Disorders of Childhood Flashcards
what are disorders of childhood
psychiatric disorders which first arise in childhood and adolescence
what perspective does studying these disorders take
a developmental perspective
- understanding typical development in order to identify atypical development
what should childhood disorders reflect
aberrations in typical development trajectory
why is it difficult to study and diagnose childhood disorders
there is considerable variability across children within typical development
factors which influence children’s behaviours
environmental
age appropriateness
family dynamics
culture
what are the long term effects of childhood disorders
reduced educational attainment
reduced employment and earnings
relationship difficulties
justice system encounters
what are externalising disorders
characterised by outward directed behaviour
examples of outward directed behaviour
non compliance
hyperactivity
disruptive behaviour
impulsivity
aggressiveness
examples of externalising disorders
ADHD
conduct disorders
oppositional defiant disorder
what are internalising disorders
characterised by inward focused behaviours
examples of inward focused behaviours
depression
anxiety
social withdrawal
examples of internalising disorders
childhood anxiety and mood disorders
childhood disorders and sex differnces
externalising - more common in boys
internalising - more common in girls
third domain of childhood disorders
disorders in which acquisition of cognitive, language, motor, or social skills is disturbed
considered chronic and persist into adulthood
examples of third domain of childhood disorders
ASD
leanring disorders
intellectual disability
criteria for ADHD - inattention
behaviours in childhood
making careless mistakes
inattention
difficulty following instructions
forgetfulness
avoiding task which require sustained effort
when are inattention symptoms of ADHD mostly observed
when enter structured environments, like school
criteria for ADHD - hyperactivity/impulsivity
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
requirements for ADHD diagnoses
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
which country is ADHD most commonly diagnosed
USA
possible reasons for prevalence of ADHD in USA
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
what age do symptoms of ADHD first appear
ages 3-4
boy : girl ratio of ADHD
3:1
symptoms of ADHD in girls
do not tend to have as many outward behaviours
less apparent in identifying
ADHD over the life span
over half of children continue to have difficulties as adults
up to 15% still meet the diagnostic criteria
possible explanation from drop in ADHD symptoms
brain for ADHD behaviours is resolved by developmental trajectory
which ADHD symptoms typically remain
inattention
social repercussion of ADHD in adults
more likely to divorce
lower education
lower earnings
substance use
be obese
be imprisoned
die prematurely
heritability estimates of ADHD
up to 70-80%
what type of genes are implicated in ADHD
dopamine candidate genes
- receptors and transporters
neurobiological factors of ADHD
brain regions with dopaminergic circuits
reward processing is affected
impaired fronto-striatal function
regions of striatum which relate to reward processing - ADHD
nucleus accumbens
caudate nucleus
putamen
what is the frontostriatal for
inhibition
working memory
attention
what does temporal discounting measure
the value that someone places on something and the extent to which this decays as a function of time
ADHD and temporal discounting
ADHD’s value of reward decays more steeply than people without ADHD
ADHD and response inhibition
ADHD need more time to cancel a response
what does ADHD differences in temporal discounting implicate
impatience symptoms
what does ADHD differences in response inhibition implicate
issues in the basic inhibition systems in brain
aetiology of ADHD
perinatal and prenatal factors
environmental toxins
parent-child relationships
ADHD associated with which peri and prenatal factors
low birth weight
maternal tobacco and alcohol use
ADHD associated with which environmental toxins
lead (small effect)
food additives (small effect on hyperactive behaviour but not a cause)
ADHD associated with which parenting factors
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
treatments of ADHD
medications which modulate dopamine system
stimulants which boost dopamine (ritalin, adderall)
effects of ADHD stimulant medication
reduces disruptive behaviour and impulsivity
improves social interactions with parents, teachers, peers
improves goal directed behaviours and concentration
reduces aggression
how do ADHD medications work
like reuptake inhibitors, leaves dopamine in synapse for longer
increases dopaminergic activity in PFC
examples of psychological treatment for ADHD
parent training
supportive classroom structure
how does parent training help ADHD and examples
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)
examples of supportive classroom structure for ADHD
brief assignments
immediate feedback
task focused style
exercise breaks
what is conduct disorder
behaviour characterised by violating the rights of others or conventional social norms
symptoms of conduct disorder
- 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
comorbidities of conduct disorder
substance abuse
internalsing disorders
prevalence of conduct disorders
~7% in adolescents
- more common in boys
life-course persistent pattern of conduct disorder
evidence of antisocial behaviour by age 3
may have significant neuropsychological deficits and family psychopathology
adolescence limited pattern of conduct disorder
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
what age does conduct disorder peak at and why
adolescence
due to important developmental stage in PFC (pruning)
pruning
when frequently used connection are strengthened and infrequently used connections are eliminated
result of pruning
grey matter decreases
neurobiological factors of conduct disorder
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
psychological factors of conduct disorder
cognitive bias
environment
cognitive bias and conduct disorder
neutral acts from others are perceived as hostile
- interpretation influences behaviours
environment and conduct disorder
modelling and reinforcement of aggressive behaviour witnessed (in home)
harsh, inconsistent parenting
poverty
peer influence
heritability of antisocial behaviours
40-50%
which traits are most heritable
callous-unemotional traits
when do genetic have strongest influence in conduct disorders
when behaviours begin in childhood
treatment of conduct disorder - multi-systemic approach
treatment addresses the multiple systems involved in child’s life
- child, family, peers, school, neighbourhood, community
multi-systemic therapy
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
family interventions - conduct disorder
parental management training
- teaches strategies (reward prosocial behaviour rather than punish antisocial behaviour
related disorders to conduct disorder
intermittent explosive disorder
oppositional defiant disorder
intermittent explosive disorder
recurrent verbal/physical aggressive outbursts that are out of proportion
oppositional defiant disorder
behaviours do not meet criteria for CD
- comorbid with ADHD, learning and communication disorders
treatments for childhood depression
combined treatment is most effective
CBT, psychosocial, psychodynamic, psychotherapy - modest effects
concern of using medications with children
associated modest increased risk of suicide attempts
do not know effects of long term use
examples of anxiety disorders in children
separation anxiety disorder
social anxiety disorder
separation anxiety disorder in children
worry about parental/personal safety when away from parents
first observed when starts school but can happen earlier
social anxiety disorder in children
extremely shy and quiet
may have selective mutism
- refusal to speak in familiar setting, to unfamiliar people
heritability of childhood anxiety
29-50%
parenting style and anxiety disorders
explains around 4% of variance
parental control more important thn rejection
environmental influences and childhood anxiety
context
deprivation
SES issues
psychological factors of childhood anxiety
emotional regulation
behvaioural inhibition
attahcment problems
what is emotional regulation
the process of modulating internal feeling states in the service on accomplishing goals
what is behavioural inhibition
tendency to become distressed and withdraw when faced with novel situations
what is attachment
the fundamental bond that connects 2 people across time and space
what is the strange situation test
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
secure attachment
child is comforted by return of parent
anxiety treatment for children/adolescents
CBT - accessible education of core concepts
involves family
- teaches parent to not model anxious behaviours, if share symptoms
learning, communication, and motor disorders - examples
dyslexia
child onset fluency disorder (stuttering)
tourettes syndrome
general framework for Learning, Communication and Motor Disorders
evidence of inadequate development in a specific area
- not due to intellectual impairment, lack of education, or physical disorders or autism
specific learning disorder - criteria
difficulties in learning basic academic skills (reading, maths, writing)
inconsistent with age, schooling, intelligence
significant interference with academic achievement or daily activities (keeping up)
dyscalculia - impairments
producing/understanding numbers
quantities
basic arithmetic operations
dyslexia - impairments
word recognition
reading comprehension
written work
spelling
aetiology of dyslexia
language processes (deficient phonological awareness)
identifying and manipulating units of oral language
word analysis and relationship to printed words
delays in learning syntactic rules
what is phonological awareness
ways to break down and process written words
neural evidence for dyslexia
fundamental difference in brain processing
- pictorial style of processing
- less activity in temporal, occipital parietal lobes during reading
treatment for dyslexia
- 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
intellectual developmental disorders
significant limitation in intellectual functioning and adaptive behaviour expressed in conceptual, social, practical adaptive skills
criteria for intellectual developmental disorders
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)
genetic abnormalities of IDD
down syndrome - extra copy of chromosome 21
frgile x syndrome - mutation in FMR1 gene on x chromosome
recessive gene disease
infectious disease of IDD
maternal rubella in utero
meningitis
- also lead/mercury poisoning
treatment of IDD
residential treatment
applied behavioural analysis
cognitive treatments
residential treatment - IDD
community residences integrated within community
- live in staff
- promote independence
applied behavioural analysis - IDD
method of operant conditioning
- teaches skills to help function more readily in world
- language, social and motor skills training
cognitive treatments - IDD
problem solving strategies
autism spectrum disorder affects ?
communication
reciprocal social interactions
play
interests
behaviours
when are ASD symptoms first seen and how long do they last
prior to age 3
lifelong
ASD problems with living in a social world
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
communication deficits in children with ASD
babbling less frequent
slower language development
echolalia
pronoun reversal
ToM and ASD
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
social communication - ASD criteria
deficits in
- social communication and interactions
- social and emotional reciprocity
- nonverbal behaviours
- development of peer relationships
restricted, repetitive behaviour patterns - ASD criteria
stereotyped or repetitive speech, motor movements, object use
excessive adherence to routines, rituals (resistant to change)
restricted interests
hyper/hypo reactivity to sensory input
general criteria for ASD diagnosis
onset in early childhood
impaired functioning
ASD and sex differences
5x more common in boys
heritability of ASD
~80%
having one child with ASD, chances of second child having ASD is
increased 10-20%
genetic liability of ASD
up to 60% contributed from common variants
neurobiology of ASD
differences in brain size and connectivity
abnormal coupling within the social brain
ASD and brain differences
normal/smaller at birth, but ASD brain of adults and children are larger than normal
comorbidity and ASD
intellectual disability
treatment for ASD
psychological treatments
applied behavioural analysis
pivotal response treatment
joint attention intervention
symbolic play
psychological treatments aims at improving … in ASD
social communication
promotes socially/situationally appropriate behaviours
what does pivotal response treatment
do for ASD
focuses on wants and needs of childre directly
Joint attention interventions for ASD
improves core components of social functioning
applied behaviour analysis aims for ASD
instrumental conditioning and reinforcement
- negative reinforcement to encourage and sustain neurotypical behaviours
neurodivergence
differences in how peoples brain works
- that deviates from the norm
