Lecture 2: Clinical Decision Making Flashcards
Functional Parenting
Communicates and listens
Is affectionate, caring
Sets firm and consistent limits
Teaches child how to solve on problems
Good model of coping with emotions
Dysfunctional Parenting
Poor model of emotional and behavioral control, perhaps because of own psychopathology
Non-nurturing
Lack of communication
Poor social and socialization model
Poor use of behavioral parenting techniques
Why do we use a diagnostic system?
Communication
Research
Treatment
Broad Changes to Our Diagnostic System
Dimensions within categories
category: you either have it or you don’t
dimension: to what degree
how various conditions relate to each other
occurrence of mental disorders across the lifespan
Operationalizing Mental Illness
Assessment measures must be objective, valid and reliable
Must rely upon observable phenomenon such as:
Physical symptoms
Psychological symptoms
Mood
Behavior
Critique of DSM-5
There was an attempt to introduce more dimensional aspects, but it is still mainly categorical
e.g. ADHD diagnosis – instead of subtype, it is now the predominant presentation type,
according to Dr. Ohr, this is pretty good however it depends on disorder
anxiety sees the large comorbidity between social anxiety, GAD, phobia etc.
What the DSM-5 offers and what it does not
Contains:
- diagnostic criteria
- associated features
- age of onset
- typical course of illness
- prevalence rates specific to age, gender and ethnicity
Does Not Contain:
- information about etiology
- information about treatment
- cultural implications
DSM-5 Changes Relevant to Children
No more separate section of child disorders
Intellectual Disability (no MR)
Social Communication Disorder
Autism Spectrum (no PDD; no Asperger’s)
Specific Learning Disability (no separate LD’s)
ADHD diagnosis extended to adults; ADHD subtypes changed to ADHD “presentations”
- no more ADD
- Russell Barkley– nuance – executive functioning not guided by consequences and working memory
- also some say there is a 4th, disorganized form of ADHD
SAD and SM moved to Anxiety Disorders
Three Anxiety Disorder Sections
New Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD) placed under Depressive Disorders
* this diagnosis aims to help avoid bipolar diagnosis in children who do not exhibit mania
New section on Trauma with RAD a new diagnosis: Disinhibited Social Engagement Disorder [DSED]
New Section: Disruptive, Impulse-Control, and Conduct Disorders
No Childhood Personality Disorders, but Dr. Ohr believes it is okay to diagnose if there is a significant cluster of symptoms
- personality is more function of age/ personality development
- mostly used for adolescents with BPD (at-risk)
Reactive Attachment Disorder (RAD)
Develops out of insufficient care, comfort and affection, or neglect and deprivation
Rare, affecting about 10% of severely neglected children
Child rarely seeks comfort when distressed and shows emotional distress when others attempt to provide comfort
Minimal social and emotional responsiveness
Limited positive affect
Unexplained irritability, sadness, or fearfulness
Disinhibited Social Engagement Disorder (DSED)
Similar to RAD, DSED develops out of insufficient care, comfort and affection, or neglect and deprivation
Rare, Affecting only about 20% of severely neglected children
* Trauma usually occurs within first 3 years
[ later trauma will result in PTSD]
The child is overly familiar with strangers and does not hesitate to leave familiar caregivers
Child has loose boundaries of people, little reticence with strangers
Doesn’t check back with caregiver after venturing away
Communication is a very superficial – not a real connection
Tendency to be hyperactive, defiant
Commonalities & Differences between RAD and Autism Spectrum Disorder
ASD is more biologically determined
RAD is precipitated by trauma
Diagnostic criteria of RAD include specific event prior to the onset of symptoms including inadequate or inconsistent opportunities to form attachments with caregivers
RAD does not include the restrictive interests, unusual sensory reactions, repetitive (but not stereotype) behavior of ASD
*Both disorders may include stereotyped behaviors such as rocking or flapping, and more importantly, impaired social reciprocity
Commonalities And Differences between RAD and DSED
Both have the same etiology of trauma, however…
RAD – internalization
DSED – externalization
Biological differences may account for variation in pathogenesis
Triad of ASD
Social Interaction
Communication
Activities & Interests
Social Interaction
- appears unresponsive
- absent/unusual eye contact, gestures, expressions
- does not spontaneously share interest or enjoyment
- does not make friends with peers
Communication
- unusual or repetitive language
- delayed or impoverished language development
- does not play “make-believe” or “pretend”
- cannot initiate or sustain conversation
Activities and Interests
- preoccupation with narrow interests
- unusual or repetitive gestures or actions (RAD may exhibit similar, but usually aim of gestures is to self-soothe)
- rigid routines
- fascination with object parts
commonality between Autism Spectrum Disorders –individuals may be skilled in some nonsocial domains
“Raising Julia” YouTube video
Initially, the non attachment could be seen as ASD, but knowing origin of orphanage, given time she may improve (while still allowing possibility of ASD comorbidity)
(*Interesting to consider that ASD made have been present and allow the child not to fully experience the traumatic environment)
