the interpretation phase)

Question 205

how do social information processes become impaired in CD

Answer 205

• parents: mothers show the hostile attribution bias, parents may unintentionally or outwardly approve of aggressive behaviours (see aggression as an appropriate response to a peer provocation)
• peers may be reinforcing (kids think aggression works, probably because it usually does and they get what they want)

Question 206

which levels in Bronfenbrenner’s model do various treatments for ODD/CD target

Answer 206

• PSST: microsystem (the individual)
• PMT: agents within the microsystem (mesosystem)
• MST: multiple levels

Question 207

Problem-Solving Skills Training (PSST)

Answer 207

• targets cognitive processes upstream to change disruptive behaviour
• underlying theory: social information processing
• targets attentional biases (encoding), hostile attribution bias (interpretation), how well you generate and evaluate response options (response search and decision)

Question 208

STEPS for solving problems

Answer 208

• PSST technique: train them to think of more solutions, how to examine them in role-playing/pros and cons, try new options even if you think they might not work (then kids get better results from using prosocial response which gets reinforced)
• Say what the problem is
• Think of solutions
• Examine each one
• Pick one and try it out
• See if it works

Question 209

Anger coping program

Answer 209

• focuses on cognitive biases
• hostile attribution
• distortion in perceptions of aggressiveness: kids underestimate how aggressive they are and overestimate how aggressive other people are
• faulty emotional identification: tendency to mislabel any high arousal (like anxiety) as anger, which leads them to react accordingly - gain emotional insight to label appropriately
• response search/selection: teaching to focus on verbal solutions instead of direct action (aggressive kids tend to think prosocial options aren’t likely to have good outcomes)
• has some good evidence, but also critiqued

Question 210

strategies for anger coping program

Answer 210

• inhibit early angry and aggressive responses
• cognitively re-label stimuli perceived as threatening (change hostile attribution)
• solve problems by generating alternative coping responses and choosing non-aggressive responses instead

Question 211

critiques of PSST and anger coping

Answer 211

• may not be enough because in the real world, problematic behaviours can be reinforced (outside the therapy setting)
• these only target the individual, but there’s a whole system they go home to that may promote unhelpful behaviours
• may need to intervene at other levels than the microsystem (like parents)

Question 212

Parent Management Training overview for ODD/CD

Answer 212

• gold standard
• reset the parent-child relationship: create opportunities to start feeling good around each other (instead of constant frustration)
• since parents tend to only react to negative behaviours and miss the positive - try to motivate the kids to get attention from positive bx (reinforce small behaviours then work your way up to the ideal)
• may not be as effective in kids with CU traits
• stronger effects for preschoolers and elementary-schoolers than adolescents (teens show more impairment and people besides parents are reinforcing behaviours)

Question 213

PMT principles

Answer 213

• operant conditioning: consequences of a bx determine the likelihood of it re-occurring
• education: help parents establish realistic expectations of their child’s behaviour (normative bx for kids that age), behaviour tends to get worse before it gets better when doing therapy
• communication: give clear instructions to kids, setting clear and firm boundaries, set immediate and doable consequences for bad bx (there should be a rationale for punishment)
• ABC model: change contingencies by modifying environments/antecedents, observe behaviours and their contexts, modify consequences

Question 214

controversy about time-outs

Answer 214

• removal of positive reinforcement/negative punishment/omission training
• 1min per year of age - highly recommended strategy
• has been shown to decrease detrimental bx in youths despite the general outcry against them in media
• robust lack of association between time-outs and adverse outcomes in short-term and long-term
• emerging studies about positive effects on well-being

Question 215

Multisystemic Therapy

Answer 215

• fit assessment: figure out what is driving the behaviour, which drivers/behaviours to target first
• considers context in which bx is occurring to produce long-lasting change
• integration of multiple evidence-based practices (because serious clinical problems arise from many interacting factors)
• PSST, PMT, global reinforcement context (association with deviant peers)
• intensive services: access to therapist 24/7, services in home and other settings, about 4 months of Tx
• used with most severe cases (chronic juvenile offenders, violent bx, substance use)

Question 216

MST efficacy

Answer 216

• difference is clinically significant in people’s lives: school performance, relationships, living skills (functional outcomes, not just statistical significance)
• but mixed evidence for MST vs. other treatments (may not improve some functional outcomes like peer relations, academics but works for delinquency and family functioning)
• strong theoretical basis for the therapy, but unclear if it’s working better than other Tx (could be because it’s only used in more severe cases)

Question 217

mediator in MST

Answer 217

• family functioning drives the effects of MST