L11: childhood disorders Flashcards
factors that influence neurodevelopmental disorders?
developmental
biological
psychosocial
what is the scope of the problem?
most adults with first psych diagnosis met criteria for disorder in childhood
percent of canadian children with clinical disorder?
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
US co-morbidity survey?
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
median age for onset of childhood disorders
- anxeity: 6yoa
- behavioural disorder: 11 yoa
- mood disorder: 13 yoa
- substance use disorder: 15 yoa
are we overestimating psychopathology?
- some argue that social phobia = shyness
- other studies say there’s an underestimate of children/adolscents who need treatment
crisis in youth access to mental health services
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.
what is developmental psychopathology?
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
what are externalizing problems?
overt, behavioural problems that are visibly expressed
what are internalizing problems?
symptoms experienced inside the person, not as noticeable
what are undercontrolled behaviours?
characterized by excess, extreme, not behaving in typical way
ie. adhd, early onset: autism, conduct disorder
what are overcontrolled behaviours?
passive, disinterested, inhibited
what are disorders of undercontrolled behaviour?
- adhd
- conduct disorder
- oppositional defiant disorder
adhd pre-1970:
identified as having minimal brain damage bc of similarities btw brain damaged children + hyperactive.
not true tho
3 main characteristics of ADHD
- deficits in attention
- hyperactivity
- impulsivity
other presentations of ADHD?
- 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
co-morbidity of ADHD?
- 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
people with ADHD more likely to?
- 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
adhd vs conduct
- hyperactivity more assoc with?
- conduct more assoc with?
-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.
co-morbidity of adhd + conduct/oppositional disorders?
50% when no intervention
- at risk for persistent antisocial behaviour
prevalence of ADHD?
- 29% worldwide
- more in boys than girls
- AA, hispanic, + other minority less likely to receive diagnosis.
factors assoc with increase risk of adhd diagnosis?
boy, raised by older mothers, externalizing problem behaviors, raised in English-speaking house.
change in severity of symptoms in adhd?
- decreases with age.
- at age 30-40 most no longer satisfy ADHD criteria.
- 50% will exhibit ongoing psychosocial impairment
symptom cut-off for adults with adhd?
5 or more symptoms required.
diff than children/adolescents = 6+ symptoms.
adhd in adulthood: job outcomes?
employed + financially independent.
- lower ses and change jobs more frequently
biological theories of adhd
- no single risk factor
- v heterogenous disorder
- genetics: 75% heritable.
- family enviro =/= significant contribution
- differences in brain structure + function
what are the subtle differences in brain structure + function in adhd?
- frontal striatal circuitry is diff
- deduced cerebrum + cerebellum
- delay in cortical maturation
- smaller basal ganglia
- dysfunction in Da and NA systems
enviro toxins theory of adhd?
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*
diathesis-stress theory of adhd?
hyperactivity develops when predisposed AND with authoritarian upbringing.
- learning, reinforced hyperactivity.
- neurological and genetic factors have greater reserach support than psych factors
treatment of adhd?
- fewer than half receive treatment
- treated with drugs/behavioural methods.
drug treatment of adhd?
ritalin (methylphenidate): easily abused, so monitor closely. increase concentration, goal-directed activity, improve classroom behaviour
psych treatment for adhd?
parent training + changes in class management based on operant conditioning.
comparing meds vs psych treatment in adhd?
ritalin + behaviour therapy. ritalin > behaviour. both together = not better than ritalin alone, but reduces dose of ritalin required.
- combined treatment: improved positive functioning.
what is conduct disorder?
defined by impact of child’s behaviour on ppl and surroundings
dsm-5 diagnoses of conduct focuses on?
behaviour that violate the basic rights of others + major societal norms
types of behaviour symptomatic of conduct disorder?
aggressive or cruel toward ppl
- damaging property
- lying
- stealing
- callous, viscious, lack of remorse
conduct + anti-social
need conduct diagnosis in youth to be diagnosed as anti-social.
- marked by callousness, viciousness, lack of remorse
prevalence of conduct disorder? oppositional defiant disorder?
- 2% of children
- prevalence of oppositional defiant disorder was 3.3%
moffitt type of conduct disorder?
moffitt: theorized that 2 diff courses of conduct problems should be distinguished
- life course persistent and adolescence-limited
what is life-course-persistent conduct disorder?
- pattern of anti-social behaviour
- conduct problems by 3yoa, persist through adulthood
- not likely to desist
what is adolescence-limited conduct disorder?
normal childhood, but high levels of antisocial behaviours in adolescence.
- once caught, reprimanded, pro-social training kick in = desist + return to non-problematic behaviour.
DSM-5 and diff onsets of conudct disorder
- 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.
three levels of severity of diagnostic criteria of conduct disorder?
- 3 levels of severity based primarily on number of conduct problems present
significant factors in conduct disorder persistence to anti-social pd ?
parent with anti-social pd
low verbal intelligence.
predictive relationship related to conduct disorder?
btw callous-unemotional traits and more severe, stable, pervasive aggressive, anti-social, delinquent, premeditated and instrumental aggression.
what is oppositional defiant disorder
pattern of angry/irritable mood, argumentative/defiant behaviour or vindictiveness.
- at least 6 months
- at least 4+ symptoms in one of 3 categories.
what are 3 categories of Oppositional defiant disorder?
- angry/irritable mood : (lose temper, touchy/easily annoyed, angry/resentful
- argumentative/defiant behaviour: argue with authority, actively defies authority, deliberately annoys, blames other for own mistakes.
- vindictiveness: spiteful/vindictive at least twice in past 6 months
etiology of conduct disorders
biological: genetic, neuropsych deficits, neurochemical correlates
- psych factors: hostile parenting, learning theory, cognitive bias, socio-cultural context factors.
discuss biological factors of conduct disorders
- 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
discuss psychological factors
- 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
treatment of conduct disorder?
- 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.
multi system treatment principles (9)
- understand connection btw problem + broader systemic context
- emphasize (+), use strengths to leverage change
- promote responsible behaviour + decrease irresponsible behaviour among famiy members.
- present-focused, action-oriented intervention.
- target sequences of behaviour in multiple systems
- developmentally appropriate + fit with needs of child
- daily effort
- evaluated continuously
- promote treatment generalization and l-t maintenance of therapeutic change
robust predictors of early-onset persistent trajectory
- maternal anxiety during pregnancy
- partner cruelty to mother
- harsh parenting
- higher level of child under-controlled temperament
prevention of CD?
- risk factors?
begin before 3 yoa
- ID families + mothers at risk: maternal anti-social behaviour, young maternal age, maternal depression, smoking during pregnancy, being male.
predictions of CD?
low income, low maternal education, family dysfunction, presence of other young siblings.
what are learning disabilities?
- learning problems in early childhood = can lead to depression + chronic illness
- inadequate development in specific area of academia, language, speech, motor skills
ld in dsm-5?
not used. grouped together into Specific Learning Disorder category. specific deficits are specifiers.
- but entails learning disorders, communication disorders + motor skills disorder
LD more common in M or F?
M.
3 categories of learning disorders?
- dylexia (reading)
- dyscalculia (math)
- disorder of written expression: eliminated.
what is dyslexia?
difficulty with word recognition, reading comprehension
what is dyscalculia?
math disorder. difficulty rapidly + accurately recalling arithmetic facts, counting objects correctly, quickly, difficulty aligning numbers into columns
dsm-5 language disorder?
- child has difficulty expressing him/herself in speech.
- eager to communicate but have inordinate difficulty finding the right words.
communication disorders
phonological disorder (formerly speech sound disorder) - stuttering (Child onset fluency disorder)
what is phonological disorder?
speech is not clear
-articulation is poor for sounds/phonemes
what is stuttering?
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
social (pragmatic) communication disorder :DSM-5
new!
- involves persistent difficulties in social use of either verbal or non-verbal forms of communication
what is developmental coordination disorder
motor disorder
- children show marked impairment in development of motor coordination.
- diagnosed if impairment interferes with academic achievement or with activities of daily living
etiology of ld?
biological
- heritable, chormosome 13 (dyslexia), generalist genes hypothesis, brain structure differences.
- family enviro: no data
- no clear causal factors
what is generalist genes hypothesis of ld?
overlap btw learning abilities, cog abilities.
- generalized genotype, phenotype expressed differently tho
what is brain structure differences hypothesis of ld?
left tempoparietal cortex activated in normal but not in dyslexic children
treatment of LD?
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.
special education services interventions
- intstuctional interventions: adjust teaching methods
- school-home notes
- performance feedback
- self-management
- contingency management interventions
- peer tutoring
- group contingencies
- co-operative learning
- phonological training
what is intellectual disability disorder?
- refers to those with mental retardation
- focus on IQ level, but also on varying levels of adaptive functioning.
intelligence-test scores
-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.
what is adaptive functioning
- 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.
dsm-5 focuses on adaptive functioning in what 3 domains?
conceptual (academic)
social
practical
age of onset of intellectual disability
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
classification of mental retardation
- 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)
prevalence of mr in canada?
- 2 per 1000.
- severe = 3.6/1000.
- comparable to estimated worldwide prevalence.
- boys more likley diagnosed than girls; 1.6:1
approach of the american association of intellectual + developmental diabilities (IDD)
- shift focus from id severity of disability to remedial supports to facilitate higher functioning.
- id strengths + weaknesses
- emphasize what’s needed to maximize functioning.
etiology of intellectual + developmental disabiltiies?
- no etiology in 30-40%
- hereditary: genetic/chromosomal abnormalities.
- early alterations of embryonic development
- late preg/perinatal problems
- medical conditions in childhood
prevention + treatment of idd
- enriched enviro: mainstream
- cognitive interventions: self-instructional training, guide problem solving efforts through speech.
- behavioural interventions based on operant conditioning:
what is autism spectrum disorder?
impairments in social interaction, social communication, imagination.
- may involve serious abnormality in the developmental process itself.
- more boys than girls
onset of autism?
infancy or early childhood
co-morbidity of autism?
MR and eplieptic seizures, depression, anxiety, adhd
asd includes what formerly known disorders?
- autism disorder, asperger’s, childhood disintegrative disorder, pervasive developmental disorder
dsm-5 changes of autism due to?
inconsistent distinctions. made it a spectrum.
global prevalence of autism spectrum disorder?
global prevalence of autism: 17/10,000
global prevalence of autistic spectrum disorders: 62/10,000
more boys than girls.
characteristics of autism + MR(serious)?
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
what is extreme autistic aloneness?
- 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
communication deficits in autism?
- babbling less frequent in infants
- may have echolalia
- pronoun reversal
- neologisms
obsessive-compulsive and rituatlistic acts of autism?
extremely upset over changes in daily routines + surroundings.
- repetitive, peculiar movements.
etiology of autistic disorder
psychological: parents were cold, insensitive, meticulour = little support
biological basis: genetic factors, neurological factors + environmental risks
genetic factors for autism?
highest heritability psychiatric disorder.!!
act through chromosomal regions, linked to deficits in communication + social areas on brain.
- possibly higher prenatal stress in mothers.
neurological factors + enviro risks for autism?
- 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.
treatment of autistic disorder
- modelling + operant conditioning are most effective. (teach proper behaviour - intensive)
- no medication
- may treat symptoms if possible
obstacles to treatment of autism?
- change is essential; they dont adjust well to change
- isolation + self-stimulation may interfere teaching
- difficult to motivate them
- overselective attention to irrelevant.
disorders of overcontrolled behaviour:
anxiety in many forms
how internalizing disorder ages? - study
70% of adolescents who had internalizing disorder at ages 13+15 had disorder in 30s,40s, 50s too.
factors in internalizing disorders?
genetic + environmental factors play a role in development.
how to classify fear as disorder?
functioning must be impaired
prevalence of anxiety disorder?
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.
age of onset of childhood anxiety disorder?
8 yoa.
- panic disorder most likely to emerge during mid-adolescence or later.
what is separation anxiey disorder
- unrealistic concern about seperation from major attachment figures
dsm-5 criteria for separation anxiety disorder?
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.
how school phobia looks?
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
predictors of anxiety disorder assessed at 4yoa?
behavioural inhibition
parental anxiety
low social skills
peer victimization
treatment of fears + phobias
many dissipate with time + maturation
- teach signs of anxiety + anxiety management strategy.
- exposure to fear while performing anxiety-reducing technique.
