externalizing behavior

Question 1

ODD

Answer 1

oppositional defiant disorder

Question 2

ODD DSM5 criteria

Answer 2

pattern of
negativistic, angry/irritable mood, argumentative/defiant behavior, or vindictiveness
lasting at least 6 months as evidenced by
at least 4 symptoms of any of the following categories,
and exhibited during interaction with at least one individual who is not a sibling

Question 3

ODD specifiers

Answer 3

mild - symptoms are confined to one setting
moderate - some symptoms are present in at least two settings
severe - some symptoms are present in three or more settings

Question 4

for the diagnosis of ODD, there has to be

Answer 4

functional impairment

Question 5

the diagnosis of ODD requires

Answer 5

symptoms in only one setting

Question 6

ODD epidemiology

Answer 6

rates vary from 2-11%
decreases with age
greater stability with more severe ODD/CD
stability as high or higher for females
more common in lower SES

Question 7

ODD natural history more prevalent in

Answer 7

males prior to puberty; rates equalize after puberty
gender differences don’t emerge until after 6 y/o

Question 8

ODD symptoms often emerge at

Answer 8

home but generalize with time

Question 9

common comorbidities

Answer 9

ADHD, LD, communication disorder
50% of kids w ADHD have ODD or CD
70% of kids w ODD or CD have ADHD

Question 10

what contributes to the severity of the symptoms

Answer 10

temperament of the child
parental characteristics
stress

Question 11

CD

Answer 11

conduct disorder

Question 12

CD criteria

Answer 12

a repetitive and persistent pattern of behavior in which the basic rights of others or major age-approriate societal norms or rules are violated,
as manifested by the presence of three or more of the following criteria in the past 12 months,
with at least one criterion present in the past six months

Question 13

CD specifiers

Answer 13

1. childhood-onset type
2. adolescent-onset type
3. unspecified onset

Question 14

childhood-onset type CD

Answer 14

unsocialized
at least one criterion before age 10 yo
usually male; frequently aggressive
disturbed peer relations
often suffered ODD as a child; may have concurrent ADHD
most likely to have persistent CD and to develop APD

Question 15

APD

Answer 15

antisocial personality disorder

Question 16

adolescent-onset type CD

Answer 16

socialized
absence of criteria prior to age 10
less likely to display aggressive behavior
tend to have normative peer relations
less likely to suffer persistent CD and to develop APD
still more males; but a lower ratio

Question 17

CD rates

Answer 17

1-10%; 6% overall
rate increases with age

Question 18

__ is a common precursor for CD

Answer 18

ODD

Question 19

CD onset is rare after

Answer 19

16 yo

Question 20

CD best predict later diagnosis in children

Answer 20

cruelty to people and weapon use

Question 21

below age 13, ___ highly predictive of later CD

Answer 21

cruelty, running away, and breaking and entering

Question 22

a model of delinquency

Answer 22

–> early childhood: poor parental monitoring and discipline
–> child: conduct problems
–> middle childhood: rejection by normal peers and academic difficulties
–> commitment to deviant peer groups
–> late childhood and adolescence: delinquency

Question 23

child biological factors possibly contributing to ODD and CD

Answer 23

family history
neuroanatomy
neurotransmitters
autonomic nervous system
neurotoxins
temperament
attachment
intelligence
impulsivity and behavioral inhibition
social cognition
puberty
parenting
assortative mating
child abuse
peer effects
neighborhood and socioeconomic factors

Question 24

factor: family history

Answer 24

maternal smoking
parental substance abuse
pregnancy and birth problems

Question 25

factor: neuroanatomy

Answer 25

• decreased glucose metabolism associated w violence
• frontal damage associated w aggression
• impairment in amygdala function

Question 26

factor: neurotransmitters

Answer 26

• low levels of sertonin metabolite in CSF
• blood serotonin is higher
• low salivary cortisol levels
• testosterone

Question 27

factor: ANS autonomic nervous system

Answer 27

• general physiological underarousal (lower heart rate at baseline, lower skin conductance)

Question 28

neurotoxin

Answer 28

lead

Question 29

intelligence

Answer 29

low verbal IQ
reading disorders

Question 30

impulsivity and behavioral inhibition

Answer 30

shyness decreases the risk of later delinquency
socially withdrawn boys have greater risks

Question 31

social cognition

Answer 31

boys w DBD focus more on concrete or external qualities and are egocentric in describing peers
have problems encoding social cues
more often select aggressive responses to problems and feel more confident in their ability to carry out an aggressive response
have less empathy

Question 32

puberty

Answer 32

early physical maturation

Question 33

parenting

Answer 33

poor monitoring
hard and inconsistent discipline
differential treatment between siblings
coercive parenting
mild physical punishment weekly related
more severe/abusive physical punishment is strong related

Question 34

assortative mating

Answer 34

females offenders are more likely to cohabit or marry male offenders

Question 35

child abuse

Answer 35

hard/abusive parenting and sexual abuse increase the risk

Question 36

neighborhood and socioeconomic factors

Answer 36

availability of drugs, community disorganization, neighborhood adults involved in crime, poverty, exposure to violence and racial prejudice

Question 37

summary of major risk factos

Answer 37

Parental neglect
History of physical or sexual abuse
Difficult early temperament
Harsh parental discipline practices
Inconsistency in primary caregivers
Large family
Association with deviant peer group
Low verbal intelligence
Parent history of CD and or antisocial PD
Low SES
Neighborhood disorganization and violence

Question 38

protective factors

Answer 38

Good relations with at least one parent
Good peer relations
Good parental monitoring

Question 39

comorbidity and differential diagnosis

Answer 39

ADHD
ODD
Mood disorder
Substance abuse
LD
Intermittent explosive disorder
PTSD

Question 40

intermittent explosive disorder

Answer 40

Recurrent behavioral outburst representing a failure to control aggressive impulses
Aggression verbal/physical 2x/week for 3 months
3 behavioral outbursts with damage to property and or assault with injury within 12 month period
Magnitude grossly out of proportion
Not premeditated
Cause distress in the individual or impair functioning
At least 6 y/o
Not better explained by another disorder