chapter 13 Flashcards
Normal vs Abnormal Behavior
Normal vs Abnormal: Depends on age and cultural background
Key: deviation from development and normative standards
Setting: home, school, generalized, etc
Neurodevelopmental disorders
A category of mental disorders in the DSM-5 affecting children and adolescents and that involve impaired brain functioning or development
⅕ American children and young adults develops a psychological disorder
- Fail to get the treatment they need
types of Neurodevelopmental disorders
Autism spectrum disorder
Intellectual disability
Specific learning disorder
Communication disorders
attention-deficit/hyperactivity disorder
Autism spectrum disorder (ASD)
A developmental disorder characterized by significant deficits in communication and social interaction, as well as development of restricted or fixed interests and repetitive behaviors
Chronic, lifelong condition
Prevalence has been rising steadily for several decades
5x as common in boys as girls
DSM
Asperger’s disorder was a distinct diagnosis in the previous edition of the DSM but is not classified in the DSM-5 as a form of autism spectrum disorder
asperger’s
A pattern of behavior characterized by social awkwardness and stereotyped or repetitive behaviors but without the significant language or cognitive deficits associated with more severe forms of autism spectrum disorder
criteria of Autism spectrum disorder (ASD)
A) Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the following, currently, or by history
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth to initiate or respond to social interactions
2. Deficits in nonverbal communicative behaviors used for social interaction, randing, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers
B) Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently, or by history
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat
same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or
perseverative interests).
4. Hyper- or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
C) Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
D) Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E) These disturbances are not better explained by intellectual developmental disorder (intellectual disability) or global developmental delay. Intellectual developmental disorder and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual developmental disorder, social communication should be below that expected for general developmental level.
Severity levels of ASD
Level 1 - Requiring Support
Level 2 - Requiring Substantial Support
Level 3 - Requiring Very Substantial Support
specify if ASD
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known genetic or other medical condition or environmental factor
Associated with a neurodevelopmental, mental, or behavioral problem With catatonia
features of ASD
Most poignant feature: aloneness
mute
echolalia (parroting back what the child has heard in a high pitched monotone)
Nonverbal communication may also be impaired or absent
Interminably twirling, flapping the hands, rocking back and forth with the arms around the knees
Preservation of sameness
Lack a differentiated self-concept and sense of themselves
Theoretical Perspectives on Autism
early
cognitive theory
genetic factors
brain abnormalities
environmental influences?
Early and now discredited belief of ASD
Reaction to parents who were cold and detached – “emotional refrigerators”
ASD cognitive theory
limited ability to process multiple stimuli at one time, aka slow stimuli association
- Difficulty integrating information from various senses
- Over or under sensitivity to stimulation, diminishing capacity to ‘make use’ of information
ASD genetic factors
high twin concordance
ASD brain abnormalities
abnormalities in neuron connection and loss of brain tissue
Autism Spectrum Disorder - Treatment
Treatment depends on ‘severity’
Behavioral treatment
- Applied behavior analysis
- Operant conditioning to increase ability to attend to others, play with others, develop academic skills and keep from self mutilation
- Intensive, 1:1
- Imitation skills
- Apps
Intellectual Disability (ID)
A generalized delay or impairment in the development of intellectual and adaptive abilities
Begins before the age of 18; improves over time (especially if they receive support, guidance, and enriched educational opportunities)
Affects conceptual, socialism and practical skills
DSM earlier - <70 IQ → DSM now doesn’t set any specific score
Causes
- Chromosomal and genetic disorders, infectious diseases, maternal alcohol use during pregnancy
- Exposure to an impoverished home environment
criteria of ID
A) Intellectual developmental disorder (intellectual disability) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following three criteria must be met:
1. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing.
2. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community.
3. Onset of intellectual and adaptive deficits during the developmental period.
Intellectual Disability - Causes
chromosomal abnormalities
genetic disorders
prenatal factors
ID - chromosomal abnormalities
Down syndrome - extra chromosome (47)
- A condition caused by the presence of an extra chromosome on the 21st pair and characterized by intellectual developmental disorder and various physical abnormalities
- 1/800 births
- Physical features: a round face, broad/flat nose, small/downward-sloping folds of skin at the inside corners of the eyes, protruding tongue, small hands, short fingers, disproportionately small arms and legs in relation to their bodies
Klinefelter - presence of an extra X chromosome
Turner syndrome - Single X instead of two X chromosomes
ID - genetic disorders
Fragile X Syndrome
- An inherited form of intellectual developmental disorder caused by a mutated gene on the X chromosome
- 1.4/10,000 males and 0.9/10,000 females
- Effects: range from mild learning disorders to ID so profound that those affected can hardly speak or function
Phenylketonuria (PKU)
- A genetic disorder that prevents the metabolization of phenylpyruvic acid, leading to intellectual development disorder unless the diet is strictly controlled
- Caused by a recessive gene
- damaging CNS
ID - prenatal factors
Maternal disease - Rubella (German measles) passed along from mother to child
Drugs
Maternal alcohol use - Ex: fetal alcohol syndrome
Intellectual Disability - Interventions
Aimed at level of severity and geared to increase function
Psycho Education and skills work to assist in vocational skills and professional work
institution, home care and residential options for the most severe cases
Psychotherapy supporting their experiences as other
Dyslexia
A learning disorder characterized by an impaired ability to read
Most common of all - 80%
Learning disorder
A deficiency in a specific learning ability in the context of normal intelligence and exposure to learning opportunities
Chronic
Children - perform poorly in school
DSM-5
Applies a single diagnosis of specific learning disorder to encompass various types of learning disorders or disabilities involving significant deficits in skills involved in reading, writing, arithmetic, and math
criteria of Learning disorder
A) Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties:
1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words).
2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read).
3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants).
4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity).
5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures).
6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems).
problems with –> learning disorder
Reading:
Word reading accuracy
Reading rate or fluency
Reading comprehension
Writing:
Spelling accuracy
Grammar and punctuation accuracy
Clarity or organization of written expression
Math:
Number sense
Memorization of arithmetic facts
Accurate or fluent calculation
Accurate math reasoning
Executive Functioning:
Organizing
Planning
Coordinating tasks
Learning Disorders - Theories
Underlying brain dysfunctions related to, but not limited:
- Processing
- Decoding
- Interpreting
- Visual information
- Auditory information
- Deficits in prefrontal cortex
Diagnosis and treatment depends on specific learning deficit
Communication Disorders
A class of psychological disorders characterized by difficulties in understanding or using language
Language disorder
A type of communication disorder involving impairments in the ability to produce or understand spoken language
Slow vocab development, errors in tenses, difficulties recalling words
criteria for language disorder
A) Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production that include the following:
1. Reduced vocabulary (word knowledge and use).
2. Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology).
3. Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation)
B) Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination.
C) Onset of symptoms is in the early developmental period.
D) The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual developmental disorder (intellectual disability) or global developmental delay.
problems with speech - language disorder
speech sound disorder
childhood-onset fluency disorder
social (pragmatic) communication disorder
speech sound disorder
characterized by difficulties in articulating speech ini absence of oral speech mechanism or neurological impairment
- Omit, substituting, or mispronouncing certain sounds
childhood-onset fluency disorder (stuttering)
characterized by impaired fluency of speech
Repetitions of sounds or syllables, prolonged sounds, interjections of inappropriate worlds, broken words, blocking of speech, word substitutions, excess of physical tension during emission, and repetition of monosyllabic whole worlds
social (pragmatic) communication disorder
characterized by difficulties communicating with others in social contexts
Treatment of communication disorders
Specialized speech and language therapy or with fluency training
Psychological counseling
Attention-deficit/hyperactivity disorder (ADHD)
A behavior disorder characterized by excessive motor activity and inability to focus one’s attention
Most widely diagnosed psychological disorder in US children - 10%
2x more likely in boys than girls
Symptoms tend to decline with age, may persist in milder forms into adolescence and adulthood
criteria for Attention-deficit/hyperactivity disorder (ADHD)
A) A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):
Inattention and hyperactivity + impulsivity
B) Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
C) Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
D) There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
E) The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
ADHD specify whether
Combined presentation
Predominantly inattentive presentation
Predominantly hyperactive/impulsive presentation
in partial remission
mild, mod, severe
ADHD in partial remission
In partial remission: When 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.
ADHD - mild, mod, sev
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.
inattention
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities
- Often has difficulty sustaining attention in tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
- Often loses things necessary for tasks or activities
- Is often easily distracted by extraneous stimuli
- Is often forgetful in daily activities
hyperactivity
- Often fidgets with or taps hands or feet or squirms in seat
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in situations where it is inappropriate
- Often unable to play or engage in leisure activities quietly
- Is often “on the go,” acting as if “driven by a motor”
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has difficulty waiting his or her turn
- Often interrupts or intrudes on others
AD/HD: Causes
Genetic
High concordance rate in twins
Environmental
Maternal stress and smoking during pregnancy
High family conflict, poor parenting skills, neglect
Biological
Breakdown of prefrontal cortex
Genetic and Environmental factors = impacted executive functioning control in brain
Trauma? Mirroring of trauma symptoms
AD/HD: Treatment
Stimulants: boost short term memory and activating prefrontal cortex
Concerta
- Ritalin
Nonstimulant: increase availability of norepinephrine
- Strattera
Therapies
- CBT
- Behavioral
- Executive functioning support
Conduct Disorder (CD)
A psychological disorder in childhood and adolescence characterized by disruptive, antisocial behavior
12% males; 7% females
Boys - stealing, fighting, vandalism
Girls - lying, truancy, running away, substance use, prostitution
Average age onset - 11.6 years
criteria of Conduct Disorder (CD)
A) 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 three 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:
–> Aggression to People and Animals
–> Destruction of Property
–> Serious Violations of Rules
B) The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
C) If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.
Aggression to People and Animals
- Often bullies, threatens, or intimidates others.
- Often initiates physical fights.
- Has used a weapon that can cause serious physical harm to
others (e.g., a bat, brick, broken bottle, knife, gun). - Has been physically cruel to people.
- Has been physically cruel to animals.
- Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
- Has forced someone into sexual activity.
Destruction of Property
- Has deliberately engaged in fire setting with the intention of causing serious damage.
- Has deliberately destroyed others’ property (other than by fire setting).
Deceitfulness or Theft
- Has broken into someone else’s house, building, or car.
- Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
- Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).
Serious Violations of Rules
- Often stays out at night despite parental prohibitions, beginning before age 13 years.
- Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
- Is often truant from school, beginning before age 13 years.
CD specify if and with
Specify:
- Childhood-onset type: Pre age 10
- Adolescent-onset type: 10+
Unspecified onset
With limited prosocial emotions:
- Lack of remorse or guilt
- Callous–lack of empathy
- Unconcerned about performance
- Shallow or deficient affect
mild, mod, sev
CD mild, mod, sev
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 others (e.g., lying, truancy, staying out after dark without permission, other rule breaking).
Moderate: The number of conduct problems and the effect on others are intermediate between those specified in “mild” and those in “severe” (e.g., stealing without confronting a victim, vandalism).
Severe: Many conduct problems in excess of those required to make the diagnosis are present, or conduct problems that cause considerable harm to others (e.g., forced sex, physical cruelty, use of a weapon, stealing while confronting a victim, breaking and entering).
Oppositional Defiant Disorder (ODD)
A psychological disorder in children and adolescence characterized by excessive oppositionality or tendencies to refuse requests from parents and others
Negativistic or oppositional
Lose temporary easily, act in a vindictive manner
1-11% of children and adolescents
criteria for Oppositional Defiant Disorder (ODD)
A) A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.
–> Angry/Irritable Mood
–> Argumentative/Defiant Behavior
–> Vindictiveness
B) The 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 dysregulation disorder.
Specify current severity ODD
Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers).
Moderate: Some symptoms are present in at least two settings.
Severe: Some symptoms are present in three or more settings.
CD and ODD - Theories and Treatment
Temperament
Psychodynamic
- Unresolved parent-child conflict or parental control
- Sign of fixation at the anal stage - when conflicts between the parent and child emerge over toilet training
Learning
- Inappropriate parental reinforcement strategies (giving in, overly strict)
Family factors
- Parental distress
- Poor or limited parenting skills
- Abuse
Perceptions of threats of harm
Behavioral Treatment for both parents and children, anger management, CBT
Anxiety-Related Disorders in Children and Adolescents
Often specific phobias, social phobia, or GAD
Cognitive biases:
- Negative self talk
- Expecting negative outcome
- Interpretation of ambiguous situations and threatening
Separation anxiety - extreme distress at being separated from parents of primary caregivers
Often manifests physically
Children lack the words to describe their experiences with these issues- hard to label until age 7 developmentally
Anxiety-Related Disorders in Children and Adolescents
Theories
Psychodynamic
Unconscious conflicts
Cognitive
Cognitive distortions
Learning
Fears of rejection or failure
Anxiety-Related Disorders in Children and Adolescents
Treatment
CBT
Play therapy
SSRIs
Depression in Children and Adolescents
Ranges from 5 to 17 years
Similar and identical sx as adult MDD
Distinct:
- Refusal to attend school
- Fear of parental death, clinging
- Conduct/academic problems
- Physical complaints
- Hyperactivity
- Aggression/sexual acting out
Like anxiety, hard to label until age 7 developmentally
Depression in Children and Adolescents
Theories
Depending on Age
- Stressful life and family events
- Exposure to discrimination
- Stressful social situations in teens
- Negative thinking
- Responses to adolescence/puberty
Depression in Children and Adolescents
Treatment
CBT
Play therapy depending on age
Psychodynamic
SSRIs
Suicide in Children and Adolescents
Not just venting → to be taken seriously
Suicide is the second-leading cause of death for teens and young adults, ages 10-34 (CDC, 2022).
25.5% of adults ages 18-24 reported having seriously considered suicide in the past month. This is a higher percentage than any other adult age group (CDC, 2020).
18.8% of high school students reported having seriously considered suicide in the past year. This percentage is higher among females (24.1%), and lesbian, gay, or bisexual teens (46.8%) (CDC, 2020).
8.9% of high school students attempted suicide in the past year. This percentage is highest among females (11.0%), black teens (11.8%), and lesbian, gay, or bisexual teens (23.4%) (CDC, 2020).
Think brain development:
C/A have lower levels of inhibition and problem solving strategies developmentally
Suicide in Children and Adolescents
RISK FACTORS
Gender
Geography
Ethnicity
Depression, hopelessness
Previous suicidal behavior
Prior sexual abuse
Family problems
Stressful life events substance abuse
Social contagion
Elimination Disorders
examples
Enuresis and encopresis
enuresis
Failure to control urination after one has reached the “normal” age for attaining such control
criteria for enuresis
A) Repeated voiding of urine into bed or clothes, whether involuntary or intentional
B) The behavior is clinically significant as manifested by either a frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.
C) Chronological age is at least 5 years (or equivalent developmental level).
D) The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder).
Specify whether of enuresis
Nocturnal only: Passage of urine only during nighttime sleep.
Diurnal only: Passage of urine during waking hours.
Nocturnal and diurnal: A combination of the two subtypes above.
Theoretical perspectives of Enuresis
Psychodynamic
Regression in response to the birth of a sibling or some other stressor or life change
Learning theorists
Common in children whose parents attempted train them early
Treatment of Enuresis
Behavioral methods have been helpful
- Alarm
Drug treatment
Encopresis
Lack of control over bowel movements that is not caused by an organic problem
criteria of Encopresis
A) Repeated passage of feces into inappropriate places (e.g., clothing, floor), whether involuntary or intentional.
B) At least one such event occurs each month for at least 3 months.
C) Chronological age is at least 4 years (or equivalent developmental level).
D) The behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition except through a mechanism involving constipation.
specify whether Encopresis
With constipation and overflow incontinence: There is evidence of constipation on physical examination or by history.
Without constipation and overflow incontinence: There is no evidence of constipation on physical examination or by history.