CHILD AND YOUTH Flashcards
Externalizing problems
Undercontrolled behavior
ADHD,ODD,CD
Internalizing problems
Overcontrolled behavior
Anxiety and mood disorders
Homotypic continuity
same disorder predicts itself in the future)
Heterotypic continuity
(a disorder predicts another disorder at a later point)
Attention-Deficit/Hyperactivity Disorder
Two symptom clusters:
1)Hyperactivity/impulsivity
2)Inattention
Behavior that is inappropriate for age in terms of
* Frequency
* Intensity
* Duration
Impairment in at least two settings (ie:home,school)
Hyperactivity
Fidgets,squirms,gets out of seat
Difficulty playing quietly
Talks excessively
Runs and climbs excessively
Often “on the go” as if “driven by a motor”
Impulsivity
Blurts out answers before question is completed
Difficulty waiting for turn
Interrupts or intrudes on others
Inattention
Careless mistakes, poor attention to detail
Difficulty sustaining attention
Avoids or dislikes tasks requiring sustained mental effort
Does not listen to directions
Does not follow through to finish work
Difficulty organizing tasks
Loses things
Often distracted by external stimuli
Forgetful
ADHD:Associated Features
Bad temper,labile mood
Rejection by peers
Academic achievement impaired
Low self esteem
Negative family relations
Etiology/Risk factors for ADHD
Biological
~Strong genetic component
Prenatal toxin Exposure
~Maternal smoking or drinking (interacts with genetics)
~Lead, mercury, phthalates
Psychosocial risk factors
~Adverse childhood events(maltreatment, foster care ~placement, maternal mental illness, paternal criminality)
Brain structure and function
of adhd
Structure
Abnormalities in prefrontal cortex
Delayed maturation in cerebellum
Function
Reduced activity in PFC (executive functions)
Long term prognosis
of adhd
Many learn to adapt to challenges of ADHD
Most employed and financially independent, but attain lower SES
Risk of impaired social functioning
Risk of dropping out of high school and developing antisocial behavior
Stimulant medications reduce core symptoms but do not improve academic or social/emotional functioning
Multimodal Treatment for adhd
Stimulant medication plus:
Caregiver psychoeducation(supports the child’s needs at home)
Classroom accommodations(maximize opportunities to learn, socialize)
Behavioral parent training (consistent use of reinforcement principles)
Oppositional defiant disorder
angry/irritable mood
Loses temper,touchy or easily annoyed, angry and resentful
argumentative/defiant
Active noncompliance with requests from adults
Deliberately annoys others
Blames others for their mistakes or behavior
Spiteful or vindictive
Conduct Disorder
Behaviors that violate basic rights of others and major societal norms
Aggression toward people and animals
Bullying,threatening,intimidate others
Starts physical fights
Physical cruelty to people or animals
Stealing while confronting a victim
Forced sexual activity
Deliberate
Deceitfulness or theft
Has broken into someone’s home,building care
Lies frequently to get things or avoid obligations
Stolen thing of nontrivial value
Serious Rule Violations
Stays out at night (<13 yrs)
Runs away
Skipping school
Associated features
of conduct disorder
Misperceive others intentions
~Poor social cognition
~Deficits in recognizing facial/vocal emotions
Callous-unemotional traits
~Lack of remorse/guilt
~Lack of empathy
~shallow/deficient affect
Common comorbidity
of conduct disorder
ADHD
ODD is a common precursor
Greater risk for substance related disorders,anxiety and depression as adult
Few children receive treatment
course of conduct disorder
Childhood onset(around 10 yrs)
Increased likelihood of substance related disorder in adulthood
Greater risk of criminality in adulthood
Adolescent onset
High antisocial behavior associated with peer group
Conduct problems-risk factors
Genetics
Heritability estimates of 44-72% stronger for males
Callous-unemotional trait more heritable than delinquent behaviour
Prenatal factors
Maternal stress
Smoking or alcohol use during pregnancy
Psychosocial Factors
Low parental monitoring, inconsistent parenting
Harsh discipline ranging up to abuse
Peer group influences
poverty/violent neighborhood
Interaction is present if lines are not parallel, or if its a bar graph the slopes between the different groups are not equal
Conduct Problems neurobiology
Decreased activity in frontal lobe
Amygdala hyporeactivity to others’ distress
~Under Activity in amygdala to others in distress/pain
Low ANS(autonomic nervous system) activity
~Low cortisol
Poor fear conditioning
~Predicts criminal behavior
Conduct disorder neurocognitive feature
Poor executive functioning
Comorbid reading disorder
Poor social cognition
Child Conduct Disorder Causal pathways
1)Marital discord is correlated with child conduct disorder
~Marital discord can cause child conduct disorder if parents are fighting and hostile, they’re modeling for child how to treat others
~Less consistent parenting
~Parents are focused on their own problems, less consistent parenting and rules/enforcement of rules if violated
~Distraction from marital problems
2)Reverse causal direction
~Challenges of child with behavioral problems can cause marital discord
3)Parental antisocial traits can cause marital discord or child conduct disorder
Coercive Family Process
parents gives directive or sets limit->child responds aggressively or with resistance->parents reacts aggressively/unproductively->both escalate until parents or child “wins”-> hostility maintains and generalize
giving in/escalation
Giving in serves as reinforcement of bad child behavior and more escalated
Escalation of behavior gets neg. reinforced
Biological predisposition(conduct disorder)
Callous unemotional traits
LOW MAOA
Comorbidity with ADHD
Temperament of irritability
Poor fear condition
Cant experience fear
Peers(conduct disorder)
Modeling aggressive behavior from peers
Peer rejection
Bullying
Parents(overlap with biological predisposition and peers)
Inconsistent parenting
Low parental involvement
Harsh discipline/abuse
Marital conflict
Sociocultural context(conduct disorder)
Poverty,low SES
Violent environment, unsafe
Failure in school
Mental processes(conduct disorder)
Hostile attribution bias
Viewing ambiguous social situations viewed in a hostile way, person responds aggressively
Executive functioning problems
Ie:social cognition, problem solving
Separation anxiety disorder
~Extreme distress when separated from attachment figure
~Can result in panic
~Typical recovery within 1 year of onset
Separation anxiety features:
Worries about harm to parents
~Animals/monsters getting their parents
Fears of abandonment
Refusal to attend school
Avoidance of being alone
~Being separated from parent
Nightmares involving separation themes
Physical complaints at separation times
~Nausea
Separation anxiety:Developmental trajectory
young(5-8):nightmares, worry about parents, worry about bad things happening to self
Older (9-12): distress upon separation,withdrawal, apathy,sadness, poor concentration
adolescents(12-19):school refusal and physical symptoms when confronted with separation
Selective mutism
Declines to speak in specific situations where there is an expectation of speaking despite speaking in other situation
Lasts at least a month and interferes with educational achievement or social communication
Not attributable to lack of knowledge or comfort with the spoken language required in the situation
Not attributable to a communication disorder or autism spectrum disorder
Fairly rare, usually associated with Social anxiety
Social impairment, teased by peers
Can sometimes be aggressive when forced to speak
Anxiety Disorder-etiology
temperament
Behavioral inhibition
* Tendency to avoid novel and unfamiliar situations
* Genetic influences, biological phenomenon
* Associated with differences in excessive autonomic reactivity(overreaction to fear situations)
* More easily conditioned to anxiety
~Anxious attachment style
~Poor social confidence
Biological functions
of anxiety disorder
Amygdala reactivity
Hyperarousal
~Have difficulty maintaining normal heart rate
Prenatal factors
Prolonged stress
Psychosocial factors(anxiety)
Vicarious learning(from peer or parents)
Avoidance as coping mechanism
Bullying victimization
Stressful childhood(poverty)
Gene Environment Interaction
Diathesis-stress framework
