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Psychological disorder > Childhood Disorders (COMPLETE) > Flashcards

Childhood Disorders (COMPLETE) Flashcards

1
Q

What are disorders of the childhood?

A

They are psychiatric disorders that are most likely to first arise in childhood and adolescence.

Requires a developmental perspective- what typical development looks like so one can identify atypical development.

Understanding psychological disorders on the basis of a normative/developmental model is important foe almost all psychiatric disorders.

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2
Q

Why is it important to take a developmental perspective on psychiatric disorders?

A

Most disorders do start in childhood and adolescence.

Because they are critical periods of brain development.

Often disorders begin their onset early as the brain is developing and is getting rid of some connections and balance is shifting.

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3
Q

Why take a normative approach?

A

Childhood disorders reflect a departure from typical developmental trajectory.

However, each child does develop somewhat differently!!!

As a result, the DSM makes the childhood disorders difficult to diagnose so typical behaviour isn’t pathologies/ treated abnormally

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4
Q

What do clinicians pay attention to when determining the existence of a childhood disorder?

A
  1. Age appropriateness of behaviour
    Example:Temper tantrums at age 2 are normal, at age 10, may be a sign of something more serious.
  2. The environment: Could an environmental factor explain why the child is acting in a certain way, rather than a disorder.
  3. Culture: In areas across the world, some disorders are more diagnosed than in others
    Ie: USA treats more ADHD children
    Thailand: Diagnoses more anxiety and depression
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5
Q

Why is it important to properly diagnose and treat childhood disorders?

A

Over diagnoses leads to overprescription of medication to children

Childhood disorders are a major source of suffering for children and families.

They also can have long lasting effects for adulthood:
Justice system encounters
Reduced employment
Relationship difficulties
Reduced education

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6
Q

What are the 3 Broad characterisations of childhood disorders?

A

Externalising Disorders

Internalising Disorders

Disorders which disturb cognitive/language/motor or social skills.

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7
Q

What are externalising disorders

A

These are characterised by outward directed behaviours like:
aggressiveness
non-compliance
Overactivity
Impulsiveness

MORE COMMON IN BOYS

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8
Q

What are the externalising disorders?

A

Attention-deficit/hyperactivity disorder(ADHD)

Conduct Disorder

Oppositional defiant disorder

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9
Q

What are internalising disorders

A

They are characterised by inward focused behaviours like:

Depression

Anxiety

Social withdrawal

MORE COMMON IN GIRLS

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10
Q

What are the internalising disorders?

A

Anxiety disorders

Mood disorders

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11
Q

What are disorders which disturb cognitive/language/motor or social skills.

A

Chronic disorders which persist into adulthood

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12
Q

What are the disorders which disturb cognitive/language/motor or social skills.

A

Autism Spectrum Disorder

Learning Disorders

Intellectual disability

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13
Q

In relation to ADHD, what is inattention?

A

Careless mistakes
Can’t follow instructions
avoid tasks that take effort
easily distracted

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14
Q

In relation to ADHD, what is Hyperactivity/impulsivity?

A

Fidgeting
Squirming
Can’t sit still
Incessant talking
Blurting out answers
Cant take turns

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15
Q

What is the DSM criteria for ADHD

A

Must have 6 or more inattentive /hyperactive symptoms(MOST HAVE BOTH)

The symptoms must:

  1. Be present before the age of 12
  2. Be more extreme than expected for a child at their developmental stage
  3. Be persistent across different situations
  4. Cause significant functional impairment
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16
Q

What is the difference between diagnosis and prevalence

A

Diagnosis: Can be inappropriately given by GPs/ school nurses
Example: in America 11 percent of children diagnoses with ADHD

Prevalence comes from structured interviews so the criteria is the same for everyone

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17
Q

What’s the diagnosis and prevalence of ADHD

A

Most commonly diagnosed in America

Prevalence constant world wide: 1-2%

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18
Q

What’s the Course of ADHD during lifetime:

A

Symptoms usually appear from ages 3-4.

3 times more boys have it than girls

Over half of the children with ADHD still have difficulties as adults.

up to 15% still meet the diagnostic criteria for ADHD
The impulsivity decreases, but the inattention remains

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19
Q

What are the consequences of being an adult with ADHD

A

More likely to divorce
Have lower education
Lower earnings
Be obese
Be imprisoned
Die prematurely
Have substance use disorder

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20
Q

What things are discussed in relation to the aetiology of ADHD

A

Genetic Factors

Neurobiological Factors

Temporal Discounting

Response inhibition

Perinatal and prenatal factors

Environmental toxins

Parent-child relationship

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21
Q

Genetic factors in relation to ADHD

A

Twin studied show 70-80% heritability

Dopamine genes:
DRD4/DRD5- receptor
DAT1: transporter

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22
Q

Neurobiological Factors in relation to ADHD

A

Some brain regions within the dopaminergic circuits are smaller- caudate, putamen, nucleus

Poor frontostriatal function, ie. inanition. attention, working memory

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23
Q

Temporal Discounting in relation to ADHD

A

The subjective value of the remade loses its magnitude when the reward is delayed.

Example: 1 Marshmallow is better now than 10 marshmallows in 10 minutes

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24
Q

Response inhibition in relation to ADHD

A

Being able to stop and think before acting

Stop signal telling them to not press cross, can they stop before acting?

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25
Q

Perinatal and prenatal factors in relation to ADHD

A

Perinatal- week 0 pregnancy to 1 year
Prenatal- week 0 pregnancy to birth

Low birth weight

Heightened risk from mother intaking tobacco and alcohol during pregnancy

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26
Q

Environmental toxins in relation to ADHD

A

Lead- but the effect is very small
Food additives may have a small effect on hyperactive behaviour but it doesn’t cause ADHD

No evidence that refined sugar causes ADHD

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27
Q

Parent- child relationship in relation to ADHD

A

There’s a misconception that parenting styles cause ADHD

Although more commanding parenting styles have been associated
Reasoning: Maybe a coping mechanism for parents to deal with the challenging behaviour.

Parents are more likely to have ADHD.
They may interact with genetic and neurological factors-ie. maternal warmth mitigates risk associated w low birth weight

NB: NO EVIDENCE THAT IT CAN CAUSE ADHD

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28
Q

What is the medical treatment for ADHD

A

Stimulants like methylphenidate (Ritalin r amphetamines like adrenal.

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29
Q

Effect of Medications for ADHD

A

Reduce disruptive behaviour and impulsivity

Improve interactions with parents, teachers, peers

Improve goal-directed behaviour and concentration

Reduce aggression

They are effective in about 75% of children with ADHD but have various side effects:
loss of appetite
weight loss
sleep problems

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30
Q

How does methylphenidate work?

A

ADHD linked to disruptionin dopamine function and prefrontal inhibitory control problems

Methylphenidate increases dopaminergic (and noradrenergic) activity in the prefrontal cortex.

It prevents the reuptake of dopamine and norepinephrine and allows it to pass through to the post-synaptic neuron

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31
Q

What are the psychological treatements for ADHD?

A

Parental training:
Monitoring behaviour and reinforcing appropriate behaviour.

Not reducing symptoms but improving academic work, task completion, social skills

Supportive class assignments

Brief assignments
immediate feedback
task focused learning
Breaks for exercise

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32
Q

What is conduct disorder?

A

Characterised by a pattern of engaging in behaviours that violate the rights of others.

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33
Q

What is the DSM 5 criteria for Conduct disorder?

A
  1. Repetitive and persistent behaviour patterns that violates the basic rights of others or conventional social norms.
  2. Must have 3/more in the past year and at least 1 in the previous 6 months:

A. Aggression to people/ animals:
Bullying
initiating physical fights
Physical cruelty to people/animals
Forcing someone into sexual activity

B. Destruction of property
Setting fire to something
Vandalism

C. Deceitfulness/theft
Breaking into house/car
conning
shoplifting

d. Serious violation of rules
Staying out at night before the age of 13
Skipping school/truancy before age of 13

  1. Significant impairment in social/academic or occupational functioning
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34
Q

What is conduct disorder co-morbid with?

A

Substance abuse- 2 conditions make each other worse

Internalising disorder

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35
Q

What’s the prevalence of conduct disorder

A

7% in adolescents
more common in boys

36
Q

What are the 2 types of conduct disorders

A
  1. Life course persistent- Antisocial behaviour evident from the age of 3
  2. Adolescence limited-
    Person matures and grows out of it
37
Q

When does CD peak?
Why?

A

Adolescence

Because of pruning: The development of the prefrontal cortex

grey matter is decreased

Infrequently used connections are being eliminated

Highest amount of arrest rates for homicide, rape, robbery, aggravated assault, and auto theft in adolescence

38
Q

Aetiological factors for conduct disorder

A

Genetic factors
Neurobiological factors
Psychological factors

39
Q

Genetic factors for CD

A

40-50 percent of antisocial behaviour is heritable

Callous unemotional traits are most heritable

Genetics are a stronger influence the behaviours begin in childhood than in adolescence

40
Q

Neurobiological factors for CD

A

Poor verbal skills, IQ

Impaired emotional processing

lower levels of rising skin conductance and heart rate suggests lower arousal levels( may be related to absence of fear/punishment)

41
Q

Psychological factors for CD

A

Cognitive bias: neutral acts by others are perceived as hostile

Environment: harsh and inconsistent parenting, poverty, peer influence

42
Q

What’s dodge’s cognitive theory of aggression

A

Act interpreted as hostile
Is aggressive towards others
others retaliate
further angry aggression towards others

Ongoing cycle

43
Q

What are the treatments for conduct disorder

A

They must address the multiple systems involved in the childs life, ie. school, family, friends

Multisystemic therapy

family interventions

44
Q

Multisystemic therapy for conduct disorder

A

Involves identifying strengths using action focused interventions
Weekly/daily family effort

45
Q

Family interventions for CD

A

Parental management training teaches parents to reward prosocial behaviour rather than punish antisocial behaviour

46
Q

What are disorders that are related to CD

A

Intermittent explosive disorder
Oppositional Defiant Disorder ODD

47
Q

What’s Intermittent explosive disorder and what is the main difference to CD

A

Recurrent verbal/physical aggressive outbursts that are out of proportion.

Key difference: the aggression is impulsive and not pre-planned

48
Q

What’s ODD and what is the main difference to CD

A

The behaviours aren’t the same an CD- trees no extreme physical aggressiveness

Co-morbid with ADHD but more deliberate than ADHD

49
Q

What are the internalising disorders?

A

Depression
Anxiety

50
Q

What are depression symptoms specific to children and adolescents

A

Higher rates of suicide
attempts and guilt

Lower rates of:
* Early morning awakening
* Early morning depression
* Loss of appetite
* Weight loss

51
Q

What’s the treatment for childhood depression?

A

It can be difficult to treat
psychotherapy has very modest effects

CBT is no better than non-CBT therapies like psychodynamic

Medications and therapy combined is the best option.

However, there are concerns about medications- potential modest increased risk of suicide attempts- drug overdose

52
Q

What are the 2 types of anxiety disorders in children?

A

Separation anxiety disorder

Social anxiety disorder

53
Q

What is separation anxiety disorder?

A

Worry about parental or personal safety when away from
parents

Typically, first observed when the child begins school

54
Q

What is social anxiety disorder

A

Child is extremely shy and quiet

may exhibit selective mutism: refusal to speak in unfamiliar social settings

55
Q

What are the factors related to the aetiology of childhood anxiety?

A

Genetics/Environment

Psychological

56
Q

Genetics/environmental factors in relation to childhood anxiety

A

30-50% heritability
Parenting style plays a small role in anxiety disorders
-4% of variance.
Parental control > parental rejection

57
Q

psychological factors in relation to childhood anxiety

A

Emotional relation- internal feeling states
Behavioural inhibition- distressed and withdraw in novel situations
Attachment issues

58
Q

What is attachment

A

a deep and enduring emotional bond that
connects one person to another across time and space

59
Q

How is attachment assessed

A

Strange situation
Mother leaves room
comes back
is child comforted- secure
upset- insecure
angry/insecure/avoidant

60
Q

What is the treatment for childhood anxiety?

A

CBT- Kendalls coping cat programme

  1. Psychoeducation
  2. Exposure
  3. Somatic management-relaxation techniques
  4. Cognitive restructuring- new ways to think act fear
    5.problem solving
61
Q

What are some examples of specific learning communication and motor disorders

A

Dyslexia
Stuttering-childhood onset fluency disorder
Tourrettes

62
Q

Comment on SL, C and M disorders

A

Evidence of an inadequate development in the area concerned

Not due to autism, lack of educational opportunity etc.

The individual is usually of average/above garage intelligence

63
Q

What is the DSM 5 criteria for Specific learning disorder?

A

Difficulties in learning basic academic skills (reading, mathematics, or writing) inconsistent with person’s age, schooling, and intelligence

Significant interference with academic achievement or activities of daily
living

64
Q

What are the 2 types of specific learning disorder?

A

Dyscalculia

Dyslexia

65
Q

what is dyscalculia

A

Problems producing/ understanding:
numbers
quantities
basic arithmetic operations

66
Q

What is dyslexia

A

Problems with
Word recognition
reading comprehension
written work/spelling

67
Q

What is the aetiology of dyslexia

A

Problems in language processing due to deficient phonological awareness

less activity in the temporal, occipital and parietal regions during reading

68
Q

What is phonological awareness

A

Being able to identify units of oral language

Being able to analyse sounds and their relationship to printed words

A person with dyslexia has problems naming familiar objects rapidly

as well as delays learning syntactic rules, ie. the correct order of words in a phrase

69
Q

What are the treatments for dyslexia?

A

Multi-sensory instruction for reading, righting listening skills

Readiness skills- to prepare for learning to read

Phonics instructions]

Support in school

70
Q

What is Intellectual Development Disorder?

A

Characterized by significant limitations both in
1. intellectual
functioning and
2. in adaptive behaviour
as expressed in conceptual, social, and practical adaptive skills.

71
Q

What’s the DSM 5 criteria for IDD

A

Limitation in:
Intellectual functioning,ie problem solving

adapt behaviour, ie. communication skills

Before the age of 18

72
Q

What is the aetiology of IDD

A

Genetic or chromosomal abnormalities:
1. Down syndrome
2. Fragile-X - syndrome
3. Recessive gene syndrome

Infectious disease- maternal rubella

Poisoning

Note: A primary cause can only be identified in 25 percent of people

73
Q

What is the treatment of IDD?

A

THE GOAL IS NOT TO CURE BUT TO IMPROVE LEVEL OF FUNCTIONING.

Residential treatment- promoting independence

Applied behaviour treatment- teaching skills for self care

Cognitive treatment- problem solving strategies

74
Q

Comment on Autism Spectrum Disorder

A

Affects communication, social interactions, play, interest and behaviour

The symptoms become present ant 3 years of age and are lifelong

Spectrum: varies in severity

Have problems living in a social world

Neglect eye region: this may be the reason why they have difficulties perceiving emotions of other people

75
Q

What is the theory of mind in relation to autism

A

The understanding that other people have different thoughts, feelings, emotions etc.
Develops between ages 2-5 normally

However children with austim are delayed in achieving this DEVELOPMENTAL MILESTONE
and are less able to understand other pals perspectives and emotional reactions

76
Q

What are some signs of autism?

A

Communication deficits
Babbling less frequent
Echoloalia: repeat phrases overheard

Need for repetitive actions and rituals
Preoccupation with patterns/ sequences
Upset if routine is disturbed

77
Q

What is the DSM criteria for ASD

A

A. Deficits in social communication and social interactions:

  1. Deficits in social or emotional reciprocity (back and forth)
  2. Deficits in nonverbal behaviours (e.g. eye contact)
  3. Deficit in development of peer relationships (appropriate to developmental stage)

B. Restricted, repetitive behavior patterns interest or
activities (at least 2):

  1. Stereotyped or repetitive speech, motor movements or object use
  2. Excessive adherence to routines, rituals (incl. resistance to change)
  3. Restricted interests, e.g. abnormally focused on parts of objects
  4. Hyper/Hypo-Reactivity to sensory input (e.g. lights, spinning objects,
    sounds)

C.Onset in early childhood

D.Impaired functioning

78
Q

What is the prevalence of ASD?

A

It is increasing in prevalence
why:
better identification, more inclusive criteria

5x more common in boys

79
Q

what causes ASD

A

Not vaccines

Genetics:
Very strong genetic link

rare mutaitons in genes

Common variants may contribute to a large proportion of genetic liability for ASD

80
Q

What is the neurobiology of ASD?

A

Abnormality in brain size connectivity
brain size normal or large but Pruning of neurons may not be occurring

81
Q

What is co-morbid with ASD

A

Intellectual disability/IQ of less than 70 is common
IDD score poorly on ALL parts of IQ test
ASD poorly on subtests related to language, sequential logic symbolism, abstract thought

Sensorimotor development intact

Sometimes have great talent in isolated areas, ie. recall/multiplying large numbers.

82
Q

What are the treatments for ASD?

A

Psychological treatments aimed at improving social communication. and promoting socially appropriate behaviours
Example: Applied behavioural analysis
Symbolic play

83
Q

Applied behaviour analysis

A

Created by Lovaas
Most widely used therapy but some ppl say its routines are cruel and is aims are misguided.

84
Q

What is neurodivergence?

A

Neurodivergence refers to
differences in how people’s
brains works
Views autism as different cognitive style that is
exacerbated by social structures and expectations

Therefore a balance approach is needed:
Some autistic people have
very serious needs and need
evidence-based supports –
in a way that is neuroinclusive and supports the development of a positive autistic identity.

Psychosocial interventions and learning supports are therefore favoured.

But behavioural approaches (i.e., ABA) may be important for some
challenging behaviours if these don’t work.

85
Q

What are the pharmacological treatments for autism.

A

Haloperidol- antipsychotic which reduces
Aggression
stereotypes and social withdrawal

HOWEVER: not as effective as the psychological treatments as they don’t address core symptoms,like language.

86
Q

Childhood disorders progression into adulthood.

A

Some that have childhood onset tend to have a chronic course like IDD and autism and are managed through the lifespan

The treatments don’t intend to cure but allow them to gain independence and thrive.

Others manifest into adult mental health conditions(internalised and externalised disorders) and can be treated.

Psychological disorder (20 decks)

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