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TCD > Disorders of Childhood > Flashcards

Disorders of Childhood Flashcards

1
Q

what are disorders of childhood

A

psychiatric disorders which first arise in childhood and adolescence

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2
Q

what perspective does studying these disorders take

A

a developmental perspective
- understanding typical development in order to identify atypical development

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3
Q

what should childhood disorders reflect

A

aberrations in typical development trajectory

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4
Q

why is it difficult to study and diagnose childhood disorders

A

there is considerable variability across children within typical development

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5
Q

factors which influence children’s behaviours

A

environmental
age appropriateness
family dynamics
culture

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6
Q

what are the long term effects of childhood disorders

A

reduced educational attainment
reduced employment and earnings
relationship difficulties
justice system encounters

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7
Q

what are externalising disorders

A

characterised by outward directed behaviour

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8
Q

examples of outward directed behaviour

A

non compliance
hyperactivity
disruptive behaviour
impulsivity
aggressiveness

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9
Q

examples of externalising disorders

A

ADHD
conduct disorders
oppositional defiant disorder

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10
Q

what are internalising disorders

A

characterised by inward focused behaviours

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11
Q

examples of inward focused behaviours

A

depression
anxiety
social withdrawal

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12
Q

examples of internalising disorders

A

childhood anxiety and mood disorders

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13
Q

childhood disorders and sex differnces

A

externalising - more common in boys
internalising - more common in girls

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14
Q

third domain of childhood disorders

A

disorders in which acquisition of cognitive, language, motor, or social skills is disturbed
considered chronic and persist into adulthood

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15
Q

examples of third domain of childhood disorders

A

ASD
leanring disorders
intellectual disability

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16
Q

criteria for ADHD - inattention

A

behaviours in childhood
making careless mistakes
inattention
difficulty following instructions
forgetfulness
avoiding task which require sustained effort

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17
Q

when are inattention symptoms of ADHD mostly observed

A

when enter structured environments, like school

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18
Q

criteria for ADHD - hyperactivity/impulsivity

A

fidgeting
squirming
unable to sit still
incessant talking
can’t take turns
blurting out answers
should be persistent to a point where the behaviours should have dissipated

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19
Q

requirements for ADHD diagnoses

A

6 or more symptoms from either category (inattention or hyperactivity(
present before age 12
be more extreme than expected for developmental stage
persistent across different situations (home, school etc)
associated with significant functional impairment

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20
Q

which country is ADHD most commonly diagnosed

A

USA

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21
Q

possible reasons for prevalence of ADHD in USA

A

misdiagnosis by teachers when children are disruptive
over diagnosis by GPs or school nurses
culture and setting can bias the rate of diagnosis prevalence, and what proportion are then treated

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22
Q

what age do symptoms of ADHD first appear

A

ages 3-4

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23
Q

boy : girl ratio of ADHD

A

3:1

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24
Q

symptoms of ADHD in girls

A

do not tend to have as many outward behaviours
less apparent in identifying

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25
Q

ADHD over the life span

A

over half of children continue to have difficulties as adults
up to 15% still meet the diagnostic criteria

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26
Q

possible explanation from drop in ADHD symptoms

A

brain for ADHD behaviours is resolved by developmental trajectory

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27
Q

which ADHD symptoms typically remain

A

inattention

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28
Q

social repercussion of ADHD in adults

A

more likely to divorce
lower education
lower earnings
substance use
be obese
be imprisoned
die prematurely

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29
Q

heritability estimates of ADHD

A

up to 70-80%

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30
Q

what type of genes are implicated in ADHD

A

dopamine candidate genes
- receptors and transporters

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31
Q

neurobiological factors of ADHD

A

brain regions with dopaminergic circuits
reward processing is affected
impaired fronto-striatal function

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32
Q

regions of striatum which relate to reward processing - ADHD

A

nucleus accumbens
caudate nucleus
putamen

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33
Q

what is the frontostriatal for

A

inhibition
working memory
attention

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34
Q

what does temporal discounting measure

A

the value that someone places on something and the extent to which this decays as a function of time

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35
Q

ADHD and temporal discounting

A

ADHD’s value of reward decays more steeply than people without ADHD

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36
Q

ADHD and response inhibition

A

ADHD need more time to cancel a response

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37
Q

what does ADHD differences in temporal discounting implicate

A

impatience symptoms

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38
Q

what does ADHD differences in response inhibition implicate

A

issues in the basic inhibition systems in brain

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39
Q

aetiology of ADHD

A

perinatal and prenatal factors
environmental toxins
parent-child relationships

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40
Q

ADHD associated with which peri and prenatal factors

A

low birth weight
maternal tobacco and alcohol use

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41
Q

ADHD associated with which environmental toxins

A

lead (small effect)
food additives (small effect on hyperactive behaviour but not a cause)

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42
Q

ADHD associated with which parenting factors

A

parents more likely to have ADHD
parenting styles (such as authoritative) is likely a coping mechanisms to challenging behaviour
parenting may interact with genetic and neurobiological factors

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43
Q

treatments of ADHD

A

medications which modulate dopamine system
stimulants which boost dopamine (ritalin, adderall)

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44
Q

effects of ADHD stimulant medication

A

reduces disruptive behaviour and impulsivity
improves social interactions with parents, teachers, peers
improves goal directed behaviours and concentration
reduces aggression

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45
Q

how do ADHD medications work

A

like reuptake inhibitors, leaves dopamine in synapse for longer
increases dopaminergic activity in PFC

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46
Q

examples of psychological treatment for ADHD

A

parent training
supportive classroom structure

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47
Q

how does parent training help ADHD and examples

A

gives parents skills to help the child at home
- behaviour monitoring, reinforcement of appropriate behaviour
- focus on improving ability to function in domains important for success (academic, task completion, social skills)

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48
Q

examples of supportive classroom structure for ADHD

A

brief assignments
immediate feedback
task focused style
exercise breaks

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49
Q

what is conduct disorder

A

behaviour characterised by violating the rights of others or conventional social norms

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50
Q

symptoms of conduct disorder

A
  • aggression to people and animals (bullying, fighting, physically cruel, forcing sexual activity)
  • destruction of property (fire setting, vandalism)
  • deceitfulness or theft (breaking in, conning, shoplifting)
  • serious violation of rules (truancy, or staying out at night before age 13)
  • significant impairment in social, academic, occupational functioning
51
Q

comorbidities of conduct disorder

A

substance abuse
internalsing disorders

52
Q

prevalence of conduct disorders

A

~7% in adolescents
- more common in boys

53
Q

life-course persistent pattern of conduct disorder

A

evidence of antisocial behaviour by age 3
may have significant neuropsychological deficits and family psychopathology

54
Q

adolescence limited pattern of conduct disorder

A

it is thought that conduct disorder is due to maturity gap between physical maturation and reward adult behaviours
- many grow out of it
gaps between typical development can cause problems

55
Q

what age does conduct disorder peak at and why

A

adolescence
due to important developmental stage in PFC (pruning)

56
Q

pruning

A

when frequently used connection are strengthened and infrequently used connections are eliminated

57
Q

result of pruning

A

grey matter decreases

58
Q

neurobiological factors of conduct disorder

A

poor verbal skills
executive function
IQ
impaired emotional processing
lower arousal levels (skin conductance/heart rate)
absence of fear of punishment/ lack of concern?
reduced reactions to threat

59
Q

psychological factors of conduct disorder

A

cognitive bias
environment

60
Q

cognitive bias and conduct disorder

A

neutral acts from others are perceived as hostile
- interpretation influences behaviours

61
Q

environment and conduct disorder

A

modelling and reinforcement of aggressive behaviour witnessed (in home)
harsh, inconsistent parenting
poverty
peer influence

62
Q

heritability of antisocial behaviours

A

40-50%

63
Q

which traits are most heritable

A

callous-unemotional traits

64
Q

when do genetic have strongest influence in conduct disorders

A

when behaviours begin in childhood

65
Q

treatment of conduct disorder - multi-systemic approach

A

treatment addresses the multiple systems involved in child’s life
- child, family, peers, school, neighbourhood, community

66
Q

multi-systemic therapy

A

intensive community based service to young - creates sense of community
identifying
- individual and family strengths
- social context
uses
- action focused interventions
- daily/weekly family efforts

67
Q

family interventions - conduct disorder

A

parental management training
- teaches strategies (reward prosocial behaviour rather than punish antisocial behaviour

68
Q

related disorders to conduct disorder

A

intermittent explosive disorder
oppositional defiant disorder

69
Q

intermittent explosive disorder

A

recurrent verbal/physical aggressive outbursts that are out of proportion

70
Q

oppositional defiant disorder

A

behaviours do not meet criteria for CD
- comorbid with ADHD, learning and communication disorders

71
Q

treatments for childhood depression

A

combined treatment is most effective
CBT, psychosocial, psychodynamic, psychotherapy - modest effects

72
Q

concern of using medications with children

A

associated modest increased risk of suicide attempts
do not know effects of long term use

73
Q

examples of anxiety disorders in children

A

separation anxiety disorder
social anxiety disorder

74
Q

separation anxiety disorder in children

A

worry about parental/personal safety when away from parents
first observed when starts school but can happen earlier

75
Q

social anxiety disorder in children

A

extremely shy and quiet
may have selective mutism
- refusal to speak in familiar setting, to unfamiliar people

76
Q

heritability of childhood anxiety

A

29-50%

77
Q

parenting style and anxiety disorders

A

explains around 4% of variance
parental control more important thn rejection

78
Q

environmental influences and childhood anxiety

A

context
deprivation
SES issues

79
Q

psychological factors of childhood anxiety

A

emotional regulation
behvaioural inhibition
attahcment problems

80
Q

what is emotional regulation

A

the process of modulating internal feeling states in the service on accomplishing goals

81
Q

what is behavioural inhibition

A

tendency to become distressed and withdraw when faced with novel situations

82
Q

what is attachment

A

the fundamental bond that connects 2 people across time and space

83
Q

what is the strange situation test

A

parent and child in room, parent leaves and stranger enters and make to play with child
- is the child distraught by parent leaving, and how comforted are they by parent’s return

84
Q

secure attachment

A

child is comforted by return of parent

85
Q

anxiety treatment for children/adolescents

A

CBT - accessible education of core concepts
involves family
- teaches parent to not model anxious behaviours, if share symptoms

86
Q

learning, communication, and motor disorders - examples

A

dyslexia
child onset fluency disorder (stuttering)
tourettes syndrome

87
Q

general framework for Learning, Communication and Motor Disorders

A

evidence of inadequate development in a specific area
- not due to intellectual impairment, lack of education, or physical disorders or autism

88
Q

specific learning disorder - criteria

A

difficulties in learning basic academic skills (reading, maths, writing)
inconsistent with age, schooling, intelligence
significant interference with academic achievement or daily activities (keeping up)

89
Q

dyscalculia - impairments

A

producing/understanding numbers
quantities
basic arithmetic operations

90
Q

dyslexia - impairments

A

word recognition
reading comprehension
written work
spelling

91
Q

aetiology of dyslexia

A

language processes (deficient phonological awareness)
identifying and manipulating units of oral language
word analysis and relationship to printed words
delays in learning syntactic rules

92
Q

what is phonological awareness

A

ways to break down and process written words

93
Q

neural evidence for dyslexia

A

fundamental difference in brain processing
- pictorial style of processing
- less activity in temporal, occipital parietal lobes during reading

94
Q

treatment for dyslexia

A
  • multi sensory instruction in listening/speaking/writing skills
  • readiness skills as preparation for learning to read
  • phonics instruction - letter sound correspondence
  • support in schools
  • aids to find different ways to achieve outcomes
95
Q

intellectual developmental disorders

A

significant limitation in intellectual functioning and adaptive behaviour expressed in conceptual, social, practical adaptive skills

96
Q

criteria for intellectual developmental disorders

A

intellectual functioning determined by IQ testing and clinical assessment
adaptive behaviour - communication, social participation, requires need for support at school/independent life
onset before age 18 (not result of brain injury)

97
Q

genetic abnormalities of IDD

A

down syndrome - extra copy of chromosome 21
frgile x syndrome - mutation in FMR1 gene on x chromosome
recessive gene disease

98
Q

infectious disease of IDD

A

maternal rubella in utero
meningitis
- also lead/mercury poisoning

99
Q

treatment of IDD

A

residential treatment
applied behavioural analysis
cognitive treatments

100
Q

residential treatment - IDD

A

community residences integrated within community
- live in staff
- promote independence

101
Q

applied behavioural analysis - IDD

A

method of operant conditioning
- teaches skills to help function more readily in world
- language, social and motor skills training

102
Q

cognitive treatments - IDD

A

problem solving strategies

103
Q

autism spectrum disorder affects ?

A

communication
reciprocal social interactions
play
interests
behaviours

104
Q

when are ASD symptoms first seen and how long do they last

A

prior to age 3
lifelong

105
Q

ASD problems with living in a social world

A

rarely approach others
look through people
turn back on them
reduced tendency to initiate play
problems in joint attention
neglected eye contact - thought to lead to difficulties in perceiving emotions of others

106
Q

communication deficits in children with ASD

A

babbling less frequent
slower language development
echolalia
pronoun reversal

107
Q

ToM and ASD

A

understanding that everyone has own internal world (beliefs, feelings etc) that is different to own
- delayed in achieving ToM
- less able to understand others perspectives and emotional reactions

108
Q

social communication - ASD criteria

A

deficits in
- social communication and interactions
- social and emotional reciprocity
- nonverbal behaviours
- development of peer relationships

109
Q

restricted, repetitive behaviour patterns - ASD criteria

A

stereotyped or repetitive speech, motor movements, object use
excessive adherence to routines, rituals (resistant to change)
restricted interests
hyper/hypo reactivity to sensory input

110
Q

general criteria for ASD diagnosis

A

onset in early childhood
impaired functioning

111
Q

ASD and sex differences

A

5x more common in boys

112
Q

heritability of ASD

A

~80%

113
Q

having one child with ASD, chances of second child having ASD is

A

increased 10-20%

114
Q

genetic liability of ASD

A

up to 60% contributed from common variants

115
Q

neurobiology of ASD

A

differences in brain size and connectivity
abnormal coupling within the social brain

116
Q

ASD and brain differences

A

normal/smaller at birth, but ASD brain of adults and children are larger than normal

117
Q

comorbidity and ASD

A

intellectual disability

118
Q

treatment for ASD

A

psychological treatments
applied behavioural analysis
pivotal response treatment
joint attention intervention
symbolic play

119
Q

psychological treatments aims at improving … in ASD

A

social communication
promotes socially/situationally appropriate behaviours

120
Q

what does pivotal response treatment
do for ASD

A

focuses on wants and needs of childre directly

121
Q

Joint attention interventions for ASD

A

improves core components of social functioning

122
Q

applied behaviour analysis aims for ASD

A

instrumental conditioning and reinforcement
- negative reinforcement to encourage and sustain neurotypical behaviours

123
Q

neurodivergence

A

differences in how peoples brain works
- that deviates from the norm

TCD (17 decks)

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