Childhood Disorders and Treatment Flashcards
Two examples of anxiety disorders in childhood?
Separation anxiety disorder, selective mutism
Two examples of neurodevelopmental disorders in childhood?
ADHD (prevalence of ~5%) and ASD (prevalence of ~1%)
Example of depressive disorders in childhood?
Disruptive mood dysregulation disorder
Categories of DSM-V Internalising Disorders?
Anxiety disorders and depressive disorders
DSM-V Externalising Disorders are a group of…
Disruptive, impulse control, and conduct disorders
DSM-V Externalising Disorders include
– Oppositional defiant disorder – Conduct disorder – IntermiRent explosive disorder – Pyromania – Kleptomania
Kim-Cohen et al, 2003 study?
- Longitudinal study
- CD and ODD seems to precede many problems in later life
- “Most adult disorders should be reframed as extensions of juvenile disorders?
- A ‘priority prevention target’ for reducing adult mental illness
Conduct Disorder DSM-V criteria?
- involving (3 or more)
- Deceitfulness/Theft
- Aggression to people and animals
- Destruction of property
- Any other serious violation of rules (running away from home, truancy)
… persistently for 12 months or more
Oppositional Defiant Disorder (ODD) DSM-V criteria? And development trajectory?
Pattern of: Angry/irritable mood, argumentative/defiant behaviour, or vindictiveness
- Often loses temper - Touchy, easily annoyed - Angry, resentful … anxiety disorders
- Argumentative
- Defiant and noncompliant
- Blames others for mistakes
… conduct disorders - Spiteful/vindictive (want to get back at others)
… severe conduct disorders
Likely outcome of angry/irritable mood in ODD?
Anxiety disorders
Likely outcome of argumentative/defiat behaviour
CD
Likely outcome of vindictive behaviour?
More severe, aggressive-type CD
About ___ percent of ODD kids go on to develop CD
40
Estimates of prevalence of disruptive behaviour disorders vary across…
- Settings (community
Prevalence of ODD
3.3% worldwide
Prevalence of CD
3.2% worldwide
Prevalence of ADHD
5.3% worldwide
Developmental course of childhood conduct problems
There is an increase in behavioural repertoire
3-8: ODD symptoms
Arguing, defiance, noncompliance, tantrums
8-17: CD symptoms building upon ODD symptoms
Aggression, property destruction, truancy, theft, lying
Antisocial Personality Disorder (APD) DSM-V criteria?
- Pervasive pattern of disregard for/violation of others rights occurring since age 15
- Repeated criminal behaviour
- Repeated lying/conning
- Impulsivity or poor planning (comorbidity with ADHD)
- Reckless disregard for others’ safety
- Chronic irresponsibility
- Lack of remorse
- Evidence of CD before 15 years
Stability of CD?
Relatively stable and persistent;~50% maintained CD diagnosis 5 years later
Factors affecting stability/persistence of conduct problems?
- Early onset of serious antisocial and criminal activity with greater initial severity
- Frequent and intense symptoms across settings
- Comorbid ADHD
- Family dysfunction and socioeconomic disadvatnge
Factors affecting desistance from conduct problems?
- Most youth desist in early to late 20s due to increased maturity leading to development of internal controls, formation of prosocial identities (e.g. relationships/marriage), employment
- Social controls
Dispositional risk factors for childhood conduct problems (ODD or CD)
- Difficult temperament
- Genetic factors
- Thrill seeking
- Impulsivity
- Low verbal intelligence
- Reward dominance
- Autonomic irregularities (e.g. low resting HR)
- Cognitive biases
- Premature birth
- Poor academic achievement
Environmental risk factors for childhood conduct problems (ODD or CD)
- Prenatal exposure to toxins/drugs
- Low SE status
- Parental psychopathology (e.g. mothers with postnatal depression)
- Deviant peers
- Violence exposures
Subtypes of conduct problems?
Childhood-onset subtype (from 10)
Adolescent-onset subtype (10 or later)
Dunedin longitudinal study 2008?
Developmental course is heterogenous
- LCP (‘childhood-onset persistent) (~10%): childhood onset, only decreases very slightly throughout life
- Childhood-limited (~24%): desist during adolescence
- Adolescent-onset persistent (~20%)
Why subtype groups?
Different behaviour, neurocognitive, and parenting risk factors
LCP group
- Parenting risk factors
- IQ deficits
- Hyperactivity and peer rejection
AL onset group
- Most problem in peer delinquency around adolescent and pre-adolescent period
LCP Adult outcomes at age 32?
- Both women and men had worst crimnal, violent, mental and physical health, and economic outcomes
- More violent crime - no desistance at early adulthood (33% of men convicted of a new voilent crime between ages 26 and 32)
- More mental and physical health problems
- Worse economic outcomes
Adolescene-Onset outcomes at age 32?
- Moderate levels of criminal activity and substance related problems
- Women were adolescence limited whereas men continued to show problems
Childhood limited type outcomes at age 32?
Very few problems
The subtypes (yikes) of childhood-onset subtype?
- Primarily impulsive type
- Callous-Unemotional type
Primarily impulsive type of childhood-onset conduct problems characteristics?
- Impulsive with high rates of ADHD
- Have empathy/guilt for effect of behaviour on others
- High levels of emotional reactivity, not much self-control
What are CU traits?
- Lack of remorse or guilt - Lack of concern for others’ feelings - Lack of concern over poor performance at school - Shallow or deficient emotions
What do CU traits in CD mean in terms of outcomes?
- Greater number and variety of conduct problems
- More delinquency (property destruction and also aggressive type)
- More severe and frequent violence
- More (instrumental) proactive and reactive aggression
- More violent sexual offending
- More severe victim injuries
- Shorter time to violent re-offense
Frick et al. study?
Childhood to adolescence
- CP + CU much more contact with police, ~60% of police contacts in entire sample of kids; poorest outcome
- CP only (primarily impulsive type)
Role of dysfunction parenting in ODD/CD symptoms?
- Wootton study
- Low CU traits: harsher parenting = drastic increase ODD/CD symptoms
- High CU traits: harsher parenting = small decrease in ODD/CD symptoms
- “Good parenting” still resulted in high number of ODD/CD symptoms
- Other factors for engaging in CP type behaviours?
Viding et al study on twins?
Twin studies show greater genetic contribution to conduct problems in youth with CU traits
- Childhood onset CD with CU traits, or without (Impulsive type)
- CU type - H = .81 vs.
- Impulsive type - H= .3
Dispositional traits of kids with CU traits?
- Fearless/behaviourally uninhibited temperament
- More thrill seeking and reward dominant
- Insensitive to punishment
- Insensitive to others distress cues
Gene/environmental contribution non-CU trait CD?
50/50 genetics and environmental contribution
fMRI brain differences in kids with low vs high CU traits?
Conduct problems with low CU
Comparison subjects
Conduct problems with high CU
- Fearful, calm targets
- Looked at how active amygdala was during presentations
- High CU had less activation of the amygdala
Other deficits in CU kids?
- SCR in adolescents with CU traits - lower to distressing images and fearful faces
- Other impairments: attention task; CU kids equally engaged by pictures of chair and someone in distress
DSM-5 criteria for CD With Limited Prosocial Emotions?
- Meets full criteria for Conduct Disorder and they show 2 or more of 4 criteria:
1) Lack of remorse or guilt
2) Callous-Lack of empathy
3) Unconcerned about performance
4) Shallow or deficient affect
Patterson from the Oregon Social Learning Centre…
- Studied interactions between parents and children with conduct problems
- Developed Parent Management Training which is based on Social Learning Theory and Operant Conditioning principles
What is Social Learning Theory?
- Bandura Study: aggression towards dolls; Importance of modelling, especially from authority figures
- Generalised: picked up hammer to beat doll even though it wasn’t shown
Thorndike’s puzzle box?
Cat has food outside the box
Law of effect
- Behaviours with favorable consequences will occur more frequently and vice versa
Gerald Patterson’s Coercion Theory?
Cycle of reinforcement taking place with child and parent
- Child: positive reinforcement (scream -> cookie)
- Parent: negative reinforcement (buy cookie -> silence)
Parent and child learning how to be more coercive
Patterson’s parent training for ODD and CD involves…
- Behavioural monitoring (giving parents ABC chart)
- Changing reinforcement schedule
- Positive reinforcement (descriptive praise: “I really like how…”)
- Extinction (ignoring)
- Punishment (timeout, low energy punishment)
- Commands vs. requests
What factors predict poorer treatment outcomes?
– CU traits
– Greater initial severity of CPs
– Comorbid ADHD
– Parental stress and psychopathology – Family conflict
