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Clinical Psychology > Behavioural Disorders > Flashcards

Behavioural Disorders Flashcards

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1
Q

Conduct Disorder DSM V

A
  1. 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)
  2. Limited pro-social emotions (lack of remorse, guilt, empathy; shallow affect)
    may be present but not required – reflects a deviant ‘moral awareness’
  3. Present for at least 12 months and causes impairment in social, academic or
    occupational functioning
  4. Childhood onset (before 10 years) or adolescent onset; can be diagnosed in adults
    also (if criteria for APD not met)
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2
Q

ASSOCIATED FEATURES AND DIFFICULTIES of conduct disorder

A
  • 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
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3
Q

Prevalence of conduct disorder

A

-4-16% boys and 1-9% girls (9.5% lifetime prevalence in USA)

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4
Q

age of onset for conduct disorder

A

10-12 years, but later for girls than boys

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5
Q

2 sub-types of conduct disorder

A

adolescence limited and life-course persistent

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6
Q

Individual level risk factors: conduct disorder

A
  1. Genetic inheritance
  2. Pre-natal risk factors (alcohol, smoking, malnutrition)
  3. Cognitive factors: lower IQ and information processing biases
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7
Q

family level factors for conduct disorder

A
  • 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
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8
Q

Community-level factors

of conduct disorder

A
  • Association with delinquent peer group
  • Exposure to community violence
  • Causes or consequences of CD?
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9
Q

DSM 5 criteria for adhd

A
  • 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
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10
Q

3 subtypes of ADHD

A
  1. Predominantly impulsive or hyperactive type
  2. Predominantly inattentive type
  3. Combined type
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11
Q

Symptoms: Inattention ADHD

A
  • 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
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12
Q

Symptoms: Hyperactivity

ADHD

A
  • Fidgets or squirms excessively
  • Leaves seat in inappropriate situations
  • Is constantly running around or climbing on things
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13
Q

Symptoms: Impulsivity

ADHD

A
  • Impatience, difficulty delaying responses
  • Can’t wait his/her turn
  • Interrupts others
  • Frequently shouts out in class
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14
Q

Social difficulties

ADHD

A

-Peer conflict and fights
-Social rejection
-Family conflict
-Labelled as ‘trouble-makers”
and “problem children

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15
Q

Scholastic difficulties

ADHD

A

Often have average or above average intelligence but:

  • Specific learning difficulties
  • Grade failures and drop out
  • Special education classes
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16
Q

Increased risk for other mental health difficulties:

ADHD

A
  • 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
17
Q

Prevalence of ADHD

A 
USA:
-5% of school aged children
-5% increase in ADHD diagnosis per year since 2003
UK:
-2.5%
SA:
5%
18
Q

Age and gender patterns:

ADHD

A
  • 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
19
Q

ETIOLOGY: BIOLOGICAL FACTORS

ADHD

A

-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)

20
Q

ETIOLOGY: PSYCHOLOGICAL FACTORS ADHD

A
  1. Parent- child interactions:
    - Inconsistent parenting style (e.g. discipline, structure)
    - Family conflict is common for children with ADHD
  2. Theory of mind deficits:
    - Ability to understand own and others’ mental states
    - Evidence inconclusive
  3. Underlying anxiety, depression or traumatic stress:
    - Higher risk than general population but only a minority affected
21
Q

Biological treatments

ADHD

A
  • 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
22
Q

Negative of biological treatment of ADHD

A
  • 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
23
Q

3 components of psychosocial treatment of ADHD

A
  1. CBT with child/adolescent (social skills training, managing impulsivity; modelling and role-play)
  2. Parenting skills training (clear rules, structured routines, praise and reward systems)
  3. Classroom interventions (structure of classroom, clear expectations/rules, setting manageable goals, reward systems)
24
Q

Comparing treatment effectiveness

ADHD

A
  • 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

Clinical Psychology (10 decks)

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