Lecture 11 - Child Psychopathology

Question 1

What is one of the key things that needs to be considered when considering whether a child is experiencing a mental health disorder?

Answer 1

Age.

Question 2

When considering childhood psychopathology is it extremely important to understand culturally age-appropriate behaviours?

Answer 2

Yes.

Question 3

What is the prevalence of children that experience a mental health disorder in childhood?

Answer 3

Two numbers mentioned in lecture:
1. 13.9% in Australia (12-month prevalence)
2. 20% in US (lifetime prevalence).

Question 4

According to Australian data, are females or males more likely to experience a mental health disorder in childhood?

Answer 4

Males.

Question 5

What groups have a higher prevalence of mental health disorders in childhood than the general population?

Answer 5

Aboriginal and Torres Strait Islander people.
LGBTQIA+ individuals.
Those living in rural settings.
Culturally and Linguistically Diverse backgrounds.

Question 6

Overall do adolescents or young children experience higher levels of mental health disorders?

Answer 6

Adolescents.

Question 7

What mental health disorders have a higher prevalence in young children than they do in adolescents?

Answer 7

ADHD and ODD.

Depression, anxiety, eating disorders higher in adolescents.

Question 8

What mental health disorders are more prevalent in female children than male children?

Answer 8

PTSD, depression, anxiety, and eating disorders.

ADHD, ODD, ASD, and specific learning disorders are higher in male children.

Question 9

Is there equal prevalence of ODD in adolescents between men and women, and higher levels of male young children with ODD than female young children?

Answer 9

Yes.

Question 10

Has ASD been increasing in prevalence across time?

Answer 10

Yes.

This may be due to many different reasons, such as awareness, access to clinicians, and environmental factors that influence development or not meet the needs of children.

Question 11

In the Mental Health in Children and Adolescents survey, did only 56% of children diagnosed with a mental health disorder actually access to support in the last 12 months?

Answer 11

Yes.

Some of the reasons behind this may be:
- stigma
- lack of access to services
- parental attribution - “I was like that. Don’t worry about it.”

Question 12

Do the majority of mental health disorders develop in childhood, adolescence, or young adulthood?

Answer 12

Yes.

Question 13

Are the criteria for diagnosing most mental health disorders in the DSM-5 mostly the same for children and adults?

Answer 13

Yes.
Some specifiers and indications that provide insight into how symtpoms may vary between children and adults.

Question 14

Do Neurodevelopmental disorders have to have childhood onsest of symptoms?

Answer 14

Yes.

Question 15

What two sections of the DSM-5 explore the mental disorders that mostly affect children?

Answer 15

1. Neurodevelopmental disorders.
2. Disruptive, Impulse control, and conduct disorders.

Question 16

Are neurodevelopmental disorders more commonly diagnosed in boys than girls?

Answer 16

Yes.

Question 17

How does the DSM-5 diagnose Intellectual Disabilities?

Answer 17

Deficits in intellectual functioning, such as cognition, problem-solving, learning from experiences, or abstract thinking.
AND
Deficits in adaptive functioning, such that there is a failure to meet developmental and sociocultural standards of independence and social responsibility. This means that, without ongoing support, the individual’s functioning in multiple domains of life is limited or impaired.
AND
Intellectual and adaptive deficits were present during developmental period.

Severity ratings are influenced by IQ tests amongst other assesments.

Question 18

What percentage of those with ASD have an intellectual disability?

Answer 18

Around 30%.

Question 19

What is the estimated prevalence of Intellectual Disability?

Answer 19

1-3%.

Question 20

How is Autism Spectrum Disorder defined in DSM-5?

Answer 20

A. Persistent deficits in social communication and social interaction.

B. Restrictive, repetitive patterns of behaviours, interests, or activities.

C. Symptoms present in early developmental period.

Question 21

Is ASD more prevalent in males or females and why might this be the case?

Answer 21

More prevalent in males.

This may be due to most early research done in men and therefore the way females express and experience ASD may not be recognised or understood leading to fewer diagnoses.

Social conditioning may also make it ‘easier’ or equip females with the ability to mask.

Question 22

How is ADHD diagnosed in DSM-5?

Answer 22

A persistent pattern of inattention and or hyperactivity-imulsivity that interferes with functioning or development.

Question 23

To diagnose individuals with ADD or ADHD a child needs to meet at least 6 of the criteria for inattention and/or hyperactivity (Separately). Adults have to meet at least 5.

What are some examples of how inattention or hyperactivity-impulsivity may express themselves?

Answer 23

Inattention:
- failure to pay close attention to details, if not interested in the acitivity, such as school work.
- does not seem to listen when spoken directly to.
- is easily distracted by extraneous things
- is forgetful in mundane and daily tasks

Hyperactivity-impulsivity:
- finds it difficult to stay seated or sit still
- has difficulty waiting turn
- interrupts on intrudes on others

Question 24

What is the childhood prevalence of ADHD?

Answer 24

5-7%

Question 25

What is the ratio of ADHD in boys and girls?

Answer 25

3:1

Question 26

There are three clinical presentations/substypes of ADHD.
What are they?

Answer 26

Predominantly inattentive.
Predominantly hyperactive/impulsive.
Combined.

Question 27

What is the proportion of those with ADHD that have the combined presentation of the disorder?

Answer 27

75%

Question 28

ADHD is highly heritable. What is the estimated percentage of heritability?

Answer 28

70%.

Question 29

Broadly, how are disorders in the Disruptive, Impulse-control, and conduct disorders section of the DSM-5 defined?

Answer 29

A pattern of problematic self-control of emotions and behaviour, with a key factor being that the behaviours involve the violation of the rights of others.
Interestingly, this is also a quote from the DSM-5: “behaviours that bring individual into significant conflict with societal norms or authority figures.” Oh, ok. Some clear control of individuals who try and question the status quo.

Question 30

What are the main criteria for Oppositional Defiant Disorder?

Answer 30

Angry or irritable mood.

Argumentative/Defiant behaviour.

Vindictiveness.

Question 31

How is Conduct Disorder diagnosed in DSM-5?

Answer 31

Aggression to people and animals.

Destruction of property.

Deceitfulness or theft.

Serious violations of rules.

Question 32

What are some of the developmental factors that influence the clarity of a diagnosis?

Answer 32

Children obviously find it difficult to reflect on and describe their internal experience.

Heavy reliance on behaviour and others’ reports of a child’s behaviour.

Establishing whether a child is experiencing distress or impairment? Parents, teachers, child?

There is a wide range of what is considered typical at any given age.

Heterogeneity of presentation across different ages.

Question 33

What is the Developmental Psychopathology framework?

Answer 33

A broad, integrative, cross-disorder approach to studying and understanding the developmental processes and pathways that lead to maladaptive and adaptive behaviour, cognition, and affect across the lifespan.

Question 34

What are the four key concepts in the Developmental Psychopathology framework?

Answer 34

1. Systems Principle.
   Children are embedded in systemic contexts, e.g. family, which is embedded in culture, which is embedded in a time in history. Think Bronfenbrenner.
2. Multiple-levels Principle.
   There is an interplay between biological, psychological, and socio-cultural factors within and around the child that influence their development, and their development in turn influences these factors also.
3. Normative Principle.
   Understanding psychopathology in a developing person requires an understanding of normative development. THIS IS KEY. Where do we get the idea of normal. This culture-specific.
   Think Piaget’s tasks at each age for example as a normative view of development.
4. Developmental pathways.
   Multiple factors interact with each other to influence outcomes, but do not necessarily determine outcomes.
   Experience of trauma may can lead to various different outcomes.
   Various different experiences can lead to similar behavioural issues, such as conduct disorder.
   Each child has their vulnerabilities and protective factors and is exposed to various different environments and circumstances that are risk factors for developing psychopathology.

Question 35

From a Developmental Pyschopathology framework what is an example of a vulnerability and a risk factor (this would fall under the Developmental pathways key concept).

Answer 35

Having certain genes is a biological vulnerability.

Experiencing poverty and family violence are risk factors.

Together these can interact and influence the development of psychopathology, such as conduct disorder, depression, or anxiety.

Question 36

What are the three types of ACEs discussed briefly?

Answer 36

1. Abuse.
2. Neglect.
3. Household dysfunction.

Question 37

What percentage of participants in the ACEs study experienced at least one ACE?

Answer 37

64% of 17,000 participants.

Question 38

What are some of the protective factors that continue to emerge across the research into childhood psychopathology?

Answer 38

1. A positive stable relationship with a caregiving figure.
2. A talent or hobby valued by adults/peers.

Question 39

How is resilience defined in this lec?

Answer 39

Resilience = successful adaption despite exposure to considerable risk.

We discussed how some have more resilience than others, but I would say that what is more interesting is understanding why some have more resilience than others.

Question 40

Do around 40% of children with one mental health disorder experience another mental health disorder?

Answer 40

Yes.

Question 41

In reference to Developmental Psychopathology framework:

What is homotypic continuity?

What is heterotypic continuity?

What is equifinality?

What is multifinality?

Answer 41

Homotypic continuity occurs if a child experiences a certain mental health disorder as a child and as an adolescent.

Heterotypic continuity occurs if a child experiences a certain mental health disorder and then experiences a different mental health disorder as an adolescent.

Equifinality refers to multiple pathways or experiences leading to one mental health disorders, such as multiple experiences leading to conduct disorder.

Multifinality refers to one or similar experiences leading to multiple different outcomes or mental health disorders, such as trauma leading to depression or anxiety or OCD.

Question 42

Do neurodevelopmental disorders have high heritability?

Answer 42

Yes.