childhood Flashcards
Developmental psychopathology refers to
disordered behaviour that is not age appropriate for the child
The DSM describes ______classes of developmental disorders
9
What are the classes of developmental disorders
Intellectual disabilities Specific learning dis'd Autism spectrum dis'd ADHD Motor dis'd Communication dis'd Feeling + eating dis'd Anxiety dis'd Disruptive/impulse control/conduct dis'd
Symptoms of externalizing dis’d
outward expressions: aggression, non-compliance, over-activity, impulsiveness
Symptoms of internalizing dis’d
social withdrawal
depression
anxiety
anxiety and mood dis’d are examples of __________
Internalizing disorders
ADHD, oppositional defiant disorder, conduct disorder are examples of ___________
externalizing disorders
Eastern cultures are likely to express _________ symptoms, whereas Western cultures are likely to show ______ symptoms
internalizing; externalizing
Hyperactivity refers to ____________
A child who is constantly in motion –> tapping, fidgeting
Core clinical descriptions of ADHD include
Behaviour is extreme for developmental period
Behaviours are persistent over different settings + functional impairment
Difficulties controlling self when asked to sit still
Difficulties forming + maintaining friends due to aggression or intrusiveness
Vicious Cycles refer to _____________
ADHD children having inability to make friends due to poor social skills, aggression, self overestimation
All are true of ADHD EXCEPT;
Symptoms of inattention need to be present for at least 6 months
Symptoms of hyperactivity need to be present for at least 6 months
Symptoms need to be present in 2 or more settings
Symptoms need to emerge before age 7
Symptoms need to emerge before 7
CORRECT need to appear before 12
Sasha is 19 years old and thinks she has ADHD. Vicki, her younger sister is 9 years old and also suspects having this disorder. Does a clinician need to make any considerations regarding diagnosis of these clients?
YES - patients aged 17 + only need to exhibit 5 symptoms for 6+ months, whereas Vicki needs to show 6 symptoms for a period of 6 months
Prevalence of ADHD is now 8-11% compared to a prior 3-7%. Why is it suggested that ADHD prevalence has been on the rise?
DSM-5 changed;
-Onset of symptoms has to be before 12
(previously 7 )
-Adults only need to meet 5 criteria (previously 6)
Potentially more awareness
Potentially more people seeking treatment
Children with inattentive subtype ADHD are likely to have issues with____________
processing speed
inattention
sustained attention
Children with combined ADHD subtype are likely to struggle with___________
conduct problems
oppositional dis’d
interpersonal conflicts
Contrast ADHD & Conduct dis’d
ADHD has better-long term prognosis
ADHD associated more with odd-task behaviour school,
ADHD associated with poorer cognitive + academic outcomes
What are the likely outcomes of comorbid CD + ADHD?
Poorest outcomes
Serious antisocial behavior,
peer rejection
poor academic outcomes
***in girls, + risky sexual behaviour
The most common internalizing comorbidities with ADHD are ______________, their prevalence is____
MDD + anx; 30%
_______ADHD subtype is associated with nicotine, alcohol + illicit drug use. This _______ by gender
Hyperactive
does NOT differ
INCORRECT statement is;
a) Girls with ADHD more likely to be anxious or depressed
b) Girls with ADHD experience executive functioning difficulties
c) Girls with ADHD likely to have ED + conduct disorder / ODD
d) Girls with ADHD are more likely to have depression
D - not true
Genetic heritability for ADHD is ____ % and genes associated are ___________
70-80%
DAT1,
DRD4+DRD5, (receptors)
SNAP-25 (plasticity sequence)
_______ genes are associated with particular environmental factors
DAT1 + DRD4, prenatal exposure to nicotine / alcohol
DA-ergic system includes ___________. In ADHD these are ________.
caudate nucleus, globus pallidus, frontal lobes.
ADHD - less activation –> inhibition difficulties
Environmental toxins associated with ADHD__________
food colourings (not anymore) lead nicotine pesticides chlorine
Treatments for ADHD_________
Dexamphetamine
• Atomoxetine
• Methylphenidate reduces impulsivity. Interacts with DA system
Combination of ^^ and behaviour MOST effective.
Psychological tmt - based on reinforcmeent, token economy. Improves acaemic performance //social skills
Who defines the guidelines for intellectual disabilities?
Association on
American Intellectual and Developmental Disabilities (AAIDD)
Australasian
Society for Intellectual Disability (ASID).
AAIDD definition of intellectual disability incl _________
significant
limitations in;
intellectual functioning + adaptive behaviour expressed
in conceptual, social, practical adaptive skills
Assumptions of ID are ________
Limitations of function are developmentally, culturally, appropriate.
Assessment considers cultural + linguistic diversity
Individual may have weaknesses AND strengths
Purpose of assmt is to develop necessary support
With appropriate support, improvement will follow
ID DSM-5 criteria _________-
a) Have intellectual disability defined by intelligence testing + clinical testing. IQ <70
b) Experience adaptive functioning deficits relative to age in 1+ areas
c) ONSET of these deficits is during childhood development
Describe some areas of adaptive functioning deficits associated with ADHD
communication, social participation, work, school, independence at home / community,
require support at school, work /independent life
Describe the distinctive types of ID
NOT mild/moderate/severe
- Conceptual (intellectual, cognitive function),
- Social
- Practical
The AIDD approach to ID’s is _______________
identify strengths + weaknesses to cater and develop independence
The MOST common developmental disorder is _________
ADHD, 7% in Au; 8-11% in US
The three core symptoms of ADHD
Inattention, hyperactivity, impulsivity
Dietary factors associated with ADHD
nutritional deficiencies
excessive sugar
low glyc index foods
Down Syndrome is a type of _____________ and is associated with __________ genetic abnormality.
Intellectual disability; extra copy (3 total) of chromosome 21
A side effect of atomoxetine is ____________
has side effects in kids with comorbid ASD
Medications for ADHD can be prescribed for children aged above __________
7
Fragile X syndrome is caused by ___________. All those with FrX have an intellectual disability (T/F)
Random mutation in FMR1 gene on the X chromosome.
False
The INCORRECT answer is;
a) Williams syndrome is the rarest genetic abnormality
b) Is caused by exposure to prenatal toxins
c) Positive cases are missing the elastin gene, leading to heart problems
d) is associated with high sociability
B - is caused by spontaneous deletion of 26 genes in chromosome 7
The foetus is particularly vulnerable to ID in utero because ___________
1st trimester - fetus has no immunological response. Vulnerable to mothers’ infectious diseases. Can effect the child’s brain post natal.
Compare behavioural and cognitive therapies for ID
behavioural - target child’s level of functioning. Objectives are defined and completed in small steps. Uses operant conditioning + behaviour analysis
Cognitive - ID have issues problem solving so use Self instructional training guides i.e. take lunch order, janitor duties
ASD is a combination of ____________ prior disorders
Asperger’s
pervasive developmental disorder
childhood disintegrative disorder
clinical specifiers of ASD are based on ________
Severity + extent of language impairment
Describe some social and emotional problems associated with ASD
RARE verbal, smiling, eye contact interaction.
spend less time looking at other people’s faces, impaired theory of mind
Theory of mind refers to _____________
person’s understanding that other people have desired,
beliefs, intentions and emotions that may be different to ones own. May be unable to understand + recognize others’ emotions
fMRI is associated with __________ neurological deficits regarding emotion in ASD
reduced activation of fusifrom gyrus, temporal lobes, amygdala.
Associated with face + emotion recognition
ASD associated with a triad of symptoms which are
- Social emotional disturbance
- Communication deficits
- Repetitive/ritualistic acts
DSM-5 features of ASD are;
Deficits in social communication and social interactions
2+ Restricted repetitive behaviour patterns, interests, or activities
Onset occurs in childhood
Symptoms limit + impair functioning
Communication defects in ASD include___________
-babbling slower in ASD infants
-2 yo lag behind the two-word-sentence formation
-Echolalia: when the child echoes i.e. copying TV, prevalent in ASD,
-Pronoun reversal: prefer to call self “he” or “she”
or by their name bc thats what others call them
Ritualistic acts in ASD characterised by ________
Attachment to inanimate objects + extreme interest in things
Upset if routine disrupted, hysteria
Rhythmic movements - rocking, tapping
Common comorbidities with ASD are_________
33% specific learning disability, anxiety, intellectual disability,
Describe prevalence trends in ASD
Begins in first month of life
1 ever 68 months
5x more likely in boys
Some diagnosed at 2, DONT meet diagnostics at 9
Genetic evidence for ASD
- Heritability - 0.8
- Risk of ASD or language delay is higher amongst siblings
- unaffected siblings also exhibited deficits in social communication
- Deletion on Chromosome 16 is associated with ASD
Neuropathology associated with ASD
Larger brain volume - frontal temporal, cerebellar.
BIGGER amygdala - more social difficulties
SMALLER amygdala - difficulties in emotional face perception, less eye gaze
The aim of of ASD treatment is___________
Reducing unusual behaviour, improve communication + social skills
Behavioural treatments for ASD_________
intensive operant conditioning based program- reward omission from aggression + compliance
= increases IQ + better academic outcomes
Drug treatments for ASD__________
Haloperidol - Haldol. Antipsychotic medication typical for schizophrenia. Reduce social withdrawal, stereotyped motor behavior, language
impairments
Naltrexone - reduced hyperactivity and moderated social interactions
What is the issue with labels in developmental disorders
SAME symptoms can have different genetic aetiology. Becomes issue because tmt is disorder-based but ADHD child may benefit most from ASD meds
ADHD neuropathology
- Smaller DA-gic areas of the brain–> spur them to seek out activities to stimulate DA
- Smaller grey matter + WM density
- Reduced cortical thickness + activation, volume
