Behaviour Disorders Flashcards
What is the evidence that specific neurobiological systems are involved in the aetiology of childhood-onset antisocial behaviour?
Research by Jeffrey Grays showed that youths diagnosed with CD with early age onset, aggressive traits and under socialised symptom patterns are associated with low cortical arousal and autonomic reactivity- ie less learning associated with punishment or aversive experiences. He developed a bioapsychosocial theory that recognised 2 neurological systems- the BAS and BIS. CD children have a low BIS and high BAS
Describe the factors that contribute to the development and maintenance of disruptive behaviours in children.
Age-inappropriate displays of anger, defiance and irritability or aggression and antisocial behaviours develop due to multiple influences including biological and psychosocial risk factors, such as family traits, school and community culture, peers/friendships and societal norms.
Genetic effects are linked to externalising and overt behaviours eg temperament, irritability, hyperactivity, impulsivity.
More overt behaviours such as violence, cruelty to animals etc linked to environment child is raised in.
IQ including verbal reasoning and executive functioning associated with behaviour disturbances.
Behavioural dysregulation associated with harsher parenting and rejection by peers, increasing rejecting and problem behaviours and association with other delinquent peers
Lower IQ and concentration/disinhibition difficulties leads to increased frustration in the classroom setting- leads to expulsion and cycle of deviance.
Parent-child relationship influenced by early biologically based difficulties- harsh punitive parenting intensifies aggression
Family psychopathology- parental antisocial behaviour and substance use (fathers) and histrionic PD (mothers)
Family structure- big families, stress, parental discord, lack of support and poverty
Extra = lead toxicity (smoking), being male, low education of parents, school organisation, parenting style, poverty and neighbourhood violence. Variations of genes of dopamine and serotonin
NB biological most influential with early onset. Biology overall moderate influence
Describe the types of information you would collect in an initial child assessment and methods used
Developmental systems assessment (DSA) has evolved from concepts and methods of developmental psychopathology and evidence based assessment. Fundamental ideas:
Focus on child’s thoughts, feelings and behaviours in specific situations and over time, as well as temperament, dispositions. How are these factors causing distress and impairment?
Focus on diagnosis, formulation, treatment plan and monitoring
Developmental stage/transitions
Multiple informants, and methods needed
Family hx
Culture, community, family climate, peer relations
Influence of parent, teacher, peers
Prior assessments
Parental concerns and goals, their role and gain info re developmental hx
General Behaviour Checklist, direct observation, psychophysiological recordings, screening q’s, problem checklists eg fear questionnaires, IQ
Describe a broadband measure for a child assessment and how it can be used diagnostically
The CBCL for 1.5-5 yrs, 6-18 yrs and caregiver, teacher support form are similar with regards to structure, items and scoring, taking 10-15 mins to complete. It measures internalising and externalising behaviour and subscales for rule breaking behaviour, and aggression. Age and gender specific norms available.
Assessment needs to cover comorbidities including language disorders.
Outline a comprehensive assessment of a child presenting with features suggestive of ODD
Assess for frequency, duration and intensity of unprovoked negative behaviour towards parents/siblings/teachers
Assess monitoring of the parent and time spent with the child
Explore forms of punishment used by the parent
Peer influences (defiant)
Social-cognitive influences and emotional responses/processes
1. Identify if referral is inappropriate eg parent having difficulty coping or normal adolescent behavior
2. Identify type and severity of odd behavior and associated impairments2. 3. Determine if child is exp other impairments related to other disorders
4. Identify risk and maintaining factors
5. Determine developmental pathway most consistent with the conduct problem pattern , comorbid conditions and risk factors including age of onset
6. Multistage assessment
S1. Screening including parent-child interaction, relevant behaviours, language function, functional behavioural assessment - is it deviance or developmental? Or ASEBA
S2. More detailed measures, re emotional impairment, risk factors, settings
S3. Behavioural observations including parent-child interaction (didactic parent child interaction behavioral coding system)- child observed for compliance and non compliance. Good inter-rater observer agreement.
S4 obtain medical history
What is behavioral inhibition and how does it relate to ADHD?
It involves the capacity to inhibit prepotent responses, creating the delay in a response to an event
2 other processes involved including the capacity to interrupt ongoing responses and a delay in responding.
ADHD consists mainly of a developmental delay in behavioural inhibition that disrupts self regulation. It disrupts the efficient execution of
(A) nonverbal working memory (covert self directed sensing)
(B) verbal working memory (internalized self directed speech)
(C) self regulation of affect/motivation/arousal
(D) planning or reconstitution. (self directed play)
What are the main differences between ODD and CD
ODD = negativistic pattern of doing things that annoy other ppl, blaming ppl for their mistakes, disobedient and losing temper.
CD = severe antisocial and aggressive behavior to ppl and animals, property destruction and deceptiveness or theft and serious rule violation.
Overt versus covert eg oppositional defiant behaviors and aggression. Covert includes nonconfrontational eg lying and stealing
Overt-Destructive (aggression) and overt nondestructive (oppositional) versus covert destructive (property violation) and covert nondestructive eg illegal because if child’s age.
What are the five factors that are considered risks for developing CPs?
Biological, cognitive correlates, family context, peers and the broader social ecology
How do the main findings of neuropsychological studies of ADHD relate to the theoretical model?
Deficits in frontal lobe functions, especially in response or executive inhibition.
Meta-analyses of neuropsychological literature illustrates difficulties with inattention and inhibition, plus working memory
Psychophysiological measures of the central and auto NS electrical activity show diminished reactivity to stimulation
Findings suggest impaired right prefrontal mechanism underlying response inhibition
QEEG and evoked response potential (ERP) measures show increased slow wave activity particularly in frontal love and excess beta activity - indicative of a pattern of under arousal and under activity in ADHD
SPECT show decreased blood flow to prefrontal regions, particularly in the right frontal area and pathways connecting these regions to the limbic system via the striatum and in the cerebellum seem related to motor impairment
Outline a thorough assessment if ADHD
Interview parent, teacher, child
Conners 3 for child, teacher and parent
Iq test, anxiety and mood screen
Observation in clinical setting, with peers, in classroom, at home- note non compliance, daydreaming and aggression
What are the findings regarding the efficacy of stimulant medication?
200 RCTS, dexamphetamine and methylphenidate strong evidence for their efficacy
75% improvements, studies with 6-12 yr olds- improvements include reductions in behavioural inhibitions and behavioral regulation
10-25% won’t respond
Not a cure! Relieves temp symptoms- only works while it’s active! Highlights neurological nature and severity
Swanson et al (1997) found no improvement in social skills, no reduction in risk of asb, and frequent side effects
It has been identified that there is a group of children that respond preferably to methylphenidate another group that responds to amphetamine and a third group that respond to both
Placebo response rates generally low
(2% to 39%), most recently 13% reported in a large multimodal treatment study of ADHD (MTA, 1999)