behavior + emotional disorders of childhood/adolescence (wk 6) Flashcards
describe the need for multiple reporters. who would this include and why?
-child, parent, teacher
-when asking diff people, reports of symptoms/behaviors often differ
-can be that parents report fewer symptoms than teachers OVV
-teachers usu in a good position to assess fnxing of children relative to same-age peers
what are 3 areas of assessment that a clinician would look at when diagnosing childhood behavior/emotional disorders? explain
-developmental + medical history: eg those w ASD/ADHD may have something unique w developmental history (eg birth history, delay in reaching milestones)
-social functioning: how child/adolescent is doing socially w peers
-educational functioning: how child/adolescent is doing in school
what are disorders that fit under the categories of “externalizing” or “internalizing” problems?
-externalizing problems: “disorders of undercontrolled behavior”
-ADHD, ODD, CD
-internalizing problems: “disorders of overcontrolled behavior”
-Separation Anxiety Disorder, selective mutism, reactive attachment disorder, anxiety disorders, mood disorders
-other:
-EDs; childhood psychotic disorders
what is the prevalence of ADHD in:
-preschool-aged children?
-children and adolescents?
-adults?
-by gender?
-preschool: 2%
-children/adolescents: 6%
-adults: 4%
-overall more common in boys than girls
what are the diagnostic criteria for ADHD? what are the 3 ‘clusters’ of symptoms and examples of each?
A. 6(+) symptoms that have persisted for AL 6mos
-Inattention: eg often has difficulty sustaining [ ] in tasks / play activities
-Hyperactivity: eg is often “on the go” or often acts as if “driven by a motor”
-Impulsivity: eg often blurts out answers before Qs have been completed
B. symptoms prior to 12yrs
C. symptoms present in 2(+) settings
D. symptoms interfere w / reduce the quality of social, academic, or occupational fnxing
E. symptoms are not better explained by another mental disorder
compare inattentive and hyperactive/impulsive ADHD (presentation, gender, complications)
-impulsive:
-inattentive: reflects difficulties in listening, learning, remembering
-more common in girls than boys
-associated w greater academic problems (esp math related)
-hyperactive/impulsive: tend to get into trouble, talk to themselves + others, interrupt others, move + fidget, highly reactive
-more common in boys than girls
-higher rates of comorbid conduct problems relative to ADHD-I
-motor symptoms ↓ w age, but fidgeting + restlessness often persist into adulthood
what are the comorbidity rates of ADHD with another disorder? list some of these disorders
-50% of children w ADHD have comorbid diagnoses
-oppositional defiant disorder
-conduct disorder
-learning disorders
-anxiety disorders
-depression
-substance abuse disorders
what is the developmental trajectory of ADHD? list some examples
-↑ risk of dev’g another psychiatric disorder
-begin substance use earlier than youth without ADHD
-4x greater risk of self-injury (particularly car accidents)
-greater academic problems
-lower occupational attainment
-become parents at an earlier age
-4x as many STIs in adolescence
-higher rates of divorce + separation
how does the brain structure and function differ in someone with ADHD?
-reduced brain size
-abnormalities in prefrontal cortex (responsible for executive fnxing) + basal ganglia (assoc w higher motor ctrl, learning, memory and cognition, emotional regulation)
-dopamine + noradrenergic (norepinephrine) abnormalities
what are risk factors of ADHD? list examples for each
-prenatal toxin exposure: (poor diet, exposure to antidepressants, antihypertensives, illicit drugs, alc, tobacco, caffeine, mercury, lead, pregnancy / delivery complications)
-genetics (more than half of the risk is genetic)
-psychosocial (low SES, large family size, paternal criminality, poor maternal MH, child maltreatment, foster care placement, family dysfunction)
what are treatment options for ADHD? what are downsides/side effects?
-stimulant medication
–does NOT teach new skills – also need supporting in terms of social + academic development, other areas of MH, anxiety, depression
-side effects: ↓ appetite, weight loss, sleep difficulties, headaches, ↑ in pulse / blood pressure
-combination treatments (ie meds + parent training) – treatment needs to change as child gets older to be developmentally appropriate (eg appropriate social skills for a 5 vs 12yo)
what are downsides/side effects of ADHD medication?
-stimulant medications helpful in ↑ concentration and ↓ impulsivity + overreactivity, BUT:
-does NOT teach new skills – also need supporting in terms of social + academic development, other areas of MH, anxiety, depression
-side effects: ↓ appetite, weight loss, sleep difficulties, headaches, ↑ in pulse / blood pressure
what are the diagnostic criteria for oppositional defiant disorder?
-pattern of negativistic, hostile, defiant behavior lasting AL 6mos, 4+ of:
-often loses temper
-is touchy / easily annoyed
-often argues w authority figures (for children, argues w adults)
-often actively defies / refuses to comply w adults’ requests or rules
-often deliberately annoys people
-often blames others for mistakes / misbehaviors
-is often angry + resentful
-has been vindictive / spiteful AL twice in the last 6mos
what are the diagnostic criteria for conduct disorder?
-repetitive + persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms of rules are violated
-3+ in the last 12mos, and AL 1 in the last 6mos:
-aggression to people/animals
-destruction of property
-deceitfulness or theft
-serious violations of rules
-specify if:
-lack of remorse or guilt
-callous – lack of empathy
-unconcerned abt performance
-shallow or deficient affect
compare ODD with CD and ADHD
-ODD vs CD:
-typically less severe in nature than CD
-does not include aggression toward people/animals, distruction of property, or a pattern of theft/deceit
-includes problems of emotional dysregulation (ie angry + irritable mood) that aren’t included in the definition of CD
-ADHD: often comorbid w ODD
-to make additional diagnosis of ODD, determine that the individual’s failure to conform to requests of others is not solely in situations that demand sustained effort + attn
what are 3 common comorbidities of ODD and CD?
-learning disorders
-ADHD
-substance use
describe a less common developmental trajectory for children with ODD. who is this usually found in?
-ODD → CD → APD
-this is the trajectory for the MINORITY of children diagnosed w ODD – most common for children whose conduct problems begin early + are severe
describe children with comorbid ADHD and CD (age of onset, symptoms)
children w comorbid ADHD + CD tend to have:
-a younger age of onset
-more severe + protracted symptoms
-symptoms tend to be more aggressive
what are psychosocial risk factors of ODD and CD? give examples
-maternal stress + smoking during
pregnancy
-Poor parenting: Low monitoring, harsh
punishment, inconsistent discipline, and child
abuse
-Peer rejection and associating with deviant
peers
-parental psychopathology, lone-parent
families, large family size, teenage pregnancy
in what circumstances are childhood maltreatment a predictor of conduct problems?
-when combined w either:
-Low monoamine oxidase A (MAOA): a gene that produces the enzyme that breaks down serotonin, norepinephrine, and dopamine) or
-High genetic risk for conduct problems
compare rates of ODD and CD by gender
-slightly more boys than girls diagnosed w ODD
-3-4x more boys than girls diagnosed w CD
what is the developmental trajectory of girls with CD? give 3 examples
-factors assoc w girls of CD:
-teen pregnancy
-suicidal behavior
-romantic involvement w antisocial males (termed assortative mating)
→ relationships between 2 antisocial indivs associated w escalating negative behavior, discord in the relationship, poor parenting of future offspring
what are 4 treatment methods for ODD/CD?
- Problem-solving skills training: targets deficits in problem-solving skills, social perception, social attribution
- Pharmacological treatment: some support for mood stabilizers, neuroleptics, antipsychotics, stimulants
- Parent training: dev a new skill set in parents that promotes prosocial behavior while also applying effective discipline techniques to minimize the negative behavior
- School and community based treatment: programs targeting families through school + community
-people who would most benefit from services eg parent training are least likely to attend (often linked to factors eg poverty, poor maternal MH)
what are the diagnostic criteria of separation anxiety disorder?
AL 3 of the following for AL 4wks:
-recurrent distress upon separation from a parent
-worry that an event will lead to harm to the parent
-persistent + excessive worry abt experiencing an untoward event (eg getting lost) that causes separation from a major attachment figure
-reluctance to go places without the parent in proximity
-reluctance to sleep away from the parent
-nightmares about separation
-complaints about physical symptoms when separation is anticipated
compare prevalence of childhood anxiety disorders among boys and girls in childhood/adolescence
-anxiety disorders equally common among boys + girls in childhood + adolescence
what future MH problems is childhood anxiety a precursor to?
-anxiety disorders (same = homotypic continuity; different than original diagnoses = heterotypic continuity)
-behavioral problems
-depressive disorders
-EDs
-suicidality
-substance abuse problems
what are etiological factors of anxiety (physiological, heritability, pregnancy?)
-abnormal functioning in the amygdala
-Heritable component: specific anxiety
disorder might be due to environment (direct observation/instruction, personal experiences)
-significant enduring stress during
pregnancy is associated with anxiety
problems in offspring
what are etiological factors of anxiety (physiological, heritability, pregnancy?)
-abnormal functioning in the amygdala
-Heritable component: specific anxiety
disorder might be due to environment (direct observation/instruction, personal experiences)
-significant enduring stress during
pregnancy is associated with anxiety
problems in offspring
describe treatment methods for children with anxiety
-CBT: Coping CAT (Kendall & Hedtke, 2006)
-psychoeducation abt anxiety
-helping parents + children to learn new ways to cope w anxiety
-exposure to anxiety-provoking situations
-medication: some support for SSRIs
-caution: side effects
-support for combo CBT + SSRIs
compare homotypic and heterotypic continuity
-homotypic: when a particular psychiatric disorder predicts itself at a later time point (eg social anxiety symptoms in adolescence predict the same symptoms in adulthood)
-heterotypic: disorder predicts another disorder at a later time point
