Final Study Guide Flashcards
Major findings from the MTA study
For core symptoms intention, ADHD;
treatment of choice - medicine
History of ADHD
ADHD has been around for over 100 years have labeled as disorder but can be called lots of diff things ADD (DSM3), ADHD combined (DSM3R), then ADHD (diff types in DSM4)
Other names of ADHD
- Fidgety Phils
- Minimal Brain Dysfunction
- Hyperkinetic/Hyperactivity Syndrome
- Recognition of Attentional Impairment and Impulsivity
DSM Diagnostic Criteria (Inattention)
- Can’t Follow instructions
- Careless mistakes
- difficulty sustaining attention
- forgetful in daily activities
DSM Diagnostic Criteria (Hyperactive/Impulsive)
- fidgets
- leaves seat
- runs or climbs excessively
- difficulty waiting turn
DSM Functional Criteria
- 6 of 9 symptoms in either or both categories
- Inattentive; Hyperactive/Impulsive; Combined type
- Persisting for at least 6 months
- Impairment in 2 settings
Natural history
- Preschoolers - Hyperactive
- Elementary to middle school - combined type
- Adolescent/adult - inattention
Factors important in making a convincing diagnosis
- Collateral Contact (Needs 2 settings besides parent reporting
- Neuropsych exam - doesn’t make diagnosis but supports diagnosis where issue is
- Rating scales for objective measures
- family history
- medication trial
Symptoms and prevalence of ADHD and subtypes
- Affects 5-7% of American children
2. have ADHD hyperactive impulsive type, inattentive, then combined type
Age, gender, and race related differences in ADHD
- Most ADHD starts being diagnosed around school age around 7 or 8 when required to sit longer times in school
- boys more than girl; if girl is diagnosed as combined type more impaired than boys
Race and ADHD
most prone kid to be medicated is 8 year old white boy
Impairments in executive functioning
difficulty organizing, time management, planning
Etiological Theory of mirror neurons
- kids learn through imitation
- damage to area in monkey results in monkeys not being able to do behaviors
Etiological Theory of Amygdala
- fear and aggression
- may have loss of neuron density
- avoids faces/eyes
Fusiform
- used to recognize faces
- not active in autism (fMRI data shows this)
Basal Ganglia
- kids with repetitive behaviors stereotype autistic behaviors
- don’t like change
- overactive in autism
Facial Inversion Effect and Fusiform Facial Area
- people with no difficulty – fusiform lights up when see peoples faces/things interested in
- Normal development causes babies to recognize faces more easily if right side up as opposed to upside down (not the case in autism)
Etiological theories of vaccines
No proof of vaccines causing autism
Etiological theories of diet
- If you tell a kid to change his diet, the kid does better
- if you don’t tell, no effect
- kids with autism have increased constipation and gut problems
Common comorbidities
- ADHD, anxiety, depression (minimally/mildly affected)
- medical – sclerosis, enzyme deficiencies
The greatest hallmark of ASD…
is inconsistencies in development
2 Domains of Diagnosis of Autism
- Social emotional reciprocity and communication
2. Repetitive stereotype behaviors, activities, and interest
The changing epidemiology of autism spectrum disorders and possible explanations
- seeing more of it than post
- sensitive about it, trained about it, popularized in movies/media
- diagnostic criteria change –e easier for diagnosis
- recognizing broader spectrum
Methods to clinically evaluate autism
- interviews, observations, collateral history with parents/teachers/caregiver/coaches
- kids observation - ADOS
- parents interview - ADIR
Alternative diagnostic concepts for Asperger’s
- nonverbal learning disorder, semantic pragmatic disorder, schizoid personality disorder, developmental disability of right brain
Nonverbal Learning Disorder
- difficulties like Asperger’s r high functioning autism, sophisticated concrete language, don’t get sarcasm/idioms/dark humor, average/above average reading, can reading/interpret
Predictors of good outcome (prognostic indicators) for ASDs
- IQ – ability to have good intellectual engagement be good learner
- communication skills
Theory of Mind
being able to understand another person’s point of view
The role of neuropsychological testing for kids with ASD
- understand what their learning is like
- Observe group work, attention issues, trouble sleeping to see what memory, nutrition are like
Define ODD & CD
- ODD: pervasive pattern of spiteful, vindictive, opposition behavior, argue, don’t follow rules
- Conduct disorder: infringement on rights of others, worse disorder
CD developmental progression model
- starts out and may have parents who give inconsistent/harsh punishments failing in school, rejected by peers
- identify with deviant peer group and may engage in criminal behavior - may put u on trajectory for CD
(MODEL not always right)
Protective and risk factors
- protective is opposite of risk
- consistent parenting, 1 good relationship with at least 1 parent, positive peer role models, do well academically
- if you have inconsistent/abusive/harsh parenting, dangerous neighborhood with accepted behavior
The difference between obsessions and compulsions
- obsessions – unwanted intrusive thoughts
2. Compulsions is a ritualistic action or behavior to reduce thoughts
Vulnerabilities to developing anxiety
Behavioral inhibition, attachment, family history modeling
Differentiating “expected” anxiety from “disorders”
- Intensity
- Impairment
- Ability to recover
(are you anticipating anxiety, degree of reaction when in situation, ability to recover when out of situation)
Theories of how fears develop
- bit by a dog so now I’m scared
2. parent runs across when sees dog so I do, so I feel fear
Behavioral Inhibition
- extremely shy kids – trait we think is relative enduring and can be risk factor of later anxiety disorder development
- can’t speak/do actions in certain settings
amygdala and anxiety
- emotional brain gets activated in fear situations
2. teens prone to anxiety – more active in situations
hippocampus and anxiety
- (memory forms during times of trauma) not forming in typical way
- Cognitive distortions about traumatic memories happen here
Changes in child/adolescent anxiety diagnoses between DSM-IV & DSM-5
- everything used to fall under anxiety
2. now moved to anxiety disorder, obsessive disorder, compulsive, and trauma disorders
Risk and protective factors
same as externalizing
Differentiate between a panic attack and panic disorder
- panic attack - unexpected feeling of being overwhelmed
2. becomes a disorder if it starts triggering thoughts that you will have another attack
When anxiety disorder develop
- separation anxiety - one of first in development
2. panic
GAD
uncontrollable worry about # of things
Social anxiety
- anxiety in social situations
SAD
- separation and worrying about caregiver
Selective Mutism
- not being able to speak in certain situations
Panic disorder
- worrying about next panic attack
Trichotillomania
- pulling out of hair as a compulsion
Difference between PTSD and Acute Stress Disorder
-Acute Stress disorder becomes PTSD after a month of symptoms
The perspective of psychoanalysis in the history of child and adolescent depression
Have to go thru oedipal complex
Gender ratio of depression
- 1:1 boy to girl before puberty then girls win out to 2:1 or 1/2:1
- Men 10-15%, total population is 25%
Ages of depression
about 1% of kids preschool kids have depression, middle school 4-8%, end of adolescent 15%
DSM-5 diagnostic criteria
Need 5 symptoms
Neurovegetative signs of depression
- sleep – decrease
- appetite
- energy level
- attention/concentration
Neurovegetative and medicine
- Neurovegetative signs get better before mood
2. Explains why suicide occurs in early stages of treatment
Why does depression increase with age?
Understand abstract world, greater sense of world, more responsibility, more experience, getting old – death,
3 theories of depression
- serotonin, not enough neurochemical makes you depressed
- attachment, don’t have bonded attachment have insecure attach, never settled in or happy
- genetics or observed family history
- behavioral theory – people don’t know how to seek reinforcement
- cognitive theory – think negative thoughts
Genetics in depression
- if parent gets better, you get better
2. identical twins – high rate of depression
What factor in parents history of depression is most potent
if parent has depression as kid
The serotonin gene
short allele receptor at more risk of suicide/depression
Developmental variants (children vs adolescents)
- Children - more somatic – irritability, stomach ache, don’t want to go to school
- Adolescence – angry, irritable, suicidal, anadomia, don’t want ot be with people
- look up adults
Clinical course of child/adolescent depression
- treat/no treat: 6-9 months it goes away
- 50% of people have another episode some point in life adults, 70% in kids
- 2nd episode, 70% for 3rd, 90% for 4th episode(adults)
- more you have it the more you will have
Predictors of increased duration and relapse of depression
- if parents have it now
- not taking treatment (medicine, doctor),
- psychosis, early onset
- more repeated episodes incomplete treatment in past
- Early on-set
- Never fully recovering
Predictors of relapse of depression
- not taking treatment
- history of mental illness in family
- family member currently ill
Factors that increase the risk of Bipolar Disorder among children/adolescents with depression
- Depression pre-puberty onset – high risk
2. 1/3 of kids who have depression before puberty will develop bipolar disorder
What are risk factors that say child with depression is at risk to be bipolar after 1st episode?
- Look for psychosis
- family history of psychosis/BP
- pharmacologically induced hypomania (SSRI)
- psychomotor retardation (melancholic depression)
- earlier onset
The importance of Emil Kraepelin’s findings regarding onset and mixed states
- early study of BPD, psychosis,
2. mixed states more common in kids – mania & depression at same time looks more like irritability
DSM-5 diagnostic criteria
elated, euphoric mood for 4 days or 7 days, or any time if hospitalized, decreased need for sleep, increases talkatively, increased risk taking behaviors, grandiosity, flight of ideas, manic bipolar disorder – no disorder for mania only
Mood cycles
- Up to hypomania, down to depression: bipolar 2
- cruise along - dysthymia
- look at slides
Pediatric Bipolar Disorder diagnostic dilemmas
Is irritability an adequate diagnosis? Or no – previously would say yes but no today
Most salient characteristics thought to separate BP Disorder in children from other psychiatric conditions
- Study of Barbara Keller
- Grandiosity (don’t see in ADHD), decreased need for sleep, hyper sexuality (could indicate sexual abuse, trauma, low IQ, cognitive impair, autistic, psychotic – raises question that its not normal behavior) – separates bipolar from ADHD
Increase in comorbidities in earlier onset Bipolar Disorder
- more confusing the younger they are
ADHD versus Bipolar symptoms
- talkatively isn’t good feature to distinguish, 2. hyperactivity is but not need for sleep
- must exhibit grandiosity/mania
Atypical presentation of child Bipolar Disorder
- irritability altering complex cycling (?)
Addiction
continues impulsive use of substance with physiological effects continued use despite knowing problems with usage.
Dependence
continue to need drug emotionally physiologically, cognitively
tolerance
can take more of it or need more to get same effect
withdrawal
emotional/physiological response to stopping
Most frequently abused drugs
- marijuana
- prescription
- alcohol
Influence of early drug/alcohol use
if use early, more likely to become addict, misuse
The “gateway” concept
a. people try milder drugs or what’s avail before other drugs; ciggs before marijuana; alcohol ciggs before other drugs
Risk and protective factors for substance abuse
- Risk - low SES, disorganized neighborhood, kids/parents who use
- Protective – good verbal IQ, religion/spirituality, parents who don’t use, neighborhood not characterized by poverty/violence
The role of education in drug abuse/addiction
More educated, less you use – may experiment but not addicted
Dopamine theory of addiction
- low dopamine receptor complement associated with people who use
- monkey study – affect of being lower in social hierarchy – lower dopamine content, more likely to use cocaine
- lower receptors, use more drugs
Negative health effects of alcohol
dehydration, liver damage, cancer, accidents
Warning signs of drug and alcohol abuse
red eyes, changing friends, not going to classes
CRAFFT screening tool
**know how to spell out
Historical differences between AN and BN
- BN– modern disorder
2. AN – around for 100s of years
DSM-5 diagnostic criteria of Eating Disorders
- common in our age group amongst women
- not achieving typical body weight – not certain body weight % but not being what’s considered standard body weight, fear of weight/fat, thinking still heavy when thing
DSM-5 of AN
overeating in short period of time and then guilt, get rid through purging, fasting, exercising, laxative, diuretics
Sub-types of AN and BN
- binge purge type/restricting
2. bulimia just bulimia
Anorexia vs. Bulimia
look at slide
Mortality rates with AN; increased risks associated with BN
- higher than any otherpsychiatric disorder
- substance abuse, sexual activity, cutting
Etiology of Eating Disorders (psychosocial and biological)
- psychosocial –not growing up/puberty, family conflict, oral impregnation, impact of media
- biological – hypothalamus, leptin
Familial transmission/genetics of Eating Disorders
6-8% higher in 1st degree relatives – more likely to have
Comorbidities of Eating Disorders
- depression in bulimia
2. OCD
Methods of purging
look at slides
Health consequences of AN and BN
look at maps
Risk factors and prognostic indicators for AN and BN
- bulimia –athlete, horse jockey, wrestler, model, alcohol use in family, family who has
- AN – personality, family history, perfectionistic personality style
- Incidence/prevalence and chronicity
- disorders don’t occur often but when they occur stick along time
- BN – less chronic, less negative outcome, carry # of years but not forever; grow out of it sometimes
- AN – keep for long time, high 30 year mortality rate. Die of AN or complications or suicidal
Course and outcome of Eating Disorders
look at slides
Definitions of obesity
- BMI over 30
2. 30% of population – growing as problem for us
The Myth of ADHD (article)
- ADHD is stupid and doesn’t exist
- Kids put in repetitive situations cannot learn this way
- Result of society rather than a disorder
ADHD in Children: One Consequence of the Rise of Technologies and Demise of Play?
- rise in technology
2. kids are not going out and playing – it is important.
Prevalence and Incidence of Depression
7% in the U.S. over 12 months 1- year incidence: Preschool 1% School 2% Adolescent 4-8% (15% by end of adol)
Sex Ratio of Depression
1:1 in childhood and 2:1 (female to male) by adolescence (1.5 – 3x higher rates in females)
Lifetime prevalence of MDD
15 – 20% (similar to adults); 15.3% per NCS
