Behavioural Disorders Flashcards
Conduct Disorder DSM V
- Repetitively and persistently violates rights of others or major social norms/rules:
-Aggression (bullying, initiates fights, uses weapons, cruel to people or animals, robbery, sexual coercion)
-Destruction of property
-Lying
-Theft
-Rule violations (stays out all night, beginning before age 13 yrs; runs away from home; truants from school) - Limited pro-social emotions (lack of remorse, guilt, empathy; shallow affect)
may be present but not required – reflects a deviant ‘moral awareness’ - Present for at least 12 months and causes impairment in social, academic or
occupational functioning - Childhood onset (before 10 years) or adolescent onset; can be diagnosed in adults
also (if criteria for APD not met)
ASSOCIATED FEATURES AND DIFFICULTIES of conduct disorder
- Misperceives intentions of others
- Poor frustration tolerance and self-control
- Insensitive to punishment
- Reckless behaviour, frequent accidents and injuries
- Academic underperformance
- School suspension/expulsion or drop out
- Legal difficulties, incarceration
- Early onset sexual behaviour and alcohol/drug use
- ADHD and ODD often comorbid
- High risk of depression and suicide
- In adults, poor work adjustment
Prevalence of conduct disorder
-4-16% boys and 1-9% girls (9.5% lifetime prevalence in USA)
age of onset for conduct disorder
10-12 years, but later for girls than boys
2 sub-types of conduct disorder
adolescence limited and life-course persistent
Individual level risk factors: conduct disorder
- Genetic inheritance
- Pre-natal risk factors (alcohol, smoking, malnutrition)
- Cognitive factors: lower IQ and information processing biases
family level factors for conduct disorder
- Parental rejection and insensitivity
- Harsh and inconsistent discipline practices or physical abuse
- Domestic violence
- Frequent changes in caregiver
- Lack of supervision
- Parent criminality
- Low family income
Community-level factors
of conduct disorder
- Association with delinquent peer group
- Exposure to community violence
- Causes or consequences of CD?
DSM 5 criteria for adhd
- Persistent pattern of inattention and/or impulsivity and hyperactivity
- Interferes significantly with social or academic functioning
- Must be present in at least two settings (usually diagnosed once schooling begins)
- Can be classified as mild, moderate or severe
3 subtypes of ADHD
- Predominantly impulsive or hyperactive type
- Predominantly inattentive type
- Combined type
Symptoms: Inattention ADHD
- Fails to attend to details or makes careless errors in schoolwork
- Difficulty sustaining attention in schoolwork or play
- Doesn’t appear to pay attention to what is said
- Fails to follow through on instructions or to finish work
- Has trouble organising work and other activities
- Avoids activities that require sustained attention
- Readily distracted
- Forgetful in daily activities
Symptoms: Hyperactivity
ADHD
- Fidgets or squirms excessively
- Leaves seat in inappropriate situations
- Is constantly running around or climbing on things
Symptoms: Impulsivity
ADHD
- Impatience, difficulty delaying responses
- Can’t wait his/her turn
- Interrupts others
- Frequently shouts out in class
Social difficulties
ADHD
-Peer conflict and fights
-Social rejection
-Family conflict
-Labelled as ‘trouble-makers”
and “problem children
Scholastic difficulties
ADHD
Often have average or above average intelligence but:
- Specific learning difficulties
- Grade failures and drop out
- Special education classes
Increased risk for other mental health difficulties:
ADHD
- In combined type of ADHD, conduct disorder comorbid in 25% and oppositional defiant disorder in 50% of cases
- Higher risk of depression than non-ADHD children
- Higher risk of developing substance misuse or antisocial behaviour in adulthood than general population
Prevalence of ADHD
USA: -5% of school aged children -5% increase in ADHD diagnosis per year since 2003 UK: -2.5% SA: 5%
Age and gender patterns:
ADHD
- Chronic disorder (persisting into adulthood in up to 60% of cases across studies)
- Across all countries, boys are at higher risk of diagnosis (ranging from 2:1 to 16:1 in different studies)
- Gender difference disappears in adolescence and adulthood
ETIOLOGY: BIOLOGICAL FACTORS
ADHD
-Genetics: twin and family studies indicate high level of heritability
What is genetically inherited?
- dysregulation in norepinephrine, dopamine and serotonin neurotransmitter systems?
- abnormalities in frontal lobes (executive functioning, response Inhibition, working memory, planning)?
-Gene-environment interaction: genetic vulnerability may only manifest as ADHD under certain environmental conditions
-Pre-natal and peri-natal factors e.g. smoking and alcohol use in pregnancy, low birth weight or prematurity, maternal stress (evidence not conclusive)
-Toxins (pesticides, lead) and diet (poor evidence)
ETIOLOGY: PSYCHOLOGICAL FACTORS ADHD
- Parent- child interactions:
- Inconsistent parenting style (e.g. discipline, structure)
- Family conflict is common for children with ADHD - Theory of mind deficits:
- Ability to understand own and others’ mental states
- Evidence inconclusive - Underlying anxiety, depression or traumatic stress:
- Higher risk than general population but only a minority affected
Biological treatments
ADHD
- Stimulant medication is most widely used intervention e.g. methylphenidate (Ritalin, Concerta) and amphetamines (Adderall)
- Recent evidence to support use of non-stimulant medications (Strattera)
- Under medical supervision, generally safe and effective in reducing symptoms for most children with ADHD
- More seat time, more time on-task, more work completed
Negative of biological treatment of ADHD
- Side effects such as appetite and sleep disturbances, anxiety or irritability (can reduce with time and dosage adjustment)
- Effects are short-acting, most children will need to continue meds into adolescence and adulthood (though adherence declines)
- Does not appear to improve work accuracy and overall academic performance
- Does not build sustainable skills to address difficulties in longer term
3 components of psychosocial treatment of ADHD
- CBT with child/adolescent (social skills training, managing impulsivity; modelling and role-play)
- Parenting skills training (clear rules, structured routines, praise and reward systems)
- Classroom interventions (structure of classroom, clear expectations/rules, setting manageable goals, reward systems)
Comparing treatment effectiveness
ADHD
- Both medication and psychosocial treatment are effective in reducing symptoms
- Medication alone is more effective than therapy alone
- Medication combined with psychotherapy is more effective than either alone
