Chapter 13 - Childhood Disorders

Question 1

The field of __________ focuses on the disorders of childhood within the context of life-span development.

Select one:

a. developmental illness investigation
b. developmental psychology
c. developmental psychopathology
d. adult development

Answer 1

c. developmental psychopathology

Question 2

Abnormal behavior in children

Select one:

a. is developmentally determined; that is, normal behavior at one age is abnormal at another.
b. can be reliably determined across age groups.
c. is typically associated with a lack of control.
d. is based upon destructiveness at any given age.

Answer 2

a. is developmentally determined; that is, normal behavior at one age is abnormal at another.

Question 3

__________ disorders are characterized by more inward-focused experiences and behaviors.

Select one:

a. Intimate
b. Individualistic
c. Internalizing
d. Intrinsic

Answer 3

c. Internalizing

Question 4

As compared to developmentally normal levels of hyperactivity, diagnosable hyperactivity

Select one:

a. impairs the child’s functioning.
b. negatively affects the child’s ability to mature appropriately.
c. is treatable only with medication.
d. all of the above.

Answer 4

a. impairs the child’s functioning.

Question 5

Research on subtypes of attention-deficit/hyperactivity disorder indicates that those with both attentional and hyperactive problems

Select one:

a. are more likely to have a behavioral, rather than a neurological, basis for their problems.
b. have equivalent outcomes to those with only attentional problems.
c. are more likely to be placed in special education classes than children with only attentional problems.
d. usually learn better than children with only attentional problems.

Answer 5

c. are more likely to be placed in special education classes than children with only attentional problems.

Question 6

In recent molecular genetic studies, genes associated with the neurotransmitter __________ have been linked to ADHD.

Select one:

a. serotonin
b. norepinephrine
c. dopamine
d. GABA

Answer 6

c. dopamine

Question 7

Shannon, a junior in high school, was recently suspended from school for stealing money from ninth-graders, writing graffiti on the bathroom walls, and beating up another student. Shannon’s teacher reports that she has very few friends. The most likely diagnosis for Shannon would be

Select one:

a. antisocial personality disorder.
b. attention-deficit/hyperactivity disorder.
c. conduct disorder.
d. oppositional defiant disorder.

Answer 7

c. conduct disorder.

Question 8

Sam is a 16-year-old adolescent who feels that he is unable to be an adult, despite the fact that he’s nearly 6 feet, 3 inches tall and has grown a beard. Although he led a “normal” childhood, when he was about 11, he began to get into frequent fights at school and has had trouble with the law ten times. According to Moffitt, Sam would be categorized as having

Select one:

a. adolescence-limited conduct problems.
b. explosive personality disorder.
c. antisocial development disorder.
d. life-course persistent conduct problems.

Answer 8

a. adolescence-limited conduct problems.

Question 9

Multisystemic therapy

Select one:

a. is multifaceted in the sense that multiple approaches to family intervention are applied.
b. is based upon intervention in ecologically valid settings such as home, school or peer group.
c. is a combination of medication and individual therapy.
d. focuses solely on the conduct disordered child.

Answer 9

b. is based upon intervention in ecologically valid settings such as home, school or peer group.

Question 10

Depressed children and their parents

Select one:

a. frequently have over involved relationships.
b. have less supportive relationships, but are generally free of conflict.
c. have more negative interactions.
d. tend to avoid conflict.

Answer 10

c. have more negative interactions.

Question 11

What are the diagnostic criteria for ADHD? What are the specifiers?

Answer 11

• Either 6+ manifestations of inattention OR hyperactivity-impulsivity present for at least 6 months to a maladaptive degree and greater than would be expected for developmental level.
• Several of the above before age 12
• Present in 2 or more settings
• Significant impairment in social, academic, or occupational functioning.

Specifiers:
Predominantly inattention; predominately hyperactive-impulsive; combination

Question 12

What are the common co-morbid diagnoses with ADHD?

Answer 12

Conduct disorder
Anxiety and depression (approx 30%)
Hyperactive symptoms predicted substance use at 14y and substance use disorders at 18y

Question 13

What is the prevalence of ADHD?

Answer 13

8 to 11%. 3 times more likely in boys. High number may be due to overdiagnosis.

Question 14

What is the prognosis of ADHD?

Answer 14

65-80% of children with ADHD still had symptoms as adolescents. 15% continued to meet diagnostic criteria. 60% still have symptoms.

Question 15

What is the ethology of ADHD?

Answer 15

• Genetics - twin and adoption studies estimate genetic component at around 70-80%. The genes responsible appear to be connected to dopamine. Dopamine receptors (DRD4 & DRD5) and dopamine transporter (DAT1). DRD4 & DAT1 associated with increased risk when prenatal alcohol or nicotine use.
• Neurobiological - brain structures are different in areas associated with dopamine. Caudate nucleus, globus pallid us and frontal lobes are smaller. Frontal lobe shows less activation and poorer performance on psychological tasks.
• Low birth weight - this can be mitigated by greater maternal warmth
• Environmental toxins - Feingold - colours and additives - no evidence.
• Nicotine associated with ADHD symptoms.
• Family factors interact with neurobiological factors. Fathers with ADHD were less effective fathers.

Question 16

What are treatments for ADHD?

Answer 16

• Methylphenidate. 80% of those diagnosed are prescribed a stimulant drug. 10% of all boys are prescribed one at some point.
  Side effects - transient loss of appetite, weight loss, sleep problems, stomach pain, cardiovascular risk.
  MTA cooperative group study - meds + intensive behavioural treatment had best outcome; however, at follow up, combined intervention was the same as behavioural intervention. Shows that carefully prescribed and managed meds are best, however, community managed meds does not appear to be effective.
• Psychological - parenting training and changes in classroom. Reinforce appropriate behaviour. Point systems and daily report cards so children can earn rewards. Focus on improving academic work etc rather than reducing symptoms.

Question 17

What is the diagnostic criteria for conduct disorder?

Answer 17

Repetitive and persistent pattern that violates the rights of others or conventional social norms as manifested by at least 3 of over the previous 6 months and 1 in the last month:
- aggression to people or animals
- deceitfulness/theft
- destruction of property
- serious violation of rules
Significant impairment to social, academic or occupational functioning.

Question 18

What is the diagnostic criteria for ODD?

Answer 18

If child doesn’t meet diagnosis for conduct disorder due to not having extreme physical aggressiveness but other behaviours.

Question 19

What is intermittent explosive disorder?

Answer 19

Recurrent verbal or physical aggressive outbursts that are far out of proportion to the circumstances. Aggression is impulsive.

Question 20

What are conduct disorder comorbid diagnoses?

Answer 20

Substance use and internalising disorders. Anxiety and depression (15-45%). CD precedes anxiety and depression except phobias and social anxiety.

Question 21

What are the two forms of conduct disorder proposed by Moffit?

Answer 21

Life-course persistent

Adolescence-limited

Question 22

What is the prevalence of conduct disorder?

Answer 22

6-9.5%. More common in boys.

Question 23

What is the aetiology for conduct disorder?

Answer 23

Heritable temperamental characteristics that interact with other neurobiological difficulties as well as environmental factors (Hinshaw & Lee).
Mixed genetic findings - estimates 40-50% heritable antisocial behaviour. Aggressive behaviour is more heritable.
Caspi - children who were maltreated and had low MAOA gene
Brain deficits in areas where emotion, particularly empathetic responses.
Abnormalities in Autonomic Nervous System.
Social-cognitive perspective - misinterprets other behaviour, leading to aggressive behaviour, which leads to more aggressive behaviour from peers resulting in cycle.
Peer influences - rejected by peers or associating with other peers.

Question 24

What are treatments for conduct disorder?

Answer 24

Family interventions - Family Check up - 3 brief sessions with toddlers at risk of CD. Reduced disruptive behaviour
Parent management training - prosocial behaviour rewarded.
MST - ecological treatment.

Question 25

What is the diagnosis for depression in children?

Answer 25

Similar to adults: depressed mood, inability to experience pleasure, fatigue, concentration problems, and suicidal ideation. Children show more guilt but lower early morning wakefulness and depression, loss of appetite and weight loss.

Question 26

What is the prevalence for depression in children

Answer 26

2-3% in under 13y. Adolescence - girls (6-16%) boys (4-7%).

Question 27

What is the aetiology for depression?

Answer 27

Genetic factors - child with parent who is depressed is 4x more likely to develop.
Gene-environment interaction - short allele of serotonin transporter gene along with stressful interpersonal events.
Hippocampus grew more slowly.
Cognitive distortions and negative attribution styles.

Question 28

What are treatments for depression in children?

Answer 28

• Antidepressants
  Side effects: diarrhoea, nausea, sleep problems, agitation. Increased risk of suicide (3%). Most recovered after 2 years but 50% had recurrent episode 5y later.
  Combined antidepressants and CBT were most effective. CBT has rapid reduction in symptoms but some evidence these changes are not sustained.

Question 29

What is the prevalence of anxiety for children?

Answer 29

3-5%. 30% lifetime prevalence. Specific phobias (19.3% and social anxiety (9%).

Question 30

What is separation anxiety disorder?

Answer 30

Excessive anxiety that is not developmentally appropriate from being away from attached people. 3 symptoms for at least 4 weeks:

• repeated and excessive distress when separated.
• excessive worry something will happen to an attachment figure.
• refusal or reluctance to sleep away from home.
• nightmares about separation
• repeated physical complaints when separated.

Question 31

What is the aetiology of anxiety disorders?

Answer 31

Heritability estimates are 29-50%.
Parenting practices - parental control and overprotectiveness.
Cognitions - children overestimate danger and underestimate their ability to cope.
Behavioural inhibition
PTSD - family stress, coping styles of family and past experiences of trauma.

Question 32

What are the treatments for anxiety disorders?

Answer 32

Exposure - more focus on modelling and reinforcement.
CBT - Coping Cat. Effective at 7 and 19y followup.

Walkup - coping cat and med (Zolof) - findings at 7y follow up were that they were just as effective however combination best in the short-term.

Question 33

What are specific learning disorders?

Answer 33

Difficulties in learning basic academic skills inconsistent with a person’s age, schooling, and intelligence. Persists for at least 6 months.
Significant interference with academic achievement or activities of daily living.

Prevalence 4-7%.

Specifiers: dyslexia and dyscalculia

Question 34

What is the aetiology of specific learning disorders?

Answer 34

Dyslexia affects 5-15%.
Herritable component to dyslexia. Highly educated parents means greater gene role as focus on education etc.
Dyslexia involves problems with language processing. Difficulties with phonological awareness. fMRI studies show left temporal, parietal and occipital regions are important. Also connections to Broca’s area.
Dyscalculia - parietal lobe.

Question 35

What is intellectual disability?

Answer 35

• Intellectual deficits (problem solving, reasoning and abstract thinking) as determined by intelligence testing and broader clinical assessment.
• Significant deficit in adaptive functioning relative to the person’s age and cultural group in 1 or more areas: communication, social participation, work or school, independence at home, need for support at school, work or independent life.
• Onset during child development

Severity assessed in context of conceptual, social and practical.

Question 36

What are causes of intellectual disability?

Answer 36

Down syndrome (extra chromosome)
Fragile X syndrome - mutation in fMR1 gene on X chromosome
Recessive gene disease - PKU - special diet needed to prevent decline in intellectual functioning.
Infectious diseases in first tri-mester
Exposure to lead

Question 37

What are the diagnostic criteria for ASD?

Answer 37

A. Deficits in social communication and interactions as exhibited by:

• deficits in social or emotional reciprocity
• deficits in nonverbal behaviour
• deficit in development of peer relationships appropriate to developmental level.

B. Restricted, repetitive behaviour patterns, interests or activities as exhibited by at least 2 of:

• stereotyped repetitive speech, motor movements or use of objects
• excessive adherence to routines, rituals in verbal or nonverbal behaviour, or extreme resistance to change
• very restricted interests that are abnormal in focus, such as preoccupation with parts of objects.
• hyper or hyperactivity to sensory input or unusual interest in sensory environment.

C. Onset in early childhood.
D. Symptoms limit and impair functioning.

Question 38

What are the aetiology of ASD?

Answer 38

Lack of activation in fusiform gyrus, temporal lobe and amydala (areas associated with recognising faces).

Deficit theory of mind

Comorbid intellectual disability.

Heritability estimate 0.80.

ASD brains are larger. Possibly due to neurons not being pruned correctly.

Enlarged cerebellum and amygdalae.

Question 39

What is the prevalence and prognosis of ASD?

Answer 39

1 out of 68. 5x more boys. IQs over 70 result in more adaptive functioning.

Question 40

What are treatments for ASD?

Answer 40

Behavioural - operant conditioning.

Drug treatment - Haldol - less effective. Some respond with reduced social withdrawal, motor behaviour and maladaptive behaviour. Many don’t and has limited effect on social functioning and language impairments. Has serious side effects.

Question 41

What are the implications of drug treatment for children.

Answer 41

Harrison et al found that most antipsychotics are prescribed for off label use (i.e. ADHD or ODD).

The number of diagnosis of bipolar in children has increased, however, very difficult to distinguish bipolar from ADHD. Agitated behaviour is a sign of both and only careful and thorough assessment can distinguish. Prescription of meds for bipolar when wrong diagnosis is not appropriate.

Antidepressants - can result in suicidal ideation. Treatment of adolescent depression study - most effective treatment was combination of Prosac and CBT. 6 taking Prosac attempted suicide where only 1 in CBT. Antidepressants can take up to 3-4 weeks to start working. UK decided benefits do not outweigh the risks. USA - FDA put black box warning about risk of suicide. CBT has fasted symptom reduction; however combination of CBT and antidepressants most effective.

Stimulants - number of children taking has increased. Does not increase risk of drug taking however does have greater risk of tried cocaine. A follow up on MTA study found that children who have ADHD have higher risk of substance abuse, this is not due to stimulant disorder. Research suggests there may be over diagnosis with large number of children being on drugs when diagnosed. Does help improve ability to focus and reduce disruptive behaviour and impulsivity.
MTA study - combined meds plus intensive behavioural treatment resulted in improved social skills than drugs, community care and behavioural intervention. At follow up, this effect was minimised. Showed that effect of drugs is best when carefully managed and prescribed.

There can be serious side effects of drugs. Can children make informed consent about this.

Drugs are not always effective in the long-term.

ASD - Haldol - limited improvement in social function and language impairments. Less effective than behavioural treatments.