Learning Disorders/Disorders of Childhood Flashcards
What is Attention Deficit/Hyperactivity Disorder (ADHD)?
- in the DSM-5, ADHD symptoms are grouped into three categories - hyperactivity, inattention, and impulsivity
- the main type of symptom the child presents will determine the diagnosis:
1. ADHD-I (inattention) girl > boys
2. ADHD-H (hyperactive) girls < boys
3. ADHD-HI (combined) girls < boys
ADHD prevalence
- 2% among preschool-aged children
- 6% among children and adolescents
- 4% among young adults
- Issues with overdiagnosis
ADHD co-morbidities
- ODD or CD, learning disorders, and anxiety disorders
- in later years, depressive disorders and substance use disorders
DSM-5 Diagnostic Criteria ADHD
A. Persistent pattern or inattention and/or hyperactivity - impulsivity that interferes with functioning or development, as characterized by (1) and/or (2)
B. Prior to age 12
C. Severe symptoms present in 2 or more settings
D. Symptoms interfere with, or reduce the quality of social, academic, or occupational functioning
E. Cannot be better diagnosed by another disorder
- Inattention (Must present 6 or more symptoms)
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities
- Often has difficulty sustaining attention in tasks or play activities
3, Often does not seem to listen when spoken to directly - Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
- Often loses things necessary for tasks or activities
- Is often easily distracted by extraneous stimuli
- Is often forgetful in daily activities
2) Hyperactivity and impulsivity (6 or more symptoms)
1. Often fidgets with or taps hands or feet or squirms in seat
2. Often leaves seat in situations when remaining seated is expected
3. Often runs about or climbs in situations where it is inappropriate
4. Often unable to play or engage in leisure activities quietly
5. Is often ‘on the go’, acting as if ‘driven by a motor’
6. Often talks excessively
7. Often blurts out an answer before a question has been completed
8. Often has difficulty waiting his or her turn
9. Often interrupts or intrudes on others
ADHD additional criteria
1) Persistent pattern that lasts for at least 6 months, started before age 12
2) Symptoms are shown in multiple settings
3) Symptoms interfere with (or reduce) the quality of social, academic, or occupational functioning
4) Inconsistent with their developmental level
ADHD etiology (mind wandering or blanking)
- children with ADHD report more mind blanking than controls (more ADHD symptoms = more mind blanking)
- Ritalin reverts the level of mind blanking to baseline (mind wandering more than focused attention)
ADHD etiology
Brain structure and function:
- abnormalities in the metabolism of dopamine and noradrenergic NTs + the functioning of genes that regulate them
- abnormalities of the prefrontal cortex
- abnormalities of the basal ganglia
Genetics:
- heritability around 77%
Prenatal and psychosocial risk factors:
- prenatal toxic exposure
- poor diet, mercury, and lead exposure
- pregnancy and delivery complications
- exposure to alcohol and maternal smoking
(gene-environmental interactions)
ADHD Assessments
- report from parents & teacher
- self-report
- clinical interview
- standardized tests (WISC IQ test, NEPSY, Test of Everyday Attention)
ADHD Treatments
Pharmacological treatment:
- stimulant medications appear to be effective for the vast majority of children with ADHD (Ritalin, Dexedrine)
- We see a decrease in hyperactivity, restlessness, impulsivity, disruptive behaviour, aggression, socially inappropriate behaviours
Psychoeducational interventions:
- caregivers/teachers are educated about the symptoms, course of the disorder, and deficits associated with ADHD and how they can facilitate the use of the child’s strengths
Parent training:
- teach behaviour modification/behaviour therapy principles to parents
- focus on positive parent-child interactions and communication skills
Academic skill facilitation and remediation:
- school-focused interventions
Other treatments
- Family therapy, cognitive-behavioural therapy, individual psychotherapy, social skills training (all less effective)
General issues in assessing and treating children & adolescents
- parents and teachers’ reports are often considered more important in assessment than the child’s input (minimal insight into their problems or the verbal capacity to describe them)
- examine the role that the environment plays in children’s symptoms
- some childhood problems persist or become worse in adulthood:
- homotypic continuity: predictive of future same diagnostic
- heterotypic continuity: predictive of future different diagnosis (anxiety to depression; ADHD to ODD)
Prevalence of Childhood Disorders
- About 20% of youth have a psychological disorder
- externalizing problems in childhood - include behaviour problems of under-control such as ADHD, ODD and CD
- internalizing problems - problems of overcontrol and include conditions such as anxiety disorders, separation anxiety disorder, selective mutism, reactive attachment disorder, depressive disorders and the newly added disruptive mood dysregulation disorder
- can co-exist
Oppositional Defiant Disorder DSM-5 Criteria
A. A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness (at least 4 symptoms from any of the following categories).
Angry/Irritable mood:
1. Often loses temper
2. Is often touchy or easily annoyed
3. Is often angry and resentful
Argumentative/Defiant Behaviour
4. Often argues with authority figures or for children and adolescents, with adults
5. Often actively defies or refuses to comply with requests from authority figures or with rules
6. Often deliberately annoys others
7. Often blames others for his or her mistakes or misbehaviour
Vindictiveness
8. Has been spiteful or vindictive at least twice within the past 6 months
B. The disturbance in behaviour is associated with distress in the individual or others in his or her immediate social context, or it impacts negatively on social, educational, occupational, or other important areas of functioning
C. Behaviours do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. The criteria are not met for disruptive dysregulation disorder
ODD to CD
- from ODD to CD (25% of boys)
- ODD & CD can be co-morbid
- Conduct Disorder (CD): Four major groups:
1. Aggression directed toward people and animals
2. Destruction of property
3. Deceitfulness or theft
4. Serious violations of rules (truant)
Conduct disorder in the DSM-5
Repetitive and persistent pattern of conduct in which the basic rights of others and major age-appropriate societal norms or rules are violated
3/15 from the following criteria in the past 12 months:
Aggression directed toward people and animals -
1. Often bullies, threatens, or intimidates others.
2. Often initiates physical fights
3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, etc.)
4. Has been physically cruel to people
5. Has been physically cruel to animals
6. Has stolen while confronting a victim (e.g., mugging)
7. Has forced someone into sexual activity
Destruction of property -
8. Has deliberately engaged in fire setting, with the intention of causing serious damage
9. Has deliberately destroyed others’ property (other than by fire setting)
Deceitfulness or theft -
10. Has broken into someone else’s house, building, or car
11. Often lies to obtain goods or favours or to avoid obligations (e.g., cons others)
12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering, forgery)
Serious violations of rules (truant) -
13. Often stays out at night despite parental prohibitions, beginning before age 13 years
14. Has run away from home overnight at least twice while living in parental or parental surrogate home, or once without returning for a lengthy period
15. Is often truant from school, beginning before age 13 years
B. The disturbance in behaviour causes clinically significant impairment in social academic, or occupational functioning
C. If the individual is 18 years or older, criteria are not met for Antisocial personality disorder
CD traits specifier
- limited prosocial emotions
- lack of remorse or guilt
- callous - lack of empathy
- unconcerned about performance
- shallow or deficient affect
