child psychiatry 1 disruptive behavior disorders Flashcards
ADHD
Attention deficit hyperactivity disorder
there is no such a thing as
ADD
how do we diagnose ADHD?
need to meet 5 criteria
- inattention (6 of 9 for more than 6 months, 5 or more for 17+)
- fails to give close attention
- difficulty sustaining attention
- does not seem to listen when spoken directly
- does not follow instruction
- difficulty organize tasks/activities
- dislikes/avoids tasks that need sustained mental effort
- loses things for tasks/activities
- easily distracted by extraneous stimuli
- forgetful in daily activities - hyperactivity: 6 or more for more than 6 months (5 or more for age 17+)
- fidgets, taps hands
- leaves seat in situations where supposed to sit
- runs around or climbs inappropriately
- unable to play or work quietly
- is often “on the go” seems “driven by a motor”
- talk excessively
- blurts out answers
- difficulty waiting turn
- interrupts or intrudes on others
what are the 2nd criteria for ADHD?
several symptoms must be present prior to age 12
the 3rd criteria for ADHD?
several symptoms present in 2+ settings
the 4th criteria for ADHD?
evidence the symptoms interfere with or reduce quality of social, academic, or occupational functioning
the 5th criteria for ADHD?
symptoms are not better explained by another disorder
specify if inattention AND hyperactivity-impulsivity criteria are met:
ADHD combined presentation
Behavioral treatment for ADHD child?
Behavioral
- Direct contingency management
- Teacher Training
- Parent Management Training (PMT)
- -> Focus on parent-child interactions
oppositional defiant disorder has pattern of
- angry/irritable mood
- argumentative/defiant behavior
- vindictiveness lasting at least 6 months
- -> includes 4 or more symptoms from any category, and occurs with at least one person who is not a sibling
what are the 3 angry/irritable mood?
Angry/Irritable Mood
Often loses temper.
Often touchy or easily annoyed.
Often angry and resentful.
what are the 4 argumentative/defiant behavior?
Argumentative/Defiant Behavior
Often argues with authority figures or adults.
Often actively defies or refuses to comply with requests from authority figures or with rules.
Often deliberately annoys others.
Often blames others for his/her mistakes or misbehavior.
Vindictiveness
Has been spiteful or vindictive at least twice within past 6 months.
Diagnosing ODD
- The disturbance in behavior is associated with distress in the individual or others in his/her immediate social context, or impacts negatively on social, educational, occupational, or other important areas of functioning.
- The behaviors do not occur during the course of a psychotic, substance use, depressive, or bipolar disorder. Criteria are not met for disruptive mood dysregulation disorder.
Specify:
Mild- symptoms confined to one setting
Moderate- some symptoms present in at least 2 settings
Severe- some symptoms present in 3+ settings
treatment for ODD?
- Parent Child Interaction Therapy (PCIT; www.pcit.org)
Uses both attachment and social learning principles
Teaches authoritative parenting – nurturance, good communication, firm control
Differential social attention to shape behavior - Problem-Solving Skills Training (PSST)
Focus on cognitive processes - PMT
Conduct DIsorder
these are child on their way to jail!
how many categories do you need to diagnose Conduct disorder?
at least 3 of the following in the past 12 months
1. aggression to people and animals
- often bullies, threatens, or intimidate
-
- destruction of property
- deceitfulenss or Theft
- serious violations of rules
to be considered as CD?
- The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
- If the individual is 18 years or older, criteria are not met for antisocial personality disorder.
specify onset
Specify: Onset
- Childhood-onset: show at least 1 symptom prior to age 10
- Adolescent-onset: show no symptoms prior to age 10
- Unspecified onset: criteria are met, but not enough info to determine if onset was before or after age 10
specify with limited prosocial emtions
Specify: With limited prosocial emotions. Must display 2+ of following persistently over at least 12 months in multiple relationships/settings:
- Lack of remorse or guilt
- Callous – lack of empathy
- Unconcerned about performance
- Shallow or deficient affect
treatment for conduct disorder
- Multisystemic therapy (MST)
Addresses multiple risk factors at multiple levels (individual, family, school, peer, neighborhood)
Focus on understanding behavior in context - Multidimensional Treatment Foster Care (MTFC)
Community based alternative to residential treatment
Child lives in foster care for 6-9 mos. while parents receive PMT - Functional Family Therapy (FFT)
Family systems approach: understand function of misbehavior - Anger Control Training
- PSST (problem solving skill training)
- PMT (parent management training)
prevelance rate for the conduct disorder among children?
4%
prevelance for OD
3%
prevelance for ADHD?
??? 5% (The highest)
gender diff
all three is more common in boys
ADHD –> 3 boys to 1 girl
