Externalising Childhood Disorders kring Flashcards
DSM-5 ADHD Inattentive sub-type
inattentive sub-type (careless mistakes, not listening well, not following instructions, distractable, forgettful)
DSM-5 ADHD -hyperactive s
hyperactive sub type (fidgeting, running inapproipriately, (restless above age 17) interrupting, intruding, incessant talking
ADHD all subtypes
7 items
6 items from hyperactive or inattentive sub-type before age 12; 5 after 17 (ICD before age 7)
combined: has some of both sub-types
6 months
maladaptive
greater than normal
two or more settings
impairment social, academic, occupational functionin
Comorbidities of ADHD
4 things
inattentive - diffuculties with information processing
conduct disorder - worst features of both
girls: more anti-social behaviour; risky sexual behaviour than girls with only ADHD
Prognosis for ADHD vs conduct disorder
3 issues
adhd more off task behaviour at school
adhd more cognitive and achievment deficits
ADHD- combined compareed with other sub-types
5 things
majority of children
more likely to have Conduct problems, oppositional behaviour
more diffucuties with peers
placed in special classes
ADHD and SLD, anxiety, depression comobidity
30% children with ADHD internalising disorder as well
15-30% SLD
ADHD prevalance
increaed from 3-7% to 8-11% USA
may be to get children out of normal classes and test results in USA
3x more common in boys
Girls with ADHd more likely to have teen eating disorders, substance abuse
ADHD Teens (2) Adults
60-80% still have symptoms as adolescence
achievment in average range
15% of childrern still have ADHD as 25 year olds
ADHD -Etiology - gene and environmental
Adoption and twin studies: genetic part
molecular genetics: multiple gene. 3 dopamine 2 dopamine receptor and one transporter
environmental factors triggers: prenatal nicotine and alcohol
ADHD - Etiology -neurobiological
brain structure Dopaminergic areas: caudate nucleus, globus pallidus, frontal lobes smaller in ADHD
function: less activation in frontal lobes
connectivity:
ADHD - Perinatal and prenatal factors
low birth weight mitigated by maternal warmth
nicotine and alcohol
ADHD - Environmental toxins
feingold: additives, artifical colour
very few children respond positivily to a diet with these removed.
refined sugar also not supported as a problem
lead - small role
nicotine - surrogate vs genetic child of smokers ADHD higher in genetic child. Still their in surrogate grop
ADHD - Family factors
parent child relationship - parents more negitive and give more commands, children less compliant and more negative
When children take a stimulant medication parents commands. negative behaviour and inffective parenting decrease
many parents have ADHD making less effective parents
family charicteristics maintain / exacerbate symptoms and consequences of ADHD. Little evidence to suggest families cause ADHD.
ADHD - treatment Drugs
stimulant medication
drugs reduct disruptive, impusive, inattention
drugs give short -term improvements by interacting with dopamine system
ADHD - psychological treatment
behaviour therapy - operant conditioning
Intermittment explosive disorder (IED)
recurrent vaerbal, physical aggressive outbursts aggression impulsive (in conduct disorder it is planned)
Oppositional defience disorder
debate about : Is ODD distinct from conduct disorder
precursor or milder version
diagnosed if sub clinical for CD
Often comorbid with ADHD but defiant behaviour is not though to arrise from attentional or impulsivity deficits
ODD boys=girls
Conduct Disorder -DSM 5
repititive, persistant violation of others rights, social norms 3+ twelve months 1 previous 6 months aggression to people and animals destruction of property deciet / theft serious rule violation significant impair: social, academic, occupational
Conduct Disorder -DSM 5 specifiers
limited prosocial emotions (callous, unemotional, lack remorse)
associated with more severe course
Conduct Disorder - Comorbidities
substance abuse - two conditions make each other worse OR CD may precede substance abuse
internalising disorders (15-45%)
CD precedes anxiety and depression
specific phobia and SAD precede CD
Conduct disorder -longitudinal
7% of preschool children
CD symptoms at 3years predict at 6 years
Dunedin Study - Moffit
some people life course persistant (early onset / other problems, more severe neuropsychological deficits, family psychopathology) Most severe adult problems: lower SES, health, education. Higher partner, child abuse and violent behaviour
adolescence-limited (gap between physical and social /emotional maturation) Men still had substance abuse, crime, mental health, impulsivity, in mid twenties. Adolescence onset more appropriate term.
Another study half of boys don’t meet criteria 1-4 years later although continued to have conduct problems
Conduct disorder - Prevalence
6-9.5% common
more common in boys
Conduct disorder - Etiology
genetic neurobiological psychological social all interact heritable tempermant charicteristics interact with enviromental, neurobiological, factors
