Chapter 13 Flashcards
Developmental psychopathology
Developmental psychopathology
Studies disorders of childhood within the context of life-span development
Two Broad Domains of Childhood Disorders
*Externalizing disorders
Characterized by outward-directed behaviors
Aggressiveness, noncompliance, overactivity, impulsiveness
Includes attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder
*Internalizing disorders
Characterized by inward-focused experiences and behaviors
Depression, social withdrawal, and anxiety
Includes childhood anxiety and mood disorders
Attention-Deficit/Hyperactivity Disorder
Hyperactive behaviors are:
Extreme for a particular developmental period
Persistent across different situations
Linked to significant impairments in functioning
May have particular difficulty controlling their activity in situations that call for sitting still (e.g., classrooms)
May experience difficulty getting along with peers
Aggressive and intrusive behaviors
Difficulty noticing subtle social cues
Singled out very quickly and rejected or neglected by peers
DSM-5 Criteria: ADHD
Either A or B:
A. Six or more manifestations of inattention present for at least 6 months to a maladaptive degree and greater than what would be expected given a person’s developmental level, e.g., careless mistakes, not listening well, not following instructions, easily distracted, forgetful in daily activities
B. Six or more manifestations of hyperactivity-impulsivity present for at least 6 months to a maladaptive degree and greater than what would be expected given a person’s developmental level, e.g., fidgeting, running about inappropriately (in adults, restlessness), acting as if “driven by a motor,” interrupting or intruding, incessant talking
Several of the above present before age 12
Present in two or more settings, e.g., at home, school, or, work
Significant impairment in social, academic, or occupational functioning
For people age 17 or older, only five signs of inattention and/or five signs of hyperactivity-impulsivity are needed to meet the diagnosis
ADHD
specifiers to indicate which symptoms predominate:
Three specifiers to indicate which symptoms predominate:
Predominantly inattentive presentation
Predominantly hyperactive-impulsive presentation
Combined presentation- Most children
ADHD Prevalence
Prevalence estimates 8 to 11% Risen dramatically in past decade Public policy can affect diagnosis rates Access to comprehensive diagnostic testing Education policies
3x more common in boys than girls
May be because boys’ behavior more likely to be aggressive
Symptoms persist beyond childhood
60-74% still exhibit symptoms in early adulthood
Girls with ADHD Compared to Girls without ADHD
Combined subtype more likely to have a comorbid diagnosis of conduct disorder or oppositional defiant disorder
Viewed more negatively by peers
Likely to have internalizing symptoms (anxiety, depression)
Exhibited several neuropsychological deficits, particularly in EXECUTIVE FUNCTIONING (e.g., planning, solving problems)
By adolescence, were more likely to have symptoms of an eating disorder and substance abuse
By early adulthood, young women who continued to meet diagnostic criteria for ADHD were more likely to have internalizing and externalizing psychopathology
Etiology of ADHD: Genetic Factors
-heritability estimates:
Adoption and twin studies
Heritability estimates as high as 70 to 80%
- Several candidate genes implicated
- DRD4, DRD5, DAT1 (Dopamine genes): Associated with increased risk only when prenatal maternal nicotine or alcohol use is present
- SNAP-25: Codes for protein that promotes plasticity
Etiology of ADHD: Neurobiological Factors
- Dopaminergic areas smaller in children with ADHD (Caudate nucleus, globus pallidus, frontal lobes)
- Poor performance on tests of frontal lobe function
- Perinatal and prenatal complications
- Low birth weight (Can be mitigated by later maternal warmth)
Etiology of ADHD: Neurobiological Factors
- Dopaminergic areas smaller in children with ADHD: Caudate nucleus, globus pallidus, frontal lobes
- Poor performance on tests of frontal lobe function
- Perinatal and prenatal complications
- Low birth weight: Can be mitigated by later maternal warmth
- Environmental toxins
- Food additives may influence ADHD symptoms
- No evidence that refined sugar causes ADHD
- Maternal smoking
Etiology of ADHD: Family Factors
Parent–child relationship interacts with neurobiological factors
Parents give more commands and have more negative interactions
Children are less compliant and more negative in interactions with their parents
Many parents of children with ADHD have ADHD themselves
Contribute to maintaining or exacerbating ADHD symptoms but do not cause them
Treatment of ADHD: Medications
Stimulants (Ritalin, Adderall, Concerta, Strattera)
Reduce disruptive behavior, aggression, and impulsivity
Improve ability to focus attention
Improve concentration, goal-directed activity, classroom behavior
Improve social interactions with parents, teachers, peers
Effective in about 75% of children with ADHD
Medication plus behavioral treatment (MTA study)
Combined treatment slightly better than medications alone and yielded improved functioning (e.g., social skills)
Benefits of medications did not persist beyond the study
Treatment of ADHD: Psychological Treatments
Parental training and changes in classroom management
behavior monitoring
Daily report cards
Reinforcement of appropriate behavior
Children earn points or stars for behaving in certain ways
They can then spend their earnings for rewards
Focus of these programs: Improving academic work Completing household tasks Learning specific social skills Do not specifically focus on reducing ADHD symptoms
Related Disorders
Intermittent explosive disorder
Oppositional Defiant Disorder (ODD)
Loses temper, argumentative, lack of compliance, deliberately aggravates others, vindictive, spiteful, touchy
Often comorbid with ADHD
Disruptive behavior of ODD more deliberate than ADHD
Conduct Disorder
Defined by the impact of child’s behavior on people and surrounding
- Focuses on aggressive behaviors
- Physical cruelty to people or animals
- Serious rule violations
- Property destruction
- Deceitfulness
- Diagnostic specifier: “limited prosocial emotions”
- Children who have callous and unemotional traits
- -Lack of remorse, empathy, and guilt, and shallow emotions
- Associated with a more severe course, cognitive deficits, antisocial behavior, and poorer response to treatment
DSM-5 Criteria: Conduct Disorder
- Repetitive and persistent behavior pattern that violates the basic rights of others or conventional social norms as manifested by the presence of three or more of the following in the previous 12 months and at least one of them in the previous 6 months:
- Aggression to people and animals, e.g., bullying, initiating physical fights, physical cruelty to people or animals, forcing someone into sexual activity
- Destruction of property, e.g., fire-setting, vandalism
- Deceitfulness or theft, e.g., breaking into another’s house or car, conning, shoplifting
- Serious violation of rules, e.g., staying out at night before age 13 in defiance of parental rules, truancy before age 13
- Significant impairment in social, academic, or occupational functioning
CD: Comorbidities and Longitudinal Course
Conduct Disorder
Substance abuse is common
Unclear whether it precedes or is concomitant with disorder
Comorbid with anxiety and depression
Comorbidity rates vary from 15 to 45%
CD precedes depression and most anxiety disorders
7% of preschool children exhibit the symptoms of conduct disorder
Assessing conduct disorder early is important
Two Courses of Conduct Problems (Moffitt, 1993; )
*Life-course-persistent pattern of antisocial behavior
Beginning to show conduct problems by age 3 and continuing into adulthood
*Adolescence-limited
Typical childhoods, engagement in high levels of antisocial behavior during adolescence, and typical, nonproblematic adulthoods
Result of a maturity gap between the adolescent’s physical maturation and the opportunity to receive rewards for assuming adult responsibilities
Continue to have troubles with substance use, impulsivity, crime, and overall mental health in their mid-20s (adolescence onset)
CD: Prevalence and Prognosis
CD is fairly common
Prevalence rates between 5 and 6%
More common in boys than girls
Life-course-persistent type of conduct disorder will likely continue to have problems in adulthood, including violent and antisocial behavior
Conduct disorder in childhood does not inevitably lead to antisocial behavior in adulthood
About half of boys with CD did not fully meet diagnostic criteria at a later assessment (1 to 4 years later)
Almost all continued to demonstrate some conduct problems
Etiology of Conduct Disorder
(slide 42)
3 overlapping circles of social, psychological, and neurobiological => conduct disorder
Etiology of CD: Genetic Factors
Heritability likely plays a part
Some genetic influences are shared with other disorders and some are specific
Importance of gene X environment interactions
Aggressive behavior is more heritable than other rule breaking behavior
Combination of conduct problems and callous/unemotional traits is more highly heritable than conduct problems alone
Aggressive and antisocial behaviors that begin in childhood are more heritable than similar behaviors that begin in adolescence
Etiology of CD: Neurobiological Factors
Deficits in regions of the brain that support emotion and empathetic responses
Reduced activation of amygdala, ventral striatum, and prefrontal cortex
Lower levels of resting skin conductance and heart rate
Lower arousal levels
May not fear punishment
Poor verbal skills, difficulty with executive functioning, and problems with memory
Children who develop conduct disorder at an earlier age:
IQ score 1 standard deviation below peers without conduct disorder
Not attributable to lower socioeconomic status or school failure
Etiology of CD:Psychological Factors
Deficient moral awareness, especially lack of remorse
*Dodge’s Cognitive Theory of Aggression
Deficits in social information processing
Interpretation of ambiguous acts (e.g., being bumped) as evidence of hostile intent
Leads to aggressive retaliation
Creates a vicious cycle:
Peers, remembering aggressive behaviors, may tend to be aggressive more often against them, further angering the already aggressive children
Dodge’s Cognitive Theory of Aggression
ambiguous act interpreted as hostile –> aggression toward others –> retaliation from others –> furuther angry aggression towards others –> (back to ) ambigous act interpreted as hostile
Etiology of CD: Peer Influences
Acceptance or rejection by peers
Rejection by peers is causally related to aggressive behavior
Rejection by peers predicts later aggressive behavior
Children prone to react negatively to situations:
More likely to be rejected by peers
More likely to engage in antisocial behavior
Affiliation with deviant peers Increases the likelihood of delinquent behavior Modeling or coercion Genetic factors encourage children with conduct disorder to select more deviant peers to associate with Environmental influences (e.g., poverty in the neighborhood, parental monitoring) play a role in whether children associate with deviant peers
Treatment of CD
(Conduct Disorder)
- Most effective when it addresses the multiple systems involved in the life of a child
- Family, peers, school, neighborhood
- Multisystemic treatment (MST)
*Family interventions
-Family check-ups (FCU)
3 meetings to assess and provide feedback to parents regarding their children and parenting practices
Associated with less disruptive behavior
-Parental management train (PMT)
Teach parents to use POSITIVE REINFORCEMENT for positive behaviors and time-out and loss of privileges for aggressive or antisocial behaviors
Most efficacious for children with CD and oppositional defiant disorder
CD Prevention Programs
*Fast Track
-Designed to help children academically, socially, and behaviorally
-Focuses on areas that are problematic in conduct disorder:
Peer relationships, aggressive and disruptive behavior, social information processing, and parent–child relationships
-Treatment delivered over the course of 10 years
–Groups and at individual families’ homes
–More intensive treatment years 1-5 and less intensive years 6-10
*Children who received Fast Track
-Reduced behavior problems and delinquent behaviors
-Better social information processing skills
-Decrease in the hostile attribution bias
-Less likely to have externalizing or internalizing psychopathology, substance use problems, or antisocial personality disorder
Depression in Children and Adolescents
- Children and adolescents ages 7 to 17 and adults show:
- Depressed mood, inability to experience pleasure, fatigue, concentration problems, and suicidal ideation.
- Children and adolescents differ from adults in:
- More guilt but lower rates of early-morning wakefulness, early-morning depression, loss of appetite, and weight loss
*Depression in children is recurrent
-Prevalence among adolescent girls (15.9%) almost twice that among adolescent boys (7.7%)
–Few differences in the types of symptoms they experience
Comorbid with anxiety
Depression in Children and Adolescents
Children and adolescents ages 7 to 17 and adults show:
Depressed mood, inability to experience pleasure, fatigue, concentration problems, and suicidal ideation.
Children and adolescents differ from adults in:
More guilt but lower rates of early-morning wakefulness, early-morning depression, loss of appetite, and weight loss
Depression in children is recurrent
Prevalence among adolescent girls (15.9%) almost twice that among adolescent boys (7.7%)
Few differences in the types of symptoms they experience
Comorbid with anxiety
Etiology of Depression in Children
*Genetic factors
Similar to factors identified in studies with adults
A child with a depressed parent has 4x greater risk than a child without a depressed parent
Gene–environment interactions
Short allele of the serotonin transporter gene AND significant interpersonal stressful life
*Early adversity and negative life events
E.g., financial hardship, maternal depression, chronic illness as a child
Body’s stress response
Cortisol taken first thing in the morning predicts onset of depression
Volume of the hippocampus grew more slowly
Cognitive distortions and negative attributional style
*Stable attributional style
Develops by early adolescence
Attributional style does not interact with negative life events to predict depression
By middle school, attributional style serves as a cognitive diathesis for depression
Treatment of Depression in Children and Adolescents
- Antidepressants
- Side effects including diarrhea, nausea, sleep problems, and agitation
- Possibility of increased risk of suicide attempts
- -Children taking medication were at risk for suicidal ideation
*CBT
In school settings more effective and associated with more rapid reduction of symptoms than family or supportive therapy
Benefits of CBT may not last long for young people
Most beneficial for:
Caucasian adolescents, those with good coping skills at pretreatment, and those with recurrent depression
Prevention of Depression in Children and Adoles
*Selective prevention programs:
Target youth based on family, environmental, or personal risk factors
*Universal programs:
Targeted large groups, typically in schools, and provide education about depression
Selective prevention more effective than universal programs
Those in selective prevention program had fewer depression episodes than the those in the usual care group
Anxiety in Children and Adolescents
Fears and worries common in childhood
More common in girls than boys
For fears and worries to be classified as disorders, child’s functioning must be impaired
Do not need to regard fear as excessive or unreasonable
Prevalence
3-5% of children and adolescents
Social anxiety may prevent acquisition of skills and participation in activities enjoyed by peers
importance of milestones: If the kid does not hit a milestone
-Example: if the kid does not speak a word by ____ years old could be a sign of autism
f the kid does not speak a word by 3 years old could be a sign of autism
in regards to prescribing medication for kids with ADHD - it is best to wait until they are older - T or F?
FALSE
In the 1990’s have a big growth in this area- teachers prescribe kids = not good
-this is one case when best to use stimulus over time – the kids are able to develop the patterns over time
(synaptic pruning- less neurons, strengthening the connections over time)
-a good reason to prescribe stimulus at a young age
T/F Selective programs are better than universal programs
TRUE
Separation Anxiety Disorder
Constant worry that some harm will befall their parents or themselves when they are away from their parents
At home, children shadow one or both of their parents
Often first observed when children begin school
Associated with the development of other internalizing and externalizing disorders at later ages
DSM-5 Criteria: Separation Anxiety Disorder
Excessive anxiety that is not developmentally appropriate about being away from people to whom one is attached, with at least three symptoms that last for at least 4 weeks (for adults symptoms must last for 6 months or more):
Repeated and excessive distress when separated
Excessive worry that something bad will happen to an attachment figure
Refusal or reluctance to go to school, work, or elsewhere
Excessive anxiety that is not developmentally appropriate about being away from people to whom one is attached, with at least three symptoms that last for at least 4 weeks (for adults symptoms must last for 6 months or more)(continued):
Refusal or reluctance to sleep away from home
Nightmares about separation from attachment figure
Repeated physical complaints (e.g., headache, stomachache) when separated from attachment figure
PTSD
Exposure to trauma
Chronic abuse
Community violence
Natural disasters
Symptoms (similar to adults) Intrusively reexperiencing Flashbacks, nightmares, intrusive thoughts Avoidance Negative cognitions and moods Increased arousal and reactivity
Negative beliefs about oneself does not apply to very young children
OCD
- prevalence:
- gender:
Prevalence 1 to 4% Symptoms similar to those in adults Most common obsessions: Dirt or contamination Aggression Sex or religion become more common in adolescence OCD more common in boys than girls
Treatment of Anxiety Disorders in Childhood and Adolescence
CBT Kendall’s Coping Cat program
Confrontation of fears
Development of new ways to think about fears
Exposure to feared situations
Relapse prevention
Parents are also included in a couple of sessions
Social anxiety disorder
behavior therapy and group cognitive behavior therapy
Specific Learning Disorder
Problems in a specific area of academic, language, speech, or motor skills
Not due to intellectual disability or deficient educational opportunities
Usually of average or above-average intelligence but have difficulty learning specific skills in the affected area
Progress in school is impeded
Often identified and treated in the school system
Autism Spectrum Disorder (ASD): Social and Emotional Deficits
Profound problems with the social world Rarely approach others, may look through people Problems in joint attention Pay less attention to speaking faces Particularly the eyes and mouth regions
- Theory of mind
- Understanding that other people have different desires, beliefs, intentions, and emotions
- Crucial for successfully engaging in social interactions
- Typically develops between 2½ and 5 years of age
- Children with ASD seem not to achieve this developmental milestone
May recognize emotions without understanding them
Children with ASD seem not to achieve this developmental milestone
- Theory of mind
- Typically develops between 2½ and 5 years of age
ASD: Communication Deficits and Repetitive behaviors
Communication deficits
Children with ASD evidence early language disturbances
Echolalia: Immediate or delayed repeating of what was heard
Pronoun reversal: Refer to themselves as “he” or “she”
Literal use of words
- Repetitive and ritualistic acts
- Become extremely upset when routine is altered
- Focused and preoccupied on specific things
- Engage stereotypical behavior, peculiar ritualistic hand movements, and other rhythmic movements
- Become attached to inanimate objects (e.g., keys, rocks
DSM-5 Criteria:Autism Spectrum Disorder
*Deficits in social communication and social interactions as exhibited by the following:
Deficits in social or emotional reciprocity such as not approaching others, not having a back-and-forth conversation, reduced sharing of interests and emotions
Deficits in nonverbal behaviors such as eye contact, facial expression, body language
Deficit in development of peer relationships appropriate to developmental level
*Restricted, repetitive behavior patterns, interests, or activities exhibited by at least two of the following:
Stereotyped or repetitive speech, motor movements, or use of objects
Excessive adherence to routines, rituals in verbal or nonverbal behavior, or extreme resistance to change
Very restricted interests that are abnormal in focus, such as preoccupation with parts of objects
Hyper- or hyporeactivity to sensory input or unusual interest in sensory environment, such as fascination with lights or spinning objects
Onset in early childhood
Symptoms limit and impair functioning
Treatment of ASD
*Intensive operant conditioning (Lovaas, 1987) 40 hours a week over more than 2 years Parents are trained Dramatic and encouraging results -Larger increase in IQ scores -Advanced to next grade
*Joint attention intervention and symbolic play used to improve attention and expressive skills
- Medication (antipsychotics)
- Less effective than behavioral treatment
- Used to treat problem behaviors
- Side effects include weight gain, fatigue, and tremors
ADHD comorbidity
Often co-occurs with
Conduct disorder
ADHD associated more with off-task behavior in school, cognitive and achievement deficits, and better long-term prognosis
Anxiety and depression
30% have a comorbid internalizing disorder
Learning disorders
Dopaminergic areas larger in children with ADHD
T/F
FALSE
Dopaminergic areas smaller in children with ADHD
Oppositional Defiant Disorder (ODD)
(a related disorder)
Loses temper, argumentative, lack of compliance, deliberately aggravates others, vindictive, spiteful, touchy
Intermittent explosive disorder
(a related disorder)
Recurrent verbal or physical aggressive outbursts that are out of proportion to the circumstances
Aggression is impulsive and not preplanned
T/F Conduct disorder in childhood inevitably leads to antisocial behavior in adulthood
FALSE
Conduct disorder in childhood does not inevitably lead to antisocial behavior in adulthood
PTSD treatment
Available research suggests CBT, whether individual or group, is effective
Depression in children: gender
Depression in children is recurrent
-Prevalence among adolescent girls (15.9%) almost twice that among adolescent boys (7.7%)
- In sex therapy, the sensate focus exercise involves
a) having sexual intercourse without taking on the spectator role.
b) engaging in intercourse as often as possible to sensitize each other’s bodies.
c) nonsexual touching.
d) caressing without engaging in intercourse.
d) caressing without engaging in intercourse.
Dopaminergic areas
Dopaminergic areas smaller in children with ADHD (Caudate nucleus, globus pallidus, frontal lobes)
In childhood, females with ADHD are likely to have _____ symptoms
In childhood, females with ADHD are likely to have internalizing symptoms (anxiety, depression)
OCD treatment
CBT recommended first line treatment for mild to moderate OCD
Medication plus CBT for severe OCD
T/F CD is attributable to lower socioeconomic status or school failure
FALSE
Not attributable to lower socioeconomic status or school failure
Echolalia:
Immediate or delayed repeating of what was heard
- Treatment for learning disorders generally involves
a. stimulant medication.
b. educational remediation.
c. family therapy.
d. cognitive-behavioral therapy
b. educational remediation.
- Alvin is a 10-year-old boy diagnosed with a mathematics disorder. His treatment plan will most likely involve
a. teaching him different strategies to compensate for areas where he has difficulty.
b. stimulant medication.
c. developing an educational plan that exempts him from
mathematics requirements.
d. placing him in a school for learning disordered children.
a. teaching him different strategies to compensate for areas where he has difficulty.
- The restricted pattern of behavior generally observed in autism involves
a. repetitive movements, such as spinning in circles
b. an intense preference for keeping things the same.
c. inappropriate communication patterns.
d. a lack of recognition of significant others.
b. an intense preference for keeping things the same.
- Cross-cultural research has indicated that autism is
a. universal across cultures and countries.
b. predominantly found in the United States.
c. predominantly found in Western cultures and countries.
d. more common in wealthy countries.
a. universal across cultures and countries.
- What is the convincing evidence that autism involves some form of brain damage?
a. Nearly half of individuals with autism have some level of intellectual disability.
b. Most children with autism suffered some form of brain trauma at birth.
c. Autism runs in families.
d. Autism develops fairly quickly and at a young age.
a. Nearly half of individuals with autism have some level of intellectual disability.
- Approximately what percentage of individuals with ASD have intellectual disabilities?
a. 12
b. 38
c. 57
d. 72
b. 38
Intellectual Disability
The severity assessed in three domains:
The severity assessed in three domains:
Conceptual (intellectual and other cognitive functioning)
Social
Practical
Etiology of Intellectual Disability
Genetic or chromosomal abnormalities
Down syndrome (trisomy 21)
Fragile-X syndrome
Phenylketonuria (PKU)
Maternal infectious disease
Consequences most serious during 1st trimester of pregnancy
E.g., rubella, cytomegalovirus, toxoplasmosis, herpes simplex
Encephalitis and meningococcal meningitis in infancy or early childhood
Lead or mercury poisoning
- The form of treatment that has been found to be most successful for individuals with intellectual
disability is
a. interpersonal therapy.
b. behavioral approach to skills training.
c. medication.
d. the cognitive approach to self-care activities.
b. behavioral approach to skills training.
Treatment of Intellectual Disability
Residential treatment
Small to medium-sized community residences
behavioral treatments
Divide target behavior into small components
Applied behavioral analysis
Operant conditioning to increase target behaviors and reduce inappropriate or harmful behaviors
Cognitive treatments
Problem-solving strategies
Computer-assisted instruction
- The cause of most Neurocognitive disorders is
a. the normal process of aging.
b. brain dysfunction.
c. alcohol/substances.
d. medication side effects
b. brain dysfunction.
- Impaired consciousness and cognition during the course of several hours or days is characteristic of
a. delirium.
b. major neurocognitive disorder.
c. Alzheimer’s.
d. amnestic disorder.
a. delirium.
