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
