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L11: childhood disorders Flashcards

1
Q

factors that influence neurodevelopmental disorders?

A

developmental
biological
psychosocial

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2
Q

what is the scope of the problem?

A

most adults with first psych diagnosis met criteria for disorder in childhood

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3
Q

percent of canadian children with clinical disorder?

A

14% - clinical disorder that causes significant distress/impairment

  • anxiety is most prevalent.
  • mental health problems are leading cause of health problems in infancy
  • <25% receive specialized treatment
  • > 50% have 2+ concurrent disorders
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4
Q

US co-morbidity survey?

A

over 10,000 adolescents between 13-18 yoa sampled.

  • 22.2% of adolescents had disorder with severe impairment/distress
  • anxiety disorder is most prevalent
  • specific phobia most common.
  • girls more likely to have anxiety disorder than boys
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5
Q

median age for onset of childhood disorders

A
  • anxeity: 6yoa
  • behavioural disorder: 11 yoa
  • mood disorder: 13 yoa
  • substance use disorder: 15 yoa
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6
Q

are we overestimating psychopathology?

A
  • some argue that social phobia = shyness

- other studies say there’s an underestimate of children/adolscents who need treatment

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7
Q

crisis in youth access to mental health services

A

only about 1/3 of adolescents receive service for disorder

  • more severe = more likely addressed, but still only 1/2 treated.
  • higher intervention for observable forms of disorder
  • fewer than 1/5 with anxiety, eating disorder, substance abuse receive treatment.
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8
Q

what is developmental psychopathology?

A

involves disorders of childhood within the context of normal lifespan development, enabling us to identify behaviours that are appropriate at one stage but considered disturbed at another

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9
Q

what are externalizing problems?

A

overt, behavioural problems that are visibly expressed

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10
Q

what are internalizing problems?

A

symptoms experienced inside the person, not as noticeable

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11
Q

what are undercontrolled behaviours?

A

characterized by excess, extreme, not behaving in typical way
ie. adhd, early onset: autism, conduct disorder

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12
Q

what are overcontrolled behaviours?

A

passive, disinterested, inhibited

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13
Q

what are disorders of undercontrolled behaviour?

A
  • adhd
  • conduct disorder
  • oppositional defiant disorder
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14
Q

adhd pre-1970:

A

identified as having minimal brain damage bc of similarities btw brain damaged children + hyperactive.
not true tho

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15
Q

3 main characteristics of ADHD

A
  • deficits in attention
  • hyperactivity
  • impulsivity
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16
Q

other presentations of ADHD?

A
  • difficulty controlling activity in situations that call to sit still
  • peer-relations difficulty: aggressive/annoying behaviours
  • difficulty implementing appropriate behaviour irl despite knowing sociall correct actions. - impulsive
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17
Q

co-morbidity of ADHD?

A
  • learning disabilities in 15-30%
  • 25% comorbid anxiety disorders
  • overlap with conduct problems
  • affective disorder, anciety, substance abuse + anti-social disorder.
  • 50% placed in special education programs
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18
Q

people with ADHD more likely to?

A
  • drop out of school
  • have few friends
  • engage in antisocial activities
  • use tobacco or illicit drugs
  • contract sti’s
  • drive at excessive speeds
  • have multiple car accidents.
  • more likely to develop conduct problems
  • more likely placed in special classes
  • more likely to have peer difficulties
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19
Q

adhd vs conduct

  • hyperactivity more assoc with?
  • conduct more assoc with?
A

-H: more assoc with off-task behaviour in school, cognitive + achievement deficits, better long-term prognosis

C: acting out in school, more aggressive, anti-social parents.

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20
Q

co-morbidity of adhd + conduct/oppositional disorders?

A

50% when no intervention

- at risk for persistent antisocial behaviour

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21
Q

prevalence of ADHD?

A
  1. 29% worldwide
    - more in boys than girls
    - AA, hispanic, + other minority less likely to receive diagnosis.
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22
Q

factors assoc with increase risk of adhd diagnosis?

A

boy, raised by older mothers, externalizing problem behaviors, raised in English-speaking house.

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23
Q

change in severity of symptoms in adhd?

A
  • decreases with age.
  • at age 30-40 most no longer satisfy ADHD criteria.
  • 50% will exhibit ongoing psychosocial impairment
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24
Q

symptom cut-off for adults with adhd?

A

5 or more symptoms required.

diff than children/adolescents = 6+ symptoms.

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25
Q

adhd in adulthood: job outcomes?

A

employed + financially independent.

- lower ses and change jobs more frequently

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26
Q

biological theories of adhd

A
  • no single risk factor
  • v heterogenous disorder
  • genetics: 75% heritable.
  • family enviro =/= significant contribution
  • differences in brain structure + function
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27
Q

what are the subtle differences in brain structure + function in adhd?

A
  • frontal striatal circuitry is diff
  • deduced cerebrum + cerebellum
  • delay in cortical maturation
  • smaller basal ganglia
  • dysfunction in Da and NA systems
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28
Q

enviro toxins theory of adhd?

A

22% of mothers with adhd children reported smoking a pack a day during pregnancy.

  • higher hyperactivity with excessive exposure early in life to traffic-related air pollution.
  • not supported: diet, refined sugar*
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29
Q

diathesis-stress theory of adhd?

A

hyperactivity develops when predisposed AND with authoritarian upbringing.

  • learning, reinforced hyperactivity.
  • neurological and genetic factors have greater reserach support than psych factors
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30
Q

treatment of adhd?

A
  • fewer than half receive treatment

- treated with drugs/behavioural methods.

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31
Q

drug treatment of adhd?

A

ritalin (methylphenidate): easily abused, so monitor closely. increase concentration, goal-directed activity, improve classroom behaviour

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32
Q

psych treatment for adhd?

A

parent training + changes in class management based on operant conditioning.

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33
Q

comparing meds vs psych treatment in adhd?

A

ritalin + behaviour therapy. ritalin > behaviour. both together = not better than ritalin alone, but reduces dose of ritalin required.

  • combined treatment: improved positive functioning.
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34
Q

what is conduct disorder?

A

defined by impact of child’s behaviour on ppl and surroundings

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35
Q

dsm-5 diagnoses of conduct focuses on?

A

behaviour that violate the basic rights of others + major societal norms

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36
Q

types of behaviour symptomatic of conduct disorder?

A

aggressive or cruel toward ppl

  • damaging property
  • lying
  • stealing
  • callous, viscious, lack of remorse
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37
Q

conduct + anti-social

A

need conduct diagnosis in youth to be diagnosed as anti-social.
- marked by callousness, viciousness, lack of remorse

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38
Q

prevalence of conduct disorder? oppositional defiant disorder?

A
  1. 2% of children

- prevalence of oppositional defiant disorder was 3.3%

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39
Q

moffitt type of conduct disorder?

A

moffitt: theorized that 2 diff courses of conduct problems should be distinguished
- life course persistent and adolescence-limited

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40
Q

what is life-course-persistent conduct disorder?

A
  • pattern of anti-social behaviour
  • conduct problems by 3yoa, persist through adulthood
  • not likely to desist
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41
Q

what is adolescence-limited conduct disorder?

A

normal childhood, but high levels of antisocial behaviours in adolescence.
- once caught, reprimanded, pro-social training kick in = desist + return to non-problematic behaviour.

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42
Q

DSM-5 and diff onsets of conudct disorder

A
  • childhood-onset type: one criterion before 10 yoa, more persistent, more likely to have adult antisocial personality disorder
  • adolescent-onset type: absence of criteria prior to 10 yoa. moffitt idea’s, more likely to desist.
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43
Q

three levels of severity of diagnostic criteria of conduct disorder?

A
  • 3 levels of severity based primarily on number of conduct problems present
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44
Q

significant factors in conduct disorder persistence to anti-social pd ?

A

parent with anti-social pd

low verbal intelligence.

45
Q

predictive relationship related to conduct disorder?

A

btw callous-unemotional traits and more severe, stable, pervasive aggressive, anti-social, delinquent, premeditated and instrumental aggression.

46
Q

what is oppositional defiant disorder

A

pattern of angry/irritable mood, argumentative/defiant behaviour or vindictiveness.

  • at least 6 months
  • at least 4+ symptoms in one of 3 categories.
47
Q

what are 3 categories of Oppositional defiant disorder?

A
  1. angry/irritable mood : (lose temper, touchy/easily annoyed, angry/resentful
  2. argumentative/defiant behaviour: argue with authority, actively defies authority, deliberately annoys, blames other for own mistakes.
  3. vindictiveness: spiteful/vindictive at least twice in past 6 months
48
Q

etiology of conduct disorders

A

biological: genetic, neuropsych deficits, neurochemical correlates
- psych factors: hostile parenting, learning theory, cognitive bias, socio-cultural context factors.

49
Q

discuss biological factors of conduct disorders

A
  • genetic: aggressive behaviour is heritable. delinquent behaviour is not.
  • neuropsych deficits: poor verbal skills, difficulty with executive fxn. amygdala hypo-reactivity to other ppl’s distress.
  • neurochemical correlates: reduced 5-ht and cortisol
50
Q

discuss psychological factors

A
  • hostile parenting, lax parental discipline
  • modelling form antisocial parent + operant conditioning (random, poor punishment)
  • cognitive bias: social-information processing theory (assume hostile intent),
  • socio-cultural context factors: lower ses, poor housing conditions, lower parental education + IQ
51
Q

treatment of conduct disorder?

A
  • interventions for young children more effective than in adolescents.
  • harsh discipline NOT GOOD = contribute to delinquency + criminal activity.
  • family interventions (parental management training)
  • multi-systematic treatment : deliver intense/comprehensive therapy services in community, youth receive treatment in home
  • cognitive approaches: anger control, teaching moral reasoning, short term gains.
52
Q

multi system treatment principles (9)

A
  1. understand connection btw problem + broader systemic context
  2. emphasize (+), use strengths to leverage change
  3. promote responsible behaviour + decrease irresponsible behaviour among famiy members.
  4. present-focused, action-oriented intervention.
  5. target sequences of behaviour in multiple systems
  6. developmentally appropriate + fit with needs of child
  7. daily effort
  8. evaluated continuously
  9. promote treatment generalization and l-t maintenance of therapeutic change
53
Q

robust predictors of early-onset persistent trajectory

A
  • maternal anxiety during pregnancy
  • partner cruelty to mother
  • harsh parenting
  • higher level of child under-controlled temperament
54
Q

prevention of CD?

- risk factors?

A

begin before 3 yoa
- ID families + mothers at risk: maternal anti-social behaviour, young maternal age, maternal depression, smoking during pregnancy, being male.

55
Q

predictions of CD?

A

low income, low maternal education, family dysfunction, presence of other young siblings.

56
Q

what are learning disabilities?

A
  • learning problems in early childhood = can lead to depression + chronic illness
  • inadequate development in specific area of academia, language, speech, motor skills
57
Q

ld in dsm-5?

A

not used. grouped together into Specific Learning Disorder category. specific deficits are specifiers.
- but entails learning disorders, communication disorders + motor skills disorder

58
Q

LD more common in M or F?

A

M.

59
Q

3 categories of learning disorders?

A
  • dylexia (reading)
  • dyscalculia (math)
  • disorder of written expression: eliminated.
60
Q

what is dyslexia?

A

difficulty with word recognition, reading comprehension

61
Q

what is dyscalculia?

A

math disorder. difficulty rapidly + accurately recalling arithmetic facts, counting objects correctly, quickly, difficulty aligning numbers into columns

62
Q

dsm-5 language disorder?

A
  • child has difficulty expressing him/herself in speech.

- eager to communicate but have inordinate difficulty finding the right words.

63
Q

communication disorders

A 
phonological disorder (formerly speech sound disorder)
- stuttering (Child onset fluency disorder)
64
Q

what is phonological disorder?

A

speech is not clear

-articulation is poor for sounds/phonemes

65
Q

what is stuttering?

A

disturbance in verbal fluency characterized by 1+ speech patterns

  • frequent repetitions
  • prolongations of sounds
  • long pauses btw words
  • substituting easy words for those more difficult to articulate
  • bodily twitching, eye blinking accompany verbal dysfluencies
66
Q

social (pragmatic) communication disorder :DSM-5

A

new!

- involves persistent difficulties in social use of either verbal or non-verbal forms of communication

67
Q

what is developmental coordination disorder

A

motor disorder

  • children show marked impairment in development of motor coordination.
  • diagnosed if impairment interferes with academic achievement or with activities of daily living
68
Q

etiology of ld?

A

biological

  • heritable, chormosome 13 (dyslexia), generalist genes hypothesis, brain structure differences.
  • family enviro: no data
  • no clear causal factors
69
Q

what is generalist genes hypothesis of ld?

A

overlap btw learning abilities, cog abilities.

- generalized genotype, phenotype expressed differently tho

70
Q

what is brain structure differences hypothesis of ld?

A

left tempoparietal cortex activated in normal but not in dyslexic children

71
Q

treatment of LD?

A

most often occurs within special-education programs in schools

  • individualized programs should be implemented.
  • match needs of child to services.
  • mainstreaming movement.
  • parental involvement is essential.
72
Q

special education services interventions

A
  • intstuctional interventions: adjust teaching methods
  • school-home notes
  • performance feedback
  • self-management
  • contingency management interventions
  • peer tutoring
  • group contingencies
  • co-operative learning
  • phonological training
73
Q

what is intellectual disability disorder?

A
  • refers to those with mental retardation

- focus on IQ level, but also on varying levels of adaptive functioning.

74
Q

intelligence-test scores

A

-original dsm definition required a judgment of intelligence
- 2/3 of popln have iq of 85-115.
below 70-75 = significant subaverage general intellectual functioning.

75
Q

what is adaptive functioning

A
  • mastering childhood skills (dressing, toilet trained)
  • understand concepts of time + money
  • able to use tools, shop, travel by public transportation
  • socially responsive

skills “we all” learn in order to function in daily life.

76
Q

dsm-5 focuses on adaptive functioning in what 3 domains?

A

conceptual (academic)
social
practical

77
Q

age of onset of intellectual disability

A

manifest before 18 yoa, or not considered developmental.. rule out mental retardation from deficits later in life.

  • severe impairments diagnosed during infancy.
  • most children not ID-ed until they enter school
78
Q

classification of mental retardation

A
  • was in DSM4, but still referred to from time to time.
  • four levels of MR
  • mild (50-55 to 70 IQ; 85%), *moderate (35-40 to 50-55 IQ; 10% of ppl), * severe (20-25 to 35-40 IQ; 3-4% of ppl with MR), *profound (<20-25 IQ, 1-2% of ppl, require total supervision)
79
Q

prevalence of mr in canada?

A
  1. 2 per 1000.
    - severe = 3.6/1000.
    - comparable to estimated worldwide prevalence.
    - boys more likley diagnosed than girls; 1.6:1
80
Q

approach of the american association of intellectual + developmental diabilities (IDD)

A
  • shift focus from id severity of disability to remedial supports to facilitate higher functioning.
  • id strengths + weaknesses
  • emphasize what’s needed to maximize functioning.
81
Q

etiology of intellectual + developmental disabiltiies?

A
  • no etiology in 30-40%
  • hereditary: genetic/chromosomal abnormalities.
  • early alterations of embryonic development
  • late preg/perinatal problems
  • medical conditions in childhood
82
Q

prevention + treatment of idd

A
  • enriched enviro: mainstream
  • cognitive interventions: self-instructional training, guide problem solving efforts through speech.
  • behavioural interventions based on operant conditioning:
83
Q

what is autism spectrum disorder?

A

impairments in social interaction, social communication, imagination.

  • may involve serious abnormality in the developmental process itself.
  • more boys than girls
84
Q

onset of autism?

A

infancy or early childhood

85
Q

co-morbidity of autism?

A

MR and eplieptic seizures, depression, anxiety, adhd

86
Q

asd includes what formerly known disorders?

A
  • autism disorder, asperger’s, childhood disintegrative disorder, pervasive developmental disorder
87
Q

dsm-5 changes of autism due to?

A

inconsistent distinctions. made it a spectrum.

88
Q

global prevalence of autism spectrum disorder?

A

global prevalence of autism: 17/10,000

global prevalence of autistic spectrum disorders: 62/10,000

more boys than girls.

89
Q

characteristics of autism + MR(serious)?

A

80% score below 70 on IQ test.

  • poor in all parts of intelligence, but mostly abstract thought, symoblism, sequential logic.
  • few may have isolated talent (savants)
  • don’t withdraw bc never were part of society.
  • extreme autistic aloneness
  • communication deficits
  • obsessive-compulsive, rituatlistic acts
90
Q

what is extreme autistic aloneness?

A
  • rarely approach others, look through them, turn backs to ppl
  • rarely offer spontaneous greeting (verbal or non-verbal)
  • may be pre-occupied with inanimate object/mechanical objects
  • sensitive to stimuli that many ppl aren’t
91
Q

communication deficits in autism?

A
  • babbling less frequent in infants
  • may have echolalia
  • pronoun reversal
  • neologisms
92
Q

obsessive-compulsive and rituatlistic acts of autism?

A

extremely upset over changes in daily routines + surroundings.

  • repetitive, peculiar movements.
93
Q

etiology of autistic disorder

A

psychological: parents were cold, insensitive, meticulour = little support

biological basis: genetic factors, neurological factors + environmental risks

94
Q

genetic factors for autism?

A

highest heritability psychiatric disorder.!!

act through chromosomal regions, linked to deficits in communication + social areas on brain.

  • possibly higher prenatal stress in mothers.
95
Q

neurological factors + enviro risks for autism?

A
  • epileptic seizures
  • larger brain but smaller brain volume.
  • abnormal areas, pfc, corpus callosum, amygdala
  • abnormalities may contribute to metabolic differences and behavioural phenotype in ASD.
96
Q

treatment of autistic disorder

A
  • modelling + operant conditioning are most effective. (teach proper behaviour - intensive)
  • no medication
  • may treat symptoms if possible
97
Q

obstacles to treatment of autism?

A
  • change is essential; they dont adjust well to change
  • isolation + self-stimulation may interfere teaching
  • difficult to motivate them
  • overselective attention to irrelevant.
98
Q

disorders of overcontrolled behaviour:

A

anxiety in many forms

99
Q

how internalizing disorder ages? - study

A

70% of adolescents who had internalizing disorder at ages 13+15 had disorder in 30s,40s, 50s too.

100
Q

factors in internalizing disorders?

A

genetic + environmental factors play a role in development.

101
Q

how to classify fear as disorder?

A

functioning must be impaired

102
Q

prevalence of anxiety disorder?

A

10-15% of children have anxiety disorder.
- more for girls than boys.
~11% have anxiety disorder
specific, social, separation anxiety, generalized anxiety, panic disorder - in that order.

103
Q

age of onset of childhood anxiety disorder?

A

8 yoa.

- panic disorder most likely to emerge during mid-adolescence or later.

104
Q

what is separation anxiey disorder

A
  • unrealistic concern about seperation from major attachment figures
105
Q

dsm-5 criteria for separation anxiety disorder?

A

8 symptoms for at least 4 weeks

  • worry about harm to attachment figures
  • refusal to attend school
  • avoidance of being alone
  • experience of nightmares involving separation themes
  • physical complaints in anticipation of being separated.
106
Q

how school phobia looks?

A 
selective mutism (refuse to speak in unfamiliar enviro)
behavioural inhibition (extreme resistance/fear/avoidance of new situations)
- vicious cycle of rejection + avoidance of social situations
107
Q

predictors of anxiety disorder assessed at 4yoa?

A

behavioural inhibition
parental anxiety
low social skills
peer victimization

108
Q

treatment of fears + phobias

A

many dissipate with time + maturation

  • teach signs of anxiety + anxiety management strategy.
  • exposure to fear while performing anxiety-reducing technique.

239 - final (5 decks)

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