Externalising disorders

Question 1

What are the 4 externalising disorders?

Answer 1

Conduct disorder, 
Oppositional defiant, 
Attention deficit hyperactivity disorder
Antisocial Personality (adult version of conduct disorder)

Question 2

Can you have both CD and ODD?

Answer 2

No. Only one. CD is much more severe and takes precedence.

Question 3

Common features of CD and ODD?

Answer 3

• Breaking rules
• Argumentative
• Often aggressive

Question 4

What is ODD?

Compared to OD that is

Answer 4

• More argumentative
• Often touchy and angry
• Often in ONE setting (e.g., home)

more for the high spirited kid, argumentative child, touchy, be sensitive. But generally okay kids. Problems occur more so in some settings than others. E.g. fine at school where there are strict rules, but difficult at home.

Question 5

What is OD , compared to ODD?

Answer 5

• More social violations
• More “severe” behaviours (e.g., fire setting, use
of weapons)
• Typically across ALL settings
• Often engages peers -Gang like mentality where these kids will interact with peers similar to them.

Question 6

ADHD?

Answer 6

• Difficulty with appropriate attentional focus and/or control over activity levels
• Must be more than for typical age
• E.g., unable to sustain attention, follow tasks,
organise activities
• E.g., unable to sit still, wait turn, stay quiet

(Tend to get a lot of overuse of the term. If you use the criteria strictly, you do find a unique set of children. )

Question 7

Prevalence of 
ODD
CD
ADHD
Lumping these three together?

Answer 7

ODD affects 2-3%, conduct 1-2% and ADHD least common 1-2%. ODD most common though.

• Lumping these three externalising disorders together, 8-10%

Question 8

Comorbidity of ODD, CD, ADHD with

anxiety/depression/substance abuse?

Answer 8

• High overlap between all of them. Kids often with ADHD will develop conduct disorder down the track.
• High levels of depression. Kids have difficulty with school, fitting in with society.
• Higher overlap btn ODD and anxiety and ADHD and anxiety but NOT with conduct disorder (protected from anxiety).
• Conduct disorder kids often grow up to develop substance abuse, but not with ODD.
• Learning difficulties, mental retardation

Question 9

Sex distribution for externalising disorders generally?

Answer 9

Mostly male disorders
– Especially CD ~4x
– ADHD ~ 3-4x
– Less ODD ~1.5-2x

Question 10

Externalising disorders are disorders of childhood onset. They (ADHD/ODD and CD) generally occur before age…

Answer 10

– ADHD by definition before age 7
– ODD usually early childhood
– CD mid/late childhood – rare after 16

Question 11

ODD find in earlier childhood and then go on to develop ……?

Answer 11

CD

Question 12

Social Difficulties of externalising disorders?

Answer 12

academic difficulties, trend towards deviant peers, high risk behaviours like drug taking, unemployed, peer rejection, truancy (missing school), family conflict, marginalised, often have a history of juvenile delinquency and go on into prison. So in other words, not looking good for these kids.

Question 13

What is anti-social behaviour

Answer 13

• Extension of conduct disorder but for adults
• Little guilt, little remorse, engage in a lot of deceit, breaking the law
• Affects 2% of population, primarily males.
• Problem decreases with age often.
• History with fights and aggression, difficulty sustaining a job.
• Violation of social and personal rights and rules
• Early history of CD
• Continued characteristics such as fighting, breaking law, deceitfulness

Question 14

More characteristics of anti personality disorder.

Answer 14

• Up to 2% of population
• Largely male
• Tends to decrease with age
• Inconsistent work history
• History of fights, aggression, and risky behaviour
• Common comorbid substance abuse and mood disorders
• Common prison history

Question 15

What is psychopathy and how does it differ to APD (anti personality disorder).

Answer 15

• Early term (back in DSM4) referred to adults who have a lack of remorse, don’t have empathy or moral engagement, self gain focus.
• DIFFERENT from antisocial personality (this is more behavioural factors), not exactly the same thing though.

Question 16

Are there such things as successful psychopaths?

Answer 16

Possibly, Yes can be an intelligent person who manipulates others to their own ends.

Question 17

Callous unemotional traits are:

Answer 17

• kids who lack empathy or moral engagement with others (this is a subset of disorders).

Question 18

Detection of fear or distress in others for those with callous unemotional traits?

Answer 18

Decreased empathy but especially reduced
recognition of fear and distress in others.

Poor recognition of distress or fear in other people. Suggests this is part of why they are aggressive, because they cant detect when someone is scared.

Question 19

Response to punishment in callous unemotional traits?

Answer 19

Abnormalities in responsiveness to cues of punishment.
Strong reward drive.

o CUK also have reduced responsiveness to punishment cues. For most of us it would make us scared and we’d stop misbehaving. They don’t. Have a STRONG reward drive as well and reduced punishment. Impulsively chasing reward without worrying about punishment.

Question 20

Any cognitive processing biases/ social info processing biases in externalising kids?
WHAT IS THE BUT in the equation?

Answer 20

o Some of the aggression involved is mediated by biases in the processing of social information. The aggression can be directly predicted by attributions of hostile intent = kids with conduct problems tend to attribute a greater level of hostile intent to other kids. E.g. if you have kids laughing in the corner and you ask the conduct kid what they’re laughing about they will say they’re laughing at me, they’re plotting to get me. Other kids: they’re sharing a joke. So they attribute hostile intentions to others. So naturally they will increase their aggression to people.

BUT their aggression may be their social experience, their hostile attributions are probably somewhat true because these kids are marginalised. But not to the same extent they attribute. So disproportionate attribution.

Question 21

Demographic risk factors

Answer 21

Demographic risk factors

•  Externalising children characterised by:
–  Male
–  Low SES
– Impoverished neighbourhoods 
– Low education

Question 22

Risk factors in family?

Answer 22

larger families usually, with a lot of marital distress, maternal depression, parents abusing substances, paternal absence= more likely to come from single parent family.

Question 23

What is an example of the cycle of escalation?

What does it suggest about parenting styles?

Answer 23

a parent might say I need u to clean your room, child says no and parent gives in. That reinforces child to say no and then get away with it. Then later mother says YOU REALLY need to clean your room, child then has a tantrum, and parent does it herself, again rewarded and reinforced to say no. Parent gets more and more desperate, child learns to produce tantrum and argumentative types of behaviour.

Suggests: poor parenting practices are involved in externalising disorders.

Question 24

What is poor parenting characterised by?

Answer 24

Characterised by harsher punishment (unconstructive). More inconsistency and poorly defined instructions.
Poor parent supervision e.g. Ask them ‘do you know where your child is right now’ parents of ODD or conduct disorder kids are more likely to say no to that question.

Question 25

How do their academic (school life) and peer relationships perpetuate their disorder?

Answer 25

• More likely to drop out of school, associate with other aggressive kids because rejected from normal kids. Drift towards ‘deviant kids’ and has a ‘gang; mentality cos they’re disenfranchised from the normal groups and drift towards extreme groups→leads to more aggression down track.

Question 26

Risk of selena’s cousin developing ADHD?

Answer 26

2-8 times increased risk (for 1st degree relatives)

Question 27

Mean heritability of ADHD in twin studies?

Answer 27

about .76 (very high!)

Question 28

Abnormalities in what biochemical systems for ADHD?

Answer 28

specific abnormalities related to adrenaline, serotonin (5HT) and dopamine systems. Strongest abnormalities related to dopamine receptors and its transport system.

Question 29

Heritability of ODD and CD? (%)

Answer 29

50%

(Twin studies show high levels of heritability to ODD and conduct, but not as high for ADHD. So only 50% of variance can be accounted for by genetic factors (for ODD and conduct).

Question 30

Are genes the only factors involved in developing ODD and CD?

Answer 30

No, interaction btn genes and environment.

Question 31

Heritability of psychopathy?

Answer 31

psychopathy: stronger heritability than overall antisocial behaviours. So heritable component to antisocial behaviours broadly is not that strong.
But the specific temperament style of callous unemotional trait high is much stronger.

Question 32

What is the dopamine theory/hypothesis related to biochemistry underpinning ADHD?

Answer 32

Dopamine hypothesis: particularly about levels of dopamine, in striatum and frontal cortex that are important. A number of animal models: show that if you increase or decrease dopamine in animals, shows quite reliable changes in attention and impulsivity and activity. Suggests dopamine is involved in those components.

Question 33

Those with ADHD have high or low levels of DA in striatum and frontal cortex?

Answer 33

Low levels of DA in striatum and frontal cortex

Question 34

In ADHD, there is a complex influence of NA on DA

Answer 34

WILD CARD :) TRICK SHOT

Question 35

4 PIECES of evidence to support Dopamine is involved in ADHD?

Answer 35

• Manipulations of DA levels in animals influence attention, impulsivity & activity
• STIMULANTS to treat ADHD work largely through DA system (ironic->increasing DA levels, reduces attention deficits).
• Imaging studies show DA abnormalities in specific brain regions
• Genes related to DA implicated in ADHD

Question 36

Underarousal in early life is said to be associated with

Answer 36

psychopathic behaviour (callous unemotional traits).

Question 37

What is ‘early theory’ referring to?

hint: arousal.

Answer 37

That low levels of arousal early in life do predict psychopathic types of tendencies later on. People with these characteristics tend to be under aroused. And seek more stimulation through more risk taking.

ie. psychopaths characterised by low arousal and hence fail to learn about punishment and seek greater stimulation

Question 38

When are the three waves where you’ll get parents taking their kids into psychologists with a suspicion of ADHD?

Answer 38

kindergarten (expectation to sit silently in class)
Year 7 (higher cognitive load, have to find their way around school)
HSC year (stress of the hsc and cant’ organise things)

Question 39

In clinical perspectives section of these lectures, the lady said there were ADHD…? Differentiate them

Answer 39

Inattentive: not likely to come to attention to teachers, cos they are spaced out, cognitively not doing much, flowers at back of room

Combined types:poor organisational skills, spaced out, but also difficulties with impulse control, blurt out answers in classroom, hyperactive, annoy everyone else

Hyperactive impulsive: don’t have cognitive problems, just overactive and unable to control themselves.