Chapter 15 - Behaviour and Emotional Disorders Flashcards
What are the current issues of behavioural and emotional disorders of children/adolescents?
Age-specific variations in symptoms
Lack of concordance of reporting
Relies on self-report
What are the two types of childhood mental disorders?
Externalizing and internalizing
What are the externalizing disorders?
Attention deficit/hyperactivity
Oppositional defiant
Conduct
What are the internalizing disorders?
Anxiety
Separation anxiety
Selective mutism
Reactive attachment
Depressive
What is comorbidity?
Co-occurence of 2+ disorders
In childhood and adolescent disorders, comorbidity is seen as a(n) _______ rather than a(n) ___________.
Rule; exception
Current diagnosis is often ________.
Predictive
What is homotypic continuity?
Prediction of same diagnosis in future
What is heterotypic continuity?
Prediction of different diagnosis in future
In North America, the most common disorders in youth and children are…
Anxiety, conduct, ADHD
What is the average age onset of anxiety disorders?
6
What is the average age onset of behaviour problems?
11
What is the average age onset of mood disorders?
13
What is the average age onset for substance use disorders?
15
What disorders do girls tend to be diagnosed more for?
Mood, anxiety, eating
What disorders do boys tend to get diagnosed more for?
Behaviour, substance
What is attention deficit/hyperactivity disorder?
Persisting pattern of inattention/hyper-impulsivity that interferes with functioning or development
Under which DSM-5 section is ADHD listed?
Neurodevelopmental disorders (brain-based)
Symptoms of ADHD almost always emerge in __________, and 1/3 children _______ diagnosis into _________.
Childhood; retain; adulthood
What are symptoms of inattention?
Careless mistakes
Difficulty focusing
Unorganized
Avoidant
Forgetful
What are symptoms of hyperactivity/impulsivity?
Fidgeting
Inappropriately active
Excessive and loud talking
Difficulty waiting
To diagnose ADHD, how many symptoms and for how long do they have to be present for?
6+ symptoms for 6+ months
What are the diagnostic criteria for ADHD?
Symptoms present before age 12
Present in 2+ settings
Interference with functioning
What are the 3 situations of ADHD presentation?
Combined
Predominantly inattentive
Predominantly hyperactive/impulsive
What are the subtypes of ADHD?
ADHD-I
ADHD-H
ADHD-HI
What is ADHD-I characterized with?
Academic/social problems
Organizational and motor control
What is ADHD-H and ADHD-HI characterized with?
Higher rates of comorbid conduct problems
Regarding the subtypes of ADHD, _________ is more common in girls, whereas _________ and __________ are more common in boys.
ADHD-I
ADHD-H; ADHD-HI
What are the 5 other disorders that 50% children with ADHD are comorbid with?
ODD/conduct
Learning
Anxiety
Depression
Substance abuse
Individuals with ADHD have higher rates of…
Grade retention, suspension, and dropout
When is ADHD typically identified?
Elementary school
What are the brain and function factors of ADHD?
Reduced/delayed brain maturation
Abnormal dopamine/noradrenergic NTs
Abnormal prefrontal cortex and basal ganglia
What are the genetic factors of ADHD?
77% risk of heritability
No gene specifically identified
What are the prenatal risk factors of ADHD?
Prenatal toxin exposure
Poor diet
Pregnancy/delivery complications
What are the psychosocial risk factors of ADHD?
Low SES
Large/dysfunctional family
Parental mental health difficulties
Maltreatment
Foster care
___________ for specific dopamine receptor gene expressed in ________ associated with greater risk for ADHD when children also exposed to _______.
Homozygosity; prefrontal cortex; inconsistent parenting
ADHD symptoms associated with maternal __________ during pregnancy only in those with __________.
Smoking; genetic predisposition
What is the assessment for ADHD?
Comprehensive
Multi-informant
Self-report for adolescents
Psychoeducational testing
What are the pharmacological treatments for ADHD?
Ritalin (methylphenidate) and dexedrine (dextroamphetamine)
What do the pharmacological treatments of ADHD do?
Increase release of DA and NE, block reuptake
Increase functioning and reduce undesirable behaviour
What are the side effects of pharmacological treatments of ADHD?
Decreased appetite
Sleep disturbances
What are the psychoeducational interventions of ADHD?
Academic skill facilitation and remediation
Parent training
What is academic skill facilitation and remediation?
Focus on academic organization
Identify challenges
What is parent training?
Educate parents on how to manage child
Contingency management
Consistency
What is conduct disorder?
Problems with basic rights of others and violation of age-appropriate societal norms
What are 4 characteristics of conduct disorder?
Aggression
Destruction of property
Deceitfulness/theft
Violation of rules
Conduct disorder is often comorbid with _________ and ________ difficulties.
ADHD; learning
What are the psychopathic tendencies associated with conduct disorder?
Callous/unemotional trait specifier
What are the subtypes of conduct disorder?
Childhood onset
Adolescent onset
Unspecified onset
What would classify childhood onset type of conduct disorder?
1+ symptoms present before age 10
According to assortative mating, what are the 4 factors of conduct disorder?
CD females date/marry CD males
Discord in relationship
Poor parenting of offspring
Children higher genetic load for CD
What is oppositional defiant disorder?
Pattern of being defiant and negative behaviours towards others
Some argue that ODD is an earlier expression of…
CD
What is the difference between CD and ODD?
CD: more pre-meditated
ODD: more reactive/emotion regulation difficulties
What are the 3 symptom groups of ODD?
Angry/irritable mood
Argumentative/defiant behaviours
Vindictiveness
More _________ are diagnosed with ODD.
Boys
What is the failure model of ODD?
Engaging in externalizing behaviour increases probability of experiencing social failure, related to development of internalizing problems
What is the acting out model of ODD?
Youth mask mood problems by behaving aggressively
What is the reciprocal model of ODD?
Associations between externalizing and internalizing problems reciprocal
What is the order of the developmental trajectory (top to bottom)?
ASPD
CD
ODD
ADHD
What is the genetic etiology for CD and ODD?
High genetic risk/influence
Intergenerational patterns of criminal behaviour
Shared heritability between depression and ODD
The shared heritability between depression and ODD is mediated by __________.
Irritability
What is the neurobiologic etiology for ODD?
Decreased glucose metabolism (frontal lobe)
Damaged PFC and amygdala
Abnormal SE, NE, and cortisol
What are the prenatal risk factors of ODD?
Maternal smoking/substance use
Pregnancy/birth complications
Maternal stress
What are the psychosocial risk factors of ODD?
Poor parenting
Peer rejection/influence
Abnormal parenthood
Low social status
According to Capsi’s study of gene-environment interactions affecting CD, childhood maltreatment AND low _________ activity led to CD in adulthood compared to childhood maltreatment with high _______ activity.
MAOA (x2)
The differential susceptibility theory and biological sensitivity to context theory state…
Vulnerability influences outcomes depending on context of environment
Children with ODD and CD more likely to interpret ambiguous situations as being __________, leading to them relying on _________ strategies.
Hostile; aggressive
What happens in problem-solving skills training for ODD and CD?
Modelling and practice
Roleplaying
Reinforcement contingencies
What does problem-solving skills training do for a child with ODD or CD?
Increase repertoire for available behaviours
Flexibility of responses
Reduce problematic behaviour
Pharmacological treatments are used for ADHD when ADHD is __________.
Comorbid
What pharmacological treatment is used for disruptive and aggressive behaviour?
Antipsychotics
Lithium (only short-term)
Why are interactions between parent and child considered to maintain and promote conduct problems?
Coercive process, where situation becomes escalated then parent gives in
What are the factors of parent training for CD?
Break coercive process
Increase positive parenting
Increase compliance
Ignore unwanted behaviour
Consistency and problem solving
What is the school and community based treatment for conduct problems?
Reduce stigmatization so no child singled out for treatment
Available to all children
When fear is age-specific, intensity is proportional to ___________, meaning it is _____________.
Perceived threat; developmentally appropriate
When fear is excessive, may impact ________________ and lead to ______________.
Normal functioning; anxiety disorders
What is separation anxiety disorder?
Excessive fear/anxiety concerning separation from those to whom individual attached
How many and for how long do symptoms have to be present to diagnose separation anxiety disorder?
3+ symptoms, 4+ weeks
What is the prevalence and onset of separation anxiety disorder?
5% equal in boys and girls
Preschool years
What are associated features of separation anxiety disorder?
Social withdrawal
Concentration difficulties
Sadness, aggression, demanding
Strange perceptual experiences
School refusal
What is the etiology for separation anxiety disorder?
Temperament
Abnormal amygdala
Genetics
Psychosocial risk factors
What are the psychosocial risk factors of separation anxiety disorder?
Modelling
Life stress
Parental overprotection
What is selective mutism?
Failure to speak in specific social situations
How long do disturbances need to be present for to diagnose selective mutism?
1+ months
What is the onset of selective mutism?
Before 5 years old
What are associated features of selective mutism?
Shyness/withdrawal
Clinging
Temper tantrums
Delays in communication/language development
What are the consequences of selective mutism?
Social communication
Underestimation of capabilities
What is the behavioural conceptualization of selective mutism?
Negative reinforcement, where child too anxious to speak and adult comes to rescue
What is the aim of treatment for anxiety?
Reduce physical symptoms and pattern of avoidance
What are the treatments for anxiety?
Psychoeducation of causes
CBT
Pharmacological (SSRIs)
