Childhood Disorders Flashcards
Stats and Trends of Childhood Disorders
- 20-40% have diagnosable disorder
- 80% needing services don’t receive them
- Historically received less attention in females, poor
Why Focus on Childhood Disorders?
- Longitudinal study taken by Kim-Cohen in 2003 over intervals
- Looking at if the age of first diagnosis provide context for their disorders later in life
- Found that of those cases, 50% had a childhood mental disorder, 11-15
- 60% in intensive mental health services had a childhood mental disorder
- Most adults have roots earlier in their life
The Dimensions of Childhood Disorders
Internalising - mostly affect the individual, child is overcontrolled
Externalising - mostly affect the people around them, child is undercontrolled
Internalising Disorders
anxiety disorders
- Separation anxiety disorder (most relevant to childhood)
- Selective mutism (most relevant to childhood)
- etc
Depressive Disorders
- Disruptive mood dysregulation disorder (most relevant to childhood)
- Identified as a precursor to MDD in adulthood
- Typically diagnosed between 6 and 10
- MDD and PDD
Externalising Disorders
Disruptive, impulse control, and conduct disorders
- Oppositional defiant disorder (most relevant to childhood)
- Conduct disorder (most relevant to childhood)
- Intermittent exclusive disorder
Neurodevelopmental Disorders
ADHD (most prevalent)
- 5% of all children
- Impulsive
- Inattention problems
Autism spectrum disorder (most prevalent) (ASD)
- Less common than a lot of disorders, 1.5% of the population
- Associated with quite profound deficits
- Struggle with social/emotional communication and non–verbal communication
Comorbidity with Childhood Disorders - Case Example
- Disruptive behaviour disorders are much more likely to be diagnosed alongside ADHD
- People with ASD are also likely to have a diagnosis of oppositional defiant disorder
Case Example -
- 5-year old boy
- Biting, hitting, defiant, oppositional, impulsive, overly active
What is Assessment?
→ psychological testing
Individualised
- Used to measure and observe client behaviour, to give full picture of strengths and limitations
- Used to test hypotheses about a patient
- Wide variety of tests and assessments
- Informs diagnosis and treatment planning
Assessment Methods for Children and Disorders
Clinical Interview - structured or semi-structured
- Developmental history
- Diagnostic interview
Psychological tests
- Self-report
- Rater measures
Behavioural observations
- A-b-c analysis
- Understanding of behaviour in clinic, home, school
Specialised testing
- IQ tests
- ASD, developmental delay
Third-party information
- medical/school/legal records
- Prior psychological testing/reports
Important Things to Consider When Assessing for Disorders in Children
Comprehensive assessment essential
- Gain knowledge about multiple settings
- Multi-reported
- Multi-method
- Relevant developmental information
For younger children, observation and rater measures especially important
Issues and Solutions When Determining What is Abnormal
- Rater based measures typically include a set of symptoms that don’t directly map onto DSM criteria
- So norms are used (normative cut-offs), a standard T-score would have a distribution with M=50, SD=10
- If a T-score is 65 then these symptoms may be considered rare to the population of children measured (normative sample)
Case Conceptualisation
a part of the assessment process
- developing theories for why these problems exist
Conduct Disorder
A repetitive and persistent pattern of behaviour involving (3 or more) for at least a year
- Aggression
- Destruction of property
- Deceitfulness/theft
- Serious violation of rules
Oppositional Defiant Disorder (ODD)
Pattern of angry/irritant mood, argumentative/defiant behaviour, or vindictiveness involving 4 or more
- Often loses temper
- Touchy, easily annoyed
- Angry, resentful
- Argumentative
- Defiant and noncompliant
- Deliberately annoys others
- Blames others for mistakes
- Spitefulness/ vindictiveness
the first three symptoms have a higher likelihood of getting an internalising disorders later in life
Why Focus on Conduct Disorder?
- Almost all adult disorders were preceded with ODD and conduct disorder
- Identified conduct disorder as a “prior prevention target” for reducing adult mental illness
50% of all cases with dsm diagnosis had conduct disorders
Prevalence of Conduct and ODD
- Estimates vary across setting, ethnic groups (systemic factors), age, gender, diagnostic
- 3-16% (worldwide - 3.3%) has ODD
CD 2-16% (3.2%)
DBD Comorbidity
- 65-90% also have ADHD
Internalising problems
~33% community
75% referred to clinic
Particularly for ODD
Consequence of behaviour
Learning disorders
Substance abuse disorders
Developmental Course of Conduct Problems
- Starts with arguing, defiance, noncompliance between 3-8
- Increases to aggression, bullying, truancy, theft, lying, property destruction between 8-17
- This is normally because the child has more capability of doing these things based on their responsibility, size etc
Antisocial Personality Disorder
- Large evidence of CD before 15
Pervasive pattern of disregard for/violation of others’ rights occurring since age 15 (3 or more):
- Repeated criminal behaviour
- Repeated lying or conning of others
- Impulsivity or poor planning
- Irritability and aggressive behaviour
- Reckless disregard for others’ safety
- Chronic irresponsibility
- Lack of remorse
Dispositional Risk Factors for Conduct Problems
(risks in the individual)
- Genetic
- Academic achievement
- Autonomic irregularities
- Premature birth
- Reward dominance
- Thrill seeking
- Cognitive biases
- And so on
Gerald Patterson’s Coercion Theory as a Cause of Conduct Disorder
Children with conduct disorders showed same behaviours as healthy kids but much more frequently
- They also were contingent on the parents behaviour, parents reinforced the child when they don’t necessarily discipline the child when they are told not to do something, the child knows that the more they complain the more they get
- Superparenting strategies
Example of Patterson’s Coercion Theory
Mum says no, child whines, mum folds, child is reinforced
Subtypes of Conduct Disorders
- Childhood-Onset Subtype (Life-Course Persistent)
- Adolescent-Onset Subtype
Dunedin Longitudinal Study Finding Trajectories of Conduct Problems
- Heterogeneity in developmental course
Found four common trajectories of conduct problems
- Childhood onset persistent
- Childhood limited
- Adolescent onset persistent
- Low / non problem
Risk Factors That Predicted assortment into these groups included;
Before the age of 10
- Dysfunctional parenting
- Parents with mental health problem
- Hyperactivity
- Low socioeconomic status
- had worst outcomes at this age group
After the age of 10
- Much more similar to the mean
- Only thing that differed is that they had more delinquent peers
- Moderate levels of criminal activity, substance abuse, physical health and economic problems
ABC Analysis
→ direct observation tool that helps understand the patterns to the events leading up to a behaviour and the consequences associated with it
- Useful when trying to reduce the frequency or intensity of a behaviour
Antecedent, Behaviour, Consequence
Used in a range of contexts
- Everyday behaviours
- Disruptive behaviours
- Autism spectrum disorder, one of the most common clinical applications is to
Applied Behavioural Analysis (ABA) - Classroom dynamics
Antecedent: ABC Analysis
Antecedent: before the behaviour, can be thought of as triggers
- Consequences of one behaviour can also be a trigger for another set of behaviours
- Helps gather more information about factors making a behaviour more or less likely to occur (reinforced or punished)
- What to consider includes,
Where, when, with whom
Activities or events
Other behaviours before ‘target behaviour’
Behaviour: ABC Analysis
Behaviour: observed behaviour - must be clearly seen and able to be described
- Important to understand the purpose or function of behaviours to express information about unmet needs
- Identifying behaviours of
concern (that may put an individual or those around them at risk of harm)
Consequence: ABC Analysis
Consequence: response to behaviour
- Can be naturally occurring or deliberately put in place
- Can impact likelihood of future behaviour (depending on if they were pleasant or unpleasant) (reinforcement or punishment)
Basic Idea of How Disruptive Behaviours are Learnt through Reinforcement and Punishment
Learn that certain behaviours are followed by pleasant consequences, while others are followed with unpleasant ones
Reinforcement
- When followed with a positive consequence, more likely for behaviour in the future
Punishment
- When followed with a negative consequence, less likely for behaviour in the future
Coercive Cycle
a push-pull between two parties (parent and child), one or the other being persuaded to do something that they don’t want to do
- Results in the escalation of behaviours before one party ‘gives in’ in some way
- Negative reinforcement is key to maintaining coercive cycles
Dina Baumrind’s Parenting Styles
vary across domains of parenting (demandingness and responsiveness)
https://www.google.com/search?sca_esv=d32948e27cff68fd&rlz=1C1UEAD_enAU1083AU1083&sxsrf=ADLYWIJyLdXdhzfNJk8N3hoVYjPS346png:1732411132155&q=diana+baumrind+parenting+styles&udm=2&fbs=AEQNm0Aa4sjWe7Rqy32pFwRj0UkWd8nbOJfsBGGB5IQQO6L3J7pRxUp2pI1mXV9fBsfh39Jw_Y7pXPv6W9UjIXzt09-Y-RVsUQytO3H9U9unQ4zjSmyc1am7RU9IOaZeZLN-vxqOLRVgtOkNIBInceOOInHD1Vy8A8dMZkK6qsEDDgBo37uamqwPID1ktpoxri6hURFY-RftoYl5J3cAxl4SOYvmGkrX6Q&sa=X&ved=2ahUKEwij_oux5vOJAxVwSGwGHc0aIssQtKgLegQIExAB&biw=1039&bih=495&dpr=1.35#vhid=ksR0J72cSI0S8M&vssid=mosaic
- High on demandingness and low on responsiveness is authoritative (considered it to be the optimal type of parenting)
- Low on demandingness and high on responsiveness is permissive
- low on demandingness and responsiveness is uninvolved
- high on demandingness and responsiveness is authoritarian
The Optimal Parenting Style According to Dina Baumrind
Authoritative
- Improved social competence
- Better psychological well being
- Higher academic achievement
- Improved moral development
- Less risk taking
- Valuable across cultures
Albert Bandura and Managing Problem Behaviour
→ two key principles
- Parents model behaviours to their children
- Parents reinforce of these behaviours
Key Principles: Imitation and Negative Reinforcement
Albert Bandura Key Principle #1
Imitation
Bobo Doll Experiment
- Parents would hit a doll
- Kids would then also hit the doll, but then also pick up a hammer and hit it
- Not only did they model it, but their behaviour increased in magnitude
- Children imitate behaviour they observe from important people in their lives
Albert Bandura Key Principle #2
Negative Reinforcement
- When child whines, and then gets what they want, they are reinforced to do this
Involved with attention
- Negative behaviours get more attention than positive behaviours
- Important to catch them being good, and give praise then instead of scolding when they’re doing something bad
Appropriate Responses When Managing Problem Behaviour
- Specific praise
- Physical affection
- Desired activities
- Tangible items
- Quality time
Treating Conduct Disorders: behaviour modification goal
- Loss of a conditioned behaviour by removing consequence
What is the Most Successful Treatment as an Intervention of Problem Behaviours
Parent Management Training (PMT) (Behavioural Parent Training)
- based in social learning
- therapist teaches caregivers skills to manage child’s problem behaviour
The Use of Planned Ignoring and Strategic Attention
- Ignore minor misbehaviour → helps child notice difference between the responses to good or bad behaviour (might get worse at first, but consistent ignoring reduces attention seeking behaviour) → see good behaviour and give a lot of attention (specific praise)
–> Behavioural targets
- Praise a positive opposite behaviour or an incompatible behaviour
- When they are screaming, we want to praise them when they are quiet
- Strategically attend to polite manners, playing gently, sharing, talking softly, asking nicely, trying even when it is hard
Constance Hanf’s Intervention
- Developed clinical intervention to strengthen the parent-child relationship and achieve authoritative and “good enough” parenting
- Teaching parents play therapy skills to build bonds
- Teaching parents firm limit setting to manage disruptive behaviour
Sheila Heiberg and Parent Child Interaction Therapy
- influenced by Constance Hanf
- Focus on relationship building and establishing firm boundaries
Goals
- Establish positive relationship
- Decrease behaviour problems, increase prosociality
- Improve parenting skills
- Foster authoritative parenting style
Research outcomes
- Reduces oppositional, non-compliant behaviour
- Improves child self esteem
- Improves parent stress
- Gains during treatment continue years after treatment
- Most effective psychological intervention
For ODD, CD, ADHD for children between 2-7 most frequently
- transdiagnostic intervention
How Does PCIT Work
- Parent wearing bug-in ear device while playing with child
- Therapist behind one-way mirror providing in-vivo coaching to parent in play with child
Phase 1 of PCIT: Child Directed Intervention
- 7+ weeks on rebuilding parent child relationship
- Positive attention strategies
Fundamental principle: follow the child’s lead, Skills of special play
- Praise - specifically, enthusiastically
- Reflect - repeating what child has said, as long as it has the same meaning, musn’t change the meaning of what the child said
- Imitate - copy what child is doing, following the child’s lead
- Describe - say what child is doing, using an action verb for around 5 seconds,
- Enjoy - act warm and happy, increasing self-esteem, enforcing a calming effect, and improving relationships
Things Not to Do During Child Directed Interaction
do not avoid the questions
- We want child to be in the lead
- Shows child that parent is listening
Don’t criticise
- Gives attention to negative behaviour
Avoid commands
- Takes lead away from the child, causes conflict
During dangerous play you stop the play, for aggressive and destructive behaviour
Phase 2 of PCIT: Parent Directed Interaction
- 7+ weeks
- Focus on reducing ‘big’ behaviour problems like chronic non-compliance, aggression, and
destructiveness - Discipline and reward strategies
Men and Women with Childhood Disorders
Women are more likely to have an internalising disorder than men
